- Email: [email protected]
Economic Impact Of Severe Asthma In Spain: Observational Longitudinal Multicenter Study
A644
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
PRS26 Early Modelling of The Cost-Effectiveness of Stratified Medicine In COPD Hoogendoorn M1, Corro Ramos I1, Baldwin M2, Gonzalez-Rojas Guix N3, Rutten-van Molken M1 University Rotterdam, Rotterdam, The Netherlands, 2Boehringer Ingelheim Germany, Ingelheim, Germany, 3Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany
1Erasmus
Objectives: To develop a health economic model that included a great diversity of COPD patient and disease characteristics and multiple intermediate outcomes, which can be used to inform stratified medicine in COPD. Methods: Relevant patient characteristics and outcomes were included in the model after three literature reviews on: 1) multidimensional prognostic COPD indices, 2) COPD phenotypes, and 3) treatment effects in subgroups. Based on this a draft conceptual model was constructed and discussed with a panel of seven COPD experts. A patient-level simulation model was developed using the baseline patient population of five large COPD trials (n= 19,378) as a starting point and regression equations predicting the changes in outcomes over time. Results: Patient characteristics included in the final conceptual model were: sex, age, BMI, smoking, packyears, history of heart failure, other CVD, asthma, diabetes and depression, reversibility, emphysema, eosinophil level and ICS use. Intermediate outcomes included were lung function, physical activity, exercise capacity, symptoms, quality of life and exacerbations, while final outcomes were mortality, QALYs and costs. Patients had a mean lung function decline of 46 ml/year, 0.52 exacerbations/year, a life-expectancy of 12.3 years, 7.77 QALYs and average costs per year of £2,055. Results for a subgroup with a history of ≥ 1 severe exacerbation were 45, 0.58, 9.8, 6.0 and £2,346, respectively. A scenario analysis in which lung function decline was decreased by 20% in the overall population led to an increase in life expectancy of 0.60 years and a gain in QALYs of 0.41. Conclusions: The developed model can be used to calculate outcomes and evaluate treatment options for a wide variety of subgroups. It can also provide valuable information to guide research and development of new treatment options in an early stage by showing the possible impact of new treatments on a range of outcomes. PRS27 Evaluating The Economic Burden And Health Care Utilization Of Bacterial Pneumonia In The US Department Of Defense Population Vaidya N1, Wang Y1, Xie L1, Baser O2 1STATinMED Research, Ann Arbor, MI, USA, 2Columbia University and STATinMED Research, New York, NY, USA
Objectives: Among military personnel, bacterial pneumonia (BP) is the most common respiratory infection for hospital admissions, associated with a significant economic burden in the United States. We examined the economic burden and health care utilization (HRU) of BP in the US Department of Defense (DoD) population. Methods: Patients diagnosed with BP were identified (International Classification of Diseases [ICD], 9th Revision, Clinical Modification diagnosis code 482.9; ICD-10: J15.9) using DoD data from 01OCT2011-30SEP2016. The first diagnosis date was designated as the index date. A comparison cohort was created for non-BP patients with the same age, gender, race, and index year—as well as similar baseline Charlson Comorbidity Index scores—as the disease cohort. The index date was chosen randomly for the comparison cohort to minimize selection bias. Patients in both cohorts were required to have continuous medical and pharmacy benefits 1 year pre- and post-index date. Study outcomes, including HRU and costs, were compared between the disease and comparison cohorts based on the matched sample. Results: Eligible patients (N= 6,342) with and without BP were identified. After 1:1 propensity score matching, 4,655 patients were identified in each cohort with well-balanced baseline characteristics. Patients with BP were more likely to report a greater mean number of inpatient (0.5 vs 0.1 visit, p< 0.001), emergency room (ER; 1.3 vs 0.5 visits, p< 0.001), ambulatory (23.2 vs 12.3 visits, p< 0.001), and pharmacy (14.0 vs 9.0 visits; p< 0.001) visits. Higher all-cause health care costs were observed among BP patients, including mean inpatient ($7,736 vs $1,582; p< 0.001), ER ($816 vs $310; p< 0.001), ambulatory ($6,994 vs $3,403; p< 0.001), pharmacy ($2,146 vs $881; p< 0.001), and total costs ($17,692 vs $6,176; p< 0.001). Conclusions: During a 12-month period, DoD patients diagnosed with BP reported higher HRU and costs than their matched controls.
