BACKGROUND: Diagnostic of diabetes mellitus type 2 (DM2T) in time is very actual for treatment and prevention of potential complications of illness. Fasting blood glucose test (FBG) is a widely used method of primary DM2T diagnose. Glycated hemoglobin (HbA1c) test is an alternative and used more rarely due to expensive. AIM: Modelling of comparative expenditures for DM2T control in cases of primary diagnostic by HbA1c test or FBG test usage in 20-years horizon. METHODS: Retrospective analysis of aggregated epidemiological Russian NATION study data in 810 patients with prediabetes and DM2T with both analysis performed, with sensitivity and specificity of each is detected. The simulation model of DM2T outcomes has been used for Health Technology assessment (direct and indirect costs of Diabetes control during 20 years). Three algorithms of the DM2T treatment were investigated for understanding of expenditures in case on diagnostic on-time and case of late verification with metformin, gliflozines, gliptins, Glucagon-like peptide-1 receptor agonists, basal insulin analogs and their combinations. RESULTS: FBG test has more negative results for DM2T diagnostics in compare with HbA1c analysis (77,4% and 36,5% accordingly). Amount of false negative results in FBG test in 3 times more often occurred in comparison with HbA1c. HbA1c test in 3 times more precisely than FBG test for carbon metabolism abnormalities detection. Diagnostic in time with HbA1c test in compare with late process of illness detection by FBG can cut common expenditures on 26,3-27,7% depending on treatment option due to macrovasular complications decreasing. Disability rate is expected decrease on 21% to 20-th year in case of diagnostic with HbA1c performing instead FBG test. CONCLUSION: HbA1c test has diagnostic advantages in compare with FBG test for primary investigation (dispanserization). Direct and indirect expenditures in average for one patient with DM2T on 20-years horizon including cost of drugs, analysis, complications, disabilities are less in case of diagnostic in time with HbA1c test in comparison with late diagnostics in case of FBG test execution.

Objectives: To assess the burden of cystic fibrosis (CF), a rare, progressive genetic disease, in infants and children aged ,6 years in the US by comparing their health care resource utilization (HCRU) with that of matched individuals without CF. Methods: In a retrospective study using US commercial and Medicaid claims databases (2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017), patients aged ,6 years with CF were matched 1:3 to individuals without CF by age, gender, geographic region, race, enrollment year, and insurance plan type. 1-year HCRU outcomes, including hospitalizations and outpatient medication use, were compared between patients with CF and controls using bivariate statistics for all patients and by age group (infants [aged ,2 years] and children aged 2-,6 years). P values ,0.05 were considered significant; no multiplicity adjustment was conducted. Results: 835 patients with CF were matched to 2505 controls in the commercial population; 735 patients with CF were matched to 2205 controls in the Medicaid population. Significantly higher HCRU was observed among patients with CF, and more were hospitalized annually versus controls (commercially insured: 15.4% vs. 5.4%; Medicaid-insured: 24.6% vs. 3.1%). Mean annual hospitalization rates were up to 4-fold higher with CF versus controls in the commercially insured population (0.25 vs. 0.06) and 10-fold higher with CF versus controls in the Medicaidinsured population (0.41 vs. 0.04). Similar patterns were observed within age subgroups, where infants and children aged ,6 years with CF had significantly higher hospitalization rates versus controls. On average, commercially insured patients aged ,6 years with CF had 31.4 total prescription fills/year versus 3.5 for controls; Medicaid-insured patients aged ,6 years with CF had 40.9 total prescription fills/ year versus 7.0 for controls. P values across all comparisons were ,0.05. Conclusions: Infants and children aged ,6 years with CF have substantial disease burden with significantly greater hospitalizations and outpatient medication use versus matched controls.

