Focus of problem
  • 2018 № 1 Development of a new model of health care: a conceptual approach and pilot implementation

    This paper presents an extended understanding of preventive healthcare model as a set of measures ad¬dressing risk factors (primary prevention), early detection of diseases (secondary prevention) and prevention of their complications (tertiary prevention). Four principles of service delivery are formulated to ensure the transition from a primarily curative to a predominantly preventive model, including strengthening the responsibility of citizens for the prevention of diseases, enhancing the role of primary care, overcoming physicians' interest in the volumes of care, as well as quality control based on the indicators of complications and neglected cases. The paper presents these principles pilot implementation in the reorganization of urological care in Voronezh oblast (Russia). Activities for early detection of diseases, strengthening the role of primary care providers, building interregional urological centers have significantly reduced the proportion of complicated cases, changed the structure of medical care towards the low-cost activities and eventually provided substantial clinical and economic benefits

    Authors: Esaulenko I. E. [3] Zolotukhin O. V. [3] Apolikhin O. I. [2] Katibov M. I. [1] Shishkin S. V. [1] Sheiman I. M. [1] Govorin N. V. [1] Shchukin A. V. [1] Kaprin A. D. [2]

    Tags: 4p medicine3 disease prevention1 health care model1 health service delivery1 urology1

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  • Marketing in health care
  • 2022 № 4 Choosing optimal treatment organisation strategy for unresectable liver cancer: case of Moscow region

    Introduction: despite quite low morbidity with up to 6 thousand cases per year in Russia, therapy for unresectable liver tumors is based on costly therapy with tyrosine kinase inhibitors or anti-PD‑1L agents thus leading to extremely high costs per life year saved. In the meantime, transaterial radioembolization (TARE)technique is reported to show better outcomes in this patient group compared to conservative treatment and transarterial chemotherapy (TACT). This article researches strategic options for regionwide treatment programs focused on involving TARE in unresectable liver tumors treatment.
    Methodology. Epidemiological data provided by national cancer report. Systematic review of literature (not meeting PRISMA criteria) was done for TARE vs. TACT and TARE vs. conservative treatment overall survival. Treatment costs were based on current governmental treatment tariffs for Moscow region. Only direct oncology costs were included without possible complications analysis. The final analysis was done for optimistic, pessimistic and moderate expected numbers of patients eligble for TARE.
    Results. Optimal treatment strategy implies maximum allowable rate of TARE with patients concentration in selected hospitals. For Moscow region (population of 7,6 million people) estimated yearly benefit of this strategy is 309,3 RUB (USD3,4 million USD) and 284 life years saved based on moderate prognosis.

    Authors: Kaprin A. D. [2] Lyadov K. V. [1] Polushkin V. G. [1] Kucherov V. V. [1] Petrosyan A. P. [1] Khailova Zh. V. [1] Ivanov S. A. [1] Majorov K. V. [1]

    Tags: cost-effectiveness analysis3 healthcare strategy1 hepatocellular cancer1 immunotherapy1 transa rterial radioembolization1

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