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Dengue Negatively Affects Gdp And Federal Revenues In Endemic Areas Of Mexico
A418
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
1Sechenov First Moscow State Medical University, Moscow, Russian Federation, 2Moscow Institute of physics and technology (State University), Dolgoprudny, Russian Federation
INFECTION – Patient-Reported Outcomes & Patient Preference Studies
Objectives: Early economic modeling is commonly used to inform decision making during the research and development of new pharmaceuticals. In this study decision modeling was used to estimate a price per month for elpivirine (VM-1500), a new non-nucleoside reverse-transcriptase inhibitor (NNRTI) in treatment-naïve patients with HIV. Methods: A Markov model was used to simulate the life-time (50-years) costs and effectiveness associated with antiretroviral therapy. Comparison of therapeutic schemes for HIV treatment that include efavirenz, lopinavir/ritonavir, raltegravir, rilpivirine and elpivirine was performed with the use of cost-utility analysis. Costs for ART and management of adverse events, were obtained from public hospitals in Russian Federation. Utility estimates were measured as quality-adjusted life years (QALYs). To calculate the acceptable price for 1-month treatment with elpivirine, we proceeded from the assumption that its cost-utility should be less than cost-utility of other antiviral drugs under study. The price per month was also estimated using 3 times the Russian’s per capita 2014 gross domestic product (GDP), which is $25 341 per QALY gained, as the threshold for economic value as suggested by the World Health Organization. Results: Pharmacoeconomic analysis showed that the lowest discounted (3%) cost per QALY ($5 915) was observed in combined treatment with the use of elpivirine. Lopinavir/ritonavir has the second least cost-utility ratio ($6 736). Assuming discounted cost per QALY for elpivirinebased scheme to be not much that for lopinavir/ritonavir based one, the maximum price per month for elpivirine should equal $305. Based on GDP, elpivirine-based scheme relative to efavirenz-based scheme should have an incremental cost less than willingness to pay threshold. Thus, the maximum price per month for elpivirin should equal $383. Conclusions: The findings of this early economic modeling suggest that to be cost-effective the acquisition cost of elpivirine should be within the range of $305 to $383 per month.
PIN65 Health State Utilities Associated with Post-Surgical Staphylococcus Aureus Infection
PIN63 Economic Evaluation Of Abbvie’s Regimen (Viekirax) For Patients With Genotype 4 Hcv In Greece Mylonas C1, Kourlaba G2, Vernadaki A3, Kakouros M3, Maniadakis N1 School of Public Health, Athens, Greece, 2Collaborative Center of Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partenrship, Athens, Greece, 3AbbVie Pharmaceuticals S.A, Athens, Greece
1National
Objectives: To conduct a cost – utility analysis of the AbbVie’s Regimen versus other established maintenance treatment options in the Greek health care setting, for patients within genotype 4 chronic hepatitis C virus (HCV). Methods: A Markov model was adapted locally to reflect the natural progression of patients with genotype 4 through different health states. Efficacy and safety data considered in the model were extracted from the relevant clinical trials and other published studies. Utilities values were extracted from the literature. Direct medical costs were incorporated in the model reflecting the year 2015. The model evaluated the comparators over a lifetime horizon in the course of a 1-year cycle. The outcomes are measured in terms of Quality Adjusted Life Years gained. While outcomes can vary, the outcomes in this analysis were measured in terms of life-years gained. The analysis was performed from a payer’s perspective. Costs and outcomes that occurred beyond one year were discounted at a 3.5% annual rate which is the standard practice in Greece as well as other jurisdictions. Results: The base case results indicate that the AbbVie Regimen is a dominant option (in the most cases) and cost-effective option for naïve patients with genotype 4 HCV. The sensitivity analysis shows that the overall cost-effectiveness results are sensitive to the model time horizon and changes in the SVR rate for patients on the comparator treatment. AbbVie’s Regimen appears cost-effective based on traditional standards in the vast majority of sensitivity analyses. In the CEAF, it is the optimal choice (on the optimality frontier) when payers are willing to pay over about 15,000€ /QALY in the majority of analyses. Conclusions: Using conservative assumptions, the present economic evaluation suggests that AbbVie’s Regimen provides greater health outcomes and is less costly compared to majority of comparators.
