In 2021, payment for therapy with genetically engineered biological drugs and selective immunosuppressants at the expense of compulsory medical insurance fund in day and inpatient care is carried out according to diagnosis-related groups ds36.004 (cost weight coefficient 9.74) and st36.003 (cost weight coefficient 5.35). At the same time, the actual hospitalization-related costs significantly range and these values are often lower compared to tariff determined by diagnosis-related group at the federal level.

OBJECTIVE

To develop a universal model (Excel calculator) for allocation of subgroups from diagnosis-related group ds36.004 in a day hospital considering the prescribed therapy with genetically engineered biological drugs and selective immunosuppressants at the regional level.

MATERIAL AND METHODS

We have analyzed 13 clinical guidelines, an up-to-date list of vital and essential drugs, medicinal product labels and federal model of diagnosis-related groups to determine a list of genetically engineered biological drugs and selective immunosuppressants eligible for payment within diagnosis-related group ds36.004. Median price for 1 mg of each drug was calculated considering the manufacturer’s maximum selling prices with a wholesale markup and VAT (10%). Cost of therapy for a day care case was calculated taking into account the dosage regimen. A step-by-step calculator algorithm (Microsoft Excel software) was developed. This calculator ensures ungrouping the federal diagnosis-related group ds36.004 considering therapeutic data at the regional level, the number of admissions, hospital stay and base cost rate.

RESULTS

A list of 31 genetically engineered biological drugs and selective immunosuppressants has been formed. Administration of these drugs can be paid within diagnosis-related group ds36.004. We determined 68 therapeutic regimens considering dosage schemes. Actual costs of 59 out of 68 therapy schemes were lower than the tariff for diagnosis-related group ds36.004. Cost of therapy for a day care case ranges from 544.56 rubles (leflunomide 100 mg per os daily for 3 days) to 1.300.820.85 rubles (canakinumab 4 mg/kg, max 300 mg). The developed algorithm for ungrouping the diagnosis-related group ds36.004 includes 4 consecutive stages with available adjustment of initial data and regional parameters.

CONCLUSION

The developed calculator unifies the process of identifying the subgroups and considers the peculiarities of regional practice of therapy with genetically engineered biological drugs and selective immunosuppressants.