Pharmacoeconomics: theory and practice
№3, 2024, Vol.12

Introduction. Pharmacoeconomic studies of chronic heart failure (CHF) treat- ment remain relevant in primary care. Objective – ABC/VEN-, analysis of the three-component therapy of CCN from the perspective of physicians’ prescribing and its use by patients. Material and methods. Two groups of CHF patients were analyzed. The first group consisted of 71 patients selected from 745 outpatient records. The second group consisted of 31 CHF patients, obtained from 1,284 online questionnaires. They studied the use of angiotensin converting enzyme in- hibitors (iACE), angiotensin II receptor antagonists (APA II), beta blockers (BB), aldosterone antagonists (AA) and fixed combinations (FC) contain- ing antihypertensive drugs. ABC, VEN, and frequency analysis and the “cost minimization” method were used. The daily cost of treatment with the drug was estimated, taking into account its price in the “EAPTEK” and the target/maximum dose prescribed in the clinical recommendations (CR). Results. Physicians and patients used 4 groups of three-component therapy (iACE/APA II; BB and AA) as well as FC in the treatment of CHF. Three-com- ponent therapy was prescribed by physicians in single cases; patients took it more often. In physicians and patients, the choice of drugs from different groups of three-component therapy for CHF from the position of VEN analysis corresponded to class A, such was not the case in classes B and C. Physicians prescribed 9 drugs from the group of ACE inhibitors to half of the patients; one third of them took 6 items. Their use did not always take into account dosing frequency and cost, contributing to 2.5 times more spending per patient per day than the use of ramipril. Physicians prescribed 5 items from the ARA II group to every fifth patient; a third of them were taking 2 drugs. Both did not always take into account the CR and the cost of the drugs. The latter resulted in 1.5 times higher costs per patient per day than the use of Lorista®. Doctors and patients used the same BB only in 60.0% of cases. The choice of drugs from this group was rationalised in only half of the cases, resulting in one- third more costs compared to cheap Bisoprolol. Physicians prescribed AA to only one in ten patients; they took them in almost one in two cases. Both preferred Verospirone to Spironolactone, which was 0.2 roubles/day cheaper. Physicians and patients used FC equally rarely. Out of 9 drugs prescribed by doctors, patients took two. Many of them contained drugs not specified in the CR for treatment of CHF. The cost of treatment of one patient with them ex- ceeded the justified use of Valsartan+hydrochlorthiazide more than 1.5 times. Conclusion. Physicians in the outpatient clinic and patients at home rarely use three-component therapy of CHF. From the position of ABC- and VEN-analy- sis, the most optimal was class A in category V, which represents drugs from all groups (iAPP/APA II; BB, AA and FC) used in the treatment of CHF. Howev- er, both do not always focus on CR and drug cost when selecting them. The latter contributes to a greater financial cost compared to the proposed option. The situation can be improved through online interaction between doctors, patients, pharmacies and pharmaceutical companies.

The article is devoted to the analysis of the specifics of budget planning when using CDK4/6 inhibitors (ribociclib, palbociclib, and abemaciclib) for the treatment of HER2-negative metastatic breast cancer in postmenopausal patients. Based on clinical trial data and cost analysis, ribociclib was found to be advantageous in terms of efficacy and cost-effectiveness. According to randomized clinical trial data, not all the CDK4/6 inhibitors demonstrated a statistically significant increase in overall survival in combination with aromatase inhibitors. Ribociclib in combination with aromatase inhibitors has a statistically significant difference in overall survival compared to aromatase inhibitor monotherapy and reduces the risk of death by 24%. More than 30% of patients receiving CDK 4/6 inhibitors therapy require dose reduction, which is accomplished in a variety of ways depending on the dosage forms. Dose reduction has an impact on the cost per CDK4/6 inhibitors treatment cycle: before dose reduction, the cost per cycle of therapy with palbociclib and abemaciclib is lower compared to ribociclib. At the first dose reduction, the cost per cycle of therapy for all CDK 4/6 inhibitors is comparable. At the second dose reduction, the cost of a cycle of therapy on ribociclib is half that of palbociclib and abemaciclib. When planning the budget for providing CDK4/6 inhibitors to patients with metastatic cancer, it is necessary to consider a number of key characteristics of drugs that affect the costs and organization of the treatment process. An important aspect of budget planning is forecasting the need for drugs, considering the need for dose reduction. For ribociclib, the calculation of annual need is simplified by the possibility of reducing the number of tablets taken, which allows the use of a single dosage form, whereas for palbociclib and abemaciclib it is necessary to purchase several dosage forms with different dosages, which complicates planning, reduces the predictability of consumption, and requires additional administrative measures.

Botulinum toxin therapy is a complex healthcare technology with a number of features from both a clinical and regulatory point of view. More and more attention is paid to the immunogenicity of this group of biological drugs when prescribing botulinum toxin type A drugs. Also noteworthy is the expanding list of indications for medical use of drugs in this group, with indications being disclosed within individual trade names. In this regard, an assessment was made of a drug with the generic name “Botulinum toxin type A” (Xeomin) as a drug characterized by the presence of prerequisites for having the most favorable immunogenicity profile among all botulinum toxin type A drugs registered in Russia and indications for use in the treatment of sialorrhea. The methodology for assessing the healthcare technology was based on a pharmacoeconomic evaluation using cost-effectiveness analysis and Markov modeling. A number of drugs with the group name “Botulinum toxin type A-hemagglutinin complex” (Botox, Dysport, Relatox), registered in the Russian Federation, were included in the assessment as a comparison drug. The conducted assessment of the healthcare technology of using botulinum therapy for a number of conditions - spasticity, cervical dystonia, blepharospasm and sialorrhea showed the feasibility and cost-effectiveness from the perspective of the healthcare system of using the drug Botulinum toxin type A (Xeomin). It was found that the values of the incremental cost-effectiveness indicator of the drug Xeomin in the treatment of spasticity, cervical dystonia, blepharospasm and sialorrhea in terms of QALY does not exceed the value of the willingness to pay threshold. In addition, the use of the drug Xeomin in the treatment of sialorrhea prevents the development of its complication - aspiration pneumonia and the costs associated with its treatment, which can be accompanied by savings of 9,406 rubles per patient. The use of Botulinum toxin type A reduces the organizational burden on the healthcare system when applying/purchasing, transporting and storing in comparison with drugs Botu- linum toxin type A-hemagglutinin complex.