Pharmacoeconomics: theory and practice
№2, 2019, Vol.7
In the pharmacoeconomic study, a comparative analysis of the insulin delivery was carried out: continuous subcutaneous insulin infusion (CSII) (using the Accu-Check Combo system as an example) in comparison with multiple daily injections (MDI) using pens in the treatment T1DM, as well as determining the economic consequences (cost-effectiveness analysis, impact budget analysis) of their application. This study was carried out by modeling with a time horizon of 15 years. As a result of the cost-effectiveness analysis, it was found that CSII is characterized by better efficiency (9,45 QALY), compared with MDI therapy patients with T1DM (8,70 QALY). The incremental cost-effectiveness ratio (ICER) is 1 100 503 rub / QALY, which is within the threshold of willingness to pay and, therefore, MDI is a cost-effectiveness analysis therapy. The switching from MDI therapy to CSII for the healthcare system requires additional funding of 54 749 rubles per year per patient and 821 228 rubles per patient for 15 years (excluding discounting).
As part of this work, a pharmacoeconomic study of drugs used in enzyme replacement therapy (ERT) of patients with mucopolysaccharidosis (MPS) type II: idursulfase and idursulfase beta was carried out. As a result, it was found that the use of the drug idursulfase beta, is a more pharmacoeconomically beneficial treatment regimen for patients with MPS type II. Saving money when switching one patient from idursulfase to idursulfase beta makes up for one year - 7 377 746 rubles, for 5 years - 36 888 728 rubles. During the budget impact analysis, it was determined that an increase in the proportion of patients up to 50% in the idursulfase beta will make it possible to achieve an overall savings of 796 845 270 rubles. for 5 years. The missed opportunities analysis showed that an additional 28 patients could be treated with money saved as a result of a change in treatment strategy.
The article presents the concept of the development of the methodology of cost-effectiveness analysis. The classic cost-effectiveness analysis allows us to determine the cost per unit of efficiency of the technologies under consideration. If one of the technologies, which is characterized by the greatest efficiency, also has a minimum value of CER, then it is considered strictly preferable. The CER in this case reflects the cost of achieving the unit of efficiency on this technology. If the more expensive technology, which is more efficient, is also characterized by a large value of the cost-effectiveness ratio, then there is a need for an incremental cost-effectiveness analysis. Its result is a calculated incremental cost-effectiveness ratio (ICER), which reflects the additional cost of additional efficiency on a more efficient technology. Thus, the result of the incremental cost-effectiveness analysis directly depends on the choice of comparison technology, as well as the presence (or absence) of these alternatives on the market, and even the order of their registration in the country. The degree of acceptance by the health authorities of the notion of a “willingness to pay” threshold directly affects decisions made. In this regard, against the background of the registration of new innovative technologies, innovative approaches to their assessment are also required, which will adequately reflect in the assessment the factors of innovation and the increase in technology efficiency. This article presents the concept of the development of the cost- effectiveness analysis methodology with the transition to a new method of pharmacoeconomic evaluation - an analysis of the «relative value», which allows solving a number of methodological problems and making decisions under conditions of greater certainty.