Pharmacoeconomics: theory and practice
Comparative analysis of the methodology of pharmacoeconomic assessment according to the origin (dated 08.28.2014) and the current (dated 10.29.2018) version of the government degree of the Russian Federation №871
The fifth year in the system of state drug provision at the federal level, the Decree of the Government of the Russian Federation N871 of 08.28.2014 introduced the requirement of pharmacoeconomic evaluation of drugs when they are included in the lists of drugs. At the end of 2018, the second edition of this document was adopted and brought dramatic changes to the rules of pharmacoeconomic evaluation. This fact prompted us to conduct a comparative analysis of the old and new versions of the document from the point of view of pharmacoeconomics in order to retrospectively identify and systematize the shortcomings and advantages of the rules of pharmacoeconomic evaluation given by the original version of the document and prospectively determine to what extent the new version of the Russian Federation Resolution N871 of 28.08. 2014 (ed. From 10.29.2018) managed to overcome the identified problems and whether it contains any new contradictions. The adoption of the first edition of the Decree of the Government of the Russian Federation N871 of 08.28.2014 approved the mandatory status of pharmacoeconomic evaluation when including drugs in the lists. At the same time, practical experience in applying the developed rules for pharmacoeconomic evaluation revealed their imbalance: due to the minimum number of scores received by a drug according to the cost-effectiveness analysis, the probability of including innovative or even modern effective drugs in the lists was very small. The lack of clear requirements for the interpretation of the results of the cost-effectiveness analysis (and the incremental cost- effectiveness analysis), the conduct of the budget impact analysis and the selection of comparative drugs with an unbalanced integral scale led to pharmacoeconomic studies aimed at achieving positive pharmacoeconomic evaluation (preparation of the minimum required number of points on an integrated scale). The new version of the document largely corrected the lack of the first version of the rules, increasing the number of scores awarded by the cost-effectiveness analysis and introducing various scenarios of this analysis method, which undoubtedly should make the new rules more focused on the evaluation of innovative and effective drugs. At the same time, the “country-specific” methodology for assessing the results of the incremental cost-effectiveness analysis was included in the updated rules. It can be predicted with high probability that an insufficiently complete and accurate description of it in Government Decree N871 of August 28, 2014 (as amended on 10.29.2018) will cause discrepancies in the integral scoring of this type of analysis, creating difficulties for all participants in the listing process: for customers of pharmacoeconomic evaluations, researchers, as well as expert organizations. Attention is drawn to the contradictions that arise when evaluating drugs according to the “cost minimization” analysis scenario, in which the required minimum passing score does not provide for the very fact of cost savings on the considered drug, but only the condition that the savings will exceed 20%. Unfortunately, the new version of the document did not solve the problem of the validity of the used gradation of the integral score scale, and moreover, this problem was increased, violating the logic of interpretation of the results of the cost-effectiveness analysis and the cost-effectiveness incremental analysis.