Cost-Effectiveness Analysis of Diagnostics of Tuberculosis Infection in The Russian Federation with The Use of Tuberculous Recombinant Allergen

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in the Elderly/Non-working sector £75M. Assuming the cognitive program reduces cost by 10% for each sector, the city should realise combined cost savings of about £93M.  Conclusions: Cognitive assessment and training interventions may reduce the economic burden of poor cognitive health for specific cohorts of a “Smart City” seeking methods to reduce social and public health costs while improving chances for learners to complete their education, reducing antisocial behaviour that often precedes entry into the criminal justice system, and increasing the likelihood for those out of work to gain full-time employment. PMD52 Potential Cost Savings of A Point-Of-Care Diagnostic Test Measuring Antipsychotic Plasma Levels for Treatment of Patients with Schizophrenia in Spain Pobre MA1, Riley R2, Predmore Z3, Horvitz-Lennon M3, Mattke S3 1Johnson & Johnson Medical, Madrid, Spain, 2Janssen Diagnostics, Titusville, NJ, USA, 3RAND Health, Boston, MA, USA

Objectives: Current management of schizophrenia remains a challenge, as only about half of patients respond to their initial pharmacological regimen. Currently, prescribers have to rely on clinical judgment and patient self-report to determine the root cause of treatment failure. This lack of objective data may lead to incorrect decisions, such as overestimating adherence. Measuring anti-psychotic blood levels at the point-of-care can provide more accurate information on the root cause and thereby lead to better treatment decisions. Our objective is to estimate potential cost savings from using point-of-case plasma level testing in Spain.  Methods: The probabilities of patients experiencing a complicated treatment course and of prescribers identifying the root cause of it correctly with and without antipsychotic levels were derived from the published literature, together with estimates for cost per case of treatment failure for Spain. A decision-analytic model was elaborated to compare annual cost of both scenarios.  Results: Without information on antipsychotic plasma levels, prescribers are estimated to make incorrect decisions in 10-18% of the approximately 40% of patients with schizophrenia and complicated treatment courses, i.e., patients that do not respond to initial treatment or experience intolerable side effects to it. Based on published cost data from Spain, we estimate that the correct treatment decision would avoid € 5589 per average patient, due to reduction in symptom recurrence and hospitalization.  Conclusions: Access to point of care antipsychotic plasma levels would help avoid incorrect management decisions in 10-18% of the complicated treatment courses and has the potential to improve disease management and reduce healthcare costs. The findings imply that plasma level testing in patients with complicated treatment courses would be at least cost-neutral, if the cost of a single test were up to between € 1397 and € 2515, assuming that correctly diagnosed patients are appropriately treated. PMD53 Cost-Effectiveness of Radial Access Versus Femoral for Diagnostic Cardiac Catheterization and Coronary Intervention in Colombia Borja H1, Gil-Rojas Y2, Castañeda-Cardona C3, Rosselli D2 de Antioquia, Medellín, Colombia, 2Pontificia Universidad Javeriana, Bogota, Colombia, 3Neuroeconomix, Bogota, DC, Colombia

1Universidad

Objectives: To evaluate the cost-effectiveness of radial compared to femoral arterial access in diagnostic coronary arteriography and percutaneous coronary intervention in adult patients with cardiovascular disease in Colombia.  Methods: A one-month time horizon decision-tree model was constructed to determine the incremental cost of radial approach in comparison to the most commonly used femoral access in diagnostic coronary arteriography and in coronary intervention in adult patients with cardiovascular disease. Costs (in 2015 Colombian pesos, 1 € =  3041 COP) of the procedures and their complications as well as effectiveness in terms of avoided complications (extracted from a review of the literature) were evaluated. Only direct medical costs, from the third party payer perspective (Colombian health care system) were assessed. Complications considered were: Major adverse cardiovascular events (death, myocardial infarction, coronary artery bypass surgery and stroke), major bleeding, failures in the procedure, minor complications and arterial thrombosis. Univariate and probabilistic sensitivity analyses were performed.  Results: The estimated weighted average cost of coronary angiography with radial approach was € 357, while femoral access would cost € 392. For percutaneous transluminal coronary angioplasty (PTCA) the average cost for radial approach would be € 2,446, and for femoral € 2,909. The radial approach was dominant for major adverse events averted; and despite having more minor complications (failures in the procedure, minor and arterial thrombosis) than femoral approach, it generates lower costs. The conclusion did not change under sensitivity analysis.  Conclusions: Radial approach for diagnostic coronary angiography and for PTCA is dominant when compared with the femoral approach for major cardiovascular adverse events, since it is associated with a lower incidence of major complications and has a lower cost. PMD54 Cost - Effectiveness Analysis of Presepsin Compared with C-Reactive Protein and Procalcitonin in Detecting Severe Bacterial Infection in Children Aged 29 Days to 36 Months Old with Fever Without Source Amastha J, Berdejo L, Acosta-Reyes J Universidad del Norte, Barranquilla, Colombia

