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PAD of 11,137€ .  Conclusions: The total annual healthcare cost for patients presenting with PAD is nearly 4 times higher compared to controls without PAD. A more intensive medical prevention is necessary to control and decrease this high cost. PCV49 The Economic Value of Rapid Deployment Aortic Valve Replacement Via Full Sternotomy Moore M1, Barnhart GR2, Chitwood WRJr 3, Rizzo JA4, Gunnarsson C5, Palli SR6, Grossi EA7 Lifesciences, Inc., Irvine, NC, USA, 2Swedish Medical Center, Seattle, NC, USA, 3East Carolina University, Greenville, NC, USA, 4Stony Brook University, Stony Brook, NC, USA, 5CTI Clinical Trial and Consulting Services, Cincinnati, OH, USA, 6CTI Clinical Trial and Consulting Services, Cincinnati, NC, USA, 7NYU Langone Medical Center, New York, NY, USA .

1Edwards

Objectives: The EDWARDS INTUITY Elite™ (EIE) valve system for rapid-deployment aortic valve replacement (RDAVR) has been shown to confer clinical benefits compared to conventional full sternotomy (FS) AVR. In order to understand its economic value, this study performed a cost evaluation of the EIE valve system used in a FS rapid-deployment approach (EIE-FS-RDAVR) versus FS-AVR with a conventional stented bio-prosthesis.  Methods: A simulation model was developed using TreeAge (and validated with MS Excel) to compare the inpatient utilization and complication costs for each treatment arm. 30-day clinical endpoints (mortality and complications) for the EIE-FS-RDAVR arm were taken from the subset of TRANSFORM trial patients undergoing isolated EIE-FS-RDAVR. For the comparator arm, a best evidence review of the published literature was undertaken, studies were pooled and parameters weighted by sample size. Baseline characteristics of the pooled studies were similarly weighed to evaluate the two treatment groups. Complication and utilization cost data (2016 USD) were taken from the Premier hospital database and published literature, respectively. Cost differences were assessed and one-way (±25%) and probabilistic sensitivity analyses performed on costs to gauge the robustness of the results.  Results: EIE-FS-RDAVR cost $800 less than FS-AVR with the difference attributable to lower complication rates (e.g., reoperation, sternal wound infection, stroke, and endocarditis) and utilization (e.g., cross-clamp and operating room times, and length of stay [LOS]). Combined with the lower mortality, EIE-FS-RDAVR was found to be a superior (dominant) technology relative to FS-AVR. One-way sensitivity analysis found these results to be robust. The results were most sensitive to LOS and/or costs and the EIE valve cost. In the probabilistic sensitivity analysis, cost savings were achieved in 50.3% of the 10,000 simulations.  Conclusions: EIE-FS-RDAVR confers superior economic value compared to conventional FS-AVR via reduced key complication and mortality rates and resource utilization. PCV50 Cost-Analysis of Heart Valve Implantations, Complications and Follow-UP Based on National Health Insurers Claims Data in The Netherlands Huygens SA1, van Erkelens JA2, Takkenberg JJ1, Rutten-van Mölken MP3 1Erasmus Medical Centre, Rotterdam, The Netherlands, 2Vektis, Zeist, The Netherlands, 3Erasmus University Rotterdam, Rotterdam, The Netherlands

