- Email: [email protected]
Economic Evaluation of Dengue Vaccination in Bangkok Metropolitan Administration
A910
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
Merck ($0.650/unit), Indinavir by Merck ($0.270/unit), Raltegravir by Merck ($2.362/ unit), Valganciclovir by Roche ($4.210/unit), Nevirapine by Boehringer Ingelheim ($0.600/unit), Lopinavir/ritonavir by Abbott/Abbvie ($0.203/unit) and combination Tenofovir /Emtricitabine ($0.875/unit) by Gilead but generic drugs are still cheaper than the lower tiered price for example Tenofovir by Cipla priced for $0.167/unit and by Ranbaxy for $0.150/unit. Conclusions: Differential pricing is not a panacea but it can be one of the useful tools to improve the access to medicines. Although it is a win-win for both consumers and industry and can reconcile both static and dynamic costs, it has not been widely implemented so far. There is an urgent need to implement regulative and legislative framework by policymakers and lawmakers to achieve success. PIN13 Cost Analysis of Levofloxacin 750mg During 5 Days Vs Levofloxacin 500mg During 10 Days for the Treatment of Comunity-Acquired Pneumonia Under the Brazilian Public Hospital Perspective Tolentino AC1, Seabra E2, Tanaka E3 1Hospital Universitario Pedro Ernesto - UERJ/HUPE, Rio de Janeiro, Brazil, 2Hospital universitario Pedro Ernesto, Rio de Janeiro, Brazil, 3CURITIBA´S HEALTH INSTITUTE, CURITIBA, PARANÁ, Brazil
Objectives: to develop cost-effectiveness analysis of levofloxacin 750mg for 5 days (L750) versus levofloxacin 500mg for 10 days (L500) in hospitalized adults fine-risk class III/IV comunity-acquired pneumonia, under the Brazilian public payer perspective. Methods: A literature search was conducted to gather efficacy data for L750 and L500 and identified one randomized controlled trial that showed L750-course for 5 days that achieved comparable clinical and microbiologic efficacy to the L500-course for 10 days. By day 3 of therapy, a greater proportion of patients in the L750 group had objective and subjective resolution of fever. The model assumed that L500 is the current practice in Brazilian public hospitals and patients are discharged at the time their course finishes. Resource use was estimated through expert panel. Only direct costs were included in the analysis and units were obtained from Brazilian official price lists. Number of hospitalized patients under the CID-10 code were obtained from the Brazilian official public health database(TABWIN). Results: 626,321 patients were hospitalized from January to December 2015, with 3,856,754 total days of hospitalization and mean hospitalization time of 6.2 days. According to the expert panel, in the public hospitals the dose of levofloxacin 500mg is the standard dose found, with waste of 250mg/patient/dose for those treated with Levofloxacin 750mg. Treatment costs are R$86,20 for both groups (with waste of 250mg or equivalent of R$4,31/dose). According to the model, the L750-course would cost R$40,491,652.60 and R$53,988,870.20 for the L500-course, with incremental of -R$13,497,217.60 (USD3,580,163.82). USD rate: $1,00= R$3.77(BRL) Conclusions: Short-course antibiotic therapy may provide new means to reduce healthcare costs. For more severe ill population, hospitalization and more agressive antimicrobial therapy may be necessary to achieve optimal clinical and economic outcomes. Besides, further studies about medication waste and its impact for the environment should be considered to be conducted. PIN14 Direct Medical Costs of Hcv Patients Using National Health Insurance Claims Data in South Korea Kang D, Lim J, Shin G, Bae E, Choi S Korea University, Sejong city, South Korea
