rfhealthЗдравоохранение Российской ФедерацииHealth care of the Russian Federation0044-197X2412-0723Federal Scientific Center of Hygiene named after F.F. Erisman10.47470/0044-197X-2025-69-5-416-422hdrtmxrfhealth-2009Research ArticleОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯHEALTH CARE ORGANIZATIONИнтегративная модель оценки медицинских технологий: перспективы для системы здравоохранения Российской ФедерацииAn integrative model for health technology assessment: perspectives for the Russian healthcare systemhttps://orcid.org/0009-0004-5544-3594НиколаевАнтон АнатольевичNikolaevAnton A.

Инженер и аспирант ФГБОУ ВО «Московский государственный университет имени М.В. Ломоносова», 119991, Москва, Россия; аналитик ГБУ НИИОЗММ ДЗМ, 115088, Москва, Россия

e-mail: nikolaevaa@my.msu.ru

Engineer and postgraduate student, M.V. Lomonosov Moscow State University, Moscow, 119991, Russian Federation; analyst at Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, Moscow, 115088, Russian Federation

e-mail: nikolaevaa@my.msu.ru

nikolaevaa@my.msu.ruФГБОУ ВО «Московский государственный университет имени М.В. Ломоносова»; ГБУ города Москвы «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы»; ФГАОУ ВО «Национальный исследовательский университет "Высшая школа экономики"»РоссияM.V. Lomonosov Moscow State University; Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department; National Research University Higher School of EconomicsRussian Federation202531102025695416422Copyright © Николаев А.А., 20252025Николаев А.А.Nikolaev A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rfhealth.ru/jour/article/view/2009Введение

Введение. В статье представлена модель расширенного анализа выгод и издержек (ECBA, Extended Cost-Benefit Analysis) в качестве интегративного подхода к оценке медицинских технологий, учитывающий клинико-экономические, институциональные, поведенческие и социальные аспекты.

Цель исследования — разработка и обоснование интегративной модели расширенного анализа выгод и издержек (Extended Cost-Benefit Analysis, ECBA) для оценки медицинских технологий с учётом управляемости, поведенческих факторов и институциональной среды в условиях централизованной системы здравоохранения.

Материалы и методы

Материалы и методы. В исследовании применена методология ECBA, включающая четыре блока: медицинские, демографические, социальные и институциональные параметры. Расчёт проводили на горизонте 10 лет с дисконтированием 18,8% и на основании данных реальной практики, эконометрических оценок, нормативных документов и кейс-анализа внедрения превентивной антиретровирусной терапии. Для формализации управленческих барьеров использовали индекс управляемости технологии.

Результаты

Результаты. Модель ECBA позволяет оценивать медицинские технологии с учётом не только клинико-экономических показателей, но и управляемости, социальной результативности и институциональной реализуемости. Иллюстративный кейс превентивной антиретровирусной терапии продемонстрировал универсальность подхода, применимого к различным типам вмешательств — от скрининга до цифровых решений в условиях централизованной системы.

Ограничения исследования

Ограничения исследования. Модель основана на ряде допущений: предполагаются неизменность эффективности и затрат во времени, единообразие поведенческого отклика и институциональной среды. Не учитываются случаи неполной реализации технологии, различия в доступности между регионами и вариативность управленческих механизмов.

Заключение

Заключение. Модель ECBA может служить инструментом поддержки решений при оценке медицинских технологий с учётом не только клинико-экономических, но и институциональных и поведенческих факторов. Она позволяет сравнивать альтернативные вмешательства в условиях ограниченных ресурсов и высокой регуляторной нагрузки.

Соблюдение этических стандартов. Исследование одобрено Этическим комитетом по экспертизе исследований в сфере общественного здоровья, организации и социологии здравоохранения при ГБУ «НИИОЗММ ДЗМ» (протокол от 11.02.2025 № 02-01/ЭК/2025).

Финансирование

Финансирование. Данная статья подготовлена в рамках НИР «Разработка методологических подходов ценностно-ориентированного здравоохранения (ЦОЗ) в городе Москве» (№ по ЕГИСУ: № 123032100062-6).

Конфликт интересов

Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов в связи с публикацией данной статьи.

Поступила

Поступила: 28.03.2025 / Принята к печати: 24.06.2025 / Опубликована: 31.10.202

Introduction

Introduction. This article presents the Expanded Cost-Benefit Analysis (ECBA) model as an integrative approach to health technology assessment, taking into account clinical, economic, institutional, behavioral, and social factors.

Purpose

Purpose. To develop and justify a comprehensive model for evaluating health technologies based on ECBA, incorporating the manageability of implementation, behavioral variability, and institutional constraints.

Materials and methods

Materials and methods. The ECBA model comprises four blocks: medical outcomes, socio-demographic benefits, implementation costs, and institutional risks. Over a 10-year horizon with an 18.8% discount rate, it integrates real-world data, shadow-cost estimates, national standards (e.g., GOST R 57525–2017), and a case study on preventive ART in a metropolitan setting. Implementation feasibility is assessed via the Technology Manageability Index (TMI).

Results

Results. The ECBA model enables structured comparison of health interventions based on clinical, economic, institutional, behavioral, and social criteria. Though illustrated with the ART case, it is applicable to various preventive, therapeutic, and digital interventions in resource-limited, centralized systems.

Research limitations

Research limitations. The model assumes stable parameters over time and uniformity of institutional and behavioral responses. It does not fully account for partial adoption scenarios, regional disparities in healthcare infrastructure, or variability in institutional implementation practices.

Conclusion

Conclusion. ECBA supports policymakers by integrating multidimensional evidence into a unified framework, improving the assessment of health technologies’ real-world viability under regulatory, fiscal, and institutional constraints. 

Compliance with ethical standards. The study was approved by the local ethics committee of the Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, Moscow, protocol dated 02.11.2025 No. 02-01/ЭК/2025.

Funding

Funding. This article was prepared within the framework of the research work «Development of methodological approaches to value-oriented healthcare (VOH) in the city of Moscow».

Conflict of interest

Conflict of interest. The authors declare no conflict of interest.

Received

Received: March 28, 2025 / Accepted: June 24, 2025 / Published: October 31, 2025

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The authors declare that there are no conflicts of interest present.