OBJECTIVE
To determine the list of medications for the treatment and prevention of complications of stage 5 chronic kidney disease (CKD), and to calculate the cost of appropriate therapy during outpatient hemodialysis.
MATERIAL AND METHODS
We established the list of medications based on clinical guidelines for CKD in adults (2021). Expert assessment of this list was carried out by the heads of dialysis centers from 7 constituent entities of the Russian Federation. Specialists determined the medications for prevention and treatment of complications of CKD stage 5 which should be used during hemodialysis but are not included in tariff for this procedure. The weighted average cost of drug therapy during hemodialysis was calculated with the use of the manufacturer’s maximum price in accordance with state register of maximum selling prices including VAT (10%). Modeling of possible payment options for drug therapy was carried out: inclusion of the entire volume of drug therapy for prevention and treatment of complications of CKD in hemodialysis service and inclusion of only parenteral drugs in hemodialysis service. All calculations were performed using Microsoft Excel software.
RESULTS
The clinical guidelines for CKD include 54 drugs, and 17 ones can be considered as means for prevention and treatment of complications of CKD stage 5 including iron supplements, antianemic drugs (erythropoiesis stimulants), antiparathyroid drugs, vitamin D, drugs for the treatment of hypercalcemia, hyperkalemia and hyperphosphatemia. Inclusion of costs for drug therapy and prevention of complications of CKD stage 5 in outpatient hemodialysis service will increase the tariff by 6.7 thousand rubles for all dosage forms or 6.3 thousand rubles for parenteral dosage form only.
CONCLUSION
Medecines for hemodialisis patients might be covered by the compulsory medical insurance through the out-patient service. Current tariff should be increased for 6.3 thousands rubles if only parenteral medecines for prevention and treatment of complications are included. Medecines used between the dialysis days should be covered from federal or regional budgets.
