The economic prognosis of the new analog of insulin glargine usage in diabetes mellitus type 2

Modelling has been performed for evaluation of economic perspectives of new insulin glargine 300 IU/ml usage for diabetes mellitus type 2 (DM2) control based on literature analysis of non-direct comparison with insulin detemir. Evaluation of the reimbursement’s reasonability for insulin glargine 300 IU/ml in clinical practice was the aim of this analysis. Utility cost of insulin glargine 300 IU/ml is higher than insulin detemir for 1 IU on 25,2% (according to Governmental Reestr of maximal manufacturers’ prices). Meanwhile efficacy of insulin glargine on control of DM2 is higher than insulin detemir (61,7% and 42,5% accordingly, Odds Ratio 2,18, 95%CI 1,41-3,34; p=0,01). Besides that, insulin glargine had less amount of hypoglycemic events, less necessity for out-patients visits and hospitalizations. Calculated “cost-effective ratio” (CER), which has included annual insulins’ cost, potential expenditures for severe hypo treatment, cost of medical aid for out-patients and in-patients has been more preferable for insulin glargine (CER for insulin glargine 46 252,40 RUR, for insulin detemir 76 681,01 RUR). Conclusion: Modelling has confirmed the economic rationality of insulin glargine 300 IU/ml usage for effective DM2 control in governmental reimbursement system because budget expenditures will not increase (expert’s conclusion). Prospective comparable trials in the future are important for economic evaluation

Basal insulin analogues in the diabetes mellitus type 2 control — economic aspects

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

Cost-minimization analysis of application acetylsalicylic acid in cardiac elderly patients

Objective: To conduct a comparative pharmacoeconomic analysis of Cardiomagnyl and Trombo ACC during antiplatelet therapy of cardiac patients. Methodology: Clinical studies have demonstrated equal efficacy of drugs containing acetylsalicylic acid so this analysis model is a «cost-minimization» and consists of a single line therapy, providing short-term economic evaluation (12 months therapy). Results: Antiplatelet therapy with Cardiomagnyl in cardiac elderly patients reduce the cost of the annual rate of pharmacotherapy for 220 rubles in the calculation of per patient compared with therapy Trombo ACC by reducing the cost of correction the side effects. Expenses for correction of side effects when using Cardiomagnyl less on 737 rubles per patient than with Thrombo ACC

Pharmacoeconomic evaluation of pramipexole extended release monotherapy in early Parkinson’s disease

Objective. Health economic expertise of pramipexole extended release monotherapy at early stages of Parkinson’s disease. Methods. An economic model was developed based on clinical studies to derive comparative information on the effectiveness, utility and direct medical costs of antiparkinsonian treatment strategies over a year period. Cost-effectiveness, cost-utility and budget impact of comparative therapies were assessed. Results. Mirapex® extended release (ER) has the lowest cost-effectiveness ratio (31 499 rub. per a patient a year responded to antiparkinsonian therapy) and the lowest cost-utility ratio (2 562 rub. for decrease of degree of abnormalities of daily activities and motive abnormalities per a point of UPDRS scale). Budget impact analysis demonstrated that pramipexole ER monotherapy resulted in cost saving of 6 499 rub. (20 %) compared to Pronoran®, 26 918 rub. (51%) compared to Requip Modutab® and 24 966 rub. (49%) compared to Azilect® per a year of therapy. Mirapex® ER was the dominant strategy demonstrating higher effectiveness at lower costs in Parkinson’s disease treatment

Cost minimization analysis of using «Ethanol wipes «МК Aseptic»»

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»»

Pharmacoeconomic analysis of perampanel for resistance partial epilepsy

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

Pharmacoeconomic analysis of adjuvant use of zonisamide therapy resistant partial epilepsy in adults

The purpose of pharmacoeconomic studies of the drug zonisamide is to determine it’s clinical and cost-effectiveness in adult patients with refractory partial epilepsy in comparison with other new antiepileptic drugs in the conditions of the Russian Federation. Target population are Russian patients older than 18 years with the diagnosis of the resistant partial epilepsy with secondary generalization or without it. Results of pharmacoeconomic modeling analysis application zonisamide and topiramate therapy in partial epilepsy for 2 years under the Russian healthcare system on one patient showed that all the above drugs were effective in the treatment of refractory partial epilepsy in their nomination in addition to other antiepileptic drugs. Comparing the efficacy, expressed in the probability of therapeutic response ≥50% after 2 years of treatment, topiramate at — 0.227, zonisamide — 0.194. The cost of the use of drugs is higher in comparison topiramate — 115 082 rubles, zonisamide — 97 342 rubles. Cost-effectiveness ratio (CER) was the lowest in zonisamide — 501 070 rubles, topiramate — 507 762 rubles. QALY at zonisamide — 1,189, topiramate — 1,191. Cost-utility ratio (CUR) was the lowest in zonisamide — 81 886 rubles, topiramate — 96 609 rubles. For all drugs increased doses resulted in an increase of efficiency of treatment, as well as the frequency of adverse events and associated with them, cessation of therapy. With increasing doses up to the maximum performance CER and CUR will be at least topiramate. None of the compared drugs does not exceed the threshold of «willingness to pay ratio», i.e. they are all pharmacoeconomical and be reimbursement. Th e budget impact analysis showed that the overall cost of the therapy will be higher in the group of topiramate is 15.4%, compared with zonisamide. Pharmacoeconomic analysis confirmed the data on effi cacy and safety, and also showed the place of comparators in the cost of treatment of patients with partial epilepsy

