6 research outputs found
Cost-effectiveness analysis of pembrolizumab versus targeted therapies in advanced melanoma
Background. The modern therapies of advanced melanoma include targeted medicines for patients with BRAF mutations. Nowadays, a new perspective on immuno-oncologic medicine pembolizumab became available in Russia. Objective. Assessment of the clinical and economic effectiveness of the use of pembolizumab in the treatment of unrespectable and metastatic melanoma in comparison with targeted medicines in the context of Russian public health. Materials and methods. The Markov model was developed, including the states Β«without progressionΒ», Β«after progressionΒ» and Β«deathΒ», the duration of one Markov cycle is 1 month, the modeling time horizon is 5 years. The probabilities of transitions between states were described using mathematical formulas obtained as a result of digitization and approximation of Kaplan-Mayer survival curves, which were derived from randomized clinical trials KEYNOTE-006, COMBI-v and COMBI-d. Direct medical costs (including drug costs, treatment of adverse events, second-line therapy after disease progression, and palliative care) were analyzed. We did not take into account the costs associated with laboratory-diagnostic procedures and visits to the doctor. The sources of information were: weighted average prices of medicines indicated during public procurement for 2016 (the price of the drug pembolizumab provided by the manufacturer), a program of state guarantees for providing free medical care to Russian citizens for 2016, federal coefficients of relative costs for clinical and statistical groups. The effectiveness criterion for cost-effectiveness analysis was the average number of saved months of a patientβs life. Results. The average number of months saved was 30, 23, 24 and 30 months with pembolizumab, vemurafenib, dabrafenib and dabrafenib plus tramethanib, respectively (calculated using the developed model). Thus, pembolizumab has the same effectiveness as a combination of dabrafenib + tramethanib and is more effective than monotherapy with targeted drugs (dabrafenib or vemurafenib). Direct medical costs per patient over 5 years were approximately 4.06, 5.53, 5.91 and 15.72 million rubles when using pembolizumab, dabrafenib, vemurafenib and a combination of dabrafenib + trametinib, respectively. The health budget saving with pembolizumab instead of dabrafenib, vemurafenib and dabrafenib + trametinib combination may be 26%, 31% and 74%, respectively. Conclusion. Pembolizumab is a rational and economically justified choice for the treatment of unresectable and metastatic melanoma since it leads to cost savings when overall survival is increased
ΠΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ Π΄Π»Ρ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠ²Π½ΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ Π»Π΅Π³ΠΊΠΈΡ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΌΠΎΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠ΅ΠΉ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠΌ ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄
In accordance with currently accepted recommendations for the diagnosis and treatment of chronic obstructive pulmonary disease (COPD), both monotherapy with long-acting anticholinergics (LAAC) or combined therapy (LAAC / long-acting beta-agonists, LABA) can be used. To justify a rational choice between these two medications, we used the methodology of clinical/economic analysis.Objective: to assess possible financial and clinical/economic consequences of replacing monotherapy based on LAAC (tiotropium bromide) by the fixed combination of LAAC / LABA (vilantererol / umeclidinum bromide) in patients with severe and extremely severe COPD.Materials and methods. The target population included patients with severe and extremely severe COPD (FEV1 <50%, CAT β₯10, mMRC β₯2, with severe symptoms). QALY (quality-adjusted life-year) was used as the main criterion of effectiveness. Direct medical costs of drug therapy, and the costs of management