PCV31 LONG-TERM COST-EFFECTIVENESS OF RIMONABANT IN GERMANY

A414 for surgery and VTEs were extracted for 49 days post-HFR. Logistic regressions (LR) with covariates of congestive heart failure, obesity, cancer, age, and gender were performed to compare VTE outcomes and mortality by TS, (reference = enoxaparin). Life-years gained (LYG) from decreased mortality were estimated from actuarial tables. Sensitivity analyses were performed on costs and rates of VTE events. RESULTS: Enoxaparin (n = 750), dalteparin (n = 117), and enoxaparin with heparin (n = 151) were associated with significantly (LR, P < 0.001) fewer DVTs (1.7%, 2.6%, and 3.3%, respectively) than enoxaparin plus warfarin (n = 128, 20.1%); with an odds ratio (OR) and 95% confidence interval (95% CI) equal to 5.1 and 2.9–8.9. PE rate was also significantly higher (LR, P = 0.002) with enoxaparin plus warfarin OR = 6.5, 95% CI = 2.3–18.3. Dalteparin was least costly and dominated (less costly/more effective) enoxaparin plus warfarin. Compared to dalteparin, enoxaparin was associated with an incremental cost-effective ratio (ICER) of $264,449/DVT avoided and $7,691/LYG. Fondaparinux was estimated to result in an ICER of $561,645/ DVT avoided and $2,752/LYG. The model was insensitive to changes in VTE rates, but sensitive to decreases in costs of VTEs or drugs. CONCLUSION: Dalteparin was most cost-effective, followed by fondaparinux (based upon clinical trials) and enoxaparin. Enoxaparin plus warfarin was dominated by other TS. PCV29 THE COST-EFFECTIVENESS ANALYSIS OF CORONARY ARTERY DISEASE DIAGNOSTIC PARAMETERS IN A CLINICAL LABORATORY SETTING

Bogavac-Satnojevic N1, Petrova Ivanova G2, Jelic-Ivanovic Z1, Memon L3, Spasic S1 1 Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia, Serbia and Montenegro, 2Faculty of Pharmacy, Medical University, Sofia, Sofia, Bulgaria, Bulgaria, 3Clinical Chemistry Laboratory, Clinical Centre “Bežanijska kosa”, Belgrade, Serbia, Serbia and Montenegro OBJECTIVES: The aim of this study was to analyse the costeffectiveness of consecutive supplementing of the Framingham scoring (FRS) algorithm for coronary artery disease (CAD) risk assessment with apolipoproteins B and A-I (apoA-I and apoB), the apo (a) phenotype, lipoprotein (a), and high sensitivity Creactive protein (hs-CRP). The perspective of the analysis is the clinical laboratory setting. METHODS: The study is prospective diagnosing of 221 CAD patients and 289 controls. First line testing followed the guidelines for risk assessment based on FRS. Risk factors included in the FRS are: age, total cholesterol, high density cholesterol, systolic blood pressure, treatment for hypertension and cigarette smoking. FRS classifies individuals into those with 10-year risk for CAD of >20% event risk (high risk group), 10–20% event risk (intermediate risk group) and <10% event risk (low risk group). The FRS algorithm was supplemented with apolipoproteins, lipoproteins and hs-CRP and the effectiveness was measured in number needed to diagnose (NND). Total cost of diagnostic procedure was calculated on the basis of the consumed resources for diagnostic tests, labor time, and consumables. To evaluate the additional number needed to be diagnosed for successful CAD risk establishment was performed and incremental cost-effectiveness analysis. RESULTS: A diagnostic strategy employing FRS followed by apoA-I had lowest cost per additionally successfully diagnoses patient than the same strategy followed by hs-CRP in the low (2.63 vs. 24.47 euros) and intermediate risk groups (2.93 vs. 122.86 euros). In the high-risk group the diagnostic strategy employing apo A-I was the cost-effective strategy. It had a lower ICER (-9.14 euros) than the strategy employing hs-CRP (7.16 euros). CONCLUSION: Cost-effectiveness analysis of different diagnostic markers

Abstracts results in improved identification of at-risk patients at a lower health cost for society. In the clinical laboratory setting it is sufficient to determine apoA-I concentration in addition to FRS for CAD risk assessment.

