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Economic Evaluation For Establishing Stroke Unit Followed By Early Supported Discharge In Egypt
A500
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1
with a greater proportion of binge drinkers. Given the growing need to improve efficiencies and reduce costs within the NHS, further investigation is needed to understand how the UK can tackle the UK’s binge-drinking culture. PHS41 The Cost Of Treating Diabetic Ketoacidosis In The UK: A National Survey Of Hospital Resource Use Dhatariya KK, Skedgel CD, Fordham RJ University of East Anglia, Norwich, UK
Objectives: Diabetic ketoacidosis (DKA) is a commonly encountered metabolic emergency. In 2014 a national survey was conducted looking at the management of DKA in adult patients across the UK. The survey reported the clinical management of individual patients as well as institutional factors that teams felt were important in helping to deliver that care. However, costs of treating DKA were not reported. We estimate these costs here. Methods: We used a combination of bottom-up and top-down costing to estimate the total costs associated with treating DKA in a mixed population sample. The data were derived from the source data from the national UK survey of 283 individual patients collected via questionnaires sent to hospitals across the country. Because the initial survey collection tool was not designed with a health economic model in mind, several assumptions were made when analysing the data. We used multiple imputation methods to account for missing data. Results: The mean and median time in hospital was 5.6 and 2.7 days, respectively. Based on the individual patient data and using the Joint British Diabetes Societies Inpatient Care Group guidelines, the cost analysis suggests that for this cohort, the average cost for an episode of DKA was £2064 per patient (95% CI: £1800, 2563). An episode of hypoglycaemia following DKA was the only statistically significant predictor of cost (-£935, p= 0.03). Conclusions: Despite relatively short stays in hospital, costs for managing episodes of DKA in adults were relatively high. However, we were unable to account for prolonged hospital stays due to co-morbidities or indirect costs such as lost productivity. Therefore, the actual costs to the healthcare system and to larger society are likely to be even higher than these first estimates. PHS42 The Cost Of Prescribing Direct Oral Anticoagulants (DOACS) – There Is A Drug Cost But What Else? Kirby A1, Murphy A1, Bradley C1, Browne J2 College Cork, Cork, Ireland, 2Cork, Cork, Ireland
1University
Objectives: In Europe, there are four direct oral anticoagulants (DOACs) available for prescribing to patients with atrial fibrillation. A key advantage of DOACs is the abolition of routine INR monitoring. Nevertheless, some level of follow-up care is required – as advocated by European Heart Rhythm Association. The high drug cost of DOACs is acknowledged and contributes to reluctance for their reimbursement in public health systems. Despite the increased adoption of DOACs there is a lack of information regarding the cost of adopting these new agents into clinical practice, beyond the drug cost. This study aims to ascertain the costs associated with followup care for DOAC patients from a health care provider’s perspective. Methods: A cost analysis is used to estimate the follow-up care associated with prescribing patients’ DOACs in Ireland. Primary data is collected from General Practitioner practices in Ireland to estimate resource use. Results: Using the EHRA practical guide as a benchmark, 58% of clinics scheduled a follow up with patients once every 3 months, which is well below recommendations. A structured follow up by the physician included checks for compliance, thrombo-embolic events, measure bleeding events, other side effects, monitoring of co-medications and the need for blood sampling in accordance with the EHRA practical guide. The follow-up test completed most frequently, was blood testing by a public health nurse for renal function reporting a time cost of between € 5.70 and € 8.54 per patient, with 79% of GPs indicating this as follow up/maintenance for DOAC patients. Conclusions: DOACs have emerged as an alternative to warfarin in patients with AF. Although there are many benefits such as fewer food and drug interactions, lack of monitoring etc. the use of DOACs will require support in the clinical setting. The cost of this follow up care needs to be considered and adequately resourced. PHS43 French People With MS And Their Caregivers Have To Financially Support Direct Non-Medical Costs Linked To Their Disease
to home services fees. 41% of respondents bought a walking-aid device and 23% a manual wheelchair. Conclusions: These results indicate that, depending upon services, about 60% of patients and 40% of caregivers dedicate part of their financial resources to cover non-medical costs directly linked to MS. PHS44 Economic Evaluation For Establishing Stroke Unit Followed By Early Supported Discharge In Egypt Abotaleb A World health organization, cairo, Egypt
