Economic aspects of insulin analogues — glargine and detemir — in the control of diabetes mellitus type 2 (DM 2) has been prepared in according to needs of the Russian health care system. It has been done that for equal control of DM 2 insulin glargine should be administered in less doses than insulin glargine based on randomized clinical trials results. Results of Russian observational studies of real practice do not show diff erence in doses of both. In the same time glargine has a better effi cacy and safety than detemir based on amount of patients with DM 2 reached targeted levels of control and hypoglycemic events. Clinicaleconomic analysis as well as sensitive analysis did not fi nd any economic advantages of detemir compare with glargine having higher cost for pack. Needed doses diff erentiation of glargine and detemir for equal results of DM 2 control should be taken into account for reimbursement.

We have performed the fi rst-ever pharmacoeconomic analysis in a Russian context of botulin toxin drugs as part of combined therapy for juvenile cerebral palsy (JCP) compared to standard clinical practice. Along with health economic modelling, an analysis of “routine clinical practice” was conducted by means of a survey of experts (practicing neurologists). Th ree medical approaches were evaluated: treatment with the use of drug-induced local myorelaxation via Botox® combined with standard clinical practice; treatment with the use of drug-induced local myorelaxation via Dysport® combined with standard clinical practice, and treatment in accordance with standard clinical practice, including rehabilitative and orthopedic care. Markov cycles, probabilistic sensitivity analysis, and budget impact analysis were used for modelling. Th e results show that the use of Botox® combined with standard clinical practice for treatment of focal spasticity in patients with JCP is an economically advantageous medical approach. Th is strategy was characterized by high clinical eff ectiveness with the lowest expenses of the medical approaches compared for treatment of spastic syndrome in JCP patients. As for the budget impact analysis, use of Botox® combined with standard clinical practice would allow saving up to an additional RUB 239 387 964 per 1000 patients with JCP over three years. Th e results of mathematical modelling correspond with information from “typical” clinical practice.

Partial epilepsy is the most common type of seizures. Th e prevalence of partial epilepsy in Russia reached 325 thousand patients, with resistant to therapy about 276 thousand. Objective. Pharmacoeconomic analysis (PHe) was conducted for perampanel use in patients older than 14 years with resistance partial epilepsy with or without secondary generalization in Russian Federation. Methodology. Th e perspective of PHe was a Ministry of Health and considers only direct medical costs (DC). Th e time horizont of PHe was adopted for 2 years. Th e data source of the clinical effi cacy was two network meta-analyzes. Th ey included randomized controlled clinical trials. Clinical effi cacy (Ef) criteria: reduction of seizures frequency ≥50%, the frequency of the «free from seizures», the frequency of discontinuation due to adverse events. As a criteria of utility were calculated QALY. In developed Markov model the 2-years time horizont calculation is divided into 6-month cycles. By the standards of primary health care for partial epilepsy in adults, we estimated DC for outpatient care, including diagnostic phase and selection of therapy, and remission phase. We conduct cost-eff ectiveness, cost-utility, budget impact and cost savings analysis. Results. Costeff ectiveness ratio (CER) of perampanel per patient (PP) was 613,968 rubles, lacosamid — 712,533 rubles. Cost-utility ratio (CUR) of perampanel PP was 206,045 rubles, lacosamid — 244, 582 rubles. Neither of comparators do not exceed the «willingness to pay» ratio. Sensitivity analysis confi rmed this fi ndings. Budget impact analysis showed that the overall cost of the therapy will be higher in the group of lacosamid at 15.7% then perampanel. Cost savings in favor of perampanel was 30,752 rubles PP within 2 years of therapy. Conclusion. Perampanel is dominant strategy in terms of CER and CUR, which reduce the DC.

Health technology assessment has been performed for osteoarthritis treatment. Several technologies were evaluated — NSAIDs, steroid therapy and hyaluronans viscosupplementation for inter joint injection. Expertise based on literature data and modeling evaluated outcomes during 2.5 years in the fourth stage of illness including knee replacement. Only one strategy — with Synvisk® injection has been eff ective in the endpoint of modeling. Expenditures for NSAIDs, steroids and Synvisk® were calculated. Synvisk® usage is more preferable based on budget impact analysis. Th is strategy can save no less than 81 million RUR (on 1000 pts.). Saved money can cover an additional quantity of patients for Synvisk® treatment. Synvisk® technology is delay a necessity of knee replacement surgeon in patients with fourth stage of osteoarthritis following to budget economy during 6-12 months treatment already.

Gadolinium based contrast agents are widely used in MRI in a diagnostic of variety of pathologies. The quality of contrast enhancement depends on the total dose (mM per kg body weight) and its relaxivity. Gadobenic acid (MultiHance® , Bracco Imaging S.p.A, Italy) has the highest relaxivity comparing to others gadolinium based contrast agents approved in Russia. The aim of the study is to conduct a health economic evaluation of gadobenic acid in contrast enhanced MRI. The cost effectiveness analysis, sensitivity analysis and budget impact analysis were used to modeling MRI of CNS, MR-angiography and MRI of the liver. In results, we can say that Multihance® is cost-effective comparing to gadopentetic acid, gadobutrol and gadodiamid in CNS MRI.

Percutaneous coronary intervention (PCI — angiography and stent placement) aren’t possible without X-ray contrast agents. Contrast enhancement depends on the iodine concentration, while the safety of particular contrast agents diff ers. Th e aim of the study is to conduct health economic evaluation of Iomeron (Bracco Imaging S.p.A., Italy) in patients with acute coronary artery disease treating with PCI. Th e cost-eff ectiveness analysis, cost-minimization analysis, sensitivity analysis and budget impact analysis were used. In results, we can say that Iomeron is cost-eff ective comparing to iodixanol, iohexol, iopromide and ioversol.

According to the authors of the Federal Law of 05.04.2013 №44 -FZ «On the contract system in the procurement of goods, works and services for state and municipal needs» new rules of organization and control in procurement should be accompanied by a reduction of waste and the risk of corruption schemes by increasing the «transparency» of the bidding procedure. Performed work showed that before the implementation of the law imposed on hopes still far away, in any case, in terms of drug procurement.

One of the legislative innovations aimed to reduce irregularities in public procurement, is the emergence of new actors — an «expert» and «expert organization», i.e. people with special knowledge, experience, expertise in the field of science, technology, art or craft required for the examination, as well as for auditing. Th is work is devoted to the possibility of carrying out an independent examination of drugs procurement for health care organizations is fixed.