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Resource use in Chronic Heart Failure in the UK: A Systematic Review
A662
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6
Responses identified the highest PA rates for: PSCK9s inhibitors (alirocumab and evolocumab)= 84.62%, lomitapide= 71.1%. Classes with generic options were often in the first tier and included statins= 47.2%, triglycerides= 33.3%; fibrates= 29.4%. Combination cholesterol agents= 44.2% and cholesterol/cardiovascular combinations= 43.1% and were mostly in tier 2. While OTC fish-oil products and supplements were generally unrestricted in Medicaid plans, not covered by Commercial or Medicare plans; the prescription therapy icosapent was PA restricted by 17.3% of plans. The most common tier 2 products included ezetimibe (40.4%) followed by the bile-acid sequesterants (32.7%) of the time compared with fibrates. In addition to the cost of clinician-administration, PSCK9s will most likely be subject to a specialty copay and administered under the medical-benefit (64.3% of respondents), pharmacy-benefit (5.4%), or use the benefit based on plan-design or price-thresholds. Conclusions: As new products enter the cholesterol management market, health plans will likely impose restrictions and plan designs on new classes favoring less expensive generically available agents until real world effectiveness data becomes available. PCV142 Cardiovascular Diseases: Pharmacotherapy Utilization In Western Europe and CEE Hambalek J, Skoupa J Czech Health-Economy Society, Prague, Czech Republic
Objectives: Cardiovascular diseases are the leading cause of morbidity and mortality in Central and Eastern Europe (CEE). We compared pharmacotherapy utilization in the CEE and Western European (WE) countries, focusing on antihypertensive and lipid lowering (statin) treatments. Methods: Based on IMS 2014 data we calculated annual consumption of units/tablets per inhabitant in 27 European countries for antihypertensive treatment and % of population treated for statins. Results: Average annual consumption of antihypertensive drugs (diuretics, beta-blockers, ACI, sartans and calcium channel blockers) is 155 units in WE compared to 127 tablets in CEE. In the CEE region only 7/12 assessed countries (Hungary, Bulgaria, Czech, Slovenia, Croatia, Poland and Slovakia) reached or exceeded WE average in 2014. Among lipid lowering treatment (statins) differences between WE and CEE were more pronounced. Treatment penetration is 8.6 % in WE compared to only 2.9 % in CEE. Only Czech Republic and Slovenia reached WE average in statin consumption. Conclusions: Average consumption of antihypertensive and lipid lowering treatments differ between WE and CEE despite high burden of cardiovascular diseases in the CEE. PCV143 Resource use in Chronic Heart Failure in the UK: A Systematic Review Gielen V1, Alexopoulos S2, Hudson P3, Mitchell S3 Pharmaceuticals UK Limited, Surrey, UK, 2Novartis Pharmaceuticals UK Limited, Camberley, UK, 3DRG Abacus, Bicester, UK
1Novartis
Objectives: Estimates for the prevalence of chronic heart failure (CHF) indicate that up to 0.9 million people in the UK may be affected. The objective was to understand the resource use associated with CHF in the UK by performing a systematic review. Methods: Electronic databases (MEDLINE, EMBASE, NHS Economic Evaluation Database and Econlit) were searched in June 2015 for direct and indirect costs. Conference proceedings and reference lists of included publications were handsearched. Included studies had to report on direct costs, hospitalisations or resource use in patients with CHF in the UK; no other restrictions were applied. Results: The search for indirect costs identified no eligible publications. The direct cost search resulted in 16,024 hits. Of these, after removal of duplicates, screening abstract and title, and screening the full text, six studies (seven publications) fulfilled the eligibility criteria. Five of the identified studies were published between 1992 and 2002. Only one study was more recent (two publications, in 2013 and 2014), but focussed primarily on comorbid disease pairs and the impact of socio-economic status on the costs of emergency department use (£120/patient over three years) and hospital inpatient cost (£3,877/patient over three years). Earlier (1990/1995) data indicate that approximately 1–1.83% of the NHS budget was spent on HF. Hospital admissions are universally considered as a key cost driver associated with CHF. In a study from 1997/1998, approximately 5% of hospital admissions were due to HF. Conclusions: Data on the resource use associated with CHF are limited and largely outdated; these indicate that hospital admissions/stays are the key cost driver and that the costs of CHF to the National Health Service (NHS) are likely to be substantial. Additional research is needed to determine the current resource use associated with CHF and cost implication of this to the NHS. PCV144 Novel Oral Anticoagulants in the UK and France: Comparative Assessment of Costs of Prescriptions Dispensed in the Non-Hospital Setting Montilva J, Silva M, Xue Y, Degun R Navigant Consulting, London, UK
