A266 proportion of HPV-related cancers remains to be established site by site and further research is needed to assess outpatient and indirect costs linked to these cancers. PCN51 51 THE COSTS OF BREAST CANCER PRIOR TO AND FOLLOWING DIAGNOSIS Broeckx S1, Den Hond E1, Torfs R1, D’Hooghe T2, Simoens S3 1 Flemish Institute for Technological Research, Mol, Belgium, 2University Hospitals Leuven, Leuven, Belgium, 3Katholieke Universiteit Leuven, Leuven, Belgium OBJECTIVES: This incidence-based cost-of-illness analysis aims to quantify the costs associated with female breast cancer in Flanders for the year prior to diagnosis and for each of the five years following diagnosis. METHODS: A bottom-up analysis from the societal perspective included direct health care costs and indirect costs of productivity loss due to morbidity and premature mortality. A retrospective case-control study design compared total costs of breast cancer patients with costs of an equivalent standardised population with a view to calculating the additional costs that can be attributed to breast cancer. The sample was made up of women who had undergone surgical treatment for breast cancer and who were affiliated with the Christian Health Insurance Funds. Resource utilisation data were derived from national publications, the Christian Health Insurance Funds and statistical institutes. RESULTS: The sample consisted of 20,439 breast cancer patients. Total average costs of breast cancer amounted to a107,456 per patient over 6 years. Total costs consisted of productivity loss costs (89% of costs) and health care costs (11% of costs). Health care costs did not vary with age at diagnosis. Health care costs of breast cancer patients converged with those of the general population at five years following diagnosis. Patients with advanced breast cancer stadia had higher health care costs. CONCLUSIONS: To reduce costs associated with breast cancer, attention needs to be focused on decreasing the productivity loss from breast cancer. The implementation of new techniques to prevent, diagnose, and treat breast cancer not only impact direct health care costs, but may also influence indirect costs of productivity loss. PCN52 52 COSTS OF ADVANCED GASTRIC CANCER (AGC) IN BRAZIL FROM THE PUBLIC PAYER PERSPECTIVE Clark O1, Santos EA2, Saggia MG2 1 Evidencias Medicas, Campinas, Sao Paulo, Brazil, 2Roche Brazil, Sao Paulo, SP, Brazil OBJECTIVES: In Brazil, 140 million citizens (^80% of the population) depend on the public health care system. Advanced gastric cancer (AGC) is the second most frequent cause of death in Brazil: 10,645 per year. This disease appears among the most costly cancers to treat. Objective was to identify the medical resource usage (MRU) to treat AGC and estimate the associated costs in the public health care sector in Brazil. METHODS: A questionnaire was developed to identify the medical resource usage (MRU) of managing AGC in the public health care system. The questionnaire was applied to 20 oncologists and 20 nurses in a structured interview. MRU data were extracted according to the following stages: 1) diagnosis and staging; 2) 1st line treatment, 3) 2nd line treatment; 4) best supportive care (BSC); and 5) terminal care. Then, modified Delphi panels were conducted in the 5 largest cities of Brazil to reach a consensus on the base-case value and on the possible ranges of each resource used. Financial values were translated into USD based on the exchange rate of R$2.40 US$1.0. RESULTS: The mostly used diagnostic procedures were upper digestive endoscopy, abdominal computed axial tomography (CAT) and thoracic radiography. For 1st line treatment, 5FU-based chemo was the first choice of 50% of the oncologists interviewed, either given in combination with cisplatin (22%), etoposide (17%) or cisplatin plus doxorubicin (11%). Most commonly used resources in BSC/terminal care were blood analysis and anti-algic radiation. The mean cost per patient were: diagnostic and staging: R$451 (US$188); 1st line treatment: R$4565 (US$1902); 2nd line treatment: R$2740 (US$1142); BSC: R$883 (US$368); and terminal care: R$416 (US$173). The total mean cost per patient were therefore R$9056 (US$3773) of which chemotherapy drugs represented 37%. CONCLUSIONS: Findings suggest that the total mean cost of treating AGC per patient in the public sector in Brazil is R$9056 (US$3773). PCN53 COST PER DISEASE STAGE OF ADVANCED GASTRIC CANCER IN BRAZIL FROM THE PRIVATE PAYER PERSPECTIVE Clark O1, Santos EA2, Saggia MG2 1 Evidencias Medicas, Campinas, Sao Paulo, Brazil, 2Roche Brazil, Sao Paulo, SP, Brazil OBJECTIVES: Gastric