Cost-Effectiveness Analysis of Neonatal Screening With Pulse Oximetry For The Detection of Critical Congenital Heart Disease In Colombia, 2017

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≥ COP30.000.000, the probability that the OEAs+AABR strategy will be cost effective compared to AABR, is 50-80%. Results are maintained in the sensitivity analysis. The DALYs discount rate, the prevalence of congenital hearing loss in neonates without risk factors, and the prevalence of profound hearing loss generated greater uncertainty in the results. PMD82 Cost-Effectiveness Of Insulin Pumps Versus Multiple Daily Insulin (MDI) Injection In Type 1 Diabetes In India From Societal Perspective Pandey P, Pandey R SIRO Clinpharm Pvt Ltd, Maharashtra, India

Objectives: Each year 3-5% of Indians develop Type 1 diabetes mellitus (T1DM). Intensified insulin therapy using insulin pumps or MDI are recommended methods. However, insulin pumps are expensive for patients living in middle income countries like India who have to bear high out-of-pocket expense. We conducted a cost-effectiveness analysis to assess the value for money of insulin pumps in Indian settings.  Methods: Analysis was conducted from societal perspective using a Markov model with time horizon of 8 years. India specific data, wherever available, were extracted, else adopted from comparable economies. Costs and qualityadjusted life years (QALYs) were discounted at a rate of 3.5% annually. Probabilistic sensitivity analysis was performed to assess the robustness of analysis. Model outcomes were reported as incremental cost-effectiveness ratio (ICERs) and costeffectiveness acceptability curve was constructed.  Results: Insulin pumps had high cost (INR 1286215.08) and high benefits (1.7787). Insulin pump incurred an additional cost of INR 9,78,114.74 to gain an additional year of perfect health. The ICER was greater than three times of India’s Gross Domestic Product (GDP) per capita (INR 1,10,368.91).  Conclusions: Insulin pumps were associated with better outcomes and higher costs. Insulin pump could be an effective and useful technique provided the patients have lower out-of-pocket expense. Scarcity of India specific data, especially efficacy estimates could have compromised the robustness of analysis. PMD83 Cost-Effectiveness Analysis of Neonatal Screening With Pulse Oximetry For The Detection of Critical Congenital Heart Disease In Colombia, 2017 Londoño D1, Taborda A1, Domínguez MT2, Sandoval NS2, Troncoso GT2, Fonseca AF2, Aranguren CA2, Novoa LN2, Dennis RJ2 1Fundación Santa Fé de Bogotá, Bogotá, Colombia, 2Fundación Cardioinfantil, Bogotá, Colombia

Objectives: Critical congenital heart diseases, such as late postnatal diagnosis, are associated with the prognosis of surgical treatment or catheterization before the first year of life, as well as with more hospital admissions, more hospital days, and more hospital costs during childhood. This research aims to establish the incremental cost-effectiveness ratio of cutaneous pulse oxymetry at 24 hours after birth, in addition to the general examination of the newborn, in the early detection of critical congenital heart disease in Colombia.  Methods: A full cost-effectiveness analysis was conducted from a societal perspective using a decision tree that compares general examination plus pulseoximetry versus the general examination only to detect critical congenital heart disease. Sensitivity and specificity of the test were taken from the best evidence available through a systematic review; costs were estimated using official sources and local rates. For non-dominated alternatives we calculated the incremental cost-effectiveness ratio and we performed a deterministic sensitivity analysis to assess the effect of uncertainty.  Results: The cost of screening with pulse oximetry and general examination was USD 124, USD 30 more than the general examination alone; the effectiveness of pulse oximetry and general examination was 0.99, 0.01 more than general examination alone. The incremental cost-effectiveness ratio was estimated at USD 3,008 per correctly diagnosed cases, that is, if we want to increase the number of correctly diagnosed cases by 1%, that amount will have to be invested. Willingness to pay was defined at USD 5,138.42 per case correctly diagnosed. Results were sensitive to changes in specificity of the tests and prevalence of critical congenital heart disease.  Conclusions: From the societal point of view and at current prices, 24-hour pulse oximetry screening in addition to general newborn screening may be a cost-effective strategy for the early detection of critical congenital heart disease in Colombia. PMD84 Cost Effectiveness Of Duragraft As A Vein Graft Treatment In Coronary Artery Bypass Grafting In Turkey Tatar M1, Şentürk A1, Nogueira E2 1Polar