Objectives: To provide real-world estimates of costs of heart valve implantations, complications and other healthcare during three post-intervention years.  Methods: We performed retrospective analyses of healthcare costs of patients that underwent heart valve implantations in 2010-2013 using claims data from health insurers (covering 99% of the Dutch citizens). Patients were selected using Diagnosis Related Group-codes and were followed from time of intervention until 31-12-2013. Costs of heart valve implantations, complications, and other types of healthcare (general practitioners, pharmaceuticals, home care, nursing homes, etcetera) were determined. To calculate the excess healthcare costs due to the heart valve implantation, we compared total healthcare costs of patients with total healthcare costs of a random sample of the Dutch population stratified by age, gender, socio-economic status, and co-morbidities. To address uncertainty, we applied non-parametric bootstrapping (2000 replicates).  Results: The 18,903 patients (17,991 underwent surgical valve replacement (SVR) and 912 transcatheter valve implantation (TVI)) and the 188,925 controls had comparable baseline characteristics. The mean procedure costs (excluding complications) were € 18,000 (95% confidence interval(CI):17,936-18,063) for SVR and € 27,841(CI:27,643-28,042) for TVI. The total healthcare costs of patients (SVR) were significantly higher than in the control sample, particularly in the year of implantation (difference year 1= € 35,667(CI:35,207-36,142); year 2= € 1,506(CI:1,174-1,852); year 3= € 1,155(CI:7431,629)). Costs were significantly higher for patients compared to controls in most types of healthcare, but costs were significantly lower for home care in year 2 and nursing homes (year 1-3).  Conclusions: After a heart valve implantation, patients have significantly higher healthcare costs compared to those in the control sample, particularly in the year of implantation. In the following years, survival of the fittest patients and lower complications rates may explain the decrease in higher costs of patients. The significantly lower costs of patients for home care and nursing homes may be due to selection of relatively healthy elderly to undergo open-heart surgery. PCV51 Systematic Review of Cost Effectiveness Analysis of Ivabradine in Heart Failure

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and exclusion criteria. The data related to economic model, cost, quality-adjusted life years (QALYs), lost years (LYs), horizon time of study and incremental costeffectiveness ratio (ICER) was extracted. The currency was converted to US$ using purchasing power parities exchange rate.  Results: A total of 51 articles were found in primary search, of which 3 studies were met our criteria. The economic model, which applied in all of them was Markov model. The cost effectiveness of standard care with and without Ivabradine were evaluated. The clinical outcomes of these studies were hospitalization rate, adverse effect and mortality rate that have been considered in the Markov model.The medical costs have been calculated in the studies. Furthermore, the time horizon of studies were 10-year and over patient’s lifetime. The incremental QALYs, LYs and cost because of adding Ibavradine to standard care had a range of 0.18 to 0.28, 0.14 to 0.25 and -8594 to 4913 dollars. In addition, the maximum amount of ICER was 24920 dollars per QALY. All ICERs were lower than the threshold.  Conclusions: Ivabradine added to standard treatment could be regarded as a cost effective option for heart failure therapy. PCV52 The Economic Burden of Heart Failure in Latin America Stevens B, Verdian L, Pezzullo L, Tomlinson J, Lui V Deloitte Access Economics, Sydney, Australia

Objectives: The economic burden of heart failure (HF) in the Latin American region has not been previously quantified. This research assessed the economic burden of HF in Brazil, Chile, Colombia, Ecuador, El Salvador, Mexico, Panama, Peru, Venezuela, and the cost effectiveness (CE) of structured telephone support (STS) and telemedicine (TM) for the treatment of HF.  Methods: To estimate the cost of HF by country, a prevalence approach was used. Costs were estimated for the year 2015 and included health system expenditures, productivity losses (absenteeism, lower workforce participation, premature mortality) and informal care costs, and deadweight losses associated with government expenditures. Data inputs for costs, including prevalence and mortality were based on secondary data sources informed by a targeted literature review including country specific grey literature and data bases. The study also appraised the value of the loss of healthy life, measured in disability adjusted life years (DALYs), using global burden of disease disability weights. All inputs were triangulated using semi-structured interviews with clinicians, insurers and health administrators. The CE of TM and STS relative to usual care was assessed using a Markov model consisting of two permanent and two temporary health states.  Results: HF affected approximately 6.5 million people (2.0% of the adult population) in the nine countries in 2015 leading to significant wellbeing loss, estimated at 1.0 million DALYs, and economic burden, estimated at USD10.7 billion in 2015. The CE analysis suggested TM and STS are both cost effective treatment options for the management of patients with HF.  Conclusions: HF imposes a significant burden to the health system and society in Latin America. Prevention and appropriate management of HF would result in substantial wellbeing benefits and economic savings. TM and STS are two potential cost effective interventions which can lead to improvements in the management of HF. PCV53 Assessing The Economic Burden of Heart Failure in Korea: Incremental Cost Approach Oh S, Cho H, Lee H, Kang H College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea

