Economic aspects of the cardiology program expansion of additional drugs provision by effective lipidlowering drugs for hypercholesterolemia control

The federal program of preferential drug provision in cardiology shows its effectiveness. However, hypercholesterolemia (HCH) remains a significant problem in patients in whom high-dose statin therapy does not provide the target level of low-density lipoprotein cholesterol (LDL cholesterol). The solution to the problem lies in the plane of prescribing lipid-lowering drugs of a different mechanism of action, for example, inhibitors of the PCSK9 enzyme. To recommend the inclusion of such kind drugs in the program, it is necessary not only to have evidence of their life-saving effect, but also the economic feasibility of their use. Aim: to evaluate the economic efficacy of alirocumab (INN) including in the federal program for patients who have suffered an acute coronary event, are receiving statins and have an LDL CH level of 5.0 mmol/l and higher.Materials and methods. Modeling was applied in a target group of 3029 patients of working age who had undergone ACS during the previous 12 months with severe, including familial, HCH, with LDL cholesterol 5.0 mmol/l and higher, receiving statins taking into account previously determined outcomes when using alirocumab + statins for 5 years. Direct medical and non-medical costs, as well as indirect costs, are identified. The cost-effectiveness analysis was applied from the point of view of the effectiveness of treatment (effects on mortality, temporary disability, disability) and direct health care costs (additional drug provision and outpatient follow-up, specialized, including high-tech, medical care in a 24‑hour hospital). Two healthcare technologies were compared: statin therapy and use of alirocumab + statins. The calculations used according to domestic methods used the cost of medical treatment, temporary disability, hospitalizations, loss of GDP and other parameters.Results. Modeling has shown a decrease in mortality, morbidity and disability when using alirocumab in even the first year of use. The economic effect of alirocumab from a decrease in temporary disability in the 1st year is 304.5 mln rub., in the 2nd — 301.5 mln rub., in the 3rd — 321.1 mln rub., in the 4th — 333.1 mln rub. The estimated amount of prevented GDP losses from mortality in the target group for 4 years in the case of alirocumab use amounted to 1,260.2 mln rub. The annual amount of avoidable GDP losses from mortality in the target group in the case of alirocumab is 27–30 %. The annual average savings per patient in the case of alirocumab use are from 7 to 17 %. The greatest impact on reducing losses from disability and mortality of the target group is noted in the group of people aged 40–59 years. Only for this group, if alirocumab is used, it is possible to reduce losses from disability and mortality by 159.2 million rubles per year (83 % of the total economic effect). Starting from the 4th year of alirocumab use, it is possible to obtain a positive economic effect in terms of hospitalization costs.Conclusion. When alirocumab is included in the program of additional drug provision in cardiology, the share of costs for the purchase of alirocumab for the target group may be only 0.01 %. At the same time, the economic effect of inclusion in the first year alone will amount to at least 393.4 million rubles of budget funds. The total amount of avoidable losses due to the alirocumab usage may amount to 1,638 million rubles over 4 years

The effect of long‐term agricultural use on the bacterial microbiota of chernozems of the forest‐steppe zone

Analysis of the composition of soil microbiota in various physicochemical conditions allows identify landmarks for understanding the principles by which it is formed. Of particular interest in this regard are the features of cultivated fertile soils that assist agricultural production. In this paper, we have assessed the occurrence of representatives of different families of bacteria in arable and nonarable chernozems of three subtype

Factors affecting the results of analgesic therapy. Results of the Russian multicentre study of NOTE (NSAID: Open-label Trial of Efficacy)

Non-steroidal anti-inflammatory drugs (NSAIDs) are most popular medications for the treatment of pain in common musculoskeletal diseases such as osteoarthritis (OA) and non-specific low back pain (LBP). However, the factors affecting the effectiveness of these drugs have not been determined fully. Aim: to identify factors affecting the effectiveness of NSAIDs in patients with OA and LBP. Materials and methods. An observational study was conducted to evaluate the effectiveness of a 2-week course of NSAIDs in OA and LBP in real clinical practice. The study group consisted of 3604 patients with OA and LBP (60.6% women and 39.4% men, mean age 55.0±13.4 years). According to the study design, aceclofenac (Airtal) and other NSAIDs used in the ratio 1:1. The main criterion of effectiveness was the frequency of complete pain relief after 2 weeks of therapy. In addition, the decrease of pain and general health were determined on a 10-point numerical rating scale (NRS). We compared the frequency of complete pain relief in patients who had and did not have the studied factors. The value of the studied factors was determined using OR (95% CI). Results and discussion. Most patients received aceclofenac (54.9%), as well as diclofenac (2.0%), ketoprofen (1.9%), lornoxicam (2.2%), meloxicam (13.7%), naproxen (2.1%), nimesulide (5.8%), celecoxib (5.9%), ethicoxib (7.1%) and other NSAIDs (4.4%); 56.2% of patients received muscle relaxants, mainly tolperisone (74.7%), vitamin B (10.4%), and proton pump inhibitors (42.8%). Complete pain relief was achieved in 54.8% of patients. The pain decrease and general health improvement were (for NRS) 63.9±13.4% and 61.7±14.8%, respectively. The efficacy of aceclofenac was slightly higher than in the whole group: complete pain relief was in 59.9% of patients. Adverse events in aceclofenac use were observed in 2.3% of patients, other NSAIDs-from 2.4 to 14.1%. The frequency of complete pain relief was higher in men: OR 1,239 (95% CI 1.08-1.418; p=0.002), who had the first episode of pain - OR 3.341 (95% CI 2.873-3.875; p=0.000), a good" response " to NSAIDs in history - OR 1.656 (95% CI 1.385-1.980; p=0.000) and received NSAIDs in combination with muscle relaxants - OR 1.218 (95% CI 1.067-1.390; p=0.004). The effect of therapy is lower in patients 65 years and older-OR 0,378 (95% CI 0.324-0.442; p=0,000), with body mass index >30 kg/m² - OR 0.619 (95% CI 0.529-0.723; p=0.000), with severe pain (≥7 points NRS) - OR 0.662 (95% CI 0.580-0.756; p=0.002), with pain at rest, - OR 0.515 (95% CI 0.450-0,589; p=0.000), pain at night - OR 0.581 (95% CI 0.501-0.672; p=0.000) and the presence of stiffness - OR 0.501 (95% CI 0.438-0,573; p=0.000). Treatment results are significantly worse in the cases of combination of LBP and joint pain, as well as pain in the trochanter major and pes anserinus area (

