P.A. Vorobyev RSPOR president

Economy of Equityand

Clinico-economic Analysisof Drug Supply in Russian

Federation

Why do we need it ?• The development of new life-

saving 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),

OR640 000 people, treated by “Trombo Acc”;28 000 people, treated by Plaviks: all

patients with stenting

Alternative costs4S 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 decision-making  

• 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