Objectives: Heart failure (HF) is a major cause of morbidity and mortality. With the aging of the Korean population, the prevalence of HF is increasing, thereby increasing the economic burden. This study aimed to assess the economic impact of HF from the restricted societal perspective. Methods: A prevalence-based, case-controlled, cost-of-illness study was performed to estimate the incremental costs for adult HF patients as compared to those without HF. We defined adult HF patients as those aged 19 years or above who had at least one insurance claim record of outpatient or inpatient services with a primary or a secondary diagnosis of HF (ICD-10 codes of I11.0, I13.0, I13.2, I50.x) from the 2014 Health Insurance Review and Assessment Service-National Patients Sample (HIRA-NPS) claims data. Costs included medical costs for insurance-covered and non-covered services, transportation costs and time costs of patients and caregivers.  Results: The average annual per-capita cost was estimated to be 7.9 million Korean won (KW, 1 US dollar approximately equals to 1,100 KW), 2.3 million KW, and 4.6 million KW for HF patients (n= 14,252 patients), non-matched controls (n= 1,116,882), and matched controls (n=  57,008), respectively. The incremental cost per case of HF as compared to matched control was 3.3 million KW, which is about 1.7 times higher. For HF patients, medical costs accounted for the largest portion of the total cost (75.13%), followed by caregivers’ cost (12.05%), patient’s productivity loss costs due to morbidity (7.21%), and transportation costs (5.61%).  Conclusions: This study shows that HF brings substantial burden to individual patients. It appears to be necessary to set a priority of allocating health care resources to prevent and to treat HF in our society. PCV54 For Estimating Costs in Patients Experiencing Cardiovascular Events Using Utilization Data From The United Kingdom

Dehghani M, Varmaghani M, Sharifi F Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of)

Danese M1, Gleeson M1, Kutikova L2, Griffiths R1, Azough A3 Insights - Epidemiology & Health Economics, Westlake Village, CA, USA, 2Amgen (Europe) GmbH, Zug, Switzerland, 3Amgen Ltd, Uxbridge, UK

Objectives: Ivabradine is a specific heart rate lowering agent that could reduce hospitalization and mortality rate due to heart failure (HF). The purpose of this study is systematically reviewing the published literature on the economic analysis of Ivabradine therapy for HF and summarizing the data of cost effectiveness analysis of this treatment.  Methods: A systematic literature review was conducted according to search strategy that included keywords related to “heart failure”, “Ivabradine” and “economic analysis” in the PubMed, Scopus and Web of Science databases. Two researchers separately selected the final articles according to the inclusion

Objectives: To implement methods for estimating direct medical costs from utilization data in the United Kingdom (UK).  Methods: We used 2006-2012 Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) inpatient hospital data to identify individuals with their first cardiovascular (CV)-related hospitalizations for myocardial infarction, ischemic stroke, heart failure, transient ischemic attack, unstable angina, and revascularization. We estimated the direct medical costs of hospitalizations, drugs, general practitioner (GP) visits, and referrals during the first 6-months (acute) and the subsequent 30-months (long-term)

