Альманах клинической медицины. 2015; 1: 36-41
ПРОБЛЕМА ОЖИРЕНИЯ И ИЗБЫТОЧНОЙ МАССЫ ТЕЛА В РОССИЙСКОЙ ФЕДЕРАЦИИ И ЕЕ ФАРМАКОЭКОНОМИЧЕСКАЯ ОЦЕНКА
https://doi.org/10.18786/2072-0505-2015-1-36-41Аннотация
Актуальность. В связи с высокой распространенностью ожирения, ставшего тяжелым экономическим и социальным бременем, в последние годы большую актуальность приобрели исследования, направленные на оценку ущерба, обусловленного этой медико-социальной проблемой.
Цель – провести оценку экономического бремени ожирения в Российской Федерации на примере трех основных социально значимых нозологий: острого нарушения мозгового кровообращения (ОНМК), острого инфаркта миокарда (ОИМ) и сахарного диабета 2-го типа (СД 2 типа).
Материал и методы. Проведен анализ существующей доказательной базы по оценке затрат на ведение и лечение пациентов с ожирением, его связи с выбранными нозологиями. Для оценки влияния ожирения на государственный бюджет использовался клинико-экономический анализ «стоимость болезни» (COI – cost of illness) с учетом популяционного риска развития ОНМК, ОИМ и СД 2 типа. Принимая во внимание особенности оценки затрат и основываясь на имеющихся в свободном доступе данных, для каждой выбранной нозологии была разработана своя модель расчета стоимости заболевания.
Результаты. Затраты государства на лечение и ведение пациентов, связанные с ожирением, составили около 10,2 млрд рублей для ОНМК 7,6 млрд рублей – для ОИМ, 346,3 млрд рублей – для СД 2 типа.
Заключение. Ожирение – серьезная проблема, приводящая к существенному экономическому и социальному ущербу, уровень которого возрастает.
Список литературы
1. WHO global burden of disease (GBD) database, McKinsey Global Institute analysis.
2. Specchia ML, Veneziano MA, Cadeddu C, Ferriero AM, Mancuso A, Ianuale C, Parente P, Capri S, Ricciardi W. Economic impact of adult obesity on health systems: a systematic review. Eur J Public Health. 2014. pii: cku170.
3. Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev. 2011;(7):CD009255.
4. Oster G, Edelsberg J, O'Sullivan AK, Thompson D. The clinical and economic burden of obesity in a managed care setting. Am J Manag Care. 2000;6(6):681–9.
5. Воробьев ПА, Авксентьева МВ, Борисенко ОВ, Воробьев АИ, Вялков АИ, Лукъянцева ДВ, Сура МВ, Юрьев АС. Клинико-экономический анализ. 3-е изд. М.: Ньюдиамед; 2008. 778 с. (Vorob'ev PA, Avksent'eva MV, Borisenko OV, Vorob'ev AI, Vyalkov AI, Luk’yantseva DV, Sura MV, Yur'ev AS. Clinical and economic analysis. 3rd edition. Moscow: N'yudiamed; 2008. 778 p. Russian).
6. Fletcher RH, Fletcher SW, Wagner EH. Clinical Epidemiology. The Essentials. Baltimore: Williams & Wilkins; 1982.
7. Постановление Правительства Российской Федерации от 18 октября 2013 г. № 932 г. Москва «О программе государственных гарантий бесплатного оказания гражданам медицинской помощи на 2014 год и на плановый период 2015 и 2016 годов». (Governmental Decree of the Russian Federation from October 18, 2013, No. 932 (Moscow) “On the program of state guarantees of free medical care provided to citizens in 2014 and for the planned period of 2015 and 2016”. Russian).
8. Стандарт медицинской помощи больным инсультом. Приложение к приказу Министерства здравоохранения и социального развития РФ от 22 ноября 2004 года № 236. (Standards of medical care for stroke patients. Addendum to the Decree of the Ministry of Health and Social Development of Russian Federation from November 22, 2004, No. 236. Russian).
9. Стандарт санаторно-курортной помощи больным с цереброваскулярными болезнями. Приложение к приказу Министерства здравоохранения и социального развития РФ от 23 ноября 2004 года № 276. (Standards of sanatorium and health resort care to patients with cerebrovascular disorders. Addendum to the Decree of the Ministry of Health and Social Development of Russian Federation from November 23, 2004, No. 276. Russian).
10. Стандарт медицинской помощи больным с острым инфарктом миокарда. Приложение к приказу Министерства здравоохранения и социального развития РФ от 22 ноября 2004 года № 230. (Standards of medical care to patients with acute myocardial infarction. Addendum to the Decree of the Ministry of Health and Social Development of Russian Federation from November 22, 2004, No. 230. Russian).
