title: Abolishing coinsurance for oral antihyperglycemic agents: effects on social insurance budgets.
abstract: OBJECTIVE
  To assess the effects of abolishing coinsurance for oral antihyperglycemic agents (OAAs) on the social insurance fund budget in Greece.
  
  
  METHODS
  A mathematical model estimating the effect of a decrease in patient coinsurance rate on demand for and adherence to OAAs and the subsequent clinical and economic outcomes.
  
  
  METHODS
  Price elasticity of demand for antidiabetic agents was used to estimate quantity demand change as a result of a coinsurance rate decrease and consequent increased adherence to OAAs. Given the inverse relationship between OAA adherence and glycated hemoglobin (A1C) level, the model calculated the mean decrease in A1C level and associated cost savings based on the cost difference between patients with controlled versus uncontrolled A1C levels.
  
  
  RESULTS
  A decrease in patient coinsurance rate from 25% to 0% led to an incremental increase in OAA adherence of 30.5% and a mean decrease in A1C level of 0.6%. The A1C level decrease contributed to an 18.5% "shift" of uncontrolled patients to controlled A1C levels (<7%), which in economic terms translated into savings of 324 euro per patient over a 3-year period and an investment return rate of 122.8%. A series of 1-way and 2-way sensitivity analyses were conducted to verify the robustness and validity of the outcomes.
  
  
  CONCLUSIONS
  The introduction of policies aimed at abolishing coinsurance for OAAs can result in improved patient outcomes and cost savings for the healthcare system.
authors.affiliation: Department of Health Economics, National School of Public Health, 196 Alexandras Ave, Athens 11521, Greece. kathanasakis@esdy.edu.gr
authors.forename: Kostas
authors.initials: K
authors.lastname: Athanasakis
authors.forename: Anastasis G
authors.initials: AG
authors.lastname: Skroumpelos
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Tsiantou
authors.forename: Katerina
authors.initials: K
authors.lastname: Milona
authors.forename: John
authors.initials: J
authors.lastname: Kyriopoulos
mesh_terms: D000284:Administration, Oral; D002017:Budgets; D017046:Cost Savings; D003669:Deductibles and Coinsurance; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics*; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D006115:Greece; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000600:supply & distribution / Q000627:therapeutic use; D008962:Models, Theoretical; D012680:Sensitivity and Specificity; D012943:Social Security / Q000191:economics*; D016903:Drug Monitoring
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents