Valsartan Introduction For Heart Failure Treatment From The French Hospital Perspective

VA L U E I N H E A LT H

compared to post-stroke patients without dysphagia. Post-stroke dysphagia was associated with € 3’000 and CHF14’000 cost increase in France and Switzerland respectively.  Conclusions: Post-stroke dysphagia is associated with increase of length of hospital stay and higher hospital costs. PCV37 Budget Impact of Alteplase In Treatment of Acute Ischemic Stroke In Turkey Tatar M1, Şentürk A1, Tetik E2, Yıldız L2, Cheynel J3 1Polar Health Economics & Policy Consultancy, Ankara, Turkey, 2Boehringer Ingelheim, ISTANBUL, Turkey, 3Boehringer Ingelheim, Dubai, United Arab Emirates

Objectives: Cerebrovascular diseases are the sixth cause of total DALYs in Turkey and the Turkish Social Security Institution (SSI) faces a challenge on reimbursement decisions for treatment. Alteplase is a recombinant human tissue plasminogen activator indicated for treatment of acute ischemic stroke (AIS). Clinical trials have proved efficacy in reducing 90-day disability measured by the Modified Rankin Score (mRS) if administered within 4,5 hours of onset of symptoms. The agent is used as an addition to Standard of Care (SoC). This study aimed at assessing the budget impact of Alteplase from national perspective in Turkey.  Methods: A budget impact model assessing the impact with and without use of Alteplase was developed. First, the number of individuals with acute ischemic stroke that are hospitalized and eligible for Alteplase was determined from published data and expert views. Calculations were made for 0 to 1,5 hours after onset, 1,5 to 3,0 hours after onset and 3 to 4,5 hours after onset for both scenarios. Acute ischemic stroke hospitalization costs and the average annual costs after hospitalization were included. Cost estimations were calculated according to mRS score. Literature review and expert opinions were used in calculating the Turkish costs.  Results: Number of patients eligible for Alteplase was estimated as 12,950. The budget impact of Alteplase was estimated as 1,490,712 TRY, 1,510,634 TRY, 1,530,555 TRY, 1,550,477 TRY, 1,570,398 TRY for the first, second, third, fourth and fifth years respectively.  Conclusions: The burden of AIS on the Turkish healthcare system and unmet need is expected to increase with current ageing trends. The budget impact model revealed that given the efficacy of Alteplase, its budget impact is affordable for the Turkish SSI. In addition to this, reduced disability with the use of Alteplase will reduce resources needed for disabilities and will have an additional budget decreasing impact. PCV38 Budget Impact Analysis of Prasugrel For Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention In Spain Crespo C1, Talegon Albariño I2, García García J3, Gross Kasztanovits E4, Martín Conde JA3, Rodríguez Barrios JM5 1Axentiva solutions, Tacoronte -Sta. Cruz de Tenerife, Spain, 2Daiichi Sankyo España, Madrid, Spain, 3Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain, 4Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain, 5Daiichi-sankyo Europe Gmbh, Munich, Germany

