КЛІНІКО-ЕКОНОМІЧНИЙ АНАЛІЗ ЗАМІСНОЇ ТА ФАРМАКОТЕРАПІЇ ХВОРИХ НА ХРОНІЧНУ ХВОРОБУ НИРОК V СТАДІЇ

Анотація

CLINICAL AND ECONOMIC ANALYSIS OF CONCOMITANT AND PHARMACOTHERAPY OF PATIENTS WITH CHRONIC KINDEY DISEASE OF V STAGE

I. O. Fedyak, *N. V. Sholoyko, V. O. Vorokh

Ivano-FrankivskNationalMedicalUniversity, Ivano-Frankivsk

*BohomoletsNationalMedicalUniversity,Kiev

       Introduction. According to the Budget Code, providing patients with chronic kidney disease (CKD) by materials for hemodialysis performed for the expense of local budgets, which do not cover all costs, and regional differences range from 20 to 80% However, besides funding of materials for maintenance apparatus “artificial kidney” patients with hemodialysis should receive concomitant therapy. The purpose of this study was to analyze parameters funding for dialysis patients with CKD stage V in different regions, as well as clinical and economic evaluation of the concomitant pharmacotherapy in patients with chronic renal failure in Ivano-Frankivsk region.

       Research methods. Specifics of hemodialysis funding in the Carpathian region have been studied by analyzing available sources and interview analysis in dynamics of years of the head of the dialysis department of theIvano-FrankivskRegionalClinicalHospital – Oleg Lehun. According to the data of patients’ medical records, it was performed integrated frequency / ABC / VEN-analysis.

       Results and discussion. During2013 in the Carpathian region, hemodialysis sessions were held 327 patients, 8 people were on peritoneal dialysis, and for 19 – was carried out an operation with kidney transplantation. The total number of patients was 364 persons, which was amounted in total to 1,000,000 of population with renal replacement therapy – 263.4 patient, with hemodialysis – 236.6 persons (89.8 %); with peritoneal dialysis – 13.0 (4.9 %); with kidney transplantation – 13.7 (5.2 %). In 2014 the total number of Precarpathians who were taken hemodialysis renal substitution therapy was 391 people, of whom at 01.01.2015 was only 337 remaining patients (difference – the dead and those who left the region). In 2015 extracorporeal blood purification method in Ivano-Frankivsk region received a total of 375 patients, and on 01.10.2015 there were 338 people. In other regions, the situation with the financing of hemodialysis according to reports in an open network was much worse.

       Distribution of 74 inpatient medical records of patients with acute and chronic renal failure by sex showed the domination of men over women. The largest number of patients were in the age range of 30-39 and 60-69 years, mostly living in rural areas (66 %). According to data analysis, patients with CKD frequently prescribed medicine is calcium carbonate (Elite-Pharm,Ukraine) (11.88 %), which is to the corresponding Protocol. At the same time, accept therapy according to the Protocols, they also have a significant treatment of concomitant diseases.

       According to the study, the total cost of pharmacotherapy consumed by patients who were treated in the department of dialysis by the methods of hemodialysis and peritoneal dialysis, amounted on 01.01.2014 as 7 461.29 UAH and on 01.07.2015 – 26 114.52 UAH (for 1 patient – 310.89 UAH and 1 088.11 UAH respectively). The leader group of the most expensive medicines were medicines for treatment of concomitant diseases.

       Conclusions: Financial support for the regional program “Health of Carpathian population in 2013-2020 years” for the last 3 years, meets the need in hemodialysis of 327-391 patients. However, the medicines patients have to purchase at their own expense. However, patients with chronic kidney disease, as the study found, mostly related to the poor and disadvantaged sections of society, so in addition to dialysis, they need state aid also on medicines. The results of retrospective clinical and economic analysis of therapy that was consumed by patients indicate that they have received treatment to prevent frequent complications of chronic kidney disease (35 % designated drugs by name and 38 % of the total cost of treatment) and treatment of concomitant diseases (65 % of medicines by name and 62 % of the cost of treatment) that requires correction according to required Formulary approach.

References

1. Pro polipshennya yakosti ta orhanizatsiyi systemy medychnoyi dopomohy doroslym khvorym nefrolohichnoho profilyu: Nakaz MOZ Ukrayiny vid 30.09.2003 r. № 65 / 462 [Elektronnyy resurs]. – Rezhym dostupu : https://moz.gov.ua/ua/portal/dn_20030930__462.html.
2. Medyko-profilaktychna dopomoha khvorym nefrolohichnoho profilyu 2009-2012, shcho robyty dali? [Tekst] / M. O. Kolesnyk, N. O. Saydakova, N. I. Kozlyuk, S. S. Nikolayenko // Ukrayinsʹkyy zhurnal nefrolohiyi i dializu. – 2013. – № 3. – S. 3–14.

3. Perytonealʹnyy dializ ta hemodializ u likuvanni khvorykh z khronichnoyu nyrkovoyu nedostatnistyu [Tekst] / [M. O. Kolesnyk, I. O. Dudar, YU. I. Honchar ta in.] // Metodychni rekomendatsiyi. Kyyiv. – 2003. – 43 s.

