Cost-Effectiveness Analysis of Using Everolimus or Axitinib in Patients with Metastatic Renal Cell Carcinoma WHO Have Failed to Use of Pazopanib or Sunitinib in First-Line Treatment

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6

treated with anti-viral drugs, we assessed the cost-effectiveness of a novel adoptive T cell therapy consisting of directly selected CMV-specific T cells.  Methods: A Markov model was developed to estimate cost-effectiveness of a CMV-specific T cell therapy for the management of CMV disease. Data sources included two randomized clinical trials for the CMV-specific T cell therapy, published literature, national costs and tariffs, and a Delphi panel of 7 English hematologists. The model simulated clinical and economic outcomes associated with the CMV-specific T cell therapy and standard of care.  Results: The use of the CMV-specific T cell therapy as 2-line CMV disease treatment increases costs from £27,882 to £30,656, which results in additional costs of £2,774, but leads to a gain in QALYs of 0.215 from 3.179 to 3.394. The probabilistic sensitivity analysis (PSA) shows a probability of 79% that the ICER remains below £30,000/QALY. The use of the CMV-specific T cell therapy as 3-line CMV treatment increases total costs from £27,882 to £28,648 leading to additional costs of £766, but to a gain in QALYs of 0.031 from 3.179 to 3.210. The PSA shows the probability is 53% that the ICER remains below £30,000/QALY.  Conclusions: CMVspecific T cell therapy is cost-effective for patients with CMV disease after allogeneic HSCT in 2-line and 3-line therapeutic treatment setting in the UK. PCN147 Is the Integrated Electronic Health Record Cost-Effective for a Cancer Consultation? Results from the E-SI (PREPS-SIPS) Study Pilet C1, Augusto V1, Hamana S1, Durand T2, Aloui S3, Doly A4, Heudel PE2, Chauvenet L3, Perol M2, Gonzalez G3, Biron P2, Perrier L2 1École Nationale Supérieure des Mines de Saint-Étienne, Saint-Étienne cedex 2, France, 2Cancer Centre Léon Bérard, Lyon Cedex 08, France, 3Centre Hospitalier Sens, Sens, France, 4Cancer Centre Jean Perrin, Clermont-Ferrand, France

Objectives: The aim of this study was to perform a cost-effectiveness analysis on Electronic Health Record (EHR) implementation in the context of cancer visits.  Methods: This prospective pilot study was conducted on a cohort of patients with cancer visit (i) in the Leon Berard and Jean Perrin cancer centers (France) using a EHR; or (ii) in Sens hospital (France) with a patient’s paper file. Costs were assessed from the health care provider perspective (in Euros, 2014). Cost calculations were based on a micro-costing approach including the preparation for the visit, the visit itself, and the visit’s report. Effectiveness was based on the number of examinations not available by the oncologist during the visit. Selection biases were controlled using a multivariate analysis. Uncertainty was captured by deterministic and probabilistic sensitivity analyses.  Results: The analysis was based on 179 patients enrolled in 2015. Breast cancer represented one in two visits, followed by gynecological and lung cancer. The mean cost per consultation reached € 52.44 (SD: 23; 95%CI:48.1-56.68) in the Leon Berard and Jean Perrin cancer centers (n= 119) and € 58.04 (SD: 27.01; 95%CI:51.07-65.03)  in Sens hospital (n= 60). Mean numbers of examinations not available per visit were 0.067 in the Leon Berard and Jean Perrin cancer centers and 0.08 in Sens hospital. The adoption of the EHR strictly dominated (i.e., was both less costly and more effective) than the patient’s paper file. Probabilistic sensitivity analyses confirmed this result at a 50% confidence level.  Conclusions: Our findings suggest that the adoption of EHRs in acute care hospitals is associated with a higher performance. Further evaluations should be conducted investigating long term outcomes to shed further light on the comparative value of EHRs.

