Transcript Equity and Access to Health Care in Russia

Equity and Access to
Health Care in Russia
Professor Pavel Vorobyev, MD, PhD
Oleg Borisenko, MD
Russian Society for Pharmacoeconomics and
Outcomes Research
Agenda
• Equity and access to medical care in
Russia
• Equity and access to common
medicines
• Equity and access to high-cost
medicines
• Reforms in health care: how can they
affect the access to drugs?
Auto-Run
Moscow - Baikal
24.07-16.08 2008
16 000 kilometers by car
looking for equity in
health care
On the side – emblems of
RSPOR и ISPOR
From
Europe
to Asia
and
back
Rare minutes of rest on the salt lake Tuz
General problems of access to
medical care (1)
Difficulties of physical access
(big distances, traffic on roads in big cities,
concentration of medical technologies in
several administrative “centers”, absence
of primary care physicians and
paramedics)
General problems of access
to medical care (2)
The needs of population for health
care are unknown : the need for cardio
surgery, oncology, hematology,
hemodialysis, transplantation,
orthopedics, orphan drugs etc., is in
several times (25-30) higher than
actually performed workload
General problems of access to
medical care (3)
• The low level of health care
financing – 11-15 billion
dollars on drugs for 145 million
people
General problems of access to
medical care (4)
• The availability of medical care to
vulnerable citizens is not
discussed: prisoners, military
personnel, nonresidents, poor
citizens, homeless
Russian health care market
(expert opinion)
• Government financing (budgets, obligatory
insurance) – no less than 25 bill. EUROS
• Patient expenditures (data of Ministry of
Health – except “grey” schemes and private
sector) is about 10 bill. EUROS
• Experts: patients spend in fact 1,2-1,5 times
more money than government, it is about
30-35 bill. EUROS
• TOTAL: health care services and
pharmaceuticals market in Russia is about
55-60 bill. EUROS
Access to common medicines (1)
• Less than 10-15% of population has an access to
reimbursement
• Financing lists include 20% of drugs with proven
ineffectiveness and with unproven effectiveness; costs are
the greatest in the reimbursement system
• Many drugs, which are included in the reimbursement
system, are not available in hospitals
• Pharmaceutical market of BAA is growing – about 1 billion
$ in 2008 биодобавки позиционируются как лекарства и
вытесняют их с рынка
• Self-treatment is widespread (including antibiotics,
hormones, etc.)
• In 2007 people spent 7.2 billion U.S. dollars on drugs
Access to common medicines (2)
• Since 1990-s – each region has been spending money
on drugs for “special categories of people”, programs
vary significantly from region to region
• Since 2000 – one List of Drug on the basis of List,
developed by the Formulary Committee
• Since 2004 – new federal drug reimbursement
program (DLO) – divides population covered with
reimbursement into 2 groups.
• The first group is financed from state budget, the
second one – from regional budgets. Since 2005
“federal” group may “take money instead of drugs”, it
has resulted in a 70%-decrease of program
participants number – about 4% of Russian population
The program for socially significant
diseases – diabetes mellitus,
tuberculosis, HIV-AIDS ,
hypertension, mental diseases,
oncology. Basically money are
spent on equipment, educational
programs. Money on drugs - from
regional budgets and other
sources.
Access to expensive,
rare used (orphan)
medicines
Access to rare used (orphan)
medicines
• Since 2008 a new program - «7 rare expensive
diseases» - was extracted from DLO program and
received extra money
• Since 2008 patients with hemophilia, cystic fibrosis,
hypophysial nanism, Gauche disease, myeloleukemia
and other hemoblastosis, disseminated sclerosis,
condition after transplantation have more access to
treatment
• 2 bill EUROS for 2 years
• New program covers 17 the most expensive drugs:
Somatropin, Glatiramer acetate, Interferon beta-1a,
Interferon beta-1b, Bortezomib, Imatinib, Rituximab,
Fludarabine, Imiglucerase, Dornase alfa, Mycophenolic
acid, Mycophenolate mofetil, Tacrolimus, Ciclosporin,
Antihemophilic factor VIII, Octocog alfa, Antihemophilic
factor IX, Eptacog alfa (activated)
• Program will be completed in 2009, perspective is
The number of patients with expensive diseases to
01.01.2008, applications were submitted and drugs were
purchased for them
Nosology
The total
number of
benefit
recipients
Hemophilia
7109
Cystic fibrosis
1380
Hypophyseal nanism
2254
Gaucher disease
151
Myeloid leukemia
13583
Multiple sclerosis
11328
Transplantation of organs
and tissues
10088
Total:
45 893
At the end of 2008, the program involves about 49 000 patients
Factor VIII concentrate supply in Russia,
IU
per
capita
3,5
3,2
3
2,5
2
1,63 1,6
1,5
1
0,788
0,5
0
0,205 0,212 0,219
0,144
0,095
0,054 0,065 0,039 0,063
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
RUSSIAN HEMOPHILIA SOCIETY
National member organization of the
World Federation of Hemophilia
HIV-AIDS (1)
• By the end of 2006, the Russian Federation had
cumulatively registered 373 259 HIV cases and
3507 AIDS cases. These numbers exclude 8083
HIV cases reported among foreigners as well as
16 929 unconfirmed cases among children born
to HIV infected mothers.
