Economic Burden Of Herpes Zoster In Spain

VA L U E I N H E A LT H

her fetus (i.e., congenital CMV [cCMV]). Roughly 20% of children with cCMV may develop permanent disability (e.g., hearing loss; developmental disabilities). While the epidemiology of cCMV has been documented, limited real-world evidence exists to quantify the associated economic burden. This study describes changes in cCMVrelated hospitalizations and associated resource use (i.e., cost; length of stay [LOS]) in the US from 2004 to 2013 for infants < 1 year old.  Methods: cCMV-related hospitalizations (ICD-9-CM diagnosis code 771.1) for infants from the 2004 through 2013 HCUP Nationwide Inpatient Samples (NIS) were analyzed. Annual cCMV-related hospitalizations per 100,000 population (standardized to the 2015 US population) were estimated using NIS sampling weights and US Census data. Additionally, perhospitalization costs (in 2016 US dollars) and LOS were assessed.  Results: cCMVrelated hospitalization rates among infants in the US fell 15%, from 20.9/100,000 in 2004 to 17.8/100,000 in 2013. However, during this period, mean (standard deviation [SD]) LOS increased, from 28.7 (36.2) days in 2004 to 36.7 (52.4) days in 2009, before falling to 29.1 (39.2) days in 2013. Mean (SD) costs increased from $93,683 ($138,604) in 2004 to $103,773 ($175,737) in 2013, peaking in 2011 at $128,052 ($202,961). Finally, the total burden of cCMV-related hospitalizations (i.e., aggregate costs across all cCMV-related hospitalizations) increased slightly, from $73M in 2004 to $77M in 2013, but did increase to > $80M in 2009, 2011, and 2012.  Conclusions: cCMV-related hospitalization rates among infants in the US fell during the early 2000s, but the economic burden of cCMV in this population varied appreciably during this period. Further research to understand factors which may influence the observed variability in cCMV-related hospitalization rates and costs is warranted. Such research may help plan optimal resource allocation. PIN36 The Cost Of Illness For Invasive Meningococcal B Disease In Germany Scholz S1, Meszaros K2, Fassbender RM3, Welte R3, Greiner W1, Koerber F3 University, Bielefeld, Germany, 2GSK, Wavre, Belgium, 3GSK, Munich, Germany

1Bielefeld

Objectives: The burden of meningococcal B (MenB) is characterized by a high case-fatality rate, serious effects of sequelae on the patients’ everyday life and the corresponding impact on health expenditures. This study is the first estimating the economic burden of MenB-related invasive meningococcal disease (IMD) cases in Germany.  Methods: A cost-of-illness study has been conducted from third-party payer and societal perspectives for 18 age-groups. Direct costs for the acute IMD phase included inpatient, rehabilitation and public health responsesrelated costs. Probabilities for sequelae (hearing loss, limp amputation, seizures, scarring, renal disease, blindness, neurological and psychological impairments like attention deficit hyperactivity disorder [ADHD]) were based on a literature review and related costs were collected for the first and subsequent years, respectively. Indirect costs included future productivity losses of patients due to IMD-mortality and sequelae as well as productivity losses of patients and parents during the acute phase. Friction-cost method and human-capital approach were employed. Secondary data, literature and expert opinion were used as data sources. Costs after 2015 were discounted at 3% following German guidelines.  Results: The average total cost per case including sequelae is 51,367€  using friction-cost and 198,529€  using the human-capital approach. Direct costs account for 21,126€  and are highest for the age-group “< 1 year” (23,594€ ) but decrease over age to 10,410€  for patients > 80 years. Seizures and renal disease have the highest sequelae cost with 157,939€  and 132,709€  per sequelae case and ADHD/anxiety and neurological disabilities cause the highest cost per IMD survivor with 4,238€  and 3,572€ , respectively.  Conclusions: Despite the rare occurrence of MenB-related IMD of on average 343.25 cases per year between 2001 and 2016, costs per age-cohort sum up to 17,631,752€ . The avoidance of IMD cases and outbreaks not only reduces the disease burden, but also the economic burden for the German healthcare system and society. PIN37 Human Papilloma Virus In Italy: Cost Of Illness And Potential Savings Due To HPV9 Primary Prevention Mennini FS1, Fabiano G1, Marcellusi A1, Bonanni P2, Pinto C3 of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome Tor Vergata, Rome, Italy, 2Department of Health Sciences, University of Florence, Italy, Florence, Italy, 3Department of Medical Oncology, S. Maria Hospital - IRCCS, Reggio Emilia, Italy, Reggio Emilia, Italy 1Faculty

