Cost Per Median Overall Survival Associated with Abiraterone Acetate and Enzalutamide For Treatment of Patients with Metastatic Castration-Resistant Prostate Cancer in Colombia

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PCN31 Inhibitors of Tirosin Kinasa in Chronic Mieloid Leukemia: Cost-Effectiveness Analysis Campos I1, Cordova P2, Fernandez P2, Lopez M2, Morales F2, Villa L2 1Universidad de Concepción, Concepción, Chile, 2Facultad de Farmacia, Universidad de Concepción, Concepción, Chile

Objectives: The Chilean national health service does not have an official recommendation regarding the initiation of pharmacological treatment in patients with Chronic Myeloid Leukemia (CML). First and second-generation tyrosine kinase inhibitors (ITKs) are used indistinctly with a high associated cost for the public health care system. The aim of this study is to establish the most cost-effective option in these patients.  Methods: Markov models were designed based on information obtained from clinical trials. Initial treatments of CML with Imatinib (400 mg once daily), dasatinib (100 mg once daily) and nilotinib (300 mg twice daily) were compared. Costs from the hospital paying perspective and direct medical costs were considered. Willingness to pay was defined as three times the Chilean per capita GDP (CLP $10.226.000 in 2013). Probabilistic and deterministic simulations and sensitivity analyses were performed.  Results: Neither of the secondgeneration drugs (dasatinib and nilotinib) were cost-effective compared to the first generation drug (imatinib) at time horizons of both 5 and 10 years. The incremental cost-effectiveness ratio (ICER) at 10 years in the deterministic simulation was CLP $370,770,321 / QALY (dasatinib versus imatinib) and CLP $85,543,684 / QALY (nilotinib versus imatinib). Both options are clearly dominated by the first generation drug.  Conclusions: Both dasatinib and nilotinib are not cost-effective compared to imatinib in 5 and 10 years simulations. We suggest that second-line drugs be reserved for when the patient does not respond appropriately to the first generation drug. PCN32 Accumulated Treatment Cost of New Therapies in Multiple Myeloma: Comparing the Combination of Daratumumab, Bortezomib and Dexamethasone with Carfilzomib and Dexamethasone For WHO Have Received at Least One Prior Therapy in Brazil Del Rey C, Asano E Janssen, Sao Paulo, Brazil

Objectives: The aim of this study is to determine treatment costs at 1 to 2 years of of relapsed/refractory Multiple Myeloma patients treated with novel treatment combinations: DVd (Daratumumab+Velcade+dexamethasone) vs K2d (Carfilzomi b+dexamethasone).  Methods: The deterministic model compares accumulated cost per week based on posology detailed in daratumumab and carfilzomib labels in combinations (DVd and K2d) for treatment of relapsed/refractory Multiple Myeloma for a maximum period of 2 years. Only pharmaceutical acquisition costs (official list price) were considered in the analysis. Costs were calculated in two scenarios: a basecase considering standard evaluation (per vial) and an alternative scenario per milligram (considering no waste of substance, using price/miligram). One-way deterministic sensitivity analysis was conducted to assess the robustness of the results.  Results: Due to the difference in posology, DVd accumulated cost curve starts higher than K2d but it eventually becomes lower after 30 to 32 weeks, as disclosed in results found onbase case (standard evaluation per vial), that from week 30 and on K2d becomes more expensive than DVd; and on alternative scenario (per milligram), this point of time is on week 32. After one year of treatment, in our basecase scenario DVd costs reached R$ 596,335 while K2d reached R$ 829,416. In the alternative scenario the costs were R$533,873 for DVd vs. R$ 665,530 for K2d. In two years of analyses, the difference is even higher (total costs 65% to 89% higherfor K2d compared with DVd): R$ 885,300 (DVd) vs. R$1,669,598 (K2d) and R$ 812,864 (DVd) vs. R$ 1,342,208 (K2d) in the basecase and alternative scenario respectively.  Conclusions: DVd scheme shows a reduced cost burden after week 30 when compared with K2d in the treatment of relapsed/refractory multiple myeloma. Reducing wastage of pharmaceuticals seems to reduce this difference, though it will still range between R$ 131,657 to R$ 529,344 at 1 and 2 years, respectively. PCN33 Treatment Sequencing for Patients With Multiple Myeloma with at Least One Prior Line: Comparing Progression-Free Survival and Costs Under a Private Payer Perspective Asano E1, Maiolino A2, Martins E1 Paulo, Brazil, 2UFRJ, Rio de Janeiro, Brazil