• The cumulative number of registered deaths
among people living with HIV was 19 269.
http://www.euro.who.int/aids/ctryinfo/overview/20060118_36
http://demoscope.ru/weekly/2008/0337/reprod01.php
HIV-AIDS (2)
• In 2006, a total of 135 340 HIV/AIDS patients
received medical care, including medical follow
up and treatment related to concomitant
disease.
• By December 2006, a total of 14 681 PLHIV had
initiated HAART of which 1430 dropped out of
treatment in 2006.
• By December 2007, a total of 31 094 people had
initiated HAART in the Russian Federation.
http://www.euro.who.int/aids/ctryinfo/overview/20060118_36
http://demoscope.ru/weekly/2008/0337/reprod01.php
HIV-AIDS (3)
• In 2007 the average number of 13-20%
registered patients in Russia was adopted as an
indicator of the adequacy of coverage by ARV
therapy.
• Currently feature of HIV infection in Russia is the
rapid increase in the number of patients, who
need antiretroviral (ARV) therapy, because the
largest number of HIV cases was registered in
1999-2001.
http://demoscope.ru/weekly/2008/0337/reprod01.php
Reimbursement drug list for HIVAIDS 2008
• Abacavir
(also in combination),
• Atazanavir,
• Darunavir,
• Didanozin,
• Indinavir,
• Zidovudin
(also in combination),
• Lamivudin
(also in combination),
• Lopinavir/ ritonavir,
• Nevirapin,
• Ritonavir
(also in combination),
• Sacvinavir,
• Stavudin,
• Telbivudin,
• Phosamprenavir,
• Phosphazid,
• Entecavir,
• Enfuvirtid,
• Efavirenz,
• Nelfinavir
Reimbursement
for oncological drugs
Drug List:
Subsidiary Drug
Supply System
(DLO)
• Anastrozole
• Kapecitabin
• Paclitaxel
• Temozolomid
• Trastuzumab
• Imatinib
• Rituximab
Program “7 expensive
diseases”:
bortezomib,
imatinib,
rituximab,
fludarabin
Market of drugs used for malignancies
Рынок онкологических препаратов в стоимостном
выражении, 2003 – 2006 гг.
130
800
98
Млн
долл.
millions
USD,
700
600
120
100
80
500
400,2
400
60
40
174,1
300
200
140
790,5
23
142,0
20
0
100
0
-20
2003
2004
USD
2005
Increase,USD
%
Прирост
2006
%%
Increase,
Прирост,
900
Соотношение секторов рынка онкологических препаратов
Hospital, retail
and DLO(USD),
sales of drugs used for malignancies
в стоимостном
выражении
Patients
coasts increased from 75.3 mln USD to 133.5 mln
2003
– 2006 гг.
USD
2006
2005
16,9
17,8
30,0
31,3
0%
38,7
54,5
45,5
53,6
46,4
2004
2003
65,3
20%
40%
Retail
Розничный
сектор
60%
80%
Hospital
Госпитальный
сектор
100%
DLO
ДЛО
Top-10 drugs used in oncology, 2007
Costs
Packs
Gleevek (imatinib)
9,33 %
Viferon (interferon)
13,60 %
Eprex (epoeitin α)
5,47 %
Methyluracil
12,16 %
Cycloferon
10,54 %
Vobenzym (combination of
enzymes)
4,13 %
Velcade (bortezomib)
4,12 %
Cyclophosphane
7,24 %
Viferon (interferon)
4,03 %
Interferon
6,65 %
5,54 %
Mabtera (rituximab)
3,63 %
Vobenzym (combination of
enzymes)
Zometa (zolendronic acid)
3,63 %
Grippferon (interferon)
4,47 %
Herceptin (trastuzumab)
3,29 %
Methotrexate
2,80 %
Arimidex (anastrozole)
3,02 %
Doxorubicin
2,72 %
Avastin (bevacizumab)
2,41 %
Tamoxifen
2,31 %
Reforms in health
care: how can they
affect the access to
drugs?
Reforms
• There are no real reforms in health care
not (over the past decade – no any fundamental
law on health care)
• The concept of the pharmaceutical industry
development – focus on profitable drugs (even
with questionable effectiveness), without taking
into account the needs of society and patients
• There is no clear vision for health development
What is necessary?
• The establishment of reference prices
• A unified list of essential medicines –
priority of financing
• Distribution of reimbursement on all
population
• Federal financing for rare, expensive
drugs
• Other logistics of the delivery of medicines
to patients
Acknowledgement
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Vlasov V. V.
Danishevskiy K.D.
Kornysheva E.A.
Saversky A.V.
Vorobiev A.P.
Aleinikova I.B.
Karev A.
Pletnev R.I.
Novikova J.V.
Svetlakova D.S.
Suleimanov C. S.
Baturin V.A.
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Vezikova N.N.
Avksenteva M.V.
Andrushenko E.V.
Basistova A.A.
Denisov A.U.
Kopylov K.G.
Kostikova O.M.
Kotenko O.N.
Litvinov A.B.
Nikitin E.A.
Ostrovskaya E.V.