Cost-Effectiveness Analysis Of Two Long-Acting Muscarinic Antagonists For Copd Treatment In Spain: Umeclidinium VS. Tiotropium (HO-17-18472)

A646

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

with a discount rate of 3.5%.Transition probabilities come from transition rates by assessing the exponential matrix of a Kolmogorov model of patient condition evolution.  Results: Total costs from the NHS, patient, and society perspectives of 1,000 patients are € 1,201,534.12, € 1,030.42, € 1,880,004.15 respectively for the control group, and € 1,316,556.09; € 0.00; € 1,399,226.49 for the study group. QoL shows a higher mean in the study than in the control group. Differences of emotional problem and PACQL scores assessed before and after randomization are not statistically different in the two groups.  Conclusions: With comparable QoL, SLIT induces an increasing of direct costs but a reduction of societal costs because of a reduction in out-of-pocket expenses and indirect costs. PRS37 Cost Effectiveness of Nintedanib Versus Pirfenidone Treatment In Idiopathic Pulmonary Fibrosis In Turkey Demir O1, Tetik E2, Kamaci E3, Cheynel J4 1Boehringer Ingelheim Ilaç Tic A.S., İstanbul, Turkey, 2Boehringer Ingelheim Ilaç Tic A.S., Istanbul, Turkey, 3Boehringer Ingelheim Tic A.S., Istanbul, Turkey, 4Boehringer Ingelheim, Dubai, United Arab Emirates

Objectives: To assess the cost effectiveness of nintedanib versus pirfenidone treatment in the treatment of patients with idiopathic pulmonary fibrosis (IPF) in Turkey.  Methods: Based on an economic evaluation of cost-effectiveness of nintedanib treatment for IPF by UK, the adaptation of this model performed in Turkey. A Markov model was mainly built on the basis of the INPULSISTM clinical data, in terms of lung function, acute exacerbations, overall survival and quality of life. In the model, patients were distributed to start in the various lung function health states according to their baseline disposition, then progress over time. Cohort is followed over lifetime and the outcomes are evaluated every 3 months. One-way and probabilistic sensitivity analyses were also conducted. Each health state was associated with a specific utility and a background treatment costs which were calculated according to expert opinion and unit costs determined by local Social Security Institution. Costs are expressed in Turkish Lira (TRY).  Results: In “broad” patient population model, Nintedanib provide a cost advantage of 1,079,338.25TL per QALY and 7,889,146.32TRY per life years gained (LYG) as compared to pirfenidone for the first year. For the following years, cost advantage of Nintedanib will be 921,977.09TL per QALY and 6,738,955.23TRY per LYG as compared to pirfenidone. In “restricted” patient population model, Nintedanib provide a cost advantage of 4,613.15TRY per QALY and 4,220.61TRY per life years gained (LYG) as compared to pirfenidone for the first year. For the following years, cost advantage of Nintedanib will be 13,517.60TRY per QALY and 12,367.37TRY per LYG.  Conclusions: Base-case deterministic results indicate that Nintedanib treatment dominates Pirfenidone, with lower costs and more QALYs gained. Lower rate of exacerbations with Nintedanib is an important driver of these results. PRS38 Economic Evaluation of Single Inhaler Triple Therapy For Patients With Chronic Obstructive Pulmonary Disease (COPD) Using The Galaxy Model Zhang S1, Shah D2, Risebrough N3, Martin AA4, Briggs A5, Ismaila A6 plc, New York, NY, USA, 3ICON plc, Toronto, ON, Canada, 4GSK, Uxbridge, UK, 5University of Glasgow, Glasgow, UK, 6GSK, Research Triangle Park, NC, USA

