A Time Series Analysis of Social Insurance and Patient Costs of Reimbursed Medical AIDS in Hungary

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a decision-analytic model assessed that the CER of four types of SEDs ranged from $1,269 to $13,943 per injury avoided, and using SEDs would not produce cost savings for hospitals.  Conclusions: Studies in most countries showed that using SEDs was cost saving. Chinese specific studies need to evaluate the value of SEDs. PMD113 A Time Series Analysis of Social Insurance and Patient Costs of Reimbursed Medical AIDS in Hungary Takacs G National Institute of Pharmacy and Nutrition, Budapest, Hungary

Objectives: The goal was to analyse changes in the nominal and real value of the social insurance and patient costs of reimbursed medical aids. (In Hungary, medical aids are medical devices and products used independently by patients, eg. hearing aids, wheelchairs, bandages.)  Methods: A time series dataset was created based on the publicly available annual data of the National Health Insurance Fund on the reimbursed sales of medical aids in Hungary between 2005-2015. Based on the created time series, an analysis was carried out comparing 2015 data to that of years 2005 and onwards. Reimbursement and patient contribution costs were analysed in aggregates and in a breakdown by main ISO groups. The changes in costs were compared to consumer price indices (CPI) published by the Hungarian Central Statistical Office.  Results: Between 2005-2015, reimbursement expenditures increased by 40.0% and patient contribution costs by 46.7%. Based on the CPIs, this equals a 3.4% and a 1.2% real value increase, respectively. The largest annual rise in the real value of the analysed costs was between 2013-2015. For this period, the total of these costs increased from 60.7 million HUF to 69.8 million HUF. Reimbursement and patient contribution costs increased in real value by 14.5% and 19.5%, respectively. The most substantial growth rates are from ISO groups 02 (bandages), 06 (ortheses and prostheses) and 21 (hearing aids, electrolarynges and optical aids), for both reimbursements and patient contributions.  Conclusions: Based on the analysis, social insurance and patient contribution costs of medical aids have increased considerably in real value between 2013-2015. For both health insurance and patient contribution costs, further research is necessary to determine the extent to which possible changes in sales volume and prices induced the growth of costs, and whether the quality of patient medical aid provision increased simultaneously. PMD114 A Modeled Health Economic Analysis of the Accucath® Intravenous Catheter System with Retractable Coiled Tip Guidewire Compared with Conventional Peripheral Intravenous Catheters Kara R1, Hollmann S2, Ferko N2, Delatore P3 Systems, Salt Lake City, UT, USA, 2Cornerstone Research Group Inc., Burlington, ON, Canada, 3CR Bard Inc., Murray Hill, NJ, USA

1Bard Access

Objectives: AccuCath® Catheters are an innovative guidewire and catheter combination designed to increase first-attempt success. A health economic model was developed from a U.S. hospital perspective to compare the costs associated with increased adoption of AccuCath® Catheter versus conventional peripheral intravenous catheters (PIVC).  Methods: The model was built to compare current care, assuming a mix of conventional PIVCs (98%) and AccuCath® Catheter (2%), to a future scenario with increased utilization of AccuCath® Catheter, assuming 90% conventional PIVCs and 10% AccuCath® Catheter. The analysis was conducted for a hypothetical annual cohort of 30,000 patients with an average hospital length of stay (LOS) of 4.5 days. The analysis was stratified by two populations: 1) all patients requiring PIVC placement (i.e., approximately 70% of patients admitted annually), and 2) a subgroup of patients requiring a PIVC placement who have difficult venous access (i.e., approximately 36% of patients requiring PIVC placement). Model parameters included the number of devices and nursing time required per successful insertion, dwell time, complication rates, medical device unit costs, and material costs associated management of complications. Model inputs were derived from published literature where possible.  Results: For a center with 30,000 patients admitted annually, the potential one-year cost savings in the future scenario with increased use of AccuCath® Catheter may be up to $244,308 for all patients requiring PIVC placement (n= 21,000; $11.63 per patient) and up to $92,238 when considering only patients with difficult venous access (n= 7,560; $12.20 per patient). Overall, patients treated with AccuCath® Catheter may receive less insertions over the course of their LOS when compared with conventional PIVCs. The results were robust to a number of sensitivity analyses.  Conclusions: These analyses suggest that from a U.S. hospital perspective, the use of AccuCath® Catheter may be costsavings when compared with conventional PIVC. PMD115 The Situate Detection System - A Cost-Effective Approach to Preventing Retained Surgical Sponges Leinwand B, Hughes KE Avalere Health LLC, Washington, DC, USA

Objectives: Estimate the cost-effectiveness of utilizing the SituateTM radiofrequency (RF) Detection System plus manual tracking of surgical sponges versus manual tracking alone, to prevent the incidence of retained surgical sponges (RSS).  Methods: We developed a one-year decision analytic model to assess the clinical and economic impacts of utilizing SituateTM Detection System to prevent RSS in a surgical facility performing 10,000 surgeries annually, using inputs from literature and clinical expert opinion. We estimated the incremental costs per RSS avoided by modeling the following parameters: counting discrepancy rates; diagnostic performance of SituateTM Detection System, manual counting, and intraoperative radiographs; time associated with searching inside/outside the surgical field and waiting for/reading radiographs; and cost of operating room (OR) time, radiographs, RF-tagged sponges and SituateTM Detection System wand covers, and infections, unreimbursed procedure, and legal costs associated with RSS. Model parameters were varied through one-way sensitivity and scenario analyses to test the robustness of model results.  Results: Under base case assumptions, SituateTM