of adverse events and/or COPD exacerbations were calculated. The costs of these two therapeutic regimens were calculated from the registered data on the maximum selling prices of VED drugs or from the prices expected if/when the given drugs are registered in the VED list (+ VAT + weighted average wholesale premium). Other direct medical costs were calculated in accordance with the Federal program of free medical care, as well as the cost-effectiveness factors recommended by the FFOMS. The obtained values of savings in direct medical costs and the cost-effectiveness ratio (CER) were evaluated for their sensitivity to changes in basic prices of the compared medications.Results. The use of vilantererol / umeclidinum bromide resulted in improved lung function (an increase in FEV1 by 120% on the 169th day, 0.205 vs 0.093), improved quality of life and reduced symptoms, as well as a 63%-lower need for urgent drugs as compared to the tiotropium bromide monotherapy. The quality of life was 0.752 and 0.732 QALY in the group of vilantererol / umeclidinum bromide and tiotropium bromide, respectively. The direct medical costs in these two groups amounted to 32,753 rubles and 37,641 rubles, respectively. Thus, the savings of using the combined medication reached 4,888 rubles, which is 13% less than that with the mono-component drug. If the current practice of treating COPD with tiotropium bromide is replaced by the combined vilantererol / umeclidinum therapy, the total budget savings can reach more than 327 million rubles.Conclusion. The use of vilantererol/umeclidinum for the treatment of severe and extremely severe COPD is strongly preferred over tiotropium bromide, as it leads to significantly better clinical outcomes and provides savings for the health care budget.Β Π ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠΈ Ρ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠΌΠΈ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΡΠΌΠΈ ΠΏΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠ²Π½ΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ Π»Π΅Π³ΠΊΠΈΡ
(Π₯ΠΠΠ) Π² ΡΡΠ΄Π΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΈΡΡΠ°ΡΠΈΠΉ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½Π° ΠΊΠ°ΠΊ ΠΌΠΎΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ Π΄Π΅ΠΉΡΡΠ²ΡΡΡΠΈΠΌΠΈ Π°Π½ΡΠΈΡ
ΠΎΠ»ΠΈΠ½Π΅ΡΠ³ΠΈΠΊΠ°ΠΌΠΈ (ΠΠΠΠ₯), ΡΠ°ΠΊ ΠΈ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΡ ΠΠΠΠ₯ Ρ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ Π΄Π΅ΠΉΡΡΠ²ΡΡΡΠΈΠΌΠΈ Π±Π΅ΡΠ°-Π°Π³ΠΎΠ½ΠΈΡΡΠ°ΠΌΠΈ (ΠΠΠΠ). ΠΠ»Ρ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π²ΡΠ±ΠΎΡΠ° ΠΌΠ΅ΠΆΠ΄Ρ Π½ΠΈΠΌΠΈ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½Π° ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ»ΠΎΠ³ΠΈΡ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π° (ΠΠΠ).Π¦Π΅Π»Ρ β ΠΎΡΠ΅Π½ΠΊΠ° Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΡΡ
ΡΠΈΠ½Π°Π½ΡΠΎΠ²ΡΡ
ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠΎΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠΉ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΡΠΌ Π₯ΠΠΠ Ρ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΌΠΈ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΠΌΠΈ ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ ΠΠΠΠ + ΠΠΠΠ₯ (Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄) Π²ΠΌΠ΅ΡΡΠΎ ΠΌΠΎΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠΠΠ₯ ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ΠΎΠΌ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π¦Π΅Π»Π΅Π²Π°Ρ ΠΏΠΎΠΏΡΠ»ΡΡΠΈΡ β ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Ρ Π₯ΠΠΠ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ (ΠΠ€Π1 <50%; Π‘ΠΠ’ β₯10 Π±Π°Π»Π»ΠΎΠ²; mMRC β₯2; Ρ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΌΠΈ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΠΌΠΈ). Π ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΊΡΠΈΡΠ΅ΡΠΈΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ QALY (ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠ΅ Π³ΠΎΠ΄Ρ ΠΆΠΈΠ·Π½ΠΈ). ΠΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΠΏΡΡΠΌΡΠ΅ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΠ΅ Π·Π°ΡΡΠ°ΡΡ Π½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡ ΡΡΠ°Π²Π½ΠΈΠ²Π°Π΅ΠΌΡΠΌΠΈ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΠΌΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ (ΠΠ), Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π½Π΅ΠΆΠ΅Π»Π°ΡΠ΅Π»ΡΠ½ΡΡ
