КЛИНИКО-ЭКОНОМИЧЕСКИЙ АНАЛИЗ ПРИМЕНЕНИЯ ПРОТИВООПУХОЛЕВОГО ЛЕКАРСТВЕННОГО ПРЕПАРАТА ЭРИБУЛИН (ХАЛАВЕН®) ДЛЯ ЛЕЧЕНИЯ БОЛЬНЫХ С МЕТАСТАТИЧЕСКИМ РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫ

Breast cancer is the most common cause of death from cancer among women in Russia. More than half of patients have metastases at diagnosis. Chemotherapy is an important component of combined modality treatment for breast cancer. The budget impact analysis of expenses for the use of eribulina demonstrated that its inclusion in the «List of Essential Drugs» greatly expand the possibilities of treatment for metastatic breast cancer without causing significant additional burden on the health budget of the Russian Federation.Рак молочной железы лидирует в структуре онкологической смертности женского населения России. Более половины пациенток имеют метастазы на момент установки диагноза. Химиотерапия является важным компонентом комплексного или комбинированного лечения рака молочной железы. Проведенный анализ влияния на бюджет затрат на использование эрибулина продемонстрировал, что его включение в «Перечень жизненно необходимых и важнейших лекарственных препаратов» существенно расширит возможности лечения метастатического рака молочной железы, не приводя к значимой дополнительной нагрузке на бюджет здравоохранения Российской Федерации

КЛИНИКО-ЭКОНОМИЧЕСКИЙ АНАЛИЗ ПРИМЕНЕНИЯ ПРЕПАРАТА ДЕГАРЕЛИКС (ФИРМАГОН) ДЛЯ ЛЕЧЕНИЯ БОЛЬНЫХ С РАСПРОСТРАНЁННЫМ ГОРМОНОЗАВИСИМЫМ РАКОМ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

Clinical and economic analysis of Degarelix (Firmagon) in treatment of patients with advanced hormone-dependent prostate cancerРак предстательной железы является распространенным онкологическим заболеванием среди мужского населения. Данное заболевание характеризуется достаточно длительным течением, и на начальных стадиях его диагностика затруднена. Ключевым маркером, который используется при диагностике рака предстательной железы является — простатоспецифический антиген. Хирургическое лечение рака предстательной железы является наиболее широко используемым и эффективным, однако оно не показано больным метастатическим раком предстательной железы. В настоящее время существует большой арсенал лекарственных препаратов для достижения медикаментозной кастрации. Наиболее перспективным лекарственным препаратом из группы антагонистов ГнРг является дегареликс. Его эффективность доказана в ходе крупных рандомизированных клинических исследований. Но учитывая высокую стоимость терапии дегареликсом, необходимо провести клинико-экономическую оценку его применения. Проведенный для дегареликса анализ влияния на бюджет, продемонстрировал, что его применение сопровождается экономией бюджетных средств

ИСПОЛЬЗОВАНИЕ ИНГИБИТОРА ЦИКЛИН-ЗАВИСИМЫХ КИНАЗ 4/6 (ПАЛБОЦИКЛИБ) В ТЕРАПИИ ГОРМОН-ЗАВИСИМОГО МЕТАСТАТИЧЕСКОГО РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ. АНАЛИЗ ЗАТРАТЫ–ПОСЛЕДСТВИЯ.

A new generation of aromatase inhibitors and target therapy directed at cycline-dependent kinases 4 and 6 gives a new opportunity to treat metastatic breast cancer. However, the cost of innovative therapy remains high. We present results of the cost-consequence analysis of combination therapy with fulvestrant and palbociclib compared to fulvestrant monotherapy or combination of exemestan and everolimus as a second-line therapy for metastatic breast cancer. It was shown that the combination therapy involving palbociclib increased the length of quality-adjusted life by 191 days and overall survival by almost a year. The use of palbociclib increased the length of quality-adjusted life by 0.06 QALY compared to the combination arm consisting of everolimus. The cumulative 10 year cost per patient was equal to 5.3 million rubles for combination therapy with palbociclib and 3.5 million rubles for combination therapy with everolimus.Появление нового поколения ингибиторов ароматазы, а также таргетной терапии, направленной на циклин-зависимые киназы 4/6, предоставляет онкологам, лечащим пациенток с метастатическим раком молочной железы, новые возможности. Однако стоимость инновационной терапии высока. В представленной работе приведен анализ «затраты–последствия» при применении комбинированной терапии второй линии фулвестрантом и палбоциклибом в сравнении с монотерапией фулвестрантом или комбинированной терапией эверолимусом и эксеместаном, применяемых в лечении метастатического рака молочной железы. Установлено, что комбинированная терапия, включающая палбоциклиб, позволяет увеличить продолжительность качественной жизни на 191 день, а общую продолжительность – почти на год. По сравнению с комбинированной терапией, включающей эверолимус, применение палбоциклиба приводило к увеличению продолжительности качественной жизни на 0,06 QALY. При этом комбинированная терапия с палбоциклибом была ассоциирована с расходами на уровне 5,3 млн рублей за 10 лет, а эверолимусом на фоне меньшей средней продолжительности жизни пациента – 3,5 млн рублей