receptor antagonists (57.1%) and biologic treatment (omalizumab) (39.3%). 139 patients (45.9%) had at least one exacerbation (mean: 1.9 exacerbation/patient), of whom 22 patients required hospitalization, with a mean hospital stay of 10.9 days/ patient. Mean sick leave due to severe asthma was 9.15 days per patient. Mean annual direct cost (confidence interval 95%) was € 7,393 (6,509-8,514) per patient. 62.4% of the cost was due to omalizumab treatment. The cost per exacerbation was € 1,195/patient. When indirect costs were added (€ 856/patient (476-1,573)), the total annual mean cost rose to € 8,250/patient (7,193-9,733). Conclusions: The economic impact of severe asthma in Spain amounts to 8,250€ /patient from the societal perspective. PRS29 Disease-Related Cost Burden In Patients Undergoing Sinus Surgery For Chronic Rhinosinusitis: A Claims-Based Analysis Hunter TD1, DeConde AS2, Manes RP3 1CTI Clinical Trial and Consulting Services, Inc., Covington, KY, USA, 2UC San Diego, San Diego, CA, USA, 3Yale School of Medicine, New Haven, CT, USA
Objectives: We sought to quantify the cost burden and healthcare utilization in chronic rhinosinusitis (CRS) patients, with and without nasal polyposis (CRSwNP and CRSsNP), who require treatment with endoscopic sinus surgery (ESS). The additive contributions of nasal polyposis (NP) and revision surgery to 1-year costs were also evaluated. Methods: Data from 2012-2015 were extracted from the Blue Health Intelligence database. Adult patients (age 18-64) having ESS (ethmoidectomy CPT 31254 or 31255) for CRS, with index visits of < 1 week and medical and pharmacy enrollment for ≥ 1 year pre- and post- index surgery were included. Related healthcare utilization was defined as any visit with a primary diagnosis of CRS, acute sinusitis, or NP, or any prescription from a therapeutic category commonly used to treat CRS or related comorbidities. The primary outcomes included one-year revision rates and one-year medical and pharmacy expenditures. Results: A total of 23,542 patients met all inclusion criteria (mean age 44; 50% male), and 9,665 (41.1%) also had NP. The revision ESS rate within 1 year was 2.1%, and these occurred twice as often in CRSwNP compared to CRSsNP (3.1% vs. 1.4%). Mean one-year cost of treatment, including the index ESS, was $8,668 for CRSsNP and $10,757 for CRSwNP in patients not requiring revision ESS. For those requiring revision ESS within the first year, mean one-year expenditures increased by $11,186 to $19,853 for CRSsNP and by $13,395 to $24,153 for CRSwNP. Conclusions: In a large commercially insured US population, the disease-related expenditures for patients having ESS for CRS are substantial, as are the additive impacts of NP and revision surgery. CRSwNP doubled the risk of revision surgery in the first year after ESS compared to CRSsNP and cost 24% more, even in the absence of a second procedure. PRS30 Prevalence And Treatment Cost of Non-Communicable Diseases Related To Smoking In Indonesia Kristina SA1, Endarti D2, Wiedyaningsih C1, Fahamsya A1 1Universitas Gadjah Mada, Yogyakarta, Indonesia, 2Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
PRS28 Economic Impact Of Severe Asthma In Spain: Observational Longitudinal Multicenter Study
Objectives: This study aimed to estimates the current incidence and treatment cost of non-communicable diseases attributed to tobacco among Indonesian population in 2015. Methods: An epidemiological study was performed. Using national universal coverage database in 2015 we calculated the incidence and treatment cost of 19 diseases. Proportion of smoking attribution toward diseases and treatment cost due to smoking were calculated using smoking attributable fraction (SAF) formula, using the prevalence of smoking and relative risk of each disease. Results: The study revealed that the incidence of smoking related diseases accounted for 991,331 about 21.6% of total incidence of chronic diseases in Indonesia. The highest rank of diseases prevalence was hypertension, chronic obstructive pulmonary diseases (COPD) and ischemic heart disease. The treatment cost of smoking