1Janssen, Sao

Objectives: Daratumumab and carfilzomib are important options recently approved in the treatment of multiple myeloma. The objective of this study is to compare progression-free survival (PFS) and treatment costs of two treatment sequences: daratumumab+bortezomib+dexamethasone (DVd) followed by carfilzomib+dexamethasone (K2d) and the opposite (K2d followed by DVd) under a private payer perspective.  Methods: A deterministic model was developed to estimate progression-free survival and treatment costs of two treatment sequences after frontline failure: DVd followed by K2d, and K2d followed by DVd. Transition probabilities and efficacy data of patients with 1 prior line and ≥ 2 prior lines of the combinations DVd and K2d were drawn from the clinical studies. Cost parameters included drug acquisition costs based on the official list price. PFS of patients with 1 prior line (PFS1) and progressing 2 prior lines (PFS2) were estimated. One and 2-year time horizon analysis was conducted. One-way sensitivity analysis was conducted to determine the robustness of the model  Results: DVd, followed by K2d provided higher efficacy and lower costs at both 1 and 2 years. At 1-year, treatment costs per patient were R$ 627,284 for DVd--> K2d and R$ 814,923 for K2d--> DVd; PFS1 was 77% for DVd--> K2d and 71% for K2d--> DVd. At 2-years, the difference both in terms of efficacy and costs escalated: treatment costs per patient with DVd--> K2d were R$ 476,363 lower than with K2d--> DVd; PFS1 was 29% higher for DVd--> K2d (72%vs43%) and 11% higher for PFS2 (85%vs74%). In the deterministic sensitivity analysis, DVd remained the option generating less costs at both 1 and 2 years.  Conclusions: Initial treatment of second line patients failing their first line therapy with DVd,

followed by K2d had lower treatment costs and higher PFS at both 1 and 2 years when compared to the opposite sequence in the treatment of multiple myeloma, under a private payer perspective. PCN34 Cost and Effectiveness of the use of Sorafenib in Differentiated Thyroid Cancer Carrasquilla-Sotomayor M1, Alvis-Zakzuk NJ2, Gomez de la Rosa F2, Alvis Zakzuk J1, Marrugo Figueroa RD3, Miranda Machado P1, Alvis Guzman N4, Herran Diazgranado SE3 1ALZAK Group, CARTAGENA, Colombia, 2ALZAK Foundation, Cartagena, Colombia, 3Bayer, Bogotá, Colombia, 4ALZAK Foundation. Universidad de Cartagena., Cartagena de Indias, Colombia

