Valsartan In The Treatment Of Heart Failure In Colombia

VA L U E I N H E A LT H

PCV69 A Business Case For Stroke Reduction Initiatives In Atrial Fibrillation: 3-Year Financial Projections For Three UK Regions Orlowski A1, Jamieson T2, Belsey J3, Slater R1, Macdonald J4 1Imperial College Health Partners, London, UK, 2Yorkshire & Humber Academic Health Science Network, Wakefield, UK, 3JB Medical Ltd, Sudbury, UK, 4Greater Manchester Academic Health Science Network, Manchester, UK

Objectives: Atrial Fibrillation (AF) is a common and treatable risk factor for ischaemic stroke and vascular dementia with rising incidence. Oral anticoagulation (OAC) therapy is a well-evidenced way to prevent AF-related strokes, as supported by NICE Clinical Guidelines (CG180, 2014).  Methods: In March 2017 the Academic Health Science Network (AHSN) launched the AF Business Case Model using publicly-reported practice-level data to help Clinical Commissioning Group (CCGs) across England identify specific areas for improving four key gaps in the diagnosis and management of AF. The cost-impact analysis identified the most cost efficient way to increase OAC therapy in order to reduce the risk of stroke, and generates a ‘business case report’ to facilitate local decision-making.  Results: The business case analysis for three regions in England reveals the net cost impact of a 12-month programme to close gaps in AF management. The 3-year net savings, based on combined health and social care costs, were as follows: Yorkshire and the Humber AHSN (101,788 patients on AF register): Identifying undiagnosed AF: £21,469,047; Assessing AF stroke risk: £8,191,236; Initiating OAC in eligible patients: £25,008,659; and Perfecting OAC: £27,134,561. Imperial College Health Partners, North West London (patients on AF register: 23,551): Identifying undiagnosed AF: £9,326,444; Assessing AF stroke risk: £2,393,238; Initiating OAC in eligible patients: £7,176,131; and Perfecting OAC: £5,967,191. Greater Manchester AHSN (patients on AF register: 49, 617): Identifying undiagnosed AF: £10,716,832; Assessing AF stroke risk: £3,655,502; Initiating OAC in eligible patients: £10,997,216; and Perfecting OAC: £12,813,309.  Conclusions: The AF Care Pathway Business Case Model helps define local healthcare investment priorities along the AF management pathway to achieve long-term cost savings and improvements in clinical outcomes. Initiating and perfecting inadequate OAC in currently diagnosed, eligible patients would achieve the greatest combined cost saving in all three regions reviewed in this cost-impact analysis. PCV70 Modelling The Societal Impact Of Alirocumab In Patients With Severe Hypercholesterolemia Treated With Apheresis In Germany Himmler S1, Mueller M1, Dippel F2, Art J2, Ostwald D1 GmbH, Darmstadt, Germany, 2Sanofi Deutschland GmbH, Berlin, Germany

1WifOR

Objectives: Patients with severe hypercholesterolemia are at high risk of cardiovascular events. Many of them do not achieve recommended LDL-C target levels by maximal lipid lowering therapy and therefore have to undergo apheresis. This study was designed to estimate the long-term productivity gains and cost effects which come along by replacing apheresis treatments with alirocumab.  Methods: A Markov model with 3-month cycles was developed to estimate the number of apheresis treatments which can be avoided over 6 years using alirocumab. The results of the ODYSSEY ESCAPE trial (NCT 02326220) were used to evaluate the effect of alirocumab on the frequency of apheresis treatments (in the trial 63.4% of patients on alirocumab avoided all and 92.7% avoided at least half of the apheresis treatments). To estimate the population wide reductions in apheresis treatments from 2017 to 2022, an open cohort population model was built. Avoided treatments were linked to productivity, through the average amount of time, patients spent on one apheresis treatment. Employment data and Time Use Surveys were used to allocate the total amount of lost time to paid and unpaid work activities. Paid work was valued according to average wages, unpaid work according to the proxy good approach. In addition, indirect and induced economic effects, resulting from additional productivity were looked at. Furthermore, the cost effects of the use of alirocumab in German apheresis patients were estimated using current prices.  Results: In a small population of 600-900 patients, 173,059 apheresis treatments could be avoided due to alirocumab in Germany within six years, corresponding to € 89 million in productivity gains and €  150 million of cost savings for the statutory health insurance (SHI).  Conclusions: Replacing costly and time consuming apheresis treatments with alirocumab in patients with severe hypercholesterolemia leads to significant productivity gains and cost savings for the SHI. PCV71 One Year Cost Of Ischemic Stroke And Intracranial Hemorrage According To Disability For Atrial Fibrillation Patients In France de Pouvourville G1, Karam P2, Giroud M3, Le Dissez C4, Luciani L5, Le Lay K4 Business School, Cergy-Pontoise, France, 2PKCS, LE VAL SAINT PERE, France, 3University Hospital of Dijon, Dijon, France, 4Boehringer Ingelheim France, Paris, France, 5Boehringer-Ingeleheim France, Paris, France

