Pub Date : 2023-11-10DOI: 10.17749/2070-4909/farmakoekonomika.2023.200
V. G. Radchenko, V. B. Grinevich, E. S. Ivanyuk, L. B. Lazebnik
Background. Ferritin is an important integral and diagnostic marker of liver diseases. In 1/3 of patients with nonalcoholic fatty liver disease (NAFLD), manifestations of hyperferritinemia are revealed. Increased ferritin level indicates the severity of the disease course and affects the prognosis. Objective: to determine the prevalence and character of hyperferritinemia manifestations in NAFLD patients and to evaluate the effectiveness of its correction with human placenta hydrolysate. Material and methods . We examined 158 patients aged from 20 to 63 years (92 men and 66 women). There were no significant differences in age between men and women. The control group consisted of 20 practically healthy individuals. Molecular mechanisms of peptide components of human placenta hydrolysate (Laennec®) impact on pathophysiological processes of serum ferritin disorders, iron metabolism indicators, and inflammation manifestations were analyzed. Results. Nineteen peptides potentially important for regulation of iron homeostasis were identified in Laennec® composition. These peptides contribute to the elimination of iron metabolism disorders by regulating the levels of hepcidin (the main hormone of iron homeostasis), reducing ferritin synthesis, as well as exhibiting anti-inflammatory, and immunomodulatory effects. The efficacy of the drug monotherapy in patients with hyperferritinemia was shown. Conclusion. Laennec® was found to be one of the medicines contributing to the reduction of hyperferritinemia manifestations, iron metabolism disorders, and systemic inflammatory process in NAFLD.
{"title":"The role of ferritin in liver disease assessment","authors":"V. G. Radchenko, V. B. Grinevich, E. S. Ivanyuk, L. B. Lazebnik","doi":"10.17749/2070-4909/farmakoekonomika.2023.200","DOIUrl":"https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.200","url":null,"abstract":"Background. Ferritin is an important integral and diagnostic marker of liver diseases. In 1/3 of patients with nonalcoholic fatty liver disease (NAFLD), manifestations of hyperferritinemia are revealed. Increased ferritin level indicates the severity of the disease course and affects the prognosis. Objective: to determine the prevalence and character of hyperferritinemia manifestations in NAFLD patients and to evaluate the effectiveness of its correction with human placenta hydrolysate. Material and methods . We examined 158 patients aged from 20 to 63 years (92 men and 66 women). There were no significant differences in age between men and women. The control group consisted of 20 practically healthy individuals. Molecular mechanisms of peptide components of human placenta hydrolysate (Laennec®) impact on pathophysiological processes of serum ferritin disorders, iron metabolism indicators, and inflammation manifestations were analyzed. Results. Nineteen peptides potentially important for regulation of iron homeostasis were identified in Laennec® composition. These peptides contribute to the elimination of iron metabolism disorders by regulating the levels of hepcidin (the main hormone of iron homeostasis), reducing ferritin synthesis, as well as exhibiting anti-inflammatory, and immunomodulatory effects. The efficacy of the drug monotherapy in patients with hyperferritinemia was shown. Conclusion. Laennec® was found to be one of the medicines contributing to the reduction of hyperferritinemia manifestations, iron metabolism disorders, and systemic inflammatory process in NAFLD.","PeriodicalId":36464,"journal":{"name":"Farmakoekonomika","volume":"118 27","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135137064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-10DOI: 10.17749/2070-4909/farmakoekonomika.2023.206
M. Imawari, M. Nagase, I. Yu. Torshin, O. A. Gromova
Objective: to evaluate the efficacy and safety of human placenta hydrolysate (HPH) Laennec® in the treatment of nonalcoholic fatty liver disease (NAFLD) in a clinical trial. Material and methods. The study involved hospitalized NAFLD patients (with non-alcoholic steatohepatitis, cirrhosis) (n=34, mean age 53±14 years). In the therapy group (n=17), patients received Laennec® HPH (4 ml intravenous drip infusion in a solution of 5% glucose 5 times a week for 2 weeks). In the control group (n=17), patients hospitalized in other departments of the clinic did not receive any therapy for NAFLD. The effectiveness of therapy was assessed after 2 and 3 weeks by subjective NAFLD symptoms (fatigue, anorexia, bloating, constipation, nausea, and pain in hypochondrium) and biochemical indicators of liver function: levels of blood serum aspartate aminotrans-ferase (AST), alanine notransferase (ALT), gamma-glutamyltransferase (GGT). Results . At the start of the study, there were no significant differences between the groups in the values of the studied indicators of liver function: blood levels of AST, ALT, GGT, etc. By the end of Week 1, a significant decrease in AST levels was registered in the group receiving Laennec® (–35 U/l; control: –8 U/l; p<0.001), ALT (–45 U/l; control: –10 U/l; p<0.001), and GGT (–23 U/l; control: –8 U/l; p=0.084; trend). At the end of the study (Week 3), the decrease in AST, ALT and GGT levels towards the normal range was even more pronounced for all three biomarkers: AST (–62 U/l; control: –23 U/l; p<0.001), ALT (–78 U/l; control: –20 U/l; p<0.001), GGT (–40 U/l; control: –15 U/l; p=0.005). Subjective NAFLD symptoms significantly improved after 3 weeks. No adverse effects were identified with the use of HPH. Conclusion . Laennec® is an effective and safe treatment for NAFLD.
