Analisis Efektivitas Biaya Kombinasi Obat Antihipertensi Pada Pasien Rawat Inap Di RS PKU Muhammadiyah Yogyakarta Tahun 2020

Terapi kombinasi disarankan pada pasien hipertensi yang memiliki tekanan darah tidak terkontrol dengan terapi tunggal. Biaya pengobatan semakin meningkat setiap tahunnya. Penelitian ini bertujuan untuk mengetahui terapi kombinasi obat antihipertensi yang paling cost effective pada pasien rawat inap RS PKU Muhammadiyah Yogyakarta tahun 2020. Penelitian ini merupakan penelitian deskriptif dengan pendekatan analisis farmakoekonomi metode Cost Effectiveness Analysis (CEA) yang dilakukan secara retrospektif. Teknik pengambilan sampel yang digunakan adalah total sampling. Data dikelompokkan berdasarkan pola terapi pasien kemudian dilakukan analisis berdasarkan ACER dan ICER. Jenis pola terapi kombinasi antihipertensi yang paling banyak digunakan adalah kombinasi dua obat (53%). Terapi dengan ACER terendah yaitu Diuretika + ARB + β Bloker (Rp. 15.257). Hasil ICER kombinasi ACEI + CCB + β Bloker + Diuretikb + Agonis α2 Sentral + ACEI memiliki nilai yang terendah dengan Rp. 25.353 jika dibandingkan dengan terapi standar. Namun, terapi CCB + β Bloker, Diuretika + ACEI + CCB, Diuretika + ARB + β Bloker, ARB + CCB + β Bloker + Agonis α2 Sentral bersifat dominan terhadap terapi standar pada cost effectiveness grid. Sehingga, terapi yang paling cost effective berdasarkan ACER dan ICER adalah Diuretika + ARB + β Bloker.Combination therapy is recommended in hypertensive patients whose blood pressure is not controlled by monotherapy. Medical expenses are increasing every year. This study aims to determine the most cost-effective antihypertensive drug combination therapy for inpatients at PKU Muhammadiyah Yogyakarta Hospital in 2020. This study is a descriptive study with a pharmacoeconomic analysis approach using the Cost-Effectiveness Analysis (CEA) method which was carried out retrospectively. The sampling technique used is total sampling. The data were grouped based on the patient's therapy pattern and then analyzed based on ACER and ICER. The most widely used combination antihypertensive therapy pattern was a combination of two drugs (53%). The therapy with the lowest ACER was Diuretica + ARB + Blockers (Rp. 15.257). The ICER result of the combination of ACEI + CCB + Blocker + Diureticb + Central α2 Agonist + ACEI has the lowest value with Rp. 25,353 when compared to standard therapy. However, CCB + Blocker, Diuretica + ACEI + CCB, Diuretic + ARB + Blocker, ARB + CCB + Blocker + Central α2 Agonist are dominant over standard therapy on the cost-effectiveness grid. Thus, the most cost-effective therapy based on ACER and ICER is Diuretica + ARB + Blockers.

Pharmacoeconomic analysis of bronchial asthma prophylaxis in adults and children with allergic rhinitis with sublingual allergen-specific immunotherapy

AIMS: to evaluate the cost-effectiveness of sASIT in children and adult patients with allergic rhinitis and / or allergic rhinoconjunctivitis. MATERIALS AND METHODS: the hypothesis of the study was based on results of the study by Devillier P. et al., 2019, according to which the incidence of asthma was 13.7% and 17.0% in the sASIT + symptomatic therapy groups and the symptomatic therapy group (odds ratio - 0.776, 95% confidence interval (0.622; 0.968)). Pharmacoeconomic study based on decision tree model. Costs taken into account: cost of sASIT, symptomatic therapy, diagnostics and routine follow-up visits due to BA, outpatient BA drug therapy, the cost of hospitalization due to BA. The modeling horizon was 5 years, including 2 years of sASIT therapy and 3 years of follow-up. RESULTS: the cost per patient when using sASIT in combination with symptomatic therapy was 166,711.93 rubles, with symptomatic therapy - 101,700.35 rubles. The CER for sASIT in combination with symptomatic therapy was 193,177.20 rubles. per 1 prevented case of asthma, for symptomatic therapy - 122,530.55 rubles. for 1 prevented case of BA. Thus, the cost of 1 averted AB case when using sASIT in combination with symptomatic therapy is 57.7% higher than with symptomatic therapy. According to the results of the cost-benefit analysis, ICUR for an additional year of life adjusted for its quality (QALY) when performing sASIT in combination with symptomatic therapy compared with symptomatic therapy alone in children and adults was 567,365.48 rubles, which is less than calculated willingness to pay threshold (WTPT) (RUB 2,248,898.50). CONCLUSIONS: based on the results of comparing the cost of 1 added QALY and WTPT, it can be concluded that sASIT in combination with symptomatic therapy compared to symptomatic therapy alone is potentially cost-effective in children and adults with AR.

