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Budget Impact Analysis of Anti-vascular Endothelial Growth Factor in Patients with Diabetic Macular Edema
당뇨황반부종에서 항혈관내피성장인자 치료의 재정 영향 분석
JKOS 2019 Jul;60(7):667-75
Published online July 15, 2019;  https://doi.org/10.3341/jkos.2019.60.7.667
Copyright © 2019 The Korean Ophthalmological Society.
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Jangmi Yang, MS1, Sang Jin Shin, PhD1, Jae Kyung Suh, PhD1, Hajin Tchoe, MS1, Songhee Cho, MS1, Min Joo Kang, MS1, Donghyun Jee, MD, PhD, MPH2
양장미1⋅신상진1⋅서재경1⋅최하진1⋅조송희1⋅강민주1⋅지동현2

Office of Economic Evaluation Research, National Evidence Based Health Care Collaborating Agency1, Seoul, Korea
Department of Ophthalmology and Visual Science, St. Vincent Hospital, College of Medicine, The Catholic University of Korea2, Seoul, Korea
한국보건의료연구원 경제성평가연구팀1, 가톨릭대학교 의과대학 성빈센트병원 안과 및 시과학교실2
Received May 8, 2018; Revised July 12, 2018; Accepted June 19, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: This study investigated the optimal strategy to minimize budgetary constraints on National Health Insurance (NHI) services, while maximizing the number of diabetic macular edema (DME) patients who receive anti-vascular endothelial growth factor (anti-VEGF) therapy.
Methods: We estimated the potential budget impact of anti-VEGF treatments in DME patients based on perceived upcoming changes in reimbursement fees over the next 5 years (2018-2022). Four scenarios were evaluated: (1) current anti-VEGF treatment patterns, (2) the hypothetical reimbursement fee, (3) the introduction of a new molecule similar to current anti-VEGF treatments, and (4) the prescription of an off-label drug, bevacizumab. The number of patients, anti-VEGF treatments, and medical costs for each scenario were calculated using claims data from the Korean NHI system and anti-VEGF prescription data from a single hospital.
Results: The potential budget impact of anti-VEGF injections in patients with DME over the next 5 years was estimated to be about 97.7 billion and 106.2 billion KRW for scenarios 1 and 2, respectively. In scenario 3, in which a biosimilar product to anti- VEGF is used, the estimated budget of the NHI system would be approximately 98.4 billion KRW. If an off-label drug is reimbursed, roughly 79.5 billion KRW will be required for the NHI system’s budget.
Conclusions: If the revised fee structure for AMD patients is similarly applied to anti-VEGF injections for DME patients, the NHI fiscal requirements will increase disproportionately over the next 5 years compared to current reimbursement conditions. Given the growth of DME patients in today’s patient population, the use of a biosimilar or off-label drug is a financially viable alternative to reduce the overall burden on the NHI system.
Keywords : Aflibercept, Anti-vascular endothelial growth factor, Diabetic macular edema, Ranibizumab

 

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