Objective: When Stroke accounts for 6·4% of all deaths and thus ranks 3rd after heart disease &gastrointestinal with a crude prevalence rate of 963/100 000 inhabitants. The clinical characteristics of Egyptian stroke patients are generally similar to those in other populations. Exceptions may include the higher prevalence of vascular risk factors and a younger mean age of stroke patients (4, 18–20). Due to those facts stroke &its complications may be one of the major economic challenges facing Egyptian health sector. The objective of this study is to evaluate Economic evaluation for establishing stroke unit followed by early supported discharge the outcome was determined as survival with minor disability. Method: Integration between A systematic literature review &Descriptive analysis of Data from patients aged (18 -60 years ) for the last 3 years including direct and indirect medical costs for conventional treatment including ( cost of treatment, complications including physical therapy , hospitalization ,outpatients costs ,rehabilitation ). The total (n) of patients enrolled in the national database = 3212. One way sensitivity analysis was conducted. Level of statistical significance was defined at (p. < 0.05). Result: Mean direct medical cost for (, neurological complications including Cerebral Edema, DVT, PE, Hemorrhagic transformation,) increasing ratio was around 3.5% at the last 3 years. Cardiac Complications were second items for cost with increasing rates2 .5, respiratory Complications ranking 3rd with 1.5 rate at last 3 years. Hospitalization ratio increased with 5.7 % for the last 3 years. Conclusion: Establishing stroke unit followed by early supported discharge might be cost saving due to it is significant impact of minimizing economic consequences of. PHS45 Characterization Of Health Care Utilization And Cost Of Hemophilia A And B In Real-Life: A 4-Year Follow-UP Study In Finland Ventola H1, Jokelainen J1, Linna M2, Lepäntalo A3, Ylisaukko-oja T1, Lassila R3 Oy, Helsinki, Finland, 2Aalto University, Espoo, Finland, 3Helsinki University Hospital, Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland 1MedEngine
Objectives: Though a majority of hemophilia treatment cost comes from factorreplacement therapy, cost savings related to healthcare use may result from optimal prophylactic therapy. We characterized real-life healthcare utilization and costs among Finnish patients with hemophilia A (HA) and hemophilia B (B). Methods: The data on resource use were collected from patient charts generated over a period of four years (2012-2016). Annual healthcare costs were calculated based on resource utilization and Finnish report of standard unit costs. Results: A total of 131 HA patients and 39 HB patients were included. Of HA patietns, 56% (n= 74) received prophylactic therapy (HAP), and 25% (n= 31) received on-demand therapy (HAO). Over 90% of HAP and HAO patients had outpatient visits during follow-up. The mean outpatient visits/year/patient was 2.4 for HAP and 1.9 for HAO. Overall, 43% of HAP patients, and 27% of HAO patients had inpatient stays during follow-up; the mean lenhgt of stay was 11.9 days for HAP, and 15.3 days for HAO. The total annual healthcare cost were 8,530€ for HAP and 12,584 for HAO. Of HB patients, 31% (n= 12) received prophylactic therapy (HBP), whereas 54% (n= 21) received on-demand therapy (HBO). Over 90% of HBP and HBO had outpatient visits during follow-up. The mean outpatient visits/year/patient was 1.8 for HBP and 2.1 for HBO. Overall, 25% of HBP patients, and 52% of HBO patients had inpatient stays during follow-up; the mean lenhgt of stay was 3.0 days for HBP, and 11.3 days for HBO. The total annual healthcare cost were 1,358€ for HBP and 9,517 for HBO. Except for the results regarding annual healthcare cost between HBP and HBO (p> 0.001), statistical significance was not reached. Conclusions: Patients receiving on-demand therapy have higher healthcare costs than patients treated prophylactically. Selecting between prophylaxis and on-demand therapy should be done under careful considearation. PHS46 Heart Failure Management: Impact Of A New Health-Care Organisation On Readmissions And Costs
van Hille B1, Heinzlef O2, Dourgnon P3, Molinier G4, Chekroun M5, Longin J6 1Merck s.a.s., LYON, France, 2Hôpital de Poissy, Poissy, France, 3IRDES, Paris, France, 4Ligue Française contre la Sclérose en Plaques, PARIS, France, 5carenity.com, Paris, France, 6Merck, LYON, France
1CHU
