Budget impact analysis of treatment flow optimization in epilepsy patients: Estimating potential impacts with increased referral rate to specialized care

Masaki Iwasaki, Takashi Saito, Akiko Tsubota, Tatsunori Murata, Yuta Fukuoka, Kazutaka Jin

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: We developed a Markov model to simulate a treatment flow of epilepsy patients who refer to specialized care from non-specialized care, and to surgery from specialized care for estimation of patient distributions and expenditures caused by increasing the referral rate for specialized care. Methods: This budget impact analysis of treatment flow optimization in epilepsy patients was performed as a long-term simulation using the Markov model by comparing the current treatment flow and the optimized treatment flow. In the model, we simulated the prognosis of new onset 5-yearold epilepsy patients (assuming to represent epilepsy occurring between 0 and 10 years of age) treated over a lifetime period. Direct costs of pharmacotherapies, management fees and surgeries are included in the analysis to evaluate the annual budget impact in Japan. Results: In the current treatment flow, the number of refractory patients treated with four drugs by non-specialized care were estimated as 8766 and yielded JPY5.8 billion annually. However, in the optimized treatment flow, the number of patients treated with four drugs by non-specialized care significantly decreased and who continued the monotherapy increased. The costs for the four-drug therapy by non-specialized care were eliminated. Hence cost-saving of JPY9.5 billion (-5% of the current treatment flow) in total national expenditures would be expected. Conclusion: This study highlights that any policy decision-making for referral optimization to specialized care in appropriate epilepsy patients would be feasible with a cost-savings or very few budget impacts. However, important information in the decision-making such as transition probability to the next therapy or excuse for sensitive limitations is not available currently. Therefore, further research with reliable data such as big data analysis or a national survey with real-world treatment patterns is needed.

Original languageEnglish
Pages (from-to)80-87
Number of pages8
JournalJournal of Health Economics and Outcomes Research
Volume8
Issue number1
DOIs
Publication statusPublished - 2021
Externally publishedYes

Keywords

  • Budget impact
  • Epilepsy
  • Markov model
  • Referral rate
  • Treatment flow optimization

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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