OBJECTIVES

Thailand’s health insurance system provides pharmaceutical benefits which include prescription and non-prescription (OTC) drugs. With the system’s limited budget, access to many high-cost drugs for catastrophic diseases is inadequate. In some countries, such as Germany and Italy, OTC drugs are not reimbursed, but in Thailand the same is not the case. In this study, therefore, we aims to examine the economic impact of abandoning OTC drug reimbursement using currently reimbursable non-sedating antihistamines for intermittent allergic rhinitis and acute urticaria. The study proposes that Thailand cease OTC drug reimbursement to allow resources to go to more expensive catastrophic disease medicines.

METHODS

Using a decision tree model for both allergic rhinitis and urticaria, the study performed a budget impact analysis to compare abandoning vs continuing reimbursement of loratadine and cetirizine from a healthcare perspective. A uni-variate sensitivity analysis focusing on doctor visits was performed as well. The primary outcomes for both analyses showed a cost decrease for the current healthcare system.

RESULTS

Assuming loratadine and cetirizine were no longer reimbursed, and doctor visits were decreased from 70% to 30%, Thailand would save 82.56 million USD (72.39 million USD from intermittent allergic rhinitis and 10.17 million USD for acute urticaria). Decreased numbers of doctor visits were central to cost reduction when visits were down to 49.86% and 39.46% among intermittent allergic rhinitis and acute urticaria patients, respectively. It was estimated that if loratadine and cetirizine were not reimbursable, patients would spend approximately 0.3 USD per patient per year.

CONCLUSIONS

Abandoning the current policy of reimbursing non-sedating antihistamines is a potential cost saving method for the Thai healthcare system. The system should reconsider current health insurance philosophies concerning which benefits insurers should provide eligible customers. Future analysis should expand to cover more drugs.