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Comparing Cost-Effectiveness Of A Centralized Versus Decentralized Stroke Care System: Using Patient-Level Data To Estimate Short- And Longterm Effects
A502
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1
referral to hospital eye services (RDR). The CUA was facilitated by a time varying Markov model and DR risk factors (HbA1c, blood pressure, duration of diabetes etc.) enabled estimates of relative costs and quality adjusted life years (QALY) gained associated with an increase to biennial screening for people with T1DM and T2DM. Results: Data from 2,286 and 36,202 people with T1DM and T2DM respectively were analysed. Increasing screening intervals to two years for people with T1DM and HbA1c of 6.5, 8.0 and 9.5 at the time of screening were estimated to lose one QALY for a cost saving to national health services (NHS) of £118,612, £48,449 and £15,818 respectively. For people with T2DM at the same HbA1c level suggested NHS saving of £109,320, £60,482 and £32,510 for each QALY lost. The incremental cost effectiveness ratio for biennial screening for people with T1DM was £30,995 for and £73,475 for people with T2DM. Conclusions: Our findings, primarily driven by the difference in the risk of progression to RDR between people with T1DM and T2DM, suggest that biennial screening intervals in people with T2DM makes best use of NHS resources. For people with T1DM however annual screening remains justified and should not be increased to biennial. PHS53 Cost-Utility Analysis Of Antihypertensive Dosage Adjustments By A Pharmacist In A Community Setting Houde F1, Lachaine J2 1University of Montreal, Montréal, QC, Canada, 2University of Montreal, Montreal, QC, Canada
Objectives: Hypertension is a chronic disease for which only 68% of treated patients were controlled in Canada in 2013. Pharmacists in the province of Québec recently received legislative authority to adjust the dosage of antihypertensive drugs if there is an agreement with the prescriber on the therapeutic target. This research aims to estimate the incremental cost-utility ratio (ICUR) of this new model of care in Québec. Methods: A Markov model was developed to extrapolate the impact of this pharmacy practice on strokes, myocardial infarctions and mortality. The model used 1-year cycles over a lifetime horizon. Framingham Risk Equations were used to derive the impact of blood pressure control on strokes and myocardial infarctions. The clinical efficacy of the intervention was derived from the RxAction clinical trial which was conducted in Alberta where pharmacists have a practice similar to Québec’s one. Efficacy was expressed as the proportion of patients with controlled blood pressure. The payer perspective was adopted and only direct costs were included. The main outcome was expressed as the number of quality-adjusted life years (QALYs) gained. Both QALYS and costs were discounted at a 1.5% annual rate. A cohort of 1000 patients entered the model at 65 years old. Results: The model yielded 768 more QALYs in the intervention group for an incremental expense of 3,925,576$. The ICUR was 5,111$/QALY. At a willingness-to-pay threshold of 50,000$/QALY, the intervention is cost-effective. The results were sensitive to the comparative efficacy of the pharmacist intervention against usual care and to the utility of hypertension. Conclusions: Providing pharmacists the ability to adjust the dosage of antihypertensive drugs within the actual fee-for-service rational appears to be cost-effective. Obtaining data on the efficacy of this pharmacy practice from a trial conducted in Québec would provide better information to inform this economic evaluation. PHS54 Comparing Cost-Effectiveness Of A Centralized Versus Decentralized Stroke Care System: Using Patient-Level Data To Estimate Short- And Longterm Effects Freriks RD1, Pizzo E2, Luijckx GJ3, Buskens E3, van der Zee D1, Mierau JO1, Lahr MM3 1University of Groningen, Groningen, The Netherlands, 2University College London, London, UK, 3University Medical Center Groningen, Groningen, The Netherlands
