Healthcare Resource Utilization and Costs Associated with Cardiovascular Events In Greece: Results From A Delphi Panel

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patients with preserved and reduced EF); cost-effectiveness was estimated using the calibrated model parameters.  Results: In the enalapril arm of PARADIGM-HF, mortality at Year 4 and the annualised all-cause hospitalisation rate was lower than the CPRD and SMR HF population. In the analysis based on an average patient in PARADIGM-HF, sacubitril/valsartan was associated with an incremental costeffectiveness ratio (ICER) of £17,624 per quality-adjusted life-year (QALY), while in the calibrated analyses the ICERs were £12,595 (CPRD) and £12,960 (SMR) per QALY.  Conclusions: Sacubitril/valsartan is a cost-effective treatment option vs ACEi, based on conventional willingness-to-pay thresholds (£20,000 per QALY), using mortality and hospitalisation rates from both PARADIGM-HF and real-world UK HF populations. PCV109 Cost Effectiveness of Sacubitril/Valsartan Versus AngiotensinConverting-Enzyme Inhibitor For The Treatment of Heart Failure From Public Health Perspective in Chile Rojas R, Balmaceda C, Vargas C, Espinoza MA Pontificia Universidad Catolica de Chile, Santiago, Chile

Objectives: Assess the cost-effectiveness of Sacubitril/Valsartan (LCZ696) versus Enalapril (ACEi) for the treatment of heart failure with reduce ejection fraction (HFrEF) from the perspective of the Chilean public healthcare system.  Methods: A patient-level Markov model was built based on data reported in the pivotal trial “PARADIGM-HF” to predict mortality, hospitalization and health-related quality of life. Expected costs were measured in Chilean pesos (1 USD =  654.07 CLP$) and benefits in quality adjusted life years (QALYs). Health related quality of life was measured in the PARADIGM-HF trial model and valuated using the Chilean tariff. A 30-year time horizon and 3% discount rate was considered for costs and outcomes. A probabilistic sensitivity analyses was performed to account for uncertainty.  Results: The total expected costs of treating HFrEF with LCZ696 are higher than ACEi (US$18,147 and US$7,524 respectively). Similarly, the expected incremental health benefit is higher in LCZ696 group (0.52 QALYs). The base case scenario (current market prices for all treatments) shows an average ICER of LCZ696 versus ACEi of US$33,244/QALY on all PARADIGM-HF patients and US$29,532/QALYs for the subgroup of Latin-American patients. At a suggested threshold between 1xGDP (US$22,000/QALY) and 3xGDP per capita (US$60,000/QALY), the probability of cost-effectiveness of LCZ was 23% and 92% respectively. The ICER is reduced to US$24,675 on all PARADIGM-HF patients and US$22,225 when considering the Latin-American subgroup when the price is reduced a 25%. The ICER was most sensitive to the mortality hazard ratio.  Conclusions: Due to the high incremental cost, it is reasonable to explore heterogeneity in order to find the most benefited subgroup of patients. PCV110 Sacubitril/Valsartan Estimated Cost Savings Based on Paradigm-HF Results Lacasa C, Figueras M, Obradors M Novartis Farmaceutica S.A., Barcelona, Spain

