OBJECTIVES : In 2018 a new model of diagnosis-related groups (DRGs) for reimbursement of antineoplastic pharmacotherapy at inpatient and day care services was implemented in Russian compulsory medical insurance (CMI) system. The model was based on 18 clinical guidelines for most prevalent types of malignant tumors that covered 90% of oncology hospital cases. 485 antineoplastic therapy regimens were divided between ten DRGs for inpatient care and eight DRGs for day care units. Still the DRGs did not comprise all antineoplastic drugs covered by CMI that is why we developed an improved version of DRGs for reimbursement of antineoplastic pharmacotherapy, implemented in 2019.

METHODS : We used 26 new clinical guidelines to identify antineoplastic pharmacotherapy regimens not previously included into DRG. We calculated cost of hospital case for each new regimen taking into account all expenditures, covered by CMI . Expected cost for the regimens already included into DRG were updated accordingly to current prices. Oncologists re-assessed prescription rates and necessary resources for each regimen. The regimens with the similar costs were pooled in new DRGs with the assigned weight coefficients (WCs) estimated on base of the expected costs.

RESULTS : New version of DRGs included 604 pharmacotherapy regimens vs 485 in 2018 with the use of 107 antineoplastic drugs vs 91 in 2018. The regimens were pooled in ten new DRGs for inpatient care and other ten for day care. The WCs range from 0.57 to 14.64 (vs 0.56-11.02 in 2018) for inpatient care and from 0.76 to 38.1 (vs 0.45-18.44 in 2018) for day care.

CONCLUSIONS : Improved DRG system promotes fairer reimbursement of antineoplastic pharmacotherapy for rare types of cancer.