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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

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Page 1: Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

Organization of Drug Supply in Medical Service of Russian

Armed Forces in Peacetime

A.V. Rudakova,

Military Medical Academy,

St. Petersburg

Page 2: 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)

Page 3: Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

«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 »

Page 4: Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

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]

Page 5: Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

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

Page 6: Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

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

Page 7: Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

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]

Page 8: Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

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 

Page 9: Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

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

Page 10: Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

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]

Page 11: Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

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