Perspective for use of the radionuclide drugs in the treatment of malignant tumors in Russiaw

This article reviews perspective of the targeted radionuclide therapy (TRT) as one of the rapidly growing fields of nuclear medicine. The characteristics, features of action, advantages and disadvantages of the most used α- and β-emitters (223Ra, 213Bi, 225Ac, 211At, 89Sr, 90Y, 131I, 153Sm, 177Lu) are presented. New approaches based on the use of α-emitting isotopes in the treatment of castration-resistant prostate cancer with bone metastases, acute myeloid leukemia, melanoma, neuroendocrine tumors, and brain tumors are discussed. The importance of TRT in routine clinical practice is underlined. The use of targeted radionuclide therapy in clinical settings in our country should be expande

Pharmacology in special populations: extreme age

The article deals the definition, history of development in Russia, the main provisions, problems and prospects of development of pharmacology of extreme ages. The features of the nomenclature of medicines and the applicability of different dosage forms in different age periods are shown. Recommendations on rational use of medicines in patients of special populations — extreme ages are given. The risks of responsible self-treatment and polypharmacology are indicated. The data of international monitoring of drug safety in patients of extreme ages are presented. The article is addressed to pharmacologists, clinical pharmacologists, drug developers and doctors of medical specialties

Pharmacoeconomic comparison of the second generation insulin analogs and insulins on their base

Effective control of Diabetes Mellitus (DM) is an actual task from clinical and economic points of view. The second generation insulin analogs increase level of DM compensation without hypoglycemia. The economic aspects of their usage have been evaluated early, but it is still actual due to changes in prices and new data about clinical efficacy were published.Materials and methods: Clinical-economic comparison of insulin glargine 300 U/ml (iGla 300), insulin degludec (iDeg) and insulin degludec/ insulin aspart (iDegAsp) in the Russian conditions has been performed in naïve patients’ group as well as in the group of patients with previous insulintherapy. Number of patients with HbA1c <7 % was chosen as efficacy criterion. Direct and indirect costs (medications, treatment of CV-complications, GDP loses etc.) were indicated and calculated based on the constructed model.Results: iGla 300 can give an economy till 20 % for medication cost and till 10 % for direct medical expenditures in compare with iDeg in DM Type 1. For both patients’ groups iGla 300 can save 10-23 % of sources in compare with iGed and iDegAsp in DM Type 2. In DM2T iGla 300 had more efficacy and less cost in compare with iDeg in elderly patients with renal insufficiency.Conclusion: An effective control of DM with modern insulins is profitable from government position of payment due to decreasing expenditures for complications treatment

Pharmacoeconomic characteristics of agonists of receptors for glucagon-like peptide-1 and medicines on their base

The effective control of Diabetes Mellitus (DM) is an actual problem from optimal expenditures of health care system point of view. Agonists of receptors for glucagon like peptide-1 (aGLP-1) are one of the modern option for glycemia control in DM Type 2 and included in all current guidelines for the treatment control. The economic comparative aspects of the use of these drugs in the local conditions have not been studied. Materials and methods. Comparative economic evaluation of insulin glargine + lixisenatide (iGlaLixi), exenatide (Exe), dulaglutide (Dula), liraglutide (Lira) and combinations of their aGLP-1 with iGla 100 U has been performed base on published clinical data of efficacy. Number of patients with HbA1c <7 % was chosen as efficacy criterion. Non-direct comparison with Odds Ratio (OR) calculation was prepared. Direct and indirect costs (medications, treatment of CV-complications, GDP loses etc.) were indicated and calculated based on constructed model. Sensitivity analysis has been provided for validation of results. Results. Pharmacoeconomic analysis based on non-direct efficacy comparisons of iGlaLixi, Exe, Lira and Dula has shown of economic advantages of effective DM2T control. iGlaLixi has demonstrated economic advantages as well usage aGLP-1 only (direct costs decreasing vs Exe on 23,8 %, vs Dula on 15,6 %, vs Lira on 54,4 %) as their combinations with iGla 100 U (direct costs decreasing vs iGla 100 U + Exe on 23,8 %, vs iGla 100 U + Dula on 15,2 %). iGlaLixi decreased a total cost (direct and non-direct) better than Exe, Dula and Lira (on 19,9, 9,3 и 45,2 % accordingly). Conclusion. An effective control of DM2T with aGLP-1 and medicines on their base has an economic value because lead to expenditures for complications decreasing from government position

Review the results of pharmacoeconomic trials of antiplatelet drugs in the treatment of patients with acute coronary syndrome

The purpose of this literature review is to systematize and synthesis of the available data for the period 20132016 years of pharmacoeconomics evaluation on the application of modern antiplatelet agents in patients with acute coronary syndrome (ACS). Methods. We conduced search in PubMed system and RNITS keywords «pharmacoeconomis and ticagrelor», «cost-effectiveness and ticagrelor», «budget impact analysis and ticagrelor», «analysis and ticagrelor», «pharmacoeconomics and ticagrelor». The review considered approaches to modelling, identifying the main cost and performance criteria. Results. Based on our analysis of published from 2013 to 2016 years literature, it can be concluded that use of ticagrelor instead of clopidogrel in patients with ACS is the dominant technology in the world and Russian practice. The subject of the comparison is most often (81%) spoke of generic clopidogrel and the entire cohort of patients with ACS, without division into tactics of treatment (81%). In the structure of the published studies pharmacoeconomic prevails (95%) temporary retrospective focus of research with a long time horizon (more than 1 year - 88% of foreign studies). In conducting research using Markov modelling in 71% of cases and the analysis of «cost-effectiveness», 52% of researchers, all of them foreign, further analysed the «cost-utility». The cost analysis of 62% of the authors consider only direct medical costs account for 19% of direct medical costs and indirect costs. The main feature is the inclusion of Russian studies in the analysis of indirect costs is that foreign researchers are doing much less (only 17% of researchers). Conclusion. The analysis of pharmacoeconomic studies of ticagrelor can be recommended as a cost-effective method for the treatment of ACS patients, regardless of treatment strategy

