Budget Impact Analysis of National Cervical Cancer Screening Program in Denmark: Cytology with HPV triage vs. HPV Primary Screening with Reflex Cytology Triage & Cintec Plus Cytology

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

Mercurio M1, Paragò V1, Velleca M1, Scagliarini L1, Parker E2, Garziera G1 & Johnson Medical S.p.A., Pratica di Mare, Italy, 2DePuy Synthes, Leeds, UK

1Johnson

Objectives: Bacterial infections are serious complications related to external ventricular drainage procedures (EVD), with a potential high impact on Health Care Services expenditure. The aim of this study is to evaluate potential cost savings as a consequence of bacterial infection rate reduction associated with the use of antimicrobial catheters impregnated with rifampin and clindamycin (AICs), compared to non-antimicrobial impregnated catheters.  Methods: An economic model was developed to estimate the cost saving associated with the use of AIC from a hospital perspective. A literature review was performed to assess infection rate reduction associated with AICs compared to non AICs. Economic values were identified through a real world data analysis carried out in an Italian Hospital, Bellaria (Bologna), regarding the following item costs: length of stay, pharmaceutical treatments, diagnostic tests, medical visits and medical devices. The probabilistic sensitivity analysis was performed to investigate model parameters uncertainties through 10,000 simulations. Results: The literature review showed an infection rate reduction of 67% across studies for AICs and the real world cost analysis resulted in a total cost for infection management of €  12,019 per patient. The deterministic model, calculated on 100 patients, assessed a total cost of catheters and infection management of €  50,239 for AICs and €  79,006 for non AICs, showing a potential cost saving of €  28,767 (catheters: AICs €  28,050, non AICs €  11,400) (Infection management: AICs €  22,189, non AICs €  67,606). The probabilistic sensitivity analysis results suggest that AICs usage is a cost saving solution in 93% of 10,000 iterations, confirming the robustness of the model.  Conclusions: Antimicrobial catheters impregnated with rifampin and clindamycin appear to be a cost-saving solution to reduce bacterial infection in EVD procedures. The results were consistent according to the probabilistic sensitivity analysis suggesting the use of AIC as a strategic solution to optimize Health Care expenditure. PMD25 Economic Analyses of Flair® and Fluency® Plus Endovascular Stent Grafts for the Treatment of Vascular Access Stenosis: A U.S. Hospital and Payer Perspective Barclay B1, Hogan A2, Hollmann S2, Ferko N2, Delatore P3 Inc., Murray Hill, NJ, USA, 2Cornerstone Research Group Inc., Burlington, ON, Canada, 3CR Bard Inc., Murray Hill, NJ, USA

1C.R. Bard

Objectives: Stenosis is a common cause of hemodialysis vascular access failure and is associated with high costs. Percutaneous transluminal angioplasty (PTA) is considered standard care for vascular access stenosis; however, patency rates are low. Bare metal stents (BMS) are sometimes used, but no randomized trials of current BMS are available for this condition. In contrast, level 1 evidence supports the superiority of covered stents (CS), including Flair® and Fluency®Plus Endovascular Stent Grafts, compared to PTA in vascular access stenosis. This study quantified the change in total costs when increasing the use of CS versus current care, from a U.S. provider and payer perspective for arteriovenous graft stenosis.  Methods: The analyses compared initial device and re-intervention costs over 24-months in a current real-world treatment mix (i.e., 90% PTA, 5% BMS, 5% CS) versus a future treatment mix (i.e., 82.5% PTA, 2.5% BMS, 15% CS). Costs for analyses were based on Medicare 2016 reimbursement amounts and company internal data, respectively. Re-intervention rates were from randomized trials of the endovascular stent grafts. BMS efficacy for reinterventions was assumed to be identical to PTA based on observational data. The payer and provider analyses assumed population sizes of 200,000 and 500 patients, respectively.  Results: From the payer perspective, the increased use of CS was estimated to have cost-savings of $27.63 million compared to the current mix. From the provider perspective, increased CS use increased initial costs but decreased downstream costs with an estimated cost impact of $48,307 over 500 patients.  Conclusions: Increasing the use of CS by 10% was predicted to provide cost savings for U.S. payers due to avoided re-interventions and have a small cost impact for hospital providers. Covered stents, such as Flair® and Fluency® Plus, provide the opportunity for cost-effective use of resources in vascular access stenosis. PMD26 Budget Impact Analysis of The Permanent Endovascular Adhesive Closure System in The Treatment of Venous Reflux and Chronic Venous Insufficiency (CVI) in Turkey Ozdemir Saltik Z, Akgul T, Can H, Copur F, Askin E Medtronic, Istanbul, Turkey

