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Follow-Up Analysis Of Validity Of Bia For Drugs Temporarily Reimbursed In Mode Of Coverage With Evidence Development
A482
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6
2010-2014. The rate of completed visits amounted to 60% regarding specialized care and 40 % to physiotherapy services. Within physiotherapy services, physiotherapy showed the highest incidence with the number of visits between 390092 and 483654. This represents approximately 85% frequency each year opposite to electrotherapy and speech therapy. Conclusions: The issue of specialized home care is inevitable in the health care system in our country. Its demand is constantly increasing. The number of physiotherapy rounds gives reason to reconsider financing and requires more support for the elaboration of physiotherapy services. PHP240 Follow-Up Analysis Of Validity Of Bia For Drugs Temporarily Reimbursed In Mode Of Coverage With Evidence Development Zizalova J, Rrahmaniova D, Svorcikova J, Vrubel F Ambruz & Dark Deloitte Legal, Prague 8, Czech Republic
Objectives: BIA is a mandatory requirement for setting the reimbursement for highly innovative drugs (HID) obtaining the coverage with evidence development (CED).Our previous analysis of HID which obtained CED in 2013 showed no match between the drug costs expected in BIA and the real costs.We analyzed whether the administrative procedures in 2014 constituted an improvement of the estimation. Methods: Eleven HIDs obtaining CED in 2013 (scope of previous analysis) were re-analyzed.Real costs were extrapolated from data of General Health Insurance Company (VZP) which holds 60% of health insurance market.The real costs of second year of therapy were compared to the relevant figure in BIA included in first submission for CED.Due to temporary nature of CED, five new procedures were held and their actualized BIAs were analyzed. Furthermore, BIAs and real costs of five new HIDs obtaining CED in 2014 were examined.Potential improvement of difference between estimated and real drug costs was investigated. Results: The estimation for second year of therapy costs was more accurate.However, the extent of differences between the estimation and real costs -86% to 272% was still observed. Only in one case the estimation for the relevant year of therapy in actualized BIA was less accurate than in the original BIA. Concerning CED from 2014, the estimated costs were dramatically exceeded in two cases (185% and 412%). In two cases real costs did not achieve the estimation (-61% and -68%).Nearly exact estimation was submitted once. Conclusions: The follow-up analysis confirmed the previous conclusion that no improvement of estimation can be expected while mandatory BIA undergoes no further review,however real world consumption data slightly improve the quality of estimation.Also the analysis of CED from 2014 showed no improvement of BIA validity caused by experience.It seems that as long as no practical impact of BIA is enforced (by payers), only formal requirement fulfilling BIAs will be produced. PHP241 Health Insurance-Related Aspects Of Home-Based Parenteral Nutrition In Hungary Gresz
M1, Endrei
D2, Csákvári T3, Danku
N2, Sebestyén A4, Horváth
L2, Boncz I2
1National
Healthcare Service Center, Budapest, Hungary, 2University of Pécs, Pécs, Hungary, of Pécs, Zalaegerszeg, Hungary, 4National Health Insurance Fund Administration, Pécs, Hungary 3University
Objectives: In Hungary, home-based parenteral nutrition has been financed by the social insurance system since January 2013. Our objective was to analyse the system of financing home-based parenteral nutrition. Methods: Data used in our analysis were taken from the financing database of the National Health Insurance Fund Administration. Period analysed included years between 2013-2015. Patients receiving home-based parenteral nutrition were assigned a code ’OENO 88744’ of International Classification of Procedures in Medicine. Results: According to the database of the National Health Insurance Fund Administration, reimbursement was given to 53 patients since January 2013, on the basis of home-based parenteral nutrition. Thirteen patients were under 18, the oldest was 73 years old. Twenty-one organisational units from 14 institutions reported cases of home-based parenteral nutrition. Szent György Hospital of Fejér County, Szent Imre Hospital from Budapest and Semmelweis University reported 76% of the patients and 78% of the days on parenteral nutrition. Twenty-two of the patients on home-based parenteral nutrition received a Hickman catheter and 18 were inserted a central venous line. Mean reimbursed nutrition units per patient were 25/month. Out of 9736 nutrition units, 6 patients were reported to receive more than two units daily ( 490 nutrition units in total). Thirty-two of the patients on home-based parenteral nutrition were reported to have had resection of the small intestine, 11 required an ileo- or jejunostoma, and 12 had undergone small intestine surgery. The most common main diagnosis was bowel insufficiency caused by Type 1 short bowel syndrome in 46% of the cases. Conclusions: As the data suggest, current patient numbers in Hungary are significantly lower from what had been procrastinated to be around 100-150 according to population size by international statistics. After the possibilities of reimbursement were created, the patients received planned parenteral nutrition. PHP242 Optimising Adverts And Campaigns For Efficient And Cost-Effective Patient Recruitment Using Social Media Wade AG, Crawford GM, McLennan K Patients Direct, Glasgow, UK