Objectives: MS is a neurodegenerative disease with an ALD status in France, i.e., MS-related medical costs are 100% covered by the National Healthcare system. A study has been performed to measure the direct costs and impacts borne by MS patients and their caregivers. Methods: The study was conducted from September to October 2016 via Carenity, a European digital patient community, a network where patients can share information and contribute to medical research in various therapeutic areas, including MS. An online questionnaire of 49 questions devoted to the financial impact of MS on patients and their relatives, was developed and approved by a scientific committee including a multiple sclerosis patient organization representative, a neurologist and a health economist. Participants, either MS patients or their caregivers living in France and registered into the community, were volunteers to participate. Results: 436 members of the community answered the questionnaire, 376 had MS and 60 were caregivers. 77% of patients were women, with a mean age of 48.3 years, 24% lived alone, 25% benefited from medical and non-medical support, and 37% benefited from financial and/or material assistance. Direct non-medical costs cover many domains including domestic help, babysitting, homework help, meal delivery, car and home fitting, etc. Over the last 12 months: 20% of patients stayed in healthcare facilities, 15% had to pay for related fees. Nearly one third of respondents benefited from domestic help. Among them, 50% had to pay part of the costs. About 40% of caregivers contributed financially
Objectives: Heart failure (HF) is a major public health issue due to its prevalence in the western world: two to three percent of the european population have HF. To improve patient care, the Montpellier university hospital (CHU) implemented in 2014 a new organisation of HF management called “optimised pathway”. The aim of our study was to compare costs and readmissions rates between 2013 and 2015, and to assess the new pathway impact. Methods: A retrospective observationnal and comparative before-after study was conducted. The clinical endpoint was the readmission rate a year after first hospitalisation for HF. CHU databases were used to characterise the patients of interest (526 and 514 for 2013 and 2015 respectively) and their stays: administrative and medico-economic database to collect relevant demographic and medical data, and cost accounting data to value the stays. Clinical and economic outcomes were measured over a one year time horizon. Results: No significant differences were found between 2013 and 2015 regarding the one year readmission rate (18.06% in 2013, 18.48% in 2015, p = 0.86). Time intervals between first hospitalisation and readmission weren’t significantly different (p = 0.18), even if a trend could be observed (114 days in 2013 vs. 142 in 2015). No significant difference were found in terms of total length of stay (p = 0.193). Total patient care cost more in 2015 (8468€ vs. 7223€ , p < 0.01), but incomes were also higher (6871€ vs. 6368€ , p = 0.088), whether not enough to compensate (difference between costs and incomes for 2013 and 2015 were -855€ and -1598€ respectively,
Bourel G1, Duteil E2, Mahieu N2, Roubille F1, Mercier G1 Montpellier, Montpellier, France, 2Novartis Pharma, Rueil-Malmaison, France
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1
with a greater proportion of binge drinkers. Given the growing need to improve efficiencies and reduce costs within the NHS, further investigation is needed to understand how the UK can tackle the UK’s binge-drinking culture. PHS41 The Cost Of Treating Diabetic Ketoacidosis In The UK: A National Survey Of Hospital Resource Use Dhatariya KK, Skedgel CD, Fordham RJ University of East Anglia, Norwich, UK
Objectives: Diabetic ketoacidosis (DKA) is a commonly encountered metabolic emergency. In 2014 a national survey was conducted looking at the management of DKA in adult patients across the UK. The survey reported the clinical management of individual patients as well as institutional factors that teams felt were important in helping to deliver that care. However, costs of treating DKA were not reported. We estimate these costs here. Methods: We used a combination of bottom-up and top-down costing to estimate the total costs associated with treating DKA in a mixed population sample. The data were derived from the source data from the national UK survey of 283 individual patients collected via questionnaires sent to hospitals across the country. Because the initial survey collection tool was not designed with a health economic model in mind, several assumptions were made when analysing the data. We used multiple imputation methods to account for missing data. Results: The mean and median time in hospital was 5.6 and 2.7 days, respectively. Based on the individual patient data and using the Joint British Diabetes Societies Inpatient Care Group guidelines, the cost analysis suggests that for this cohort, the average cost for an episode of DKA was £2064 per patient (95% CI: £1800, 2563). An episode of hypoglycaemia following DKA was the only statistically significant predictor of cost (-£935, p= 0.03). Conclusions: Despite relatively short stays in hospital, costs for managing episodes of DKA in adults were relatively high. However, we were unable to account for prolonged hospital stays due to co-morbidities or indirect costs such as lost productivity. Therefore, the actual costs to the healthcare system and to larger society are likely to be even higher than these first estimates. PHS42 The Cost Of Prescribing Direct Oral Anticoagulants (DOACS) – There Is A Drug Cost But What Else? Kirby A1, Murphy A1, Bradley C1, Browne J2 College Cork, Cork, Ireland, 2Cork, Cork, Ireland
1University
