| Abstrakt: |
This study aimed to estimate the budget impact and affordability of empagliflozin added to usual care compared with usual care alone, in a diabetic population with established cardiovascular disease, from a private healthcare payer perspective in South Africa. A budget impact model was adapted and localized. Epidemiological data were obtained from the South African Council for Medical Schemes. Clinical event rates were sourced from the EMPA-REG OUTCOME trial and drug costs from list prices. Clinical event costs were derived from a claims data analysis of the South African private healthcare sector and microcosting. Scenario analyses were performed on select inputs. The modeled outcomes included annual budget impact of empagliflozin, the incremental cost per life per month, cardiovascular deaths averted, and incremental cost per life saved, over 3 years. A total of 9 503 patients were eligible for empagliflozin (year 1), 12 670 (year 2), and 16 947 (year 3). The incremental cost was $1 272 297, $1 764 705, and $2 455 235, for years 1 to 3, respectively. The incremental cost per beneficiary per month was calculated as $0.012 (year 1), $0.016 (year 2), and $0.023 (year 3). The model estimated a 38.6% reduction in cardiovascular deaths, 305 lives saved, and an incremental cost per life saved of $17 999. Adding empagliflozin to usual care has a marginal budget implication and is highly affordable for private healthcare payers, with an acceptable incremental cost based on clinical outcomes. • Empagliflozin is a sodium-glucose cotransporter 2 inhibitor that has been shown to reduce cardiovascular events in patients with type 2 diabetes mellitus (T2DM) with established cardiovascular disease (EMPA-REG OUTCOME trial). Previous studies in other countries have investigated the budget impact of adding empagliflozin to usual care for the treatment of adult patients with T2DM and established cardiovascular disease. These studies found that adding empagliflozin to usual care was budget saving because of reduced cardiovascular-related management costs. • In the private healthcare setting in South Africa, adding empagliflozin to usual care for patients with T2DM offers substantial clinical benefits at a reasonable and highly affordable cost for private healthcare payers. The affordability is driven by the substantial clinical benefits (resulting in lives saved) and the implicit clinical event management costs these benefits offset, particularly when contextualized within the current "willingness to fund" environment in the South African private healthcare sector. • Notwithstanding the higher cost of empagliflozin compared with comparator drugs (with the exception of glucagon-like peptide-1 agonists and insulin), based on the marginal budget impact of adopting this strategy, as well as the substantial clinical benefits as add-on to usual care for patients with T2DM with established cardiovascular disease, empagliflozin should be considered a worthy addition to usual care in these patients. The evidence from this study could guide private healthcare payers in their reimbursement decisions. [ABSTRACT FROM AUTHOR] |
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