- Email: [email protected]
Evaluating The Annual Cost Per Response Rate of Pirfenidone And Nintedanib For The Treatment of Patients With Idiopathic Pulmonary Fibrosis
A642
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
treatment were calculated and compared for two scenarios: market distributions with and without selexipag included. Epidemiology inputs, mortality rates, incidence of adverse events and market share estimates were based on expert consultation and published literature. Selexipag is assumed to be used in PGI2- naïve patients taking share from other drugs acting on the PGI2 pathway. Official published sources were used to derive drug acquisition (hospital prices), administration, monitoring and adverse event costs (€ , 2017). Results: The number of FC III PAH patients treated with selexipag as add-on to ERA and PDE-5i was projected to be 21 in 2017 and 77 in 2021. The 5-year total cost is expected to be reduced by 19.13% (€ 11,610,710), corresponding to cost-savings of € 126,880 per patient (€ 536,232 versus € 663,112), after the introduction of selexipag added to double background therapy. Cost savings were mostly driven by reduced drug, administration and consumables cost. Sensitivity analyses showed that the results were mostly influenced by PAH prevalence, incident usage of other PGI2 and proportion of FC III patients. Conclusions: The adoption of selexipag as a treatment option for PAH FC III triple therapy may result in budget savings for the public payer, in the Greek healthcare setting. PRS15 The Cost of Tiotropium 5MCG + Olodaterol 5MCG In The Management Of Copd In Greece Souliotis K1, Kousoulakou H2, Tritaki G2, Papageorgiou I3 of Peloponnese, Corinth, Greece, 2Health Policy Institute, Athens, Greece, 3Boehringer Ingelheim Hellas, Athens, Greece
1University
Objectives: To estimate the annual cost of COPD management in Greece with and without the use of tiotropium 5mcg + olodaterol 5 mcg (Spiolto® Respimat®). Methods: A cost minimization model was developed in Excel 2010®, which estimated the annual per patient cost of COPD management by treatment. Only direct medical costs were included in the analysis. The model took into consideration three cost categories: pharmaceutical costs, cost of exacerbations and other disease management costs (including hospitalization, patient follow-up and lab and imaging tests). Resource use data were obtained from Greek published studies, as well as the international literature when necessary. Drug acquisition costs were estimated based on the Price Bulletins issued by the Ministry of Health. All unit costs were taken from officially published sources. The cost base year was 2016 and the perspective adopted was that of the National Organization of Health Care Services Provision (EOPYY). Results: The estimated annual per patient cost to EOPYY for the management of COPD ranged between € 1,443.1 and € 1,642.4. Thirtythree percent of total costs was attributed to pharmaceutical treatment, 31% was associated with the management of exacerbations, and the remaining 36% was associated with patient monitoring and follow-up costs. The annual per patient cost of Spiolto® Respimat® was estimated at € 1,568.9, which was lower than the respective cost of other new generation drugs, such as Ultibro® Breezhaler® (€ 1,614.4), Anoro® Ellipta® (€ 1,614.4) and Duaklir® Genuair® (€ 1,642.4). In addition, the annual cost of Spiolto® appeared to be comparable with the cost of older COPD drugs, since although it increased pharmaceutical costs, it reduced other cost components, such as exacerbation costs. Conclusions: The introduction of tiotropium 5mcg + olodaterol 5 mcg in the management of COPD in Greece is anticipated to have a manageable budget impact to EOPYY. PRS16 Evaluating The Annual Cost Per Response Rate of Pirfenidone And Nintedanib For The Treatment of Patients With Idiopathic Pulmonary Fibrosis Papageorgiou L, Skroumpelos A, Samara K, Caporis X Roche (Hellas) S.A., Athens, Greece
Objectives: The current clinical practice for the management of patients with Idiopathic Pulmonary Fibrosis (IPF) includes two alternative therapeutic options, pirfenidone and nintedanib. The analysis aimed at evaluating their efficiency within the Greek healthcare system by comparing their annual cost per response rate from a payer’s perspective. Methods: In assessing the efficiency of the two therapeutic options, the cost per response rate was estimated to reflect the annual drug cost for achieving a rate of decline not more than 10 percentage points in the % predicted FVC, an endpoint consistent with a slowing of disease progression and clinical stabilization. Clinical data for the IPF patient populations of mild-to-moderate physiological impairment were derived from pirfenidone’s ASCEND & CAPACITY 1 & 2 trials (weighted average) and nintedanib’s INPULSIS 1 & 2 trials. For each therapeutic option, respective costing data of drug acquisition were obtained from official government sources (values in € , 2017). Results: The analysis estimated that the annual costs to achieve clinical stabilization was € 27.856 and € 31.802 with pirfenidone and