Routine practice of managing patients with obesity in the Russian Federation: Pharmacoepidemiological and pharmacoeconomic aspects
Abstract. Due to the high socio-economic significance of obesity (OB), it is necessary to improve the provision of medical care to that category of patients, which requires representative data on the real clinical practice concerning management and characteristics of patients with OB in Russia.Nedogoda S.V., Bagdasaryan A.M., Barykina I.N., Bolotova S.L., Vachugova A.A., Koziolova N.A., Kunitsyna M.A., Lutova V.O., Petunina N.A., Popova E.A., Sergeeva-Kondrachenko M.Yu., Salasyuk A.S., Tsygankova O.V., Chesnikova A.I.
The aim: to assess the costs of the healthcare system for the management of patients with OB based on a retrospective analysis of primary medical documentation.
Material and methods. An analysis of outpatient records of 1000 patients over 18 years of age, observed for 1 year by a general practitioner or endocrinologist in outpatient medical and preventive institutions in 8 regions of Russia, was performed. Diagnosis of OB was made for them at least a year before inclusion in the study.
Results. Final analysis included 801 patients (55.2% male, 44.8% female individuals), average age of them was 55 [45; 62] years. Most of them had stage 1 OB at the beginning of the study. In 94.4% of them the degree of the disease did not change or increased over 1 year of observation. Arterial hypertension (82.3%) and type 2 diabetes mellitus (33%) prevailed in the structure of comorbid pathology. The frequency of clinical, laboratory and instrumental examination methods, as well as the frequency of dispensary observation, did not comply with clinical recommendations. During observation period, 32% of patients were hospitalized, most often due to cardiovascular diseases (43.5%) and diabetes mellitus (28.5%). About 21% of examined individuals received drug therapy (DT) for OB during the year of observation, but the frequency of drug prescriptions did not comply with the standard. The average cost of managing 1 patient with OB in 2022 was 70,450.53 rubles per year. The share of DT in the cost structure from the state’s perspective was only 9.46%, and the maximum costs were for outpatient care (24%), hospitalizations (26%) and disability payments (18.5%). When recalculating the cost of drug therapy for patients with OB in 2024, taking into account the use of semaglutide, a significant decrease in this index is shown –15,507.93 rubles per year per patient versus 21,748.71 rubles per year in 2022.
Conclusion. The real practice of managing patients with OB in the Russian Federation differs significantly from clinical recommendations. As a result, 1-year therapy for OB does not lead to a significant decrease in body weight. Low coverage of patients with subsidized drug provision may be one of the reasons for non-compliance with recommendations for DT in outpatient settings.
Keywords
pharmacoepidemiology
obesity
body mass index
disease burden
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About the Authors
Sergey V. Nedogoda, MD, Dr. Sci. (Medicine), professor, head of the Department of internal medicine of the Institute of Continuous Medical and Pharmaceutical Education, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400066, Volgograd, 1 Pavshikh Bortzov Sq.E-mail: nedogodasv@rambler.ru
ORCID: https://orcid.org/0000-0001-5981-1754. Scopus ID: 6507198479. eLibrary SPIN: 7005-7846
Alla M. Bagdasaryan, MD, head of the Department of endocrinology, Alexandro-Mariinsky Regional Clinical Hospital No. 1 (Astrakhan region). Address: 414056, Astrakhan, 2 Tatishcheva St.
E-mail: bagdasaryan_1952@mail.ru
Irina N. Barykina, MD, PhD (Medicine), associate professor of the Department of internal medicine of the Institute of Continuous Medical and Pharmaceutical Education, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400066, Volgograd, 1 Pavshikh Bortzov Sq.
E-mail: irinbarykin@yandex.ru
ORCID: https://orcid.org/0000-0002-7061-6164. Scopus ID: 55673000500. eLibrary SPIN: 5894-7499
Svetlana L. Bolotova, MD, PhD (Medicine), associate professor of the Department of internal medicine of the Institute of Continuous Medical and Pharmaceutical Education, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400066, Volgograd, 1 Pavshikh Bortzov Sq.
E-mail: bolotovasl@yandex.ru
ORCID: https://orcid.org/0000-0001-6654-1000. Scopus ID: 58694759900. eLibrary SPIN: 2721-2114
Alla A. Vachugova, MD, head of the Department of endocrinology, Volgograd Regional Clinical Hospital No. 1, chief external expert – endocrinologist of Volgograd Region Healthcare Committee, assistant professor of the Department of internal medicine of the Institute of continuous medical and pharmaceutical education, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400066, Volgograd, 1 Pavshikh Bortzov Sq.