cancer is the second most frequent cause of cancer death worldwide. Approximately 22,000 new cases are expected in Brazil annually. Our aim was to estimate the cost per disease stage of advanced gastric cancer in Brazil in the private health care sector. METHODS: A questionnaire was developed to identify the medical resource usage (MRU) of managing gastric cancer in the private health care system. The questionnaire was applied in a structured interview to 40 experts (20 oncologists and 20 nurses) who represented different Brazilian regions. MRU data were extracted according to the following stages: 1) diagnosis and staging; 2) 1st line treatment; 3) 2nd line treatment; 4) best supportive care (BSC), and v) terminal care. Later, a modified Delphi panel was conducted to reach a consensus on the base-case value and on possible ranges for each resource identified. A micro-costing technique was then applied to calculate costs. Financial values were translated into USD based on the exchange rate of R$2.40 US$1.0. RESULTS: The most used diagnostic procedures were upper digestive endoscopy, abdominal computed axial tomography (CAT) and thoracic radiography. 5FU/capecitabine-based chemo was the oncologists’
Paris Abstracts first choice for both 1st and 2nd line treatment (48% and 42%, respectively). Most commonly used resources in the BSC/ terminal care stages were medical visits and blood analysis. The mean cost per patient were: diagnostic and staging: R$1,283 (US$ 535); 1st line treatment: R$ 0.502 (US$12,710); 2nd line treatment: R$ 6,406 (US$2,670); BSC; R$6,833 (US$2,847); and terminal care: R$743 (US$310). The total mean cost per patient were R$45,768 (US$19,070), of which chemotherapy drugs represented 66%. CONCLUSIONS: The findings indicate that the most expensive stage in treating advanced gastric cancer in the private sector in Brazil is the 1st line treatment. Further studies are recommended to explore the results. PCN54 A DESCRIPTIVE ANALYSIS OF SUBJECTS WITH METASTATIC GASTRIC CANCER (MGC) Oglesby AK1, Lage MJ2, Wang PF1 1 Amgen, Inc., Thousand Oaks, CA, USA, 2HealthMetrics Outcomes Research, LLC, Groton, CT, USA OBJECTIVES: To examine the patient characteristics, comorbidities, and medication usage of subjects diagnosed with mGC. METHODS: Subjects in the Marketscan Commercial Claims and Encounter Database (July 1, 2003–June 30, 2008) were included for analysis if they received a diagnosis of mestastasis based on ICD-9 codes on or after the first occurrence of GC, had no claims for other secondary metastases in the 6 months prior to the initial mGC claim, and had continuous insurance coverage from 6 months prior through at least one month post the initial diagnoses of mGC. Health care costs and resource utilization (HRU) are described from the date of initial mGC diagnosis through end of data collection due to patient drop out or end of the data collection period (e.g. post-period). Study data are shown as summary (or descriptive) statistics. RESULTS: A total of 2058 subjects with mGC were included in the analysis. At mGC diagnosis, the median age was 58 years (25th /75th percentile: 31 and 62 years respectively) and 60% were male. The mean length of follow-up after mGC was 2.6 years (SD: 1.3 years). The most common comorbidities at the time of mGC diagnosis were cardiovascular disease (48%), hypertension (29%), and diabetes (16%). Sixty-five percent of mGC subjects received outpatient chemotherapy in the post-period. Mean monthly medical costs were $5080 in the post-period, which consisted of 46% inpatient costs, 40% outpatient costs, and 14% outpatient chemotherapy costs. CONCLUSIONS: One-third of mGC patients were not treated with outpatient oncolytics. Outpatient chemotherapy costs constituted a small portion of the total cost of mGC. PCN55 THE ECONOMIC EVALUATION OF SUNITINIB AND SORAFENIB IN MRCC PATIENTS IN THE CZECH REPUBLIC Demlova R1, Ondrackova B2, Kominek J1 1 Masaryk Memorial Cancer Institute, Brno, Czech Republic, 2Masaryk University, Brno, Czech Republic OBJECTIVES: Sunitinib and sorafenib, the multikinase inhibitors, launched into the Czech market in the middle of 2006 as a second-line treatment of metastatic renal cell carcinoma (mRCC) and were not yet economically evaluated in real clinical practice. The aim was to assess direct medical costs in mRCC patients treated in comprehensive cancer centre from a health care payer perspective. METHODS: Between May 2006 and May 2009 31 mRCC patients were treated with sorafenib and/or sunitinib after previous cytokine therapy failure (mean age 52 years; 23 men). The progression of disease and costs (including concomitant medication, examination, check-ups, hospitalization) were assessed each two-months of therapy. Cost of cycle to progression, cost of cycle after progression and the structure of costs were determined. (1a 26.8CZK) RESULTS: Seventeen patients started therapy with sunitinib, 8 of which were converted to sorafenib after progression. 