EVALUATION OF THE EFFECTIVENESS OF THE GASTRODUODENITIS PREVENTION PROGRAM IN PATIENTS OF RETIREMENT AGE WITH ESSENTIAL ARTERIAL HYPERTENSION WHO TOOK PART IN THE PROGRAM ,AFFORDABLE MEDICINES- UNDER THE IBCR.

OBJECTIVE: The aim: To assess the e!ectiveness of the gastroduodenitis prevention program we have developed in patients of retirement age with essential arterial hypertension who participate in the «A!ordable Medicines¼ program. PATIENTS AND METHODS: Materials and methods: A combined (retrospective and prospective) study was conducted, in which 150 patients took part. The main group consisted of 100 patients of retirement age with essential arterial hypertension and gastroduodenitis, which arose against the background of treatment of essential arterial hypertension. The control group consisted of 50 patients of retirement age with essential arterial hypertension without gastroduodenitis. For this category of the population developed a program for the prevention of gastroduodenitis. To assess the e!ectiveness of this prevention program, an «incremental cost-benefit ratio¼ (#C$R) is used. RESULTS: Results: An assessment of the e!ectiveness of the gastroduodenitis prevention program we developed in patients of retirement age with essential arterial hypertension who participate in the «A!ordable Medicines¼ program. CONCLUSION: Conclusions: Identified categories of patients for whom the developed prevention program is effective.

SAMPLE SIZE CALCULATION IN STRUCTURAL EQUATION MODELING OF EQUILIBRIUM.

OBJECTIVE: The aim: To pave the way and exemplify sample size calculation to studies with complex data structures describing equilibrium. PATIENTS AND METHODS: Materials and methods: Try is probated to apply ad-hoc power analysis to structural equation modeling (SEM) of equilibrium. As example we use theoretical structural equation system that describes equilibrium of price, quality and comfort of health services developed by Dranove D., Satterthwaite M. (1992). We show the way of transition from theoretical balance models to SEM that can be processed with common statistical tools. SEM is prerogative for such transition as demonstrated in the paper. We introduced some new ideas to support transition. We use Satorra & Sarris (1985) method of ad-hoc power analysis to SEM. RESULTS: Results: The sample size to support error types 1 and 2 at arbitrary accepted levels 0.05 and 0.2 is 400 at least to test the influence of equilibrium price (p*) on equilibrium quality (q*). 600 sample size is needed to check for the influence of equilibrium price (p*) on equilibrium comfort (c*). Sample size of 600 is required to test hypothesis on informational noise about quality influences equilibrium value of quality. CONCLUSION: Conclusions: It's new ground that we are tentatively exploring in paper concerning SEM of equilibrium. The main challenge as we see it is the transition from theoretical balance models to SEM that can be processed with common statistical tools. SEM is prerogative for such transition as demonstrated in the paper.

Assessment of the effectiveness of the gastropathy risk reduction program in patients with arterial hypertension.