Health Economics & Policy Consultancy, Ankara, Turkey, 2Qmed Consulting, Køge, Denmark

Objectives: Following revascularization procedures, Vein Graft Failure (VGF) can generate complications such as repeat revascularization, myocardial infarction (MI), mortality, hospital readmission, quality of life and co-morbidities. VGF is the most common complication of Coronary Artery Bypass Grafting (CABG). Storage and flushing of the vein graft is the most critical stage of the surgery. DuraGraft is one-time intraoperative vein graft treatments that prevents VGF and reduces repeat revascularization and MI by 48% and 53% respectively. The main objective of this study is to analyze the cost effectiveness of DuraGraft in CABG in Turkey.  Methods: A simple decision model was used in the study. Analyses were made from the Turkish Social Security Institution’s (SSI/SGK) perspective. Literature research and expert opinions were used to estimate the cost of CABG and complications as revascularization and myocardial infarction. The comparison was made with use and nonuse of DuraGraft. Outcome measures were taken from literature, cost data were obtained from expert views of use of resources in both CABG and treatment of complications. The results were presented as incremental cost per averted complication.  Results: There were 46.956 CABG procedures performed in Turkey in 2016. Revascularization after CABG was 4,59% and experts stated that 35% of these patients undergo another CABG, with and ballon+stent applied to the other patients. MI rate after CABG was 4,44%. Cost of treatment per patient was 6.430 TRY for CABG, 1.865 TRY for balloon+stent and 8.277 TRY for MI. The incremental number

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of averted complications was 2.724. In terms of incremental cost effectiveness ratio, use of DuraGraft as a vein graft treatment dominated non-use and achieved better outcomes with lower cost.  Conclusions: The results showed that use of DuraGraft as a vein graft treatment in CABG is a cost effective option for the Turkish SSI/SGK. PMD85 Cost Effectiveness of Ultrasound Screening, Cancer Patients, To Detect Asymptomatic Thrombosis Kourlaba G1, Gourzoulidis G1, Rasmussen E2, Kontodimas S3, Maniadakis N4 1Evroston LP, Athens, Greece, 2LEO Pharma, København, Denmark, 3LEO Pharma Hellas, Athens, Greece, 4National School of Public Health, Athens, Greece

Objectives: Cancer patients are at high risk to develop thrombosis with an even distribution between symptomatic and asymptomatic. The objective was to evaluate the cost-effectiveness of screening with ultrasound (US) cancer patients for asymptomatic deep vein thrombosis (DVT) at the time of cancer diagnosis.  Methods: A decision tree was developed to compare two approaches for detecting DVT in highrisk cancer patients without symptomatic DVT at the time of cancer diagnosis: (a) screening all patients by US and subsequent treatment, and (b) clinical surveillance for signs or symptoms of DVT and treatment after clinical confirmation of DVT or pulmonary embolism (PE). To increase US specificity all patients with a positive US were subjected to a second one. Prevalence of symptomatic and asymptomatic DVT, sensitivity and specificity of US, incidence of PE and DVT in those receiving or not receiving anticoagulants for asymptomatic DVT, risk of hemorrhage and mortality rates were extracted from literature. Cost inputs include: PE, DVT, and hemorrhage management costs, US cost and medication cost for the management of asymptomatic DVT. Unit costs were obtained from local resources (prices € 2017). The analysis was conducted from the Greek third-party payer perspective.  Results: Screening a hypothetical cohort of 907 high-risk cancer patients without symptomatic DVT (i.e. 1000 high risk patients minus those with symptomatic DVT), 49.66 venous thromboembolic events (VTE) were avoided at a total incremental cost of € 13,958, resulting in an incremental cost/VTE avoided of € 281.5 over clinical surveillance). Specificity of US and incidence of PE and DVT among patients not receiving anticoagulants for treating asymptomatic DVT are the major drivers of the results.  Conclusions: Our findings indicate that screening high-risk cancer patients by US to detect asymptomatic DVT is a cost-effective strategy over clinical surveillance, even when all patients with a positive first US are subjected to a second US. PMD86 Cost-Effectiveness of A Flash Glucose Monitoring System Based On Real-World Usage For Type 2 Diabetes (T2DM) Patients Using Intensive Insulin: A Swedish Perspective Bilir SP1, Wehler EA2, Hellmund R3, Munakata J1 1QuintilesIMS, San Francisco, CA, USA, 2QuintilesIMS, Plymouth Meeting, PA, USA, 3Abbott Diabetes Care, Alameda, CA, USA

