Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

«Military medicine is an application of well- known medical principles to military people» M. J. Mudrov ( )

«Rationally framed standard for consumption of medical resources in hospital is very important… I am convinced from the experience, that without certain rules medical resources in hospital often are spent needlessly …» N.I. Pirogov ( ) «Military medical work and private aid in the theater of war in Bulgaria and in the rear of field army in »

6,96 million people are on medical support (military personnel– 1,15 million, veterans – 0,91 million)  187 hospitals (50 thousand beds), 125 outpatient clinics  Drugs – 25% of the funds, allocated for the purchase of medical equipment property The most significant are:  Cardiovascular diseases: coronary heart disease (an increase in the number of hospitalizations in 2006 compared to 2003 by 37%), arterial hypertension, cerebrovascular diseases  Neoplasms [Kartashov V.T. et al., 2007; Miroshnichenko Y. V. et al., 2008]

Dynamics of drug consumption [Miroshnichenko Y. V. et al. // VMJ №4, with changes] «It is necessary to achieve a balance between the the level of government commitment and the funding» [V.V. Shappo // VMJ, 2008, №8, P ] Year The centra- lised purcha- ses, % The volume of consumption compared to 2005, % Average per capita drug consump- tion in RF AF, rbl. Average per capita drug consumption in RF, rbl. (according to the DSM group) Average per capita drug consumption in RF, rbl. (public funds ) (according to the DSM group) ,3100, ,2123, ,8155,

Analysis of drug therapy Evaluation of clinical efficacy and safety Сost-effectiveness analysis Budget impact analysis Formulary approval, development of clinical recommendations Models (decision trees, Markov models) Evaluation of consumption pattern New drugs

USA (The Veterans Health Administration)  The VA Formulary encourages the use of generic drugs and lower-cost drugs  The Formulary contains only 38% of drugs approved by the FDA in the 1990's and 19% of drugs approved since 2000 [American College of Physicians, 2008]  The VA provides a range of services to ~ 5,5 million veterans and their dependents 156 hospitals, 711 outpatient clinics The focus on prevention and on outpatient care  “The Department of Veterans Affairs Pharmacy Plan as a National model” [C. Good et al. // Am.J. of Public Health Vol №12]

DrugPatients C/E, th. €/ LYG Indapamide ± perindopril Arterial hypertension, 80 years old0,7 Perindopril Stable angina, diabetes mellitus, 60 years old 3,7 Candesartan Heart failure, 65 years old, intolerance to ACEI 5,2 Rosuvastatin After MI, 55 years old, men6,3 Perindopril +indapamide Diabetes mellitus, 55 years old6,8 Omega-3 PUFAsAfter MI, 60 years old6,9 PerindoprilStable angina, 60 years old7,3 EprosartanAfter stroke, 65 years old11,2 RosuvastatinStable angina, 75 years old, men12,9 ClopidogrelAfter ACS, 64 years old21,7 Cost-effectiveness of drugs

How should formulary system work? The formulary should be based on protocols of care with a clear reference to groups of patients and clinical states. It is necessary to assess not only the cost- effectiveness, but also the budget impact The formulary is a basis of educational activities for the implementation of highly effective medical technologies, acceptable from an economic standpoint

The system of medical support for attached contingents in peacetime (project) Military personnel Veterans, family members, civil staff of AF RF Military medical institutions The institutions of civil Health Care service Troops compulsory medical insurance (CMI) fund (contribution for each military) Compulsory medical insurance (CMI) fund Military medical facilities should become full participants in the medical service market [by V.V. Shappo, 2008]

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