Valsartan for The Treatment of Chronic Heart Failure in Greece

A654

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

Clay E1, Jamotte A1, Cohen AT2, van Hout B3, Gumbs PD4, Verhamme P5 1Creativ-Ceutical, Paris, France, 2Guy’s and St Thomas’ NHS Foundation Trust, London, UK, 3HSE University, St Petersburg, Russia, 4Daiichi-Sankyo Europe GmbH, Munich, Germany, 5University Hospitals Leuven, Leuven, Belgium

Objectives: Venous thromboembolism (VTE) is the third most common acute cardiovascular disease. VTE includes both pulmonary embolism (PE) and deep vein thrombosis (DVT) and represents an important clinical burden for patients and significant expenses for payers. Currently, the most prescribed treatment in the UK is the combination of warfarin with a parenteral anticoagulant during the first few days. The aim of this analysis was to develop a health-economic evaluation in order to estimate the cost-effectiveness of edoxaban, a non-VKA oral anticoagulant, in the treatment and secondary prevention of VTE compared to warfarin.  Methods: A Markov model was built using data from the Hokusai-VTE randomized controlled trial to estimate the lifetime costs and quality-adjusted life years (QALYs) in patients with VTE treated with either edoxaban or warfarin in the UK over a lifetime horizon. The model included VTE events, the occurrence of VTE-related complications and adverse events associated with anticoagulation treatment, i.e. bleeds. The VTE related complications included in the model are post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension. The base case assumed initial treatment duration of 6 months after a first VTE event, followed by flexible treatment duration after recurrence, i.e. tertiary prevention.  Results: From an NHS perspective Edoxaban was estimated to be cost-effective vs. warfarin with an incremental cost-effectiveness ratio (ICER) of £927 per QALY. The reduction of patient management costs, specifically monitoring costs, outweighed the higher drug costs of edoxaban vs warfarin. The results were similar in all subgroups (split by index VTE type) with a maximum ICER of £1,096 per QALY. Edoxaban was cost-effective versus warfarin in 99.8% of cases in the probabilistic sensitivity analysis when considering a threshold of £20,000 per QALY gained.  Conclusions: Edoxaban represents a cost-effective alternative compared to warfarin in the treatment of patients with VTE in the UK. PCV100 Cost-Effectiveness Analysis of Dabigatran for The Prevention of Stroke in Iranian Atrial Fibrillation Patients Keshavarz K1, Hashemi Meshkini A2, Nikfar S2, Ashkuh MS3, Sanati E4 University of Medical Sciences, School of Management and Information Sciences, Shiraz, Iran (Islamic Republic of), 2Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of), 3Shiraz University of Medical Sciences, Shiraz, Iran (Islamic Republic of), 4Tehran University of Medical Sciences, Faculty of Pharmacy, Tehran, Iran (Islamic Republic of) 1Shiraz

Objectives: Atrial fibrillation (AF) is a common clinically cardiac rhythm abnormality associated with substantial morbidity and mortality. AF is the main cause of stroke and systematic embolism (SSE) which can lead to death, disability and quality of life impairment. The standard care for AF patients is vitamin K antagonists such as warfarin but some studies indicated that the rate of stroke and SSE will dabigatran were lower than those with warfarin. This study was aimed to estimate the cost-effectiveness dabigatran etexilate versus warfarin for prevention of stroke in Iranian patients with AF.  Methods: A Morkov micro-simulation model was constructed to analysis the cost-effectiveness of two treatment strategies (doseadjusted warfarin and dabigatran 150mg twice daily) in AF patients. The designed model included eight disease states. Modelled outcome over a lifetime horizon was quality-adjusted life-years (QALYs) which was collected from previous published studies. Direct healthcare costs for each state and treatment strategy were determined from review of medical records, expert opinion and interview with patients. The results were presented in form of incremental cost-effectiveness ratio (ICER) and sensitivity analysis was carried out to indicate robustness of results.  Results: The QALYs values calculated for dabigatran and warfarin were 6.72 and 6.59 respectively. In addition, the costs for dabigatran and warfarin were obtained 10,251 and 8,270 $ respectively. Base on acceptability curve results in 45 to 60% range of simulations dabigatran was found to be a cost-effective strategy over warfarin (ICER= 11,773 $/QALY) well below the local thresholds of acceptance; 51,909 $ PPP. The results were robust over a wide range of inputs in sensitivity analysis.  Conclusions: This study suggests that the use of dabigatran for the prevention of stroke is likely to be cost-effective and also due to reduce drug monitoring and hospitalization time can represent as first priority treatment in Iranian AF patients. PCV101 Low-Density Lipoprotein Cholesterol Lowering Efficacy of Evolocumab May Reduce Need for Apheresis in Heterozygous Familial Hypercholesterolaemia Patients According to Russian Guidelines Gonzalez TD1, Kurylev A2, Kolbin A2, Zinina T3, Sidelnikov E4, Villa G1 Modeling COE, Zug, Switzerland, 2First Pavlov State Medical University of St. Petersburg, Saint Petersburg, Russia, 3Amgen LLC, Moscow, Russian Federation, 4Amgen, Global Health Economics, Zug, Switzerland 1Amgen, Economic