ΡΠ²Π»Π΅Π½ΠΈΠΉ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ Π₯ΠΠΠ. Π‘ΡΠΎΠΈΠΌΠΎΡΡΡ ΠΠ ΡΠ°ΡΡΡΠΈΡΡΠ²Π°Π»ΠΈ ΠΈΡΡ
ΠΎΠ΄Ρ ΠΈΠ· Π΄Π°Π½Π½ΡΡ
ΡΠ΅Π΅ΡΡΡΠ° ΠΏΡΠ΅Π΄Π΅Π»ΡΠ½ΡΡ
ΠΎΡΠΏΡΡΠΊΠ½ΡΡ
ΡΠ΅Π½ ΠΠΠΠΠ ΠΈΠ»ΠΈ ΠΎΡΠ½ΠΎΠ²ΡΠ²Π°ΡΡΡ Π½Π° ΠΎΠΆΠΈΠ΄Π°Π΅ΠΌΠΎΠΉ ΡΠ΅Π½Π΅ ΠΏΡΠΈ ΡΠ΅Π³ΠΈΡΡΡΠ°ΡΠΈΠΈ ΡΠ΅Π½Ρ ΠΠΠΠΠ (+ ΠΠΠ‘ + ΡΡΠ΅Π΄Π½Π΅Π²Π·Π²Π΅ΡΠ΅Π½Π½Π°Ρ ΠΎΠΏΡΠΎΠ²Π°Ρ Π½Π°Π΄Π±Π°Π²ΠΊΠ°). ΠΡΡΠ³ΠΈΠ΅ ΠΏΡΡΠΌΡΠ΅ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΠ΅ Π·Π°ΡΡΠ°ΡΡ ΡΠ°ΡΡΡΠΈΡΡΠ²Π°Π»ΠΈ Π² ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠΈ Ρ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠΎΠΉ Π³ΠΎΡΡΠ΄Π°ΡΡΡΠ²Π΅Π½Π½ΡΡ
Π³Π°ΡΠ°Π½ΡΠΈΠΉ ΠΎΠΊΠ°Π·Π°Π½ΠΈΡ Π±Π΅ΡΠΏΠ»Π°ΡΠ½ΠΎΠΉ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΊΠΎΡΡΡΠΈΡΠΈΠ΅Π½ΡΠΎΠ² Π·Π°ΡΡΠ°ΡΠΎΠ΅ΠΌΠΊΠΎΡΡΠΈ, ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΠ΅ΠΌΡΡ
Π€Π€ΠΠΠ‘. ΠΠΎΠ»ΡΡΠ΅Π½Π½ΡΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΠΈ ΠΏΡΡΠΌΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
Π·Π°ΡΡΠ°Ρ ΠΈ ΡΠΎΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΡ Β«Π·Π°ΡΡΠ°ΡΡ-ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΒ» (CER) ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ Π½Π° ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΊ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΈΡΡ
ΠΎΠ΄Π½ΡΡ
Π΄Π°Π½Π½ΡΡ
ΠΎ ΡΠ΅Π½Π°Ρ
ΡΡΠ°Π²Π½ΠΈΠ²Π°Π΅ΠΌΡΡ
ΠΠ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΠ» ΠΊ ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ ΡΡΠ½ΠΊΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ
(ΠΠ€Π1 Π½Π° 169-ΠΉ Π΄Π΅Π½Ρ Π½Π° 120% Π²ΡΡΠ΅; 0,205 ΠΏΡΠΎΡΠΈΠ² 0,093), ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΆΠΈΠ·Π½ΠΈ ΠΈ ΡΠΌΠ΅Π½ΡΡΠ΅Π½ΠΈΡ ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ², ΡΠΎΠΊΡΠ°ΡΠ΅Π½ΠΈΡ ΠΏΠΎΡΡΠ΅Π±Π½ΠΎΡΡΠΈ Π² ΡΠΊΠΎΡΠΎΠΏΠΎΠΌΠΎΡΠ½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°Ρ
Π½Π° 63% ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΠ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ. ΠΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΆΠΈΠ·Π½ΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ 0,752 ΠΈ 0,732 QALY Π² Π³ΡΡΠΏΠΏΠ΅ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΠΈ ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. Π‘ΡΠΌΠΌΠ° ΠΏΡΡΠΌΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
Π·Π°ΡΡΠ°Ρ Π² Π³ΡΡΠΏΠΏΠ°Ρ
Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΠΈ ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 32 753 ΡΡΠ±. ΠΈ 37 641 ΡΡΠ±. ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. Π’Π°ΠΊΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ, ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡ ΠΏΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 4 888 ΡΡΠ±., ΠΏΡΠΈ Π΅Π³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ ΡΡΠΌΠΌΠ° Π·Π°ΡΡΠ°Ρ ΡΠΎΠΊΡΠ°ΡΠ°Π΅ΡΡΡ Π½Π° 13%. ΠΡΠΈ Π·Π°ΠΌΠ΅Π½Π΅ ΡΠ΅ΠΊΡΡΠ΅ΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ Π₯ΠΠΠ Ρ ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ΠΎΠΌ Π½Π° ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΡ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡ Π±ΡΠ΄ΠΆΠ΅ΡΠ° ΠΌΠΎΠΆΠ΅Ρ Π΄ΠΎΡΡΠΈΠ³Π½ΡΡΡ Π±ΠΎΠ»Π΅Π΅ 327 ΠΌΠ»Π½ ΡΡΠ±.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΠ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ Π΄Π»Ρ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π₯ΠΠΠ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ Π²ΠΌΠ΅ΡΡΠΎ ΠΠ ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΡΠΎΠ³ΠΎ ΠΏΡΠ΅Π΄ΠΏΠΎΡΡΠΈΡΠ΅Π»ΡΠ½ΡΠΌ, ΡΠ°ΠΊ ΠΊΠ°ΠΊ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈ-Π·Π½Π°ΡΠΈΠΌΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΈ ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΡΠ΅Ρ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΠΈ Π±ΡΠ΄ΠΆΠ΅ΡΠ° ΡΠΈΡΡΠ΅ΠΌΡ Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ.
