Transcript Vorobyev_P_A_eng

P.A. Vorobyev
RSPOR president
Economy of Equity
and
Clinico-economic Analysis
of Drug Supply in Russian
Federation
Why do we need it ?
• The development of new lifesaving technologies and drugs
• Growth of the population needs
(aging, polymorbidity, knowledge
of people)
• Increased costs of health care
• Turbidity of information flow
The development of new life-saving
technologies and drugs
• ACE inhibitors eliminate hypertension, heart
failure, diabetic angiopathy
• Home (preventive, prophylaxis) treatment of
hemophilia by VIII factor allows to be healthy
• Recovery and long-term remission of most
oncohematological diseases – “target”
therapy (recovery of 80% of patients with
chronic lymphoid leukemia), bone marrow
transplantation
Alternative costs of health care
• Relatively inexpensive, but mass
treatment
• Widespread use of ineffective
drugs
• Using of extremely expensive, but
rare drugs
Alternative
costs
• 14 million benefit recipients will receive 1
phial of Korvalol costs 4.50 rubles a
month during the year (756 million rubles a
year),
OR
640 000 people, treated by “Trombo Acc”;
28 000 people, treated by Plaviks: all patients
with stenting
Alternative costs
4S research: Simvastatin 20-40 mg per day, 5,4 years,
NNT = 30 (to prevent 1 death),
11 (to prevent 1 cardiovascular event).
• 1 prevention of death coasts 1.36 million rubles
• 1 prevention of cardiovascular event coasts 498.9
thousand rubles
1 year of additionally saved life with use of Alteplase
compared with Streptokinase coasts 3,8 million rubles
One patient with mucopolysaccharidosis 9-15 million rubles a year
Construction of 1 km of the road from 300 million rubles up to 18 billion rubles
In Russia there is no understanding,
on what to spend or not to spend
money
The world community uses different
economic restrictions,
in particular –
Cost of Quality Adjusted Life Year
The ratio of budgets
•Government - 40%:
•insurance - 30%;
•budgets - 70%.
•Patients – 60%.
Only 10-15% of people are in
the reimbursement system
Drug Market in 2007
• Market size - 9 billion Euros.
• Market growth rate = + 12% in 2007.
• Forecast - +20-25% or 10 – 11 billion
Euros in 2008
(1 billion Euros – for a new program
«7 rare expensive diseases»)
Who makes decisions in Russia?
• Ministry of Health and its bodies – drug reimbursement
program, purchasing equipment within a national
project «Health», standards of medical care
• Federal Service on Standardization and Metrology –
Committee on Medical Technology 466: protocols of care
• Expert bodies: Formulary Committee (Lists of essential
medicines, negative list, orphan list, hospital model
formulary)
• Regional Formulary Committees (regional standards, lists
of medicines for benefit recipients)
• Formulary Committees and Hospital Quality Committees
(formularies, standards)
The basic principles of decisionmaking
• Evidence (examination of scientific
research)
• Economy (defining of acceptability and
feasibility threshold)
• Consensus (taking into account many
factors and interests of different target
groups)
• Ethics (absence of conflict of interest)
The status of vital importance
A medicine, without using of which in a
particular disease or in specific clinical
situation, the inevitable progression of
disease with the development of severe
complications, disabilities and self-limiting or
death will happen,
as well as drugs for treatment or prevention of
diseases, which are dangerous for social
surroundings
In conclusion – seven bedrock principles
• Equity – every medicine is available to everyone, who
needs it
• The minimum requirement is determined by
standards
• The list of essential medicines includes only drugs
with proven effectiveness
• Reference prices are set for all drugs, included in the
Lists of essential medicines
• Reimbursement – based strictly on the List of essential
medicines
• For rare diseases – a special program– financing and
logistics of delivery to the patient
• Monitoring, establishment of registers, scientific
analysis of the situation , transparency and openness
of the system