Objectives: The prevalence of differentiated thyroid cancer (DTC) locally advanced or metastatic refractory to radioactive iodine (RAI) has been increasing in the past decade. The treatments related to this condition are limited and are associated with substantial direct medical costs, low quality of life and survival. The aim of this study was to estimate the cost and effectiveness of sorafenib administrated in radioiodine-refractory DTC patients in Colombia.  Methods: We adapted a Markov Model to simulate the process of radioiodine-refractory DTC patients treated with sorafenib. Clinical data were obtained from a systematic review. Costs were estimated from a standard costing based on expert panel. The primary outcomes were costs and QALYS. We performed one-way sensitivity analysis as well as probabilistic sensitivity analysis based on Monte Carlo simulation of 1000 iterations to explore the uncertainty of the parameters used in the model.  Results: The estimated direct medical cost of DTC-RAI was COP $ 575,512 in ambulatory patients. The standard cost of the disease progression was COP $ 2,481,336 in outpatient and COP $ 10,812,295 in inpatient. The progression free survival was 1.30 months for sorafenib and 0.45 for Best Supportive Care (BSC). The monthly costs of treatments were COP $ 20,510,821 and COP $ 9,138,752 for BSC and Sorafenib, respectively. Treatment with sorafenib resulted in additional gains in terms of effectiveness compared to the BSC option. (0.67 QALYs more than treatment with BSC which reported gains of 1.74 QALYs). Moreover, sorafenib results in cost savings for early progression in COP $ 11,299,586 compared to BSC.  Conclusions: Sorafenib is a treatment that delays disease progression. Also, given its cost savings results, is a potentially cost effective treatment option in patients with DTC-RAI in Colombia. PCN35 Estudio De Costo-Efectividad E Impacto Presupuestal De Denosumab vs. Ácido Zoledrónico Para El Manejo De Metástasis Óseas En Pacientes Con Cáncer De Próstata En Colombia Pérez M1, Garcia Perlaza J1, Fletscher PM1, Vargas-Valencia J2 1AMGEN, Bogotá, Colombia, 2Econopharma Consulting, Mexico, Mexico

Objectives: Los pacientes con metástasis óseas (MO) de tumores sólidos con frecuencia experimentan Complicaciones Óseas Relacionadas con el esqueleto (COR) que incluyen fracturas patológicas, compresión de la médula espinal, radiación al hueso y cirugía ósea. El objetivo fue evaluar la costo-efectividad y el impacto presupuestal de denosumab vs. ácido zoledrónico para el manejo de MO en pacientes con cáncer de próstata, desde la perspectiva del sistema de salud Colombiano.  Methods: Un modelo de Markov fue utilizado, con tres estados (en tratamiento, sin tratamiento y muerte), en un horizonte temporal de toda la vida del paciente. Los inputs de eficacia y seguridad se obtuvieron de los estudios clínicos que comparan denosumab vs. ácido zoledrónico para el tratamiento de las MO en pacientes con Cáncer de Próstata. Los costos incluidos (tratamiento, medicamentos, eventos adversos y COR) se obtuvieron de SISMED- 2016 y manual ISS- 2001+ 30%, validado por un panel de expertos clínicos. Los resultados se expresaron en términos de años de vida ajustados por calidad (AVAC) y Complicaciones Óseas Relacionadas con el Esqueleto Evitadas (CORE). Se realizó un análisis de sensibilidad determinístico para las variables más importantes (+/- 30%).  Results: Teniendo en cuenta un umbral de 3 PIB per cápita, los resultados para el caso base sugieren que denosumab es una alternativa “altamente costo-efectiva” para la prevención de COR en pacientes con cáncer de próstata (Costo por AVAC ganado: $1,117,970 COP; Costo por CORE $151,717 COP). Los resultados del impacto presupuestal a 5 años, sugieren que denosumab es una alternativa que generaría ahorros al Sistema de Salud Colombiano (Ahorro $195,431,756 COP).  Conclusions: Denosumab es una alternativa “altamente costo-efectiva” para la prevención de Complicaciones Óseas Relacionadas con el esqueleto en pacientes con cáncer de próstata, y es una alternativa que podría generar ahorros al Sistema de Salud Colombiano. PCN36 Cost Per Median Overall Survival Associated with Abiraterone Acetate and Enzalutamide For Treatment of Patients with Metastatic Castration-Resistant Prostate Cancer in Colombia Aguirre A1, Guerrero E2 1Janssen Cilag SA, Bogota, Colombia, 2Janssen Colombia, Bogota, Colombia

Objectives: To calculate costs per monthly median overall survival (OS) in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate plus prednisone (AA+P) or enzalutamide.  Methods: Median treatment duration and median OS data from published Phase 3 clinical trials and prescribing information were used to calculate costs per monthly median OS based on ex-factory price (EFP) for patients with mCRPC treated with AA+P or enzalutamide. Sensitivity analyses were performed to understand how variations in treatment duration and treatment-related monitoring recommendations influenced cost per median OS. Cost-effectiveness estimates of other Phase 3 trial outcomes were also explored: Cost per month of chemotherapy avoided and per median radiographic progression-free survival (rPFS).  Results: The results demonstrated that AA+P has a lower cost per monthly median OS than enzalutamide ($846.00 vs. 1,573.00; 46% reduction), based on the following assumptions: exchange rate USD 1 =  COP 2967, median treatment duration of 14 months for AA+P and 18 months for enzalutamide, median OS of 34.7 months for AA+P and 35.3 months



