Use of modeling in the study of economic burden of influenza in the elderly population in Central and Eastern European countries

The economic burden of the incidence of influenza and ARI requires careful study, since annually about 15% of the world's population suffers from these diseases. In addition, the flu can cause complications that are dangerous to human life and health, especially those at risk. The elderly population belongs precisely to this group, therefore we have chosen to analyze the economic burden of this category of population. According to the international classification, this group of diseases is divided into the following types: Influenza-like illness (ILI); – Acute respiratory infection (ARI); – Severe acute respiratory infections (SARI); – Severe Acute Respiratory Syndrome (SARS). The aim of the work was to develop a model for systematization flows of patients and treatment costs in assessing the economic burden of influenza and ARI morbidity in the elderly peoples in Central and Eastern Europe. The model was developed in cooperation with the Syreon Institute, Hungary. The study involved Hungary, Poland, the Czech Republic, Romania, Ukraine and Kazakhstan. The structure of the model is based on the assumption of a flow of patients. The principle of the model was as follows: in order to assess the economic burden of the disease in a certain period of time, it is necessary to quantify (1) the number of patients, and (2) the costs of health care and treatment. The cost of treatment is different in each case, patients should be divided into relatively homogeneous groups. Since the quantity and quality of the epidemiological data on influenza and related diseases is rather heterogeneous in different countries, WHO offers certain objects of influenza research, taken as a basis for constructing such a model. According to this classification of influenza and WHO definition, the central structure of our model was formed by acute respiratory infections (ARI), representing outpatient cases and severe acute respiratory infections (SARI), representing inpatient cases. The next stage of the research was the study of the cost structure and the principles of collecting expenditure data. The economic burden of influenza in the elderly populations has been analyzed based on the type of health system. In older people, it is difficult to establish a link between influenza and complications of chronic diseases and other acute medical conditions (eg, acute coronary syndrome). This analysis does not include estimates of the economic impact of influenza on other co-morbidities and long-term chronic effects associated with complications of influenza. Since the population of 60+ or 65+ is a risk group and is a numerical group, the cost of treatment in the event of complications and hospitalization will increase cost for the patient and for the medical institution. However, in this case indirect costs is missing, such as paying a sick list. Direct medical cost were subject to analysis. The proposed methodology allows you to objectively assess the costs of treatment and calculate the economic burden, taking into account the type and health system

Cost analysis of botulinum therapy of spastic forms of cerebral palsy in Ukraine

Cerebral palsy (CP) represents a group of disorders of the mechanisms of movement and body position, causing limitations of activity, which are caused by non-progressive damage to the developing brain, fetus or child. About 80% of cases are spastic forms of cerebral palsy. Along with motor rehabilitation, the use of botulinum toxin type A (BoNT-A) is considered one of the main methods of treatment of choice for focal spastic and dystonic syndromes, regardless of their etiology. At present, there are no studies in Ukraine on the analysis of the costs of using drugs based on BoNT-A, taking into account the recommended dose and frequency of administration. The aim of the work. Carrying out an analysis of minimizing the cost of botulinum therapy for spastic forms of cerebral palsy in patients aged two years and older. The annual dosage and frequency of administration of abobotulotoxin and onabotolutoxin for the treatment of dynamic equinus deformity of the foot caused by focal spasticity due to cerebral palsy in children over two years of age were obtained from the instructions for use. The cost of abobotulotoxin and onabotolutoxin was obtained from the Register of Wholesale Prices of the Ministry of Health of Ukraine. Cost analysis for a model cohort of children in different weight categories showed that abobotulotoxin 500 U will be the least expensive treatment technology in the weight category of 21–33 kg at a dosage of 15 U/kg in the treatment of diplegia. Abobotulotoxin 300 U is most rationally used in weight categories 10–20 kg and 34–40 kg with a dosage of 15 U/kg in the treatment of hemiplegia and in the weight category 17–20 kg with a dosage of 30 U/kg in the treatment of diplegia. Weight categories were identified in which the costs of using abobotulotoxin 300 U and abobotulotoxin 500 U were equal to and less than the costs of onabotolutoxin treatment. The study was the first to analyze the cost of botulinum therapy, which identified the benefits of abobotulotoxin in the symptomatic treatment of hemiplegia and diplegia in cerebral palsy in the focus of different weight groups of children. Possible variability in the dosage and frequency of administration of onabotolutoxin per year indicates the relevance of collecting additional information on the application in real clinical practice and further pharmacoeconomic studies

Cost minimization and budget impact analysis of the use of a new 6-month form of triptorelin in the treatment of patients with prostate cancer in Ukraine

