Hepatitis C Virus: Determinants Of Patients’ Management Costs

A786

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

US$ 101,499,040 for ABRS and US$ 57,191,330 for AOM in clinical practice along with 20% (US$ 20,260,100) and 9.8% (US$ 5,626,990) cost reductions, respectively in case of adherence to guidelines. In case of 5% higher antibiotic resistance, total annual antibiotic treatment costs were increased by 18.3% (US$ 18,593,590) in ABRS and by 14.1% (US$ 9,063,630) in AOM.  Conclusions: In conclusion, our findings indicate that ABRS and AOM pose a considerable burden to health economics in Turkey, with antibiotic prescription identified as the main cost driver and emphasize the likelihood of substantial cost savings by adherence to guideline recommendations and reduced antibiotic resistance. PIN41 Hepatitis C Virus: Determinants Of Patients’ Management Costs Foglia E1, Ferrario L1, Garagiola E1, Menzaghi B2, Tebini A2, Rizzardini G3, Cossu MV3, Fagiuoli S4, Pasulo L4, Colombo M5, De Nicola S6, Bruno R7, Sacchi P7, Galli M3, Croce D1 1LIUC University, Castellanza, Italy, 2ASST Valle Olona, Busto Arsizio, Italy, 3ASST Fatebenefratelli Sacco, Milan, Italy, 4Papa Giovanni XXIII Hospital, Bergamo, Italy, 5Clinical and Research Center Humanitas Rozzano Italy, Rozzano, Italy, 6Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy, 7Policlinico San Matteo, Pavia, Italy

Objectives: While Hepatitis C Virus (HCV) is a significant economic burden for healthcare providers, limited evidence is available on determinants of resources absorption, both in treatment-experienced and treatment-naïve HCV patients. The present study aimed to investigate the principal determinants of HCV management costs.  Methods: A multi-centred observational study was conducted within 5 Hospital Authorities in Northern Italy. Demographic, clinical and economic information were collected from the enrolled patients, related to 2014. Cost data (haematological exams, diagnostic and specialist procedures, territorial drugs, anti-viral therapy and HAART) were analysed from the Italian NHS perspective. Descriptive statistics and regression analyses were used to determine patterns and determinants of costs.  Results: The sample was composed of 324 treatment-experienced and 1,245 naïve patients, for whom the same trends emerged: i) the management cost of HCV depends on the severity of the disease, demonstrating significant differences according to the Metavir Score (p=  0.000), ii)HIV/HCV patients absorb more economic resources than HCV patients (p= 0.000), with a higher consumption of both haematological exams and specialist visits. The HCV duration (β = 0.087, p= 0.000), the infection severity (β = 0.181, p= 0.000), the type of genotype (β = 0.189, p= 0.000), the achievement of a sustained virological response (SVR) (β = -0.327, p=  0.000) and the previous clinical history (β = -0.218, p= 0.000), in the treatment-experienced patients, are antecedent to a variation of HCV management costs (Adjusted R²= 0.376). The level of liver fibrosis and the SVR alone explains the 11.2% and 12.9% respectively, of costs variance. The number of comorbidities (β = 0.070, p= 0.000), the level of liver fibrosis (β = 0.075, p= 0.000), and the presence of a concomitant HIV infection (β = 0.889, p= 0.000) determines higher HCV management costs (Adjusted R²=  0.782) in the treatment-naïve patients.  Conclusions: Economic information related to clinical pathway could be useful for health policy decision-makers, in order to optimise the appropriateness of resources allocation for the HCV management. PIN42 Herpes Zoster Related Healthcare Burden And Costs In Both Immunocompromised (IC) And Ic-Free Populations In The United Kingdom Curran D1, Hunjan M2, El Ghachi A3, El Hahi Y4, Bianco V1, Ferreira G5 1GSK, Wavre, Belgium, 2GSK, Uxbridge, UK, 3Roche, Basel, Switzerland, 4Valesta, Mechelen, Belgium, 5P-95 Epidemiology and pharmacovigilance services, Heverlee, Belgium