Comparative pharmacoeconomic analysis of the use of erythropoiesis-stimulating drugs for the treatment of anemia in cancer patients

Introduction. Currently, a number of pharmacoeconomic studies describing use of erythropoietin stimulating agent (ESA) in cancer patients with anemia have been published, however, most of the publications on this topic are foreign. At the same time, there are practically no studies comparing the economic efficiency of various ESA preparations with each other. Some of works by foreign colleagues reflect that the clinical efficacy of using ESA namely the degree of increase in Hb, significantly depends on the patient’s body weight: the higher the weight, the greater the dose of EPO is required for a single administration and a course of therapy.Aim. Сomparative pharmacoeconomic analysis of epoetin alfa usage for the treatment of anemia in adult cancer patients with weight 80 kg.Materials and methods. The following drugs were selected for comparative analysis: epoetin alfa, epoetin beta, darbepoetin. Clinical efficacy was assessed in terms of the rate of in Hb level increase. Pharmacoeconomic analysis was carried out using the cost-effectiveness method (CEA).Results. Тhe usage of epoetin alfa 12,000 IU for 8 weeks therapy course in cancer patients weighting over 80 kg had a better cost-effectiveness ratio compared to epoetin alfa (10,000 IU, 30,000 IU, 40,000 IU) and darbepoetin, giving way in price only to the cheapest epoetin beta which can be administered 4 injections simultaneously. Its the infringement of patients rights to avoid additional pain. Its the infringement of patients rights to avoid additional pain. At the 16th week of therapy, the usage of epoetin alfa 12,000 IU had an advantage over all ESA.Conclusions. Тhe usage of russian epoetin alfa 12,000 IU for the treatment of anemia in adult cancer patients weighing over 80 kg approximately in real clinical practice in Russian Federation is an economically justified approach to the medical care organization.

Hypertonic saline in the treatment of patients with cystic fibrosis in Russian Federation

Introduction. Mucolytic therapy is basic in the treatment of patients with cystic fibrosis (CF). Currently, inhalation of hypertonic saline (HS) of NaCl is recommended for the treatment of CF patients.The aim of the study was to investigate the experience of the use of HS NaCl for inhalations CF patients in the Russian Federation.Material and methods. To estimate the use of HS NaCl, data of national registers for 2011–2019 were used. Pharmacoeconomic analysis of “HS 7% NaCl + 0.1% sodium hyaluronate”, presented in the Russian market, carried out according to the cost estimate for the course of therapy based on the cost from the site of the unified information system in the sphere of procurement.Results. From 2011 to 2019, an increase in the number of patients receiving the inhalation of a HS is observed. 2011 –8.7% of patients with CF, by 2019 – in 71.5% of CF patients. In 25 regions of the Russian Federation more than 80% of CF patients used HS NaCl. The cost analysis of Russian-made medicinal products for human use containing 7% HS and 0.1% sodium hyaluronate solution, and foreign-made products of similar composition showed that the annual cost of therapy with Russian-made products was 2.15 times lower than that with the foreign-made products. As for the medicinal product mannitol, the annual cost of therapy with a foreign-made product is 8.1 times higher than the cost of a Russian-made product.Conclusions. The clinical practice of treating patients with CF has accumulated positive use of HS in inhalations, the use of which has increased significantly since 2011. Medical products 3 and 7% HS with a 0.1% solution of sodium hyaluronate are prescribed from the moment of diagnosis and have advantages over the HS pharmacy production over portability and ease of use. The use of the “7% HS with a 0.1% solution of sodium hyaluronate” is mainly determined by the financial accessibility.