Prostate cancer is one of the most serious health problems encountered by the manhood of different countries of the world. Prostate cancer is a hormone-dependent tumor – growth and proliferation of both normal and cancer cells significantly depend on level of androgens. The analogues of gonadotropin-releasing hormone have been widely applied in prostate cancer therapy for more than 15 years. In Ukraine goserelin (1 month, 1 M; 3 months, 3 M) currently occupies the major part of market among the analogues of gonadotropin-releasing hormone. The alternative to goserelin is triptorelin (1 month, 1 M; 1 months, 3 M; 6 months, 6 M) – another well-studied and widely applied analogue of gonadotropin-releasing hormone, which is used for medical castration in cases of prostate cancer. Taking this into consideration, conducting the analysis of triptorelin and goserelin application is relevant. The purpose of the work was to conduct cost minimization and budget impact analysis using triptorelin 6 M and goserelin 3 M in hormonal therapy of prostate cancer in Ukrainian patients. The research was based on treatment cost of one patient during one year under condition of equivalent efficacy and safety of goserelin and triptorelin. The pharmacoeconomic analysis was conducted according to the «cost minimization» method. For calculation of direct costs when applying goserelin and triptorelin a pharmacoeconomic decision tree model was used, according to which the costs are computed with an allowance for possibilities and expenditures on side effects. The results of pharmacoeconomic modeling showed a tendency for a yearly cost cut in the amount of 2 887.69 UAH per patient when using triptorelin in model cohort which consisted of 1 000 patients. Besides, it allows 137 additional patients per thousand of them to be treated with triptorelin. As the result of modeling the influence on budget it was estimated that the amount of cost saving on buying triptorelin would average at 4,6 million UAH per every year for five years of its implementation. Hormone therapy with application of the analogues of gonadotropin-releasing hormone is one of the major treatment methods of patients with prostate cancer. A pharmacoeconomic analysis of triptorelin application in comparison with goserelin for treating patients with prostate cancer in Ukraine was conducted. The results of pharmacoeconomic modeling showed that a significant cost cut is expected when using triptorelin. It will allow additional patients, who need hormone therapy, to be treated

The use of integrated frequency ABC/VEN-analysis of application of medicines for the treatment of influenza and its complications in the hospital

The problem of limiting and rational use of funds in the health care system is relevant worldwide. Influenza and acute respiratory viral infections are cause of a lot of discussion about the treatment and prevention of the disease. The aim of the work ‒ to conduct an analysis of the data of the actual practice of appointment for patients with severe forms of influenza and its complications that were hospitalized at the hospital of the Lviv Regional Infectious Diseases Clinical Hospital. For the analysis of data of real practice of appointments were included data of 260 medical cards of patients of the Lviv Regional Infectious Clinical Hospital, which were hospitalized in 2016–2017 years with the diagnosis of influenza and SARI. We used statistical methods, real world evidence analysis, integrated frequency ABC/VEN analysis. The results of the VEN analysis indicate that in this department pharmacotherapy performs according to the current Protocols for medical care. Integrated frequency, VEN and ABC analysis showed that the leader of applications is Reosorbilact (the rate of expenses is 19%, the frequency of applications – 14%, the percentage of patients to whom it was appointed is 85%). Very expensive antibiotic Tigacil followed them, the next medicines in this list – Xylat (a rate of of expenses 10%, a frequency of applications is 5%, a share of patients – 28%). By answering the question about use the funds for important and vitally necessary medication, we can see that the rate of expenses for medicines of category V is 88.99%, it means that there is a rational use of funds. Analyzing the frequency of using the most expensive drugs (the cost of antibiotics is 46% of the total cost of drugs), it would be advisable to study the possibility of replacing it with cheaper counterparts. In general, pharmacological therapy is clinically and economically viable, but requires further standardization, and the analysis shows possible ways to optimize it, and reminds us how dangerous are the complications of the influenza, and which resources are needed for their treatment