{"title":"An open-label, controlled trial of the clinical effects of Laennec® in patients with nonalcoholic steatohepatitis or cirrhosis","authors":"M. Imawari, M. Nagase, I. Yu. Torshin, O. A. Gromova","doi":"10.17749/2070-4909/farmakoekonomika.2023.206","DOIUrl":"https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.206","url":null,"abstract":"Objective: to evaluate the efficacy and safety of human placenta hydrolysate (HPH) Laennec® in the treatment of nonalcoholic fatty liver disease (NAFLD) in a clinical trial. Material and methods. The study involved hospitalized NAFLD patients (with non-alcoholic steatohepatitis, cirrhosis) (n=34, mean age 53±14 years). In the therapy group (n=17), patients received Laennec® HPH (4 ml intravenous drip infusion in a solution of 5% glucose 5 times a week for 2 weeks). In the control group (n=17), patients hospitalized in other departments of the clinic did not receive any therapy for NAFLD. The effectiveness of therapy was assessed after 2 and 3 weeks by subjective NAFLD symptoms (fatigue, anorexia, bloating, constipation, nausea, and pain in hypochondrium) and biochemical indicators of liver function: levels of blood serum aspartate aminotrans-ferase (AST), alanine notransferase (ALT), gamma-glutamyltransferase (GGT). Results . At the start of the study, there were no significant differences between the groups in the values of the studied indicators of liver function: blood levels of AST, ALT, GGT, etc. By the end of Week 1, a significant decrease in AST levels was registered in the group receiving Laennec® (–35 U/l; control: –8 U/l; p<0.001), ALT (–45 U/l; control: –10 U/l; p<0.001), and GGT (–23 U/l; control: –8 U/l; p=0.084; trend). At the end of the study (Week 3), the decrease in AST, ALT and GGT levels towards the normal range was even more pronounced for all three biomarkers: AST (–62 U/l; control: –23 U/l; p<0.001), ALT (–78 U/l; control: –20 U/l; p<0.001), GGT (–40 U/l; control: –15 U/l; p=0.005). Subjective NAFLD symptoms significantly improved after 3 weeks. No adverse effects were identified with the use of HPH. Conclusion . Laennec® is an effective and safe treatment for NAFLD.","PeriodicalId":36464,"journal":{"name":"Farmakoekonomika","volume":"119 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135137229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-10DOI: 10.17749/2070-4909/farmakoekonomika.2023.211
S. K. Zyryanov, I. N. Dyakov
Objective: to evaluate the pharmacoeconomic efficiency of atezolizumab (inhibitor of programmed death ligand 1 (PD-L1)) in comparison with other checkpoint inhibitors (inhibitors of programmed cell death protein 1 (PD-1)) in patients with advanced non-small cell lung cancer (NSCLC) after previous chemotherapy in the current conditions of the Russian healthcare system. Material and methods. The study design was a retrospective analysis of publications and modeling. The previously performed pharmacoeconomic study was updated considering a decrease in the cost of pembrolizumab after the generic form was released on the market and actualization of calculated target population. Cost minimization analysis was carried out and the impact on the healthcare system budget was estimated when treating all NSCLC patients provided with PD-1/ PD-L1 inhibitors in the second and third lines of therapy with atezolizumab. For calculations, we used registered prices according to the state register of maximum selling prices and average weighted marginal wholesale markup according to the Federal Antimonopoly Service. Results. In the cost minimization analysis, atezolizumab showed greater clinical and economic efficiency, its use reduces costs by 28.6% over 3 years compared to nivolumab and by 8.8% compared to pembrolizumab in the second and third lines of NSCLC therapy. The budget impact analysis demonstrated that if all patients in the target group currently receiving various PD-1/PD-L1 inhibitors in the second and third lines of NSCLC therapy were initially provided with atezolizumab, it would reduce the budget load over 3 years by 11.6%, or by 722.4 mln rubles. Conclusion. The use of atezolizumab is pharmacoeconomically justified and feasible compared to nivolumab and pembrolizumab, even after a release of the generic version of the latter, and will reduce the costs of PD-1/PD-L1 inhibitors in the second and third lines of NSCLC therapy.
