Клинични ползи и финансова тежест на pasireotidе
Abstract
Цел: Да се извърши клинична и икономическа оценка на pasireotide, прилаган при пациенти с болест на Кушинг и акромегалия от гледна точка на българската здравноосигурителна система.
Материал и методи: Извършен е систематичен преглед в интернет бази данни на проучвания относно ефикасността и безопасността на pasireotide. Приложен е подходът на макроостойностяване за остойностяване на разходите за лекарства, заплащани от Националната здравноосигурителна каса (НЗОК) за периода 2016-2018 г. Разходите са сравнени с помощта на статистическия софтуер MedCalc и екстраполирани за следващите 3 години с прилагане на линейни функции. Приложен е тест на Mann-Whitney за независими извадки за тестване на статистически значими разлики в разходите.
Резултати: Въз основа на доказателствата за ефикасност и безопасност, ръководствата на Европейското ендокринологично дружество посочват pasireotide като втора линия терапия за болестта на Кушинг и акромегалия. Годишните разходи за лечение с pasireotide са статистически значимо по-високи за всяка следваща година спрямо предишната: 310 356 лв. през 2016 г., 419 028.36 лв. през 2017 г. и 502 003.52 лв. през 2018г. Делът на разходите за pasireotide от общите лекарствени разходи, изплатени от НЗОК за амбулаторни грижи за 3-годишния период е между 0,04 и 0,07%.
Изводи: Pasireotide подобрява съответните клинични параметри, но прилагането му е свързано с по-висок риск от хипергликемия, което изисква внимателно мониториране. Свързаните с pasireotide разходи са сравнително високи за българската здравна система и показват тенденция на нарастване за следващия тригодишен период. Вероятно увеличението на годишните разходи е в резултат на увеличаване на посочените пациенти за лечение с pasireotide. Това подчертава значението му като втора линия терапия и за двете групи пациенти.
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