Фармакоэкономическая оценка интермиттирующей и продолжительной заместительной почечной терапии

Abstract

Lately, in Russia, the number of patients with severe stage of acute renal failure requiring renal replacement therapy is increasing. Intermittent hemodialysis is the most common type of this therapy, however, the continuous methods of renal replacement therapy also started to be more often used in clinical practice despite of their high basic cost. The subject of this study is to investigate of pharmaco-economic results reflecting direct medical and indirect non-medical costs when using these technologies versus the maximum effective use of funds while treating patients with severe renal dysfunctions. Objective: to perform comparative clinical and economic analysis of intermittent and continuous renal replacement therapy in the intensive care wards of medical units in Russia. Methods. The study was conducted in compliance with acting Standards on Clinical Economic Studies used in Russian Federation. The study methods included evaluation of existing randomized clinical studies and trials which included data from network meta-analyses and systematic reviews of the investigated technologies. The direct medical and indirect non-medical costs were calculated and analyzed in respect of cost-effectiveness and costs-utility and budget impact analyses, utility, expressed in the number of saved quality-adjusted life years. Result: Simulation and comparative healtheconomic analysis of intermittent (IRRT) and continuous (CRRT) renal replacement therapy showed that the use continuous (CRRT) renal replacement therapy resulted in reduction of direct medical and indirect non-medical costs even within the first year. By the end of the third year savings can achieve 341,129.5 RUR per patient, and of this amount, savings in direct medical costs show 279,646.3 RUR and savings of indirect non-medical costs show 61,483.1 RUR. Budget impact analysis identified that using continuous renal replacement therapy (CRRT) allowed to save more than 230 million RUR for the whole country during 3 years per 1,740 patients with acute renal failure. Conclusion: Despite its high initial costs, the use of CRRT results in the reduction of costs and maximum efficient use of funds, and thus CRRT can be recommended for wider use in the Russian practice.