PHARMACOECONOMIC ASPECTS OF BRONCHIAL ASTHMA TREATMENT


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Abstract

Relevance. The prevalence of bronchial asthma (BA) in the world reaches 300 million patients, accounting for 6.9% among adults. In clinical guidelines, the main criterion for the effectiveness of BA pharmacotherapy is symptom control with a decrease in the frequency of exacerbation of the disease. The search for clinically significant BA phenotypes is a promising tool for optimizing the pharmacotherapy of the disease in order to increase its effectiveness and reduce treatment costs. It seems promising to study the modes of pharmacotherapy of bronchial asthma taking into account phenotypic heterogeneity in order to calculate pharmacoeconomic indicators to increase the effectiveness of treatment.

Purpose. On the basis of a comprehensive pharmacoeconomic study, substantiate drug provision for patients suffering from bronchial asthma, taking into account the phenotype of the disease.

Materials and methods. The object of the study was 570 patients hospitalized in the pulmonary department of the ChUZ "Clinical Hospital" Russian Railways Medicine ", Voronezh". During the collection of material, 570 records of patients hospitalized with BA exacerbation were filled in. When analyzing the costs of therapy, ABC-VEN-analysis, frequency analysis, the method of “cost minimization” were used. Statistical processing of the results was carried out using Microsoft Excel (2010). The chi-square test and Fisher's exact test were used to assess the statistical significance of the differences. Differences were assessed as significant at p <0.05.

Results. In patients with bronchial asthma, a pharmacoeconomic assessment of therapy for exacerbation of the disease was carried out. Differences in the cost of one bed-day in patient groups were determined by a combination of drugs that included basic treatment (ICS / LABA) and additional therapy (mucolytics, short-acting beta-agonists, systemic glucocorticosteroids), the intake of which depended on the clinical course of the disease. The costs of BA pharmacotherapy depended on the disease phenotype (allergic BA, non-allergic BA, “late onset” BA, BA in obese patients). The study found that the cost of treatment increased by 17-20% in patients with a mixed BA phenotype. The results of the study showed that the formation of drug supply for BA patients should take into account the list of medical prescriptions, and the cost of the pharmacotherapy performed depends on the phenotype of the disease.

Conclusion. The obtained data make it possible to formulate the formulary of the pulmonary department in patients with asthma. This is necessary for planning budgetary funds for financing the therapy of BA exacerbation at the stage of hospital treatment. The continuation of the study is the development of a program for calculating the individual cost of pharmacotherapy depending on the severity of the disease, the duration of inpatient treatment, and the nature of concomitant pathology.

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RELEVANCE

The prevalence of asthma in the world reaches 300 million patients, accounting for 6.9% among adults [1]. In clinical guidelines, the main criterion for the effectiveness of pharmacotherapy for bronchial asthma (BA) is the control of symptoms with a decrease in the frequency of exacerbation of the disease [2]. For the basic therapy of bronchial asthma, the most highly effective anti-inflammatory drugs are inhaled glucocorticosteroids (ICS) and their combination with long-acting β2-agonists (LABA) [3]. The search for clinically significant AD phenotypes is a promising tool for optimizing the pharmacotherapy of the disease in order to increase its effectiveness and reduce treatment costs [4, 5, 6, 7]. It seems promising to study the modes of pharmacotherapy of bronchial asthma taking into account phenotypic heterogeneity in order to calculate pharmacoeconomic indicators to increase the effectiveness of treatment.

PURPOSE

On the basis of a comprehensive pharmacoeconomic study to substantiate drug provision for patients suffering from bronchial asthma, taking into account the phenotype of the disease.

MATERIALS AND METHODS

1. Study design: conducting a pharmacoeconomic assessment of therapy for exacerbation of bronchial asthma depending on the phenotype.

