Beyond the budget silo approach: estimating health system sustainability for future dementia drugs

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Fundings: There were no institutional or private fundings for this article.
Conflict of interests: The authors declare that they have no conflict of interests.
Authors’ contributions: The authors contributed equally to the realization of the manuscript.
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Ethical approval: N/A.

Aim of the study: to analyze the impact of a hypothetic disease-modifying drug (DMD) on the estimated costs of dementia sustained by the National Health System (NHS) based on current real-world data.
We performed our analysis on the Caserta Local Health Unit (LHU) database and the ARNO Observatory, which include data from 19 Italian LHUs. Participants with at least 1 year of database history and a diagnosis of dementia were identified using the ICD-9CM codes for dementia in the hospital discharge diagnosis, specific exemption codes and prescriptions of anti-dementia drugs. An assessment of the actual healthcare costs was performed using available data on all healthcare services reimbursed by the NHS in the reference period. Finally, we made prevalence projection for Caserta’s and for ARNO’s population and estimated the number of new cases avoided by decreasing the incidence of 20% and 40% five years after the introduction of DMD in 2025.
Average annual cost per patient with dementia equaled € 2,193 for the Caserta LHU and € 4,356 for the ARNO LHUs. The NHS 5-years savings was equal to € 4,057,050 and € 8,116,293 for Caserta, and € 96,563,808 and € 193,127,616 for ARNO, considering a 20% and 40% reduction of dementia incidence after the introduction of the hypothetical new anti-dementia drug in 2025.
Our study forecasts the impact of future prevalence on health management based on real-world prevalence and expenditure data and provides a useful model to project theoretical savings after the introduction of a new DMD for dementia and for other unmet medical needs. Although comparable by sample type and selection criteria, the estimated difference in disease expenditures from the two databases indicates that the method of generating costs could be linked to a distinct health management in LHUs.