Supplementary materials: Budget impact analyses of hemoglobin A1c and lipid panel point-of-care testing with Afinion™ 2 in Canada and Italy

<b>These are peer-reviewed supplementary materials for the article</b><b> </b><b>'</b><b>Budget impact analyses of hemoglobin A1c </b><b>and lipid panel point-of-care testing with </b><b>Afinion™ 2 in Canada and Italy</b><b>'</b><b> </b><b>published in the</b><b> </b><b><i>Journal of Comparative Effectiveness Research</i></b><b>.</b><b>Supplementary Table 1: </b>Market Shares<b>Supplementary Table 2: </b>Patient Flow Subcategorization of Monitoring Patients with Diagnosed Diabetes or Dyslipidemia<b>Supplementary Table 3: </b>Afinion™ 2 POC Device Costs and PCP Practice Parameters<b>Supplementary Table 4: </b>HbA1c POC Healthcare Resource Use Costs in the Monitoring Population<b>Supplementary Table 5: </b>Lipid Panel POC Healthcare Resource Use Costs in the Monitoring Population<b>Supplementary Table 6: </b>Indirect Costs in the Monitoring Population<b>Appendix A</b><b>Supplementary Table 7: </b>Indirect Costs in the Screening Population<b>Supplementary Table 8: </b>Scenario Analyses: Incremental Budget Impact of Afinion™ 2 POC HbA1c Testing – Canada<b>Supplementary Table 9: </b>Scenario Analyses: Incremental Budget Impact of Afinion™ 2 POC HbA1c Testing<b>Appendix B</b><b>Supplementary Table 10: </b>Scenario Analyses: Incremental Budget Impact of Afinion™ 2 POC Lipid Panel Testing – Canada – Italy<b>Supplementary Table 11: </b>Scenario Analyses: Incremental Budget Impact of Afinion™ 2 POC Lipid Panel Testing – Italy Baseline (2024) Year<b>References</b><b>Abstract</b><br><b>Aim:</b> Screening and monitoring of diabetes or dyslipidemia frequently involves a multi-step processrequiring patients to obtain test requisitions from their primary care physician (PCP), followed by a laboratory visit and re-consultation. Point-of-care testing (POCT) for hemoglobin A1c (HbA1c) and lipid panel can streamline the patient care pathway. This study assessed the budget impact of introducing Afinion™ 2 POCT (Abbot Rapid Diagnostics) from the Canadian and Italian societal perspectives. <b>Methods: </b>Budget impact models were developed for Canada and Italy over a 5-year time horizon (2025 to 2029). The analyses considered the screening and monitoring of diabetes or dyslipidemia for patients utilizing the public healthcare system and attending primary care, and included direct costs (testing, consultations) and indirect costs (productivity loss, transportation) based on published sources. The budget impact (BI) was calculated by comparing scenarios with and without POCT. All costs were adjusted to Canadian dollars ($) or 2024 Euros (€). Scenario analyses were conducted to explore the impact of alternative assumptions. <b>Results:</b> The 5-year cumulative BI was -$758,006,692 (-$50,709,964 direct, -$707,296,728 indirect) for HbA1c POCT and -$726,452,755 ($2,684,011 direct, -$729,136,766 indirect) for lipid panel POCT in Canada and -€1,380,658,764 (-€6,391,954 direct, -€1,374,266,809 indirect) for HbA1c POCT and -€851,792,115 (€55,962,879 direct, -€907,754,993 indirect) for lipid panel POCT in Italy. In both countries, cost savings for both the healthcare payer and patients were observed for HbA1c POCT, while costs savings were derived from patient indirect costs for lipid panel POCT. The analyses estimated that 1,558,062 and 1,501,260 PCP consultations in Canada, 4,962,338 and 1,951,026 PCP consultations in Italy were avoided with implementation of POCT for HbA1c and lipid panel, respectively. Scenario analyses demonstrated potential further cost savings with implementation of POCT in pharmacies. <b>Conclusion:</b> This study demonstrates that the adoption of Afinion 2 POCT for HbA1c and lipid panel can provide efficiencies to different types of healthcare systems through reducing PCP consultations, saving time and money for patients and providing cost savings for payers.

