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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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Presentation on theme: "Equity and Access to Health Care in Russia Professor Pavel Vorobyev, MD, PhD Oleg Borisenko, MD Russian Society for Pharmacoeconomics and Outcomes Research."— Presentation transcript:

1 Equity and Access to Health Care in Russia Professor Pavel Vorobyev, MD, PhD Oleg Borisenko, MD Russian Society for Pharmacoeconomics and Outcomes Research

2 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?

3 Auto-Run Moscow - Baikal 24.07-16.08 2008 16 000 kilometers by car Auto-Run Moscow - Baikal 24.07-16.08 2008 16 000 kilometers by car looking for equity in health care

4 On the side – emblems of RSPOR и ISPOR From Europe to Asia and back

5 Rare minutes of rest - on the salt lake Tuz

6 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)

7 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

8 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

9 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

10 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

11 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 биодобавки позиционируются как лекарства и вытесняют их с рынка Self-treatment is widespread (including antibiotics, hormones, etc.) In 2007 people spent 7.2 billion U.S. dollars on drugs

12 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

13 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.

14 Access to expensive, rare used (orphan) medicines

15 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

16 to 01.01.2008, 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 Hemophilia7109 Cystic fibrosis1380 Hypophyseal nanism2254 Gaucher disease151 Myeloid leukemia13583 Multiple sclerosis11328 Transplantation of organs and tissues 10088 Total: 45 893 At the end of 2008, the program involves about 49 000 patients

17 Factor VIII concentrate supply in Russia, IU per capita RUSSIAN HEMOPHILIA SOCIETY National member organization of the World Federation of Hemophilia


19 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.

20 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.

21 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.

22 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

23 Drug List: Subsidiary Drug Supply System (DLO) Anastrozole Kapecitabin Paclitaxel Temozolomid Trastuzumab Imatinib Rituximab Program “7 expensive diseases”: bortezomib, imatinib, rituximab, fludarabin Reimbursement for oncological drugs

24 Рынок онкологических препаратов в стоимостном выражении, 2003 – 2006 гг. Market of drugs used for malignancies USD, millions Increase, %

25 Соотношение секторов рынка онкологических препаратов в стоимостном выражении (USD), 2003 – 2006 гг. Hospital, retail and DLO sales of drugs used for malignancies Patients coasts increased from 75.3 mln USD to 133.5 mln USD Retail HospitalDLO

26 Top-10 drugs used in oncology, 2007 Costs Packs Gleevek (imatinib)9,33 % Viferon (interferon)13,60 % Eprex (epoeitin α)5,47 % Methyluracil12,16 % Vobenzym (combination of enzymes)4,13 % Cycloferon10,54 % Velcade (bortezomib)4,12 % Cyclophosphane7,24 % Viferon (interferon)4,03 % Interferon6,65 % Mabtera (rituximab)3,63 % Vobenzym (combination of enzymes) 5,54 % Zometa (zolendronic acid)3,63 % Grippferon (interferon)4,47 % Herceptin (trastuzumab)3,29 % Methotrexate2,80 % Arimidex (anastrozole)3,02 % Doxorubicin2,72 % Avastin (bevacizumab)2,41 %Tamoxifen2,31 %

27 Reforms in health care: how can they affect the access to drugs?

28 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

29 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

30 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.

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