Rational Pharmacotherapy in Cardiology

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Aim. To study the clinical and economic advantages of patient-oriented treatment in comparison with the traditional treatment of polymorbid patients with hypertension according to the secondary combined end point (benefit) and the primary end point (total mortality).

Material and methods. A change in the "advantage" index and total mortality in patient-oriented treatment (n=500) and traditional treatment (n=500) were studied in a cohort study in 1,000 polymorbid patients with hypertension.

Results. The change in advantage was related to the intensity of the response of the starting therapy and the effectiveness of its subsequent modification based on an assessment of the respondents' initial adherence to treatment, rather than the class or cost of medicines, the original or generic nature of the drugs, or their dosage frequency. The patient-centered approach, based on active feedback, demonstrated advantages over traditional treatment. The principle of estimating the "cost of living in effective rubles" has shown that in patient-oriented treatment, even with an increase in the direct costs of pharmacotherapy, clinical improvement with a reduction in overall mortality ensures greater treatment benefits than traditional therapy. The initial advantage of treatment was 4.22 and 4.28 effective rubles, by the 100th week of the study – 3.08 and 4.09, and by the 200th week – 2.75 and 3.75 rubles, respectively. The mortality rate for 200 weeks was 3.8% in the first, and 5.4% in the second subsample (p=0.017).

Conclusion. The analysis of advantage can be a step towards resolving the "conflict of interests" of the subjects of medical care. The introduction of clinical advantage assessment in medical practice allows a practical doctor to substantiate the clinical and economic feasibility of a specific therapeutic regimen, including the selection of a commercial nomenclature of medicines.

About the Authors

N. A. Nikolayev
Omsk State Medical University
Russian Federation

Nikolay A. Nikolayev – MD, PhD, Associate Professor, Chair of Faculty Therapy, Occupational Diseases

Lenina ul. 12, Omsk, 644099

Yu. P. Skirdenko
Omsk State Medical University; Omsk Cardiological Clinic
Russian Federation

Yulia P. Skirdenko – MD, Assistant, Chair of Faculty Therapy, Occupational Diseases, Omsk State Medical University, Cardiologist, Omsk Cardiological Clinic

Lenina ul. 12, Omsk, 644099, Lermontova ul. 41, Omsk, 644024

S. S. Bunova
Medical Clinic "Family Doctor"
Russian Federation

Svetlana S. Bunova – MD, PhD, Medical Director

Pervaya Miusskaya ul. 2-3, Moscow, 125047

A. V. Ershov
Omsk State Medical University
Russian Federation

Anton V. Ershov – MD, PhD, Associate Professor, Chair of Pathophysiology, Clinical Pathophysiology

Lenina ul. 12, Omsk, 644099


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For citations:

Nikolayev N.A., Skirdenko Yu.P., Bunova S.S., Ershov A.V. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY: FROM MINIMIZATION OF EXPENSES TO EFFECTIVE MANAGEMENT. Rational Pharmacotherapy in Cardiology. 2018;14(2):292-297. (In Russ.)

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)