20 (2017) A399–A811

A613

disability. Costs of initial stays were €  8,353 €  for patients who died, €  6,108, €  7,708, €  7,908 according to disability for ischemic strokes. Costs for intracranial hemorrhages were respectively € 7,307 for patients who died, €  7,627, €  9,654 and €  8,863 according to disability. One year costs for survivors according to disability levels were €  7 277, €  30,293 and €  19,508 for ischemic strokes, out of which rehabilitation accounted for 2.2%, 61.7% and 48.0%. One year costs for intracranial hemorrhages were €  9,628, €  33,610 and €  21,986, amongst which rehabilitation weighted 2.1%, 54.9% and 42.6%.  Conclusions: Disability and rehabilitation drive one-year costs for AF patients who experience intra-cerebral events. PCV72 Cost-Effectiveness Of Sacubitril/Valsartan In The Treatment Of Heart Failure In Colombia Lacey M1, Brouillette M1, Karpf E2, Lenhart G1, Barbeau M3, Russell M1 Health Analytics, an IBM company, Cambridge, MA, USA, 2Novartis Colombia, Bogota, Colombia, 3Novartis Pharmaceuticals Canada Inc., Dorval, QC, Canada 1Truven

Objectives: To analyze the cost-effectiveness of sacubitril/valsartan versus usual care in heart failure with reduced ejection fraction (HFrEF) for patients classified as New York Heart Association (NYHA) Class II-IV, in Colombia.  Methods: Previously developed UK cost-effectiveness model based on PARADIGM-HF (McMurray, 2014) trial was adapted to Colombia using the Latin-American trial subgroup (N= 1,433) and Colombia-specific epidemiologic and economic data to assess the impact of sacubitril/valsartan versus usual care (ACEi). A (Markov) cost-utility model structured as a regression-based cohort model with one-month cycling was utilized to examine a hypothetical cohort of HFrEF patients receiving therapy. Clinical outcomes included mortality, hospitalization, and adverse events. Quality-adjusted-life years (QALY) were derived from the trial. Costs (2015 COP$) include drug, hospitalization and resource use. Primary outcome was cost-utility (cost/QALY gained) over a 30-year time horizon. Sensitivity analyses were performed.  Results: Basecase results suggest that compared with an ACEi, sacubitril/valsartan is associated with incremental costs of COP$16.6 million and 0.50 QALYs gained, resulting in an incremental cost-effectiveness ratio of COP$32.4 million per QALY gained. Increased costs of pharmacological therapy were offset by reductions in hospitalization costs. All-cause– and CV-related mortality are projected to be reduced at all time points. Expected survival is estimated to increase from 7.20 years for those receiving an ACEi to 8.11 years for a cohort of patients receiving sacubitril/valsartan. Overall, results were not sensitive to changes in model parameters; results were most sensitive to parameters used to estimate CV mortality and duration of treatment effect.  Conclusions: The Colombia-adapted model estimates suggest that sacubitril/valsartan represents a cost-effective intervention in the treatment of HFrEF (NYHA Class II-IV) versus an ACEi, assuming a willingness-to-pay threshold of 3 times the 2015 per capita GDP in Colombia (COP$52.4 million). Consequently, sacubitril/valsartan represents reasonable value compared with other commonly accepted health care interventions. PCV73 Cost-Effectiveness Of Radiofrequency Catheter Ablation Of Atrial Fibrillation Based On Real-World Data: Manual Or Robotic?” Diaz R1, Nuñez J2, Aldea F1, Hidalgo A3, Barrio T4, Almendral J4 1Fundacion de Investigacion HM Hospitales, madrid, Spain, 2Fundacion de Investigacion HM Hospitales, Madrid, Spain, 3University of Castilla-La Mancha, Toledo, Spain, 4Centro Integral de Enfermedades Cardiovasculares, HM Hospitales, madrid, Spain

Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia, associated with significant mortality and morbidity and thus a relevant socioeconomic impact. The purpose is to outline the general overview of manual and robotic navigation techniques for radiofrequency catheter ablation (RFA) of AF from a costeffectiveness point of view with hospital perspective.  Methods: The analysis of the different techniques has been conducted through a cost-effectiveness study facing two manual and one robotic technique to obtain the RFA as the definitive treatment of AF. The study has used a decision-tree model for patients with AF based on a real world data database consisting of 688 registries with records from 2005 to 2015, all of them with a 1-year follow-up. The cost of each RFA technique was calculated from daily costs procedures of HM Hospitales.  Results: After the 1-year follow-up from the first RFA treatment, the use of steerable sheath is always cost-effective. The associated ICER of the robotic navigation system is 21,461.35 €  per additional percentage point of success in RFA procedure versus the use of non-steerable sheath.  Conclusions: The results of the cost-effectiveness analysis shows the advantages of the steerable sheath versus other RFA techniques in order to treat atrial fibrillation. The robotic navigation system is not cost-effective versus steerable sheath although it achieves similar success rates.

1ESSEC

Objectives: Patients with atrial fibrillation (AF) are at high risk of cerebral thromboembolic and hemorrhagic events, with potential residual disability. The aim of this research was to estimate the one-year costs of these events in the French context.  Methods: A retrospective analysis of the French National Hospital Discharge Abstract database was performed for years 2013-2015. AF patients hospitalized for either an ischemic stroke, a hemorrhagic stroke or an intracranial hemorrhage with an identified diagnosis of FA or a previous hospitalization for AF were followed during one year. Readmissions to acute care, admissions and stays in rehabilitation centers were identified per patient. Data were matched with Dijon registry data to identify patients according to their Modified Rankin Score at discharge, reclassified in “no disability”=  Rankin 0-1, “slight to moderate disability”=  Rankin 2 to 4, “severe disability” =  Rankin 5. Costs were documented using the French National Cost Survey.  Results: 20,625 stays for ischemic strokes, and 4,647 intracranial hemorrhages were identified. In-hospital mortality was respectively 14.3% and 34.2 %. Respectively 50.2% and 56.5% of surviving patients had no disability, 35.2% and 30.3% had a slight to moderate disability, and 14.6% and 13.2% a severe

PCV74 Cost-Effectiveness Of Ivabradine In The Treatment Of Chronic Heart Failure From The Mexican Perspective Constanzo AE1, Rodriguez-Mendoza MM2, Sanchez-Trejo K2 1SERVIER, Mexico City, Mexico, 2Independet consultant, Mexico, Mexico

Objectives: To assess the cost-effectiveness of ivabradine for the treatment of chronic heart failure as an adjuvant to the standard therapy in patients with systolic dysfunction, NYHA class II to IV, with sinus rhythm, heart rate ≥  75 bpm. The study was conducted in comparison with standard therapy alone, from the perspective of public health institutions in Mexico.  Methods: A Markov model was developed with 8 health states. The model cycles were 3 months and the time horizon was 2 years, and extrapolated to 5 years. The costs of hospitalization and standard therapy were obtained from government sources. The transition probabilities to the 1st hospitalization state and death state were obtained from the sub-analysis of SHIFT study (Böhm, y otros, 2013), second and third hospitalization states were taken from another sub-analysis (Borer, y otros, 2012) The main effectiveness outcome were life-years gained (LYG). incremental cost effectiveness ratio (ICER) per LYG was calculated to compare the treatments.  Results: Over a 2-year time horizon,