Objectives: Fever is one of the most common symptoms in children. However, although the frequency of fever as the main symptom is high, there is considerable controversy in the management of children that have fever without source. The aim of this study was to determine the incremental rate of cost-effectiveness of presepsin compared with C – reactive protein (CRP) and procalcitonin in detecting severe bacterial infection (SBI) in children aged 29 days to 36 months that have fever without source according to pre-test probability in Colombia.  Methods: An economic analysis of cost-effectiveness structured using the technique of decision

analysis (TreeAge Pro ®) was performed. Systematic reviews and meta-analysis were analyzed to establish the sensibility and specificity of CRP, procalcitonin and presepsin, a consensus of experts determined the length of hospitalization, costs of hospitalization and tests evaluated were determined from the average direct costs (USD). The cutoffs used were <  0.5 mg/dl for procalcitonin, >  40 mg/L for CRP and 625 pg/ml for Presepsin. The pre-test probability ranged from 10% to 90%, considering low, intermediate and high probability of SBI.  Results: The different strategies had similar cost-effectiveness for a correctly diagnosed patient with SBI. However, presepsin was the most C/E strategy for the pretest probability scenarios between 30% - 90%, ranging from $911 to $2685 per diagnosed patient. In the lowest pre-test probability, 10%, the CRP performed better.  Conclusions: In the clinical practice, a large amount of children with fever without source have a wide range of pre-test probabilities of SBI. Our results found that presepsin can be a good diagnostic tool in patients with a 30% or higher probability of presenting SBI in children in Colombia. Additional research of new diagnostic tools is necessary to improve care evidence in children with SBI. PMD55 Cost-Effectiveness of Different Cervical Cancer Primary Screening Using Cytology, HPV Or P16/KI-67 Testing Alone Or in Combinations for The Austrian Health Care Context Sroczynski G1, Esteban E1, Widschwendter A2, Oberaigner W3, Hintringer K4, Endel G5, Siebert U6 1UMIT - University for Health Sciences, Medical Informatics and Technology/ ONCOTYROL Center for Personalized Cancer Medicine, Hall in Tyrol/ Innsbruck, Austria, 2Medical University Innsbruck, Innsbruck, Austria, 3Tirol Kliniken Innsbruck, Innsbruck, Austria, 4TGKK-Tyrolean Sickness Fund, Innsbruck, Austria, 5Main Association of Austrian Social Insurance Institutions, Vienna, Austria, 6Harvard Medical School, Institute for Technology Assessment & Department of Radiology, Hall i.T., Austria

Objectives: To systematically evaluate the long-term effectiveness and cost-effectiveness of different cervical cancer primary screening strategies for the Austrian health care context.  Methods: A Markov-state-transition model was developed for the Austrian health care context and applied to evaluate different screening strategies that differ by primary screening test (including cytology, p16/Ki-67-dual stain, and HPV-testing alone or in combinations), screening interval, age, and specific follow-up algorithms for positive test results. We used Austrian clinical, epidemiological and economic data (year 2014), and test accuracy data from international meta-analyses and trials. We adopted a health care system perspective and discounted costs and effects at 5% annually. Predicted outcomes were relative reduction in cancer incidence and death, and incremental cost-effectiveness ratios (ICER; in Euro per life year gained [LYG]). Comprehensive sensitivity analyses were performed.  Results: Within the same screening interval, HPV-based primary screening strategies are more effective (relative reduction cancer death: 56%-79% for 5-2 yearly screening intervals) compared with cytology (42%-69%) or with p16/ Ki-67 testing alone (50%-76%). Adopting risk-based follow-up algorithms including p16/Ki-67 triage for women with ASCUS or LSIL and colposcopy referral for women with HSIL or p16/Ki-67-positivity can improve efficiency. In the base-case analysis (31-43% screening adherence in women below 60 years of age), biennial HPV-testing (with cytology triage of HPV-positive women) at the age of 30 years and biennial cytology (with p16/Ki-67-triage of women with ASCUS/LSIL) at younger age was considered cost-effective with an ICER of 43,700 Euro/LYG. In sensitivity analyses results were sensitive to HPV-test cost, cytology test accuracy, screening adherence rate and annual discount rate.  Conclusions: Based on our results, biennial primary HPV screening with cytology triage in women age 30 years and older and biennial cytology with p16/Ki-67-triage in younger women can be considered as a cost-effective screening option for the Austrian context. PMD56 Cost-Effectiveness Analysis of Diagnostics of Tuberculosis Infection in The Russian Federation with The Use of Tuberculous Recombinant Allergen Holownia M, Solodun I, Bashlakova E, Ermolaeva T, Davydovskaya M, Evdoshenko E State Budgetary Institution of Moscow City «Center of Clinical Trials Management and Performance of Moscow Department of Healthcare», Moscow, Russia

