Indirect Costs Associated with Ulcerative Colitis In Poland

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added-on caspofungin; patients failing first-line LAMB or caspofungin were switched-to or added-on voriconazole. Base-case evaluation included drug management and additional hospitalization costs due to severe adverse events. Treatment success rates were obtained from pivotal clinical trials (voriconazole, 52.8%; LAMB, 50.0%; caspofungin, 33%). First-line treatment duration was assumed 24 days for voriconazole (14-day 4-6mg/kg/d IV followed by 10-day 200mg/BID oral), IV LAMB (3-5mg/kg/d), and IV caspofungin (50-70mg/d); second-line treatment duration was assumed 15 days regardless of therapy.  Results: Results from our model showed considerably lower total treatment costs for voriconazole (LBP14,144,427/$9,411) than LAMB (LBP32,982,623/$21,945) and caspofungin (LBP26,202,736/$17,434) in Lebanon.  Voriconazole cost savings primarily resulted from lower drug costs, higher treatment efficacy, and shorter IV LOT compared to LAMB and caspofungin. First-line voriconazole therapy remained cost saving even when the entire voriconazole treatment course was administered intravenously. Cost drivers included treatment efficacy and i.v. drug per-day costs (voriconazole LBP462,914/$308; LAMB LBP1,130,232/$752; caspofungin LBP766,513/$510).  Conclusions: Results from this study suggest that voriconazole is cost-saving compared to LAMB and caspofungin in the treatment of IA from payer perspectives in Lebanon. PSY52 A Cost of Illness Study Evaluating The Burden of Wolfram Syndrome In The United Kingdom Eljamel S1, De Stone S1, Ghosh W1, Griffiths A1, Barrett TG2, Thompson RS3 1Costello Medical Consulting Ltd, Cambridge, UK, 2Birmingham Children’s Hospital, Birmingham, UK, 3Findacure, Cambridge, UK

Objectives: The aim of this study was to assess the indirect costs (IC) borne by absenteeism associated with multiple sclerosis (MS) based on data of the Social Insurance Institution (ZUS) in Poland.  Methods: Data for the period 2012 - 2015 concerning days on sick leave, the short-term disability, the sufferers of which claim rehabilitation benefit, and the long-term disability (permanent or fixed-time), the sufferers of which claim disability pension was collected. Costs were calculated using Gross Domestic Product (GDP) per capita equaled from € 10 101 in 2012 to € 11 128 in 2015, Gross Value Added (GVA) per worker equaled from € 24 362 in 2012 to € 25 486 in 2015 and Gross Income (GI) per worker equaled € 10 281 in 2012 to € 11 380 in 2015.  Results: Total IC of MS in the year 2012 was calculated using GDP per capita, GVA and GI per worker were € 40 779 597, € 98 354 421 and € 41 508 253, respectively. Those costs grew to € 68 922 972, € 165 406 270 and € 71 255 532 in 2013 and then decreased to € 29 593 921, € 69 372 124 and € 30 520 789 in 2014; in 2015 they increased to € 39 073 708, € 89 492 811 and € 39 958 703. Each year the highest component of IC was long-term disability accounted for 69% in 2014 to 87% in 2013. Considering a number of patients from 5 300 in 2012 to 5 942 in 2015 average IC per patient varied between € 7 694, € 18 557 and € 7 832 in 2012 to € 6 576, € 15 061 and € 6 725 in 2015.  Conclusions: MS in Poland generated high IC. The main component was long-term disability pension; short-term disability generated lower costs of lost productivity. The highest cost per patient was generated by long-term disability. PSY55 The Health And Economic Burden of Obesity In Chile – An Epidemiological And Economic Simulation Model Cuadrado C Universidad de Chile, Santiago, Chile

Objectives: Wolfram syndrome (WFS) is a rare genetic disorder characterised by juvenile-onset diabetes mellitus and optic atrophy. It is progressive and neurodegenerative, and patients can manifest a range of other symptoms, including sensorineural hearing loss, psychiatric problems, and neurologic abnormalities. Currently, limited data are available on the economic burden of WFS. The aim of this study was to evaluate the cost of illness (COI) from a service provider perspective (National Health Service, NHS) of all people with WFS in the UK, and to identify major determinants of cost.  Methods: The model was based on standard practice of the UK WFS specialist service. Model inputs were informed by a pragmatic literature review, NHS Reference Costs (2014–2015), PSSRU (2015), and British National Formulary (2016), in conjunction with patient interviews and expert opinion. Only direct costs to the NHS were considered. A prevalencebased approach was used for all patients known to the UK WFS specialist service. A deterministic sensitivity analysis (DSA) was run at 10% to identify major cost drivers.  Results: In total, the COI of all people with WFS to the NHS was £990,588.45 per year, with an average annual cost per patient of £15,477.94. The costs associated with diabetes mellitus care, late-stage complications of diabetes mellitus, hearing impairment, and visual impairment contributed most to the final COI result (19%, 18%, 18%, and 11% of the final result, respectively). The DSA identified costs associated with diabetes mellitus care and those associated with late-stage complications of diabetes mellitus as major drivers in the model.  Conclusions: The annual cost of WFS to the NHS per patient was found to be considerable. This study identified areas of potential cost savings where the development of an effective treatment to halt progression of disease and provide better control of symptoms is needed.

