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Budget Impact Analysis of Aclidinium Bromide In The Treatment of Chronic Obstructive Pulmonary Disease
A550
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
contained about 500,000 patients. During 2009-2013 the number of patients with a recorded diagnosis of asthma increased from 2% up to 5%. Among asthma patients, no real trend over time was observed for the prevalence of severe and poorly controlled severe asthma. The proportion of patients with severe asthma fluctuated between 8% and 10% and the proportion with poorly controlled severe asthma fluctuated between 2.5% and 3.5%. These prevalences were higher among females than males. Conclusions: Results regarding the prevalence of asthma are in line with known literature. Prevalences of (poorly controlled) severe asthma were subject to fluctuations within a single year, but remained stable during 2009-2013. Determining prevalences of (poorly controlled) severe asthma by using healthcare databases only requires multiple proxies. Therefore, the question is whether the observed prevalences correctly reflect the actual prevalences. Using patient reported outcomes might support studies regarding severe asthma and/or poorly controlled severe asthma.
RESPIRATORY-RELATED DISORDERS – Cost Studies PRS9 Budget Impact Model Of Indacaterol/Glycopyrronium In The Treatment Of Copd In Italy Based On Flame Study Pitotti C1, Burke C2 1Novartis Farma, Origgio, Italy, 2Product Lifecycle Services - Novartis Business Services, Dublin, Ireland
Objectives: A 3-year budget-impact model (BIM) using data from the FLAME study was developed to estimate the economic impact on the Italian health care budget of switching COPD patients treated with salmeterol/fluticasone to indacaterol/glycopyrronium. Methods: The model considered patients with moderate, severe and very severe COPD who are diagnosed and treated only with salmeterol/fluticasone or indacaterol/glycopyrronium in the Italian setting. The BIM was developed from the perspective of the National Healthcare Service (NHS). Only direct medical costs were considered: drug costs (salmeterol/fluticasone and indacaterol/ glycopyrronium ), adverse events costs (pneumonia, tuberculosis and influenza) and disease-related costs (exacerbations management costs, emergency department and hospitalisation). The model assumes an uptake of patients treated with indacaterol/glycopyrronium of 50% in the first year, 30% in the second year and 30% in the third year deriving from salmeterol/fluticasone. Public net prices and National Tariffs were considered to estimate cost of drugs and medical resources used, respectively. Costs were assessed in Euros (2015). Results: The total number of patients considered in the model was 195.518 (Year 1), 4.100 of which treated with indacaterol/glycopyrronium. After switching, the number of patient treated with indacaterol/glycopyrronium was estimated to be 151.865 (at Year 3). The reduction of exacerbation events (moderate, severe and very severe) was estimated to be 28.852. Considering all costs, as listed, the budget impact of switching patients from salmeterol/fluticasone to indacaterol/glycopyrronium was estimated to generate a saving of 10 million Euros over 3 years for the NHS. Considering only drugs costs, it was estimated saving would be 3,7 million Euros over 3 years. Conclusions: Indacaterol/glycopyrronium compared to salmeterol/fluticasone used to treat moderate, severe and very severe COPD patients was estimated to be cost saving for the Italian NHS. Greater savings are predicted if a higher number of patients switch to indacaterol/glycopyrronium.
PRS10 Budget Impact of Bronchial Thermoplasty In Patients with Uncontrolled Severe Asthma
Objectives: Despite clinical and National Institute for Health and Care Excellence (NICE) guidelines for managing cow’s milk protein allergy (CMPA), amino acid formulas (AAFs) are often used first-line in place of recommended extensively hydrolysed formulas (eHFs). We evaluated potential cost savings to be made through improving prescribing practice in line with guidelines. Methods: An Excel-based budget impact model (BIM) was developed for management of infants under 2 years old diagnosed with CMPA (UK national health service [NHS] perspective [2015]: Clinical Commissioning Group [CCG] prescribing data: live UK birth data, CMPA product acquisition costs [£] and specialist visit costs). Three base case scenarios were considered: mean eHF/AAF prescribing values with current CMPA product distribution; recommended eHF/AAF prescribing values (90% eHF / 10% AAF) with current CMPA product distribution; recommended eHF/AAF prescribing values with increased use of the Nestlé Health Science (NHSc) CMPA portfolio (Althera [eHF] and Alfamino [AAF]). Univariate sensitivity analyses evaluated the impact on cost savings of prescribing practices across CCGs, product costs and physician visits. Results: Mean eHF:AAF