11. Стандарт санаторно-курортной помощи больным с ишемической болезнью сердца. Приложение к приказу Министерства здравоохранения и социального развития РФ от 23 ноября 2004 года № 221. (Standards of sanatorium and health resort care to patients with ischemic heart disease. Addendum to the Decree of the Ministry of Health and Social Development of Russian Federation from November 23, 2004, No. 221. Russian).
12. Федеральный фонд обязательного медицинского страхования. Рекомендации по способам оплаты специализированной медицинской помощи в стационарных условиях и в дневных стационарах на основе групп заболеваний, в том числе клинико-статистических групп (КСГ) и клинико-профильных групп (КПГ) за счет средств системы обязательного медицинского страхования. (Federal Foundation of obligatory medical insurance. Recommendation on the ways of payment for specialized medical care in the in-patient units and day care units based on groups of diseases, including clinical/statistical groups (CSG) and clinical/profile groups (CPG), from budgets of the obligatory medical insurance system. Russian).
13. Ягудина РИ, Куликов АЮ, Аринина ЕЕ. Фармакоэкономика сахарного диабета второго типа. М.: МИА; 2011. (Yagudina RI, Kulikov AYu, Arinina EE. Pharmacoeconomics of type 2 diabetes mellitus. Moscow: MIA; 2011. Russian).
14. Министерство здравоохранения РФ. Статистические материалы. Общая заболеваемость взрослого населения РФ за 2012 год. Ч. II, IV. (Ministry of Health of Russian Federation. Statistical materials. Total morbidity of adult population of Russian Federation in 2012. Part II, IV. Russian).
15. Bahia L, Coutinho ES, Barufaldi LA, Abreu Gde A, Malhão TA, de Souza CP, Araujo DV. The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study. BMC Public Health. 2012;12:440.
16. Onwudiwe NC, Stuart B, Zuckerman IH, Sorkin JD. Obesity and medicare expenditure: accounting for age-related height loss. Obesity (Silver Spring). 2011;19(1):204–11.
17. Daviglus ML, Liu K, Yan LL, Pirzada A, Manheim L, Manning W, Garside DB, Wang R, Dyer AR, Greenland P, Stamler J. Relation of body mass index in young adulthood and middle age to Medicare expenditures in older age. JAMA. 2004;292(22):2743–9.
Almanac of Clinical Medicine. 2015; 1: 36-41
THE PROBLEM OF OBESITY AND OVERWEIGHT IN THE RUSSIAN FEDERATION AND ITS PHARMACOECONOMIC ASSESSMENT
https://doi.org/10.18786/2072-0505-2015-1-36-41Abstract
Background: Due to high prevalence of obesity that has turned into enormous economic and social burden, studies aimed at assessment of damages caused by this medico-social problem are seen as very important in the last years.
Aim: To assess economic burden of obesity in the Russian Federation taking as an example three main socially significant medical conditions: acute cerebrovascular accident (stroke), acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM).
Materials and methods: We analyzed available evidence on assessment of costs of management and treatment of obese patients and its relation to the disorders selected. To measure costs of obesity for the state budget, we used clinical and economic analysis “cost of illness” with consideration of risks of stroke, AMI and T2DM in the population. Taking into account specific features of cost assessment and based on publically available data, we developed separate models to calculate cost of illness for each selected disease type.
Results: Obesity-related expenses incurred by the state for treatment and management of patients amounted to 10.2 billion rubles for stroke, 7.6 billion rubles for AMI and 346.3 billion rubles for T2DM.
Conclusion: Оbesity is a serious problem causing significant economic and social losses that are increasing.
References
1. WHO global burden of disease (GBD) database, McKinsey Global Institute analysis.
2. Specchia ML, Veneziano MA, Cadeddu C, Ferriero AM, Mancuso A, Ianuale C, Parente P, Capri S, Ricciardi W. Economic impact of adult obesity on health systems: a systematic review. Eur J Public Health. 2014. pii: cku170.
3. Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev. 2011;(7):CD009255.
4. Oster G, Edelsberg J, O'Sullivan AK, Thompson D. The clinical and economic burden of obesity in a managed care setting. Am J Manag Care. 2000;6(6):681–9.
5. Vorob'ev PA, Avksent'eva MV, Borisenko OV, Vorob'ev AI, Vyalkov AI, Luk\"yantseva DV, Sura MV, Yur'ev AS. Kliniko-ekonomicheskii analiz. 3-e izd. M.: N'yudiamed; 2008. 778 s. (Vorob'ev PA, Avksent'eva MV, Borisenko OV, Vorob'ev AI, Vyalkov AI, Luk’yantseva DV, Sura MV, Yur'ev AS. Clinical and economic analysis. 3rd edition. Moscow: N'yudiamed; 2008. 778 p. Russian).
