[The adaptation of methodology of expert selection of indicators for integral evaluation of effectiveness and efficiency of organization of medical care support at the level of subject of the Russian Federation at the "pediatrics" profile].

The adaptation of methodology of expert selection of indicators for integral evaluation of efficiency of organization of medical care on profile "pediatrics" at the level of the Subject of the Russian Federation. The study was organized as expert survey using structured interview technique. At the first stage, primary selection of indicators carried out. At the second stage, selection of experts in accordance with inclusion criteria and assessment of level of expert competence was organized. Then, criteria of expert evaluation of significance of selected indicators in accordance with international principles applied in of bench-marking systems construction were formulated. The Kendall's concordance coefficient (W) was calculated for quantitative assessment of degree of agreement between the experts answers. The non-parametric Friedman test was applied to evaluate significance of differences. The indicators with high degree of agreement between opinions of experts and availability of statistical significance according concordance coefficient are recommended as indicators for assessment of efficiency of organization of medical care of children at the level of the Subject of the Russian Federation. The following indicators satisfy these requirements: mortality of children aged 0-17 years (per 100 000 of population of corresponding age), mortality of children aged 0-1 year (per 1000 live births), mortality of children aged 0-4 years (per 1000 live births), support of population with beds for children, percentage of children aged 0-17 years under dispensary observation with diagnosis established for the first time. The study permitted to select indices (indicators) that can be applied both for integral rating of the Subjects of the Russian Federation and in formation of Federal projects or departmental target programs in pediatrics. The study results can also be applied in development of system of monitoring efficiency of implementation of these projects and programs.

[METHODOLOGICAL APPROACHES TO THE FORMATION OF THE RATING OF THE CONSTITUENT ENTITIES OF THE RUSSIAN FEDERATION, REFLECTING THE EFFICIENCY AND QUALITY OF MEDICAL CARE BY PROFILE].

Aim of the study - determination of approaches to the formation of the rating of the constituent entities of the Russian Federation, reflecting the state of medical care in various profiles (the effectiveness and quality of medical care in various profiles). The study included a comprehensive analysis of the structure and content of the reports based on the results of national medical research centers field events using classification and grouping methods. Assessment of the advantages and disadvantages of the used variants of the methodology for forming the subject rating of the Russian Federation used the method of selective SWOT analysis of methodologies published in the form of scientific articles. Further, based on the results obtained, the main requirements for building a rating system for subjects of the Russian Federation based on the indicators of efficiency (performance) and the quality of medical care were formulated. The possibility of applying international experience in building benchmarking systems in the Russian Federation is analyzed and requirements are formulated for building a subject rating system of the Russian Federation, taking into account the peculiarities of the domestic healthcare system. There are 3 main methodological approaches to the formation of the subject rating of the Russian Federation: a quantitative score rating assessment of quantitative indicators without weight coefficients, a qualitative rating assessment of the effectiveness of medical care in a profile without weight coefficients, and a mixed score-rating assessment of quantitative and qualitative indicators using weight coefficients determined only by an expert method. It has been established that many of the existing approaches to the formation of the subject rating of the Russian Federation are based on a combination of a point rating and weight coefficients established by an expert method. Since different indicators have different contributions to the final integral value of the subject rating of the Russian Federation, it is advisable to conduct another study to establish weight coefficients for indicators.

[CLINICAL AND ECONOMIC ANALYSIS OF ALTERNATIVE SCHEMES OF ANTIVIRAL THERAPY OF CHRONIC HEPATITIS C GENOTYPE 1 IN PATIENTS WHO DID NOT ANSWER TO THE PRIOR THERAPY, IN THE RUSSIAN FEDERATION].

We conducted clinical and economic analysis of the protease inhibitor simeprevir versus currently available in Russia protease inhibitors (boceprevir and telaprevir) in combination with pegylated interferon and ribavirin and dual therapy with pegylated interferon and ribavirin in patients with chronic hepatitis C genotype 1 without polymorphism Q80K, who had not responded to previous treatment. Global cost-effectiveness model was adapted to the Russian health care system. We calculated differences in direct medical costs between the antiviral therapy schemes, treatment of long-term complications of chronic hepatitis C and the costs of achieving sustained virological response (SVR) to treatment. The incremental cost-effectiveness ratio - additional cost per life year saved was calculated as well. Available published data and the tariffs of the Russian healthcare system were used for the calculations. Simeprevir was shown to be more effective than dual therapy with acceptable additional costs and more effective than boceprevir and telaprevir in the number of life years saved being less costly therapy option.