Equity%20and%20Access%20to%20Health%20Care%20in%20Russia

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Equity and Access to Health Care in Russia

• Professor Pavel Vorobyev, MD, PhD
• Oleg Borisenko, MD
• Russian Society for Pharmacoeconomics and
• Outcomes Research

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Agenda

• Equity and access to medical care in Russia
• Equity and access to common medicines
• Equity and access to high-cost medicines
• Reforms in health care how can they affect the
  access to drugs?

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Auto-Run Moscow - Baikal24.07-16.08 200816 000
kilometers by carlooking for equity in health
care
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On the side emblems of RSPOR ? ISPOR
From Europe to Asia and back
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Rare minutes of rest -on the salt lake Tuz
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General problems of access to medical care (1)

• Difficulties of physical access
•  (big distances, traffic on roads in big
  cities, concentration of medical technologies in
  several administrative centers, absence of
  primary care physicians and paramedics)

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General problems of access to medical care (2)

• The needs of population for health care are
  unknown the need for cardio surgery, oncology,
  hematology, hemodialysis, transplantation,
  orthopedics, orphan drugs etc., is in several
  times (25-30) higher than actually performed
  workload 

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General problems of access to medical care (3)

• The low level of health care financing  11-15
  billion dollars on drugs for 145 million people

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General problems of access to medical care (4)

• The availability of medical care to vulnerable
  citizens is not discussed prisoners, military
  personnel, nonresidents, poor citizens, homeless

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Russian health care market (expert opinion)

• Government financing (budgets, obligatory
  insurance) no less than 25 bill. EUROS
• Patient expenditures (data of Ministry of Health
  except grey schemes and private sector) is
  about 10 bill. EUROS
• Experts patients spend in fact 1,2-1,5 times
  more money than government, it is about 30-35
  bill. EUROS
• TOTAL health care services and pharmaceuticals
  market in Russia is about 55-60 bill. EUROS

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Access to common medicines (1)

• Less than 10-15 of population has an access to
  reimbursement 
• Financing lists include 20 of drugs with proven
  ineffectiveness and with unproven effectiveness
  costs are the greatest in the reimbursement
  system
• Many drugs, which are included in the
  reimbursement system, are not available in
  hospitals
• Pharmaceutical market of BAA is growing about 1
  billion in 2008 ?????????? ??????????????? ???
  ????????? ? ????????? ?? ? ?????
• Self-treatment is widespread (including
  antibiotics, hormones, etc.) 
• In 2007 people spent 7.2 billion U.S. dollars on
  drugs

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Access to common medicines (2)

• Since 1990-s each region has been spending
  money on drugs for special categories of
  people, programs vary significantly from region
  to region
• Since 2000 one List of Drug on the basis of
  List, developed by the Formulary Committee
• Since 2004 new federal drug reimbursement
  program (DLO) divides population covered with
  reimbursement into 2 groups.
• The first group is financed from state budget,
  the second one from regional budgets. Since
  2005 federal group may take money instead of
  drugs, it has resulted in a 70-decrease of
  program participants number about 4 of Russian
  population

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• The program for socially significant diseases
  diabetes mellitus, tuberculosis, HIV-AIDS ,
  hypertension, mental diseases, oncology.
  Basically money are spent on equipment,
  educational programs. Money on drugs - from
  regional budgets and other sources.

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• Access to expensive, rare used (orphan) medicines

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Access to rare used (orphan) medicines

• Since 2008 a new program - 7 rare expensive
  diseases - was extracted from DLO program and
  received extra money
• Since 2008 patients with hemophilia, cystic
  fibrosis, hypophysial nanism, Gauche disease,
  myeloleukemia and other hemoblastosis,
  disseminated sclerosis, condition after
  transplantation have more access to treatment
• 2 bill EUROS for 2 years
• New program covers 17 the most expensive drugs
  Somatropin, Glatiramer acetate, Interferon
  beta-1a, Interferon beta-1b, Bortezomib,
  Imatinib, Rituximab, Fludarabine, Imiglucerase,
  Dornase alfa, Mycophenolic acid, Mycophenolate
  mofetil, Tacrolimus, Ciclosporin, Antihemophilic
  factor VIII, Octocog alfa, Antihemophilic factor
  IX, Eptacog alfa (activated)
• Program will be completed in 2009, perspective
  is unknown

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The number of patients with expensive diseases to
01.01.2008, applications were submitted and drugs
were purchased for them
Nosology  The total number of benefit recipients
Hemophilia 7109
Cystic fibrosis 1380
Hypophyseal nanism 2254
Gaucher disease 151
Myeloid leukemia 13583
Multiple sclerosis 11328
Transplantation of organs and tissues  10088
Total 45 893
At the end of 2008, the program involves about 49
000 patients 
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Factor VIII concentrate supply in Russia, IU per
capita
RUSSIAN HEMOPHILIA SOCIETY
National member organization of the World
Federation of Hemophilia
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(No Transcript)
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HIV-AIDS (1)

