Pharmacoeconomic justification of the choice of specific therapy schemes for the treatment of adult patients with pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a progressive and debilitating disease that causes the blood vessels in the lungs to thicken and narrow, forcing the heart to pump blood through the lungs at high pressure. In recent years, a significant number of therapies have become available for the treatment of PAH. Pharmacoeconomic justification of the choice of specific pharmacotherapy requires weighing the effectiveness and cost of treatment of this disease and is extremely relevant. Given the limited budget for health care, the choice of drugs (drugs) should be based not only on the comparative clinical effectiveness of treatment, but also on the comparative cost-effectiveness, which ensures the maximum effectiveness of providing pharmaceutical care to patients with PAH. PAH is a life-threatening orphan disease with a poor prognosis, and in many cases a combination of specific drugs may be required regardless of their cost. Like patient survival, quality of life is the main factor in the pharmacoeconomic justification of the choice of specific drugs for the treatment of PAH. The objective of the paper – pharmacoeconomic research of specific therapy for the treatment of PAH and determination of «cost–utility», «quality of life», «QALY» indicators in various approaches to pharmacotherapy of PAH. The object of the study was the results of the analysis of pharmacotherapy schemes of patients with PAH in accordance with a certain functional class. Analytical, documentary, informational, graphic and mathematical research methods were used during the research. Our pharmacoeconomic analysis of the pharmacotherapy of patients with PAH who were in a certain functional class (FC) showed that for patients with FC II and FC III PAH, endothelin receptor antagonists (APE) or the combination of APE with prostaglandins was the least expensive treatment strategy and gave the largest average QALYs. At the same time, the obtained research results are the basis for the development of differential financing of PAH therapy for patients with different FCs. It should be noted that the study conducted by us is the first in Ukraine and can be the basis for further studies, strengthened by additional information and direct measurement of the impact of specific treatment on the quality of life of patients with the help of specially developed Ukrainian questionnaires, which can be used to estimate the increase in the QALY indicator during treatment, which will give a better idea about the effectiveness of these treatment methods

Scientific substantiation of the concept of pharmacoeconomic analysis of technologies for early diagnosis and pharmacotherapy of pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a rare, progressive disorder characterized by high blood pressure (hypertension) in the arteries of the lungs (pulmonary artery) for no apparent reason. Because symptoms are nonspecific and physical signs may be subtle, the disease is often diagnosed at late stages. Over the past few decades, significant progress has been made in the field of pulmonary arterial hypertension. Technological progress allows to diagnose the disease in the early stages, as well as to better assess the severity of the disease. Today, screening studies are becoming increasingly important to establish a clinical diagnosis and minimize lost opportunities without timely diagnosis, especially in patients with idiopathic PAH. Therefore, the issue of early diagnosis of patients with suspected PAH and confirmation of the diagnosis is a very important and urgent issue today. The objective of the paper: to study the methods of implementation of technologies for early diagnosis and pharmacotherapy of pulmonary arterial hypertension and conceptual presentation of the results of their implementation. The work used available scientific sources of information on the results of the implementation of diagnostic screening for early detection of PAH and pharmacotherapy in the world. The analysis of input data was carried out using systematic, documentary, informational and graphical research methods. The result of the analysis of information materials showed that over the past two decades, significant progress has been made in the treatment of PAH and more than doubled the survival rate of patients. It has been found that diagnostic screening is a relatively unique medical technology in relation to other medical interventions and can be defined as the systematic use of diagnostic technologies in individuals at risk to detect the disease before the onset of symptoms. The study proposes a systematic concept of economic evaluation of the diagnostic screening program for PAH to determine its optimal design. At the same time, this concept embodies the complex effect of the introduction of technologies for early diagnosis and pharmacotherapy of PAH, which is expressed in the positive dynamics of clinical indicators, reduced mortality and improved quality of life. It should be noted that a number of new tools and approaches for diagnostic screening give hope that advances in the diagnosis of PAH will also affect the effectiveness of medical care

Clinical characteristics of patients hospitalized to the Ukrainian expert-consultative center of pulmonary hypertension for adults