ESTIMATION OF THE EFFICIENCY OF MEDICAL REHABILITATION OF PATIENTS WITH OBSTRUCTIVE DUST BRONCHITIS

Проведен ретроспективный анализ 200 историй болезни больных пылевым обструктивным бронхитом получавших одинаковые комплексы медикаментозного и восстановительного лечения. Выявлены наиболее динамичные клинико-функциональные и лабораторные показатели. Разработаны критерии эффективности медицинской реабилитации

The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Worldwide, both the incidence and death rates of pancreatic cancer are increasing. Evaluation of pancreatic cancer burden and its global, regional, and national patterns is crucial to policy making and better resource allocation for controlling pancreatic cancer risk factors, developing early detection methods, and providing faster and more effective treatments. Methods: Vital registration, vital registration sample, and cancer registry data were used to generate mortality, incidence, and disability-adjusted life-years (DALYs) estimates. We used the comparative risk assessment framework to estimate the proportion of deaths attributable to risk factors for pancreatic cancer: smoking, high fasting plasma glucose, and high body-mass index. All of the estimates were reported as counts and age-standardised rates per 100 000 person-years. 95% uncertainty intervals (UIs) were reported for all estimates. Findings: In 2017, there were 448 000 (95% UI 439 000\u2013456 000) incident cases of pancreatic cancer globally, of which 232 000 (210 000\u2013221 000; 51\ub79%) were in males. The age-standardised incidence rate was 5\ub70 (4\ub79\u20135\ub71) per 100 000 person-years in 1990 and increased to 5\ub77 (5\ub76\u20135\ub78) per 100 000 person-years in 2017. There was a 2\ub73 times increase in number of deaths for both sexes from 196 000 (193 000\u2013200 000) in 1990 to 441 000 (433 000\u2013449 000) in 2017. There was a 2\ub71 times increase in DALYs due to pancreatic cancer, increasing from 4\ub74 million (4\ub73\u20134\ub75) in 1990 to 9\ub71 million (8\ub79\u20139\ub73) in 2017. The age-standardised death rate of pancreatic cancer was highest in the high-income super-region across all years from 1990 to 2017. In 2017, the highest age-standardised death rates were observed in Greenland (17\ub74 [15\ub78\u201319\ub70] per 100 000 person-years) and Uruguay (12\ub71 [10\ub79\u201313\ub75] per 100 000 person-years). These countries also had the highest age-standardised death rates in 1990. Bangladesh (1\ub79 [1\ub75\u20132\ub73] per 100 000 person-years) had the lowest rate in 2017, and S\ue3o Tom\ue9 and Pr\uedncipe (1\ub73 [1\ub71\u20131\ub75] per 100 000 person-years) had the lowest rate in 1990. The numbers of incident cases and deaths peaked at the ages of 65\u201369 years for males and at 75\u201379 years for females. Age-standardised pancreatic cancer deaths worldwide were primarily attributable to smoking (21\ub71% [18\ub78\u201323\ub77]), high fasting plasma glucose (8\ub79% [2\ub71\u201319\ub74]), and high body-mass index (6\ub72% [2\ub75\u201311\ub74]) in 2017. Interpretation: Globally, the number of deaths, incident cases, and DALYs caused by pancreatic cancer has more than doubled from 1990 to 2017. The increase in incidence of pancreatic cancer is likely to continue as the population ages. Prevention strategies should focus on modifiable risk factors. Development of screening programmes for early detection and more effective treatment strategies for pancreatic cancer are needed. Funding: Bill & Melinda Gates Foundation

