Transcript Слайд 1 - rspor.ru

Organization of Drug Supply
in Medical Service of Russian
Armed Forces in Peacetime
A.V. Rudakova,
Military Medical Academy,
St. Petersburg
M. J. Mudrov (1776-1831)
«Military medicine is an application of wellknown medical principles to military
people»
«Rationally framed
standard for consumption of
medical resources
in hospital is very important…
I am convinced from the experience,
that without certain rules
medical resources in hospital
often are spent needlessly …»
N.I. Pirogov (1810-1881)
«Military medical work and private aid
in the theater of war in Bulgaria and in the rear
of field army in 1877-1878 »
6,96 million people are on medical support
(military personnel– 1,15 million,
veterans – 0,91 million)
 187 hospitals (50 thousand beds), 125 outpatient
clinics
 Drugs – 25% of the funds, allocated for the purchase
of medical equipment property
The most significant are:
 Cardiovascular diseases: coronary heart disease (an
increase in the number of hospitalizations
in 2006 compared to 2003 by 37%), arterial
hypertension, cerebrovascular diseases
 Neoplasms
[Kartashov V.T. et al., 2007;
Miroshnichenko Y. V. et al., 2008]
Dynamics of drug consumption
Average
The
The volume per
capita
centraof
drug
Year lised consumption consumppurcha- compared tion in RF
ses, % to 2005, %
AF, rbl.
Average per
Average per
capita drug
capita drug
consumption consumption in
in RF, rbl.
RF, rbl. (public
(according to
funds )
the DSM
(according to
group)
the DSM group)
2005 31,3
100,0
258
1301
390
2006 50,2
123,1
318
1604
626
2007 48,8
155,6
402
1995
678
[Miroshnichenko Y. V. et al. // VMJ.- 2008.-№4, with changes]
«It is necessary to achieve a balance between the
the level of government commitment and the funding»
[V.V. Shappo // VMJ, 2008, №8, P. 4-11.]
Analysis of drug therapy
Evaluation of
consumption pattern
New drugs
Evaluation of clinical efficacy
and safety
Models
(decision trees, Markov models)
Сost-effectiveness analysis
Budget impact analysis
Formulary approval,
development of clinical recommendations
USA
(The Veterans Health Administration)

The VA provides a range of services to ~ 5,5 million
veterans and their dependents
156 hospitals, 711 outpatient clinics
The focus on prevention and on outpatient care
 “The Department of Veterans Affairs Pharmacy Plan
as a National model”
[C. Good et al. // Am.J. of Public Health.- 2007.- Vol. 97.- №12]
 The VA Formulary encourages the use of generic
drugs and lower-cost drugs
 The Formulary contains only 38% of drugs approved
by the FDA in the 1990's and 19% of drugs approved
since 2000
[American College of Physicians, 2008]
Cost-effectiveness of drugs
Drug
Indapamide ±
perindopril
Perindopril
Candesartan
Rosuvastatin
Perindopril
+indapamide
Omega-3 PUFAs
Perindopril
Eprosartan
Rosuvastatin
Clopidogrel
Patients
C/E,
th. €/
LYG
Arterial hypertension, 80 years old
0,7
Stable angina, diabetes mellitus, 60
years old
Heart failure, 65 years old,
intolerance to ACEI
After MI, 55 years old, men
3,7
Diabetes mellitus, 55 years old
6,8
After MI, 60 years old
Stable angina, 60 years old
After stroke, 65 years old
Stable angina, 75 years old, men
6,9
7,3
11,2
12,9
After ACS, 64 years old
21,7
5,2
6,3
How should formulary system work?
The formulary should be based on protocols of
care with a clear reference to groups of
patients and clinical states.
It is necessary to assess not only the costeffectiveness, but also the budget impact
The formulary is a basis of educational activities
for the implementation of highly effective medical
technologies, acceptable from an economic
standpoint
The system of medical support for
attached contingents in peacetime
(project)
Troops compulsory medical
insurance (CMI) fund
(contribution for each military)
Compulsory medical insurance
(CMI) fund
Military
personnel
Veterans, family
members, civil
staff of AF RF
Military medical institutions
The institutions of civil Health
Care service
Military medical facilities should become
full participants in the medical service market
[by V.V. Shappo, 2008]
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