Objectives: Individuals with immunocompromising (IC) conditions are at a higher risk of developing Herpes Zoster (HZ) than IC-free individuals. The study objective was to assess the healthcare burden of HZ in IC and IC-free individuals ≥ 18 years of age (YOA).  Methods: We conducted an observational retrospective study in a cohort of IC (N= 621,588) and IC-free (N= 621,588) individuals, matched by age, gender and GP practice, registered in the Clinical Practice Research Datalink (1999-2012) and linked to the Hospital Episode Statistics inpatient data. Healthcare resource utilization (HCRU, i.e. primary and secondary care consultations, hospital inpatient stays, and prescriptions) was analyzed from 7 days before the HZ diagnosis date to: (1) 30 days, (2) 365 days after the HZ diagnosis date for subjects with (1) HZ only (No postherpetic neuralgia) and (2) subjects with postherpetic neuralgia only. Healthcare costs were computed by multiplying the number of units of resources by the unit costs and summed over all HCRU categories to obtain a total cost per individual. Values were expressed in 2014 UK pound sterling (£) and presented for HZ cases overall, stratified by age category (i.e. 18-49, 50-59, 60-69, 70-79 and ≥ 80) and IC status.  Results: The percentage of HZ-cases hospitalized were higher in IC subjects (e.g. 2.7% versus 0.4% in IC and IC-free individuals, respectively aged 18 to 49 YOA and 9.5% versus 7.5% in IC and IC-free individuals respectively aged ≥ 80 YOA). Similarly, HZ-related mean treatment costs per subject were higher in IC subjects (£189 versus £104 in IC and IC-free individuals, respectively aged 18 to 49 YOA and £557 versus £401 in IC and IC-free individuals, respectively aged ≥ 80 YOA). Costs varied considerably by IC condition.  Conclusions: Individuals with IC conditions not only have a higher risk of HZ than IC-free individuals, but also incur higher HZ-related healthcare costs. PIN43 Outcomes And Costs Of Treating Hepatitis C With Direct-Acting Antivirals: Results From The German Hepatitis C-Registry Krauth C1, Krüger K1, Rossol S2, Mauss S3, Boeker KH4, Schott E5, Klinker H6, Pathil A7, Heyne R8, Stahmeyer JT1 1Hannover Medical School, Hannover, Germany, 2Krankenhaus Nordwest, Frankfurt a.M., Germany, 3Center for HIV and Hepatogastroenterology, Düsseldorf, Germany, 4Leberpraxis Hannover, Hannover, Germany, 5Charité Universitätsmedizin Berlin, Berlin, Germany, 6University Hospital Würzburg, Würzburg, Germany, 7University Clinic of Heidelberg, Heidelberg, Germany, 8Leberzentrum am Checkpoint, Berlin, Germany

Objectives: Chronic HCV infection is associated with a significant health burden. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The introduction of direct-acting antivirals (DAAs) has dramatically changed hepatitis C treatment and sustained virologic response rates (SVR) of > 90% were observed in clinical trials. Especially interferon-free regimens allow a shorter treatment duration and show favorable toxicity profile. Nevertheless new treatment options were accompanied with higher pharmaceutical costs. The aim of the current study was to analyze outcomes and treatment costs in a realworld setting.  Methods: Data were derived from the German Hepatitis C-Registry (DHC-R). The DHC-R is a prospective, multicenter real-world registry study comprising approximately 10,500 patients. Patients are treated at the discretion of the physician. This analysis included all patients with HCV genotype (GT) 1 and 3 who initiated and finished treatment between 02/2014 and 02/2017 and were documented in the pharmacoeconomic substudy.  Results: A total of 2,673 patients receiving antiviral treatment were analyzed; 88.0% had GT-1 and 12.0% GT-3 infection. Mean age was 54.6 years, 52.3% were male. Estimated mean duration of infection was 20.6 years. About half of the population (48.1%) was treatment-naïve and 30.2% had liver cirrhosis. 93.5% of all patients achieved SVR (GT-1: 94.0%, GT-3: 89.1%). Average total treatment costs were € 67,979 (€ 67,131 pharmaceutical costs, € 824 ambulatory care, € 24 hospital costs). Treatment costs were considerably lower in GT-1 compared to GT-3 patients (€ 65,650 vs. € 85,039). Average costs per SVR (cure) of € 69,841 for GT-1 and € 95,443 for GT-3 were calculated.  Conclusions: This analysis confirms high SVR rates for newly introduced DAAs in a real-world setting. Although costs for antiviral treatment have further increased, costs per SVR estimated are comparable to first generation DAAs. Detailed analyses stratified by treatment status, degree of cirrhosis and regimen should follow. PIN44 Cost-Effectiveness Of Interferon-Free Treatment Strategies For Hepatitis C After Generic Entry Of Direct-Acting Antivirals In The Kazakhstan Almadiyeva A1, Kostyuk A2, Uralov S3 for Health Technology Assessment, Astana, Kazakhstan, 2Republican Center for Healthcare Development, Astana, Kazakhstan, 3SK-Pharmacy, Astana, Kazakhstan