Objectives: Hepatitis C virus is a Bloodborne virus causing hepatitis C, which is correlated to liver cirrhosis and liver cancer. Recently, new drug class called direct acting agent (DAA) with near 100% efficacy was developed. With these new medications to be available soon, it is necessary to estimate the cost of illness of HCV patients precisely to conduct the pharmacoeconomic evaluation. This study aims to estimate direct medical costs of HCV patients in South Korea using national health insurance claims data. Methods: A dataset called Health Insurance Review & Assessment service National Inpatient Sample (HIRA-NIS) was used to estimate direct medical costs. Data of patients with HCV disease code were obtained. All of the patients had comorbid diseases and those with liver cancer or cirrhosis were included for medical cost analysis, assuming they were caused by chronic HCV. Results: Among 1.1 million inpatients and outpatients, 7008 patients were diagnosed with HCV. Among them, 306 patients had liver cancer, 717 patients had cirrhosis and 382 had both liver cancer and cirrhosis as comorbid diseases. Annual medical costs per patient for each health state were $7,830, $3,000 and $10,160 for liver cancer, cirrhosis, and both respectively. The obtaining medical cost of HCV state was impossible since there was no patient with HCV only in the database. Conclusions: Compared to the prevalence from the previous epidemiologic study, the weighted percentage of the patients diagnosed with HCV in this study was significantly low(0.78% vs. 0.21%). It is lower because most patients get screened for HCV when symptoms appear due to comorbidity while HCV infection itself is usually asymptomatic. Thus, using health insurance claims data, medical costs of HCV-related liver cancer or cirrhosis can be obtained, but not of HCV by itself. PIN15 Economic Burden of Antibiotic-Resistant Nosocomial GramNegative Infections in Singapore Hospitals Chen G1, Lim S1, Ma Q1, Ghosh W2 Medical Singapore Pte Ltd, Singapore, Singapore, 2Costello Medical Consulting Ltd, Cambridge, UK
Upon development of a GN bacteraemia, patients were initially treated by an empirical antibiotic, E1, and a culture test was taken. If the empirical antibiotic was not appropriate, patients were subsequently treated by a definitive antibiotic, D1, based on the culture test results. If D1 was also not appropriate, a second definitive antibiotic, D2, was administered. Finally, if the patient remained infected after treatment by D2, the patient was assumed to die. Each stage of therapy was associated with a probability of success, leading to discharge; or of failure, leading to prolonged hospital stay and subsequent lines of therapy, or death. Singapore data from a structured literature review were used when possible, supplemented by Singapore data from non-peer reviewed sources and conservative assumptions. Guidance on model structure and assumptions were provided by local clinical experts. Results: The model provides a conceptual framework for assessing the impact of drug-resistance on hospital costs amongst patients with GN bacteraemia. With the current assumptions, DR nosocomial GN bacteraemia amongst ICU patients in Singapore were estimated to be associated with excess hospital costs of 6.96 million SGD over one year, with length of hospital stay as a major cost driver. Conclusions: Drug-resistance in GN bacteria is a major public health concern associated with excess hospital costs and deaths. Our conservative estimations suggest that antibiotic surveillance programmes and other measures to reduce the prevalence of DR infections may contribute to cost savings in Singapore hospitals. PIN16 Economic Evaluation of Dengue Vaccination in Bangkok Metropolitan Administration Liulak W1, Chuenkitmongkol S2, Thongsri W2, Beucher S3, Baurin N4, Thisyakorn U5 1Health Department, Bangkok Metropolitan Administration, Bangkok, Thailand, 2Sanofi Pasteur, Bangkok, Thailand, 3Sanofi Pasteur, Singapore, Singapore, 4Sanofi Pasteur, Lyon, France, 5Department of Pediatrics, Faculty of Medicine,Chulalongkorn University, Bangkok, Thailand