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Detection System dominated manual counting alone by preventing 2 additional RSS while resulting in $620,789 fewer costs. Cost reductions were due to the efficiencies gained by using the device, lower utilization of radiographs, and fewer medical/legal costs resulting from RSS. Model results were robust to the sensitivity analyses. Even with legal costs removed from the model, which was by far the greatest cost, to conservatively reflect an ex-U.S. medical malpractice landscape, SituateTM Detection System still reduced costs by $65,448 and continued to dominate manual counting.  Conclusions: The implications of RSS can be both clinically and economically significant for patients and healthcare facilities, and the literature suggests that standard manual counting is not optimal in preventing RSS. Our model suggests that, even using conservative estimates, SituateTM Detection System can avert medical and legal costs, decrease unproductive OR time, and most importantly, more effectively prevent RSS. PMD116 Is Big Data in Healthcare about Big Hope or Big Hype? Early Health Technology Assessment of Big Data Analytics in Healthcare Bakker LJ1, Aarts J2, Redekop WK3 for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands, 2University at Buffalo, Buffalo, NY, USA, 3Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands 1institute

Objectives: Popular media and the scientific literature frequently point to Big Data analytics as an excellent way to improve health outcomes and reduce healthcare costs. The question is, can it really deliver? This study used early health technology assessment (HTA) methodologies to assess Big Data (BD) analytics in healthcare.  Methods: Interviews were conducted with clinicians in three different areas (chronic lymphocytic leukaemia, diabetes and intensive care) to identify potential applications of BD analytics. The potential health and economic impact of each application was then estimated using existing HTA methodologies (including decision tree modelling).  Results: The generic nature of BD analytics complicates development and clarification of the scope. Therefore, several critical requirements should be considered besides existing HTA methodologies. These requirements are: the clinical value of the BD analytics application, the technical feasibility, and the availability of data. Case studies revealed that the most common obstacle hampering further development of BD analytics for use in a particular application was insufficient data. Estimates of the potential impact of BD analytics on health gains or cost-savings requires a combination of ‘Big Data’ (e.g., genetics data) with other data (e.g., long-term survival).  Conclusions: BD analytics is unlikely to change clinical decision-making on its own. Certain requirements are essential to ensure that it is not viewed as a big hype that does not deliver on its promises. First, clinicians must identify shortcomings in care. Second, it is essential to consider whether the available data is sufficient to enable BD analytics to achieve its potential. Early HTA can also help BD analytics to meet its potential since it can estimate the potential health and economic benefits before all the work is done. PMD117 Perioperative Therapies Reducing Homologous Transfusions During Cardiovascular Surgery: A Network Meta-Analysis of Randomized Controlled Trials Pradelli L1, Povero M1, Myers G2 1AdRes Srl, Torino, Italy, 2Eastern Perfusion International, Dartmouth, NS, Canada

Objectives: Determine the most effective therapy or combination of therapies minimizing homologous blood consumption during the entire perioperative period while maximizing post-operative patient outcome.  Methods: Evidences of the Australian Patient Blood Management Guidelines up to July 2009 were integrated with a systematic review of the literature between July 2009 and July 2015 on Randomized Controlled Trials (RCTs) via PubMed. Investigated outcomes were post-operative (PO) hemoglobin (Hb), transfusion rate (TR) and total number of transfused packed red blood cells (PRBCs). A random effect model with hierarchic structure was coded in WinBUGS, TR was modeled on the logit scale while continuous variables (PO Hb and mean number of PRBCs transfused) using a normal likelihood.  Results: A total of 86 RCTs were selected, comparing 48 different active strategies that were grouped into five broad categories: [1] auto-transfusion (AT) of processed blood through the use of either centrifugal cell washing (CS), or intraoperative blood processed using only an UltraFiltration device (UF), or unprocessed/unwashed blood (noCS); [2] administration of antifibrinolytics (AA); [3] the combined use of auto-transfusion and antifibrinolytics (AT+AA); [4] acute normovolemic haemodilution (ANH); [5] no intervention (NT). AT+AA has the highest probability (> 90%) to be the best technique in reducing both TR and PRBCs transfused with high PO Hb, followed by AT alone (> 40%). In combination with AA, the most effective AT strategy results CS; CS+AA decreases the odds of TR: 0.36 (95% CrI 0.19─0.69) vs noCS+AA, 0.31 (95% CrI 0.11─0.88) vs UF+AA with Bayesian p-value> 0.99; and the amount of PRBCs transfused: -0.74 (95% CrI -1.41─0.02) vs noCS+AA, -0.9 (95% CrI -1.75─0.05) vs UF+AA both with Bayesian p-value> 0.97.  Conclusions: CS+AA may be considered the optimum strategy for addressing perioperative blood loss; replacing CS with other AT techniques or abolishing AA will result in increased recourse to banked blood. PMD118 Impact of Whole Exome Sequencing (WES) on Costs and Medical Decision-Making Middelburg P1, Monroe G2, van Gassen K2, Hovels A1, Knoers N2, Vrijenhoek T2, Frederix G2 Institute for Pharmaceutical Sciences, Utrecht, The Netherlands, 2University Medical Centre Utrecht, Utrecht, The Netherlands

1Utrecht

Objectives: Primary objective of this research is to assess and quantify the total costs of a genetic diagnosis for children suspected for intellectual disability (ID). Secondary objective is to identify the impact of genetic testing on medical decisionmaking and costs in the future.  Methods: We retrospectively analyzed medical records of 371 young patients who have undergone WES at various stages of their