1Kazakh Agency

Objectives: Following the long phase of interferon-based HCV treatment, directacting antiviral agents (DAAs) were developed. Availability of DAAs has changed the treatment landscape of hepatitis C virus (HCV) infection. However, access to DAAs is limited by their exceptionally high pricing, up to USD23,000 per 12-week course in Kazakhstan. The high price of DAAs has restricted their use in Kazakhstan. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective.  Methods: We constructed Markov models to compare the outcomes of no treatment versus treatment with DAAs for the HCV-infected population in Kazakhstan. Model parameters were estimated from from a systematic review of clinical trial results. Cost-effectiveness of HCV treatment using available DAAs was calculated, from a Kazakh payer perspective, assuming 3% annual discounting. The main outcome of the models was cost per quality-adjusted life-year (QALYs), total costs, and incremental cost-effectiveness ratio of DAAs versus no treatment. One-way and probabilistic sensitivity analyses were conducted.  Results: The models indicated that, compared with with no treatment, the use of generic DAAs in Kazakh HCV patients would increase the life expectancy by 8.14 years, increase QALYs by 3.95, avert 19.01 DALYs, and reduce the lifetime healthcare costs by $2,100 per-person treated. Payback for the upfront costs of DAA drugs would be achieved in an overall average of less than 10 years under 5 years for patients at advanced stages of HCV disease and almost 12 years if treatment begins at earlier stages. The results were robust to multiple sensitivity analyses.  Conclusions: Treatment with generic DAAs available in Kazakhstan will improve patient outcomes, provide a good value for money within 2 years, and be ultimately cost-saving. Therefore, in this and similar settings, HCV treatment should be a priority from a public health as well an economic perspective. PIN45 Cost Of Hospital Treatment For Severe And Moderate-To-Severe Influenza In Russia Pyadushkina E, Avxentyeva M, Derkach EV, Boyarskaya T, Ignatyeva V The Russian Presidential Academy of National Economy and Public Administration, Moscow, Russian Federation

Background: Respiratory viral infection (RVI) both in children and adults is one of the leading causes of hospitalizations in Russia every year. Presently the Russian mandatoty medical insurance system (MMIS) defines low tariffs for RVI hospitalization (€ 401.37-€ 575.22) and a lot of cases are thought to be eligible for out-patient care. Still some influenza patients may need expensive hospital care, but the cost has never been calculated.  Objectives: The aim of this study was to estimate the cost of hospital treatment for severe and moderate-to-severe influenza in adult patients.  Methods: The list of recourses used in severe and moderate-to-severe influenza hospital treatment was made by experts - clinical practitioners in the field of infectious diseases. Pharmacotherapy and laboratory tests for identifying influenza virus by polymerase chain reaction (PCR) were considered to be cost drivers by experts, when use of other resources was considered to be equal to routine care in an infectious ward. The drug costs were calculated on the basis of registered maximal manufacture’s prices. The cost of PCR was submitted by regional hospitals. Other medical costs were calculated based on average cost per inpatient-day in the infectious ward of the regional hospitals (excluding drugs) and average length of hospital stay of influenza patients with different degree of severity.  Results: The cost of drugs is € 1,605.48 and € 129.12 per patient with severe and moderateto-severe influenza, respectively. The total cost of hospitalization is € 2,300.87 for a severe influenza case and € 664.28 for moderate-to-severe patient. 1st place in the drug costs structure belongs to antibiotics for bacterial complications (56 % of drug costs) in moderate-to-severe influenza, and to plasma protease inhibitors (38%) in severe flu. PCR makes a small share in total costs.  Conclusions: Cost of severe