Objectives: Centralizing acute stroke treatment increases the chance of treatment and lowers costs from onset to treatment compared to care at community hospitals. It is unclear whether the centralized model is cost-effective in a real-world setting after treatment. Methods: This study uses observational data from 780 patients in a decentralized system and 267 patients in a centralized system in the Northern Netherlands. Multiple observational datasets were linked to estimate actual healthcare costs and Quality-Adjusted Life Years (QALYs) up to 3 months. Secondary outcomes are lifetime QALYs and healthcare costs, using a probabilistic Markov model. Difference in outcome include 95% Confidence Intervals (CI). Results: Mean healthcare costs up to 3 months are € 6,313 (CI, 5,507 – 7,118) for the centralized system compared to € 7,535 (CI, 7,060 – 8,010) for the decentralized system (P < 0.01). The mean QALYs at 3 months are 0.65 (CI, 0.63 – 0.67) for the decentralized system and 0.69 (CI, 0.65 – 0.73) for the centralized system (P < 0.10). Results remain stable after adjusting both parametrically and non-parametrically for age, gender, stroke severity on arrival, and referrer (P < 0.05). Conclusions: A centralized system for acute stroke care is cost-effective in a real-world setting. Centralizing acute stroke care significantly improves health of the patients by optimizing care efficiency – thereby substantially saving healthcare costs. PHS55 Disease Burden Of Fractures In Patients With Osteoporosis In Japan Fujiwara S1, Umareddy I2, Jaffe D3, Teoh C2, Taguchi Y4 1Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan, 2Kantar Health, Singapore, Singapore, 3Kantar Health, Tel Aviv, Israel, 4Amgen Astellas BioPharma K.K., Tokyo, Japan
Objectives: Osteoporosis remains undertreated in Japan, and bone fractures are the most frequent complications imposing heavy burden on individuals and the community. This research investigates the disease burden of fractures in osteoporosis patients (≥ 50 years old) in Japan with respect to health status, work productivity and activity impairment (WPAI), and healthcare resource utilization. Methods: This study uses the National Health and Wellness Survey (NHWS) 2012–2014 database in Japan with participants’ demographics, health history and health outcomes assessed. Respondents who were aged ≥ 50 years old and indicated a physician diagnosis of osteoporosis were included (N= 1107). Participants with/without prior fractures after age of 50 were compared with respect to health status (assessed via the mental [MCS] and physical component summary [PCS] scores from the Short Form-36v2),
WPAI (assessed via the WPAI-GH instrument) and self-reported healthcare resource utilization in the past 6 months. A secondary analysis was conducted to compare between respondents with ≥ 2 bone fractures (N= 172) and those with 1 bone fracture (N= 242) to assess the association between estimated burden and incremental fractures. Comparisons were made using one-way ANOVAs with a significance level of p< 0.05. Results: Total 414 osteoporosis patients reported prior fractures (female: 92%; mean age: 66.6). Comparing to those without prior fractures, respondents with prior fractures reported significant lower PCS (46.1 vs. 48.7), MCS (47.2 vs. 49.0), health utilities (0.69 vs. 0.72), and significant greater productivity loss due to presenteeism (26.6% vs. 18.8%), activity impairment (34.6% vs. 28.9%), physician visits (13.4 vs. 10.8) and hospitalizations (3.0 vs. 1.1). Similar results were observed for respondents with ≥ 2 bone fractures compared with those with 1 bone fracture. Conclusions: Fractures in osteoporosis patients were associated with poorer health status, greater work productivity loss due to presenteeism and greater healthcare resource utilization. A significant greater burden with incremental fractures was also identified. PHS56 Burden Of Disease, Healthcare Pathways And Costs Of Primary Progressive Multiple Sclerosis: An Italian Real World Study On 10 Million Inhabitants Piccinni C1, Ronconi G1, Dondi L1, Rossi E2, Pedrini A1, Martini N1 1CORE srl – Collaborative Outcome Research, Casalecchio di Reno (Bologna), Italy, 2CINECA Interuniversity Consortium, Casalecchio di Reno, Italy