{"title":"Updated pharmacoeconomic analysis of atesolizumab efficiency compared with other PD-1 inhibitors in patients with advanced non-small cell lung cancer after chemotherapy","authors":"S. K. Zyryanov, I. N. Dyakov","doi":"10.17749/2070-4909/farmakoekonomika.2023.211","DOIUrl":"https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.211","url":null,"abstract":"Objective: to evaluate the pharmacoeconomic efficiency of atezolizumab (inhibitor of programmed death ligand 1 (PD-L1)) in comparison with other checkpoint inhibitors (inhibitors of programmed cell death protein 1 (PD-1)) in patients with advanced non-small cell lung cancer (NSCLC) after previous chemotherapy in the current conditions of the Russian healthcare system. Material and methods. The study design was a retrospective analysis of publications and modeling. The previously performed pharmacoeconomic study was updated considering a decrease in the cost of pembrolizumab after the generic form was released on the market and actualization of calculated target population. Cost minimization analysis was carried out and the impact on the healthcare system budget was estimated when treating all NSCLC patients provided with PD-1/ PD-L1 inhibitors in the second and third lines of therapy with atezolizumab. For calculations, we used registered prices according to the state register of maximum selling prices and average weighted marginal wholesale markup according to the Federal Antimonopoly Service. Results. In the cost minimization analysis, atezolizumab showed greater clinical and economic efficiency, its use reduces costs by 28.6% over 3 years compared to nivolumab and by 8.8% compared to pembrolizumab in the second and third lines of NSCLC therapy. The budget impact analysis demonstrated that if all patients in the target group currently receiving various PD-1/PD-L1 inhibitors in the second and third lines of NSCLC therapy were initially provided with atezolizumab, it would reduce the budget load over 3 years by 11.6%, or by 722.4 mln rubles. Conclusion. The use of atezolizumab is pharmacoeconomically justified and feasible compared to nivolumab and pembrolizumab, even after a release of the generic version of the latter, and will reduce the costs of PD-1/PD-L1 inhibitors in the second and third lines of NSCLC therapy.","PeriodicalId":36464,"journal":{"name":"Farmakoekonomika","volume":"120 14","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135136183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-10DOI: 10.17749/2070-4909/farmakoekonomika.2023.198
I. Yu. Torshin, O. A. Gromova, L. A. Maiorova
Background. The structure of corrin tetrapyrrole macrocycles (compounds similar in structure to vitamin B12) is a kind of universal chemical template for targeted drug delivery, and the development of chemical sensors and antidotes. Objective: systematization of information on targeted modulation of certain corrins’ properties through chemical modifications. Material and methods . Literature analysis using modern methods of topological and metric data analysis was carried out. All relevant publications (n=863) were extracted from the PubMed/MEDLINE database on request “(cobalamin OR Cobyrinic OR vitamin B12) AND (Molecular Conformation [MeSH Terms] OR Vitamin B 12/*analogs & derivatives/*chemistry [MeSH Terms] OR Vitamin B 12/*chemistry [MeSH Terms] OR Structure-Activity Relationship [MeSH Terms])”. Results. Information was systematized on how it is possible to regulate the properties of vitamin B12 (cobalamin) derivatives by introducing specific substitutions of groups in the corrin ring, on chemical modifications of cobalamin derivatives, biosynthetic approaches to the synthesis of cobalamin derivatives, and the effects of interactions of these modified corrins with “small” inorganic and organic molecules. Conclusion. The results obtained by systematic computer analysis of publications on corrins make it possible to reasonably form samples of candidate molecules for corrin studies in silico, in vitro, and in vivo.
背景。corrin四吡咯大环(结构类似维生素B12的化合物)是一种通用的化学模板，可用于靶向给药，开发化学传感器和解毒剂。目的:通过化学修饰有针对性地调节某些科林斯性质的信息的系统化。材料和方法。采用现代拓扑和度量数据分析方法进行文献分析。根据要求从PubMed/MEDLINE数据库中提取所有相关出版物(n=863)“(cobalamin OR Cobyrinic OR vitamin B12) AND (Molecular构象[MeSH术语]OR vitamin B12 /*类似物&衍生物/*化学[MeSH术语]或维生素b12 /*化学[MeSH术语]或构效关系[MeSH术语])”。结果。通过在钴胺环中引入特定的取代基团来调节维生素B12(钴胺素)衍生物的特性，对钴胺素衍生物的化学修饰，合成钴胺素衍生物的生物合成方法，以及这些修饰的钴胺素与“小”无机和有机分子相互作用的影响的信息进行了系统的整理。结论。通过对有关科林斯的出版物进行系统的计算机分析获得的结果，可以合理地形成候选分子样品，用于科林斯在硅、体外和体内的研究。
{"title":"The prospects for the use of vitamin B12 derivatives in pharmacology","authors":"I. Yu. Torshin, O. A. Gromova, L. A. Maiorova","doi":"10.17749/2070-4909/farmakoekonomika.2023.198","DOIUrl":"https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.198","url":null,"abstract":"Background. The structure of corrin tetrapyrrole macrocycles (compounds similar in structure to vitamin B12) is a kind of universal chemical template for targeted drug delivery, and the development of chemical sensors and antidotes. Objective: systematization of information on targeted modulation of certain corrins’ properties through chemical modifications. Material and methods . Literature analysis using modern methods of topological and metric data analysis was carried out. All relevant publications (n=863) were extracted from the PubMed/MEDLINE database on request “(cobalamin OR Cobyrinic OR vitamin B12) AND (Molecular Conformation [MeSH Terms] OR Vitamin B 12/*analogs & derivatives/*chemistry [MeSH Terms] OR Vitamin B 12/*chemistry [MeSH Terms] OR Structure-Activity Relationship [MeSH Terms])”. Results. Information was systematized on how it is possible to regulate the properties of vitamin B12 (cobalamin) derivatives by introducing specific substitutions of groups in the corrin ring, on chemical modifications of cobalamin derivatives, biosynthetic approaches to the synthesis of cobalamin derivatives, and the effects of interactions of these modified corrins with “small” inorganic and organic molecules. Conclusion. The results obtained by systematic computer analysis of publications on corrins make it possible to reasonably form samples of candidate molecules for corrin studies in silico, in vitro, and in vivo.","PeriodicalId":36464,"journal":{"name":"Farmakoekonomika","volume":"111 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135138391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-10DOI: 10.17749/2070-4909/farmakoekonomika.2023.210
A. S. Kolbin, Yu. M. Gomon, M. A. Proskurin, Yu. E. Balykina
Objective: to evaluate the clinical and economic effectiveness of alectinib in comparison with lorlatinib in adult patients with advanced anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC). Materials and methods. The calculations included the direct costs of the healthcare system: the costs of drug therapy, detecting and relieving adverse events, palliative care. A Markov model consisting of three patient states (“alive without progression”, “alive with progression”, “death”) was constructed, the probabilities of which were obtained from previously conducted clinical studies. Due to the equivalence of strategies regarding overall and non-progressive survival, the cost minimization analysis was applied. Results. The total costs per 1 patient when using lorlatinib were 40.63% higher than for alectinib (12,551,770 and 7,451,522 rubles, respectively). At the same time, the difference was mainly determined by different costs of targeted therapy: in the alectinib group, the cost of drug therapy per 1 patient amounted to 6,646,247 rubles, in lorlatinib group – to 11,922,814 rubles (44% higher). Conclusion. The use of alectinib in the treatment of patients with ALK-positive NSCLC is justified not only from clinical, but also from an economic point of view.
