54 research outputs found
ΠΡΠΎΠ±Π»Π΅ΠΌΡ Π²ΡΠ±ΠΎΡΠ° ΠΈΡΡ ΠΎΠ΄ΠΎΠ² Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌ ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ ΠΏΠΎΡΠ»Π΅ ΠΈΠ½ΡΡΠ»ΡΡΠ° ΠΈ Π§ΠΠ’
this article considers the appropriateness of surrogate points and endpoints utilization as evaluation criteria for rehabilitationΒ programs efficiency in patients after stroke, craniocerebral injury or other CNS diseases (e.g. tumors, neuroinfections etc.) inΒ Russian Federation. The purpose of this study is to evaluate surrogate and final outcomes of neurorehabilitation program in patientsΒ after stroke and craniocerebral injury. Materials and methods. The study was carried out using data provided by the Center ofΒ speech pathology and neurorehabilitation. A notion of Social status recovery was selected as an economically significant surrogateΒ outcome which was evaluated by physicians at the end of the rehabilitation course. A notion of Disability conferred by the FederalΒ State Institutions of Disability Evaluation was selected as an economically significant final outcome. Surrogate and final outcomesΒ comparison was performed based on the regulatory materials. Results. Surrogate outcomes evaluation revealed that at the end ofΒ rehabilitation course most patients (86.64%) reached the level of social and living needs, i.e. they have an ability to live and to takeΒ care for themselves without assistance. Final outcomes evaluation revealed that proportion of patient without disability decreasedΒ by 4-fold between the first and second visits and that total changes in disability degree by the time of the last visit were significantlyΒ smaller in comparison with the second patient's visit to the Center. Comparison of surrogate and final outcomes revealed significantΒ discrepancy between the patient's status characteristics. Thus, in the disability group I only 7.66% of patients were actually unable toΒ perform activities of daily living without assistance, while 90.46% of patients were able to live without assistance, that corresponds toΒ the disability group II. Conclusion. Established degree of disability often does not correspond to the actual patient's state. The analysisΒ based on the disability group changes is not sensitive enough for the evaluation of rehabilitation programs efficacy. Therefore, theΒ use of indirect signs of economically significant recovery seems to be more appropriate for the efficacy evaluation of such technology.Β Π² ΡΡΠ°ΡΡΠ΅ ΠΎΠ±ΡΡΠΆΠ΄Π°ΡΡΡΡ Π²ΠΎΠΏΡΠΎΡΡ ΡΠ΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΠΎΡΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΡΡΡΠΎΠ³Π°ΡΠ½ΡΡ
ΠΈ ΠΊΠΎΠ½Π΅ΡΠ½ΡΡ
ΡΠΎΡΠ΅ΠΊ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² ΠΎΡΠ΅Π½ΠΊΠΈ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌ ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
, ΠΏΠ΅ΡΠ΅Π½Π΅ΡΡΠΈΡ
ΠΈΠ½ΡΡΠ»ΡΡ, ΡΠ΅ΡΠ΅ΠΏΠ½ΠΎΠΎΠ·Π³ΠΎΠ²ΡΡ ΡΡΠ°Π²ΠΌΡ ΠΈΠ»ΠΈ Π΄ΡΡΠ³ΠΈΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π¦ΠΠ‘ (ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ, Π½Π΅ΠΉΡΠΎΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΈ Π΄Ρ.), Π² Π ΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ Π€Π΅Π΄Π΅ΡΠ°ΡΠΈΠΈ. Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠΎΡΡΠΎΡΠ»Π° Π² ΠΎΡΠ΅Π½ΠΊΠ΅ ΡΡΡΡΠΎΠ³Π°ΡΠ½ΡΡ
ΠΈ ΠΊΠΎΠ½Π΅ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΡ Π½Π΅ΠΉΡΠΎΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΏΠ΅ΡΠ΅ΡΡΠΈΡ
ΠΈΠ½ΡΡΠ»ΡΡ ΠΈ Π§ΠΠ’. ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΎΡΡ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ Π΄Π°Π½Π½ΡΡ
, ΠΏΡΠ΅Π΄ΠΎΡΡΠ°Π²Π»Π΅Π½Π½ΡΡ
Π¦Π΅Π½ΡΡΠΎΠΌ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΡΠ΅ΡΠΈ ΠΈ Π½Π΅ΠΉΡΠΎΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΈ. Π ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎΠ³ΠΎ ΡΡΡΡΠΎΠ³Π°ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ
ΠΎΠ΄Π° Π±ΡΠ»ΠΎ Π²ΡΠ±ΡΠ°Π½ΠΎ Β«Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΠ΅ ΡΠΎΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ°Β», ΠΊΠΎΡΠΎΡΠΎΠ΅ ΠΎΡΠ΅Π½ΠΈΠ²Π°Π΅ΡΡΡ Π²ΡΠ°ΡΠ°ΠΌΠΈ ΠΏΠΎ ΠΎΠΊΠΎΠ½ΡΠ°Π½ΠΈΠΈ ΠΊΡΡΡΠ° ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΈ. Π ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎΠ³ΠΎ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ
ΠΎΠ΄Π° Π±ΡΠ»Π° ΠΎΡΠΎΠ±ΡΠ°Π½Π° Β«ΠΈΠ½Π²Π°Π»ΠΈΠ΄Π½ΠΎΡΡΡΒ», ΠΏΡΠΈΡΡΠΆΠ΄Π°Π΅ΠΌΠ°Ρ ΡΠ΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΠΌΠΈ Π³ΠΎΡΡΠ΄Π°ΡΡΡΠ²Π΅Π½Π½ΡΠΌΠΈ ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡΠΌΠΈ ΠΌΠ΅Π΄ΠΈΠΊΠΎ-ΡΠΎΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΡΠΊΡΠΏΠ΅ΡΡΠΈΠ·Ρ. ΠΠ° ΠΎΡΠ½ΠΎΠ²Π΅ Π½ΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΡ
ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π»ΠΎΠ² Π±ΡΠ»ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΠΎΠΏΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ ΡΡΡΡΠΎΠ³Π°ΡΠ½ΡΡ
ΠΈ ΠΊΠΎΠ½Π΅ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ². Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΠΈ ΠΎΡΠ΅Π½ΠΊΠ΅ ΡΡΡΡΠΎΠ³Π°ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (86,64%) ΠΊ ΠΊΠΎΠ½ΡΡ ΠΊΡΡΡΠ° Π΄ΠΎΡΡΠΈΠ³Π°ΡΡ ΡΡΠΎΠ²Π½Ρ ΡΠΎΡΠΈΠ°Π»ΡΠ½ΠΎ Π±ΡΡΠΎΠ²ΡΡ
ΠΏΠΎΡΡΠ΅Π±Π½ΠΎΡΡΠ΅ΠΉ, ΡΠΎ Π΅ΡΡΡ ΠΎΠ±Π»Π°Π΄Π°ΡΡ ΡΠΏΠΎΡΠΎΠ±Π½ΠΎΡΡΡΡ ΠΆΠΈΡΡ ΠΈ ΡΡ
Π°ΠΆΠΈΠ²Π°ΡΡ Π·Π° ΡΠΎΠ±ΠΎΠΉ ΡΠ°ΠΌΠΎΡΡΠΎΡΡΠ΅Π»ΡΠ½ΠΎ. ΠΡΠ΅Π½ΠΊΠ° ΠΊΠΎΠ½Π΅ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² ΠΏΠΎΠΊΠ°Π·Π°Π»Π°, ΡΡΠΎ Π΄ΠΎΠ»Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±Π΅Π· ΠΈΠ½Π²Π°Π»ΠΈΠ΄Π½ΠΎΡΡΠΈ ΡΠΌΠ΅Π½ΡΡΠ°Π΅ΡΡΡ Π² 4 ΡΠ°Π·Π° ΠΎΡ ΠΏΠ΅ΡΠ²ΠΎΠ³ΠΎ ΠΊΠΎ Π²ΡΠΎΡΠΎΠΌΡ Π²ΠΈΠ·ΠΈΡΡ, Π° ΠΎΠ±ΡΠΈΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΡΠ΅ΠΏΠ΅Π½Π΅ΠΉ ΠΈΠ½Π²Π°Π»ΠΈΠ΄Π½ΠΎΡΡΠΈ ΠΏΡΠΈ ΠΏΠΎΡΠ»Π΅Π΄Π½Π΅ΠΌ Π²ΠΈΠ·ΠΈΡΠ΅ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΌΠ΅Π½ΡΡΠ΅, Π΅ΡΠ»ΠΈ ΡΡΠ°Π²Π½ΠΈΠ²Π°ΡΡ ΠΈΡ
ΡΠΎ Π²ΡΠΎΡΡΠΌ ΠΏΠΎΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠ΅Π½ΡΡΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΌ. ΠΡΠΈ ΡΠΎΠΏΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΠΈ ΡΡΡΠΎΠ³Π°ΡΠ½ΡΡ
ΠΈ ΠΊΠΎΠ½Π΅ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² Π²ΡΡΠ²ΠΈΠ»ΠΎΡΡ Π±ΠΎΠ»ΡΡΠΎΠ΅ ΡΠ°ΡΡ
ΠΎΠΆΠ΄Π΅Π½ΠΈΠ΅ Π² ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΡ
ΡΡΠ°ΡΡΡΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². Π’Π°ΠΊ, Π² I Π³ΡΡΠΏΠΏΠ΅ ΠΈΠ½Π²Π°Π»ΠΈΠ΄Π½ΠΎΡΡΠΈ ΡΠΎΠ»ΡΠΊΠΎ 7,66% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π΄Π΅ΠΉΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎ Π½Π΅ ΡΠΏΠΎΡΠΎΠ±Π½Ρ ΠΊ ΠΆΠΈΠ·Π½Π΅Π΄Π΅ΡΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π±Π΅Π· ΠΏΠΎΡΡΠΎΡΠΎΠ½Π½Π΅ΠΉ ΠΏΠΎΠΌΠΎΡΠΈ, Π° 90,46% ΡΠΏΠΎΡΠΎΠ±Π½Ρ ΠΆΠΈΡΡ ΡΠ°ΠΌΠΎΡΡΠΎΡΡΠ΅Π»ΡΠ½ΠΎ, ΡΡΠΎ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΠ΅Ρ II ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΈΠ½Π²Π°Π»ΠΈΠ΄Π½ΠΎΡΡΠΈ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π£ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½Π°Ρ ΡΡΠ΅ΠΏΠ΅Π½Ρ ΠΈΠ½Π²Π°Π»ΠΈΠ΄Π½ΠΎΡΡΠΈ ΡΠ°ΡΡΠΎ Π½Π΅ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΠ΅Ρ ΡΠ΅Π°Π»ΡΠ½ΠΎΠΌΡ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°. ΠΠ½Π°Π»ΠΈΠ· Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ Π΄Π°Π½Π½ΡΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ Π³ΡΡΠΏΠΏΡ ΠΈΠ½Π²Π°Π»ΠΈΠ΄Π½ΠΎΡΡΠΈ ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π΅ Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠΎΠΌ Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌ ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΈ. ΠΠΎΡΡΠΎΠΌΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΊΠΎΡΠ²Π΅Π½Π½ΡΡ
ΠΏΡΠΈΠ·Π½Π°ΠΊΠΎΠ² ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎΠ³ΠΎ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅ΡΡΡ Π±ΠΎΠ»Π΅Π΅ ΡΠ΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΡΠΌ Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΏΠΎΠ΄ΠΎΠ±Π½ΠΎΠΉ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΈ
Π‘ΡΠ°Π²Π½Π΅Π½ΠΈΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΠ΅ΠΌΡΡ ΡΠΊΡΠΈΠ½ΠΈΠ½Π³ΠΎΠ²ΡΡ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌ Π² Π‘Π¨Π, ΠΠ°Π½Π°Π΄Π΅, ΠΠΈΠ΄Π΅ΡΠ»Π°Π½Π΄Π°Ρ ΠΈ ΠΠ΅ΡΠΌΠ°Π½ΠΈΠΈ
