Costs Analysis Of Novel Flash Glucose Monitoring Technology In Adults With Type 2 Diabetes Mellitus (T2DM) Under Insulin Treatment In Spain

VA L U E I N H E A LT H

to find treatment options. In the UK, the National Institute for Health and Clinical Excellence (NICE) has implemented an end-of-life (EoL) premium since 2009. The aim of this study is to assess the cost-effectiveness value of CMI in a health system.  Methods: A model described by McCabe and colleagues is adapted to show the value of CMI. To populate the model, threshold cost and real-world incremental cost-effectiveness ratio (ICER) data from the health technology assessments performed by NICE in the past year (November 2015-December 2016) were used as comparators. Data collected in a prospective observational study conducted by Caris demonstrated a survival benefit in patents treated in line with the CMI report. An ICER for CMI was calculated based on the demonstrated survival benefit and the clinical utility.  Results: To date, NICE recommendations have consistently used a £50,000 per QALY threshold for these EoL treatments. This equates to a health benefit of 7.3 days of additional benefit per £1,000 expenditure by the health care system. A CMI unit price of £5,000 was used in the ICER calculation. According to Caris registry data, CMI can extend overall survival by 138 days (or 0.337 years) for health economic evaluation. CMI-guided therapy is administered in 78% of profiled patients, meaning that a decision impact factor of 0.78 could be included in ICER calculation. The ICER for CMI was calculated as CMI Cost / (QALYs gained x decision impact factor). Based on these assumptions, the ICER for CMI is £19,022 or equivalent to 19.20 days benefit per £1,000 expenditure.  Conclusions: Data from this model shows that CMI exceeds the threshold opportunity cost and represents value for health care systems that surpasses many recently approved drugs. PMD39 Economic Effectiveness Of The Attune® Knee System - Analysis Of Real World Hospital Length Of Stay And Incidence Of Early Complications Mantel J1, Corso KA2, Wei D2, Holy CE2, Muehlendyck C3, Jayakumar P4, Higgins M5, Westbrook A5 Synthes, Leeds, UK, 2Johnson & Johnson, New Brunswick, NJ, USA, 3Johnson & Johnson Medical GmbH, Norderstedt, Germany, 4Johnson and Johnson Medical Devices, London, UK, 5Nottingham University Hospital, Nottingham, UK 1DePuy

Objectives: Briggs et al. highlight the importance of reducing hospital length of stay (LOS) and early post-operative readmissions to reduce the financial burden of elective orthopaedics. DePuy Synthes (DS) ATTUNE® Knee was engineered to enhance stability, thus potentially accelerating time to normal activities. This study was designed to evaluate whether patients treated with ATTUNE had a shorter LOS and less delayed discharge (DD) and post-operative events compared to patients treated with other implants.  Methods: Retrospective analysis of all primary adult TKAs at a single hospital within the United Kingdom between April 2014 and April 2015 was conducted. Three groups of patients were compared by implant type: ATTUNE, DS SIGMA® or Aesculap Columbus®. Outcomes were LOS, DD >  3 days, all-cause 30-day readmissions, all-cause 60-day complications and all-cause 60-day reoperations. Bivariate comparisons of baseline characteristics and outcome measures were generated. Multivariable models were constructed to examine the differences in outcomes between implants and the covariates that may affect these outcomes.  Results: In this study a total of 716 patients were included (ATTUNE: N= 238, SIGMA: N= 332, Columbus: N= 149); 59.4% were female and had an average age of 69.2 (SD: 9.8). No significant differences were noted in age and sex; however, the proportion of patients ≥  65 years was significantly greater for Columbus versus ATTUNE (48.3% vs 32.8% respectively). Multivariable regressions showed significantly shorter LOS and significantly smaller proportions of patients with DD for ATTUNE vs. SIGMA and Columbus (LOS (days): ATTUNE: 5.6 (95%CI: 5.2-6.1), Columbus: 6.6 (95%CI: 5.9-7.4), SIGMA: 6.4 (95%CI: 5.9-6.9); DD: ATTUNE: 63.4%; Columbus: 77.2%; SIGMA: 73.8%). Non-significant trends of lower 30-day readmission and 60-day complication and reoperation rates were observed in the cohort treated with ATTUNE vs. Columbus or SIGMA.  Conclusions: In this study, patients treated with ATTUNE experienced significantly shorter LOS and fewer DDs compared to those treated with Columbus or SIGMA. PMD40 The Resource And Cost Consequences Of Using Antibiotic Coated Intramedullary Nails Compared To Non-Coated Nails In Open Tibia Fractures Across Four European Centres Taylor H1, Wolf S2, Paparouni K2 1Johnson & Johnson Medical Limited, Leeds, UK, 2Synthes GmbH, Zuchwil, Switzerland