nintedanib, respectively. The difference in the annual cost per response rate between the two alternatives was in favor of pirfenidone with generated savings of € 3.947 (€ 31.802 vs € 27.856). For the treated IPF patient population, results indicate that the savings realized from treating patients with pirfenidone instead of nintedanib could be invested in covering the annual cost for 17% more IPF patients receiving therapy with pirfenidone or for 14% more IPF patients reaching clinical stability. Conclusions: Within the Greek healthcare environment of scarce resources and significant budget constraints, the annual cost per response rate indicates that pirfenidone constitutes a cost-saving therapeutic alternative to nintedanib for the treatment of patients with mild-to-moderate IPF and yields sufficient savings to treat and stabilize disease progression for more patients compared to its competitor. PRS17 Systematic Review On Economic Impact Of Air Pollution On Health Jaafar H1, Azzeri A2, Isahak M2, Dahlui M2 1Islamic Science University of Malaysia, KL, Malaysia, 2University of Malaya, KL, Malaysia
Objectives: The impact of the exposures to air pollution can be seen from both health and economical perspective. This review study synthesizes available
literatures that related to the financial implications of air pollution on human’s health. Methods: The databases used to find the relevance articles were PubMed, Scopus and Web of Science. Online databases were searched until April 2017. Searching strategies were done using MesH terms and identified keywords for each databases. The articles were limited to English language and journal articles only. Articles on indoor air pollution or from review papers, proceedings and reports were excluded from this review. From initial search of 2095 articles, 268 duplicate articles were removed. After reviewing titles and abstracts, 36 articles fulfilled our inclusion and exclusion criteria to be included in this review. Results: Effects of air pollution on health cause significant increased in healthcare utilization. For every increased in particulate matter 10-2.5, there were 0.3% to 3.7% increased in hospital admissions and outpatient visits due to air pollution related illnesses. The effects were more prominent in short-term, high level of particulate matter exposures. The financial implications of haze on health were measured using cost of illness (COI) and willingness to pay (WTP) approaches. It was calculated from either provider’s perspective, patient’s perspective or combination of both. The financial implication of haze on health measured using WTP was higher because it included preventing, averting, mitigating and utility loss due to illness. The ratio of monetary values of economic impact of air pollution on health calculated using WTP to COI were ranging from 1.5:1 to 9:1. Conclusions: The monetary burden due to the economic loss and increase in healthcare expenditure was very significant. We need to allocate appropriate resources to reduce air pollution level and to meet the healthcare demand associated with it. PRS18 A Cost-Of-Illness Analysis For Community Acquired Pneumonia In Greece Naoum P1, Liapikou A2, Toumbis M2, Athanasakis K1, Kyriopoulos J1 1National School of Public Health, Athens, Greece, 2Sotiria Chest Diseases Hospital, Athens, Greece
Objectives: Community acquired pneumonia (CAP) is accompanied by a high clinical and economic burden, especially when patients’ condition requires hospitalization. The purpose of the present analysis was to estimate the mean direct outpatient and inpatient cost of CAP episodes in Greece. Methods: Data were collected from the Emergency Department of the Sotiria Chest Diseases Hospital. For CAP outpatients, data on diagnostic tests, number of physician visits and medication were collected, while for inpatients, data included diagnostic tests, medication, length of hospital stay, additional tests during hospitalization and discharge instructions. Moreover, it was recorded whether patients of both groups returned for reassessment and if so, whether additional tests and medication were provided. Cost calculations were performed from a third payer perspective (direct costs only) and refer to 2016. Results: Overall, 249 patients were included in the analysis, 149 inpatients and 100 outpatients, with a mean age of 55.1 years (SD= 18.764). Mean length of hospital stay was calculated at 11.35 days (SD= 9.71). For outpatients, mean direct cost was estimated at 110.64€ (SD= 58.23) per patient, while for inpatients at 7,406.56€ (SD= 12,124.93) per patient. The main driver of the inpatient cost was hospitalisation (94.97%), followed by medication during hospitalisation (3.30%) and diagnostic tests (0.87%). For outpatients, prescribed medication represented the highest proportion of total cost (38.84%), followed by diagnostic tests (33.51%) and physician visits (17.54%). Conclusions: CAP imposes a high economic burden on the Greek healthcare system, mainly due to the cost of hospitalisation. Further investigation is required to identify the reasons of the high hospitalisation rates and duration observed in Greece, in order to improve patient management models and reduce, when possible, inpatient care, while maintaining optimum clinical outcomes. PRS19 Economic Evaluation of Multi-Drug Resistant Tuberculosis In Ghana: Patient Level Direct Cost Analysis 2013 - 2016 Davies-Teye B1, Dziedzom A2, Vanotoo L3, Eleeza J4, BonsuFa 5 1Ghana Health Service and Drifney Consult Ltd, Accra, Ghana, 2Regional TB Program, Ghana Health Services, Accra, Ghana, 3Ghana Health Services and Promise Ghana, Accra, Ghana, 4Regioal Health Directorate Ghana Health Service, Accra, Ghana, 5Ghana Health Service, National T B Program, Accra, Ghana
