Cost-Effectiveness Of Dolutegravir In HIV-1 Treatment-Naive Patients In Russia

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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

develop two scenarios: 1) DCV+SOF versus LDV+SOF in Gt1 and Gt4 HCV patients; 2) DCV+SOF versus no retreatment option in HCV Gt1, Gt3 and Gt4 patients. The percentage of patients who failed first line treatment with SOF/ SIM /RBV or SOF/ RBV and were retreated or not, were used to populate the model. HCV resources consumption and SVR rates were quantified using PITER real life data. Transition probabilities and utility rates were derived from the literature. The outcomes were expressed in terms of Quality Adjusted Life Years (QALYs). Probabilistic sensitivity analysis (PSA) was performed considering a cost-effectiveness threshold of €  30,000/QALY.  Results: In the base-case analysis DCV+SOF is cost-effective from the INHS perspective in both scenarios, with an ICER of€  3,461.52 and €  6,868.69 costs/QALYs compared to LDV+SOF and no treatment respectively. The PSA showed robust results, ICERs remain below threshold in 94% and 99% simulations in Scenario 1 and 2 respectively.  Conclusions: The results show that DCV+SOF is a cost effectiveness option in HCV patients who failed to reach SVR12 after first line DAA treatment. PIN52 Cost-Effectiveness Of Dolutegravir In HIV-1 Treatment-Naive Patients In Russia Piercy J1, Jakubanis R2, Chounta V3, Bukin E4, Kovalchuk N4, Punekar YS3, Holbrook T2 1Adelphi Real World, Manchester, UK, 2Adelphi Real World, Bollington, UK, 3ViiV Healthcare, Brentford, Middlesex, UK, 4ViiV Healthcare, Moscow, Russian Federation

Objectives: To evaluate the cost-effectiveness of dolutegravir (DTG) when compared to raltegravir (RAL) and ritonavir-boosted darunavir (DRV/r) in treatment-naive HIV-1-infected patients in Russia.  Methods: The assessment of costeffectiveness was based on a decision tree analysis. Response rates defined by the probability of virologic suppression (HIV RNA< 50 copies/mL) at 48 weeks were obtained from a published network meta-analysis. Responders were distributed across CD4 health states allowing the calculation of quality-adjusted life-years (QALYs). Baseline patient characteristics were informed using pooled data from DTG phase 3 clinical trials (SINGLE, SPRING-1, SPRING-2 and FLAMINGO). Costs obtained from Russian data included antiretroviral drug costs, treatment costs such as routine care, costs of treating cardiovascular conditions, opportunistic infections and drug-related adverse effects, and mortality costs. Utility values and mortality rates were obtained from published literature. A 48 week analysis was conducted using the societal perspective. Outcomes included QALYs, life-years (LYs), incremental cost per QALY ratio (ICER) and incremental cost per responder (ICPR). The analysis assumed no incremental mortality benefit due to better virologic response in the base case. The year of analysis was 2017.  Results: The rate of response among patients receiving DTG was 0.84 versus 0.73 for DRV/r and 0.80 for RAL. Total costs for treatment with DTG were 162,066 RUB, compared with 233,195 RUB for treatment with DRV/r and 369,723 RUB for treatment with RAL. In the ICPR analysis DTG dominated both DRV/r and RAL. Patients treated with RAL generated 0.740 QALYs compared to 0.738 with DTG and 0.736 with DRV/r. DTG dominated DRV/r in terms of ICER whilst RAL compared with DTG had an ICER of 124,492,962.35 RUB/QALY.  Conclusions: With lower costs, higher response rates and comparable QALYs, DTG can be considered as a cost-effective alternative among the three treatment options. PIN53 Cost-Effectiveness Assessment Of Herpes Zoster Vaccination In Germany van Oorschot DA1, Anastassopoulou A2, Varghese L3, von Krempelhuber A2, Neine M4, Lorenc S4, Curran D1 1GSK, Wavre, Belgium, 2GSK, Munich, Germany, 3GSK, Singapore, Singapore, 4Freelance C/O GSK, Wavre, Belgium

