Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime

1. Organization of Drug Supply in Medical Service of Russian Armed Forces in Peacetime A.V. Rudakova, Military Medical Academy, St. Petersburg

2. «Military medicine  isan application of well-known medical principles to military people» M. J. Mudrov (1776-1831)

3. «Rationally framed standard for consumption of medical  resources  in hospital is very important… I am convinced from the experience, that without certain rules medical  resources  in hospital often are spent needlessly …» N.I. Pirogov (1810-1881) «Military medical work and private aid  in the theater of war in Bulgaria and in the rear  of field army in 1877-1878 »

4. 6,96 million people are on medical support (military personnel– 1,15 million, veterans  – 0,91 million) • 187 hospitals(50 thousand beds), 125 outpatient clinics • Drugs – 25% of the funds, allocated for the purchase of medical equipmentproperty The most significant are: • Cardiovascular diseases: coronary heart disease (an increase in the number of hospitalizations in 2006 compared to 2003 by 37%), arterial hypertension, cerebrovascular diseases  • Neoplasms [Kartashov V.T. et al., 2007; Miroshnichenko Y. V. et al., 2008]

5. Dynamics of drug consumption [Miroshnichenko Y. V. et al. // VMJ.- 2008.-№4, with changes] «It is necessary to achieve a balance between the the level of government commitment and the funding» [V.V. Shappo // VMJ, 2008, №8, P. 4-11.]

6. Evaluation of consumption pattern New drugs Evaluation ofclinical efficacy and safety Models (decision trees, Markov models) Сost-effectivenessanalysis Budget impact analysis Formulary approval, development of clinical recommendations Analysis of drug therapy

7. USA(The Veterans Health Administration) • The VA Formulary encourages the use of generic drugs and lower-cost drugs • The Formulary contains only 38% of drugs approved by the FDA in the 1990's and 19% of drugs approved since 2000 • The VA provides a range of services to ~5,5million veterans and their dependents 156 hospitals, 711 outpatient clinics The focus on preventionand on outpatient care • “The Department of Veterans Affairs Pharmacy Plan as a National model” [C. Good et al. // Am.J. of Public Health.- 2007.- Vol. 97.- №12] [American College of Physicians, 2008]

8. Cost-effectiveness of drugs

9. How should formulary system work? The formularyshould be based on protocols of care with a clear reference to groups of patients  and clinical states. It is necessary to assess not only the cost-effectiveness, but also the budget impact The formularyis a basis ofeducational activities for the implementation of highly effective medical technologies,acceptable from an economic standpoint

10. Troops compulsory medical insurance (CMI) fund (contribution for each military) Compulsory medical insurance (CMI) fund Military personnel Veterans, family members, civil staff of AF RF Military medical institutions The institutions of civil Health Care service The system of medical support for attached contingents in peacetime (project) Military medical facilities should become full participants in the medical service market [by V.V. Shappo, 2008]

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