CC BY
0ANALYSIS OF THE RATIONAL USE OF DRUGS USED IN
CERVICAL CANCER
1Akhmedova K.K., 2Sultanova G.A.
Tashkent Pharmaceutical Institute https://doi.org/10.5281/zenodo.14030361
Abstract. One of the important ways to develop the health system of the Republic of Uzbekistan is the rational use of drugs in medical practice. Medicines can provide an effective, cost-effective solution to a number of health-related problems if they are economically affordable, of good quality, and suitable for consoumption. In particular, according to the Decision of the President of the Republic of Uzbekistan "On further development of oncology services in the Republic of Uzbekistan in 2017-2021 and measures to improve the provision of oncological care to the population" specialised oncological medical care for people in the formation and development of a system that fully covers all layers of the cervical cancer research is carried out using pharmacoeconomic analysis.
Keywords: oncology, cervical cancer, drug targeting, content analysis, disease treatment, ABC/VEN analysis.
Relevance of work. Today, while non-infectious diseases constitute the root cause of most global diseases, malignant tumours are one of the leading causes of death and are the only significant impediment to increasing life expectancy around the world in the 21st century. Cervical cancer is a serious health system problem and ranks second among oncological diseases. One of the main causes of a high mortality rate with cervical cancer is the detection of this disease in the late stages. From oncoginecological diseases, it is divided into cervical cancer, uterine srato and ovarian cancer. Cervical cancer is considered one of the serious diseases that threaten women's health. In 2020, there were nearly 570,000 new cases of cervical cancer in the world. More than 311,000 women die from this disease each year. According to the prevalence of cervical cancer, it is the fourth most common cancer in women in the world. As in the world, in our country, cervical cancer is next to breast cancer in terms of prevalence among women of all ages. In the current period, it is important to distribute budget allocations by the state to the health sector economically, making the most of them. In these conditions, treatment provides the opportunity to rationally and effectively use the drugs used in treating patients in preventive institutions, saving budget deductions. This is due to the fact that the quality of diagnostics is not satisfactory, the absence of oncological caution among general practitioners working in the primary state of the health system, in addition to the low medical culture of patients and as a result of this, the late referral to specialized clinics is ultimately explained by the inability to provide such patients with timely and necessary medical care. Thus, an analysis of literature from various sources showed that the incidence and mortality rates of cervical cancer are growing all over the world. This indicates the relevance of the problem of dealing with this pathology.
The purpose of the work. Studying the epidemiology and etiology of cervical cancer, analyzing the standards of treatment, conducting a pharmacoeconomic assessment of the drugs used in cervical cancer in ham and their rational use.
Materials and methods. The basis of the research materials was Tashkent regional branch of the specialized scientific practical medical center of oncology and radiology of the Republic of
Uzbekistan, the price data of drug preparations in wholesale pharmacy institutions from the consolidated price sheet of primary Statistics data, medicines and medical products. The study used methods of content analysis of drugs, cost effectiveness and disease value.
Research results and their discussion. Our methodological approach, which we used to analyse the prices of drug therapy for cervical cancer and determine the advantages among alternative treatment schemes, was based on the following principles: a) the choice of an object of study and the possibility of solving existing problems, b) complexity of the combination of marketing and Pharmacoeconomic population with clinical observation data.
Studies have noted that during chemotherapy, patients suffering from ovarian cancer are prescribed a 10-percent dose. DC Docetaxel + cisplatin and CC cisplatin + cyclophosphamide. Morphological examination performed as blood mesons showed that ultrasound / CT in patients with impaired renal function within 2 cm of the normal hematological index = 0-1-2 (in patients with a normal hematological diagnosis). The parameters and functions of the kidneys and adipose tissue, as well as vascular neoplasms, were observed in patients with severe forms of malignant neoplasms (up to 5 years old), and brain metastases.
When assessing the cost of treatment, direct medical costs associated with hospitalization, diagnostics, salaries of medical personnel, co-therapy, chemotherapy drugs, as well as the cost of treating complications (30% of the total cost of treatment) were taken into account. The average cost of therapy for 6 courses of treatment for Patient 1 was calculated.
It has been found that 7 pharmacotherapeutic groups have been used to treat cervical cancer: antimetabolites, plant alkaloids, an arsenal of antibiotics is fully used; alkylating and other anti-cancer drugs are used 40.0%. For a database and subsequent marketing analysis, drugs included in the list of basic drugs for studying the assortment of various drugs used to treat cancer of the female genitals, as well as the most used drugs in oncogynecology, according to literature, were selected.