Objectives: Heterozygous familial hypercholesterolaemia (HeFH) patients who receive standard of care (SOC) therapy yet still have significantly elevated lowdensity lipoprotein cholesterol (LDL-C) levels qualify for apheresis. Apheresis is an invasive, burdensome and resource intensive (RUR 2,406,252 per patient-year) LDL-C lowering procedure and should be retained for patients where other lipid-lowering therapies (LLTs) are insufficient. This analysis aims to evaluate the ability of evolocumab added to SOC to reduce apheresis use in HeFH patients through LDL-C lowering, and further to evaluate the economic impact associated with reducing apheresis use in accordance with Russian guidelines.  Methods: Patient characteristics and efficacy data were taken from the RUTHERFORD-2 phase-3 trial, due to lack of Russian data. The cohort had a baseline LDL-C level ≥ 160mg/dL with a mean (standard deviation) of 201 (43) mg/dL. The mean percentage reduction in LDL-C by evolocumab was 61.3%. Baseline LDL-C and LDL-C after evolocumab treatment were

modeled by assuming log-normal distributions. Patients were deemed eligible for apheresis with LDL-C levels ≥ 300mg/dL in primary prevention (PP) or ≥ 200mg/dL in secondary prevention (SP) according to Russian guidelines. The use of apheresis was calculated with and without evolocumab treatment over a lifetime horizon, with costs assigned to LLTs. A previously published decision analytic model was used to track the proportion of the cohort with history of events and to account for mortality.  Results: The model predictions indicate that 3.1% (PP) and 34.6% (SP) of patients would receive apheresis at baseline. Mean survival was increased by 5.6 years, whilst the use of apheresis was reduced by 3.8 patient-years in evolocumab treated patients. Despite increased survival, treatment with evolocumab resulted in a per-patient saving of RUR 957,016 for the overall cost of LLTs.  Conclusions: Evolocumab may lead to a significant reduction in apheresis use according to Russian guidelines and a subsequent savings in apheresis costs. PCV102 Cost-Utility Analysis of Sacubitril/Valsartan for The Treatment of Chronic Heart Failure in Greece Stafylas P1, Farmakis D2, Kourlaba G3, Giamouzis G4, Chatzikou M5, Kossiva E6, Maniadakis N7, Parissis J8 1Medical Research & Innovation LP; University of Macedonia, Thessaloniki, Greece, 2Attikon University Hospital, Athens, Greece, 3Collaborative Center of Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partenrship, Athens, Greece, 4Larissa Univerity Hospital, Larissa, Greece, 5Novartis (Hellas) S.A.C.I., Athens, Greece, 6Novartis Hellas, Metamorphosis, Greece, 7National School of Public Health, Athens, Greece, 8University Hospital “Attikon”,, Athens, Greece

