VALUE IN HEALTH REGIONAL ISSUES 16C (2018) 39–45

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Economic Evaluation
Optimization Approach for Estimating the Required Amount of
Pharmaceuticals in the Russian Federation
A.V. Prasolov, DSc1,2, A.S. Kolbin, MD, PhD1,3, Yulia E. Balykina, PhD1,*
1
Saint Petersburg State University, Saint Petersburg, Russia; 2Higher School of Economics, National Research University,
Saint Petersburg, Russia; 3Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia

AB STR A CT

Objectives: To propose an algorithm that relates the effectiveness of of drug volumes. A unit of quantity corresponding to the maximum
drugs for a wide range of diseases with the financial capabilities of effect of the drug in question is proposed in the work. Conclusions:
patients. Methods: Estimates of the volume of pharmaceuticals that The proposed algorithm for estimating the amount of medicines can
are consumed in the Russian Federation by all segments of the be successfully used by both pharmaceutical (or dealer) companies
population regardless of household income were considered. These and government agencies for objective population provision. The
were calculated using statistically valid probabilities of the appear- usual sources of such estimates are based either on market surveys
ance of various diseases, official state data on the structure of or on pharmacy network data. Both ways are very expensive and do
expenditures of various strata of the population, and the optimal not allow predicting mass demand in the future, for example, with an
choice of the most effective medicines with income restrictions taken unexpected epidemic or the emergence of new medicines. In addition,
into account. The main idea was to introduce the utility function of the proposed algorithm can be successfully applied to the pricing
the drug and the cost of treatment. For each disease, its own set of problem: a variation in price may show a change in the volume
drugs was selected. Results: On the basis of the real-world data for of use.
several diseases, optimal estimates were calculated using the pro- Keywords: health technology assessment, optimal choice of treatment
posed algorithm. In the process of approbation, some weak points of plan, pharmacoeconomics.
the algorithm were found, such as the methods of packaging phar-
maceuticals and associated cost of a packaging unit. These character- Copyright & 2018, International Society for Pharmacoeconomics and
istics should be discussed separately, introducing conventional units Outcomes Research (ISPOR). Published by Elsevier Inc.

considered either as an expert assessment of individual market

Introduction
players or as data from regulatory bodies. In this article, the use
One of the main goals in the pharmaceutical market is to of drugs in the RF is formalized in mathematical terms with
determine the production volumes of different drugs and to respect to some “major” diseases; that is, a mathematical model
assess the dynamics of these volumes. Within this framework, for the optimal drug choice (treatment plan) is proposed with a
pharmacoeconomic studies in the current period of the health budget allocated for treatment. We consider a household member
care economy development are one of the challenging areas (HM), who achieves the highest effectiveness (utility) of drugs, as
allowing to optimally solve the problem of drug assistance for the decision maker. Results of the selection of optimal treatment
patients receiving treatment, with scarce financial resources [1]. plans are combined into a macroeconomic problem of estimating
Management and effective planning of the drug supply system the necessary volumes of medicines throughout the country. In
cannot exist without information support, which forms the this regard, official statistics on the disease likelihood were used.
decision-making process at all levels. The pharmaceutical market Solving these issues has a wide utility of the pharmaceuticals
undergoes various changes; for example, the technology of drug used. Obtained results might be useful at the producer level, as
production and distribution is changing and conditions for an opportunity to forecast the production and sale of medicines,
monitoring are emerging. At present, information on the struc- as well as at the state level.
ture and volume of the pharmaceutical market is disparate and Different aspects of demand and need for drugs have been
incomplete. This applies both to different regions and to the considered in research studies by Dremova [2], Dzhuparova and
Russian Federation (RF) as a whole. This information can be Sboeva [3], Kobzar and Avetisyan [4], and many others. The