Objectives: To improve cost-effective patient recruitment via social media for online medical surveys. Methods: Recruiting patients from social media channels into online medical questionnaires is increasingly common. For every patient completing successfully, many others have failed to engage with the advert or finish the questionnaire. For recruitment to be both successful and cost effective the ratio of those completing to those lost during the process must be maximised. In a social media recruitment campaign for a pain relief gel study we used analytics to record throughput of potential candidates at every stage of the process. At bottlenecks we put a series of A/B tests in place and continuously measured the impact of changes to wording, images and calls to action to throughput at those points. Results: We
identified the key points in the patients’ journey where significant losses occurred: advert click through, landing page click through and questionnaire completion. By using A/B testing at these points we were able to improve the landing page conversion rate from 40% to 55% and the completion rate from 45% to 75% over a 7 week period. Conclusions: Cost-effective recruitment to medical surveys via social media requires ongoing monitoring and adjustment of adverts, landing pages and questionnaires (i.e. continuous A/B testing). These changes cannot be anticipated in advance and require experimentation. Ethical review committees should be aware of this requirement and the need to make small adjustments to adverts etc., without an additional consultation process. Alternatively, flexibility may be built into adverts and surveys submitted to Ethical review committees for approval in the form of options for images, headings and text that may be combined as necessary. PHP243 Trend Of Pharmacoeconomics And Health Outcome Studies In Turkey Kockaya G1, Yenilmez FB2, Tuna E3 Economics and Policy Association, Ankara, Turkey, 2Hacettepe University, Ankara, Turkey, 3Polar Health Economics and Policy Consultancy, Ankara, Turkey
1Health
Objectives: Health Transformation Program changed all health policies in Turkey. As an example, reimbursement of pharmaceuticals, medical devices or health services were defined first time with the program. The new implementations might have an impact on pharmacoeconomics and health outcomes studies in Turkey. The aim of the study is to evaluate the trend of pharmacoeconomics and health outcome studies which are specific for Turkey in years. Methods: Database of ISPOR Outcome Research Digest were searched online from the begining of database 1998 to 2015 with the key words “Turkey”. The inclusion criteria were taken as study must be specific for Turkey. Included abstract evaluated for increasing in years, distribution in study topics and diseases areas. Results: 282 abstracts were matched with inclusion criteria. First posters were published in 2000. There was an increasing trend for the publications in each years. There were 7, 56 and 219 published posters between 2000 to 2005, 2006 to 2010 and 2011 to 2015, respectively. Majority of studies were published in 2015 with 64 posters. Cost Studies(CS) were the main focus of studies. It was followed by Health Care Use & Policy Studies(HP). Conclusions: Pharmacoeconomics and health outcome studies are increasing from year to year in Turkey. Main reason for the increasing trend may the implementation of Health Transformation Program. However, it is needed to evaluate the real reason of increasing trend with detailed analysis. PHP244 Cost Minimisation Analysis: When And Where? A Review Of Hta Guidance On Cost Minimisation Analysis Hirst A, Vlachaki I, Shephard C, Wang-Silvanto J WG Access Ltd, London, UK