Objectives: To determine the most cost-effective medical technology for diagnosing tuberculosis infection in the Russian Federation.  Methods: As a part of a retrospective study, we created models for comparative evaluation of diagnostic techniques used for tuberculosis screening in children and adolescents (aged 1-17 years) in Moscow. The following were compared: Model 1 - the Mantoux test (data based on screening conducted in 2008 in 1,302,490 children and adolescents in Moscow); model 2 - the Mantoux test followed by recombinant tuberculosis allergen test in individuals with the positive Mantoux test reaction (data based on screening conducted in 2013 in 1,420,100 children and adolescents in Moscow); and model 3 – the stand-alone tuberculous recombinant allergen test (data based on screening conducted in 2015 in 108,729 children in Penza region). Cost calculations were based on price data from the State Register of Selling Price Limits, as well as the service cost data obtained from the Moscow Centre for Tuberculosis and No. 106 Polyclinics of St. Petersburg.  Results: The effectiveness of the analysed diagnostic methods, expressed as the percentage of active tuberculosis infection among the screened individuals, was 0.006%, 0.012% and 0.019% for models 1, 2 and 3, respectively. Screening costs per 100 patients were € 250.75, € 220.43 and € 200.16 for models 1,2 and 3, respectively (calculated based on the exchange rate announced by the National Bank of Russia on 16.06.2016). The cost-effectiveness ratios were 2,992,771.35, 1,359,327.53 and 779,574.74 for models 1, 2 and 3, respectively.  Conclusions: The recombinant tuberculosis allergen test is the most costeffective tuberculosis screening method in children and adolescents, superior to the stand-alone Mantoux test or Mantoux test followed by recombinant tuberculosis allergen test.



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A695

PMD57 The Cost-Effectiveness of whole-Exome Sequencing in Complex Paediatric Neurology

PMD60 Cost-Effectiveness of Active Surveillance of Beta-D-Glucan in Intensive Care Units in Hong Kong

van Nimwegen K, Vissers L, Willemsen M, Schieving J, Veltman J, van Der Wilt G, Grutters JP Radboud university medical center, Nijmegen, The Netherlands

Pang Y, Ip M, You J The Chinese University of Hong Kong, Shatin, Hong Kong

Objectives: The current diagnostic trajectory in complex paediatric neurology is lengthy, resource-intensive, and low yield. As complex paediatric neurologic disorders generally have a genetic origin, implementing whole exome sequencing (WES) is expected to increase diagnostic yield in this complex paediatric neurology. However, it might also increase the costs in this diagnostic trajectory. The aim of this study is to empirically examine the cost-effectiveness of WES in clinical practice.  Methods: 100 consecutive children with complex neurologic disorders of suspected genetic origin were included and underwent both the conventional diagnostic trajectory and WES. Health care resource use was measured prospectively and retrospectively. The primary effectiveness outcome was diagnostic yield. A trial-based cost-effectiveness analysis (CEA) of WES was performed with the prospective costs. Uncertainty was addressed using bootstrapping. To explore the costeffectiveness of WES as a first-tier test, a model-based CEA was performed based on the retrospective costs.  Results: < span”> WES increased diagnostic yield from 8% to 30%. The conventional diagnostic trajectory cost on average € 1,882 when prospectively and € 9,330 when retrospectively measured. TheWES trajectory cost € 4,166. This resulted in an ICER of € 10,673 per additional diagnosis. Our decision model indicated that WES as a first-tier test could result in cost savings if at least 31% of all paediatric neurology patients were complex ones.  Conclusions: We showed that WES can provide value for money if not used as a last-resort test, and could even be cost-saving when applied as a first-tier test. Physicians should take this into account in deciding whether and when to use WES.