Objectives: This study address the policy question of what is the actual economic burden of obesity in Chile and its projections until the year 2030. The aim of such research question is to inform decision-makers on the magnitude and potential future trends if no actions are undertake.  Methods: A transition state population level simulation model that incorporate the natural history of obesity and 16 related conditions had been development for the 2010-2030 period. Outcomes of the model consider annual number of cases, deaths, year of life lost (YLL) and direct cost associated with each condition. Epidemiological input data has estimated using DISMOD II® equations. Cost parameters are based on national representative data sources. Univariate and multivariate deterministic sensitivity analysis and second order Monte Carlo simulation for multivariate probabilistic analysis are performed. The model is programed in Excel (Microsoft ® Office Excel 15) with Visual Basic ® Macros.  Results: An average of 2,29% (CI95% 1,14%-2,75%) of the annual total health expenditure are attributed to obesity and its related conditions with a clearly increasing trend during the years of analysis, accounting for nearly 3% of the health expenditures in the year 2030. Both health and economic impact are greater in females than in males. Main drivers of those cost are the type 2 diabetes mellitus, the chronic kidney disease, bariatric surgery and some cancers that together contribute with more than half the health expenditures attributable to obesity within the country.  Conclusions: Obesity represent a preventable condition that accounts for an important share of the total health expenditure of the Chilean health system. Increasing trends on the obesity prevalence and ageing are both important drivers of an expected future rise in the cost attributable to obesity in the country. Future works needs to address the potential impact of policy strategies to tackle this health problem.

PSY53 The Relationship Between Target Joints And Non-Drug Direct Costs In Severe Haemophilia

PSY56 Indirect Costs Associated with Ulcerative Colitis In Poland

Carroll L1, O’Hara J2, Mazza G3, Camp C4, Stentoft Hoxer C5, Wilkinson L6 Haemophilia Society, London, UK, 2University of Chester, Chester, UK, 3University College London, London, UK, 4HCD Economics, Daresbury, UK, 5Novo Nordisk, Bagsvaerd, Denmark, 6Novo Nordisk A/S, Søborg, Denmark

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Objectives: Target joints (TJs) are a common complication of severe haemophilia. While factor replacement therapy constitutes the majority of costs in haemophilia, the relationship between TJs and non-drug-related direct costs (NDDCs) has not been studied.  Methods: Data were drawn from the ‘Cost of Haemophilia across Europe – a Socioeconomic Survey’ (CHESS) study, a cost assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the UK) in which 139 haemophilia specialists provided demographic and clinical information for 1,285 adult patients. NDDCs were calculated using publically available cost data, including 12-month ambulatory and secondary care activity: haematologist and other specialist consultant consultations, medical tests and examinations, bleed-related hospital admissions, and payments to professional care providers. A generalised linear model was developed to investigate the relationship between NDDCs and TJs (defined in the CHESS study as areas of chronic synovitis), adjusted for patient covariates including socio-demographic characteristics and comorbidities. Patients with a diagnosed inhibitor at the time of reporting (n= 58) were excluded from the analysis.  Results: Five hundred and thirteen patients (42% of the sample) had no diagnosed TJs; a total of 1,376 TJs were recorded in the remaining 714 patients. Mean adjusted NDDCs for persons with no TJs were EUR 3,134 (standard error (SE) EUR 158); for persons with one or more TJs, mean adjusted NDDCs were EUR 3,913 (SE EUR 157; average marginal difference EUR 779; p< 0.001).  Conclusions: Our analysis suggests that the presence of one or more TJs has a significant impact on NDDCs for patients with severe haemophilia. Prevention and management of TJs should be an important consideration of managing haemophilia patients in the current cost constrained healthcare environment. PSY54 Indirect Costs Genereted By Absenteeism Associated with Sclerosis Multiplex In Poland Malinowski K, Kawalec P Jagiellonian University Medical College, Krakow, Poland

Kawalec P1, Stawowczyk E2 1Jagiellonian University Medical College, Krakow, Poland, 2Statsoft Polska Sp z o.o., Krakow, Poland

Objectives: The aim of this study was to assess the indirect costs of ulcerative colitis (UC) in Poland. Two subgroup analyses were also performed - for patients with an active disease and for patients in remission.  Methods: A questionnaire survey was conducted using the Patient Simple Clinical Colitis Activity Index (P-SCCAI) to assess disease activity and the modified Work Productivity and Activity Impairment Questionnaire to assess productivity loss. Both absenteeism (productivity loss due to absence from work) and presenteeism (productivity loss due to lower productivity at work) were considered during the assessment of indirect costs of UC in the Polish settings. Indirect costs were assessed using the human capital approach. Results were presented in Polish zlotys (PLN) and Euros (1 Euro =  4.18 PLN).  Results: The analysis was performed based on the answers of 225 adult patients with UC, of which 25% were in remission. Most patients (73.8%) had paid work. Among working patients, the average number of work hours missed due to the disease was 210.96 per year. A significant effect of the disease on productivity at work was also observed. The symptoms of UC reduced patients’ productivity at work by an average of 19.6%, and it was particularly noticeable among patients with active disease. The total loss of productivity at work (both absenteeism and presenteeism) among working patients equaled 26.2%. The costs of lost productivity generated by UC equaled 17,585PLN (4,207Euros) per working patient, of which 42.7% was due to absenteeism and 57.3% – due to presenteeism. Indirect costs in remission were lower than in active disease - 6,895PLN (1,650Euros) vs 20,802PLN (4,977Euros) respectively.  Conclusions: The results of the analysis showed that UC constitutes a considerable burden for the society; it was observed that the lower the disease activity, the lower the indirect costs. PSY57 A Cost of Illness Study Evaluating The Healthcare And Societal Burden of Friedreich’s Ataxia In The United Kingdom Hanman K1, Griffiths A1, Bobrowska A1, Vallortigara J2, Greenfield J2, Thompson RS3 Medical Consulting Ltd, Cambridge, UK, 2Ataxia UK, London, UK, 3Findacure: The Fundamental Diseases Partnership, Cambridge, UK

1Costello