PHP33 USE OF PHARMACOECONOMICS FOR CREATION OF THE STATE FORMULARY IN UKRAINE

Aprovat al Consell General del Consorci de desembre de 200

Multiple criteria decision analyisis for health technology assessment: scientific substantiation of criteria selection in Ukraine

Multiple-criteria decision analysis (MCDA) is a framework where multiple criteria are being considered in a well-structured manner during the decision-making process. This methodology is becoming increasingly popular for aiding and supporting health-care decision making. Defining the criteria is a critical stage in the process as it forms the foundation of MCDA. Our aim was to review information sources on the application of MCDA in practice in the world and to analyze the criteria included in the MCDA models. Research objects were MCDA reports and models from PubMed database. Research methods were system and content analyzes, data synthesis, generalization, extrapolation, statistical. We reviewed scientific publications and official documents of existing or proposed MCDA models. We identified the criteria and assigned them into nine groups: Economics, Disease description, Intervention description, Health gain, Feasibility, Prevalence, Evidence quality, Social and ethical factors and Other criteria. We looked at MCDAs which are aimed to be used for Reimbursement or Investment Decisions (86%) and for Authorization Decisions (14%). Of the reviewed 25 MCDA models aimed to support reimbursement decisions only 1 lacks cost-related criteria, while 7 scoring systems lack social and ethical factors and 12 MCDAs don’t mention epidemiology or classification of target groups directly. We found that none of the reviewed MCDAs used for authorization decisions mentioned socioeconomic criteria. There is no direct connection between the number of criteria included in MCDA models intended to support reimbursement decisions and the GDP per capita figures of countries. It can be seen that the selection of criteria has no standardized approach yet and most of the existing or proposed MCDA models were conducted to be relevant for decision-makers in the particular decision problems. The MCDAs supporting reimbursement decisions considered more criteria and the majority of them included economics and societal factors while most MCDAs intended to support authorization decisions only focused on the potential health benefits and outcomes. The most MCDA models included in our research were built in high-income countries

Overview of the pharmaceutical market of anticoagulants for the treatment of coronavirus disease (COVID-19) during marital state in Ukraine

The war in Ukraine has not changed the epidemic situation with coronavirus disease (COVID-19). Further, new cases of disease and death among the population are recorded every day. A large number of people in shelters and bomb shelters, in transport during the evacuation, increases the risk of infection. One of the main complications that occur in patients with COVID-19 is the formation of blood clots, which can lead to negative consequences and death of the patient, and therefore, at the present stage, the use of anticoagulants in the form of low molecular weight heparins plays a very important role in the hospital treatment of coronavirus disease. Heparin potentially has advantages over other anticoagulants for its not only anticoagulant but also anti-inflammatory properties (reducing lung inflammation and improving oxygenation) and also has potential antiviral properties. The purpose of our study was to analyze the availability and range of anticoagulants used to treat coronavirus disease (COVID-19) and post-COVID syndrome in Ukraine. The materials of our study were the data of the State Register of Medicines, the Compendium directory, the Register of wholesale selling prices for medicines and the prices for anticoagulants in Lviv pharmacies. We have analyzed the domestic market of low molecular weight heparins used for the treatment of coronavirus disease (COVID-19) and post-covid syndrome according to the international non-proprietary name, taking into account all forms of production, manufacturers and prices. It has been established that in the pharmaceutical market of Ukraine these medicines are represented by 9 trade names, which in turn are divided according to the amount of active substance in 1 ml of solution. Analyzing the manufacturing companies, it was found that more than half (52.6%) of the presented heparins were produced in Ukraine, and 47.4% of the trade names of drugs are imported. The state of supply and prices for low molecular weight heparins in pharmacies in Lviv was analyzed. It has been established that the pharmacies of the city are provided with a sufficient amount of these medicines, manufacturers and dosages are widely represented. Although the current number of active patients coronavirus disease (COVID-19) in Ukraine has decreased compared to 2021, there is still a large number of patients who are treated with anticoagulants after an illness as a preventive measure or rehabilitation. There fore, the provision of pharmacies with a wide range of anticoagulant drugs in sufficient quantity and variety of dosage plays an important role in providing pharmaceutical assistance to the population in full

Вивчення стану обізнаності фармацевтичних працівників щодо коронавірусної хвороби (COVID-19)

