Budgetary Impact Analysis of the Nutritional Home Care Service

VA L U E I N H E A LT H

remained consistent, indicating improved effectiveness and economic efficiency upon introduction of fidaxomicin.  Conclusions: The results of this model demonstrate that fidaxomicin is superior to other treatments in preventing CDI recurrence, and through reductions in recurrence, payers can expect moderate cost savings over a 6-month time horizon PGI8 Budgetary Impact Analysis of the Nutritional Home Care Service Nuñez J1, Diaz R2, Aldea F2, Hidalgo A3, Belda C4 1Fundacion de Investigacion HM Hospitales, Madrid, Spain, 2Fundacion de Investigacion HM Hospitales, madrid, Spain, 3University of Castilla-La Mancha, Toledo, Spain, 4HM Hospitales, madrid, Spain

Objectives: The aim of the study was to analyze the SNS budget impact of domiciliary administration of parenteral nutrition.  Methods: A retrospective digestive surgery patient cohort was analyzed. The variable costs associated with all reported cases that required parenteral nutrition have been extracted to estimate the hospital stay cost per patient. The group of patients susceptible to receiving the Nutritional Home Care Service (NHCS) has been estimated through a comparison of the hospital stay of patients who required parenteral nutrition versus the average hospitalization days of each Diagnostic Related Group (DRG) published by the Spanish National Health System (SNS). The budgetary impact of incorporating the nutritional assistance service outside the hospital setting has been estimated by calculating the daily cost and hospitalization days in which the patient could have received domiciliary parenteral nutrition care. The budgetary impact in the SNS has been estimated using a Markov model processed in 15,000 Monte Carlo simulations for the whole Spanish population, through the probability distributions of the variables: variable cost of the PN and Cost of stay, patients receiving PN, patients likely to receive NHCS (study population) and number of surgical procedures performed in the SNS in digestive surgery.  Results: The initial cohort was composed of 504 patients who required an average 10.26 days of hospitalization with parenteral nutrition consumption in 2015. The study population was estimated at around 120 patients. The health insurers that finance private health care would see savings in the private sector of 36,535.30€ . In the National Health System, the budgetary impact would be estimated at a saving of 1,834,965.31 € .  Conclusions: The Nutritional Home Care Service would reduce healthcare expenditure and lengthy hospital stays. PGI9 Budget-Impact-Analysis of Iron Treatment using Intravenous Ferric Carboxymaltose in Patients with Iron Deficiency Anemia in Austria Walter E, Lazic-Peric A, Schalle K Institute for Pharmaeconomic Research, Vienna, Austria

Objectives: Iron deficiency (ID) appears in 60-80% of patients with inflammatory bowel disease (IBD), out of which about one-third is affected by anemia. Anemia which depicts a frequent extra-intestinal manifestation of IBD has a significant impact on quality-of-life components such as emotional, physical and cognitive functions, the ability to work, hospitalization, as well as healthcare costs. Thus, the objective of this analysis is the evaluation of the cost saving potential through an increased use of intravenous iron therapy with ferric carboxymaltose (FCM) based on clinical trial evidence.  Methods: A budget-impact-analysis (BIA) with a four-year’s time horizon was developed from the payer’s perspective. IBD patients with IDA run into a Markov-model and receive different iron-deficiency strategies (FCM, Iron-Sucrose (IS), oral or no-treatment) according to current clinical practice. The model includes 6 states (treatment success, recurrent anemia, hospitalization, disease worsening and death) based on RCT-data of FERGIcor and FERGImain. The objective of the model was to assess the influence of a higher percentage of treated patients (65%-74%) in general and an increased share of IV substances (49%-59%) on health-care budgets from the payers perspective. Input-data were derived via a systematic literature review. Direct costs were retrieved from published sources and were expressed in 2016€ .  Results: The result of the BIA shows that an increased use of iron-therapy (+9%) and a shift towards IV application (+10%) in IBD patients with IDA leads to a positive budget impact from the second year onwards (-44.075€  in the 3rd year). The additionally treated patients (+713) causes increased costs for iron medication and outpatient services (+51,175€  1st year to +208,221€  in the 3rd year). Saving effects are achieved due to reduced hospital stays (-40,679€  in the 1st year to -252,296€  in the 3rd year).  Conclusions: IV iron therapy with FCM in IDA patients are associated with cost-savings by reduced hospitalisations. PGI11 Analyzing the Treatment Cost of Liver Cirrhosis from Healthcare Payer’s Perspective of Vietnam in 2015 Nguyen