Objectives: To evaluate the prevalence of primary progressive multiple sclerosis (PPMS) in Italy and to describe the healthcare utilization resources and related costs for National Health Service (NHS). Methods: A cross-sectional analysis of real-world data collected in the ARNO Observatory database, covering > 10 million Italian inhabitants was performed. Starting from a cohort of patients affected by multiple sclerosis (MS) in the 2013 (identified through all available administrative databases), PPMS subjects were defined by the concomitant presence of the following criteria: (i) presence of MS exemption code, (ii) utilization of rehabilitation ambulatory services, (iii) no prescription of Disease-Modifying-Drugs labelled for relapsed remitting MS. For each subject the healthcare utilization in terms of drug prescriptions, outpatient services and hospitalizations was analyzed. The overall average cost per person was estimated by integrating all expenditure items for NHS. Results: Out of 14,971 patients with MS, a cohort of 941 (6.9%) subjects affected by PPMS was selected, with a prevalence of 9.1 per 100,000 inhabitants. Among these, 24.9% received baclofen, 11.3% azathioprine and 10.4% oxybutynin. Moreover, 8.1% of patients was admitted due to MS complications and 98,2% used at least an outpatient service (excluded rehabilitation therapy). PPMS patients generated an average cost of € 4,283 per person. The main cost-driver was hospitalizations, accounting for 55.3% of overall expenditure (€ 2,370 per person), followed by outpatient services (€ 1,229 per person, 28.7%) and drug prescriptions (€ 684 per person, 16.0%). Conclusions: This study provided real-world data of PPMS in Italy, depicting the actual burden of disease with related healthcare utilization and costs. These findings could be useful to estimate the target population of incoming therapies addressed to PPMS that, to date, represents an unmet clinical need. PHS57 Healthcare Resource Utilization And Cost Of Patients With Acute Coronary Syndromes In Tianjin, China Wang Y1, Cong H2, Lu C3, Liu J4, Wu J1 1Tianjin University, Tianjin, China, 2Tianjin Chest Hospital, Tianjin, China, 3Tianjin First Center Hospital, Tianjin, China, 4Tianjin Health Insurance Research Association, Tianjin, China
Objectives: To evaluate healthcare resource utilization and cost among patients with acute coronary syndromes (ACS) in Tianjin, China. Methods: Data were extracted from Tianjin Urban Employee Basic Medical Insurance database (20112015). Adult patients with primary discharge diagnosis of ACS during 2012-2014, and with insurance coverage of at least 12 months before index hospitalization and after index discharge were included. Optimal medical therapy (OMT) was defined as receiving antiplatelets, statins, ACEIs/ARBs and β -blockers. ACS-related hospitalization and outpatient visit were defined as those with ACS diagnosis, and ACS-related cost as sum of ACS-related hospitalization/outpatient cost and OMT cost from services without ACS diagnosis. Patients were divided into two cohorts according to OMT use at discharge. Propensity-score matching was employed to adjust baseline difference. Generalized linear model (GLM) was conducted to assess the effect of OMT. Results: 22,041 patients (64.7±10.7 years; 45.4% male) were identified, of which 15.1% received OMT at discharge. Within 1 year after discharge, each patient experienced an average of 11.24 ACS-related outpatient visits and 0.24 ACS-related hospitalizations. The ACS-related total cost per patient was￥8,531, among which OMT cost was ￥2,037 while hospitalization cost was ￥4,666. After matching for baseline of OMT vs. non-OMT patients, there were 3,336 patients in each cohort. During 1-year follow up, OMT patients had more frequent outpatient visits than non-OMT patients (14.24 vs. 13.62, P< 0.001), while OMT patients experienced less ACS-related hospitalization (0.21 vs. 0.24, P< 0.001) as well as less ACS-related total cost (￥9,759 vs. ￥10,374, P= 0.005). GLM result also indicated that OMT was associated with lower ACS-related total cost (coefficient: -0.12, P= 0.039). Conclusions: Hospitalization cost was the driver even after index discharge. OMT at discharge was associated with less hospitalizations and lower costs. Further strategies are needed to improve the optimal medical care of ACS. PHS58 Cost Of Treatment-Related Adverse Events (TRAES) In Second-Line (2l) Advanced Hepatocellular Carcinoma (AHCC): Match Adjusted Indirect Comparison (MAIC) Of Nivolumab And Regorafenib Venkatachalam M1, Stenehjem D2, Parikh ND3, Singh P4, Marett B4, Sill B4, Wisniewski T4, Prakash V5, Shukla P5, Korytowsky B4, Siddiqui MK5 1PAREXEL International, Waltham, MA, USA, 2University of Minnesota, Duluth, MN, USA, 3University of Michigan, Ann Arbor, MI, USA, 4Bristol-Myers Squibb, Princeton, NJ, USA, 5PAREXEL International, Chandigarh, India
