Konvergentna validacija farmakoekonomskih aspekata terapije benigne hiperplazije prostate u Crnoj Gori

Abstract

Benigna hiperplazija prostate je jedno od najčešćih oboljenja kod muškaraca starijih od 50 godina. Postoji više strategija u terapiji benigne hiperplazije koje se razlikuju po mogućnosti primjene i ekonomskoj isplativosti u zavisnosti od socio- ekonomskih uslova svake pojedinačne zemlje. Cilj ove studije je da pokaže koje su terapijske opcije sa aspekta odnosa troškova i efikasnosti najopravdanije za korišćenje u Crnoj Gori. ID Metod: U izradi studije su primjenjene tri različite metode istraživanja (triangulacioni pristup): farmakoekonomsko modeliranje, studija troškova i kvalitativna studija metodom intervjua. Modeliranje je sprovedeno kroz izradu farmakoekonomskog Markovljevog modela, kojim je upore odnos troškova i efikasnosti dutasterida i finasterida. Markovljev model je razvijen na osnovu podataka iz literature o efektivnosti i na osnovu troškova liječenja u Crnoj Gori. Trajanje jednog ciklusa u modelu je jedna godina a vremenski horizont praćenja 20 godina. Za troškove i ishode korišćena je perspektiva društva i oni su diskontovani po stopi od 3% godišnje. Urađena je Monte Karlo mikrosimulacija modela sa 1.000 virtuelnih pacijenata. Studija troškova je sprovedena tzv. “microcosting” pristupom, kroz analizu istorija bolesti pacijenata liječenih u Opštoj bolnici Nikšić. Metoda intervjua je primjenjena na osobama koje su ključne za donošenje odluka u zdravstvenom sistemu Crne Gore. Ova studija je pokazala da dutasterid ima bolji odnos troškova i kliničke efikasnosti u odnosu na finasterid, pa je finansiranje dutasterida od strane Fonda za zdravstveno osiguranje Crne Gore farmakoekonomski opravdano. Ova studija će doprinijeti da Fond za zdravstveno osiguranje Crne Gore izabere farmakoekonomski najpovoljniju strategiju liječenja benigne hiperplazije prostate što će omogućiti bolju terapiju ovog oboljenja za pacijente u Crnoj Gori.

Benign prostatic hyperplasia is one of the most common diseases in men older than 50 years. There are several strategies for the treatment of benign prostatic hyperplasia which differ in their application possibilities and economic profitability depending on the socioeconomic conditions of each country. The aim of this study is to demonstrate that the therapeutic options in terms of cost and efficiency most apt to use in Montenegro. Method: In the preparation of the study were applied three different methods of research (triangulation access): pharmacoeconomic modeling, costs study and a qualitative study through interviews. Modeling was carried out through the creation of Mark model, which is comparing the cost-effectiveness of dutasteride and finasteride. A Mark model was developed using data from the literature on the effectiveness of and on the basis of the cost of treatment in Montenegro. The duration of one cycle in the model is the one year, time horizon and follow-up for 20 years. For costs and outcomes societal perspective was used and they are discounted at a rate of 3% per annum. We performed Monte Carlo microsimulation with 1000 virtual patients. The study was carried out socalled costs. "Microcosting" approach, through the analysis of medical histories of patients treated at the General Hospital Niksic. Interview method was applied to the persons who are the key decision-making in the health system of Montenegro. This study demonstrated that dutasteride has a better ratio of cost and clinical effectiveness compared to finasteride so financing of dutasteride by the Fund for health insurance Montenegro pharmacoeconomically justified. This study will contribute to the Health Insurance Fund of Montenegro chooses the most favorable pharmacoeconomic strategy of treating benign prostatic hyperplasia which will enable better therapy of this disease for patients in Montenegro.