Evaluation of the pharmacoeconomical effectiveness of triple therapy of chronic obstructive pulmonary disease in employees at the large transport company

Introduction. According to the literature, exacerbation of chronic obstructive pulmonary disease (COPD) is a key factor that leads to an increase in the severity of the symptoms of the disease, deterioration of lung function, decreased exercise tolerance and, as a result, contribute to an increase in mortality. The prevention of exacerbations of COPD has social and economic significance and should be a primary task in the treatment of this disease. It is known that the use of fixed combinations improves patients' adherence to therapy by about 2 times, which, in turn, leads to an increase in the effectiveness of treatment. The study aims to evaluate the pharmacoeconomical effectiveness of triple therapy for chronic obstructive pulmonary disease using the example of a fixed triple combination of budesonide+glycopyrronium bromide+formoterol (BUD/GLI/FORM). Materials and methods. 698,359 employees of a large transportation company participated in the study. 2,154 of whom had an updated diagnosis of COPD, and 193 cases of COPD were registered for the first time. The authors conducted a clinical and economic analysis taking into account the current recommendations of the Federal State Budgetary Institution "Center for Expertise and Quality Control of Medical Care" of the Ministry of Health, Russian Federation, published in December 2016. The authors have used methods such as cost estimation, budget impact analysis, and cost–effectiveness analysis. To conduct a pharmacoeconomical analysis, the researchers used data from clinical studies comparing the effectiveness of three types of therapy in patients with moderate and severe COPD on an outpatient basis. The cost of comparison drugs is taken from the official website of the state register of maximum selling prices. The researchers analyzed the costs of the employer in accordance with the Recommendations for heads of medical institutions and attending physicians, specialist doctors of the executive bodies of the Social Insurance Fund of the Russian Federation "Approximate terms of temporary disability in the most common diseases and injuries" (in accordance with ICD-10) (approved by the Ministry of Health of the Russian Federation and the Social Insurance Fund of the Russian Federation dated August 21 2000 No. 2510/9362-34, 02-08/10‑1977P). The authors determined the cost–effectiveness ratio (CER) using the formula: CER=DC/Ef, where DC (direct costs) is the direct cost of medical technology (cost of treatment, rubles); Ef is an indicator of the effectiveness of therapy, which is expressed in the percentage of patients who successfully completed the course, which allows us to evaluate the amount of cost to ensure stable remission in 1 patient. Results. The results clearly indicate a significant reduction in financial losses of the enterprise for the absence of an employee due to temporary disability (TD) against the background of using a triple combination of BUD/GLI/FORM compared with alternative schemes. The economic effect amounted to more than 124 million rubles compared with the appointment of dual therapy DAX/DBA and more than 61 million rubles compared with the appointment of dual therapy IGCS/DDBA. The assessment of indirect costs in case of potential loss of working capacity and labor productivity as a result of exacerbation of COPD from the point of view of the macroeconomics of the region demonstrated a decrease in gross domestic product (GDP) losses in case of exacerbation and death among patients receiving BUD/GLI/FORM. Conclusion. BUD/GLI/FORM therapy in a comparative study is dominant, characterized by excellent clinical efficacy and reduced overall costs associated with a decrease in the frequency of moderate and severe exacerbations of COPD. Ethics. This study was performed in accordance with the rules of good clinical practice and the Helsinki Declaration, and did not require the conclusion of the Ethics Committee.