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1
referral to hospital eye services (RDR). The CUA was facilitated by a time varying Markov model and DR risk factors (HbA1c, blood pressure, duration of diabetes etc.) enabled estimates of relative costs and quality adjusted life years (QALY) gained associated with an increase to biennial screening for people with T1DM and T2DM. Results: Data from 2,286 and 36,202 people with T1DM and T2DM respectively were analysed. Increasing screening intervals to two years for people with T1DM and HbA1c of 6.5, 8.0 and 9.5 at the time of screening were estimated to lose one QALY for a cost saving to national health services (NHS) of £118,612, £48,449 and £15,818 respectively. For people with T2DM at the same HbA1c level suggested NHS saving of £109,320, £60,482 and £32,510 for each QALY lost. The incremental cost effectiveness ratio for biennial screening for people with T1DM was £30,995 for and £73,475 for people with T2DM. Conclusions: Our findings, primarily driven by the difference in the risk of progression to RDR between people with T1DM and T2DM, suggest that biennial screening intervals in people with T2DM makes best use of NHS resources. For people with T1DM however annual screening remains justified and should not be increased to biennial. PHS53 Cost-Utility Analysis Of Antihypertensive Dosage Adjustments By A Pharmacist In A Community Setting Houde F1, Lachaine J2 1University of Montreal, Montréal, QC, Canada, 2University of Montreal, Montreal, QC, Canada
Objectives: Hypertension is a chronic disease for which only 68% of treated patients were controlled in Canada in 2013. Pharmacists in the province of Québec recently received legislative authority to adjust the dosage of antihypertensive drugs if there is an agreement with the prescriber on the therapeutic target. This research aims to estimate the incremental cost-utility ratio (ICUR) of this new model of care in Québec. Methods: A Markov model was developed to extrapolate the impact of this pharmacy practice on strokes, myocardial infarctions and mortality. The model used 1-year cycles over a lifetime horizon. Framingham Risk Equations were used to derive the impact of blood pressure control on strokes and myocardial infarctions. The clinical efficacy of the intervention was derived from the RxAction clinical trial which was conducted in Alberta where pharmacists have a practice similar to Québec’s one. Efficacy was expressed as the proportion of patients with controlled blood pressure. The payer perspective was adopted and only direct costs were included. The main outcome was expressed as the number of quality-adjusted life years (QALYs) gained. Both QALYS and costs were discounted at a 1.5% annual rate. A cohort of 1000 patients entered the model at 65 years old. Results: The model yielded 768 more QALYs in the intervention group for an incremental expense of 3,925,576$. The ICUR was 5,111$/QALY. At a willingness-to-pay threshold of 50,000$/QALY, the intervention is cost-effective. The results were sensitive to the comparative efficacy of the pharmacist intervention against usual care and to the utility of hypertension. Conclusions: Providing pharmacists the ability to adjust the dosage of antihypertensive drugs within the actual fee-for-service rational appears to be cost-effective. Obtaining data on the efficacy of this pharmacy practice from a trial conducted in Québec would provide better information to inform this economic evaluation. PHS54 Comparing Cost-Effectiveness Of A Centralized Versus Decentralized Stroke Care System: Using Patient-Level Data To Estimate Short- And Longterm Effects Freriks RD1, Pizzo E2, Luijckx GJ3, Buskens E3, van der Zee D1, Mierau JO1, Lahr MM3 1University of Groningen, Groningen, The Netherlands, 2University College London, London, UK, 3University Medical Center Groningen, Groningen, The Netherlands