Objectives: With over 306,000 cases every year, leading to an annual bill of €  182M to society, Herpes Zoster (HZ) and its complications have a significant burden on the German health-care system. This health economic analysis was designed to support an informed decision-making for a potential HZ vaccination recommendation in the German population aged ≥ 60 years. We compared two HZ vaccines, a two-dose candidate HZ adjuvanted subunit vaccine (HZ/su) and Zoster Vaccine Live-attenuated (ZVL).  Methods: The ZOster ecoNomic Analysis (ZONA) model is a static, multicohort Markov model that followed ≥ 60-year-old subjects over lifetime from the year of vaccination. Both HZ/su and ZVL introduction were compared to no vaccination. Model inputs included demographics, epidemiology, vaccine characteristics, utility, and costs. Costs and outcomes were presented over the lifetime of individuals, both discounted at 3% per year. The incremental cost-effectiveness ratio (ICER) was calculated based on the societal perspective. We assumed 40% coverage for both vaccines, with a second dose compliance of 70% for HZ/su. Model uncertainty will be addressed by performing scenario and sensitivity analyses.  Results: The cohort consisted of 22,5M people aged ≥ 60 years. Vaccinating with HZ/su results in 1M HZ and 197K postherpetic neuralgia (PHN) cases avoided, a gain of 38,546 quality-adjusted life years (QALYs), an incremental € 1,490M in direct medical and vaccination costs and savings of € 63M from indirect costs. Vaccinating with ZVL results in 301K HZ and 92K PHN cases avoided, a gain of 16,338 QALYs, € 1,423M in incremental costs and savings of 35M from indirect costs. From a societal perspective, HZ/su and ZVL result in ICERs of € 37,025 and € 84,961 per QALY gained, respectively.  Conclusions: Both vaccines would substantially reduce the burden of disease in Germany. It was demonstrated that HZ/su would potentially have a superior public health impact over ZVL and would be the more cost-effective strategy.

PIN54 Cost-Effectiveness Analysis Of Sequential Vaccination Of 13-Valent Pneumococcal Conjugate Vaccine (PCV13) And 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) On Adult Population In South Korea Park D, Kang S Pfizer Korea, Seoul, Korea, Republic of (South)

Objectives: Currently in South Korea, National Immunization Program (NIP) offers 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) in order to prevent pneumococcal diseases among the over-65 elderly population; however, 13-Valent Pneumococcal Conjugate Vaccine (PCV13) is not included in the program. This study proffers a comparative analysis of PCV13 versus PPSV23 for Korean adult population.  Methods: Analysis was designed in Markov model and from a healthcare perspective for a full life-cycle. Epidemiological and cost data used for analysis, such as incidence and mortality of pneumococcal diseases and serotype coverage, were drawn from Health Insurance Review & Assessment Service’s Big Data, Korea Centre for Disease Control & Prevention reports and research resources from Korean medical institutions. An expert panel was hosted to verify data. The CAPiTA trial and Cochrane meta-analysis for PCV13 and PPSV23 was utilizaed for effectiveness data. The addition of PCV13 to current NIP (PCV13 is followed by PPSV23) was compared to vaccination of PPSV23 only. The analysis was based on 2 types of population classified by co-morbidity (all population vs. risk group) and age groups (18~64, over 65 and over 75 years old)  Results: When the addition of PCV13 vaccination was compared to the vaccination of PPSV23 only for over 65 years old, incremental cost-effectiveness ratio (ICER) turned out to be 3,300 USD per quality-adjusted life years (QALY). For risk group of those over 65 year old, ICER of addition of PCV13 over existing PPSV23-only vaccination was 3,404 USD/QALY. For 18-64yrs risk group, vaccinating both PCV13 and PPSV23 yielded ICER of 3,629 USD/QALY over existing PPSV23. In addition, sequential vaccination of PCV13 and PPSV23 to all elderly population over 75 resulted in ICER of 1,007 USD/QALY.  Conclusions: The strategy of vaccination sequential vaccination of PCV13 and PPSV23 in all age groups can be interpreted as cost effective from healthcare perspective in Korea. PIN55 A Cost-Effectiveness Analysis Of Shortened Direct-Acting Antiviral Treatment For Mild Chronic Hepatitis C Virus Fawsitt CG1, Vickerman P1, Cooke G2, Welton NJ1 1University of Bristol, Bristol, UK, 2Imperial College London, London, UK