{"title":"Efficacy of alectinib in comparison with lorlatinib in patients with ALK-positive non-small cell lung cancer: pharmacoeconomic study","authors":"A. S. Kolbin, Yu. M. Gomon, M. A. Proskurin, Yu. E. Balykina","doi":"10.17749/2070-4909/farmakoekonomika.2023.210","DOIUrl":"https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.210","url":null,"abstract":"Objective: to evaluate the clinical and economic effectiveness of alectinib in comparison with lorlatinib in adult patients with advanced anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC). Materials and methods. The calculations included the direct costs of the healthcare system: the costs of drug therapy, detecting and relieving adverse events, palliative care. A Markov model consisting of three patient states (“alive without progression”, “alive with progression”, “death”) was constructed, the probabilities of which were obtained from previously conducted clinical studies. Due to the equivalence of strategies regarding overall and non-progressive survival, the cost minimization analysis was applied. Results. The total costs per 1 patient when using lorlatinib were 40.63% higher than for alectinib (12,551,770 and 7,451,522 rubles, respectively). At the same time, the difference was mainly determined by different costs of targeted therapy: in the alectinib group, the cost of drug therapy per 1 patient amounted to 6,646,247 rubles, in lorlatinib group – to 11,922,814 rubles (44% higher). Conclusion. The use of alectinib in the treatment of patients with ALK-positive NSCLC is justified not only from clinical, but also from an economic point of view.","PeriodicalId":36464,"journal":{"name":"Farmakoekonomika","volume":"120 13","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135136184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-10DOI: 10.17749/2070-4909/farmakoekonomika.2023.190
A. A. Taube, T. V. Alexandrova, O. A. Demidova, M. V. Zhuravleva
Background. The global recommendations for the treatment strategy of community-acquired pneumonia (CAP) include the empirical prescription of antibiotic therapy (ABT) – beta-lactams, fluoroquinolones, macrolides until the results of laboratory tests are obtained to identify the etiological agent responsible for CAP to determine etiotropic therapy. According to the national Russian clinical guidelines, macrolides, fluoroquinolones, cephalosporins and aminopenicillins are recommended for empirical prescription. Meta-analyses found better outcomes in patients treated with a combination of macrolides with beta-lactam compared to beta-lactam alone. At the same time, the clinical benefit of adding macrolides to beta-lactams for the empirical treatment of moderate CAP remains controversial, since the difference in the results of therapy may depend on the age and comorbid conditions of patients. Objective: to analyze the costs of treating CAP with various ABT strategies in order to optimize the cost structure of a medical organization and plan the budget of local healthcare systems. Material and methods. A retrospective epidemiological analysis of extracts from 157 medical records of middle-aged patients in accordance with the World Health Organization classification treated in multidisciplinary medical organizations was carried out. The methods included frequency analysis, cost of illness analysis, cost minimization analysis, and cost-effectiveness analysis. Depth of research was 2 years. Results. Frequency analysis revealed that the initial strategy of ceftriaxone and azithromycin combination (n=74; 47%) prevailed in prescriptions. In terms of the rate of prescriptions, ceftriaxone monotherapy (n=37; 24%) was in the second place. The analysis of the effectiveness of the selected ABT strategies showed that, in general, 113 (72%) of prescriptions were effective. Standard therapy strategies were equivalent in absolute costs and had a similar cost structure. Conclusion . Doctors’ adherence to national clinical guidelines for CAP treatment was found when prescribing the initial empirical ABT, the dominant strategies were identified. Cost of illness analysis demonstrated that the applied strategies were optimal in terms of cost minimization, and cost-effectiveness ratio. The costs structure in therapy with various ABT strategies did not have significant differences. In medical organizations, they adhere to the most rational and cost-effective strategy for CAP treatment and prescribe ABT regimens in each individual case based on risk factors, as well as the results of studies of CAP pathogens sensitivity.
