J Korean Ophthalmol Soc.  2019 Jul;60(7):667-675. 10.3341/jkos.2019.60.7.667.

Budget Impact Analysis of Anti-vascular Endothelial Growth Factor in Patients with Diabetic Macular Edema

• Yang J
• Shin SJ
• Suh JK
• Tchoe H
• Cho S
• Kang MJ
• Jee D

• KMID: 2453018
• DOI: http://doi.org/10.3341/jkos.2019.60.7.667

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 toda'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.

Keyword

Aflibercept; Anti-vascular endothelial growth factor; Diabetic macular edema; Ranibizumab

MeSH Terms

Bevacizumab
Budgets*
Endothelial Growth Factors*
Fees and Charges
Humans
Macular Edema*
National Health Programs
Prescriptions
Ranibizumab
Vascular Endothelial Growth Factor A
Bevacizumab
Endothelial Growth Factors
Ranibizumab
Vascular Endothelial Growth Factor A

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