Effect of centralized procurement of drugs for chronic lymphocytic leukemia

Abstract

Objective. To assess the optimizing drug provision for patients with chronic lymphocytic leukemia via centralized procurement of targeted drugs that are not included in the list of drugs for high-cost diseases. Material and methods. Potential effect of centralized procurement of medicines for the treatment of chronic lymphocytic leukemia was determined considering the cost of targeted therapy in all patients with chronic lymphocytic leukemia after decentralized procurement and drug price reduction in centralized procurement compared to decentralized one. Price reduction in centralized procurement was retrospectively analyzed considering the data in the unified information system of procurement. We used 2 methods for evaluation. The first method involved comparing prices for drugs purchased within the high-cost disease program with prices for the same drugs included in the same program but purchased in decentralized fashion (comparison of prices in one period). The second method included comparing prices for drugs purchased within the high-cost disease program with prices for the same drugs before they were included in this program (before-after price comparison). We analyzed all drugs of the high-cost disease program using the first method and only one group of drugs for malignancies of lymphoid, hematopoietic and similar tissues using the second method. Results. Centralized procurement of the drugs included in high-cost disease program but purchased under other subsidized drug provision programs reduces prices for drugs by 6.4—12.1%. Centralized procurement of all drugs included in this program in 2021 (with the exception of hospital purchases in the same volume) would have saved from 800 million to 1.5 billion rubles. Inclusion of medicines for cancer of lymphoid, hematopoietic and similar tissues in the list of high-cost diseases and centralized purchase of these drugs reduce prices by 5.6—16.7%. Potential effect of centralized procurement of venetoclax, obinutuzumab and ibrutinib can range from 959 to 2.371 million rubles. Considering price reduction after inclusion of these drugs into high-cost disease program and their subsequent centralized purchase, total budget for therapy of chronic lymphocytic leukemia is 12.5— 18.5 billion rubles. Conclusion. Drug provision of patients with chronic lymphocytic leukemia requires further improvement. Centralized purchase of expensive drugs is an effective tool to increase their availability and reduce prices. It is also necessary to improve development and approval of clinical guidelines and standards of medical care regarding inclusion of economic assessment of these documents.