E-mail: avachugova@yandex.ru
ORCID: https://orcid.org/0000-0002-5800-9759. Scopus ID: 57226564780. eLibrary SPIN: 7144-2996
Natalia A. Koziolova, MD, Dr. Sci. (Medicine), professor, head of the Department of internal medicine propaedeutics No. 2, Academician E.A. Wagner Perm State Medical University of the Ministry of Healthcare of Russia. Address: 614990, Perm, 26 Petropavlovskaya St.
E-mail: nakoziolova@mail.ru
ORCID: https://orcid.org/0000-0001-7003-5186. Scopus ID: 6506515610. eLibrary SPIN: 1044-0503
Marina A. Kunitsyna, MD, Dr. Sci. (Medicine), head of the Regional Endocrinology Center of Saratov, professor of the Department of hospital therapy of the Faculty of general medicine, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bolshaya Kazachya St.
E-mail: kounitsyna@mail.ru
ORCID: https://orcid.org/0000-0003-1397-1327. Scopus ID: 6505933693. eLibrary SPIN: 6444-2033
Victoria O. Lutova, MD, PhD (Medicine), associate professor of the Department of internal medicine of the Institute of Continuous Medical and Pharmaceutical Education, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400066, Volgograd, 1 Pavshikh Bortzov Sq.
E-mail: 3asabird@inbox.ru
ORCID: https://orcid.org/0000-0002-0646-5824. Scopus ID: 57189647005. eLibrary SPIN: 4601-9910
Nina A. Petunina, MD, Dr. Sci. (Medicine), professor, corresponding member of RAS, head of the Department of endocrinology of N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare o Russia (Sechenov University), member of the Board of the Russian Association of Endocrinologists, chief endocrinologist of the Ministry of Healthcare of Russia in Central Federal District. Address: 123423, Moscow, 2/44, bldg. G Salyama Adilya St.
E-mail: napetunina@mail.ru
ORCID: https://orcid.org/0000-0001-9390-1200. Scopus ID: 6603436552. eLibrary SPIN: 9784-3616
Ekaterina A. Popova, MD, PhD (Medicine), senior lecturer of the Department of internal medicine of the Institute of Continuous Medical and Pharmaceutical Education, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400066, Volgograd, 1 Pavshikh Bortzov Sq.
E-mail: cutting_saw@mail.ru
ORCID: https://orcid.org/0000-0002-3498-7718. Scopus ID: 57194330452. eLibrary SPIN: 6983-1086
Marina Yu. Sergeeva-Kondrachenko, MD, Dr. Sci. (Medicine), professor, head of the Department of therapy, general medical practice, endocrinology, gastroenterology and nephrology, Penza Institute for Advanced Medical Training – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 440060, Penza, 8A Stasova St.
E-mail: marserkon@mail.ru
ORCID: https://orcid.org/0000-0002-7323-8840. Scopus ID: 57209295985. eLibrary SPIN: 6311-1113
Alla S. Salasyuk, MD, Dr. Sci. (Medicine), professor of the Department of internal of the Institute of Continuous Medical and Pharmaceutical Education, Volgograd State Medical University of the Ministry of Healthcare of Russia. Address: 400066, Volgograd, 1 Pavshikh Bortzov Sq.
E-mail: salasyukas@outlook.com
ORCID: https://orcid.org/0000-0002-6611-9165. Scopus ID: 55807712600. eLibrary SPIN: 2651-2916
Oksana V. Tsygankova, MD, Dr. Sci. (Medicine), associate professor, professor of the Department of emergency therapy with endocrinology and occupational pathology of the Faculty of advanced training and professional retraining of physicians, Novosibirsk State Medical University of the Ministry of Healthcare o Russia, senior researcher at the Research Institute of Therapy and Preventive Medicine – a branch of the Federal Research Center Institute of Cytology and Genetics of Siberian branch of the Russian Academy of Sciences. Address: 630091, Novosibirsk, 52 Krasny Avenue.
E-mail: oksana_c.nsk@mail.ru
ORCID: https://orcid.org/0000-0003-0207-7063. Scopus ID: 16835397600. eLibrary SPIN: 1817-4484
Anna I. Chesnikova, MD, Dr. Sci. (Medicine), professor, head of the Department of internal medicine No. 1, Rostov State Medical University of the Ministry of Healthcare of Russia. Address: 344022, Rostov-on-Don, 29 Nakhichevansky Lane.
E-mail: rostov-ossn@yandex.ru
ORCID: https://orcid.org/0000-0002-9323-592X. Scopus ID: 55344352600. eLibrary SPIN: 9677-0932
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