Cost Effectiveness Of A Diabetes Self-Management Education Programme Of Type 2 Diabetes Patients In Riyadh, Saudi Arabia

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The costs were estimates in American Dollar (US) 2014, from the payer’s perspective.  Results: Out of 9.244 pregnant women, 75% live in urban areas. The mean age was 23 years old (CI95% 23,5 – 23,8). The average cost of live births was USD$ 638,4 and 87% of women attended at least one prenatal care visit (PCV). The average cost of live births with PCV was USD 609,1 and without PCV was USD 857,8. The mean length of stay (LOS) of women who attended PCV was 1 day (CI95% 0,8 – 1,03) and without PCV was 1.3 days (CI95% 0,9 – 1,4). Not attending PCV increases in 10% the probability of having more than one inpatient stay. The mean health care costs were different in both groups and increased in 32% (CI95% 27,1 – 41) in women who did not attended PCV. MMR in women who attended PCV was 72,7 per 100.000 live births, in women who missed PCV was 166,6 per 100.000 live births.  Conclusions: Attending PCV at least one time during pregnancy reduces LOS, maternal mortality and the probability of incurring in extra cost from the payer’s perspective.

physician visits, diabetes complications and date of death. All analyses were taken from the government’s health policy perspective. Cost of diabetes was calculated based on the government reimbursement rates and adjusted for inflation until 2015. Cost-effectiveness analysis were performed as incremental cost per patient with controlled HbA1c. According to WHO, the patient’s HbA1c is considered controlled when its value is less or equal to 7%. A series of sensitive analyses were also performed.  Results: The pharmaceutical care group had lower costs, R$ 5,170.92 (US$ 1,293.28), and higher effectiveness (39%) compared to the conventional group, that presented costs of R$ 11,351.18 (US$ 2,839.00) and effectiveness of 21%. For the period of 2007-2011, the ICER presented a saving of R$ 33,795.77 (US$ 8,452.53) per patient with controlled HbA1c.  Conclusions: Our findings showed that in type 2 diabetic patients, the pharmaceutical care is a dominant intervention, increasing rates of HbA1C control and reducing treatment costs.

PHS42 Cost-Effectiveness Analysis Of Neonatal Screening Of Critical Congenital Heart Defects In China

PHS45 Income Growth Trajectory For Parents Of Children With Down Syndrome In The United States

Gai R National Center for Child Health and Development, Tokyo, Japan

Samuelson D1, Kageleiry A1, Duh MS1, Lefebvre P2, Campbell JY3, DerSarkissian M4, Haider BA1, Skotko BG5 1Analysis Group, Inc., Boston, MA, USA, 2Groupe d’analyse, Ltée, Montreal, QC, Canada, 3Harvard University, Cambridge, MA, USA, 4Analysis Group, Inc., Los Angeles, CA, USA, 5Massachusetts General Hospital, Boston, MA, USA

Objectives: Pulse oximetry as an adjunct to postnatal clinical assessment is a highly accurate tool for the early detection of congenital heart disease (CHD) in newborn infants. As the technique is simple, non-invasive and inexpensive, it has high potential benefits for developing countries. However, certain barriers may impede its wider implementation. In this study, we aim to inform clinical and health policy decisions by assessing the cost-effectiveness of CHD screening in China.  Methods: We developed a cohort model to evaluate the cost-effectiveness of screening all Chinese newborns annually using two possible screening options compared to no intervention: (1) clinical assessment alone, and (2) pulse oximetry as an adjunct to clinical assessment. We calculated the incremental cost per averted disability-adjusted life years (DALYs) in 2014 international dollars to measure costeffectiveness. One-way sensitivity analyses and multivariate probabilistic sensitivity analysis were performed to test robustness of the model.  Results: Comparing with no intervention, postnatal clinical assessment is cost-effective with an incremental cost-effectiveness ratio (ICER) of Int$ 34,673/DALY, while pulse oximetry as an adjunct to clinical assessment yielded the best health outcomes. Sensitivity analysis showed that when the proportion of timely access to both diagnosis and treatment increased up to 32%, pulse oximetry plus clinical assessment showed the better expected values compared to clinical assessment alone.  Conclusions: In China, screening for CHD is cost-effective and expected to achieve potential health benefits with improvement of accessibility to pediatric cardiological care. PHS43 Cost Effectiveness Of A Diabetes Self-Management Education Programme Of Type 2 Diabetes Patients In Riyadh, Saudi Arabia Alaboudi IS Buridah Central Hospital, Buridah, Saudi Arabia

Objectives: This research aims to estimate the cost of Diabetes Self-Management Education (DSME) programme and evaluate its cost-effectiveness compared with usual care group from the perspective of health care providers.  Methods: A total 150 participants in this cohort study design were divided into the intervention group (n =  75) and the control group (n =  75) and followed-up over a 6-month period. Costs of DSME programme and outcomes were compared between intervention and control groups using cost-effectiveness analysis (CEA). Cost-effectiveness ratios (CERs) were expressed as cost per unit improvement in glycaemic control (HbA1c), TC, LDL-C, HDL-C, SBP, DBP and BMI. The fraction of the gross domestic product (GDP) was calculated by dividing ICER by the GDP per capita of Saudi Arabia. One-way sensitivity analysis was performed by changes the effectiveness of in serum TC and LDL-C levels at ± 25% and varying in medication costs arbitrarily by ± 50% for both intervention and control groups.  Results: The total cost incurred by the intervention group was SAR 1456.889, which was lower than the cost incurred by the control group (SAR 2039.10) (USD1 =  SAR 3.75). The education programme demonstrated cost saving per unit improvement in each unit of HbA1c levels, TG levels, HDL-C levels, SBP, DBP and BMI. The ICER per unit improvement in serum TC and serum LDL-C levels were 0.14 and 0.17, respectively (< 1.0 GDP per capita in Saudi Arabia) compared with the control group, meeting the definition of being highly cost-effective. The predicted outcome of ICER remained well within the highly cost-effective range (< 1.0 GDP per capita), with no impact on the ICER for both parameters.  Conclusions: The present study demonstrated the efficacy of the DSME programme as a highly cost-effective method of improving TC and LDL-C levels from the perspective of health care providers that would be cost-effective if implemented in Riyadh, Saudi Arabia. PHS44 Cost-Effectiveness Analysis Of Pharmaceutical Care For Type 2 Diabetes Mellitus Pacients In Ribeirão Preto Brazil Picoli RM1, Pereira LB1, Barros MT2, Nunes AA1, Pereira LR1, Costa AL1 1University of São Paulo, Ribeirão Preto, Brazil, 2Brandeis University, Waltham, MA, USA

