A budget impact analysis of substituting sitagliptin with liraglutide in type 2 diabetes from a private health insurance perspective in Egypt

Introduction Type 2 diabetes mellitus causes a sizable burden globally from both health and economic points of view. This study aimed to assess the budget impact of substituting sitagliptin with liraglutide versus other glucose-lowering drugs from the private health insurance perspective in Egypt over a 3-year time horizon. Methods Two budget impact models were compared with the standard of care (metformin, pioglitazone, gliclazide, insulin glargine, repaglinide, and empagliflozin) administered in addition to liraglutide or sitagliptin versus the standard of care with placebo. A gradual market introduction of liraglutide or sitagliptin was assumed, and the existing market shares for the other glucose-lowering drugs were provided and validated by the Expert Panel. The event rates were extracted from the LEADER and TECOS trials. Direct and mortality costs were measured. Sensitivity analyses were performed. Results The estimated target population of 120,574 type 2 diabetic adult patients was associated with cardio vascular risk. The budget impact per patient per month for liraglutide is EGP29 ($6.7), EGP39 ($9), and EGP49 ($11.3) in the 1st, 2nd, and 3rd years, respectively. The budget impact per patient per month for sitagliptin is EGP11 ($2.5), EGP14 ($3.2), and EGP18 ($4.1) in the 1st, 2nd, and 3rd years, respectively. Furthermore, adoption of liraglutide resulted in 203 fewer deaths and 550 avoided hospitalizations, while sitagliptin resulted in 43 increased deaths and 14 avoided hospitalizations. The treatment costs of liraglutide use are mostly offset by substantial savings due to fewer cardiovascular-related events, avoided mortality and avoided hospitalizations over 3 years. Conclusion Adding liraglutide resulted in a modest budget impact, suggesting that the upfront drug costs were offset by budget savings due to fewer cardiovascular-related complications and deaths avoided compared to the standard of care. Sitagliptin resulted in a small budget impact but was associated with increased deaths and fewer hospitalizations avoided.

Insurance Perspective of Yusuf Qardhawi and Abdul Wahab Khalaf

Insurance that has just emerged at this contemporary stage, its quality causes mixed understanding among researchers. There are several researchers who prohibit insurance, including Yusuf al-Qardawi who blocks existing insurance, especially life insurance. Yusuf al-Qardawi forbade insurance on the grounds that according to him insurance is far from the idea of exchange and solidarity with the association. Whereas in life insurance, basically it is very possible to say that it is a broken understanding. The explanation is because between the two meetings there is a common desire and currently realizes that the strengths of each are not solid. Insurance in Yusuf al-Qardawi's view is that Islam does not recognize the current type of insurance with every implementation, it does not mean that Islam is against insurance as a whole, not in any way, what Islam opposes is part of its implementation practice. According to Abdul Wahaf Khalaf, insurance takes any form and can benefit the local community as long as there is no usury, the law is halal or allowed in Islamic teachings.

A Budget Impact Analysis of Substituting Sitagliptin with Liraglutide in Type 2 Diabetes from A Private Health Insurance Perspective in Egypt

IntroductionType 2 diabetes mellitus (T2DM) causes a sizable burden globally both from health and economic points of view.This study aimed to assess the budget impact of substituting sitagliptin with liraglutide versus other glucose lowering drugs from the private health insurance perspective in Egypt over a 3-year time horizon. MethodsTwo budget impact models were comparedthe standard of care (metformin, pioglitazone, gliclazide, insulin glargine, repaglinide, and empagliflozin)administered in addition to liraglutide or sitagliptin versus the standard of care with placebo. A gradual market introduction of liraglutide or sitagliptin was assumed, and the existing market shares for the other glucose lowering drugs were provided and validated by Expert Panel. The event rates were extracted from the LEADER and TECOS trials. Direct and mortality costs were measured. Sensitivity analyses were performed. ResultsThe estimated target population of 120,574 T2DM adult patients were associated with CV risk. The budget impact per patient per month (PPPM) for liraglutide is EGP29 ($6.7), EGP39 ($9), and EGP49 ($11.3) in the first, second, and third year, respectively. The budget impact PPPM for sitagliptin is EGP11 ($2.5), EGP14 ($3.2), and EGP18 ($4.1) in the first, second, and third year, respectively. Furthermore, adoption of liraglutide resulted in 203 fewer deaths and 550 avoided hospitalizations, while sitagliptin resulted in 43 increased deaths and 14 avoided hospitalizations. The treatment costs of liraglutide use are mostly offset by substantial savings due to fewer CV-related events, avoided mortality and avoided hospitalizations over 3-years. Conclusion Adding liraglutide resulted in a modest budget impact, suggesting that the upfront drug costs were offset by budget savings due to fewer CV-related complications and deaths avoided compared to the standard of care. While sitagliptin resulted in a small budget impact but associated with deaths increased and less hospitalizations avoided.

The IFRS 17 contractual service margin: a life insurance perspective

IFRS 17 Insurance Contracts is a new accounting standard currently expected to come into force on 1 January 2023. It supersedes IFRS 4 Insurance Contracts. IFRS 17 establishes key principles that entities must apply in all aspects of the accounting of insurance contracts. In doing so, the Standard aims to increase the usefulness, comparability, transparency and quality of financial statements. A fundamental concept introduced by IFRS 17 is the contractual service margin (CSM). This represents the unearned profit that an entity expects to earn as it provides services. However, as a principles-based standard, IFRS 17 results in entities having to apply significant judgement when determining the inputs, assumptions and techniques it uses to determine the CSM at each reporting period. In general, the Standard resolves broad categories of mismatches which arise under IFRS 4. Notable examples include mismatches between assets recorded at current market value and liabilities calculated using fixed discount rates as well as inconsistencies in the timing of profit recognition over the duration of an insurance contract. However, there are requirements of IFRS 17 that may create economic or accounting mismatches of its own. For example, new mismatches could arise between the measurement of underlying contracts and the corresponding reinsurance held. Additionally, mismatches can still arise between the measurement of liabilities and the assets that support the liabilities. This paper explores the technical, operational and commercial issues that arise across these and other areas focusing on the CSM. As a standard that is still very much in its infancy, and for which wider consensus on topics is yet to be achieved, this paper aims to provide readers with a deeper understanding of the issues and opportunities that accompany it.

Earthquake Risk Assessment from Insurance Perspective

The assessment of earthquake and risk to a portfolio, in urban or regional scale, constitutes an important element in the mitigation of economic and social losses due to earthquakes, planning of immediate post-earthquake actions as well as for the development of earthquake insurance schemes. Earthquake loss and risk assessment methodologies consider and combine three main elements: earthquake hazard, fragility/vulnerability of assets and the inventory of assets exposed to hazard. Challenges exist in the characterization of the earthquake hazard as well as in the determination of the fragilities/vulnerabilities of the physical and social elements exposed to the hazard. The simulation of the spatially correlated fields of ground motion using empirical models of correlation between intensity measures is an important tool for hazard characterization. The uncertainties involved in these elements and especially the correlation in these uncertainties, are important to obtain the bounds of the expected risks and losses. This paper looks at the current practices in regional and urban earthquake risk assessment, discusses current issues and provides illustrative applications from Istanbul and Turkey.