This publication presents a comparison of recommendations of screening programs and prevention activities in the United States, Canada, the Netherlands and Germany for adult non-pregnant population excluding infectious diseases. Sources of funding for such programs and information about their implementation are descripted. According to the search results of the relevant information in open sources, a list of recommended screening programs, as well as the amount of available information describing these programs in foreign countries varies.Π Π΄Π°Π½Π½ΠΎΠΉ ΠΏΡΠ±Π»ΠΈΠΊΠ°ΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΉ ΡΠΊΡΠΈΠ½ΠΈΠ½Π³ΠΎΠ²ΡΡ
ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌ ΠΈ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ΅ΡΠΎΠΏΡΠΈΡΡΠΈΠΉ Π² Π‘Π¨Π, ΠΠ°Π½Π°Π΄Π΅, ΠΠΈΠ΄Π΅ΡΠ»Π°Π½Π΄Π°Ρ
ΠΈ ΠΠ΅ΡΠΌΠ°Π½ΠΈΠΈ Π΄Π»Ρ Π²Π·ΡΠΎΡΠ»ΠΎΠ³ΠΎ Π½Π΅Π±Π΅ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ³ΠΎ Π½Π°ΡΠ΅Π»Π΅Π½ΠΈΡ, Π·Π° ΠΈΡΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ. Π Π°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ ΠΈΡΡΠΎΡΠ½ΠΈΠΊΠΈ ΡΠΈΠ½Π°Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ°ΠΊΠΈΡ
ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌ ΠΈ ΡΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΎΠ± ΠΈΡ
ΡΠ΅Π°Π»ΠΈΠ·Π°ΡΠΈΠΈ Π½Π° ΡΠ΅ΡΡΠΈΡΠΎΡΠΈΠΈ ΡΡΡΠ°Π½Ρ. ΠΠΎ ΠΈΡΠΎΠ³Π°ΠΌ ΠΏΠΎΠΈΡΠΊΠ° ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΡΡΠ΅ΠΉ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠΈ Π² ΠΎΡΠΊΡΡΡΡΡ
ΠΈΡΡΠΎΡΠ½ΠΈΠΊΠ°Ρ
ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ Π² ΡΠ°Π·Π²ΠΈΡΡΡ
Π·Π°ΡΡΠ±Π΅ΠΆΠ½ΡΡ
ΡΡΡΠ°Π½Π°Ρ
Π²Π°ΡΡΠΈΡΡΠ΅ΡΡΡ ΠΊΠ°ΠΊ ΠΏΠ΅ΡΠ΅ΡΠ΅Π½Ρ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΠ΅ΠΌΡΡ
ΡΠΊΡΠΈΠ½ΠΈΠ½Π³ΠΎΠ²ΡΡ
ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌ, ΡΠ°ΠΊ ΠΈ ΠΎΠ±ΡΠ΅ΠΌ Π΄ΠΎΡΡΡΠΏΠ½ΡΡ
ΡΠ²Π΅Π΄Π΅Π½ΠΈΠΉ, ΠΎΠΏΠΈΡΡΠ²Π°ΡΡΠΈΡ
ΡΠ°ΠΊΠΈΠ΅ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΡ
ΠΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΠ΅ΡΡΠ° ΡΡΠΎΠΌΠ±ΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ, ΠΏΡΠΎΡ ΠΎΠ΄ΡΡΠΈΡ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π²ΡΠΏΠΎΠΌΠΎΠ³Π°ΡΠ΅Π»ΡΠ½ΡΡ ΡΠ΅ΠΏΡΠΎΠ΄ΡΠΊΡΠΈΠ²Π½ΡΡ ΡΠ΅Ρ Π½ΠΎΠ»ΠΎΠ³ΠΈΠΉ Π² Π ΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ Π€Π΅Π΄Π΅ΡΠ°ΡΠΈΠΈ
Objective: early assessming the clinical and economic efficacy of the thrombodynamics test in infertile patients undergoing treatment with assisted reproductive technologies (ART), as well as the impact of this test on the health care budget of the Russian Federation.Material and methods. The study was carried out on the basis of statistical data on the number of ART cycles, the proportion of patients with hypercoagulation and normocoagulation of blood, data on the clinical effectiveness of ART programs in Russia, including the dependency on the status of blood coagulation, as well as cost data. The analysis was carried out according to three scenarios: 1) thrombodynamics test with subsequent correction of the revealed hypercoagulability status before in vitro fertilization (IVF); 2) thrombodynamics test with the subsequent refusal to perform IVF in patients with hypercoagulability; 3) thrombodynamics test with subsequent correction of the revealed hypercoagulability status before the start of the frozen-thawed embryo transfer. The criteria for clinical effectiveness were the following indicators: the number of children born and the number of potentially saved life years. Clinical and economic efficacy criteria included: total direct medical costs; incremental cost-effectiveness ratio (ICER); changes in the amount of total direct medical costs; resizing effectively and ineffectively spent funds.Results. The use of the thrombodynamics test will potentially increase the number of children born by 21β33 children and the number of years of life saved, with discounting considered, within the range of 923β1448 years per 1000 ART cycles, depending on the study scenario. The smallest ICER values were observed in Scenario 2, and amounted to 112,120 rubles for 1 child born and 2519 rubles for 1 saved year of life. The highest ICER values were obtained in Scenario 1: 275,576 rubles for 1 child born and 6191 rubles for 1 saved year of life. The use of the thrombodynamics test in women with infertility before ART in Russia will require an increase in direct medical costs from 174 to 425 million rubles (by 1β5% of the initial level of costs) in absolute terms, depending on the chosen scenario with a time horizon of 1 year.Conclusion. Due to the expected significant improvement in treatment outcomes and the small amount of additional costs, the introduction of the thrombodynamics test into the routine practice of assessing blood clotting in infertile patients before the start of the ART cycle is potentially cost-effective, but further clinical studies are required for a more accurate economic assessment.