in Indonesia was conservatively estimated to be at least US$ 2,177 million, approximately 2.5% of the 2015 gross domestic product. A majority of the cost was largely concentrated in the male population (US$2,164 million). Treatment costs of hypertension, COPD, and ischemic heart disease had the highest cost burden. Conclusions: This study finding provides scientific evidence about economic burden of smoking, particularly the healthcare expenditure covered by government. Tobacco control efforts need to be prioritized in to prevent higher losses of the nation. This study’s evidence is important for informing national public health policy to advocate the health promotion and prevention program.
1Hospital
Melero C1, Quirce S2, Huerta A3, Uría E4, Cuesta M4, Brosa M4 Universitario 12 Octubre, Madrid, Spain, 2Hospital Universitario La Paz de Madrid, Madrid, Spain, 3GlaxoSmithKline, Tres Cantos (Madrid), Spain, 4Oblikue Consulting, Barcelona, Spain
PRS31 Cost-Benefit Analysis of A Smoking Cessation Program Funded By The Spanish National System In Pre-Operative Patients
Objectives: Severe asthma is responsible for a considerable amount of the burden associated with asthma. This study aimed to estimate the economic impact of severe asthma from the Spanish societal perspective through the annual estimation of the associated direct and indirect costs. Methods: Observational, longitudinal, retrospective, multi-centre study carried out in 20 Spanish secondary settings (Pulmonology and Allergy Services) among a representative sample of patients aged ≥ 18, diagnosed with severe asthma according to ERS/ATS consensus and who have not experienced an exacerbation in the previous 2 months. Asthmarelated healthcare resource utilization (routine and emergency visits, hospitalizations, tests, pharmacologic treatment) as well as asthma-related days off work were collected over a retrospective 12-month period from medical records review (inclusion period: June to November 2016). Total costs were calculated by multiplying the natural resource units used within 1 year by the corresponding unit cost (€ 2017). Results: 303 patients were included, mean age was 54.3 years and 66.7% were women. There were 5.7 physician visits per patient (3.3 in secondary care) The most common pharmacologic treatment was fixed dose combination of β 2-adrenergic antagonists/inhaled glucocorticoids (96.7%), followed by leukotriene
Jiménez CA1, Martín V2, Rejas J3 1Servicio Madrileño de Salud, Madrid, Spain, 2Universidad Carlos III, Getafe (Madrid), Spain, 3Pfizer SLU, Alcobendas, Spain
Objectives: Despite measures to stop smoking leading to a drop in its prevalence, morbi-mortality due to tobacco use is still high. Patients smoking at the time of surgery are at elevated risk of postoperative complications. Thus, decreasing smoking prevalence is a primary objective for healthcare professionals and authorities yet. The aim was to analyze the efficiency of a smoking-cessation program in pre-operative patients funded by the National Health System (NHS) in Spain. Methods: A cost-benefit analysis was performed from the NHS perspective in year 2016 in a smoking annual any-type surgery cohort ready to quit smoking. This cohort was identified from the year-2014 national annual hospital discharge report and characterized using published inputs from national health survey. Included costs corresponded to the implementation of the smokingcessation program, and were medical counselling/follow up and quitting smoking drugs (varenicline, bupropion and nicotine-replacement-therapy), which are not funded currently. Benefits were considered healthcare costs avoided due to
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
PRS26 Early Modelling of The Cost-Effectiveness of Stratified Medicine In COPD Hoogendoorn M1, Corro Ramos I1, Baldwin M2, Gonzalez-Rojas Guix N3, Rutten-van Molken M1 University Rotterdam, Rotterdam, The Netherlands, 2Boehringer Ingelheim Germany, Ingelheim, Germany, 3Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany
1Erasmus
