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Since generics and biosimilars have entered the Russian market of medications, there are new trends in the general picture of drug prices and consumption. In the present study, we analyze these trends to enable the prediction of possible savings or redistribution of funds in the area of anticancer drug supply, with a special view on highly expensive medications. The aim of this study is to identify changes in the market prices and consumption of medications for the treatment of solid tumors. Materials and methods . We analyzed the dynamics of prices and consumption rates of eight international non-proprietary names (INN) of anticancer drugs, whose generics or biosimilars entered the Russian pharmaceutical market in 2010-2018. Results. With an overall downward trend in prices, differences between individual drugs become apparent with time of joint circulation in the market. The rates of increase/decrease in the prices of the reference drugs that circulate together with generics/biosimilars for at least 4 years, have changed from -50 to +22%; for the respective generics/biosimilars, the figures ranged from -35 to -69%. After generics/biosimilars have entered the market in the Russian Federations, the consumption of the INNs have been increasing, but again with different paces for different drugs. Conclusion . With a general downward trend in prices and an increase in consumption of anticancer medications, there are significant differences in this dynamics as far as individual INNs are concerned. Additional studies are needed to identify factors having an impact on the prices and drug consumption of INNs after their generics/biosimilars have become available. For example, the number of original drugs with expired patent protection may be important. Without a good understanding of such factors, it is difficult to predict the size of savings and the possibility of their redistribution within the budget framework.

According to the current legislation, the standards of medical care lay the ground for the development of a program on state guarantees (SGP) to deliver free medical care to the citizens. While this standard provides an opportunity for calculating the costs of implementing the SGP, the past experience indicates the need for changes to produce new standards that would consider the “completed treatment” factor. The article proposes approaches to updating the standards and improving the methodology of cost calculation. In addition, this analysis is expected to help optimize the cost of medical care in various clinical and statistical groups.

Integrated clinical and economic analysis of the efficiency of screening was made in patients with adrenal incidentalomas under the established practical conditions; the average cost of screening of a patient with adrenal incidentalomas and the cost of one detected case were determined under these conditions. Based on the clinical and economic analysis, the authors have elaborated and scientifically substantiated an algorithm for screening of patients with adrenal incidentalomas, the use of which will permit, with high clinical efficacy, a significant reduction in the cost of screening.На основе клинико-экономического анализа разработан алгоритм скринингового обследования пациентов с инциденталомами надпочечников. Проведена комплексная клинико-экономическая оценка эффективности скринингового обследования пациентов с инциденталомами надпочечников в условиях сложившейся практики, определены средняя стоимость проведения скринингового обследования больного с инциденталомой надпочечника и стоимость одного выявленного случая в условиях сложившейся практики. На основе клинико-экономического анализа разработан и научно обоснован алгоритм скринингового обследования пациентов с инциденталомами надпочечников, использование которого при высокой клинической эффективности позволит значительно сократить затраты на проведение скрининга.

Cost minimization analysis was performed on the basis of the efficacy and safety evaluation of dabigatran etexilate (DE, Pradaxa®) versus other common anticoagulants (AC). Total costs including laboratory and instrumental examinations, consultations related to venous thromboembolism (VTE) and post-operative anticoagulation therapy were calculated by the data of 828 individual registration cards. All patients were divided into 2 groups: 761 patients (91.9%) after total hip and knee arthroplasty (1 st group) and 67patients (8.1%) after other orthopaedic operations (2 nd group). In 1 st group costs for drug prophylaxis of VTE and total costs per patient were significantly lower (by 1196.66 and 432.41 rbl, respectively) when DE was used as compared to AC application. After other orthopaedic operations reliable differences neither in costs for drug prophylaxis of VTE nor in total costs per patient were detected. However the significance of obtained results was limited by the number as well as the differences in initial condition of patients.

