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

Objective: to evaluate the clinical and economic effectiveness of benralizumab in comparison with standard therapy in patients with severe bronchial asthma (SBA) with an eosinophilic phenotype in the Russian Federation. Material and methods. A clinical and economic analysis of using benralizumab in addition to standard therapy was carried out in comparison with standard therapy for SBA with an eosinophilic phenotype by means of a modeling method. Cost calculations were performed in a mathematical model adapted to the Russian healthcare conditions with the help of cost indicators and patient population characteristics. Results. The use of benralizumab as a mandatory component of standard therapy compared with standard therapy alone for SBA with an eosinophilic phenotype will allow for an additional 0.65 life years gained (LYGs) and 1.12 quality-adjusted life years (QALYs) per 1 patient during lifelong therapy. It will provide avoiding 4.95 exacerbations, simultaneously with a reduction in total costs by 584,144 rubles by reducing gross domestic product (GDP) losses due to mortality and temporary disability over an assessment horizon equal to life expectancy. The costs of 1 LYG and 1 QALY in the case of benralizumab were 869,455 and 1,252,056 rubles, in the case of standard therapy they were 911,615 and 1,303,811 rubles, respectively. Conclusion. Intensification of SBA therapy with an eosinophilic phenotype with benralizumab is clinically justified (leads to an increase in life expectancy, a decrease in the rate of exacerbations and an increase in patients’ working life), and is also economically feasible, as it allows to reduce direct costs and GDP losses of the state.

Aim. To present data from the AURA Registry (real-world data registry on AlbUminuRia detection rate among patients with previously undiAgnosed chronic kidney disease). It is important to perform population studies both to study the occurrence of markers (albuminuria (AU), decreased glomerular filtration rate (GFR)) and the prevalence of chronic kidney disease (CKD), which will provide information on the actual detection rate of CKD and the related markers in territories included in the registry of research centers.Material and methods. The article presents the first data from the AURA registry. Recruitment was carried out from March 6, 2023 to January 23, 2024. Thirty-four research centers in various federal districts of the Russian Federation and 104 doctors took part in the recruitment. We included 4580 subjects over the age of 40 years who had no previously established diagnosis of CKD and did not have type 1 or type 2 diabetes. During recruitment, the researchers were guided by the AURA study protocol (Version 1.7/12-26-2022).Results. AU more than 20 mg/g was detected in 64,9% of cases. At the same time, AU is more common at GFR values that may correspond to stage 3A of CKD. The rarer occurrence of AU in those examined with GFR >60 ml/min/1,73 m2 may be explained by less severe renal damage at this CKD stage. The incidence of AU was significantly higher in men, older people, smokers, people with metabolic syndrome, hypertension (HTN), prediabetes and overweight. The occurrence of AU also increased as HTN grade increased. AU detection rate was associated with hypertriglyceridemia, a high blood level of C-reactive protein, which is an integrative marker of inflammation that negatively affects cardiovascular risk.Conclusion. The presented first data from the AURA registry demonstrated the high AU prevalence in people over 40 years of age. A high incidence of AU was typical for patients with HTN, coronary artery disease, atrial fibrillation, heart failure, and prediabetes. An association has been demonstrated between the high incidence of AU and male sex, age, overweight, hyperuricemia, dyslipidemia, and a number of other cardiovascular risk factors.