Aim. To analyze and summarize the results of a questionnaire on the state of awareness of pharmaceutical workers in the Western regions of Ukraine about the coronavirus disease (COVID-19). Materials and methods. The results of a survey of pharmacy managers, pharmacists and interns working in pharmacies in 8 regions of the Western area of Ukraine were used. The survey of respondents lasted 12 months: December 2021 – December 2022. A special questionnaire was developed to determine the level of knowledge about the coronavirus disease (COVID-19) caused by the SARS-CoV-2 coronavirus. Results and discussion. With the beginning of the full-scale invasion of the Russian Federation, COVID-19 practically disappeared from the information space and ceased to be an urgent issue for Ukrainians. However, in recent weeks, the Ministry of Health has recorded an increase in the number of hospitalizations due to the coronavirus disease. During the period of martial law and the coronavirus disease pandemic (COVID-19), the pharmacy is the most accessible healthcare institution for the population and ranks first in terms of the number of citizens’ requests for symptoms, methods of treatment and prevention of SARS-CoV-2, therefore, the awareness of pharmacists – practitioners about COVID-19 is very important to provide complete and high-quality pharmaceutical care to patients. A review of the specialized scientific literature over the past 5 years confirmed the lack of studies on the level of awareness of pharmaceutical workers about the symptoms, methods of diagnosis, treatment and prevention of the main diseases that are widespread in the Western regions of Ukraine. With the help of a questionnaire, we conducted an expert assessment of the level of knowledge of pharmacy managers, pharmacists and interns working in pharmacy institutions in 8 regions of the Western area of Ukraine regarding the main symptoms, methods of diagnosis, treatment and prevention of uncomplicated forms of the coronavirus disease (COVID-19). After analyzing the answers of the respondents, it can be assumed that pharmaceutical workers know the main manifestations of the coronavirus disease (COVID-19) and are oriented towards the threatening indicators of the patient’s condition. It causes concern that some respondents incorrectly determine the reasons for prescribing antibacterial therapy to a patient, which can lead to incorrect recommendations and advice during the implementation of pharmaceutical care, however, the introduction of electronic prescriptions for dispensing antimicrobial drugs and information and educational work with pharmaceutical workers should correct the situation. Conclusions. In our opinion, it is promising to conduct further research to improve the level of knowledge and competencies of pharmaceutical workers during their specialization courses and thematic improvement in the system of continuous professional developmentМетою роботи був аналіз та узагальнення результатів анкетування щодо стану обізнаності фармацевтичних працівників Західного регіону України про коронавірусну хворобу (COVID-19). Матеріали та методи. Використано результати анкетування завідувачів аптек, фармацевтів та інтернів, які працюють в аптеках 8-и областей Західного регіону України. Опитування респондентів складало 12 місяців: грудень 2021 – грудень 2022 року. Було розроблено спеціальну анкету для визначення рівня знань щодо коронавірусної хвороби (COVID-19), спричиненої коронавірусом  SARS-CoV-2. Результати та їх обговорення. З початком повномасштабного вторгнення Російської Федерації COVID-19 практично зник з інформаційного простору та перестав бути нагальним питанням для українців. Проте протягом останніх тижнів МОЗ фіксує зростання кількості госпіталізацій через коронавірусну хворобу. У період воєнного стану та пандемії коронавірусної хвороби (COVID-19) аптечна установа є найдоступнішим закладом охорони здоров’я для населення та виходить на перші місця за кількістю звернень громадян щодо симптомів, методів лікування та профілактики SARS-CoV-2, тому обізнаність фармацевтів-практиків щодо COVID-19 є дуже  важливою для надання повної та якісної фармацевтичної опіки пацієнтам. Огляд спеціалізованої наукової літератури за останні 5 років підтвердив відсутність досліджень рівня обізнаності фармацевтичних працівників щодо симптомів, методів діагностики, лікування та профілактики основних захворювань, розповсюджених у Західному регіоні України. За допомогою анкетування нами було проведено експертне оцінювання рівня знань завідувачів аптек, фармацевтів та інтернів, які працюють в аптечних установах 8-и областей Західного регіону України, щодо основних симптомів, методів діагностики, лікування та профілактики неускладнених форм коронавірусної хвороби (COVID-19). Проаналізувавши відповіді респонденті, можемо констатувати, що фармацевтичні працівники знають основні прояви коронавірусної хвороби (COVID-19) та орієнтуються у загрозливих показниках стану хворого. Викликає занепокоєння, що деяка частина опитаних некоректно визначає підстави для призначення антибактеріальної терапії хворому, що може призвести до неправильних рекомендацій та порад під час здійснення фармацевтичної опіки, однак введення електронного рецепта на відпуск протимікробних лікарських засобів та інформаційно-просвітницька робота з фармацевтичними працівниками має виправити ситуацію. Висновки. На нашу думку, перспективним є проведення подальших досліджень  для покращення рівня знань та компетентностей фармацевтичних працівників під час проходження ними курсів спеціалізації та тематичного удосконалення в системі безперервного професійного розвитку

