Budget Impact Analysis of Tocilizumab, Infliximab and Etanercept Drugs for The Treatment of Rheumatoid Arthritis in Ecuador

VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 8 5 3 – A 9 4 3

economia anual para o Ministério da Saúde variou de R$ 6,05 milhões no primeiro ano, seguido de R$ 19,3 milhões, R$ 34,09 milhões, R$ 49,13 milhões e R$ 57,9 milhões nos anos seguintes. Neste período, a economia para o MS é de aproximadamente R$ 166,5 milhões.  Conclusions: A incorporação do tofacitinibe no SUS para tratamento dos pacientes com AR que não respondem aos MMCD sintéticos proporciona economia direta ao sistema de saúde, além de permitir o acesso a uma nova tecnologia. PMS11 Analysis of The Budget Impact of Secukinumab use Versus Anti-Tnf Agents in Ankylosing Spondylitis Patients Romero Prada ME, Roa Cardenas NC, Serrano GY, Huerfano LM Salutia Foundation - Research center in economy, management and health technologies., Bogota, Colombia

Objectives: To conduct an analysis of the budget impact of secukinumab use in the treatment of Ankylosing Spondylitis in Colombia versus TNF-α  inhibitors.  Methods: A budget impact model was developed to compare the drug acquisition and administration costs with and without the introduction of secukinumab to the Health Benefit Plan for treatment of Ankylosing Spondylitis patients. This analysis was developed from the adaptation of a cost-effectiveness analysis that mimics the natural history of the disease via a Markov model. TNF-α  inhibitors currently available in Colombia were included in the analysis. The licensed posology was used for all treatments. Current and future market share projections were obtained from SISMED and a marketing study. The impact of secukinumab use was estimated for the first, second, and third year.  Results: Total cumulative budget impact in Colombian Pesos (COP$) when including secukinumab in the benefits plan for treatment of Ankylosing Spondylitis patients generates savings of COP$ 46,957,425,832, which corresponds to a value of COP$ 952.65 per capita at third year and represents savings of 0.128% on 2017 Capitation Payment Unit (UPC).  Conclusions: Secukinumab is a cost-saving treatment option for Ankylosing Spondylitis from the first year for the Colombian healthcare system. This is a result of comparing impact of secukinumab inclusion for treatment of Ankylosing Spondylitis patients versus current setting of TNF-α  inhibitors therapy. PMS12 Budget Impact Analysis of Tocilizumab, Infliximab and Etanercept Drugs for The Treatment of Rheumatoid Arthritis in Ecuador Briceno V1, Naranjo F2, Moscoso JD2, Salazar D2 College of Pharmacy & Health Sciences, Boston, MA, Ecuador, 2Hospital Eugenio Espejo, Quito, Ecuador

1Massachusetts

Objectives: According to the current Ecuadorian Constitution, health is a right guaranteed by the State; So it is important to generate a budget impact analysis so as to keep in mind the available alternatives that generate the desired results in the population, but optimizing the use of resources from the perspective of the National Health System.  Methods: Considering a RA population of 210 in Eugenio Espejo Hospital and of 3000 in Ecuador (0.9% prevalence), the BIA analyzes the cost of the drug, cost of follow-up and administration costs of those drugs available in the NFL (Infliximab and etanercept) vs. tocilizumab. The average weight for an Ecuadorian person from 30-59 years old is 66kg for women and 73kg for men.  Results: Within Eugenio Espejo Hospital, for a total of 201 patients tocilizumab resulted in the least expensive treatment with a total annual cost of $1.773.756 for the institution while the most expensive was etanercept resulting in an annual cost of $2.611.850,28 for the institution. Extrapolating these results to the Ecuadorian population, tocilizumab would generate an annual cost of $26.473.980, infliximab of $31.551.660 and etanercept of $ 38.982.840.  Conclusions: The reimbursement of tocilizumab would generate savings of $ 838.093 to the hospital and of $ 12.508.860 to the government when compared to etanercept and of $ 340.204,56 to the hospital and of $ 5.077.680 to the government when compared to infliximab making tocilizumab the least costly and equally effective option for treating RA in Ecuador. PMS14 Cost-Savings Due to The Withdrawing of Biological Therapy for Treatment of Rheumathoid Artritis in A Specialized Center in Colombia Santos-Moreno P1, Villarreal Peralta L1, Jaimes H1, Jaimes J1, Buitrago-Garcia D2, Castro C2 1Biomab, center for rheumatoid arthritis, bogota, Colombia, 2SIIES investigation and research, Colombia, bogota, Colombia