Pulmonary arterial hypertension (PAH) is a group of rare, malignant diseases that, without optimal treatment, quickly lead to death (the average survival of patients in the absence of specific therapy is 2.8 years from diagnosis). This nosology is most often diagnosed at an earlier age and mainly in female patients. The global trend indicates a predominance of PAH in women over men in 2–4 times greater. The objective of the paper to study the condition of inpatients to determine the strategy of medical care and identify ways to improve the pharmaceutical supply of patients with pulmonary arterial hypertension. The object of the study were the results of a retrospective analysis of medical records of inpatients 93 patients hospitalized at the Ukrainian Expert-Consultative Center for Pulmonary Hypertension for Adults, established on the basis of NSC «Strazhesko Institute of Cardiology of the National Academy of Medical Sciences of Ukraine». Analytical, documentary, informational, graphic and retrospective research methods were used during the research. According to the results of a retrospective analysis of 93 medical records of inpatients who were registered and treated at the Ukrainian Expert Advisory Center for Adults for the period from 2018 to 2021, it was found that almost all patients with PAH have heart problems and other concomitant pathological conditions. The period of inpatient treatment consisted of maintenance therapy with diuretics (spironolactone, furosemide, triphas, torside, torasemide), anticoagulants (warfarin), cardiac glycosides (digoxin) and iron supplements (maltoferfol) and specific therapies using calcium channel blockers (amlodipine), prostacyclin analogues (ventavis), endothelin receptor antagonists (bosentan) and phosphodiesterase type 5 inhibitors (sildenafil, no-lag). Patients with PAH were hospitalized for 2 days to 31 days, the average number of bed-days was 8.75 days per 1 patient. Thus, the results of the study of the clinical characteristics of patients hospitalized at the Ukrainian Expert Advisory Center of Pulmonary Hypertension for Adults, indicate the need to determine the technology of specific therapy of PAH with pharmacoeconomic analysis

Complex prophylaxis of postoperative complications in colorectal surgery

Objective. To improve the immediate results of surgical treatment of colorectal cancer, using more effective prophylaxis of morbidity. Маterials and methods. The treatment efficacy of the Program of complex prophylaxis of postoperative complications in colorectal surgery, elaborated in the Clinic was studied up, using comparative analysis of the morbidity, occurred in 1253 patients, radically operated for cancer recti. In 2005 - 2010 yrs, when some elements of the elaborated Program have begun introduced into clinical practice, 361 patients were operated on (Group I). In 2011 - 2017 yrs, when the Program for prophylaxis of postoperative complications was applied in full volume, 892 patients, presenting the main group (Group II) were operated on. Results. Сomparative analysis of the elaborated program for complex prophylaxis of postoperative complications and of the «fast track» concept have shown several essential differences between them. Introduction of the Program elaborated into clinical practice have improved the immediate results of surgical treatment of cancer recti due to essential lowering of rate of different morbidities from 14.9 tо 9.2% and mortality - from 3.0 tо 1.8%. Conclusion. The Program for complex prophylaxis of postoperative complications in colorectal surgery, elaborated in the Clinic, guarantees the results improvement while surgical treatment of cancer recti and may be recommended for wide clinical application

Organization of pharmaceutical provision of patients with pulmonary hypertension on the example of Kyiv

In Ukraine, pharmaceutical provision of patients with pulmonary hypertension (PH) as a rare (orphan) disease is one of the important components of the State policy. Despite the permanent reform of the medical and pharmaceutical sector, a significant number of problems in the formation of a balanced system for providing the necessary medicinal products (MP) to orphan patients have not yet been resolved. The purpose of the study is to study the process of pharmaceutical provision of patients with PH, using the example of Kyiv. Information on MP purchases for patients in Kyiv, included in the Unified Clinical Protocol for Emergency, Primary, Secondary (Specialized) Medical Care Pulmonary Hypertension in Adults for the State and local budgets for 2018–2021, has been chosen as the object of the study. We have used system-review, documentary, and marketing research methods. The result of the analysis of the annual need for 2018–2021 in INN, necessary for the pharmaceutical provision of Kyiv patients with PH, has shown that the annual decrease in funding compared to 2018, namely: in 2019– by 17.54%, in 2020– by 32.52%, in 2021 – by 50.08%, due to a decrease in the cost of INN Sildenafil (Sildenafilum) by an average of 89.21% annually, compared with the cost in 2018. At the same time, the state of providing MP for patients with PH in Kyiv for the period 2018–2021 indicates that the total need for them was met at the expense of the State Budget of Ukraine and the budget of Kyiv for the implementation of the City Target Program «Health of Kievans» in 2018 – by 81.46%, and in 2019 – by 91.67% of the need. The supply of MP ordered for 2020 for the treatment of PH at the expense of the State Budget took place only at the end of 2021. Only Iloprost (Iloprostum) of the six supplies of INN ordered was completed, which accounted for 82.27% of the declared need. In 2021, only Sildenafil (Sildenafilum) was purchased at the expense of the State Budget of Ukraine, which is 8% of the need to provide treatment for patients with PH in the city of Kyiv. The City Target Program «Health of Kievans» for 2021 does not provide for expenses in the «Pulmonary Hypertension» direction. Thus, the results of a study of the organization of pharmaceutical support for Kyiv residents with PH indicate that there are no financial guarantees for the provision of free medical care to patients with rare (orphan) diseases