Conflicts of interest: The authors have indicated that they have no conflicts of interest with regard to the content of this article.
* Address correspondence to: Yulia E. Balykina, Saint Petersburg State University, Universitetskaya nab., 7/9, Saint Petersburg 199034,
Russia.
E-mail: [email protected].
2212-1099$36.00 – see front matter Copyright & 2018, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Published by Elsevier Inc.
https://doi.org/10.1016/j.vhri.2018.04.002
40 VALUE IN HEALTH REGIONAL ISSUES 16C (2018) 39–45

offered methods allow carrying out an analysis of the necessity followed by calculations. The data are extrapolated to restore sales
for different medicines in individual market segments: certain volumes across all pharmacies of the city, region, and market in
categories of patients, various prevention and treatment institu- general. Thus, having analyzed various studies on the subject, it
tions, different pharmacotherapeutic categories, and so forth. can be summarized that for the most part, the question of
Dremova [2] distinguishes the following methods for studying the analyzing the pharmaceutical market is based on the empirical
assortment of medicines, depending on the goals. The first data from pharmacy institutions with the involvement of econo-
method is a marketing analysis of the range of drugs at the metric methods.
regional or local level, which creates an array of marketing In a study by Smith et al. [9], the construction of a planning
information about drugs. The drugs are then systematized and promotion strategy for business in the pharmaceutical
according to their international nonproprietary names, trade market is considered. The Protek company shares its experience.
names, volumes, pack forms, and so forth. Production is analyzed For example, at one of the stages of strategic analysis, namely,
on the basis of the number of foreign and domestic drugs, the analysis of sociodemographic positions, the authors show
original drugs, and generics, as well as other characteristics. that the growth of the average income level in the country entails
The second method is an analysis of drug assortment by a change in demand in favor of drugs of higher price categories
prescriptions, which can be made on the basis of the following with greater efficiency. Similar issues were described by Prasolov
information sources: prescriptions, ambulatory medical records, and Kolbin [10]. The present article examines the changes in drug
and case records. The sample is either taken for a certain period demand depending on the structure of income and expenditure.
of time (month, quarter, or year) or is specific (for certain medical For the first time, the problem is taken up on the possibility of
specialists, certain types of diseases, etc.). This information is estimating the drug market on the basis of the utility and
processed by calculating statistical characteristics of the sample available budget, when the consumer has budget constraints
and the consumption intensity factors. The third refers to socio- and chooses the optimal “recovery” regime.
logical methods, which provide an opportunity within a short
time to obtain information based on public opinion. Major
techniques used are survey questionnaires and interviews. Methods
Expert judgments are also considered because these are neces-
sary for obtaining and studying the opinions of certain specialists
Adoption of an Optimal Strategy for One Disease and
in an industry related to the drug market.
While studying the literature on the subject, it was observed that Several Drugs
most often the analysis issues are considered from the viewpoint of Let us consider a situation in which a person falls sick and is
the policy of the pharmaceutical organizations. There are, however, needed to choose a drug from the set that is suitable for the
many works devoted to individual diseases or groups of diseases. For disease. At the same time, we need to remember that every person
example, in the study by Dzhuparova and Sboeva [3], stratification of has a budget limit and that each drug has its own effect on the
patients diagnosed with diabetes mellitus was carried out using body. The problem of estimating the need for certain drugs can be
questionnaires. As a result, three main groups were identified: solved with help of econometric methods: the pharmacy system is
patients with low, middle, and high income. The coefficients of monitored and, after appropriate extrapolations, estimations of the
income elasticity were then found, as well as the willingness of consumption amount of a given medicine are deduced, as
patients to participate in partial payment for medicines, self-mon- described earlier. In this article, we proceeded from the consumer
itoring, and insulin administration. Other examples of studies task (one of the most developed models in microeconomics [11]), in
devoted to the analysis of the drug market for certain groups of which the HM solves the problem of optimizing the treatment
diseases include forecast of the development of drugs assortment strategy, taking into account his budgetary constraints.
for the treatment of bronchial asthma in children by Kobzar and Data on the budget expenditures of an HM were obtained from
Avetisyan [4] and the marketing analysis of the sedative drugs the Federal State Statistics Service [12]. First, the entire popula-
market by Andreeva et al. [5]. In these studies, analysis usually tion of the RF was divided into 10 equal parts, called deciles,
refers to sociological methods of data collection and its statistical which were united by one (medium) income level. The structure
analysis. If forecasting is necessary, the basic econometric methods of expenditures in deciles is different, in particular with respect
are used. For example, in the study by Frolova and Tulyakov [6], a to health care. Table 1 presents official statistical data [12] of the
short-term forecasting of the demand for pharmaceutical products average RF income and some expenses per month for one HM (in
based on sales data for previous periods is made using a mathe- rubles [R]), as well as the annual drug consumption. Because the
matical apparatus of artificial neural networks. official statistics combine the costs of medicines and hygiene
It should also be noted that there are many analytical agencies items, in further calculations we proceeded from the assumption
working in the Russian pharmaceutical market: Pharmexpert, that for any category of consumer security, hygiene items
DSM, COMCON-Pharma, IMS, RMBC, and so forth. All these account for one-quarter of the total expenditure. This is reflected
companies carry out monitoring and publish analytical reviews in the last row of Table 1.
with comprehensive analysis of market volumes, dynamics, struc- The “utility function” of medicines was introduced to assess the
ture, and so forth. For example, the DSM Group releases monthly effect of the chosen drug. To describe the drug effects, we were
analytical reviews, which reflect the overall situation and changes guided by the fact that when using small doses, the drug almost
that occurred in the pharmaceutical market during the reporting does not affect a patient’s body; then there is a dose that delivers
period. The information presented in the reports is based on the the greatest possible effect (which can be obtained from this
data of the retail audit [7]. Needless to say, companies do not medicine), and there is also the amount after which the harmful
disclose their methods of analysis, but the general methodology for effect begins (overdose). We suggest the following dependence as
collecting, processing, and analyzing data, using the example of a function of the effectiveness of one drug for one disease [13]:
Pharmexpert, is as follows [8]. First, a data collection system is
ϕðxÞ ¼ax2 ðm−xÞ, ð1Þ
developed. Data are collected in cooperation with pharmacy
institutions. They provide data on drug purchases. The character- where x is the drug volume (measurement units and the corre-
istics of the sample are then gathered. The sample has three stages sponding prices will be addressed later), a is the parameter
of stratification: with respect to the regions, the cities within each characterizing the maximum level of drug efficacy, and m is the
selected region, and the pharmacies inside each city. This is parameter equal to such a drug quantity at which it ceases to be
 VALUE IN HEALTH REGIONAL ISSUES 16C (2018) 39–45 41