Objectives: Paradigm study demonstrated the superiority of sacubitril/valsartan to enalapril in both survival and quality of life of patients with acute heart failure. This study aims to estimate the cost-effectiveness of sacubitril/valsartan (LCZ696) compared with enalapril for the treatment of acute heart failure patients with reduced ejection fraction (HFrEF) in Greece.  Methods: A two-state Markov model was used corresponding to health states of a chronic failure patient. Clinical outcomes were extracted from the PARADIGM-HF study. Costs and outcomes were evaluated over lifetime (30 years), discounted at 3.5% with 2016 as reference year from the perspective of the Greek health care payer. The mean daily sacubitril/valsartan acquisition cost for the Greek social security system, after rebates and taking into account the current co-payment rate of 25%, has been estimated at € 3.49, which is based on the estimated ex-factory price and it represents the maximum possible daily cost. The population characteristics were extracted from a sub-analysis of the Greek pilots of the ESC Heart Failure Survey. The primary outcome was the incremental cost per quality-adjusted life year gained (QALYs) and secondary the incremental cost per life-year gained (€ /LYG). One-way and probabilistic sensitivity analyses on clinical and economic data were performed.  Results: Sacubitril/valsartan demonstrated improvement in patients’ survival by 0.75 years, leading to 0.61 additional QALYs and 5.83% fewer hospitalisations (0.10/year absolute reduction; 7.67% reduction in discounted lifetime hospitalisation costs). In addition the incremental cost effectiveness ratio was € 15,992 per QALY gained and the incremental cost per LYG was € 13,107. The results were robust in probabilistic analysis and one-way sensitivity analyses.  Conclusions: Sacubitril/valsartan was proved to be a cost-effective choice for heart failure patients with reduced ejection fraction in the Greek setting, with € 15,992 per QALY gained, which is lower than the mean per capita GDP of 2015 (€ 16,451) based on WHO recommendations. PCV103 Cost-Effectiveness of Ticagrelor 60 Mg in High-Risk Post-Mi Patients From A Dutch Societal Perspective Moore P1, Briggs A2, Davies A3, Sculpher M4, Williams J5, Fenwick E6, van de Wetering G7, Magnuson EA8, Cohen DJ8, van Haalen HG9, Mellstrom C9 1Commercial Eyes, MELBOURNE, Australia, 2Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK, 3ICON Health Economics & Epidemiology, Oxford, UK, 4University of York, Heslington, York, UK, 5ICON Health Economics & Epidemiology, London, UK, 6ICON Health Economics and Epidemiology, Abingdon, UK, 7Pharmerit International, Rotterdam, The Netherlands, 8Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA, 9AstraZeneca, Mölndal, Sweden

Objectives: Treatment with ticagrelor 60mg BID + low dose aspirin (ASA) reduces the risk of cardiovascular (CV) events whilst increasing the risk of major bleeding compared to ASA alone in patients who have had a myocardial infarction (MI) more than one year ago and who are at high risk of a further atherothrombotic event (PEGASUS-TIMI 54, NCT01225562). The aim of this study was to investigate, from a Dutch societal perspective, the cost-effectiveness of ticagrelor 60mg BID + ASA versus ASA alone in a sub-population from the PEGASUS-TIMI 54 trial that initiated treatment within 2 years from their index MI or within one year after stopping previous adenosine diphosphate receptor inhibitor treatment.  Methods: A Markov model was developed, based on competing risks analysis, to simulate the occurrence of relevant events with the alternative treatments. These events were non-fatal MI, non-fatal stroke, CV and other death, as well as dyspnea and TIMI bleeds (major and minor). EQ-5D data collected in the PEGASUS-TIMI 54 trial were converted into Dutch utilities. Expected costs for clinical events were based on the literature, drug costs were based on official Dutch list prices and a 50-year time horizon was applied. Deterministic and probabilistic sensitivity analyses were performed. Results: Treatment with ticagrelor 60mg BID + ASA resulted in a QALY gain of 0.11 versus ASA alone, this was driven by a reduction of CV events. Healthcare costs were higher with ticagrelor 60mg (€ 1,395) which resulted in a cost per QALY of € 12,310; a value that would be considered cost-effective with a commonly applied costeffectiveness threshold of € 20,000 per QALY. The results were robust to changes in input parameter values.  Conclusions: This analysis suggests that, from a Dutch societal perspective, ticagrelor 60 mg BID is a cost-effective treatment option in a high risk post-MI patient population.