1GSK, Collegeville, PA, USA, 2ICON

Objectives: FULFIL (NCT02345161) showed the clinical benefit of single inhaler, once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100μ g/62.5μ g/25μ g versus twice-daily budesonide/formoterol (BUD/FOR) 400μ g/12μ g for patients with symptomatic COPD (Lipson, 2017). The cost-effectiveness analysis of FF/UMEC/VI versus BUD/FOR, based on FULFIL data, is reported here.  Methods: A treatment-specific adaptation of the GALAXY COPD model (Briggs, 2017) was developed to assess cost-effectiveness from the UK healthcare system perspective. The model input parameters included baseline characteristics and efficacy results from FULFIL and UK National Health Service reference cost data. Outputs included exacerbation rates, costs, life-years (LYs) gained and quality-adjusted life years (QALYs). Estimated incremental costs (ICER) per LY and per QALY gained were calculated. A discount rate of 3.5% for costs and benefits was used. Sensitivity analyses were performed on input parameters.  Results: The predicted cumulative number of exacerbations per patient over their lifetime was 8.26 with FF/UMEC/VI and 10.3 with BUD/FOR. The accumulated LYs (undiscounted) was 10.197 in patients who received FF/UMEC/VI and 9.43 with BUD/FOR; the accumulated QALYs were 5.36 and 4.89, respectively. The total accumulated costs over a lifetime were £20,080 with FF/UMEC/VI and £18,410 with BUD/FOR. Patients who received FF/UMEC/VI gained an additional 0.767 LYs and 0.478 QALYs compared with BUD/FOR, with an additional cost of £1,670. The ICER was £3,500 per QALY, compared with BUD/FOR. Using alternative time horizons, treatment with FF/UMEC/VI was associated with ICERs of £3,660 at 5 years and £3,300 at 10 years, per QALY, compared with BUD/ FOR. Sensitivity analyses showed that variation in main parameters did not alter the results.  Conclusions: Based on the economic analysis, treatment with FF/ UMEC/VI was predicted to reduce the total cumulative number of exacerbations, including severe events, compared with BUD/FOR. LY, QALY and cost findings suggest that FF/UMEC/VI may be a cost-effective treatment option for COPD in the UK. Funding: GSK (HO-16-13835) PRS39 Cost-Effectiveness Analysis Of Two Long-Acting Muscarinic Antagonists For Copd Treatment In Spain: Umeclidinium VS. Tiotropium (HO-17-18472) Huerta A, Vallejo-Aparicio LA GlaxoSmithKline, Tres Cantos (Madrid), Spain

Objectives: To estimate the incremental cost-effectiveness ratio (ICER) of the long-acting muscarinic antagonist umeclidinium compared with tiotropium, considered the standard of care for Chronic Obstructive Pulmonary Disease (COPD), from the Spanish National Health System (NHS) perspective. Methods: The

analysis was based on a head-to-head trial comparing changes from baseline in lung function (FEV1) between umeclidinium 62.5mcg and tiotropium 18mcg, on a 12-week-period (Feldman G. et al. Int J Chron Obstruct Pulmon Dis 2016). A previously published linked equations cohort model, based on ECLIPSE and TORCH studies, which estimates COPD progression, exacerbation rates, associated healthcare-costs, quality-adjusted-life-years (QALYs) and survival, was used (Miravitlles M. et al. Int J Chron Obstruct Pulmon Dis 2016). A 3-year time horizon was selected. COPD diagnosed patients with post-bronchodilator FEV1 of 30%-70% predicted and respiratory symptoms (mMRC dyspnoea scale ≥  2) were included. Differential treatment effect was maintained until first year of analysis, based on a 52-weeks umeclidinium trial; subsequently no differences were assumed. Effectiveness was measured in QALYs, deriving utilities from a Spanish observational study. Directcosts were obtained from local sources and treatments-costs from Spain retail prices for 2017 (€ 45.27 and € 49.06 for umeclidinium and tiotropium respectively). Results were expressed as incremental costs per QALY gained (ICER), applying a 3% discount to costs and QALYs. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were performed. On DSA different discounts for tiotropium retail price were tested.  Results: At base-case umeclidinium was dominant over tiotropium, gaining 0.0135 QALYs with cost-savings of € 192.20. DSA for tiotropium price showed that umeclidinium was cost-effective up to 36.3% tiotropium discount, as ICERs were below the accepted € 30,000/QALY willingness-to-pay threshold in Spain. Varying main parameters in PSA did not have a significant impact on results.  Conclusions: From the Spanish NHS perspective, umeclidinium is a dominant alternative to tiotropium, the standard of care for COPD. PRS40 Cost-Effectiveness Analysis of Adding New Drug Thiozonide To Iv-Th Drug Regimens For Multidrug-Resistant Tuberculosis Krysanov I1, Ermakova V2, Tiapkina M2 of Medical and Social Technologies, Moscow National University of Food Production, Moscow, Russia, 2Sechenov First Moscow State Medical University, Moscow, Russian Federation 1Institute

