Care Now, Pay Later (CNPL): Evaluating the Budgetary and Access Implications of a Novel Financing Model for Inclisiran in Atherosclerotic Cardiovascular Disease (ASCVD) Patients in India
Author(s)
Vidya Chellasamy, MPH1, Dimple Butani, MPH2, Gautam Partha, M.Pharm1, Pallavi Kawatra, MD, MBBS2, Palvi Kudyar, DM, MD, MBBS2, Gaurav Gosh, MSHM, BAMS2, Chanakya Misra, PGPM, B. Pharm2, Rishi Jain, MD, MBBS2, Prateek Tandon, PGPM, MSc, and BSc2.
1Novartis Healthcare Pvt. Ltd, Hyderabad, Telangana, India, 2Novartis Healthcare Pvt. Ltd, Mumbai, Maharashtra, India.
1Novartis Healthcare Pvt. Ltd, Hyderabad, Telangana, India, 2Novartis Healthcare Pvt. Ltd, Mumbai, Maharashtra, India.
OBJECTIVES: Patients in low and middle-income countries (LMIC) with high prevalence of ASCVD face significant out-of-pocket expenditure on medical treatment, limiting access to healthcare. A new financial scheme, CNPL has been introduced in India that provides interest-free monthly payments for the innovative therapy Inclisiran. The objective of this study is to evaluate the potential of CNPL payment scheme in reducing the payer’s burden as compared to upfront payment.
METHODS: A budget impact analysis was performed for ASCVD population in India using a state transition Markov model from payer's perspective in private hospitals. This analysis compares Inclisiran + standard of care (SoC) against existing market for lipid lowering therapies which includes a) SoC (comprising high dose statins), b) evolocumab+SoC; c) bempedoic acid (BPA)+ SoC; d) ezetimibe+SoC; and e) BPA+ezetimibe+SoC for one year. Key scenarios modeled were: (1) Upfront payment of Inclisiran, and (2) payment via CNPL financial scheme. Drug and cardiovascular event (myocardial infarction, unstable angina, ischaemic stroke and revascularization) treatment costs were sourced from local literature and clinical expert’s insights. Efficacy data for Inclisiran and comparators was based on a previously published network meta-analysis. Baseline population characteristics and epidemiological data were sourced from local published literature. The current market share of Inclisiran and other comparators were derived from IQVIA India sales data.
RESULTS: The CNPL scheme resulted in a 16.15% reduction in budget when compared with the upfront payment. The first year per patient cost with upfront payment was € 90.90 (€1=101.35 INR). Under the CNPL scheme, this cost was reduced to € 75.77 resulting in a budget offset of €15.13 per patient.
CONCLUSIONS: For LMIC, CNPL demonstrates a potential way for innovator therapies to reduce budgetary impact for the healthcare system. By distributing payments over a period, such schemes can improve budget management and accelerate patient access.
METHODS: A budget impact analysis was performed for ASCVD population in India using a state transition Markov model from payer's perspective in private hospitals. This analysis compares Inclisiran + standard of care (SoC) against existing market for lipid lowering therapies which includes a) SoC (comprising high dose statins), b) evolocumab+SoC; c) bempedoic acid (BPA)+ SoC; d) ezetimibe+SoC; and e) BPA+ezetimibe+SoC for one year. Key scenarios modeled were: (1) Upfront payment of Inclisiran, and (2) payment via CNPL financial scheme. Drug and cardiovascular event (myocardial infarction, unstable angina, ischaemic stroke and revascularization) treatment costs were sourced from local literature and clinical expert’s insights. Efficacy data for Inclisiran and comparators was based on a previously published network meta-analysis. Baseline population characteristics and epidemiological data were sourced from local published literature. The current market share of Inclisiran and other comparators were derived from IQVIA India sales data.
RESULTS: The CNPL scheme resulted in a 16.15% reduction in budget when compared with the upfront payment. The first year per patient cost with upfront payment was € 90.90 (€1=101.35 INR). Under the CNPL scheme, this cost was reduced to € 75.77 resulting in a budget offset of €15.13 per patient.
CONCLUSIONS: For LMIC, CNPL demonstrates a potential way for innovator therapies to reduce budgetary impact for the healthcare system. By distributing payments over a period, such schemes can improve budget management and accelerate patient access.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE1
Topic
Economic Evaluation, Health Technology Assessment, Patient-Centered Research
Topic Subcategory
Budget Impact Analysis
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)