Π¦Π΅Π»Ρ: ΡΠ°Π½Π½ΡΡ ΠΎΡΠ΅Π½ΠΊΠ° ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΠ΅ΡΡΠ° ΡΡΠΎΠΌΠ±ΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ Π±Π΅ΡΠΏΠ»ΠΎΠ΄ΠΈΠ΅ΠΌ, ΠΏΡΠΎΡ
ΠΎΠ΄ΡΡΠΈΡ
Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π²ΡΠΏΠΎΠΌΠΎΠ³Π°ΡΠ΅Π»ΡΠ½ΡΡ
ΡΠ΅ΠΏΡΠΎΠ΄ΡΠΊΡΠΈΠ²Π½ΡΡ
ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΉ (ΠΠ Π’), Π° ΡΠ°ΠΊΠΆΠ΅ Π²Π»ΠΈΡΠ½ΠΈΡ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΡΠ΅ΡΡΠ° Π½Π° Π±ΡΠ΄ΠΆΠ΅Ρ Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ Π ΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ Π€Π΅Π΄Π΅ΡΠ°ΡΠΈΠΈ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π΄Π°Π½Π½ΡΡ
ΠΎ ΡΠΈΡΠ»Π΅ ΡΠΈΠΊΠ»ΠΎΠ² ΠΠ Π’, Π΄ΠΎΠ»Π΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ Π³ΠΈΠΏΠ΅ΡΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠ΅ΠΉ ΠΈ Π½ΠΎΡΠΌΠΎΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠ΅ΠΉ ΠΊΡΠΎΠ²ΠΈ, Π΄Π°Π½Π½ΡΡ
ΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌ ΠΠ Π’ Π² Π ΠΎΡΡΠΈΠΈ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΡΡΠ°ΡΡΡΠ° ΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠΈ ΠΊΡΠΎΠ²ΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΡΠΎΠΈΠΌΠΎΡΡΠ½ΡΡ
Π΄Π°Π½Π½ΡΡ
. ΠΠ½Π°Π»ΠΈΠ· Π²ΡΠΏΠΎΠ»Π½Π΅Π½ ΠΏΠΎ ΡΡΠ΅ΠΌ ΡΡΠ΅Π½Π°ΡΠΈΡΠΌ: 1) ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΠ΅ΡΡΠ° ΡΡΠΎΠΌΠ±ΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠ΅ΠΉ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠ΅ΠΉ Π²ΡΡΠ²Π»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° Π³ΠΈΠΏΠ΅ΡΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠΈ ΠΏΠ΅ΡΠ΅Π΄ ΡΠΊΡΡΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΡΠΌ ΠΎΠΏΠ»ΠΎΠ΄ΠΎΡΠ²ΠΎΡΠ΅Π½ΠΈΠ΅ΠΌ (ΠΠΠ); 2) ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΠ΅ΡΡΠ° ΡΡΠΎΠΌΠ±ΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ ΠΎΡΠΊΠ°Π·ΠΎΠΌ Π² ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠΈ ΠΠΠ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠ°ΠΌ Ρ Π³ΠΈΠΏΠ΅ΡΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠ΅ΠΉ; 3) ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΠ΅ΡΡΠ° ΡΡΠΎΠΌΠ±ΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠ΅ΠΉ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠ΅ΠΉ Π²ΡΡΠ²Π»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° Π³ΠΈΠΏΠ΅ΡΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠΈ Π΄ΠΎ Π½Π°ΡΠ°Π»Π° ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ° ΡΠ°Π·ΠΌΠΎΡΠΎΠΆΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΠΌΠ±ΡΠΈΠΎΠ½Π°. ΠΡΠΈΡΠ΅ΡΠΈΡΠΌΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΡΠ²Π»ΡΠ»ΠΈΡΡ ΡΠ»Π΅Π΄ΡΡΡΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ: ΡΠΈΡΠ»ΠΎ ΡΠΎΠΆΠ΄Π΅Π½Π½ΡΡ
Π΄Π΅ΡΠ΅ΠΉ ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΡΡ
Π»Π΅Ρ ΠΆΠΈΠ·Π½ΠΈ. ΠΡΠΈΡΠ΅ΡΠΈΠΈ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π²ΠΊΠ»ΡΡΠ°Π»ΠΈ: ΠΎΠ±ΡΠΈΠ΅ ΠΏΡΡΠΌΡΠ΅ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΠ΅ Π·Π°ΡΡΠ°ΡΡ, ΠΈΠ½ΠΊΡΠ΅ΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ Β«Π·Π°ΡΡΠ°ΡΡβΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΒ», ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΠ°Π·ΠΌΠ΅ΡΠ° ΠΎΠ±ΡΠΈΡ
ΠΏΡΡΠΌΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
Π·Π°ΡΡΠ°Ρ, ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΠ°Π·ΠΌΠ΅ΡΠ° ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΈ Π½Π΅ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ Π·Π°ΡΡΠ°ΡΠ΅Π½Π½ΡΡ
ΡΡΠ΅Π΄ΡΡΠ².Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ΅ΡΡΠ° ΡΡΠΎΠΌΠ±ΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΡ ΡΠ²Π΅Π»ΠΈΡΠΈΡΡ ΡΠΈΡΠ»ΠΎ ΡΠΎΠΆΠ΄Π΅Π½Π½ΡΡ
Π΄Π΅ΡΠ΅ΠΉ Π½Π° 21β33 ΡΠ΅Π±Π΅Π½ΠΊΠ° ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΡΡ
Π»Π΅Ρ ΠΆΠΈΠ·Π½ΠΈ Ρ ΡΡΠ΅ΡΠΎΠΌ Π΄ΠΈΡΠΊΠΎΠ½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π² ΠΏΡΠ΅Π΄Π΅Π»Π°Ρ
