Health Economic Evidence on Non-Pharmacological Interventions For Persons With Dementia: A Systematic Review

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an observational study. Clinical and economic data were obtained from a Brazilian Medical cooperative PHI database. Inclusion criteria: age >  18 years old, diagnose of psychiatric disorder and length of stay longer than 100 days at psychiatric hospitals. Inpatients hospitalized from May 12, 2006 to March 31, 2017 were included. This PHI cover 342.757 clients in Ceará - Brazil. Data was collected of the total inpatient costs, health care resources utilization and length of stay (LOS).  Results: A total of 36 inpatients met our inclusion criteria. The majority was male (n= 25/ 69.44%). 68% of male patients have 25 to 44 years old (n= 17) and 81.82% of female have 35 to 54 years (n= 9). The CID-10 more frequent on males was F-20-Schizophrenia (n= 20/ 80%). Among females, F-20 represented 36.4% (n= 4). Antipsychotics were the medication used more frequently (43.74%), representing 75.49% of medication costs (U$202.082,79). The total hospitalization cost was U$2.802.397,34 without medical fees and the average was U$77.844,37. The total LOS was 29,390 days and the average 816,9 days (max. 3.976 days). Four patients obtained judicial injunctions allowing them to stay at psychiatric hospitals  Conclusions: Psychiatric hospitalizations are a challenge to brazilian PHI, demanding special attention due the long LOS and high cost of hospitalizations. In addition, these patients are usually male diagnosed with schizophrenia at productive working-age. Strategies which could decrease LOS and consequently hospitalization costs, could benefit PHIs, patients and families. PMH23 Health Insurance Cost of Psychotic Disorders In Hungary: A Cost of Illness Study Oberfrank F1, Donka-Verebes É2, Boncz I3 of Experimental Medicine, Budapest, Hungary, 2Integra Consulting Zrt., Budapest, Hungary, 3University of Pécs, Pécs, Hungary

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of PP3M in the Turkish healthcare system,using the once-monthly paliperidone palmitate treatment(PP1M) as the comparison agent. Methods: The cost-ofillness methodology has been used in calculation of the cost data in Turkey. The analysis has been performed retrospectively in a one-year time horizon and from the healthcare payer perspective.Quality-Adjusted Life Year(QALY) caused by the difference in the administration of the two treatments,three-monthly and monthly injections,have been considered as the effectiveness value.American dollars were used as the currency unit based on the purchasing power parity(PPP) ($1= 1.31TL-OECD 2016).  Results: The annual mean cost per schizophrenia patient has been calculated at 6330.2 PPP-$ for treatment with PP1M and at 6006.8 PPP-$ for the treatment with PP3M.For PP1M,drug treatment cost,which consists of antipsychotic drugs used in practice,accounts for 83.7% of the total cost,while outpatient follow-up cost is the second significant cost component at 9.8%.Service and intervention costs comprise 5.7% of the total cost.For PP3M,drug treatment costs,which consist of antipsychotics used in practice,comprises 83.8% of the total cost,while outpatient follow-up cost ranks the second significant cost component at 10.3%.Service and intervention cost accounts for 5.1% of the total cost.Considering the QALY values (0.65-PP1M versus 0.70-PP3M),PP3M treatment has been found to be dominant compared to maintenance therapy with PP1M.(per QALY -6468.0 PPP-$)  Conclusions: PP3M addresses unmet needs expected by new treatments due to several positive characteristics such as reduction of the treatment discontinuation risk,prevention of relapses,reduction in Healthcare Resource Use related to hospitalization.Therefore,PP3M has been determined to be cost-saving health technology by lowering the costs of hospitalization,drug treatment,adverse event and outpatient clinic,compared to maintenance schizophrenia therapy with PP1M.