Objectives: In Ghana, Direct cost of Multi-Drug Resistant (MDR) TB treatment is mainly covered by public sector through Global Fund financing mechanism. This includes economic support of patients to reduce out-of-pocket payment, improve treatment uptake and adherence. In spite of this, MDR-TB patients experience several economic barriers to access healthcare. This study evaluated the direct cost of illness to the patients and determine the adequacy of economic support to inform policy in the Greater Accra Region. Methods: We conducted a census of all MDR-TB patients diagnosed in Greater Region, Ghana from January 2013December 2016. Reviewed MDR-TB laboratory and treatment registers and identified all MDR-TB client diagnosed during the period. All clients who were alive at time of study and had not been lost to follow up participated in the study. We interviewed participants using digitized structured questionnaire on TBcare mobile app. Data abstracted include demographic, occupation, monthly income, cost of transportation, feeding, consultation, diagnosis, hospitalization, food supplement, medication or treatment and accommodation (if client lost it due to illness). We also abstracted data of direct financial support received from Global fund through Health facility. Data was managed in EPI info 7 to determine per capita direct cost and estimated total direct cost saving to patients. Results: Cumulative incidence MDR-TB was 1.4/100,000 with 14.5 percent Case fatality and 16.4 percent lost to follow up. Age ranged 18-58 years with mean 38.6±10.2 and 77.8 percent males. Monthly Income ranged 0.00-1162.80 USD with mean 168.10 USD Direct cost of illness ranged 300.50 – 16,130.20 USD with per capita direct cost of illness 2,202.60 USD which constitutes 109.2 percent of client’s annual income. Total Direct cost saving to patients 121,144.50 USD Conclusions: In spite of Global fund economic support, direct cost of illness to MDR-TB patients in the region is still high, constituting 109% of annual income.
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
treatment were calculated and compared for two scenarios: market distributions with and without selexipag included. Epidemiology inputs, mortality rates, incidence of adverse events and market share estimates were based on expert consultation and published literature. Selexipag is assumed to be used in PGI2- naïve patients taking share from other drugs acting on the PGI2 pathway. Official published sources were used to derive drug acquisition (hospital prices), administration, monitoring and adverse event costs (€ , 2017). Results: The number of FC III PAH patients treated with selexipag as add-on to ERA and PDE-5i was projected to be 21 in 2017 and 77 in 2021. The 5-year total cost is expected to be reduced by 19.13% (€ 11,610,710), corresponding to cost-savings of € 126,880 per patient (€ 536,232 versus € 663,112), after the introduction of selexipag added to double background therapy. Cost savings were mostly driven by reduced drug, administration and consumables cost. Sensitivity analyses showed that the results were mostly influenced by PAH prevalence, incident usage of other PGI2 and proportion of FC III patients. Conclusions: The adoption of selexipag as a treatment option for PAH FC III triple therapy may result in budget savings for the public payer, in the Greek healthcare setting. PRS15 The Cost of Tiotropium 5MCG + Olodaterol 5MCG In The Management Of Copd In Greece Souliotis K1, Kousoulakou H2, Tritaki G2, Papageorgiou I3 of Peloponnese, Corinth, Greece, 2Health Policy Institute, Athens, Greece, 3Boehringer Ingelheim Hellas, Athens, Greece
1University
Objectives: To estimate the annual cost of COPD management in Greece with and without the use of tiotropium 5mcg + olodaterol 5 mcg (Spiolto® Respimat®). Methods: A cost minimization model was developed in Excel 2010®, which estimated the annual per patient cost of COPD management by treatment. Only direct medical costs were included in the analysis. The model took into consideration three cost categories: pharmaceutical costs, cost of exacerbations and other disease management costs (including hospitalization, patient follow-up and lab and imaging tests). Resource use data were obtained from Greek published studies, as well as the international literature when necessary. Drug acquisition costs were estimated based on the Price Bulletins issued by the Ministry of Health. All unit costs were taken from officially published sources. The cost