PIN64 Dengue Negatively Affects Gdp And Federal Revenues In Endemic Areas Of Mexico Samaniego R, Aburto C Instituto Tecnologico Autonomo de Mexico, Mexico City, Mexico
Objectives: Empirical research on the impact of the incidence of dengue on various aggregate economic indicators using Mexican states and municipal data was undertaken to 1) measure the monetary effect of reductions in the incidence of dengue on Gross Domestic Product (GDP) of each state, 2) estimate the impact of changes in the GDP of each state on the collection of federal taxes and 3) model various scenarios of reductions of the incidence of dengue and its effect on the number of foreign tourists in the 20 most visited municipalities of Mexico. Methods: Based on econometric time series regression models we obtained 1) estimates of the effect of the incidence of dengue on GDP for each state, 2) assessments of the incidence of dengue on the federal tax revenues collected in each state, and 3) further calculations of the effect of a reduction in the of dengue incidence on the number of foreign tourists in the top 20 Mexican tourist destinations. Results: 1) The incidence of dengue on GDP by state for 1996-2015 had the expected negative sign. The weighted average elasticity was -0.027, 2) the estimates of the incidence of dengue on federal tax revenue by state result in a weighted average elasticity of -0.011, and 3) the elasticity of the incidence of dengue on the number of foreign tourists in the top 20 tourist destinations in Mexico had an average elasticity of -0.0177. Conclusions: Dengue incidence negatively affects a broad range of socioeconomic variables in Mexico. The results obtained are a promising complement to traditional measurements of the costs of dengue. Additional studies are required to expand our analyses.
Matza LS1, Kim K1, Yu H2, Belden K3, Chen AF4, Kurd M4, Lee BY5, Webb J6 1Evidera, Bethesda, MD, USA, 2Pfizer, Collegeville, PA, USA, 3Sydney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA, 4Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA, 5Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 6Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
Objectives: Surgical site infection (SSI) occurs in approximately 2% of patients undergoing surgery, with outcomes ranging from mild to life threatening. Staphylococcus aureus is a virulent pathogen frequently identified as a cause of SSI. Cost-utility analyses are useful for assessing and comparing the value of treatments developed to address and reduce the risk of these infections. Therefore, the purpose of this study was to estimate utilities associated with varying levels of post-surgical Staphylococcus aureusinfection following joint (hip or knee) and spine surgery. Methods: In time trade-off (TTO) interviews with a 1-year time horizon, general population participants in the UK (London, Edinburgh) valued health states drafted based on literature and clinician interviews. The health states described a year including either joint or spine surgery, with or without post-surgical infection. For joint surgery health states, possible infections included superficial wound infection, deep infection requiring debridement and implant retention (DAIR), and deep infection requiring two-stage revision arthroplasty. Spine surgery health states described infections either requiring or not requiring surgical intervention. Results: A total of 201 participants completed interviews (50.25% female; mean age= 46.2y). The mean (SD) utilities of health states describing a year with joint and spine surgery without infections were 0.79 (0.23) and 0.78 (0.23), respectively. Disutilities (i.e., utility decrease) of infections associated with joint surgery were -0.03 (superficial), -0.18 (DAIR), and -0.32 (two-stage revision arthroplasty). Disutilities of infections associated with spine surgery were -0.03 (infection not requiring surgery) and -0.16 (infection requiring surgery). T-tests comparing health states without infection to those with infections found that these disutilities were statistically significant (all p< 0.001). Conclusions: Findings suggest that the vignette-based TTO method was feasible for quantifying the disutility of post-surgical infection. It may be useful to incorporate these disutilities into cost-utility models comparing among interventions intended to reduce the risk of post-surgical infections. PIN66 Health State Utility Values (Hsuvs) Measured By The Euroqol 5-Dimensions (Eq-5d) Questionnaire In People Living With Hiv (Plhiv): A Systematic Literature Review (Slr) Using Rapid Review Methodology Buchanan-Hughes AM1, Eddowes LA1, Ma Q2, Perard R3, Hay P4 1Costello Medical Consulting Ltd, Cambridge, UK, 2Costello Medical Singapore Pte Ltd, Singapore, Singapore, 3Gilead Sciences Europe Ltd, Uxbridge, UK, 4St George’s University Hospital, London, UK