Objectives: Bone and deep wound infections are associated with increased length of stay and higher costs in patients with open tibial fractures. Infection risks increase with implant usage and open fracture severity. Innovations to reduce risks include antibacterial coated implants. This study models whether use of antibiotic coated implants in patients at high-risk of infection is cost-effective.  Methods: An economic model compared infection rates and costs associated with surgery and hospital stay in patients with a Gustilo-Anderson (GA) classification open fractures, for two patient cohorts. All GAIII patients in the first cohort received an antibiotic coated tibial nail (ETN PROtect®) whilst the remaining GAI and GAII patients in the same cohort received a standard nail. GAIII patients received the antibiotic coated nail due to their higher infection risk. The second cohort all received a standard tibial nail. Four European trauma centres provided patient-level data on inpatient days, theatre use and related costs for patients with and without infections. Absolute infection risks and relative risk reductions, for antibiotic coated nails compared to standard nails were obtained from a meta-analysis.  Results: Using the antibiotic coated implant in patients at high-risk of infection (GAIII) was cost saving; the higher cost of the implant was offset by fewer infections, reduced inpatient days and fewer re-operations. Scenario analysis demonstrated using a coated nail in all open fracture patients was cost effective in 3 out of 4 centres.  Conclusions: The analyses demonstrated that hospitals could reduce costs by 4-13% by adopting the antibiotic coated nail in patients at high-risk of infection. Infection reduction releases beds and reduces re-operations. Results are sensitive to underlying infection risks; therefore patient selection is important to ensure a cost-effective

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outcome. Further research is required to improve the identification of high-risk patients most likely to benefit from antibiotic coated implants. PMD41 Costs Analysis Of Novel Flash Glucose Monitoring Technology In Adults With Type 2 Diabetes Mellitus (T2DM) Under Insulin Treatment In Spain Khan-Mirón A, Sánchez-Iriso E, Cabases-Hita JM Universidad Pública de Navarra, Pamplona, Spain

Objectives: Among patients with diabetes, frequent glucose testing is one of the major barriers to achieve optimal glycemic control. The current standard of care is self-monitoring blood glucose (SMBG) involving finger pricking. Flash Glucose Monitoring (FGM) is a novel, sensor based, technology that continuously measures glucose levels and patients obtain their values by sensor scanning. The aim of this analysis is to estimate the costs associated with FGM as a replacement for routine SMBG in patients with T2DM under insulin treatment in Spain.  Methods: REPLACE Study showed an average of 3.8 tests a day. Patients using a FGM system spent less time in hypoglycemia when compared to patients using SMBG, but no reduction in the number of hypoglycemic events was shown. Unit costs for SMBG were 0.04€  per lancet, 0.24€  per strip, 25.20€  per meter and 19.52€  per lancing device. Unit costs for FGM were 59.90€  per FGM reader and 59.90€  per sensor.  Results: Annual cost of 3.8 SMBG test/day is 433€  per patient compared with 1592€  per patient using FGM. Meaning that with the cost of each FGM reimbursed patient, more than 3 SMBG patients could be afforded. If all patients with T2DM under insulin treatment in Spain (12% of the patients with T2DM) were switched from SMBG to FGM, 12% of the patients (FGM) would concentrate 31% of the glucose measuring resources, while 88% of the patients (SMBG) would take the remaining 69%. In Spain, the cost of SMBG Test Strips equals 2% of the annual Diabetes Budget, if patients with T2DM under insulin treatment were switched to FGM, the amount would raise to 3% of the budget.  Conclusions: While FGM is a great innovation that simplifies daily diabetes management and patient adherence to testing frequency, the costs associated with this technology are still a major barrier for patient access. PMD42 Treatment Choices Based On Multiplatform Profiling Platform, Unlike Those With Sequencing Alone, Do Not Cause A Cost Explosion In Refractory Cancer Patients Russell KJ1, Janssens J2, Dean A3, Hernandez A1, Voss A1 Life Sciences, Basel, Switzerland, 2University Hasselt, Hasselt, Belgium, 3St John of God Hospital, Subiaco, Australia

