Long-term muscarinic antagonists in the treatment of Chronic Obstructive Pulmonary Disease: a budget impact analysis

Abstract

Objective: To raise costs and estimate the financial consequences for the state of Mato Grosso of a probable incorporation of long term muscarinic antagonists (LAMA) in the treatment of moderate to severe chronic obstructive pulmonary disease (COPD). Methods: Static modeling technique was used in the Microsoft Excel program for a time horizon of 5 years from the perspective of the Unified Health System at the state level. The eligible population was estimated mainly based on epidemiological data from the state’s smoking population; causal relationship between smoking and COPD and expert consensus by the Delphi technique. Only direct costs with the acquisition of the proposed technologies from sales prices negotiated directly with their respective manufacturers were considered. Results: In a hypothetical scenario of incorporation of lower price LAMA, the budget impact for Mato Grosso was estimated at R$ 1,179,008.36 in the first year and could reach R$ 2,526,446.48 in the fifth year. If the scenario consisting of the three LAMAs available in the market with preferential offer of the lowest cost option were adopted, the assumed impact is R$ 1,109,959.20 and R$ 2,219,918.40 for the first and fifth years, respectively. Bivariate sensitivity analysis using the eligible population and deployment rate parameters revealed that the budgetary impact is potentially sensitive to these variables. Conclusion: the budgetary impact presents to the state manager subsidies for budget programming and logistics, as well as for the elaboration of a LAMA access protocol in the state of Mato Grosso.