Economic Analysis of Endovascular Interventions for The Treatment of Femoropopliteal Peripheral Artery Disease in Austria

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in the analysis. Costs were obtained from different Spanish sources and expressed in €  2016.  Results: The budget impact for the Spanish healthcare system of treating a patient with T1D presenting recurrent severe hypoglycaemic episodes compared with MDI over a four-year period is ─ € 9,851 (─ € 2,463 per patient per year). During this time horizon, incremental therapy costs per patient with CSII compared with MDI was € 9,479 (€ 11,872 versus € 2,393). Savings of € 19,330 were estimated thanks to the reduction of severe hypoglycaemic episodes associated with CSII therapy compared with MDI (€ 1,371 versus € 20,701).  Conclusions: The higher therapy costs associated with CSII for the treatment of patients with severe recurrent hypoglycaemic episodes compared with MDI are totally offset by the reduction of severe hypoglycaemic events and result in cost savings contributing to the clinical value of CSII therapy. PMD30 Economic Value of Eptfe Stent-Grafts Compared to Balloon Angioplasty for Treating Thrombosed and Dysfunctional Arteriovenous Grafts in England Mohr BA1, Evans RM2 1W. L. Gore & Associates, Inc., Flagstaff, AZ, USA, 2W.L. Gore & Associates (UK) Limited, Livingston, UK

Objectives: To establish the economic value of revising an arteriovenous graft (AVG) with a stent-graft versus balloon angioplasty using data from the Gore REVISE Clinical randomized controlled trial along with cost data specific to the treatment setting in England as Hemodialysis patients with AVG implants can experience AVG stenosis and thrombosis requiring revision.  Methods: The REVISE Clinical Study (NCT00737672) was a prospective, multicenter, RCT in the U.S. comparing the GORE® VIABAHN® Endoprosthesis with Heparin Bioactive Surface (N= 131) versus angioplasty (N= 138) for treatment of dysfunctional or thrombosed prosthetic AVGs and followed patients for 2-years. The trial collected resource utilization data used in the economic analysis, including the number of devices used and the types of repeat interventions performed. Procedure cost data is from the 2014/2015 NHS England Reference Costs. The 2015 UK list prices are used for the GORE® VIABAHN® Device and prices for other stent-grafts used in repeat interventions are from a 2015 UK market analysis report (©2015 Millennium Research Group, Inc.).  Results: Patients in the stent-graft treatment arm incurred average total costs (ATCs) per patient of £22,235 at 2-years compared to £27,327 for angioplasty arm patients with a significant savings of £5,091 (p< .001). ATCs include index procedure costs, where stent-graft patients had higher procedure and device costs compared to angioplasty (£1,466, p< .001), but average repeat intervention costs (ARICs) over 24-months for stent-graft patients were lower than the angioplasty arm by £6,558 (p< .001), making up for the index cost difference. In patients that presented with thrombosed AVGs, the savings was much greater: the stent-graft arm had lower ARICs of £12,021 (p< .001) and lower ATCs of £10,516 (p< .001).  Conclusions: Treating dysfunctional and thrombosed AVGs with a stent-graft is shown to have a significant economic benefit for NHS England compared to angioplasty in addition to a significant clinical benefit as demonstrated in the REVISE Clinical Study. (Vesely. 2016). PMD31 A Real World Cost Analysis of Serum Hbsag Quantification Test in Patients with Chronic Hepatitis B: The Case of The University of Naples Federico II Aiello A1, Guarino M2, D’Ausilio A1, Toumi M3, Caporaso N2, Morisco F2 1Creativ Ceutical, Milano, Italy, 2University of Naples “Federico II”, Naples, Italy, 3Faculté de Médecine, Laboratoire de Santé Publique, Aix-Marseille Université, Université de la Méditerranée, Marseille, France