923β1448 Π»Π΅Ρ Π² ΡΠ°ΡΡΠ΅ΡΠ΅ Π½Π° 1000 ΡΠΈΠΊΠ»ΠΎΠ² ΠΠ Π’ Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΡΡΠ΅Π½Π°ΡΠΈΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ. ΠΠ°ΠΈΠΌΠ΅Π½ΡΡΠΈΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΈΠ½ΠΊΡΠ΅ΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ Β«Π·Π°ΡΡΠ°ΡΡβΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΒ» Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈΡΡ Π² ΡΡΠ΅Π½Π°ΡΠΈΠΈ 2 ΠΈ ΡΠΎΡΡΠ°Π²Π»ΡΠ»ΠΈ 112 120 ΡΡΠ±. Π½Π° ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΡΠΎΠΆΠ΄Π΅Π½Π½ΠΎΠ³ΠΎ ΡΠ΅Π±Π΅Π½ΠΊΠ° ΠΈ 2519 ΡΡΠ±. Π½Π° ΠΎΠ΄ΠΈΠ½ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΡΠΉ Π³ΠΎΠ΄ ΠΆΠΈΠ·Π½ΠΈ. ΠΠ°ΠΈΠ±ΠΎΠ»ΡΡΠΈΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡΒ ΠΏΠΎΠ»ΡΡΠ΅Π½Ρ Π² ΡΡΠ΅Π½Π°ΡΠΈΠΈ 1: 275 576 ΡΡΠ±. Π½Π° ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΡΠΎΠΆΠ΄Π΅Π½Π½ΠΎΠ³ΠΎ ΡΠ΅Π±Π΅Π½ΠΊΠ° ΠΈ 6191 ΡΡΠ±. Π·Π° ΠΎΠ΄ΠΈΠ½ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΡΠΉ Π³ΠΎΠ΄ ΠΆΠΈΠ·Π½ΠΈ. ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΠ΅ΡΡΠ° ΡΡΠΎΠΌΠ±ΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Ρ ΠΆΠ΅Π½ΡΠΈΠ½ Ρ Π±Π΅ΡΠΏΠ»ΠΎΠ΄ΠΈΠ΅ΠΌ ΠΏΠ΅ΡΠ΅Π΄ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ΠΌ ΠΠ Π’ Π² Π ΠΎΡΡΠΈΠΈ ΠΏΠΎΡΡΠ΅Π±ΡΠ΅Ρ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΡ ΠΏΡΡΠΌΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
Π·Π°ΡΡΠ°Ρ Π² Π°Π±ΡΠΎΠ»ΡΡΠ½ΡΡ
Π·Π½Π°ΡΠ΅Π½ΠΈΡΡ
ΠΎΡ 174 Π΄ΠΎ 425 ΠΌΠ»Π½ ΡΡΠ±. (Π½Π° 1β5% ΠΎΡ ΠΈΡΡ
ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΡΡΠΎΠ²Π½Ρ Π·Π°ΡΡΠ°Ρ) Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ Π²ΡΠ±ΡΠ°Π½Π½ΠΎΠ³ΠΎ ΡΡΠ΅Π½Π°ΡΠΈΡ ΠΏΡΠΈ Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠΌ Π³ΠΎΡΠΈΠ·ΠΎΠ½ΡΠ΅ 1 Π³ΠΎΠ΄.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ° ΡΡΠ΅Ρ ΠΏΡΠ΅Π΄ΠΏΠΎΠ»Π°Π³Π°Π΅ΠΌΠΎΠ³ΠΎ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΈ Π½Π΅Π±ΠΎΠ»ΡΡΠΎΠ³ΠΎ ΡΠ°Π·ΠΌΠ΅ΡΠ° Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΡ
Π·Π°ΡΡΠ°Ρ Π²Π½Π΅Π΄ΡΠ΅Π½ΠΈΠ΅ ΡΠ΅ΡΡΠ° ΡΡΠΎΠΌΠ±ΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Π² ΡΡΡΠΈΠ½Π½ΡΡ ΠΏΡΠ°ΠΊΡΠΈΠΊΡ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΠ²Π΅ΡΡΡΠ²Π°Π΅ΠΌΠΎΡΡΠΈ ΠΊΡΠΎΠ²ΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ Π±Π΅ΡΠΏΠ»ΠΎΠ΄ΠΈΠ΅ΠΌ Π΄ΠΎ Π½Π°ΡΠ°Π»Π° ΡΠΈΠΊΠ»Π° ΠΠ Π’ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ, ΠΎΠ΄Π½Π°ΠΊΠΎ Π΄Π»Ρ Π±ΠΎΠ»Π΅Π΅ ΡΠΎΡΠ½ΠΎΠΉ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΠ΅Π±ΡΡΡΡΡ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠΈΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ
ΠΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π±ΡΠ΅Π½ΡΡΠΊΡΠΈΠΌΠ°Π±Π° Π²Π΅Π΄ΠΎΡΠΈΠ½Π° Ρ Π²Π·ΡΠΎΡΠ»ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΡΡΡΠ΅ΠΉ ΠΈΠ»ΠΈ ΡΠ΅ΡΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΠΉ Π»ΠΈΠΌΡΠΎΠΌΠΎΠΉ Π₯ΠΎΠ΄ΠΆΠΊΠΈΠ½Π°
Objective: to perform cost-effectiveness analysis of brentuximab vedotin (BV) in patients with relapsed or refractory CD30-positive Hodgkinβs lymphoma (HL).Materials and methods. This study was performed in two parts in 2015. In the first part Markov model was built on the basis of the results of cohort prospective and retrospective studies and clinical expert survey to assess cost-effectiveness of BV in patients with relapsed or refractory CD30-positive HL. Time horizon of the model was 40 years. The model simulated transition between three health states: progression-free, post-progression and death for patients with relapsed or refractory CD30-positive HL after autologous stem cell transplantation (ASCT). Three alternatives were analyzed: 1) chemotherapy with or without radiotherapy (Ch Β± RT), 2) Ch Β± RT with allogeneic stem cell transplantation (alloSCT) and 3) BV. The economic evaluation was made from the Russian healthcare system point of view. Incremental cost-effectiveness ratio (ICER) for BV vs Ch Β± RT and Ch Β± RT + alloSCT vs Ch Β± RT per life year (LY) and quality-adjusted life year (QALY) was calculated. In the second part we calculated ICER for BV vs standard treatment based on drugs costs only and compared it with ICER for some other costly oncologic drugs, calculated