Objective. To evaluate the cost-effectiveness of the use of modern inhibitors of the renin-angiotensinaldosterone system (RAAS) in patients with arterial hypertension (HTN) in the Russian Federation. Design and methods. An analytical decision-making model was built in MS Excel, which enables to evaluate the additional benefit in reducing blood pressure and preventing cardiovascular outcomes when prescribing the most effective RAAS inhibitors in patients with HTN over 65 years of age on the background of antihypertensive therapy (AHT) (as a basic RAAS blocker the following agents were considered: valsartan 80 mg, enalapril 20–40 mg, lisinopril 10–20 mg, perindopril 2,5–5 mg, candesartan 8–32 mg, irbesartan 150 mg, losartan 50–100 mg, olmesartan 10 mg and telmisartan 40 mg). Results. Azilsartan medoxomil 80 mg is the most effective and will prevent 3,86 cases of myocardial infarction, 2,48 cases of acute cerebrovascular accident and 1,66 deaths from all causes per 1000 patient-years. At the same time, reducing the cost of managing complications and saving lives makes therapy with modern RAAS inhibitors economically feasible, reducing the total costs of illness. Taking into account the direct costs of treating adverse events, as well as the indirect costs of disability benefits and gross domestic product losses, the maximum potential savings can be achieved when using irbesartan 300 mg — 10,384,47 rubles/year of therapy, azilsartan 20 mg — 9 035,90 rubles/year of therapy, azilsartan 40 mg — 8 500,82 rubles/year of therapy, azilsartan 80 mg — 8 384,14 rubles/year of therapy, telmisartan 80 mg — 8 721,41 rubles/year of therapy and candesartan 32 mg — 8 204,21 rubles/year of therapy. Conclusions. The use of modern RAAS inhibitors, including azilsartan medoxomil in hypertensive patients, leads to a reduction in healthcare costs, the achievement of the targets of the national project “Fight against cardiovascular diseases”, while significantly improving the prognosis of patients and their quality of life.

Objective. To study the changes in the vascular wall, vascular age and metabolic parameters in polymorbid COVID-19 conva-lescents. Material and methods. The study included 62 patients with hypertension who reached the target blood pressure (BP) with dual an-tihypertensive therapy after severe and extremely severe COVID-19. The following examinations were performed: laboratory tests of metabolic parameters, assessment of changes in the vessel elasticity indices (pulse-wave velocity (PWV), augmentation index (AI), central systolic BP (cSBP), 24-hour BP monitoring, and non-invasive markers of liver fibrosis. Results. According to office BP measurements, after the coronavirus infection, an increase in systolic BP (SBP) by 29.6% and di-astolic BP (DBP) by 23.6%, as well as heart rate (HR) by 11.8% (p<0.05) was reported during regular antihypertensive therapy. In addition, 24-hour BP monitoring data indicated an increase in the average daily SBP, DBP, and heart rate. After the coronavirus infection, an increase in PWV by 35.4% (p<0.05), AI by 24.4% (p<0.05), cSBP by 22.1% were reported. Carbohydrate and lipid metabolism parameters deteriorated. A pronounced adverse effect of coronavirus infection on liver function was observed. The vascular age (according to the modified SCORE scale) increased by 6 years (p<0.05). Conclusion. Our study showed that patients after severe and extremely severe COVID-19 have a high risk of liver fibrosis, hypertension and lipid metabolism control worsening and accelerating vascular aging.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Purpose. To evaluate the clinical and economic efficacy of the drug complex of beta-iron (III) oxyhydroxide, sucrose, and starch (Velphoro) in comparison with sevelamer in patients with stage 5 chronic kidney disease (CKD) receiving phosphate binding therapy during renal replacement therapy (RRT) in the conditions of the healthcare system of the Russian Federation. Materials and methods. An analytical decision-making model, which allows estimating the costs of managing patients with stage 5 CKD receiving phosphate binding therapy along with RRT, was built in MS Excel. The model included the costs of phosphate binding therapy with beta-iron (III) oxyhydroxide-sucrose-starch complex or sevelamer, as well as the cost and incidence of non-RRT hospitalizations in patients with CKD. The frequency of hospitalizations was determined according to a retrospective analysis of the data from End Stage Renal Disease Seamless Care Organizations (ESCOs), USA (2016-2018). The potential economic impact of using comparison strategies was calculated in 19,617 estimated patients with stage 5 CKD receiving RRT and phosphate binders. Results. The use of beta-iron (III) oxyhydroxide, sucrose, and starch complex in comparison with sevelamer is associated with a reduction in costs by 10,222 rubles or by 7.4 % on average per patient, which allows fully reimbursing the costs of more expensive drug therapy (the difference in costs minus the cost of drug therapy is 896 rubles in favor of the beta-iron (III) oxyhydroxide, sucrose, and starch complex), and reducing the number of hospitalizations in the target population by more than 6,000 cases. When used in the target cohort of patients, savings will amount to 200.5 million rubles (17.6 million rubles minus the difference in the cost of drug therapy). Conclusion. The use of beta-iron (III) oxyhydroxide, sucrose, and starch complex in patients with CKD during the RRT is clinically and economically feasible, as it allows reducing the number of hospitalizations and is characterized by fewer pills taken daily, reducing the overall costs of patient treatment.