Table 1 – Average RF incomes and some expenses per month for one HM (in rubles).
Income and expenses Deciles

1 2 3 4 5 6 7 8 9 10

Income ðBj Þ 4,578 6,453 7,881 9,336 10,965 13,044 15,949 19,897 26,381 51,487
Nonfood goods ðBj Þ 866 1,317 1,669 2,064 2,598 3,214 4,222 5,421 7,694 15,377
Expenses for medical goods and 192 266 326 369 434 505 568 656 795 906
hygiene items
Annual expenses for drugs and 2,304 3,192 3,912 4,428 5,208 6,060 6,816 7,872 9,540 10,872
hygiene items
Annual expenditure on drugs 1,728 2,394 2,934 3,321 3,906 4,545 5,112 5,904 7,155 8,154
HM, household member; RF, Russian Federation.

useful and becomes harmful. The behavior of the effectiveness levels. Let us denote xi, yi, and pi as the number of drug units, the
function, with respect to the amount of drugs consumed, is shown drug therapy cost, and the unit cost, respectively, for every drug i.
in Figure 1 (four functions with different parameters). It is clear that yi ¼ xi pi . Suppose that a doctor, when proposing a
Let us introduce discrete efficiency levels: 1/3, weak utility; treatment plan, knows either mi in terms of the amount of
2/3, normal utility (improvement of the health condition); and 1, medicine, more of which a patient cannot take, or 23 mi in terms
strong utility (recovery). Because the greatest value of the func- of the amount of medicine that provides the maximum effect.
tion φðxÞ is achieved at x¼ 23 m, these discrete utility levels As a result, we get the effectiveness (Equation 1) of medication
correspond to the following values of the parameter a: with the i-th drug as a function of costs yi:
 2  
9 9 27 y y
aweak ¼ ; anorm ¼ ; astr ¼ : ð2Þ φi ðyi Þ¼ ai i mi − i : ð3Þ
4m3 2m3 4m3 pi pi

