Individualized prophylactic treatment of patients with hemophilia A to improve effectiveness and optimize product consumption on the example of octocog alpha and rurioctocog alpha pegol. A systematic literature review

Objective: to review the data on the efficacy and consumption of octocog alfa and rurioctoctog alfa pegol in standard prophylaxis and individualized prophylaxis in hemophilia A patients based on published international data. Material and methods: a systematic literature search and review were performed. Among 25 sources identified within the systematic search 7 relevant sources describing the comparison of treatment with octocog alfa and rurioctocog alfa pegol in adult and pediatric patients with severe and moderate hemophilia A based on personalized assessment of the pharmacokinetic curve using the interactive tool myPKFit versus the standard (non-personalized) dosage regimen were selected. Data on individual patients, as well as data from secondary subgroups defined by age, bleeding rate, risk of bleeding associated with the daily physical activity were combined and analyzed. Results. In observational studies, adjustments of the dose and administration of octocog alfa in patients with severe hemophilia based on personalized assessment of the pharmacokinetic curve using myPKFit resulted in the reduced consumption and/or increased efficacy of prophylaxis — a reduced annual bleeding rate. In an extended controlled study of rurioctocog alpha pegol a trend toward reduced bleeding rate and increased mean annual consumption of the drug was reported in patients who received myPKFit guided prophylaxis compared to a non-personalized treatment regimen. In the single-cut studies, myPKFiT use resulted in the regimen revisions in less than a quarter of patients. Summary. Personalized dosing for octocog alpha and rurioctocog alpha pegol based on pharmacokinetic curve built using pharmacokinetic population model enables reasonable dose adjustments and improves outcomes

Primerjava toksičnosti etanola in acetaldehida za podganje astrocite v primarni kulturi

This study compared the effects of toxicity of ethanol and its first metabolite acetaldehyde in rat astrocytes through cell viability and cell proliferation. The cells were treated with different concentrations of ethanol in the presence or absence of a catalase inhibitor 2-amino-1,2,4 triazole (AMT) or with different concentrations of acetaldehyde. Cell viability was assessed using the trypan blue test. Cell proliferation was assessed after 24 hours and after seven days of exposure to either ethanol or acetaldehyde. We showed that both ethanol and acetaldehyde decreased cell viability in a dose-dependent manner. In proliferation studies, after seven days of exposure to either ethanol or acetaldehyde, we observed a significant dose-dependent decrease in cell number. The protein content study showed biphasic dose-response curves, after 24 hours and seven days of exposure to either ethanol or acetaldehyde. Co-incubation in the presence of AMT significantly reduced the inhibitory effect of ethanol on cell proliferation. We concluded that long-term exposure of astrocytes to ethanol is more toxic than acute exposure. Acetaldehyde is a much more potent toxin than ethanol, and at least a part of ethanol toxicity is due to ethanol’s first metabolite acetaldehyde.V študiji smo primerjali toksičnost etanola in njegovega prvega metabolita acetaldehida za podganje astrocite z določitvijo celične viabilnosti in proliferacije. Celične kulture smo tretirali z različnimi koncentracijami etanola, etanola v prisotnosti inhibitorja katalaze 2-amino-1,2,4 triazol-a (AMT) ali z različnimi koncentracijami acetaldehida. Celično viabilnost smo vrednotili s pomočjo testa s tripanskim modrilom, celično proliferacijo pa s štetjem celic in določitvijo koncentracije proteinov po 24-urni, kot tudi 7-dnevni izpostavljenosti. S študijo smo pokazali, da tako etanol kot tudi acetaldehid v odvisnosti od njune koncentracije zmanjšata celično viabilnost. V študiji proliferacije sta etanol in acetaldehid, v odvisnosti od njunih koncentracij, značilno zmanjšala število celic po 7-dnevni izpostavljenosti. Pri ugotavljanju vsebnosti proteinov smo dobili bifazno krivuljo tako po 24-urni, kot tudi po 7-dnevni izpostavljenosti različnim koncentracijam etanola oziroma acetaldehida. Prisotnost AMT je signifi kantno zmanjšala učinek etanola na celično proliferacijo. Zaključimo lahko, da je dolgotrajna izpostavljenost astrocitov etanolu bolj toksična kot akutna. Acetaldehid je močnejši toksin kot etanol in vsaj del toksičnosti etanola je posledica delovanja njegovega prvega metabolita, acetaldehida

