The results of the analysis of medical prescriptions and the drug consumption in patients with lymphogranulomatosis in Ukraine

Aim. To analyze medical prescriptions and the structure of the drug consumption in patients with lymphogranulomatosis in Ukraine. Materials and methods. The data of medical records (455) of patients with lymphogranulomatosis were studied. The historical, analytical-comparative, systemic, logical, hypothetical-deductive, graphical methods of scientific research, as well as clinical and economic analysis as one of the components of health technology assessment were used. Results. It was found that, on average, the patients were in the hospital for 32 bed-days, and they received 16,835 medical prescriptions. There were 37 prescriptions per patient. The leaders in the number of prescriptions were drugs from groups L – Antineoplastic and immunomodulating agents, B – Drugs affecting the blood system and hematopoiesis, and A – Drugs affecting the digestive system and metabolism. These groups of drugs accounted for more than half of medical prescriptions (9247 or 54.93 %). The structure of prescriptions was dominated by drugs in the form of solutions or powders for their preparation (62.78 % of all prescriptions or 10569). In accordance with the II level of the ATC classification, the first three positions in the number of prescriptions were drugs used in the chemotherapy and elimination of symptoms of exacerbation of chronic pathologies. These drugs were from the following groups: L01 – Antineoplastic and immunomodulating agents (12.80 % or 2154 prescriptions), B05 – Blood substitutes and perfusion solutions (11.95 % or 2012, respectively), C01 – Drugs for the treatment of heart diseases (9.99 % or 1681, respectively). Antineoplastic prescriptions ranged from 31 (L01C D01 – Paclitaxel) to 289 (L01DB01 – Doxorubicin) ones. The most prescribed drugs were L01DB01 – Doxorubicin, AA01 – Cyclophosphamide, and L01CB01 – Etoposide. It was proven that patients with lymphogranulomatosis received an average of 8.3 prescriptions of antitumor drugs. The general indicator of the drug consumption was 23440.30 thousand UAH or 822.58 thousand US dollars, which, in terms of one patient, amounted to 51,517.14 UAH or 1807.86 US dollars. It was found that 38797,60 UAH or 1361.50 USD were spent on the effective chemotherapy and maintenance of the patient’s body, which was 8.21 and 17.1 times more than the minimum wage and living wage according to the data presented in the state budget for 2020 in Ukraine. Conclusions. It has been found that medical prescriptions and the consumption of drugs by patients with lymphogranulomatosis reflect the nature of the therapy, namely the need for intensive courses of chemotherapy, polymorbidity of patients, as well as the severity of the pathological process. Considering the high cost of the treatment the solution to the issue of increasing the level of its availability requires a systemic solution in various directions. Key words: clinical and economic analysis; medical prescriptions; lymphogranulomatosis; Hodgkin’s disease; antineoplastic drugs; health technology assessment.

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PP071 Health Technology Assessment In Bulgaria: A Review Of The First Fifteen Reports Assessed

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317002458 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 103-104

Author(s):

Ralitsa Raycheva ◽

Georgi Iskrov ◽

Rumen Stefanov

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

Heart Diseases ◽

Health Technology ◽

Assessment Process ◽

Chronic Obstructive ◽

Regulatory Body ◽

Working Groups ◽

The Impact ◽

Small Working

INTRODUCTION:In Bulgaria, the regulatory body sets for the first time legal requirements for Health Technology Assessment (HTA) in Law on Medicinal Products in Human Medicine (LMPHM) on 27 June 2015. The next essential step for HTA capacity building was the promulgation of Ordinance 9 / December 1, 2015 on the conditions and procedures for conducting health technology assessment by the Ministry of Health (1). In the beginning of 2016, the Main Price and Reimbursement Committee was set and launched a process for establishing the small working groups with the task of reviewing the first applicants reports of pharmaceuticals for inclusion in the Positive Drug List (PDL).METHODS:The objective of this study is to summarize the recommendations of the newly established HTA Committee in Bulgaria and to examine the characteristics of the technologies and the key considerations that led to those decisions. We systematically read all published by the Committee recommendations for 2016 and analyzed them under: type of recommendations (positive or negative for inclusion in PDL), population, specialization, type of service, type of justification and the impact on final conclusions.RESULTS:For the first year of its work the HTA Committee was able to assess fifteen technologies (pharmaceuticals) and only one received a negative recommendation (6 percent) from the working group. All the rest (n = 14; 94 percent) were recommended for funding. The final recommendation from the Main Price and Reimbursement Committee is available for four (27 percent) technologies – all positive for inclusion in PDL. All recommendations were connected with adults and in oncology (n = 4; 27 percent); heart diseases (n = 4; 27 percent); Chronic Obstructive Pulmonary Disease, COPD (n = 2; 13 percent); diabetes (n = 2; 13 percent); psoriasis (n = 2; 13 percent); Hepatitis C (n = 1; 7 percent). The only negative recommendation was justified due to lack of robust evidence, safety issues and credibility of HTA analysis (2).CONCLUSIONS:The information about the number of applications received from the Committee is not available and correct conclusions about the capability is not possible, but indirect circumstances, as the lack of well-trained HTA experts, certainly impede establishment of the small working groups and slow the assessment process (3). At this point it is clear that additional efforts are need to overcome the barriers and smooth adoption and implementation of HTA methods in Bulgaria.

