title: Impact of orphan drugs on Latvian budget.
abstract: Number of orphan medicinal products on the market and number of rare disease patients, taking these usually expensive products, are increasing. As a result, budget impact of orphan drugs is growing. This factor, along with the cost-effectiveness of orphan drugs, is often considered in the reimbursement decisions, directly affecting accessibility of rare disease therapies. The current study aims to assess the budget impact of orphan drugs in Latvia.
  
  
  
  Our study covered a 5-year period, from 2010 to 2014. Impact of orphan drugs on Latvian budget was estimated from the National Health Service's perspective. It was calculated in absolute values and relative to total pharmaceutical market and total drug reimbursement budget. A literature review was performed for comparison with other European countries.
  
  
  
  Orphan drug annual expenditure ranged between EUR 2.065 and 3.065 million, with total 5-year expenditure EUR 12.467 million. It constituted, on average, 0.84 % of total pharmaceutical market and 2.14 % of total drug reimbursement budget, respectively. Average annual per patient expenditures varied widely, from EUR 1 534 to EUR 580 952. The most costly treatment was enzyme replacement therapy (Elaprase) for MPS II. Glivec had the highest share (34 %) of the total orphan drug expenditure. Oncological drugs represented more than a half of the total orphan drug expenditure, followed by drugs for metabolic and endocrine conditions and medicines for cardiopulmonary diseases. Three indications: Ph+ CML, MPS II, and PAH accounted for nearly 90 % of the total orphan drug expenditure.
  
  
  
  Budget impact of orphan drugs in Latvia is very small. It increased slightly over a period of five years, due to the slight increase in the number of patients and the number of orphan drugs reimbursed. Current Latvian drug reimbursement system is not sufficient for most orphan drugs.
authors.affiliation: Department of Pharmacology, Riga Stradins University, 13 Pilsonu Street, Riga, LV-1002, Latvia. konstantins.logviss@gmail.com.
authors.forename: Konstantins
authors.initials: K
authors.lastname: Logviss
authors.affiliation: Department of Education and Science, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia.|University of Latvia, 19 Raina Boulevard, Riga, LV-1586, Latvia.
authors.forename: Dainis
authors.initials: D
authors.lastname: Krievins
authors.affiliation: Department of Pharmacology, Riga Stradins University, 13 Pilsonu Street, Riga, LV-1002, Latvia.
authors.forename: Santa
authors.initials: S
authors.lastname: Purvina
mesh_terms: D002017:Budgets / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D056947:Enzyme Replacement Therapy / Q000191:economics; D006801:Humans; D007844:Latvia; D016532:Mucopolysaccharidosis II / Q000188:drug therapy; D009965:Orphan Drug Production / Q000191:economics*
keywords: Budget impact; Expenditure; Latvia; Orphan drugs; Reimbursement