Сравнительный фармакоэкономический анализ иммуноонкологических лекарственных препаратов при метастатическом уротелиальном раке

Objective: to determine the economic and clinical consequences of using atezolizumab in metastatic urothelial cancer compared with pembrolizumab and nivolumab.Materials and methods. An assessment of the effectiveness and safety of medicines for urothelial cancer was carried out on the basis of a systematic search and review of clinical studies and an analysis of direct medical costs for medicines from public procurement in Moscow in 2019-2020 and information from official instructions for medical use.Results. Systematic search identifies 4, 4 and 7 clinical trials of nivolumab, pembrolizumab and atezolizumab, respectively, as well as 2 meta-analyses. The obtained data on the efficacy and safety did not allow us to identify greater or lesser effective options. Calculation of cost of three months therapy revealed that the cost of atezolizumab (935 thousand rubles) is 7 % lower vs. pembrolizumab (1 million rubles) and 18 % lower vs. nivolumab (1,136 million rubles). Thus, when using atezolizumab instead of pembrolizumab or atezolizumab, budget savings may occur, or allowing additional therapy to be provided to every 14th or every 6th patient, respectively within fixed budget.Conclusion. The use of atezolizumab in metastatic urothelial cancer led to budget savings or the possibility of additional treatment coverage with immuno-oncological therapy.Цель исследования - определить экономические и клинические последствия использования атезолизумаба при метастатическом уротелиальном раке по сравнению с пембролизумабом и ниволумабом.Материалы и методы. Проведены оценка эффективности и безопасности лекарственных препаратов при уротелиальном раке на основании систематического поиска и обзора клинических исследований и анализ прямых медицинских затрат на лекарственные средства в соответствии с данными о ценах на них в рамках государственных закупок в г. Москве в 2019-2020 гг. и информацией о режимах использования лекарственных препаратов из официальных инструкций по медицинскому применению.Результаты. В результате систематического поиска было отобрано 4, 4 и 7 клинических исследований эффективности ниволумаба, пембролизумаба и атезолизумаба соответственно, а также 2 метаанализа. Полученные сведения об эффективности и безопасности рассматриваемых лекарственных препаратов не позволили выделить лекарственные препараты с большим или меньшим влиянием на выживаемость. В результате расчета стоимости курса терапии (в расчете на 3 мес) выявлено, что стоимость терапии атезолизумабом (935 тыс. руб.) на 7 % ниже по сравнению со стоимостью терапии пембролизумабом (1 млн руб.) и на 18 % ниже по сравнению со стоимостью терапии ниволумабом (1,136 млн руб.). Таким образом, при применении атезолизумаба вместо пембролизумаба или ниво-лумаба может возникнуть экономия затрат бюджета, позволяющая обеспечить дополнительно терапией каждого 14-го или каждого 6-го пациента соответственно при условии фиксированного бюджета.Заключение. Применение атезолизумаба при метастатическом уротелиальном раке приводит к экономии затрат бюджета или к возможности дополнительно пролечить больных с использованием иммуноонкологической терапии

Ocrelizumab in treatment of primary-progressive multiple sclerosis: systematic review

Aim. To analyze the efficacy, safety and pharmacoeconomic indicators of ocrelizumab in adult patients with primary progressive multiple sclerosis (PPMS). Methods. An information search was conducted in the databases Embase, PubMed, Cochrane and eLibrary.ru. The levels of evidence were determined in the studies. Results. Therapy with ocrelizumab compared with placebo characterized by a decrease in the rate of progression of the disease. Treatment with ocrelizumab was associated with a significant slowdown in progression compared to other drugs: rituximab, fingolimod, myelin basic protein peptide 82–98, intravenous immunoglobulin; plasmapheresis / plasma metabolism, corticosteroids, general irradiation of lymphoid tissue, and other most common adverse events: infusion reactions, nasopharyngitis, upper tract respiratory and urinary tract infections, headaches. Life years and quality-adjusted life years for patients receiving ocrelizumab were 16.11 and 3.33, compared with 15.61 and 2.75 for patients receiving better supportive care, respectively. The annual average potential impact on the budget for 1 patient with PPMS in the treatment of ocrelizumab for 5 years ranged from $ 18,300 to 44 200. Conclusions. Ocrelizumab is the only drug that has proven its clinical efficacy in the previously non-curable type of multiple sclerosis, PPC, with risk profile acceptable with respect to clinical benefits

Antioxidant activity and hepatoprotective potential of agaro-oligosaccharides in vitro and in vivo

BACKGROUND: Agaro-oligosaccharides derived from red seaweed polysaccharide have been reported to possess antioxidant activity. In order to assess the live protective effects of agar-oligosaccharides, we did both in vitro and in vivo studies based on own-made agaro-oligosaccharides, and the structural information of this oligosaccharide was also determined. METHOD: Structure of agaro-oligosaccharides prepared with acid hydrolysis on agar was confirmed by matrix-assisted ultraviolet laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS) and NMR. The antioxidant effect of agaro-oligosaccharides on intracellular reactive oxygen species (ROS) was assessed by 2', 7'-dichlorofluorescin diacetate. Carbon tetrachloride was used to induce liver injury, some index including SOD, GSH-Px, MDA, AST, ALT were examined to determine the hepatoprotective effect of agaro-oligosaccharides. RESULTS: Agaro-oligosaccharides we got were composed of odd polymerizations with molecular weights ranged from 500 to 2500. Results from intracellular test indicated that agaro-oligosaccharides could significantly scavenge the level of oxidants in the hepatocytes, more beneficially, also associated with the improvement of cell viability In vivo studies of the antioxidant effects on tissue peroxidative damage induced by carbon tetrachloride in rat model indicated that agaro-oligosaccharides could elevate the activity of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and decrease the level of malondialdehyde (MDA), glutamate oxaloacetate transaminase (AST), glutamic pyruvic transaminase (ALT) significantly. At 400 mg/kg, MDA level reduced 44 % and 21 % in liver and heart, SOD and GSH-Px increased to highest in liver and serum, while ALT level decreased 22.16 % in serum. CONCLUSION: Overall, the results of the present study indicate that agaro-oligosaccharides can exert their in vitro and in vivo hepatoprotective effect through scavenging oxidative damage induced by ROS