PCN148 Economic Evaluation of Pertuzumab Neoadjuvant Treatment for Patients with Locally Advanced, Inflammatory, or Early Stage HER2-Positive Breast Cancer in Greece Mylonas C1, Kourlaba G2, Skroumpelos A3, Maniadakis N1 1National School of Public Health, Athens, Greece, 2Collaborative Center of Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partenrship, Athens, Greece, 3Roche (Hellas) S.A., Athens, Greece

Objectives: To conduct a cost – effectiveness analysis comparing combination therapy with pertuzumab, trastuzumab and docetalex (PTD) with trastuzumab and docetaxel (TD) only for neoadjuvant treatment of patients with locally advanced, inflammatory, or early HER2-positive breast cancer in Greece.  Methods: A Markov model, comprising six health states, was developed to describe disease progression and evaluate the cost and consequences of the comparators. Efficacy and safety data considered in the model were extracted from the relevant randomized Phase II clinical trials and other published studies. Utilities values were extracted from the literature. Direct medical costs were incorporated in the model reflecting the year 2015. The model evaluated the comparators over a lifetime horizon in the course of a 1-month cycle. Probabilistic sensitivity analysis was conducted to account for uncertainty and variation in the parameters of the model. The analysis was performed from a payer’s perspective. Costs and outcomes that occurred beyond one year were discounted at a 3.5% annual rate which is the standard practice in Greece as well as other jurisdictions.  Results: Total lifetime cost per patient for PTD was estimated at 98,126€  and for TD at 93,980€ . On average patients treated with PTD are estimated to live for 16.65 years, that is 0.35 years and 0.30 quality adjusted life years over those on TD. Probabilistic analysis confirmed the deterministic results. Based on the above outcomes, the resulting cost-effectiveness ratios associated with the administration of PTD were 11,734€  per life-year gained and 12,090€  per QALY gained.  Conclusions: Results suggest that PTD represents a cost - effective alternative relative to TD for neoadjuvant treatment of patients with locally advanced, inflammatory, or early HER2-positive breast cancer in Greece.

PCN149 Cost-Effectiveness Analysis of Using Everolimus or Axitinib in Patients with Metastatic Renal Cell Carcinoma WHO Have Failed to Use of Pazopanib or Sunitinib in First-Line Treatment

A735

Romero Prada ME1, Huerfano LM2, Roa Cardenas NC2 1Fundación Salutia, Bogotá, Colombia, 2Salutia Foundation - Research center in economy, management and health technologies., Bogota, Colombia

Objectives: To develop an economic evaluation of cost-effectiveness of using Everolimus versus Axitinib for the treatment of patients with metastatic renal cell carcinoma, after they have progressed in the first-line treatment with pazopanib or sunitinib, in the Colombian context.  Methods: Two Markov models were designed in quarterly cycles, with a time horizon of three years for a hypothetical cohort of 1 patient diagnosed with metastatic renal cell carcinoma, who have progressed on first-line treatment, one after using sunitinib and the other after using pazopanib. Second-line treatment technologies are everolimus versus axitinib. The analysis included the probabilities of second-line progression, progression-free survival and the adverse events the technologies can produce. The outcome evaluated was life years saved, in addition to the total costs for treatments. These costs were taken from Colombian health system information databases. The costs are showed in United States dollars, using current exchange rate to Colombian pesos.  Results: According to the analysis, in terms of cost-effectiveness, the use of Everolimus has 0.11 life years more than Axitinib, with savings of US $ 2,586 if patients used pazopanib during first-line. If patients used sunitinib during first-line everolimus has 0.02 life years more than axitinib, with savings of US $ 2,508. Concluding that the cost of using everolimus treatment is less than using axitinib and effectiveness is greater compared to Axitinib. A sensitivity analysis using different discount rates was made, showing dominance in all the scenarios, the discount rates used were 0%, 3.5% and 10%  Conclusions: The use of Everolimus is a dominant option compared to Axitinib, in a time horizon of three years related to the treatment of patients with metastatic renal cell carcinoma in both models, which means, in patients who were treated in first line with pazopanib and patients who were treated with sunitinib in first line. PCN150 Use of Real World Data in Identifying Relevant Comparators in Medico Economic Models at EU5 Level: A Case Study on Multiple Myeloma Jubert H, Kolahi C, Karusisi N, Mitrofan L IMS Health, La Défense, France