Objectives: To assess potential cost savings of sacubitril/valsartan use compared to ACE inhibitors in chronic heart failure patients with reduced ejection fraction (HFrEF) in Spain.  Methods: Potential direct and indirect costs from the use of sacubitril/valsartan were analyzed with a social perspective in two scenarios: including the whole PARADIGM-HF population, and patients under 65 years. Hospitalization and caregivers costs were included as direct costs and productivity loss (temporary disability costs) due to hospitalization and death as indirect costs. Hospitalization and caregiver costs were calculated from PARADIGM-HF data and a heart failure burden study in Spain (Delgado, 2014) and a heart failure hospitalization cost study (Obradors, 2015). Productivity loss due to hospitalization were estimated from PARADIGM-HF data, average days of disability (Social Security Spanish Institute), and Spanish average salary (Statistics Spanish Institute). Productivity loss due to death was calculated by the estimation of Life Years Gained (Clagget, 2015) adjusted for one year. Indirect costs were adjusted for working age population and activity rate in Spain. Results were expressed as a differential costs of sacubitril/valsartan vs enalapril for both groups of patients.  Results: Use of sacubitril/valsartan could reduce direct and indirect costs by 2.083,1€ per patient/year (5,7€ per patient /day) in general population. Cost savings for patients under 65 years would be of 2.416,3 €  per patient/year (6,6€  per patient/day).  Conclusions: Sacubitril/valsartan potentially reduce direct and indirect costs in chronic heart failure patients with reduced ejection fraction (HFrEF) in Spain. As different sources of information have been used, future investigations in real-world evidence will be needed to confirm the results. PCV111 Healthcare Resource Utilization and Costs Associated with Cardiovascular Events In Greece: Results From A Delphi Panel Kotsopoulos N1, Relakis J2, Kutikova L3, Maruszczak M3, Villa G4, Souliotis K5 1Health Policy Institute, Athens, Greece, 2Amgen Hellas, Marousi, Greece, 3AMGEN (Europe) GmbH, Zug, Switzerland, 4Amgen, Economic Modeling COE, Zug, Switzerland, 5University of Peloponnese, Corinth, Greece

Objectives: Cardiovascular (CV) disease remains the most frequent cause of premature mortality in Greece. Moreover, CV-related morbidity leads to increased healthcare resource utilization (HRU) posing a significant economic burden to the healthcare system. The objective of this study was to assess, from a national health insurance perspective, the HRU and associated costs for Greek patients hospitalized due to CV events defined as myocardial infarction, unstable angina and acute heart failure.  Methods: Prospective, panel-based study using the Delphi methodology with a group of 10 clinicians, eliciting HRU in patients hospitalized for CV events (two-year follow-up) in Greece. Clinicians were selected if they had more than 10 years of experience in treating patients for CV disease in Greece. HRU data collected included: acute events and follow-up re-hospitalizations; outpatient visits; ambulatory imaging/lab tests; and drug therapy. Official 2016 Greek tariffs were applied to

translate HRU into direct medical costs.  Results: Acute (i.e. first year) and followup (i.e. second year) mean (SD) costs for ST and non-ST elevation myocardial infarction were estimated at € 3,681 (€ 433) and € 1,668 (€ 420), respectively. Unstable angina yielded acute costs of € 3,109 (€ 416) and follow-up costs of € 1,714 (€ 313). Acute heart failure costs were estimated at € 5,968 (€ 410) and follow-up costs at € 2,974 (€ 193). The acute cost of coronary artery bypass grafting for the Greek national health payer was found to be € 4,276. Hospitalization costs and pharmacy costs represented 70% of acute cost components. Similarly, pharmacy costs and re-hospitalizations represented almost 70% of the total follow-up costs.  Conclusions: This study suggests that CV events in Greece are associated with high acute and long-term follow-up costs. Given the high incidence of CV events in the Greek population, healthcare interventions to prevent such events could be used to reduce the relevant health and economic burden for the healthcare system. PCV112 Will Stem Cells For Heart Failure Be The Next Sofosbuvir Issue? Hanna E1, Dorey J2, Aballéa S2, Auquier P1, Toumi M1 1Faculté de Médecine, Laboratoire de Santé Publique, Aix-Marseille Université, Marseille, France, 2Creativ-Ceutical, Paris, France