Analysis of costs and results of assisted reproductive technologies in the world and Ukraine

Taking into account the demographic situation in Ukraine, the use of assisted reproductive technologies (ART) is an urgent task for increasing access to modern, expensive methods of infertility treatment. The aim of this study was to summarize the legislative requirements for the implementation of ART, the number of cycles, depending on the type, and the costs for ART in the leading countries of the world and in Ukraine. We showed, that most countries in Europe have budgetary financing for a certain number of cycles, while the medical restrictions and age requirements for parents are included. It was revealed that the highest costs for ART are in the USA, the lowest in Japan and Scandinavian countries. We calculated the rate of provision for IVF and ICSI cycles per 1 million population (Kart) and the countries were ranked into 3 groups. It was shown that Ukraine belongs to countries with a low indicator ‒ less than 500 cycles. Leading countries of Europe, which have government funding for ART (France, Germany, Sweden), are characterized by a high Kart. The need to increase budgetary financing for ART in Ukraine is shown. The cost analysis for ART according to official websites of private clinics was conducted in Ukraine. We established that the average cost per 1 cycle of IVF was 52 584 UAH, for 1 cycle of ICSI was 6 694 UAH. The calculated solvency adequacy ratio for IVF was 703, it indicates a low availability for the population, and for ICSI is 89, which in 7.9 more affordable for families. It was found that in 7 clinics there are no Internet pages, and on the websites of 12 clinics information on the cost of services is shown, without taking into account the use of drugs in the protocols of ART. According to the different approaches to informing on websites of the ART clinics, it is advisable to unify the information providing on the sites about the availability of cycles and the total costs for them to improve provision and access for patients. Therefore, it is important to increase the state funding for ART programs

Analysis of information providing for antihypertensive medicines according to the data of Ukrainian web services

The digitalization of the pharmaceutical field provides new opportunities to meet patient’s needs and to improve communications, which is important for pharmacies. According to the Law of Ukraine dated 17.09.2020 «On Amendments to Article 19 of the Law of Ukraine "On Medicines" regarding the implementation of electronic retail trade of medicinal products» and Article 81 of the Law of Ukraine «On Medicines» dated 28.07.2022), pharmacies were allowed to carry out electronic retail trade of pharmaceuticals on the condition that information about the right to online trade is entered in the Licensing Register for the manufacture of medicines The aim was the analysis and detailed study of the information content of sections of web services of pharmacies and web portals of Ukraine using the example of drugs for the treatment of arterial hypertension and substantiating the need for unification of information for patients. The basis of our analysis was information from 18 web services of pharmacy chains and 5 Internet portals for booking medicines. The analysis of the information support revealed that the most common filters for searching drugs for the treatment of arterial hypertension on resources were: medicine price scale, manufacturer, form of release and dosage. The results of the structural analysis of information showed that the following parameters are available on all sites and platforms: trade name of the medicinal product, price, form of release, dosage and quantity in the package. The information about the manufacturer is presented on 66% of pharmacy web services and 60% of web platforms. Only 28% of the pharmacy web services and 60% web platforms inform patients about the dispensing of prescription drugs. Identified differences in the information content of websites and web platforms require the unification of information for patients with arterial hypertension according to such parameters as: prescription leave; dispensing by e-prescription, with an emphasis on application features; the participation of pharmacies in social programs, especially reimbursement, which will contribute to the optimization of information and educational provision of patients for the rational use of drugs for chronic non-infectious diseases

Experience and perspectives of distance learning of pharmacists-interns in the system of continuous education

