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Patients with type 2 diabetes (T2D) often present with multiple comorbidities, which boosts overall medical care costs. As the number of patients with T2D increases with population aging, so will the prevalence of diabetic comorbidities, including diabetic macular edema (DME) and diabetic nephropathy (DN). Such comorbidities are frequently an outcome of uncontrolled T2D, which results from a multitude of factors including poor access to more-effective, but yet premium-priced therapies, and poor compliance with treatment (usually metformin, followed by other less-expensive options such as sulfonylureas). Indeed, the use of novel therapies, such as DPP-IV inhibitors, GLP-1 analogues, and SGLT-2 inhibitors, which could provide greater disease control and thus lower the incidence of diabetes-related comorbidities, is hampered by limited healthcare budgets. Moreover, the detection and management of DME and DN is also far from ideal in these cost-constrained markets, which drives faster disease progression and significantly increases the financial and societal impact of these comorbidities and, consequently, the budgetary burden of T2D.
This Emerging Physician & Payer Forum surveys 100 endocrinologists and PCPs, 101 nephrologists, and 104 ophthalmologists, and interviews 16 payers in Brazil and Mexico to assess the budgetary impact of treating diabetic comorbidities, particularly DME and DN, to these countries’ healthcare systems. It also seeks to explore the extent to which the financial burden of diabetic comorbidities is taken into account by healthcare organizations when determining the treatment algorithm for T2D, budget allocation, and coverage decisions, and how this panorama is expected to evolve in these countries in the next 2-3 years. Interviewees were required to be influential in determining patient access to therapies for T2D, DME, and/or DN at the institutional or regional/national level, and came from the following backgrounds:
- Brazil: Head of pharmaceutical assistance programs at São Paulo State; head of the pharmaceutical division of a major public hospital in São Paulo, consultant for the São Paulo State Department of Health and the Ministry of Health, specialist in pharmacoeconomics; director of the drug standardization committee and audit department at a major HMO; medical auditor responsible for the disease and portfolio management at a major insurance company, member of the drug standardization committee of the institution; nephrologist KOL, professor at a university hospital, member of the drug standardization committee of the institution; ophthalmologist KOL, member of the drug standardization committee at a major private HMO; ophthalmologist/retina specialist, member of the drug standardization committee at a university hospital, private practice owner.
- Mexico: Coordinator of the National Staged Diabetes Medical Management Program at ISSSTE; endocrinologist responsible for the diabetes and obesity program at a family medicine unit from IMSS; endocrinologist KOL, director of the endocrinology department at a major private hospital in Mexico, member of the Board of Governors of Mexico State at the Mexico chapter of the American College of Physicians; chief of the ophthalmology department at a hospital from ISSSTE; ophthalmologist responsible for the retina service at a hospital from IMSS; chief of ophthalmology at a hospital from the Secretaria de Salud; nephrologist KOL, active member of the Mexican Institute of Nephrology Research; chief of Nephrology at an IMSS hospital, director of a hemodialysis unit, member of the Board of Nephrologists of Mexico.
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