Objectives: Centralizing acute stroke treatment increases the chance of treatment and lowers costs from onset to treatment compared to care at community hospitals. It is unclear whether the centralized model is cost-effective in a real-world setting after treatment. Methods: This study uses observational data from 780 patients in a decentralized system and 267 patients in a centralized system in the Northern Netherlands. Multiple observational datasets were linked to estimate actual healthcare costs and Quality-Adjusted Life Years (QALYs) up to 3 months. Secondary outcomes are lifetime QALYs and healthcare costs, using a probabilistic Markov model. Difference in outcome include 95% Confidence Intervals (CI). Results: Mean healthcare costs up to 3 months are € 6,313 (CI, 5,507 – 7,118) for the centralized system compared to € 7,535 (CI, 7,060 – 8,010) for the decentralized system (P < 0.01). The mean QALYs at 3 months are 0.65 (CI, 0.63 – 0.67) for the decentralized system and 0.69 (CI, 0.65 – 0.73) for the centralized system (P < 0.10). Results remain stable after adjusting both parametrically and non-parametrically for age, gender, stroke severity on arrival, and referrer (P < 0.05). Conclusions: A centralized system for acute stroke care is cost-effective in a real-world setting. Centralizing acute stroke care significantly improves health of the patients by optimizing care efficiency – thereby substantially saving healthcare costs. PHS55 Disease Burden Of Fractures In Patients With Osteoporosis In Japan Fujiwara S1, Umareddy I2, Jaffe D3, Teoh C2, Taguchi Y4 1Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan, 2Kantar Health, Singapore, Singapore, 3Kantar Health, Tel Aviv, Israel, 4Amgen Astellas BioPharma K.K., Tokyo, Japan
Objectives: Osteoporosis remains undertreated in Japan, and bone fractures are the most frequent complications imposing heavy burden on individuals and the community. This research investigates the disease burden of fractures in osteoporosis patients (≥ 50 years old) in Japan with respect to health status, work productivity and activity impairment (WPAI), and healthcare resource utilization. Methods: This study uses the National Health and Wellness Survey (NHWS) 2012–2014 database in Japan with participants’ demographics, health history and health outcomes assessed. Respondents who were aged ≥ 50 years old and indicated a physician diagnosis of osteoporosis were included (N= 1107). Participants with/without prior fractures after age of 50 were compared with respect to health status (assessed via the mental [MCS] and physical component summary [PCS] scores from the Short Form-36v2),
WPAI (assessed via the WPAI-GH instrument) and self-reported healthcare resource utilization in the past 6 months. A secondary analysis was conducted to compare between respondents with ≥ 2 bone fractures (N= 172) and those with 1 bone fracture (N= 242) to assess the association between estimated burden and incremental fractures. Comparisons were made using one-way ANOVAs with a significance level of p< 0.05. Results: Total 414 osteoporosis patients reported prior fractures (female: 92%; mean age: 66.6). Comparing to those without prior fractures, respondents with prior fractures reported significant lower PCS (46.1 vs. 48.7), MCS (47.2 vs. 49.0), health utilities (0.69 vs. 0.72), and significant greater productivity loss due to presenteeism (26.6% vs. 18.8%), activity impairment (34.6% vs. 28.9%), physician visits (13.4 vs. 10.8) and hospitalizations (3.0 vs. 1.1). Similar results were observed for respondents with ≥ 2 bone fractures compared with those with 1 bone fracture. Conclusions: Fractures in osteoporosis patients were associated with poorer health status, greater work productivity loss due to presenteeism and greater healthcare resource utilization. A significant greater burden with incremental fractures was also identified. PHS56 Burden Of Disease, Healthcare Pathways And Costs Of Primary Progressive Multiple Sclerosis: An Italian Real World Study On 10 Million Inhabitants Piccinni C1, Ronconi G1, Dondi L1, Rossi E2, Pedrini A1, Martini N1 1CORE srl – Collaborative Outcome Research, Casalecchio di Reno (Bologna), Italy, 2CINECA Interuniversity Consortium, Casalecchio di Reno, Italy