As a result, the m parameter remained “free.” Its value can be Here, the coefficient ai is chosen according to Equation 2,
chosen in two ways: it is known either at what quantity of the because the doctor knows the level of effectiveness of treatment
consumed drug the deterioration of the condition (harmful effect) with the drug under consideration. The patient, on the basis of
occurs or at what quantity the greatest effect takes place his finances (Bj – budget, where j is the number of deciles),
(maximum efficiency). In the first case, the parameter coincides chooses a treatment plan with the number i, which leads to the
in value with the rate of consumption, after which negative body highest value of Equation 3.
reaction begins. In the second case, m is 1.5 times greater than To understand the algorithm, let us consider a theoretical
the best effective drug’s rate of consumption. For the transition example with four treatment plans for one disease. At the same
from x (i.e., quantities) to costs, we need to pair each drug with its time, only one drug corresponds to each plan. Let us note that in
price. This is another challenging problem, because prices vary the given example all prices, quantities, and levels of effective-
greatly from region to region, from pharmacy to pharmacy, and ness have no connection with reality. Table 2 presents the
so forth. In addition, each drug has its own measurement unit: parameters for the four different drugs.
grams, packages, vials, and so forth. This issue is discussed later. The first drug has the highest price ðp1 Þ and the highest level
We now discuss abstract units for each drug, and the prices of efficiency ða1 ¼astr Þ (Fig. 1). The second drug is priced 2 times
corresponding to these units. less, but the efficiency is also lower ða2 ¼ anorm Þ. The third and
Let us suppose that there are several ways of medical treat- fourth drugs have the lowest efficiency; in addition, the third
ment for one fixed disease, with different costs and different effect drug requires large funds to achieve the maximum effect.

Fig. 1 – The behavior of the effectiveness function.

42 VALUE IN HEALTH REGIONAL ISSUES 16C (2018) 39–45

Table 2 – Parameters for the four different drugs.

Drug 1 Drug 2 Drug 3 Drug 4

m1 90 m2 110 m3 200 m4 350

p1 100 p2 50 p3 20 p4 7
a1 9.26 × 10−6 a2 3.38 × 10−6 a3 2.81 × 10−7 a4 5.25 × 10−8
Note. ai is the parameter characterizing the maximum level of drug efficacy, mi is the parameter equal to such a drug quantity at which it
ceases to be useful and becomes harmful, and pi is a unit cost for every drug i.