PCV30 COST-EFFECTIVENESS OF CLOPIDOGREL IN MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION—A EUROPEAN MODEL BASED ON THE CLARITY AND COMMIT TRIALS: ADAPTATION TO HUNGARY

Berg J1, Odhiambo R2, Lindgren P3 1 Stockholm Health Economics, Stockholm, Sweden, 2sanofi-aventis Zrt, Budapest, Hungary, 3I3 innovus, Stockholm, Sweden OBJECTIVES: Several clinical trials have shown the added benefit of clopidogrel in reducing the risk of ischemic events in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina as well as in ST-segment elevation myocardial infarction (STEMI). The objective of our study was to evaluate the cost-effectiveness of clopidogrel in the management of patients with STEMI in Hungary. METHODS: The analysis is based on the CLARITY and COMMIT trials, which have investigated the effect of clopidogrel in patients with STEMI. A combined decision tree and Markov model was developed. Effectiveness was measured as the number of life-years gained (LYG) from clopidogrel treatment. Since existing evidence indicates similar long-term outcomes after STEMI and NSTEMI, data from the long-term NSTEMI CURE trial was combined with one-month data from CLARITY and COMMIT to model the effect of treatment up to one year. The risk of death, MI and stroke in an untreated population and long-term survival were derived from the Swedish Hospital Discharge and Cause of Death registers. The model was run separately for the two STEMI trials. A payer perspective was chosen for the analysis. Costs are reported in Hungarian Forints (HUF) at 2006 price levels. The annual discount rate was set to 5 percent. RESULTS: Treatment with clopidogrel for up to one year results in 0,086 LYG at an incremental cost of €40 (HUF 9,820) when using a patient cohort with the same characteristics and event rates as the CLARITY population. By comparison, using data from the COMMIT study, clopidogrel treatment results in 0.134 LYG at an incremental cost of €572 (HUF 140,662). The incremental cost-effectiveness ratios thus amount to €464 (HUF114,007)/ LYG and €4,281 (HUF1,052,071)/LYG, respectively. CONCLUSION: Treatment of STEMI patients with clopidogrel for up to one year is cost-effective in Hungary with predicted costeffectiveness ratios well below generally accepted thresholds (€20,000–30,000).

PCV31 LONG-TERM COST-EFFECTIVENESS OF RIMONABANT IN GERMANY

Pirk O1, Hessel F2, Kotowa W1, Hertel N1 1 IMS Health, Nuremberg, Germany, 2Sanofi-Aventis, Berlin, Germany OBJECTIVES: Obesity is associated with a high risk for diabetes type-2 (T2DM) and cardiovascular diseases. Rimonabant, the first cannabinoid-1receptor blocker, is a new therapeutic option for overweight patients with additional risk factors and obese patients. In the RIO-studies rimonabant showed significant reductions in weight and waist circumference, an improvement of HbA1c, HDL and triglycerides, when added to diet and exercise. The aim of this study was to evaluate the cost-effectiveness of rimonabant in patients with BMI ⱖ30 kg/m2 or BMI >27 kg/m2 and additional risk factors from the German SHIperspective. METHODS: The previously developed Rainbow

Abstracts model was adjusted. Diabetics and non-diabetics were analysed separately. Data on effectiveness of 12 month treatment were taken from RIO-Diabetes (overweight/obese patients with T2DM) and RIO-Europe (overweight with co-morbidities/obese patients, without T2DM), respectively. Cost data were derived from published sources for the year 2006 using €2.39 as daily costs of rimonabant. A time horizon of 40 years and a discount rate of 3% were applied. Input model data were varied plus/ minus 20% performing sensitivity analyses. RESULTS: The model shows that adding rimonabant to diet and exercise, in patients with BMI ⱖ30 kg/m2, or BMI >27 kg/m2 and additional risk factors leads to an increased life expectancy as well as an improved quality of life. Costs per LYG were €12,322 (diabetics) and €46,966 (non-diabetics). Costs per QALYG were €8,788 (diabetics) and €12,590 (non-diabetics). Considering the internationally utilized threshold of €50,000 per QALYG, the treatment with rimonabant can be assessed as cost-effective. The robustness of this result was substantiated through sensitivity analyses. CONCLUSION: Based on the results of the Rainbow model, treating patients with rimonabant in combination with diet and exercise is associated with a benefit in effectiveness at acceptable costs from a SHI-perspective, compared to a modification of lifestyle alone. PCV32 COST-EFFECTIVENESS OF IRBESARTAN IN THE TREATMENT OF PATIENTS WITH HYPERTENSION,TYPE-2 DIABETES AND RENAL DAMAGE IN MEXICO