Objectives: Early initiation of antifungal treatment for invasive candidiasis is associated with significant reduction of morality. The process of blood culture is timeconsuming and sensitivity is low for the deep-seated infection. Blood culture-guided treatment is mostly delayed. 1,3-beta-D-glucan (BDG) is one of the components in fungal cell wall and BDG assay is recommended for diagnosis of invasive candidiasis. The objective of this study was to evaluate the potential cost-effectiveness of active BDG surveillance for invasive candidiasis in patients admitted to ICU from the perspective of Hong Kong healthcare provider.  Methods: A Markov model was designed to simulate outcomes of active BDG surveillance with preemptive antifungal therapy (surveillance group) and no surveillance (standard care group). Candidiasis-associated outcome measures were mortality rate, quality-adjusted life year (QALY) loss, and direct medical cost. Sensitivity analyses evaluated robustness of model results.  Results: In base-case analysis, the surveillance group was more costly (USD1,387 versus USD664) (USD1= HKD7.8) with lower candidiasis-associated mortality rate (0.653 versus 1.426 per 100 ICU admissions) and QALY loss (0.116 versus 0.254) than standard care group. The incremental cost per QALY saved by surveillance group versus standard care group was 5,239 USD/QALY. One-way sensitivity analyses found base-case results to be robust to variation of all model inputs. In probabilistic sensitivity analysis, the probability of surveillance group to be costeffective was 100% at willingness-to-pay (WTP) threshold of ≥ 27,800 USD/QALY (gross domestic product per capita in Hong Kong 2015= USD40,596).  Conclusions: Active BDG surveillance in ICU setting appears to be a highly cost-effective strategy to reduce candidiasis-associated mortality rate and save QALY in Hong Kong.

PMD58 Cost-Effectiveness of Screening for Severe Sleep-Disordered Breathing in Japan

PMD61 Cost-Effectiveness of D-Dimer in The Diagnosis of Venous Thromboembolism in Colombia

Takegami M1, Moriwaki K2, Nishimura K1, Miyamoto Y1 1National Cerebral and Cardiovascular Center, Suita, Japan, 2Kobe Pharmaceutical University, Kobe, Japan

Objectives: Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) increase the risk of cardiovascular disease, and lead to motor vehicle and public transportation accidents. SDB is therefore considered a problem requiring attention from both clinical and public health perspectives. The objective of this study was to estimate the cost-effective of screening for identification of patients with SDB using simple scoring system (Four Item-Screener for Sleep Apnea Syndrome; FISSAS) in community setting.  Methods: A Markov model was constructed to assess the cost-effectiveness of screening and subsequent intervention for SDB compared with no screening. The model depicted the management of a 50-year-old patient with severe OSAHS as defined by an apnoea-hypopnoea index of 30 or more. Base available clinical data from publications, national surveillance data, and claim data was used. One-way and probabilistic sensitivity analyses were performed considering uncertainties in the parameters.  Results: In the base-case analysis, the strategy with a screening for severe SDB resulted in an incremental cost of 266,740 Japanese yen (¥; £1,749) and incremental effective of 0.125 quality-adjusted life years (QALYs) per 0.125 per person screened. The incremental cost-effectiveness ratio was ¥2,129,915 (£13,962) per QALY. Sensitivity analyses suggested in order to achieve both reductions in cardiovascular disease and traffic accidents and cost-effective in Japan.  Conclusions: Within the limitations of the model, screening for SDB using FISSAS was found to be cost-effective than no screening, applying the willingness to pay threshold of £20,000 to 30,000 per QALY gained in the UK. PMD59 Investigating The Cost-Effectiveness of Genetic Counselling for Couples At Known Risk of Having Children with Tay-Sachs Disease: A Two-Generation Model Ghosh W, Griffiths M, Griffiths A Costello Medical Consulting Ltd, Cambridge, UK