Objectives: To estimate the 3-year budget impact of Venaseal venous closure system for the treatment of venous reflux disease and CVI by the permanent, complete, endovascular adhesive closure of the great saphenous vein and associated varicosities in the Turkish setting.  Methods: Payer perspective is applied. Only direct costs are considered. Literature research is performed for global and local epidemiologic data. Comparators are identified as the other peripheral venous adhesive embolization products for the same indications in the positive list. Device and procedure costs are derived from positive list prices. For Venaseal, proposed reimbursement price is taken. Complication, re-hospitalization rates and length-of-stay are similar, thus related costs are ignored. Unilateral-bilateral intervention rates are based on reported rates from clinical studies, supported and confirmed by expert opinions. Current market share estimates are based on public tender results database. Further market share estimations are based on Medtronic sales data and forecast.  Results: compared with the other peripheral venous embolization products in the market, Venaseal is a qualified and latest technology treatment option for CVI, predicted to provide 0.89 million TL, 1.6 million TL, and 2.4 million TL savings in first, second and third years respectively. Total estimated cost-saving swill be approximately 4.8 million TL.  Conclusions: Endovascular adhesive closure technique for varicose veins is an innovative, non-thermal, non-tumescent therapy option for CVI, compared to radiofrequency ablation, stripping and surgery. It offers an effective outpatient alternative to endovascular therapies in patients with below-the-knee and bilateral venous disorders and those unable to tolerate post-procedure compression, where

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patients can get back to their daily routines immediately without being hospitalized. Besides the cost-savings it offers in comparison with the other on-the-market adhesive closure systems, with its ease-of-use, reliable and reproducible results, Venaseal represents the next generation in endovascular technology and should be the non-tumescent treatment alternative for CVI. PMD27 Budget Impact Analysis of National Cervical Cancer Screening Program in Denmark: Cytology with HPV triage vs. HPV Primary Screening with Reflex Cytology Triage & Cintec Plus Cytology Kempers J1, Narvestad J2, Kofod M2, Mikkelsen RM2 Diagnostics, Almere, The Netherlands, 2Roche Diagnostics, Hvidovre, Denmark

1Roche

Objectives: Healthcare decision makers search for cervical cancer (CC) screening strategies that produce better clinical outcomes, while controlling the cost. Possibilities for the introduction of primary HPV screening are currently investigated in Denmark. This modeling study compares clinical benefits and costs of the current practice; cytology with HPV triage, with a comparator; Cobas® HPV test with cytology and CINtec PLUS Cytology® (CINtec) triage in the national CC screening program in Denmark.  Methods: The Markov model compares screening performance, clinical outcomes and costs. A hypothetical cohort of 796,000 Danish 30-59-year-old women is followed for two screening cycles. Screening intervals are; the current practice is 3.9 years (weighted average) and the comparator five years. Test sensitivity and specificity data are from ATHENA trial. Other inputs include the local prevalence of HPV, CIN1-3 and CC. Screening, diagnosis and CC treatment costs are calculated from a healthcare provider’s perspective in 2015. In the current practice; normal cytologies return to routine screening, ASCUS and LSIL results have a reflex HPV triage, and HSIL undergo a colposcopy. Sensitivity limitations of this strategy may lead to missed diagnoses. The comparator addresses this shortcoming. HPV- return to routine screening, HPV+ have a reflex cytology triage. ASCUS and LSIL have a CINtec triage, which identifies women with highgrade pre-cancerous cervical lesions. CINtec+ or HSIL undergo a colposcopy. Normal cytologies or CINtec- have an HPV re-test in two years.  Results: The comparator improves the detection of ≥ CIN2 cases from 52.1% to 71.2% and reduces annual CC incidence in the screened population from 183.3 to 150.1. The annual cost increase by 9%, from 105 to 114 million DKK, which is mainly caused by increasing treatment costs.  Conclusions: The results suggest that replacing the current practice, with HPV primary screening with cytology and CINtec triage produces better clinical outcomes and increases costs by 9%. PMD28 Increased Clinical and Economic Benefit in Spain Associated with Improvement to ±8.5% of The Accuracy of Glucose Meters Adapted to The Current ISO 15197:2013 (±15%) Sanz-Granda Á1, Artola-Menéndez S2, Franch-Nadal J3, Mata-Cases M3, Merino-Torres JF4 1Proyectos de Farmacoeconomía, Navacerrada (Madrid), Spain, 2CS José Marvá, Madrid, Spain, 3Fundación redGPDS, DAP_CAT, Barcelona, Spain, 4Hospital Universitari i Politècnic La Fe, Valencia, Spain