Objectives: To develop a health economic model that included a great diversity of COPD patient and disease characteristics and multiple intermediate outcomes, which can be used to inform stratified medicine in COPD. Methods: Relevant patient characteristics and outcomes were included in the model after three literature reviews on: 1) multidimensional prognostic COPD indices, 2) COPD phenotypes, and 3) treatment effects in subgroups. Based on this a draft conceptual model was constructed and discussed with a panel of seven COPD experts. A patient-level simulation model was developed using the baseline patient population of five large COPD trials (n= 19,378) as a starting point and regression equations predicting the changes in outcomes over time. Results: Patient characteristics included in the final conceptual model were: sex, age, BMI, smoking, packyears, history of heart failure, other CVD, asthma, diabetes and depression, reversibility, emphysema, eosinophil level and ICS use. Intermediate outcomes included were lung function, physical activity, exercise capacity, symptoms, quality of life and exacerbations, while final outcomes were mortality, QALYs and costs. Patients had a mean lung function decline of 46 ml/year, 0.52 exacerbations/year, a life-expectancy of 12.3 years, 7.77 QALYs and average costs per year of £2,055. Results for a subgroup with a history of ≥ 1 severe exacerbation were 45, 0.58, 9.8, 6.0 and £2,346, respectively. A scenario analysis in which lung function decline was decreased by 20% in the overall population led to an increase in life expectancy of 0.60 years and a gain in QALYs of 0.41. Conclusions: The developed model can be used to calculate outcomes and evaluate treatment options for a wide variety of subgroups. It can also provide valuable information to guide research and development of new treatment options in an early stage by showing the possible impact of new treatments on a range of outcomes. PRS27 Evaluating The Economic Burden And Health Care Utilization Of Bacterial Pneumonia In The US Department Of Defense Population Vaidya N1, Wang Y1, Xie L1, Baser O2 1STATinMED Research, Ann Arbor, MI, USA, 2Columbia University and STATinMED Research, New York, NY, USA
Objectives: Among military personnel, bacterial pneumonia (BP) is the most common respiratory infection for hospital admissions, associated with a significant economic burden in the United States. We examined the economic burden and health care utilization (HRU) of BP in the US Department of Defense (DoD) population. Methods: Patients diagnosed with BP were identified (International Classification of Diseases [ICD], 9th Revision, Clinical Modification diagnosis code 482.9; ICD-10: J15.9) using DoD data from 01OCT2011-30SEP2016. The first diagnosis date was designated as the index date. A comparison cohort was created for non-BP patients with the same age, gender, race, and index year—as well as similar baseline Charlson Comorbidity Index scores—as the disease cohort. The index date was chosen randomly for the comparison cohort to minimize selection bias. Patients in both cohorts were required to have continuous medical and pharmacy benefits 1 year pre- and post-index date. Study outcomes, including HRU and costs, were compared between the disease and comparison cohorts based on the matched sample. Results: Eligible patients (N= 6,342) with and without BP were identified. After 1:1 propensity score matching, 4,655 patients were identified in each cohort with well-balanced baseline characteristics. Patients with BP were more likely to report a greater mean number of inpatient (0.5 vs 0.1 visit, p< 0.001), emergency room (ER; 1.3 vs 0.5 visits, p< 0.001), ambulatory (23.2 vs 12.3 visits, p< 0.001), and pharmacy (14.0 vs 9.0 visits; p< 0.001) visits. Higher all-cause health care costs were observed among BP patients, including mean inpatient ($7,736 vs $1,582; p< 0.001), ER ($816 vs $310; p< 0.001), ambulatory ($6,994 vs $3,403; p< 0.001), pharmacy ($2,146 vs $881; p< 0.001), and total costs ($17,692 vs $6,176; p< 0.001). Conclusions: During a 12-month period, DoD patients diagnosed with BP reported higher HRU and costs than their matched controls.
