Estimations of Resource use, Costs, Clinical and Epidemiological Outcomes of Continuous and Intermittent Renal Replacement Therapies

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VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 8 5 3 – A 9 4 3

Objectives: The authors performed a healthcare utilization and cost comparison of RF ablation versus medical treatment among AF patients in the Brazilian private healthcare system.  Methods: Data were analyzed from the Orizon database. The study population consisted of 165 consecutive patients who underwent RF ablation procedures for AF. Healthcare utilization and costs were measured from 2 years before to 2 years after the procedure. That is the preliminary results from the 50 first patients analyzed.  Results: Considering a total of AF patients who underwent catheter ablation, 45 had at least 3 months follow-up prior the ablation and 45 had at least 3 months follow-up post ablation. There was no difference in the 2-years estimated number of outpatient visits prior and after ablation (4.8 visits (± 4.3) vs. 3.9 visits (± 4.4), p= 0.29), but the outpatient’s costs (including appointments and exams) were lower after ablation procedure (R$ 2,732.17 (± 3,299) vs. R$ 1,642.05 (± 1,326), p= 0.02). The 2-years estimated emergency care visits and costs were lower after ablation procedure (2.02 visits (± 2.23) vs. 0.96 visits (± 1.98), p= 0.006) and (R$ 3,781.03 (± 5,784) vs. R$ 499.90 (± 1,489), p= 0.0003), respectively. Patients before ablation had a higher risk of overall complications and arrhythmia in the ER visits (OR 4.5 – CI 95% 1.8 to 11 – p= 0.0009) and (OR 17.2 – CI 95% 3.7 to 79.8 – p= 0.0001), respectively. There was no difference regarding stroke and angina pectoris in the ER visits (p= 0,49 and p= 0,71), respectively.  Conclusions: Catheter ablation in AF patients reduces outpatients costs, emergency room utilization and costs and the risk of overall complications and arrhythmia ER related visits, but doesn’t reduce the risk of stroke and angina pectoris ER related visits. PMD15 Estimations of Resource use, Costs, Clinical and Epidemiological Outcomes of Continuous and Intermittent Renal Replacement Therapies Garay OU1, Palacios A1, Tapia-Lopez E1, Hernández-Vásquez A1, Garcia Marti S1, Pichon-Riviere A1, Augustovski F2, Bardach A3 1Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina, 2Institute for Clinical Effectiveness and Health Policy (IECS), CABA, Argentina, 3National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina

Objectives: To estimate resource use, costs, clinical and epidemiological outcomes associated to the treatment of Acute Kidney Injury (AKI) at Intensive Care Unit (ICU) with Continue or Intermittent Renal Replacement Therapies (CRRT or IRRT) in Argentina to feed a Cost-Effectiveness (CE) model that compares long-term economic and health outcomes.  Methods: After validation of model and assumptions with local experts, a list of parameters where defined. The perspective was stated as of the insurance for the elderly (PAMI). Costs of daily CRRT, IRRT, Dialysis Dependence (DD) and Independence (DI) were estimated using a macro-costing approach, in ARS 2017. Clinical and epidemiological parameters were obtained from a review of studies indexed in PubMed, Cochrane Library, EMBASE, LILACS and relevant grey literature. Epidemiological parameters were survival rates at days 0, 60 and 180 and for DD at 90 and 1,095 from hospital discharge. Quality-of-life weights included were AKI patients at UTI, with DD and DI; Length of Stay (LoS) in ICU; therapy duration and percentage of patients switching from CRRT to IRRT.  Results: Costs of daily CRRT, IRRT, DD and DI were $7,066.8, $1,963.0, $766.3 and $3.4 respectively. Survival at days 0, 60 and 180 were 0.655, 0.46 and 0.37 respectively for both therapies. DD at 90 and 1,095 days were 0.164 and 0.217 for CRRT and 0.208 and 0.266 for IRRT. LoS in ICU and therapy duration were 12.0 and 7.0 for both therapies and the switch of therapies 33.8%.  Conclusions: No local-relevant literature was found. Evidence suggests no difference in survival rates, nevertheless the DD appears to be lower in CRRT than in IRRT. Daily costs of CRRT resulted higher than IRRT. This results will be used in the next phase, after a validation with a local expert panel, to derive CE results in Argentina, and can be extended to other countries in the region. PMD16 Cost Associated with Ballon-Expandable Valve vs Self-Expandable Valves in Patients Undergoing Transcatheter Aortic Valve Replacement Ferreira CN1, PaloniEd 2, Rodrigues SR3, Brunet VA2 Lifesciences Latam, São Paulo, Brazil, 2Orizon, Barueri, Brazil, 3Universidade de São Paulo, São Paulo, Brazil 1Edwards

