PHÂN TÍCH TÁC ĐỘNG NGÂN SÁCH CỦA VIỆC TĂNG TỶ LỆ THANH TOÁN BẢO HIỂM Y TẾ CHO ADALIMUMAB TRONG ĐIỀU TRỊ VIÊM CỘT SỐNG DÍNH KHỚP TẠI VIỆT NAM

Abstract

Background: Ankylosing spondylitis (AS) is a chronic inflammatory arthritis primarily affecting the axial skeleton. Its prevalence ranges from 0.03% to 1.8%, and it is associated with various severe complications, particularly in the spinal joints, leading to pain and impaired patient productivity. Biological drugs such as adalimumab have demonstrated effectiveness, safety, and improved quality of life for AS patients. Despite being covered by 50% of health insurance, access to adalimumab remains limited due to its high cost. Therefore, in order to increase coverage rate for adalimumab in AS treatment, it is neccessary to evaluate the impact on health insurance budgets before. Objective: To analyze the budget impact of raising health insurance coverage rate for adalimumab in treating AS in Vietnam. Methods: A modeling approach was employed to evaluate the budgetary impact of adalimumab for AS patients with an inadequate response to conventional therapy from a Vietnamese healthcare payer perspective over a five-year period (2024-2028). Data were gathered through literature reviews and consultations with clinical experts. Usage costs included drug costs, disease management monitoring, adverse event treatment, and acute complication treatment. Scenario analysis was conducted with varying health insurance reimbursement rates of 60%, 70%, and 80%. Results: With a target AS population ranging from 1,119 to 1,615 from the 1st to 5th year, increasing health insurance coverage rate for adalimumab from 50% to 60% led to a rise in adalimumab treatment access rate from 14.3% to 30.3%. Health insurance budget savings increased from 0.28 billion to 1.48 billion VND, with a total 5-year savings of 4.24 billion VND. Scenario analysis at health insurance coverage rate of 70% and 80% resulted in total 5-year health insurance budget savings of 4.98 billion VND and 5.66 billion VND, respectively. Conclusion: Raising the health insurance coverage rate for adalimumab in AS treatment not only enhances treatment access rate but also contributes to saving the health insurance budget. This provides compelling evidence for health policy decision-making agencies to consider increasing the health insurance coverage rate for adalimumab in Vietnam.