Objectives: Hepatitis C virus (HCV) is a blood borne virus that can infect the liver, causing cirrhosis and decompensation of the liver, and hepatocellular carcinoma, requiring liver transplantation. A new class of oral medicines, called direct-acting antivirals (DAAs), have been developed to treat HCV, with cure rates observed in over 95% of patients treated for 12 weeks. DAAs are expensive; 12 weeks of therapy costs approximately £15,000 per patient. Shortened treatment durations, which have lower cure rates, have been proposed to reduce costs. We evaluate the lifetime cost-effectiveness of short-course first-line and re-treatment DAA regimens for treatment of non-cirrhotic HCV in genotype 1 patients.  Methods: Assuming a UK National Health Service perspective, we use a decision tree and Markov model to compare eight, six, and four weeks of shortened treatment regimens against a standard 12-week treatment regimen; patients for whom shortened treatment is unsuccessful are retreated with a standard 12-week treatment regimen. Evidence on efficacy of treatment and retreatment, drug and healthcare costs and utilities are taken from a review of the literature.  Results: Shortening treatment to eight weeks, with a cure rate of 88%, saves £4,899.57 per 1,000 patients and generates the same quality adjusted-life years (QALYs) as the standard 12-week treatment regimen. Treating patients for six weeks, with a cure rate of 63%, saves £2,549.08 but results in a QALY loss of 0.04 due to greater numbers developing advanced liver disease. Shortening treatment to four weeks, with a 33% cure rate, costs an additional £3,597.41 and results in a QALY loss of 0.11.  Conclusions: Treating patients for eight weeks is the dominant strategy, generating considerable cost-savings with no effect on QALYs. The results are sensitive to patient heterogeneity, namely patient’s baseline viral load. Future research should identify patients for whom shortened treatment duration is likely to be effective. PIN56 Cost-Effectiveness Analysis Of Vancomycin And Linezolid: A Systematic Literature Review Huang Y1, Li M2, Zhao B1 1University of Florida, Gainesville, FL, USA, 2University of Washington, Seattle, WA, USA

Objectives: Vancomycin and linezolid are the first-line treatments for Methicillinresistant Staphylococcus aureus (MRSA) recommended in IDSA guideline. Linezolid has an easier dosing regimen but a higher acquisition cost in the US compared to vancomycin. This review is to evaluate if linezolid is a cost-effective treatment for MRSA.  Methods: We conducted a systematic literature review of cost-effectiveness studies of linezolid and vancomycin. We searched PubMed and Embase with the keywords: “cost-effectiveness”, “vancomycin”, “linezolid”, and “MRSA”. We excluded non-human studies, studies conducted in countries other than the US, and literature reviews from this review.  Results: Seven studies met the inclusion criteria and were included in this review. In these studies, linezolid and vancomycin were indicated for nosocomial pneumonia, surgical site infection, or complicated skin and soft tissue infection (cSSTI). Five out of seven studies used a decision tree model structure. Treatment duration of linezolid or vancomycin ranged from three days to 21 days, and time horizon of the model ranged from 35 days to two years. Six studies used number of patients cure as their effectiveness measure while one used number of lives saved. All seven studies included drug acquisition cost and cost of hospital stay as cost components. Five studies were funded by the manufacturer of linezolid. Four out of seven studies showed linezolid dominated vancomycin, two showed linezolid was cost-effective, and one showed linezolid was not cost-effective.  Conclusions: The results of this review indicated that linezolid is likely a cost-effective treatment for MRSA in nosocomial pneumonia and cSSTI. Evidence from published cost-effectiveness studies need to be interpreted carefully for potential bias. PIN57 A Cost Effectiveness Analysis Of Seasonal Quadrivalent Influenza Vaccine In Italy Using A Static Model Mennini FS1, Bini C1, Marcellusi A1, Rinaldi A2, Franco E3