ΠΠΈΠ½ΠΈΠΌΠΈΠ·Π°ΡΠΈΡ ΡΡΠΎΠΈΠΌΠΎΡΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΠΈ ΠΎΠ»ΠΎΠ΄Π°ΡΠ΅ΡΠΎΠ» + ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ Π΄Π»Ρ Π±Π°Π·ΠΎΠ²ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΈΠ²Π°ΡΡΠ΅ΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠ²Π½ΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ Π»Π΅Π³ΠΊΠΈΡ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ
The recently introduced novel drug combinations for the treatment of COPD are based on long-acting beta-agonists (vilantererol / umeclidinum bromide) and long-acting anticholinergics (olodaterol / tiotropium bromide). In addition to their beneficial clinical effects, these medications have an impact on COPD treatment costs. Minimizing the costs of highly effective medications is necessary to improve the public medical care and drug supply.Objective: to identify the key differences between vilantererol / umeclidinum bromide and olodaterol / tiotropium bromide, and evaluate the ways of minimizing health budget expenditures.Materials and methods. We used the available information from research, clinical trials, and instructions for medical use to conduct a cost analysis that was based on the prices for these medications at different levels of drug supply. As a result, the impact on the healthcare budget was determined under conditions of choosing the least expansive medication and adding vilantererol / umeclidinum bromide in the list of VED.Results. According to the network meta-analysis, when compared with mono-component drugs, vilantererol / umeclidinum bromide showed a more favorable effect on cardiovascular events, as well as a more pronounced effect on the volume of forced exhalation in the first second (FEV1). For the olodaterol / tiotropium bromide combination, no such trend was seen. The costs of 12-month therapy with vilantererol / umeclidinum bromide and with olodaterol / tiotropium bromide were 27,541 and 36,120 rubles, respectively (a difference of 24%). The average direct medical costs were 32,753 and 41,333 rubles per patient per year, respectively. If the vilantererol / umeclidinum bromide combination is added to the VED list and the manufacturerβs maximum selling price is registered at the level of the reference countries, the savings can reach 3-5%.Conclusion. In patients with severe and extremely severe COPD, and also when COPD monotherapy in patients without severe symptoms (FEV1 β₯50%, CAT <10 scores, mMRC <2) or with mild to moderate symptoms (FEV1 β₯50%) is not effective, the use of vilantererol / umeclidinum bromide in place of olodaterol / tiotropium bromide is more promising in terms of minimizing health budget spending.Β Π ΠΏΡΠ°ΠΊΡΠΈΠΊΡ Π²ΠΎΡΠ»ΠΈ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΡΠ΅ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ (ΠΠ) Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠ²Π½ΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ Π»Π΅Π³ΠΊΠΈΡ
(Π₯ΠΠΠ) Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ Π΄Π΅ΠΉΡΡΠ²ΡΡΡΠΈΡ
Π±Π΅ΡΠ° Π°Π³ΠΎΠ½ΠΈΡΡΠΎΠ² (ΠΠΠΠ) ΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ Π΄Π΅ΠΉΡΡΠ²ΡΡΡΠΈΡ
Π°Π½ΡΠΈΡ
ΠΎΠ»ΠΈΠ½Π΅ΡΠ³ΠΈΠΊΠΎΠ² (ΠΠΠΠ₯): Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΠΈ ΠΎΠ»ΠΎΠ΄Π°ΡΠ΅ΡΠΎΠ» + ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄. ΠΡ
ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² Π₯ΠΠΠ, Π½ΠΎ ΡΠ°ΠΊΠΆΠ΅ ΠΎΠΊΠ°Π·ΡΠ²Π°Π΅Ρ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π½Π° Π±ΡΠ΄ΠΆΠ΅Ρ. ΠΠΈΠ½ΠΈΠΌΠΈΠ·Π°ΡΠΈΡ ΡΡΠΎΠΈΠΌΠΎΡΡΠΈ Π²ΡΡΠΎΠΊΠΎΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΡ
ΠΠ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ ΡΠΎΠ²Π΅ΡΡΠ΅Π½ΡΡΠ²ΠΎΠ²Π°Π½ΠΈΡ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½ΠΈΡ.Π¦Π΅Π»Ρ β ΠΎΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ ΠΊΠ»ΡΡΠ΅Π²ΡΠ΅ ΡΠ°Π·Π»ΠΈΡΠΈΡ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΠ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΠΈ ΠΎΠ»ΠΎΠ΄Π°ΡΠ΅ΡΠΎΠ» + ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄, Π° ΡΠ°ΠΊΠΆΠ΅ Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ ΠΈ ΠΎΠΆΠΈΠ΄Π°Π΅ΠΌΡΠ΅ ΠΎΠ±ΡΠ΅ΠΌΡ ΠΌΠΈΠ½ΠΈΠΌΠΈΠ·Π°ΡΠΈΠΈ Π·Π°ΡΡΠ°Ρ Π±ΡΠ΄ΠΆΠ΅ΡΠ° Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ°ΡΡΠ½ΡΠΉ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠΎΠ½Π½ΡΠΉ ΠΏΠΎΠΈΡΠΊ ΠΈ Π°Π½Π°Π»ΠΈΠ· ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΡΠ²Π΅Π΄Π΅Π½ΠΈΠΉ ΠΈΠ· ΠΈΠ½ΡΡΡΡΠΊΡΠΈΠΉ ΠΏΠΎ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΌΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ, Π°Π½Π°Π»ΠΈΠ· ΡΡΠΎΠΈΠΌΠΎΡΡΠΈ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠΈ ΠΎ ΡΠ΅Π½Π°Ρ
ΠΠ Π½Π° ΡΠ°Π·Π½ΡΡ
ΡΡΠΎΠ²Π½ΡΡ
Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½ΠΈΡ. ΠΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ ΡΠ°Π·ΠΌΠ΅Ρ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΠΈ Π±ΡΠ΄ΠΆΠ΅ΡΠ° ΡΠΈΡΡΠ΅ΠΌΡ Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ ΠΏΡΠΈ Π²ΡΠ±ΠΎΡΠ΅ Π½Π°ΠΈΠΌΠ΅Π½Π΅Π΅ Π·Π°ΡΡΠ°ΡΠ½ΠΎΠ³ΠΎ ΠΠ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΡΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΠΈ ΠΠ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ Π² ΠΏΠ΅ΡΠ΅ΡΠ΅Π½Ρ ΠΠΠΠΠ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΎ Π΄Π°Π½Π½ΡΠΌ ΡΠ΅ΡΠ΅Π²ΠΎΠ³ΠΎ ΠΌΠ΅ΡΠ°-Π°Π½Π°Π»ΠΈΠ·Π° ΠΏΡΠΈ ΡΡΠ°Π²Π½Π΅Π½ΠΈΠΈ Ρ ΠΌΠΎΠ½ΠΎΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠ½ΡΠΌΠΈ ΠΠ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ»Π° + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΠΈΠΌΠ΅Π»ΠΎ ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ ΠΊ Π±ΠΎΠ»Π΅Π΅ Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠΌΡ ΠΏΡΠΎΡΠΈΠ»Ρ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΡΡ
ΡΠΎΠ±ΡΡΠΈΠΉ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΊ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΠΌΡ Π²Π»ΠΈΡΠ½ΠΈΡ Π½Π° ΠΎΠ±ΡΠ΅ΠΌ ΡΠΎΡΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π²ΡΠ΄ΠΎΡ
Π° Π² ΠΏΠ΅ΡΠ²ΡΡ ΡΠ΅ΠΊΡΠ½Π΄Ρ (ΠΠ€Π1); Π΄Π»Ρ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ ΠΎΠ»ΠΎΠ΄Π°ΡΠ΅ΡΠΎΠ» + ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΡΠ°ΠΊΠΎΠΉ ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΠΈ Π²ΡΡΠ²Π»Π΅Π½ΠΎ Π½Π΅ Π±ΡΠ»ΠΎ. Π‘ΡΠΎΠΈΠΌΠΎΡΡΡ Π³ΠΎΠ΄ΠΎΠ²ΠΎΠ³ΠΎ ΠΊΡΡΡΠ° ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠ ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ + Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» ΠΈ ΠΠ ΠΎΠ»ΠΎΠ΄Π°ΡΠ΅ΡΠΎΠ» + ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 27541 ΠΈ 36120 ΡΡΠ±. ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ (ΡΠ°Π·Π½ΠΈΡΠ° Π² 24%). Π‘ΡΠΌΠΌΠ° ΠΏΡΡΠΌΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