ТАРГЕТНЫЙ ПРЕПАРАТ БРЕНТУКСИМАБ ВЕДОТИН ДЛЯ ЛЕЧЕНИЯ РЕЦИДИВИРУЮЩЕЙ ИЛИ РЕФРАКТЕРНОЙ CD30-ПОЛОЖИТЕЛЬНОЙ ЛИМФОМЫ ХОДЖКИНА

Objective. To perform literature review of clinical trials reporting on the use of single-agent brentuximab vedotin (BV) 1.8 mg/kg therapy in adult patients with relapsed/refractory (R/R) CD30-positive Hodgkin lymphoma (HL).Methods. A literature search was performed in Pubmed and eLIBRARY. RU databases to identify all studies published from 1 July 2007 until 1 July 2017. We used the key words “brentuximab vedotin” and “Hodgkin lymphoma” simultaneously. The inclusion criteria required that study population included ≥ 20 adult patients with R/R HL. We included clinical trials, systematic reviews, meta-analysis, pharmacoeconomic studies: total 25 publications met inclusion criteria. Publications were grouped by 3 BV indications in instruction for use: adult patient with relapsed/refractory CD30-positive Hodgkin lymphoma post-autologous stem cell transplantation (postASCT), adult patient with refractory CD30-positive HL after failure of at least 2 prior multiagent chemotherapy regimens in patients who are not candidates for ASCT, adult patient with classical HL at high risk of relapse or progression post-ASCT.Results. Overall response rate (ORR) and complete rate (CR) were 75% and 34% respectively in adult patients with R/R CD30-positive HL post-ASCT in SGN35–0003 study. In patients with refractory HL after failure of at least 2 prior multiagent chemotherapy regimens who are not candidates for auto-SCT ORR and CR were 40% and 30% respectively. In mixed population ORR were 56-80%, CR – 10-46.5%. In patients with CD30-positive Hodgkin lymphoma at increased risk of relapse or progression following ASCT ORR was not evaluated, median progression-free survival was improved in patients in BV group compared with those in placebo group (42.9 and 24.1 months respectively). Overall survival in both group was similar. In patients with R/R CD30-positive HL the incremental cost-effectiveness ratio per quality-adjusted life year (ICER/QALY) was 6.7 million rub. и 3 million rub. from a Russian and a Scottish healthcare payer respectively. ICER/QALY when BV compared with best supportive care was 9.79 million rubles. In patients who were at risk for HL repapse after ASCT if BV consolidation compared with active surveillance ICER/QALY was 8.86 million rub.Conclusion. As a result of the literature review, it was found that the response rate, the complete response to BV therapy, and the overall survival and progression-free survival with use of BV in different patient populations differ; in most cases, the result of effectiveness favors BV. The found safety data indicated a good tolerability of the drug. The results of the found pharmacoeconomic studies differ depending on the comparison therapy and the accepted pharmacoeconomic indicator.Цель исследования. Обзор основных опубликованных за последние 10 лет клинических исследований эффективности брентуксимаба ведотина (БВ) в рекомендуемой дозе 1,8 мг/кг у взрослых пациентов с рецидивирующей или рефрактерной (р/р) СD30-положительной лимфомой Ходжкина (ЛХ).Материалы и методы. Поиск литературы был проведен в базах данных Pubmed и eLIBRARY.RU с временным фильтром (2007–2017 гг.) по ключевым словам «брентуксимаб ведотин» (brentuximab vedotin), «лимфома Ходжкина» (Hodgkin lymphoma) одновременно. Были включены рандомизированные и нерандомизированные клинические исследования (КИ), систематические обзоры и мета-анализы и фармакоэкономические исследования, в которых было ≥ 20 взрослых пациентов с р/р ЛХ, получавших БВ в дозе 1,8 мг/кг. Данные из 25 отобранных публикаций были сгруппированы в соответствии с тремя популяциями пациентов с ЛХ из инструкции по применению препарата.Результаты. В исследовании SGN35–0003 у пациентов с р/р ЛХ после аутологичной трансплантации гемопоэтических стволовых клеток (аутоТГСК) частота ответа и полного ответа составили 75% и 34% соответственно. В другом исследовании у пациентов с рефрактерной ЛХ после как минимум двух линий предшествующей терапии, когда аутоТГСК или комбинированная терапия не рассматривается как вариант лечения, частота ответа и полного ответа составила 40% и 30% соответственно. В исследовании смешанной популяции пациентов частота ответа составила от 56 до 80%, а частота полного ответа – от 10 до 46,5%. В исследовании AETHERA у пациентов с повышенным риском рецидива после аутоТГСК частота ответа не оценивалась, медиана выживаемости без прогрессии (ВБП) составила 42,9 мес. и 24,1 мес. в группе БВ и плацебо соответственно. Выживаемость в группе БВ и плацебо оказалась схожей. В двух найденных фармакоэкономических исследованиях было обнаружено, что для пациентов с р/р ЛХ после аутоТГСК показатель приращения эффективности затрат за дополнительный год жизни с поправкой на качество (ICER/QALY) для БВ по сравнению ХТ±ЛТ составил 6,7 млн рублей и 3 млн рублей с точки зрения российского и шотландского плательщика соответственно. Показатель ICER/LY для БВ – ниже по сравнению с ХТ±ЛТ+аллоТСК на 0,6 млн руб. для российского плательщика. В другом исследовании ICER/QALY при сравнении терапии БВ с поддерживающей терапией составил 9,79 млн руб. В четвертой публикации у пациентов с риском рецидива после аутоТГСК было проведено сравнение консолидационной терапии БВ и активного наблюдения, ICER/QALY составил 8,86 млн руб.Выводы. В итоге проведенного литературного обзора обнаружено, что частота ответа, полного ответа на терапию БВ, а также общая выживаемость и выживаемость без прогрессии при применении БВ у разных популяций пациентов отличаются; в большинстве случаев отмечен результат эффективности в пользу БВ. В найденных данных по безопасности отмечена хорошая переносимость препарата. Результаты найденных фармакоэкономических исследований отличаются в зависимости от терапии сравнения и принятого фармакоэкономического показателя

