Pharmacoeconomics: theory and practice
Cost-effectiveness analysis of thrombolytic therapy for ischemic stroke in real-life clinical practice
Objective: to carry out a cost-effectiveness analysis of treating ischemic stroke (IS) patients with and without the use of TLT in real-life (routine) clinical practice. Material and Methods: 63 consecutive cerebral infarction patients hospitalized on an emergency basis at vascular centres of the City of Saratov were included from July 01st, 2013 to February 28th, 2014 into the undertaken open-label comparative prospective pharmacoeconomic study. Two groups of patients were formed to meet the objective of the comparative study. The first group consisted of patients who received standard therapy in combination with a thrombolytic; the second group included patients receiving only standard therapy. Neurological deficits were assessed by the National Institutes of Health Stroke Scale (NIHSS), the degree of functional limitations – by the modified Rankin scale (mRS) (on admission, were 4 overall points). The clinical and economic analysis of therapy was carried out with calculation of the cost-effectiveness ratio (CER). The following effectiveness criteria were used: ”neurological regression by NIHSS ≥4 during the first 24 hours of therapy“; “the degree of functional limitations by mRS 0-1 points after 3 months of therapy”. Results: the average cost of hospitalization of one patient in the group with TLT amounted 91,915 rubles, in the group without TLT – 59,008 rubles, however, when analyzing CER for all the effectiveness criteria used, the advantage of routine TLT was shown: for the criterion “neurological regression by NIHSS ≥4 during the first 24 hours of therapy” CER for TLT amounted 276,021 rubles, without TLT – 329,654 rubles; for the criterion “the degree of functional limitations by mRS 0-1 points after 3 months of therapy” for TLT amounted 200,688 rubles, without TLT – 287,844 rubles. Conclusions: TLT with Alteplase during the acute period of IS in the real-life clinical practice in Saratov Oblast is cost-effective.
Economic effect of the application of three-component schemes with iksasomib or carfilsomib for therapy of multiple myeloma in adult patients
Introduction. Therapeutic options for the management of patients with multiple myeloma include innovative drugs. One of the therapeutic approaches is the use of new proteasome inhibitors – Ixazomib and Carfilzomib – which have similar indications for use in combination with lenalidomide and dexamethasone. In conditions of limited funding, one of the determining factors is the cost of therapy, thus, it is necessary to conduct a clinical and economic analysis of the use of these drugs to determine the most economically viable treatment option. Materials and methods. The study design is an analysis of the impact on the budget of using the drug Ixazomib (Ninlaro®) in combination with lenalidomide and dexamethasone compared with carfilzomib in combination with lenalidomide and dexamethasone in the city of Moscow. Target population: adult patients with recurrent and / or refractory multiple myeloma after at least one line of previous therapy. The modeling time horizon is 3 years. Two scenarios for treating patients were considered: current medical practice (without using Ixazomiba) – basic, simulated medical practice (using Ixazomiba) – alternative. The assessment of the cost of patient care was based on direct medical costs. Results. The total direct costs when using the combination with ixazazomib for 1 year amounted to about 7.1 million rubles, when using the combination with carfilzomib – more than 9.5 million rubles, while using lenalidomide with dexamethasone – more than 3.5 million rub. The use of the combination with Ixazomib is associated with lower costs for medicinal preparations, correction of undesirable effects, as well as with the absence of costs for the administration of the drug as compared with the use of the regimen with carfillosome. A gradual increase in the use of Ixazomib in combination with lenalidomide and dexamethasone during the 1st year will save more than 3.1 million rubles for the Moscow health care budget, about 5.7 million rubles for the 2nd year, during the 3rd year - about 9.9 million rubles. Conclusion The use of Ixazomib in combination with lenalidomide and dexamethasone in the treatment of patients with recurrent and / or refractory multiple myeloma after at least one therapy line is clinically effective and cost-effective within the framework of preferential drug supply in the city of Moscow.
Pharmacoeconomic evaluation of Secukinumab use as a first- line biologic in patients with psoriatic arthritis
Possessing a high prevalence and disability, psoriatic arthritis (PsA) is a serious socio-economic burden for the patient and for society. Therefore, the choice of the PsA treatment strategy requires focusing on not only the prevention and control of the disease but also the effective allocation of the available resources of the healthcare system. Objective. In this regard, the purpose of this study was to conduct a comparative pharmacoeconomic evaluation of biologics: secukinumab (Cosentyx), golimumab (Simponi®), certolizumab pegol (Cimzia®), Ustekinumab (Stelara®), adalimumab (Humira®), etanercept (Enbrel®) and infliximab (Remicade®, Flammegis®, Infliximab produced by local BIOCAD company). Materials and methods. Based on data on the effectiveness of compared treatment regimens, data on the cost of drugs and medical services, as well as the frequency of their provision, an analysis of direct costs, cost-effectiveness analysis, as well as budget impact analysis were carried out. Results. The cost analysis educed that the amount of direct costs for treatment with secukinumab 150 mg for ‘biologic-naive’ patients with active PsA is on average 28% and 40% lower than the cost of treatment with certolizumab pegol, golimumab, ustekinumab, adalimumab, etanercept and infliximab in the first and subsequent years of therapy, in accordance. Estimation of costs and efficacy showed that treatment of PsA with secukinumab 150 mg is characterized by lower costs per unit of effectiveness (ACR 20/50/70 response), relative to the indicators of the compared drugs in the first and subsequent years of therapy. The assumed prescription of secukinumab instead of certolizumab pegol, golimumab, ustekinumab, adalimumab, etanercept, and infliximab (including biosimilar) 19% of patients with active PsA leads to budget savings of 468 million rubles and 1.5 billion rubles for the first and three years of treatment, in accordance, on the calculated patient population. Conclusion. According to the results of the study, the pharmacoeconomic feasibility of using secukinumab 150 mg as a first-line line biologic for the treatment of active PsA has been established.