THE CLINICAL ECONOMIC ANALYSIS OF SCHEMES OF GRADED ANTI-BACTERIAL THERAPY AS A LEVEL OF AMELIORATION OF QUALITY OF MEDICAL CARE SUPPORT OF PATIENTS WITH UROLOGICAL PATHOLOGY

The necessity of implementing clinical economic studies was conditioned by a significant prevalence of infections of urinary tracts, wide variety and high cost of antibacterial pharmaceuticals for their treatment. The sampling included 539 cases of application of step schemes of antibiotics treatment in patients of urological departments in 2014-2015. Overall, six the most prevalent schemes (87.4% of all cases) were picked out. Every scheme was analyzed by application rate, clinical efficiency, treatment cost and average duration of patient stay in hospital. The most clinical efficiency was established for the scheme that included amoxicillin + сlavulanic acid in injection and peroral components without implementing peri-operational antibiotics prevention (97.7%). However, period of hospitalization was in average 2.9 days longer and transition of patient from injection component of therapy to a peroral one occurred 2.3 days later than in case of application of the same pharmaceutical in combination with peri-operational antibiotics prevention (efficiency index 96.0%). It is established that the scheme with amikacin being from economic point of view the most attractive one (cost of treatment is 2.5-6.1 times lower and period of hospitalization the shortest) and differing by high clinical efficiency (95.2%) is applied only in 4.4% of analyzed cases because amikacin has many side effects restricting its application in medical practice. The received information permits physician to rationally prescribe optimal schemes of treatment that decreases costs of therapy, risk of development of complications initiated by antibacterial therapy and also increases quality of life of patient.

infection, urinary tracts, antibacterial therapy, efficiency of treatment, clinical economic analysis

1. Арустамян Г.Н. Клинико-экономический анализ и его роль в управлении качеством медицинской помощи. Государственное управление. Электронный вестник. 2011; (29). Available at: http://e-journal.spa.msu.ru/uploads/vestnik/2011/vipusk__29._dekabr_2011_g./problemi_upravlenija_teorija_i_praktika/arustamyan.pdf

2. Лопаткин Н.А. Урология национальное руководство. М.: ГЭОТАР-Медиа; 2009.

3. Аляев Ю.Г., Глыбочко П.В., Пушкарь Д.Ю., ред. Урология. Российские клинические рекомендации. М.: ГЭОТАР-Медиа; 2016.

4. Плеханов А.Н., Дамбаев А.Б. О современных подходах к лечению инфекций мочевых путей. Вестник Бурятского научного центра Сибирского отделения Российской академии наук. 2016; 21(1): 141-8.

5. Grabe M., Bjerklund-Johansen T.E., Botto H., Çek M., Naber K.G., Tenke P., et al. European Association of Urology. Guidelines on urological infections. Available at: http://uroweb.org/wp-content/uploads/18_Urological-infections_LR.pdf

6. Schito G.C., Naber K.G., Botto H., Palou J., Mazzei T., Gualco L., et al. The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int. J. Antimicrob. Agents. 2009; 34(5): 407-13.

7. Страчунский Л.С., Розенсон О.Л. Ступенчатая терапия: новый подход к применению антибактериальных препаратов. Клиническая фармакология и терапия. 1997; 6 (4): 15-24

8. Kandil H., Cramp E., Vaghela T. Trends in Antibiotic Resistance in Urologic Practice. Eur. Urol. Focus. 2016; 2(4): 363-73

9. Плеханов А.Н., Дамбаев А.Б. Инфекция мочевых путей: эпидемиология, этиология, патогенез, факторы риска, диагностика (обзор литературы). Acta Biomedica Scientifica. 2016; 106 (1): 70-4.

10. Ярец Ю.И., Шевченко Н.И., Старовойтов А.А., Русаленко М.Г. Хронические инфекции мочевыводящих путей: состояние проблемы. Медико-биологические проблемы жизнедеятельности. 2015; 14(2): 18-23.