Π·Π°ΡΡΠ°Ρ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 32753 ΠΈ 41333 ΡΡΠ±. Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ Π½Π° ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π² Π³ΠΎΠ΄ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄Π° + Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» ΠΈΠ»ΠΈ ΠΎΠ»ΠΎΠ΄Π°ΡΠ΅ΡΠΎΠ» + ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄Π° ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. ΠΡΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΠΈ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ Π² ΠΏΠ΅ΡΠ΅ΡΠ΅Π½Ρ ΠΠΠΠΠ ΠΈ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠ΅ΠΉ ΡΠ΅Π³ΠΈΡΡΡΠ°ΡΠΈΠΈ ΠΏΡΠ΅Π΄Π΅Π»ΡΠ½ΠΎΠΉ ΠΎΡΠΏΡΡΠΊΠ½ΠΎΠΉ ΡΠ΅Π½Ρ ΠΏΡΠΎΠΈΠ·Π²ΠΎΠ΄ΠΈΡΠ΅Π»Ρ ΠΈΠΌΠΏΠΎΡΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° Π½Π° ΡΡΠΎΠ²Π½Π΅ ΡΠ΅ΡΠ΅ΡΠ΅Π½ΡΠ½ΡΡ
ΡΡΡΠ°Π½ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡ ΠΌΠΎΠΆΠ΅Ρ ΡΠΎΡΡΠ°Π²ΠΈΡΡ 3-5%.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π Π³ΡΡΠΏΠΏΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π₯ΠΠΠ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΊΠΎΠ³Π΄Π° ΠΌΠΎΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ Π₯ΠΠΠ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±Π΅Π· Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΡ
ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² (ΠΠ€Π1 β₯50%; Π‘ΠΠ’ <10 Π±Π°Π»Π»ΠΎΠ²; mMRC <2) ΠΈ/ΠΈΠ»ΠΈ Ρ Π»Π΅Π³ΠΊΠΈΠΌ ΠΈ ΡΡΠ΅Π΄Π½Π΅ΡΡΠΆΠ΅Π»ΡΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ (ΠΠ€Π1 β₯50%) Π½Π΅ ΡΠ²Π»ΡΠ΅ΡΡΡ Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠΉ, ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΠ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠΌΠ΅ΠΊΠ»ΠΈΠ΄ΠΈΠ½ΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ Π²ΠΌΠ΅ΡΡΠΎ ΠΠ ΠΎΠ»ΠΎΠ΄Π°ΡΠΎΡΠΎΠ» + ΡΠΈΠΎΡΡΠΎΠΏΠΈΡ Π±ΡΠΎΠΌΠΈΠ΄ ΡΠ²Π»ΡΠ΅ΡΡΡ Π±ΠΎΠ»Π΅Π΅ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ ΠΌΠΈΠ½ΠΈΠΌΠΈΠ·Π°ΡΠΈΠΈ Π·Π°ΡΡΠ°Ρ Π±ΡΠ΄ΠΆΠ΅ΡΠ° Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ.
Π‘ΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΌΠΈΠ½ΠΈΠΌΠΈΠ·Π°ΡΠΈΠΈ Π·Π°ΡΡΠ°Ρ ΠΈ Π²Π»ΠΈΡΠ½ΠΈΡ Π½Π° Π±ΡΠ΄ΠΆΠ΅Ρ ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΉ ΠΈΠ½Π³Π°Π»ΡΡΠΈΠΎΠ½Π½ΡΡ Π³Π»ΡΠΊΠΎΠΊΠΎΡΡΠΈΠΊΠΎΡΡΠ΅ΡΠΎΠΈΠ΄ΠΎΠ² ΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ Π΄Π΅ΠΉΡΡΠ²ΡΡΡΠΈΡ Π±Π΅ΡΠ°-Π°Π³ΠΎΠ½ΠΈΡΡΠΎΠ² Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ Π°ΡΡΠΌΡ
Comparative pharmacoeconomic analysis of fixed-dose combinations (FDC) vilanterol / fluticasone furoate vs budesonide / formoterol was needed to identify the preferable FDC for asthma management.Study objective: to identify the preferable FDC of inhaled corticosteroid/ longacting beta agonist combinations (ICS/LABA) for the treatment of moderate or severe asthma in Russia. Materials andMethods. Retrospective comparative pharmacoeconomic study; cost-minimization analysis and budget-impact analysis.Results. The present analysis shows that the 12-month direct medical costs for the treatment of asthma using vilanterol / fluticasone furoate and budesonide / formoterol are 29,276 and 40,447 RUR per patient, respectively. The direct costs of treatment with vilanterol / fluticasone furoate are less than those for budesonide / formoterol by 28%. The annual health budget savings that result from replacing budesonide / formoterol by vilanterol / fluticasone furoate are 1,151,512,731 RUR per 100,000 patients.Conclusion. The present results indicate that the vilanterol / fluticasone furoate FDC is preferable (more beneficial) as compared with the budesonide / formoterol FDC.Β ΠΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈΠ½ΡΠ΅ΡΠ΅Ρ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΡΠ°Π²Π½Π΅Π½ΠΈΠ΅ ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΉ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠ»ΡΡΠΈΠΊΠ°Π·ΠΎΠ½Π° ΡΡΡΠΎΠ°Ρ ΠΈ Π±ΡΠ΄Π΅ΡΠΎΠ½ΠΈΠ΄ + ΡΠΎΡΠΌΠΎΡΠ΅ΡΠΎΠ» Π΄Π»Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΠΏΡΠ΅Π΄ΠΏΠΎΡΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Ρ ΡΠ΅Π»ΡΡ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ Π±ΡΠΎΠ½Ρ
ΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π°ΡΡΠΌΡ Ρ ΠΏΠΎΠ·ΠΈΡΠΈΠΈ ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠΊΠΎΠ½ΠΎΠΌΠΈΠΊΠΈ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ, ΠΊΠ°ΠΊΠ°Ρ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΡ ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΈΠ½Π³Π°Π»ΡΡΠΈΠΎΠ½Π½ΡΡ
ΠΊΠΎΡΡΠΈΠΊΠΎΡΡΠ΅ΡΠΎΠΈΠ΄ΠΎΠ² ΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ Π΄Π΅ΠΉΡΡΠ²ΡΡΡΠΈΡ
Π±Π΅ΡΠ°-Π°Π³ΠΎΠ½ΠΈΡΡΠΎΠ² Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ Π°ΡΡΠΌΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π² Π ΠΎΡΡΠΈΠΈ Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ Π±ΡΠΎΠ½Ρ
ΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π°ΡΡΠΌΡ ΡΡΠ΅Π΄Π½Π΅ΠΉ ΠΈΠ»ΠΈ ΡΡΠΆΠ΅Π»ΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΏΠ΅ΡΡΠΈΡΡΠΈΡΡΡΡΠ΅Π³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π Π΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΡΠ°ΡΠΌΠ°ΠΊΠΎΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅, Π°Π½Π°Π»ΠΈΠ· ΠΌΠΈΠ½ΠΈΠΌΠΈΠ·Π°ΡΠΈΠΈ Π·Π°ΡΡΠ°Ρ ΠΈ Π°Π½Π°Π»ΠΈΠ· Π²Π»ΠΈΡΠ½ΠΈΡ Π½Π° Π±ΡΠ΄ΠΆΠ΅Ρ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘ΡΠΌΠΌΠ° ΠΏΡΡΠΌΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
Π·Π°ΡΡΠ°Ρ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΉ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠ»ΡΡΠΈΠΊΠ°Π·ΠΎΠ½Π° ΡΡΡΠΎΠ°Ρ ΠΈ Π±ΡΠ΄Π΅ΡΠΎΠ½ΠΈΠ΄ + ΡΠΎΡΠΌΠΎΡΠ΅ΡΠΎΠ» Π½Π° ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π² Π³ΠΎΠ΄ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 29 276 ΠΈ 40 447 ΡΡΠ±., ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠ»ΡΡΠΈΠΊΠ°Π·ΠΎΠ½Π° ΡΡΡΠΎΠ°Ρ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ ΡΡΠΌΠΌΡ ΠΏΡΡΠΌΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
Π·Π°ΡΡΠ°Ρ Π½Π° 28% ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠΌ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ. ΠΡΠΈ Π·Π°ΠΌΠ΅Π½Π΅ ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Π±ΡΠ΄Π΅ΡΠΎΠ½ΠΈΠ΄ + ΡΠΎΡΠΌΠΎΡΠ΅ΡΠΎΠ» Π½Π° Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠ»ΡΡΠΈΠΊΠ°Π·ΠΎΠ½Π° ΡΡΡΠΎΠ°Ρ Ρ 100 000 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π±ΡΠΎΠ½Ρ
ΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π°ΡΡΠΌΠΎΠΉ Π² Π Π€ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡ Π±ΡΠ΄ΠΆΠ΅ΡΠ° Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ ΡΠΎΡΡΠ°Π²ΠΈΡ ΠΏΡΠΈΠΌΠ΅ΡΠ½ΠΎ 1 151 512 731 ΡΡΠ±.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ Π½Π°ΡΠ΅Π³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π° ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΈ, ΡΡΠΎ ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΡ Π²ΠΈΠ»Π°Π½ΡΠ΅ΡΠΎΠ» + ΡΠ»ΡΡΠΈΠΊΠ°Π·ΠΎΠ½Π° ΡΡΡΠΎΠ°Ρ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠ΅Π΄ΠΏΠΎΡΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ (ΡΡΡΠΎΠ³ΠΎ Π΄ΠΎΠΌΠΈΠ½ΠΈΡΡΠ΅Ρ) ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠ΅ΠΉ Π±ΡΠ΄Π΅ΡΠΎΠ½ΠΈΠ΄ + ΡΠΎΡΠΌΠΎΡΠ΅ΡΠΎΠ».