Objectives: To evaluate the budget impact (BI) of increase Prasugrel prescription versus Ticagrelor and Clopidogrel in the treatment of patients with acute coronary syndrome undergoing Percutaneous Coronary Intervention from a Spain healthcare payer perspective.  Methods: A BI model was developed to capture drug and clinical events (acute myocardial infarction, stroke, Urgent Target Vessel Revascularization (UTVR) and major/minor bleeding) costs (€  2017) over a 3-year period. The scenarios evaluated were I) current scenario based on Spanish market research data from 2016, II) increase prasugrel prescription only or III) increase prasugrel and ticagrelor. Using available data with clinical cost data for hospital and outpatient procedures and pharmaceutical costs, the model reported on the economic differences associated with the three scenarios. The resulting cost per patient, cost differences and results of a 1-way sensitivity analysis are reported.  Results: The total impact after 3 years is €  229M for scenario I, €  241M for scenario II and €  257M for scenario III, which is equivalent to increases of 5.5% and 12.5%, respectively. The greater incorporation of prasugrel and ticagrelor leads to reduced events and the cost of myocardial infarctions (€  -5.2M, -6.12% scenario II vs I, €  -10.5M, -12.34% Scenario III vs I), stroke (€  -0.74M, -6.42% scenario II vs I, €  -0.71M, -6.15% scenario III vs I) and the UTVR (€ - 4.3M, -8.19% scenario II vs I,€ -2.4M, -4.55% scenario III vs. I). The higher incorporation of ticagrelor increase the cost related to bleedings. On the other hand, the cost per patient of prasugrel is lower than ticagrelor (€  1,212.76 vs €  1,518.75) cost due to lower pharmacological cost and fewer events such as UTVR, stroke and bleeding.  Conclusions: This study provides additional health economic rationale for boost prasugrel prescription, due to the reduction of clinical events rate with marginal BI. PCV39 Budget Impact Analysis of Sacubitril/Valsartan Introduction For Heart Failure Treatment From The French Hospital Perspective Cariou C, Duteil E, Sion M, Mahieu N, Duco J, Achouba A Novartis Pharma, Rueil-Malmaison, France

Objectives: The study objective was to estimate the budget impact related to sacubitril/valsartan introduction in treatment strategy for patients with symptomatic chronic heart failure (HF) and reduced ejection fraction. The ESC 2012 HF guidelines recommend treatment with an ACE inhibitor or angiotensin II receptor blocker. Sacubitril/valsartan demonstrated a significant risk reduction of cardiovascular deaths by 20% and hospitalizations for HF by 21% versus enalapril, an ACE inhibitor.  Methods: A budget impact model was developed to estimate the impact of sacubitril/valsartan introduction in HF treatment strategy. HF patients eligible for sacubitril/valsartan were estimated from a local prevalence rate calculated by matching characteristics of HF patients in terms of age and gender distribution (Échantillon généraliste de bénéficiaires, 2012) with local INSEE data. Number of hospitalized patients for HF was estimated from PMSI database (2012). The following ICD10 codes were extracted as principal diagnosis, related diagnosis or associated diagnoses: I500,

20 (2017) A399–A811

A607

I501, I509, I110, I130 and I132. For each hospitalization, a weighted disease related group (DRG) cost (€ , 2012) was calculated. No discount rate was applied.  Results: If 100,000 patients are treated with sacubitril/valsartan, about 4,500 deaths and 39,000 hospitalizations may be avoided over 5 years. From a DRG perspective those avoided hospitalizations may lead to cost savings of about 130m€ . From a hospital budget perspective this may lead to a 10m€  avoided budget deficit. Indeed, there was a difference between weighted DRG cost (3,329€ ) and costs incurred in the national cost study (Etude Nationale de Coûts à méthodologie Commune) for HF hospitalizations (3,591€ ). The budget deficit corresponds to this difference multiplied by the number of avoided hospitalizations.  Conclusions: From the French hospital perspective, sacubitril/valsartan introduction in HF treatment strategy has the potential to generate substantial savings and to minimize budget deficit. An analysis from a broader perspective (including drugs costs) should be conducted. PCV40 Budget Impact of IV Iron Therapy with Ferric Carboxymaltose In Patients with Chronic Heart Failure And Iron Deficiency In France Bourguignon S1, Levesque K2, Faller M3, Champs F3, Gremaud N3, Moutier H3, Caranhac G4, Cohen-Solal A5 1Stratégique Santé, Évry, France, 2Vifor Pharma, Paris La Défense, France, 3STRATEGIQUE SANTE, Evry, France, 4Hox-Com Analytics, Vincennes, France, 5Hôpital Lariboisière, Paris, France

