A539of 16 criteria. Methods: 85 experts were interviewed to estimate the importance of each criterion in the decision-making on financing MT for rare diseases. We used 10-point scale, where 10 points mean major importance to the priority indicator, and 1point means minor importance. Mean estimates were calculated using descriptive statistics, then means were normalized. Results: Respondents were 41 years on average (ranging from 23 to 64 years), and included 20 public servants, 16 health administrators, 32 practitioners, and 14 researchers. 44 respondents had a scientific degree. The most important criteria were characteristics of treatment -"Effect of treatment on quality of life" and "Effect of treatment on life expectancy" with 1 points each. The least important criteria were both characteristics of the disease -"Cognitive disorders as manifestations of the disease and "Additional burden on the daily lives of care-givers" with 0.28 and 0.1 respectively. ConClusions: Characteristics of treatment turned out to be more important for respondents than characteristics of disease, therefore characteristics of treatment should be given consideration when evaluating rare diseases to determine priority financing.

В статье описаны основные подходы к вычислению QALY. В зарубежных странах разработана и используется стандартизованная методика расчета QALY, позволяющая применять данный показатель как универсальный критерий эффективности при проведении оценки технологий здравоохранения. Его универсальность позволяет принимать решения о финансировании медицинских технологий для лечения различных заболеваний в рамках ограниченного бюджета. При этом финансовые ресурсы распределяются таким образом, чтобы максимизировать прирост QALY. В России на сегодняшний день использование QALY как критерия эффективности при проведении комплексной оценки лекарственных препаратов не представляется возможным ввиду отсутствия стандартизованной методики расчета, а также отсутствия единых тарифов для перевода профилей состояний здоровья в полезность. Приведены основные методы расчета полезностей состояний здоровья, необходимых для вычисления QALY, описаны основные достоинства и недостатки существующих методов.

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The aim was to develop a methodology for determining the willingness to pay threshold (WTPT) and its upper limit value within the Russian health care system.Materials and methods. WTPT was calculated based on the shadow budget price (i. e. determining the WTPT by the suppling party). This method is an empirical assessment of the cost-effectiveness threshold that reflects the utmost productivity of the health care system, as determined from the relationship between changes in healthcare expenditure and health outcomes achieved. The state’s willingness to pay for improving their citizens’ healthcare was evaluated considering the population of the Russian Federation, mortality and life expectancy in different age and gender groups, as well as the volume of government spending. The cost of disability-adjusted life-year prevented (DALY) and the cost of quality-adjusted life-year saved (QALY) were determined by the suppling party, that is, they reflect the cost the state is willing to pay for improving the health of their population under conditions of limited budget. The described approach considers the performance of the country’s healthcare system over a certain period and the costs incurred in functioning of the system.Results. As part of this study, it was found that the cost of one additionally prevented DALY would be 313,878.21 rubles, and the cost of one additionally saved QALY – 365,060.31 rubles.Conclusion. The WTPT for medical technologies in the Russian Federation, determined by estimating the shadow budget price will amount to 313,878.21 rubles for one prevented DALY and 365 060,31 rubles for one saved QALY. With regard to clinical and economic analysis, medical technologies with the incremental cost-effectiveness indicator not exceeding the one calculated in this study can be seen as cost-effective. The obtained threshold value is a recommendation. A medical technology can be approved even with a WTPT higher than the recommended level, because this specific technology may have additional  advantages other than WTPT when compared with the reference technologies.