Cost-Effectiveness Evaluation of Tips Procedures with Expanded Polytetrafluoroethylene (EPTFE) Covered Stent-Grafts Compared to Large Volume Paracentesis in Patients with Refractory Ascites – A Spanish Scenario

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

to Endoscopic Procedures to Manage Acute Variceal Bleeding – A Spanish Scenario Pérez-Mitru A1, Villacampa Lordan A1, Scarpa F2 Consulting, Barcelona, Spain, 2W.L.GORE & Associates, Verona, Italy

1Oblikue

Objectives: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is considered as rescue therapy following the failure of endoscopic procedures to manage recurrent bleeding in patients with portal hypertension. Trials have shown clinical benefit, from the earlier use of TIPS with ePTFE covered stent-grafts in patients with persistent bleeding at high risk for treatment failure and death. A cost-effectiveness analysis of the early use of TIPS with ePTFE covered stent-grafts compared to the endoscopic approach has been developed.  Methods: A 2-years Markov model was adapted considering the Spanish National Healthcare System perspective in order to measure the clinical and economic consequences of early TIPS with ePTFE covered stent-grafts, compared to endoscopic band ligation EBL plus pharmaceuticals in high risk patients with acute variceal bleeding. Clinical management patterns and resource consumption were defined by an interview process with Spanish key opinion leaders. The model was populated with published clinical data including an RCT. Healthcare costs were obtained from Spanish databases and expressed in € 2015.Univariate sensitivity analyses were performed to test the model’s robustness.  Results: Over 2-years, the economic model shows a minimal incremental cost per patient of € 57 using early TIPS with ePTFE covered stent-grafts € 7,657 compared to endoscopic approach € 7,600. Although TIPS implant and subsequent re-interventions produced a reduced incremental cost, main cost savings came from fewer recurrent bleeding and related EBL procedures. Mortality was reduced in the early TIPS alternative by 56% compared to endoscopic treatment, resulting in 0.4 life-years gained (LYG) per patient. Consequently, incremental cost per LYG ratio resulted in € 137. Sensitivity analysis indicated that model estimations were maintained across the scenarios tested.  Conclusions: Early TIPS with ePTFE covered stent-grafts compared to endoscopic band ligation plus pharmaceuticals in high risk patients with acute variceal bleeding would improve survival at a neutral incremental cost for the Spanish NHS. PMD47 Cost-Effectiveness Evaluation of Tips Procedures with Expanded Polytetrafluoroethylene (EPTFE) Covered Stent-Grafts Compared to Large Volume Paracentesis in Patients with Refractory Ascites – A Spanish Scenario Pérez-Mitru A1, Villacampa Lordan A1, Scarpa F2 Consulting, Barcelona, Spain, 2W.L.GORE & Associates, Verona, Italy

