With the rapid development of medical technologies, it has become clear that financial support for all medical developments is simply impossible. There is a need to conduct a serious assessment of the clinical, economic and social effectiveness of any technology before deciding on its future fate. The history of clinical and economic research begins in the 70s of the 20th century. Over the past 40 years, their importance has increased significantly and at the moment clinical and economic assessment is mandatory. In 1995, the non-profit International Society for Pharmacoeconomic Research (ISPOR) was organized, the main task of which was to ensure the rational use of limited resources in healthcare. IN Russian Federation The industry standard “Clinical and economic studies. General provisions"(OST 91500.14.0001-2002), which prescribes the methodology for such studies.

IN this standard stand out the following types clinical and economic analysis:

• 1. cost-effectiveness analysis (CEA), which compares the clinical results and economic costs of two or more interventions,
• 2. cost minimization analysis (CMA) - a special case of cost-effectiveness analysis, when two or more interventions are evaluated, with the same effectiveness and safety, but different costs,
• 3. cost-utility analysis (CUA) - in which the results of the intervention are presented in units of “utility” for the consumer medical care(used frequently integral indicator"years of quality life saved" - QALY),
• 4. Cost benefit analysis (CBA) assumes that the results of interventions should be presented in monetary terms.

Which analysis option is most appropriate for evaluating robot-assisted operations?

First of all, it is necessary to determine on the basis of what clinical data we will conduct the assessment. It all depends on the goals of the researcher and depending on them, it can be either retrospective data from one particular institution or the results scientific research(mainly RCTs, meta-analyses, systematic reviews). The first option is justified if the goal is to evaluate clinical economic efficiency exploitation of technology in a single organization. Based on the results of such a study, it is possible to make decisions on optimizing further work with this technology or even raise the question of the advisability of its further use in principle. Can also be developed practical recommendations for other organizations just starting to use the technology or at the stage of making a decision on its implementation. A serious limitation of the use of retrospective clinical data from a single institution is the virtually mandatory presence of systematic error in their collection and analysis. The organizational features of a particular institution, the level of professionalism of the staff, differences in the interpretation of the same facts, the scrupulousness and honesty of researchers in collecting and analyzing clinical results - all this is in highest degree influences the final results. To make an objective decision on more high level, national or regional, it is necessary to use data from RCTs, meta-analyses and systematic reviews. A big mistake could be accepting funding for a technology based on excellent results obtained in only one clinic, even a large and reputable one. In this situation, there is too high a risk that this technology will be deeply unprofitable in economically and not effective clinically.

Objective assessment The clinical and economic effectiveness of RCC is not fully possible precisely due to the lack of a sufficient number of good quality clinical studies. Based on the data presented in the previous chapter, we can reliably judge only that if the indications for robot-assisted interventions are followed, their results are no worse than those obtained with other methods. The superiority of using RHC has not been proven.

In this regard, the most appropriate method for assessing economic efficiency is cost minimization analysis (CMA). However, to assess the effectiveness of using RHC in a particular institution, we have the right to conduct cost-effectiveness analysis and cost-utility analysis.

Regarding the cost-utility analysis, it is worth mentioning separately. The use of the QALY indicator for robotic surgery of the pancreas, liver, and spleen does not have serious limitations and therefore is not used in studies. The patient’s quality of life after removal of part of the pancreas or liver will depend to the greatest extent on factors unrelated to the operating technique. Thus, for the pancreas, the volume of resection and the initial state of the pancreatic parenchyma will be of key importance, an objective quantitative assessment of which is virtually impossible. Thus, it is not possible to conduct a cost-utility analysis for the robotic surgeries that are the subject of our study. For the evaluation of other robotic interventions, such as RA prostatectomy, this analysis can be very useful. For this procedure, there is low-grade evidence of better recovery of erectile function and a lower percentage of patients with urinary incontinence, which has a direct impact on quality of life.

To assess the clinical and economic effectiveness of RA operations in abdominal surgery, the “cost minimization” analysis is most suitable.

To assess the clinical and economic efficiency of operating a chemical treatment system in a single organization, it is possible to perform a cost-effectiveness analysis.