1Institute

Objectives: The aim of our study is to calculate the annual health insurance treatment cost of psychotic disorders in Hungary. Methods: The data derive from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the health insurance treatment cost and the number of patients for the year 2010. The following cost categories were included into the study: out-patient care, in-patient care, CT-MRI, PET, home care, transportation, general practitioner, drugs and medical devices. Psychotic disorders were identified with the following codes of the International Classification of Diseases 10th revision: F20-F29.  Results: The Hungarian National Health Insurance Fund Administration spent 23.3 billion Hungarian Forint (HUF) (112.1 million USD) for the treatment of patients with brain cancer. The annual average expenditure per patient was 67553 HUF (324.5 USD) while the average expenditure per one inhabitant was 2330 HUF (11.2 USD). Major cost drivers were pharmaceuticals (76.0 %) of total health insurance costs), acute inpatient care (12.7 %) and chronic inpatient care (6.1 %). The number of patients with psychotic disorders was 345 per 10000 populations. We found the highest patient number in outpatient care (345480 patients) pharmaceuticals (231797 patients) and general practitioners (44847 patients). Conclusions: Psychotic disorders represent a significant burden for the health insurance system. Reimbursement of pharmaceuticals and acute inpatient care are the major cost drivers for psychotic disorders in Hungary. PMH24 Health Insurance Cost of Affective Disorders In Hungary: A Cost of Illness Study Oberfrank F1, Donka-Verebes É2, Boncz I3 of Experimental Medicine, Budapest, Hungary, 2Integra Consulting Zrt., Budapest, Hungary, 3University of Pécs, Pécs, Hungary

1Institute

Objectives: The aim of our study is to calculate the annual health insurance treatment cost of affective disorders in Hungary.  Methods: The data derive from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the health insurance treatment cost and the number of patients for the year 2010. The following cost categories were included into the study: out-patient care, in-patient care, CT-MRI, PET, home care, transportation, general practitioner, drugs and medical devices. Affective disorders were identified with the following codes of the International Classification of Diseases 10th revision: F30-F39.  Results: The Hungarian National Health Insurance Fund Administration spent 18.4 billion Hungarian Forint (HUF) (88.5 million USD) for the treatment of patients with brain cancer. The annual average expenditure per patient was 24943 HUF (119.8 USD) while the average expenditure per one inhabitant was 1840 HUF (8.8 USD). Major cost drivers were pharmaceuticals (45.0 %) of total health insurance costs), acute inpatient care (20.3 %) and primary care/general practitioners (18.2 %). The number of patients with affective disorders was 737.5 per 10000 populations. We found the highest patient number in pharmaceuticals (738560 patients), outpatient care (622435 patients) and primary care/general practitioners (543257 patients).  Conclusions: Affective disorders represent a significant burden for the health insurance system. Reimbursement of pharmaceuticals and acute inpatient care are the major cost drivers for affective disorders in Hungary. PMH25 Cost-Effectiveness Analysis of The Paliperidone Palmitate 3-Month Formulation Versus 1-Month Formulation From A Healthcare Payer Perspective Arikan Y1, Koral S1, Baris H1, Malhan S2, Oksuz E2 Pharmaceuticals, Johnson and Johnson Ltd., Istanbul, Turkey, 2Baskent University, Ankara, Turkey

1Janssen

Objectives: Schizophrenic episodes cause socio-economic problems and compliance with therapy is a known problem for schizophrenia patients and their families.The 3-monthly paliperidone palmitate formulation(PP3M) offers longterm benefits for patients by preventing schizophrenic episodes,also reducing the partial compliance risk.This study aims to perform a cost-effectiveness analysis

PMH26 Cost-Consequence Analysis of Using Neurofarmagen In The DecisionMaking Process During The Treatment of Patients With Depression In The U.S Espadaler J1, Carcedo D2, Pérez-Mitru A2, Menchón J3, Saiz-Ruiz J4, Bobes J5, Vieta E6, Alvarez E7, Pérez V8 1AB-Biotics, Sant Cugat del Vallès, Spain, 2Oblikue Consulting, Barcelona, Spain, 3Hospital de Bellvitge, Hospitalet de Llobregat, Spain, 4Hospital Universitario Ramón y Cajal, Madrid, Spain, 5Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain, 6Hospital Clínic, Barcelona, Spain, 7Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 8Hospital del Mar, Barcelona, Spain