prescribing was 41%:59%, ranging from 19%:81% to 84%:16%. Based on current product acquisition prices, possible annual savings exceeding £10 million are possible for the UK NHS through improving prescribing practices. Annual cost savings were observed across all CCGs, from £1 million (84% eHF) to over £14 million (19% eHF). More can be saved by increasing prescription of the NHSc product portfolio (£400,000 additional savings over 5 years by reaching 15%). The proportion of AAF was the main driver of costs, whereas physician visits was not. Conclusions: Prescribing eHFs/AAFs according to guidelines can produce substantial cost savings for the UK NHS. Further savings can be made by increased use of the NHSc CMPA product portfolio. Thus, there is an opportunity to reduce CMPA cost burden in the UK through optimised prescribing. PRS12 Budget Impact Analysis of Aclidinium Bromide In The Treatment of Chronic Obstructive Pulmonary Disease Yagudina R, Kulikov A, Makarova E I.M. Sechenov First Moscow State Medical University, Moscow, Russia
Objectives: To assess the budget impact of switching adult patients with chronic obstructive pulmonary disease (COPD) from Glycopyrronium bromide and Tiotropium bromide to Aclidinium bromide in the Russian Federation. Methods: Information search was conducted in the public domain. Pharmacoeconomic analysis method - budget impact analysis and direct cost analysis were performed. For reference, we accepted the exchange rate was 1 EUR = 74, 70 RUB. Results: This study was designed for two possible scenarios. The first scenario was included direct comparison COPD treatment with Aclidinium bromide and Tiotropium bromide. The second scenario was based on meta-analyses of Aclidinium bromide, Glycopyrronium bromide and Tiotropium bromide. We started with the calculation of direct cost of the various medications per patient for two scenarios. Cost analysis was conducted on the cost of basic pharmacotherapy, compensation costs for treatment of exacerbations, compensation costs for side effects and adverse reactions for each scenario. The study had a time frame of one year. The total cost per one patient with COPD amounted to 483 EUR (60 doses) and 500 EUR (30 doses) for the Aclidinium group and 585 EUR for the Tiotropium group for the first scenario and 335 EUR (60 doses) and 352 EUR (30 doses) for the Aclidinium group, 412 EUR and 436 EUR for the Tiotropium group and Glycopyrronium group respectively for the second scenario. Further in the present study, based on the results of the “cost analysis” it was revealed that the switching 100 patients to Aclidinium bromide saved 9 379 EUR for the first scenario and 7 667 EUR for the second scenario. Conclusions: The budget impact analysis results obtained in this Aclidinium bromide versus others long-acting muscarinic antagonists comparative study demonstrated that Aclidinium therapy resulted in budget saving.
Chanez P1, Marty R2, Croisille A2, Benet C3, Saidani N3, Aubier M4 University, Marseille, France, 2HEVA-HEOR, Lyon, France, 3Boston Scientific, Voisins-le-Bretonneux, France, 4Hospital Bichat APHP and INSERM U1152 Diderot University, Paris, France
PRS13 Health Economic Evaluation of HDM Slit-Tablet For Allergen Immunotherapy In House Dust Mite Induced Allergic Rhinitis with or Without Allergic Asthma In An Italian Setting
Objectives: To investigate the budget impact in France of bronchial thermoplasty (BT) as add-on to standard care (BT-SC) compared to omalizumab as add-on to standard care (O-SC) and to standard care (SC) alone in the treatment of patients with severe asthma who fail intense pharmacological treatment. Methods: Clinical outcomes were modelled (Markov model) in a cohort of uncontrolled, severe asthma patients over 5 years. BT is given as a course of 3 sessions during the 1st year. Costs were allocated on the basis of French standard health costs. Four cost scenarios were examined, varying the cost of BT, the burden of hospital stays and the extent of healthcare consumption. Results: In the scenario with lowest total cost of BT and lowest healthcare consumption, per capita costs over the 1st year in BT-SC were € 14,016 higher than in SC, but € 3,356 lower than in O-SC. From the 2nd year onward, BT-SC would generate an annual per capita saving of € 208 compared to SC and of € 17,771 compared to O-SC. In the scenario with highest total cost of BT and highest healthcare resource utilization, the excess cost associated with BT-SC during the 1st year was € 17,273 and the cost saving for years 2-5 compared to SC was € 735/year. When extrapolated to all adult patients with uncontrolled severe asthma in France (16,651 individuals; 10% treated by BT-SC, 2.5% by O-SC and 87.5% with SC), the budget impact of introduction of BT would be savings of € 9,758,566 to € 16,390,259, depending on the cost scenario. Conclusions: Introduction of BT for patients with severe uncontrolled asthma would generate cost savings in the French setting.