Objectives: Rheumatoid arthritis (RA) is the prevalent autoimmune inflammatory arthritis found in adults, with a worldwide prevalence ranging from 0.4% to 1.3%. The biological therapy for the treatment of RA can cost more than ten times the cost of conventional disease modifying RA drugs (DMARDs). Moreover, the increasing use of biologics is the greatest source of direct costs of patients with RA impacting health systems. The aim of this study was to describe the cost savings regarding the discontinuation of biological therapy in patients with RA during five years in a specialized RA medical center.  Methods: A descriptive study was performed. We reviewed the records from patients that were receiving biological therapy and after some time had a withdrawing of the therapy; the criteria for discontinuation of medications were: diagnostic mistake, therapy failure, comorbidities, adverse events or very extended remission.  Results: Between 2011 and 2016, 140 patients were withdrawn from biological therapy; 23% of patients stopped therapy due to adverse events, 16% due to complex comorbidities, 15% for obtaining remission, 15% due to serious infections, 13% diagnostic mistake and 7% for therapy failure. The correct discontinuation of biological therapy saved per patient 9.800 USD/year and for the 140 patients 1.372.000 USD/million  Conclusions: The biological therapy for the treatment of RA brings high costs in several countries from the perspective of the health system and the society. These results suggest that adequate discontinuation of biological therapy can reduce the health care system expenses.

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PMS15 Análise De Custo Minimização Na Substituição De Infliximabe Por Seu Biossimilar No Sistema De Saúde Suplementar Brasileiro Alexandre RF, Santana CF, Squiassi HB Pfizer, São Paulo, Brazil

Objectives: Avaliar a custo minimização da substituição do infliximabe por seu biossimilar, para o tratamento da artrite reumatóide (AR), na perspectiva do Sistema de Saúde Suplementar (SSS) brasileiro.  Methods: A análise considerou a premissa de que 2.500 pacientes são tratados com infliximabe no sistema de saúde suplementar. Esta população foi ajustada pela taxa de crescimento de 0,09% após o primeiro ano. O cenário com substituição foi iniciado a partir de 30% das unidades de infliximabe, com crescimento anual de 5%, alcançando 50% no final de 5 anos. Foram incluídos apenas os custos diretos dos medicamentos considerando o preço unitário publicado pela CMED em Março de 2017.  Results: No primeiro ano, os custos do cenário sem substituição foram de R$ 120,75 milhões, seguidos de R$ 120,86 milhões, R$ 120,97 milhões, R$ 121,08 milhões e R$ 121,19 milhões nos anos seguintes. Para o cenário com substituição pelo biossimilar, os custos foram de R$ 108,28 milhões no primeiro ano, seguidos de R$ 106,29 milhões, R$ 104,3 milhões, R$ 102,31 milhões e R$ 100,32 milhões nos anos seguintes. A diferença entre os cenários resultou em uma economia total de R$ 83,34 milhões, no período analisado.  Conclusions: A utilização do medicamento biossimilar do infliximabe no tratamento da AR pode proporcionar economia significativa para o sistema suplementar de saúde no Brasil, podendo contribuir para a ampliação do acesso ao tratamento dos pacientes com esta condição clínica. PMS16 Secukinumab Shows Higher Symptomatic Improvement and Lower Cost Per Response vs. Adalimumab After One Year Treatment of Active Ankylosing Spondylitis: A Cost Per Responder Analysis from A Chilean Perspective Rojas R1, Barbeau M2, Jugl SM3, MacPherson A4 1Pontificia Universidad Catolica de Chile, Santiago, Chile, 2Novartis Pharmaceuticals Canada Inc., Dorval, QC, Canada, 3Novartis Pharma AG, Basel, Switzerland, 4Dalhousie University, Halifax, NS, Canada