Objectives: As the life expectancy for PLHIV approaches that of the general population, health-related quality of life (HRQoL) is an increasing consideration when comparing therapies. The objective of this SLR was to identify HSUVs for individuals with HIV-1, to inform cost-effectiveness modelling. Methods: A previously-published SLR, Tran et al. (BMC Health Serv Res 2015;15:7) was used to identify studies from January 2000–February 2014. Four electronic databases were searched in June 2015 to identify additional studies published since February 2014. Database searches were supplemented by hand-searching bibliographies of SLRs and economic evaluations, and The Lancet HIV (formerly not indexed in bibliographic databases). Eligible studies reported HSUVs measured by the EQ-5D questionnaire. Studies from resourcelimited settings or where all patients had comorbidities not widely relevant to HIV models were excluded. Results: Fifteen of 49 articles from Tran et al. (2015) met the inclusion criteria of this SLR (the remainder used non-EQ-5D measures or were from resource-limited settings). Database searching yielded 1128 records; only one fulfilled this review’s inclusion criteria. Four additional articles were identified through hand-searches. Twenty articles (reporting 14 studies) were therefore included in this SLR. Of the 14 included studies, two compared HSUVs of PLHIV vs. the general population; both reported substantially lower HSUVs for PLHIV (mean [SD] 0.65 [0.28] vs. 0.86 [0.23], p= 0.0001; and 0.74 [NR] vs. 0.82 [NR], p< 0.0001). Eight studies examined impact of disease severity. Six found that more severe disease was associated with significantly lower HSUVs; two found mixed effects (eg. not significant for CD4+ count but significant for viral load). Conclusions: HIV-1 infection is associated with a lower HRQoL compared to the general population. However, the specific impact of disease severity on HRQoL is unclear. Due to substantial variation between studies, care is needed when selecting appropriate HSUVs for economic evaluations in HIV-1. PIN67 Effect Of Sociodemographic Determinants And Socio-Economic Status On Poliomyelitis Immunization Among Under-Five Children In Pakistan Iqbal MS1, Iqbal MZ2, Bahari MB2 of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan. Department of Clinical Pharmacy, Faculty of Pharmacy, MAHSA University, Selangor, Malaysia, 2Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, AIMST University, Kedah, Malaysia 1Faculty
Objectives: Pakistan is among those countries where poliomyelitis (polio) is still categorized as an endemic viral infection. However, in rural areas of Punjab province of Pakistan, little is known about the determinants of polio and its prevalence in under-five children. That’s why, this study sought to examine the sociodemographic factors that determine polio among under-five children in Punjab, Pakistan. Methods: This study used secondary data drawn from the 2014 Punjab Demographic and Health Survey. Multivariate analysis based on binary logistic
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
1Sechenov First Moscow State Medical University, Moscow, Russian Federation, 2Moscow Institute of physics and technology (State University), Dolgoprudny, Russian Federation
INFECTION – Patient-Reported Outcomes & Patient Preference Studies
Objectives: Early economic modeling is commonly used to inform decision making during the research and development of new pharmaceuticals. In this study decision modeling was used to estimate a price per month for elpivirine (VM-1500), a new non-nucleoside reverse-transcriptase inhibitor (NNRTI) in treatment-naïve patients with HIV. Methods: A Markov model was used to simulate the life-time (50-years) costs and effectiveness associated with antiretroviral therapy. Comparison of therapeutic schemes for HIV treatment that include efavirenz, lopinavir/ritonavir, raltegravir, rilpivirine and elpivirine was performed with the use of cost-utility analysis. Costs for ART and management of adverse events, were obtained from public hospitals in Russian Federation. Utility estimates were measured as quality-adjusted life years (QALYs). To calculate the acceptable price for 1-month treatment with elpivirine, we proceeded from the assumption that its cost-utility should be less than cost-utility of other antiviral drugs under study. The price per month was also estimated using 3 times the Russian’s per capita 2014 gross domestic product (GDP), which is $25 341 per QALY gained, as the threshold for economic value as suggested by the World Health Organization. Results: Pharmacoeconomic analysis showed that the lowest discounted (3%) cost per QALY ($5 915) was observed in combined treatment with the use of elpivirine. Lopinavir/ritonavir has the second least cost-utility ratio ($6 736). Assuming discounted cost per QALY for elpivirinebased scheme to be not much that for lopinavir/ritonavir based one, the maximum price per month for elpivirine should equal $305. Based on GDP, elpivirine-based scheme relative to efavirenz-based scheme should have an incremental cost less than willingness to pay threshold. Thus, the maximum price per month for elpivirin should equal $383. Conclusions: The findings of this early economic modeling suggest that to be cost-effective the acquisition cost of elpivirine should be within the range of $305 to $383 per month.