Objectives: A recent study at Gastroenterology Unit of “Federico II” Naples University, showed in a 95 patient cohort that annually HBV surface antigen (HBsAg) quantification in patients receiving nucleo(t)side-analogues (NUC) antiviral therapy, with stable viral suppression, helps identifying patients achieving HBsAg seroconversion, allowing to stop NUC. However no cost analysis was available. The objective is to estimate the costs associated to introduction of yearly HBsAg monitoring test in routine clinical practice, estimating savings related to NUC discontinuation.  Methods: Data on resource consumption were retrospectively captured through patient chart abstraction in the same cohort of 95 patients, with a median treatment follow-up of 111 months (range 25–183 months). To estimate HBV drugs costs (lamivudine, tenofovir and entecavir) current ex-factory prices were used, while diagnostic and laboratory tests were valorised with national outpatient tariffs. For each determination of the HBsAg diagnostic test a price of € 5.98 was used. Then we made an extrapolation from our initial data to a 10-year follow-up assuming the rate of seroconversion would remain stable over future years.  Results: The analysis shows that despite the increased costs related to HBsAg monitoring test in the cohort, and the seroconversion rate in only 4/95 patients, generated 2,606 saved days of NUC treatment, which has become unnecessary, representing € 20,171 of total cost-saved. Simulating this cohort of patients in the next 10 years and assuming no changes for other variables (ie patients managements and cost of NUC), the introduction of the HBsAg test will generate € 115,179 saving.  Conclusions: Results of this preliminary analysis show that the systematic yearly HBsAg quantification monitoring test is a cost-saving strategy for the Italian healthcare system, when considering avoided NUC therapy. Future works should explore additional potential savings associated to reduction in others healthcare resources in HBV patients undergoing the test. PMD32 Economic Analysis of Endovascular Interventions for The Treatment of Femoropopliteal Peripheral Artery Disease in Austria Pietzsch JB1, Geisler BP1, Jaff MR2, Zeller T3, Brodmann M4 1Wing Tech Inc., Irvine, CA, USA, 2Harvard University, Boston, MA, USA, 3UniversitaetsHerzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany, 4Medizinische Universtität Graz, Graz, Austria

Objectives: Our objective was to study the economic impact of the four main endovascular treatment strategies for femoropopliteal arterial disease on payers and providers in Austria, using latest clinical evidence and current reimbursement rates and device costs.  Methods: We estimated clinical performance of percutaneous transluminal angioplasty (PTA), bare metal stents (BMS), drug-coated balloons (DCB), and drug-eluting stents (DES) using information from a recent systematic search of studies of femoropopliteal lesions reporting target lesion revascularization (TLR) as an endpoint. Pooled 24-month TLR rates were estimated for each treatment. A previously published decision-analytic Markov model was adapted to the Austrian setting taking into account country-specific therapy utilization and 2016 costs. For the four index procedure strategies, we computed budget impact to payers and operational headroom (reimbursement revenue minus device cost) for providers, considering up to one reintervention. In addition, we computed numbers needed to treat (NNT) to avoid one reintervention.  Results: Twenty-eight studies were included, reporting on n =  5,167 primarily de-novo TASC A or B lesions. Pooled 24-month probabilities of TLR were 17.6%, 19.4%, 26.9%, and 38.5% for DCB, DES, BMS, and PTA, respectively. Over 24 months, DCB had the lowest budget impact to payers of € 4,100, followed by PTA (€ 5,010), DES (€ 5,478), and BMS (€ 5,747). Provider headroom was lowest for DCB (€ 3,324) and highest for BMS (€ 5,046). Comparing DCB to the least effective therapy (PTA), we found a NNT of 4.8, suggesting that for every five patients treated with DCB, one TLR could be avoided over 24 months.  Conclusions: Latest clinical evidence indicates that drug-coated balloons likely provide the most favorable clinical outcome among the considered endovascular treatments for femoropopliteal artery disease. Adoption of drug-coated balloon therapy is currently associated with substantial savings to payers and concurrent financial disincentives for providers in Austria, suggesting the need to re-evaluate reimbursement rates. PMD33 A Cost-Minimization Analysis of Dermatophyte Test Kit with Onychomycosis Under Health Care System in Japan Watanabe R1, Igarashi A2, Wakamoto H3, Osawa H3 Medical University, Tokyo, Japan, 2University of Tokyo, Graduate School of Pharmaceutical Sciences, Tokyo, Japan, 3JNC Corporation, Tokyo, Japan