Моноклональное антитело окрелизумаб для терапии рассеянного склероза у взрослых пациентов: систематический обзор

Aim: To analyze the efficacy, safety and pharmacoeconomic aspects of using ocrelizumab in adult patients with relapsing/remitting multiple sclerosis (R/R MS).Materials and Methods. We used the commonly accepted PICo(S) questionnaire with the following specifics: the population – patients with R/R MS; the intervention – ocrelizumab; the comparators – all disease-modifying treatments for MS; the outcomes – the annualized relapse rate, confirmed disability progression, MRI results, quality-adjusted years of survival (QALYs), adverse events, and other clinical outcomes. The search for the relevant information was conducted in 2018 by using the embase, PubMed, Cochrane and eLibrary.ru databases and the «ocrelizumab» AND «multiple sclerosis» keywords. The levels of evidence and conclusiveness of the cited studies were also assessed.Results. Treatments with ocrelizumab resulted in a lower rate of disease progression as compared with interferon β -1a. As evidenced by a randomized clinical trial, the annualized relapse rate estimated after 96 weeks was lower with ocrelizumab than that with interferon β-1a (0.16 vs. 0.29, 47% decrease, p<0.001). For most secondary end points, patients on ocrelizumab showed better outcomes than those on interferon β-1a. In the ocrelizumab group, the most common adverse events were caused by reactions to the drug infusion, nasopharyngitis, upper respiratory and urinary tract infections, and headaches. No cases of progressive multifocal leukoencephalopathy have been reported so far. ocrelizumab is more clinically effective than the first-line disease-modifying therapies; this conclusion also refers to patients with the aggressive (highly active) form of MS. ocrelizumab showed the efficacy similar to the second-line disease-modifying therapies, but it had a more favorable safety profile. The pharmacoeconomic indices showed that using ocrelizumab had a positive impact on the budget in the long-term perspective.Conclusions. ocrelizumab can be considered as the main treatment alternative for patients with highly active MS and patients with a high risk of progressive multifocal leukoencephalopathy. However, an additional assessment of the risk caused by rare adverse events is needed. Цель. Проведение сравнительного анализа эффективности, безопасности и клинико-экономических показателей препарата окрелизумаб (Окревус®) в терапии рецидивирующих форм рассеянного склероза (РРС) у взрослых пациентов.Материалы и методы. Определены критерии PICo(S): популяция – больные с РРС; интервенция – окрелизумаб; компараторы – все препараты, изменяющие течение РС (ПИТРС); результаты – среднегодовая частота обострений, степень прогрессирования инвалидизации, результаты МРТ, годы жизни с поправкой на качество (QALYs), нежелательные явления (НЯ) и другие клинические результаты; вид исследований – все прямые и непрямые сравнения интервенции с одним или несколькими компараторами. Информационный поиск проведен в 2018 г. в базах данных embase, PubMed, Cochrane, eLibrary.ru по ключевым словам «ocrelizumab» и «multiple sclerosis». Оценен уровень доказательности и убедительности результатов отобранных публикаций.Результаты. Терапия окрелизумабом характеризовалась более низкими показателями активности и прогрессирования заболевания, чем терапия интерфероном β-1a: годовая частота обострений на неделе 96 значительно ниже в группе окрелизумаба, чем в группе интерферона β-1a в РКИ (0,16 против 0,29, снижение на 47%; р<0,001). Окрелизумаб эффективнее, чем интерферон β-1a по большинству вторичных конечных точек. Наиболее частые НЯ у пациентов, получавших окрелизумаб: инфузионные реакции, инфекции, в частности назофарингит, инфекции мочевыводящих и верхних дыхательных путей, головная боль. Случаев прогрессирующей мультифокальной лейкоэнцефалопатии (ПМЛ) не отмечено. Окрелизумаб превосходит по клинической эффективности ПИТРС первой линии терапии, в том числе в популяции взрослых пациентов с агрессивной (высокоактивной) формой течения РС. В сравнении с ПИТРС второй линии окрелизумаб имеет сходную эффективность, но более благоприятный профиль безопасности. Клинико-экономические показатели свидетельствуют о значительной пользе окрелизумаба и положительном влиянии на бюджет в долгосрочной перспективе.Выводы. Окрелизумаб может рассматриваться в качестве главной альтернативы для терапии пациентов с высокоактивным РС и имеющим высокий риск развития ПМЛ, однако требуется дополнительная оценка для изучения риска развития редких НЯ.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ СТОИМОСТИ ЛЕКАРСТВЕННОЙ ТЕРАПИИ САМЫХ ВЫСОКОЗАТРАТНЫХ ОНКОЛОГИЧЕСКИХ ЗАБОЛЕВАНИЙ В ГОРОДЕ МОСКВЕ

