Direct and Indirect Costs Associated with Legal Blindness Caused by Retinal Disorders in Brazil

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PSS29 Direct Cost Estimation of Psoriasis Treatment in Turkey: Results from a Delphi Panel Atakan N1, Cavusoglu Sezen S2, Malhan S3, Oksuz E3, Yalcin B4 1Hacettepe University, Ankara, Turkey, 2Novartis, Istanbul, Turkey, 3Baskent University, Ankara, Turkey, 4Ankara Numune Training and Research Hospital, Ankara, Turkey

Objectives: The purpose of this study was to estimate the annual direct costs of psoriasis treatment from a public payer perspective (SSI) in Turkey.  Methods: Delphi panel was organized for collecting data based on clinicians’ experience. The type and number of resources used in treating psoriasis was determined by two experts. Follow up visits, hospital and emergency admissions, complications and side effects were included. Unit costs for each resource were determined with SSI perspective based on country-specific 2016 reimbursement price list. Costs associated with comorbidities, complications and side effects were calculated separately based on Delphi panel data and included in the total cost in accordance with their prevalence rates.  Results: According to the Delphi panel, Narrow-band ultraviolet B is an intervention performed for 40% of the patients while hydrotherapy is used in 30%, Psoralen Ultraviolet A is administered in 10% and surgical therapy is used in 1.6% of the patients. Conventional systemic treatments (methotrexate/cyclosporine) are used in 15% of the patients while biologic treatments are used in 1%. Among reimbursed biologic treatments, treatment cost for Adalimumab is € 5,639.7 including drug monitoring cost, € 8,145.3 for Infliximab, € 5,422.1 for Etanercept and € 8,186.0 for Ustekinumab. The mean annual cost per patient was € 165 for outpatient visit, € 838.0 for inpatient treatment, € 308.1 for intervention and € 315.1 for prescription/pharmaceutical costs. The cost of comorbid disease was € 278.2 per patient annually. The mean cost of complications and side effects is € 795.7 on an annual basis per patient. The mean annual total cost of psoriasis is € 2,700.2 per patient.  Conclusions: These results contribute to increase awareness on treatment patterns and associated costs of the disease in Turkey. PSS30 Annual Cost of Illness of Macular Edema (ME) Secondary to Branch Retinal Vein Occlusion (BRVO) in Turkey Sar C1, Malhan S2, Oksuz E2, Eldem B3, Unlu N4, Alp MN5, Durukan AH6, Erdal E1, Kahveci B1 Kimya San. Ltd. Sti., Istanbul, Turkey, 2Baskent University, Ankara, Turkey, 3Hacettepe University, Ankara, Turkey, 4Ankara Training & Research Hospital, Ankara, Turkey, 5Ankara Numune Training & Research Hospital, Ankara, Turkey, 6Gülhane Askeri Tıp Akademisi, Ankara, Turkey

1Bayer Turk

Objectives: This study aims to determine the annual direct costs of illness for ME secondary to BRVO in Turkey from payer [Social Security Institution (SSI)] perspective.  Methods: Delphi technique was applied to determine the type and the amount of resources used including epidemiology, diagnosis, treatment of symptoms and side effects, follow-up visits, hospital admissions based on physicians clinical assessment by gathering experts in a meeting to build up consensus. Unit costs of resources used in outpatient and inpatient were obtained from official lists of SSI and total costs were calculated using the opinions of physicians on resource utilisation. Calculations were made in TRY and results converted to EUR using the current currency (May 2016).  Results: In ME/BRVO, intravitreal injection (IVI) with ranibizumab is the most commonly used intervention (90% of patients), followed by laser photocoagulation (10%), dexamethasone implant (10%) and vitreous surgery (2%). Ranibizumab costs € 376.07, whereas IVI intervention unit cost is € 53.44. Annual cost of extended release dexamethasone implants is found as € 434.04 and intravitreal administration costs € 32.06. LPC’s package fee for five sessions is € 26.65. Vitreous surgery costs € 552.25 and the costs of cataract, endophthalmitis, retinal detachment, vitreous hemorrhage, occular hypertension, and blindness were added as side effects. Mean following cost per patient on an annual basis was found as € 165.64. Mean intervention cost was calculated as € 65.23 per patient and drug/prescription costs were calculated as € 470.96. The mean cost of side effects are € 31.82 on annual basis and per patient.  Conclusions: In light of these components, annual mean ME/BRVO cost per patient was calculated as € 733.65. The number of ME/BRVO patients is estimated as 6,355 and the burden of ME/BRVO for Turkey is calculated as € 4,662,345.75. This amount is 0.013% of expected total health expenditure of Turkey in 2016.

