organization of drug supply in medical service of russian armed forces in peacetime a.v. rudakova,...
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Organization of Drug Supply in Medical Service of Russian
Armed Forces in Peacetime
A.V. Rudakova,
Military Medical Academy,
St. Petersburg
«Military medicine is an application of well-known medical principles to military people»
M. J. Mudrov (1776-1831)
«Rationally framed standard for consumption of medical
resources in hospital is very important…
I am convinced from the experience,
that without certain rules medical resources in hospital often are spent needlessly …»
N.I. Pirogov (1810-1881)
«Military medical work and private aid in the theater of war in Bulgaria and in the rear of field army in 1877-1878 »
6,96 million people are on medical support (military personnel– 1,15 million,
veterans – 0,91 million)
187 hospitals (50 thousand beds), 125 outpatient clinics
Drugs – 25% of the funds, allocated for the purchase of medical equipment property
The most significant are: Cardiovascular diseases: coronary heart disease (an
increase in the number of hospitalizations in 2006 compared to 2003 by 37%), arterial
hypertension, cerebrovascular diseases Neoplasms
[Kartashov V.T. et al., 2007; Miroshnichenko Y. V. et al., 2008]
Dynamics of drug consumption
[Miroshnichenko Y. V. et al. // VMJ.- 2008.-№4, with changes]
«It is necessary to achieve a balance between the the level of government commitment and the funding»
[V.V. Shappo // VMJ, 2008, №8, P. 4-11.]
Year
The centra-lised
purcha-ses, %
The volume of
consumption compared to
2005, %
Average per capita
drug consump-tion in RF AF, rbl.
Average per capita drug
consumption in RF, rbl.
(according to the DSM
group)
Average per capita drug
consumption in RF, rbl. (public
funds ) (according to
the DSM group)
2005 31,3 100,0 258 1301 390
2006 50,2 123,1 318 1604 626
2007 48,8 155,6 402 1995 678
Analysis of drug therapy
Evaluation of clinical efficacyand safety
Сost-effectiveness analysis Budget impact analysis
Formulary approval, development of clinical recommendations
Models (decision trees, Markov models)
Evaluation ofconsumption pattern New drugs
USA (The Veterans Health Administration)
The VA Formulary encourages the use of generic drugs and lower-cost drugs
The Formulary contains only 38% of drugs approved by the FDA in the 1990's and 19% of drugs approved since 2000
[American College of Physicians, 2008]
The VA provides a range of services to ~ 5,5 million veterans and their dependents 156 hospitals, 711 outpatient clinics The focus on prevention and on outpatient care
“The Department of Veterans Affairs Pharmacy Plan as a National model”
[C. Good et al. // Am.J. of Public Health.- 2007.- Vol. 97.- №12]
Drug PatientsC/E, th. €/ LYG
Indapamide ± perindopril Arterial hypertension, 80 years old 0,7
Perindopril Stable angina, diabetes mellitus, 60 years old 3,7
Candesartan Heart failure, 65 years old, intolerance to ACEI 5,2
Rosuvastatin After MI, 55 years old, men 6,3
Perindopril+indapamide Diabetes mellitus, 55 years old 6,8
Omega-3 PUFAs After MI, 60 years old 6,9Perindopril Stable angina, 60 years old 7,3Eprosartan After stroke, 65 years old 11,2Rosuvastatin Stable angina, 75 years old, men 12,9
Clopidogrel After ACS, 64 years old 21,7
Cost-effectiveness of drugs
How should formulary system work?
The formulary should be based on protocols of care with a clear reference to groups of patients and clinical states.
It is necessary to assess not only the cost-effectiveness, but also the budget impact
The formulary is a basis of educational activities for the implementation of highly effective medical technologies, acceptable from an economic standpoint
The system of medical support for attached contingents in peacetime
(project)
Military personnel
Veterans, family members, civil staff of AF RF
Military medical institutions The institutions of civil Health Care service
Troops compulsory medical insurance (CMI) fund
(contribution for each military)Compulsory medical insurance
(CMI) fund
Military medical facilities should becomefull participants in the medical service market
[by V.V. Shappo, 2008]
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