Budget Impact of Introducing Linagliptin into Bosnia and Herzegovina Health Insurance Drug Reimbursement List in 2016-2018

Abstract

Introduction:Diabetes is reaching epidemiological scales worldwide. Beside health implications diabetes bears significant financial impact on health systems. Different treatment options aiming to prevent diabetes complications are available. Dipeptidyl-peptidase-IV (DPP-4) inhibitors like linagliptin are usually add-on therapy to metformin in order to achieve glycemic control. Expenditure for oral antidiabetic medicines in Bosnia and Herzegovina (B&H) is low accounting for only 2.53% of the total drug market expenditure. Linagliptin is not reimbursed in B&H mainly due to it’s perception of high cost medication.Aim:To assess budget impact (BI) of introducing linagliptin into health insurance reimbursement list in B&H through development of the budget impact model (BIM).Material and methods:Budget impact model was developed using Microsoft Excel 2010 based on current legislation and practice in B&H. Local epidemiology data and data on drug consumption from government reports in 2014 were used. Two scenarios with three-year time horizon have been developed: 1) without and 2) with linagliptin reimbursed and compared.Results:Inclusion of linagliptin into reimbursement list in Canton Sarajevo and Canton Tuzla would have positive budget impact on national level of B&H resulting in total savings of 18,194€, 235,570€ and 699,472€, in 2016, 2017 and 2018, respectively.Conclusion:Introduction of linagliptin into reimbursement list would decrease total costs for DPP-4 inhibitors and is favorable for positive decision on reimbursement in B&H. Applying BIM in decision making would assure better allocation and planning of resources at any region or administrative level in B&H.

Use of Food Supplements in Diabetes Mellitus Treatment in Bosnia and Herzegovina from the Pharmacists Perspective

“…IDF Diabetes Atlas estimated that in 2017 there were 451 million people with diabetes worldwide and it is expected that this number will increase to 693 million by 2045 (1). It is estimated by the diabetes associations in Bosnia and Herzegovina (B&H) that more than 220.000 people or 5,1% of population suffer from diabetes and majority are patients with type 2 diabetes (2). The main goal of diabetes treatment is to prevent or delay complications and maintain quality of life as stated in the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Consensus Report published in 2018 (3).…”

Budget Impact Analysis of Diabetes Drugs: A Systematic Literature Review

“…The discounting rate was not always clearly reported in the included BIA studies. Four studies reported the discounting rate ranging from 3 to 5% (16,(23)(24)(25), eight studies (11,15,(17)(18)(19)(20)(21)27) did not consider the discounting rate in compliance with the ISPOR Task Force guidelines (7). Meanwhile, six studies (10, 12-14, 22, 26) did not mentioned the discounting rate in the articles.…”

“…Condition-related costs included adverse event costs and complication costs. Seven studies only calculated treatmentrelated costs only (10,(13)(14)(15)(21)(22)(23). Eleven studies took into account both treatment-related costs and condition-related costs (11,12,(16)(17)(18)(19)(20)(24)(25)(26)(27), of which nine studies considered the cost of hypoglycemia which was further classified into minor and severe hypoglycemia (11,12,16,18,20,(24)(25)(26)(27), six studies considered the cost of diabetes-related complications (11,16,17,19,25,27) (mainly including myocardial infarction (MI), stroke, heart failure, heart disease) and only one took the cost of adverse event (including dizziness, vomiting, fatigue and loss of appetite) into account (12).…”

“…Some studies even presented the cost per patient per year (n = 8) (10,14,16,18,20,(24)(25)(26) and the cost per member per month in a hypothetical health plan (n = 4) (20,24,25,27). Twelve studies (10,12,13,15,(17)(18)(19)(22)(23)(24)(25)(26) reported that increasing use of new drug or introducing a new drug into the reimbursement list would reduce the financial budget. Six studies (11,14,16,20,21,27) concluded that the adoption or increasing use of new intervention for diabetes treatment would increase the budget.…”

“…Among the five basal insulin BIA studies, one of them was about insulin glargine biosimilar (13). The rest of BIA studies targeted GLP-1 RA (n = 4, including once-weekly semaglutide, oral semaglutide, and benaglutide) (12,14,25,27), DPP-4i (n = 3, including vildagliptin, saxagliptin, and linagliptin) (10,15,23), SGLT-2i (n = 2, both were dapagliflozin) (11,17) and metformin (n = 1) (19).…”