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Varicella is a significant burden on society and the healthcare system.Objective: to analyze the cost effectiveness of universal vaccination of children against varicella.Material and methods. The analysis was carried out from the perspective of the healthcare system and societal perspective, based on epidemiological data for the Russian Federation. The effect was taken into account only in the vaccinated population. The time horizon of the study is 10 years. The amount of direct medical costs for treatment of varicella was calculated based on the rates of compulsory medical insurance in St. Petersburg in 2020. The cost of drug therapy in outpatient settings was calculated based on the weighted average retail price of prescribed drugs. The analysis of direct nonmedical and indirect costs was carried out taking into account statistical data on the Russian Federation and duration of temporary disability of family members of sick children. Costs and quality-adjusted life expectancy were discounted by 3.5% per year.Results. The average cost due to the disease in the Russian Federation is 43,139 rubles / patient, of which 8,5% is direct cost. Vaccination of 100,000 children will prevent 38,551 cases of varicella in 10 years. When analyzing from a social perspective, vaccination provides a reduction in costs compared to no vaccination, and the savings will amount to 10.1 thousand rubles per 1 vaccinated person.If vaccination coverage is 90%, taking into account the fact that the cohort of children in the Russian Federation at the age of 1 year is about 1.9 million people, the cost of vaccination will amount to about 8.1 billion rubles annually. At the same time, already 6 years after vaccination, the volume of averted budgetary costs will exceed the costs of vaccination.Conclusion. Universal varicella vaccination of children will reduce the incidence of the disease and reduce the budget costs associated with this disease.

According to requirements of WHO, the trivalent influenza vaccines (TIV) have to contain antigens of two influenza A strains (A/H1N1, A/H3N2) and one influenza B strain which can be presented by antigens of a virus of lineages Yamagata or Victoria. In a season of 2017/2018 the discrepancy of the vaccinal and circulating influenza B strains was noted that caused decrease in effectiveness of vaccination, especially at children’s age when the frequency of detection of influenza B is higher, than in other age groups. Now in the Russian Federation it is registered, in addition to TIV, quadrivalent vaccine (QIV) manufactured in the Russian Federation and including antigens of influenza B viruses of the two lineages.The purpose of work was assessment of the cost-effectiveness of QIV in comparison with TIV at children of preschool age on the basis of epidemiological data on the Russian Federation for a season of 2017/2018.Material and methods. The analysis was carried out by a modeling method from a health care system and societal perspective taking into account epidemiological data on the Russian Federation and the European data on effectiveness of TIV at citizens of various age. Indirect effect of vaccination was not considered. The cost of the TIV and QIV (Grippol plus and Grippol quadrivalent, respectively) corresponded to the registered price including VAT.Results. The analysis showed that use QIV instead of TIV for children of preschool age in an epidemiological season of 2017/2018 would allow to increase quantity of the prevented influenza cases by 17.1%. The prevented indirect costs exceed the prevented direct medical costs. The incremental cost-effectiveness ratio (ICER) is 1042.65-1093.7 thousand rubles/QALY in the analysis from the health care system perspective and 124.50-267.91 thousand rubles/QALY in the analysis from the societal perspective.Conclusions. Vaccination against influenza of children of preschool age in the Russian Federation in a season of 2017/2018 with quadrivalent vaccine would allow to increase significantly the number of the prevented cases of disease and could be considered as economically highly effective intervention. Reduction of vaccine price less, than for 5% in comparison with the registered price would allow to avoid completely additional budget burden.

