Cost-Effectiveness of Implementing Computed Tomography Screening for Early Diagnosis of Lung Cancer in Taiwan

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into the Australian healthcare setting. This model is limited by the data informing it, and could be validated further by testing with prospective data. PMD12 Cost-Effectiveness of Transfemoral Aortic Valve Implantation Compared with Surgical Aortic Valve and Medical Management in Patients with Severe Symptomatic Aortic Stenosis in Australia Mervin MC Griffith University, Meadowbrook, Australia

Objectives: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative for treating aortic stenosis, particularly in patients who are poor candidates for surgical aortic valve replacement. In Australia, TAVI is not yet subsidised on the Medicare Benefits Schedule. The purpose of this study was to assess the cost-effectiveness of transfemoral aortic valve replacement interventions (TAVI-TF) compared with surgical aortic valve replacement and with medical management in patients with symptomatic severe aortic valve stenosis from an Australian healthcare provider perspective.  Methods: We constructed a Markov model-based probabilistic cost-effectiveness analysis and compared TAVI-TF with surgical aortic valve replacement and with medical management, in terms of lifetime costs, quality-adjusted life years, and cost-effectiveness. The model considered two patient populations: high surgical risk patients and inoperable patients. Overall survival was based on the 5-year published data of the PARTNER trial. Costs were estimated using published data and included the cost of the intervention, index hospitalization, adverse events, follow-up care, and end-of-life care. Utilities were derived from the published PARTNER studies. A 5% discount rate was used for both costs and health outcomes. Deterministic and probabilistic sensitivity analysis was performed to explore uncertainties around assumptions and model input parameters.  Results: In the base case, if TAVI-TF is available, the cost per quality-adjusted life year gained is $55,843 in the high-risk cohort and $1,392 for the inoperable cohort. The economic model is most sensitive to the cost of index hospitalization and the cost of the valve system.  Conclusions: Transfemoral TAVI compared with surgical aortic valve replacement is cost-effective in Australia if the price of the device is lower. Transfemoral TAVI compared with medical management is cost-effective in Australia for inoperable patients. The sensitivity analyses provided enable decision makers in other countries with similar health care practices to Australia to determine the acceptability of cost-effectiveness ratios according to their willingness-to-pay thresholds. PMD13 Cost-Effectiveness Analysis of Xpert MTB/RIF Assay for Diagnosing Tuberculosis in Malaysia Using Dynamic Transmission Model Lee KK1, Fun WH2, Wu DB1, Cheong YM1, Mohamad Noordin N3 University Malaysia, Subang Jaya, Malaysia, 2Institute For Health Systems Research, Setia Alam, Malaysia, 3National Public Health Laboratory, Sungai Buloh, Malaysia

1Monash

Objectives: Despite the endorsement by World Health Organization to use Xpert MTB/RIF test for diagnosing Tuberculosis (TB) and rifampicin resistance, its use as a rapid diagnostic test is still at infancy stage in Malaysia. This study aimed to determine the cost-effectiveness of Xpert MTB/RIF for early detection and treatment of TB in addition to current practice.  Methods: A dynamic transmission model was built to estimate the disease burden and economic burden of TB over a 10-year period. We calculated the incremental cost-effectiveness ratios (ICERs), comparing the current practice with Xpert scenario where Xpert MTB/ RIF was added into diagnostic algorithm. The ICER was expressed as cost (USD) per disability-adjusted life year (DALY) averted. Additionally, one-way sensitivity analysis and probabilistic sensitivity analysis were conducted to assess the individual and joint effects of uncertainty across input parameters. This study was performed from a government perspective. A 3% discount rate was used for calculating both the costs and DALYs.  Results: Our study suggests that using Xpert MTB/RIF could reduce the notification rate by 7.8% after 10 years. In the base case analysis, the incorporation of Xpert MTB/RIF to the current practice would lead to an ICER of USD12,437/DALY averted. One-way sensitivity analysis revealed that Xpert scenario is highly sensitive to rapid progression rate, transmission rate and case detection rate. At the willingness to pay (WTP) threshold of 1 time Malaysian gross domestic product (GDP) per DALY averted (USD10,427.80 in 2014), the probability of Xpert MTB/RIF being cost effective from the government perspective is 98.86%.  Conclusions: With the current evidence available, our model suggests that Xpert MTB/RIF is cost-effective to be implemented in Malaysia if the WTP threshold is set at 1 time GDP per DALY averted. This provides valuable information for stakeholders to consider in developing new public health policy to eliminate TB from the country. PMD14 Cost-Effectiveness of Interferon-Gamma Release Assay for Tuberculosis Screening of Mental Patients with Tobacco Smoking Kowada A Ota City Office,Tokyo, Japan

Objectives: The prevalence of tuberculosis (TB) and latent tuberculosis infection (LTBI) among mental patients is higher than that of the general　population. Smokers have an increased risk of reactivating LTBI, TB recurrence and death. Interferon-gamma release assays (IGRAs); QuantiFERON-TB® Gold In-Tube (QFT) and T-SPOT®.TB (T-SPOT), are new alternatives to the tuberculin skin test (TST) to detect LTBI with higher sensitivities and specificities. This study aimed to assess the cost effectiveness for TB screening of mental patients with tobacco smoking using IGRAs compared to TST and chest X-ray (CXR).  Methods: Decision trees and Markov models were constructed with seven strategies; QFT, T-SPOT, TST, TST followed by QFT, TST followed by T-SPOT, CXR and no screening. 30-years-old mental patients with and without tobacco smoking were chosen as a hypothetical cohort using a societal perspective on a lifetime horizon. Incremental cost per quality adjusted life year (QALY) gained ratios were compared. All costs and clinical