Aim. To estimate the cost-effectiveness of dapagliflozin across the range of ejection fraction in patients with heart failure (HF) in Russian Federation. Materials and methods. Cost-effectiveness model was developed for estimate the use of dapagliflozin as part of standard therapy in patients with HF regardless of ejection fraction is unknown. The calculation of costs was carried out in a mathematical model adapted to the conditions of Russian healthcare system by using Russian costs inputs and patient population characteristics. Results. In the model, dapagliflozin therapy yielded a mean of 0.209 additional life-years compared with standard of care in 10 years horizon. The incremental cost of 1 additional life-year was 665,715 RUB, which does not exceed the threshold of willingness to pay 2,235,202 RUB. Conclusion. Thus, the intensification of chronic HF therapy with dapagliflozin is cost effective. The use of dapagliflozin in a cohort of 1000 target patients over 10 years will avoid 146 hospitalizations and 39 emergency visits due to HF, as well as prevent 32 deaths from cardiovascular diseases.

Gestational diabetes mellitus is characterized by an increased risk of fetal macrosomia and obstetric complications during childbirth, as well as the development of type 2 diabetes in the mother after pregnancy. Timely diagnosis and treatment of hyperglycemia during pregnancy reduces adverse pregnancy outcomes. The first step towards tight glucose control during pregnancy is self-monitoring of glycemia. Aim: to evaluate the effectiveness of regular glycemic control using a Satellite express glucometer calibrated on capillary whole blood in patients with gestational diabetes mellitus (GDM) in outpatient practice. Material and methods. The 96-week prospective observational non-interventional study included 150 patients with GDM. In women with confirmed GDM, blood glucose was measured using a satellite express glucometer. At each visit, further tactics for the treatment of GDM were determined based on the results of glycemia (data from the self-monitoring diary). Until the 34th week of pregnancy, an endocrinologist was consulted with a frequency of 1 time in 2 weeks in the form of a medical appointment and telephone contact. After 34 weeks of pregnancy, consultation of an endocrinologist with a frequency of 1 time per week. 6–12 weeks after delivery, an oral glucose tolerance test and consultation with an endocrinologist were performed to assess the degree of carbohydrate metabolism disorder. Results. The participation of 138 (92%) patients in the study ended in childbirth, 12 (8%) patients dropped out of the study ahead of schedule. Spontaneous abortions were noted in patients who performed self-monitoring of glycemia 0–1 times a day, independent births were more often observed in patients who performed self-monitoring 3–4 times a day, and these patients also had more stable glycemic indices. 9 patients out of 138 gave birth to children weighing 4000 g or more. The weight of the rest of the children at birth did not exceed 3500 g. Conclusion. A well-controlled course of GDM, adequate self-monitoring and dynamic observation of women allows delivery to be carried out within the generally accepted terms without worsening its outcomes.

Aim. To evaluate the cost-effectiveness of empagliflozin therapy in patients with heart failure (HF) across the ejection fraction (EF) range in the Russian Fe­­deration. Material and methods. An analysis of the cost of HF management was carried out and an analytical decision-making model was built in MS Excel, which makes it possible estimating the costs of HF management with empagliflozin from the state position. Results. Taking into account the direct costs of adverse events, as well as indirect costs, the potential economic benefit of empagliflozin use for 766028 HF patients with low EF could be RUB 7,6-7,8 billion per year of therapy, while for 5790280 patients with HF with moderately reduced and preserved EF — RUB 27,6-29,6 billion per year of therapy. The potential economic benefit of empagliflozin for 664960 patients with HF immediately after hospitalization for an HF exacerbation could be RUB 1,4-1,6 billion per year of therapy, allowing to prevent 69438 deaths and 60822 repeated exacerbations of HF. Conclusion. Empagliflozin is the optimal regimen for the treatment of patients with HF across the entire EF range, both with and without type 2 diabetes, both in terms of clinical efficacy of treatment and economic feasibility.