Objectives: To assess and compare the expenditure on novel oral anticoagulants (NOACs) in the non-hospital setting, in England and France. Methods: Nonsystematic review of publically available health authority websites and peer review journals. Prescription costs data, from 2012-2015, were obtained and analyzed for England from the Health and Social Care Information Centre Prescription Cost Analysis for England reports, and for France from the Assurance Maladie Medic’AM reports. Results: In the UK, clinical objections raised by prescribers have limited NOAC uptake in the past; however, between 2012-2015 the costs associated to non-hospital dispensed prescriptions for the three main NOACs, rivaroxaban, apixaban and dabigatran, increased from £3,7M in 2012 to £144,2M in 2015, showing a considerable increase in expenditure, mostly due to the increase in rivaroxaban and apixaban prescription. This can be partly attributed to the issue of NICE guidance favoring the use of NOACs in non-valvular atrial fibrillation and efforts to
implement NICE recommendations. Similar results have been observed in France, where costs associated to NOAC prescriptions dispensed in the non-hospital setting have increased from € 56.3M in 2012 to € 309,8M in 2015. In response to increasing NOAC prescription, the ANSM and Assurance Maladie consider there is a need for increased vigilance in their use. These findings highlight the considerable increase in NOAC prescriptions and costs in both England and France, and should inform future policy efforts to encourage adequate use of NOACs in order to control increasing expenditure. Conclusions: Between 2012 and 2015, there was a considerable increase in NOAC drug expenditures from prescriptions dispensed in the non-hospital setting, in both England and France, which suggests that policies aimed at incentivizing NOAC prescriptions have been effective, but should further factor in the increasing economic impact of these treatments. PCV145 Programme Budgeting Marginal Analysis for the Real World: The ‘Prudent Pbma’ Anderson P1, Mitchell K2 1Swansea University, Swansea, UK, 2Abertawe Bro Morgannwg Local Health Board, Swansea, UK
Objectives: Programme Budgeting Marginal Analysis (PBMA) is framework that accommodates economic analysis, multi-stakeholder inputs, values, needs and perspectives within the one framework – balancing health services, outcomes and budgets to optimise use of limited resources. In Wales PBMA aligns with ‘Prudent Healthcare’ and the need for informed resource reallocation. A Welsh Health Board (HB) had challenges providing and funding anticoagulation services for people with Atrial Fibrillation (AF) within a fixed budget, which provided the context for this research, which involved the implementation of PBMA process along with a process evaluation to assess its replicability and utility for future use. Methods: The PBMA was based on a synthesis of the literature and consideration of the criteria for successful PBMAs (Tsourapas, 2011). A HB project team and stakeholder community supported PBMA delivery. Results: The costs of the service were challenging to define and determine but eventually were ascertained to a reasonable extent. A NICE costing model enabled some estimates of the impact of an ageing population, AF prevalence and stroke rates, changes in use of anticoagulants, monitoring requirements, potential to generate hypothetical ‘savings’ and reduction in stroke rates related to improved anticoagulation. The NICE model was restrictive/password protected and frustrating to use. The PBMA outcomes suggested some modest service reorganisation and quality improvement could be made within budget, but no substantial improvement/expansion of services could be undertaken as it would exceed the available budget. The HB commissioning team found the information from the PBMA ‘journey’ as useful as much as the recommendations. The process of undertaking the pilot enabled a PBMA framework – RADAR - for the HB to be created and available for future exercises. Conclusions: A ‘lean’ PBMA framework for the time-poor environment of the HB is possible, indeed essential, to operationalise realworld resource reallocation in healthcare commissioning and delivery environment. PCV146 The Impact of Economic Crisis on Drug Consumption and Pharmaceutical Expenditure in Greece Giannakou A, Kani C, Peppou L, Economou M, Souliotis K University of Peloponnese, Corinth, Greece