Objectives: Almost half of U.S. population has experienced at least one psychiatric disorder in their lifetime, being major depression (MD) the most common among these illnesses. MD is highly debilitating to society, due in part to the increased utilization of health care resources and their associated cost and to frequent suboptimal treatment responses. The aim of this study is to compare the cost and consequences of using the Neuropharmagen® (NFG) pharmacogenetic tool in the decision-making process of treating depression relapsed patients in the U.S.  Methods: A decisiontree model was developed in order to estimate the cost and consequences of using NFG over a 3-year time horizon. Model compared NFG testing-guided treatment vs. treatment as usual (TaU) in MD patients who had not responded to 1-3 previous treatment(s). Treatment response and stabilization rates were obtained from the 3-months assessment reported in the prospective randomized controlled trial of NFG and extrapolated up to 1 year. For “responder” patients, yearly relapse rate of 0.2 was considered. “Non-responder” and relapsed patients progressed to the next treatment line. The model considered direct costs (2017 US$) for “responder” and “non-responder” patients obtained from published literature  Results: In patients with 1-3 prior treatment failures, total management costs per patient (responder and non-responder) after 1 and 3 years were $1,307 and $4,172 lower in NFG testingguided treatment compared with TaU respectively, not counting testing cost. 67.1% more patients achieved treatment response in NFG testing-guided treatment compared with TaU already first year (TaU response rate =  31.0%). Scenarios including other patient subgroups were tested, and one-way sensitivity analysis confirmed the robustness of these results  Conclusions: In patients with 1 to 3 prior treatments, NFG testing-guided treatment of patients with MD will represent a costsaving option vs TAU after 1 year. After 3-year time horizon, the analysis showed considerable savings PMH27 Health Economic Evidence on Non-Pharmacological Interventions For Persons With Dementia: A Systematic Review Nickel F, Kolominsky-Rabas PL Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany

Objectives: Over the last decade research on non-pharmacological interventions for persons with dementia (PwD) has gained momentum. The aim of this systematic review was therefore to assess the economic evidence on non-pharmacological interventions directly targeted at PwD.  Methods: A systematic literature search was conducted in the following databases: Cochrane Library, Centre for Reviews and Dissemination, EconLit, Embase, PsycINFO and PubMed. Trial-based economic evaluations published between 2010 and 2016 were included. Study quality was assessed according to the Drummond checklist.  Results: In total, nine RCT-based economic evaluations were identified. Of these, two studies evaluated exercise interventions for community-dwelling PwD. Considering the outcomes physical functioning and behavioral and psychological symptoms, these exercise programs were found likely to be cost-effective. Another study indicated that individually tailored occupational therapy for PwD exhibiting behavioral and psychological symptoms is cost-effective. Furthermore, the economic evidence on cognitive interventions was inconsistent. Joint reminiscence groups for community-dwelling PwD and informal caregivers as well as a carer-led individual cognitive stimulation therapy were unlikely to be costeffective. In contrast, there is evidence that a group-based maintenance cognitive stimulation therapy for PwD residing in care homes or visiting day care centers is cost-effective. With regard to psychological and behavioral treatments two interventions, namely self-management group rehabilitation for PwD and their spouses

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as well as cognitive-behavioral therapy for PwD-caregiver dyads, demonstrated effectiveness and cost-neutrality.  Conclusions: There is some evidence on costeffective non-pharmacological interventions for PwD. However, the included studies showed a high degree of methodological heterogeneity with regard to outcomes, sample size, perspective and time horizon. In particular, quality-of-life values of PwD should be interpreted cautiously, this holds as well for proxy-rated values. This research work was funded by the Karl and Veronica Carstens-Foundation as part of the national graduate college ‘Optimisation strategies in Dementia – OptiDem’. PMH28 Internet Based Treatment of Depressive Symptoms – A Health Economic Evaluation of Costs and Benefits Gräfe V1, Greiner W2 1School of Public Health, Bielefeld University, Bielefeld, Germany, 2Bielefeld University, Bielefeld, Germany

Objectives: Despite differentiated guidelines, depressive episodes often stay undiagnosed or are treated inadequately. Online-based self-help-, consulting- and treatment-services may reduce deficits in treating depressive disorders and reduce disease-related costs. This study aimed to examine the potential of the internetbased cognitive behavioural therapy “deprexis” to reduce total costs of statutory health insurance. Secondary, changes in depression severity, health-related quality of life and impairment in functioning were examined.  Methods: Participants with mild to moderate depressive symptoms were recruited from a huge German sickness fund and randomized to either a 12-week internet intervention (deprexis) or care as usual (CAU). The primary outcome measure was costs of statutory health insurance (excluding outpatient costs), secondary outcomes were depression severity (PHQ-9), health-related quality of life (SF-12 and EQ-5D-3L) and impairment in functioning (Work and Social Adjustment Scale). Outcomes were assessed at baseline, three months and six months, using an online based questionnaire. Additionally, health insurers’ administrative data were included in the analyses.  Results: A total of 3.806 participants were randomized. In both groups, total costs of statutory health insurance decreased during the study period, but the changes from baseline differed significantly between groups. In the intervention group the total costs decreased by 32% from 3.139€  per year at baseline to 2.119€  in the study year (vs. a mean reduction in total costs of 13% in CAU-group; p< 0.002). In comparison to the CAUgroup, the intervention group also showed a significant greater reduction in PHQ-9, a significant greater decrease in impairment in functioning and a significant greater increase in health-related quality of life.  Conclusions: The study underlines the potential of innovative e-mental-health programs in treating depressive disorders. The results suggest that the use of deprexis over a period of 12 weeks leads to a significant improvement of symptoms with a simultaneous reduction in cost of statutory health insurance.