Initiation of insulin therapy with basal insulin analogues has become the standard of care for type 2 diabetes mellitus (T2DM). Timely administration of insulin allows not only to slow down the progression of type 2 diabetes, but also to reduce the frequency and severity of complications associated with it. This paper reviews the efficacy and safety of the use of the latest basal insulin analogues in type 2 diabetes from the perspective of current clinical guidelines, and also reviews updated data on the efficacy and safety of therapy by various members of the class. In this paper a review of the efficacy and safety of latest basal insulin analogues use in T2DM from the standpoint of current clinical guidelines has been carried out, and updated data on the efficacy and safety of therapy by various members of the class have been reviewed, taking into account their impact on the risk of hypoglycemia and glycemic variability. The available data indicate that insulin degludec 200 U/mL may be the drug of choice for those at high risk of developing severe forms of hypoglycemia. Since severe hypoglycemia and high glycemic variability are important risk factors for cardiovascular events and mortality, it has been shown that a differentiated approach to insulin therapy in the treatment of T2DM is currently advisable, taking into account the effect on the risk of hypoglycemia and glycemic variability.

Background. The economic costs associated with chronic kidney disease (CKD) are a significant burden on the health care system. The use of dapagliflozin is a breakthrough strategy in the management of patients with CKD and type 2 diabetes mellitus (T2DM) to slow the progression of the disease and reduce healthcare costs. Aim. To evaluate the clinical and economic efficiency of dapagliflozin in patients with T2DM and CKD in the Russian Federation. Materials and methods. A cost-effectiveness/utility analysis was carried out. The calculation of direct costs was carried out in a model adapted to the conditions of healthcare in the Russian Federation by using Russian cost indicators and characteristics of the patient population. Results. Dapagliflozin in addition to standard therapy compared with standard therapy will provide an additional average of 0.253 life years and 0.219 quality-adjusted life years per patient with stage 2–4 CKD and T2DM during 10 years of therapy. Cost reduction in case of using dapagliflozin and standard therapy compared with standard therapy alone amounted to an average of 49,350 rubles per patient. Dapagliflozin and standard therapy compared with standard therapy alone on the modeling horizon of 10 years allows to extend the stay in the pre-dialysis stages of CKD by an average of 7 months per patient. The use of dapagliflozin in 1000 targeted patients for 10 years will help to avoid 26 hospitalizations for heart failure (NNT – 39), as well as prevent 44 cases of acute kidney injury (NNT – 23) and 51 deaths from all causes (NNT – 20). Probabilistic sensitivity analysis showed the robustness of the results to changes in parameters of cost of therapy, clinical efficacy and usefulness of the studied medical interventions. Conclusion. Intensification of standard CKD therapy with dapagliflozin in patients with T2DM is clinically and economically justified.