In a case based on expert conclusions on the clinic, one guru was treated for patients under Scheme 1 i.e. DC - Dosetaxel + cisplatin. Table 1 presents the results of the application of Scheme 1 in relation to 1 patient. It was found to cost him 5,168,250 soums for patients treated mainly under scheme 1.
Table 1.
Results of the application of Scheme 1 in relation to one patient
Indications Quantity Price (soum) Total (soum)
Treatment regimen in one therapeutic dose
Dosetaxel 80mg/m 781 375 4 688 250
Cisplatin 50mg/m 80 000 480 000
The average number of the course of action of the drug 6 course
Total 5 168 250
Table 2
Results of the application of Scheme 2 in relation to one patient
Indications Quantity Price (soum) Total (soum)
Treatment regimen in one therapeutic dose
Cisplatin 50mg/m 80 000 480 000
Ciphlophosphamide 100mg/m 11 500 69 000
The average number of the course of action of the drug 6 course
Total 549 000
In the case based on clinical expert opinions, one group of patients was treated according to scheme 2, i.e. Cisplatin + Cyclophosphamide. Table 2 shows the results of the application of scheme 2 in relation to 1 patient. Based on it, it was determined that 549,000 soums will be spent for patients treated under scheme 2.
Table 3.
Analysis of the costs of diagnosing cervical cancer
Indications Quantity Price (soum) Total (soum)
Rectovaginal examination 1 67 100 67 100
Cervical biopsy 2 47 300 94 600
Clinical blood test 2 20 800 41 600
Chest rengenogram 1 49 500 49 500
General urine analysis 1 11 600 11 600
EKG 1 22 500 22 500
Abdominal UTT 1 65 600 65 600
Total 352 500
According to scheme 2 of the Gynaecology Department of Tashkent regional branch of the scientific-practical medical centre of specialized oncology and radiology of the Republic, the costs for the treatment of side diseases and drug side effects in patients treated using DC -Dosetaxel + cisplatin and CC - cisplatin + cyclophosphamide were determined. (Table 3)
Table 3 lists the costs of putting a diagnosis of cervical cancer, according to which we can see that the total cost is 352,500 soums.
In Table 4, the costs spent on the treatment of complications of an adverse condition were found. Based on it, the cost soum for Scheme 1 was - 4,171,651. The sum of costs for scheme 2 was 7,900,487. Costs at different stages of cervical cancer differ from each other. The earlier cancer is detected, the lower the costs are.
Table 4
Expenses spent on the treatment of complications of an adverse condition
Harmful cases For scheme1 For scheme 2
adverse conditions % Cost (soum) adverse conditions % Cost (soum)
Neutropenia 31,0 1 293 212 12,0 948 058
Neurotoxicity 27,0 1 126 346 36,0 2 844 176
Nephrotoxicity 25,0 1 042 913 31,0 2 449 151
Anemia 14,0 584 031 18,0 1 422 088
Vomit 3,0 125 149 3,0 237 014
Total 100 4 171 651 100 7 900 487
Picture 1. Cost structure of cervical cancer at different stages. The total treatment costs of the scheme 1and scheme 2of cervical cancer are given in Table 5, which was mainly determined to be 10,659,550 soums according to Scheme 1 and 6,077,300 soums according to scheme 2.
Table 5
Cost of treatment of cervical cancer according to Scheme 1 and Scheme 2
Specification costs of scheme I costs of scheme II
Seat-day expenses 130 000 130 000
For laboratory tests 352 500 352 500
Onco-surgeon service 2 958 211 2 958 211
Chamber nurse service 1 119 262 1 119 262
For the ward cleaner 958 827 958 827
For chemotherapy 5 168 250 549 000
Total 10 696 550 6 077 300
According to scheme 1 and 2, all the total costs and their diff erences are presented.
Table 6
General cost analysis
The amount of expenses Scheme 1 (soums) Scheme 2 (soums) Difference (soums)
Treatment 10 696 550 6 077 300
Harmful cases 4 171 651 7 900 487
Total 14 868 200 13 977 787 890 413
The table 6 shows that the difference in treatment costs according to Scheme 1 and Scheme 2 was 890,413.
Conclusions
1. A comparative analysis of general treatment costs was carried out on the DC (docetaxel + cisplatin) and CC (cisplatin+ cyclophosphamide) schemes used in Phase 1 chemotherapy for patients with cervical cancer diagnosis.
2. The cost of treatment on DC (dosetaxel + cisplatin) under scheme 1 in the treatment process was 14,868,200 and the cost of treatment under scheme II on CC (cisplatin+ cyclophosphamide) was 13,977,787. The difference in treatment costs under Scheme 1 and scheme 2 was 890,413.
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