PUK6 - Budget Impact Analysis of Increasing Uptake of Renin-Angiotensin System Inhibitors (RAS) Drugs to Prevent Progression of Kidney Disease in Diabetic Hypertensive Patients in Malaysia

Abstract

Renin-angiotensin system inhibitors (RAS) drugs have a proteinuria-reducing effect that could prevent the progression of kidney disease in patients with diabetes. Our study aimed to assess the budget impact based on healthcare payer perspective of increasing uptake of RAS drugs into current treatment mix of standard anti-hypertensive treatments to prevent progression of kidney disease in patients’ co-morbid with hypertension and diabetes. A Markov model of Malaysian cohort with diabetes and hypertension was used to estimate the total and per-member-per-month (PMPM) impact costs of RAS uptake. Efficacies and costs were estimated based on stages of kidney function. An increasing uptake of RAS drugs would incur a total projected cost of treatment ranged from MYR 4.89 billion (PMPM of MYR 27.95) at Year 1 to MYR 16.26 billion (PMPM of MYR 92.89) at Year 5. This would represent a range of incremental costs between PMPM of MYR 0.20 at Year 1 and PMPM of MYR 1.62 at Year 5. Over the period, the care costs showed a downward trend but costs of purchasing drugs were increasing. Sensitivity analyses showed that the model to be quite resistant to changes in the input parameters. RAS utilization would have mild impact to the overall healthcare budget. The long-term positive health consequences of RAS treatment would reduce the cost of care in preventing deterioration of kidney function offsetting the costs of purchasing RAS drugs. The initial observation of rising budget would be compensated by total cost saving with prolonged use of RAS. This evidence may be able to convince the Malaysian policymakers.