base year was 2016 and the perspective adopted was that of the National Organization of Health Care Services Provision (EOPYY). Results: The estimated annual per patient cost to EOPYY for the management of COPD ranged between € 1,443.1 and € 1,642.4. Thirtythree percent of total costs was attributed to pharmaceutical treatment, 31% was associated with the management of exacerbations, and the remaining 36% was associated with patient monitoring and follow-up costs. The annual per patient cost of Spiolto® Respimat® was estimated at € 1,568.9, which was lower than the respective cost of other new generation drugs, such as Ultibro® Breezhaler® (€ 1,614.4), Anoro® Ellipta® (€ 1,614.4) and Duaklir® Genuair® (€ 1,642.4). In addition, the annual cost of Spiolto® appeared to be comparable with the cost of older COPD drugs, since although it increased pharmaceutical costs, it reduced other cost components, such as exacerbation costs. Conclusions: The introduction of tiotropium 5mcg + olodaterol 5 mcg in the management of COPD in Greece is anticipated to have a manageable budget impact to EOPYY. PRS16 Evaluating The Annual Cost Per Response Rate of Pirfenidone And Nintedanib For The Treatment of Patients With Idiopathic Pulmonary Fibrosis Papageorgiou L, Skroumpelos A, Samara K, Caporis X Roche (Hellas) S.A., Athens, Greece
Objectives: The current clinical practice for the management of patients with Idiopathic Pulmonary Fibrosis (IPF) includes two alternative therapeutic options, pirfenidone and nintedanib. The analysis aimed at evaluating their efficiency within the Greek healthcare system by comparing their annual cost per response rate from a payer’s perspective. Methods: In assessing the efficiency of the two therapeutic options, the cost per response rate was estimated to reflect the annual drug cost for achieving a rate of decline not more than 10 percentage points in the % predicted FVC, an endpoint consistent with a slowing of disease progression and clinical stabilization. Clinical data for the IPF patient populations of mild-to-moderate physiological impairment were derived from pirfenidone’s ASCEND & CAPACITY 1 & 2 trials (weighted average) and nintedanib’s INPULSIS 1 & 2 trials. For each therapeutic option, respective costing data of drug acquisition were obtained from official government sources (values in € , 2017). Results: The analysis estimated that the annual costs to achieve clinical stabilization was € 27.856 and € 31.802 with pirfenidone and nintedanib, respectively. The difference in the annual cost per response rate between the two alternatives was in favor of pirfenidone with generated savings of € 3.947 (€ 31.802 vs € 27.856). For the treated IPF patient population, results indicate that the savings realized from treating patients with pirfenidone instead of nintedanib could be invested in covering the annual cost for 17% more IPF patients receiving therapy with pirfenidone or for 14% more IPF patients reaching clinical stability. Conclusions: Within the Greek healthcare environment of scarce resources and significant budget constraints, the annual cost per response rate indicates that pirfenidone constitutes a cost-saving therapeutic alternative to nintedanib for the treatment of patients with mild-to-moderate IPF and yields sufficient savings to treat and stabilize disease progression for more patients compared to its competitor. PRS17 Systematic Review On Economic Impact Of Air Pollution On Health Jaafar H1, Azzeri A2, Isahak M2, Dahlui M2 1Islamic Science University of Malaysia, KL, Malaysia, 2University of Malaya, KL, Malaysia
Objectives: The impact of the exposures to air pollution can be seen from both health and economical perspective. This review study synthesizes available
literatures that related to the financial implications of air pollution on human’s health. Methods: The databases used to find the relevance articles were PubMed, Scopus and Web of Science. Online databases were searched until April 2017. Searching strategies were done using MesH terms and identified keywords for each databases. The articles were limited to English language and journal articles only. Articles on indoor air pollution or from review papers, proceedings and reports were excluded from this review. From initial search of 2095 articles, 268 duplicate articles were removed. After reviewing titles and abstracts, 36 articles fulfilled our inclusion and exclusion criteria to be included in this review. Results: Effects of air pollution on health cause significant increased in healthcare utilization. For every increased in particulate matter 10-2.5, there were 0.3% to 3.7% increased in hospital admissions and outpatient visits due to air pollution related illnesses. The effects were more prominent in short-term, high level of particulate matter exposures. The financial implications of haze on health were measured using cost of illness (COI) and willingness to pay (WTP) approaches. It was calculated from either provider’s perspective, patient’s perspective or combination of both. The financial implication of haze on health measured using WTP was higher because it included preventing, averting, mitigating and utility loss due to illness. The ratio of monetary values of economic impact of air pollution on health calculated using WTP to COI were ranging from 1.5:1 to 9:1. Conclusions: The monetary burden due to the economic loss and increase in healthcare expenditure was very significant. We need to allocate appropriate resources to reduce air pollution level and to meet the healthcare demand associated with it. PRS18 A Cost-Of-Illness Analysis For Community Acquired Pneumonia In Greece Naoum P1, Liapikou A2, Toumbis M2, Athanasakis K1, Kyriopoulos J1 1National School of Public Health, Athens, Greece, 2Sotiria Chest Diseases Hospital, Athens, Greece
