S.A. Martynchik¹, S.V. Filatenkova^2
1I.M. Sechenov First Moscow State Medical University, Moscow
²Polyclinic ¹6 at the Federal Security Service of Russia, Moscow

Summary. A brief review of the foreign and domestic literature that had been devoted to evaluation of the social economic burden associated with ischemic heart disease was compiled. Under this burden a whole complex of factors was meant here, including social, economic, and organizational ones. The latter implied a wide range of problems including elevating medical access through organizational measures, improving the quality of medical care, and enhancing efficiency of budget funding.

Expediency of program-target approach to managing programs of funding for acute coronary syndrome associated with high risk of instantaneous death and fatal/non-fatal myocardial infarction was appreciated.

Adopted programmed measures for improving organizational patterns of delivering medical care were investigated into, including wide introduction of endovascular technologies of re-perfusion therapy and measures of secondary prevention of ischemic heart disease following old myocardial infarction. Optimization of operation of the facilities of cardiac profile necessitates economic substantiation of technologies and programs of budgeting, including creation of national hospital register and introduction of the quality control system for providing medical care on the basis of standards of medical care and target indicators.

Quality of medical care and medical access for the population were studied in connection with the efficiency of budget expenditure for medical facilities. Cost evaluation of expenditure per completed case of medical care in coronary syndrome was performed. Efficacious means of reimbursement for expenditure implying immediate and remote receipts were assessed.

Economically expedient means of financial provision of the programs for the improvement of methodological foundation of standardization of all ways of expenditure was considered here, including development of methodological foundation for such standardization, procedure of planning with the use of enlarged volumes of medical care, grouping of patients along the criteria of clinical and outlaying similarity, establishment of standards of financial costs and differentiated tariffs that would imply elevation to new therapeutic and diagnostic highlights, predictability in fulfillment of programs and measures, creation of certain stimuli for reducing expenditure and efficient management of the materiel resources.

Keywords. Acute coronary syndrome; unstable angina pectoris; myocardial infarction; hospital lethality; endovascular techniques of diagnosis and treatment; thrombolytic therapy; hospital registers; standardization of expenditure; clinical statistical groups; standards of financial expenditure; means of prospective payment; programmed budgeting aimed to result.

