Compare the cost effectiveness and budget impact of vortioxetine in monotherapy of depressive disorders with several other important antidepressants using pharmacoeconomic methods within context of Russian healthcare. Agomelatine, fluvoxamine, escitalopram and paroxetine were used as comparators. A «decision tree» model describing probabilities of relevant clinical outcomes and events during the course of therapy with vortioxetine and the comparator drugs (including adverse events) was built using information from available clinical trials. Afterwards, data obtained via modelling, existing Russian documents regarding medical care standards and expert opinion survey data were used to calculate cost of treatment for vortioxetine and for each of the comparators (including costs associated with adverse events). These estimates were used to perform the following types of pharmacoeconomic analysis: cost-effectiveness analysis (CEA), sensitivity analysis (SA) and budget impact analysis (BIA). CEA has demonstrated that vortioxetine definitely dominates among all compounds investigated in the current study with a CER of 41.990 rub., and escitalopram ranks as second with a CER of 77.360 rub. SA confirmed the robustness of this result. BIA indicated that utilization of vortioxetine, as the monotherapy regimen choice is associated with minimum fund expenditure among the compounds compared in the current study. wtP/CER was best for vortioxetine (35,5) according to pharmacoeconomic expediency analysis. The results of this pharmacoeconomic analysis of vortioxetine performance as monotherapy solution for treating depressive disorders in the RF indicate the following: • costs associated with adverse events constitute a significant portion of overall depression treatment costs; • possessing a favorable combination of clinical effectiveness and tolerability parameters, vortioxetine confidently dominates both in terms of raw effectiveness and in terms of CEA; • the aforementioned result is robust - according to sensitivity analysis it remains stable even under considerably unfavorable assumptions; • both complete and incomplete suicide, in addition to having considerable social and clinical consequences, contribute to increasing the budgetary burden; • according to BIA, vortioxetine use is associated with a decreased budgetary burden, which is explained by its low suicidogenic potential and high cost effectiveness; • it is interesting to note that paroxetine use is associated with a very high budgetary burden (which is especially relevant given that paroxetine remains widespread in Russian clinical practice). Compared to vortioxetine, the overall budget spending in case of paroxetine use is 60.3% higher; • among the compounds investigated in this study, vortioxetine is the most attractive from the RF drug reimbursement system point of view.

We conducted a comparative pharmacoeconomic analysis of the use of botulin toxin drugs in complex therapy of poststroke spasticity syndrome under Russian conditions. Together with a health economic modelling, we conducted a “standard practice” analysis through polling of experts (neurologist physicians) with subsequent use of the Delphi method. We evaluated three medical technologies for treatment of poststroke spasticity in combination with standard clinical practice: treatment using drug-induced local miorelaxation by Botox®, Dysport® and Xeomin®. In the modelling, we used a Markov cycle, a probabilistic sensitivity analysis and budget impact analysis. It was determined that, in conducting one course of therapy, the strategy using Botox® was least expensive and most effective, both in the case of examining one course of therapy and according to the results of three-year observation. According to the results of the cost-effectiveness analysis for therapy of the various strategies, the strategy using Botox® was predominant. That result was observed both when examining efficacy and when examining effectiveness according to the results of the three-year modelling of using the treatment strategies. From the standpoint of the budget impact analysis, Botox® is also the most preferable strategy: using this drug saves up to 141 million rubles of budgetary funds and makes it possible to treat an additional 227 patients with this strategy. The results obtained in the mathematical modelling correlate to the “standard” data of clinical practice and the pharmacoepidemiological analysis conducted concurrently.

Purpose: Definition the scheme of hormonal stimulation, which is the most pharmacoeconomical founded. Methods: Pharmacoeconomic analysis was performed using the cost minimization analysis on the assumption of equal effectiveness compared schemes of hormonal stimulation, which was confirmed in the review of clinical trials and meta-analysis. To estimate the cost of drugs for ovulation induction we used registered VED rates and recommended in the instructions for medical use and the standard of care for infertility using assisted reproductive technologies dosing regimens. Results: The cost of the courses of drugs (1) corifollitropin a + ganirelix (32.9%), corifolhtropin a + ganirelix + follitropin (3 (67.1%) and (2) follitropin a + cetrorelix was 38 108.5 rub. and 47 102 rub., respectively. Cost saving of the budget by using the first scheme was 8 993.5 rub. for one course of in vitro fertilization. Conclusions: The scheme of hormonal stimulation using corifollitropin a is more pharmacoeconomical reasonable.