2. Compliance criteria: the presence of a confirmed analysis "Bronchial asthma" in the medical record of the inpatient.

3. Conditions of the event. The work was carried out at the Department of Clinical Pharmacology, Voronezh State Medical University named after N.N. Burdenko. The base for this study was the ChUZ "Clinical Hospital" Russian Railways-Medicine ", Voronezh".

4. The duration of the study was 1 calendar year.

5. Description of manipulations carried out with objects of research. The object of the study was 570 patients hospitalized in the pulmonary department of the ChUZ "Clinical Hospital" Russian Railways Medicine ", Voronezh". During the collection of material, 570 records of patients hospitalized with BA exacerbation were filled in. The research objects served to obtain the necessary information on the research topic.

6. The main outcome of the study: determination of the cost of pharmacotherapy depending on the phenotype of the disease (the study found that the cost of treatment increases by 17-20% in patients with a mixed BA phenotype).

7. Additional study outcomes: assessment of the structure of prescribing anti-asthma drugs (differences were noted in group 3 (BA "late onset"), whose patients were not prescribed salbutamol. In group 2 (non-allergic BA) and group 5 (mixed BA), patients additionally received antimicrobial therapy (ceftriaxone, levofloxacin)

8. Group analysis In the course of the study, 5 groups of patients were identified depending on the phenotype of the disease: 1 - 98 patients with allergic BA; 2 - 162 patients diagnosed with non-allergic BA; 3 - 112 patients suffering from BA with obesity; 4 - 21 patients with BA of "late onset"; 5 - 177 patients with mixed BA.

9. Methods of registration of outcomes. Analysis of the results of the study was carried out using Microsoft Excel spreadsheets.

10. Statistical analysis. When analyzing the costs of therapy ABC-VEN-analysis, frequency analysis, “cost minimization” method were used. Calculations included only direct costs for medicines. For ABC-VEN analysis software was used (certificate No. 200613701). Statistical processing of the results was carried out using Microsoft Excel (2010). The chi-square test and Fisher's exact test were used to assess the statistical significance of the differences. Differences were assessed as significant at p <0.05.

RESULTS

Analysis of the clinical course of bronchial asthma (BA) made it possible to distinguish 5 groups depending on the phenotype of the disease. The first group consisted of 98 patients with allergic BA (BA all.), In whom the disease began in childhood, had concomitant allergic diseases (allergic rhinitis, allergic dermatitis), high IgE values ​​were noted.

The second group included 162 patients who were diagnosed with non-allergic BA. The inflammatory process in the lungs was accompanied by the addition of infection, pharmacotherapy included antimicrobial drugs.

The third group (n = 112) included obese BA patients with BMI> 30 kg / m2.

The fourth group consisted of 21 patients (BA "late onset"), in whom the disease was first diagnosed at the age of over 60 years, and the BMI was <30 kg / m2.

The fifth group - mixed BA (n = 177) included patients with a combination of overweight, over 60 years of age, and the appointment of antimicrobial therapy.

According to the severity of the clinical course, 79-90% of patients had a moderate course, in 5-17% of cases the disease was severe. The duration of hospital stay in 67-78% of patients was from 11 to 14 days, with a minimum hospitalization period (up to 10 days) in 14-18% of patients.

Frequency analysis of medical prescriptions in patients revealed the structure of prescribing anti-asthma drugs (systemic corticosteroids, ICS / LABA, KDBA, aminophylline), the composition and dosage regimen of which corresponded to the clinical recommendations for the treatment of asthma (2019). Differences were noted in group 3 (“late onset” BA), whose patients were not prescribed salbutamol. In group 2 (non-all BA) and group 5 (mixed BA), patients were additionally treated with antimicrobial therapy (ceftriaxone, levofloxacin).

The use of the “cost minimization” method made it possible to calculate the average cost of 1 bed-day for the treatment of asthma exacerbation, which made it possible to identify differences depending on the phenotype. Patients of three groups had similar treatment costs (BA all. - 1622.1 ± 14 rubles / day, BA "late onset" - 1590.2 ± 16 rubles / day and BA with obesity - 1627.2 ± 21 rubles / day ).

