1. P.A. Vorobyev RSPOR president Economy of Equity and Clinico-economic Analysis of Drug Supply in Russian Federation

2. Why do we need it ? The development of new life- saving technologies and drugs Growth of the population needs (aging, polymorbidity, knowledge of people) Increased costs of health care Turbidity of information flow

3. The development of new life-saving technologies and drugs ACE inhibitors eliminate hypertension, heart failure, diabetic angiopathy Home (preventive, prophylaxis) treatment of hemophilia by VIII factor allows to be healthy Recovery and long-term remission of most oncohematological diseases – “target” therapy (recovery of 80% of patients with chronic lymphoid leukemia), bone marrow transplantation

4. Alternative costs of health care Relatively inexpensive, but mass treatment Widespread use of ineffective drugs Using of extremely expensive, but rare drugs

5. Alternative costs 14 million benefit recipients will receive 1 phial of Korvalol costs 4.50 rubles a month during the year (756 million rubles a year), OR 640 000 people, treated by “Trombo Acc”; 28 000 people, treated by Plaviks: all patients with stenting

6. Alternative costs 4S research: Simvastatin 20-40 mg per day, 5,4 years, NNT = 30 (to prevent 1 death), 11 (to prevent 1 cardiovascular event). 1 prevention of death coasts 1.36 million rubles 1 prevention of cardiovascular event coasts 498.9 thousand rubles 1 year of additionally saved life with use of Alteplase compared with Streptokinase coasts 3,8 million rubles One patient with mucopolysaccharidosis - 9-15 million rubles a year Construction of 1 km of the road - from 300 million rubles up to 18 billion rubles

7. In Russia there is no understanding, on what to spend or not to spend money The world community uses different economic restrictions, in particular – Cost of Quality Adjusted Life Year

8. The ratio of budgets Government - 40%: insurance - 30%; budgets - 70%. Patients – 60%. Only 10-15% of people are in the reimbursement system

9. Drug Market in 2007 Market size - 9 billion Euros. Market growth rate = + 12% in 2007. Forecast - +20-25% or 10 – 11 billion Euros in 2008 (1 billion Euros – for a new program «7 rare expensive diseases»)

10. Who makes decisions in Russia? Ministry of Health and its bodies – drug reimbursement program, purchasing equipment within a national project «Health», standards of medical care Federal Service on Standardization and Metrology – Committee on Medical Technology 466: protocols of care Expert bodies: Formulary Committee (Lists of essential medicines, negative list, orphan list, hospital model formulary) Regional Formulary Committees (regional standards, lists of medicines for benefit recipients) Formulary Committees and Hospital Quality Committees (formularies, standards)

11. The basic principles of decision- making Evidence (examination of scientific research) Economy (defining of acceptability and feasibility threshold) Consensus (taking into account many factors and interests of different target groups) Ethics (absence of conflict of interest)

12. The status of vital importance A medicine, without using of which in a particular disease or in specific clinical situation, the inevitable progression of disease with the development of severe complications, disabilities and self-limiting or death will happen, as well as drugs for treatment or prevention of diseases, which are dangerous for social surroundings

13. In conclusion – seven bedrock principles Equity – every medicine is available to everyone, who needs it The minimum requirement is determined by standards The list of essential medicines includes only drugs with proven effectiveness Reference prices are set for all drugs, included in the Lists of essential medicines Reimbursement – based strictly on the List of essential medicines For rare diseases – a special program– financing and logistics of delivery to the patient Monitoring, establishment of registers, scientific analysis of the situation, transparency and openness of the system