Pharmacoeconomics: theory and practice
№2, 2020, Vol.8
Budget impact analysis of treatment of ankylosing spondylitis was carried out on the for cohort of 100 patients in the Russian Federation. With the current distribution of patients, adalimumab received 26%, golimumab – 14%, infliximab – 26%, etanercept 18%, certolizumab pegol 7%, secukinumab – 9%. With the simulated distribution of patients, the share of the most economical drug, secukinumab, was increased to 21.8%, while the shares of adalimumab, golimumab, infliximab, certolizumab pegol and etanercept were 21.6%, 13.8%, 13.8%, 5, 8%, 13.8%, respectively. Also, in the simulated distribution, the shares of recently registered drugs – netakimab - 6.8%, and ixekizumab – 2.6% were taken into account. With the current distribution of patients between drugs the budget is 92,868,680 rubles in the first year and 258,825,970 rubles for three years. With a simulated distribution, the costs in the first year are 86,626,248 rubles and 240,444,152 rubles for three years. Thus, when calculating per 100 patients, the simulated distribution of patients in comparison with the current one provides savings in the amount of 6,242,431 rubles in the first year and 18 381 818 rubles for three years. With the saved money, 9 patients can be additionally treated with secukinumab.
In Russia, as in all countries of the world, there is a significant increase in the prevalence of diabetes: from 2000 to 2018. the number of diabetic patients increased by 2.5 million. However, these data underestimate the real number of patients, since only identified and registered cases of the disease are taken into account. The real number of patients with diabetes in the Russian Federation is at least 8-9 million people (about 6% of the population), which poses an extreme threat to the long-term perspective. The aim of this study was to determine, from the point of view of pharmacoeconomic analysis, the predominant self-monitoring blood glucose (glucometer with test strips) used in the complex treatment of diabetes mellitus based on a comparison of the ratio between costs and effectiveness, safety and quality of life when using Accu-Chek Performa (ACP) in comparison with the Russian satellite Express (SE) glucometer. According to the efficiency analysis, ACP model use is more effective than the SE model. As a result of the cost-effectiveness analysis, it was revealed that in comparison with the use of the SE model, ACP is the dominant medical technology. The budget impact analysis determined that the ACP scheme results in savings in the health system budget.
With its high disability and severity, Crohn’s disease (CD) is a serious socio- economic burden for both the patient and society as a whole. Therefore, the choice of a therapy strategy for CD should be aimed not only at controlling the disease but also at the rational allocation of resources in health care system. Taking into account the appearance of innovative biologic drugs (biologics) that offer additional options for the treatment of the CD with new data from clinical studies, the decrease of registered maximal selling prices, the development and output of biological analogues (biosimilars) as well as taking into account the limited budget of the health care system, it became obvious that it is necessary to update the pharmacoeconomic evaluation of biologics in CD therapy. The purpose of this study was to evaluate the introduction of ustekinumab drug into clinical practice of CD therapy basing on cost analysis, cost-effectiveness analysis and budget impact analysis in comparison with alternative biologics. The study found that the sum of costs for the use of ustekinumab in the regimen of 1 injection at 12 weeks was the lowest among vedolizumab, adalimumab and infliximab biosimilars and comparable in costs among adalimumab, infliximab and certolizumab pegol. The cost-effectiveness analysis showed that treatment of CD with ustekinumab is characterized by lower costs per effectiveness unit (share of patients who achieved a CDAI-100 response, share of patients who achieved a CDAI remission of <150, and QALY) in a 1/12 weeks dosing regimen compared to all other biologics and in the 1/8 weeks dosing regimen among infliximab biosimilars; in the first year of therapy ustekinumab is also a “cost-effectiveness” technology compared to vedolizumab. Switching of 15% of patients to ustekinumab (1/12) is characterized by budget slight increase in costs within the ONLS and RLO financing channels for the 1st year and three years of therapy. Within the OMI system there is a decrease in costs allocated by the OMI Fund for a treatment facility and there is a decrease in the difference between the amount of payment received by a treatment facility for cases with the use of biologics and the cost of purchasing biologics. As a result of the study, the introduction of ustekinumab in clinical practice is justified from the pharmacoeconomics point of view.