An increase in the cost of treatment by 9.7% for patients with non-allergic asthma (1780.2 ± 13 rubles / day), compared with the cost of treating patients with allergic asthma (1622.1 ± 14 rubles / day), was explained by the additional prescription of antimicrobial therapy ( p <0.01).

The most expensive in terms of the cost of one day of pharmacotherapy was group 5 (mixed BA - 1920.4 ± 34 rubles / day), which can be explained by combined pathology with a significant drug load. This increased direct medical costs by 17-20%, compared with other groups of patients isolated by the AD phenotype (p <0.05).

The results of the ABC analysis assigned the drugs of the ICS and ICS / LABA groups to group A. regardless of age and phenotype. diseases. The share of costs for ICS varied from 23% to 28% of the budget for BA treatment, while costs for other GCS (dexamethasone) were no more than 3%.

Additionally, group A included levofloxacin, ceftriaxone (8-10% of the budget), and sodium chloride solution (23-25% of the budget). This fact is explained by the need to purchase a significant amount of infusion solutions for intravenous administration of drugs (aminophylline, dexamethasone), which were received by up to 88% of patients.

DISCUSSION

In patients with bronchial asthma, a pharmacoeconomic assessment of the treatment of exacerbation of the disease was carried out. This made it possible to determine the characteristics of drug provision depending on the phenotype of the disease.

Differences in the cost of one bed-day in patient groups were determined by a combination of drugs that included basic treatment (ICS / LABA) and additional therapy (mucolytics, short-acting beta-agonists, systemic glucocorticosteroids), the intake of which depended on the clinical course of the disease.

The results of the study made it possible to identify the most expensive treatment option for asthma. The cost of treatment increased by 17-20% with a mixed phenotype of the disease. The increase in costs was due to the need for additional drug load due to lower respiratory tract infection.

The data obtained make it possible to formulate the formulary of the pulmonary department in patients with asthma. This is necessary for planning budgetary funds for financing the therapy of BA exacerbation at the stage of hospital treatment.

The continuation of the study is the development of a program for calculating the individual cost of pharmacotherapy, depending on the severity of the disease, the duration of inpatient treatment, and the nature of concomitant pathology.

CONCLUSION

The costs of BA pharmacotherapy depend on the disease phenotype (allergic BA, non-allergic BA, “late onset” BA, BA in obese patients). The study found that the cost of treatment increases by 17-20% in patients with a mixed BA phenotype.

The results of the study showed that the formation of drug supply for BA patients should take into account the list of medical prescriptions, and the cost of the pharmacotherapy performed depends on the phenotype of the disease.

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About the authors

Sofia A. Korchagina

Воронежский государственный медицинский университет им. Н.Н. Бурденко

Author for correspondence.
Email: sophia.korchagina@yandex.ru
ORCID iD: 0000-0002-9534-3166
SPIN-code: 3413-7661
Russian Federation

Anastasia I. Matyashova

Воронежский государственный медицинский университет им. Н.Н. Бурденко

Email: matiaschowa.an@yandex.ru
ORCID iD: 0000-0003-0482-1677
Russian Federation

Nikolay S. Gridnev

Воронежский государственный медицинский университет им. Н.Н. Бурденко

Email: columradi29@mail.ru
ORCID iD: 0000-0002-4197-3672
Russian Federation

Oksana I. Novik

Воронежский государственный медицинский университет им. Н.Н. Бурденко

Email: novikoksanka@rambler.ru
ORCID iD: 0000-0001-5106-6323
Russian Federation

Galina A. Batishcheva

Воронежский государственный медицинский университет им. Н.Н. Бурденко

Email: bat13@mail.ru
ORCID iD: 0000-0001-5388-7686

доктор медицинских наук, профессор кафедры клинической фармакологии

Russian Federation

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