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One of the most important areas in increasing the efficiency of medical care has become the optimization of costs while observing state guarantees providing citizens of the Russian Federation with free medical care. The basis for solving these issues was clinical economic analysis.

Clinical and economic analysis is understood as a methodology for comparative assessment of the quality of two or more methods of prevention, diagnosis, drug and non-drug treatment based on a comprehensive interrelated accounting of the results of medical intervention and the costs of its implementation. This methodology is applicable to any medical technologies: medicinal and non-medicinal treatment, methods of diagnosis, prevention and rehabilitation. In the field of drug supply, clinical and economic analysis is called “ pharmacoeconomics ».

Principles of clinical and economic analysis

The basic principle of clinical and economic analysis is that any medical intervention must be considered in comparison with an alternative, and when making a decision, preference is given to the one (or those) of them that achieve the optimal medical and economic result. Economic assessment the effectiveness of CVD treatment methods is based on clinical data obtained in studies carried out in accordance with the requirements of evidence-based medicine. Transparency and reproducibility of results should be considered important principles of clinical and economic analysis. It is imperative to adhere to an analytical position that reflects economic interests payer bearing the analyzed costs (state, society, medical insurance organization, patient, medical institution, charitable society, family members of the patient, etc.). The analytical horizon implies a time interval covering the main clinical and economic results of the treatment methods being studied.

Methods of clinical and economic analysis

Clinical and economic analysis is carried out using the following main methods:

cost-effectiveness analysis (CEA - cost-effectiveness analysis);

cost minimization (CMA - cost-minimization analysis);

cost-utility analysis (CUA - cost-utility analysis);

cost-benefit analysis (CBA - cost-benefit analysis).

Economic evaluation is carried out on the basis of data on results and costs obtained in the course of special clinical and economic studies or clinical and economic modeling.

results

When assessing the result of using the analyzed methods, they take into account effectiveness [for example, relieving an attack of angina, increasing left ventricular ejection fraction (LV)], efficiency, utility, profit or other parameters that are expressed in very specific units of measurement. The choice of the effectiveness criterion and the method of its measurement is carried out depending on the problem posed and the drugs being compared, as well as the method of clinical and economic analysis.

Expenses

Calculation of costs for each of the compared medical interventions includes financial expenses over a period of time, direct and indirect, medical and non-medical (required in connection with the disease) are distinguished. It is important to observe the rule of a single time slice: costs are determined simultaneously for all types of costs and in relation to a specific location of the study.

S.G. Gorokhova
Clinical and economic analysis in cardiology

1

Currently, in the context of the active introduction to the pharmaceutical market of new drugs with high pharmacological activity, the emergence of large quantity generics and a simultaneous increase in the number of adverse events with irrational combinations of drugs, there is a constant increase in the cost of pharmacotherapy. This leads to a serious increase in the cost of health care systems, which become an unreasonable burden on the budgets of even the richest countries. Clinical and economic (pharmacoeconomic) analysis can help in finding ways to optimize drug consumption. Methods for obtaining information for clinical and economic analysis: clinical studies, computer modeling, retrospective analysis of databases, or a combination thereof. Modern methodological approaches to conducting a comprehensive clinical and economic assessment of medical technologies during procurement in medical organizations should be based on an interrelated analysis of “cost and effectiveness” and “impact on the budget.” Since the key to a comprehensive clinical and economic analysis is the assessment of the cost of treatment, the methodology for its implementation is the domain of clinicians, pharmacists, economists and specialists who should be involved in work in medical organizations.

modeling

pharmacoeconomic analysis

medical organizations

procurement activities

clinical and economic analysis

1. Markun T.A. Clinical and economic analysis. – Access mode: URL: http://bono-esse.ru/blizzard/DM/ebm_y4.html.

2. Parkhomenko E. Pharmacoeconomics for pharmacists // Pharmaceutical Review. – 2003. - No. 7-8. – Access mode: URL: http://www.worklib.ru/laws/ml02/pages/10016396.php.