Objectives: Results of recent studies have demonstrated that pharmaceutical care can lead to significant improvements in the control of fasting plasma glucose and hemoglobin A1c (HbA1c) in type 2 diabetic patients. This study aims to assess the cost-effectiveness of pharmaceutical care in type 2 diabetic patients in Ribeirão Preto, Brasil, compared with the conventional care provided just by a physician (status quo).  Methods: A prospective and experimental study with seventy-one patients divided into two groups: control and pharmaceutical care developed by the Pharmaceutical Assistance and Clinical Pharmacy Research Center (Borges, 2008) was used as data base for this study. Patients in the pharmaceutical care group were followed up monthly by a single clinical pharmacist during 18 months, from March 2006 until August 2007. Thereafter, medical records were collected until 2011, including: HbA1c, fasting plasma glucose, medication consumption, number of

Objectives: Expectant parents who receive a prenatal diagnosis of Down syndrome (DS) may be inclined to consider their future income trajectories when making pregnancy decisions. Given limited evidence on the impact of having a child with DS on parents’ income growth, this study aimed to determine whether the rate of income growth among parents of children with DS differs from that among parents of children without chromosomal conditions.  Methods: This retrospective observational study included individuals identified as the parent of a child with a diagnosis of DS (ICD-9-CM code 758.0x) enrolled as employee subscribers in their health plans who had income data for at least two consecutive years while their child was under 18 years old from the OptumHealth Reporting and Insights administrative claims database. These parents were matched to control parents of children without chromosomal conditions using propensity scores. The difference in mean log annual income between parents of children with DS and their matched controls was calculated for each period of two consecutive years and compared using Wilcoxon signed-rank tests.  Results: After matching, parents of children with DS were similar to their matched controls on baseline covariates (N= 17,062 per matched cohort). Parents of children with DS had a lower mean annual income growth rate compared to their matched controls (4.0% vs. 4.1%; p< 0.027). No significant differences existed when analyzed separately for fathers (-0.07%; N= 8,691 per matched cohort; p= 0.070) and mothers (-0.13%, N=8,371 per matched cohort; p=0.193).  Conclusions: Parents of children with DS experience lower mean annual income growth compared to parents of children without chromosomal conditions. Based on the 2013 US median income of $50,383 and $39,621 among yearly full-time working men and women, respectively, this difference in income growth translates into $35 reductions in annual income growth for fathers and $52 reductions for mothers of children with DS. PHS46 Characteristics And Health Care Utilization Among Adults With Chronic Obstructive Pulmonary Disease According To Missed Work Status: A Retrospective Analysis Of The Medical Expenditure Panel Survey Dashputre AA, Kamal KM, Covvey JR Duquesne University Mylan School of Pharmacy, Pittsburgh, PA, USA

Objectives: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease affecting an estimated 24 million individuals in the USA. Although research commonly focuses on older individuals, patients with COPD prior to work retirement may face loss of productivity. The study objective was to describe and compare the characteristics amongst employed adults with COPD according to missed work status.  Methods: Employed adults (≥ 18 years) with clinical classification code 127 (COPD and bronchiectasis) were retrospectively identified by pooling data from 2011 and 2012 Medical Expenditure Panel Survey and stratified into: (1) those who reported no missed work, and (2) those who reported missed work. Descriptive statistics were utilized to assess the differences in demographics, clinical characteristics and healthcare utilization. Healthcare utilization was quantified for office-based, emergency, inpatient, outpatient visits and prescription use. Logistic regression was utilized to assess the factors associated with missing work. Analysis was performed using Statistical Analysis System 9.4 software (SAS Institute; Cary, NC).  Results: A total of 585 adults were identified from the survey data: group 1 (n= 185) and group 2 (n= 400). Statistical significance was observed for sex (p< 0.001), education status (p= 0.029) and perceived health status (p= 0.039). The results of the regression showed that males had significantly lower odds of missing work as compared to women (OR: 0.465, 95% CI: 0.325-0.666) and adults who perceived their health status as ‘fair’ or ‘poor’ had significantly higher odds of missing work as compared to those who rated ‘excellent’ or ‘very good’ (OR: 2.012, 95% CI 1.141-3.548). Though utilization was not significantly different, adults who missed work had higher costs as compared to those who did not miss work.  Conclusions: Female sex and poor perception of health status is associated with missing work in adults with COPD, which may result in higher healthcare utilization costs. PHS47 Cost Of Inflammatory Bowel Disease Hospitalizations In Ireland Baj R, Hogan A AbbVie Ltd., Dublin 24, Ireland

Background: Inflammatory bowel disease (IBD) places a physical and psychosocial burden on patients. It also places a burden on the healthcare system for several reasons, including disease related hospitalization/surgery. For healthcare