Objectives: Cost minimisation analysis (CMA) is a form of economic evaluation advocated in cases where products have equal efficacy. Whilst there is consensus on this point, the criteria for establishing equal efficacy varies by source. Additionally, the availability of guidelines on the acceptability of CMA is not always available from HTA bodies. This study reviewed HTA guidelines to determine: 1) if guidelines on the use of CMA are available; and 2) how consistent requirements are between HTA bodies. Methods: Searches of 10 HTA body websites were undertaken. The following terms were applied: ‘cost-minimisation’ or ‘cost minimisation’ or ‘costminimization’ or ‘cost minimization’. Additionally, available guidelines on HTA methods were reviewed. Results were hand searched to identify those reporting methods for CMA. Where guidelines was reported the definition of equal efficacy was extracted. Results: Of the 10 HTA websites reviewed seven had readily accessible details on CMA. In two instances this was simply a definition of CMA whilst the remaining five provided details of where CMA is considered an appropriate methodology. Of these there were two common definitions, those that focused purely on clinical efficacy and those that broadened the definition to include patient outcomes in addition to clinical outcomes. Only the guidelines published by PBAC in Australia reported detailed criteria for meeting clinical equivalence. Conclusions: This review aimed to identify availability of guidelines on CMA methodology. Three bodies did not report any information, although in the case of some this may be driven by the nature of the products assessed. Where details were given there was a lack of consistency in the criteria for CMA, with the issue of whether only considering clinical efficacy or also incorporating broader patient outcomes needing consistency. Finally, the exact criteria for equivalence were only stated by PBAC. PHP245 Cost-Efficiency Of Clinical Pharmacy Services At Ministry Of Health In Saudi Arabia Application Of American Model Alomi YA Ministry of Health, Riyadh, Saudi Arabia
Objectives: Clinical Pharmacy services at King Saud Medical City (KSMC) were the first founded by Ministry of Health; it covers more than 1400 beds. The aim of this study was to estimate cost-efficiency of clinical pharmacy services in Saudi Arabia used American model of cost avoidance. Methods: Simulation including all 5- month of providing clinical pharmacy services for adults organized by local drug information center at KSMC. Ten Clinical Pharmacist and expert trained pharmacist-provided clinical pharmacy services. All pharmacists should document the clinical pharmacy activities on a monthly basis; the clinical activities consisted of Central Clinical Pharmacy Activities domain, Patient-Specific Clinical Pharmacy Activities, Administration-Specific Clinical Pharmacy Activities domain, and some activities and time spent. The author calculated the estimated cost avoidance by using International Study Model (Kinky et al., Ann Pharmacother 1999), expressed in USD, the cost considered were the expected results of drug-related problems sequel of drug information inquiries and pharmacist intervention. Results: The total net estimated cost avoidance from all clinical services (17,554,931.46 USD).
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6
2010-2014. The rate of completed visits amounted to 60% regarding specialized care and 40 % to physiotherapy services. Within physiotherapy services, physiotherapy showed the highest incidence with the number of visits between 390092 and 483654. This represents approximately 85% frequency each year opposite to electrotherapy and speech therapy. Conclusions: The issue of specialized home care is inevitable in the health care system in our country. Its demand is constantly increasing. The number of physiotherapy rounds gives reason to reconsider financing and requires more support for the elaboration of physiotherapy services. PHP240 Follow-Up Analysis Of Validity Of Bia For Drugs Temporarily Reimbursed In Mode Of Coverage With Evidence Development Zizalova J, Rrahmaniova D, Svorcikova J, Vrubel F Ambruz & Dark Deloitte Legal, Prague 8, Czech Republic
Objectives: BIA is a mandatory requirement for setting the reimbursement for highly innovative drugs (HID) obtaining the coverage with evidence development (CED).Our previous analysis of HID which obtained CED in 2013 showed no match between the drug costs expected in BIA and the real costs.We analyzed whether the administrative procedures in 2014 constituted an improvement of the estimation. Methods: Eleven HIDs obtaining CED in 2013 (scope of previous analysis) were re-analyzed.Real costs were extrapolated from data of General Health Insurance Company (VZP) which holds 60% of health insurance market.The real costs of second year of therapy were compared to the relevant figure in BIA included in first submission for CED.Due to temporary nature of CED, five new procedures were held and their actualized BIAs were analyzed. Furthermore, BIAs and real costs of five new HIDs obtaining CED in 2014 were examined.Potential improvement of difference between estimated and real drug costs was investigated. Results: The estimation for second year of therapy costs was more accurate.However, the extent of differences between the estimation and real costs -86% to 272% was still observed. Only in one case the estimation for the relevant year of therapy in actualized BIA was less accurate than in the original BIA. Concerning CED from 2014, the estimated costs were dramatically exceeded in two cases (185% and 412%). In two cases real costs did not achieve the estimation (-61% and -68%).Nearly exact estimation was submitted once. Conclusions: The follow-up analysis confirmed the previous conclusion that no improvement of estimation can be expected while mandatory BIA undergoes no further review,however real world consumption data slightly improve the quality of estimation.Also the analysis of CED from 2014 showed no improvement of BIA validity caused by experience.It seems that as long as no practical impact of BIA is enforced (by payers), only formal requirement fulfilling BIAs will be produced. PHP241 Health Insurance-Related Aspects Of Home-Based Parenteral Nutrition In Hungary Gresz