PIN65 Health State Utilities Associated with Post-Surgical Staphylococcus Aureus Infection
PIN63 Economic Evaluation Of Abbvie’s Regimen (Viekirax) For Patients With Genotype 4 Hcv In Greece Mylonas C1, Kourlaba G2, Vernadaki A3, Kakouros M3, Maniadakis N1 School of Public Health, Athens, Greece, 2Collaborative Center of Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partenrship, Athens, Greece, 3AbbVie Pharmaceuticals S.A, Athens, Greece
1National
Objectives: To conduct a cost – utility analysis of the AbbVie’s Regimen versus other established maintenance treatment options in the Greek health care setting, for patients within genotype 4 chronic hepatitis C virus (HCV). Methods: A Markov model was adapted locally to reflect the natural progression of patients with genotype 4 through different health states. Efficacy and safety data considered in the model were extracted from the relevant clinical trials and other published studies. Utilities values were extracted from the literature. Direct medical costs were incorporated in the model reflecting the year 2015. The model evaluated the comparators over a lifetime horizon in the course of a 1-year cycle. The outcomes are measured in terms of Quality Adjusted Life Years gained. While outcomes can vary, the outcomes in this analysis were measured in terms of life-years gained. The analysis was performed from a payer’s perspective. Costs and outcomes that occurred beyond one year were discounted at a 3.5% annual rate which is the standard practice in Greece as well as other jurisdictions. Results: The base case results indicate that the AbbVie Regimen is a dominant option (in the most cases) and cost-effective option for naïve patients with genotype 4 HCV. The sensitivity analysis shows that the overall cost-effectiveness results are sensitive to the model time horizon and changes in the SVR rate for patients on the comparator treatment. AbbVie’s Regimen appears cost-effective based on traditional standards in the vast majority of sensitivity analyses. In the CEAF, it is the optimal choice (on the optimality frontier) when payers are willing to pay over about 15,000€ /QALY in the majority of analyses. Conclusions: Using conservative assumptions, the present economic evaluation suggests that AbbVie’s Regimen provides greater health outcomes and is less costly compared to majority of comparators.
PIN64 Dengue Negatively Affects Gdp And Federal Revenues In Endemic Areas Of Mexico Samaniego R, Aburto C Instituto Tecnologico Autonomo de Mexico, Mexico City, Mexico
Objectives: Empirical research on the impact of the incidence of dengue on various aggregate economic indicators using Mexican states and municipal data was undertaken to 1) measure the monetary effect of reductions in the incidence of dengue on Gross Domestic Product (GDP) of each state, 2) estimate the impact of changes in the GDP of each state on the collection of federal taxes and 3) model various scenarios of reductions of the incidence of dengue and its effect on the number of foreign tourists in the 20 most visited municipalities of Mexico. Methods: Based on econometric time series regression models we obtained 1) estimates of the effect of the incidence of dengue on GDP for each state, 2) assessments of the incidence of dengue on the federal tax revenues collected in each state, and 3) further calculations of the effect of a reduction in the of dengue incidence on the number of foreign tourists in the top 20 Mexican tourist destinations. Results: 1) The incidence of dengue on GDP by state for 1996-2015 had the expected negative sign. The weighted average elasticity was -0.027, 2) the estimates of the incidence of dengue on federal tax revenue by state result in a weighted average elasticity of -0.011, and 3) the elasticity of the incidence of dengue on the number of foreign tourists in the top 20 tourist destinations in Mexico had an average elasticity of -0.0177. Conclusions: Dengue incidence negatively affects a broad range of socioeconomic variables in Mexico. The results obtained are a promising complement to traditional measurements of the costs of dengue. Additional studies are required to expand our analyses.