COST-EFFECTIVENESS OF VILANEROL / UMECLIDINIUM VERSUS TIOTROPIUM IN SEVERE AND VERY SEVERE COPD
In accordance with currently accepted recommendations for the diagnosis and treatment of chronic obstructive pulmonary disease (COPD), both monotherapy with long-acting anticholinergics (LAAC) or combined therapy (LAAC / long-acting beta-agonists, LABA) can be used. To justify a rational choice between these two medications, we used the methodology of clinical/economic analysis.Objective: to assess possible financial and clinical/economic consequences of replacing monotherapy based on LAAC (tiotropium bromide) by the fixed combination of LAAC / LABA (vilantererol / umeclidinum bromide) in patients with severe and extremely severe COPD.Materials and methods. The target population included patients with severe and extremely severe COPD (FEV1 <50%, CAT β₯10, mMRC β₯2, with severe symptoms). QALY (quality-adjusted life-year) was used as the main criterion of effectiveness. Direct medical costs of drug therapy, and the costs of management of adverse events and/or COPD exacerbations were calculated. The costs of these two therapeutic regimens were calculated from the registered data on the maximum selling prices of VED drugs or from the prices expected if/when the given drugs are registered in the VED list (+ VAT + weighted average wholesale premium). Other direct medical costs were calculated in accordance with the Federal program of free medical care, as well as the cost-effectiveness factors recommended by the FFOMS. The obtained values of savings in direct medical costs and the cost-effectiveness ratio (CER) were evaluated for their sensitivity to changes in basic prices of the compared medications.Results. The use of vilantererol / umeclidinum bromide resulted in improved lung function (an increase in FEV1 by 120% on the 169th day, 0.205 vs 0.093), improved quality of life and reduced symptoms, as well as a 63%-lower need for urgent drugs as compared to the tiotropium bromide monotherapy. The quality of life was 0.752 and 0.732 QALY in the group of vilantererol / umeclidinum bromide and tiotropium bromide, respectively. The direct medical costs in these two groups amounted to 32,753 rubles and 37,641 rubles, respectively. Thus, the savings of using the combined medication reached 4,888 rubles, which is 13% less than that with the mono-component drug. If the current practice of treating COPD with tiotropium bromide is replaced by the combined vilantererol / umeclidinum therapy, the total budget savings can reach more than 327 million rubles.Conclusion. The use of vilantererol/umeclidinum for the treatment of severe and extremely severe COPD is strongly preferred over tiotropium bromide, as it leads to significantly better clinical outcomes and provides savings for the health care budget
COST-MINIMIZATION OF VILANTEROL / UMECLIDINIUM VERSUS OLODATEROL / TIOTROPIUM IN THE BASIC THERAPY OF SEVERE AND VERY SEVERE COPD
The recently introduced novel drug combinations for the treatment of COPD are based on long-acting beta-agonists (vilantererol / umeclidinum bromide) and long-acting anticholinergics (olodaterol / tiotropium bromide). In addition to their beneficial clinical effects, these medications have an impact on COPD treatment costs. Minimizing the costs of highly effective medications is necessary to improve the public medical care and drug supply.Objective: to identify the key differences between vilantererol / umeclidinum bromide and olodaterol / tiotropium bromide, and evaluate the ways of minimizing health budget expenditures.Materials and methods. We used the available information from research, clinical trials, and instructions for medical use to conduct a cost analysis that was based on the prices for these medications at different levels of drug supply. As a result, the impact on the healthcare budget was determined under conditions of choosing the least expansive medication and adding vilantererol / umeclidinum bromide in the list of VED.Results. According to the network meta-analysis, when compared with mono-component drugs, vilantererol / umeclidinum bromide showed a more favorable effect on cardiovascular events, as well as a more pronounced effect on the volume of forced exhalation in the first second (FEV1). For the olodaterol / tiotropium bromide combination, no such trend was seen. The costs of 12-month therapy with vilantererol / umeclidinum bromide and with olodaterol / tiotropium bromide were 27,541 and 36,120 rubles, respectively (a difference of 24%). The average direct medical costs were 32,753 and 41,333 rubles per patient per year, respectively. If the vilantererol / umeclidinum bromide combination is added to the VED list and the manufacturerβs maximum selling price is registered at the level of the reference countries, the savings can reach 3-5%.Conclusion. In patients with severe and extremely severe COPD, and also when COPD monotherapy in patients without severe symptoms (FEV1 β₯50%, CAT <10 scores, mMRC <2) or with mild to moderate symptoms (FEV1 β₯50%) is not effective, the use of vilantererol / umeclidinum bromide in place of olodaterol / tiotropium bromide is more promising in terms of minimizing health budget spending