Pharmacoepidemiological analysis of routine management of obese patients in the Russian Federation

Aim: Assessment of the resources of the health care system involved in the management of obesity patients, based on a analysis of data from the primary medical documentation. Materials and method: We analyzed the outpatient records of 1000 patients who were followed up for 1 year by a general practitioner or an endocrinologist in an outpatient treatment and prevention facility (TPF) in 8 regions of the Russian Federation (RF). Men and women over 18 years of age who had been diagnosed with obesity for at least one year before inclusion in the study were included in the study. Results: The final analysis included 801 patients (55.2 men and 44.8 % women), mean age 55 [45...62] years. Analysis of the distribution of patients by body mass index (BMI) showed that the majority of patients at the start of follow-up had grade I obesity, in 94.4 % of patients weight did not change or increased during the 1-year follow-up. Arterial hypertension (AH) and type 2 diabetes mellitus (type 2 DM) were predominant in the structure of comorbid pathology 82.3 and 33 %, respectively. Evaluation of the frequency of clinical, laboratory, and instrumental examinations, as well as the frequency of follow-up, revealed a pronounced discrepancy between the recommended and actual frequency of patient appointments and examinations, as well as the number of visits to the doctor. Hospitalization during the observation period was required for 32 % of patients, with cardiovascular disease (43.5 %) and DM (28.5 %) being the most common reasons for hospitalization. About 21 % of patients received drug therapy for obesity during the year of observation, but the frequency of prescription of drugs for the treatment of obesity did not meet the standard. It was shown that the average cost of managing 1 obese patient was 66 130 rubles per year. The cost of drug therapy differed significantly depending on the source of funding – the total cost of therapy received by patients was about 21,000 rubles per year, while the patient received therapy in the amount of about 800 rubles per year in the framework of preferential drug coverage. Thus, the share of drug therapy in the structure of costs per patient from the state’s point of view was only 9.46 %, and the maximum costs were in outpatient care (24 %), hospitalizations (26 %) and disability payments (18.5 %). The amount of direct costs for the management of obesity excluding drug therapy (examination, inpatient and outpatient treatment) averaged 25,828 rubles/year. Conclusion: The actual practice of managing obese patients in the Russian Federation differs significantly from the clinical recommendations, which leads to the fact that obesity therapy within 1 year does not result in a pronounced decrease in body weight. Low coverage of patients with subsidized drug coverage may be one of the reasons for non-compliance with recommendations on drug therapy in outpatient settings