Interferon-free therapy for genotype 1 hepatitis C are preferable from the point of view of clinical effectiveness and safety.The purpose of work was the assessment of costs and costeffectiveness of regimens for the treatment of HCV (1 genotype) at the treatment-naive patients.Methods. The assessment was carried out from the payer perspective. In base case the analysis of costs of the drugs included and recommended for inclusion in the List of VED was carried out on the basis of a median of the registered prices including VAT and the average wholesale extra charge taking into account population in the Russian Federation.Besides, the scenario with the assessment on the basis of the prices of all drugs (which both are included, and not included in the List by VED) revealed in auctions for 2016 is analysed.Results. In the base case cost of paritaprevir/ombitasvir/ dasabuvir/ritonavir (PTV/OBV/DSV/r) therapy in patients without cirrhose is 12,2-26,6% less compared with simeprevir with pegylated interferon alfa and ribavirin (PegIFN/RBV/ SMV) at a full course of the last (12 weeks) at all patients. In scenario with refusal of inefficient therapy with PegIFN/ RBV/SMV after 4 weeks, PTV/OBV/DSV/r is characterized by the comparable volume of expenses – from decrease by 15,5% to increase by 3,2%.The analysis on the basis of the prices of auctions has shown that in comparison with the PegIFN/RBV/SMV (without refusal of inefficient therapy with PegIFN/RBV/SMV after 4 weeks) and daclatasvir and asunaprevir, economy at therapy by a PTV/OBV/DSV/r will make 4,1-19,8% and 28,3%, respectively. In comparison with PegIFN/RBV/SMV (with refusal of therapy in the absence of effect in 4 weeks) PTV/OBV/DSV/r is characterized by the comparable volume of expenses (from decrease by 7,5% to increase by 12,8%). In genotype 1b costs of PTV/OBV/DSV/r are 24,6% higher compared with narlaprevir in a combination with ritonavir, peginterferon and ribavirin.Cost-effectiveness of PTV/OBV/DSV/r is higher at patients without cirrhosis in comparison with all analysed alternatives, except for a narlaprevir in a combination with ritonavir, peginterferon and ribavirin (genotype 1b).At patients with cirrhosis the analysis on the basis of the registered prices has shown that at a full cycle of therapy decrease in costs of a PTV/OBV/DSV/r ± RBV will make 8,4% in comparison with the PegIFN/RBV/SMV, but at refusal of PegIFN/RBV/SMV in 4 weeks in the absence of the response, additional expenses on PTV/OBV/DSV/r ± RBV will make 5,6%.In the analysis on the basis of the prices of auctions PTV/ OBV/DSV/r ± RBV will allow to lower expenses at patients with cirrhosis on average by 11,9% in comparison with the daclatasvir and asunaprevir. In comparison with PegIFN/ RBV/SMV PTV/OBV/DSV/r ± RBV or it doesn’t influence expenses (at a full course of a simeprevir at all patients), or it increases them by 15,2% (at refusal of therapy in the absence of the response in 4 weeks). The cost-effectiveness of PTV/ OBV/DSV/r ± RBV surpasses all comparators at patients with cirrhosis, as well as at patients without cirrhosis. The sensitivity analysis has shown high reliability of the received results.Conclusions. Costs of PTV/OBV/DSV/r ± RBV at treatment-naive patients with HCV (1 genotype) without cirrhosis and with the compensated cirrhosis, are comparable to costs of a PegIFN/RBV/SMV at higher clinical and economic effectiveness.Taking into account the need for repeated courses of therapy to treatment-naive patients with the compensated cirrhosis, now purpose of a PTV/OBV/DSV/r ± RBV in the first line of therapy is the most preferable economically.

Now WHO experts annually formulates references on structure of both the 3rd, and 4 valent vaccines against influenza applied worldwide.The purpose of work was the assessment of averted costs due to influenza vaccination with trivalent and quadrivalent vaccines in different age groups.Material and methods. The analysis was carried out by a modeling from a societal perspective taking into account epidemiological data on the Russian Federation.Results. According to data on structure of the allocated influenza viruses in the Russian Federation for 2006-2015, at vaccination coverage of 40% of the population, replacement of trivalent vaccines with quadrivalent vaccines could prevent in addition during the season on average 604 cases of influenza per 100 thousand children aged up to 3 years, 736 cases per 100 thousand children at the age of 3–6 years, 613 cases per 100 thousand children aged from 7 up to 14 years, 106 cases per 100 thousand citizens at the age of 15– 64 years, 19 cases per 100 thousand citizens at the age of 65 years and older. In the whole population replacement of trivalent vaccines with quadrivalent vaccines would allow to prevent during the season on average 181 cases of influenza per 100 thousand citizens in addition.The averted cost is the greatest at vaccination of children of preschool and school age.In general, the volume of the costs averted when replacing trivalent vaccines with quadrivalent vaccines against influenza could be increased for 2006–2015 on average by 15,0%, and during separate seasons this increasing could be more.Replacement of a trivalent vaccines with quadrivalent vaccines could cause decrease in number of cases of influenza during the season by 265,8 thousand, and the costs averted could make 2,498 billion rubles.Conclusions. Influenza vaccination with quadrivalent vaccines can increase clinical effectiveness and costs averted in comparison with trivalent vaccines. Replacement of trivalent vaccines with quadrivalent vaccines can be the most significant at vaccination of children of preschool and school age, and also in adults from risk groups and elderly people. Economic and clinical advantages of quadrivalent vaccines in comparison with the trivalent vaccines depend on a share in the general structure of a case rate of the strains of influenza B which aren’t relating to the line included in the trivalent vaccine.