3. The concept of pharmacoeconomic analysis. – Access mode: URL: http://www.mospharma.org/?q=node/25.

4. Pharmacoeconomics: why, where and how to conduct pharmacoeconomic research? / D.Yu. Belousov, A.Yu. Kulikov, A.S. Kolbin et al. // Pharmacoeconomics. – 2010. – T.3, No. 2. – pp. 19-21.

5. Filippova I. Pharmacoeconomics: from the price of the drug to the price of the result // Remedium. – 2010. - No. 9. – P. 7-15.

6. Yagudina, R.I. Theoretical basis pharmacoeconomic method: analysis of “impact on the budget” / R.I. Yagudina, A.Yu. Kulikov // Pharmacoeconomics. – 2011. – T.4, No. 2. – P.9-12.

Currently, in the context of the active introduction of new drugs with high pharmacological activity to the pharmaceutical market, the emergence of a large number of generics and a simultaneous increase in the number of undesirable side effects with irrational combinations of drugs, there is a constant increase in the cost of pharmacotherapy. This leads to a serious increase in the cost of health care systems, which become an unreasonable burden on the budgets of even the richest countries. Clinical-economic (pharmacoeconomic) analysis can help in finding ways to optimize drug consumption - a relatively new area of ​​research, the need for which is determined by:

1. Rapid growth in the cost of treatment of the most common diseases and general increase in prices medical services;

2. The emergence of alternative methods of treatment (but not cure) for the same disease, when choosing which it is necessary to take into account not only their clinical effectiveness, but also cost;

3. The existing gap in all countries between the possibilities of financing high-tech and expensive treatment methods and the pace of their creation.

Such an analysis makes it possible to assess the clinical effectiveness of treatment in terms of the cost of treatment for society, healthcare institutions, in the context of clinic departments and individual patients. Clinical and economic analysis focuses on solving the question of how much the desired treatment outcome costs the patient, medical organization and (or) society.

Purpose of the study. Using clinical and economic analysis, justify the decision-making algorithm on inclusion or exclusion from the list of medications purchased by medical organizations.

Materials and methods. The research materials included regulatory legal acts of the Russian Federation in the field of procurement activities of medical organizations, works of domestic and foreign authors on pharmacoeconomics. The work uses methods of situational, logical, comparative and content analysis, and the method of analogy.

Results and discussion. Currently, when conducting clinical and economic research, several main methods are used: cost of illness analysis, cost minimization analysis, cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, budget impact analysis "and analysis of the 'willingness to pay threshold'. For a more complete clinical and economic assessment of new treatment methods at the stage of their implementation, the most significant is the joint use of cost-effectiveness and budget impact analysis methods.

Cost of illness analysis. The essence of the method is to calculate the costs associated with a particular disease without correlation with the results of treatment. In the Russian Federation, the true cost of treatment, prevention, and rehabilitation of a specific disease is not always known, and the amount of economic damage due to morbidity and mortality is often not calculated due to the complexity of data collection, therefore, studies performed using this method of analysis are of interest to health care organizers and society generally. At the same time, the data obtained can serve as the basis for further in-depth clinical and economic analysis. The Cost of Disease Analysis methodology is used by WHO to calculate the cost of the “burden of disease” to society through DALYs (Disability Adjusted Life Years). If we calculate the cost of all costs associated with a case of disease from the moment of its occurrence to the final resolution (recovery or death) or at a specific point in time, regardless of what stage the patient’s disease is at, then the data obtained can be considered as an independent method of analysis. Although analysis of the cost of illness does not refer to clinical and economic methods in its pure form, this method allows for more efficient planning of expenditure measures for a particular nosology.

Cost Minimization Analysis. Cost minimization analysis - determining cost preferences of different treatment regimens from the payer's perspective. Required condition, which must be strictly observed, is the same effectiveness of the compared alternatives. Criteria for assessing effectiveness can be different: either in the form of direct clinical parameters (blood pressure level, % cure, volume of diuresis, etc.), or in the form of an indicator of “years of life saved.” In practice, such interventions are assessed absolutely equally in terms of both effectiveness and safety and are rare. Results are expressed in monetary terms, calculated for all patients or for one patient with different group sizes, and preference is given to treatment with the lowest cost.

