Pharmacoeconomic Analisys of Ixabepilone Monotherapy in Patients with Advanced or Metastatic Breast Cancer Resistant To Anthracyclines, Taxanes and Capecitabine

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VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1

of euros 50 000/year of PFS gained. Using OS, the ICER became non-statistically significant. Using QALY the ICER is non-statistically significant again, even considering 3 weighted health states (DFS, progression and death) and 4 weighted health states (DFS without GVHD, DFS with GVHD, progression and death) for the QALY calculation.  Conclusions: The choice of effectiveness criteria is crucial since it affects conclusions of economic evaluation. Using Intermediary endpoints allows economic evaluation to be available earlier in the life cycle of an innovation. However, it implies strong hypotheses about the predictive value of the PFS over the OS, and it does not include quality of life considerations. Longer period evaluation and QALY may reverse preliminary results. PCN155 Cost Effectiveness of Nivolumab for Patients with Advanced, Previously Treated Renal Cell Carcinoma in Scotland S1, Bullement A2, Willis A2, Sullivan W2, Britton

JA2, Cox

L2, Tyas

D3, Sowdani A3

Mahon 1BresMed Ireland, Dublin 24, Ireland, 2BresMed Health Solutions, Sheffield, UK, 3Bristol-Myers Squibb, Uxbridge, UK

Objectives: In advanced, previously-treated renal cell carcinoma (RCC), nivolumab monotherapy was the first treatment to demonstrate a significant overall survival (OS) benefit in a Phase III trial setting (CheckMate 025). The superior OS benefit observed versus everolimus [hazard ratio: 0.73 (98.5% confidence interval: 0.57, 0.93); p= 0.0018] is expected to translate into long-term OS benefits for a substantial proportion of patients treated with nivolumab. This expectation is based on the immunogenic nature of RCC, the immunomodulatory action of nivolumab and supportive Phase I/II data with up to 5 years follow-up. This study aimed to assess the cost effectiveness of nivolumab versus everolimus or axitinib as monotherapies for the treatment of advanced, previously-treated RCC from a Scottish National Health Service (NHS) perspective.  Methods: A previously reviewed de novo statetransition model was adapted to the NHS Scotland perspective. The model is based on the key clinical outcomes of disease progression and death, and is informed by CheckMate 025 data and published literature, with modelling assumptions clinically and economically validated for the NHS Scotland setting. The base case assumes efficacy and utility equivalence between everolimus (mTORi class) and axitinib (VEGFR-TKI class), and considers nivolumab’s expected immunomodulatory effect on OS.  Results: Nivolumab was associated with incremental cost-effectiveness ratios (ICERs) of £36,685 and £46,140 versus axitinib and everolimus, respectively (all list prices, Dec 2016). Robust sensitivity analyses suggest that nivolumab is a cost-effective alternative to the primary comparator of axitinib; ICERs were below £50,000 for all scenarios tested.  Conclusions: The results show nivolumab to be a highly effective and cost-effective end-of-life treatment option for patients with advanced, previously-treated RCC in Scotland. As the first immunotherapy in RCC, nivolumab represents a notable advancement in current treatment options and is considered a step-change in the management of this life-limiting condition. PCN156 The Impact of Increase in The Proportion of Early Breast Cancer Cases on Costs and Outcomes Ignatyeva V, Avxentyeva M, Derkach EV, Omelyanovskiy VV, Boyarskaya T The Russian Presidential Academy of National Economy and Public Administration, Moscow, Russian Federation