The incidence of chronic hepatitis C inRussiais extremely high, that requires an increase the access to effective treatment regimens.The aim of the study is to assess the cost of HCV therapy (genotype 1) of naïve patients without cirrhosis with second wave protease inhibitors narlaprevir and simeprevir in combination with peg-INF + RBV.Materials and methods. Analysis of the cost-effectiveness is conducted from the perspective of the health care system. The assessment took into account only the cost of antiviral drugs. In the base case, costs were calculated based on the median price including VAT and the weighted average trade margin of theRussian Federationon given population. The cost of narlaprevir was calculated on the basis of estimated registration price including VAT and average trade margin on given population (price of registration – 98 000 RUB per pack 100 mg № 56). The sensitivity analysis evaluated the option of modifying the registered price of simeprevir and the estimated rates of narlaprevir registered price on 25%, and took into consideration the auction prices in 2016.Results. In the base case costs on narlaprevir therapy 29,9% less compared with simeprevir (due to therapy with simeprevir failure after 4 weeks if lack of response). In the calculation of the full course of therapy, the savings increases to 38,4%. Analysis on prices of auctions also demonstrates the economic benefits of narlaprevir: estimated savings will account for 26,7% and 35,7% with and without allowance for failures with simeprevir in the absence of response after 4 weeks, respectively. Subgroup analysis shows that with any degree of fibrosis, narlaprevir allows reducing costs compared to simeprevir. Even in case of increasing the narlaprevir registration price and lower the simeprevir registration price compared to the baseline (in both cases – 25%) cost of therapy with narlaprevir will be 1,8% lower compared with simeprevir. Thus, the sensitivity analysis demonstrated a high reliability of the obtained results in the baseline.Conclusions. Narlaprevir in combination with peg-INF + RBV will significantly decrease the cost of treatment of naïve patients with HCV genotype 1 infection without cirrhosis compared with the combination of simeprevir and therefore increase the availability of therapy.

In the treatment of chronic hepatitis C (CHC) protease inhibitors (PI) are actively used. The aim of this analysis was to evaluate the cost-effectiveness of narlaprevir and simeprevir in the CHC (genotype 1) therapy in treatment-naïve patients and relapsers.Material and methods. Analysis of the cost-effectiveness of simeprevir and narlaprevir was conducted from the perspective of the health care system based on QUEST-1, QUEST-2, ASPIRE and PIONEER clinical trials. The relative risk of achieving SVR 24 compared to the peg-INF + RBV therapy was used in the model. Treatment discontinuation in patients receiving narlaprevir assumed in the absence of a SVR after 12 weeks and in patients receiving simeprevir in the SVR absence after 4 weeks. The cost of narlaprevir was calculated on the basis of estimated registration price in case of EDL inclusion, including VAT. Costs of other antiviral drugs were in line with the results of 2016 average auctions prices.Results. In the base case costs on antiviral drugs with narlaprevir as therapy are lower compared with simeprevir by 37,3 % (542,0 and 864,6 thousand rur, respectively), and the cost per patient with SVR 24 by 34,5%. In patients after relapse costs on antiviral drugs with narlaprevir as first-line therapy will decrease compared with simeprevir by 22,8% (542,0 and 702,5 thousand rur, respectively), and the cost per patient with SVR 24 by 41,3%. The sensitivity analysis demonstrated a high reliability of obtained results.Conclusions. With comparable clinical efficacy and tolerability of narlaprevir and simeprevir both in treatment-naïve patients and patients with relapse after therapy, which included pegylated interferon and ribavirin, narlaprevir reduces the burden on the budget.

The protease inhibitors (PI) actively using for the treatment of chronic hepatitis C (CHC).The aim of this analysis was to evaluate the cost-effectiveness of narlaprevir and simeprevir in the CHC (genotype 1) therapy in treatment-naïve patients and relapses.Material and methods. Analysis of the cost-effectiveness of simeprevir and narlaprevir was conducted from the perspective of the health care system and base on QUEST-1, QUEST-2, ASPIRE and PIONEER clinical trials. The relative risk of achieving SVR 24 compared to the peg-INF + RBV therapy was used in the model. Treatment discontinuation in patients receiving narlaprevir assumed in the absence of a SVR after 12 weeks and in patients receiving simeprevir in the SVR absence after 4 weeks. The cost of narlaprevir was calculate based on estimated registration price in case of EDL (essential pharmaceutical list approved by MOH) inclusion, including VAT (10%) and 10% as trade margin. Costs of other antiviral products were in line with the results of 2015 average auctions prices.Results. In the base case costs on antiviral products with narlaprevir as first-line therapy are lower compared with simeprevir by 12,2% (950,6 and 1083,0 thousand RUR, respectively), and the cost per patient with SVR 24 by 7,8%. In patients group after relapse costs on antiviral products with narlaprevir as first-line therapy will decrease compared with simeprevir by 4,3% (971,3 and 1014,7 thousand RUR, respectively), and the cost per patient with SVR 24 by 25,0%. The sensitivity analysis demonstrated a high reliability of obtained results. Thus, assuming equal clinical effectiveness of narlaprevir and simeprevir, costs of treatment naive patients will be 10.6% lower for narlaprevir group compared to simeprevir group (953,0 and 1066,0 thousand rur, respectively), and by 12,9% for the treatment of relapses (957,9 and 1100,0 thousand RUR, respectively).Conclusions. With comparable clinical efficacy and tolerability of narlaprevir and simeprevir both in treatmentnaïve patients and patients with relapse after therapy, which included PEGylated interferon and ribavirin, narlaprevir reduces the burden on the budget. Due to substantial variability of PI prices, it is advisable to take into account local pricing at regional programs implementation.