Objectives: Regular glucose monitoring is important for T2DM patients receiving intensive insulin, with lower HbA1c observed in patients testing glucose more frequently (Schutt 2006). A novel, factory-calibrated flash glucose monitoring (“FM”) system (the FreeStyle Libre™ system) continuously measures glucose levels from interstitial fluid without requiring routine self-monitoring of blood glucose (SMBG). Data is then transferred to a handheld reader from the wearable arm sensor. Realworld data collected from a cohort of 50,831 readers indicates FM users scan more often on average than SMBG users (16 scans/day vs 2.7 tests/day (Schutt 2006)), and confirms lower HbA1c associated with more frequent testing. This analysis evaluates potential clinical and economic benefits of more frequent testing associated with FM compared to SMBG in T2DM patients using intensive insulin.  Methods: The QuintilesIMS Core Diabetes Model was run for 40 years, modelling a population reflecting the REPLACE study (Haak 2017). Intervention effects include: HbA1c intervention benefit (0.94%) based on number of tests/day; REPLACE study-based reductions in hypoglycaemic events (27.7% reduction in glucose < 70 mg/dL); and a 0.03 utility benefit (Matza 2017). Costs were reported in 2016 SEK. Disaggregated costs and effects were estimated, with sensitivity analyses conducted on the scan frequency interquartile range, as well as exploration of scan frequency impact on major hypoglycaemic event rates.  Results: In base case analysis FM dominated SMBG, with 0.906 more QALYs (6.444 vs 5.538) and SEK84,586 in combined (direct and indirect) cost savings (FM: SEK1,966,052 vs SMBG: SEK2,050,638). Explored scenarios also showed that FM dominated, with incremental savings: SEK34,808 to SEK154,809 and incremental QALYs: 0.829 to 0.988.  Conclusions: Real-world data indicate a high testing frequency among FM users compared to SMBG use. Given that higher test frequency is associated with lower HbA1c and hypoglycaemia, FM may be considered dominant for T2DM patients receiving intensive insulin in Sweden. PMD87 Assessing The Cost-Effectiveness Of The Manchester Acute Coronary Syndrome (MACS) Decision-Aid: A Feasibility Study Thompson AJ1, Lecky F2, Body R3 University of Manchester, Manchester, UK, 2Salford Royal NHS Foundation Trust, Salford, UK, 3Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK

1The

Objectives: Chest pain is the most common reason for emergency hospital admission yet only a minority of patients admitted to hospital ultimately have acute coronary syndrome (ACS). The Manchester Coronary Acute Syndromes (MACS) model is a validated clinical decision model that ‘rules in’ and ‘rules out’ ACS at admission using one blood test. MACS can potentially release economic benefits by preventing unnecessary admission and discharging patients home early. This feasibility study aimed to evaluate whether MACS represents a potentially cost-effective use of resources.  Methods: An economic evaluation integrated into a randomised controlled trial compared (i) MACS guided care pathway (n= 67) to (ii) ‘standard care’ pathway (n= 65) with delayed (12 hour) troponin testing. Patients presenting to the emergency department at two hospitals with suspected ACS were included. In the MACS arm, clinicians were given patient’s risk of ACS and individualised