Introduction: There is a widespread belief among medical specialists in Russia, that increase in the proportion of breast cancer (BC) cases detected on early stages would lead to the substantial decrease in BC costs in the following years, thus all screening interventions are considered as cost-saving.  Objectives: To estimate the impact of the increase of the proportion of early BC cases on costs and outcomes for the cohort of women 50-54 years old.  Methods: We developed a model to assess lifelong costs and outcomes for the cohort of patients diagnosed with BC in 2014 at age of 50-54 (7,450 cases, 69.1% with stage I-II). Only direct medical costs (treatment and follow-up) of the BC covered by health care system were estimated, based on federal statistics, cancer registry data and experts’ survey. During the first year, costs and survival for the initial treatment were assessed. Then patients entered Markov model with 3 states: “progression-free”, “progression”, “death” with cycle length of 1 year. Transition probabilities were defined using published data, risk of death in “progression-free” state was assumed to be the same as in general population. At the next step, we estimated costs and outcomes if the proportion of early BC cases would increase by 1% (75 cases diagnosed at stage I-II, instead of IV). Costs and outcomes were discounted at 3,5% rate.  Results: In the basecase analysis lifelong costs per cohort were € 44.04 million and outcome–60,665 life years. Increase in the proportion of early BC cases by 1% resulted in € 120,414 decrease in costs during the first year, but at the lifelong horizon costs increased by € 110,072, and 513 life years were gained per cohort.  Conclusions: The improvement in the survival of BC patients due to earlier diagnosis results in higher lifelong costs, which are not compensated by the lower cost of initial cancer treatment. PCN157 Economic Evaluation of Exemestane Versus Tamoxifen in PostMenopausal Women with Early Breast Cancer from The Egyptian Health Care System Perspective Elshafeiz A, Abourawash AS, Elsisi GH central adminstrationof pharmaceutical affairs-ministry of health, Cairo, Egypt

Objectives: Breast cancer is the most common cause of cancer death in women worldwide. It imposes a substantial economic burden on the healthcare resources in Egypt each year. It is therefore becoming increasingly important to evaluate the cost-effectiveness of Exemestane 25mg versus Tamoxifen 20mg in post-menopausal women with early breast cancer from the Health Care system perspective in Egypt.  Methods: A Markov process model over 15-year time horizon with five health states (no recurrence, local or distant recurrence, contralateral breast cancer and death) based on the Egyptian clinical practice was developed. Transition probabilities were estimated based on the results from The Intergroup Exemestane

Study (IES). Health effects were expressed in terms of quality adjusted life years (QALYS). Direct medical costs were obtained from the governmental hospitals in Egypt. All costs and effects were discounted at 3.5% annually according to the Egyptian pharmacoeconomic guidelines. Deterministic sensitivity analyses were conducted.  Results: The study revealed that Exemestane yielded an additional gain of 0.23 QALYs at lower cost estimated by EGP 24,976 than Tamoxifen over 15-years, Exemestane is the dominant therapy. Deterministic sensitivity analyses indicated that the transition probability between health states of no recurrence to distant metastasis for Exemestane arm had the greatest impact on the results.  Conclusions: Exemestane 25mg is a cost saving strategy compared to Tamoxifen 20mg in post-menopausal women with early breast cancer. PCN158 Pharmacoeconomic Analisys of Ixabepilone Monotherapy in Patients with Advanced or Metastatic Breast Cancer Resistant To Anthracyclines, Taxanes and Capecitabine Kolbin A1, Mosikian A1, Kurylev A1, Balykina Y2, Proskurin M2 1First Pavlov State Medical University of St. Petersburg, Saint Petersburg, Russia, 2Saint Petersburg State University, Saint Petersburg, Russia