Objectives: The aim of this study was to conceptualise and implement a modelling approach to assess cost-effectiveness of pre-conception genetic counselling (and genetic screening) for couples at risk of having children with the rare autosomal recessive genetic disorder Tay-Sachs disease, a progressive and debilitating disease for which there is no known cure. This study sought to examine the influence of genetic counselling on the quality-of-life and costs accrued by a two-generation family, providing a case study that highlights the inherent challenges in modelling a question of this kind.  Methods: A decision tree was developed with a time horizon of 15 years from the time of genetic counselling. The base case assumed that one adult knows their status as a carrier. Collective costs and quality-adjusted life years (QALYs) of the family unit were calculated from the societal perspective, and presented as cost per QALY per family member. No equity weighting of QALYs was applied.  Results: A range of assumed values were tested for the probability that parents decide not to conceive following a positive genetic test. Varying this probability from 1–0.3 gave a theoretical incremental cost-effectiveness ratio of £89,053.80–£269,307.89. Influence of counselling on parental decisions was, along with carrier probability, a key model driver, demonstrating that results are highly dependent on the severity and prevalence of the disease in question. Data limitations stemming from disease rarity necessitated use of inputs from related diseases. A key challenge during model development was the appropriate application of utility inputs in this context.  Conclusions: This study considers an ethically challenging and sensitive question. Although data limitations and inherent difficulties in framing questions of this kind in economic terms limit conclusions on cost-effectiveness, this research provides a valuable case study highlighting challenges in the application of health economic analysis to rare, inheritable conditions.

Gil-Rojas Y1, Castañeda-Cardona C2, Rosselli D1 Universidad Javeriana, Bogota, Colombia, 2Neuroeconomix, Bogota, DC, Colombia

1Pontificia

Objectives: To assess the cost-effectiveness of D-dimer compared with imaging techniques (current practice) in the diagnostic process of pulmonary embolism (PE) and deep vein thrombosis (DVT) in Colombia.  Methods: Two decision-tree economic models were developed to assess the cost-effectiveness of high sensitivity D-dimer compared with images, for the exclusion of PE and of DVT, in adult patients with low and intermediate probability, according to the pre-test assessment evaluated by the Wells’ scale. The model parameters were obtained from a literature review and validated by an expert panel. Imaging techniques were high-resolution computed tomography and lung scintigraphy for PE and Doppler ultrasound for DVT. The time horizon was one year; we used a third party payer perspective. Costs were estimated in 2015 Colombian pesos 1 EUR =  3041 COP.  Results: For the diagnosis of PE, the average estimated cost was € 895 with D-dimer and € 956 with the imaging technique. D-dimer represented a savings of € 61, and had less false positive and false negative rates. For the diagnosis of DVT, the estimated average cost was € 306 with D-dimer and € 300 with the imaging technique. Despite the slightly higher cost, it again had less false positive and false negative rates. One-way and probabilistic sensitivity analyses showed similar results under most scenarios tested.  Conclusions: The economic model developed for PE shows that highly sensitive D-dimer is a dominant alternative in patients with low and intermediate probability of PE, and is probably cost-effective in patients with low and intermediate probability of DVT, when compared with imaging techniques in Colombia. PMD62 Cost-Effectiveness Analysis of Telemonitoring in Gynaecology and Obstetrics Gajdoš O, Hrubý J Czech Technical University in Prague, Kladno, Czech Republic

Objectives: Nowadays, new medical technologies and related new possibilities for improving the healthcare in all areas are constantly appearing. Premature uterine activity remains one of the most important signals of preterm labor that needs to be monitored. The aim of this study is to compare the prenatal care supported by telemonitoring with the currently used practice in obstetrics and gynaecology consulting rooms.  Methods: Clinical outcomes have been obtained through a literature review of clinical trials. Value engineering methods and multiple-criteria decision making methods were used, especially Saaty’s matrix and the Concordance Discordance Analysis method, for setting the scales of criteria and effects, respectively. Costs are processed by a systematic cost analysis. Cost-effectiveness analysis compares the standard prenatal treatment with the telemonitoring system from payer’s perspective.  Results: A total of 44 patients have been enrolled in the study. The total costs are CZK 182 934 (~EUR 6 758) for the standard ambulatory prenatal care of pregnants at a high risk of preterm labor, and CZK 200 485 (~EUR 7 406) for the prenatal care with interventions through the preterm uterine activity telemonitoring system. The CEA indicator value is 7.27 for the standard care, and 14.71 for the telemonitoring care, while the ICER is CZK 10 834 (~EUR 400).  Conclusions: Total costs are higher in the group with telemonitoring care, but cost-effectiveness analysis showed that the use of telemonitoring in the prenatal care is significantly more cost effective than the standard care, which is now practiced in most gynaecologyobstetrics departments in the Czech Republic. PMD63 Systematic Review of Cost-Effectiveness Analysis (CEA) of The Cell Free DNA (CFDNA) / Non-Invasive Prenatal Test (NIPT) for Trisomy 21 (T21) Screening Bourdoncle M1, Li J2, Berthelot A2, Cognet M3, Sambuc C3, Scemama O3, Rumeau-Pichon C3