Purpose. To evaluate the cost effectiveness of use of ustekinumab (Stelara®), infliximab (Remicade®) and adalimumab (Humira®) for treatment of moderate and severe psoriasis. Methods. A cost-effectiveness analysis and budget impact analysis have been conducted. Clinical efficacy was evaluated by reduction in PASI scores by 50, 75 and 90%. The efficacy and safety of compared anti-psoriasis agents were derived from a meta-analysis of efficacy of biologic agents in treatment of moderate and severe plague psoriasis containing all compared drugs. The expenses counted includes costs of anti-psoriasis therapy, cost of drug administration and associated medical services. Results. Ustekinumab (Stelara®) was shown to be the most cost-effective biologic agent with respect to the cost per patient achieving PASI50, PASI75 and PASI90 scores. Total direct medical costs associated with use of ustekinumab for treatment of psoriasis turned to be 2 824 rub. (0.2%) per patient per year less than total cost of treatment associated with adalimumab and 444 315 rub. (27.3%) per patient per year less than total costs associated with infliximab. Thus, treatment of patient with moderate and severe psoriasis with ustekinumab results in optimal health care resource utilization. Conclusion. Prescribing of ustekinumab (Stelara®) was demonstrated to be dominating strategy of treatment of moderate and severe psoriasis being the most effective and less costly strategy among those based on other biologic agents.

The objective was to evaluate the cost-effectiveness and budget impact of ceftaroline fosamil compared with other intravenous antibiotics with anti-MRSA activity in the treatment of complicated skin and soft tissue infections (cSSTI). The source of data on the efficacy and safety were randomized controlled trials and meta-analyzes devoted to the study of drugs for the treatment cSSTI. Comparison drugs were daptomycin, tigecycline, vancomycin and linezolid. To “overlap” gram-negative infections for vancomycin, linezolid and daptomycin was taken into account levofloxacin and cefoperazone/sulbactam with the share of each of them at 50%. For the efficacy was taken clinical response at day 7-14 after a course of treatment in ITT-population of patients with cSSTI. We calculated the direct medical and indirect non-medical costs associated with premature mortality. The data obtained are the following types of pharmacoeconomic analysis: cost-effectiveness analysis (CEA), budget impact analysis (BIA) and sensitivity analysis (SA). The results of pharmacoeconomic analyzes have shown that the cost-effectiveness ratio (CER) per patient was lowest in vancomycin - 79.613 rub., further follow: ceftaroline - 94.474 rub., linezolid - 118.049 rub., tigecycline - 122.424 rub. and daptomycin - 127.484 rub. Evaluation of cost-effectiveness threshold demonstrated that CER do not exceed the value of “willingness-to-pay ratio” none of the comparators, i.e., they are subject to state reimbursement under the compulsory health insurance system. Analysis of indirect costs per patient associated with premature mortality and the shortfall in GDP gave the following results: at ceftaroline they accounted for 31.391 rub., daptomycin - 78.458 rub., tigecycline - 105.688 rub., linezolid - 151.880 rub., vancomycin - 187.774 rub. The total costs (direct and indirect) per patient were at least in ceftaroline group - 108.094 rub., further follow: daptomycin - 182.102 rub., tigecycline - 203.493 rub., vancomycin - 251.743 rub. and linezolid - 252.151 rub. BIA shows that the transition from comparators to ceftaroline is costs saving overall of the budget: with linezolid - 144.056 rub., vancomycin - 143.649 rub., tigecycline - 95.399 rub., daptomycin - 74.008 rub. SA confirmed these results. Ceftaroline is the best alternative to daptomycin, tigecycline, vancomycin and linezolid. Active implementation of ceftaroline as a drug for the treatment of cSSTI can contribute both to optimize budget spending at various levels.

Objective: To perform comprehensive pharmacoeconomical assessment of use etravirine and raltegravir in HIV-infected patients. Methodology: Cost-eifectiveness and budget impact analyses of etravirine or raltegravir on the top of optimized background therapy in adult treatment-experienced HIV-infected patients were conducted. Results: Cost to achieve an undetectable viral load (<50 copies/ml) were 2 958 646 rubles for etravirine-based treatment regimen and 3 859 041 rubles for raltegravir-based therapy per one HIV-infected patient treated within two years. Use of etravirine instead of raltegravir associated with budget savings in the amount of 513 225 rubles per one HIV-infected patient treated during two years. Conclusions: Etravirine shown to outperform raltegravir in terms of cost-effectiveness and budget savings in management of adult treatment-experienced HIV-infected patients.

It was conducted cost-minimization analysis (CMA) for use in a hospital medical product «Ethanol wipes «МК Aseptic»» in comparison with «routine» practice of making and using gauze (or cotton balls) and 70% ethanol or 70% isopropyl alcohol. CMA has shown that when calculating manufacturing «manual» method gauze moistened with 70% ethanol, the manufacturing cost will be 3.62 rub. /pcs., which is 2.5 once higher than the purchase price of products manufactured on an industrial scale. In calculating the production of «manual» method of cotton balls moistened with 70% ethanol, the cost of manufacturing was 2.79 rub. /pcs., which is 1.9 once higher than the purchase price of products manufactured on an industrial scale. The dominant technology was the «Ethanol wipes «МК Aseptic»».

The level of medical activities are often determined by attractive image and level of medical professionalism - corresponding self-improvement, a fixture of the physicians image Society dictates medicine and its direct representatives of their demands, but the process of health and fitness - it is an interconnected process which is due to the efforts of both sides. Style physician behavior has a large value in the format of a modern medical communication, sometimes decisive, in terms of the psychological predisposition of the patient to a productive dialogue.