Problems of Social Hygiene, Public Health and History of MedicineProblems of Social Hygiene, Public Health and History of Medicine0869-866X2412-2106Joint-Stock Company Chicot42510.32687/0869-866X-2020-28-s2-1154-1161Научная статьяASSESSMENT OF THE ECONOMIC EFFICIENCY OF THE DRUG SUPPLY STRATEGY FOR PATIENTS WITH HEPATITIS C IN THE CITY OF MOSCOWKornilovaE. B.-Holovnya-VoloskovaM. E.-KornilovM. N.ekaterinakornilova2017@gmail.comZavyalovA. A.-State Budgetary Institution «Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department»Medical University of Warsaw, 02-091, WarsawNational Research University Higher School of Economics15122020281154116106042021Copyright © 2020,2020Evaluate the cost-effectiveness of various options for the supply of direct antiviral agents for patients with chronic viral hepatitis C.An analysis of the data of Moscow Department of Health on the drug supply of patients with chronic hepatitis C antiviral drugs at the expense of budgetary funds in Moscow was carried out. The direct medical costs of the urban healthcare system for the use of direct antiviral action drugs for the period from 2017 to 2019 were calculated.For the period from 2017 to 2019, 6,936 patients with chronic hepatitis C received medication with antiviral drugs at the expense of budget funds in Moscow. An increase in the number of patients compared to the base (2017) year was noted by 76%, as well as an increase in the volume of interferon-free antiviral therapy sets against the background of an increase in budget expenditures by 212%. The average level of cost for all sets with direct antiviral drugs amounted to 689,844 rub. The most commonly used set is Dac + Asu. The average cost of this set per patient treated as part of the first-line antiviral therapy was 58,899 rub. cheaper than a set of 3D, and 58,861 rub. more expensive than the Grz/Elb set, while the need for retreatment for the Dac + Asu set was 8.4%, and for the 3D, Grz/Elb and Gle/Pib sets, 0.58%, 0% and 0%, respectively. An even greater excess of the average was recorded for the Sof + Dac, Sof + Sim sets: which naturally entailed the excess of the costs of treating one patient with this distribution of treatment sets and financial resources by 253,236 rub. and 189,173 rub., respectively, which is 1.36 and 1, 27 times the average cost of all prices for antiviral treatment sets. Most often, re-medication was provided to patients who were initially provided with Sof set (33%), followed by Sim + Dac set (18.6%), 8.4% of re-medication cases were registered in patients who received Dac + Asu set as the first line of therapy. Budget costs for the second and subsequent sets of therapy increased by 92,739,115.30 rub.chronic hepatitis CHCV infectionsustained virologic responsedirect antiviral agentsantiviral therapycost-effectivenessdrug supplydirect medical costsbudget impact analysispharmacoeconomicspharmacoeconomic analysisхронический гепатит СHCV-инфекцияустойчивый вирусологический ответпрепараты прямого противовирусного действияпротивовирусная терапияэкономическая эффективностьлекарственное обеспечениепрямые медицинские затратыанализ влияния на бюджетфармакоэкономикафармакоэкономический анализ[Нурмухаметова Е.А, Блохина Н. П., Сметанина С. В. Организация медицинской помощи и лекарственное обеспечение больных хроническим гепатитом С в Москве. Доказательная гастроэнтерология. 2019;8(1-1):84-92.][Stanaway J. D., Flaxman A. D., Naghavi M., Fitzmaurice C., Vos T., Abubakar I., et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016;388(10049):1081-8. doi: 10.1016/S0140-6736(16)30579-7][Никитин И. Г., Попович Л. Д., Потапчик Е. Г. Экономическое бремя гепатита С в России. Эпидемиология и инфекционные болезни. Актуальные вопросы. 2015;(6):9-13.][Шестакова И. В., Попович Л. Д., Потапчик Е. Г., Блохина Н. П. Возможный социально-экономический эффект от внедрения инновационной технологии лечения хронического гепатита С в России. Эпидемиология и инфекционные болезни. Актуальные вопросы. 