Objectives: Dengue is a major public healthcare concern in Bangkok Metropolitan Administration (BMA), and 2015 saw the highest number of cases in the past decade. The first dengue vaccine has recently been licensed in several endemic countries. This study aims to estimate the public health impact of dengue vaccination strategies in BMA and determine cost-effective vaccination price thresholds. Methods: A dengue transmission model, specifically calibrated using Thai and Bangkok epidemiological and economic data, as well as vaccine efficacy data from two international, phase III trials, has been used to evaluate the potential public health and economic impact of dengue vaccination, over a 10 years period from public payer and societal perspectives. Five vaccination strategies were simulated including routine vaccination at 9 years old plus 1,2,3,6 and 20 catch-up cohorts, i.e.one time vaccination expansion program of all ages 10, 10-11, 10-12, 10-15 and 10-29, respectively. Threshold analysis defined upper vaccination costs based on Thai guidelines (160,000 THB per DALYs averted). 3% discount rate was applied and probabilistic sensitivity analyses were performed to assess parameters uncertainty. Results: Dengue vaccination is cost effective up to a range price of 48.02-58.75 USD per dose for all scenarios, based on a 90% coverage rate, from societal perspective. Routine at 9 plus 20 catch ups showed the highest health impact over 10 years, with ~364k prevented dengue cases, 353 prevented dengue-related deaths and 15,567 prevented DALYs. In economics aspect, this program would reduce costs to the payer and society by up to USD100 million and USD160 million, respectively. Conclusions: The analysis demonstrated that dengue vaccination is a good “value-for-money” investment and has potential to reduce dengue disease and economic burden in Bangkok. The results of this study are important for providing evidence to policy makers to decide on dengue vaccination implementation in BMA. PIN17 Treatment Pattern of Antibiotics and Cost Analysis in Sepsis Patients: A Cross Sectional Retrospective & Prospective Study Erraboina M1, Gopagoni K1, Manthen A1, Bandari S2, Vurumadla S2 Institute of Pharmaceutical Sciences, Hanamkonda, India, 2St Peter’s Institute of Pharmaceutical sciences, Hanamkonda, India
1St.Peter’s
Objectives: Increasing health care cost is a major concern in the developing world and has increased the economic burden for a common man. The study objective is to describe and appraise the pattern of antibiotics prescribing based on the culture report and to evaluate the cost analysis in sepsis patients. Methods: A retrospective and prospective analysis was conducted at tertiary care hospitals, Warangal. The follow up was done for all patients enrolled in the study. Antibiotic-prescription pattern in both culture positive and negative were analyzed and compared. The data collection comprises the direct medical and non-medical cost, cost of medications prescribed during the therapy and while discharge. Mean ± SD (Standard Deviation) cost of treatment were calculated. Results: A combined analysis of antibiotic pattern and cost of treatment was performed. The most commonly prescribed antibiotics were Piperacillin + Tazobactum, Vancomycin, Clindamycin, Tobramycin, Cefpodoxime, Meropenem and Imipenam. The cost for culture positive patients was 35,920 ± 15,292 rupees and culture negative patients was 18,082 ± 7,987 rupees. The culture and sensitivity testing was carried out and the common organisms isolated were Escherichia coli and Klebsiella pneumoniae. The overall cost of Klebsiella pneumoniae patients (Rs.35,688 ± 15,162) was higher than the Escherichia coli (Rs.24,767 ± 15,498). The dissimilarity in the cost of therapy is due to change of treatment site. Conclusions: The present study infers that treatment pattern of antibiotics varied based on the culture report of an individual patient; for majority cohort piperacillin + tazobactum was the drug of choice for both culture positive and negative sepsis patients. On the basis of current cost analysis data, the treatment cost of culture positive patients is significantly high than that of culture negative patients.
1Costello
Objectives: To estimate the total economic burden attributed to drug-resistant (DR) nosocomial gram-negative (GN) bacteraemia amongst intensive care unit (ICU) patients in Singapore, from a hospital perspective. Methods: A decision-tree model was developed to estimate the hospital costs of ICU patients with nosocomial GN bacteraemia.