анализ влияния на бюджет применения эртуглифлозина у пациентов с сахарным диабетом 2 типа и недостижением целевой гликемии на фоне монотерапии метформином 1 Федеральное государственное бюджетное образовательное учреждение «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской Федерации, 400131, г.Волгоград, Российская Федерация 2 Общество с ограниченной ответственностью «МСД Фармасьютикалс», 119049, Москва, Российская Федерация недогода С.в. 1 , Саласюк а.С. 1 , Барыкина и.н. 1 , лутова в.о. 1 , Попова е.а. 1 , Крылов в.а. 2 , Угрехелидзе д.т. 2Цель -анализ влияния на бюджет нового ингибитора натрий-глюкозного котранспортера 2-го типа (иНГЛТ-2) эртуглифлозина при включении в Перечень жизненно необходимых и важнейших лекарственных препаратов (ПЖНВЛП).Препараты данного класса -пероральные сахароснижающие лекарственные средства, занимающие свою нишу в лечении сахарного диабета 2-го типа (СД2).Материал и методы.В ходе настоящего исследования построена аналитическая модель принятия решений в MS Excel, которая позволяет провести анализ влияния на бюджет применения эртуглифлозина в сравнении с другими лекарственными препаратами группы иНГЛТ-2 для лечения СД2, включенными в ПЖНВЛП.В модели были учтены только прямые медицинские затраты на одного пациента (затраты на лекарственную терапию препаратами группы иНГЛТ-2).В качестве целевой популяции для проведения анализа влияния на бюджет рассматривали взрослых пациентов с СД2, принимающих препараты группы иНГЛТ-2 для интенсификации терапии метформином при ее неэффективности в рамках ПЖНВЛП, по данным мониторинга закупок лекарственных средств информационно-аналитической системы IQVIA за 2020 г.Результаты.Проведенный анализ влияния на бюджет показал, что при полной замене эртуглифлозина у целевой популяции пациентов с СД2 за 1 год терапии удастся снизить текущую нагрузку на бюджет системы здравоохранения на 15%, или 483 млн руб.Средняя экономия бюджета системы здравоохранения в рамках бюджета ПЖНВЛП за 5 лет терапии составит 10,5%, или 316 млн руб.Анализ чувствительности подтвердил устойчивость результатов исследования к изменению цен на лекарственные препараты, доле пациентов, переводимых на эртуглифлозин в течение 1-5 лет внедрения лекарственного препарата, а также численности целевой популяции пациентов.Разница влияния на бюджет при колебании всех вышеперечисленных параметров в пределах ±20% остается в пользу внедрения эртуглифлозина.Наибольшее воздействие на величину влияния на бюджет оказывает изменение стоимости препаратов сравнения и количество пациентов.Финансирование.Исследование выполнено при поддержке «МСД Фармасьютикалс».Никто из авторов не имеет финансовой заинтересованности в представленных материалах или методах.Конфликт интересов.В.А.Крылов и Д.

Aim. Pharmacoeconomic analysis of new Bruton tyrosine kinase inhibitor for the treatment of high-risk adult patients with chronic lymphocytic leukemia (CLL) within the framework of health state budget. Materials and methods. In the course of this study, an analytical decision-making model was built in MS Excel, which allows to provide pharmacoeconomic analysis and analysis of the budget impact of acalabrutinib in comparison with the combination of venetoclax with obinutuzumab in the first line of therapy for high-risk CLL, as well as acalabrutinib and the combination of venetoclax with rituximab in the treatment of high-risk relapses and refractory forms of CLL. The model took into account only direct medical costs per patient (drug therapy costs). Results. The cost minimization analysis showed that the use of the drug acalabrutinib in the 1st line and for the treatment of relapses and refractory forms of high-risk CLL is the preferred option compared to comparators, having comparable efficacy and lower cost. The cost reduction in the first-line therapy of high-risk CLL and the treatment of relapses and refractory forms of high-risk CLL compared with ibrutinib amounted to 0.8 million rubles or 15.4%, in the first-line therapy of high-risk CLL compared with the combination of venetoclax + obinutuzumab 1.2 million rubles or 21.0%, in the treatment of relapses and refractory forms of high-risk CLL in comparison with the combination of venetoclax + rituximab 0.9 million rubles or 17.6%. Budget impact showed that in the case of initiation of first-line acalabrutinib and treatment of relapses and refractory forms in high-risk CLL patients, the burden on the health care system budget can be reduced by 0.813 billion rubles or 16.0% for 1 year of therapy and by 1.219 billion rubles or 9.1% over 3 years of therapy, taking into account only the costs of drugs.

Purpose: identifying the causes of early vascular aging (EVA) in patients with metabolic syndrome (MetS), assessing the relationship between vascular age and various metabolic disorders, the severity of metabolic syndrome , tissue and circulating risk markers, the severity of non-infectious inflammation, and derive a new score for calculation vascular age and predicting early vascular aging in patients with metabolic syndrome. Materials and methods : а total of 750 patients aged 35 to 80 years with metabolic syndrome were examined. Early vascular aging syndrome was detected in 484 patients with metabolic syndrome and carotid-femoral pulse wave velocity (cfPWV) values exceeding expected for average age values by 2 or more SD. Results: Multiple logistic regression shown, that presence of type 2 diabetes and IR were associated with greater risk of early vascular aging, the risk of having early vascular aging increased by 76% with an increase in HOMA-IR by 1 unit, by 17% with an increase in carotid-femoral pulse wave velocity by 1 mg/l, by 4% with an increase in DBP by 1 mm Hg, and by 1% with each 1 pmol / L increase in the level of UA. For vascular age, calculated from carotid-femoral pulse wave velocity, SCORE scale, QRISK-3 scale and Framingham scale, respectively. Diabetes mellitus and clinical markers of IR (yes/no), HOMA-IR and UA level were used to develop a new VAmets score for EVA prediction providing a total accuracy of 0.830 (95% CI 0,799 to 0,860). Conclusion: parallel efforts for effective integration simple clinical score into clinical practice have been offered. Our score (VAmets) may accurately identify patients with metabolic syndrome and early vascular aging on the basis of widely available clinical variables and classic cardiovascular risk factors can prioritize using of vascular age in routine care.