Objectives: To estimate and compare the long-term cost per responder based on the Assessment of Spondyloarthritis International Society (ASAS) outcomes following one year of treatment of ankylosing spondylitis (AS) with Secukinumab (fully human anti-IL-17A antibody) relative to Adalimumab (anti-TNF antibody).  Methods: The cost per responder for each treatment (Secukinumab and Adalimumab), was estimated by dividing the retail/private cost of the drug, in Chilean Pesos (CLP), for the course of treatment with its response rate. One year response rates were estimated from a matching-adjusted indirect comparison (MAIC) based on data from MEASURE 2 and ATLAS clinical trials of Secukinumab and Adalimumab, respectively. A sensitivity analyses was also conducted by varying the choice of the matching characteristics.  Results: MAIC analysis showed that ASAS (20, 40 and 5/6) response rates were significantly higher for Secukinumab compared to Adalimumab at one year. ASAS 20, ASAS 40 and ASAS 5/6 response rates were 81% vs. 65%, 62% vs. 47%, and 74% vs. 55% for Secukinumab vs. Adalimumab, respectively. The cost per ASAS 20 responder was $14,511 vs. $29,047, the cost per ASAS40 responder was $18,864 vs. $40,386, whereas, the cost per ASAS 5/6 responder was $16,224 vs. $34,556 for Secukinumab vs. Adalimumab, respectively. The costs per ASAS (20, 40 and 5/6) responders were about 50%, 47%, and 47% lower for Secukinumab compared to Adalimumab after one year. Sensitivity analyses for ASAS response rates and cost per responder showed similar results, confirming the robustness of the main analysis.  Conclusions: The long term cost per responder for all ASAS response rates at one year were consistently lower for Secukinumab vs. Adalimumab. These findings indicate that it is more efficient to treat AS patients with Secukinumab vs. Adalimumab. In addition, more AS patients could be effectively treated in Chile with Secukinumab vs. Adalimumab with a given budget, due to the cost-offsets. PMS17 Secukinumab vs Adalimumab for The Treatment of Psoriatic Arthritis: A Cost Per Responder Analysis At 48 Weeks from A Chilean Perspective Rojas R1, Barbeau M2, Jugl SM3, MacPherson A4 1Pontificia Universidad Catolica de Chile, Santiago, Chile, 2Novartis Pharmaceuticals Canada Inc., Dorval, QC, Canada, 3Novartis Pharma AG, Basel, Switzerland, 4Dalhousie University, Halifax, NS, Canada

Objectives: The cost per responder analysis attempts to quantify the relative value of two comparator drugs by assessing how the two agents compare in terms of cost per treatment outcome. The objective of this analysis was to estimate and compare the long-term cost per responder based on the American College of Rheumatology outcomes (ACR 20/50/70) following 48 weeks of psoriatic arthritis (PsA) treatment with Secukinumab relative to Adalimumab in Chile.  Methods: The cost per responder for each treatment was estimated by dividing the retail/private cost, in Chilean Pesos (CLP), for the course of treatment with its response rate. The response rates were derived from a previous matching-adjusted indirect comparison (MAIC). A sensitivity analysis was also conducted by using response rates from a MAIC with a variation of the matching characteristics.  Results: The MAIC showed that ACR (20/50/70) response rates were higher for Secukinumab 150mg and 300mg compared to Adalimumab at 48 weeks. ACR 20 response rates were 80%, 74% and 56%, ACR 50 response rates were 57%, 61% and 44%, whereas the ACR 70 response rates were 32%, 43% and 30% for Secukinumab 150mg, Secukinumab 300 mg, and Adalimumab respectively. The costs per ACR20 responder were $13,768, $29,817 and $31,166, the costs per ACR50 responder were $19,186, $35,698 and $40,138, and the costs per ACR70 responder were $33,887, $51,109, and $58,869, for Secukinumab 150mg, Secukinumab 300mg and Adalimumab respectively.