PIN18 Economic Burden of Community-Acquired Pneumonia Among Elderly Konomura K1, Nagai H2, Akazawa M1 1Meiji Pharmaceutical University, Tokyo, Japan, 2National Hospital Organization Tokyo National Hospital, Tokyo, Japan
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
Merck ($0.650/unit), Indinavir by Merck ($0.270/unit), Raltegravir by Merck ($2.362/ unit), Valganciclovir by Roche ($4.210/unit), Nevirapine by Boehringer Ingelheim ($0.600/unit), Lopinavir/ritonavir by Abbott/Abbvie ($0.203/unit) and combination Tenofovir /Emtricitabine ($0.875/unit) by Gilead but generic drugs are still cheaper than the lower tiered price for example Tenofovir by Cipla priced for $0.167/unit and by Ranbaxy for $0.150/unit. Conclusions: Differential pricing is not a panacea but it can be one of the useful tools to improve the access to medicines. Although it is a win-win for both consumers and industry and can reconcile both static and dynamic costs, it has not been widely implemented so far. There is an urgent need to implement regulative and legislative framework by policymakers and lawmakers to achieve success. PIN13 Cost Analysis of Levofloxacin 750mg During 5 Days Vs Levofloxacin 500mg During 10 Days for the Treatment of Comunity-Acquired Pneumonia Under the Brazilian Public Hospital Perspective Tolentino AC1, Seabra E2, Tanaka E3 1Hospital Universitario Pedro Ernesto - UERJ/HUPE, Rio de Janeiro, Brazil, 2Hospital universitario Pedro Ernesto, Rio de Janeiro, Brazil, 3CURITIBA´S HEALTH INSTITUTE, CURITIBA, PARANÁ, Brazil
Objectives: to develop cost-effectiveness analysis of levofloxacin 750mg for 5 days (L750) versus levofloxacin 500mg for 10 days (L500) in hospitalized adults fine-risk class III/IV comunity-acquired pneumonia, under the Brazilian public payer perspective. Methods: A literature search was conducted to gather efficacy data for L750 and L500 and identified one randomized controlled trial that showed L750-course for 5 days that achieved comparable clinical and microbiologic efficacy to the L500-course for 10 days. By day 3 of therapy, a greater proportion of patients in the L750 group had objective and subjective resolution of fever. The model assumed that L500 is the current practice in Brazilian public hospitals and patients are discharged at the time their course finishes. Resource use was estimated through expert panel. Only direct costs were included in the analysis and units were obtained from Brazilian official price lists. Number of hospitalized patients under the CID-10 code were obtained from the Brazilian official public health database(TABWIN). Results: 626,321 patients were hospitalized from January to December 2015, with 3,856,754 total days of hospitalization and mean hospitalization time of 6.2 days. According to the expert panel, in the public hospitals the dose of levofloxacin 500mg is the standard dose found, with waste of 250mg/patient/dose for those treated with Levofloxacin 750mg. Treatment costs are R$86,20 for both groups (with waste of 250mg or equivalent of R$4,31/dose). According to the model, the L750-course would cost R$40,491,652.60 and R$53,988,870.20 for the L500-course, with incremental of -R$13,497,217.60 (USD3,580,163.82). USD rate: $1,00= R$3.77(BRL) Conclusions: Short-course antibiotic therapy may provide new means to reduce healthcare costs. For more severe ill population, hospitalization and more agressive antimicrobial therapy may be necessary to achieve optimal clinical and economic outcomes. Besides, further studies about medication waste and its impact for the environment should be considered to be conducted. PIN14 Direct Medical Costs of Hcv Patients Using National Health Insurance Claims Data in South Korea Kang D, Lim J, Shin G, Bae E, Choi S Korea University, Sejong city, South Korea
