HTA Office, LLC, Cairo, Egypt.
Department of Pharmacy Practice, Faculty of Pharmacy, Future University, Cairo, Egypt.
J Med Econ. 2020 Aug;23(8):908-914. doi: 10.1080/13696998.2020.1764571. Epub 2020 May 28.
Type 2 diabetes mellitus (T2DM) is a major health problem in Egypt with a high impact on morbidity, mortality, and healthcare resources. This study evaluated the budget impact and the long-term consequences of dapagliflozin versus other conventional medications, as monotherapy, from both the societal and health insurance perspectives in Egypt. A static budget impact model was developed to estimate the financial consequences of adopting dapagliflozin on the healthcare payer budget. We measured the direct medical costs of dapagliflozin (new scenario) as monotherapy, compared to metformin, insulin, sulphonylurea, dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinedione, and repaglinide (old scenarios) over a time horizon of 3 years. Myocardial infarction (MI), ischemic stroke, hospitalization for heart failure (HHF), and initiation of renal replacement therapy (RRT) rates were captured from DECLARE TIMI 58 trial. One-way sensitivity analyses were conducted. The budget impact model estimated 2,053,908 patients eligible for treatment with dapagliflozin from a societal perspective and 1,207,698 patients from the health insurance (HI) perspective. The new scenario allows for an initial savings of EGP121 million in the first year, which increased to EGP243 and EGP365 million in the second and third years, respectively. The total cumulative savings from a societal perspective were estimated at EGP731 million. Dapagliflozin allows for savings of EGP71, EGP143, and EGP215 million in the first, second and third years respectively, from the HI perspective, with total cumulative savings of EGP430 million over the 3 years. Treating T2DM patients using dapagliflozin instead of conventional medications, maximizes patients' benefits and decreases total costs due to drug cost offsets from fewer cardiovascular and renal events. The adoption of dapagliflozin is a budget-saving treatment option, resulting in substantial population-level health gains due to reduced event rate and cost savings from the perspective of the national healthcare system.
2 型糖尿病（T2DM）是埃及的一个主要健康问题，对发病率、死亡率和医疗保健资源有重大影响。本研究从社会和医疗保险的角度评估了达格列净与其他常规药物（作为单一疗法）的预算影响和长期后果，在埃及。建立了一个静态预算影响模型，以估算采用达格列净对医疗保健支付者预算的财务影响。我们测量了达格列净（新方案）作为单一疗法的直接医疗费用，与二甲双胍、胰岛素、磺酰脲类、二肽基肽酶-4（DPP-4）抑制剂、噻唑烷二酮和瑞格列奈（旧方案）相比，在 3 年的时间范围内。从DECLARE TIMI 58 试验中捕获心肌梗死（MI）、缺血性中风、心力衰竭住院（HHF）和开始肾脏替代治疗（RRT）的发生率。进行了单因素敏感性分析。预算影响模型估计从社会角度来看，有 2053908 名患者符合达格列净治疗标准，从医疗保险（HI）角度来看，有 1207698 名患者符合达格列净治疗标准。新方案在第一年可节省 1.21 亿埃及镑，第二年和第三年分别增加到 2.43 亿和 3.65 亿。从社会角度来看，总累计节省额估计为 7.31 亿埃及镑。从 HI 角度来看，达格列净在第一年、第二年和第三年分别可节省 7100 万、1.43 亿和 2.15 亿埃及镑，3 年内累计节省 4.30 亿埃及镑。用达格列净治疗 2 型糖尿病患者，最大限度地提高了患者的获益，并通过心血管和肾脏事件减少药物成本，降低了总费用。从国家医疗保健系统的角度来看，采用达格列净是一种节省预算的治疗选择，由于事件发生率降低和成本节约，可带来显著的人群健康收益。