3 patients finished sunitinib therapy due to adverse events (AE). Fourteen patients started with sorafenib therapy, 2 of which were converted to sunitinib due to AE, other 2 patients were converted to sunitinib after progression. The main AE were skin toxicity, oedema, arthralgia and other pain. The dose was reduced in 10 patients due to AE. Median number of twomonth progression free cycles was 4; mean cost of one cycle was a7546. Cost of medication formed 95.4% (sunitinibsorafenib 94.3%), investigations and check-ups 4.42% and hospitalizations 0.18% of total costs. Median two-month cycles after progression was 2 with mean cost a4840. Sunitinib and sorafenib formed 90.5%, investigations and check-ups 6.2%; and hospitalizations 0.8% of total costs; 9 patients died. CONCLUSIONS: The analysis of direct medical costs in patients with mRCC proved high costs concerned with multikinase inhibitors´ therapy. Since data on the economic burden of oncology treatment in the Czech Republic are limited it is essential to start with cost-of-illness studies to enable pharmacoeconomic analyses for drug reimbursement. PCN56 COST OF RENAL CELL CARCINOMA TREATMENT IN PATIENTS TREATED WITH INTERFERON-ALPHA Purmonen T1, Vuorinen R2, Kataja V3, Pyrhönen S4, Kellokumpu-Lehtinen P5 1 University of Kuopio, Kuopio, Finland, 2University of Turku, Turku, Finland, 3Kuopio University Hospital and Vaasa Central Hospital, Kuopio, Finland, 4Turku University Hospital and University of Turku, Turku, Finland, 5Tampere University Hospital and University of Tampere, Tampere, Finland OBJECTIVES: Renal cell carcinoma (RCC) accounts for three peercent deaths in Finland. However, information on treatment modalities and the cost of treatment in different hospitals is scarce. The aim of the study was to clarify the current situation
Paris Abstracts of RCC-treatment in Finland. METHODS: Health care resource use, medication and survival data from 83 patients with metastatic RCC, who had received 1st line interferon-based therapy, were collected from the hospital records of 3 university hospitals. A structured form was utilized in the retrospective data collection. Kaplan-Meier method was used in survival analysis. RESULTS: Median survival time from diagnosis to death was 20.7 months (95%CI 14.9–26.4). All patients had received interferon-A (IFN) as the cytokine of choice, the duration of IFN-treatment was 5.6 months (median). Patients survived 11.9 months (95%CI 9.2–14.7) after initiation of active IFN-treatment. Median survival time after IFN-treatment failure was 3.8 months (95%CI 1.38–6.3). There were no significant differences in survival times between the hospitals. Most of the total treatment costs were due to hospitalization and IFNtreatment. The average treatment cost per follow-up day was a36 in population level. IFN-A caused 89% (median a7170/patient) of all medication costs. Hospitalization was responsible for majority of total non-medication costs (78%; median a10,980/ patient). The composition of different costs changed during disease progression. During active treatment period, the medication costs comprised the majority (60%) of total treatment costs. After the active IFN-treatment was stopped, i.e. during palliative phase, 94% of all costs were non-medication costs. Average cost per treatment day was less during the active treatment than after disease progression. CONCLUSIONS: Prolonging progression-free time and keeping patients out of hospital provide desirable outcomes both from humanistic and from economic perspective. New targeted treatments have shown their potential in the treatment of RCC. Nevertheless, their economic consequences should be carefully evaluated. PCN57 EVALUATION OF THE COMPLICATION RATE AND COST OF TREATMENT ACCORDING TO THE MASCC INDEX IN PATIENTS WITH FEBRILE NEUTROPENIA Borget I1, Bonnet P2, Gachot B2, Di Palma M3, Antoun S1, Merad M1 1 Institut de Cancérologie Gustave Roussy, Villejuif, France, 2Institut Gustave Roussy, Villejuif, France, 3Insitut Gustave Roussy, Villejuif, France OBJECTIVES: Febrile neutropenia (FN) is a side effect of chemotherapy, inducing significant morbidity and mortality. A previous study showed that MASCC score can distinguish patients according to their risk of FN-related complications. The