Modernization of the educational process at the postgraduate stage using modern computer technologies is extremely urgent. The purpose of the study was to analyze the experience of distance learning of pharmacists-interns at the department of Organization and Economics of Pharmacy, drug technology and pharmacoeconomics and to substantiate promising directions for conducting distance education of pharmacists. Methods – questioning, interviewing of pharmacists-interns, questionnaire development. A special questionnaire has been developed and the method of individual questioning has explored the possibilities of distance learning of the pharmacist-interns at the postgraduate stage. The questionnaire included the passport part: the age, the form of training of the pharmacist-intern, the former place of work; A special part on the questions blocks under study. A survey was conducted of 128 pharmacists-interns: 72 full-time study form and 56 people of external study form. The questioning was conducted by each individual pharmacist individually, so it can be considered independent. As a result of the survey, we found out that about 61% of the pharmacists-interns do not have previous experience in distance learning. However, 81.5% are ready to independently study the topics of interest to them on pharmaceutical topics: New drugs registered in Ukraine, rational use of medicines, pharmaceutical care and assistance, etc. 67% of the surveyed pharmacists-interns believe that knowledge control is better done after the development/study of each topic, and 33% is better at the end of the study of the thematic cycle. The optimal ways of conducting distance learning are established: two-way on-line interaction, publications on the educational program website, two-way interactive video. At the Department of the Organization and Economics of Pharmacy, the Technology of Medicines and Pharmacoeconomics, experience has been accumulated and a system for studying pharmacoeconomics has been created and activities conducted by the Ukrainian Department of UCOPOR. Considerable attention is paid to the use of information and communication technologies from pharmacoeconomics for distance learning on the basis of the home site from pharmacoeconomics (www.uspor.org.ua), and 6 instructional modules on pharmacoeconomics developed by teachers in cooperation with international specialists are available on the international website ISPOR in Ukrainian. Prospective directions of the further development of postgraduate education, taking into account the results of questioning of pharmacists-interns can be the development of distance learning technologies, which will be actively introduced both in the preparation of the pharmacists-interns, and for the pharmacists-trainees of the training cycles, thematic improvement. It is established that more than 80% of pharmacists-interns are ready to independently study the topics of interest to them on pharmaceutical topics: New drugs registered in Ukraine, rational use of medicines, Pharmaceutical care and assistance, Pharmaceutical cosmetology and Pharmaceutical legislation To control and evaluate the self-mastered material, 67% of interrogated interveners interviewed believe that it is advisable to conduct it after processing / studying each topic. It has been established that the optimal methods for conducting distance learning are: two-way on-line interaction, publications on the educational program site and two-way interactive video. Teachers of the Department of the Organization and Economics of Pharmacy, drug technology and pharmacoeconomics have developed a special distance learning program with pharmacoeconomics based on international modules, which is designed to provide knowledge and skills on the methodology of pharmacoeconomic research

Analysis of extemporal production trends in pharmacies for children

Medicines for children are insufficiently represented in pediatric dosages and appropriate dosage forms in the pharmaceutical market of Ukraine. Pediatricians are forced to prescribe children's medicines in dosages that are not available in the State Register of Medicines of Ukraine. Extemporaneously compounded medicines (ECM) are useful when a required dose or dose form is unavailable commercially, or is needed for individualised dosing. The aim of the study was to analysis a real data of the list of medicines which are produced in hospital and public pharmacies of Lviv region during 2020–2021. Methods. Content analysis of extemporal prescriptions for children, depending on the composition of the active pharmaceutical ingredient, dose and dosage form, comparative cost analysis of ECM and industrial medicines. In the hospital doctors prescribe ECМ in liquid forms (75%) – solutions for injection and in solid forms (25%) – dosed simple powders – 19%, dosed complex powders – 6%. It was determined the structure of ECM, which are produced in 6 studied pharmacies in 2020–2021. There are soft ECM 61.6% in dosage forms: ointments, creams, paste; liquid ECM are 28.3% in mixtures, solutions, mumbles; solid ECM are 8.3% in mono, combine powders, suppositories and 1.8% – other ECM: powders and nail polishs. There were highlighted unique recipes of ECM which analogues were not present in industrial dosage forms. We conducted analysis of the cost of children’s ECM in these pharmacies. It was determined that ECM cost were 40.5–305.6 UAH depending on the dosage form. The comparative analysis showed that ECM are in 2.2–4.9 times more cheaper for children compare with similar active ingredients in industrial medicines. ECMs are much more compliant for treatment in children and babies, they provide higher effect, safety, reduce dosing errors, especially at the inpatient stage, and continuation of therapy on an outpatient basis and more cost-effective for individual needs. The use of ECMs allows parents to properly dose them for children, to avoid errors in dosing, improper administration, which is extremely important to ensure the rational use of medicines in pediatric practice