Objectives: Community acquired pneumonia (CAP) is accompanied by a high clinical and economic burden, especially when patients’ condition requires hospitalization. The purpose of the present analysis was to estimate the mean direct outpatient and inpatient cost of CAP episodes in Greece. Methods: Data were collected from the Emergency Department of the Sotiria Chest Diseases Hospital. For CAP outpatients, data on diagnostic tests, number of physician visits and medication were collected, while for inpatients, data included diagnostic tests, medication, length of hospital stay, additional tests during hospitalization and discharge instructions. Moreover, it was recorded whether patients of both groups returned for reassessment and if so, whether additional tests and medication were provided. Cost calculations were performed from a third payer perspective (direct costs only) and refer to 2016. Results: Overall, 249 patients were included in the analysis, 149 inpatients and 100 outpatients, with a mean age of 55.1 years (SD= 18.764). Mean length of hospital stay was calculated at 11.35 days (SD= 9.71). For outpatients, mean direct cost was estimated at 110.64€ (SD= 58.23) per patient, while for inpatients at 7,406.56€ (SD= 12,124.93) per patient. The main driver of the inpatient cost was hospitalisation (94.97%), followed by medication during hospitalisation (3.30%) and diagnostic tests (0.87%). For outpatients, prescribed medication represented the highest proportion of total cost (38.84%), followed by diagnostic tests (33.51%) and physician visits (17.54%). Conclusions: CAP imposes a high economic burden on the Greek healthcare system, mainly due to the cost of hospitalisation. Further investigation is required to identify the reasons of the high hospitalisation rates and duration observed in Greece, in order to improve patient management models and reduce, when possible, inpatient care, while maintaining optimum clinical outcomes. PRS19 Economic Evaluation of Multi-Drug Resistant Tuberculosis In Ghana: Patient Level Direct Cost Analysis 2013 - 2016 Davies-Teye B1, Dziedzom A2, Vanotoo L3, Eleeza J4, BonsuFa 5 1Ghana Health Service and Drifney Consult Ltd, Accra, Ghana, 2Regional TB Program, Ghana Health Services, Accra, Ghana, 3Ghana Health Services and Promise Ghana, Accra, Ghana, 4Regioal Health Directorate Ghana Health Service, Accra, Ghana, 5Ghana Health Service, National T B Program, Accra, Ghana
Objectives: In Ghana, Direct cost of Multi-Drug Resistant (MDR) TB treatment is mainly covered by public sector through Global Fund financing mechanism. This includes economic support of patients to reduce out-of-pocket payment, improve treatment uptake and adherence. In spite of this, MDR-TB patients experience several economic barriers to access healthcare. This study evaluated the direct cost of illness to the patients and determine the adequacy of economic support to inform policy in the Greater Accra Region. Methods: We conducted a census of all MDR-TB patients diagnosed in Greater Region, Ghana from January 2013December 2016. Reviewed MDR-TB laboratory and treatment registers and identified all MDR-TB client diagnosed during the period. All clients who were alive at time of study and had not been lost to follow up participated in the study. We interviewed participants using digitized structured questionnaire on TBcare mobile app. Data abstracted include demographic, occupation, monthly income, cost of transportation, feeding, consultation, diagnosis, hospitalization, food supplement, medication or treatment and accommodation (if client lost it due to illness). We also abstracted data of direct financial support received from Global fund through Health facility. Data was managed in EPI info 7 to determine per capita direct cost and estimated total direct cost saving to patients. Results: Cumulative incidence MDR-TB was 1.4/100,000 with 14.5 percent Case fatality and 16.4 percent lost to follow up. Age ranged 18-58 years with mean 38.6±10.2 and 77.8 percent males. Monthly Income ranged 0.00-1162.80 USD with mean 168.10 USD Direct cost of illness ranged 300.50 – 16,130.20 USD with per capita direct cost of illness 2,202.60 USD which constitutes 109.2 percent of client’s annual income. Total Direct cost saving to patients 121,144.50 USD Conclusions: In spite of Global fund economic support, direct cost of illness to MDR-TB patients in the region is still high, constituting 109% of annual income.