Pharmacoeconomic Evaluation of Cancer Treatments in India

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8

Objectives: Renal Cell Carcinoma (RCC) is the most common type of kidney cancer. Its incidence has increased rapidly in China in recent years. Targeted therapy is the main treatment option for metastatic RCC(mRCC). The objective of this study is to estimate and compare the cost of different sequential treatment regimens for mRCC from a Chinese payer’s perspective.  Methods: A cost analysis was performed to assess the health care costs of all possible treatment sequences from the perspective of National Health Insurance in China. The base case sequential treatment regimens included: 1) sunitinib as 1st-line (1L), axitinib as 2nd-line (2L) and everolimus as 3rd-line (3L) (SuAE); 2) sunitinib as 1L, sorafenib as 2L and axitinib as 3L (SuSoA); 3) sunitinib as 1L, everolimus as 2L and sorafenib as 3L (SuESo). The medication costs were derived from databases of Ministry of Health and insurance organizations. Current patient assistance programs for sorafenib, sunitinib and axitinib in China were incorporated by applying the relevant cost discounts. Treatment duration(estimated based on progression-free survival), cost and incidence of AEs by treatment line were obtained from the literature. Cost per patient per month (PPPM), cost per patient were calculated for each treatment sequences.  Results: When sunitinib was used as 1L, axitinib as 2L and everolimus as 3L(i.e.,SuAE), the PPPM cost was ¥15,106, which was lower than the SuSoA(¥18,824) or SuESo(¥20,479) regimens. The total treatment duration for SuAE was 21.4 months, slightly shorter than SuSoA (21.7 months) and longer than SuESo (18.3 months).The total regimen cost per patient was ¥322,714 for SuAE , ¥408,253 for SuSoA, and ¥374,892 for SuESo.  Conclusions: This study suggests that adding axitinib to treatment strategy as 2L following sunitinib may lower total treatment regimen costs in mRCC from the Chinese National Health Insurance payer’s perspective. PCN16 Burden of Cancers Attributable to Tobacco Smoking in Member Countries of the Association of South East Asian Nations (Asean), 2012 Kristina SA1, Endarti D1, Thavorncharoensap M2 1Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia, 2Mahidol University, Bangkok, Thailand

Objectives: This study aims to estimate burden of cancers attributable to tobacco smoking in ASEAN, 2012. Methods: In this study, smoking prevalence was combined with Relative Risks (RR) of cancer to obtain Smoking Attributable Fraction (SAF). Cancer morbidity and mortality data were derived from GLOBOCAN 2012.  Results: The findings showed that tobacco smoking was responsible for 131, 022 cancer cases and 105,377 cancer mortality in ASEAN countries in 2012. In other words, tobacco smoking was accounted for 28.2% (43.3% in male and 8.0% in female) and 30.3% (44.1% in male and 9.0% in female) of cancer cases and cancer deaths in ASEAN, respectively. When looking at the type of cancer, lung cancer showed the strongest association with tobacco smoking. The number of cancer cases and cancer deaths attributable to tobacco smoking varied by countries due to the different size of population, background risk of cancer, and prevalence of smoking in each country.  Conclusions: As about 30% of cancer cases and mortality in ASEAN are attributable to tobacco smoking ASEAN member countries are strongly encouraged to put in place stronger tobacco control policies and to strengthen the existing tobacco control measure in order to effectively control cancer. PCN19 Economic Burden of Gefitinib Versus Pemetrexed for Insured Patients with Lung Cancer in Urban Xinjiang Province, China: A Real World Research MAO W, Chen W Fudan University, Shanghai, China

Objectives: To compare the economic burden of lung cancer patients treated with Gefitinib or Pemetrexed in real world  Methods: Discharge diagnosis (ICD-10) of hospital admissions was used to identify lung cancer patients and their hospital admissions and outpatient visits records during 2012-2015 were extracted from insurance database. Records after first treatment with Gefitinib or Pemetrexed were eligible  Results: 350 patients with average age of 62.63 have been averagely followed up for 7.46 months, among which 55.14% are male and 87.14% were enrolled in UEBMI and the rest in URBMI. For 157 patients (44.86%) treated with Gefitinib, average fee per OP visit is 240$, 210$ and 214$ for the 3, 6 and 12 months respectively after first treatment, while average fee per hospital admission is accordingly 4,062$, 3,938$ and 3,984$. For 193 patients with Pemetrexed, average fee per OP visit is 57$, 68$ and 83$ for the 3, 6 and 12 months respectively while average fee per hospital admission is accordingly 4,826$, 4,703$ and 4,554$. Reimbursement rate is 43% for OP visit and 75% for hospital admission for both Gifitinib and Pemetrexed. Gefitinib group has lower total expense per patient than that of Pemetrexed (p< 0.01), which is 6,698$, 9,040$ and 12,082$ vs. 10,952$, 13,559$ and 14,959$ in 3, 6 and 12 months respectively. Overall OOP rate is about 21.7% for Gefitinib group, compared to 23.2% for Pemetrexed. Gefitinib or Pemetrexed takes about 40% of total expense whileas 85% and 98% of total expense was spent on hospital admissions for Gefitinib and Pemetrexed group  Conclusions: Lung cancer patients are faced with heavy economic burden and basic health insurance has been playing a crucial role in relieving financial burden. Although expense per OP visit is higher for Gefitinib, the expense per hospital admission and total expense per patient are much lower than those of Pemetrexes PCN20 Pharmacoeconomic Evaluation of Cancer Treatments in India Sundar S1, Rajan S1, Nagappa A2 1Manipal University, Manipal, India, 2SCS College of Pharmacy, Harpanahalli, India

