<p><strong>CLINICAL AND ECONOMIC ANALYSIS OF </strong><strong>CONCOMITANT AND PHARMACOTHERAPY </strong><strong>OF PATIENTS WITH CHRONIC KINDEY DISEASE OF V STAGE</strong></p><p>I. O. Fedyak, *N. V. Sholoyko, V. O. Vorokh</p><p>Ivano-FrankivskNationalMedicalUniversity, Ivano-Frankivsk</p><p>*BohomoletsNationalMedicalUniversity,Kiev</p><p class="1">       <strong>Introduction.</strong> According to the Budget Code, providing patients with chronic kidney disease (CKD) by materials for hemodialysis performed for the expense of local budgets, which do not cover all costs, and regional differences range from 20 to 80% However, besides funding of materials for maintenance apparatus “artificial kidney” patients with hemodialysis should receive concomitant therapy. The <strong>purpose</strong> <strong>of this study</strong> was to analyze parameters funding for dialysis patients with CKD stage V in different regions, as well as clinical and economic evaluation of the concomitant pharmacotherapy in patients with chronic renal failure in Ivano-Frankivsk region.</p><p class="1">       <strong>Research methods.</strong> Specifics of hemodialysis funding in the Carpathian region have been studied by analyzing available sources and interview analysis in dynamics of years of the head of the dialysis department of theIvano-FrankivskRegionalClinicalHospital – Oleg Lehun. According to the data of patients’ medical records, it was performed integrated frequency / ABC / VEN-analysis.</p><p class="1">       <strong>Results and discussion.</strong> During2013 in the Carpathian region, hemodialysis sessions were held 327 patients, 8 people were on peritoneal dialysis, and for 19 – was carried out an operation with kidney transplantation. The total number of patients was 364 persons, which was amounted in total to 1,000,000 of population with renal replacement therapy – 263.4 patient, with hemodialysis – 236.6 persons (89.8 %); with peritoneal dialysis – 13.0 (4.9 %); with kidney transplantation – 13.7 (5.2 %). In 2014 the total number of Precarpathians who were taken hemodialysis renal substitution therapy was 391 people, of whom at 01.01.2015 was only 337 remaining patients (difference – the dead and those who left the region). In 2015 extracorporeal blood purification method in Ivano-Frankivsk region received a total of 375 patients, and on 01.10.2015 there were 338 people. In other regions, the situation with the financing of hemodialysis according to reports in an open network was much worse.</p><p class="1">       Distribution of 74 inpatient medical records of patients with acute and chronic renal failure by sex showed the domination of men over women. The largest number of patients were in the age range of 30-39 and 60-69 years, mostly living in rural areas (66 %). According to data analysis, patients with CKD frequently prescribed medicine is calcium carbonate (Elite-Pharm,Ukraine) (11.88 %), which is to the corresponding Protocol. At the same time, accept therapy according to the Protocols, they also have a significant treatment of concomitant diseases.</p><p class="1">       According to the study, the total cost of pharmacotherapy consumed by patients who were treated in the department of dialysis by the methods of hemodialysis and peritoneal dialysis, amounted on 01.01.2014 as 7 461.29 UAH and on 01.07.2015 – 26 114.52 UAH (for 1 patient – 310.89 UAH and 1 088.11 UAH respectively). The leader group of the most expensive medicines were medicines for treatment of concomitant diseases.</p><p class="1">       <strong>Conclusions:</strong> Financial support for the regional program “Health of Carpathian population in 2013-2020 years” for the last 3 years, meets the need in hemodialysis of 327-391 patients. However, the medicines patients have to purchase at their own expense. However, patients with chronic kidney disease, as the study found, mostly related to the poor and disadvantaged sections of society, so in addition to dialysis, they need state aid also on medicines. The results of retrospective clinical and economic analysis of therapy that was consumed by patients indicate that they have received treatment to prevent frequent complications of chronic kidney disease (35 % designated drugs by name and 38 % of the total cost of treatment) and treatment of concomitant diseases (65 % of medicines by name and 62 % of the cost of treatment) that requires correction according to required Formulary approach.</p><p class="1"><strong>References</strong></p><p class="1">1. Pro polipshennya yakosti ta orhanizatsiyi systemy medychnoyi dopomohy doroslym khvorym nefrolohichnoho profilyu: Nakaz MOZ Ukrayiny vid 30.09.2003 r. № 65 / 462 [Elektronnyy resurs]. – Rezhym dostupu : https://moz.gov.ua/ua/portal/dn_20030930__462.html.<br /> 2. Medyko-profilaktychna dopomoha khvorym nefrolohichnoho profilyu 2009-2012, shcho robyty dali? [Tekst] / M. O. Kolesnyk, N. O. Saydakova, N. I. Kozlyuk, S. S. 