1Oblikue

Objectives: Large volume paracentesis (LVP) is the standard treatment for patients with refractory ascites and portal hypertension. Clinical studies have shown that Transjugular Intrahepatic Portosystemic Shunt (TIPS) represents a valid alternative to reduce the recurrence of the ascites and subsequent LVP sessions, improving mortality but associated with hepatic encephalopathy. A cost-effectiveness analysis was developed studying the use of TIPS with ePTFE covered stent-grafts (SG) compared to LVP in patients with refractory ascites.  Methods: A 2 years Markov model was adapted to Spanish National Healthcare System perspective in order to measure clinical and economic consequences of TIPS with ePTFE stent-grafts compared to LVP in patients with refractory ascites. Clinical management patterns and resource use were defined by an interview process with Spanish key opinion leaders. The model was populated with clinical data from published literature. Healthcare costs were obtained from Spanish databases and expressed in € 2015. Univariate sensitivity analyses were performed to test the robustness of the model.  Results: The economic model shows that TIPS with ePTFE covered stent-grafts was a dominant (cost saving and reduced mortality) option compared to LVP in patients with refractory ascites. Total treatment costs per patient were € 14,728 for TIPS and € 15,360 for LVP, with € 632 cost saving per patient. Main costs savings obtained with TIPS implants came from the avoided LVP sessions. Over 2 years, mortality was reduced in TIPS arm by 20% compared to LVP treatment, resulting in 0.17 life-years gained (LYG) per patient. Sensitivity analysis corroborated the robustness of the model indicating that the results could have been underestimated as main clinical data derive from a meta-analysis of TIPS with uncovered stents.  Conclusions: TIPS with ePTFE covered stent-grafts compared to LVP represent a more efficient (cost saving and reduced mortality) therapeutic option in the management of patients with recurrent ascites. PMD48 Cost Analysis of Human Genome Sequencing in Cancer Diagnosis in France: Next Generation Sequencing Kossi DS1, Touzani R2, Borget I3, Zhaomin Z4, Vaur D5, Rouleau E6, Preudhomme C7, Lacroix L4, Perrier L8, Durand-Zaleski I9, Marino P2, Baffert S1 1Fondation Ophtalmologique Adolphe de Rothschild, Paris, France, 2Institut Paoli Calmettes, Marseille, France, 3Univ Paris-Sud, Faculty of Pharmacy, GRADES, Châtenay-Malabry, France, 4Institut Gustave Roussy, Villejuif, France, 5Centre François Baclesse-Inserm U1079 - Génétique du cancer et Maladies Neuropsychiatriques, Caen, France, 6Institut Curie, Paris, France, 7CHRU de Lille - Centre de Biologie Pathologie Génétique, Lille, France, 8Cancer Centre Leon Berard, Lyon, France, 9AP-HP, Créteil, France

Objectives: Next Generation Sequencing (NGS) consists of a simultaneous study of a large number of genes as opposed to a gene-by-gene approach. Our objective is to assess the global cost of performing NGS techniques in French laboratories in a routine clinical setting.  Methods: The cost analysis involved 10 national platforms including 18 laboratories in both constitutional and somatic genetics. The cost of the sequencing process included the cost of the pre-analytical phase, enrichment, library preparation, sequencing, bioinformatics, technical and biological validation. The time horizon was from the registration of the sample to the delivery of the result by the clinician. Resources consumed were prospectively collected in situ in each granted laboratory, using a micro-costing approach. Additional management and structure costs were estimated using a gross costing valuation. Uncertainty was captured for each stage using a deterministic sensitivity analysis. Prices were

A693

expressed in year 2015 euros.  Results: We observed a wide variety of practices, techniques, sample size and indications. Cost drivers were personal, consumables and equipment. In the 10 constitutional genetic laboratories, mean total cost was estimated at 470€  (SD: 122€ ) per patient. In the 8 somatic genetic laboratories, it was estimated at 564€  (SD: 241€ ). The enrichment stage cost represented 50% of the total cost per patient and was the costliest stage of the sequencing process both in constitutional and somatic genetics. If the cost of the enrichment and sequencing stages were driven by consumables respectively for 85% and 67% of total cost, the technical and biological validation stages were mostly made of staff costs at respectively 55% and 100%.  Conclusions: In constitutional genetics, the NGS cost per patient remains fairly homogenous and reflects the stabilization of the sequencing practices. While in somatic genetics, this cost varies widely due probably to an on-going learning curve. PMD49 Cost-Benefit Analysis for Direct Visual Observation of Nasogastric Enteral Feeding Tube Placement Saunders R1, Ozols A2 Scientific, Freiburg im Breisgau, Germany, 2Medtronic, Boulder, CO, USA

