OBJECTIVES: Reimbursement of inpatient and day care services in Russia is mostly based on diagnostic-related groups (DRG). Three DRGs cover antineoplastic pharmacotherapy at hospitals and three others at day care units; diagnosis is the main classification criteria. Each DRG is assigned a payment weight coefficient (WC). Presently the healthcare system is aimed at implementing modern clinical guidelines. Current DRGs have too average WCs and do not stimulate effective but costly treatment. We developed new DRG for reimbursement of antineoplastic pharmacotherapy on the base of clinical guidelines.

METHODS: Pharmacotherapy schemes for 90% of oncology hospital cases were derived from clinical guidelines. Expected cost of each case of treatment with the use of each scheme was calculated. We took into account all expenditures, covered by compulsory insurance system, including salaries of medical staff, medicines, devices, etc. Oncologists assessed prescription rates for each scheme and necessary resources for treatment. Prices for drugs and devices were taken from state procurements’ database; salaries were calculated on the base of legislatively established payment rates. Information on the actual expenses of the medical organizations that participated in the cost-accounting pilot project was used for other items of expenditures. Schemes with the similar costs were pooled in new DRGs, WC were estimated on the base of expected costs.

RESULTS: CONCLUSIONS: New DRG-based payment for antineoplastic pharmacotherapy at Russian hospitals proposes higher reimbursement rates for expensive drugs. Nevertheless, we will be able to estimate the impact of these changes only after the real-world data is available by the end of 2018.