Objectives: Advanced Therapy Medicinal Products (ATMPs) are therapies expected to cure, halt or slow down the progression of many disabling diseases among which Heart Failure disease (HF). About 1000 ATMPs are in development of which 65 already in phase III. These therapies are expected to cure, halt or significantly slow down the progression of chronic and severely disabling diseases. Stem cell therapies targeting HF are in development. Our objective is to evaluate ATMPs Drug budget impact (DBI) on Health Insurance (HI) in HF assuming various efficacy profiles.  Methods: A Markov model was developed to compare two strategies: Standard of care (SoC) and ATMPs for a representative cohort of HF patients over a 10-year period, with 1-month cycle-length. Model input data, SoC costs and quality-adjusted life-year (QALY) data were derived from published sources. We assumed that one procedure allows achieving the outcome. Five efficacy scenarios were tested to evaluate the cost of ATMP procedures assuming an ICER threshold of 50,000€ /QALY. DBI was computed by multiplying the procedure cost by HF prevalence in France.  Results: In the first and second scenarios, 100% and 50% patients were cured respectively with a DBI of 348,144,688,850€  and 192,523,977,243€ . In the third and fourth scenarios, probabilities of progression were reduced by 50% or 33% leading to respective DBI of 1,186,221,568€  and 1,606,499,643€ . In the fifth scenario, patients did not progress further and the DBI was 2,355,086,110€ .  Conclusions: If ATMPs successfully reach the market, they will bring unprecedented clinical and social benefits to patients and society. However they are likely to severely impact the French health service budget thus threatening sustainability of the healthcare system. Without deep policy changes in the pharmaceutical interventions pricing, the sustainability of health system in the EU Member States will be severely threatened.

CARDIOVASCULAR DISORDERS – Patient-Reported Outcomes & Patient Preference Studies PCV113 TREATMENT PATTERNS AND MEDICATION ADHERENCE OF ACUTE ISCHEMIC STROKE PATIENT IN KOREA Yoon B1, Chung P2, Lee Y3, Shin B4, Kim H5, Cha J6, Kim Y6 National University Hospital, Seoul, South Korea, 2Kangbuk Samsung Hospital, Seoul, South Korea, 3Gachon University Gil Medical Center, Incheon, South Korea, 4CHONBUK NATIONAL UNIVERSITY MEDICAL SCHOOL AND HOSPITAL, Jeollabuk-do, South Korea, 5Konkuk University Medical Center, Seoul, South Korea, 6Pfizer Pharmaceuticals Korea Ltd., Seoul, South Korea 1Seoul

Objectives: Stroke is one of leading causes of death and disability. The treatment of lowering LDL cholesterol is known to have an important impact on the prevention and management of stroke recurrence. It aimed to investigate treatment patterns and medication adherence among acute ischemic stroke patients.  Methods: It was a prospective, multicenter and observational study conducted at nationwide 19 tertiary hospitals from March 2014 to September 2015. Patients who were hospitalized and discharged for either acute Cerebral Ischemic Infarction or Transient Ischemic Attack, in the last 1 month were eligible for participation, and those who were not prescribed with statin at hospital leave were excluded. Demographic and clinical characteristics were examined through a self-administered questionnaire and medical chart review. Medication adherence was assessed both at 3 and 6 months using Morisky Medication Adherence Scales – 8. Adherence levels were categorized as followings; High= 8 scores, Moderate= 6 to 8 scores, Low< 6 scores.  Results: It included 991 patients with mean age of 64.3±12.0, and 65.6% were male. Small vessel occlusion(32.8%) and large artery atherosclerosis(31.3%) were dominant diagnosis, and 20.7% were recurrent patients. At discharge, a majority of the patients were prescribed with statin monotherapy accounting for 978 patients, and 56.8% were prescribed with low dose of statin while others received high dose. The rates of high and moderate adherence were approximately 66% and 26% respectively at each follow-up. At 6 months, a significant difference in total cholesterol was found by adherence levels(High= 178.4±42.1mg/dL vs. Moderate= 181.6±40.7mg/ dL vs. Low= 190.4±43.9mg/dL, p= 0.0505). The same tendency was found to be present in LDL cholesterol(High= 112.0±37.0mg/dL vs. Moderate= 115.3±35.6mg/dL vs. Low= 123.9±36.9mg/dL, p= 0.0134).  Conclusions: The study found there were significant differences in total and LDL cholesterol by different levels of adherence. These results highlight that medication adherence should be taken into account while the treatment of lowering LDL cholesterol for the prevention and effective management of stroke patients. PCV114 Pharmacoutilization In Patients Suffering From Non-Valvular Atrial Fibrillation