References

1. Akchurin R.S., Vasilyev V.P., Galyautdinov D.M., Korolev S.V., Lepilin M.G., Partigulov S.A., Shiryayev A.A.. Sovremennaya khirurgiya koronarnykh arteriy [The present-day surgery of coronal arteries]. Kardiologicheskiy vestnik 2010;(1):45-48.
2. Gratsianskiy N.A. K publikatsii obnovlennogo rukovodstva Yevropeyskogo obshchestva kardiologov po lecheniyu ostrogo koronarnogo sindroma bez podyemov segmenta ST na EKG [On publication of updated manual of the European Cardiological Society on treatment of acute coronary syndrome with no ST segment rising in ECG]. Kardiologiya 2007;(9):24-33.
3. Gratsianskiy N.A. Antitromboticheskoye lecheniye pri ostrom koronarnom sindrome bez podyemov segmenta ST: sovremennoye sostoyaniye i nekotoryye perspektivy [Anti-thrombosis treatment in acute coronary syndrome with no ST segment rising: the current state and some prognosis]. Aterotromboz 2008;(1):4-21.
4. Savchenko A.P., Rudenko B.A. Klinicheskaya effektivnost endovaskulyarnykh tekhnologiy pri lechenii ishemicheskoy bolezni serdtsa [Clinical efficiency of endovascular methods in treatment of ischemic heart diseases]. Kardiologicheskiy vestnik 2008;(1):5-11.
5. Timchinskiy D.L. Sovershenstvovaniye mekhanizmov oplaty statsionarnoy pomoshchi kardiologicheskogo profilya i tarifnogo regulirovaniya v usloviyakh dobrovolnogo meditsinskogo strakhovaniya [Improving payment methods for inpatient cardiological care and tariff regulation in voluntary health insurance]. [PhD. Thesis]. Moscow; 2010. 24 p.
6. Chazov Ye.I., Boytsov S.A. Okazaniye meditsinskoy pomoshchi bolnym s ostrym koronarnym sindromom v ramkakh programmy sozdaniya regionalnykh i pervichnykh sosudistykh tsentrov v Rossiyskoy Federatsii strane [Delivery of medical care to patients with acute coronary syndrome within the frames of the Program on development of regional and primary vascular centers in the Russian Federation]. Kardiologicheskiy vestnik 2008;(2):5-11.
7. Chazov Ye.I., Boytsov S.A. Puti snizheniya serdechno-sosudistoy smertnosti v strane [Ways of reducing cardiovascular mortality in the country]. Kardiologicheskiy vestnik 2009;(1):5-10.
8. Shchetinkina I.N. Klinicheskaya i farmakoekonomicheskaya effektivnost tromboliticheskoy terapii infarkta miokarda s podyemom ST v klinicheskoy praktike [Clinical and pharmaeconomical efficiency of thrombolytic therapy of myocardial infarction with ST rising in clinical practice] [PhD. Thesis]. Saratov; 2009. 23 p.
9. Erlikh A.D., Gratsianskiy N.A. Lecheniye bolnykh ostrym koronarnym sindromom s podyemom ST v statsionarakh imeyushchikh i ne imeyushchikh vozmozhnosti vypolneniya koronarnykh vmeshatelstv (dannyye registra «REKORD» [Treatment of acute coronary syndrome patients with ST rising in hospitals having (having no) the capacity to perform coronary interventions (by “RECORD” registration data]. Aterotromboz 2009;(1):120-122.
10. Andre E., Cordero A., Maga P., Alegrı E., Leo M., Luengo E., Botaya R,. Ortiz L. J. Casasnovasd. Long-Term Mortality and Hospital Readmission After Acute Myocardial Infarction: an Eight-Year Follow-Up Study. Rev. Esp. Cardiol. 2011;(4):1–7.
11. Avxentieva M, Vorobjov P., Sura M. Cost of myocardial infarction treatment in Russian Federation PCV38: Value in Health, Volume 7, Issue 6, November–December 2004, Pages 696-697.
12. Celik Turgay, Iyisoy Atila. Primary stenting in the patients with acute myocardial infarction: The preferred strategy. Int. J. Cardiol. 2009;133:241–4.
13. Chen Chin-Shyan, Liu Tsai-Ching, Chiu Wen-Ta, Lin Herng-Ching. Impact of hospital and physician characteristics on medical expenditures for acute myocardial infarction hospitalization. International Journal of Cardiology 2007;121:127–129.
14. Cox D.A., Cohen D. J. Cost Effectiveness of Paclitaxel-Eluting Stents for Patients Undergoing Percutaneous Coronary Revascularization. Journal of the American College of Cardiology 2006;48(2):253–61.
15. Epstein D.M., Sculpher M. J., Clayton T.C., Henderson R.A., Pocock S.J., Buxton M.J., Fox K.A. Costs of an early intervention versus a conservative strategy in acute coronary syndrome. International Journal of Cardiology 2008;127:240–246.
16. Holmes D.R., Firth B.G., Wood D.L. Paradigm Shifts in Cardiovascular. Medicine Journal of the American College of Cardiology 2004;43(4):507–12.
17. Lee V.W, Chan W.K., Lam N.L., Lee K.K. Evaluation on the cost of management of acute myocardial infarction in a local public hospital in Hong Kong. PCV44: Evaluation on the cost of management of acute myocardial infarction in a local public hospital in Hong Kong. Value in Health, Vol., Issue 3, May–June 2003, Page 323.
18. Lieu T.A., Gurley R.J., Lundstrom R. J., Ray G.T., Fireman B.H., Weinstein M.C., Parmley W.W. Projected Cost-Effectiveness of Primary Angioplasty for Acute Myocardial Infarction. JACC 1997;30(7):1741–50.
19. López-Valcárcel B.G., Pinilla J. The Impact of Medical Technology on Health: A Longitudinal Analysis of Ischemic Heart Disease. Value in Health 2008; Vol. 11, Number 1, p.88-96
20. Mantovani L.G., Fornari C., Madotto F., Riva M. A, Merlino L., Ferrario M.M., Chiodini V., Zocchetti A., Corrao G., Cesana G. Burden of acute myocardial infarction. Curr. Med. Res. Opin 2008;24:461–8.
21. Myocardial Infarction Redefined - A Consensus Document of The Joint European Society of Cardiology (American College of Cardiology Committee for the Redefinition of Myocardial Infarction The Joint European Society of Cardiology). American College of Cardiology Committee. Journal of the American College of Cardiology 2000;36(3):959–69.
22. Salvo T.G. Di, Paul S.D., Lloyd-Jones D., J.Smith A., Levy G.V. Bamezal V., Hussen S., Eagle K. A., O’Gara P. T. Care of Acute Myocardial Infarction by Noninvasive and Invasive Cardiologists: Procedure Use, Cost and Outcome. J. Am. CoLL. Cadiol. 1996;27:242–9.
23. Smolderen K.G., Bell A., Lei Y., Cohen E.A., Steg G. Bhatt D. L, Mahoney E. M. One-year costs associated with cardiovascular disease in Canada: Insights from the Reduction of Atherothrombosis for Continued Health (REACH) registry for Continued Health (REACH) registry. Can J. Cardiol. 2010;26(8):297–305.
24. Spertus J.I., Hlatky M., Martin J.S., Weaver W.D. Length of Hospital Stay After Acute Myocardial Infarction in the Myocardial Infarction Triage and Intervention (MITI) Project Registry. JACC 1996;28(2):287–93.
25. Steinberg E.P., Topol E.J., Sakin J.W., Kahane S.N., Apptel L.J., Powe N.R., Anderson G.F., Erikson J.E., Guerci A.D. Cost and Procedure Implications of Thrombolytic Therapy for Acute Myocardial Infarction. I. Am. Coll. Cardiol. 1988;12:58A–68A.
26. Torti F.M, Shelby D.R., Kevin A.S. Analytic Considerations in Economic Evaluations of Multinational Cardiovascular Clinical Trials. Value in Health 2008; vol. 9, Number 1, 88-96.
27. Vaitkus P.T., Witmer W.T., Brandenburg R.G., Wells S.K., Zenhnacker J.B. Economic Impact of Angioplasty Salvage Techniques, With an Emphasis on Coronary Stents: A Method Incorporating Costs, Revenues, Clinical Effectiveness and Payer Mix. J. Am. Coll. Cardiol. 1997;30:894–900.
28. Valensi P., Lorgisb L., Cottinb Y. Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: A review of the literature. Archives of Cardiovascular Disease 2011;104:178–188.
29. Vidovich M.I., Xu Y. Cost and length of hospitalization in Hispanic patients with acute myocardial infarction in the United States. J. Cardiol. 2009;131:149–50.
30. Wang O., Wang C., Bernheim S.M., Drye E., Krumholz H.M. Indentifying value in acute myocardial infraction care: compraring hospitals on medicare costs and mortality E1171. JACC 2011;57 April 5, Issue 14.

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