Objectives: Transcatheter aortic valve implantion (TAVI) is an effective alternative to surgical valve replacement for inoperable patiens with aortic stenosis (AS). This analysis assemed the cost per lenght of stay wheter the ballon-expandable (BE) valve and self-expandable (SE) valve.  Methods: An administrative claims database containing over 18 million lives (ORIZON, Brazilian Private Health Care, Fee-for-service) was assessed (from jan/2015 until dec/2016), of patients who underwent a BE valve replacement (n= 30) and SE valve replacement (n= 54). After group identification, the average length of stay (LOS), cost and median differences between groups were assessed thru Kruskal-Wallis method. A significance level of 5% was adopted.  Results: The average cost per lenght of stay the day was BRL 7,553 and BRL 10,906 for BE and SE (p< 0.0001) valve, respectively and the cost per patient was BRL 220.384 (IC95% BRL 152.464- BRL 288.308) and BRL 238,410 (IC95% BRL 202,031 - BRL 274,789) for BE and SE valve respectively (include de cost with valve). The treatment with BE valve represented 32% of economic saving comparing with SE  Conclusions: In the present analisis among patients with high-risk aortic stenosis undergoing TAVR, the use of a balloon-expandable valve should save than use of a self-expandable valve. It could be attributed with the clinical complications, which should be tested in future economic and clinical data. PMD17 Burden Disease of Aortic Stenosis Associated in Patients Undergoing Transcatheter Aortic Valve Replacement Ferreira CN1, PaloniEd 2, Rodriguez SR2, Brunet VA2 1Edwards Lifesciences Latam, São Paulo, Brazil, 2Orizon, Barueri, Brazil

Objectives: To estimate the cost and length of stay (LOS) of aortic stenosis (AS) with transcatheter aortic valve replacement (TAVR)  Methods: An administrative claims

database containing over 18 million lives (ORIZON, Brazilian Private Health Care, Feefor-service) was assessed (from jan/2015 until dec/2016), of patients who underwent a transcatheter aortic valve replacement (n= 84) . Records showed expenditure with material, tax, procedures, medication and diagnostics. The average and median with confidence interval of 95% was adopted.  Results: 84 patients made use of TAVI and had complete index hospital bills available (the treatment in Brazil are approval only for inoperable and high-risk patients) . The averange cost per patient was BRL 231,972 (include the valve and complications), the cost per day was BRL 9,896 (IC95% 5,579 -14,213), and the median LOS was 16 days. Almost 55% of cost was related with other expenses (tax, procedure, others materials and medications.  Conclusions: Most of the treatment cost were not related with Device for this reason the avoidance clinical complications should improve the LOS and cost treatment of TAVR for high-risk and inoperable patients. PMD18 Estimación De Costos De Los Servicios De Hemodiálisis Crónica Y Hemodiafiltración EN Argentina Palacios A, Mengarelli C, Augustovski F Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina

Objectives: Estimar el costo de la sesión de hemodiálisis crónica y de hemodiafiltración en Argentina.  Methods: Se utilizó información contable y médica de las tres empresas de terapia renal más importantes del país, que brindan el 46% de las sesiones totales. Se adoptó una perspectiva de análisis del prestador, por lo que sólo se consideraron los costos directos e indirectos de la prestación. Se diseñó un instrumento de recolección de la información que identifica 17 categorías de costos, con detalles de los recursos utilizados, cantidades, tasas de uso y precios unitarios. Se empleó una metodología de costeo “top-down”. El costo de la sesión de cada servicio fue estimado como el promedio ponderado de los costos de cada empresa.  Results: Las principales categorías (y su incidencia en) los costos de la sesión de hemodiálisis crónica son: Recursos humanos (44%), material descartable (11%), inmuebles (8%) y traslados (8%). El costo de la sesión de hemodiálisis crónica fue estimado en $AR 2.693 (USD 170.12). En el caso de la sesión de hemodiafiltración se observaron las mismas categorías de costos principales, aunque cambia su magnitud relativa: Recursos humanos (35%), material descartable (25%), inmuebles (7%) y traslados (6%). El costo estimado de la sesión de hemodiafiltración fue de $AR 3.372 (USD 213.01).  Conclusions: La incidencia de la enfermedad renal crónica se ha incrementado en los últimos años a escala global, hecho que aparejado con su elevada mortalidad, morbilidad y costos, constituye un motivo de preocupación creciente en los sistemas de salud. En el caso argentino, los costos en recursos humanos y material descartable dieron cuenta del 55-60% del costo total de la provisión del servicio. El presente estudio puede ser de utilidad en Argentina a la hora de acordar tarifas entre pagadores y proveedores. PMD19 Enhanced Surgical Recovery Program Perioperative Goal Directed Therapy (PGDT) Economic Benefit Okumura LM1, Riveros BS2, Lucchetta RC2, Rosim MP3, Nita ME4, Goodall G5, Ferreira CN6 Universidade Católica (PUC-RS), Porto Alegre, Brazil, 2Universidade Federal do Paraná, Curitiba, Brazil, 3Universidade de São Paulo, São Paulo, Brazil, 4Market Access and Patient Engagement Solutions - MAPES, São Paulo, Brazil, 5Edwards Lifesciences SA, Nyon, Switzerland, 6Edwards Lifesciences Latam, São Paulo, Brazil 1Pontifícia

Objectives: To estimate the economic benefit from Perioperative goal directed therapy (PGDT performed with ClearSight, a non-invasive hemodynamic monitoring strategy) in high-risk surgeries in Brazilian daily practice (Brazilian Supplementary Health System).  Methods: We developed an exploratory economic analysis by creating a simple decision tree model. Randomized clinical trials evaluating PGDT as an intervention versus non-PGDT implementation as a control group were used as sources of clinical outcomes and benefits. Costs were extracted from a Brazilian supplementary health system-oriented study on the costs of perioperative complications. We projected 200 procedures for each hemodynamic monitoring strategy and calculated global costs, length of stay (LOS) and average costs per patient. No patient centric outcomes such as quality of life or opportunity costs derived from reduced LoS were captured in this analysis.  Results: The total cost saving for PGDT versus non-PGDT was R$ 449.670 even after factoring the costs of materials for PGDT. There was also an average reduction in length of stay (LOS) of 1,95 days per patient. The effective cost saving per patient was R$ 2,248 with a reduction in morbidity of 56% for PGDT.  Conclusions: In the present exploratory study, we propose that PGDT has the potential to generate sufficient cost savings from avoidable post-surgical complications to significantly offset the costs of implementation for the Brazilian Supplementary Health System. This should be tested in future more stringent economic analysis as soon as upcoming data is published. PMD20 Direct Costs of Long-Term Psychiatric Hospitalization in Public Hospital of the State of Sao Paulo, Brazil: The Complexo Hospitalar Juquery Case Siomi AB, Razzouk D Universidade Federal de São Paulo, São Paulo, Brazil

Objectives: To estimate total direct costs of psychiatric hospital diary and its components of costs in a public psychiatric hospital the Complexo Hospitalar Juquery.  Methods: A retrospective cost study covering six months period (from July to December, 2015) and using top down approach, from public health provider´s perspective was designed to estimate the mean direct cost per patient per day in a psychiatric unit with 128 subjects. Components of costs were: capital costs (equipment and furniture), hotel costs (support services, transport, overhead, consumables, and human resources) and treatment costs (medication).  Results: The mean direct costs per patient per day was BRL373,79. Clinical human resources accounted for 48,75%, hotel costs for 30,44%, overhead costs for 11,41%, Non-clinical human resources costs for 7,24%, consumables and clothes costs for 0,99%, medicamentos