1Outcomes

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after the first CV event. Hospitalization costs were estimated using the 2013/2014 HRG Reference Costs Grouper software, processed with R (version 3.2.2). Drug costs were abstracted from NHS Drug Tariff lists and applied to anti-hypertensive, antithrombotic, anti-diabetic, and anti-hyperlipidemic drugs at the level of the drug and dose, multiplying the cost per dose unit by the quantity provided. GP visits were categorized as clinic, surgery, or telephone and costed using Personal Social Services Research Unit 2014 unit costs. Referrals were mapped to the closest specialist visit cost from NHS Reference Costs. Challenges included handling deprecated inpatient diagnosis codes, mapping text-based drug name fields between the cost and the prescription data, categorizing physician visits, and applying a hierarchy for CV event classification.  Results: We estimated costs for 24,093 patients. We costed 94,304 hospitalizations, 1,380,858 GP visits, 71,204 referral visits, and 2,571,243 prescription fills representing 855 unique drug and dose combinations. Mapping and categorization challenges were reconciled by a panel of clinicians. The mean acute period and mean annualized long-term period costs (2014 £) were £4060 and £1433 for hospitalizations, £436 and £619 for GP and referral visits, and £98 and £208 for drugs.  Conclusions: Detailed costing using utilization data is feasible and representative of UK clinical practice, but is labor intensive. The economic burden of cardiovascular disease is substantial. PCV55 The Direct Cost Components in Heart Failure with Reduced Ejection Fraction (HF-REF) in Turkey: The Results of A Delphi Panel Aras D1, Aydogdu S1, Bozkurt E2, Cavusoglu Y3, Eren M4, Erol E5, Gulec S5, Sarioz F6, Ongen Z7, Ozdemir O8, Tokgozoglu L9, Yeter E2, Yilmaz MB10 1Karabuk University Faculty of Medicine, Zonguldak, Turkey, 2Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey, 3Eskisehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey, 4Siyami Ersek Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey, 5Ankara University Faculty of Medicine, Ankara, Turkey, 6Novartis, İstanbul, Turkey, 7Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey, 8Yorum Consulting Ltd., Istanbul, Turkey, 9Hacettepe University Faculty of Medicine, Ankara, Turkey, 10Cumhuriyet University Faculty of Medicine, Sivas, Turkey

Objectives: The aim of the present study was to analyze the health-related direct cost components in HF-rEF in Turkey.  Methods: A two-round Delphi process to get the opinions of local experts (eleven cardiologists who were experienced in HF), was performed. A questionnaire with items to collect the opinions of the panelists on all cost components, including medications, surgical treatment, hospitalization and out-patient follow-up procedures were developed under supervision of one of the experts (ZÖ). End-of-2015 local prices released by Ministry of Health and Social Security Institution in Turkey were used as references. End of 2015 Euro/TL currency rate (3.065 TL/Euro) was used.  Results: Approximately 32% of average HF patients is assumed to be hospitalized 1.64 times a year, for an average of 6.77 days each time. When patients with HF-rEF are considered, annual rate of hospital stays per patient is 0.70, with an average length-of-stay of 4.58 days per year. The 39.1% of the patients, who are hospitalized at least once a year, stay at first at CCU, then are transferred to internal medicine ward. The remaining 60.9% are hospitalized directly at internal medicine ward. Estimated total annual costs of HF-rEF is calculated as 698 Euro. Main cost driver is the cost of hospital stays (476 Euro/year; 68% of the total). The estimated cost of a single hospital stay is 323 Euro and the cost of a single day of hospital stay is 115 Euro.  Conclusions: This cost analysis confirmed that costs related with hospitalization makes the major part of total direct cost in HF-rEF. Therefore, if the disease is managed better on out-patient basis, it might be assumed that need for hospitalization will be decreased. Accordingly reducing the rate and/or length of hospitalizations, will lower the cost of disease in HF-rEF. PCV56 The Economic Burden of Myocardial Infarction in Latin America Stevens B, Verdian L, Pezzullo L, Tomlinson J, Nugent J Deloitte Access Economics, Sydney, Australia