M1, Endrei
D2, Csákvári T3, Danku
N2, Sebestyén A4, Horváth
L2, Boncz I2
1National
Healthcare Service Center, Budapest, Hungary, 2University of Pécs, Pécs, Hungary, of Pécs, Zalaegerszeg, Hungary, 4National Health Insurance Fund Administration, Pécs, Hungary 3University
Objectives: In Hungary, home-based parenteral nutrition has been financed by the social insurance system since January 2013. Our objective was to analyse the system of financing home-based parenteral nutrition. Methods: Data used in our analysis were taken from the financing database of the National Health Insurance Fund Administration. Period analysed included years between 2013-2015. Patients receiving home-based parenteral nutrition were assigned a code ’OENO 88744’ of International Classification of Procedures in Medicine. Results: According to the database of the National Health Insurance Fund Administration, reimbursement was given to 53 patients since January 2013, on the basis of home-based parenteral nutrition. Thirteen patients were under 18, the oldest was 73 years old. Twenty-one organisational units from 14 institutions reported cases of home-based parenteral nutrition. Szent György Hospital of Fejér County, Szent Imre Hospital from Budapest and Semmelweis University reported 76% of the patients and 78% of the days on parenteral nutrition. Twenty-two of the patients on home-based parenteral nutrition received a Hickman catheter and 18 were inserted a central venous line. Mean reimbursed nutrition units per patient were 25/month. Out of 9736 nutrition units, 6 patients were reported to receive more than two units daily ( 490 nutrition units in total). Thirty-two of the patients on home-based parenteral nutrition were reported to have had resection of the small intestine, 11 required an ileo- or jejunostoma, and 12 had undergone small intestine surgery. The most common main diagnosis was bowel insufficiency caused by Type 1 short bowel syndrome in 46% of the cases. Conclusions: As the data suggest, current patient numbers in Hungary are significantly lower from what had been procrastinated to be around 100-150 according to population size by international statistics. After the possibilities of reimbursement were created, the patients received planned parenteral nutrition. PHP242 Optimising Adverts And Campaigns For Efficient And Cost-Effective Patient Recruitment Using Social Media Wade AG, Crawford GM, McLennan K Patients Direct, Glasgow, UK
Objectives: To improve cost-effective patient recruitment via social media for online medical surveys. Methods: Recruiting patients from social media channels into online medical questionnaires is increasingly common. For every patient completing successfully, many others have failed to engage with the advert or finish the questionnaire. For recruitment to be both successful and cost effective the ratio of those completing to those lost during the process must be maximised. In a social media recruitment campaign for a pain relief gel study we used analytics to record throughput of potential candidates at every stage of the process. At bottlenecks we put a series of A/B tests in place and continuously measured the impact of changes to wording, images and calls to action to throughput at those points. Results: We
identified the key points in the patients’ journey where significant losses occurred: advert click through, landing page click through and questionnaire completion. By using A/B testing at these points we were able to improve the landing page conversion rate from 40% to 55% and the completion rate from 45% to 75% over a 7 week period. Conclusions: Cost-effective recruitment to medical surveys via social media requires ongoing monitoring and adjustment of adverts, landing pages and questionnaires (i.e. continuous A/B testing). These changes cannot be anticipated in advance and require experimentation. Ethical review committees should be aware of this requirement and the need to make small adjustments to adverts etc., without an additional consultation process. Alternatively, flexibility may be built into adverts and surveys submitted to Ethical review committees for approval in the form of options for images, headings and text that may be combined as necessary. PHP243 Trend Of Pharmacoeconomics And Health Outcome Studies In Turkey Kockaya G1, Yenilmez FB2, Tuna E3 Economics and Policy Association, Ankara, Turkey, 2Hacettepe University, Ankara, Turkey, 3Polar Health Economics and Policy Consultancy, Ankara, Turkey