Depending on the funds allocated for treatment, a treatment If the expenses of consumer y allocated to the disease treat-
plan is chosen: if the budget is insufficient, then the treatment ment are less than y⁎ ¼1795, then the consumer is ready either to
goals are determined to be lower than for the wealthy patients. pay the price p4 ¼ 7 or to buy the quantity of x4 ¼ y=p4 , when
Figure 2 clearly shows how the highest utility moves from drug 4 yo 23 m4 p4 ≈1631, or the optimal amount x4 ¼ 23 m4 ≈233, as yo y⁎ . If
for the patient with very low material security to drug 2 in the the patient’s welfare is good enough, namely, y⁎ o yo y⁎⁎ , then he
case when the allowable costs increase from 1500 price units to can afford more effective treatment with the second drug, which
2000. Furthermore, it can be seen that drug 1 becomes available he acquires for the amount of x2 ¼ y=p2 . Furthermore, the most
and preferred in terms of effectiveness when the allowable costs well-off patients, with y4 y⁎⁎ , will be able to afford the first drug
become higher than 3700 price units. Also, the graph shows the in the amount of x1 ¼ y=p1 :
envelope that characterizes the maximum effect that can be Thus, in the aforementioned example, the most effective drug
obtained from all considered drugs, depending on the costs. The can be afforded by an HM from the fifth and higher deciles, that
strategy will be optimal if the patient moves precisely along this is, 85.2 million people from the RF. Patients from the second,
envelope when changing his or her budget. third, and fourth deciles will take the second medication and
Let us now calculate the points of priority changes. At first improve their condition somewhat. There are 42.6 million such
φ4 ðyÞ dominated, then φ2 ðyÞ, and then φ1 ðyÞ. Thus, the priority HMs. Patients with low income from the first decile will be able to
change points are determined as follows: purchase only the fourth drug with low efficiency. There are 14.2
 2    2   million such patients in the RF. No one will generally buy the
y y y y third drug with such characteristics.
a4 m4 − ¼ a2 m2 − ,
p4 p4 p2 p2 It should be noted that the problem of making an optimal
choice of the treatment plan is solved by the HM not independ-
 2    2  
y y y y ently, but with the medical specialist’s involvement. Neverthe-
a1 m1 − ¼ a2 m2 − :
p1 p1 p2 p2 less, the specialist, when prescribing treatment, takes into
consideration the financial situation of the patient and they
Utility functions are so simple that the roots always exist make a choice together.
(except for obvious exceptions) and can be found analytically for
any treatment plans i and j:
  Estimating Drug Volumes Nationwide
aj p2i mj −ai p2j mi pi pj To determine the amount of drugs that must be produced in the
y¼ :
aj p3i −ai p3j RF, it is necessary to analyze various diseases and possible
treatment courses and also take into account the probabilistic
In our case, it is y⁎ ¼ 1795 and y⁎⁎ ¼3678. structure of these diseases. From an economic point of view, the

Fig. 2 – An example of the behavior of utility functions for the four treatment plans (Table 2), depending on the drug cost in
rubles.
 VALUE IN HEALTH REGIONAL ISSUES 16C (2018) 39–45 43

budget of the country’s households influences the choice of the Naturally, each drug has different effects on the disease. Some
treatment strategy: not all patients can choose the best treatment drugs have a bactericidal effect; that is, the action is character-
strategy, because it may be too expensive for them [14]. ized by the fact that under the influence of an antibiotic, the
death of microorganisms occurs, whereas others have a bacter-
iostatic effect, in which there is only a cessation of the growth
Results and reproduction of microorganisms. In the latter case, when
such an antibiotic is excluded, the microorganisms may spread
once again. In the treatment of infectious diseases, in most cases
Example with Real-World Data
the bacteriostatic action of antibiotics in conjunction with the