Objectives: In Europe, there are four direct oral anticoagulants (DOACs) available for prescribing to patients with atrial fibrillation. A key advantage of DOACs is the abolition of routine INR monitoring. Nevertheless, some level of follow-up care is required – as advocated by European Heart Rhythm Association. The high drug cost of DOACs is acknowledged and contributes to reluctance for their reimbursement in public health systems. Despite the increased adoption of DOACs there is a lack of information regarding the cost of adopting these new agents into clinical practice, beyond the drug cost. This study aims to ascertain the costs associated with followup care for DOAC patients from a health care provider’s perspective. Methods: A cost analysis is used to estimate the follow-up care associated with prescribing patients’ DOACs in Ireland. Primary data is collected from General Practitioner practices in Ireland to estimate resource use. Results: Using the EHRA practical guide as a benchmark, 58% of clinics scheduled a follow up with patients once every 3 months, which is well below recommendations. A structured follow up by the physician included checks for compliance, thrombo-embolic events, measure bleeding events, other side effects, monitoring of co-medications and the need for blood sampling in accordance with the EHRA practical guide. The follow-up test completed most frequently, was blood testing by a public health nurse for renal function reporting a time cost of between € 5.70 and € 8.54 per patient, with 79% of GPs indicating this as follow up/maintenance for DOAC patients. Conclusions: DOACs have emerged as an alternative to warfarin in patients with AF. Although there are many benefits such as fewer food and drug interactions, lack of monitoring etc. the use of DOACs will require support in the clinical setting. The cost of this follow up care needs to be considered and adequately resourced. PHS43 French People With MS And Their Caregivers Have To Financially Support Direct Non-Medical Costs Linked To Their Disease
to home services fees. 41% of respondents bought a walking-aid device and 23% a manual wheelchair. Conclusions: These results indicate that, depending upon services, about 60% of patients and 40% of caregivers dedicate part of their financial resources to cover non-medical costs directly linked to MS. PHS44 Economic Evaluation For Establishing Stroke Unit Followed By Early Supported Discharge In Egypt Abotaleb A World health organization, cairo, Egypt
Objective: When Stroke accounts for 6·4% of all deaths and thus ranks 3rd after heart disease &gastrointestinal with a crude prevalence rate of 963/100 000 inhabitants. The clinical characteristics of Egyptian stroke patients are generally similar to those in other populations. Exceptions may include the higher prevalence of vascular risk factors and a younger mean age of stroke patients (4, 18–20). Due to those facts stroke &its complications may be one of the major economic challenges facing Egyptian health sector. The objective of this study is to evaluate Economic evaluation for establishing stroke unit followed by early supported discharge the outcome was determined as survival with minor disability. Method: Integration between A systematic literature review &Descriptive analysis of Data from patients aged (18 -60 years ) for the last 3 years including direct and indirect medical costs for conventional treatment including ( cost of treatment, complications including physical therapy , hospitalization ,outpatients costs ,rehabilitation ). The total (n) of patients enrolled in the national database = 3212. One way sensitivity analysis was conducted. Level of statistical significance was defined at (p. < 0.05). Result: Mean direct medical cost for (, neurological complications including Cerebral Edema, DVT, PE, Hemorrhagic transformation,) increasing ratio was around 3.5% at the last 3 years. Cardiac Complications were second items for cost with increasing rates2 .5, respiratory Complications ranking 3rd with 1.5 rate at last 3 years. Hospitalization ratio increased with 5.7 % for the last 3 years. Conclusion: Establishing stroke unit followed by early supported discharge might be cost saving due to it is significant impact of minimizing economic consequences of. PHS45 Characterization Of Health Care Utilization And Cost Of Hemophilia A And B In Real-Life: A 4-Year Follow-UP Study In Finland Ventola H1, Jokelainen J1, Linna M2, Lepäntalo A3, Ylisaukko-oja T1, Lassila R3 Oy, Helsinki, Finland, 2Aalto University, Espoo, Finland, 3Helsinki University Hospital, Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland 1MedEngine