Objectives. According to literature and experts, prostate cancer (PC), breast cancer (BC), colon cancer (CC), melanoma (MEL) and renal cell carcinoma (RCC) are the most high-cost oncological diseases. The aim of our study was to calculate the charges for each of these nosologies from the point of view of Moscow’s budget and compare them with each other.Methods. To assess the annual costs of drug therapy in Moscow in patients with PC, BC, CC, MEL and RCC there has been developed an analytical model in MS Excel software, considering the data of Cancer Register, as well as literature sources.Results. There has been estimated that if the costs of drug therapy for all five of assessed types of cancer are taken as 100 %, then the most costly is BC (41 % of costs), then MEL (20 %), RCC (15 %), CC (13 %) and PC (12 %). There has been also calculated, that if the number of patients with all five types of assessed cancer undergoing drug therapy, we would consider as 100 %, the highest percentage of them is in BC (50 % of all patients), then PC (36 %), CC (9 %), MEL (3 %) and RCC (1 %).Conclusions. The structure of drug therapy costs in patients with PC, BC, MEL, CC and RCC in Moscow shows that the most expensive is the treatment of patients with melanoma (for 3 % of patients Moscow City Health Department spends 20 % of charges) and RCC (1 % of patients spends 15 % of charges).Введение. По данным литературы и оценкам экспертов, рак предстательной железы (РПЖ), рак молочной железы (РМЖ), рак ободочной кишки (РОК), меланома кожи (МК) и почечно-клеточный рак (ПКР) являются самыми высокозатратными онкологическими заболеваниями.Целью исследования стал подсчет медицинских затрат на каждую из этих нозологий с точки зрения бюджета г. Москвы и их сравнение.Методы. Для оценки медицинских затрат на лекарственное обеспечение в г. Москве пациентов с РПЖ, РМЖ, РОК, МК и ПКР построена аналитическая модель в программе MS Excel с учетом данных Канцеррегистра, а также литературных источников.Результаты. Посчитано, что если принимать затраты на лекарственную терапию всех пяти рассматриваемых видов рака за 100 %, то самым затратоемким является РМЖ (41 % затрат), затем МК (20 %), ПКР (15 %), РОК (13 %) и РПЖ (12 %). Если принимать количество проходящих ЛТ больных всеми рассматриваемыми пятью видами рака за 100 %, самый большой процент занимает РМЖ (50 % от общего числа), затем РПЖ (36 %), РОК (9 %), МК (3 %) и ПКР (1 %).Выводы: Представленная в модели структура затрат на лекарственную терапию больных РПЖ, РМЖ, МК, РОК, МК и ПКР в г. Москве показывает, что самым дорогим является лечение пациентов с МК (на 3 % больных уходит 20 % затрат) и ПКР (на 1 % больных уходит 15 % затрат)

