Оценка технологии здравоохранения и значение дистанционного диэлектрического исследования в диагностикe и контроле лечения хронической сердечной недостаточности в Российской Федерации

Abstract

As with any socially significant disease, in chronic heart failure (CHF), the control of diagnostic and treatment, including monitoring the condition of patients in order to maintain optimal therapy, is of decisive importance. The specificity of CHF is the high frequency of repeated hospitalizations for acute decompensation of heart failure (ADHF). One of the key aspects of monitoring the patient’s condition is the assessment of congestion - the identification and determination of the degree of it for the timely optimization of the treatment in order to prevent re-hospitalization. In this regard, of great interest is a new technology for non-invasive measurement of fluid in the lungs - Remote Dielectric Sensing (ReDS), implemented in a medical device under the ReDS Pro brand (manufacturer - Sensible Medical Innovations, Israel). ReDS technology is a quantitative non-invasive method for measuring the total volume of fluid in the lungs in patients with signs of volume overload, including those with CHF. The technology is based on the following principle: low-power electromagnetic radiation passes through the lung tissue from the emitter to the receiver, the assessment of changes in radio wave parameters provides an accurate measurement of the total volume of fluid in the tissue. The result of the examination is a quantitative indicator that reflects the percentage of total fluid in the total volume of the lung. The emergence of a new technology makes its assessment relevant for monitoring treatment and diagnostic measures for CHF in the Russian Federation at the inpatient and outpatient stages of medical care. The described study of health technology assessment was based on the developed model, which, taking into account the clinical advantages of ReDS technology, made it possible to analyze its “budget impact” both at the federal and regional levels from the standpoint of the inpatient or outpatient stages of medical care. The assessment of the economic and clinical feasibility of introducing ReDS tech- nology was carried out separately for the inpatient and outpatient stages (for the outpatient stage, the calculation was carried out both for a model that takes into account the costs of additional visits to patients for scheduled examinations, and without them) in conditions of achieving the technology availability indicator for at least 95% of the population. The results of the assessment showed that at a given level of implementation of ReDS technology at the inpatient level, the number of re-hospitalizations of patients with CHF in the Russian Federation will decrease from 375,703 to 252,208 per year (by 32.9%). The introduction of technologies at the outpatient level will reduce the number of readmissions from 375,703 to 82,782 per year (by 78.0%). This corresponds to a decrease in the annual cost of hospitalizations for CHF (both primary and recurrent) with the introduction of ReDS in hospitals from 24.93 billion rubles to 20.96 billion rubles (decrease by 15.9%); when implementing the method at the outpatient level from 24.93 billion rubles to 15.52 billion rubles (decrease by 37.8%), and taking into account the cost of additional visits to patients at the outpatient level from 24.93 billion rubles to 19.70 billion rubles (decrease by 21.0%). At the same time, one-time costs for the purchase of a ReDS medical device in outpatient and inpatient clinics amount to 12.06 billion rubles and 11.04 billion rubles respectively. The results of the “budget impact” analysis (taking into account the discount factor of 3.5%) of the introduction of ReDS technology at the outpatient level demonstrate that over 7 years it provides savings in the amount of 20,335,833,423 rubles (including costs for additional visits) up to 45,926,532,070 rubles (excluding the cost of additional visits), and at the inpatient level - 13,613,327,627 rubles. Evaluation of the introduction of ReDS technology into the Russian healthcare system at the federal level, both at the outpatient and inpatient stages of medical care, with a total need for a ReDS medical device in the range of 1129-1234 units, providing coverage of more than 95% of the population with this technology, showed its clinical and economic benefit, which is expressed in a decrease in the number of readmissions and net savings in the health care system already during the third year of using the ReDS technology.