Article type
Abstract
Background: Brazilian Public Health System (SUS) has decided to include short-acting insulin analogues on its drug list for free access for type-1 Diabetes Mellitus. All costs will be carried by the Ministry of Health.
Objectives: To estimate the budgetary impact of replacing regular human insulin with short-acting insulin analogues for the population aged between 04 and 18 years with type-1 diabetes mellitus (DM1) in the Brazilian Public Health System (SUS) over a time horizon of 15 years.
Method: Data obtained from the literature and national statistics, stratified by sex and age, were used to estimate drug demand. Three price scenarios were considered: reimbursement of the Brazilian Popular Pharmacy Program (PFPB) without adjustment; PFPB adjusted for 2016; and centralised purchase by Ministry of Health. Sensitivity analysis included: incidence of DM1, price of short-acting insulin analogues, economies of scale (quantity-dependent discount), diffusion rate, population weight and daily dose of insulin.
Results: According to our analysis, in 2031 the estimated population with DM1 would be between 99,130 and 132,576. The exclusive disbursement for regular insulin was estimated at USD 86.2 million in PFPB-without adjustment scenario, USD 122.9 million in PFPB-adjusted scenario and USD 44.9 million for centralized acquisition. In base case scenarios, the total incremental budgetary impact would be USD 64.5 million in PFPB-without adjustment scenario, USD 29.9 million in PFPB-adjusted scenario and USD 103.5 million for centralisd acquisition. The parameters whose uncertainty represented the greatest impact in the estimates were: quantity-dependent discount, population weight, and price of short-acting insulin analogues.
Conclusions: Budgetary impact with insulin therapy for children and adolescents shows an increased trend, with or without short-acting insulin analogues. Including short-acting insulin analogues, the increase would reach 331%. Magnitude of budgetary impact is specially correlated with access setting, with a comparative advantage for centralisd acquisition models based on economies of scales.
Objectives: To estimate the budgetary impact of replacing regular human insulin with short-acting insulin analogues for the population aged between 04 and 18 years with type-1 diabetes mellitus (DM1) in the Brazilian Public Health System (SUS) over a time horizon of 15 years.
Method: Data obtained from the literature and national statistics, stratified by sex and age, were used to estimate drug demand. Three price scenarios were considered: reimbursement of the Brazilian Popular Pharmacy Program (PFPB) without adjustment; PFPB adjusted for 2016; and centralised purchase by Ministry of Health. Sensitivity analysis included: incidence of DM1, price of short-acting insulin analogues, economies of scale (quantity-dependent discount), diffusion rate, population weight and daily dose of insulin.
Results: According to our analysis, in 2031 the estimated population with DM1 would be between 99,130 and 132,576. The exclusive disbursement for regular insulin was estimated at USD 86.2 million in PFPB-without adjustment scenario, USD 122.9 million in PFPB-adjusted scenario and USD 44.9 million for centralized acquisition. In base case scenarios, the total incremental budgetary impact would be USD 64.5 million in PFPB-without adjustment scenario, USD 29.9 million in PFPB-adjusted scenario and USD 103.5 million for centralisd acquisition. The parameters whose uncertainty represented the greatest impact in the estimates were: quantity-dependent discount, population weight, and price of short-acting insulin analogues.
Conclusions: Budgetary impact with insulin therapy for children and adolescents shows an increased trend, with or without short-acting insulin analogues. Including short-acting insulin analogues, the increase would reach 331%. Magnitude of budgetary impact is specially correlated with access setting, with a comparative advantage for centralisd acquisition models based on economies of scales.