Objectives: Though a majority of hemophilia treatment cost comes from factorreplacement therapy, cost savings related to healthcare use may result from optimal prophylactic therapy. We characterized real-life healthcare utilization and costs among Finnish patients with hemophilia A (HA) and hemophilia B (B). Methods: The data on resource use were collected from patient charts generated over a period of four years (2012-2016). Annual healthcare costs were calculated based on resource utilization and Finnish report of standard unit costs. Results: A total of 131 HA patients and 39 HB patients were included. Of HA patietns, 56% (n= 74) received prophylactic therapy (HAP), and 25% (n= 31) received on-demand therapy (HAO). Over 90% of HAP and HAO patients had outpatient visits during follow-up. The mean outpatient visits/year/patient was 2.4 for HAP and 1.9 for HAO. Overall, 43% of HAP patients, and 27% of HAO patients had inpatient stays during follow-up; the mean lenhgt of stay was 11.9 days for HAP, and 15.3 days for HAO. The total annual healthcare cost were 8,530€ for HAP and 12,584 for HAO. Of HB patients, 31% (n= 12) received prophylactic therapy (HBP), whereas 54% (n= 21) received on-demand therapy (HBO). Over 90% of HBP and HBO had outpatient visits during follow-up. The mean outpatient visits/year/patient was 1.8 for HBP and 2.1 for HBO. Overall, 25% of HBP patients, and 52% of HBO patients had inpatient stays during follow-up; the mean lenhgt of stay was 3.0 days for HBP, and 11.3 days for HBO. The total annual healthcare cost were 1,358€ for HBP and 9,517 for HBO. Except for the results regarding annual healthcare cost between HBP and HBO (p> 0.001), statistical significance was not reached. Conclusions: Patients receiving on-demand therapy have higher healthcare costs than patients treated prophylactically. Selecting between prophylaxis and on-demand therapy should be done under careful considearation. PHS46 Heart Failure Management: Impact Of A New Health-Care Organisation On Readmissions And Costs
van Hille B1, Heinzlef O2, Dourgnon P3, Molinier G4, Chekroun M5, Longin J6 1Merck s.a.s., LYON, France, 2Hôpital de Poissy, Poissy, France, 3IRDES, Paris, France, 4Ligue Française contre la Sclérose en Plaques, PARIS, France, 5carenity.com, Paris, France, 6Merck, LYON, France
1CHU
Objectives: MS is a neurodegenerative disease with an ALD status in France, i.e., MS-related medical costs are 100% covered by the National Healthcare system. A study has been performed to measure the direct costs and impacts borne by MS patients and their caregivers. Methods: The study was conducted from September to October 2016 via Carenity, a European digital patient community, a network where patients can share information and contribute to medical research in various therapeutic areas, including MS. An online questionnaire of 49 questions devoted to the financial impact of MS on patients and their relatives, was developed and approved by a scientific committee including a multiple sclerosis patient organization representative, a neurologist and a health economist. Participants, either MS patients or their caregivers living in France and registered into the community, were volunteers to participate. Results: 436 members of the community answered the questionnaire, 376 had MS and 60 were caregivers. 77% of patients were women, with a mean age of 48.3 years, 24% lived alone, 25% benefited from medical and non-medical support, and 37% benefited from financial and/or material assistance. Direct non-medical costs cover many domains including domestic help, babysitting, homework help, meal delivery, car and home fitting, etc. Over the last 12 months: 20% of patients stayed in healthcare facilities, 15% had to pay for related fees. Nearly one third of respondents benefited from domestic help. Among them, 50% had to pay part of the costs. About 40% of caregivers contributed financially
Objectives: Heart failure (HF) is a major public health issue due to its prevalence in the western world: two to three percent of the european population have HF. To improve patient care, the Montpellier university hospital (CHU) implemented in 2014 a new organisation of HF management called “optimised pathway”. The aim of our study was to compare costs and readmissions rates between 2013 and 2015, and to assess the new pathway impact. Methods: A retrospective observationnal and comparative before-after study was conducted. The clinical endpoint was the readmission rate a year after first hospitalisation for HF. CHU databases were used to characterise the patients of interest (526 and 514 for 2013 and 2015 respectively) and their stays: administrative and medico-economic database to collect relevant demographic and medical data, and cost accounting data to value the stays. Clinical and economic outcomes were measured over a one year time horizon. Results: No significant differences were found between 2013 and 2015 regarding the one year readmission rate (18.06% in 2013, 18.48% in 2015, p = 0.86). Time intervals between first hospitalisation and readmission weren’t significantly different (p = 0.18), even if a trend could be observed (114 days in 2013 vs. 142 in 2015). No significant difference were found in terms of total length of stay (p = 0.193). Total patient care cost more in 2015 (8468€ vs. 7223€ , p < 0.01), but incomes were also higher (6871€ vs. 6368€ , p = 0.088), whether not enough to compensate (difference between costs and incomes for 2013 and 2015 were -855€ and -1598€ respectively,
Bourel G1, Duteil E2, Mahieu N2, Roubille F1, Mercier G1 Montpellier, Montpellier, France, 2Novartis Pharma, Rueil-Malmaison, France