PDB118 - Real Life Applications of Social Security Institution (SSI) Regulations; A Case Study of DPP4 Inhibitors in Treatment of Diabetes in Turkish Health Care System

Abstract

Analyze real life applications of SSI regulations via a case study: patient access to DPP4 inhibitors (ProductA*&Product B**) for Diabetes treatment, in Turkish health care system (2010-2012). Regulation analysis is completed to define access conditions to DPP4 inhibitors. IMS Medical Index is used for prescription data analysis (patient age, sex, diagnosis, localization, medications, etc.). Calculations and process modelling are completed by Microsoft Excel-2007. Patient access to DPP4 inhibitors is possible if glycemic control cannot be sustained after use of maximum tolerable doses of metformin and/or sulphonylurea. This new requirement is being applied since April 2011. This study evaluates two comparable timeframes T1 and T2 (before and after regulation update); T1: 2010 (Q1/Q2/Q3/Q4) & 2011 (Q1) and T2: 2011 (Q2/Q3/Q4) & 2012 (Q1/Q2). From T1 to T2, Product A percentages of monotherapy, w-biguanides and w-sulphonylurea prescriptions changed from 32% to 35% (+3%), 51% to 42% (-9%) and 17% to 23% (+6%), whereas for Product B presciptions changed from 10% to 37% (+27%), 68% to 47% (-21%) and 22% to 16% (-6%), respectively. For Product A, after the regulation update, prescription rate for w-biguanides is decreased, while that for w-sulphonylurea and monotherapy options are increased. However, for Product B, prescription rate for w-sulphonylurea is decreased, while those for w-biguanides and monotherapy options are increased. For both products, prescription rate for monotherapy is increased. Limitation of this study is level of comprehensiveness for the system variables (market dynamics, patient profiles, etc.) This study concludes that, regardless regulation updates, there is an unmet need, which results in physicians’ preference of innovative treatment options in clinical practice for treatment of Diabetes. *ProductA=Sitagliptin, **ProductB=Vildagliptin