Pharmacoeconomics: Theory and Practice
№3, 2023, Vol.11
As with any socially significant disease, in chronic heart failure (CHF), the control of diagnostic and treatment, including monitoring the condition of patients in order to maintain optimal therapy, is of decisive importance. The specificity of CHF is the high frequency of repeated hospitalizations for acute decompensation of heart failure (ADHF). One of the key aspects of monitoring the patient’s condition is the assessment of congestion - the identification and determination of the degree of it for the timely optimization of the treatment in order to prevent re-hospitalization. In this regard, of great interest is a new technology for non-invasive measurement of fluid in the lungs - Remote Dielectric Sensing (ReDS), implemented in a medical device under the ReDS Pro brand (manufacturer - Sensible Medical Innovations, Israel). ReDS technology is a quantitative non-invasive method for measuring the total volume of fluid in the lungs in patients with signs of volume overload, including those with CHF. The technology is based on the following principle: low-power electromagnetic radiation passes through the lung tissue from the emitter to the receiver, the assessment of changes in radio wave parameters provides an accurate measurement of the total volume of fluid in the tissue. The result of the examination is a quantitative indicator that reflects the percentage of total fluid in the total volume of the lung. The emergence of a new technology makes its assessment relevant for monitoring treatment and diagnostic measures for CHF in the Russian Federation at the inpatient and outpatient stages of medical care. The described study of health technology assessment was based on the developed model, which, taking into account the clinical advantages of ReDS technology, made it possible to analyze its “budget impact” both at the federal and regional levels from the standpoint of the inpatient or outpatient stages of medical care. The assessment of the economic and clinical feasibility of introducing ReDS tech- nology was carried out separately for the inpatient and outpatient stages (for the outpatient stage, the calculation was carried out both for a model that takes into account the costs of additional visits to patients for scheduled examinations, and without them) in conditions of achieving the technology availability indicator for at least 95% of the population. The results of the assessment showed that at a given level of implementation of ReDS technology at the inpatient level, the number of re-hospitalizations of patients with CHF in the Russian Federation will decrease from 375,703 to 252,208 per year (by 32.9%). The introduction of technologies at the outpatient level will reduce the number of readmissions from 375,703 to 82,782 per year (by 78.0%). This corresponds to a decrease in the annual cost of hospitalizations for CHF (both primary and recurrent) with the introduction of ReDS in hospitals from 24.93 billion rubles to 20.96 billion rubles (decrease by 15.9%); when implementing the method at the outpatient level from 24.93 billion rubles to 15.52 billion rubles (decrease by 37.8%), and taking into account the cost of additional visits to patients at the outpatient level from 24.93 billion rubles to 19.70 billion rubles (decrease by 21.0%). At the same time, one-time costs for the purchase of a ReDS medical device in outpatient and inpatient clinics amount to 12.06 billion rubles and 11.04 billion rubles respectively. The results of the “budget impact” analysis (taking into account the discount factor of 3.5%) of the introduction of ReDS technology at the outpatient level demonstrate that over 7 years it provides savings in the amount of 20,335,833,423 rubles (including costs for additional visits) up to 45,926,532,070 rubles (excluding the cost of additional visits), and at the inpatient level - 13,613,327,627 rubles. Evaluation of the introduction of ReDS technology into the Russian healthcare system at the federal level, both at the outpatient and inpatient stages of medical care, with a total need for a ReDS medical device in the range of 1129-1234 units, providing coverage of more than 95% of the population with this technology, showed its clinical and economic benefit, which is expressed in a decrease in the number of readmissions and net savings in the health care system already during the third year of using the ReDS technology.
Purpose - a comparative pharmacoeconomic analysis of starting doses of antibiotic therapy for community-acquired pneumonia (CAP) to calculate budgetary funds and correct the prescription of antibacterial drugs at the level of medical institutions. The design of the study was a retrospective analysis of prescriptions from the medical records of patients in the treatment of CAP who were treated in multidisciplinary medical organizations providing inpatient care. Information from the patients’ medical records was entered into registration cards specially designed for this study. The research horizon is 2 years. Pharmacoeconomic analysis was carried out using methods: frequency analysis, disease cost analysis, cost minimization analysis, cost-effectiveness analysis. The calculations took into account direct medical and non-medical and indirect costs. Analysis of the frequency of appointments showed that one strategy prevailed - the appointment of a combination of ceftriaxone + azithromycin - 76% (n=39). At the same time, this strategy was effective in 74% of cases (n=29). This strategy is consistent with approved clinical guidelines for the treatment of lower respiratory tract infections. In second place in terms of the frequency of prescriptions is the strategy of monotherapy with ceftriaxone 9.8% (n=5), while in one case of prescription, azithromycin was added to ceftriaxone after 2 days of use, which can also be attributed to one therapy strategy and the treatment is considered effective. The effectiveness of the ceftriaxone treatment strategy showed its effectiveness in 80% (n=4). The structure of costs in the treatment of CAP by various strategies is similar and, in general, the strategies differ only in the greater cost of drugs for combined antibiotic therapy. The average cost of CAP treatment per patient was 37,740.50 rubles, including the cost of antibiotic therapy, which is al- most 12% of the total cost of treatment. The cost of treating CAP with the combination of ceftriaxone + azithromycin was 34232.79±4815 rubles, with ceftriaxone - 19922.08±72940 rubles. The dominant strategy for the treatment of community-acquired pneumonia in young patients was revealed - the combination of ceftriaxone + azithromycin, ceftriaxone monotherapy is also prescribed, which corresponds to current clinical guidelines and treatment protocols. This conclusion coincides with the results of previous studies on the frequency of use of antibacterial drugs in Russia. The administration of ceftriaxone and its combination with azithromycin also proved to be the most effective empiric therapy strategy with the fewest adverse reactions.
The paper systematizes scientific papers devoted to the study of various diseases impact on the countries’ economic and financial performance. In order to identify the main subject areas and topic branches a text analysis methodology was used, including bag of words methods, principle component analysis. Content-analysis was implemented to find out the key models which are used while studying the problem. A detailed analysis of the articles’ content was realized, including calculation of the words and phrases most frequently mentioned in the abstracts, estimation of the connection between them, identification of the methods used while studying the diseases’ impact on economy. Implementation of text analysis techniques identified three key thematic areas. They are the impact of the disease spread on financial markets and their indicators, on general economic and macroeconomic indicators, on the social sphere and the resulting economic consequences. This paper differs from the existing research in the following aspects: 1. it systemizes overall studies analyzing the impact of different diseases on the financial and economic indicators; 2. it expands the current literature by including the research on the impact of the new COVID-19 virus; 3. the innovative methodology of text analysis is used while developing a literature review