objective of this study was to assess the predictive value of the MASCC score in identifying patient management options following an FN episode. METHODS: Prospective study of consecutive patients with a solid tumour and FN. According to the MASCC score and the antibiotic treatment, 3 management groups were defined: ambulatory (A MASCC 21 and oral antibiotics), hospitalization (H MASCC a 19 and IV antibiotics) or short hospitalization followed by outpatient management (AH 16 a MASCC a 26 and oral antibiotics). Data were collected on demographic, clinical, biological and therapeutic characteristics, as well as serious FN complications. Costs were analyzed from the societal perspective. Resources consumed (hospitalization, drugs, biological exams, transportations and follow-up) were collected during hospitalization and outpatient management. RESULTS: From January 2008 to April 2009, 138 FN episodes were registered in 128 patients. Mean age was 53 years and 77 patients were women. Thirteen patients received prophylaxis for FN with G-CSF. Twenty-seven episodes (20%) were managed at home (A): there was no complication and mean treatment cost was 498a o 748. Thirty nine episodes (28%) were treated in hospitalization (group H) for a mean of 6.9 days. Nine episodes were treated curatively with GCSF. There were 8 complications, including 3 FN-related deaths, leading to a mean management cost of 6216a o 3844. The AH group was composed of 72 episodes (52%). Secondary prophylaxis by G-CSF concerned 15 episodes (20%). There was no complication and no death in this group. Patients were hospitalized for a mean of 4.1 o 2.2 days, management cost being estimated at 3738a o 2038. CONCLUSIONS: MASCC score and type of antibiotic treatment allowed optimal management of patient to be determined. Future research would identify factors distinguishing highrisk patients from the intermediary population. PCN58 RESOURCES USED IN PATIENTS WITH ANEMIA INDUCED BY CHEMOTHERAPY REQUIRING BLOOD TRANSFUSIONS. EPICOST STUDY, PRELIMINARY RESULTS (ONVIDA GROUP) Camps C1, Casas A2, Barón F3, Colmenarejo A4, Jara C5, Lobo F6, Massuti B7, Poveda JL8, Rifá J9, Sánchez-Maestre C10, Rubio-Terrés C11 1 Hospital General Universitario de Valencia, Valencia, Spain, 2Hospital Universitario Virgen del Rocio, Seville, Spain, 3Hospital Universitario Santiago de Compostela, Santiago de Compostela, La Coruña, Spain, 4Hospital Central de la Defensa, Madrid, Spain, 5Hospital Unversitario de Alcorcón, Alcorcón, Madrid, Spain, 6Hospital Fundcaión Jiménez Díaz, Madrid, Spain, 7Hospital General de Alicante, Alicante, Spain, 8Hospital Universitario La Fe, Valencia, Spain, 9Hospital Son Dureta, Palma de Mallorca, Balearic Islands, Spain, 10Roche, Madrid, Spain, 11HERO Consulting, Madrid, Spain OBJECTIVES: To evaluate the medical, non-medical and indirect resources used in a group of patients with anemia induced by chemotherapy requiring blood transfusions and their associated costs. METHODS: An epidemiological, prospective study was conducted in 19 Spanish hospital sites during 2007–2008. 108 patients with anemia induced by chemotherapy were included and finally 32 patients who required blood transfusions were analyzed. The consumption of resources was obtained through two medical visits: basal and 5 months later. The resources and costs estimated were: (i) direct medical: related to blood transfusions; (ii) Indirect: workplace absence for patients and carers; (iii) direct non-medical: transportation to the hospital. The time horizon used was 5 months. RESULTS: The mean age of patients was: 62.1 o 8.6
A267 years old; 90.6% were men. Mean basal Hb level was 9.33 o 0.96 g/dl. and years from disease diagnostic: 0.50 o 0.96. (i) Direct medical costs: each patient received 3.7 o 2.6 units of red cell concentrates, the estimated cost was 306.40a. Mean length of stay due to transfusions was 318.6 o 280.2 minutes, the mean cost per patient was a699.22; (ii) Indirect costs: all patients visited the hospital with a carer; 16.1% of patients and 24.1% of carers had an employment, the he estimated cost per patient and carer was a33.82; (iii) Direct non-medical costs: the means of transport used were car (60.7%), taxi (21.4%) and bus/metro (17.9%); being mean cost per patient/carer a3.13. The total cost along 5 months, from the social perspective, related to blood transfusions in a patient with anemia induced by chemotherapy was a1,042.57/transfusion. CONCLUSIONS: According to the study, blood transfusions in patients with anemia induced by chemotherapy involve substantial costs due to consumption of medical and non-medical resources. PCN59 