CLINICAL ECONOMIC ANALYSIS OF USING ERIBULIN (HALAVEN®) FOR TREATMENT OF PATIENTS WITH METASTATIC BREAST CANCER

Breast cancer is the most common cause of death from cancer among women in Russia. More than half of patients have metastases at diagnosis. Chemotherapy is an important component of combined modality treatment for breast cancer. The budget impact analysis of expenses for the use of eribulina demonstrated that its inclusion in the «List of Essential Drugs» greatly expand the possibilities of treatment for metastatic breast cancer without causing significant additional burden on the health budget of the Russian Federation

THE USE OF PALBOCKLIB, A CYCLINE-DEPENDENT KINASE 4/6 INHIBITOR, IN THE TREATMENT OF METASTATIC BREAST CANCER. A COST-CONSEQUENCE ANALYSIS

A new generation of aromatase inhibitors and target therapy directed at cycline-dependent kinases 4 and 6 gives a new opportunity to treat metastatic breast cancer. However, the cost of innovative therapy remains high. We present results of the cost-consequence analysis of combination therapy with fulvestrant and palbociclib compared to fulvestrant monotherapy or combination of exemestan and everolimus as a second-line therapy for metastatic breast cancer. It was shown that the combination therapy involving palbociclib increased the length of quality-adjusted life by 191 days and overall survival by almost a year. The use of palbociclib increased the length of quality-adjusted life by 0.06 QALY compared to the combination arm consisting of everolimus. The cumulative 10 year cost per patient was equal to 5.3 million rubles for combination therapy with palbociclib and 3.5 million rubles for combination therapy with everolimus

COST-EFFECTIVENESS AND COST-UTILITY OF GENOTHERAPEUTIC DRUG NEOVASCULGEN IN TREATMENT OF CHRONIC LOWER LIMB ISCHEMIA

Pl-VEGF165 (Neovasculgen) is a new genotherapeutic drug for treatment of chronic lower limb ischemia.  It is registered in Russia and underwent effectiveness assessment in clinical trial. Objective of this study is to report results of the economical modeling study to compare long-term effectiveness and costs of the treatment. The comparison show that the treatment with this drug allows to decrease number of amputations by 6.5 fold and increase quality adjusted length of life by 2.6 QALYs. Summary  costs were lower with new drug by 574 thousand rubles with lifelong modeling and by 353 thousand rubles in first 5 years

DNA STRUCTURE, REPLICATION AND GENOME VARIABILITY CORRELATION

The study of special features of a new molecular DNA structure synthesis based on the fact that monomers transpositions can occur in the backbone of polymer chains according to the mathematical law known as a Fibonacci numerical series and «the Golden ratio» was performed. The example of the formation of a new DNA model demonstrates that there are dimers of three types in DNA structure: • Dimers with phosphodiester bond P-O-C, [(s-p) + (s-p)]; [(p-s)+(p-s)]; • Dimers with phosphatic bond P-O-P, [(s-p) + (p-s)]; • Dimers with glycosidic bond C-O-C, [(p-s)+(s-p)]. Dimers of the [(s-p) + (p-s)] type are of special importance for the process of replication. For example, if an enzyme catalyst (DNA polymerase) interacts in the backbone of matrix thread with a dimer of [(s-p) + (p-s)] type during the replication process it leads to a thread break. The growth of the daughter thread does not occur until the enzyme catalyst finds the transition point to another matrix thread of DNA, which contains in its backbone monomers similar to those, necessary for the activity of the given DNA polymerase. Thus, during the process of replication the genetic material is redistributed in the cell, and each daughter thread gets the information about genes belonging to both matrix threads of DNA molecule. This pattern of cell genome changing may manifest itself in phenotype or genotype of the body in different ways

PHARMACOECONOMIC ANALYSIS OF THE IMPACT ON THE BUDGET COSTS OF ADDING DEXMEDETOMIDINE (DEXDOR) INTO THE LIST OF VITAL AND ESSENTIAL DRUGS

Analysis of  four pharmacoeconomic replacement models for  midazolam, propofol and  phentanyl with dexmedetomidine for sedation in resuscitation and intensive care unit (RICU) shows increase of the annual costs (at current prices) by 14-28 million rubles (at prices of the reference country – by 9-23 million rubles). The calculation of the RICU stay cost in the rates of the health care providers rather than in that of the Compulsory Health Insurance (CHI) effects a saving of up to 1 billion rubles at current prices and up to 3.5 billion rubles at prices of the reference country