The number of diseases and medicines is quite large, which protective mechanisms of the body ensures the recovery of the
makes it difficult to analyze the entire market of medicines. patient. It is also worth noting that the proposed algorithm can
Therefore, we will consider a small group of medicines and the be used in the case in which more than one drug can be
corresponding diseases that are cured with the help of these prescribed for the disease treatment in real clinical practice.
drugs. Taking these conclusions into account, Table 3 presents the
drug effectiveness in relation to selected diseases and also
The Choice of Drugs for Research indicates the price of the course. By course we mean the amount
necessary to achieve the planned effect.
In this study, we decided to consider a group of macrolides [15].
Macrolides are a class of antibiotics containing a macrocyclic
lactone ring as the underlying chemical structure. The lactone Probabilities of Certain Diseases
rings are usually 14-, 15-, or 16-membered. The main clinical The next step in our study was the need to take into account the
importance is the activity of macrolides against gram-positive probabilistic structure of diseases. To do this, we turned to the
cocci and intracellular pathogens—mycoplasma, chlamydia, statistics provided by the Ministry of Healthcare and reviewed
campylobacter, and legionella. Macrolides are used for treating the table of morbidity by the main classes of diseases. We
infections caused by gram-positive flora, tonsillitis, and otitis allocated our diseases to these groups, and conditionally (only
as well as for the prevention of atypical mycobacterial infec- within this study) accepted that each group consists of 1000
tions in HIV-infected people. Antimicrobial drugs of this group equiprobable diseases. We matched each disease number (i) to
are usually well tolerated, are among the least toxic anti- the main disease class and found its probability on the basis of
biotics, and have a minimal number of prescription contra- the aforementioned assumption. The results are presented in the
indications, which will help to tend to zero the bias of the fact last column of Table 3.
that a patient buys drugs taking into account personal Let us presume that one person can get several diseases per
considerations. year. Of course, in real life a person is unlikely to be able to
Let us now turn to the consideration of medicines belonging endure all diseases simultaneously. Therefore, we assume that
to this group [16] and name the diseases for which these the patient can have a maximum of two diseases at the same
medicines are prescribed. For convenience, we introduce the time. Consequently, the following events E are possible: {1,0,0,
notation βj , where j ¼ 1,…, 5: …,0}, {0,1,0,…,0}, …, {0,0,0,…,1}, {1,1,0,…,0}, {1,0,1,…,0}, …, {0,0,0,
…,1,1} with a total of N¼ 10 þ45 ¼55 events. Probabilities corre-
β1 ¼ Erythromycin (tonsillitis, diphtheria, acute bronchitis, and sponding to disease pairs were calculated as the product of
pneumonia); probabilities of independent events for each pair.
β2 ¼ Azithromycin Forte (pharyngitis, otitis, sinusitis, laryng-
itis, acute bronchitis, pneumonia, and chlamydial infections);
β3 ¼ Josamycin (pharyngitis, otitis, sinusitis, laryngitis, tonsil- The Strategy of Choosing Medicines for Various Diseases
litis, diphtheria, acute bronchitis, pneumonia, pertussis, and Thus, we examined the behavior of a person when an event E
chlamydial infections); occurred, with a need to choose the optimal strategy. The goal
β4 ¼ Clarithromycin (pharyngitis, otitis, sinusitis, acute bron- was to estimate the volume of drugs needed. It was assumed that
chitis, and pneumonia); and at the same levels of efficiency, a consumer chooses the least
β5 ¼ Roxithromycin (otitis, diphtheria, acute bronchitis, pneu- expensive drug. According to the algorithm described earlier,
monia, pertussis, and chlamydial infections). the amount of each drug was determined for the i-th disease.