1Tokyo

Objectives: Tinea unguium is a common nail disorder caused by fungal infections. Guidelines issued by Japanese Dermatological Association strongly recommends direct microscopic test for a definite diagnosis of tinea unguium, which requires sophisticated skill by physicians. However, Iwanaga et al. reported that about 40% of patients were diagnosed only based on the clinical presentation, which may lead to misdiagnosis. In 2016, the dermatophyte test kit was approved in Japan. As the kit enables physicians to easily diagnose tinea unguium with high specificity, the reduction of unnecessary treatment cases is expected. The aim of this study is to reveal the impact of implementing the dermatophyte test kit on the budget of the public healthcare system.  Methods: Following the decision tree model of diagnosis/ treatment process in patients with suspected tinea unguium, a cost-minimization analysis was conducted from the public healthcare payer’s perspective. The specificity of diagnoses, the numbers of estimated false-positive cases, and the diagnosis/ treatment costs were calculated for both diagnosis by clinical presentation and diagnosis with dermatophyte test kit.  Results: Approximately 514,000 patients received clinical examination without microscopic test for nail symptoms, and of these patients, 336,000 (65.3%) were diagnosed with tinea unguium. 68,000 falsepositive cases were estimated according to the specificity of diagnosis by clinical presentation (Sp= 0.61), whereas a significant reduction in false-positive cases to 28,000 was expected if the dermatophyte test kit (Sp= 0.88) was introduced. The total reduction in diagnosis/treatment costs was estimated at JPY 700 million (approx. USD 6.7 million). Sensitivity analysis with a tornado diagram supported similar result although the result is sensitive to the prevalence rate and specificity of each diagnostic approach.  Conclusions: The implementation of the dermatophyte test kit with tinea unguium may lead to a positive budget impact on the public healthcare system in Japan through a decrease in false-positive cases caused by diagnosis without a microscopic test. PMD34 Budget Impact Analysis of A Flash Glucose Monitoring System for Patients with Diabetes Who Are Using Intensive Insulin Hellmund R Abbott Diabetes Care, Alameda, CA, USA

Objectives: The FreeStyle Libre™ system is a novel, sensor-based, factory-calibrated flash monitoring system that continuously measures glucose levels in the interstitial fluid. Data is wirelessly transferred from the 14-day adhesive sensor to a handheld reader. A budget impact model (BIM) was created to assess the impact of introducing the flash monitoring system from a German healthcare perspective.  Methods: The BIM was designed with a 3-year time horizon for patients with T2DM using intensive insulin. Budget impact of flash monitoring was compared with self-monitoring of blood glucose (SMBG) using inputs from a randomised controlled trial (the REPLACE study) for glucose monitoring, healthcare use following non-severe hypoglycaemia events, and all-cause resource utilisation. Resource utilisation included the cost of visits to the emergency room, ambulance call-outs and admissions to hospital. Sensor cash price was € 59.90.  Results: Estimated costs for flash monitoring system users PPPY are: glucose monitoring € 1635, healthcare use following non-severe hypoglycaemia € 104, and resource utilisation € 472, for a total of € 2210 PPPY. For SMBG users, the corresponding estimated costs are € 576, based on 3 SMBG tests per patient per day observed in REPLACE, € 143 and € 1764, for a total of € 2484 PPPY. Hence the overall PPPY costs for flash monitoring system users are estimated to be € 274 (11%) less than for SMBG. Therefore although there are additional costs of glucose monitoring associated with the flash monitoring system, there may be an overall saving to the health system from cost offsets related to reductions in hypoglycaemia and healthcare utilisation.  Conclusions: Given the reduction in resource utilisation observed in the REPLACE study for patients using the flash