OBJECTIVES: To estimate the potential budget impact of dapagliflozin as an alternative in treating T2DM from Chinese payer’s perspective.

METHODS: An Excel-based budget impact model was developed to compare the differences of annual health insurance expenditure in two scenarios which were listing dapaglifozin or not in national reimbursement drug list (NRDL) over a 5-year time horizon (2018-2022). Target population was calculated according to China Statistical Yearbooks and epidemiology statistics of T2DM in China, then divided into two programs of Urban Employee Basic Medical Insurance (UEBMI) or Urban and Rural Resident Basic Medical Insurance (URRBMI), respectively. The model assumed an increasing market share of dapagliflozin with a consequent decreasing of branded drugs of alpha-glucosidase inhibitors, sulfonylureas and DPP-4 inhibitors according to expert opinions and IMS market monitoring data. Both drug costs and medical costs associated with adverse events (AEs), which were severe hypoglycemia, major adverse cardiovascular events, and hospitalization for heart failure or renal diseases, were considered in the model. Drug costs were calculated by daily dosages, unit prices and days of utilization. The incidence and annual medical costs of AEs were derived from published literature.

RESULTS: If dapagliflozin was listed in NRDL, the number of T2DM patients treated with dapagliflozin was increased from 0.16 to 1 million from 2018 to 2022. The estimated incremental annual health insurance expenditure would be +$10.44, +$20.81, +$37.56, +$27.67 and -$1.21 million for years 2018 to 2022, respectively. Because of the lower rates of AEs, especially of cardiovascular events, the cost-savings of AEs exceeded the incremental drug costs among patients with dapagliflozin in 2022. One-way sensitivity analyses indicated the results did not change dramatically when parameters varied.

CONCLUSIONS: Listing dapagliflozin in NRDL may have a modest increasing impact of short-term budget while would lead to long-term net cost-savings caused by lower rates of AEs, especially the long-term cardiovascular benefits.