in inpatient hospital days, shorter inpatient stays and reduced emergency room visits were reported as the most significant savings in terms of costs for BPD patient care and health care services.  Conclusions: Provision of DBT for patients with BPD is shown to incur reduced healthcare costs, particularly regarding inpatient hospital days and emergency room visits. This result was consistent in the studies included for review when comparing costs incurred in the pre-DBT-treatment year and post-DBT-treatment year. PMH32 Pharmacoeconomics Analysis of Sertindole Use In The Treatment of Schizophrenia In Russia Krysanov I1, Ermakova V2, Tiapkina M2 1Institute of Medical and Social Technologies, Moscow National University of Food Production, Moscow, Russia, 2Sechenov First Moscow State Medical University, Moscow, Russian Federation

Objectives: to conduct a comparative pharmacoeconomic analysis of atypical antipsychotics for the treatment of schizophrenia – sertindole (SRT) versus quetiapine (QTP) and paliperidone (PAL).  Methods: the primary outcomes for analysis were relapse and rehospitalization rates. Using the odds ratio (OR) of prehospitalization we calculated the related risk (RR) for three drugs. The cost of the annual drug therapy of schizophrenia in the outpatient setting, costs of hospital readmission and total costs were calculate. One-way sensitivity analysis was performed on 7 scenarios. Willingness to pay threshold (WTP) for Russian health care system was estimated at € 26,383 (1648924 RUB), exchange rate mean in 2017 - € 1 =  62.5 RUB.  Results: the drug cost for annual therapy was the lowest for SRT – € 1,550 (96856 RUB) – by 6% and 45% less than for QTP and PAL respectively. The RR of rehospitalization was 2.0% for PAL, 2.13% for SRT and 16.24% for QTP, so the cost for rehospitalisation was 7 times less for SRT versus QTP and only by 6.5% greater than for PAL. Therefore SRT therapy was the most cost saving by total cost – 13.8% less vs QTP and 31% versus PAL. Cost-effectiveness ratio (CER) for 1 patient treated without rehospitalization was € 1,608 (100472 RUB) for SRT, € 2,180 (136226 RUB) for QTP. SRT has higher CER versus PAL, but incremental cost-effectiveness ratio (ICER) for PAL more than 20 times higher than WTP (ICER=  € 532,542 (33 283 846 RUB). The most influential variable in the sensitivity analysis was dosage regimen.  Conclusions: SRT is the most cost-effective treatment versus QTP (CER less than CER QTP) and versus PAL ( SRT has insignificant deferens in treatment effectiveness -0,13%, but will be more cost saving treatment, ICER for PAL more than 20 times higher than Russian WTP threshold). PMH33 An Economic Evaluation of A Psychoeducational Suicide Intervention Programme O’Sullivan M1, Murphy A2, Bourke J2 College cork, Cork, Ireland, 2University College Cork, Cork, Ireland

1University

PMH30 Early Economic Evaluation of The New Atypical Antipsychotic N1, Vaskova

L1, Omelyanovskiy VV2, Lemeshko V1, Teptsova T1

Musina 1Sechenov First Moscow State Medical University, Moscow, Russian Federation, 2The Russian Presidential Academy of National Economy and Public Administration, Moscow, Russian Federation

Objectives: To assess the economic viability of the new atypical antipsychotic and to establish what price is required for an economically viable drug. In this study early economic modeling was used to estimate the price per course for difluoroclozapine, a new atypical neuroleptic drug in the treatment of resistant schizophrenia.  Methods: An early Markov model was developed, based on the data derived from preclinical and clinical trials, to estimate costs and effectiveness of the antipsychotic therapy. Comparison of new neuroleptic drug with standard therapy with clozapine was performed with the use of cost-utility analysis. Costs of clozapine therapy and management of agranulocytosis were estimated as costs of medical care according to the standards of therapy. Utility for both drugs was measured in terms of quality-adjusted life years (QALYs). The headroom method was used to calculate the acceptable price for 1 course treatment with difluoroclozapine. It was estimated using utility difference between 10-years therapies and cost of 1 QALY for clozapine.  Results: Analysis showed that the discounted QALY difference between difluoroclozapine and clozapine was 0.02 (∆QALY). Estimated cost per 1 QALY for clozapine was 4 735.78$. Based on COST/1QALY the difluoroclozapine price in comparison with clozapine can’t be more than 1.14%.  Conclusions: According to assumption about same efficacy of difluoroclozapine and clozapine and only safety advantages of difluoroclozapine (the ability to reduce agranulocytosis rate) the cost of difluoroclozapine course shouldn’t be more than the cost of clozapine course (over 1.14%). PMH31 The Cost Of Dialectic Behaviour Therapy (DBT) For People Diagnosed With Borderline Personality Disorder (BPD): A Review of The Literature O’Sullivan M1, Murphy A2, Bourke J1 College cork, Cork, Ireland, 2University College Cork, Cork, Ireland