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Objectives: To evaluate and analyse the pharmacoeconomic evaluation of cancer treatments in a tertiary care facility in South India.  Methods: In this prospective study, a survey of cancer treatments is carried out in a tertiary care hospital from the case reports of cancer patients who are under treatment for cancer. The average cost of treatment, cost of medicines, and indirect non-medical expenses are computed. The results are expressed in terms of percentage of cost of treatment, cost of medicines and non-direct medical expenses.  Results: The cost are expressed in INR. The overall average cost of treatment is 5 Lakhs; cost of medicines 30,000 INR per visit per dose and non-medical costs 3,000 INR per visit per dose. The treatment involves 5 - 10 cycles of chemotherapy. The cost also involved the cost of surgery and radiation therapy for some patients which enhanced the average cost of treatment. Most of the patients are paying for the treatment out of pocket.  Conclusions: The treatment of cancer is not only expensive, but beyond the economic means of an individual patient as the government subsidies and insurance coverage is not adequate to meet the high cost of cancer treatment. PCN21 Comparison of Cost-Effectiveness Between Egfr-Tkis Therapy and Chemotherapy for Advanced Nsclc Zhang T1, Cai S1, Wu C2, Xu J1, Lin T1, Jiang J1 1Jinan University, Guangzhou, China, 2Sun Yat-sen Universtiy, Guangzhou, China

Objectives: To speculate the cumulated ICER of EGFR-TKIs treatments in ten years for advanced NSCLC patients with different EGFR gene mutation status and assist the government to make decision on drug reimbursement in order to achieve the optimal value of the limited healthcare resource.  Methods: TreeAge Pro 2011 was used and one month was set as a stage. A total of 120 stages were circulated to evaluate the 10-year cost and effectiveness.  Results: According to roll back analysis, the total cost for chemotherapy was $28273 with the prolongation of 15.814 month in cumulated 10 years, and $37405 with the prolongation of 17.102 months for EGFR-TKIs. The ICER was $1304.72/LGM (life-gained month) through Markov cohort analysis and $1297.38/LGM through Monte Carlo analysis. Neither of the ICER values exceeded the predefined WTP (three times of GDP per capita per month). According to the probability sensitivity analysis, there was a probability of 87.1% for EGFR-TKIs being more cost-effective than chemotherapy. For cities or provinces with a GDP per capita per month more than $378.75, there was a probability of more than 50% for EFR-TKIs being more cost-effective. Chengdu, the city from which our clinical data came, gained GDP per capita per month in 2014 of $942.83, Therefore, its WTP would raise to $2862.5 (three times of $942.83) which largely exceeds the ICER either speculated by Markov cohort ($1304.72/ LGM) or by Monte Carlo analysis ($1297.38/LGM).  Conclusions: As WTP was predefined as three times of GDP per capita per month,EGFR-TKIs showed a probability of 87.1% being more cost-effective than chemotherapy for advanced NSCLC patients with mutated EGFR gene under the continuing fund support from China Charity Federation. Taking the example of Chengdu, EGFR-TKIs was 99% probably superior to chemotherapy in cost-effectiveness for NSCLC patients with mutated EGFR gene. PCN22 Current Trends in Methods of Pharmacoeconomic Studies of Cancer Therapies in China Ma F1, Cheng X2, Aballéa S3, Toumi M4 1Creativ-Ceutical, Beijing, China, 2Creativ-Ceutical, Hong Kong, Hong Kong, 3Creativ-Ceutical, Paris, France, 4Aix-Marseille University, Marseille, France

Objectives: This study aimed to describe the evolution of methodology of published pharmacoeconomic studies of cancer treatments conducted in China from 2003 to 2015. Methods: A systematic literature search was performed using Chinese literature databases, including CNKI, Wanfang and CQvip, to identify pharmacoeconomic studies on anti-cancer drugs conducted in China. The inclusion criteria were: 1) patients with cancer; 2) anti-cancer drugs compared with other anticancer drugs or placebo; 3) cost-effectiveness, cost-utility, cost-minimization, or cost-benefit studies; 4) original research (excluding literature reviews); 5) conducted in China and written in Chinese. Study characteristics related to publication, study design, data sources and outcomes were extracted.  Results: 144 studies, covering 10 main types of cancers published between January 2003 and September 2015, were selected. The average annual growth rate (AAGR) of the number of published studies was 17.7%. In the past 12 years, three most studied cancers were lung (45.8%), breast (17.4%), and gastric cancers (10.4%), which matched with the top three leading cancers in China during 2000-2011. Further, lung cancer had the highest AAGR (14.7%) among pharmacoeconomic studies. The cost-effectiveness analysis framework was most widely used, from 100% of published studies in 2003 to 75% in 2015. Since 2010, an average of roughly 10% of studies was based on models. Observed data from single-center were the main source of effectiveness, increasing from 33.3% in 2003 to 75% in 2015. On average, direct non-medical and indirect costs were evaluated by less than 10% of studies each year. 68.6% of studies chose tumor response rate as primary health outcome.  Conclusions: Although the number of pharmacoeconomic studies is increasing rapidly in China, most evaluations of cancer therapies are based on single-center data and report surrogate outcomes instead of systematic review of evidence and final outcomes, such as utilities, which are preferred by the Chinese Guidelines for Pharmacoeconomic Evaluations and Manual.

PCN23 Implications of Price Erosion of Docetaxel After Loss of Exclusivity on Cost-Effectivess