Pharmacoeconomics: theory and practice
№4, 2015, Vol.3
Pharmacoeconomic analysis of thrombo ass in treatment of patients with previous cardiovascular events
For many years antiplatelet therapy is the basis for the prevention of cardiovascular diseases. Acetylsalicylic acid is the “gold standard” among all antiplatelet drugs. However, ASA administration has an adverse effect in the form of development of NSAID-induced gastropathy To reduce this effect various forms of production of medicines ASA are used. In this study the pharmacoeconomic assessment of drugs Thrombo ASS, Cardiomagnyl and Aspirin Cardio in patients with previous cardiovascular diseases was conducted. According to the results of conducted cost-minimization analysis determined that the treatment scheme with the use of Thrombo ASS is characterized by the lowest cost compared with Cardiomagnyl and Aspirin Cardio. The results of the budget impact analysis suggest that therapy drugs Thrombo ASS leads to budget savings up to 33 million rubles calculated for all patients with cardiovascular diseases in Moscow compared with alternatives.
Pharmacoeconomic analysis of ryzodeg®, a combination of soluble ultra-long-acting human insulin analogue (insulin degludec) and ultra-short insulin analogue (insulin aspart), use in therapy of type 2 diabetes
Title: “Pharmacoeconomic Analysis of Ryzodeg®, a Combination of Soluble Ultra-long-acting Human Insulin Analogue (Insulin Degludec) and Ultra-short Insulin Analogue (Insulin Aspart), Use in Therapy of Type 2 Diabetes” Study objective: The objective of this study was to evaluate, whether the use of the combination of basal ultra-long insulin (degludec) and ultra-short insulin (aspart) in the ratio of 70% and 30% in one injection is pharmacoeconomically justified choice for insulin therapy with basal and prandial components for type 2 diabetes mellitus patients with insufficient glycemic control, treated with maximum tolerated doses of metformin in monotherapy.
Materials and methods: Study design – retrospective, modeling. Methods of pharmacoeconomic analysis used are “cost-effectiveness” (“cost–utility”). The modeling horizon was 10 years; the discounting rate was 3%. Alternative comparators included combination of insulin degludec/insulin aspart (Ryzodeg®) and biphasic insulin aspart (NovoMix® 30).
Results: Calculated ICUR ratio showed that incremental cost of 1 additional QALY gained as a result of switching from NovoMix® 30 therapy to Ryzodeg® in addition to metformin therapy equals 519,896 rub. Comparing ICUR with WPS in the RF it can be concluded that Ryzodeg® insulin use is clinico-economically effective in comparison with biphasic insulin aspart. Pharmacoeconomic benefit of Ryzodeg® insulin reflects clinical superiority of the new insulin over the conventional biphasic insulin analogue: possibility to achieve control with a significantly better safety profile, a lower dose of insulin, less pronounced body weight changes and a flexible dosage regimen.
Pharmacoeconomic analysis of treatment of patients with severe and moderate ischemic stroke (NIHSS score > 12)
This study includes pharmacoeconomic analysis of treatment of patients with severe and moderate ischemic stroke (NIHSS score > 12). The results of data search showed that today an evidential base for these patients treatment exists for cerebrolysin only. The analysis of «budget impact» showed that the transfer of one patient from the basic therapy to the combined therapy with cerebrolysin using gives saving of about 79703 rubles. Therefore the analysis of «costs-efficiency» ratio for the basic therapy with cerebrolysin using demonstrated it to be a dominated technology in comparison with the basic therapy only.
Pharmacoeconomic analysis of vemurafenib in treatment of inoperable or metastatic melanoma in patients with BRAF V600 mutation
Objective of this study was to determine cost-effectiveness of vemurafenib in treatment of inoperable or metastatic melanoma in patients with BRAF V600 mutation from Russian healthcare system perspective and a long-term use. Cost-effectiveness analysis (CEA) has been used and cost-effectiveness ratio (CER) has been calculated. Incremental analysis has been conducted with calculation of incremental cost-effectiveness ratio (ICER) when exceeding the costs and effectiveness of one of the studied regimens as compared to the other one. Cost analysis included calculation of the following direct costs (DC): the cost of the main disease treatment (cutaneous melanoma, CM) – costs of the drug; the cost of laboratory and instrumental methods of investigation as well as hospitalizations and out-patient treatment; the cost required to determine exon 15 BRAF mutation in melanoma; the cost of the drug therapy aimed at management of adverse events (AEs) caused by the drug when treating the main disease. Two medical technologies have been assessed (anti-tumor regimens depending on the chosen method): vemurafenib at a dose of 960 mg twice a day; dacarbazine at a dose of 1000 mg/m2 i/v every 3 weeks. Mathematical modelling underlies this study. As a result it has been demonstrated that the use of vemurafenib strategy in treatment of metastatic melanoma in patients with BRAF V600 mutation had better progression-free survival (PFS) rate throughout the entire modelling horizon. The use of vemurafenib in treatment of metastatic and inoperable melanoma in patients with BRAF V600 mutation is economically advisable taking into account the data on effectiveness (PFS). The use of vemurafenib in patients with BRAF V600 mutation is an absolutely innovative medical technology which currently does not have any alternative. Vemurafenib may be indicated for inclusion in reimbursement lists for treatment of patients with this mutation.
Budget impact analysis is one of the main methods of pharmacoeconomic analysis and obligatory one for pharmacoeconomic assessment during the apply for inclusion in state reimbursement list in the Russian Federation. Results of budget impact analysis being presented in monetary values are the most convincing ones among the pharmacoeconomic values for healthcare decision-makers. The conduct of budget impact analysis includes such stages as choice of effectiveness criteria, costs analysis. During this type of pharmacoeconomic assessment the following factors are taken into account: time horizon, the peculiarities of choice of patients’ models, characteristics of market penetration with health technologies. Budget impact analysis presents wide opportunities for conducted pharmacoeconomic assessment, defining the total economic impact under basic scenario. In the same time budget impact analysis allows to compare the figures of total economic impacts for several technologies, showing the least costly alternatives. If it is necessary using budget impact analysis it is possible to make accurate models describing the budgets of any healthcare programme of ones for treatment of certain nosologies with the function of prognosis and optimization.