Objectives: to build a model, including clinical characteristics of patients with multidrug-resistant tuberculosis (MDR-TB), and estimate healthcare costs and efficacy of therapy MDR-TB in Russian.  Methods: a cohort-based Markov cost-effectiveness model was developed to estimate the incremental cost-efficacy ratio (ICER) of adding new drug thiozonide ( 200 mg, 400 mg, 600 mg + IV-th drug regimen) to IV-th drug regimen (involving 8 months Cm Lfx Z Cs/Trd PAS Pto/Eto + 12-18 month Lfx Z PAS Cs/Trd (Pto/Eto) for the treatment of MDR-TB. As clinical research currently ongoing and there is no efficacy data on thiozonide, for the early economic evaluation the assumption was made that thiazonide will be not less efficacy than bedaquilline (assumption based on their similar chemical molecule). Outcome measures were quality-adjusted life years (QALY) and disability-adjusted Life Year (DALY). The model used a 3-year time horizon and 3 month cycle length. Willingness to pay threshold (WTP) for Russian health care system was estimated at € 26,383 (1648924 RUB), exchange rate mean in 2017 - € 1 =  62.5 RUB.  Results: applying the base case settings resulted in 1.15 incremental QALYs, -4.75 incremental DALYs, and incremental costs of € 1,654.74, € 3,309.5 and € 4,964.2 (103421, 206841, 310262 RUB) for thiozonide 200/400/600 mg dosages regimen respectively сompared with the fourth treatment regimen alone. Incremental cost-efficacy ratio (ICER) evaluated at € 1,438.9, € 2,877.8 and € 4,964.2 (89931, 179862, 269793 RUB) per QALY gained and € 362.1, € 724.2, € 1,086.3 (22630, 45261, 67891 RUB) per DALY for 200/400/600 mg dosages regimen or thiozonide respectively. According to non-official WTP threshold of € 26,383 (1648924 RUB) adding thiozonide to IV drug regimens therapy of MDR-TB will be cost-effective versus IV-th drug regimens alone.  Conclusions: using the model the user can enter their own data (sample size, efficacy, relapse and mortality rate) for the early economic evaluation of the new drug for multidrug-resistant tuberculosis treatment. PRS41 Comparison of Budesonide Inhalers For Treatment of Asthma In Adults And Adolescents In Russian Federation: Cost – Effectiveness Analysis Makarova E, Yagudina R, Kulikov A I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Objectives: To evaluate of the cost - effectiveness of two budesonide dry powder inhalers, which included Easyhaler and Turbuhaler devices in adult and adolescent patients in Russian Federation. The patients were represented by persons older than 12 years of age with asthmatic disease, who had no experiences with inhaler usage (inhaler naive).  Methods: Information search was conducted in the public domain. Pharmacoeconomic analysis  Methods: cost – effectiveness analysis was performed. The study had a time horizon of 1 year. The evaluation of therapy effectiveness was based on quality-adjusted life years (QALY) criteria. The QALY was calculated of relationship between quality of life and compliance. Utility data were received from published literature. The direct cost of the various medications per patient was calculated. Cost analysis was conducted on the cost of basic pharmacotherapy, compensation costs for treatment of exacerbations, compensation costs for side effects and adverse events. Exacerbation defined as any of the following: hospital visits, primary care physician visits and visits to healthcare professional  Results: Results showed that budesonide via Easyhaler had a total direct cost per adult/ adolescent patient with asthma amounted to EUR 985 per year (versus EUR 1,113 to the Turbuhaler group) and cost saving prepared by of EUR 161 per QALY versus budesonide via Turbuhaler.  Conclusions: Treatment of asthma in adult/ adolescent patients of budesonide via Easyhaler was a dominant by compare to budesonide via Turbuhaler in Russian Federation. PRS42 Cost –Utility Analysis of Two Budesonide Inhalers For Treatment of Asthma In Children In Russian Federation Makarova E, Yagudina R, Kulikov A I.M. Sechenov First Moscow State Medical University, Moscow, Russia