Cost-effectiveness analysis. This method is one of the most popular and most frequently used. Its essence is to determine the ratio of costs and obtained effectiveness in the compared methods of therapy. The cost-effectiveness ratio used for this purpose is the ratio of the cost of treatment to the achievement of an effectiveness indicator, which can be taken as, for example, the percentage of patients cured, years of life saved or deaths prevented. And the lower this ratio turns out to be, the less significant the costs incurred per unit of effectiveness, which means the use of the treatment method in question is more economical.

When comparing more expensive, but also more effective method treatments resort to “incremental analysis”, i.e. comparing the cost-effectiveness ratios of two treatment methods, with an understanding of how much additional you need to pay for the additional benefit of the compared therapy.

Cost-utility analysis is based on the definition of “utility”, the most applicable criterion of which is quality adjusted life years (QALYs) saved. In this type of analysis, the clinical effect of therapy is translated into the plane of its utility, which is understood as quantitative values ​​that reflect the subjective preferences of individuals (doctors, patients) regarding the outcomes or methods of treating the disease under conditions of uncertainty. Utility indicators are predictive in nature. This approach more closely reflects the patient’s “point of view” and the importance and value of medical intervention for him.

Budget impact analysis. This method of clinical and economic analysis allows you to evaluate possible savings or sum of money additional costs that should be taken into account in the budget for the next time period, after the start of using the “new product” in clinical practice.

The analysis of “budget impact” must correspond to the interests of the population, i.e. be based on information that realistically reflects the size of the population exposed to this disease, and currently used treatment regimens, the effectiveness and safety (in clinical trials) of new and current treatment methods, the use of resources and costs of using a high-tech treatment regimen. When conducting this analysis, the components of the analytical structure are the characteristics of the disease, methods of its treatment, and the consequences of using certain medical technologies. The purpose of this analysis method is not to specifically assess the budgetary impact of using a new medical technology, but to provide a reasonable model (computer structure) that allows users to understand the relationship between the entered parameters and possible consequences for the budget when introducing modern medical technology (or changing the use of existing ones).

The budget impact analysis compares scenarios that represent treatment regimens, i.e. consisting of a number of used medical technologies, rather than single technologies. Each script must contain information about the treatment regimen used in this moment, for selected groups and subgroups of patients. For comparison, scenarios should be modeled based on realistic, evidence-based proposals prior to comparison, and should take into account changes in existing treatment regimens as new medical technologies become available.

The budget impact analysis should be carried out in a time frame that is most appropriate for the budget recipient. Time constraints should be consistent with the budget planning process of the health system of interest, which typically occurs annually. However, the time frame can be extended in studies related to chronic diseases, because will reflect the effect that can be expected once a steady state is achieved if no further changes in the treatment regimen are anticipated.

The “willingness to pay threshold” analysis is an auxiliary tool for clinical and economic analysis that allows one to determine the financial acceptability of the drug under study for a specific healthcare system. The analysis of the “willingness to pay threshold” is based on a comparison of the willingness to pay threshold calculated for a given specific healthcare system with the resulting incremental cost-utility coefficient (incremental cost-effectiveness coefficient, in the case where efficiency is expressed by the indicator of the year of added life - Life years gained , LYG) for the studied drug. The willingness to pay threshold is the calculated reference value of the maximum recommended acceptable cost of a unit of drug efficiency.

Triple gross method internal product(GDP), recommended by WHO, defines the willingness-to-pay threshold as three times the gross domestic product per capita. This approach seems optimal for the Russian Federation, since it reflects the threshold of willingness to pay from the position of the state’s capabilities, since the healthcare system of the Russian Federation is state-owned. Thus, mathematically, the threshold of willingness to pay is expressed by the formula:

WTP=3xGDPpc, where

WTP - willingness to pay threshold, rub.;

GDPpc - GDP per capita, rub.

Results and discussion. In our country there is an industry standard “Clinical and economic studies. General provisions" (OST 91500.14.0001-2002), approved. Order of the Ministry of Health of Russia dated May 27, 2002 No. 163, which determines the procedure for conducting clinical and economic analysis, allowing to evaluate an intervention or technology based on comparing the effects of the following criteria:

1. Measured in natural units:

The frequency of deaths, life-threatening and disabling complications, the frequency of re-hospitalizations, etc.;

Duration of treatment;

Survival, mortality, etc.