2016;(2):15-22.][Feld J. J., Moreno C., Trinh R., Tam E., Bourgeois S., Horsmans Y., et al. Sustained virologic response of 100% in HCV genotype 1b patients with cirrhosis receiving ombitasvir/paritaprevir/r and dasabuvir for 12 weeks. J. Hepatol. 2016;64(2):301-7. doi: 10.1016/j.jhep.2015.10.005][Zeuzem S., Serfaty L., Vierling J., Cheng W., George J., Sperl J., et al. The safety and efficacy of elbasvir and grazoprevir in participants with hepatitis C virus genotype 1b infection. J. Gastroenterol. 2018;53(5):679-88. doi: 10.1007/s00535-018-1429-3][Zeuzem S., Foster G. R., Wang S., Asatryan A., Gane E., Feld J. J., et al. Glecaprevir-pibrentasvir for 8 or 12 weeks in HCV genotype 1 or 3 infection. N. Engl. J. Med. 2018;378(4):354-69. doi: 10.1056/NEJMoa1702417][Lu C. Y., Zhang F., Golonski N., Lupton C., Jeffrey P., Wagner A. K. State medicaid reimbursement for medications for chronic hepatitis C infection from 2012 through 2015. Value Health. 2018;21(6):692-7. doi: 10.1016/j.jval.2017.09.011][Crespo J., Cuadrado A., Perello C., Cabezas J., Llerena S., Llorca J., et al. Epidemiology of hepatitis C virus infection in a country with universal access to direct-acting antiviral agents: data for designing a cost-effective elimination policy in Spain. J. Viral Hepat. 2020;27(4):360-70. doi: 10.1111/jvh.13238][Asrani S. K., Devarbhavi H., Eaton J., Kamath P. S. Burden of liver diseases in the world. J. Hepatology. 2019;70(1):151-71. doi: 10.1016/j.jhep.2018.09.014][European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C 2018. J. Hepatol. 2018;69(2):461-511. doi: 10.1016/j.jhep.2018.03.026][Marshall A. D., Cunningham E. B., Nielsen S., Aghemo A., Alho H., Backmund M., et al. Restrictions for reimbursement of interferon-free direct-acting antiviral therapies for HCV infection in Europe. Lancet Gastroenterol. Hepatol. 2018;3(2):125-133. doi: 10.1016/S2468-1253(17)30284-4.][Assoumou S. A., Tasillo A., Leff J. A., Schackman B. R., Drainoni M. L., Horsburgh C. R., et al. Cost-effectiveness of one-time hepatitis C screening strategies among adolescents and young adults in primary care settings. Clin. Infect. Dis. 2018;66(3):376-84. doi: 10.1093/cid/cix798][Chhatwal J., Wang X., Ayer T., Kabiri M., Chung R. T., Hur C., et al. Hepatitis C Disease Burden in the United States in the era of oral direct-acting antivirals. Hepatology. 2016;64(5):1442-50. doi: 10.1002/hep.28571][Rudakova A. V., Gusev D. A., Uskov A. N., Shestakova I. V., Lobzin Y. V. Cost-effectiveness of antiviral therapy in treatment-naive patients with chronic hepatitis C (genotype 1) with various severity of fibrosis stage. J. Infectol. 2017;9(4):93-101. doi: 10.22625/2072-6732-2017-9-4-93-101][Sibley A., Han K. H., Abourached A., Lesmana L. A., Makara M., Jafri W., et al. The present and future disease burden of hepatitis C virus infections with today’s treatment paradigm - volume 3. J. Viral Hepat. 2015;22 Suppl 4:21-41. doi: 10.1111/jvh.12476][Martin N. K., Vickerman P., Dore G. J., Grebely J., Miners A., Cairns J., et al. Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation. J. Hepatol. 2016;65(1):17-25. doi: 10.1016/j.jhep.2016.02.007][van Santen D. K., Sacks-Davis R., Doyle J. S., Scott N., Prins M., Hellard M. Measuring hepatitis C virus elimination as a public health threat: beyond global targets. J. Viral Hepat. 2020;27(8):770-3. doi: 10.1111/jvh.13294][Welzel T. M., Yang M., Sajeev G., Chen Y. J., Pinsky B., Bao Y., et al. Assessing patient preferences for treatment decisions for new Direct Acting Antiviral (DAA) therapies for chronic hepatitis C virus infections. Adv. Ther. 2019;36(9):2475-86. doi: 10.1007/s12325-019-01012-6][Lu C. Y., Ross-Degnan D., Zhang F., LeCates R., Lupton C., Sherman M., et al. Cost burden of hepatitis C Virus treatment in commercially insured patients. Am. J. Manag. Care. 2019;25(12):e379-87.][Goel A., Chen Q., Chhatwal J., Aggarwal R. Cost-effectiveness of generic pan-genotypic sofosbuvir/velpatasvir versus genotype-dependent direct-acting antivirals for hepatitis C treatment. J. Gastroenterol. Hepatol. 2018;33(12):2029-36. doi: 10.1111/jgh.14301]