Pharmacoeconomics: theory and practice
№4, 2025, Vol.13

During the reforms of the 90s, the centralized, uniformly funded by the article-by-article budget method, the Soviet state model was replaced by a decentralized, multi-layered (public-private) fragmented (multichannel) budget and insurance model, which uses many sources and financing schemes, including drug procurement. The model change required the creation of a new financial resource accounting system in the form of national Health Accounts (NHS). It is a framework integrated with the System of National Accounts (SNA) for the systematic accounting, classification and analysis of healthcare costs. The current version of the International Standard of Health Accounts SHA 2011 has been adopted by the OECD, WHO and the European Union as a universal methodology for tracking financial flows in the healthcare system, ensuring transparency, comparability of data and the ability to assess the effectiveness, efficiency and equity of resource allocation. However, an attempt in the late 90s to create health accounts in Russia as part of a World Bank project proved unsuccessful. The federal statistical observation form No. 62 “Information on the provision of resources and medical care to the population” (Form No. 62) developed based on the results of this project does not comply with the SNA 2011 standard on the principles of data accounting, classification and analysis. The study compared Form No. 62 with the SNA 2011 standard in terms of tracking drug costs. The authors conclude that it is necessary to implement the NHS according to the SNA 2011 standard and propose to start this process by supplementing the cost accounting for medicines in Form No. 62 upon purchase with parallel accounting upon their actual consumption, using data from the National System of Digital Labeling and Traceability of Goods “Honest Mark”.

The wide range of medications complementing standard therapy for psoriatic arthritis (PsA) and ankylosing spondylitis (AS), coupled with the lack of a strict prescribed sequence for their administration that would establish conventional lines of therapy, predetermines a variety of approaches to prescribing medications to patients based on their individual characteristics. At the same time, biological medications and small targeted molecule medications are characterized by relatively high costs, and the primary mechanism for ensuring their accessibility to patients is reimbursement, funded by both federal and regional budgets. Organizing reimbursement implies formalizing the selection of the nomenclature and volumes of medications used. Regional executive authorities have the authority to determine the nomenclature and volume of drugs for outpatient subsidized medicine provision, and senior external specialists play a key role in these processes. This may determine regional differences in the distribution of patients with PsA and AS between alternative drugs. Therefore, it is important to study regional practices for distributing patients with PsA and AS between biological medicines and small targeted molecule medicines, identifying these regional differences as a basis for further improvements in the organization of medicine provision for patients with PsA and AS. Using a developed form, data were collected from 11 constituent entities of the Russian Federation on the distribution of patients with PsA and AS between biological medicines and small targeted molecule medicines, followed by calculation of the average cost of this pharmacotherapy in each region. An analysis of data from 11 constituent entities of the Russian Federation on the distribution of patients with PsA and AS between biological therapy and small targeted molecule medicines revealed the highest demand for the IL-17 inhibitor secukinumab, which is characterized by the highest average proportion of patients on this medicine for both PsA and AS across all 11 constituent entities of the Russian Federation. The average annual cost of treating one patient with PsA and AS across all 11 constituent entities of the Russian Federation was 554,690 rubles and 542,114 rubles, respectively. Based on medicine consumption patterns, five regional groups for PsA and two for AS were formed across the 11 constituent entities of the Russian Federation.

The wide range of manifestations of systemic lupus erythematosus (SLE) contributes to a reduction in the quality and duration of life of the patients. The high incidence of the disease among the young population leads to an increase in both direct and indirect costs to the state for this group of patients. Achieving remission and reducing damage from the disease is only possible with the right treatment, often involving the use of expensive biologics. However, the comparative clinical and economic efficacy of these therapies remains inadequately explored. Objective: To evaluate the comparative clinical-economic effectiveness of 12-month therapy with belimumab (BLM), anifrolumab (AFL), and rituximab (RTX) in patients with active SLE. Materials and methods. Sixty-eight patients with moderate-to-high SLE activity were enrolled in the study. Patients were newly initiated on biologics therapy: 29 pts received BLM (Group 1), 22 pts received AFL (Group 2), and 17 pts received RTX (Group 3) for a 12-month period. Treatment response was defined as a reduction in SLE activity according to SLEDAI-2K, achieving low activity (SLEDAI-2K ≤ 4) or remission (SLEDAI-2K = 0). Pharmacoeconomic analysis employed a Cost-Effectiveness Analysis (CEA) by calculating the Cost-Effectiveness Ratio (CER) using the Cost Per Responder (CPR) model. Results and discussion. After six months of biologics therapy, patients exhibited a significant decline in SLE activity by SLEDAI-2K. Low activity/remission was attained by 62% of patients in the BLM group, 77% in the AFL group, and 12% in the RTX group. By the 12-month mark, the proportion of responders continued to increase, reaching 79% in Group 1, 91% in Group 2, and 41% in Group 3. The CER at six months was lowest in the AFL group (415,000 RUB), compared to 445,000 RUB in the BLM group and over 1 million RUB in the RTX group. At 12 months, CER values in Groups 1 and 3 were nearly equivalent at approximately 630,000 RUB, while Group 2 reached 702,000 RUB. TheIncremental Cost-Effectiveness Ratio (ICER) at six months was similar across comparisons (BLM vs. AFL, AFL vs. RTX, and BLM vs. RTX), approximating 290,000 RUB. At 12 months, ICER values were 1.2 million RUB for AFL vs. BLM, 757,000 RUB for AFL vs. RTX, and 624,000 RUB for BLM vs. RTX. Conclusion. The six-month therapy with AFL demonstrated superior clinical efficacy and economic affordability compared to BLM and RTX. However, the clinical-economic benefits of AFL diminished by the end of the 12-month treatment period, underscoring the need for a comprehensive assessment of short- and long-term economic factors when selecting optimal SLE treatment strategies.

Mortality from diseases of the circulatory system remains the first cause in the structure of mortality of people of working age and older, where the main cause of complications is atherosclerotic disease, for the correction of which lipid-lowering drugs are used. THE AIM of the study was to assess the effect of the use of high doses of atorvastatin in drug therapy on mortality from dis- eases of the cardiovascular system. MATERIAL AND METHODS. The register of dispensed prescriptions patients that received medicines for free for the period from 2021 to 2023, as well as data on the death of patients from cardiovascular diseases (death certificates) for the same period were used. The construction of variation series and the assessment of the reliability of relative numbers based on the Student’s double T-test were carried out. Results. The reliability of impact on mortality high doses of atorvastatin was established in the group of women from 49 to 59 years old and men from 60 to 74 years old. CONCLUSION. In order to implement the «Fight against cardiovascular diseases» program, this study can be used in making management decisions and organizing events that affect the mortality of the population from diseases of the cardiovascular system.