Pharmacoeconomics: theory and practice
№3, 2014, Vol.2
The article covers various aspects of smoking in Russia and around the world. High prevalence of tobacco smoking and difficulties in combating it are shown. Scientific theories are presented to explain the occurrence of nicotine addiction and the difficulty in overcoming it. The widespread use of smokeless tobacco products and electronic means of nicotine delivery necessitates the development of new standards and legislative approaches that take into account the possibility of reducing harm to health and providing additional motivation to quit smoking.
Pharmacoeconomic analysis of linagliptin (Trajenta®) as part of combination therapy in the treatment of type 2 diabetes
Purpose of the study: Determine whether linagliptin is a pharmacoeconomically sound choice when it is included in therapy in patients with insufficient glycemic control, receiving the maximum tolerated dose of metformin in monotherapy, or in combination with sulfonylurea derivatives or thiazolidinediones, as well as in comparison with the IPDP-4 preparations present on the market St. Petersburg.
Pharmacoeconomic evaluation of axitinib introduction in metastatic renal cell carcinoma treatment scheme
During the pharmacoeconomic analysis of axitinib use as a secondline therapy for mRCC, it was found that this target therapy regimen would significantly increase the time to progression, overall survival and annual survival rate. Despite the high cost of this treatment regimen at the horizon of ten year study, the treatment regimen including axitinib characterized by the lowest values of the cost-effectiveness ratio, reflecting the costs incurred by the health care system for patient’s life saving, and increme
Study purpose: To determine preferential medicinal products for the treatment of diabetes mellitus type 2 in terms of pharmacoeconomic analysis based on comparative cost and efficacy, safety and quality of life ratio between the modern insulin analogues.
Materials and methods: Study design – retrospective, modeling. Methods of pharmacoeconomic analysis - cost-effectiveness, costutility. Alternatives compared – insulin aspart (NovoRapid®), insulin lispro (Humalog®), insulin glulisine (Apidra®), premix insulin aspart 30/70 (NovoMix® 30), premix insulin lispro 25/75 (HumalogMix® 25), insulin detemir (Levemir®) and insulin glargine (Lantus®).
Data sources: efficacy – analysis of publications on clinical studies performed; medicinal product prices – registry of quoted prices for vital and essential medicines; cost of healthcare resources – outpatient and polyclinical assistance standards.
Study results: Among short-acting insulin analogues, CER value was 1091.84 rub.; 1133.55 rub. and 1175,27 rub. for NovoRapid®, Humalog® and Apidra®, respectively. Among premix insulin analogues, CER value was 1418.47 rub. for NovoMix® 30 and 1512.08 rub. for HumalogMix® 25. Among basal insulin analogues CER value was 2084.39 rub. for Levemir® and 2471.23 rub. – for Lantus®. Costutility analysis for NovoRapid®, Humalog®, Apidra®, NovoMix® 30, HumalogMix® 25, Levemir® and Lantus® CUR value was 84463.04 rub., 87689.69 rub., 90917.35 rub., 99573.21 rub., 106144.38 rub., 79269.45 rub. and 93981.16 rub. for 1 QALY, respectively. Therefore, in terms of costutility, when insulins were added to OAD treatment, NovoRapid® is the preferable drug because of the lowest CUR value. Among premix and basal insulin analogues, NovoMix® 30 and Levemir® were preferable drugs because of the lowest CUR values in their group.
Pharmacoeconomic evaluation of Sitagliptin compared to sulfonylruea derivatives in patients with type 2 diabetes not controlled by Metformin monotherapy
Study objective: To perform a comparative pharmacoeconomic analysis of the therapy combinations: sitagliptin with metformin, and sulfonylureas with metformin in patients with type 2 diabetes on metformin monotherapy whose target glycemic goal is not reached with diet and exercise.
Materials and methods: A time horizon of 10 years was used to conduct the comparative pharmacoeconomic analysis. The following were used as reference data for the calculations: drug prices, as registered in the VED [Vital Essential Drugs]; earlier publications on the cost of complications; and data on treatment outcomes and hypoglycaemia rates in comparator groups from the JADE modelling study, based upon the data from clinical study 024 for the Russian patient population.