receptor antagonists (57.1%) and biologic treatment (omalizumab) (39.3%). 139 patients (45.9%) had at least one exacerbation (mean: 1.9 exacerbation/patient), of whom 22 patients required hospitalization, with a mean hospital stay of 10.9 days/ patient. Mean sick leave due to severe asthma was 9.15 days per patient. Mean annual direct cost (confidence interval 95%) was € 7,393 (6,509-8,514) per patient. 62.4% of the cost was due to omalizumab treatment. The cost per exacerbation was € 1,195/patient. When indirect costs were added (€ 856/patient (476-1,573)), the total annual mean cost rose to € 8,250/patient (7,193-9,733). Conclusions: The economic impact of severe asthma in Spain amounts to 8,250€ /patient from the societal perspective. PRS29 Disease-Related Cost Burden In Patients Undergoing Sinus Surgery For Chronic Rhinosinusitis: A Claims-Based Analysis Hunter TD1, DeConde AS2, Manes RP3 1CTI Clinical Trial and Consulting Services, Inc., Covington, KY, USA, 2UC San Diego, San Diego, CA, USA, 3Yale School of Medicine, New Haven, CT, USA
Objectives: We sought to quantify the cost burden and healthcare utilization in chronic rhinosinusitis (CRS) patients, with and without nasal polyposis (CRSwNP and CRSsNP), who require treatment with endoscopic sinus surgery (ESS). The additive contributions of nasal polyposis (NP) and revision surgery to 1-year costs were also evaluated. Methods: Data from 2012-2015 were extracted from the Blue Health Intelligence database. Adult patients (age 18-64) having ESS (ethmoidectomy CPT 31254 or 31255) for CRS, with index visits of < 1 week and medical and pharmacy enrollment for ≥ 1 year pre- and post- index surgery were included. Related healthcare utilization was defined as any visit with a primary diagnosis of CRS, acute sinusitis, or NP, or any prescription from a therapeutic category commonly used to treat CRS or related comorbidities. The primary outcomes included one-year revision rates and one-year medical and pharmacy expenditures. Results: A total of 23,542 patients met all inclusion criteria (mean age 44; 50% male), and 9,665 (41.1%) also had NP. The revision ESS rate within 1 year was 2.1%, and these occurred twice as often in CRSwNP compared to CRSsNP (3.1% vs. 1.4%). Mean one-year cost of treatment, including the index ESS, was $8,668 for CRSsNP and $10,757 for CRSwNP in patients not requiring revision ESS. For those requiring revision ESS within the first year, mean one-year expenditures increased by $11,186 to $19,853 for CRSsNP and by $13,395 to $24,153 for CRSwNP. Conclusions: In a large commercially insured US population, the disease-related expenditures for patients having ESS for CRS are substantial, as are the additive impacts of NP and revision surgery. CRSwNP doubled the risk of revision surgery in the first year after ESS compared to CRSsNP and cost 24% more, even in the absence of a second procedure. PRS30 Prevalence And Treatment Cost of Non-Communicable Diseases Related To Smoking In Indonesia Kristina SA1, Endarti D2, Wiedyaningsih C1, Fahamsya A1 1Universitas Gadjah Mada, Yogyakarta, Indonesia, 2Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
PRS28 Economic Impact Of Severe Asthma In Spain: Observational Longitudinal Multicenter Study
Objectives: This study aimed to estimates the current incidence and treatment cost of non-communicable diseases attributed to tobacco among Indonesian population in 2015. Methods: An epidemiological study was performed. Using national universal coverage database in 2015 we calculated the incidence and treatment cost of 19 diseases. Proportion of smoking attribution toward diseases and treatment cost due to smoking were calculated using smoking attributable fraction (SAF) formula, using the prevalence of smoking and relative risk of each disease. Results: The study revealed that the incidence of smoking related diseases accounted for 991,331 about 21.6% of total incidence of chronic diseases in Indonesia. The highest rank of diseases prevalence was hypertension, chronic obstructive pulmonary diseases (COPD) and ischemic heart disease. The treatment cost of smoking in Indonesia was conservatively estimated to be at least US$ 2,177 million, approximately 2.5% of the 2015 gross domestic product. A majority of the cost was largely concentrated in the male population (US$2,164 million). Treatment costs of hypertension, COPD, and ischemic heart disease had the highest cost burden. Conclusions: This study finding provides scientific evidence about economic burden of smoking, particularly the healthcare expenditure covered by government. Tobacco control efforts need to be prioritized in to prevent higher losses of the nation. This study’s evidence is important for informing national public health policy to advocate the health promotion and prevention program.