Objectives: The financial crisis has greatly affected the drug market in Greece. Pharmaceutical expenditure includes only drugs that are provided through all the pharmacies of the country and are used for non-hospital patients. The aim of this study was to analyze the effects of the economic crisis on the consumption of drugs and the pharmaceutical expenditure, giving special emphasis on expenditure incurred by the consumption of cardiovascular drugs and antidepressants, since cardiovascular diseases and mental disorders have increased during the years of crisis. Methods: Data were obtained from the database of the National Organization for Healthcare Provision, analyzing the prescriptions and the expenditure of these therapeutic categories in the years 2012-2014, while there were no information about patients’ gender and age. Pivot tables and graphs were drawn to present the results per year and therapeutic area. Results: The results showed that the prescription of brand-name drugs on and off patent seems to dominate in the pharmaceutical market in Greece. During 2013 and 2014 the prescription of generics seems to increase for cardiovascular diseases (2,2%) and for depression (5,35%). The amount of prescriptions, that means and the amount of drug consumption, during these years has not changed, while there is a reduction in the expenditure. Conclusions: Pharmaceutical expenditure is being reduced mainly because of increasing the participation in brand-name drugs and non taking medication by economically weak patients, although the use of generic drugs effectively reduces public pharmaceutical expenditure. The economic crisis may affect the pharmaceutical expenditure mainly by reducing drug prices and less on reducing drug consumption. Further research is needed to evaluate the economic impact of different therapeutic approaches in order to provide implements that can lead to cost-effective therapeutic options while maintaining high-quality care. PCV147 Age and Gender Specific Trends in Acute Inpatient Stroke Incidence in Germany Beinhauer I1, Huelsebeck M1, Dintsios C2 GmbH, Leverkusen, Germany, 2Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
1Bayer Vital
Objectives: Aim of the analysis is to describe trends in acute in-patient stroke incidence in Germany and to contextualize these trends and potential reasons. Methods: The diagnoses of hospital in-patients statistics for 2010-2014, published by the Federal Statistical Office, are analyzed. The principal diagnoses subarachnoid hemorrhage (I60), intracerebral hemorrhage (I61), cerebral infarction (I63) and stroke of unspecified type (I64) are considered. The absolute number of cases and directly standardized rates based on the residential population of 2010, stratified by gender and age, are
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6
Responses identified the highest PA rates for: PSCK9s inhibitors (alirocumab and evolocumab)= 84.62%, lomitapide= 71.1%. Classes with generic options were often in the first tier and included statins= 47.2%, triglycerides= 33.3%; fibrates= 29.4%. Combination cholesterol agents= 44.2% and cholesterol/cardiovascular combinations= 43.1% and were mostly in tier 2. While OTC fish-oil products and supplements were generally unrestricted in Medicaid plans, not covered by Commercial or Medicare plans; the prescription therapy icosapent was PA restricted by 17.3% of plans. The most common tier 2 products included ezetimibe (40.4%) followed by the bile-acid sequesterants (32.7%) of the time compared with fibrates. In addition to the cost of clinician-administration, PSCK9s will most likely be subject to a specialty copay and administered under the medical-benefit (64.3% of respondents), pharmacy-benefit (5.4%), or use the benefit based on plan-design or price-thresholds. Conclusions: As new products enter the cholesterol management market, health plans will likely impose restrictions and plan designs on new classes favoring less expensive generically available agents until real world effectiveness data becomes available. PCV142 Cardiovascular Diseases: Pharmacotherapy Utilization In Western Europe and CEE Hambalek J, Skoupa J Czech Health-Economy Society, Prague, Czech Republic
Objectives: Cardiovascular diseases are the leading cause of morbidity and mortality in Central and Eastern Europe (CEE). We compared pharmacotherapy utilization in the CEE and Western European (WE) countries, focusing on antihypertensive and lipid lowering (statin) treatments. Methods: Based on IMS 2014 data we calculated annual consumption of units/tablets per inhabitant in 27 European countries for antihypertensive treatment and % of population treated for statins. Results: Average annual consumption of antihypertensive drugs (diuretics, beta-blockers, ACI, sartans and calcium channel blockers) is 155 units in WE compared to 127 tablets in CEE. In the CEE region only 7/12 assessed countries (Hungary, Bulgaria, Czech, Slovenia, Croatia, Poland and Slovakia) reached or exceeded WE average in 2014. Among lipid lowering treatment (statins) differences between WE and CEE were more pronounced. Treatment penetration is 8.6 % in WE compared to only 2.9 % in CEE. Only Czech Republic and Slovenia reached WE average in statin consumption. Conclusions: Average consumption of antihypertensive and lipid lowering treatments differ between WE and CEE despite high burden of cardiovascular diseases in the CEE. PCV143 Resource use in Chronic Heart Failure in the UK: A Systematic Review Gielen V1, Alexopoulos S2, Hudson P3, Mitchell S3 Pharmaceuticals UK Limited, Surrey, UK, 2Novartis Pharmaceuticals UK Limited, Camberley, UK, 3DRG Abacus, Bicester, UK