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Today, there is a need to introduce medical devices into everyday medical practice with the goal to self-administer injectional drugs. The speed and safety of auto-injectors / pre-filled syringe pens use (AI/PFS) is the introduction of an injectional form drug in a special medical device, which allows patients to enter a pre-designated therapeutic dose due to the characteristics of the structure of the product, automatic dosing, data of the interactive display on some devices, comfortable design, etc. Considering that AI/PFS were developed to improve the quality of life of patients with various pathological conditions, therefore the creation of affordable medical devices for low-income groups of the population is relevant today. Also an actual issue is the provision of high-quality first-aid kits for soldiers, which is a vital component for medical care in the context of active combat conditions and the lack of the required number of field hospitals.The speed of administration, the onset of effect and ease of use provides significant advantages for AI / PFS. Therefore, the issue of affordability for the low-income groups of the population and the army with the necessary drugs should be sufficiently supported by state regulation.Purpose of study – study of the international experience in the implementation and use of drugs (drugs) in the form of affordable, safe and effective modern dosage forms in the form of autoinjectors.Materials and methods – foreign and domestic literature on the use of AI/PFS in complex and monotherapy treatment of various diseases. State registries of medicines of Ukraine, the USA and some EU countries. The study used systematic, statistical and comparative analyzes, as well as the generalization of information. The data used is freely available among various medical scientific and metric bases, the Internet and international scientific conferences.The analysis of the use of AI/PFS indicates that today the world market of medicines and medical devices contains a large number of drugs under different trade names. However, many patients in the world refrain from using these dosage forms due to the significant cost of medical devices, which makes impossible the required regular use of such drugs for the low-income population groups. This is a significant disadvantage, since AI / PFS is implemented to correct not only chronic diseases such as rheumatoid arthritis, multiple sclerosis, but also to provide emergency careinurgent conditions (anaphylactic reactions, intense pain, etc.).In the global market for drugs and medical devices, injectable medicines in the form of AI/PFS are widely represented. The effectiveness of the use of such devices indicates the advantages and prospects for the use of existing AI/PFS on the global market for patients and medical personnel. Today, the most commonly used drugs in AI/PFSare for the treatment of diabetes, emergency conditions in civil and military medicine, chronic diseases of various etiologies, pediatric practice. The use of AI /PFS significantly improves patient compliance for the treatment of chronic diseases due to ease of use and reduction of adverse reactions at the site of administration. Most of the analyzed sources indicate a low level of economic affordability of drugs in the form of AI/PFS for the population and the government sector of drug supply due to the high cost of the medical devices, compared to traditional syringes. But the results of the study indicate a high level of advantages and prospects in the use of drugs in AI/PFS in medical practice for both medical personnel and patients.

<p>РЕЗЮМЕ. У статті наведено результати частотного аналізу листків призначень хворих на цирози печінки різної етіології. Вони вказують, що препарати, які були спожиті пацієнтами в умовах стаціонару, насамперед призначалися для лікування ускладнень основного діагнозу. Встановлено, що гепатоцелюлярна недостатність різного ступеня спостерігалася у 94 % пацієнтів, портальна гіпертензія – у 87,4 %, асцит – у 37,9 %. Тому найчастіше призначали: Верошпірон (Gedeon Richter Plc., Угорщина) – отримали 64,2 % пацієнтів, Тіогама Турбо (Woerwag Pharma GmbH &amp; Co. KG, Німеччина) – 45,8 % та Дуфалак (Solvay Pharmaceuticals B.V., Нідерланди) – 41 % хворих.</p><p> </p><p>КЛЮЧОВІ СЛОВА: цирози печінки; ускладнення цирозу печінки; частотний аналіз; лікарські засоби, що застосовуються при захворюваннях печінки.</p>

Despite the widespread recognition of the importance of opioid analgesics for the treatment of moderate to severe pain in oncology and in the palliative care in many countries the adequate pain relief and availability of opioids for medical purposes is still a problem. To analyze prescribing and use of opioids for palliative patients, the data of 43 patients treated by mobile palliative care teams in Western Ukraine have been collected. The results obtained have been compared with international guidelines of pain relief and use of opioids in palliative care. It was determined that 60.5% of patients consumed opioids for 44 days on average; more than half of cancer patients received morphine, usually at the end of life. Opiods prescribed for pain relief were: tramadol -to 48.8% patients, morphine or omnopon -to 39.5%; nalbuphine -to 9.3%; promedol -to 7.3%. Only one third of the patients administered opioids orally. Morphine drugs were received by 54.8% of cancer patients, an average daily consumption of morphine was 26.17 mg and the average duration of administration 9.82 days. Most patients received morphine and omnopon 2 or 3 times a day. Prescriptions of morphine started with a single injection of 10 mg of injection morphine (or 11.5 mg in the case of omnopon injection). A limited range of opioids and peculiarities of providing these medicines to patients in Ukraine restricted the application of pain relief in accordance with international guidelines: prescribing oral forms of opioids at first; introduction of opioids at fixed intervals of time; titrating the dose.