Objectives: Iron deficiency (ID) is highly prevalent in chronic heart failure (CHF) patients and imposes a significant disease burden. CHF with ID is a major reason for hospitalization and represents important costs for national health care budgets. In France, Intravenous iron therapy with ferric carboxymaltose (FCM) is the only treatment recommended for those patients. This analyze aims to evluate the budget impact of FCM versus placebo for patients with chronic heart failure and iron deficiency in the French health care setting.  Methods: An event-based budget impact model was adapted to forecast the budget impact from the French health insurance perspective over a 5-year horizon. The main objective of the model is to assess the costs associated with changes of disease progression in patients treated with FCM versus placebo. In the model, cost saving may occur through NYHA class improvement and rate of hospitalization. Epidemiological parameters for France are derived from a literature review. Clinical evidence is based on a pooled analysis of four clinical trials (FER-CARS-01, FAIR-HF, EFFICACY-HF and CONFIRM-HF). Cost parameters use the French Diagnostic-Related Groups and hospital activity from the French national hospitalizations database (PMSI). Market shares of FCM versus placebo are provided by Vifor Pharma. Scenario analysis assess the influence of various factors, including FCM dose, cost of other medication, cost of hospitalization, cost of outpatient visits by NHYA levels.  Results: Compared to placebo, the use of FCM in France for patients with CHF and ID results in a decrease in costs associated with hospitalizations due to CHF, outpatient visits, and other medications than FCM.  Conclusions: In this study, costs of the use of FCM in iron deficient CHF from the national health insurance perspective are expected to be in favor of an increase use in France. A final round of validation with expert is carried out to ensure robustness. PCV41 Budget Impact Analysis of Treprostinil To Treatment of Patients With Pulmonary Arterial Hypertension Nyha Class Iv Without Response To Pharmacological Therapies In Mexico Sinta Cortes G1, Roa-Coria J1, Espitia-Hernandez M2, Soto Molina H1, Mendoza Medrano G3 1HS Estudios Farmacoeconómicos S.A. de C.V., Mexico City, Mexico, 2ISSSTE, Mexico City, Mexico, 3Ferrer Mexico, México City, Mexico

Objectives: To estimate the financial implications of introducing Treprostinil to treatment of patients with pulmonary arterial hypertension NYHA class IV without response to pharmacological therapies in the budget of public health institutions in Mexico.  Methods: A budget impact analysis was performed where two scenarios were considered, the current scenario in which the target population is treated with the standard therapy (diuretics, digitalis and vasodilators), on the other hand, the future scenario where these patients are treated with Treprostinil based in a market penetration rate of 2% in the first year and increases of 2% per annum over a 5-year horizon (2017-2021). Direct medical costs were considered, which are the drugs for each of the therapies included in the analysis. The target population was estimated based on the prevalence of pulmonary arterial hypertension NYHA class IV without response to pharmacological therapies in patients aged 16 to 65 years and affiliated with a public health institution. The costs and results are presented in pound sterling (£, 2017) and the epidemiology data used was obtained from institutional sources in the country and from a panel of experts (Delphi method).  Results: The average annual cost per patient was £ 68,167.70 for treatment with Treprostinil. Based in the penetration rate, the time horizon and the population eligible for treatment (280 in 2017, 284 in 2018, 287 in 2019, 291 in 2020 and 294 in 2021), the estimated additional average consumption is £ 1,183,990.00. Represents 0.0187% of the total budget allocated to medicines, all within the 5 years’ time horizon.  Conclusions: The introduction of Treprostinil into the public health sector in Mexico does not represent a significant financial impact of mexican’s budget. PCV42 Analysis of Clinical And Economic Effectiveness of Statins For Secondary Prevention of Cardiovascular Disease In Kazakhstan Avdeyev A1, Makalkina L2, Akanov A2, Kim V2, Baidullayeva D2, Toktybayeva A2, Dyusembayeva N2 1Hospital of the Medical Center of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan, 2Astana Medical University, Astana, Kazakhstan

Objectives: Secondary prevention of cardiovascular disease (CVD) means 1) prevention of premature death, 2) reduction in the progression of coronary artery atherosclerosis or achievement of its partial regression and 3) prevention of clinically significant complications. It is generally accepted, that the most effective lipidlowering medicines are statins; but at the present time there is no clear answer