Economic perspectives for effective control of diabetes mellitus type 2 with fixed combination of basal insulin analog and GLP-1 agonist

Fixed antidiabetic drugs’ combinations have aim to improve Diabetes Mellitus type 2 (DMT2) control as well as a safety treatment increasing. Soliqua SoloStar® is a new registered drug for control fasting and prandial glucose levels, contained insulin glargine 100 Ul/ml and lixisenatide. In the published non-direct comparison, it was more effective for DMT2 control vs insulin glargine 100 Ul/ml and lixisenatide separately, and daily insulin dose was less on 22 UI.Aim. To evaluate of Soliqua SoloStar® reasonability for inclusion from pharmacoeconomics point of view into the State program of the free medical Aid guarantees.Materials and methods. Retrospective comparative economic analysis based on published data an new methodology treatment with Soliqua SoloStar® in compare with the current treatment methodology with usage of insulin glargine and lixisenatide separately. Common used methodology of clinical-economic analysis was used, and target group of patients was established based on Federal Diabetes Register. Direct medical cost was defined as a cost of medications. Differentiation between direct medical cost for the proposed methodology and current practice of the separate usage of insulin glargine 100 Ul/ml and lixisenatide was calculated. Discounting at 5% annually used in the calculation of the 3 years’ time horizon. The results of health technology assessment are confirmed by sensitivity analysis. Microsoft Excel was used for calculation.Results. Calculation has been performed for two pens of Soliqua SoloStar® with different prices (Variation 1 and 2) in compare with different drugs of insulin glargine 100 Ul/ml and lixisenatide. Soliqua SoloStar® had less daily dose (by insulin glargine) on 22 UI vs free combination, and dose of lixisenatide was 20 mkg per day. Amount of patients who have reached HbA1c<7% was higher in Soliqua group vs free combination group on 29 % (95 % CI: 20,2-30,7; p<0,0001). Cost of daily dose in Variation 1 is 216,15 RUR., for Variation 2 — 172,48 RUR. In the same time cost of the free combination of insulin glargine 100 UI and lixisenatide is depended from trades name of the drug, while cost of lixisenatide per day is the same for free combination and has 158,8 RUR. Soliqua SoloStar® usage can decrease budget impact in comparison with free combination on 27,65-42,26 % (depending on cost of insulin glargine 100 UI from different manufacturers and Soliqua pen cost. Conclusion. Soliqua SoloStar® has pharmacoeconomics evidences to be included into the Governmental program of free medical Aid in Diabetes Mellitus type 2 patients

Pharmacoeconomic comparison of insulin glargine and insulin detemir in diabetes mellitus type 2

Second generation insulin analogue — insulin glargine 300 UI/ml (GLA-300) — can provide an effective control of Diabetes Mellitus (DM) with minimal risk of hypoglycemic events and prevent of cardiovascular complications or events (CVS). Pharmacoeconomic comparison of most used insulins — GLA-300 and detemir (IDet) has been based on indirect treatment comparison in DM Type 2. Materials and methods. Indirect treatment comparison was created according to published data of a real world evidence data for the treatment of DM Type 2 with GLA-300 and IDet, and common comparator — GLA-100 — has been used. Patients (%) who reached HbA1c target were indicated as an efficacy criteria. Odds ratios (OR) were calculated for clinical efficacy and severe hypoglycemia’s rate comparisons for GLA-300 and IDet. Direct (cost of annual treatment, hypoglycemia correction, CVS treatment), indirect medical costs as well as indirect costs (GDP loses) were calculated for GLA-300 and IDet strategies. Sensitivity analysis has been performed for confirmation of the base scenario results. Results. GLA-300 has advantages vs IDet by efficacy and less risks of severe hypoglycemia (OR 1.27 CI 95 % 1.02; 1.58 and OR 0.72 CI 95 % 0.56; 0.88 accordingly). Probability of good control of DM Type 2 (based on target of HbA1c<7.0 %) was higher on 27 % in GLA-300. Costs of insulins, expenditures for CVS treatment and payment for temporary disability were similar for GLA-300 and IDet groups (for the one-year treatment period), in the same time in GLA-300 group the less expenditures for hypoglycemia were observed. Total expenditures were slightly less for GLA-300 on 3.7 % vs IDet.Conclusion. GLA-300 and IDet have no economic advantages between groups in total costs, but GLA-300 has tended for economic benefi ts in compare with IDet in DM Type 2

Analysis of the structure of consumption of antiplatelet drugs in the Russian pharmaceutical market: 2014-2016

This article analyzes the volume of the Russian pharmaceutical market of antiplatelet drugs in the period 2014-2016. 80% of patients take clopidogrel generics, giving preference to Zilt®. Among the original drugs, the leaders of consumption are Plavix® and Coplavix® - in 2016 year 16%. In the structure of consumption of antiplatelet drugs, the share of original drugs as a whole account for about 60% of consumption in value terms, which is about 25% in packs. Clopidogrel generics (54% in value terms and 85% in natural terms) pass through the state segment, which means that most of the original drugs are purchased by patients through the retail pharmacy network, despite their high cost