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Health technology assessment: features of national / regional and hospital-based medical technology assessment

Socìalʹna farmacìâ v ohoronì zdorov â ◽

10.24959/sphhcj.21.230 ◽

2021 ◽

Vol 7 (3) ◽

pp. 21-30

Author(s):

O. M. Filiniuk ◽

K. L. Kosyachenko ◽

N. O. Datsiuk ◽

V. V. Skrylov

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

Scientific Information ◽

Cost Optimization ◽

Health Technology ◽

State Budget ◽

Access To Treatment ◽

Health Technologies ◽

Healthcare Needs ◽

Need To Evaluate

The State Budget of Ukraine in 2021 is 159,2 billion UAH. It is 36.8 % more than in 2020, but this amount is still insufficient to cover all the healthcare needs in Ukraine. Economic hardships, the lack of funds in the healthcare system of Ukraine, as well as COVID-19 pandemic have increased the importance of Health Technology Assessment (HTA) as a tool of cost optimization. The introduction of hospital-based HTA along with national / regional HTA allows providing the use of effective, safe and economically justified health technologies that will give our citizens the access to treatment and the rational use of funds, in particular the budget ones. Aim. To analyze the world experience of using hospital-based HTA and its main differences from national / regional HTA. Materials and methods. The scientific information of international and domestic literary sources was analyzed. The methods of content analysis, historical, system-analytical and generalization were used during the research.Results. The authors reviewed the literature in Pubmed and Google Scholar databases devoted to the international experience of hospital-based HTA and its main differences from national / regional HTA. It has been determined that the transfer of the national / regional HTA results to the hospital level is hindered by a number of differences between the country as a whole and hospitals in particular. These include, first of all, features related to demographic indicators, epidemiology of diseases, the level of resistance, local approaches to treatment, various types of equipment used in hospitals, and others. In order to have practical benefits, HTA must be built taking into account the peculiarities of a medical institution where the health technologies studied will be used in the future.Conclusions. The need of effective management of hospital resources when a number of health technologies is increasing, the desire to improve clinical outcomes, improve the quality of life and its expectancy using health technologies with the proven effectiveness and safety, the need to evaluate medical equipment and consider organizational aspects related to introduction of a health technology, as well as assess the current equipment and treatment methods require to develop the scientific and practical approaches to hospital-based HTA and recommendations on collaboration between national / regional and hospitalbased HTA in Ukraine.

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The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation

Health Technology Assessment ◽

10.3310/hta22110 ◽

2018 ◽

Vol 22 (11) ◽

pp. 1-204 ◽

Cited By ~ 6

Author(s):

Matthew Cox ◽

Catherine O’Connor ◽

Katie Biggs ◽

Daniel Hind ◽

Oscar Bortolami ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Economic Analysis ◽