1Health
Objectives: Health Transformation Program changed all health policies in Turkey. As an example, reimbursement of pharmaceuticals, medical devices or health services were defined first time with the program. The new implementations might have an impact on pharmacoeconomics and health outcomes studies in Turkey. The aim of the study is to evaluate the trend of pharmacoeconomics and health outcome studies which are specific for Turkey in years. Methods: Database of ISPOR Outcome Research Digest were searched online from the begining of database 1998 to 2015 with the key words “Turkey”. The inclusion criteria were taken as study must be specific for Turkey. Included abstract evaluated for increasing in years, distribution in study topics and diseases areas. Results: 282 abstracts were matched with inclusion criteria. First posters were published in 2000. There was an increasing trend for the publications in each years. There were 7, 56 and 219 published posters between 2000 to 2005, 2006 to 2010 and 2011 to 2015, respectively. Majority of studies were published in 2015 with 64 posters. Cost Studies(CS) were the main focus of studies. It was followed by Health Care Use & Policy Studies(HP). Conclusions: Pharmacoeconomics and health outcome studies are increasing from year to year in Turkey. Main reason for the increasing trend may the implementation of Health Transformation Program. However, it is needed to evaluate the real reason of increasing trend with detailed analysis. PHP244 Cost Minimisation Analysis: When And Where? A Review Of Hta Guidance On Cost Minimisation Analysis Hirst A, Vlachaki I, Shephard C, Wang-Silvanto J WG Access Ltd, London, UK
Objectives: Cost minimisation analysis (CMA) is a form of economic evaluation advocated in cases where products have equal efficacy. Whilst there is consensus on this point, the criteria for establishing equal efficacy varies by source. Additionally, the availability of guidelines on the acceptability of CMA is not always available from HTA bodies. This study reviewed HTA guidelines to determine: 1) if guidelines on the use of CMA are available; and 2) how consistent requirements are between HTA bodies. Methods: Searches of 10 HTA body websites were undertaken. The following terms were applied: ‘cost-minimisation’ or ‘cost minimisation’ or ‘costminimization’ or ‘cost minimization’. Additionally, available guidelines on HTA methods were reviewed. Results were hand searched to identify those reporting methods for CMA. Where guidelines was reported the definition of equal efficacy was extracted. Results: Of the 10 HTA websites reviewed seven had readily accessible details on CMA. In two instances this was simply a definition of CMA whilst the remaining five provided details of where CMA is considered an appropriate methodology. Of these there were two common definitions, those that focused purely on clinical efficacy and those that broadened the definition to include patient outcomes in addition to clinical outcomes. Only the guidelines published by PBAC in Australia reported detailed criteria for meeting clinical equivalence. Conclusions: This review aimed to identify availability of guidelines on CMA methodology. Three bodies did not report any information, although in the case of some this may be driven by the nature of the products assessed. Where details were given there was a lack of consistency in the criteria for CMA, with the issue of whether only considering clinical efficacy or also incorporating broader patient outcomes needing consistency. Finally, the exact criteria for equivalence were only stated by PBAC. PHP245 Cost-Efficiency Of Clinical Pharmacy Services At Ministry Of Health In Saudi Arabia Application Of American Model Alomi YA Ministry of Health, Riyadh, Saudi Arabia
Objectives: Clinical Pharmacy services at King Saud Medical City (KSMC) were the first founded by Ministry of Health; it covers more than 1400 beds. The aim of this study was to estimate cost-efficiency of clinical pharmacy services in Saudi Arabia used American model of cost avoidance. Methods: Simulation including all 5- month of providing clinical pharmacy services for adults organized by local drug information center at KSMC. Ten Clinical Pharmacist and expert trained pharmacist-provided clinical pharmacy services. All pharmacists should document the clinical pharmacy activities on a monthly basis; the clinical activities consisted of Central Clinical Pharmacy Activities domain, Patient-Specific Clinical Pharmacy Activities, Administration-Specific Clinical Pharmacy Activities domain, and some activities and time spent. The author calculated the estimated cost avoidance by using International Study Model (Kinky et al., Ann Pharmacother 1999), expressed in USD, the cost considered were the expected results of drug-related problems sequel of drug information inquiries and pharmacist intervention. Results: The total net estimated cost avoidance from all clinical services (17,554,931.46 USD).