Objectives: The objective of this study is to estimate the economic burden associated with Human Papilloma Virus considering the new universal vaccination strategy in Italy (National Immunization Plan 2017-19), and total direct medical costs preventable associated with nine major HPV-related diseases.  Methods: A Cost of Illness incidence based model was developed in order to estimate incidence and costs of invasive cervical cancer, cervical dysplasia, cancer of the vulva, vagina, anus, penis, head and neck, anogenital warts, and recurrent respiratory papillomatosis from the Italian National Health System Perspective. For each of the nine conditions, we used available Italian secondary data to estimate the lifetime cost per case, the number of incident cases of each disease, the total economic burden, and the relative prevalence of HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58 in order to estimate the aggregate fraction of the total economic burden attributable to HPV infection.  Results: The total direct costs (expressed in 2017 Euro) associated with the annual incident cases of the nine HPV-related conditions included in the analysis were estimated to be € 503.2 million, with a plausible range of € 492.7– 651.9 million. The fraction attributable to the HPV9 was € 320.0 (range € 298– € 342 million), accounting for approximately 63.6% of the total annual burden of HPVrelated disease in Italy.  Conclusions: Comparing our data to the previous analysis conducted in 2011, the introduction of primary and secondary prevention strategy was an important step forward in public health because of the reduced incidence rates of HPV related diseases and consequently costs (from € 503,2 to € 534.5 million estimated in 2011). Moreover the new HPV9 vaccine represents an important investment for the public health that could prevent about 64% (range 60% - 68%)

20 (2017) A399–A811

A785

of total Economic Burden compared to 59% in the vaccination strategies available in 2011 preventable costs. PIN38 Investigating The Economic Impact Of HIV-Associated Renal And Bone Co-Morbidities In UK Inpatients Using The Hes Database Wild L1, Sathia L1, Smith A1, Davies S1, Pedreño Fernandez D2, Lawrence D1 Sciences, London, UK, 2QuintilesIMS, London, UK

1Gilead

Objectives: Several studies have suggested people living with HIV (PLWH) are at increased risk of certain co-morbidities, including renal disease and osteoporosis. There are currently limited UK data on the additional cost associated with comorbidities in this group. We aimed to use a national database, the Hospital Episode Statistics (HES), containing information including all admissions to characterise and assess economic implications of inpatient episodes.  Methods: We analysed 5 years of HES data (April 2011-March 2016) to extract episodes coded with a HIV diagnosis and a concurrent diagnosis of co-morbidities of interest – renal disease and osteoporosis; non-HIV episodes for each co-morbidity were also extracted as a control group. Relevant ICD10 codes for each co-morbidity were obtained from the Charlson co-morbidity index. Cost per episode (tariff derived from both diagnosisbased Healthcare Resource Group and matched NHS reference costs) was evaluated between the groups.  Results: A total of 83,388 HIV coded episodes were identified, with 5,103 renal disease and 1,608 osteoporosis coded episodes. The average age for episodes coded as renal disease (48 vs. 68; p< 0.01) and osteoporosis (53 vs. 76; p< 0.01) were two decades lower for PLWH than controls. Average cost per episode was higher in PLWH compared to the non-HIV control group: renal; £1,899 vs. £937 (p< 0.01) and osteoporosis; £2,799 vs. £2,132 (p< 0.01). We estimate the additional HIV-associated economic burden of these co-morbidities to be £5.98M over 5 years, assuming the difference in cost is applied to the total number of HIV episodes for these co-morbidities.  Conclusions: HIV-associated renal and bone co-morbidities present 20 years earlier and add significant additional economic burden. Early identification and proactive management of patients at increased risk could reduce this burden. This large dataset is valuable in highlighting increased inpatient episode cost. With an ageing population of PLWH, financial impact will increase further. PIN39 Economic Burden Of Herpes Zoster In Spain Díez-Domingo J1, Ordobás M2, Curran D3, Matthews S4, CambroneroMd 5, García-Martínez JA5, Morano R5 1FISABIO Public Health, Valencia, Spain, 2Epidemiology Department, Public Health Madrid, Madrid, Spain, 3GSK, Wavre, Belgium, 4Freelance on behalf of GSK, Wavre, Belgium, 5GSK, Madrid, Spain

