The program of medical care standards for patients with epilepsy is balanced: 91.9% of GDP loss accounts for the general type of epilepsy and 90% of drugs are in the List of Vital and Essential Drugs. . On the other side, it is necessary to pay attention to the partial type of epilepsy to optimize the total costs.
Analysis of medical tariffs in Russian regions (taken from the Tariff agreements approved by the territorial funds of the Compulsory Medical Insurance for 2018) showed that medication expenses amount to 65% of all costs.
Thus, the reduction of the cost of drugs for partial epilepsy will have the greatest influence on total cost reduction.
Epilepsy diagnosis and treatment costs
Conclusions were made that the financial losses are greater for partial type epilepsy at the diagnosis and therapy selection phase, while the remission phase is cheaper. But for generalized epilepsy, diagnosis is way cheaper compared to the remission phase. Treatment of epilepsy with general type seizures is approximately half as expensive as the partial type epilepsy.
The same estimates show that costs per patient are the highest in Chukotka Autonomous Okrug, Nenets Autonomous Okrug and the Republic of Dagestan; the lowest are in Khanty-Mansi Autonomous Okrug, Irkutsk Oblast and Murmansk Oblast. Taking into account the disease prevalence by region, costs per patient are the highest in Moscow, and the lowest in Chukotka Autonomous Okrug.
Epilepsy treatment in 2018 was estimated to cost approximately 1. 1 billion dollars. One-fifth of estimated costs accounts for the Central Federal District, and the Siberian Federal District amounts to one-sixth of expenses. It is somehow not consistent with calculated DALY and GDP loss, where “problem” territories are the Northwestern and partly the Far Eastern federal districts. Almost 25% of the estimated amounts will be spent in Volga Federal Region, but not because of higher disease prevalence, but due to higher medical facilities tariffs for this region.
New epilepsy classification 2017
Epilepsy diagnosis and treatment cost estimates were calculated based on the new standard for epilepsy classifications, introduced at the International Epilepsy Congress (Sep- September 2-6, 2017, Barcelona, Spain) by Dr. Ingrid E. Scheffer (Australia), the lead of the International League Against Epilepsy disease classification research group. The new standard divides seizures into partial and generalized and specifies healthcare practices to treat each of them. Calculations do not take into account such etiological characteristics as structural, genetic, infectious roots, etc.
Costs of epilepsy diagnosis and treatment (per region and for the whole country) were calculated based on the Russian Federal State Statistics Service reports on the prevalence of generalized and partial seizure cases in the federal subjects. The total cost of medication course is based on prices stated in the List of Vital and Essential Drugs in 2017, approved by Russian Federation Government Decree No 2885-r as of December 28, 2016.
Tariffs for medical measures in the Russian subjects were taken from the Tariff agreements approved by the territorial funds of Compulsory Medical Insurance for 2018. Frequency of diagnosis, treatment and control procedures, list of medications and course medication doses per patient calculations are based on the Epilepsy Treatment General Medical Services Standards, established by Ministry of Health of the Russian Federation.
Standards include the following procedures: medical specialists office visits, examination, consultation, supervision; laboratory and instrumental tests; nursing care and supervision; drug-free methods of prevention, treatment and medical rehabilitation.
Medications in Cost Structure per Patient in Russia
The program of medical care standards for patients with epilepsy is balanced: 91.9% of GDP loss accounts for general epilepsy and 90% of drugs are in the List of Vital and Essential Drugs.
Order of Ministry oh Health (Russia). 24th Dec 2012. No 1439n "On approval of the standard primary health care in generalized epilepsy" (phase of diagnosis and selection of therapy)
Order of Ministry oh Health (Russia). 24th Dec 2012. No 1440n "On approval of the standard primary health care for generalized epilepsy in remission”
Order of Ministry oh Health (Russia). 24th Dec 2012. No 1404n "On approval of the standard of primary health care in partial epilepsy (phase of diagnosis and selection of therapy)”
Order of Ministry oh Health (Russia). 20th Dec 2012. No 1107n "On approval of the standard of primary health care in partial epilepsy in remission»