DK1, Nguyen TT2, Pho

NV1

1University

of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam, 2University of Medicine and Pharmacy in HCMC, Ho Chi Minh City, Vietnam

Objectives: Cirrhosis is one of the leading causes of death worldwide and also a substantial economic burden for patient, healthcare system and society. However, researches concentrating on the cost of cirrhosis treatment in Vietnam are still limited. Therefore, the aim of this study was to estimate the inpatient treatment costs of liver cirrhosis and influencing factors on costs in Vietnam in 2015.  Methods: Descriptive cross-sectional study has been conducted based on retrospective data of all cirrhosis patient’s records in 2015 from two hospitals (HCMC Tropical Hospital and Bach Mai Hospital), satisfied inclusion and exclusion criteria. Descriptive and analytic statistics were performed with relevant statistical test (T-test, one-way ANOVA, correlation) and 95% confidence level.  Results: Study sample included 313 cirrhosis patients with average age of 56.86 ± 13.09 years, male: female ratio – 2.13:1; 72.5% decompensated cirrhosis and 27.5% compensated cirrhosis; 79.6% of patients with cirrhosis due to hepatitis and 11.2% of patients with alcoholic cirrhosis; average number of days in hospital of 8.29 ± 6.19 days. The median cost of treatment per session is 7,439,527.40 ± 5,251,403.97 VND; in the structure of total cost, 68.25% was covered by health insurance and 31.75% - by patients. In structure of treatment

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cost, drugs cost accounted for the highest proportion with 44.52%; the lower is the clinical test cost with 21.67% (3,376,153.70 and 1,643,644.83 VND; respectively). The influential factors on costs of treatment included the place of residence, the number of days in hospital, the stage and the complications of cirrhosis.  Conclusions: With the rising trend of liver cirrhosis in Vietnam and the high cost of treatment, national health policies and medical programs should be considered. PGI12 Evaluating Cost of Regimens in Hepatitis C Treatment from Healthcare Payer Vietnam’s Perspective Tran NN1, Nguyen TT2, Nguyen TL1 1University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam, 2University of Medicine and Pharmacy in HCMC, Ho Chi Minh City, Vietnam

Objectives: Chronic hepatitis C (CHC) is a global health problem with 130-150 million people infected worldwide. With chronic infectious characteristics and severe consequences such as cirrhosis and liver cancer, HCV causes high economic and disease burden for both society and healthcare system. This study aimed to estimate the direct treatment cost of CHC, genotype 1 in the Vietnam with different treatment regimens.  Methods: Decison-tree models were built to estimate the direct medical costs of CHC for the whole treatment course of different regimens with the real-world data in 2 specialized hospitals in Vietnam (Hospital of Tropical diseases in HCMC and Hanoi). Treatment costs include drug costs, healthcare service costs (including 5 components by circular of 37/MOH-VN). The treatment regimens included in the analysis were Peg-Interferon/Ribavirin (Peg-INF/RBV), solfosbuvir/ ledipasvir (SOF/LDV).  Results: Based on decision-tree models, simulating the treatment process with different regimen for CHC patients, genotype 1, it has been shown that medical direct cost was higher in peg-IFN/RBV regimen, which was 2,85 times than SOF/LDV regimen (141.46 VND million vs 49.58 VND million, respectively). In the structure of medical direct cost, the drug cost had predominated.  Conclusions: Peg-IFN/RBV regimen was costly than SOL/LDV regimen despite of the higher price of SOL/LDV compared to Peg-IFN/RBV. The drug cost was the majority part of total medical direct cost. With the rising trend of hepatitis C chronic in Vietnam and the high cost burden of treatment, healthcare policies and national medical programs should be considered. PGI13 Cost of Treatment for Chronic Hepatitis C Infection at a National Tertiary-Care Referral Centre in an Asian Middle-Income Country Azzeri A1, Shabaruddin FH1, Mohamed R1, McDonald SA1, Tan SS2, Kamarulzaman A1, Dahlui M1 1University of Malaya, Kuala Lumpur, Malaysia, 2Selayang Hospital, Selangor, Malaysia