Objectives: To evaluate the prevalence of primary progressive multiple sclerosis (PPMS) in Italy and to describe the healthcare utilization resources and related costs for National Health Service (NHS). Methods: A cross-sectional analysis of real-world data collected in the ARNO Observatory database, covering > 10 million Italian inhabitants was performed. Starting from a cohort of patients affected by multiple sclerosis (MS) in the 2013 (identified through all available administrative databases), PPMS subjects were defined by the concomitant presence of the following criteria: (i) presence of MS exemption code, (ii) utilization of rehabilitation ambulatory services, (iii) no prescription of Disease-Modifying-Drugs labelled for relapsed remitting MS. For each subject the healthcare utilization in terms of drug prescriptions, outpatient services and hospitalizations was analyzed. The overall average cost per person was estimated by integrating all expenditure items for NHS. Results: Out of 14,971 patients with MS, a cohort of 941 (6.9%) subjects affected by PPMS was selected, with a prevalence of 9.1 per 100,000 inhabitants. Among these, 24.9% received baclofen, 11.3% azathioprine and 10.4% oxybutynin. Moreover, 8.1% of patients was admitted due to MS complications and 98,2% used at least an outpatient service (excluded rehabilitation therapy). PPMS patients generated an average cost of € 4,283 per person. The main cost-driver was hospitalizations, accounting for 55.3% of overall expenditure (€ 2,370 per person), followed by outpatient services (€ 1,229 per person, 28.7%) and drug prescriptions (€ 684 per person, 16.0%). Conclusions: This study provided real-world data of PPMS in Italy, depicting the actual burden of disease with related healthcare utilization and costs. These findings could be useful to estimate the target population of incoming therapies addressed to PPMS that, to date, represents an unmet clinical need. PHS57 Healthcare Resource Utilization And Cost Of Patients With Acute Coronary Syndromes In Tianjin, China Wang Y1, Cong H2, Lu C3, Liu J4, Wu J1 1Tianjin University, Tianjin, China, 2Tianjin Chest Hospital, Tianjin, China, 3Tianjin First Center Hospital, Tianjin, China, 4Tianjin Health Insurance Research Association, Tianjin, China
Objectives: To evaluate healthcare resource utilization and cost among patients with acute coronary syndromes (ACS) in Tianjin, China. Methods: Data were extracted from Tianjin Urban Employee Basic Medical Insurance database (20112015). Adult patients with primary discharge diagnosis of ACS during 2012-2014, and with insurance coverage of at least 12 months before index hospitalization and after index discharge were included. Optimal medical therapy (OMT) was defined as receiving antiplatelets, statins, ACEIs/ARBs and β -blockers. ACS-related hospitalization and outpatient visit were defined as those with ACS diagnosis, and ACS-related cost as sum of ACS-related hospitalization/outpatient cost and OMT cost from services without ACS diagnosis. Patients were divided into two cohorts according to OMT use at discharge. Propensity-score matching was employed to adjust baseline difference. Generalized linear model (GLM) was conducted to assess the effect of OMT. Results: 22,041 patients (64.7±10.7 years; 45.4% male) were identified, of which 15.1% received OMT at discharge. Within 1 year after discharge, each patient experienced an average of 11.24 ACS-related outpatient visits and 0.24 ACS-related hospitalizations. The ACS-related total cost per patient was￥8,531, among which OMT cost was ￥2,037 while hospitalization cost was ￥4,666. After matching for baseline of OMT vs. non-OMT patients, there were 3,336 patients in each cohort. During 1-year follow up, OMT patients had more frequent outpatient visits than non-OMT patients (14.24 vs. 13.62, P< 0.001), while OMT patients experienced less ACS-related hospitalization (0.21 vs. 0.24, P< 0.001) as well as less ACS-related total cost (￥9,759 vs. ￥10,374, P= 0.005). GLM result also indicated that OMT was associated with lower ACS-related total cost (coefficient: -0.12, P= 0.039). Conclusions: Hospitalization cost was the driver even after index discharge. OMT at discharge was associated with less hospitalizations and lower costs. Further strategies are needed to improve the optimal medical care of ACS. PHS58 Cost Of Treatment-Related Adverse Events (TRAES) In Second-Line (2l) Advanced Hepatocellular Carcinoma (AHCC): Match Adjusted Indirect Comparison (MAIC) Of Nivolumab And Regorafenib Venkatachalam M1, Stenehjem D2, Parikh ND3, Singh P4, Marett B4, Sill B4, Wisniewski T4, Prakash V5, Shukla P5, Korytowsky B4, Siddiqui MK5 1PAREXEL International, Waltham, MA, USA, 2University of Minnesota, Duluth, MN, USA, 3University of Michigan, Ann Arbor, MI, USA, 4Bristol-Myers Squibb, Princeton, NJ, USA, 5PAREXEL International, Chandigarh, India