Objectives: The economic burden of myocardial infarction (MI) in the Latin American region has not been previously quantified. This research assessed the economic burden of MI in Brazil, Chile, Colombia, Ecuador, El  Salvador, Mexico, Panama, Peru, Venezuela.  Methods: To estimate the cost of MI by country, an incidence approach was used. Costs were estimated for the year 2015 and included health system expenditures, productivity losses (absenteeism, lower workforce participation, premature mortality) and informal care costs, and deadweight losses associated with government expenditures. Data inputs for costs, including prevalence and incidence, were based on secondary data sources informed by a targeted literature review including country specific grey literature and databases. The study also appraised the value of the loss of healthy life, measured in disability adjusted life years (DALYs), using global burden of disease disability weights. All inputs were triangulated using semi-structured interviews with clinicians, insurers and health administrators.  Results: MI was found to affect approximately 756,492 people (0.2% of the adult population, average of 64.2 years old) in selected Latin American countries in 2015 leading to significant wellbeing loss, estimated at 2.6 million DALYs, and economic burden, estimated at USD12.6 billion in 2015. Health system expenditures accounted for USD8.2 billion (65%) and productivity costs USD4.4billion (35%) of the total financial burden of MI. On average, health system expenditure represented 0.17% of total gross domestic product (GDP) across the nine countries with Brazil (0.29%), Colombia (0.28%) and El Salvador (0.30%) spending more than the average. Total financial costs averaged 0.28% of GDP.  Conclusions: MI imposes a significant burden to the health system and society in Latin America. Health system expenditure accounts for the majority of the burden of MI in the region. Prevention and appropriate management of MI may result in substantial wellbeing benefits and economic savings. PCV57 The Direct Cost-Components in Pulmonary Arterial Hypertension: An Expert Panel Approach for Estimation of Costs

Mogulkoc N1, Okumus G2, Yildizeli B3, Kaymaz C4, Nalbantgil S1, Ozdemir O5, Erdal E6, Sar C6 1Ege University Faculty of Medicine, Izmir, Turkey, 2Istanbul University Faculty of Medicine, Istanbul, Turkey, 3Marmara University Faculty of Medicine, Istanbul, Turkey, 4Kosuyolu Training and Research Hospital, Istanbul, Turkey, 5Yorum Consulting Ltd., Istanbul, Turkey, 6Bayer Turk Kimya San. Ltd. Sti., Istanbul, Turkey

Objectives: To estimate the direct cost components of pulmonary arterial hypertension (PAH) in a Turkish setting. Methods: Delphi-technique was used. An expert-panel consisting of members from cardiology, pulmonology and cardiovascular surgery met to discuss the disease management processes in PAH. The global and local-literature and guidelines have been reviewed and local clinical practices questionnaires (separately for functional classes (FC)) have been completed. All costcomponents, including medications, surgical treatment, hospitalization, screening and outpatient follow-up procedures were reviewed. February-2016 local prices released by Ministry of Health and Social Security Institution in Turkey were used as references. February-2016 currency rate was used.  Results: The total-costs, excluding disease-specific medications, of PAH/year for patients in FC-II, FC-III and FC-IV were calculated as 576€ , 1,005€  and 5,542€ , respectively. The corresponding costs of disease-specific medications were 8,864€ , 17,920€  and 17,920€  (panel experts noted that disease-specific drugs are given in similar combinations and doses in FC-III and FC-IV). Therefore, the total annual-costs of PAH in FC-II, FC-III and FC-IV were estimated as 9,440€ , 18,925€  and 23,462€ , respectively. Costs of other components per annum, used in calculating the total-cost in FC-II, FC-III and FC-IV were as follows: follow-up: 101€ , 199€  and 1,355€ ; medications for palliation: 116€ , 156€  and 1,867€ ; non-pharmacologic treatment: 126€ , 366€  and 366€ ; laboratory tests: 232€ , 283€  and 1,211€ , respectively. Cost of lung-transplantation was found as 742€  in FC-IV (percentage of FC-IV patients assumed to be transplanted “lung” and “heart-lung” is 2.5% and 0.1%, respectively and price of each operation is 28,550€  [28,550x2.5%+28,5 50x0.1%= 742€ ]).  Conclusions: The main driver of direct cost components in PAH is the cost of disease-specific drugs. The total direct cost components increase when the functional class of the patients progresses from FC-II to FC-IV. Consequently, improving diagnosis rate and ensuring to start appropriate treatment in early stages in PAH patients may help to decrease the costs of treatment. PCV58 The Economic Burden of Atrial Fibrillation in Latin America Stevens B, Verdian L, Pezzullo L, Tomlinson J, Estrada C Deloitte Access Economics, Sydney, Australia