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for enzalutamide, and EFP per 30-day supply of $2,096.57 for AA+P versus $3,084.11 for enzalutamide. Sensitivity analyses showed that accounting for recommended treatment-related monitoring costs or assuming identical treatment durations for AA+P and enzalutamide (18 months) resulted in costs per median OS month 31% to 44% lower for AA+P than for enzalutamide. Costs per month of chemotherapy avoided were $1,165.00 for AA+P and $1,983.00 for enzalutamide, while costs per month to achieve median rPFS were $1,779.00 for AA+P and $2,776.00 for enzalutamide.  Conclusions: Costs per monthly median OS, along with costs of other Phase 3 trial outcomes, were lower for AA+P than for enzalutamide. The findings were robust to sensitivity analyses. These results have important implications for population health decision makers evaluating the relative value of therapies for mCRPC patients. PCN37 Costo Utilidad De Los Bloqueadores HER2 Contra El Cáncer De Mama Metastásico En Mujeres Peruanas Gutierrez-Aguado A1, Escobedo-Palza S2 1UNMSM, Lima, Peru, 2SPEAS, Lima, Peru

Objectives: Estimar el costo-utilidad de los bloqueadores HER2 contra el cáncer de mama en mujeres peruanas.  Methods: Se realizó una evaluación económica de tipo costo-utilidad. La población de estudio fue una cohorte hipotética de mujeres peruanas. Los costos se estimaron desde la perspectiva del financiador. Se utilizó una tasa de descuento de 3% con base en estos costos y los años de vida ajustados por calidad (QALY) como medidas de resultado de cada una de las intervenciones evaluadas. Se calculó la razón de costo-efectividad incremental (RCEI) y el análisis de sensibilidad.  Results: El costo anual del tratamiento contra el cáncer de mama recurrencia distante se estimó entre 180’560,216.66 y 341’096,546.96 soles con tratamiento trastuzumab. Asimismo, se estimó entre 430’123,003.16 y 812’545,940.96 soles con tratamiento trastuzumab+pertuzumab. La RCEI para el tratamiento con trastuzumab fue de 663,509 USD/QALY resultó ser la intervención costo efectiva con respecto a tratamiento “trastuzumab+pertuzumab”. El Impacto presupuestal, desde el año 2007, el país viene implementando una manera diferente de gestionar la asignación de recursos en el Sector Público, a través de Programas Presupuestales. Uno de los programas se denomina Programa Presupuestal de Prevención y Control de Cáncer (PP PCCáncer) que se inicia el año 2011 (29), este programa presupuestal tiene 32 productos (intervenciones) que tiene como objetivo final el disminuir la morbimortalidad de cáncer en el país. El PP PCCáncer, para el año 2015, cuenta con un Presupuesto Institucional Modificado (PIM) de 692’423,278 soles, bajo toda fuente de financiamiento y toda genérica de gasto. Dentro de los productos que tiene el PP PCCáncer los relacionados a cáncer de mama representa una asignación presupuestal de 84’123,209 soles. Si consideramos solo los costos de tratamiento “trastuzumab+pertuzumab” se tendría un impacto presupuestal muy importante.  Conclusions: el tratamiento con “trastuzumab+pertuzumab” no resultó ser costo efectiva.