Hernandez H1, Lepe L2, Gonzalez A3, Lemus A4, Reyes A5 1 National Medical Center, IMSS, Guadalajara, Jalisco, Mexico, 2National Medical Center, La Raza, Mexico City, D.F, Mexico, 3National Medical, Mexico City, D.F, Mexico, 4Sanofi aventis de México, Mexico City, D.F, Mexico, 5Mexican Children Hospital, Mexico City, D.F, Mexico OBJECTIVES: To perform a cost-effectiveness analysis of irbesartan for the management of nephropathy in patients with hypertension, type-2 diabetes and microalbuminuria in the Mexican scenario. METHODS: The treatment of patients was simulated with early irbesartan, 300 mg daily (initiating in the microalbuminuria stage) and late irbesartan (initiating in the stage of manifest nephropathy). These strategies were compared with a control, consisting of standard anti-hypertensive therapy. The progression of microalbuminuria to nephropathy, increase to the doubling of serum creatinine, end stage renal disease (ESRD) to death, was simulated over a temporary horizon of 20 years, using a Markov model previously published and adapted to the Mexican scenario. The transition probabilities were based in the study named Irbesartan in Reduction of Microalbuminuria-2, and the study called Irbesartan in Diabetic Nephropathy Trial, and local sources. The costs and clinical outcomes were discounted to an annual rate of 3%, and the perspective of the public health care institutions in Mexico. RESULTS: With early irbesartan there was a gain of 539.1 years of life per 1000 treated patients, and with late irbesartan there was a gain of 131.1, both compared to control. After 20 years of treatment, early irbesartan prevented 87 cases of ESRD per 1000 patients treated, and late irbesartan prevented 54, both compared to control. The cost per life-year gained with early irbesartan was €22,998.93 and the cost per year free from ESRD with late irbesartan was €11,503.94. The sensitivity analysis showed that therapy with irbesartan is still costeffective compared to conventional antihypertensive treatment after modifying various plausible assumptions. CONCLUSION: The addition of irbesartan to conventional antihypertensive therapy demonstrated an improvement in life expectancy and reduction in the years with ESRD. It represented a cost-effective

A415 option compared to control, which means greater efficiency in the treatment of hypertension patients with type-2 diabetes and microalbuminuria in Mexico.

PCV33 RESOURCE USE AND TREATMENT COSTS FOR ACUTE DECOMPENSATED HEART FAILURE: ECONOMIC ANALYSIS OF THE SURVIVE TRIAL

De Lissovoy G1, Fraeman K1, Sterz R2, Salon J3 1 United BioSource Corporation, Bethesda, MD, USA, 2Abbott GmbH & Co. KG, Ludwigshafen, Germany, 3Abbott Laboratories, Columbus, OH, USA OBJECTIVES: Acute decompensated heart failure (AHF) is lifethreatening and a frequent cause of hospitalization for older persons. The SURVIVE randomized controlled trial compared levosimendan (levo) versus dobutamine (dob) with 180-day mortality as primary endpoint. All-cause mortality at 31 days was levo 12% and dob 14% (hazard ratio 0.85, p = 0.29) with a similar differential at 180 days (HR 0.91, p = 0.40). Presented here is the SURVIVE economic analysis. METHODS: SURVIVE was conducted in Russia, Poland, France, Israel, Finland, UK, Latvia, Germany, and Austria. Enrolled patients (N = 1327) required IV inotropic support after insufficient response to IV diuretics or vasodilators. Case report forms (CRFs) documented study drug administration, inpatient days (ICU, routine care), procedures (e.g., PTCA, CABG, ICD), and safety data, during initial admission. CRFs also described subsequent admissions during follow-up. Hospital cost was calculated according to length of day and procedures. Source of cost data was national hospital payment schedules for France, Germany, and UK. Cost for levo was not included in base case analysis. Costeffectiveness analysis used average market price for levo with post-trial survival projected per published AHF methodology. RESULTS: Length of stay (days) during initial admission was identical (levo 14.4, dob 14.5, p = 0.96). During follow-up similar patterns were observed for number of hospital admissions (levo 0.7, dob 0.9, p = 0.25) and total hospital days (levo 11.5, dob 12.4, p = 0.46). Mean cost of initial hospital admission was similar (levo €5060, dob €4945, p = 0.91) as was total hospital cost for the complete trial episode (levo €5471, dob €5273, p = 0.93). Incremental cost per life year gained for levo relative to dob was less than €27,000 with greater than 50% likelihood. CONCLUSION: In SURVIVE hospital resource use and costs were similar for levo and dob. Based on the survival difference, levo is cost-effective relative to dob using accepted benchmarks.

PCV34 COST-EFFECTIVENESS OF ATORVASTATIN PLUS AMLODIPINE VERSUS ATORVASTATIN PLUS ATENOLOL IN HYPERTENSIVE PATIENTS WITHOUT PREVIOUS CORONARY HEART DISEASE, NORMAL TO MILDLY ELEVATED CHOLESTEROL LEVELS AND AT LEAST 3 CARDIOVASCULAR RISK FACTORS

F Bobadilla J1, Merikle E2, García M3, Darba J4, Sánchez C1 1 Pfizer Spain, Madrid, Spain, 2Pfizer Canada, Kirkland, ON, Canada, 3 Euroclin Institute, Madrid, Spain, 4Universitat de Barcelona, Barcelona, Spain OBJECTIVES: To assess the cost per quality-adjusted-life-year (QALY) of Atorvastatin 10 mg (ATV) + Amlodipine 5/10 mg (AML) compared with Atenolol 10 mg (ATE) + ATV, in hypertensive patients with no history of coronary heart disease (CHD) with normal to mildly elevated cholesterol and with at least 3