PSS31 Direct and Indirect Costs Associated with Legal Blindness Caused by Retinal Disorders in Brazil Lopes N1, Takemoto MS2, Suzuki C1, Dias LL2, Barbeau M3 Brazil, Sao Paulo, Brazil, 2ANOVA, Rio de Janeiro, Brazil, 3Novartis Pharmaceuticals Canada Inc., Dorval, QC, Canada 1Novartis

Objectives: The primary aim of this study was to describe direct and indirect costs associated with legal blindness caused by retinal disorders from the Brazilian society perspective.  Methods: Cross-sectional, observational and multicenter study enrolling patients with legal blindness (visual acuity< 20/200) caused by retinal disorders. Data collection occurred between December/2012 and December/2014. During a face-to-face structured interview, patients answered questions about demographics, professional activities, disease characteristics, health resource utilization (frequency of consultations, hospitalizations, emergency department visits, procedures, tests and therapies) and use of non-medical resources (home lay caregivers, nursing homes, home adaptations, support equipment) for a recall period of 1 year. Productivity losses were measured using the human capital method and a monetary value was determined based on self-reported income relative to the time they were absent from paid work. Local currency - Brazilian Real (BRL) - was converted into American dollar values (USD) [USD1.00 =  BRL 3.03; (05/ July/2015)].  Results: 146 patients with a mean age of 68 (±14.8) years and equal gender distribution were included in 17 sites. The most frequent cause of visual impairment was age-related macular degeneration (46.6%), followed by diabetic macular edema (40.4%). Patients had an annual cost of USD 795.77 when only medi-

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cal resources were considered, with an increment of USD 72.02 per patient related to non-medical resources (visual aids, lay caregivers, etc.). Societal annual costs related to loss of patients’ work productivity summed USD 406.81 per patient. Only 5.5% and 6.8% of patients reported to receive eye disorder-specific therapies and visual rehabilitation services, respectively.  Conclusions: These findings indicate that blindness leads to additional costs to the Brazilian society, both in terms of consumption of health resources and productivity loss.

PSS32 Social and Economic Burden of Skin Disease in Europe. A Narrative review of the Literature Comellas M1, de Paz HD1, Marti I2, Casañas M2, Lizan L1, Cortes X2 1Outcomes 10, Universitat Jaume I, Castellon, Spain, 2Almirall, Barcelona, Spain

