Objectives: Primary-Progredient Multiple Sclerosis (PPMS) is an indication in which, until recently, only the best supportive therapy (BSC) was used. Drugs used in highly active remitting multiple sclerosis (HARMS) are high-cost therapy and their effectiveness differ. Ocrelizumab is a new drug from the group of monoclonal antibodies to the CD20 B-lymphocyte receptor and its use can lead to changes in the budget for the treatment of PPMS and HARMS. The aim of the study was to determine the budget impact of the inclusion in the public funding of the use of ocrelizumab in both indications in Russia. Methods: The populations of PPMS and HARMS were determined on the basis of literature data (both is 10% of the total population of MS patients). The analysis point of view (federal and regional), the time horizon (1, 2, 5 years), and analysis scenarios were set basing on MS experts' opinion. For PPMS, it was assumed that patients would receive BSC (existing scenario) or ocrelizumab (new scenario). For HARMS, it was assumed that patients would receive alemtuzumab or natalizumab (existing scenarios 1 and 2) or ocrelizumab (new scenario). Results: The use of ocrelizumab instead of BSC in PPMS increases costs/year by 73 864 873.84 euro. The use of ocrelizumab instead of natalizumab and alemtuzumab in HARMS reduces costs in the first year by 35 134 031,85 and 174 442 131,17 euro, respectively. Conclusions: The use of ocrelizumab instead of BSC in PPMS causes additional budget costs, and in HARMS instead of natalizumab and alemtuzumab, with reduces them. The use of ocrelizumab in both indications could lead to providing PPMS patients with the first effective drug therapy in their indication and at the expense of financial savings associated with the use of ocrelizumab instead of alemtuzumab in HARMS and would not lead to additional costs of MS therapy.

Background. The average annual increment (5,09 %) of the prostate cancer (PC) incidence was highest across male oncological diseases registered in Russia from 2007 to 2017. 4643 new cases of PC were diagnosed in Moscow in 2017. As of 1st January 2018, the total number of living males with PC registered within Moscow healthcare system was 31,567.The study objective was to obtain the structure of factual costs related to medicine therapy of PC covered by the budget funds of the Moscow Healthcare Department in 2016–2017, that would help to further improve the system of subsidized drug provision for Moscow residents.Materials and methods. Using data from the information database of the Center for Medicine Provision of the Moscow City Department of Healthcare the following parameters were determined: total sum of expenses on drug purchase, mean treatment cost per 1 patient, number of patients receiving therapy, number of prescriptions, number of prescribed drug packs, mean pack cost, and others. The analyzed medicines were classified based on pharmacological and clinical groups. Costs for each class of therapies were studied.Results. During studied period (2016–2017), the most funds in Moscow were spent on abiraterone and goserelin. In 2016–2017, the amounts of prescribed packs were highest for androgen deprivation therapy: luteinizing hormone-releasing hormone agonists – goserelin and buserelin. In the group comprising 10 therapeutic regimens associated with highest costs, the percentages of costs for hormonal therapy and chemotherapy were respectively as following: 80 % and 16 % in 2016 and 75 % and 23 % in 2017. In the simplified model of costs associated with androgen deprivation therapy and treatment of metastatic castration-resistant PC without consideration of androgen deprivation therapy constituted 39 % and 61 % in 2016 and 36 % and 64 % in 2017. In the population of patients with prostate cancer, zoledronic acid, abiraterone, docetaxel, cabazitaxel were the most used medications in 2017 and the rate of enzalutamide usage was lowest.Conclusion. The highest costs are associated with treatment of metastatic castration-resistant PC. There is a growing necessity for improvement of funds spending on medications for patients with castration-resistant PC. This improvement could be achieved through development of medical methodologies that facilitate the selection of the most cost-effective approaches for early diagnosis and treatment.

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Lung cancer is leading cause of death across oncological diseases. Nowadays, the therapy of lung cancer remains most serious problem of oncology. Targeted therapy including tyrosine kinase inhibitors (TKIs) is widely used in current clinical practice to treat advanced or metastatic non-small cell lung cancer. This paper reviews the clinical aspects of TKIs application in practical medicine. The article summarizes the results and outcomes of key clinical trials focused on efficiency and safety of TKIs, describes the results of analysis for TKIs need within the Moscow City Department of Healthcare system providing preferential medicines. The perspectives of future clinical developments of targeted treatments for lung cancer are postulated and discussed as well. Our previously unpublished data clearly demonstrate that gefitinib, erlotinib and afatinib turned out to be the most used TKIs for treatment of non-small cell lung cancer in the system of preferential medicine supply for Moscow population in 2018. The choice of targeted drugs directly depends on the molecular genetic profile of the tumor. To further improve the use of financial resources of the Moscow City Department of Healthcare it is essential to define accurately the molecular profile of the tumor specimens and prescribe the most effective TKIs for each individual case of lung cancer.

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