Health Technology Assessment ◽

Usual Care ◽

Technology Assessment ◽

Pulmonary Rehabilitation ◽

Controlled Trial ◽

Health Technology ◽

Randomised Controlled ◽

The Uk

BackgroundChronic obstructive pulmonary disease (COPD) affects > 3 million people in the UK. Acute exacerbations of COPD (AECOPD) are the second most common reason for emergency hospital admission in the UK. Pulmonary rehabilitation is usual care for stable COPD but there is little evidence for early pulmonary rehabilitation (EPR) following AECOPD, either in hospital or immediately post discharge.ObjectiveTo assess the feasibility of recruiting patients, collecting data and delivering EPR to patients with AECOPD to evaluate EPR compared with usual care.DesignParallel-group, pilot 2 × 2 factorial randomised trial with nested qualitative research and an economic analysis.SettingTwo acute hospital NHS trusts. Recruitment was carried out from September 2015 to April 2016 and follow-up was completed in July 2016.ParticipantsEligible patients were those aged ≥ 35 years who were admitted with AECOPD, who were non-acidotic and who maintained their blood oxygen saturation level (SpO2) within a prescribed range. Exclusions included the presence of comorbidities that affected the ability to undertake the interventions.Interventions(1) Hospital EPR: muscle training delivered at the patient’s hospital bed using a cycle ergometer and (2) home EPR: a pulmonary rehabilitation programme delivered in the patient’s home. Both interventions were delivered by trained physiotherapists. Participants were allocated on a 1 : 1 : 1 : 1 ratio to (1) hospital EPR (n = 14), (2) home EPR (n = 15), (3) hospital EPR and home EPR (n = 14) and (4) control (n = 15). Outcome assessors were blind to treatment allocation; it was not possible to blind patients.Main outcome measuresFeasibility of recruiting 76 participants in 7 months at two centres; intervention delivery; views on intervention/research acceptability; clinical outcomes including the 6-minute walk distance (6WMD); and costs. Semistructured interviews with participants (n = 27) and research health professionals (n = 11), optimisation assessments and an economic analysis were also undertaken.ResultsOver 7 months 449 patients were screened, of whom most were not eligible for the trial or felt too ill/declined entry. In total, 58 participants (76%) of the target 76 participants were recruited to the trial. The primary clinical outcome (6MWD) was difficult to collect (hospital EPR,n = 5; home EPR,n = 6; hospital EPR and home EPR,n = 5; control,n = 5). Hospital EPR was difficult to deliver over 5 days because of patient discharge/staff availability, with 34.1% of the scheduled sessions delivered compared with 78.3% of the home EPR sessions. Serious adverse events were experienced by 26 participants (45%), none of which was related to the interventions. Interviewed participants generally found both interventions to be acceptable. Home EPR had a higher rate of acceptability, mainly because patients felt too unwell when in hospital to undergo hospital EPR. Physiotherapists generally found the interventions to be acceptable and valued them but found delivery difficult because of staffing issues. The health economic analysis results suggest that there would be value in conducting a larger trial to assess the cost-effectiveness of the hospital EPR and hospital EPR plus home EPR trial arms and collect more information to inform the hospital cost and quality-adjusted life-year parameters, which were shown to be key drivers of the model.ConclusionsA full-scale randomised controlled trial using this protocol would not be feasible. Recruitment and delivery of the hospital EPR intervention was difficult. The data obtained can be used to design a full-scale trial of home EPR. Because of the small sample and large confidence intervals, this study should not be used to inform clinical practice.Trial registrationCurrent Controlled Trials ISRCTN18634494.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 22, No. 11. See the NIHR Journals Library website for further project information.

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Versorgungsforschung in der Klinischen Neuropsychologie – eine Standortbestimmung

Zeitschrift für Neuropsychologie ◽

10.1024/1016-264x.19.4.253 ◽

2008 ◽

Vol 19 (4) ◽

pp. 253-269 ◽

Cited By ~ 3

Author(s):

Sabine Heel ◽

Sonja Fischer ◽

Stefan Fischer ◽

Tobias Grässer ◽

Ellen Hämmerling ◽

...

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

Health Technology ◽

Empirische Forschung

Zunächst führt dieser Artikel in die wesentlichen Begrifflichkeiten und Zielstellungen der Versorgungsforschung ein. Er befasst sich dann mit der Frage, wie die einzelnen Teildisziplinen der Versorgungsforschung, (1) die Bedarfsforschung, (2) die Inanspruchnahmeforschung, (3) die Organisationsforschung, (4) das Health Technology Assessment, (5) die Versorgungsökonomie, (6) die Qualitätsforschung und zuletzt (7) die Versorgungsepidemiologie konzeptionell zu fassen sind, und wie sie für neuropsychologische Anliegen ausformuliert werden müssen. In diesem Zusammenhang werden die in den einzelnen Bereichen jeweils vorliegenden versorgungsrelevanten Studienergebnisse referiert. Soweit es zulässig ist, werden Bedarfe für die Versorgungsforschung und Versorgungspraxis in der Neurorehabilitation daraus abgeleitet und Anregungen für die weitere empirische Forschung formuliert. Der Artikel bezieht sich – entsprechend seines Anliegens – ausschließlich auf Studien, die sich mit der Situation der deutschen Neurorehabilitation befassen.

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