Objectives: Disease burden due to chronic hepatitis C virus(HCV) infection is expected to increase in the coming decades in countries without comprehensive national treatment strategies with direct acting antivirals(DAA). Severe clinical sequalae of HCV, which includes end stage liver disease and liver cancer, will cause substantial financial implication. This study aims to estimate the healthcare cost of managing HCV at a tertiary-care referral centre in Malaysia, as an example of a middle-income country that has not yet adopted DAA drugs as standard HCV treatment.  Methods: A costing analysis was conducted from the healthcare provider perspective. Annual resource use of standard interferon-based HCV treatment pathways was obtained by face-to-face interviews of local clinical experts(n= 4). Unit costs specific to the referral centre(price year 2014) were derived by combining top down and bottom up activity-based costing methods. Costs were reported in US dollars(USD).  Results: Estimated first year costs of managing non-cirrhotic chronic infection(NCCI), compensated cirrhosis(CC), decompensated cirrhosis(DC) and hepatocellular carcinoma(HCC) were USD7080, USD7295, USD7503 and USD7713 respectively which include interferon cost for NCCI and CC. Costs for subsequent years for NCCI and CC were USD243 and USD410 while costs for DC and HCC remain the same annually. Cost drivers for NCCI and CC was the cost of interferon(73% and 70%) in the first year, for DC was symptomatic clinical management of liver disease(47%) and for HCC was clinical management of cancer(33%).  Conclusions: The estimated annual healthcare costs increased corresponding to the severity of HCV-related liver disease. Current interferon-based treatment may lead to substantial downstream implications due to the low clinical effectiveness and limited patient eligibility for treatment. Adoption of DAA as standard treatment may require substantial upfront investment but it can potentially reduce HCV-related clinical morbidity and mortality and lower the national clinical and economic burden of HCV infection. PGI14 Economic and Clinical Impact of Serum-Derived Bovine Immunoglobulin / Protein Isolate (SBI) in the Management of Chronic Diarrhea in Inflammatory Bowel Disease (IBD) Tyson C1, Shafran I2, Hilal R3, Chalasani R4, Good L5, Taxman T6, Maheshwari S7, Silver HS8, Glamour TS9, Wallis BJ10, Bradshaw T11, Shaw A11, Dalfonso LL12, Magar R12 1AHRM Inc., Buffalo, NY, USA, 2Shafran Gastroenterology Center/University of Central Florida Medical School, Winter Park, FL, USA, 3Center for Advanced Gastroenterology/Assistant Professor, UCF-College of Medicine, Maitland, FL, USA, 4Digestive and Liver Disease Consultants, Houston, TX, USA, 5South Nassau Communities Hospital, Lynbrook, NY, USA, 6Institute for Women’s and Children’s Health, Lyndhurst, OH, USA, 7Center for Digestive Disease, The Woodlands, TX, USA, 8Knoxville Gastroenterology Consultants, Knoxville, TN, USA, 9Advanced Gastro & Liver Care, Pinellas Park, FL, USA, 10Advanced GI Associates, Crystal River, FL, USA, 11Entera Health, Cary, NC, USA, 12AHRM Inc., Raleigh, NC, USA

Objectives: This study sought to evaluate the real-world economic and clinical impact of EnteraGam®—a medical food containing serum-derived bovine immunoglobulin/protein-isolate (SBI) for the management of chronic diarrhea.  Methods: Medical records were reviewed across nine US gastroenterology practices for patients diagnosed with either ulcerative colitis (UC) or Crohn’s disease (CD). Patients included in the study had at least six months’ treatment for IBD prior to a minimum of six months’ continuous SBI use. Patients were excluded if they