Objectives: The economic burden of atrial fibrillation (AF) in the Latin American region has not been previously quantified. This research assessed the economic burden of AF in Brazil, Chile, Colombia, Ecuador, El  Salvador, Mexico, Panama, Peru, Venezuela.  Methods: To estimate the cost of AF by country, a prevalence approach was used. Costs were estimated for the year 2015 and included health system expenditures, productivity losses (absenteeism, lower workforce participation, premature mortality) and informal care costs, and deadweight losses associated with government expenditures. Data inputs for costs, including prevalence and mortality were based on secondary data sources informed by a targeted literature review including country specific grey literature and data sources. The study also appraised the value of the loss of healthy life, measured in disability adjusted life years (DALYs), using global burden of disease disability weights.  Results: AF was found to affect approximately 2.7 million people (0.8% of the adult population, average of 69.5 years old) in selected Latin American countries in 2015. This leads to significant wellbeing loss, estimated at 664,460 DALYs, and economic burden, estimated at USD2.4 billion in 2015. Health system expenditures accounted for USD2.3billion (95%) and productivity costs USD115million (5%) of the total financial burden of AF. On average, health system expenditure represented 0.06% of total gross domestic product (GDP) across the nine countries with Brazil (0.07%), Chile (0.08%), Colombia (0.07%), Ecuador (0.06%) and El Salvador (0.13%) spending more than the average. Total financial costs averaged 0.06% of GDP.  Conclusions: AF imposes a significant burden to the health system and society in Latin America. Health system expenditure accounts for the majority of the burden of AF in the region. Prevention and appropriate management of AF may result in substantial wellbeing benefits and economic savings. PCV59 The Cost of Hypercholesterolaemia in Ireland Kennelly B1, Patterson K1, Cafferky C2, Quinn E2 University of Ireland Galway, Galway, Ireland, 2Sanofi, Dublin, Ireland

1National

Objectives: Hypercholesterolaemia is a common condition in Ireland with over 70% of people aged 55 and older being found to have high cholesterol levels. The purpose of this paper is to estimate the total healthcare costs of hypercholesterolaemia in Ireland.  Methods: A prevalence—based approach was used with the most upto-date data from 2012. Estimates of the prevalence of hypercholesterolaemia in Ireland and for parameters relating the condition with major adverse cardiac events including acute coronary syndrome (ACS), stroke, peripheral arterial disease (PAD), and chronic heart disease (CHD) were obtained from relevant literature found on Medline (PubMed). The cost of treating major adverse cardiac events was estimated by calculating the amount of inpatient care such events required and applying an appropriate unit cost for each episode of care. Unit costs for inpatient care were obtained from Hospital In-Patient Enquiry (HIPE) data. The cost of treating hypercholesterolaemia by GPs at the community level was estimated by calculating the number of GP visits to treat hypercholesterolaemia and applying an appropriate unit cost to these visits.  Results: In 2012, the cost of inpatient care for major adverse cardiac events attributable to hypercholesterolaemia was € 165.5 million. The cost of community care for hypercholesterolaemia was over € 72 million. Drug costs for treating hypercholesterolaemia were estimated to be € 181.9 million. The total healthcare cost of hypercholesterolaemia was estimated to be € 419.7 million.  Conclusions: Hypercholesterolaemia and its associated diseases result in a significant financial burden to the Irish healthcare system, estimated to be