Cadario G1, Maspoli M2, Di Matteo S3, Valentino MC3, Oselin M3, Bruno GM3, Colombo GL4 1Città della Salute Hospital, Turin, Italy, 2Piedmont Region-Regional Healthcare System, Turin, Italy, 3S.A.V.E. Studi - Health Economics & Outcomes Research, Milan, Italy, 4University of Pavia, Milan, Italy
1Aix-Marseille
PRS11 The Health Economic Impact of Managing CMPA According To Guidelines: Challenging Current Treatment Practise In The UK Wright A1, Yi Y1, Delaney M2, Dive-Pouletty C3 1PHMR Ltd, London, UK, 2Nestle Health Science, Gatwick, UK, 3Nestle Health Science, Lausanne, Switzerland
Objectives: We conducted a health economic evaluation of allergen immunotherapy with HDM SLIT-tablet for patients with house dust mite induced allergic rhinitis (AR) and for patients with allergic rhinitis plus allergic asthma (RA+AA) in an Italian setting. Methods: Analysis included patients and data taken from Regional Allergy Network of the Piedmont Region (RRA). We built a cost utility model with the aim to capture the costs and health consequences of treatment for HDM AR and AA plus AR patients. The following parameters were included: effectiveness of available treatment options; acquisition costs of treatment; symptomatic pharmacotherapy use and other healthcare resource use associated with the considered conditions; quality of life experienced by patients. A budget impact analysis was carried out to assess the annual cost of treatment per patient with HDM SLITTABLET as compared to patients receiving symptomatic pharmacotherapy only. The analysis estimated the total costs and QALYs for one hypothetical adult patient receiving HDM SLIT-TABLET in addition to symptomatic pharmacotherapy and one hypothetical adult patient receiving symptomatic pharmacotherapy only, over a ten-year period. Results: Regarding the cost-utility analysis, ICER values were found to be equal to € 73,254 for the first year, € 7,797 for the fifth year and € 3,456 for the tenth year for AR patients. The ICER values for AR plus AA were € 31,095 for the first year, € 6,254 for the fifth year and € 3,153 for the tenth year. The first year was the most critical one, due to the drug cost; starting from the first year for AR patient and from the second year for AA plus AR patients an acceptable ICER value was achieved, due to the improved quality of life. Conclusions: Patients receiving HDM SLIT-TABLET in addition to symptomatic pharmacotherapy were cost effective as compared to patient receiving symptomatic pharmacotherapy only.
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
contained about 500,000 patients. During 2009-2013 the number of patients with a recorded diagnosis of asthma increased from 2% up to 5%. Among asthma patients, no real trend over time was observed for the prevalence of severe and poorly controlled severe asthma. The proportion of patients with severe asthma fluctuated between 8% and 10% and the proportion with poorly controlled severe asthma fluctuated between 2.5% and 3.5%. These prevalences were higher among females than males. Conclusions: Results regarding the prevalence of asthma are in line with known literature. Prevalences of (poorly controlled) severe asthma were subject to fluctuations within a single year, but remained stable during 2009-2013. Determining prevalences of (poorly controlled) severe asthma by using healthcare databases only requires multiple proxies. Therefore, the question is whether the observed prevalences correctly reflect the actual prevalences. Using patient reported outcomes might support studies regarding severe asthma and/or poorly controlled severe asthma.
RESPIRATORY-RELATED DISORDERS – Cost Studies PRS9 Budget Impact Model Of Indacaterol/Glycopyrronium In The Treatment Of Copd In Italy Based On Flame Study Pitotti C1, Burke C2 1Novartis Farma, Origgio, Italy, 2Product Lifecycle Services - Novartis Business Services, Dublin, Ireland
Objectives: A 3-year budget-impact model (BIM) using data from the FLAME study was developed to estimate the economic impact on the Italian health care budget of switching COPD patients treated with salmeterol/fluticasone to indacaterol/glycopyrronium. Methods: The model considered patients with moderate, severe and very severe COPD who are diagnosed and treated only with salmeterol/fluticasone or indacaterol/glycopyrronium in the Italian setting. The BIM was developed from the perspective of the National Healthcare Service (NHS). Only direct medical costs were considered: drug costs (salmeterol/fluticasone and indacaterol/ glycopyrronium ), adverse events costs (pneumonia, tuberculosis and influenza) and disease-related costs (exacerbations management costs, emergency department and hospitalisation). The model assumes an uptake of patients treated with indacaterol/glycopyrronium of 50% in the first year, 30% in the second year and 30% in the third year deriving from salmeterol/fluticasone. Public net prices and National Tariffs were considered to estimate cost of drugs and medical resources used, respectively. Costs were assessed in Euros (2015). Results: The total number of patients considered in the model was 195.518 (Year 1), 4.100 of which treated with indacaterol/glycopyrronium. After switching, the number of patient treated with indacaterol/glycopyrronium was estimated to be 151.865 (at Year 3). The reduction of exacerbation events (moderate, severe and very severe) was estimated to be 28.852. Considering all costs, as listed, the budget impact of switching patients from salmeterol/fluticasone to indacaterol/glycopyrronium was estimated to generate a saving of 10 million Euros over 3 years for the NHS. Considering only drugs costs, it was estimated saving would be 3,7 million Euros over 3 years. Conclusions: Indacaterol/glycopyrronium compared to salmeterol/fluticasone used to treat moderate, severe and very severe COPD patients was estimated to be cost saving for the Italian NHS. Greater savings are predicted if a higher number of patients switch to indacaterol/glycopyrronium.