2. Measured in conventional units of “utility”:

Healthy year equivalents (HYEs),

Disability adjusted life years (DALYs)

Returned years of full life (QULYs - quality adjusted life years), correlated with indicators in monetary terms.

Based on the analysis results international experience and domestic conditions of drug supply to the population, a model decision-making algorithm when planning drug purchases in medical organizations may look like this:

Conducting clinical and economic studies of alternative treatment regimens using one or another drug;

Making a decision on the purchase of drugs based on the obtained pharmacoeconomic assessment.

Clinical and economic assessment of drug technology can be carried out both in the conditions of a medical organization and according to data published by various authors of clinical and economic studies.

Conditions for positive decision on the purchase of medicines are:

Higher clinical effectiveness;

Higher cost-effectiveness ratio when comparing alternative schemes;

According to the results of the “budget impact” analysis, it does not require additional costs compared to alternatives;

The incremental cost-utility coefficient does not exceed the value of the accepted threshold of “willingness to pay”, calculated by the method of triple GDP per capita for last year for the region (Figure 1).

Fig. 1. Algorithm for making a decision on inclusion (exclusion) of drugs from the list of purchased drugs by the Moscow Region

The proposed algorithm was tested when deciding on the purchase of low molecular weight heparins for the orthopedic department of the hospital. Enoxaparin and bemiparin were compared for the effectiveness of treating thrombosis and thromboembolism after surgical interventions on the joints.

We used data from clinical and economic modeling of two strategies for treating venous thrombosis during knee replacement in a patient.

Table 1

Results of a comparative evaluation of two treatment regimens with low molecular weight heparins

The data in Table 1 indicate that the use of bemiparin is cost-effective compared to enoxaparin. Clinical and economic modeling revealed lower costs for bemiparin compared to enoxaparin in the prevention of venous thrombosis and embolism in patients in the orthopedic department. In addition, the use of bemiparin instead of enoxaparin will reduce healthcare budget costs Stavropol Territory by 26183.0 rubles per 100 patients.

It was also found that the “willingness to pay threshold” indicator is higher than the incremental cost-utility ratio and both drugs are financially acceptable for the region’s healthcare.

That's why by decision There may be a purchase of drugs with more optimal clinical and economic indicators, i.e. bemiparina.

conclusions. Thus, based on the above, we can conclude that modern methodological approaches to conducting a comprehensive clinical and economic assessment of medical technologies during procurement in medical organizations should be based on an interrelated analysis of cost-effectiveness and budget impact. Since the key to a comprehensive clinical and economic analysis is the assessment of the cost of treatment, the methodology for its implementation is the domain of clinicians, pharmacists, economists and specialists who should be involved in work in medical organizations.

Reviewers:

Denisenko O.N., Doctor of Pharmacy, Professor of the Department of Pharmacy of the Pyatigorsk Medical and Pharmaceutical Institute - a branch of the state budgetary educational institution higher professional education "Volgograd State Medical University" of the Ministry of Health of the Russian Federation, Pyatigorsk;

Gatsan V.V., Doctor of Pharmacy, Professor of the Department of Organization and Economics of Pharmacy of the Pyatigorsk Medical and Pharmaceutical Institute - a branch of the state budgetary educational institution of higher professional education "Volgograd State Medical University" of the Ministry of Health of the Russian Federation, Pyatigorsk.

Clinical and economic analysis is a methodology for the comparative assessment of two or more medical technologies (methods of diagnosis, prevention, treatment, rehabilitation) based on a comprehensive interrelated accounting of the results of their use and the costs of their implementation. The methodology of clinical and economic analysis is described in the OST “Clinical and economic studies. General provisions" (approved by order of the Ministry of Health of Russia

these from 05/27/02? 163). In relation to the drug component, the term “pharmacoeconomic analysis” is often used.

