Kasyan G R, Dreval R O, Krivoborodov G G, Gadzhieva Z K, Salyukov R V, Stroganov R V, Shipitsyn V V
Municipal clinical hospital named after S.I. Spasokukotskiy of the Moscow Healthcare Department, Moscow, Russia.
Nonprofit Partnership for Social Health Care Programs Center for Social Economy, Moscow, Russia.
Urologiia. 2020 Nov(5):127-132.
to evaluate the medico-economic significance of neurogenic lower urinary tract dysfunction (NLUTD) in the Russian Federation, to calculate the economic burden of NLUTD in patients with targeted entities and to prepare suggestions for improving the methods of payment for the provision of medical care to patients with NLUTD in inpatient practice.
an analysis of the literature and an expert assessment of the prevalence of NLUTD in the Russian Federation were performed. Due to the various etiology of NLUTD, the following entities were considered: craniocerebral trauma, acute stroke, multiple sclerosis, spinal cord injury (hereinafter referred to as targeted entities), characterized by the highest rate of NLUTD and high social significance (damage to the working-age population): traumatic brain injury, acute stroke, multiple sclerosis, spinal cord injury. The calculations of the economic burden of NLUTD and its main complications (stage 5 of chronic kidney disease (CKD), urinary tract infection) in the Russian Federation (using mainly the normative method) were carried out, based on national statistics, regulatory legal acts and expert assessments of healthcare specialists. Proposals have been prepared for improving the reimbursement (tariffs of the KSG) for payment of NLUTD in the inpatient practice.
according to the study, the number of patients with NLUTD due to the group of targeted entities is estimated at 910 000. The economic burden (excluding indirect and unaccounted costs) of the NLUTD is 33.3 billion rubles per year. The burden associated with secondary complications (stage 5 CKD, urogenital infection) due to ineffective diagnosis and treatment of NLUTD is 51.6 billion rubles. The total costs on the NLUTD is estimated at 84.9 billion rubles. Direct costs, calculated by the normative method based on the analysis of standards of medical care per patient are 36,546 rubles per year. Provision of medical care to patients with NLUTD in accordance with federal guarantees within the framework of the compulsory medical insurance is provided in accordance with the tariffs of KSG st30.005 (profile "urology"). The KSG tariff for 2019 (taking into account the established standards of financial costs for one case of hospitalization in the inpatient department and the established cost-intensity coefficients (CZ) established by the CG is 21,495.07 rubles, which is 58% of the minimum need, excluding the cost of treatment of complications, according to the normative method of calculation. The real estimate of the tariff for the payment of treatment of NLUTD in the constituent entities of the Russian Federation is 35-38% of the minimum need, excluding the cost of treatment of complications, according to the normative method of calculation. The real estimate of the costs for the treatment of NLUTD in regions is 35-38% of the minimum need, excluding the cost of treatment of complications, according to the normative method of calculation. To provide effective specialized urological care in the framework of compulsory medical insurance at the rates of the CSG for neuro-urological care (st30.005), expert calculations of the actual cost of NLUTD therapy were made. The proposed average cost of the CSG and the values of the cost intensity factors: CSG (min) st30.005.1 - 39,936 rubles, CZ - 1.65; CSG (max) st30.005.2 - 68,531 rubles, CZ - 2.75. The weighted average savings while expanding the availability of complex neuro-urological care for patients with NLUTD in accordance with the proposed payment rates is 9.4 billion rubles per year.
Evaluation of the prevalence and burden of NLUTD showed the high medical and economic significance of NLUTD in the Russian Federation. The results of the study indicate a significant discrepancy between the requirements and the real costs within federal guarantees for the organization of medical care for patients with NLUTD. To provide effective specialized urological care in the compulsory medical insurance at the rates of CSG for neuro-urological care, it is necessary to increase funding, through the correction at the federal level of the cost-intensity coefficient from 1.65 to 2.75 for the CSG st30.005, which will ensure the increase in the cost for a case of treatment in inpatient department in form 39 936 to 68 531 rubles. The weighted average savings while expanding the availability of complex neuro-urological care for patients with NLUTD in accordance with the proposed payment rates is 9.4 billion rubles per year.
评估俄罗斯联邦神经源性下尿路功能障碍（NLUTD）的医学经济意义，计算目标疾病患者中NLUTD的经济负担，并就改善住院治疗中为NLUTD患者提供医疗服务的支付方式提出建议。
对俄罗斯联邦NLUTD患病率进行文献分析和专家评估。由于NLUTD病因多样，考虑以下疾病：颅脑创伤、急性中风、多发性硬化症、脊髓损伤（以下简称目标疾病），其NLUTD发生率最高且具有较高社会意义（对劳动年龄人口造成损害）：创伤性脑损伤、急性中风、多发性硬化症、脊髓损伤。基于国家统计数据、规范性法律文件以及医疗专家的评估，采用规范性方法计算俄罗斯联邦NLUTD及其主要并发症（慢性肾脏病（CKD）5期、尿路感染）的经济负担。已就改善住院治疗中NLUTD支付的报销（KSG费率）提出建议。
根据研究，目标疾病组导致的NLUTD患者数量估计为91万。NLUTD的经济负担（不包括间接和未计入成本）为每年333亿卢布。由于NLUTD诊断和治疗无效导致的继发并发症（CKD 5期、泌尿生殖系统感染）负担为516亿卢布。NLUTD的总成本估计为849亿卢布。根据每位患者医疗护理标准分析采用规范性方法计算的直接成本为每年36,546卢布。在强制医疗保险框架内，按照联邦保障为NLUTD患者提供医疗服务是根据KSG st30.005（“泌尿外科”专业）的费率进行的。2019年KSG费率（考虑到住院部一例住院的既定财务成本标准以及中央政府确定的成本强度系数（CZ））为21,495.07卢布，根据规范性计算方法，这是最低需求的58%，不包括并发症治疗成本。根据规范性计算方法，俄罗斯联邦各主体中NLUTD治疗支付费率的实际估计为最低需求的35 - 38%，不包括并发症治疗成本。根据规范性计算方法，各地区NLUTD治疗成本的实际估计为最低需求的35 - 38%，不包括并发症治疗成本。为按照神经泌尿外科护理的CSG费率在强制医疗保险框架内提供有效的专科泌尿外科护理，对NLUTD治疗的实际成本进行了专家计算。提议的CSG平均成本和成本强度因子值：CSG（最低）st30.005.1 - 39,936卢布，CZ - 1.65；CSG（最高）st30.005.2 - 68,531卢布，CZ - 2.75。按照提议的支付费率扩大NLUTD患者获得复杂神经泌尿外科护理的可及性，加权平均节省为每年94亿卢布。
对NLUTD患病率和负担的评估表明，NLUTD在俄罗斯联邦具有很高的医学和经济意义。研究结果表明，在联邦保障下为NLUTD患者组织医疗护理的要求与实际成本之间存在显著差异。为按照神经泌尿外科护理的CSG费率在强制医疗保险中提供有效的专科泌尿外科护理，有必要增加资金，通过在联邦层面将CSG st30.005的成本强度系数从1.65调整到2.75，这将确保住院部一例治疗的成本从39,936卢布增加到68,531卢布。按照提议的支付费率扩大NLUTD患者获得复杂神经泌尿外科护理的可及性，加权平均节省为每年94亿卢布。