Objectives: Breast cancer (BC) morbidity in Russia is the highest among all tumors. The increasing use of anthracyclines and taxanes causes growing number of patients that has developed resistance. Therapeutic options in such patients are limited to ixabepilone, eribulin or chemotherapy combination regimens. The aim is to perform health-economic evaluation of ixabepilone in patients with metastatic BC.  Methods: Cost-effectiveness analysis and sensitivity analysis were performed. Progression-free survival and overall survival were included into the model as the effectiveness criteria. Decision tree model with Markov cycles was used. All costs were calculated from the healthcare system perspective.  Results: An analysis showed that direct medical total costs of ixabepilone (702369 RUR/patient/year) was by 13,6% less expensive compared to eribulin (812471 RUR/patient/year) and the two drug showed comparable effectiveness: median OS (10.24 and 11.38 for ixabepilone and eribulin, consequently) and median PFS (5.26 and 4.52 for ixabepilone and eribulin, consequently). Costs of AEs correction were two times higher in ixabepilone group (92150 RUR/patient/year) comparing to eribulin (43778 RUR/patient/year), given 13% and 5% share from total direct medical cost in ixabepilone and eribulin group, consequently. CER OS for ixabepilone was by 4% lower comparing to eribulin (1234634 RUR/patient/year and 1285104 RUR/patient/year, consequently). CER PFS for ixabepilone was by 35% lower comparing to eribulin (200295 RUR/patient/ month and 269625 RUR/patient/month, consequently). Eribulin ICER (OS) was 3476895 RUR/LYG which is 110% higher than cost-effectiveness threshold in Russia in 2016. Ixabepilone dominates eribulin when PFS is used as effectiveness criteria. Sensitivity analysis confirmed results of the baseline scenario.  Conclusions: Ixabepilone therapy was less costly and as effective as eribulin. The study showed ixabepilone is a cost-effective strategy in patient with advanced or metastatic BC resistant to anthracyclines, taxanes and capecitabine. PCN159 The Comparative Cost-Effectiveness of Cabozantinib, Everolimus and Axitinib in Advanced Renal Cell Carcinoma (ARCC) After Failure of Prior Therapy: Scottish Perspective Lister J1, Vataire A2, Amzal B3, Dinet J2, Meng J4, Karcher H3, Gabriel S2 1Analytica LASER, Lörrach, Germany, 2Ipsen Pharma, Boulogne-Billancourt, France, 3Analytica Laser, London, UK, 4LASER Analytica, Lorrach, Germany

Objectives: To compare the cost-effectiveness in Scotland of cabozantinib with axitinib and everolimus in adult patients with aRCC following prior vascular endothelial growth factor receptors (VEGFR) targeted therapy.  Methods: An economic model was developed to assess the cost-effectiveness using a lifetime time horizon, which equated to 30 years. Efficacy (time to discontinuation, progression free survival (PFS), overall survival) data came from the phase III trial METEOR (NCT01865747) comparing cabozantinib to everolimus. Equal efficacy for axitinib and everolimus was assumed due to the absence of head-to-head studies and differences in the design of pivotal trials, which precluded an indirect comparison. Tolerability (grade 3 and 4 adverse events) data came from two phase III trials: METEOR and AXIS (NCT00678392). Treatment duration for cabozantinib and everolimus was modelled through estimating time to treatment discontinuation (TTD), while treatment duration for axitinib was assumed to reflect PFS. For all efficacy endpoints, parametric curves were independently fitted to Kaplan-Meier curves of the three treatments to estimate outcomes during and beyond the trial period. Utilities were taken from METEOR. Costs data were specific to Scotland and list prices from the British National Formulary were used for drugs for this analysis.  Results: In the base case, treatment with cabozantinib was estimated to cost an average of 86,378 GBP per patient while providing them with 2.80 lifeyears (LY) and 2.21 quality-adjusted life-years (QALY). It resulted in an incremental cost effectiveness ratio (ICER) of 93,221 GBP/LY and 115,473 GBP/QALY compared to everolimus, and an ICER of 78,716 GBP/LY and 97,224 GBP/QALY compared to axitinib.  Conclusions: Treatment with cabozantinib was more costly but also more effective in terms of LYs and QALYs gained than treatment with everolimus or axitinib. These conclusions held true across a range of scenarios and sensitivity analyses, including one-way and probabilistic analyses. PCN160 Cost-Effectiveness of Afatinib, Gefitinib, Erlotinib, and PemetrexedBased Chemotherapy as First-Line Treatments for Egfr Mutation Positive, Advanced Non-Small Cell Lung Cancer in China Zhu J1, Ye M2, Fu J2, Wu B3, Chu Y4, Zhao Y5, Zhang Y4, Kuo D5, Su B6 1Shanghai Chest Hospital, Shanghai Jiaotong University, shanghai, China, 2Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, shanghai, China, 3Shanghai Jiaotong University, Shanghai, China, 4Boehringer Ingelheim (China) Investment Co., Ltd., Beijing, China, 5Boehringer Ingelheim China Investment Co., Ltd., Shanghai, China, 6Boston Healthcare, shanghai, China