Objectives: Hepatitis C virus is a Bloodborne virus causing hepatitis C, which is correlated to liver cirrhosis and liver cancer. Recently, new drug class called direct acting agent (DAA) with near 100% efficacy was developed. With these new medications to be available soon, it is necessary to estimate the cost of illness of HCV patients precisely to conduct the pharmacoeconomic evaluation. This study aims to estimate direct medical costs of HCV patients in South Korea using national health insurance claims data. Methods: A dataset called Health Insurance Review & Assessment service National Inpatient Sample (HIRA-NIS) was used to estimate direct medical costs. Data of patients with HCV disease code were obtained. All of the patients had comorbid diseases and those with liver cancer or cirrhosis were included for medical cost analysis, assuming they were caused by chronic HCV. Results: Among 1.1 million inpatients and outpatients, 7008 patients were diagnosed with HCV. Among them, 306 patients had liver cancer, 717 patients had cirrhosis and 382 had both liver cancer and cirrhosis as comorbid diseases. Annual medical costs per patient for each health state were $7,830, $3,000 and $10,160 for liver cancer, cirrhosis, and both respectively. The obtaining medical cost of HCV state was impossible since there was no patient with HCV only in the database. Conclusions: Compared to the prevalence from the previous epidemiologic study, the weighted percentage of the patients diagnosed with HCV in this study was significantly low(0.78% vs. 0.21%). It is lower because most patients get screened for HCV when symptoms appear due to comorbidity while HCV infection itself is usually asymptomatic. Thus, using health insurance claims data, medical costs of HCV-related liver cancer or cirrhosis can be obtained, but not of HCV by itself. PIN15 Economic Burden of Antibiotic-Resistant Nosocomial GramNegative Infections in Singapore Hospitals Chen G1, Lim S1, Ma Q1, Ghosh W2 Medical Singapore Pte Ltd, Singapore, Singapore, 2Costello Medical Consulting Ltd, Cambridge, UK
Upon development of a GN bacteraemia, patients were initially treated by an empirical antibiotic, E1, and a culture test was taken. If the empirical antibiotic was not appropriate, patients were subsequently treated by a definitive antibiotic, D1, based on the culture test results. If D1 was also not appropriate, a second definitive antibiotic, D2, was administered. Finally, if the patient remained infected after treatment by D2, the patient was assumed to die. Each stage of therapy was associated with a probability of success, leading to discharge; or of failure, leading to prolonged hospital stay and subsequent lines of therapy, or death. Singapore data from a structured literature review were used when possible, supplemented by Singapore data from non-peer reviewed sources and conservative assumptions. Guidance on model structure and assumptions were provided by local clinical experts. Results: The model provides a conceptual framework for assessing the impact of drug-resistance on hospital costs amongst patients with GN bacteraemia. With the current assumptions, DR nosocomial GN bacteraemia amongst ICU patients in Singapore were estimated to be associated with excess hospital costs of 6.96 million SGD over one year, with length of hospital stay as a major cost driver. Conclusions: Drug-resistance in GN bacteria is a major public health concern associated with excess hospital costs and deaths. Our conservative estimations suggest that antibiotic surveillance programmes and other measures to reduce the prevalence of DR infections may contribute to cost savings in Singapore hospitals. PIN16 Economic Evaluation of Dengue Vaccination in Bangkok Metropolitan Administration Liulak W1, Chuenkitmongkol S2, Thongsri W2, Beucher S3, Baurin N4, Thisyakorn U5 1Health Department, Bangkok Metropolitan Administration, Bangkok, Thailand, 2Sanofi Pasteur, Bangkok, Thailand, 3Sanofi Pasteur, Singapore, Singapore, 4Sanofi Pasteur, Lyon, France, 5Department of Pediatrics, Faculty of Medicine,Chulalongkorn University, Bangkok, Thailand