ECOLOGY OF MICROORGANISMS MICROBIOLOGICAL AND ENVIRONMENTAL ASPECTS OF NATURAL FOCAL SAPRONOSES GIDROEKOSISTEME IN THE VOLGA-CASPIAN BASIN

Frequent occurrence of opportunistic microflora in different hydrobionts and water of the Volga-Caspian region was revealed, the representatives of the family Enterobacteriaceae, Vibrionaceae и Pseudomonaceae were predominants. They had features of pathogenicity and plural antibiotic resistance. The given data prove that they meet all criteria of natural focal sapronosis infections

The geoecological aspects of bacteriocoenosis in Volga delta in conditions of anthropogenic load

Long-term sanitary-microbiological monitoring indicated persistence and domination of opportunistic bacteria of the families Enterobacteriaceae, Pseudomonadaceae and Vibriona-ceae in water and among hydrobionts which is indicative of unsatisfactory sanitary characteristics of the species under study. Most of the isolated microflora showed various degrees of pathogenicity and multiple resistances to antibiotics. This is suggestive of epidemiological importance of isolated microorganisms

Analytical opportunities of information-analytical system on collection funds of botanical gardens

Recently, the accents in the field of application of information technologies for needs of biological collections are displaced from registration and account in area of the analysis of the data. If to determine a biodiversity, as the genetic resources, distributed in space, it is easy to make a conclusion, that one of the most powerful tools of the invesigation of biodiversity are the geoinformation systems. The estimation of taxonomy representation of col- lections of botanical gardens of Russia for different taxonomic ranks is carried out in view of influence of the ecological factors

VIOLATIONS OF CYTOKINE REGULATION IN THE PATHOGENESIS OF PROLIFERATIVE DIABETIC RETINOPATHY

Purpose. To study the content of the transforming growth factorbeta 2 (TGF-β2), vascular endothelial growth factor (VEGF), pigment epithelium factor (PEDF) and several cytokines in the vitreous body in patients with proliferative diabetic retinopathy (PDR), to evaluate an activity of proliferative and immune-inflammatory process.Material and methods. Vitreous samples of patients with proliferative diabetic retinopathy and retinal detachment traction were examined as well as patients with traction retinal detachment without the PDR (control). Concentration of TGF- β 2, VEGF, PEDF MCP-1, interleukin 4, 6, 8, 10, 17A was determined by the ELISA method.Results. A reliable increase in the concentrations of pro-inflammatory cytokines IL-17A, IL-8, IL-6, MCP-1, anti-inflammatory cytokine IL-4, transforming growth factor-beta 2, vascular endothelial growth factor, factor of pigment epithelium and monocyte chematacticprotein-1 was detected in the vitreous of PDR patients.Conclusions. The findings indicate the existence of cytokine regulation violations in the PDR pathogenesis. It was noted that the activity of local inflammatory and proliferative processes was determined in the PDR pathogenesis. The revealed correlative relationships indicate interdependence of these processes. The detected reliable increase of monocyte chemotactic protein-1 in the vitreous of PDR patients, allows to make an assumption about its participation in the mechanisms of vascular proliferation

APPLICATION OF TOOLS OF STATISTICAL SUPERVISION FOR AN ESTIMATION OF DEPENDENCE OF VOLUMES OF FINANCING AND THE EPIDEMIOLOGICAL DATA ON A HIV-INFECTION IN THE RUSSIAN FEDERATION

Since 2001, the system of the public health of Russian Federation is effectively used tool of the statistical observation, founded on System account public healths, which allows to collect and analyze financial-economic information on all establishments of the system of the public health – a form 62 "Information about realization of the Program state warranty rendering to people of Russian Federation medicare". Information collected by means of given forms, is an important element for system financial-economic monitoring and forecasting of the needs for program and action, directed on reluctance to spreading HIV-infections. In this article given mathematical motivation existing dependencies of the volume of the financing the programs and action, directed on prevention of the spreading HIV-infections, and quality of the work on revealing the events HIV-infections in Russian Federation

Penuntun mengenal memahami dan menghargai puisi

viii, 56p; 22 c