Immunohistochemical Profile of Mucins and their Expression in Precancerous Changes of the Stomach

The aim of this study was to assess the profile of mucins (MUC1, MUC2, MUC5AC) in the intestinal metaplasia (IM) of the gastric mucosa through the immunohistochemical method. Methods: To identify the metaplastic areas in the gastric mucosa, chromoendoscopy was employed using 0.5% solution of methylene blue. The expression of the profile of the mucins was determined using immunohistochemistry with MUC1, MUC5AC, and MUC2 antibodies (clone Ma695, clone CLH2, Ccp58 and CLH5, "Novocastra "Great Britain). Results: In the regions adjacent to the adenocarcinoma and neoplastic modified cells, a visible weak expression of MUC2 and MUC5AC was observed. In the case of complete IM, a visibly maximum MUC2 expression was observed in the goblet cells; thus, the MUC5AC, MUC1, and MUC6 marking were absent in the columnar epitheliocytes with the brush border. In the case of incomplete IM, along with the positive MUC2 markings of the goblet cells, the presence of gastric mucin (MUC5AC) has been observed in 25% of such patients with chronic atrophic gastritis (CAG) having incomplete IM; however, in the columnar epitheliocytes the characteristic occurrence of gastric mucin (MUC5AC) was observed in 100% of the patients while a small amount of MUC2 was recorded in 15% of patients. Conclusion: The MUC5AC expression of the gastric mucins in the columnar epithelial cells and the goblet exocrinocytes marks the formation of the gastrointestinal phenotype viz., incomplete intestinal metaplasia, along with the simultaneous production of the MUC2 by the goblet cells. The decrease with further loss of the protective MUC5AC production by the columnar epithelial cells and goblet exocrinocytes that were found in the regions of severe dysplasia and IM, adjacent to the neoplastic altered cells, may serve as additional criteria of early malignancy of the gastric mucosa

Results of the geological-geomorphological processes research in the easy prize for 2008-2010

UA: Багаторічні дослідження динаміки геолого-геоморфологічних процесів Приазов’я (Західного, Північного та Східного) надали можливість підтвердити результати наукових робіт попередніх дослідників, проаналізувати геологічну будову, стратиграфію, тектоніку Східного Приазов’я, придбати нові дані про прояви та розвиток геолого-геоморфологічних процесів у регіоні. Польові роботи проводилися співробітниками кафедри фізичної географії і геології МДПУ ім. Б. Хмельницького у складі експедиції Приазовської комплексної геологічної партії (м. Волноваха) казенного підприємства «Південукргеологія». EN: The long-term studies of the dynamics of the geo- geomorphological processes of the Azov Sea (Western, Northern and Eastern) provided an opportunity to confirm the results of previous works by scientific researchers, to analyze geological structure, stratigraphy, tectonics of the Eastern Azov Sea, to acquire new data on the manifestations and development of geological and geomorphological processes in the region

Features of holiday practice from geography of soil in the conditions of Girsk and step Crimea

En: Field soil surveys occupy an important place in the system of training geography teachers. The skills and experience gained in this practice are used by senior students, as well as for further work in general education schools. In conducting field practice, the focus is on the methodology of field research: the proper choice of the location of the soil and geographic profile and soil cuts, the description of the soil morphological properties, as well as methods for studying the soil cover, including ground mapping issues

Features of holiday practice from geography of soil in the conditions of girsk and step Сrimea

UK: Стан грунтів пов’язан з різноманіттям навколишнього середовища та впливом анторопогенного фактору, чим обумовлюється виділення категорій придатності грунтів для використання у землеробстві. EN: Field soil surveys occupy an important place in the system of training geography teachers. The skills and experience gained in this practice are used by senior students, as well as for further work in general education schools. In conducting field practice, the focus is on the methodology of field research: the proper choice of the location of the soil and geographic profile and soil cuts, the description of the soil morphological properties, as well as methods for studying the soil cover, including ground mapping issues

Place of excursions and approaches in study of useful couples in a school course of geography

Роль екскурсій та походів школярів у вивченні свого краю особливо підвищується в теперішній час, коли питання раціонального використання природних ресурсів та охорони довкілля набувають першочергового значення. Оволодіння основами раціонального природокористування стають необхідними для кожного громадянина незалежної України