4. Kolesnyk M. O. Standarty nefrolohichnoyi dopomohy: klinichna nastanova, medychnyy standart ta protokoly likuvannya metodom hemodializu / Za redaktsiyeyu profesora M. O.Kolesnyka [Tekst] // Dovidnyk likarya «Nefroloh» – K.: TOV «Doktor-Media», 2011. – 180 s.

5. Rehionalʹna prohrama nadannya medychnoyi dopomohy khvorym nefrolohichnoho profilyu u Lʹvivsʹkiy oblasti, 2015 [Elektronnyy resurs]. – Rezhym dostupu: www.oblrada.lviv.ua/.../1315.doc.
6. Yakovleva O. S. Doslidzhennya stan finansuvannya farmatsevtychnoho zabezpechennya khvorykh na khronichnu nyrkovu nedostatnistʹ u sviti ta v Ukrayini [Tekst] / O. S. Yakovleva // Formuvannya Natsionalʹnoyi likársʹkoyi polityky za umov vprovadzhennya medychnoho strakhuvannya: pytannya osvity, teoriyi ta praktyky: III Vseukr. nauk.-prakt. konf., 12 ber. 2015 r. : materialy konf. – Kharkiv: Vyd-vo NFaU, 2015. – S. 72–81.

7. Protokol likuvannya patsiyentiv z khronichnoyu khvoroboyu nyrok V stadiyi: diahnostyka stanu ta korektsiya porushenʹ fosforno-kalʹtsiyevoho obminu u khvorykh, yaki likuyutʹsya metodom hemodializu [Tekst] / M. O. Kolesnyk, K. M. Zakonʹ, M. V. Kulyzʹkyy, L. O. Liksunova [ta in.] // Ukrayinsʹkyy zhurnal nefrolohiyi i dializu. – 2010. – № 2. – S. 39–42.

8. Protokol likuvannya patsiyentiv z khronichnoyu khvoroboyu nyrok V stadiyi: likuvannya anemiyi [Tekst] / M. O. Kolesnyk, K. M. Zakonʹ, M. V. Kulyzʹkyy, L. O. Liksunova [ta in.] // Ukrayinsʹkyy zhurnal nefrolohiyi i dializu. – 2010. – № 2 – S. 29–38.
9. Natsionalʹnyy reyestr khvorykh na khronichnu khvorobu nyrok : 2012 rik [Tekst] / uklad. N. I. Kozlyuk, S. S. Nikolayenko, M. V. Kulyzʹkyy; Derzhavna ustanova «Instytut nefrolohiyi NAMN Ukrayiny»; hol. red. M. O. Kolesnyk. – K., 2013. – 89 s.
10. Medyko-demohrafichna sytuatsiya ta osnovni pokaznyky medychnoyi dopomohy naselennyu v rehionalʹnomu aspekti 2013 rik – Kyyiv, 2014 – 168 s. [Elektronnyy resurs]. – Rezhym dostupu : http://www.uiph.kiev.ua/dawnload/ Vidavnictvo/Medikodemografichna%20situacia.%202013.pdf.
11. Oblasna vlada zaluchyla shche 14 mln. hrn. na hemodializ do kintsya roku [Elektronnyy resurs]. – Rezhym dostupu : http://www.if.gov.ua/news/24800.

12. Osoblyvosti byudzhetu Prykarpattya na 2015 rik [Elektronnyy resurs]. – Rezhym dostupu : http://paralleli.if.ua/news/49884.html.

13. Vstupne slovo Premʺyer-ministra Ukrayiny Arseniya Yatsenyuka na zasidanni Uryadu Ukrayiny 19.11.2014 r. [Elektronnyy resurs]. – Rezhym dostupu : http://www.kmu.gov.ua/ control/publish/article?art_id=247762308.

14. Kharʹkovskye vrachy bʹyut trevohu [Elektronnyy resurs]. – Rezhym dostupu : http://gx.net.ua/region/ harkovskih-medikov-ostavili-bez-finansirovaniya-.html.

15. V Odesse polovynu vseho byudzheta na medykamenty vydelyayut dlya 300 horozhan [Elektronnyy resurs]. – Rezhym dostupu : http://www.reporter.com.ua/news/pcp590/.
16. Likuvannya anemiyi u khvorykh z khronichnoyu nyrkovoyu nedostatnistyu [Tekst] / M. O. Kolesnyk, I. O. Dudar, YU. I. Honchar [ta in.] // Metodychni rekomendatsiyi. Kyyiv. – 2003. – 22 s.

17. Yershova A. K. Etiolohiya, patohenez ta likuvannya zalizodefitsytnoyi anemiyi [Tekst] / A. K. Yershova // MZH. Klinichni rekomendatsiyi ta alhorytmy dlya praktykuyuchykh likariv. – 2009. – T.19, № 12. – S. 790–794.