{"title":"Retrospective pharmacoeconomic study of antibiotic therapy in community-acquired pneumonia","authors":"A. A. Taube, T. V. Alexandrova, O. A. Demidova, M. V. Zhuravleva","doi":"10.17749/2070-4909/farmakoekonomika.2023.190","DOIUrl":"https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.190","url":null,"abstract":"Background. The global recommendations for the treatment strategy of community-acquired pneumonia (CAP) include the empirical prescription of antibiotic therapy (ABT) – beta-lactams, fluoroquinolones, macrolides until the results of laboratory tests are obtained to identify the etiological agent responsible for CAP to determine etiotropic therapy. According to the national Russian clinical guidelines, macrolides, fluoroquinolones, cephalosporins and aminopenicillins are recommended for empirical prescription. Meta-analyses found better outcomes in patients treated with a combination of macrolides with beta-lactam compared to beta-lactam alone. At the same time, the clinical benefit of adding macrolides to beta-lactams for the empirical treatment of moderate CAP remains controversial, since the difference in the results of therapy may depend on the age and comorbid conditions of patients. Objective: to analyze the costs of treating CAP with various ABT strategies in order to optimize the cost structure of a medical organization and plan the budget of local healthcare systems. Material and methods. A retrospective epidemiological analysis of extracts from 157 medical records of middle-aged patients in accordance with the World Health Organization classification treated in multidisciplinary medical organizations was carried out. The methods included frequency analysis, cost of illness analysis, cost minimization analysis, and cost-effectiveness analysis. Depth of research was 2 years. Results. Frequency analysis revealed that the initial strategy of ceftriaxone and azithromycin combination (n=74; 47%) prevailed in prescriptions. In terms of the rate of prescriptions, ceftriaxone monotherapy (n=37; 24%) was in the second place. The analysis of the effectiveness of the selected ABT strategies showed that, in general, 113 (72%) of prescriptions were effective. Standard therapy strategies were equivalent in absolute costs and had a similar cost structure. Conclusion . Doctors’ adherence to national clinical guidelines for CAP treatment was found when prescribing the initial empirical ABT, the dominant strategies were identified. Cost of illness analysis demonstrated that the applied strategies were optimal in terms of cost minimization, and cost-effectiveness ratio. The costs structure in therapy with various ABT strategies did not have significant differences. In medical organizations, they adhere to the most rational and cost-effective strategy for CAP treatment and prescribe ABT regimens in each individual case based on risk factors, as well as the results of studies of CAP pathogens sensitivity.","PeriodicalId":36464,"journal":{"name":"Farmakoekonomika","volume":"118 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135136903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-09DOI: 10.17749/2070-4909/farmakoekonomika.2023.187
O. A. Gromova, I. Yu. Torshin, A. N. Gromov
Background. The enzymatic cofactor coenzyme Q10 (CoQ10) is involved in the synthesis of adenosine triphosphate in mitochondria. The CoQ10 biosynthesis declines when using statin drugs. Objective : systematization of the impact of coenzyme Q10 on chronic, sluggish systemic inflammation leading to the development of atherosclerosis, liver and pancreas pathologies, and neurodegeneration. Material and methods. Systematic computer analysis of 16,788 publications on CoQ10 found by the query “coenzyme Q10 OR ubiquinone” in PubMed/MEDLINE database of biomedical publications was carried out. Current methods of topological and metric data analysis developed at the scientific school of Academician of the Russian Academy of Sciences Yu.I. Zhuravlev were used. Results. CoQ10 is involved in the regulation of inflammation and exhibits lipid-lowering, hepatoprotective, nephroprotective, anti-asthenic, cardioprotective, and neuroprotective effects. CoQ10 favorably affects carbohydrate metabolism and a wide range of neurological diseases. Conclusion. CoQ10 supplementation improves glycemic control in insulin resistance, kidney function, and is useful in the treatment of migraine and neurodegenerative pathologies (Parkinson’s disease, etc.).