Table 3 – Effectiveness table.

Drug

i Disease (Ai) 1 2 3 4 5 Probability (Pi)

1 Pharyngitis 0 0.33 0.33 1 0 0.000338

2 Otitis 0 0.33 0.67 0.67 1 0.000028
3 Sinusitis 0 0.33 0.33 0.67 0 0.000338
4 Laryngitis 0 0.33 0.67 0 0 0.000338
5 Tonsillitis 0.33 0 0.33 0 0 0.000338
6 Diphtheria 0.33 0 0.67 0 0.67 0.000031
7 Acute bronchitis 0.33 0.33 0.33 0.33 0.67 0.000338
8 Pneumonia 0.33 0.33 0.67 0.67 0.33 0.000338
9 Pertussis 0 0 0.33 0 0.33 0.000031
10 Chlamydial infections 0 0.33 0.33 0 0.67 0.000031


Drug cost per course Prj (rubles) 95 288 1119 1156 1786
44 VALUE IN HEALTH REGIONAL ISSUES 16C (2018) 39–45

Table 4 – Optimal drug choice for a single disease (diagonal elements) and for different pairs of diseases.
i Disease А1 А2 А3 А4 А5 А6 А7 А8 А9 А10

1 Pharyngitis 0,0,0,10,0
2 Otitis 0,1,2,10,7 0,0,1,0,9
3 Sinusitis 0,1,0,19,0 0,3,1,7,9 0,0,0,10,0
4 Laryngitis 0,1,0,19,0 0,2,10,0,8 0,1,10,9,0 0,0,10,0,0
5 Tonsillitis 10,0,0,10,0 10,0,1,0,9 10,0,0,10,0 10,0,10,0,0 10,0,0,0,0
6 Diphtheria 1,0,9,10,0 2,0,9,0,9 1,0,9,10,0 1,0,19,0,0 10,0,10,0,0 0,0,10,0,0
7 Acute bronchitis 3,0,0,10,7 4,0,1,0,15 3,0,0,10,7 2,0,10,0,8 11,0,0,0,9 2,0,10,0,8 0,0,0,0,10
8 Pneumonia 1,0,9,10,0 2,0,9,0,9 1,0,9,10,0 1,0,19,0,0 10,0,10,0,0 1,0,19,0,0 2,0,10,0,8 0,0,10,0,0
9 Pertussis 0,0,9,10,0 0,0,11,0,8 0,1,10,9,0 0,1,19,0,0 10,0,10,0,0 1,0,19,0,0 2,0,10,0,8 1,0,19,0,0 0,0,10,0,0
10 Chlamydial infections 0,3,0,10,7 0,4,1,0,15 0,3,0,10,7 0,2,10,0,8 10,1,0,0,9 0,2,10,0,8 4,1,0,0,15 0,2,10,0,8 0,2,10,0,8 0,1,0,0,9

To decide on the optimal strategy for complex events, it is optimal treatment strategy from a set of possible ones, and the task
necessary to consider different combinations. For example, the of estimating the volume of the drug market on the basis of this
event {1,1,0,…,0} means that the patient gets sick during the year problem. As a result of the study, the structure of the drug
with two diseases (pharyngitis and otitis). The highest effective- consumption by all sections of the RF population was described
ness is achieved when using drugs β4 and β5 . The total cost of this mathematically by using the utility function, in which the levels of
choice is R1156 þR1786 ¼ R2942. the drug’s effect were determined, depending on the effect that can
Representatives of the first three deciles cannot afford this course be achieved by using a particular drug. Then, on the basis of this
of treatment. The next maximum efficiency is achieved when using method, an algorithm was developed that estimated the average
two drugs: β4 or β3 and β4 , with total values of 2312 and 2275 units, required amount of particular drugs within the country. It relied on
respectively. Patients from the second and third deciles will choose the probabilistic structure of diseases, the limited budget of the
the second option, because with the same efficiency the second household, and the fact that the patient chooses the most effective
option is less expensive. Representatives of the first option, in turn, way of treatment. The last stage of this work was dedicated to the
will choose β2 and β4 at a cost of R1336. As a result, we obtain that demonstration of the algorithm with real-world data for a certain
drug β2 will be claimed by patients from one decile ðqβ2 ¼1Þ, drug β3 range of diseases. As a result of this example, we evaluated the
will be claimed by patients from two deciles ðqβ3 ¼ 2Þ, and likewise average amount of certain drugs that are needed throughout Russia.
qβ4 ¼ 10, qβ5 ¼7, and, finally, there will be no demand for drug β1 . Of course, to obtain the full picture, it is necessary to evaluate the
Table 4 presents the optimal drug choice for a single disease huge number of drugs and diseases and only then compare with the
(diagonal elements) and for different pairs of diseases. In each cell, empirical data. Also, it should be mentioned that the proposed
five integers correspond to the number of deciles whose representa- algorithm does not take into account the factors of state regulation,
tives will choose the appropriate drug. Thus, in the “pharyngitis-
 to which various grants and benefits can be attributed. The solution
otitis” cell, five numbers 0-1-2-10-7 qβ1 ,qβ2 ,qβ3 ,qβ4 ,and qβ5 are to this issue is to adjust the budget constraints, taking into account
placed, which corresponds to the example analyzed earlier. which sectors of the population this regulation is aimed at.

