Budget Impact Analysis of Pemetrexed Introduction: Case Study from a Teaching Hospital Perspective, Thailand
Farsai Chanjaruporn MM*, Elizabeth E Roughead PhD**, Cha-oncin Sooksriwong DrPH*, Sming Kaojarern MD***
Affiliation : * Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Thailand ** Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, Australia *** Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
Objective : Thailand does not currently require Budget Impact Analysis (BIA) assessment. The present study aimed to estimate
the annual drug cost and the incremental impact on the hospital pharmaceutical budget of the introduction of pemetrexed to
a Thai teaching hospital.
Material and Method: The budget impact model was conducted in accordance with the Guidelines for preparing submissions
to the Pharmaceutical Benefits Advisory Committee (PBAC). The model variables consisted of number of patients, growth
rate of lung cancer, uptake rate of pemetrexed over time, unit prices of drugs, and the length and cost of treatment. Sensitivity
analysis was performed to determine changes in budgetary impact due to variation of parameters or assumptions in the
model.
Results : The introduction of pemetrexed was estimated to cause considerable costs for the teaching hospital. In the base-case
analysis, the incremental costs were estimated at 8,553,984 Baht in the first year increasing to 12,118,144 Baht, 17,820,800
Baht and 17,820,800 Baht in the following years. The 4-year net budgetary impact was 20,154,480 Baht or approximately
127,560 Baht per patient. Sensitivity analyses found that number of treatment cycles and proportion of patients assumed to be
treated with pemetrexed were the two most important influencing factors in the model.
Conclusion : New costly innovative interventions should be evaluated using the BIA model to determine whether they are
affordable. The Thai government should consider requiring the BIA study as one of the requirements for drug submission to
assist in the determination of listing and subsidizing decision for medicines.
Keywords : Budget impact analysis, Pemetrexed, Teaching hospital, Pharmaceutical subsidization