PRS10 Budget Impact of Bronchial Thermoplasty In Patients with Uncontrolled Severe Asthma
Objectives: Despite clinical and National Institute for Health and Care Excellence (NICE) guidelines for managing cow’s milk protein allergy (CMPA), amino acid formulas (AAFs) are often used first-line in place of recommended extensively hydrolysed formulas (eHFs). We evaluated potential cost savings to be made through improving prescribing practice in line with guidelines. Methods: An Excel-based budget impact model (BIM) was developed for management of infants under 2 years old diagnosed with CMPA (UK national health service [NHS] perspective [2015]: Clinical Commissioning Group [CCG] prescribing data: live UK birth data, CMPA product acquisition costs [£] and specialist visit costs). Three base case scenarios were considered: mean eHF/AAF prescribing values with current CMPA product distribution; recommended eHF/AAF prescribing values (90% eHF / 10% AAF) with current CMPA product distribution; recommended eHF/AAF prescribing values with increased use of the Nestlé Health Science (NHSc) CMPA portfolio (Althera [eHF] and Alfamino [AAF]). Univariate sensitivity analyses evaluated the impact on cost savings of prescribing practices across CCGs, product costs and physician visits. Results: Mean eHF:AAF prescribing was 41%:59%, ranging from 19%:81% to 84%:16%. Based on current product acquisition prices, possible annual savings exceeding £10 million are possible for the UK NHS through improving prescribing practices. Annual cost savings were observed across all CCGs, from £1 million (84% eHF) to over £14 million (19% eHF). More can be saved by increasing prescription of the NHSc product portfolio (£400,000 additional savings over 5 years by reaching 15%). The proportion of AAF was the main driver of costs, whereas physician visits was not. Conclusions: Prescribing eHFs/AAFs according to guidelines can produce substantial cost savings for the UK NHS. Further savings can be made by increased use of the NHSc CMPA product portfolio. Thus, there is an opportunity to reduce CMPA cost burden in the UK through optimised prescribing. PRS12 Budget Impact Analysis of Aclidinium Bromide In The Treatment of Chronic Obstructive Pulmonary Disease Yagudina R, Kulikov A, Makarova E I.M. Sechenov First Moscow State Medical University, Moscow, Russia
Objectives: To assess the budget impact of switching adult patients with chronic obstructive pulmonary disease (COPD) from Glycopyrronium bromide and Tiotropium bromide to Aclidinium bromide in the Russian Federation. Methods: Information search was conducted in the public domain. Pharmacoeconomic analysis method - budget impact analysis and direct cost analysis were performed. For reference, we accepted the exchange rate was 1 EUR = 74, 70 RUB. Results: This study was designed for two possible scenarios. The first scenario was included direct comparison COPD treatment with Aclidinium bromide and Tiotropium bromide. The second scenario was based on meta-analyses of Aclidinium bromide, Glycopyrronium bromide and Tiotropium bromide. We started with the calculation of direct cost of the various medications per patient for two scenarios. Cost analysis was conducted on the cost of basic pharmacotherapy, compensation costs for treatment of exacerbations, compensation costs for side effects and adverse reactions for each scenario. The study had a time frame of one year. The total cost per one patient with COPD amounted to 483 EUR (60 doses) and 500 EUR (30 doses) for the Aclidinium group and 585 EUR for the Tiotropium group for the first scenario and 335 EUR (60 doses) and 352 EUR (30 doses) for the Aclidinium group, 412 EUR and 436 EUR for the Tiotropium group and Glycopyrronium group respectively for the second scenario. Further in the present study, based on the results of the “cost analysis” it was revealed that the switching 100 patients to Aclidinium bromide saved 9 379 EUR for the first scenario and 7 667 EUR for the second scenario. Conclusions: The budget impact analysis results obtained in this Aclidinium bromide versus others long-acting muscarinic antagonists comparative study demonstrated that Aclidinium therapy resulted in budget saving.