Objectives: Dengue is a major public healthcare concern in Bangkok Metropolitan Administration (BMA), and 2015 saw the highest number of cases in the past decade. The first dengue vaccine has recently been licensed in several endemic countries. This study aims to estimate the public health impact of dengue vaccination strategies in BMA and determine cost-effective vaccination price thresholds. Methods: A dengue transmission model, specifically calibrated using Thai and Bangkok epidemiological and economic data, as well as vaccine efficacy data from two international, phase III trials, has been used to evaluate the potential public health and economic impact of dengue vaccination, over a 10 years period from public payer and societal perspectives. Five vaccination strategies were simulated including routine vaccination at 9 years old plus 1,2,3,6 and 20 catch-up cohorts, i.e.one time vaccination expansion program of all ages 10, 10-11, 10-12, 10-15 and 10-29, respectively. Threshold analysis defined upper vaccination costs based on Thai guidelines (160,000 THB per DALYs averted). 3% discount rate was applied and probabilistic sensitivity analyses were performed to assess parameters uncertainty. Results: Dengue vaccination is cost effective up to a range price of 48.02-58.75 USD per dose for all scenarios, based on a 90% coverage rate, from societal perspective. Routine at 9 plus 20 catch ups showed the highest health impact over 10 years, with ~364k prevented dengue cases, 353 prevented dengue-related deaths and 15,567 prevented DALYs. In economics aspect, this program would reduce costs to the payer and society by up to USD100 million and USD160 million, respectively. Conclusions: The analysis demonstrated that dengue vaccination is a good “value-for-money” investment and has potential to reduce dengue disease and economic burden in Bangkok. The results of this study are important for providing evidence to policy makers to decide on dengue vaccination implementation in BMA. PIN17 Treatment Pattern of Antibiotics and Cost Analysis in Sepsis Patients: A Cross Sectional Retrospective & Prospective Study Erraboina M1, Gopagoni K1, Manthen A1, Bandari S2, Vurumadla S2 Institute of Pharmaceutical Sciences, Hanamkonda, India, 2St Peter’s Institute of Pharmaceutical sciences, Hanamkonda, India
1St.Peter’s
Objectives: Increasing health care cost is a major concern in the developing world and has increased the economic burden for a common man. The study objective is to describe and appraise the pattern of antibiotics prescribing based on the culture report and to evaluate the cost analysis in sepsis patients. Methods: A retrospective and prospective analysis was conducted at tertiary care hospitals, Warangal. The follow up was done for all patients enrolled in the study. Antibiotic-prescription pattern in both culture positive and negative were analyzed and compared. The data collection comprises the direct medical and non-medical cost, cost of medications prescribed during the therapy and while discharge. Mean ± SD (Standard Deviation) cost of treatment were calculated. Results: A combined analysis of antibiotic pattern and cost of treatment was performed. The most commonly prescribed antibiotics were Piperacillin + Tazobactum, Vancomycin, Clindamycin, Tobramycin, Cefpodoxime, Meropenem and Imipenam. The cost for culture positive patients was 35,920 ± 15,292 rupees and culture negative patients was 18,082 ± 7,987 rupees. The culture and sensitivity testing was carried out and the common organisms isolated were Escherichia coli and Klebsiella pneumoniae. The overall cost of Klebsiella pneumoniae patients (Rs.35,688 ± 15,162) was higher than the Escherichia coli (Rs.24,767 ± 15,498). The dissimilarity in the cost of therapy is due to change of treatment site. Conclusions: The present study infers that treatment pattern of antibiotics varied based on the culture report of an individual patient; for majority cohort piperacillin + tazobactum was the drug of choice for both culture positive and negative sepsis patients. On the basis of current cost analysis data, the treatment cost of culture positive patients is significantly high than that of culture negative patients.
1Costello
Objectives: To estimate the total economic burden attributed to drug-resistant (DR) nosocomial gram-negative (GN) bacteraemia amongst intensive care unit (ICU) patients in Singapore, from a hospital perspective. Methods: A decision-tree model was developed to estimate the hospital costs of ICU patients with nosocomial GN bacteraemia.
PIN18 Economic Burden of Community-Acquired Pneumonia Among Elderly Konomura K1, Nagai H2, Akazawa M1 1Meiji Pharmaceutical University, Tokyo, Japan, 2National Hospital Organization Tokyo National Hospital, Tokyo, Japan