Routine practice of managing patients with obesity in the Russian Federation: pharmacoepidemiological and pharmacoeconomic aspects

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Due to the high socio-economic significance of obesity (OB), it is necessary to improve the provision of medical care to that category of patients, which requires representative data on the real clinical practice concerning management and characteristics of patients with OB in Russia.

The aim: to assess the costs of the healthcare system for the management of patients with OB based on a retrospective analysis of primary medical documentation.

Material and methods. An analysis of outpatient records of 1000 patients over 18 years of age, observed for 1 year by a general practitioner or endocrinologist in outpatient medical and preventive institutions in 8 regions of Russia, was performed. Diagnosis of OB was made for them at least a year before inclusion in the study.

Results. Final analysis included 801 patients (55.2% male, 44.8% female individuals), average age of them was 55 [45; 62] years. Most of them had stage 1 OB at the beginning of the study. In 94.4% of them the degree of the disease did not change or increased over 1 year of observation. Arterial hypertension (82.3%) and type 2 diabetes mellitus (33%) prevailed in the structure of comorbid pathology. The frequency of clinical, laboratory and instrumental examination methods, as well as the frequency of dispensary observation, did not comply with clinical recommendations. During observation period, 32% of patients were hospitalized, most often due to cardiovascular diseases (43.5%) and diabetes mellitus (28.5%). About 21% of examined individuals received drug therapy (DT) for OB during the year of observation, but the frequency of drug prescriptions did not comply with the standard. The average cost of managing 1 patient with OB in 2022 was 70,450.53 rubles per year. The share of DT in the cost structure from the state’s perspective was only 9.46%, and the maximum costs were for outpatient care (24%), hospitalizations (26%) and disability payments (18.5%). When recalculating the cost of drug therapy for patients with OB in 2024, taking into account the use of semaglutide, a significant decrease in this index is shown –15,507.93 rubles per year per patient versus 21,748.71 rubles per year in 2022.

Conclusion. The real practice of managing patients with OB in the Russian Federation differs significantly from clinical recommendations. As a result, 1-year therapy for OB does not lead to a significant decrease in body weight. Low coverage of patients with subsidized drug provision may be one of the reasons for non-compliance with recommendations for DT in outpatient settings.

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作者简介

Sergey Nedogoda

Volgograd State Medical University of the Ministry of Healthcare of Russia

Email: nedogodasv@rambler.ru
ORCID iD: 0000-0001-5981-1754
SPIN 代码: 7005-7846

MD, Dr. Sci. (Medicine), professor, head of the Department of internal medicine of the Institute of Continuous Medical and Pharmaceutical Education

俄罗斯联邦, Volgograd

Alla Bagdasaryan

Alexandro-Mariinsky Regional Clinical Hospital No. 1

Email: bagdasaryan_1952@mail.ru

MD, head of the Department of endocrinology

俄罗斯联邦, Astrakhan

Irina Barykina

Volgograd State Medical University of the Ministry of Healthcare of Russia

Email: irinbarykin@yandex.ru
ORCID iD: 0000-0002-7061-6164
SPIN 代码: 5894-7499

MD, PhD (Medicine), associate professor of the Department of internal medicine of the Institute of Continuous Medical and Pharmaceutical Education

俄罗斯联邦, Volgograd

Svetlana Bolotova

Volgograd State Medical University of the Ministry of Healthcare of Russia

Email: bolotovasl@yandex.ru
ORCID iD: 0000-0001-6654-1000
SPIN 代码: 2721-2114

MD, PhD (Medicine), associate professor of the Department of internal medicine of the Institute of Continuous Medical and Pharmaceutical Education

俄罗斯联邦, Volgograd

Alla Vachugova

Volgograd State Medical University of the Ministry of Healthcare of Russia; Volgograd Regional Clinical Hospital No. 1

Email: avachugova@yandex.ru
ORCID iD: 0000-0002-5800-9759
SPIN 代码: 7144-2996

MD, head of the Department of endocrinology, chief external expert – endocrinologist of Volgograd Region Healthcare Committee, assistant professor of the Department of internal medicine of the Institute of continuous medical and pharmaceutical education

俄罗斯联邦, Volgograd; Volgograd

Natalia Koziolova

Academician E.A. Wagner Perm State Medical University of the Ministry of Healthcare of Russia

Email: nakoziolova@mail.ru
ORCID iD: 0000-0001-7003-5186
SPIN 代码: 1044-0503

MD, Dr. Sci. (Medicine), professor, head of the Department of internal medicine propaedeutics No. 2