Objectives: Herpes zoster (HZ) and its complications, including post-herpetic neuralgia (PHN), is a severe and painful disease, mainly observed in people ≥ 50 years old. The economic burden of HZ in Spain is not well documented, with only isolated regional data available. The aim of the study was to estimate HZ-related healthcare resources utilization and costs in Spanish adults ≥ 50 years.  Methods: A prospective, observational study was performed using surveillance networks in 3 regions in Spain (Madrid, Valencia and Cataluña). HZ cases in adults ≥ 50 were recruited, stratified by age group, through primary care centers. Both payer and societal perspectives were considered in the costs calculated during the 3 months following HZ rash onset or up to 9 months for PHN. Unit costs were taken from regional healthcare services tariffs and medication costs from public pharmacist’s retail prices. The costs associated with working days lost were evaluated by multiplying number of days lost by the average daily earnings from National Statistics Institute 2014.  Results: 545 HZ cases were included and 25 patients developing PHN were evaluated. HZ patients had on average 1.7 primary care visits per episode, 7 patients (1%) had emergency room visits and 11 (2%) were hospitalized. Regarding medication, 85% patients were prescribed antivirals for systemic use and 55% were prescribed analgesics. 16 patients (3%), all aged 50-64 years, lost on average 9.9 days of work per HZ episode. Overall costs were € 240 (payer perspective) and € 296/HZ episode (societal perspective). Costs were higher in the 70-79-year-old age group (€ 331-€ 349) due to higher proportion of subjects hospitalized. For PHN patients, overall costs were € 571 and € 712/HZ episode from the payer and societal perspectives respectively.  Conclusions: HZ and PHN have an important economic burden both for payers and society in general. Any intervention preventing HZ could contribute to avoid considerable costs in Spain. PIN40 The Economic Burden Of Acute Bacterial Rhinosinusitis And Acute Otitis Media In Turkey: An Epidemiology Based Cost Of Illness Study With Respect To Clinical Practice And Available Guidelines Oksuz E1, Malhan S1, Unal S2 University, Ankara, Turkey, 2Hacettepe University, Ankara, Turkey

1Baskent

Objectives: To estimate economic burden of acute bacterial rhinosinusitis (ABRS) and acute otitis media (AOM) in Turkey via an epidemiology-based cost of illness study with respect to clinical practice and available guidelines.  Methods: Tree age pro model was used for this analysis. Probability of each health condition in clinical practice or in guideline based management of pediatric and adult patients with ABRS and AOM was also determined. Average per patient direct cost in primary, secondary and tertiary-care management of ABRS and AOM was calculated based on cost items related to outpatients, laboratory and radiological tests, drug treatment, hospitalizations and interventions. Total annual treatment cost was calculated via prevalence-based extrapolation of per patient annual treatment costs for different health conditions managed in clinical practice and per guideline recommendations as well as in case of 5% higher antibiotic resistance.  Results: Average per patient annual treatment costs in clinical practice were US$ 24.29 for pediatric ABRS, US$ 26.83 for adult ABRS, US$ 25.70 for pediatric AOM and US$ 27.10 for adult AOM, while adherence to guidelines was associated with per patient US$ 3.09, US$ 5.84, US$ 2.95 and US$ 2.13 cost reductions, respectively. Total annual treatment cost was