1Hospital
Melero C1, Quirce S2, Huerta A3, Uría E4, Cuesta M4, Brosa M4 Universitario 12 Octubre, Madrid, Spain, 2Hospital Universitario La Paz de Madrid, Madrid, Spain, 3GlaxoSmithKline, Tres Cantos (Madrid), Spain, 4Oblikue Consulting, Barcelona, Spain
PRS31 Cost-Benefit Analysis of A Smoking Cessation Program Funded By The Spanish National System In Pre-Operative Patients
Objectives: Severe asthma is responsible for a considerable amount of the burden associated with asthma. This study aimed to estimate the economic impact of severe asthma from the Spanish societal perspective through the annual estimation of the associated direct and indirect costs. Methods: Observational, longitudinal, retrospective, multi-centre study carried out in 20 Spanish secondary settings (Pulmonology and Allergy Services) among a representative sample of patients aged ≥ 18, diagnosed with severe asthma according to ERS/ATS consensus and who have not experienced an exacerbation in the previous 2 months. Asthmarelated healthcare resource utilization (routine and emergency visits, hospitalizations, tests, pharmacologic treatment) as well as asthma-related days off work were collected over a retrospective 12-month period from medical records review (inclusion period: June to November 2016). Total costs were calculated by multiplying the natural resource units used within 1 year by the corresponding unit cost (€ 2017). Results: 303 patients were included, mean age was 54.3 years and 66.7% were women. There were 5.7 physician visits per patient (3.3 in secondary care) The most common pharmacologic treatment was fixed dose combination of β 2-adrenergic antagonists/inhaled glucocorticoids (96.7%), followed by leukotriene
Jiménez CA1, Martín V2, Rejas J3 1Servicio Madrileño de Salud, Madrid, Spain, 2Universidad Carlos III, Getafe (Madrid), Spain, 3Pfizer SLU, Alcobendas, Spain
Objectives: Despite measures to stop smoking leading to a drop in its prevalence, morbi-mortality due to tobacco use is still high. Patients smoking at the time of surgery are at elevated risk of postoperative complications. Thus, decreasing smoking prevalence is a primary objective for healthcare professionals and authorities yet. The aim was to analyze the efficiency of a smoking-cessation program in pre-operative patients funded by the National Health System (NHS) in Spain. Methods: A cost-benefit analysis was performed from the NHS perspective in year 2016 in a smoking annual any-type surgery cohort ready to quit smoking. This cohort was identified from the year-2014 national annual hospital discharge report and characterized using published inputs from national health survey. Included costs corresponded to the implementation of the smokingcessation program, and were medical counselling/follow up and quitting smoking drugs (varenicline, bupropion and nicotine-replacement-therapy), which are not funded currently. Benefits were considered healthcare costs avoided due to