背景。辅酶辅酶Q10 (CoQ10)参与线粒体中三磷酸腺苷的合成。使用他汀类药物时，辅酶q10的生物合成下降。目的:系统化研究辅酶Q10对导致动脉粥样硬化、肝脏和胰腺病变以及神经变性的慢性、迟缓的全身性炎症的影响。材料和方法。对在PubMed/MEDLINE生物医学出版物数据库中通过查询“coenzyme Q10 OR ubiquinone”查询到的辅酶Q10相关文献16,788篇进行了系统的计算机分析。目前的拓扑和度量数据分析方法是由俄罗斯科学院院士yui的科学学院开发的。朱拉夫列夫被使用了。结果。辅酶q10参与炎症调节，并表现出降脂、保肝、保肾、抗衰弱、保心脏和保神经的作用。辅酶q10积极影响碳水化合物代谢和广泛的神经系统疾病。结论。补充辅酶q10可改善胰岛素抵抗、肾功能的血糖控制，并可用于治疗偏头痛和神经退行性疾病(帕金森病等)。
{"title":"Possibilities of using coenzyme Q10 for the treatment of diseases associated with mitochondrial dysfunction and chronic inflammation","authors":"O. A. Gromova, I. Yu. Torshin, A. N. Gromov","doi":"10.17749/2070-4909/farmakoekonomika.2023.187","DOIUrl":"https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.187","url":null,"abstract":"Background. The enzymatic cofactor coenzyme Q10 (CoQ10) is involved in the synthesis of adenosine triphosphate in mitochondria. The CoQ10 biosynthesis declines when using statin drugs. Objective : systematization of the impact of coenzyme Q10 on chronic, sluggish systemic inflammation leading to the development of atherosclerosis, liver and pancreas pathologies, and neurodegeneration. Material and methods. Systematic computer analysis of 16,788 publications on CoQ10 found by the query “coenzyme Q10 OR ubiquinone” in PubMed/MEDLINE database of biomedical publications was carried out. Current methods of topological and metric data analysis developed at the scientific school of Academician of the Russian Academy of Sciences Yu.I. Zhuravlev were used. Results. CoQ10 is involved in the regulation of inflammation and exhibits lipid-lowering, hepatoprotective, nephroprotective, anti-asthenic, cardioprotective, and neuroprotective effects. CoQ10 favorably affects carbohydrate metabolism and a wide range of neurological diseases. Conclusion. CoQ10 supplementation improves glycemic control in insulin resistance, kidney function, and is useful in the treatment of migraine and neurodegenerative pathologies (Parkinson’s disease, etc.).","PeriodicalId":36464,"journal":{"name":"Farmakoekonomika","volume":" 13","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135290719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-09DOI: 10.17749/2070-4909/farmakoekonomika.2023.195
A. D. Ermolaeva, T. N. Ermolaeva, K. A. Kokushkin
Objective: assessment of feasibility of using four-component drug therapy for patients with chronic heart failure with reduced ejection fraction (CHFrEF) in medical organizations of the Moscow Region (MR). Material and methods. Clinical and economic analysis of combined standard therapy with angiotensin-converting enzyme inhibitors, beta-blockers, and mineralocorticoid-receptor antagonists in combination with dapagliflozin (a sodium-glucose cotransporter 2) in the treatment of patients with CHFrEF was carried out. The effectiveness criteria were the number of prevented cardiovascular (CV) deaths and the percentage of the contribution to the achievement of the target indicator to reduce mortality from circulatory diseases within the framework of the regional program “Health care development”. In order to determine the economic feasibility of quadritherapy, direct medical costs for the implemented technology were calculated, the cost of one prevented CV death was determined based on the values of the number needed to treat (NNT) indicator. Budget impact analysis was performed which allowed to build two analytical models. Results . It was shown that the use of quadritherapy can significantly contribute to achieving the target indicator by additionally preventing 512 CV deaths by 2024, which will make it possible to fulfill up to 74.74% of the indicator set by the MR state program “Health care of the Moscow Region” (451.4 persons per 100 thousand population). Using quadruple therapy in 1000 target patients during the first year will prevent 11 CV deaths (NNT 90 persons). The cost of one prevented CV death was 3.860 million rubles. The budget impact analysis made it possible to determine that when CHF patients switch from standard treatment regimens to quadritherapy, including in combination with a drug of the angiotensin/neprilysin receptor inhibitor group (valsartan + sacubitril), this will entail an increase in healthcare system budget costs by 18.8%. Conclusion. The results demonstrate that the standard therapy in combination with the innovative drug dapagliflozin leads to a proven reduction in mortality from circulatory diseases. This technology is a cost-effective approach to organizing medical care for adult patients with CHFrEF on the MR territory.