• By the end of 2006, the Russian Federation had
  cumulatively registered 373 259 HIV cases and
  3507 AIDS cases. These numbers exclude 8083 HIV
  cases reported among foreigners as well as 16 929
  unconfirmed cases among children born to HIV
  infected mothers.
• The cumulative number of registered deaths among
  people living with HIV was 19 269.

http//www.euro.who.int/aids/ctryinfo/overview/200
60118_36 http//demoscope.ru/weekly/2008/0337/repr
od01.php
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HIV-AIDS (2)

• In 2006, a total of 135 340 HIV/AIDS patients
  received medical care, including medical follow
  up and treatment related to concomitant disease.
• By December 2006, a total of 14 681 PLHIV had
  initiated HAART of which 1430 dropped out of
  treatment in 2006.
• By December 2007, a total of 31 094 people had
  initiated HAART in the Russian Federation.

http//www.euro.who.int/aids/ctryinfo/overview/200
60118_36 http//demoscope.ru/weekly/2008/0337/repr
od01.php
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HIV-AIDS (3)

• In 2007 the average number of 13-20 registered
  patients in Russia  was adopted as an indicator
  of the adequacy of coverage by ARV therapy.
• Currently feature of HIV infection in Russia is
  the rapid increase in the number of patients, who
  need antiretroviral (ARV) therapy, because the
  largest number of HIV cases was registered  in
  1999-2001.

http//demoscope.ru/weekly/2008/0337/reprod01.php
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Reimbursement drug list for HIV-AIDS 2008

• Abacavir
•  (also in combination),
• Atazanavir,
• Darunavir,
• Didanozin,
• Indinavir,
• Zidovudin
• (also in combination),
• Lamivudin
• (also in combination),
• Lopinavir/ ritonavir,
• Nevirapin,

• Ritonavir
• (also in combination),
• Sacvinavir,
• Stavudin,
• Telbivudin,
• Phosamprenavir,
• Phosphazid,
• Entecavir,
• Enfuvirtid,
• Efavirenz,
• Nelfinavir 

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Reimbursement for oncological drugs

• Drug List Subsidiary Drug Supply System (DLO)
• Anastrozole
• Kapecitabin
• Paclitaxel
• Temozolomid
• Trastuzumab
• Imatinib
• Rituximab

• Program 7 expensive diseases
• bortezomib,
• imatinib,
• rituximab,
• fludarabin

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????? ?????????????? ?????????? ? ???????????
?????????, 2003 2006 ??.
Market of drugs used for malignancies
Increase,
USD, millions
Increase,
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??????????? ???????? ????? ??????????????
??????????? ??????????? ????????? (USD),2003
2006 ??.
Hospital, retail and DLO sales of drugs used for
malignancies Patients coasts increased from 75.3
mln USD to 133.5 mln USD 
Retail
Hospital
DLO
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Top-10 drugs used in oncology, 2007
Costs Costs Packs Packs
Gleevek (imatinib) 9,33 Viferon (interferon) 13,60
Eprex (epoeitin a) 5,47 Methyluracil 12,16
Vobenzym (combination of enzymes) 4,13 Cycloferon 10,54
Velcade (bortezomib) 4,12 Cyclophosphane 7,24
Viferon (interferon) 4,03 Interferon 6,65
Mabtera (rituximab) 3,63 Vobenzym (combination of enzymes) 5,54
Zometa (zolendronic acid) 3,63 Grippferon (interferon) 4,47
Herceptin (trastuzumab) 3,29 Methotrexate 2,80
Arimidex (anastrozole) 3,02 Doxorubicin 2,72
Avastin (bevacizumab) 2,41 Tamoxifen 2,31
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• Reforms in health care how can they affect the
  access to drugs?

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Reforms

• There are no real reforms in health care
  not (over the past decade no any fundamental
  law on health care)
• The concept of the pharmaceutical industry
  development focus on profitable drugs  (even
  with questionable effectiveness), without taking
  into account the needs of society and patients
• There is no clear vision for health development 

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What is necessary? 

• The establishment of reference prices
• A unified list of essential medicines priority
  of financing
• Distribution of reimbursement on all population
• Federal financing for rare, expensive drugs 
• Other logistics of the delivery of medicines to
  patients 

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Acknowledgement

• Vlasov V. V.
• Danishevskiy K.D.
• Kornysheva E.A.
• Saversky A.V.
• Vorobiev A.P.
• Aleinikova I.B.
• Karev A.
• Pletnev R.I.
• Novikova J.V.
• Svetlakova D.S.
• Suleimanov C. S.
• Baturin V.A.

• Vezikova N.N.
• Avksenteva M.V.
• Andrushenko E.V.
• Basistova A.A.
• Denisov A.U.
• Kopylov K.G.
• Kostikova O.M.
• Kotenko O.N.
• Litvinov A.B.
• Nikitin E.A.
• Ostrovskaya E.V.