本内容为发表于《比较效果研究杂志》（*Journal of Comparative Effectiveness Research*）的论文《加拿大与意大利使用Afinion™ 2开展糖化血红蛋白与血脂谱即时检验的预算影响分析》的同行评议补充资料。

补充表1：市场份额
补充表2：确诊糖尿病或血脂异常患者的监测队列患者流向亚分类
补充表3：Afinion™ 2即时检验（Point-of-care testing, POCT）设备成本与基层医师（primary care physician, PCP）执业参数
补充表4：监测人群中糖化血红蛋白（hemoglobin A1c, HbA1c）即时检验的医疗资源使用成本
补充表5：监测人群中血脂谱（lipid panel）即时检验的医疗资源使用成本
补充表6：监测人群间接成本
附录A
补充表7：筛查人群间接成本
补充表8：情景分析：加拿大Afinion™ 2糖化血红蛋白即时检验的增量预算影响
补充表9：情景分析：Afinion™ 2糖化血红蛋白即时检验的增量预算影响
附录B
补充表10：情景分析：加拿大与意大利Afinion™ 2血脂谱即时检验的增量预算影响
补充表11：情景分析：意大利2024基准年Afinion™ 2血脂谱即时检验的增量预算影响
参考文献
摘要

目的：糖尿病或血脂异常的筛查与监测通常需经历多环节流程：患者先从基层医师处获取检验申请单，随后前往实验室完成检测，再返回复诊。糖化血红蛋白与血脂谱即时检验可优化患者诊疗路径。本研究从加拿大与意大利的社会视角出发，评估引入Afinion™ 2即时检验设备（雅培快速诊断公司，Abbot Rapid Diagnostics）所带来的预算影响。

方法：针对加拿大与意大利构建为期5年（2025年至2029年）的预算影响模型。分析对象为使用公立医疗系统并就诊于基层医疗的糖尿病或血脂异常筛查与监测患者，纳入基于公开文献来源的直接成本（检验、诊疗）与间接成本（生产力损失、交通成本）。通过对比有无即时检验的场景计算预算影响（Budget Impact, BI）。所有成本均调整为加元（$）或2024年欧元（€）。开展情景分析以探索不同假设条件下的影响效果。

结果：加拿大地区糖化血红蛋白即时检验的5年累计预算影响为-758,006,692加元（直接成本减少50,709,964加元，间接成本减少707,296,728加元），血脂谱即时检验的5年累计预算影响为-726,452,755加元（直接成本增加2,684,011加元，间接成本减少729,136,766加元）；意大利地区糖化血红蛋白即时检验的5年累计预算影响为-1,380,658,764欧元（直接成本减少6,391,954欧元，间接成本减少1,374,266,809欧元），血脂谱即时检验的5年累计预算影响为-851,792,115欧元（直接成本增加55,962,879欧元，间接成本减少907,754,993欧元）。两国的糖化血红蛋白即时检验均实现了医保支付方与患者的成本节约，而血脂谱即时检验的成本节约主要来源于患者间接成本的降低。本分析估算，加拿大地区通过开展糖化血红蛋白与血脂谱即时检验，分别可减少1,558,062次与1,501,260次基层医师门诊，意大利地区则分别可减少4,962,338次与1,951,026次基层医师门诊。情景分析显示，在药房开展即时检验可实现进一步的成本节约。

结论：本研究表明，在糖化血红蛋白与血脂谱检测中采用Afinion™ 2即时检验设备，可通过减少基层医师门诊量、为患者节省时间与成本、为医保支付方节约开支，为不同类型的医疗系统提升运行效率。