Objectives: The current ISO 15197:2013 has improved the accuracy of glucose meters, ±15%, (GM-2013), by reducing the frequency of false negative readings; this allows a better control of the treatment. It has been shown that this reduces the incidence of macro/microvascular events and hypoglycemic episodes. The aim was to estimate the improvement of clinical and economic outcomes in Spain associated with glucose meters of higher accuracy, ±8.5%, (GM-2016), compared to ±15% GM-2013.  Methods: All diabetes Spanish patients, type 1 (DM1) and 2 (DM2), were included. The incidence of false negative readings was estimated from current GM-2013 and new GM-2016; after that, the frequency of potential and associated hypoglycemic and hypoglycemic events was calculated. Finally, the management cost of those events was estimated for GM-2013 and GM-2016. Clinical and economic benefit was calculated as the difference in the results (number of events and the total costs) in both scenarios.  Results: Total cost of test strips used in the self-monitoring blood glycaemia was € 480,138,728 (in 116,058 DM1 and 956,482 DM2 patients). 2,055 and 1,223 hyperglycemic events, and 16,448 and 7,698 hypoglycemic episodes were estimated with GM-2013 and GM-2016, respectively. Total cost for managing those was € 140,865,956 and € 133,122,487, respectively. It resulted in a net saving of € 7,743,469 yearly, associated to the use of GM-2016 (±8.5% accuracy) instead GM-2013, adapted to current ISO 15197:2013 (±15% accuracy).  Conclusions: The use of glucose meters having higher accuracy (±8.5%) than required by current ISO 15197:2013 (±15%), would increase clinical benefit by reducing the incidence of complications and would be associated with cost savings (7.74 mill€ ), equivalent to 6.2% of test strip total cost. PMD29 Budget Impact of Continuous Subcutaneous Insulin Infusion Compared with Multiple Daily Insulin Injections for The Treatment of Type 1 Diabetes in Spain Elías I1, Giménez M2, Álvarez M1, Quirós C2, Conget I2 Ibérica, S.A., Madrid, Spain, 2Diabetes Unit. Endocrinology Department. Hospital Clínic i Universitari de Barcelona. IDIBAPS, Barcelona, Spain

1Medtronic

Objectives: To estimate the budget impact of continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin injections (MDI) for the treatment of patients with type 1 diabetes (T1D) presenting recurrent severe hypoglycaemic events in Spain.  Methods: A budget impact model was developed from a Spanish healthcare system perspective to estimate direct healthcare costs for T1D patients over a four-year period. The target population was defined based on a retrospective observational study evaluating the efficacy of CSII for the treatment of patients with T1DM at Hospital Clínic i Universitari de Barcelona (2003–2008), where one of the main indications for switching to CSII was recurrent severe hypoglycaemia episodes; in this study, the mean number of episodes per year in the last 2 years before starting CSII was 1.33, being 0.08 in the last 2 years of follow up (P= 0.003). Therapy costs (insulin and CSII) together with major hypoglycaemic events costs were considered