{"title":"Clinical and economic assessment of feasibility of using quadritherapy in patients with reduced ejection fraction chronic heart failure in medical organizations of the Moscow Region","authors":"A. D. Ermolaeva, T. N. Ermolaeva, K. A. Kokushkin","doi":"10.17749/2070-4909/farmakoekonomika.2023.195","DOIUrl":"https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.195","url":null,"abstract":"Objective: assessment of feasibility of using four-component drug therapy for patients with chronic heart failure with reduced ejection fraction (CHFrEF) in medical organizations of the Moscow Region (MR). Material and methods. Clinical and economic analysis of combined standard therapy with angiotensin-converting enzyme inhibitors, beta-blockers, and mineralocorticoid-receptor antagonists in combination with dapagliflozin (a sodium-glucose cotransporter 2) in the treatment of patients with CHFrEF was carried out. The effectiveness criteria were the number of prevented cardiovascular (CV) deaths and the percentage of the contribution to the achievement of the target indicator to reduce mortality from circulatory diseases within the framework of the regional program “Health care development”. In order to determine the economic feasibility of quadritherapy, direct medical costs for the implemented technology were calculated, the cost of one prevented CV death was determined based on the values of the number needed to treat (NNT) indicator. Budget impact analysis was performed which allowed to build two analytical models. Results . It was shown that the use of quadritherapy can significantly contribute to achieving the target indicator by additionally preventing 512 CV deaths by 2024, which will make it possible to fulfill up to 74.74% of the indicator set by the MR state program “Health care of the Moscow Region” (451.4 persons per 100 thousand population). Using quadruple therapy in 1000 target patients during the first year will prevent 11 CV deaths (NNT 90 persons). The cost of one prevented CV death was 3.860 million rubles. The budget impact analysis made it possible to determine that when CHF patients switch from standard treatment regimens to quadritherapy, including in combination with a drug of the angiotensin/neprilysin receptor inhibitor group (valsartan + sacubitril), this will entail an increase in healthcare system budget costs by 18.8%. Conclusion. The results demonstrate that the standard therapy in combination with the innovative drug dapagliflozin leads to a proven reduction in mortality from circulatory diseases. This technology is a cost-effective approach to organizing medical care for adult patients with CHFrEF on the MR territory.","PeriodicalId":36464,"journal":{"name":"Farmakoekonomika","volume":" 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135290573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-09DOI: 10.17749/2070-4909/farmakoekonomika.2023.203
D. V. Fedyaev, F. S. Nikitin, T. N. Artamonova, S. A. Kovaleva, V. V. Omelyanovskiy
Background. Each constituent entity of the Russian Federation (RF) on the basis of the territorial programme of state guarantees of free medical care for citizens forms a tariff agreement (TA) on payment for medical care. Despite the list of requirements to the content and structure of the tariff agreement established by the decree of the Ministry of Health of the RF, there are significant differences among the regional tariff agreements in terms of content and completeness of the information provided. Objective: a comparative analysis of TA of the RF constituent entities and additional agreements to them to identify differences in their structure and content. Material and methods . To carry out the analysis, the data of TA for the full calendar year 2022 were systematised into a single database with the allocation of the main parameters regulated by legal documents. On the basis of the database, the availability and form of information presentation in the TA were analysed. Results. The differences were revealed, which can be divided into two groups. In the first group, they relate to the content and structure of TA; in the second group, to the presentation of TA in public domain. The differences are related to the information content of TA, details of tariffs for medical services, the presence or absence of tariffs for separate medical services, as well as the presentation and formats of TA files on the websites of territorial compulsory health insurance funds. Conclusion. To date, there are still a significant number of differences between TA of the RF constituent entities. The lack of unification in data presentation in the regions increases the risk of errors in comparative analysis, which may ultimately affect the correctness of its results presented to the authorities for decision-making in the health care sector. The new unified form of TA will make it possible to eliminate the above-mentioned differences in content and presentation by bringing the data to a single format.
{"title":"Analysis of tariff agreements of the constituent entities of the Russian Federation: form and completeness of data presentation","authors":"D. V. Fedyaev, F. S. Nikitin, T. N. Artamonova, S. A. Kovaleva, V. V. Omelyanovskiy","doi":"10.17749/2070-4909/farmakoekonomika.2023.203","DOIUrl":"https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.203","url":null,"abstract":"Background. Each constituent entity of the Russian Federation (RF) on the basis of the territorial programme of state guarantees of free medical care for citizens forms a tariff agreement (TA) on payment for medical care. Despite the list of requirements to the content and structure of the tariff agreement established by the decree of the Ministry of Health of the RF, there are significant differences among the regional tariff agreements in terms of content and completeness of the information provided. Objective: a comparative analysis of TA of the RF constituent entities and additional agreements to them to identify differences in their structure and content. Material and methods . To carry out the analysis, the data of TA for the full calendar year 2022 were systematised into a single database with the allocation of the main parameters regulated by legal documents. On the basis of the database, the availability and form of information presentation in the TA were analysed. Results. The differences were revealed, which can be divided into two groups. In the first group, they relate to the content and structure of TA; in the second group, to the presentation of TA in public domain. The differences are related to the information content of TA, details of tariffs for medical services, the presence or absence of tariffs for separate medical services, as well as the presentation and formats of TA files on the websites of territorial compulsory health insurance funds. Conclusion. To date, there are still a significant number of differences between TA of the RF constituent entities. The lack of unification in data presentation in the regions increases the risk of errors in comparative analysis, which may ultimately affect the correctness of its results presented to the authorities for decision-making in the health care sector. The new unified form of TA will make it possible to eliminate the above-mentioned differences in content and presentation by bringing the data to a single format.","PeriodicalId":36464,"journal":{"name":"Farmakoekonomika","volume":" 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135290720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-09DOI: 10.17749/2070-4909/farmakoekonomika.2023.208