Pharmacoeconomic analysis of Movalis in patients with osteoarthritis and rheumatoid arthritis

Objective: To conduct a comparative cost minimization analysis (CMA) of Movalis with other non-steroidal antiinflammatory drugs (NSAIDs) such as diclofenac, nimesulide, celecoxib and etoricoxib. Methodology: Was conducted search of publications from 1990 to 2014, devoted to randomized controlled clinical trials, a network meta-analysis and systematic reviews (level of evidence: AI) use of NSAIDs in patients with osteoarthritis (OA) and rheumatoid arthritis (RA). The model evaluates economical effectiveness of drugs and the comparison is based on the results of the randomized controlled clinical trials (RCCT), network meta-analyzes and systematic reviews. Since the data RCCT, network meta-analyzes and systematic reviews have shown equal efficacy of NSAIDs, model is a particular drug and CMA consists of one line therapy, providing short-term economic evaluation and impact on the health of patients with OA and RA. Results: The results of used of NSAIDs CMA and treatment of complications in patients with OA and RA showed that the total cost of the Movalis (meloxicam) is lower than another drugs: Voltaren (diclofenac), Nimesil (nimesulide), Celebrex (celecoxib) and Arcoxia (etoricoxib). Costs saving for one patient is favor for Movalis in comparison with the Voltaren was 465 rubles (-8.55%), Celebrex - 1.255 rubles (-23.09%), Arcoxia - 1.274 rubles (-23.43%) for a 1 month of therapy. Sub-analysis of the Movalis compared with the Nimesil (nimesulide) for 15 days of therapy showed that the cost savings per patient is favor for meloxicam will be 1.504 rubles (-117.74%). Sensitivity analysis confirmed these findings: an increase in drug prices Movalis by 25% and reducing the price of the reference drugs by 25%, minimizing the cost figures do not go beyond the parameters of the Movalis that demonstrates the stability of the obtained data in the study

Comparative evaluation of economic effi ciency of modern inhaled anesthetics

The purpose of presented retrospective analysis was to identify retrospectively and estimate the economic benefits that can occur when comparing the costs of using desflurane or sevoflurane for anesthesia during surgery. Formalization and evaluation were carried out in accordance with the industry standard “Health technology assessment”, approved and signed into law June 14, 2014 by Order of the Federal Agency for Technical Regulation and Metrology of the Russian Federation GOST №568-art and ISPOR recommendations, and meet the requirements of statistical significance, allowing to develop recommendation conclusions on the use of each product in any given situation. Pharmacoeconomic evaluation is based on data from official registration licenses and patient information leaflets, randomized controlled clinical trials data and information on value, pricing and costs obtained from the public independent sources. In accordance with the objectives, indications and limitations on the use of these drugs for anesthesia, the target population of this study were patients of diff erent ages, who required the use of inhalation anesthesia during the ongoing surgical procedures: patients with physiological status not higher than Class I (ASA I) on the scale of the American Association of Anesthesiologists. Compared medical technologies were III generation inhalation analgesics Sevorane and Suprane. Th ere was conducted a cost-effectiveness analysis of the inhalation anesthetics, during which cost of achieving the minimum alveolar concentration (MAC) using compared inhaled anesthetic drugs was estimated. The analysis showed that the difference in favor of desflurane is 155.72 rub for a four-hour operation. The most significant influence on the direct medical costs associated with the use of inhalation anesthesia was shown by the cost of inhalation anesthetic (gas) per 1 ml, the concentration of the gas, the flow rate of fresh gas, duration of anesthesia. Sensitivity analysis confirmed the data obtained. In the current situation of the retrospective evaluation the assumed shift from sevoflurane to desflurane in 1 000 patients aged 12 to 60 years that require inhalation anesthesia, will be accompanied by cost savings of 102,907 rub to 155,720 rub, and with the use of induction of anesthesia with propofol up to 162 900 rub. Whereas during anesthesia in newborns and patients older than 60 years shift of desflurane to sevoflurane in 1 000 patients will reduce the cost by 266,354 rub and 225,672 rub respectively. Therefore the economic benefit from the use of a single inhalation anesthetic both as an induction drug and as a drug anesthetic drug has not been proved clinically and from an economic point of view that may require individual assessment of costs on the basis of regions of the Russian Federation or a particular institution