РЕКОМЕНДАЦІЇ ЩОДО РОЗРОБКИ ШКАЛИ РІВНІВ ВПЛИВУ НА БЮДЖЕТ ПРИ ОЦІНЦІ ЗАКУПІВЛІ ЛІКАРСЬКИХ ЗАСОБІВ В УКРАЇНІ

The aim of the work. Development of a rate of budget impact when evaluating the inclusion of a medicines on the National List of Essential Medicines (National List) in the analysis of the economic efficiency. Materials and methods. ABC analysis used for developed of this recommendations. The aim is assessing of the potential impact on the budget of medicines in case of its inclusion on the National List. The study used data provided by the Pharmexsplorer market research system, Support in Market Development (SMD) for 2018. Results and discussion. The developed of scale of rate of budget impact is recommended to be used to assess the financial consequences of using medical technology over an appropriate time horizon of 1 year or more to ensure an adequate level of functioning in the healthcare sector.  In the case of procurement by state budget and local budgets, if expenses per one INN exceeds 40 million UAH per year, the budget impact rate is excessive. If the expenses for one INN are in the range from 20 million to 40 million, the budget impact rate is big, if the costs range from 10 to 20 million UAH, then the impact is moderate, if expenses are less than 10 million, then the impact is insignificant. Subject to the inclusion of a medicinal product in the National List, in the case of procurement by health care institutions that are financed from the local budget, the scale of budget impact levels has the following gradation: if the cost per INN exceeds 17 million UAH per year, the budget impact rate is excessive. If the expenses for one INN are in the range from 6 to 17 million UAH, the budget impact rate is big, if the expenses for one INN are in the range from 3 to 6 million UAH, the impact is moderate; if the expenses are less than 3 million, the impact is insignificant. Conclusion. A scale for determining of rate of budget impact was developed based on the analysis of the procurement of medicines from the National List for 2018. It has such a gradation in four levels of influence: excessive, big, moderate and insignificant. It is promising to use a rate of budget impact for HTA with the aim of future financing by the expenses of state and local budgets in Ukraine.Мета роботи. Розробка шкали рівнів впливу на бюджет при оцінці включення лікарського засобу до Національного переліку основних лікарських засобів (Національного переліку) під час аналізу економічної ефективності лікарських засобів (ЛЗ). Матеріали і методи. З використанням АВС-аналізу розроблено рекомендації з оцінки потенційного впливу на бюджет ЛЗ у разі його включення до Національного переліку. В дослідженні використано дані, представлені системою дослідження ринку «Фармексплорер»,  Support in Market Development (SMD) за 2018 рік. Результати й обговорення. Розроблену шкалу рівнів впливу на бюджет рекомендовано використовувати для оцінки фінансових наслідків використання медичної технології протягом відповідного часового горизонту -  на 1 та більше років для забезпечення належного рівня функціонування у сфері охорони здоров’я. Якщо витрати  на одну міжнародну непатентовану назву (МНН) при закупівлі за кошти державного та місцевого бюджетів перевищують 40 млн грн на рік, то вплив на бюджет буде надмірний. Якщо витрати на одну МНН знаходяться в межах від 20 млн до 40 млн грн, то вплив на бюджет – великий, якщо витрати становлять від 10 до 20 млн грн – помірний, а менше 10 млн грн  -  незначний. При умові включення ЛЗ до Національного переліку для закупівлі закладами та установами охорони здоров’я, що фінансуються з місцевих бюджетів, шкала рівнів впливу на бюджет має таку градацію:  якщо витрати  на одну МНН перевищують 17 млн грн на рік, то вплив на бюджет буде надмірний, в межах від 6 до 17 млн грн – великий, в межах від 3 до 6 млн грн - помірний, менше 3 млн – незначний. Висновок. На основі проведеного аналізу закупівель ЛЗ з Національного переліку за 2018 рік розроблено шкалу рівнів впливу на бюджет, яка має таку градацію за чотирма рівнями впливу: надмірний, великий, помірний та незначний.  Перспективним є використання шкали рівнів впливу на бюджет при оцінці медичних технологій з метою їх подальшого фінансування за кошти державного та місцевих бюджетів в Україні

Численый анализ двумерной задачи сверхзвуковых взаимодействий скачка уплотнения с пограничным слоем

Наведено результати числового моделювання характеру взаємодій надзвукових турбулентних течій в області нахиленої з навітряної грані сходинки для кута нахилу відносно горизонту β = 8, 25, 90° та чисел Маха M∞ = 2,9, 2,94. В якості математичної моделі використані осереднені за Рейнольдсом рівняння Нав’є-Стокса з використанням моделі турбулентності k-ω SST для в’язкого стисливого середовища. Проведено порівняльний аналіз розподілу тиску та поверхневого тертя з наявними експериментальними даними.The results of numeric modeling of the nature of supersonic turbulent flows interaction in the field of inclined from the windward side plane of the step for the canting angle β = 8, 25, 90° and Mach numbers M∞ = 2,9, 2,94. The Navier-Stokes equations averaged by Reynolds with the usage of turbulent model were used as a mathematical model k-ω SST for viscous compressed environment. Comparative analysis of the pressure distribution and surface friction with gained experimental data was held.Приведены результаты численного моделирования характера взаимодействий сверхзвуковых турбулентных течений на наклоном участке с наветренной грани ступеньки для угла наклона относительно горизонта β = 8, 25, 90° та чисел Маха M∞ = 2,9, 2,94. В качестве математической модели использованы усредненные за Рейнольдсом уравнения Навье-Стокса с использованием модели турбулентности k-ω SST для вязкой сжимаемого среды. Проведен сравнительный анализ распределения давления и поверхностного трения с имеющимися экспериментальными данными