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УДК: 616.83 DOI:10.33920/med-13-2003-01

Моделирование исходов и затрат при лечении рассеянного склероза

Мокрова Анна Сергеевна студентка, ФГАОУ ВО «Первый МГМУ имени И. М. Сеченова» Минздрава России (Сеченовский Университет); 119361, г. Москва, ул. Б. Очаковская, д. 45, к. 1, кв. 55; тел.: +79687507800, e-mail: anechkamokrova@mail.ru, https://orcid.org/0000-0003-3862-1200
Сологова Сусанна Сергеевна канд. биол. наук, доцент кафедры фармакологии, ФГАОУ ВО «Первый Московский государственный медицинский университет им. И. М. Сеченова» Минздрава России (Сеченовский Университет); 119991, г. Москва, ул. Трубецкая, 8/2, e-mail: susanna.sologova@yandex.ru, http://orcid.org/0000-0002-8526-7147
Игнатьева Виктория Игоревна канд. мед. наук, научный сотрудник, Институт прикладных экономических исследований, Лаборатория оценки технологий в здравоохранении; 119571, г. Москва, пр-т Вернадского, д. 82–84, корп.9, офис 1805, e-mail: ignatyeva-vi@ranepa.ru, http://orcid.org/0000-0001-6789-9514

Современная терапия рассеянного склероза (РС) требует значительных затрат со стороны государства, что обуславливает необходимость тщательной оценки клинических и экономических последствий включения в практику новых препаратов для лечения этого заболевания. Введение. Рассеянный склероз (РС) является тяжелым инвалидизирующим заболеванием, поражающим преимущественно лиц трудоспособного возраста. Новые лекарственные препараты (ЛП) способны существенно улучшить прогноз для пациентов, но требуют значительных дополнительных затрат бюджета здравоохранения, что обуславливает необходимость использования клинико-экономического моделирования для аккуратной оценки возможных преимуществ новой терапии. Цель: Выявление клинико-экономических моделей терапии РС, которые могут быть использованы в условиях российского здравоохранения, а также изучение методологических особенностей выявленных моделей для последующего использования при разработке собственной модели РС. Методы. В результате систематического поиска были выявлены опубликованные клинико-экономические исследования по РС, использовавшие моделирование. Далее было оценено методологическое качество идентифицированных моделей и возможность их адаптации к российским условиям. Наконец, были описаны основные методологические особенности моделей, такие как временной горизонт, подходы к моделированию движения потоков пациентов в модели и оценки затрат. Результаты. В результате систематического поиска было найдено 20 публикаций, описывающих оригинальные модели терапии РС. Анализ методологических особенностей показал, что в последние годы была выработана унифицированная структура представления течения РС и моделирования эффекта использования ЛП. В результате проведенного анализа было выбрано 4 модели, которые могут быть адаптированы к условиям российского здравоохранения, учитывая качество описания моделей, обуславливающего возможности их воспроизведения, а также отсутствие отличий между моделируемыми практиками ведения и популяций пациентов с РС от российских. Заключение. Было идентифицировано 4 клинико-экономических модели терапии РС, которые могут быть использованы в условиях российского здравоохранения. Окончательный выбор модели или принятие решения о разработке собственной модели должны основываться на конкретных вопросах, стоящих перед исследователями, также влияние будут оказывать характеристики изучаемой технологии и доступность отечественных данных.

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Рассеянный склероз (РС) (multiple sclerosis — MS) является одним из самых распространенных неврологических расстройств во всём мире. Медико-социальная значимость заболевания обусловлена как прогрессирующим течением заболевания с формированием стойкой инвалидизации, так и преимущественным поражением лиц трудоспособного возраста. По результатам эпидемиологических исследований в настоящее время отмечается увеличение распространенности РС в мире с расширением возрастных, географических и этнических границ [1, 13, 36, 66].

РС также ассоциируется со значительными финансовыми затратами как для системы здравоохранения и государства, так и для самого пациента, его семьи и близких [14, 23, 47, 50].

По оценкам зарубежных исследователей, объем рынка ЛП для лечения РС составил в 2018 г. 25,4 млрд долл. США, при этом ожидается, что в течение 2020 г. будут зарегистрированы 5 новых лекарственных препаратов. Прогнозируется, что их внедрение в практику приведет к росту объема рынка на 1,1 млрд долл. США в течение 10 последующих лет [69].

В соответствии с действующим законодательством РФ для новых ЛП требуется комплексная оценка, включающая в себя сравнение клинической эффективности и безопасности ЛП, оценку экономических последствий его применения, изучение дополнительных последствий его применения в целях принятия решений о возможности включения в Перечень жизненно необходимых и важнейших лекарственных препаратов (ПЖНВЛП) [2]. Чтобы снизить трудоемкость подобных исследований и обеспечить их надлежащее методологическое качество, рациональным подходом будет использование ранее разработанных клинико-экономических моделей лечения РС, уже прошедших обсуждение и оценку международным экспертным сообществом.

Целью настоящего исследования было выявление клинико-экономических моделей лечения РС, которые могут быть использованы для российского здравоохранения, а также изучение методологических особенностей выявленных моделей для последующего использования при разработке собственной модели РС.

Для Цитирования:
Мокрова Анна Сергеевна, Сологова Сусанна Сергеевна, Игнатьева Виктория Игоревна, Моделирование исходов и затрат при лечении рассеянного склероза. Фармацевтическое дело и технология лекарств. 2020;3.
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