Objectives: In routine practice, the choice of relevant active comparators in medico economic modeling is done by using the standard of care and through market studies. However, decision makers are expressing an increasing interest in real life data, to better manage uncertainty while making decisions and also to fill the gap between existing guidelines and real usage. As guidelines are not updated with the introduction of new therapies and are heterogeneous at EU5 level, the objective of this study was to confirm the added value of real world data (RWD) in the identification of relevant comparators at country level. Relapsed/Refractory Multiple Myeloma (RRMM) have been used as a case study, due to the introduction of multiple innovative therapies in the last year and also due to heterogeneity of treatment in this patient segment.  Methods: A retrospective analysis was performed using IMS RWD Oncology cross-sectional survey data, a retrospective, longitudinal cancer treatment database collecting anonymized patient-level oncology data in 5 European countries. We extracted EU5 patients with RRMM in 2015. Relapse/Refractory is based on the calculation of time gaps between therapies.  Results: Of the currently 60,731 projected treated populations with MM in EU5, 23% are in 2nd line and 7% in 3rd line plus. 2nd Line RRMM patients received lenalinomide-based regimen (46%) in monotherapy and combination with dexamethasone followed by mephalan (13%) and bortezomib/dexamethasone (10%). In 3rd line dexamethasone based regimens were the gold standard, alone (32%) or in combination with pomalidomid (10%) or bortezomib (8%). Differences were observed at country level.  Conclusions: Increasing request by authorities to validate cost-effectiveness and budget impact models makes the usage of RWD a suitable solution. Due to the availability of detailed conditions of use according to patient profile, these data may improve the quality and the efficiency of medico economic models in RRMM. PCN151 Cost Effectiveness Analysis of Nilotinib Versus Imatinib in Newly Diagnosed Chronic Myeloid Leukemia from the Health Insurance Perspective in Egypt Abourawash aS1, Eldessouky R2, Elsisi gH2 1central adminstration of pharmaceutical affairs, cairo, Egypt, 2fayoum university, cairo, Egypt

Objectives: Chronic myeloid leukemia (CML) is a relatively rare disease having an annual incidence of approximately 1 – 2 per 100 000 people, and accounts for 15 – 20% of adult leukemias. The main objective of this study is to compare costs and outcomes associated with the use of nilotinib 300 mg versus imatinib 400mg in patients with newly diagnosed chronic myeloid leukemia from the health insurance prespective  Methods: A decision tree model over 36 months was constructed to compare the outcomes and costs of nilotinib versus imatinib in patients with newly diagnosed CML theThe probability of patients achieving major molecular response (MMR) was the main clinical outcome used in this study and was derived from ENESTnd trial. Utilities data were derived from previously published study using the time trade off method. Direct medical costs were collected from the health insurance hospitals Deterministic sensitivity analysis was performed.  Results: Two scenarios were adopted in the model; per-protocol analysis and intent –to treat (ITT) analysis. For per-protocol analysis, nilotinib 300 mg is cost effective compared with imatinib 400mg at an ICER of 76793 EGP/QALY. For intent-to treat analysis, nilotinib 300 mg is less costly and more effective than imatinib 400 mg. Deterministic sensitivity analysis in per-protocol analysis showed that probability of patients still on core treatment of nilotinib has the largest impact on the results while in ITT analysis, the probability of no MMR response has the largest impact on the results.  Conclusions: Nilotinib 300 mg is a good value for money