Objective. To determine the pharmacoeconomical feasibility of using a combination of atezolizumab + nab-paclitaxel in the 1st line of therapy for locally advanced or metastatic triple negative breast cancer (TNBC) in adult PDL1 positive patients in the Russian healthcare system. Materials and methods. A decision analysis model was used followed by Markov modelling for the economic evaluation of the drugs in the treatment of metastatic TNBC. We used the «cost-effectiveness» analysis and the «impact on the budget» (BIA) analysis. Two therapeutic approaches were evaluated: the use of combined therapy with atezolizumab + nab-paclitaxel and monotherapy with nab-paclitaxel. The analysis included direct costs. Additionally, the obtained pharmacoeconomical indicators of the use of a combination of atezolizumab and nab-paclitaxel and other drugs for the treatment of locally advanced and metastatic breast cancer were compared. Results. The use of the estimated therapeutic approaches in the treatment of metastatic TNBC was characterized by the following costs: with a modelling horizon of 1 year, the cost of using atezolizumab in combination with nab-paclitaxel was 5,076,321 rubles per patient. The costs for the use of single agent nab-paclitaxel with was 60 % less than: — 2 020 038,78 RUB. At the same time, the effectiveness of therapy with a combination of atezolizumab and nab-paclitaxel clinically significantly exceeded that of nab-paclitaxel monotherapy: a 38 % reduction in the risk of death or progression, a 10-fold increase in the frequency of complete response to therapy (10 vs 1 %), and a 7-month increase in the median overall survival (25 vs 18 months). The economic evaluation of the combination of atezolizumab with nab-paclitaxel was carried out with the calculation of the incremental cost-effectiveness ratios (ICER) — the calculation of the additional cost for each additional year of life in comparison with standard therapy. Due to the fact that currently in Russia for patients with metastatic TNBC no similar performance modes of therapy ICER for the combination atezolizumab + nab-paclitaxel compared with the ICER for palbociclib in combination with fulvestrant (drugs, showed improved overall survival in clinical research and included in clinical guidelines for the treatment of diseases of the same class ICD-10 in locally advanced and metastatic breast cancer). The ICER for overall survival at the end of the first year of follow-up for atezolizumab + nab-paclitaxel and palbociclib + fulvestrant was 30.5 million rubles and 47.4 million rubles, respectively. For the combination of atezolizumab + nab-paclitaxel, ICER is lower than the similar ICER for the palbociclib + fulvestrant mode by 36 %. Analysis of trends in the weighted average cost of systemic pathogenetic treatment of breast cancer (breast cancer) shows the following: increased use of the combination of atezolizumab + nab-paclitaxel for the treatment of patients with metastatic TNBC doesn’t lead to a considerable growth in the cost of therapy in patients with breast cancer — providing therapy to 1400 patients that includes the entire target population of patients with TNBC and expression of PD-L1 in Russia changes in the costs of chemotherapy and immunotherapy of breast cancer will remain within 2.6 %. Conclusion. Pharmacoeconomic indicators of the use of atezolizumab in combination with nab-paclitaxel are more cost-effective in comparison with other expensive schemes for the treatment of breast cancer, and tumors of other localities that are actively used in current practice, which suggests the acceptability and feasibility of introducing and expanding the use of this therapeutic option in the target population.

Summary: Objective of this study was to determine cost-effectiveness of vemurafenib in treatment of inoperable or metastatic melanoma in patients with BRAFV600 mutation from Russian healthcare system perspective and a long-term use. Cost-effectiveness analysis (CEA) has been used and cost-effectiveness ratio (CER) has been calculated. Incremental analysis has been conducted with calculation of incremental cost-effectiveness ratio (ICER) when exceeding the costs and effectiveness of one of the studied regimens as compared to the other one. Cost analysis included calculation of the following direct costs (DC): the cost of the main disease treatment (cutaneous melanoma, CM) -costs of the drug; the cost of laboratory and instrumental methods of investigation as well as hospitalizations and out-patient treatment; the cost required to determine exon 15 BRAF mutation in melanoma; the cost of the drug therapy aimed at management of adverse events (AEs) caused by the drug when treating the main disease. Two medical technologies have been assessed (anti-tumor regimens depending on the chosen method): vemurafenib at a dose of 960 mg twice a day; dacarbazine at a dose of 1000 mg/m 2 i/v every 3 weeks. Mathematical modelling underlies this study. As a result it has been demonstrated that the use of vemurafenib strategy in treatment of metastatic melanoma in patients with BRAF V600 mutation had better progression-free survival (PFS) rate throughout the entire modelling horizon. The use of vemurafenib in treatment of metastatic and inoperable melanoma in patients with BRAF V600 mutation is economically advisable taking into account the data on effectiveness (PFS). The use of vemurafenib in patients with BRAF V600 mutation is an absolutely innovative medical technology which currently does not have any alternative. Vemurafenib may be indicated for inclusion in reimbursement lists for treatment of patients with this mutation.

diversity of the health professionals and the basic scenario. The costliest scenarios were the one implementing HPV DNA testing which did not provide further participation despite a high cost and the one based on P4P incentives towards GP, although it allows high participation rates. ConClusions: Using a comprehensive BIM, we show that full coverage of OS might be the most cost-effective way to implement it, although practical and financial issues might favour other scenarios that may be more balanced regarding the distribution of costs between stakeholders or may be more easily implemented and accepted by health professionals.