Objectives: To assess social (morbidity and mortality) and economic (direct and indirect cost) burden related to skin diseases (SD) in Europe, according to the literature.  Methods: Electronic databases [MedLine/PubMed, MEDES, IBECS y CSIC-IME, Congress proceedings and] were searched to identify publications analyzing the burden related to SD in Europe, published in English or Spanish between 2006 and 2016. Spanish health policy strategies were reviewed and used as an example to determine those strategies adopted by a National Health Systems to manage SD in Europe.  Results: In 2010 SD were the 4th leading cause of nonfatal burden worldwide, expressed as years lost due to disability (YLD) [Europe: median YLD/100.000 individuals: 416-493 (men) and 477-547 (women)], and the 18th cause of health burden taking to account health loss due to premature death (disability-adjusted life years). SD also affect the patients’ health related quality of life, mainly emotional component. Nearly 30% of SD patients have clinically significant levels of distress being, stress, anxiety, anger, depression, shame, social isolation, low self-esteem and embarrassment the main psychological problems. Between 12.4%-20% of primary care visits were related to SD, and around 17% of SD patients required to visit the specialist. Skin lesions, psoriasis and eczema were the SDs that required a greater number of visits to the specialist. SD were related to 30% of occupational disease, being the cost associated to loss of productivity of these patients 5 billion of € /year. In Spain, out of the 19 health care strategies being currently in force in the different regions, only 3 propose actions related to SD.  Conclusions: The burden of SD in Europe is high, mainly associated to the loss of productivity and patient’s emotional impact. The results highlighting the need to include SD in prevention and management health policies, in order to improve patients’ management. PSS33 Cost Comparison of Wet Age-Related Macular Degeneration Treatment with Aflibercept or Ranibizumab Gerasimova K1, Derkach EV2 1I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 2The Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia

Background: Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in people over the age of sixty in Russia. Costs associated with treatment are important for decision makers in healthcare.  Objectives: To conduct cost analysis of aflibercept (AFL) vs ranibizumab (RBZ) in patients with wet AMD for Russian healthcare setting.  Methods: Randomized clinical trials (RCT) showed equal efficacy for the AFL and the RBZ in patients with wet AMD with a fewer injections of AFL. A decision tree was constructed to calculate direct medical costs associated with wet AMD for 2 years. Endpoints were death, treatment success or treatment failure, followed by laser photocoagulation; all probabilities were taken from relevant RCT. Costs were calculated on the basis of registered maximal manufactures’ drug prices and tariffs of state healthcare system. Probabilistic sensitivity analysis was conducted. Probabilities of all patient conditions, number of drugs injections and costs of medical services were used as variables in the sensitivity analyses.  Results: AFL is less costly than RBZ. The difference in costs in favor of AFL amounted to € 1,584 EUR per 1 patient per 2 years (7,800 and 9,384 EUR, for AFL and RBZ respectively). The main factor affecting the results of the baseline scenario was a fewer AFL injections over 2 years of treatment. In the sensitivity analysis the probability of AFL domination was 73%.  Conclusions: AFL seems to be a costsaving option compared with RBZ with a similar efficacy for Russian healthcare. PSS34 Financial Impact of Intraviteal Ranibizumab or Aflibercepte for Neovascular Age-Related Macular Degeneration and for Macular Edema Secondary to Central Retinal Vein Occlusion Coverage for a Health Care System of Public Employees Located in Northeast Brazil Between July 2015 and December 2015 de Souza NN1, Silva Jd2, Silva Sd2, Novis CS1 1UFBA, SALVADOR, Brazil, 2Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil

Objectives: To trace the epidemiological profile and financial impact to cover the anti angiogenic treatment for neovascular age-related macular degeneration and macular edema secondary to central retinal vein occlusion to a health care system of public employees located in northeastern Brazil between July 1, 2015 and December 31, 2015.  Methods: A retrospective cohort study. They were evaluated in 954 intravitreal applications authorized in this period using ranibizumab or aflibercept for neovascular age-related macular degeneration and macular edema secondary to occlusion of the central retinal vein. Age, sex, ICD and costs were compared in both pathologies coverage. Data were collected in the electronic system of this health system and analyzed using Microsoft Excel 2007 spreadsheets and statistical calculations for SPSS Statistics 17.0.  Results: Based on the literature, was adopted protocol developed by this health system with coverage to age 60 years in cases of macular degeneration related to age. It analyzed authorized applications 954, and 836 for neovascular age-related macular degeneration and 118 for macular edema secondary to central retinal vein occlusion. In most cases it was found as the cause macular degeneration. The cost for neovascular age-related macular degeneration