OBJECTIVE: Introduction: For primary health care patients with concomitant morbidity are usual phenomena. Combination of gastropathy with arterial hypertension is increasingly being studied. However, the assessing of the medical and economic effectiveness of treatment of patients with concomitant morbidity still methodologically challenging. The issue aggravated by different cushion programs aimed to alleviate financial burden to indigent population. These cover non-expensive drugs with probable hazard to concomitant morbidity. The aim: to evaluate the effectiveness of the gastropathy risk reduction program in patients with arterial hypertension (AH). PATIENTS AND METHODS: Materials and methods: data on 150 patients with AH collected by panel design with dynamic cohort traced up to 17 years. We have elaborated a program for the prevention of gastropathy in patients taking antihypertensive therapy. Program is based on regulations of the Ministry of Health of Ukraine, adapted clinical guidelines, and other official sources of information, since holistic prevention of gastropathy is not depicted in any source. Two main cohorts were distinguished: those in prevention program (PP) and patients with usual treatment. 6 built in cohorts (Group№0-№5) helped to diversify PP across groups of different severity. Event of interest was incidence or aggravation of gastropathy (gastroduodenitis mainly). We used Poisson model to study average treatment effect of PP on annual number of aggravations. RESULTS: Results: The main effect of program participation is significant in a model of fixed effects (ß = -0.269; p = 0.0156), and even more supportive in the mixed model (ß = -0.282; p = 0.0097). Other components with a variable "PP participation", namely participation in the program given the group, participation in the program given GP duration, participation in the program given compliance, appeared to be nonsignificant, that suggest absence of substantial selection bias due to non-randomness of allocation. The greatest risk reduction due to program participation was in patients of Group0, that is, in patients with hypertension who do not receive antihypertensive therapy. In groups №1-№5 with more aggressive hypertension treatment the effects of program participation are obvious but less pronounced. CONCLUSION: Conclusions: The elaborated program differentiates patients by groups and furthermore allows one to consider each patient characteristics, taking into account income, age, gender, progression of the disease, comorbidity, drugs the patient takes. The established program based on cooperation of patient, general practitioner, and gastroenterologist. We reduced selection bias due to possible randomness blemishes in allocation to the PP by control function method. The main effect of program participation is significant in a model of fixed effects (ß = -0.269; p = 0.0156), and even more supportive in the mixed model (ß = -0.282; p = 0.0097).

[Substantiation of the model of clinical and economic efficiency evaluation of prevention, treatment, and dispenserization of the patients with comorbidity. The example of patients with arterial hypertension and duodenitis].

OBJECTIVE: Introduction: Evidence based medicine requires reliant estimators of medical programs efficiency both in clinical and economical dimensions. It necessitates the substantiation of evaluation of assessment tools on the ground of clinical and economic theory. Developed model has advantage of direct link with classical economic analyses such as costutility, cost-efficiency, and cost-benefit. The aim was to substantiate the model of clinical and economic efficiency evaluation of medical program with allowance for comorbidity. PATIENTS AND METHODS: Materials and methods: Model developed on the premises of Zweifel & Breyer [1, 2], theoretical foundation based upon classical theory of moral hazard and consumer utility. Model describes equilibrium of patient's decision on the volume of medical services to consume. RESULTS: Results: We delivered the model development and equilibrium examination. Transformation of equilibrium model to cost-utility, cost-efficiency, and cost-benefit models displayed. There was also demonstrated the allowance for comorbidity with example of patients with duodenitis and arterial hypertension. CONCLUSION: Conclusions: Proffered model based on theoretical ground of moral hazard and consumer utility. There is a direct linkage with cost-utility, cost-efficiency, and cost-benefit models. For the purpose of better cognition of practical applicability we introduced model in the context of dispenserization of the patients with duodenitis and arterial hypertension.

[Evaluation on changes in risk of spasm of accommodation in pupils due to implementation of prevention program].

OBJECTIVE: Introduction: Number of children with myopia increased 3-fold while those with spasm of accommodation followed a suit by 5-fold increase over last decade to some extend due to computerization. These tidings necessitate the development and implementation of primordial prevention programs. The aim was to evaluate the changes in risk of spasm of accommodation in pupils due to implementation of prevention program. PATIENTS AND METHODS: Materials and methods: Data collection was based on dynamic panel of pupils padding by first-formers over 2012-2015 and tracing up to 2017, sample size is 1115. Program was administered randomly at the entrance point to 594 pupils. We used 3 models to analyze the impact of program and possible confounders on spans to spasm development, i.e. base log-logistic survival model (1), survival fraction model (2), and survival fraction frailty model (3). RESULTS: Results: Program effect was significant by all models, the highest by model 3 with median effect of .-2,4340, i.e. with annual risk decrease of 0,72%. Fraction of non-sensitives was next to zero. Data rebutted group segregation by innate propensity to spasm development. CONCLUSION: Conclusions: Program effect proved to be significant by all models. The most validated estimation was by survival fraction frailty model (3). Incorporating frailty squared attenuation of regression effects by selection bias. Frailties followed clean cut unimodal distribution, it allowance improved model information value significantly. The starting point of program participation is of significance too, each consecutive lag decreased program effect.