I. S. Krysanov, E. V. Makarova, V. Yu. Ermakova
Background . In recent decades, a course of chemotherapy with etoposide (EP) and platinum preparations (сarboplatinum, CP) has been recommended as a standard first-line treatment option in patients with advanced small cell lung cancer (SCLC), but with the advent of new immunological drugs, immune checkpoint inhibitors, approaches to therapy have changed. Based on randomized clinical trials, courses combining traditional platinum-containing chemotherapy with inhibitors of programmed death-ligand 1 (PD-L1) atezolizumab (ATZ) or durvalumab (Durv) have been included in many clinical recommendations for oncologists. Objective: to evaluate the clinical and cost-effectiveness of using ATZ and Durv as first-line therapy in advanced SCLC adult patients within the Russian healthcare system. Material and methods. The model of treatment of advanced SCLC adult patients in conditions of the healthcare system of the Russian Federation included the most popular options for first-line immunochemotherapy: CP/EP + ATZ and CP/EP + Durv courses. Pharmacoeconomic cost-effectiveness analysis, sensitivity analysis of the selected model to changes in its initial parameters, budget impact analysis were carried out. Results. The total medical costs for CP/EP + ATZ course (2,310,546.07 rubles) were significantly lower than for the CP/EP + Durv course (4,081,833.98 rubles). With comparable costs for the treatment of complications (426,175.17 and 407,704.50 rubles, respectively), the cost of Durv exceeded ATZ by 94.8%. When conducting a cost-effectiveness analysis, the advantage was retained by the CP/EP + ATZ course, the cost-effectiveness ratios for which amounted to 187,849.27 rubles per month of patient's life and 444,335.78 rubles per month of patient's life without progression (for CP/EP + Durv, 316,421.24 and 800,359.60 rubles, respectively). When choosing the CP/ET + ATZ strategy, the savings will be 128,571.96 rubles per month of life and 356,023.82 rubles per month of life without progression. Sensitivity analysis demonstrated the stability of the developed model: to increase in the price of the CP/EP + ATZ course up to +68%; to decrease in overall survival with the course of CP/EP + ATZ up to –40%; to decrease in progression-free survival with the course of CP/EP + ATZ to –44%. Budget impact analysis showed that with a possible cohort size of 4,448 people an increase in the proportion of patients receiving CP/EP + ATZ course from 70% to 90% will reduce budget costs by 1,575,737,725.38 rubles per year, which will allow additional treatment of 681.9 advanced SCLC patients per year (+15.3%). Conclusion. The use of ATZ combined with standard platinum-containing chemotherapy in advanced SCLC adult patients as the first-line therapy is clinically and cost-effective strategy within the Russian healthcare system, as it allows to reduce therapy costs compared to Durv and treat more SCLC patients, which fully corresponds to the target indicators of the federal program “Oncol
{"title":"Comparative analysis of using atezolizumab vs. durvalumab in combination with platinum-containing chemotherapy in adult patients with advanced small cell lung cancer","authors":"I. S. Krysanov, E. V. Makarova, V. Yu. Ermakova","doi":"10.17749/2070-4909/farmakoekonomika.2023.208","DOIUrl":"https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.208","url":null,"abstract":"Background . In recent decades, a course of chemotherapy with etoposide (EP) and platinum preparations (сarboplatinum, CP) has been recommended as a standard first-line treatment option in patients with advanced small cell lung cancer (SCLC), but with the advent of new immunological drugs, immune checkpoint inhibitors, approaches to therapy have changed. Based on randomized clinical trials, courses combining traditional platinum-containing chemotherapy with inhibitors of programmed death-ligand 1 (PD-L1) atezolizumab (ATZ) or durvalumab (Durv) have been included in many clinical recommendations for oncologists. Objective: to evaluate the clinical and cost-effectiveness of using ATZ and Durv as first-line therapy in advanced SCLC adult patients within the Russian healthcare system. Material and methods. The model of treatment of advanced SCLC adult patients in conditions of the healthcare system of the Russian Federation included the most popular options for first-line immunochemotherapy: CP/EP + ATZ and CP/EP + Durv courses. Pharmacoeconomic cost-effectiveness analysis, sensitivity analysis of the selected model to changes in its initial parameters, budget impact analysis were carried out. Results. The total medical costs for CP/EP + ATZ course (2,310,546.07 rubles) were significantly lower than for the CP/EP + Durv course (4,081,833.98 rubles). With comparable costs for the treatment of complications (426,175.17 and 407,704.50 rubles, respectively), the cost of Durv exceeded ATZ by 94.8%. When conducting a cost-effectiveness analysis, the advantage was retained by the CP/EP + ATZ course, the cost-effectiveness ratios for which amounted to 187,849.27 rubles per month of patient's life and 444,335.78 rubles per month of patient's life without progression (for CP/EP + Durv, 316,421.24 and 800,359.60 rubles, respectively). When choosing the CP/ET + ATZ strategy, the savings will be 128,571.96 rubles per month of life and 356,023.82 rubles per month of life without progression. Sensitivity analysis demonstrated the stability of the developed model: to increase in the price of the CP/EP + ATZ course up to +68%; to decrease in overall survival with the course of CP/EP + ATZ up to –40%; to decrease in progression-free survival with the course of CP/EP + ATZ to –44%. Budget impact analysis showed that with a possible cohort size of 4,448 people an increase in the proportion of patients receiving CP/EP + ATZ course from 70% to 90% will reduce budget costs by 1,575,737,725.38 rubles per year, which will allow additional treatment of 681.9 advanced SCLC patients per year (+15.3%). Conclusion. The use of ATZ combined with standard platinum-containing chemotherapy in advanced SCLC adult patients as the first-line therapy is clinically and cost-effective strategy within the Russian healthcare system, as it allows to reduce therapy costs compared to Durv and treat more SCLC patients, which fully corresponds to the target indicators of the federal program “Oncol","PeriodicalId":36464,"journal":{"name":"Farmakoekonomika","volume":" 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135290721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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