There was a clinical and economic study of ustekinumab (stelara) as compared to etanercept (enbrel), infliximab (remicade) and adalimumab (humira) for treating patients with severe psoriasis. The clinical efficacy and safety of the biological drugs were analyzed, and estimated costs for their application as well as cost/efficacy ratio and cost efficacy increment were calculated. Advantages of ustekinumab vs. etanercept were demonstrated: the costs per one patient with severe psoriasis turned out to be less with the achieved positive effect. When the cost/efficacy ratio was calculated, the economic advantages of ustekinumab vs. infliximab were established beginning with Weeks 24-28 of the therapy (according to the results of individual studies, as early as beginning with Week 10 of the therapy). The economic advantage of ustekinumab vs. adalimumab increases by Week 52 of the therapy. The calculations of the cost efficacy increment proved that ustekinumab was more efficient than infliximab both in the short (Weeks 10-12 of the therapy) and long run (Weeks 50-52) and more efficient than adalimumab in the long run (Week 52 of the therapy).

Overactive bladder syndrome (OAB), accompanied by incontinence, is a relatively common disease. Currently, in the Russian Federation, unfortunately, management of patients with OAB includes the recommendations for symptomatic use of incontinence pads without pharmacotherapy. Along with this, the market is represented by a number of drugs that can reduce the occurrence of adverse symptoms associated with OAB syndrome. This study presents the pharmacoeconomic analysis of use of solifenacin for the treatment of patients with the OAB syndrome in Russia. Based on previous clinical studies, formal mathematical model for the development of OAB have been suggested, taking into account the concomitant symptoms (urinary incontinence), and complications (urinary tract infections, skin infections, depression and fractures). The model considers the direct medical and non-medical costs, as well as indirect social costs, arising from the traditional management of patients with OAB syndrome (no medication) and the use of solifenacin. As a result, it was found that the use of solifenacin is economically feasible option for the management of patients with OAB within 1 year, the difference in costs between these strategies per patient is 2,385 rubles. The use of solifenacin ceases to be a resource-saving if the cost of incontinence pads will reduced by more than half of the basic price included in the calculations, or if the effectiveness of solifenacin would be 15% lower than the value used in the basic model.

Peripheral arteries occlusive disease (PAOD) is a prevalent illness that needs improved pharmacological management, especially for patients not eligible for surgical revascularization. Prostanoids (alprostadil or iloprost) were shown to be effective in PAOD and critical limb ischemia (CLI) but are rather costly. The results of our pharmacoeconomic study (cost estimation based on randomized control trial results) showed that iloprost does not increase cost of treatment when only direct medical costs are taken into account. If indirect costs are included into the analysis iloprost saves up to 27 thousand rubles per patient. Clinical efficacy is still high. Thus iloprost is a better alternative than alprostadil for CLI.

The study was aimed at assessing feasibility of treatment of patients suffering from critical ischaemia of lower extremities with iloprost as compared to the basic therapy by means of pharmacoeconomic analysis. The findings of clinical studies and meta-analyses demonstrated that therapy with iloprost results in a pronounced clinical effect as compared with the basic therapy: significantly (p0.005) decreasing the number of amputations above the knee joint (23% versus 39%) and more frequently decreasing the size of trophic ulcers (in 49% of cases versus 26%). This provides maintenance of the ability to work in part of patients and a decrease in the frequency of hospitalization, which in its turn results in decreased costs of treatment and indirect expenses.. The results of the carried out study show that with due regard for only direct costs economy from treatment with iloprost would amount to 1,544,556 Roubles per 100 patients. With additionally taking into account of indirect costs economy from using iloprost as compared with basic therapy increases to 25,689,11 Roubles per 100 patients.

To estimate cost-effect efficacy of vasaprostan treatment of inpatients with arterial chronic obliteration (ACO) with critical ischemia of the lower limbs (Fonten stage III-IV).Case histories of 105 ACO patients with critical ischemia of the lower limbs (mean age 65 +/- 11.8 years) were analysed to compare efficacy and cost of the "typical practice" of hospital treatment of such patients with prognostic cost of basaprostan treatment using drug-cost modeling.The cost-effect analysis comparing efficacy of "typical practice" and vasaprostan treatment showed that in "typical practice" amputations of the limb are inevitable in 41% while vasaprostan treatment reduces the percentage of the operations to 8.6-12% (according to the literature); overall cost of the "typical" treatment for 105 patients reached 3,909,222 roubles while relevant prognostic cost of vasaprostan treatment made up 4,407,162-4,570,653 roubles. Thus, vasaprostan treatment is characterized by less expense per 1 case of the limb amputation prevention vs "typical practice".The models used demonstrated that vasaprostan treatment is more cost-effective than "typical practice".