Clinical and economic analysis is a tool for selecting the most appropriate of several technologies that can be used in the same situation, based on a comparative assessment of their effectiveness and cost. The results of clinical and economic analysis are used in the formation of standards of medical care, formulary lists of drugs, determination priority areas healthcare development. The purpose of using clinical and economic analysis is the rational use of healthcare resources: obtaining the best result within the framework of a known (fixed) budget.

Highlight main (basic) And helper methods clinical and economic analysis. The main methods boil down to calculating the relationship between costs and results obtained. The results reflect the dynamics of clinical symptoms, demographic indicators, patient or societal preferences, including those expressed in money.

Analysis cost-effectiveness(English) cost-effectiveness analysis- CEA) is a type of clinical and economic analysis in which a comparative assessment of the ratio of costs and effect (result) is made for 2 or more medical technologies, the effectiveness of which is different, but the results are measured in the same units (indicators of clinical effectiveness or life expectancy as a result of the use of technology).

When conducting an analysis, for each medical technology, the cost-effectiveness ratio is calculated using the formula:

Where CER (cost-effectiveness ratio) is the cost-effectiveness ratio (shows the costs per unit of effectiveness, for example, how much does it cost to reduce blood pressure by 1 mm Hg); DC - direct costs; IC - indirect costs; Ef is the effectiveness of the use of medical technology.

When analyzing cost efficiency increments difference between costs 2 alternative options treatments are divided by the difference in their effectiveness:

Where: CER incr is an indicator of incremental cost efficiency (an incremental or marginal indicator of the ratio of costs and efficiency, which actually demonstrates what additional investments are required to achieve 1 additional unit of efficiency when using a more efficient technology); DC 1 - direct costs when using technology 1; IC 1 - indirect costs when using technology 1; DC 2 and IC 2 are, respectively, direct and indirect costs for technology 2; Ef 1 and Ef 2 are the treatment effects when using technologies 1 and 2, respectively.

Cost increment analysis is necessary only if technology 1 is more efficient than technology 2, but its costs are higher. If technology 1 is more efficient than technology 2 and its costs are lower, then technology 1 is dominant.

Analysis cost minimization(cost-minimization analysis - CMA)- a special case of cost-effectiveness analysis, in which 2 or more technologies are compared, having identical efficiency and safety, but different costs. It is recommended to use cost minimization analysis in a comparative study of the use of different dosage forms or different conditions of use of the same drug or the same medical technology (for example, the use of the same treatment regimen in inpatient and outpatient settings). This methodology is unacceptable when comparing generic analogues of drugs, since they are often not equivalent in therapeutic effect.

Analysis cost-utility (utilitarianism)(cost-utility analysis - CUA)- a variant of cost-effectiveness analysis, in which the results are assessed in units of “utility” from the point of view of the consumer of medical care. As an indirect criterion of utility, the patient’s quality of life and the indicator “quality-adjusted life years saved” are most often used. quality-adjusted life-years- QALY).

The calculation of the cost-utility ratio (utility) is made using a formula similar to the cost-effectiveness analysis, but instead of the efficiency values, the utility value is substituted:

Where CUR is an indicator of costs per unit of utility (utility), cost-utility ratio (i.e. cost of a unit of utility, for example, 1 year of quality life); CUR incr is an indicator of the increment in costs per unit of utility when comparing 2 technologies (utility), cost-utility ratio (i.e., the added cost of an additional unit of utility, for example, 1 year of quality life); DC 1 and IC 1 - direct and indirect costs for technology 1; DC 2 and IC 2 - direct and indirect costs for technology 2; Ut 1 and Ut 2 - utility for technology 1 and 2.

QALYs are most often used to assess utility.

Analysis cost-benefit(cost-benefit analysis- CBA), unlike previous options, involves assessing both costs and effectiveness (benefits, benefits) in monetary terms. This is the only option for truly economic analysis - “in its pure form”. It is recommended to present the results of a cost-benefit analysis in the form of a benefit-to-cost ratio:

BCR = B/C (8.5)

or the absolute difference between costs and benefits in monetary terms:

CBD = C - B, (8.6)

where BCR (benefit-cost ratio)- cost-benefit ratio; B - benefit (in monetary terms); C - costs; CBD (cost-benefit difference) is the absolute difference between costs and benefits in monetary terms.