OFraMP: a fragment-based tool to facilitate the parametrization of large molecules

An Online tool for Fragment-based Molecule Parametrization (OFraMP) is described. OFraMP is a web application for assigning atomic interaction parameters to large molecules by matching sub-fragments within the target molecule to equivalent sub-fragments within the Automated Topology Builder (ATB, atb.uq.edu.au) database. OFraMP identifies and compares alternative molecular fragments from the ATB database, which contains over 890,000 pre-parameterized molecules, using a novel hierarchical matching procedure. Atoms are considered within the context of an extended local environment (buffer region) with the degree of similarity between an atom in the target molecule and that in the proposed match controlled by varying the size of the buffer region. Adjacent matching atoms are combined into progressively larger matched sub-structures. The user then selects the most appropriate match. OFraMP also allows users to manually alter interaction parameters and automates the submission of missing substructures to the ATB in order to generate parameters for atoms in environments not represented in the existing database. The utility of OFraMP is illustrated using the anti-cancer agent paclitaxel and a dendrimer used in organic semiconductor devices. Graphical abstract: OFraMP applied to paclitaxel (ATB ID 35922).[Figure not available: see fulltext.

Quo Vadis HTA for medical devices in Central and Eastern Europe? Recommendations to address methodological challenges

Objectives: Methodological challenges in the evaluation of medical devices (MDs) may be different for early and late technology adopter countries, as well as the potential health technology assessment (HTA) solutions to tackle them. This study aims to provide guidance to Central and Eastern European (CEE) countries on how to address key challenges of HTA for MDs with special focus on the transferability of scientific evidence. Methods: As part of the COMED Horizon 2020 project, a comprehensive list of issues related to MD HTA were identified based on a targeted literature review. Health technology assessment issues which pose a greater challenge or require different solutions in late technology adopter countries were selected. Draught recommendations to address these issues were developed and discussed in a focus group. The recommendations were then validated with a wider group of experts, including HTA and reimbursement decision makers from CEE countries in May and June 2020. Results: A consolidated list of 11 recommendations were developed in 3 major areas: (1) clinical value assessment, focusing on the use of joint EU work, relying on real-world evidence, use of coverage with evidence development schemes, transferring evidence from foreign countries and addressing the challenges of learning curve and centre effect; (2) economic value assessment, covering cost calculation of complex medical devices and transferability of economic evaluations of MDs; (3) HTA processes, related to the frequent product modifications and various indications of MDs. Conclusions: Central and Eastern European countries with limited resources for conducting HTA, can benefit from HTA methods and evidence generated in early technology adopter countries. Considering the appropriate reuse of international HTA materials, late technology adopter countries can still implement HTA, even for MDs, which have a more limited evidence base compared with pharmaceuticals