In the study, Infarmed analyzed reimbursement costs both in this scenario – users with PCIPO criteria (between 170,405 and 180,880) – and in the case of the estimated adult population (between 25 and 74 years old) with obesity, which reaches 2,008,386, according to the National Health Survey with Physical Examination (INSEF).
If the reimbursement included these more than two million obese adults estimated to exist in Portugal, the cost of reimbursement for these medicines – taking into account two years of treatment with all patients entering at the same time – could vary between 2,296 million and 11,248 million euros.
According to data from Infarmed, between January and September, spending on medicines grew by 14.9% (+257 million euros) in hospitals and 13.1% in outpatient clinics (+162 million euros), reaching 2,381.4 million euros.
In analyzing the budgetary impact of the reimbursement for the eligible population according to the PCIPO, Infarmed estimated both the values of the different levels to be reimbursed and the hypothesis of all patients entering treatment in the same year or 50% entering each year.
In this second scenario, with the phased introduction, expenditure in bracket A (90% contribution) would vary between 229.1 million (1st year) and 477.2 million (2nd year). In bracket D (15% contribution), it would be 46.8 million in the 1st year and 97.4 million euros in the 2nd year.
At the end of the analysis, Infarmed says that the reimbursement regime to be defined must provide for monitoring and evaluation based on the objectives and results obtained, as well as the reevaluation of financed medicines based on the results in reducing the level of obesity and associated comorbidities in the population.
There are already several countries in Europe that share some of the medicines to treat obesity, five of which are sold in Portugal, but are entirely at the expense of the user and require a prescription: Mounjaro (Tirzepatide), Wegovy (Semaglutide), Saxenda (Liraglutide), Mysimba (Bupropion + Naltrexone) and Orlistat 120 mg.
The indications approved in the Marketing Authorization (AIM) for these medicines are overlapping, indicated in addition to a reduced calorie diet and increased physical activity in adult patients with a Body Mass Index (BMI) equal to or greater than 30 Kg/m² or between 27 Kg/m² and 30 Kg/m2, if the person has at least one weight-related comorbidity, although not all of them have an indication for the treatment of obesity in teenagers.
All countries that reimburse these medicines and that Infarmed used as a reference for this analysis have defined criteria for reimbursement based on both the patient’s Body Mass Index (BMI) and the results obtained, which provide for a maximum of two years of reimbursement.
The PCIPO defines the eligibility criterion for this medication as the user having a BMI equal to or greater than 35 kg/m2, with at least one comorbidity associated with excessive adiposity, for most drugs, considering some exceptions.
It also foresees the fact that there was no success in other non-pharmacological interventions after a period of 12 months of multidisciplinary monitoring, with nutritional intervention, physical activity plan and psychological intervention.
The PCIPO defines that the non-surgical treatment of obesity must have a structured and multidisciplinary approach, focused on lifestyle modification (nutritional intervention and physical activity plan), psychological support, pharmacological therapy and monitoring of clinical evolution.