by the same approach. Drugs used for ICER comparison were: bevacizumab for metastatic renal cell carcinoma, eribulin for metastatic breast cancer, panitumumab for adenocarcinoma of the colon or rectum and cabazitaxel for metastatic castration-resistant prostate cancer. ICER was calculated separately for each single drug as the ratio of increment costs of analyzed drug vs the comparator and the increment overall survival; data was derived from clinical trials.Results. In patients with relapsed or refractory CD30-positive HL after ASCT ICER was 5,8 million rub. per LY for BV vs Ch Β± RT and 6,4 million rub. for Ch Β± RT + alloSCT vs Ch Β± RT. Cost of additional month of life for BV in patients with relapsed or refractory CD30-positive HL after ASCT was 524 thousand rub. that was lower than for bevacizumab for metastatic renal cell carcinoma and eribulin for metastatic breast cancer, both drugs included into 2016 Essential and Vital Drugs List: 2,5 million rub. and 923 thousand rub., respectively.Conclusion. In patients with relapsed or refractory CD30- positive HL after ASCT BV is an appropriate alternative as ICER per LY is lower than for standard treatment Ch Β± RT + alloSCT vs Ch Β± RT. Cost of additional month of life is lower than for other oncologic drugs included into Russian Essential and Vital Drugs List.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· Π»Π΅ΡΠ΅Π½ΠΈΡ Π±ΡΠ΅Π½ΡΡΠΊΡΠΈΠΌΠ°Π±ΠΎΠΌ Π²Π΅Π΄ΠΎΡΠΈΠ½ΠΎΠΌ (ΠΠ) Π²Π·ΡΠΎΡΠ»ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΡΡΡΠ΅ΠΉ ΠΈΠ»ΠΈ ΡΠ΅ΡΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΠΉ CD30-ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½ΠΎΠΉ Π»ΠΈΠΌΡΠΎΠΌΠΎΠΉ Π₯ΠΎΠ΄ΠΆΠΊΠΈΠ½Π° (ΠΠ₯).ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΎΡΡ Π² 2015 Π³. Π² Π΄Π²Π° ΡΡΠ°ΠΏΠ°. ΠΠ° ΠΏΠ΅ΡΠ²ΠΎΠΌ ΡΡΠ°ΠΏΠ΅ Π² ΠΌΠ°ΡΠΊΠΎΠ²ΡΠΊΠΎΠΉ ΠΌΠΎΠ΄Π΅Π»ΠΈ, ΠΏΠΎΡΡΡΠΎΠ΅Π½Π½ΠΎΠΉ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΊΠΎΠ³ΠΎΡΡΠ½ΡΡ
ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΡ
ΠΈ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΡ
Π½Π΅ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΠΈ ΠΎΠΏΡΠΎΡΠ° ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΊΡΠΏΠ΅ΡΡΠΎΠ², ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ Π°Π½Π°Π»ΠΈΠ· Β«Π·Π°ΡΡΠ°ΡΡ-ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΒ» ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΠ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΡΡΡΠ΅ΠΉ ΠΈΠ»ΠΈ ΡΠ΅ΡΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΠΉ CD30-ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½ΠΎΠΉ ΠΠ₯. ΠΠΎΠ΄Π΅Π»Ρ ΠΈΠΌΠ΅Π΅Ρ Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠΉ Π³ΠΎΡΠΈΠ·ΠΎΠ½Ρ 40 Π»Π΅Ρ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΡΠ΅Ρ ΠΏΠ΅ΡΠ΅Ρ
ΠΎΠ΄ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΌΠ΅ΠΆΠ΄Ρ ΡΡΠ΅ΠΌΡ ΡΠΎΡΡΠΎΡΠ½ΠΈΡΠΌΠΈ: Π±Π΅Π· ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ, ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΈ ΡΠΌΠ΅ΡΡΡ β Π½Π° ΡΠΎΠ½Π΅ ΡΡΠ΅Ρ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΡΡΡΠ΅ΠΉ ΠΈΠ»ΠΈ ΡΠ΅ΡΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΠΉ CD30-ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½ΠΎΠΉ ΠΠ₯ ΠΏΠΎΡΠ»Π΅ Π°ΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎΠΉ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ ΡΡΠ²ΠΎΠ»ΠΎΠ²ΡΡ
ΠΊΠ»Π΅ΡΠΎΠΊ (ΠΠ’Π‘Π): 1) Ρ
ΠΈΠΌΠΈΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ (Π₯Π’) Β± Π»ΡΡΠ΅Π²Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ (ΠΠ’), 2) Π₯Π’ Β± ΠΠ’ Ρ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠ΅ΠΉ Π°Π»Π»ΠΎΠ³Π΅Π½Π½ΠΎΠΉ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠ΅ΠΉ ΡΡΠ²ΠΎΠ»ΠΎΠ²ΡΡ
ΠΊΠ»Π΅ΡΠΎΠΊ (Π°Π»Π»ΠΎΠ’Π‘Π); 3) ΠΠ. Π Π°ΡΡΠ΅Ρ Π·Π°ΡΡΠ°Ρ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΡΡ Ρ ΠΏΠΎΠ·ΠΈΡΠΈΠΈ ΡΠΈΡΡΠ΅ΠΌΡ Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ Π Π€. Π Π°ΡΡΡΠΈΡΡΠ²Π°Π»ΡΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΏΡΠΈΡΠ°ΡΠ΅Π½ΠΈΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π·Π°ΡΡΠ°Ρ (incremental cost-effectiveness ratio, ICER) Π½Π° ΠΎΠ΄ΠΈΠ½ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΡΠΉ Π³ΠΎΠ΄ ΠΆΠΈΠ·Π½ΠΈ ΠΈ Π½Π° ΠΎΠ΄ΠΈΠ½ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΡΠΉ Π³ΠΎΠ΄ ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΆΠΈΠ·Π½ΠΈ Π΄Π»Ρ ΠΠ vs Π₯Π’ Β± ΠΠ’ ΠΈ Π΄Π»Ρ Π₯Π’ Β± ΠΠ’ + Π°Π»Π»ΠΎΠ’Π‘Π vs Π₯Π’ Β± ΠΠ’. ΠΠ° Π²ΡΠΎΡΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΠΏΡΠΎΠΈΠ·Π²Π΅Π΄Π΅Π½ΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΠ΅ ICER, ΡΠ°ΡΡΡΠΈΡΠ°Π½Π½ΠΎΠ³ΠΎ ΠΏΠΎ Π΅Π΄ΠΈΠ½ΠΎΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ΅ Π΄Π»Ρ ΠΠ ΠΏΡΠΈ ΠΠ₯ ΠΈ Π΄ΡΡΠ³ΠΈΡ
Π΄ΠΎΡΠΎΠ³ΠΎΡΡΠΎΡΡΠΈΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ β Π±Π΅Π²Π°ΡΠΈΠ·ΡΠΌΠ°Π±Π° ΠΏΡΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΏΠΎΡΠ΅ΡΠ½ΠΎ-ΠΊΠ»Π΅ΡΠΎΡΠ½ΠΎΠΌ ΡΠ°ΠΊΠ΅, ΡΡΠΈΠ±ΡΠ»ΠΈΠ½Π° ΠΏΡΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ ΡΠ°ΠΊΠ΅ ΠΌΠΎΠ»ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ, ΠΏΠ°Π½ΠΈΡΡΠΌΡΠΌΠ°Π±Π° ΠΏΡΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π°Π΄Π΅Π½ΠΎΠΊΠ°ΡΡΠΈΠ½ΠΎΠΌΠ΅ ΡΠΎΠ»ΡΡΠΎΠΉ ΠΈΠ»ΠΈ ΠΏΡΡΠΌΠΎΠΉ ΠΊΠΈΡΠΊΠΈ ΠΈ ΠΊΠ°Π±Π°Π·ΠΈΡΠ°ΠΊΡΠ΅Π»Π° ΠΏΡΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΊΠ°ΡΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΎ-ΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΠΎΠΌ ΡΠ°ΠΊΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ. ICER ΡΠ°ΡΡΡΠΈΡΡΠ²Π°Π»ΡΡ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ Π΄Π»Ρ ΠΊΠ°ΠΆΠ΄ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° ΠΎΡΠ΄Π΅Π»ΡΠ½ΠΎ, ΠΊΠ°ΠΊ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΡΠ°Π·Π½ΠΈΡΡ Π·Π°ΡΡΠ°Ρ Π½Π° Π΅Π³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° cΡΠ°Π²Π½Π΅Π½ΠΈΡ, ΠΈ ΡΠ°Π·Π½ΠΈΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΡΡΠ΅ΠΊΡΠΎΠ² ΠΏΠΎ ΠΊΡΠΈΡΠ΅ΡΠΈΡ ΠΎΠ±ΡΠ΅ΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π Π°ΡΡΡΠΈΡΠ°Π½Π½ΡΠΉ Π² ΠΌΠ°ΡΠΊΠΎΠ²ΡΠΊΠΎΠΉ ΠΌΠΎΠ΄Π΅Π»ΠΈ ICER Π½Π° ΠΎΠ΄ΠΈΠ½ Π³ΠΎΠ΄ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΠΎΠΉ ΠΆΠΈΠ·Π½ΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΡΡΡΠ΅ΠΉ ΠΈΠ»ΠΈ ΡΠ΅ΡΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΠΉ CD30-ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½ΠΎΠΉ ΠΠ₯ ΠΏΠΎΡΠ»Π΅ ΠΠ’Π‘Π Π΄Π»Ρ ΠΠ vs Π₯Π’ Β± ΠΠ’ ΡΠΎΡΡΠ°Π²ΠΈΠ» 5,8 ΠΌΠ»Π½ ΡΡΠ±., Π΄Π»Ρ Π₯Π’ Β± ΠΠ’ + Π°Π»Π»ΠΎΠ’Π‘Π vs Π₯Π’ Β± ΠΠ’ β 6,4 ΠΌΠ»Π½ ΡΡΠ±. Π Π°ΡΡΡΠΈΡΠ°Π½Π½Π°Ρ Π½Π° Π²ΡΠΎΡΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΡΡΠΎΠΈΠΌΠΎΡΡΡ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅ΡΡΡΠ° ΠΆΠΈΠ·Π½ΠΈ ΠΏΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ ΠΠ Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΡΡΡΠ΅ΠΉ ΠΈΠ»ΠΈ ΡΠ΅ΡΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΠΉ CD30- ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½ΠΎΠΉ ΠΠ₯ ΠΏΠΎΡΠ»Π΅ ΠΠ’Π‘Π ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 524 ΡΡΡ. ΡΡΠ±. ΠΈ Π±ΡΠ»Π° Π½ΠΈΠΆΠ΅, ΡΠ΅ΠΌ Ρ Π΄Π²ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ², Π²Ρ
ΠΎΠ΄ΡΡΠΈΡ
Π² ΠΏΠ΅ΡΠ΅ΡΠ΅Π½Ρ ΠΠΈΠ·Π½Π΅Π½Π½ΠΎ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΡΡ
ΠΈ Π²Π°ΠΆΠ½Π΅ΠΉΡΠΈΡ
Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² (ΠΠΠΠΠ) Π½Π° 2016 Π³.: Π±Π΅Π²Π°ΡΠΈΠ·ΡΠΌΠ°Π±Π° ΠΏΡΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΡΠ΅ΡΠ½ΠΎ-ΠΊΠ»Π΅ΡΠΎΡΠ½ΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½ΠΎΠΌΠ΅ ΠΈ ΡΡΠΈΠ±ΡΠ»ΠΈΠ½Π° ΠΏΡΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ ΡΠ°ΠΊΠ΅ ΠΌΠΎΠ»ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ β 2,5 ΠΌΠ»Π½ ΡΡΠ±. ΠΈ 923 ΡΡΡ. ΡΡΠ±., ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈ ΠΏΡΠΈΠ΅ΠΌΠ»Π΅ΠΌΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠ΅ΠΉ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΡΡΡΠ΅ΠΉ ΠΈΠ»ΠΈ ΡΠ΅ΡΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΠΉ CD30-ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½ΠΎΠΉ ΠΠ₯ ΠΏΠΎΡΠ»Π΅ ΠΠ’Π‘Π ΡΠ°ΠΊ ΠΊΠ°ΠΊ ΠΏΡΠΈ Π΅Π³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠ°ΡΡ
ΠΎΠ΄Ρ Π½Π° ΠΎΠ΄ΠΈΠ½ Π³ΠΎΠ΄ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΠΎΠΉ ΠΆΠΈΠ·Π½ΠΈ Π² ΡΡΠ°Π²Π½Π΅Π½ΠΈΠΈ Ρ Π₯Π’ Β± ΠΠ’ Π½ΠΈΠΆΠ΅, ΡΠ΅ΠΌ Ρ ΠΏΡΠΈΠ½ΡΡΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π₯Π’ Β± ΠΠ’ + Π°Π»Π»ΠΎΠ’Π‘Π, Π° ΠΏΡΠΈ ΡΡΠ΅ΡΠ΅ ΡΠΎΠ»ΡΠΊΠΎ ΡΠ°ΡΡ
ΠΎΠ΄ΠΎΠ² Π½Π° Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ ΡΡΠΎΠΈΠΌΠΎΡΡΡ ΡΠΎΡ