Pharmacoeconomic analysis of drug supply of the military personnel with chronic bronchitis

Despite the superiority of bronchitis in the structure of respiratory diseases in the military personnel, its course develops with certain peculiarities due to the peculiarities of military service. Consequently, the optimization of the costs of providing the military personnel with medicines is becoming more and more of medical and social importance. Reasonable selection of medicines in the treatment of chronic bronchitis is the result of the choice of effective and safe drugs, considering the cost of the components for military health care. Aim. To perform a pharmacoeconomic analysis of drug supply to the military personnel with chronic bronchitis. Materials and methods. The materials of the study were a database of drugs registered in Ukraine, presented on the official website of the State Institution “State Expert Center” of the Ministry of Health of Ukraine. The study employed “cost – effectiveness” method, which allows comparing the cost of a particular treatment method and its effectiveness. Results. The scheme of the pharmacoeconomic analysis method has been offered. According to the results of the previously formed list of drugs for the treatment of military personnel with chronic bronchitis, a further analysis of the proposed range of drugs is conducted using an expert survey. By calculating the efficacy ratio within each presented pharmacotherapeutic group, a 10-item list of the most optimal drugs for the treatment of chronic bronchitis has been compiled. Conclusions. Pharmacoeconomic analysis of medical supply to the military personnel is a constructive solution in the process of identifying manufacturers as potential suppliers of medicines to cover the needs of the medical service of the Armed Forces of Ukraine. Based on the results of the pharmacoeconomic analysis of the drug supply to military personnel with chronic bronchitis, a recommended list of drugs for their treatment has been formed. However, this list can be expanded to include drugs with the highest efficacy – according to the expert assessment. In the future it may become the basis for inclusion of drugs in the clinical protocols of medical care and could be used for the development of cost standards for the relevant nosological forms, which will improve the efficiency and quality of treatment and will provide economic benefits.

Analysis of the vitamin’s list with pharmacoeconomic rates for the treatment of long covid conditions during the pandemic COVID-19 in Ukraine

To ensure adequate vital activity, especially during the COVID-19 pandemic, the human body needs, in particular vitamins, minerals (macro and micronutrients). The purpose of the study is the range, qualitative and quantitative composition of vitamin complexes (VC) in the pharmaceutical market of Ukraine; to develop a method of pharmacoeconomic analysis to determine the cost of treatment of VC. Materials of research – data DRLZ, «Compendium», prices for VC (www.tabletki.ua). Research methods: webometric, comparative, content, «cost minimization» analysis; systematization, generalization. 20 VCs were analyzed, of which 15 – group A11A (75%) and 5 – A11B (25%). The highest content of vitamins in: Elevit Pronatal, Vitrum Energy, etc. All groups of vitamins contain: Vitrum Centuri, Vitrum Energy. The least vitamins in – Metovitan, Optics. Vitrum Centuri and Vitrum Energy contain most of the trace elements. Metovitan, Optics, Quadevit contain the least amount of trace elements. In addition to trace elements, the composition of VC includes: amino acids (cysteine, methionine), papain, fish oil, etc. It is established that the recommended doses of vitamins A, C, B1, B2, B5, B6, B12 in Ukraine are higher than recommended by the WHO; D, B9, H – the recommended doses in Ukraine are lower than recommended by the WHO; recommended doses of all trace elements in Ukraine are higher than the WHO. 20 VCs are registered in Ukraine, of which 15 are group A11A and 5 are A11B. 90% of VC contain vitamins A, E, C, B1, B2, B9, B12, PP. Vitamin B6 – in 85% of VC; vitamin D3 is in the composition of 62% of VC; vitamin B5 – 58%; vitamins H and K – in the composition of almost 15% of VC. It was found that 54% of VCs contain calcium; 61.5% of VC contain iron and copper; 31% of VC contain phosphorus and manganese; up to 23% of VCs contain molybdenum, boron, nickel, vanadium, tin, etc. It is established that Zinc is a part of 62% of VCs registered in Ukraine. The results of pharmacoeconomic analysis by the method of «minimization of cost» showed that the affordability of domestic multivitamin and vitamin-mineral complexes are 1.5–4.7 times more economically affordable for treatment compared to imported, with a qualitative composition are similar. Quantitative content of vitamins and minerals in domestic VC meets the national requirements of daily intake.