Matza LS1, Kim K1, Yu H2, Belden K3, Chen AF4, Kurd M4, Lee BY5, Webb J6 1Evidera, Bethesda, MD, USA, 2Pfizer, Collegeville, PA, USA, 3Sydney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA, 4Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA, 5Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 6Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
Objectives: Surgical site infection (SSI) occurs in approximately 2% of patients undergoing surgery, with outcomes ranging from mild to life threatening. Staphylococcus aureus is a virulent pathogen frequently identified as a cause of SSI. Cost-utility analyses are useful for assessing and comparing the value of treatments developed to address and reduce the risk of these infections. Therefore, the purpose of this study was to estimate utilities associated with varying levels of post-surgical Staphylococcus aureusinfection following joint (hip or knee) and spine surgery. Methods: In time trade-off (TTO) interviews with a 1-year time horizon, general population participants in the UK (London, Edinburgh) valued health states drafted based on literature and clinician interviews. The health states described a year including either joint or spine surgery, with or without post-surgical infection. For joint surgery health states, possible infections included superficial wound infection, deep infection requiring debridement and implant retention (DAIR), and deep infection requiring two-stage revision arthroplasty. Spine surgery health states described infections either requiring or not requiring surgical intervention. Results: A total of 201 participants completed interviews (50.25% female; mean age= 46.2y). The mean (SD) utilities of health states describing a year with joint and spine surgery without infections were 0.79 (0.23) and 0.78 (0.23), respectively. Disutilities (i.e., utility decrease) of infections associated with joint surgery were -0.03 (superficial), -0.18 (DAIR), and -0.32 (two-stage revision arthroplasty). Disutilities of infections associated with spine surgery were -0.03 (infection not requiring surgery) and -0.16 (infection requiring surgery). T-tests comparing health states without infection to those with infections found that these disutilities were statistically significant (all p< 0.001). Conclusions: Findings suggest that the vignette-based TTO method was feasible for quantifying the disutility of post-surgical infection. It may be useful to incorporate these disutilities into cost-utility models comparing among interventions intended to reduce the risk of post-surgical infections. PIN66 Health State Utility Values (Hsuvs) Measured By The Euroqol 5-Dimensions (Eq-5d) Questionnaire In People Living With Hiv (Plhiv): A Systematic Literature Review (Slr) Using Rapid Review Methodology Buchanan-Hughes AM1, Eddowes LA1, Ma Q2, Perard R3, Hay P4 1Costello Medical Consulting Ltd, Cambridge, UK, 2Costello Medical Singapore Pte Ltd, Singapore, Singapore, 3Gilead Sciences Europe Ltd, Uxbridge, UK, 4St George’s University Hospital, London, UK
Objectives: As the life expectancy for PLHIV approaches that of the general population, health-related quality of life (HRQoL) is an increasing consideration when comparing therapies. The objective of this SLR was to identify HSUVs for individuals with HIV-1, to inform cost-effectiveness modelling. Methods: A previously-published SLR, Tran et al. (BMC Health Serv Res 2015;15:7) was used to identify studies from January 2000–February 2014. Four electronic databases were searched in June 2015 to identify additional studies published since February 2014. Database searches were supplemented by hand-searching bibliographies of SLRs and economic evaluations, and The Lancet HIV (formerly not indexed in bibliographic databases). Eligible studies reported HSUVs measured by the EQ-5D questionnaire. Studies from resourcelimited settings or where all patients had comorbidities not widely relevant to HIV models were excluded. Results: Fifteen of 49 articles from Tran et al. (2015) met the inclusion criteria of this SLR (the remainder used non-EQ-5D measures or were from resource-limited settings). Database searching yielded 1128 records; only one fulfilled this review’s inclusion criteria. Four additional articles were identified through hand-searches. Twenty articles (reporting 14 studies) were therefore included in this SLR. Of the 14 included studies, two compared HSUVs of PLHIV vs. the general population; both reported substantially lower HSUVs for PLHIV (mean [SD] 0.65 [0.28] vs. 0.86 [0.23], p= 0.0001; and 0.74 [NR] vs. 0.82 [NR], p< 0.0001). Eight studies examined impact of disease severity. Six found that more severe disease was associated with significantly lower HSUVs; two found mixed effects (eg. not significant for CD4+ count but significant for viral load). Conclusions: HIV-1 infection is associated with a lower HRQoL compared to the general population. However, the specific impact of disease severity on HRQoL is unclear. Due to substantial variation between studies, care is needed when selecting appropriate HSUVs for economic evaluations in HIV-1. PIN67 Effect Of Sociodemographic Determinants And Socio-Economic Status On Poliomyelitis Immunization Among Under-Five Children In Pakistan Iqbal MS1, Iqbal MZ2, Bahari MB2 of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan. Department of Clinical Pharmacy, Faculty of Pharmacy, MAHSA University, Selangor, Malaysia, 2Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, AIMST University, Kedah, Malaysia 1Faculty
Objectives: Pakistan is among those countries where poliomyelitis (polio) is still categorized as an endemic viral infection. However, in rural areas of Punjab province of Pakistan, little is known about the determinants of polio and its prevalence in under-five children. That’s why, this study sought to examine the sociodemographic factors that determine polio among under-five children in Punjab, Pakistan. Methods: This study used secondary data drawn from the 2014 Punjab Demographic and Health Survey. Multivariate analysis based on binary logistic