CLINICAL AND ECONOMICAL ASPECTS OF NOVEL APPROACHES TO THE TREATMENT OF CHRONIC HEART FAILURE DECOMPENSATION

Aim. To study the changes in expenses for the usage of the novel medication serelaxine in treatment of decompensated chronic heart failure.

Material and methods. At the core of study — buit-up Mark model that takes into consideration two scenarios of the disease course in patients with decompensated CHF: the usage of standard treatment and standard treatment with serelaxine add-on. Probability of the shift from one condition to another for both groups is calculated based on the results of international clinical trials Pre-Relax-AHF and Relax-AHF as by the data of Russian registry ORAKUL-RF. The sources of information on the price of the resources involved were open. As the whole data was not completely comparable in the build-up of the model we made some presuppositions: time hoirizon of observation — 1 year; results of Pre- Relax-AHF and Relax-AHF extrapolated to 1 year; serelaxine was prescribed only in the first episode of CHF decompensation therapy; mean rate of deaths in decompensated CHF in all age groups was the same; dynamics of mortality inside the each time cutoff (1 month, 2-6 months, 7-12 months) was similar. Except of the direct medical expenses the followinf were also calculated: amount of undercollected GDP as a result of economically active patients death; expenses for repeated hospitalizations; expenses for emergency calls; expenses for the treatment of heart failure exacerbation; size of undercollected GDP as a result of no-show of the patient at workplace for economically active patients.

Results. Expenses for hospitalization and emergency calls in serelaxine group due to lower rate of hospitalizations were almost two times lower comparing to the standard therapy group: 40,9 and 19,3 mln. rubles per 1000 patients, respectively. While using serelaxine the GDP losses due to temporary disability (the size of undercollected GDP) in the group of 1000 patients decreased by 11,5 mln. rubles, or 50%, and if to include the death related losses — by 29,3 mln. rubles (36,5%) by 1 year. Additional expenses for drug therapy of heart failure by serelaxine are compensated by the decrease of general expenses (including additional therapy by serelaxine) by 7,4-28% in patients of economically active age with decompensated CHF.

Conclusion. Serelaxine as drug with the main clinical properties as the decrease of general and cardiovascular mortality, positive influence on the level of nephrologic complications and hospitalizations, shows economical superiority in the management of economically active age patients. Currently the use of serelaxine in patients with decompensated CHF might optimize the expenses of Russian healthcare budget related to the treatment of patients with this condition.

1. Eldar-lissai A, Eapen S, Ong SH, et al. PCV100 Acute Heart Failure Patients with and Without Renal Impairment: A Study of Heart Failure-Related Resource Utilization and Costs in the United States. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research 2012;15:A130

2. National Guidelines on Diagnostics & Treatment HF, 4rd Review. Journal of Heart Failure, 2013, 14, 7 (81)/ Russian (Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Журнал Сердечная Недостаточность. Том 14, № 7 (81), 2013 г).

3. Maggioni AP, Dahlstrom U, Filippatos G, et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 2013;15:808-17.

4. Setoguchi S,et al. Repeated hospitalizations predict mortality in the community population with heart failure. American Heart Journal, 2007;154:260-6.

5. Teerlink J, et al. Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet. 2013;381(9860):29-39.

6. http://www.gks.ru

7. http://www.rosminzdrav.ru/ministry/61/22/stranitsa-979/stranitsa-983

8. Nesterov YI, et al. Chronic heart failure: diagnostics and treatment. Kemerovo: KemGMA, 2006. Russian (Нестеров, Ю. И . Хроническая сердечная недостаточность: диагностика и лечение/ Нестеров Ю. И ., Ласточкина Л. А., Ю. И . Нестеров. Кемерово: КемГМА, 2006).