Оптимізація фармацевтичного забезпечення пільгових дитячих категорій населення за умов реімбурсації вартості лікарських засобів

Abstract

Уперше на підставі результатів комплексних організаційно-правових, марке-тингових, медико-соціальних, статистичних та фармакоекономічних досліджень на-уково обґрунтовано підходи до оптимізації фармацевтичного забезпечення пільго-вих дитячих категорій населення, хворих на гострий простий бронхіт (ГПБ), шляхом розробки методичних засад формування заходів підвищення рівня його ефективнос-ті та доступності у разі надання фармацевтичної допомоги цим категоріям. На осно-ві багатокритеріальної кількісної та якісної оцінки позицій лікарських засобів (ЛЗ) розроблено рекомендації до формування основного та додаткового переліків анти-бактеріальних, противірусних, імуномодулювальних та муколітичних ЛЗ для фар-макотерапії ГПБ у дітей. Із використанням методу математичного моделювання ро-зроблено й опрацьовано методику прогнозування потреби в основних ЛЗ та обсягів реімбурсації вартості для фармакотерапії ГПБ у дітей раннього віку за адміністрати-вно-територіальними одиницями країни.

Впервые на основе результатов комплексных организационно-правовых, мар-кетинговых, медико-социальных, статистических и фармакоэкономических исследо-ваний научно обоснованы подходы к оптимизации фармацевтического обеспечения льготных детских категорий населения, больных острым простым бронхитом (ОПБ), путем разработки методических основ формирования мер, направленных на повыше-ние уровня его эффективности и доступности при предоставлении фармацевтической помощи данным категориям. На основе многокритериальной количественной и каче-ственной оценки позиций лекарственных средств (ЛС) разработаны рекомендации к формированию основного и дополнительного перечня антибактериальных, противо-вирусных, иммуномодулирующих и муколитических ЛС, предназначенных для фар-макотерапии ОПБ у детей. С использованием метода математического моделирова-ния разработана и отработана методика прогнозирования потребности в основных ЛС и объемов реимбурсации стоимости фармакотерапии ОПБ у детей раннего возраста для отдельных административно-территориальных единиц страны.

For the first time scientifically grounded methodical approaches to optimization of pharmaceutical provision of preferential children's categories of the population (PCCP), for example, children under the age of three, patients with acute simple bronchitis (ASB), under the conditions of introduction of reimbursement of the cost of drugs by developing recommendations for the formation of lists of major medicines and the forecasting of the amount of reimbursement of their cost using mathematical modelling. The paper presents the study of medical and social indicators among the children's population of Ukraine, the results of which have found that the most common pathology among children is the respiratory diseases (RD), whose share in the structure of the total morbidity is 68.7% and the prevalence of illnesses – 54.2%. One of the main nosologies that form children's incidence of RD is ASB, the incidence of which is highest in young children and according to data obtained at 2016, it takes 132.62 cases per 1000 children. The analysis of national standards and clinical guidelines made it possible to establish that ASB pharmacotherapy in young children is aimed at conducting etiological therapy using antiviral and immunomodulatory drugs (AIMD), and in some cases antibacterial drugs (ABD), and pathogenetic cough therapy involving the use of mucokinetic drugs (MD). Using the method of questionnaire survey of drug users and practitioners of pharmacy, we evaluated the current state of the pharmaceutical provision of children under 3 years of age on preferential terms, in order to identify the most problematic issues. According to the results of the survey, it was determined that the overwhelming majority of respondents consider the current system of reimbursement of the cost of pharmaceutical aid to the PCCP, including children under the age of 3 years, is ineffective and needs improvement. We proposed a model for assessing the current state of pharmaceutical provision of the PCCP, which includes three content modules: the study of morbidity and mortality due to illness among the child population; assessment of the current state of pharmaceutical provision of a separate PCCP; analysis of the state of financing the pharmaceutical supply of the PCCP by country's regions. Based on the results of the marketing analysis of the Ukrainian market of medicines for the treatment of RD in children, it was established that the assortment of ABD consists of 237 trade names from 16 pharmacotherapeutic subgroups, AIMD – 47 trade names from 9 subgroups and MD – 51 trade names from 5 subgroups. Domestic market of ABD and MD is more fully provided with foreign drugs. Instead, the segment of AIMD is main-ly represented by domestic drugs, the share of which in the overall structure is 59.6%. Based on the results of calculating the accessibility indicator, it was determined that in 2016 all investigated subgroups of MD were available to the population. The results of the analysis of the market for ABD and AIMB according to this indicator show a general decrease of its level during 2013-2015 for almost all subgroups of the drug-related drugs of the indicated segments, however, already in 2016, 89.0% of AIMB and 87.0% of ABD were positioned as available to the population. According to the results of a comprehensive clinical and economic analysis with the use of data of 551 medical cards of young children registered in the Kharkiv City Children's Outpatient Clinic with diagnosis of ASB, was formed a list of the most costly, vitally neces-sary and important medicines for pharmacotherapy for the indicated patients under the condi-tions of their ambulatory-polyclinic treatment. The list includes 38 international non-proprietary names of medicines from 24 pharmacotherapeutic groups, in the general structure of which the share of ABD is 21.1%, and the shares of AIMD and MD make up 10.5% each. First time ever, based on the systematization of the results of pre-conducted compre-hensive organizational-legal, marketing, medical-social, statistical and pharmaco-economic studies, we have developed and scientifically substantiated the recommended main and sec-ondary lists of ABD, AIMD and MD for the pharmacotherapy of ASB in young children. In the recommended list included 24 drugs (2 names of amoxicillin medicine, 3 amoxicillin preparations with clavulanic acid, 1 preparation of cefixime, 1 preparation of cefpodoxime, 1 preparation of clarithromycin, 5 preparations of azithromycin, 1 prepara-tion of inosine pranobex, 2 preparations of interferon alfa-2b, 6 preparations of ambroxol and 1 name of drugs acetylcysteine and carbocysteine), among which the domestic drug production in the aggregate is 20.8%. With the use of the method of mathematical modeling was proposed and worked out the method of forecasting the objective need in the drug and the amount of compensation of the cost of pharmacotherapy ASB in young children, which combines five interrelated stages. It is forecasted that in 2017 and 2018, the volume of reimbursement of the cost of consumed by young children, patients with ASB, preparations from the recommended main list and established that in the calculation per child the amount of compensation in 2017 will be 154.98 UAH, and in 2018 – 169.09 UAH. The socio-economic model of optimization of pharmaceutical provision for children under 3 years of age with ASB is developed and scientifically substantiated, which envis-ages the generalization of the results of the complex scientific researches and defines the directions of improvement of the existing system of pharmaceutical provision of the PCCP in the conditions of reimbursement of the cost of the drug.