Clinical practice is developing under influence of the evidence-based clinical practice guidelines (EBCPG). In Russia development of the documents prescribing the content of care is connected with the idea that they may be used as well for estimation of the cost of care. The outcome is the national healthcare legislation of 2011. It dictates that care should be planned, funded, provided, and evaluated in agreement with standards of healthcare (SHC)—documents prescribing the content of care. The objective of this study was to evaluate how the correction of the SHC with the relevant EBCPG may change the cost of the prescribed care.
We selected the random sample of the SHC from the approved by the Ministry of Health for primary healthcare (SPHC) and specialized healthcare (SSHC). We analyzed interventions comparing SHC to the relevant EBCPG. Not recommended interventions were considered unnecessary. If the recommended by EBCPG intervention was missed in the SHC, then it increased the cost. We take the drug costs and the costs of interventions from the relevant ministerial registries. We calculated the total cost of the SHC by summing up the cost of each medical intervention/medications specified in the SHC.
SPHC and SSHC both contain medical interventions and drugs that should not be provided. The total cost of all SHC included became lower: SPHC cost decreased by 66%, SSHC by 19%. The smaller change of the cost of SSHC is explained by the fact that the major part of the total cost of SSHC is the stay in a hospital.
Correction of the SHC using EBCPG may reduce the cost of care
The aim of this study was to explore the feasibility of different health-related quality-of-life valuation methods in a new setting. Based on a small feasibility study of 100 young Russians, we trialed different methodologies and identified key differences that have implications for the development of health technology assessment in Russia.
In face-to-face interviews, respondents completed a series of health self-assessments based on a modified version of the EQ-5D-3L, visual analogue scale, time tradeoff, standard gamble, and best-worst scaling methodologies, covering actual and hypothetical health states.
We found that (1) the visual analogue scale produced lower health valuations and fewer logical inconsistencies than either time trade-off or standard gamble methodologies; (2) initial health states can be decisive in determining values assigned to health improvements; (3) respondents evaluate abstract health states more positively than their own actual health states; (4) there is evidence consistent with the hypothesis that actual and hypothetical health state valuation, using EQ-5D-3L, is an artifact of understanding rather than preference and that the incorporation of additional levels may therefore be no panacea if the dimensions themselves overlook important attributes; and (5) the country context is important in determining how respondents relate to the survey tools and how those survey tools are translated and delivered.
Russia is commencing its health technology assessment journey and should proceed cautiously as it moves toward the valuation of health benefits. These results suggest a useful framework for a more in-depth development of health valuation methodologies in Russia.