1Caris

Objectives: Molecular testing of cancers is quickly becoming standard of care using diverse approaches, either academic or commercial in origin. Some oncologists remain apprehensive about the clinical utility of molecular profiling, based on the degree to which information can be used in a treatment decision, and whether it would lead to selection of more expensive treatments that may not be accessible. The aim of this study is to examine the decision impact of a multiplatform tumor profiling service, Caris Molecular Intelligence (CMI), and evaluate CMI-guided treatment costs compared to prior and planned treatments in prospective and retrospective clinical studies.  Methods: In 5 physician-led clinical studies, the treatment decision prior to receipt of the CMI report was captured (n= 137 patients). A systematic review of treatment data from 10 clinical studies of CMI (n= 385 patients) allowed a comparison of planned versus actual (n= 137) and prior versus actual (n= 229) treatment costs. Costing information was taken from the British National Formulary (BNF) giving a treatment cost per cycle per patient. Decision impact (n= 232) and treatment cost per cycle (n= 131) were also compared with corresponding data from studies of next generation sequencing (NGS)-only approaches.  Results: Decision impact was changed in 88% of CMI-profiled cases compared to 29% of NGS-only approaches. The CMI-guided treatment cost per cycle was £995 in 385 treated patients. Planned treatment costs were comparable to actual treatment costs (£979 versus £945; p= 0.7123) and prior treatment costs were also not significantly different to profiling-guided treatments (£892 versus £850; p= 0.6319). NGS-only guided treatments cost £2,501 per cycle per patient. Conclusions: Treatment costs guided by a multiplatform-profiling platform were comparable to planned and prior treatment and do not cause a cost explosion, as the majority of treatments used were conventional chemotherapies. NGS-only approaches rely on more expensive targeted therapies and higher treatment cost per cycle per patient. PMD43 Comparison of U.S. Hospital Costs Between Transcatheter Aortic Valve Replacement (TAVR) And Surgical Aortic Valve Replacement (SAVR) Meduri C1, Chung JK2, Gaffney JC2, Henley S2, Williams JM2, Gada H3 Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA, 2Medtronic, Mounds View, MN, USA, 3PinnacleHealth System, Wormleysburg, PA, USA

1Marcus

Objectives: Given TAVR’s broadening application, the budget constraints faced by hospitals, and the higher cost of the TAVR valve compared to SAVR, there is great interest in understanding how hospital costs compare between TAVR and SAVR.  Methods: To evaluate in-hospital costs across U.S. hospitals, we conducted a retrospective analysis of patients undergoing TAVR or SAVR between January 1, 2014 – September 30, 2016 using the Premier Hospital Database. Patients were included in the study if they underwent a TAVR or SAVR procedure based on ICD-9 and -10 procedure codes and were 65 years or older at the time of the procedure. Patients were matched 1:1 using propensity score method based on patient age, Charlson comorbidity index grouping (4 indices), gender, race, and payor type. In-hospital costs were defined as the total hospitalization cost including operating room, supply, room and board, ICU, lab, etc. plus pharmacy cost, adjusted to 2016 dollars. We supplemented this aggregate-level cost analysis by examining the average in-hospital costs and reimbursement for TAVR and SAVR at two U.S. hospitals.  Results: We matched 13,030 TAVR and SAVR patients in the Premier