ΡΠ°Π½Π΅Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅ΡΡΡΠ° ΠΆΠΈΠ·Π½ΠΈ Π½ΠΈΠΆΠ΅, ΡΠ΅ΠΌ Ρ Π½Π΅ΠΊΠΎΡΠΎΡΡΡ
Π΄ΠΎΡΠΎΠ³ΠΎΡΡΠΎΡΡΠΈΡ
ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ², Π²Ρ
ΠΎΠ΄ΡΡΠΈΡ
Π² ΠΏΠ΅ΡΠ΅ΡΠ΅Π½Ρ ΠΠΠΠΠ 2016 Π³
Design, conduct, analysis and reporting of a multi-national placebo-controlled trial of activated protein C for persistent septic shock
The role of drotrecogin alfa (activated) (DAA) in severe sepsis remains controversial and clinicians are unsure whether or not to treat their patients with DAA. In response to a request from the European Medicines Agency, Eli Lilly will sponsor a new placebo-controlled trial and history suggests the results will be subject to great scrutiny. An academic steering committee will oversee the conduct of the study and will write the study manuscripts. The steering committee intends that the study will be conducted with the maximum possible transparency; this includes publication of the study protocol and a memorandum of understanding which delineates the role of the sponsor. The trial has the potential to provide clinicians with valuable data but patients will only benefit if clinicians have confidence in the conduct, analysis and reporting of the trial. This special article describes the process by which the trial was developed, major decisions regarding trial design, and plans for independent analysis, interpretation and reporting of the data
Growing burden of sepsis-related mortality in northeastern Italy: a multiple causes of death analysis
Resolvin D2 is a potent regulator of leukocytes and controls microbial sepsis
National Institutes of Health grants GM-38765 and P50-DE016191 (C.N.S.), Welcome Trust Programme grant 086867/Z/08/Z (R.J.F. and M.P.) and Project grant 085903/Z/08 (R.J.F.) and Arthritis Research Campaign UK fellowships 18445 and 18103 (to L.V.N. and D.C., respectively). M.S. received a National Research Service Award from the NHLBI (HL087526)
Differences in reported sepsis incidence according to study design: a literature review
MicroRNA Fingerprints Identify miR-150 as a Plasma Prognostic Marker in Patients with Sepsis
BACKGROUND: The physiopathology of sepsis continues to be poorly understood, and despite recent advances in its management, sepsis is still a life-threatening condition with a poor outcome. If new diagnostic markers related to sepsis pathogenesis will be identified, new specific therapies might be developed and mortality reduced. Small regulatory non-coding RNAs, microRNAs (miRNAs), were recently linked to various diseases; the aim of our prospective study was to identify miRNAs that can differentiate patients with early-stage sepsis from healthy controls and to determine if miRNA levels correlate with the severity assessed by the Sequential Organ Failure Assessment (SOFA) score. METHODOLOGY/PRINCIPAL FINDINGS: By using genome-wide miRNA profiling by microarray in peripheral blood leukocytes, we found that miR-150, miR-182, miR-342-5p, and miR-486 expression profiles differentiated sepsis patients from healthy controls. We also proved by quantitative reverse transcription-polymerase chain reaction that miR-150 levels were significantly reduced in plasma samples of sepsis patients and correlated with the level of disease severity measured by the SOFA score, but were independent of the white blood counts (WBC). We found that plasma levels of tumor necrosis factor alpha, interleukin-10, and interleukin-18, all genes with sequence complementarity to miR-150, were negatively correlated with the plasma levels of this miRNA. Furthermore, we identified that the plasma levels ratio for miR-150/interleukin-18 can be used for assessing the severity of the sepsis. CONCLUSIONS/SIGNIFICANCE: We propose that miR-150 levels in both leukocytes and plasma correlate with the aggressiveness of sepsis and can be used as a marker of early sepsis. Furthermore, we envision miR-150 restoration as a future therapeutic option in sepsis patients
Advanced age is associated with worsened outcomes and a unique genomic response in severely injured patients with hemorrhagic shock
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