1Novartis
Objectives: Estimates for the prevalence of chronic heart failure (CHF) indicate that up to 0.9 million people in the UK may be affected. The objective was to understand the resource use associated with CHF in the UK by performing a systematic review. Methods: Electronic databases (MEDLINE, EMBASE, NHS Economic Evaluation Database and Econlit) were searched in June 2015 for direct and indirect costs. Conference proceedings and reference lists of included publications were handsearched. Included studies had to report on direct costs, hospitalisations or resource use in patients with CHF in the UK; no other restrictions were applied. Results: The search for indirect costs identified no eligible publications. The direct cost search resulted in 16,024 hits. Of these, after removal of duplicates, screening abstract and title, and screening the full text, six studies (seven publications) fulfilled the eligibility criteria. Five of the identified studies were published between 1992 and 2002. Only one study was more recent (two publications, in 2013 and 2014), but focussed primarily on comorbid disease pairs and the impact of socio-economic status on the costs of emergency department use (£120/patient over three years) and hospital inpatient cost (£3,877/patient over three years). Earlier (1990/1995) data indicate that approximately 1–1.83% of the NHS budget was spent on HF. Hospital admissions are universally considered as a key cost driver associated with CHF. In a study from 1997/1998, approximately 5% of hospital admissions were due to HF. Conclusions: Data on the resource use associated with CHF are limited and largely outdated; these indicate that hospital admissions/stays are the key cost driver and that the costs of CHF to the National Health Service (NHS) are likely to be substantial. Additional research is needed to determine the current resource use associated with CHF and cost implication of this to the NHS. PCV144 Novel Oral Anticoagulants in the UK and France: Comparative Assessment of Costs of Prescriptions Dispensed in the Non-Hospital Setting Montilva J, Silva M, Xue Y, Degun R Navigant Consulting, London, UK
Objectives: To assess and compare the expenditure on novel oral anticoagulants (NOACs) in the non-hospital setting, in England and France. Methods: Nonsystematic review of publically available health authority websites and peer review journals. Prescription costs data, from 2012-2015, were obtained and analyzed for England from the Health and Social Care Information Centre Prescription Cost Analysis for England reports, and for France from the Assurance Maladie Medic’AM reports. Results: In the UK, clinical objections raised by prescribers have limited NOAC uptake in the past; however, between 2012-2015 the costs associated to non-hospital dispensed prescriptions for the three main NOACs, rivaroxaban, apixaban and dabigatran, increased from £3,7M in 2012 to £144,2M in 2015, showing a considerable increase in expenditure, mostly due to the increase in rivaroxaban and apixaban prescription. This can be partly attributed to the issue of NICE guidance favoring the use of NOACs in non-valvular atrial fibrillation and efforts to
implement NICE recommendations. Similar results have been observed in France, where costs associated to NOAC prescriptions dispensed in the non-hospital setting have increased from € 56.3M in 2012 to € 309,8M in 2015. In response to increasing NOAC prescription, the ANSM and Assurance Maladie consider there is a need for increased vigilance in their use. These findings highlight the considerable increase in NOAC prescriptions and costs in both England and France, and should inform future policy efforts to encourage adequate use of NOACs in order to control increasing expenditure. Conclusions: Between 2012 and 2015, there was a considerable increase in NOAC drug expenditures from prescriptions dispensed in the non-hospital setting, in both England and France, which suggests that policies aimed at incentivizing NOAC prescriptions have been effective, but should further factor in the increasing economic impact of these treatments. PCV145 Programme Budgeting Marginal Analysis for the Real World: The ‘Prudent Pbma’ Anderson P1, Mitchell K2 1Swansea University, Swansea, UK, 2Abertawe Bro Morgannwg Local Health Board, Swansea, UK