6. Fletcher RH, Fletcher SW, Wagner EH. Clinical Epidemiology. The Essentials. Baltimore: Williams & Wilkins; 1982.
7. Postanovlenie Pravitel'stva Rossiiskoi Federatsii ot 18 oktyabrya 2013 g. № 932 g. Moskva «O programme gosudarstvennykh garantii besplatnogo okazaniya grazhdanam meditsinskoi pomoshchi na 2014 god i na planovyi period 2015 i 2016 godov». (Governmental Decree of the Russian Federation from October 18, 2013, No. 932 (Moscow) “On the program of state guarantees of free medical care provided to citizens in 2014 and for the planned period of 2015 and 2016”. Russian).
8. Standart meditsinskoi pomoshchi bol'nym insul'tom. Prilozhenie k prikazu Ministerstva zdravookhraneniya i sotsial'nogo razvitiya RF ot 22 noyabrya 2004 goda № 236. (Standards of medical care for stroke patients. Addendum to the Decree of the Ministry of Health and Social Development of Russian Federation from November 22, 2004, No. 236. Russian).
9. Standart sanatorno-kurortnoi pomoshchi bol'nym s tserebrovaskulyarnymi boleznyami. Prilozhenie k prikazu Ministerstva zdravookhraneniya i sotsial'nogo razvitiya RF ot 23 noyabrya 2004 goda № 276. (Standards of sanatorium and health resort care to patients with cerebrovascular disorders. Addendum to the Decree of the Ministry of Health and Social Development of Russian Federation from November 23, 2004, No. 276. Russian).
10. Standart meditsinskoi pomoshchi bol'nym s ostrym infarktom miokarda. Prilozhenie k prikazu Ministerstva zdravookhraneniya i sotsial'nogo razvitiya RF ot 22 noyabrya 2004 goda № 230. (Standards of medical care to patients with acute myocardial infarction. Addendum to the Decree of the Ministry of Health and Social Development of Russian Federation from November 22, 2004, No. 230. Russian).
11. Standart sanatorno-kurortnoi pomoshchi bol'nym s ishemicheskoi bolezn'yu serdtsa. Prilozhenie k prikazu Ministerstva zdravookhraneniya i sotsial'nogo razvitiya RF ot 23 noyabrya 2004 goda № 221. (Standards of sanatorium and health resort care to patients with ischemic heart disease. Addendum to the Decree of the Ministry of Health and Social Development of Russian Federation from November 23, 2004, No. 221. Russian).
12. Federal'nyi fond obyazatel'nogo meditsinskogo strakhovaniya. Rekomendatsii po sposobam oplaty spetsializirovannoi meditsinskoi pomoshchi v statsionarnykh usloviyakh i v dnevnykh statsionarakh na osnove grupp zabolevanii, v tom chisle kliniko-statisticheskikh grupp (KSG) i kliniko-profil'nykh grupp (KPG) za schet sredstv sistemy obyazatel'nogo meditsinskogo strakhovaniya. (Federal Foundation of obligatory medical insurance. Recommendation on the ways of payment for specialized medical care in the in-patient units and day care units based on groups of diseases, including clinical/statistical groups (CSG) and clinical/profile groups (CPG), from budgets of the obligatory medical insurance system. Russian).
13. Yagudina RI, Kulikov AYu, Arinina EE. Farmakoekonomika sakharnogo diabeta vtorogo tipa. M.: MIA; 2011. (Yagudina RI, Kulikov AYu, Arinina EE. Pharmacoeconomics of type 2 diabetes mellitus. Moscow: MIA; 2011. Russian).
14. Ministerstvo zdravookhraneniya RF. Statisticheskie materialy. Obshchaya zabolevaemost' vzroslogo naseleniya RF za 2012 god. Ch. II, IV. (Ministry of Health of Russian Federation. Statistical materials. Total morbidity of adult population of Russian Federation in 2012. Part II, IV. Russian).
15. Bahia L, Coutinho ES, Barufaldi LA, Abreu Gde A, Malhão TA, de Souza CP, Araujo DV. The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study. BMC Public Health. 2012;12:440.
16. Onwudiwe NC, Stuart B, Zuckerman IH, Sorkin JD. Obesity and medicare expenditure: accounting for age-related height loss. Obesity (Silver Spring). 2011;19(1):204–11.
17. Daviglus ML, Liu K, Yan LL, Pirzada A, Manheim L, Manning W, Garside DB, Wang R, Dyer AR, Greenland P, Stamler J. Relation of body mass index in young adulthood and middle age to Medicare expenditures in older age. JAMA. 2004;292(22):2743–9.