Purpose: identifying the causes of early vascular aging (EVA) in patients with metabolic syndrome (MetS), assessing the relationship between vascular age and various metabolic disorders, the severity of metabolic syndrome , tissue and circulating risk markers, the severity of non-infectious inflammation, and derive a new score for calculation vascular age and predicting early vascular aging in patients with metabolic syndrome.Materials and methods: а total of 750 patients aged 35 to 80 years with metabolic syndrome were examined. Early vascular aging syndrome was detected in 484 patients with metabolic syndrome and carotid-femoral pulse wave velocity (cfPWV) values exceeding expected for average age values by 2 or more SD.Results: Multiple logistic regression shown, that presence of type 2 diabetes and IR were associated with greater risk of early vascular aging, the risk of having early vascular aging increased by 76% with an increase in HOMA-IR by 1 unit, by 17% with an increase in carotid-femoral pulse wave velocity by 1 mg/l, by 4% with an increase in DBP by 1 mm Hg, and by 1% with each 1 pmol / L increase in the level of UA. For vascular age, calculated from carotid-femoral pulse wave velocity, SCORE scale, QRISK-3 scale and Framingham scale, respectively. Diabetes mellitus and clinical markers of IR (yes/no), HOMA-IR and UA level were used to develop a new VAmets score for EVA prediction providing a total accuracy of 0.830 (95% CI 0,799 to 0,860).Conclusion: parallel efforts for effective integration simple clinical score into clinical practice have been offered. Our score (VAmets) may accurately identify patients with metabolic syndrome and early vascular aging on the basis of widely available clinical variables and classic cardiovascular risk factors can prioritize using of vascular age in routine care.

within the preferential medication supply according to the List of Vital and Essential Drugs. Patients and Methods: the analytical model of decision-making was created using the MS Excel software to analyze the budgetary impact and "missed opportunities" when using alogliptin compared to other DPP-4 inhibitors for T2D. This model included only direct medical costs for one patient (medical costs of medical treatment with DPP-4 inhibitors). The target population included adults with T2D who received DPP-4 inhibitors from the List of Vital and Essential Drugs to enhance ineffective therapy with metformin based on the monitoring of the IQVIA drug purchase in 2021. Results: complete switch to alogliptin in the target population (249,700 patients with T2D) eased the strain on a budget of the health care system by 18%, or 839.7 million of RUB, over a 1-year therapy. Considering the previously calculated penetration rate, the average budget savings of the health care system over a 5-year therapy will be 11% or 448.6 of RUB. In addition, the analysis of "missed opportunities" has demonstrated that prescribing alogliptin in adults with T2D (considering replacement schedule) allows for additional treatment of 13,693 patients within the first year and 146,311 patients within five years in a fixed budget. Conclusion: in T2D, alogliptin is more effective compared to other DPP-4 inhibitors in terms of economics due to lower cost and similar efficacy. KEYWORDS: diabetes, dipeptidyl peptidase 4 inhibitors, alogliptin, analysis of budgetary impact, pharmacoeconomics. FOR CITATION: Nedogoda S.V., Salasyuk A.S., Barykina I.N. et al. Analysis of the budgetary impact of alogliptin in type 2 diabetes and unachieved target glycemia with metformin. Russian Medical Inquiry. 2021;5(9):559–567 (in Russ.). DOI: 10.32364/2587-6821-2021-5-9-559-567.