Pharmacoeconomic Analysis of Treatment Regimens for Coronavirus Infection Coronavirus Disease-19

BACKGROUND: In March 2020, the coronavirus disease (COVID-19) infection was assigned the status of a pandemic. As of the beginning of 2021, the Russian Federation ranks fourth in terms of the prevalence of coronavirus infection. Over the period from March 2020 to February 2021, more than 84,000 fatal cases of the disease were recorded in Russia. AIM: However, at the moment, there are no medications with proven effectiveness and safety against the novel coronavirus infection. In this regard, the purpose of our study was to conduct a pharmacoeconomic analysis of medications for etiotropic therapy of all forms of COVID-19 recommended by the Ministry of Health of the Russian Federation (clinical guidelines, version 10 dated February 8, 2021) to identify the best treatment option. MATERIALS AND METHODS: In the course of the study, the “cost of illness” was determined for all forms of the disease in an outpatient and inpatient setting. The authors took into account the direct medical costs of medication therapy and diagnostic and treatment procedures. In terms of direct non-medical costs, they calculated the cost of a bed-day excluding medication treatment, and indirect costs included payments for temporary disability sheets. Costs for medications were calculated based on the active ingredient (AI) and the packages for treatment on an outpatient basis and in the case of the hospital setting based on the AI only. The cost of medical and diagnostic procedures was determined based on the Tariff Agreement for 2020 dated December 30, 2019. Next, a cost-effectiveness analysis was performed. Effectiveness criteria were selected based on published clinical trial results for the medications in question. Then, they performed a calculation of the cost-effectiveness coefficients and an incremental analysis. RESULTS: Thus, in the course of the analysis of the cost of illness, the most economically profitable treatment regimens were the ones with hydroxychloroquine both for outpatient treatment (13,150.31 rubles: Mild form, 22,326.44 rubles: Moderate form excluding antibiotic therapy, and 21,513.76 rubles: Moderate form, taking into account antibacterial therapy) and for inpatient treatment (34,441.53 rubles). CONCLUSION: As a result of the cost-effectiveness analysis, the use of favipiravir can be considered optimal (comparative effectiveness research = 17,607.14 rubles), and for the mild form, the optimal medication is umifenovir, since during the incremental analysis, it was found that for therapy with favipiravir, 100 people would need an additional allocation of 96.291 rubles, which, given the form of the disease, is not entirely appropriate.

EPIDEMIOLOGICAL AND PHARMACOECONOMIC ANALYSIS OF DRUGS, USED IN ATOPIC DERMATITIS IN THE REPUBLIC OF KAZAKHSTAN

В статье рассмотрены эпидемиологические показатели и фармакоэкономический анализ лекарственных препаратов при лечении атопического дерматита в Республике Казахстан The article deals with epidemiological indicators and pharmacoeconomic analysis of drugs in the treatment of atopic dermatitis in the Republic of Kazakhstan.

Analysis of consumption trends of antibacterial and antivirus medicines in pharmacies during COVID-19 pandemic in Ukraine

Rational pharmacotherapy of COVID-19 in the world, treatment protocols, prescriptions of antibacterial (AB), antiviral (AV) medicines have been systematically improved due to updated data of evidence-based medicine. The study aim was to analyze the trends of AB, AV consumption for outpatients with confirmed COVID-19: to study the reasons of the growing demand for AB, AV; optimization of pharmaceutical care directions for rational cost-effectiveness use, prevention antibiotic resistance. Methods – the survey on consumption trends of AB and AV, side effects of AB; survey data of 205 pharmacists, 5 regions of Ukraine; pharmacoeconomic analysis «cost-minimization», content analysis of instructions, side effects. Analysis of surveys showed that the demand on AB, AV increased by 50.1% to 2019, such groups: beta-lactams, respiratory fluoroquinolones, macrolides. We found the most often were released: azithromycin, cefoperazone, cefipime, piperacillin with tazobactam, meropenem. Pharmacists noted that patients often used AB, AV without a prescriptions, it complicates the release from pharmacies. So it is necessary to implement e-prescriptions for AB, AV for monitoring of effectiveness, side effects, to prevent antibiotic resistance in pandemic. We found 53.7% of pharmacists noted about insufficient of trade names, stocks of AB and AV. It is the difficulties to provide outpatients with covid-19. Content-analysis data showed the most common side effects during AB course. We identified the main directions of information pharmacist providing to prevent side effects, antibiotic resistance. We conducted the demand for AV, AV medicines increased by 50.1% vs to 2019. It was identified the AB groups, trade names in high demand. Used pharmacoeconomic analysis «cost-minimization», we established that depending on the manufacturer, an antibiotic course costs differ by 15.1 times. The necessity of including in the list of the reimbursement program «Affordable Medicines» the essential AB, AV, to reduce costs for COVID-19 outpatients was substantiated. We showed 83,1% of pharmacists consider the need of approval, implementation of «Protocol for symptomatic treatment of uncomplicated forms of COVID-19». It will improve the results of pharmaceutical care for COVID-19 patients due to GPP requirements.