Estimation of the Volumes of Necessary Drugs

Conclusions
The next step was to calculate the mathematical expectation qβj ,
which allowed to draw conclusions about the required quantity A mathematical model for estimating the amount of medicines
of each drug per capita. Required quantities were calculated that the inhabitants of the country consume throughout the year
using the following formula, where the corresponding qβi have is developed. The model performance for calculating optimal
been taken from Table 4: estimates is shown on the basis of the real-world data for several
diseases. Nevertheless, calculations for all drugs and diseases
Eβi ¼ Pð1,0,…,0Þ  qβi ð1,0,…,0Þ þ …þ Pð0,0,…,1Þ  qβi ð0,0,…,1Þþ Pð1,1,…,0Þ 
would require significant computational costs, which somewhat
qβi ð1,1,…,0Þþ …þ Pð1,0,…,1Þ  qβi ð1,0,…,1Þþ … þPð0,…,1,1Þ  qβi ð0,…,1,1Þ, reduces the application value of the model.
Source of financial support: The authors have no other financial
where i¼ 1,…, 5: relationships to disclose.
Thus, Eβ1 ¼0:003385145; Eβ2 ¼0:0000313865; Eβ3 ¼ 0:007411017,
Eβ4 ¼ 0:00676746, and Eβ5 ¼ 0:003911891.
According to the Federal State Statistics Service data as of May 19, R EF E R EN C ES
2014, the population of the RF was 143.7 million people. If we
multiply the result by the number of citizens in Russia, we will get
the amount of each drug that must be produced. After rounding up [1] Tatarinova M. Calculation of the total cost of multiple sclerosis
the fractional numbers, the following data were obtained: treatment. Qual Clin Pract 2003;2:44–7.
Erythromycin, 972,891 units; Azithromycin Forte, 9,021 units; [2] Dremova NB. Medical and Pharmaceutical Merchandising. Kursk;
Josamycin, 2,129,927 units; Clarithromycin, 1,944,968 units; and Russia: Kursk State Medical University, 2005.
[3] Dzhuparova IA, Sboeva SG. Management of medicinal supply of
Roxithromycin, 1,124,278 units. patients with socially significant diseases on the basis of the
stratification method. A New Pharmacy. Effective Management
2011;11:12–5.
[4] Kobzar LV, Avetisyan MM. Development forecast of a range of drugs for
Discussion the treatment of bronchial asthma in children. A new pharmacy
2002;8:66–70.
The present study addressed the following two issues: the consumer [5] Andreeva NA, Ivanchenko OG, Kabakova TI. Marketing analysis of
problem, when a patient (together with the doctor) chooses the sedative medicines. Fundam Res 2011;10:604–7.
 VALUE IN HEALTH REGIONAL ISSUES 16C (2018) 39–45 45

[6] Frolova TA, Tulyakov DS. Short-term forecasting of demand for [12] Federal State Statistics Service. Incomes, expenditures and
pharmaceutical products. Probl Contemp Sci Pract 2011;2: consumption of households in 2011 (based on the results of a sample
78–82. survey of household budgets). 2012. Available from: http://www.gks.ru/
[7] DSM Group: Analytical reports. Available from: http://www.dsm.ru/ wps/wcm/connect/rosstat_main/rosstat/ru/statistics/publications/
marketing/free-information/analytic-reports/. [Accessed April 7, catalog/doc_1140096812812. [Accessed March 7, 2017].
2017]. [13] Prasolov AV. Some Quantitative Methods and Models in Economic
[8] Federal State Statistics Service. Available from: http://www.gks.ru/ Theory. New York, NY: Nova Science Publishers Inc., 2016.
free_doc/new_site/population/zdrav/zdr2-2.xls. [Accessed April 20, [14] Popov DA, Prasolov AV, Kolbin AS. On the evaluation of the amount of
2017]. drugs. Inter-Medical 2015;1:91–7.
[9] Smith MC, Kolassa EM, Perkins G, Siecker B. Pharmaceutical Marketing: [15] Inozemtsev G (ed) Macrolides against infection: which drug to choose.
Principles, Environment, and Practice. New York, NY: Informa 2007. Available from: http://www.pharmvestnik.ru/publs/
Healthcare, 2002. staryj-arxiv-gazety/makrolidy-protiv-infektsii-kakoj-preparat-vybrat.
[10] Prasolov AV, Kolbin AS. On the demand function for health goods in html#.WQuorvmGOYk. [Accessed April 7, 2017].
the Russian Federation. Finance Bus 2013;3:76–88. [16] Register of pharmaceuticals in the Russian Federation: macrolides
[11] Cheremnykh YN. Microeconomics. Advanced Level. Moscow: INFRA-M, pharmacological group. Available from: http://www.rlsnet.ru/
2008. fg_index_id_259.htm. [Accessed April 1, 2017].