REAL-WORLD COSTS OF ADJUVANT TREATMENT FOR STAGE III COLON CANCER PATIENTS IN THE NETHERLANDS van Gils CWM1, Tan SS2, Redekop WK1, Punt CJA3 1 Erasmus University Medical Center, Rotterdam, The Netherlands, 2Erasmus MC University Medical Center, Rotterdam, The Netherlands, 3University Medical Center St Radboud, Nijmegen, The Netherlands OBJECTIVES: The potentially limited generalisability of RCT-based economic analysis may seriously restrict their relevance to policy-making. Therefore, the present study aimed to examine the costs of adjuvant treatment in stage III colon cancer based on real-world resource use. In addition, we determined the economic burden in the Netherlands. METHODS: Real-world data were gathered from the Dutch populationbased Cancer Registry supplemented with data from medical records in 19 hospitals. We were able to observe treatment patterns in clinical practice during 2005–2006 (N 427). From a representative patient sample (N 206), mean costs per patient were calculated in regard to the four most common treatment groups. Total costs for individual patients were determined by estimating resource use and unit costs of all relevant cost components. All costs were reported in euro 2007. RESULTS: Four percent of the patients received fluorouracil plus leucovorin (5FU/LV), 24% received capecitabine, 35% received 5FU/LV plus oxaliplatin and 37% received capecitabine plus oxaliplatin. Mean costs per patient amounted to a8,968, a9,901, a32,593 and a23,593 respectively. We found a substantial cost variation in the total costs obtained for individual patients as well as in each individual cost component. Inpatient hospital days, daycare treatments, outpatient visits and chemotherapy (leucovorin, capecitabine and oxaliplatin) were the most important cost drivers. Extrapolating the mean treatment cost per treatment group to all patients treated in 2005 and 2006 (n 2248) resulted in an economic burden of a26.1 million per year. CONCLUSIONS: Our results suggest a trend towards oxaliplatin plus either 5FU/LV or capecitabine as the preferred treatment for stage III colon cancer which is in line with national guidelines. Furthermore, a trend towards capecitabine is observed. This can be encouraged by lower treatment costs for capecitabine plus oxaliplatin over 5FU/LV plus oxaliplatin which may in part relieve the economic burden of stage III colon cancer in the future. PCN60 TREATMENT COSTS ASSOCIATED WITH METASTATIC BREAST CANCER Park HJ, Ko S Pfizer Korea, Seoul, South Korea OBJECTIVES: To better understand the economic implications of breast cancer on Korean society, it is important to quantify the costs of interventions during the late stage of breast cancer. This study was designed to examine the treatment costs in patients with metastatic breast cancer based on the clinical practice guidelines in breast cancer from Korea Breast Cancer Society. METHODS: To estimate the treatment costs consisting of drug and administration, we identified the preferred regimens for metastatic breast cancer from the Korean clinical practice guidelines in breast cancer; ‘Preferred single agents’, ‘Preferred agents with Bevacizumab’, ‘Preferred Chemotherapy Combination’, ‘Preferred first-line agents with trastuzumab for HER2-positive disease’ and ‘Preferred agents for trastuzumab-exposed HER2-positive disease’. Mean body surface area and weight of female adults in Korea were obtained from the Korea National Health and Nutritional Examination Survey (KNHANES). Costs of each agent and the administration costs were drawn from Korean pharmaceutical pricing lists, and the published chemotherapeutic administration reference from Health Insurance Review & Assessment Service, respectively. Shares of metastatic breast cancer patients to 1st, 2nd, and 3rd–line treatments were derived from the Market Research Report [2007^2008, 575 breast cancer patients]. The two non-reimbursed agents were excluded from the cost estimation. RESULTS: Among the single agents, the cost per month of taxanes class based regimen (KRW 1,013,600^2,173,148) is higher than anthracyclines class (KRW 120,497 ^ 354,950). The most frequent 1st line treatment, namely, docetaxel-based or paclitaxel-based combination chemotherapy was more than KRW 2,000,000 per month. The monthly cost of first-line agents with trastuzumab for HER2-positive disease was from KRW 2,620,030 to 5,085,866. The weighted monthly cost of 1st, 2nd, and 3rd line treatment was KRW 1,562,312, 1,226,304, and 1,322,615, respectively. CONCLUSIONS: The treatment costs of the metastaic breast cancer are substantial and vary by regimen in Korea.