1Coreva

Objectives: Requirement for assisted nutrition is common in healthcare and is often achieved via an enteral feeding tube (EFT). Misplacement and use of an EFT in the respiratory tract can lead to serious patient harm and is a ‘never event’ for certain national health services. Standard EFTs are placed ‘blind’ and must be confirmed by X-ray. Here, cost-benefit of an EFT with a built-in camera is estimated.  Methods: Comparison of direct visual observation (DVO) and blind EFT tube placement was performed using a decision tree. For each blind procedure, the EFT was placed correctly (pyloric 94.5% or postpyloric 60.4%), placed in the trachea (1.9%, range 1.5%-2.1%), or otherwise misplaced in the gastric tract. Misplaced EFTs were replaced, with replacement after a tracheal insertion having a misplacement rate of 32%. A mean of 1.4 and 1.8 X-rays per EFT were required to confirm pyloric and postpyloric placement, respectively. Pneumothorax incidence was 10.2% (6.9%33.3%) after tracheal placement, with associated mortality being 14.3% (0.0%-44.4%). The DVO and standard EFTs cost $150 and $5, respectively, per tube. Confirmation X-rays cost $150 ($100-$300). Early studies indicate that each DVO placement takes 5.5 minutes, 45% required two attempts, no severe AEs occur, and no X-ray was used in 95% of cases.  Results: Assuming reuse of the DVO-EFT, this methodology was cost saving. If each replacement required a new EFT, the methodology would likely be considered beneficial at a cost-benefit threshold $10,000 per pneumothorax avoided. DVO is cost-saving in this scenario if costs for care, provider time, and ICU are considered. Other AE rates require confirmation, but pneumothorax rates could be increased and the cost-benefit of DVO would still be realized under the current model conditions.  Conclusions: The incremental cost DVO is fully or partially offset by reduced X-ray use. Avoidance of radiation and saved time are additional benefits. PMD50 Cost-Benefit Analysis of Dental Prosthesis in Ukraine Got S, Zaliskyy O, Zaliska O Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Objectives: Dental implantation is the most modern solution for the replacement of missing teeth. The use of implants in the mandible to retain a fixed or removable prosthesis is rapidly becoming the first choice in treatment planning for edentulous patients. Such treatment, however, presents a distinct limitation in terms of costs. We therefore carried out a research comparing implant-supported over-denture prostheses (4 implants) and complete dentures with the aim to explore, from the payers’ perspective, the cost-benefit ratio of these dental prostheses for patients with secondary complete adentia in Ukraine.  Methods: eighty four patients were included in two treatment groups and were followed up for two years and six months at Danylo Halytsky Lviv National Medical University. Patients were selected among the low income pensioners. Direct and indirect costs of treatments were covered by the charity funds from private dental clinics in Lviv, Ukraine.  Results: Total costs for the group (#1) with implant-supported over-denture prostheses were 105,841$ and for the group (#2) with complete dentures were 7,998$. The analyses yields a cost-benefit ratio of 47,4 for group #1 and 27,7 for the group #2.  Conclusions: The research supports the view that implant-supported dentures provide a positive cost-benefit ratio compared with the complete dentures. Dental implantation in Ukraine continues to be the widely recommended treatment for the patients with secondary complete adentia. PMD51 Evaluating The Cost-Benefit of A Cognitive Assessment and Training Program Across A Smart City Population in The UK Sparrowhawk K1, Cliveden P1, Ratto M1, Ogle-Welbourn W2, Sunley A2 City Council, Peterborough, UK

1MyCognition, London, UK, 2Peterborough

Objectives: Poor cognitive health is associated with various psychological disorders and antisocial behaviours which increase the costs of public health and social services. This research analyses the costs of poor cognitive health across a UK “Smart Cities” city population and evaluates the potential of an on-line cognitive assessment and training program to improve overall health and employability of residents.  Methods: Empirical evidence of the program’s outcomes has been collected by analysing data from case studies. Cost allocations in education, the workplace, and elderly/non-working populations were made based on secondary data sources for health- and social-related effects of poor cognitive health in these cohorts. A cost-benefit analysis was conducted of the impact of the cognitive assessment and training program on the annual costs of this Smart City’s interventions in the different social sectors.  Results: The annual pro rata cost of poor cognitive health in the Education sector amounts to roughly £26M, comprising £17M for Special Educational Needs, £4M for youth crime, and £5M for psychiatric disorders. The mental health cost in the Working Population sector is £154M and