Results: Total medical expenditures for one patient came to 449,927 rubles in the sitabliptin+metformin group, and 415,385 rubles in the sulfonylurea+metformin group – a difference of 7.7%. Within this, the share of costs for the actual drugs was 53% and 11%, respectively, indicating a greater burden due to longterm consequences (hypoglycaemia, complications from type 2 diabetes, transitioning to insulin) for the sulfonylurea group. When converted to 10,000 patients, the cost of the drugs in the sitagliptin group was 2,149 million rubles higher, and the expenditures for complications, including hypoglycaemia and insulin therapy, were 1,559 million rubles lower. Thus, in the sitagliptin group – unlike the sulfonylurea group – 410,000 cases of hypoglycaemia were prevented, as well as 40 cases of macro- and microvascular complications. Conclusion: the results suggest that the combination use of sitagliptin + metformin is pharmacoeconomically justified when compared to sulfonylurea + metformin to treat type 2 diabetes patients.
Pharmacoeconomic study of botulinum toxin type A in treatment of post-stroke spasticity in the upper limb
According to the World Health Organization, the prevalence of post-stroke spasticity is 200 people per 100 thousand inhabitants and the total number of patients in the world exceeds 12 million people. Approximately 450 000 people have a cerebrovascular accident (CVA) annually in the Russian Federation and the post-stroke spasticity is developed in about one third of the survivors. The main goal of this study is to conduct pharmacoeconomic analysis of three bestselling in the Russian Federation botulinum toxin type A preparations - Dysport®, Botox®, Xeomin compared with standard therapy without botulinum toxin type A. According to the conducted cost-effectiveness analysis where Modified Ashworth scale score is used as a main outcome Dysport® is a dominated alternative compared with other studied therapy schemes. What is more, budget impactanalysis shows that therapy with Dysport® during one year leads to the saving of 45 563 rubles compared with Botox® and saving of 44 408 rubles compared with Xeomin per one patient.
Pharmacoeconomic evaluation of medicinal products used as first-line targeted therapy of metastatic kidney cancer
Abstract: A pharmacoeconomic evaluation of sunitinib as the firstline metastatic renal-cell carcinoma targeted agent in the Russian healthcare settings was performed in comparison with sorafenib and bevacizumab + interferon. A pharmacoeconomic Markov model was created and used to assess the costs and effectiveness (including mean overall survival in months) of each therapeutic regimen. The evaluation presented also includes a probabilistic multivariate sensitivity analysis. The results show that sunitinibbased treatment is dominant over sorafenib and bevacizumab + interferon, which makes it the most costeffectiveness treatment option.
On the possibilities of combining budget impact analysis and cost-effectiveness analysis - development of «3D» pharmacoeconomic model
Summary: Abstract: Pharmacoeconomic analysis is becoming more common as a decisionmaking tool in healthcare of the Russian Federation. On the one hand, this process is accompanied with the complexity of the used methods. In particular, the simultaneous use of both types of analysis (budget impact analysis and costeffectiveness analysis) is intended. It’s important to note that pharmacoeconomic assessment based on these indicators often has controversial character. Thus, the results of one type of analysis can characterize assessed health technology favorably, and the results of other critically. On the other hand, the use of pharmacoeconomic approaches at the system level requires formalization of the decision-making on the basis of pharmacoeconomic evaluations. In this regard, there is a problem of correct interpretation of the results of both types of pharmacoeconomic analysis when making a unified formalized pharmacoeconomic report. In this article, we offer our methodological solution of the stated problem. This solution is a useful tool in making unite pharmacoeconomic report based on cost-effectiveness analysis and budget impact analysis results. Use of this model preserves the meaning and significance of each type of pharmacoeconomic analysis. The article also presents the concept of a practical embodiment of the described methodology - the creation of «3D» pharmacoeconomic model.