Chanez P1, Marty R2, Croisille A2, Benet C3, Saidani N3, Aubier M4 University, Marseille, France, 2HEVA-HEOR, Lyon, France, 3Boston Scientific, Voisins-le-Bretonneux, France, 4Hospital Bichat APHP and INSERM U1152 Diderot University, Paris, France
PRS13 Health Economic Evaluation of HDM Slit-Tablet For Allergen Immunotherapy In House Dust Mite Induced Allergic Rhinitis with or Without Allergic Asthma In An Italian Setting
Objectives: To investigate the budget impact in France of bronchial thermoplasty (BT) as add-on to standard care (BT-SC) compared to omalizumab as add-on to standard care (O-SC) and to standard care (SC) alone in the treatment of patients with severe asthma who fail intense pharmacological treatment. Methods: Clinical outcomes were modelled (Markov model) in a cohort of uncontrolled, severe asthma patients over 5 years. BT is given as a course of 3 sessions during the 1st year. Costs were allocated on the basis of French standard health costs. Four cost scenarios were examined, varying the cost of BT, the burden of hospital stays and the extent of healthcare consumption. Results: In the scenario with lowest total cost of BT and lowest healthcare consumption, per capita costs over the 1st year in BT-SC were € 14,016 higher than in SC, but € 3,356 lower than in O-SC. From the 2nd year onward, BT-SC would generate an annual per capita saving of € 208 compared to SC and of € 17,771 compared to O-SC. In the scenario with highest total cost of BT and highest healthcare resource utilization, the excess cost associated with BT-SC during the 1st year was € 17,273 and the cost saving for years 2-5 compared to SC was € 735/year. When extrapolated to all adult patients with uncontrolled severe asthma in France (16,651 individuals; 10% treated by BT-SC, 2.5% by O-SC and 87.5% with SC), the budget impact of introduction of BT would be savings of € 9,758,566 to € 16,390,259, depending on the cost scenario. Conclusions: Introduction of BT for patients with severe uncontrolled asthma would generate cost savings in the French setting.
Cadario G1, Maspoli M2, Di Matteo S3, Valentino MC3, Oselin M3, Bruno GM3, Colombo GL4 1Città della Salute Hospital, Turin, Italy, 2Piedmont Region-Regional Healthcare System, Turin, Italy, 3S.A.V.E. Studi - Health Economics & Outcomes Research, Milan, Italy, 4University of Pavia, Milan, Italy
1Aix-Marseille
PRS11 The Health Economic Impact of Managing CMPA According To Guidelines: Challenging Current Treatment Practise In The UK Wright A1, Yi Y1, Delaney M2, Dive-Pouletty C3 1PHMR Ltd, London, UK, 2Nestle Health Science, Gatwick, UK, 3Nestle Health Science, Lausanne, Switzerland
Objectives: We conducted a health economic evaluation of allergen immunotherapy with HDM SLIT-tablet for patients with house dust mite induced allergic rhinitis (AR) and for patients with allergic rhinitis plus allergic asthma (RA+AA) in an Italian setting. Methods: Analysis included patients and data taken from Regional Allergy Network of the Piedmont Region (RRA). We built a cost utility model with the aim to capture the costs and health consequences of treatment for HDM AR and AA plus AR patients. The following parameters were included: effectiveness of available treatment options; acquisition costs of treatment; symptomatic pharmacotherapy use and other healthcare resource use associated with the considered conditions; quality of life experienced by patients. A budget impact analysis was carried out to assess the annual cost of treatment per patient with HDM SLITTABLET as compared to patients receiving symptomatic pharmacotherapy only. The analysis estimated the total costs and QALYs for one hypothetical adult patient receiving HDM SLIT-TABLET in addition to symptomatic pharmacotherapy and one hypothetical adult patient receiving symptomatic pharmacotherapy only, over a ten-year period. Results: Regarding the cost-utility analysis, ICER values were found to be equal to € 73,254 for the first year, € 7,797 for the fifth year and € 3,456 for the tenth year for AR patients. The ICER values for AR plus AA were € 31,095 for the first year, € 6,254 for the fifth year and € 3,153 for the tenth year. The first year was the most critical one, due to the drug cost; starting from the first year for AR patient and from the second year for AA plus AR patients an acceptable ICER value was achieved, due to the improved quality of life. Conclusions: Patients receiving HDM SLIT-TABLET in addition to symptomatic pharmacotherapy were cost effective as compared to patient receiving symptomatic pharmacotherapy only.