1University

Objectives: To produce a systematic literature review on the cost of dialectic behaviour therapy (DBT) for people diagnosed with Borderline Personality Disorder (BPD). People with BPD require extensive healthcare resources and services. This review evaluates existing literature to determine the cost of providing DBT treatment for persons with BPD.  Methods: Using the PICOS framework, cost studies of DBT for a population of persons diagnosed with BPD were included for review. The evidence was combined and summarised using a narrative synthesis. The methodological quality of the economic studies was evaluated using appropriate checklists.  Results: Providing BPD patients with DBT treatment has shown to have a positive effect on reducing health care utilization and related health care costs. Across the included studies, the mean average cost per patient was shown to be reduced by 21 – 35% from pre-DBT-treatment to post-DBT treatment. A reduction

Objectives: The Eden Programme is a psycho-educational programme targeting people who have attempted suicide or experienced suicidal ideation. The programme, developed by an Irish charity, Suicide or Survive. A licensed Eden programme is being rolled out on a pilot basis in Ireland. This study’s objective is to undertake a cost-effectiveness analysis of the Eden Programme from the perspective of the Ireland’s health care provider.  Methods: Researchers identified all relevant resources and utilised a combination of micro-costing and gross costing to measure resources. A net cost per programme and per participant were calculated, accounting for the current maximum intake for an Eden Programme (n= 14). To measure effectiveness, average BDI scores from pre-and post-Eden Programme surveys were used. BDI scores were mapped onto the EQ5D-3L using an algorithm developed by Grochtdreis et al., (2016). To account for uncertainty, a Monte Carlo simulation was used to do a probabilistic sensitivity analyses. A cost-effectiveness ratio was used to determine the probability of the programme being cost-effective compared to usual care.  Results: Preliminary results indicate an improvement in average BDI scores from baseline to end of programme. Mapping these scores onto the EQ5D-3L showed utility improvement. As the Eden programme is a complement to usual care,there are additional costs. In addition, scenario analyses reveal that should economies of scale (e.g. dual-site training) be realised, there is the potential for cost savings. There is a less than 60%. Probability of cost effectiveness of the Eden programme compared with usual care.  Conclusions: As a therapeutic area, mental health has long been underfunded. As decision makers increase funding for programmes in mental health, it is important to ensure that resource allocation decisions are appropriate. One means of informing such decisions is to conduct economic evaluations to determine if the additional benefits are worth the additional cost. PMH34 Cost-Effectiveness of Guided Internet-Based Treatments for Depression In Comparison With Control Conditions: An IndividualParticipant Data Meta-Analysis Kolovos S1, van Dongen JM1, Riper H2, van Tulder MW1, Bosmans JE1 Universiteit Amsterdam, Amsterdam, The Netherlands, 2VU Amsterdam, Amsterdam, The Netherlands

1Vrije

Objectives: Previous studies have shown the effectiveness of guided Internetbased interventions for depression compared to control groups. It is often hypothesized that Internet-based treatments are associated with lower costs, because face-to-face time with therapist is reduced. The objective of this study was to conduct an individual-participant data meta-analysis (IPD-MA) evaluating the costeffectiveness of guided Internet-based interventions for depression compared to controls from a societal perspective.  Methods: A systematic literature search was conducted in electronic databases from 2000 to January 1st 2017. Studies were included if they were randomized controlled trials (RCTs) in which the costeffectiveness of a guided Internet-based intervention for depression was compared to a control. Cost-effectiveness analyses were conducted for improvement in depressive symptoms measured by CES-D, response to treatment, and Quality-Adjusted Life-Years (QALYs) at 8-weeks, 6-months, and 12-months follow-up.  Results: IPD