Budget Effect Analysis of Ivabradine in the Treatment of Heart Failure on Medical Insurance Fund in China / 中国药房

ABSTRACT

OBJECTIVE： To evaluate the effects of ivabradine in the treatment of heart failure on medical insurance fund budget in China， and to provide support evidence of related economical evaluation for medical insurance department to solve the problem of reimbursement admission of the drug in hospital outpatient department and the establishment of drug list in hospital. METHODS： Excel decision tree model was used. Pharmacoeconomic analysis was conducted based on the data reported in domestic literatures over the years. Firstly， according to the prevalence rate of heart failure in China， the number of patients with heart failure was estimated， which accorded with NYHA cardiac function class Ⅱ-Ⅳ， systolic blood pressure dysfunction and ivabradine indication. Then the cost of ivabradine was estimated. Secondly， the total number of hospitalizations and the cost of hospitalization due to heart failure were estimated. Finally， the cost of ivabredine and the cost of treatment saved by avoiding re-hospitalization due to the use of ivabredine were considered comprehensively. Static budget impact analysis was conducted to evaluate the effects of the use of ivabredine on medical insurance fund budget. RESULTS： The prevalence rate of heart failure in China was raised to 1.3％ in 2013. It was estimated that the number of heart failure patients between 35-75 years old in China could be about 8.51 million and total hospitalization times was about 4.32 million per year. The economic burden of hospitalization in heart failure patients was about 168.940 billion yuan in whole country. Since 18％ of patients could be avoided re-hospitalization after treatment with ivabradine， the cost of hospitalization could be saved by about 30.410 billion yuan， while the total cost of taking ivabradine was about 17.525 billion yuan. Therefore， the use of ivabradine could save the hidden medical cost budget by about 12.886 billion yuan， which had obvious cost-effectiveness. Static budget impact analysis results showed that by 2019-2020， the expected proportion of patients with heart failure covered by ivabradine would increased to 8.70％， and the total consumption sum would reach about 1.797 billion yuan. The incremental cost savings ratio （ICSR） showed that the cost of hospitalization could be saved by about 11 951 yuan for each additional case of heart failure treated with ivabradine； there could be 5 711 yuan of balance by deducting drug cost 6 240 yuan of ivabradine. CONCLUSIONS： The cost savings of hospitalization treated by ivabradine is not only enough to offset the cost of ivabradine itself， but also has a premium effect. The drug is of certain economy for the treatment of heart failure in China.