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benefits were discounted at a fixed annual rate of 3%.  Results: In base-case analysis, TST followed by QFT strategy was the most cost-effective among mental patients. No screening and CXR strategies were less cost-effective. Cost-effectiveness was sensitive to LTBI rate and BCG vaccination rate among non-smokers. No screening strategy was more cost-effective than TST followed by QFT strategy at the willingness to pay level of $US 100,000/QALY gained when LTBI rate among non-smokers was less than 0.10. The QFT strategy was more cost-effective than TST followed by QFT strategy at the willingness to pay level of $US 100,000/QALY gained when BCG vaccination rate among non-smokers was less than 0.18.  Conclusions: TB screening using an IGRA for mental patients is recommended on the basis of the cost-effectiveness, especially with tobacco smoking. This suggests that further supporting tobacco cessation intervention for smoking mental patients is beneficial to control TB. PMD15 Health Economic Evaluation of Watchmantm Left Atrial Appendage Closure (LAAC) Device Vesus Long-Term Warfarin Therapy in Patients with Atrial Fibrillation (AF) in China Zhu S1, Zhang M2, Zeng Z2, Shi J2, Chen G2, Xuan J3 1Shanghai Centennial Scientific Co., Ltd, Shanghai, China, 2Boston Scientific, Shanghai, China, 3Sun Yat-Sen University, Guangzhou, China

Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia which is a significant risk factor for stroke. Warfarin is the standard therapy for stroke prevention. Left atrial appendage closure (LAAC) with the WATCHMAN is a new proven effective stroke prevention strategy. Multiple clinical studies (PROTECT-AF and PREVAIL trials) have demonstrated the stroke prevention efficacy. However, no studies have evaluated the economic impact of the two strategies in China in non-valvular AF patients. The current study utilizes Chinese cost data to evaluate cost-effectiveness of LAAC versus long-term warfarin therapy for stroke risk reduction in AF patients.  Methods: A Markov model (30 years) was developed to estimate the cost-effectiveness of LAAC Vs. warfarin from government payer perspective. Clinical efficacy data and utility values were abstracted from the PROTECT-AF(4y) trial, published meta-analysis by D. Holmes and published literatures. Chinese local cost data is extracted from literature review and through a micro-costing study of 50 attending physicians at 12 tertiary hospitals located in representative cities of Beijing, Shanghai, Foshan, Nanjing, Hangzhou and Chengdu in China.  Results: LAAC was projected to increase life expectancy with an additional 0.984 quality-adjusted life years (QALYs) compared with warfarin with incremental total costs of RMB 94,233.75 yuan. The estimated 30 years (life time) incremental cost-effectiveness ratio was RMB 95,746.27 yuan per QALY with LAAC compared with warfarin, which was below the willingness-to-pay threshold recommended by WHO. Sensitivity analyses indicated that results were robust to a wide range of inputs.  Conclusions: The lifetime economic modeling study suggests that LAAC is a cost-effective alternative to warfarin in stroke prevention for AF patients in China. PMD16 Cost-Effectiveness of Implementing Computed Tomography Screening for Early Diagnosis of Lung Cancer in Taiwan Wang J National Cheng Kung University College of Medicine, Tainan, Taiwan

Objectives: This study attempted to estimate the cost-effectiveness of implementing computed tomography (CT) screening based on the experience of the National Lung Screening Trial (NLST) for early diagnosis of lung cancer in Taiwan.  Methods: From a nation-wide, 13-year follow-up cohort, we estimated quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures per case of lung cancer stratified by pathology and stage. Stage distributions for CT-screening and no-screening were assumed equal to those of the NLST to estimate the savings in loss-of-QALE and additional costs of lifetime healthcare expenditures after CT screening. Costs attributable to false-positive cases and radiation-induced lung cancer were added for comparison.  Results: The incremental costs were US$22,755 per person. After dividing it by savings of loss-of-QALE (1.16 quality-adjusted life year (QALY)), the incremental cost-effectiveness ratio (ICER) was US$19,683 per QALY. The ICER rose to US$31,066 per QALY and US$29,349 per QALY, respectively, when cost of CT and numbers of diagnostic follow-ups doubled. If we applied the stage distribution of Taiwan without regular chest radiography as the non-screened group, ICER became US$11,367 per QALY.  Conclusions: Low-dose CT screening for early diagnosis of lung cancer in Taiwan would be cost-effective. This methodology provides a quasi-real world analysis from the payer’s perspective and could be applied for examining the cost-effectiveness of other screening programs.

PMD17 Cost-Effectiveness Analysis of National Screening Program for Pulmonary Tuberculosis in Korea Yang J1, Shin M1, Tchoe H1, Kwon H2, Ahn J3, Shin S1 1National Evidence based Health-care Collaborating Agency, Seoul, South Korea, 2Koshin University Gospel Hospital, Busan, South Korea, 3Department of Health Convergence, Ewha Womans University, Seoul, South Korea

Objectives: The universal screening program to detect pulmonary tuberculosis (TB) patients has been conducted for asymptomatic adults with chest x-ray (CXR) in 1 or 2 years in South Korea since 1995. However, the prevalence of TB in Korea is highest among OECD countries and its economical efficiency has not been evaluated yet. This study aimed to assess the cost-effectiveness of the universal screening program of TB with Korea Healthcare system perspective.  Methods: A Markov model was constructed stimulating the Quality-adjusted life-years (QALYs) and costs in a cohort over a time horizon of life time (30 years). The base-case analysis was performed on the universal TB screening strategy for asymptomatic people