engleski

Introduction of anti-dementia drugs in Croatia : epidemiological and budget impact analysis

Background: Many studies with anti-dementia drugs indicate that slowing the progression of Alzheimer's disease (AD) and delaying institutionalization will have a dramatic impact on overall societal costs for managing AD. Any anti-dementia drug (cholinesterase inhibitors or memantine) is not currently available in Croatia through the Croatian National Health Insurance (CNHI) Positive Drugs List (PDL). The aim of our study is to analyze the impact of cholinesterase inhibitors (ChEIs) inclusion to the CNHI PDL according to defined clinical guidelines and budget impact analysis (BIA). Methods: Limited reimbursement for ChEIs usage (for mild to moderate AD patients) through the CNHI PDL is proposed according to evidence-based medical criteria and main international guidelines. We have calculated the number of patients who will be treated with ChEIs in three-years’ period after the reimbursement following the proposed clinical limitation. The share of the each drug from the group has been estimated using the market data from other countries. The price is calculated according to the Croatian MoH Pricing Ordinance and the total costs for the CNHI have been calculated. Results: The total number of patients with mild to moderate AD in Croatia, who could be potential candidates for the treatment, is 17, 127 in 2011 to 18, 960 in 2014. In the next step of calculation we have taken into account several limitations (the percentage of the diagnosed, persistence, compliance) and the real treated patients will be between 692 (2011) and 1, 423 (2014). BIA shows that ChEIs inclusion on the CNHI PDL will cost 415, 462 US$ in 2012, 537, 278 in 2013 and 661, 966 US$ in 2014. Further, we have calculated the budget impact according to the case of patient co-payment. Conclusion: These epidemiological data and BIA show that the inclusion of ChEIs to PDL, according to the suggested restrictive reimbursement criteria (limited indication), will not have a significant impact on the CNHI budget, and the usage of different grades of co-payment could also minimize this amount for the Croatian Health Insurance. Further, our study supports the usage from the clinical and pharmacoeconomical aspect and it could give certain clinical benefits for this selected group of patients and their caregivers.

pharmacoeconomics; anti-dementia drugs; budget impact analysis

DOI:10.1016/j.jalz.2012.05.1518