Pharmacoeconomics: theory and practice
№1, 2015, Vol.3
Application of health technology assessment to targeted therapy in the treatment of inoperable locally advanced and metastatic basal cell carcinoma
Basal cell carcinoma (BCC) is the most common non-melanocytic skin cancer and is a tumor of the basal layer of the epidermis and hair follicles. Patients with a history of locally advanced or metastatic forms of BPC, undergo surgical treatment or radiation therapy. Until now, in the absence of the effectiveness of these methods, palliative medical care was provided to the patient with CCB. The emergence of a molecular-directed drug, vismodegib (Erivedge ™), opens up new prospects for the treatment of these forms of BPC and requires justification of its use in BPC patients with the help of health technology assessment (HTA). In the decision-making process regarding the implementation of this treatment method for patients with locally advanced and metastatic BPC, it is necessary to take into account both economic, clinical components and social significance, since the use of vismodehyb represents the only possibility of treating patients with these forms of BPC, surgical method and radiation therapy is not applicable.
Practice of pharmacoeconomic analysis usage for optimization of hospital procurement of surgical gloves
The choice and procurement of surgical gloves on the Russian hospital market were experience-based until now. In most cases, the determining factor is their purchase cost. So functional traits of gloves are not covered, the factors of eligibility defined by direct consumers on all characteristics are not taken into account, the additional costs arising from the use of low-quality goods are also not taken into account. Model of surgical gloves choice and procurement optimization designed by Medcom-MP allows to change situation by taking into account such factors as: as the limit of the expenditure, the amount, type and duration of operations and other surgical procedures, the number of users (surgeons, operating and dressing nurses), individual tolerance of different glove materials, etc. Results obtained using this model can be used for can be used to support state and municipal procurement.
Pharmacoeconomic analysis of eviplera (rilpivirine/ tenofovir/ emtricitabine) in the treatment of hiv/aids in the Russian Federation
The aim of this study was to determine the optimal medical technique of treatment of human immunodeficiency virus (HIV) infected adults with HIV-1 RNA<100 000 copies/ml by assessing costs and effectiveness of highly active antiretroviral therapy: rilpivirine/ tenofovir/ emtricitabine (single tablet regimen (STR)), efavirenz + tenofovir/ emtricitabine (multi-pill regimen), lopinavir + tenofovir/ emtricitabine (multi-pill regimen). The obtained results have demonstrated that prescription of rilpivirine-containing combined Highly Active Antiretroviral Therapy (HAART) (STR) is associated with additional costs on ambulatory treatment, that are overlaid by lower costs (direct and indirect) on new persons with HIV, infected by the analyzed group. Therefore, cost savings, as compared to mentioned schemes of HAART, accompany prescription of the scheme rilpivirine/ tenofovir/ emtricitabine (Eviplera), according to the «budget impact» analysis.
Mantle cell lymphoma (MCL) accounts for approximately 2% to 10% of the total number of lymphatic system tumours, the incidence rate in Western Europe and Scandinavia is approximately 0,5/100 000 people. Most MCL cases are aggressive lymphomas, and overall survival is in the range of 3 to 5 years, while the disease is characterized by a short time to progression. The objective of this study was to determine the better treatment option between temsirolimus and ibrutinib in the treatment of MCL, in terms of pharmacoeconomic analysis, by means of comparative cost-effectiveness assessment. The cost-effectiveness results obtained in this temsirolimus versus ibrutinib comparative study demonstrated that ibrutinib therapy was associated with lower cost per effectiveness unit when life years gained and quality-adjusted life years were utilized as effectiveness criteria. Obtained budget impact analysis results revealed that ibrutinib therapy resulted in budget saving.
A pharmacoeconomic study of the treatment of phenylketonuria (PHU) treatment using Kuvan drug product combined with the diet or dietary therapy alone has been conducted. It has been established that the therapy is dominant in the first case when compared to the second case because it shows better therapeutic effectiveness and is characterized by a lower cost–effectiveness ratio. It has also been determined that the addition of Kuvan to the dietary therapy requires additional costs of 11,569,761 RUB per one patient over 16 years. Despite the increase in the costs linked to the use of the new and only drug for the treatment of PKU, the overall effect on the budget will be decreased due to the low prevalence of the disease.
The article presents the methodological basics of the effectiveness analysis in pharmacoeconomic studies of medicinal drugs or health technologies. In particular, the main challenge that researchers face is the defining criterionof the effec tiveness of the evaluated alternatives is described. What is more, main positive and negative sides of using surrogate and final performance criteria, as well as provide methodological recommendations for their selection and evaluation.