Наукове обґрунтування фармакоекономічних підходів до лікування ентеритів вірусного походження у дітей за умов медичного страхування

Abstract

Дисертація присвячена комплексному фармакоекономічному обґрунтуванню підходів щодо удосконалення фармацевтичного забезпечення дітей, хворих на ентерити вірусного походження за умов впровадження в Україні соціального медичного страхування. Вперше Вперше Вперше Вперше обґрунтовано фармакоекономічні підходи щодо підвищення ефективності регідратаційної та допоміжної терапії дітям, хворих на ентерити вірусного походження, зокрема за умов впровадження в Україні соціального медичного страхування. Запропоновані науково-методичні рекомендації щодо удосконалення фармацевтичного забезпечення дітей, хворих на ентерити вірусного походження знайшли практичне використання у роботі Департаментів охорони здоров’я обласних державних адміністрацій, закладів охорони здоров’я, а також впроваджені в навчальний процес вищих навчальних закладів медичного та фармацевтичного профілю в Україні.

Диссертация посвящена комплексному фармакоэкономическому обоснованию подходов по совершенствованию фармацевтического обеспечения детей, больных энтеритами вирусного происхождения в условиях внедрения в Украине социального медицинского страхования. Впервые обосновано фармакоэкономические подходы по повышению эффективности регидратационной и вспомогательной терапии детям, больным энтеритами вирусного происхождения, в частности в условиях внедрения в Украине социального медицинского страхования. Предложенные научно-методические рекомендации по совершенствованию фармацевтического обеспечения детей, больных энтеритами вирусного происхождения нашли практическое применение в работе департаментов здравоохранения областных государственных администраций, учреждений здравоохранения, а также внедрены в учебный процесс высших учебных заведений страны.

The thesis is devoted to the complex pharmacoeconomic substantiation of approaches to improving the pharmaceutical providing of children suffering from enteritis of viral origin in the context of the introduction of social health insurance in Ukraine. As a result of the statistical analysis of the incidence of children with enteritis of viral origin, it has been established that the epidemiological situation in Ukraine can be characterized as complex, having regional specificity – each level of morbidity - "low", "high" and "very high" – includes 8 regions. A characteristic feature of the structure of morbidity is the significant dominance of patients aged from 1 to 4 years (up to 70%), which corresponds to the world trends of epidemiology of the pathology. There is a tendency of increasing of list of drugs (an average annual increase of 11,60%) that has been established using the methods of marketing analysis of the domestic market of drugs for the pharmacotherapy of viral enteritis. It is proved that the share of domestic drugs has increased from 49.07% in 2012 to 57.81% in 2016. The analysis of price availability of drugs for the wholesale pharmaceutical market of drugs used in the treatment of enteritis of viral origin in children, suggests a decreasing of their availability. There is a tendency for a significant decline in the availability rate (below 1) in 2014-2016 As a result of the socio-economic crisis. On average, the availability of domestic medicines was 0,93 and for foreigners – 0,87 for the period 2013-2016. It was determined that 13,43% of the total expenditures were spent on rehydration therapy, 37,39% for auxiliary therapy, and 48,50% for antibiotic therapy, using the method of ABC-analysis of drug consumption. The VEN-analysis has demonstrated the domination in the structure of the appointment of vital (V) and important (E) drugs (over 90%). The results of the ABC / VEN analysis showed that the highest proportion of expenditures have belonged to A / V – drugs (33.06%), which are characterized as high-value in the consumption index and belong to the group V. Pharmacoeconomic analysis by the "cost-effectiveness" method and the calculation of the "lost opportunity" coefficient have been conducted. It has been established that the application of technology based on a complex of regimens of oral rehydration therapy and diosmectitis ("Smecta") is the most expedient in terms of cost-effectiveness in the treatment of children suffering from viral diarrhea. Clinical and economic advantage of application of technology based on the complex of regimen therapy regimens and Bifidobacterium lactis ("Bifiform") has been proved. A new method for carrying out a pharmacoeconomic analysis by the "budget impact analysis" method for the treatment and vaccine prevention of enteritis of viral etiology in children has been developed and tested. It was established that the ratio of total expenses for the treatment of enteritis of viral etiology to the cost of vaccination will be between 1:30 and 1:10 in 2017-2018. An essential annual reduction in the cost of diarrhea pharmacotherapy in children with term the immunization of children with the antirotavirus vaccine had been proved. Insurance lists of drugs had been scientifically substantiated on the basis of complex researches - epidemiological, marketing, pharmacoeconomic and expert survey of pediatric doctors - infectionists, taking into account all types of pharmacotherapy of enteritis of viral origin in children. The proposed basic list contains 15 trade names of drugs, most of which are domestic (73%), and the additional list contains 14 drugs, the majority of foreign origin (57%). For the first time, a modeling of the estimated volumes of compensation for the cost of vaccination and pharmacotherapy of rotavirus infection for children under 2 years old in Ukraine and in all regions had been conducted. It was established that the estimated average amount of compensation for the cost of drugs for the treatment of rotavirus enteritis in children by the basic insurance list consists of 3560,853 thousand UAH or 134, 068 thousand $ USA in Ukraine in 2018 (for one patient – 281,49 UAH or 10,60 USD). The largest share in the predicted reimbursement of costs is observed for auxiliary therapy (63.47%), according to the types of pharmacotherapy. For the first time, pharmacoeconomic approaches to improving the efficiency of rehydration and auxiliary therapy for children with enteritis of viral origin were substantiated, in particular, in the context of the introduction of social health insurance in Ukraine. Proposed scientific and methodical recommendations for the improvement of pharmaceutical providing for children with enteritis of viral origin have found practical application in the work of Health Departments of regional administrations, health care institutions, and also have implemented into the educational process of higher educational institutions of the country.