刚果, Perm

Marina Kunitsyna

V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia

Email: kounitsyna@mail.ru
ORCID iD: 0000-0003-1397-1327
SPIN 代码: 6444-2033

MD, Dr. Sci. (Medicine), head of the Regional Endocrinology Center of Saratov, professor of the Department of hospital therapy of the Faculty of general medicine

俄罗斯联邦, Saratov

Victoria Lutova

Volgograd State Medical University of the Ministry of Healthcare of Russia

Email: 3asabird@inbox.ru
ORCID iD: 0000-0002-0646-5824
SPIN 代码: 4601-9910

MD, PhD (Medicine), associate professor of the Department of internal medicine of the Institute of Continuous Medical and Pharmaceutical Education

俄罗斯联邦, Volgograd

Nina Petunina

I.M. Sechenov First Moscow Medical University of the Ministry of Healthcare of Russia (Sechenov University)

Email: napetunina@mail.ru
ORCID iD: 0000-0001-9390-1200
SPIN 代码: 9784-3616

MD, Dr. Sci. (Medicine), professor, corresponding member of RAS, head of the Department of endocrinology of N.V. Sklifosovsky Institute of Clinical Medicine, member of the Board of the Russian Association of Endocrinologists, chief endocrinologist of the Ministry of Healthcare of Russia in Central Federal District

俄罗斯联邦, Moscow

Ekaterina Popova

Volgograd State Medical University of the Ministry of Healthcare of Russia

Email: cutting_saw@mail.ru
ORCID iD: 0000-0002-3498-7718
SPIN 代码: 6983-1086

MD, PhD (Medicine), senior lecturer of the Department of internal medicine of the Institute of Continuous Medical and Pharmaceutical Education

俄罗斯联邦, Volgograd

Marina Sergeeva-Kondrachenko

Penza Institute for Advanced Medical Training – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia

编辑信件的主要联系方式.
Email: marserkon@mail.ru
ORCID iD: 0000-0002-7323-8840
SPIN 代码: 6311-1113

MD, Dr. Sci. (Medicine), professor, head of the Department of therapy, general medical practice, endocrinology, gastroenterology and nephrology

俄罗斯联邦, Penza

Alla Salasyuk

Volgograd State Medical University of the Ministry of Healthcare of Russia

Email: salasyukas@outlook.com
ORCID iD: 0000-0002-6611-9165
SPIN 代码: 2651-2916

MD, Dr. Sci. (Medicine), professor of the Department of internal of the Institute of Continuous Medical and Pharmaceutical Education

俄罗斯联邦, Volgograd

Oksana Tsygankova

Novosibirsk State Medical University of the Ministry of Healthcare of Russia; Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences

Email: oksana_c.nsk@mail.ru
ORCID iD: 0000-0003-0207-7063
SPIN 代码: 1817-4484

MD, Dr. Sci. (Medicine), associate professor, professor of the Department of emergency therapy with endocrinology and occupational pathology of the Faculty of advanced training and professional retraining of physicians, senior researcher at the Research Institute of Therapy and Preventive Medicine

俄罗斯联邦, Novosibirsk; Novosibirsk

Anna Chesnikova

Rostov State Medical University of the Ministry of Healthcare of Russia

Email: rostov-ossn@yandex.ru
ORCID iD: 0000-0002-9323-592X
SPIN 代码: 9677-0932

MD, Dr. Sci. (Medicine), professor, head of the Department of internal medicine No. 1

俄罗斯联邦, Rostov-on-Don

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2. Fig. 1. Annual cost of obesity treatment with comparator drugs in patients included in the study: A - 2022; B - 2024

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3. Fig. 2. Distribution of patients included in the study by body mass index.

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4. Fig. 3. Change in obesity degree in patients included in the study during the observation period.

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5. Fig. 4. Structure of comorbid pathology in patients included in the study.

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6. Fig. 5. Cost of examinations per patient included in the study per year, RUB.

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7. Fig. 6. Causes of hospitalization of patients with obesity included in the study.

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8. Fig. 7. Structure of obesity pharmacotherapy in patients included in the study.

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9. Fig. 8. Cost of obesity treatment considering the frequency of its administration to patients included in the study, RUB.

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10. Fig. 9. Ratio of the number of registered patients with 'obesity' diagnosis in Russia to the total number of annual courses of sibutramine, orlistat, and liraglutide use in 2011–2021.

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