Chanjaruporn Farsai, Roughead Elizabeth E, Sooksriwong Cha-oncin, Kaojarern Sming
Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Thailand.
J Med Assoc Thai. 2011 Sep;94(9):1026-34.
Thailand does not currently require Budget Impact Analysis (BIA) assessment. The present study aimed to estimate the annual drug cost and the incremental impact on the hospital pharmaceutical budget of the introduction of pemetrexed to a Thai teaching hospital.
The budget impact model was conducted in accordance with the Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (PBAC). The model variables consisted of number of patients, growth rate of lung cancer, uptake rate of pemetrexed over time, unit prices of drugs, and the length and cost of treatment. Sensitivity analysis was performed to determine changes in budgetary impact due to variation of parameters or assumptions in the model.
The introduction of pemetrexed was estimated to cause considerable costs for the teaching hospital. In the base-case analysis, the incremental costs were estimated at 8,553,984 Baht in the first year increasing to 12, 118, 144 Baht, 17,820,800 Baht and 17,820,800 Baht in the following years. The 4-year net budgetary impact was 20,154,480 Baht or approximately 127,560 Baht per patient. Sensitivity analyses found that number of treatment cycles andproportion of patients assumed to be treated with pemetrexed were the two most important influencing factors in the model.
New costly innovative interventions should be evaluated using the BIA model to determine whether they are affordable. The Thai government should consider requiring the BIA study as one of the requirements for drug submission to assist in the determination of listing and subsidizing decision for medicines.
泰国目前不要求进行预算影响分析（BIA）评估。本研究旨在估计培美曲塞引入泰国一家教学医院后的年度药品成本以及对医院药品预算的增量影响。
预算影响模型是根据向药品福利咨询委员会（PBAC）提交申请的指南进行构建的。模型变量包括患者数量、肺癌增长率、培美曲塞随时间的采用率、药品单价以及治疗时长和成本。进行敏感性分析以确定由于模型参数或假设的变化而导致的预算影响变化。
预计培美曲塞的引入会给教学医院带来相当大的成本。在基础案例分析中，第一年的增量成本估计为8,553,984泰铢，随后几年分别增至12,118,144泰铢、17,820,800泰铢和17,820,800泰铢。四年的净预算影响为20,154,480泰铢，即每位患者约127,560泰铢。敏感性分析发现，治疗周期数和假设接受培美曲塞治疗的患者比例是模型中两个最重要的影响因素。
应使用BIA模型评估新的昂贵创新干预措施，以确定它们是否负担得起。泰国政府应考虑要求将BIA研究作为药品申报的要求之一，以协助确定药品的上市和补贴决策。