Objectives: Programme Budgeting Marginal Analysis (PBMA) is framework that accommodates economic analysis, multi-stakeholder inputs, values, needs and perspectives within the one framework – balancing health services, outcomes and budgets to optimise use of limited resources. In Wales PBMA aligns with ‘Prudent Healthcare’ and the need for informed resource reallocation. A Welsh Health Board (HB) had challenges providing and funding anticoagulation services for people with Atrial Fibrillation (AF) within a fixed budget, which provided the context for this research, which involved the implementation of PBMA process along with a process evaluation to assess its replicability and utility for future use. Methods: The PBMA was based on a synthesis of the literature and consideration of the criteria for successful PBMAs (Tsourapas, 2011). A HB project team and stakeholder community supported PBMA delivery. Results: The costs of the service were challenging to define and determine but eventually were ascertained to a reasonable extent. A NICE costing model enabled some estimates of the impact of an ageing population, AF prevalence and stroke rates, changes in use of anticoagulants, monitoring requirements, potential to generate hypothetical ‘savings’ and reduction in stroke rates related to improved anticoagulation. The NICE model was restrictive/password protected and frustrating to use. The PBMA outcomes suggested some modest service reorganisation and quality improvement could be made within budget, but no substantial improvement/expansion of services could be undertaken as it would exceed the available budget. The HB commissioning team found the information from the PBMA ‘journey’ as useful as much as the recommendations. The process of undertaking the pilot enabled a PBMA framework – RADAR - for the HB to be created and available for future exercises. Conclusions: A ‘lean’ PBMA framework for the time-poor environment of the HB is possible, indeed essential, to operationalise realworld resource reallocation in healthcare commissioning and delivery environment. PCV146 The Impact of Economic Crisis on Drug Consumption and Pharmaceutical Expenditure in Greece Giannakou A, Kani C, Peppou L, Economou M, Souliotis K University of Peloponnese, Corinth, Greece
Objectives: The financial crisis has greatly affected the drug market in Greece. Pharmaceutical expenditure includes only drugs that are provided through all the pharmacies of the country and are used for non-hospital patients. The aim of this study was to analyze the effects of the economic crisis on the consumption of drugs and the pharmaceutical expenditure, giving special emphasis on expenditure incurred by the consumption of cardiovascular drugs and antidepressants, since cardiovascular diseases and mental disorders have increased during the years of crisis. Methods: Data were obtained from the database of the National Organization for Healthcare Provision, analyzing the prescriptions and the expenditure of these therapeutic categories in the years 2012-2014, while there were no information about patients’ gender and age. Pivot tables and graphs were drawn to present the results per year and therapeutic area. Results: The results showed that the prescription of brand-name drugs on and off patent seems to dominate in the pharmaceutical market in Greece. During 2013 and 2014 the prescription of generics seems to increase for cardiovascular diseases (2,2%) and for depression (5,35%). The amount of prescriptions, that means and the amount of drug consumption, during these years has not changed, while there is a reduction in the expenditure. Conclusions: Pharmaceutical expenditure is being reduced mainly because of increasing the participation in brand-name drugs and non taking medication by economically weak patients, although the use of generic drugs effectively reduces public pharmaceutical expenditure. The economic crisis may affect the pharmaceutical expenditure mainly by reducing drug prices and less on reducing drug consumption. Further research is needed to evaluate the economic impact of different therapeutic approaches in order to provide implements that can lead to cost-effective therapeutic options while maintaining high-quality care. PCV147 Age and Gender Specific Trends in Acute Inpatient Stroke Incidence in Germany Beinhauer I1, Huelsebeck M1, Dintsios C2 GmbH, Leverkusen, Germany, 2Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
1Bayer Vital
Objectives: Aim of the analysis is to describe trends in acute in-patient stroke incidence in Germany and to contextualize these trends and potential reasons. Methods: The diagnoses of hospital in-patients statistics for 2010-2014, published by the Federal Statistical Office, are analyzed. The principal diagnoses subarachnoid hemorrhage (I60), intracerebral hemorrhage (I61), cerebral infarction (I63) and stroke of unspecified type (I64) are considered. The absolute number of cases and directly standardized rates based on the residential population of 2010, stratified by gender and age, are