In Thailand, the management of heart failure among patients with type 2 diabetes (T2D) is both a clinical challenge and a financial concern. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have emerged as promising agents offering cardiovascular benefits. However, their absence from Thailand’s National List of Essential Medicines (NLEM) raises questions about their economic value. This scenario necessitates a thorough exploration of market access issues, particularly regarding the inclusion of SGLT2i in national healthcare plans.
Study Objective and Methodology
The research aimed to assess the cost-utility of incorporating SGLT2i into the standard therapeutic regimen for T2D patients suffering from heart failure in Thailand. Utilizing a Markov model with 3-month cycles over a lifetime horizon, the study adopted a societal perspective. Efficacy data were sourced from systematic reviews and meta-analyses. Key factors such as transition probabilities and direct medical costs were extracted from the National Health Security Office database, while non-medical costs and utility inputs were derived from patient interviews at Siriraj Hospital. The analysis focused on incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).
Findings and Economic Implications
Canagliflozin demonstrated the most significant improvement in QALYs, followed by dapagliflozin and empagliflozin. However, the additional treatment costs were substantial, with canagliflozin being the most expensive. Analyzing ICERs, none of the SGLT2i were cost-effective against Thailand’s willingness-to-pay threshold. Market access challenges become apparent here, as cost reductions are necessary for these medications to be economically viable options. The study suggests considerable price adjustments for these drugs to align with cost-effectiveness standards.
The budget impact analysis highlighted that treating T2D patients with heart failure over five years would cost approximately US$15.6 million. This figure underscores the financial implications of introducing SGLT2i into standard practices without strategic market access and pricing policies.
Key Inferences
- Canagliflozin offers the most QALY gains but at a higher cost, demanding strategic price negotiations for market access.
- Dapagliflozin and empagliflozin require significant price reductions to meet cost-effectiveness thresholds in Thailand.
- The study emphasizes the importance of aligning drug costs with national healthcare budgets to enhance market access.
In conclusion, while adding SGLT2 inhibitors to the standard treatment regimen for T2D-HF patients can improve outcomes, their current pricing makes them non-viable within Thailand’s healthcare budget constraints. An emphasis on reducing costs and strategic market access planning is crucial for these drugs to become feasible options for broader patient inclusion.
Original Article: Pharmacoecon Open. 2024 Sep 22. doi: 10.1007/s41669-024-00526-2. Online ahead of print.
This article has been prepared with the assistance of AI and reviewed by an editor. For more details, please refer to our Terms and Conditions. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author.
