Pharmacoeconomics: theory and practice
№1, 2014, Vol.2
The goal of this analysis is to evaluate the incremental cost-utility of insulin degludec compared with glargine in patients with type 2 diabetes receiving basal-only therapy in addition to metformin as per prescribing conditions in the Russia. Total medical costs and effectiveness in terms of QALY were collected and analysed for insulin degludec and insulin glargine, both in combination with metformin. Sources of data: the effectiveness - the analysis of publications of clinical studies, drug prices - register for the prices of the VED, the cost of health care resources - standard providing outpatient services. Results: The analysis illustrates that insulin degludec for type 2 diabetes provides a significant health improvement expressed in quality adjusted lifeyears. The ICUR of insulin degludec in combination with metformin compared to insulin glargine, both added to metformin was estimated at 337 112 rub for QALY which demonstrates its cost-effectiveness.
During the pharmacoeconomic analysis of Crizotinib use as a firstline chemotherapy for ALK-positive non-small cell lung cancer (NSCLC), based on the results of Markov models, it was found that this chemotherapy regimen would significantly increase the time to progression and the overall survival, with an annual survival rate of 73%, 43% and 21% of patients following the first, second and third year of treatment, respectively. Despite the high cost of this treatment regimen, reaching 5,262,681 rubles at the horizon of ten year study, the treatment regimen including Crizotinib will be characterized by the lowest values of the cost-effectiveness ratio, reflecting the costs incurred by the health care system for patient’s life saving. Thus, Crizotinib use as firstline of chemotherapy in patients with ALK-positive NSCLC is the most preferable treatment regimen from a pharmacoeconomic point of view
Currently the health care system of the Russian Federation has gone through the stages of systematic changes to meet the modern requirements and realize the settled objectives. However, the mentioned changes are not only limited to the incorporation of innovative prophylactic, medical-diagnostic and rehabilitative technologies but they mainly affect the areas of management and decision-making in the health system. One of the most important tips in the health system management is the development of rules/algorithms including medical technologies in public health programs. Taking into account the ongoing public deliberations on the draft of the rules on forming the lists of medicines, it’s an actual point to submit to the professional community the author’s vision on the algorithm of decision-making in regard to the inclusion/exclusion of medicines in public programs/lists on the basis of pharmacoeconomic assessment. The offered algorithm of the article involves two stages. The goal of the first stage is the expertise on the pharmacoeconomic assessment of the considered medicament. The requirements applicable to the pharmacoeconomic research of the considered medicine are designed and introduced in the scopes of the expertise. The second stage applies to the actual decision-making algorithm based on the pharmacoeconomic assessment (in the case of the expertise is conducted). The algorithm is a list of strict formal rules interpreting the outcomes of pharmacoeconomic assessments. The rules are seen as sufficient conditions to deliver a recommendation for the approval or refusal on including/ leaving of the medicine in the public program of medicine supply.