Provision of biologic therapy for severe asthma and chronic obstructive pulmonary disease: an analysis of data from 51 regions of the Russian Federation

Abstract

Objective. To assess the actual coverage of biologic therapy in patients with asthma and chronic obstructive pulmonary disease (COPD), the structure of its funding channels and between-region variability of provision, and to compare two independent data sources on biologic use. Material and methods. A descriptive study covering 51 constituent entities of the Russian Federation (population 73.8 million) for 2025. Sources: monitoring conducted by the national medical research centre for pulmonology of Sechenov University (Monitoring) and public procurement records (Procurement). Scaling between absolute measures was modelled by power-law regression on the log—log scale with the slope tested against unity; agreement between sources was assessed by Bland—Altman analysis on the log scale. Results. A total of 7.611 patients received biologic therapy — 10.3 per 100.000 population of the sample (median across regions 8.6 [4.0; 12.5]; range 0.2—78.8). Asthma accounted for 97.8% of cases and COPD for 2.2%. Funding channels: mandatory health insurance 54%, regional drug provision 34%, federal programme 12%. The number of treated patients scaled sub-proportionally with registered asthma prevalence (slope 0.61; 95% confidence interval 0.30—0.92; p=0.017), whereas scaling with population size was indistinguishable from proportional (slope 0.78; p=0.245). The aggregate difference between sources was +13.7%, yet limits of agreement were ×0.26 to ×6.14 and Lin’s concordance coefficient was 0.71 (0.47—0.84); in 18 of 51 regions the difference exceeded 50%. For dupilumab and omalizumab, Procurement exceeded Monitoring by 2.002 patients, whereas for the three respiratory-specific molecules it fell below Monitoring by 958 (–31%). Conclusion. Provision varies between regions by two orders of magnitude and grows more slowly than the number of registered asthma patients. The aggregate concordance of the two sources results from mutual cancellation of opposing regional discrepancies and does not indicate interchangeability.