Cancer – Patient-Reported Outcomes & Patient Preference Studies PCN38 Oncologic Pain Attitudes, Intensity And Treatment In Brazil Holtz L1, Julian GS2, Cecilio L1, de Oliveira RW2, MoreiraEd 2 1Oncoguia, São Paulo, Brazil, 2Evidências - Kantar Health, São Paulo, Brazil

Objectives: Patient reported outcomes (PRO) data are essential to decisionmaking process, especially in medical signs, like pain. In oncology, pain is highly prevalent, affecting more than 50% of the oncology patients. Therefore, the aim of this survey was to evaluate pain profile and perceptions in oncologic patients in Brazil.  Methods: From July 2015 to July 2016, 423 respondents answered an internet-based survey related to pain in oncology from Oncoguia Institute, an independent nonprofit cancer advocacy institution. Patients reported pain according to a numerical scale range 0-3 mild, 4-6 moderate and 7-10 severe.  Results: Of the 423 respondents, 87.5% were women, 56.9% aged from 40 to 59 years, 44.7% covered exclusively by the private setting, 41.5% exclusively by the public setting, and 13.8% by both. Breast cancer accounted for 48.9% of the respondents, while colorectal cancer, cervix cancer and other cancers corresponded to 5.9%, 5.7% and 39.5% of the answers, respectively. Respondents reported mild, moderate and severe pain in 15.1%, 40.2% and 44.7%, respectively. The majority of the patients (82.7%) discussed their pain with the oncologist and 69% talked to other healthcare professionals. In 52.6% of the cases, pain was responsible for another health issue, most commonly anxiety. Of all respondents, 84.6% were taking at least one pain medication, with 38.3% of them using more than one drug. The most common treatments were paracetamol (21.3%), anti-inflammatories (17.7%), tramadol (13.9%) and others (40.0%).  Conclusions: In line with other studies in this area, our results showed that there is still space for improvement in the treatment of oncologic pain. Therefore, several patients remain unsatisfied with pain treatment and educational intervention would be a good strategy to overcome the barriers in oncologic pain treatment. PCN39 Imagem Corporal EM Mulheres Submetidas Ao Tratamento Do Câncer De Mama Guedes SR1, De Camargo Cancela M2, Dantas de Oliveira NP1, Martins Holanda A1, Albuquerque Reis M1, Patrocínio da Silva C1, Rocha e Silva BL1, Bezerra de Souza DL1 Federal do Rio Grande do Norte, Natal, Brazil, 2Instituto Nacional de Câncer, Rio de Janeiro, Brazil

1Universidade

Objectives: Verificar a prevalência de insatisfação com a imagem corporal e seus fatores associados em mulheres sobreviventes ao câncer de mama.  Methods:

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Estudo transversal, que avaliou 103 mulheres residentes no município de Natal-RN, com diagnóstico de neoplasia mamária há no mínimo um ano, submetidas a tratamento oncológico e que permanecem em acompanhamento clínico. A coleta de dados foi realizada por meio do acesso aos prontuários das pacientes diagnosticadas com câncer de mama e de entrevista individual. A imagem corporal foi mensurada através do questionário validado Body Image Scale (BIS). Também foram coletadas variáveis socioeconômicas, histórico ginecológico, clínico e hábitos de vida. A análise bivariada foi realizada por meio do teste Qui-quadrado de Pearson (Exato de Fisher), calculando a razão de prevalência com intervalo de confiança de 95%. A análise multivariada foi feita por meio da Regressão de Poisson com variância robusta. Considerou-se o nível de significância estatística de 0,05.  Results: A média da idade das pacientes incluídas no estudo foi igual a 55,97 anos (±10,6), da raça branca, casadas, com vínculo empregatício antes do tratamento (81,6%). A prevalência de insatisfação com a imagem corporal foi de 74,8%, IC (0,65-0,82). A imagem corporal apresentou associação estatisticamente significativa com o acompanhamento multiprofissional e presença de vínculo empregatício após o tratamento.  Conclusions: A prevalência de insatisfação com a imagem corporal foi elevada. Mulheres que relataram ter vínculo empregatício após o tratamento para o câncer apresentaram mais alterações na autopercepção quanto a aparência. Em relação ao acompanhamento multiprofissional, aquelas pacientes que não receberam o seguimento do cuidado relataram um impacto negativo na imagem corporal, evidenciando a necessidade de estratégias que aumentem a resolutividade dos serviços de forma a atender as principais demandas dessa população.