For determining monetary value“benefits” from the use of medical technologies, several approaches are used: the “ human capital”, the “revealed preference” assessment and the “willingness to pay” assessment.

Auxiliary types of clinical and economic analysis include, first of all, analysis "cost of illness"(cost of illness - COI) is a method that involves the calculation of all costs associated with the management of patients with a certain disease at a certain stage (period of time) or at all stages of medical care. This analysis does not involve comparison of the effectiveness of medical technologies and is used to study the typical practice of managing patients with any disease. Historically, the first attempts at economic analysis in medicine were associated precisely with the calculation of the “cost of illness”; this analysis is widely used to solve certain problems, such as cost planning, determining tariffs for payments between subjects of the healthcare system and health insurance and so on. In some countries (eg, the United States), a “cost of illness” has been calculated for most diseases, and these calculations have been used to justify a system of diagnostic-related group standards; in other countries (in Europe), the “cost of illness” has been studied for the most common diseases.

In the context of Russian healthcare, calculating the “cost of illness” is necessary due to the fact that the costs of providing medical care to patients with many diseases have not yet been determined. Huge data on the “cost of illness” have been accumulated by health care organizations working in compulsory medical insurance system and especially - VHI, but these data are not analyzed and not published; it is likely that some of them are irretrievably lost.

At the same time, if you have access to this data, you should keep in mind their unreliability - doctors, health care managers in non-state, and often in state medical organizations, are engaged in prescribing services and medicines in order to “master” as large volumes as possible financial resources, A Insurance companies in most cases they have no influence on this process. At the same time, the volume of medical services and medicines is far from optimal.

ABC analysis- distribution (ranking) of individual medical technologies according to the share of costs for each of them in the overall cost structure - from the most costly to the least costly, distinguishing 3 groups. Group A includes technologies that account for 80% of the costs (naturally, the group contains 10-15% of all technologies used), group B includes technologies that required 15% of funds (up to 20-30% of the total) and group C - technologies, the costs of which amounted to 5% of the costs (usually more than 50% of the range under study). The method is used to determine priorities and the appropriateness of spending funds based on a retrospective assessment of real costs.

Frequency analysis- retrospective assessment of the frequency of use of a particular technology, which, in combination with taking into account the costs of each type of service,

gi or drugs makes it possible to determine which types of assistance account for the bulk of expenses - massive and cheap or rarely used but expensive.

VEN analysis- distribution of medical technologies according to the degree of their importance: V (vital) - vital, E (essential) - important, N (non-essential) - secondary (unimportant, insignificant).

All 3 analyzes complement each other and, as a rule, are carried out simultaneously. ABC and VEN analyzes were initially recommended to be used at the health care facility level to assess the cost structure and identify cases of irrational distribution of finances. For example, the predominance of secondary drugs (N) in group A is considered irrational. Based on the results of ABC, frequency and VEN analysis, it is possible to develop recommendations for the preparation and further improvement of a medical organization’s formulary or a list of preferential drug dispensing.

Modeling- a method of studying various objects, processes and phenomena, based on the use of mathematical (logical) models, which are a formalized description of the object being studied (patient, disease, epidemiological situation) and its dynamics when using medical technologies.

Discounting- the introduction of an adjustment factor when calculating costs (and sometimes efficiency) taking into account the influence of the time factor: costs to be incurred in the future are less significant than those incurred today, and, on the contrary, benefits acquired today are more valuable than those to come in the future.

Sensitivity Analysis establishes the extent to which the results of the study will change when the initial parameters change (for example, fluctuations in drug prices, changes in the frequency of side effects, etc.).

All the methods described above are not specific to clinical and economic analysis and are widely used in various types of epidemiological, economic and management studies.

Studies using basic methods of clinical and economic analysis are carried out mainly by research organizations and the Society for Pharmacoeconomic Research. In medical organizations, specialists more often use auxiliary methods: calculation of the “cost of illness”, ABC, frequency and VEN analyzes of the cost structure. In addition, medical organizations must be able to interpret the results of clinical and economic studies in order to use them to develop standards and formularies.