CANCER – Health Care Use & Policy Studies PCN40 Pink October in the Social Media: Are We Still (MIS)Guiding the Public? Bueno CC, Almeida PR, Clark LG Evidencias - Kantar Health, Campinas, Brazil

Objectives: Pink October, the breast cancer awareness campaign (BCAC), occurs annually in Brazil since 2002 aiming to share information about breast cancer (BC) and raise awareness on the importance of early detection. However, information from BCAC is often incomplete, decontextualized and even out-of-date, which may misguide the public in several aspects. Traditional mass media coverage has been enhanced by social media in cancer treatment decision making and care support. Yet, there is a dearth of literature on how patients use these technologies during the treatment decision process and even less is known about whether online communication influences patient appraisals of decision making. The objective of this study is to assess social media campaigns during Pink October regarding information and education on breast cancer awareness.  Methods: We searched Facebook using the term breast cancer. Analysis was restricted to groups related to breast cancer, operated in English or Portuguese, and publicly available. We collected breast cancer-related tweets from 01 to 31 October 2016, using Twitter’s application programming interface; each tweet was classified as an original or a retweet. Also, the Brazilian National Cancer Institute (INCA) and Ministry of Health (MoH) websites were reviewed to evaluate data on BC and BCAC.  Results: We found 50 breast cancer groups from Brazil on Facebook containing a total of 12,688 members. Regarding Twitter, we found approximately 911 tweets on breast cancer by on the assessed period. Communication both in Facebook and in Twitter focused more on wearing pink, fundraising and self-exam.  Conclusions: Communication is an important tool for BC education and awareness, and social media is gaining increasing prominence in this medium; however, it still emphasizes fundraising and self-exam, not promoting any specific preventive behavior. PCN41 Supporting Individual Reflection and Patient-Clinician Shared Decision-Making on GEP-NET Management Options Using Reflective Multi-Criteria Decision Analysis Wagner M1, Samaha D2, O’Neil B3, Khoury H3, Bennetts L3, Lavoie L3, Badgley D3, Gabriel S4, Berthon A4, Dinet J4, Dolan J5, Kulke MH6, Goetghebeur MM7 1Analytica LASER, Montreal, QC, Canada, 2LASER Analytica, London, UK, 3LASER Analytica, Montreal, QC, Canada, 4Ipsen Pharma SAS, Boulogne-Billancourt, France, 5University of Rochester, Rochester, NY, USA, 6Dana-Farber Cancer Institute, Boston, MA, USA, 7Analytica LASER and School of Public Health, University of Montreal, Montreal, QC, Canada

Objectives: Patients with slowly-growing, unresectable, well- or moderatelydifferentiated, non-functioning GEP-NETs may have to decide between somatostatin analog (SSA) treatment to delay progression, or watchful waiting (WW). We developed a comprehensive, MCDA-based decision framework to support patientclinician reflection and communication on management options.  Methods: The framework, designed based on EVIDEM structure with input from patients and physicians, consisted of 6 domains: Outcomes (Effectiveness, Patient-Reported Outcomes, Autonomy, Dignity, Convenience, Safety); Type of benefit; Need (Disease severity, Unmet needs, Population size); Costs & constraints (Intervention, Medical, Non-medical); Knowledge (Quality of evidence, Expert consensus); and Feasibility (System capacity). Pertinent evidence addressing two decision scenarios (treatment vs WW; SSA-1 [lanreotide] vs SSA-2 [octreotide]) was collected (literature review) and incorporated into the framework. During a workshop run under the Chatham House Rule, US patients and physicians, using scoring scales designed to capture individual reflection, expressed how consideration of each criterion would impact their decision in favor of one option or the other (-5 to +5), and shared verbally and in writing knowledge and insights.  Results: Scoring and considering each criterion along with the available evidence prompted a rich exchange of perspectives and revealed individual assumptions and interpretations. Large variations in scores were observed, particularly when evidence was absent or inconclusive, reflecting diversity in interpretations and the need to share them. At the group level,