PMH17 COST-EFFECTIVENESS OF LONG ACTING METHYLPHENIDATE-OROS IN ADHD YOUTHS WITH SUBOPTIMAL SYMPTOM CONTROL ON IMMEDIATE-RELEASE METHYLPHENIDATE IN THE NETHERLANDS

A314 functioning. METHODS: A Markov model was developed to estimate the cost-effectiveness of sertindole compared with risperidone, olanzapine and aripiprazole in the management of schizophrenia in Hungary over a two-year period. Patients entered the model upon experiencing intolerance to their antipsychotic treatment during an episode of acute psychopathology. Confounding factors included drug-induced adverse events (extrapyramidal symptoms, weight gain, sedation, sexual dysfunction, diabetes), compliance, relapse and treatment setting. Effectiveness was defined as the length of time without relapse over the two-year evaluation period, and by Quality Adjusted Life Years (QALYs). Parameter estimates were based upon published literature and comparative clinical trial data. Resource use data were obtained from the Psychiatry Department, Semmelweis University (Budapest), and costs were evaluated from the Hungarian National Insurance perspective. RESULTS: The time without relapse (over 2 years) for patients receiving sertindole was equivalent to those with risperidone, olanzapine and aripiprazole (0.768, 0.768, 0.764 and 0.766, respectively). The average cost per patient for two years after starting treatment with sertindole equalled that of the other atypical antipsychotics. The costs per year without relapse were similar for sertindole treated patients compared with the atypical risperidone, olanzapine and aripiprazole treated patients (€15,435, 15,096, 15,925 and 15,712, respectively). Sensitivity analyses confirmed robustness of the model. CONCLUSIONS: With equivalent clinical benefits, a good tolerability profile and similar costs, sertindole is an additional valuable treatment alternative to other atypical antipsychotics available in Hungary. PMH15 COST-EFFECTIVENESS OF AMISULPRID COMPARED TO RISPERIDONE AND OLANZAPINE IN THE TREATMENT OF SCHIZOPHRENIA IN POLAND

Kowalik E1, Jakubczyk M2, Lis J3, Niewada M4 1 Institute of Cardiology, Warsaw, Poland, 2Warsaw School of Economics, Warsaw, Poland, 3Sanofi-Aventis, Warsaw, Poland, 4Medical University of Warsaw, Warsaw, Poland OBJECTIVES: The aim of the study was to asses costs and effectiveness of amisulpride and other atypical antipsychotic drugs for the treatment of patients with schizophrenia in Poland. METHODS: The cost-effectiveness analysis from the payer perspective was conducted. Clinical data was derived from published clinical trials. Clinical improvement according to the Brief Psychiatric Rating Scale (BPRS) was adopted as a measure of effectiveness. Only direct medical costs were included and were expressed in polish zloty (PLN), 1 EUR = 3.95 PLN, exchange rate; 1 EUR = 1.98 PLN, purchasing power parities). The study horizon amounted to 8 weeks (the short-term model) and to 6 months of treatment (the long-term model). In the analysis there were three strategies of treatment compared: amisulpride, risperidone and olanzapine. The comparison was done pairwisely: amisulpride vs olanzapine and amisulpride vs risperidone. RESULTS: Both in the short-term and in the long-term model, the amisulpride proved to be a dominant strategy— having lower average cost and higher average effect—against risperidone as well as against olanzapine. Comparing amisulpride and risperidone—in the short-term model the costeffectiveness ratios (average cost per one unit of BPRS improvement) amounted to 55.3 PLN and 83.1 PLN for amisulpride and risperidone, respectively. In the long-term model the numbers were 135.7 PLN and 179.3 PLN, respectively. Conducting the amisulpride vs olanzapine comparison—in the short-term model the cost-effectiveness ratios amounted to 34 PLN for amisulpride and 43.5 PLN for olanzapine, and in the long-term model to:

Abstracts 105 PLN and 125 PLN, respectively. As amisulpride was a dominant strategy in all comparisons, acceptability curves were calculated instead of incremental cost-effectiveness ratios. CONCLUSIONS: The pharmacoeconomic evaluation in the short-term model as well as in the long-term model shows that amisulpride is a dominant strategy in the treatment of schizophrenia in Poland. PMH16 COST EFFECTIVENESS MODEL COMPARING FAST DISSOLVING OLANZAPINE AND CONVENTIONAL OLANZAPINE TABLETS IN THE TREATMENT OF SCHIZOPHRENIA

Ozsogut B1, Saylan M2 1 Yeditepe University Faculty of Pharmacy, Istanbul, Turkey, 2Eli Lilly and Company, Istanbul, Turkey OBJECTIVES: Olanzapine in fast dissolving orodispensable formulation (OOT) was shown to be associated with greater patient acceptance and improved medication adherence compared to olanzapine in conventional tablet form (OCT) in acute treatment settings. This study assessed, from a payer perspective, the cost and effectiveness of OOT compared to OCT over a 1-year period in the treatment of schizophrenia patients in Turkey. METHODS: Survival Curve Model was used to assess the dynamic effects of relapses and hospitalizations on direct cost of treatment by considering medication efficacy and patients’ adherence to the medication. Rates of relapse and rates of treatment discontinuation—due to poor efficacy, medication intolerability, or patient preference/nonadherence—were based on published medical literature, unpublished data, and a clinical expert panel. The model assumed that treatment discontinuation is lower with OOT compared with OCT in stabilized schizophrenia patients. Model assumptions were validated by an independent expert panel. RESULTS: Based on model projections, the number of patients who would discontinue their current medication during one year of treatment would be 28 for OOT and 40 for OCT group. The number of predicted relapses was 15 for OOT and 18 for the OCT groups. Results indicate a 12% increase in the number of patients who would continue their therapy and 3% decrease in the number of relapses for the OOT group. The projected annual total direct cost for a cohort of 100 patients was 355.629,46 YTL for OOT treatment and 412.845,36 YTL for OCT treatment. If all patients were assumed to be treated with OOT treatment instead of OCT, 16% would be treated, without any additional cost to the payers in Turkey. CONCLUSIONS: The use of olanzapine in fast dissolving orodispensable formulation is predicted in this model to be more cost effective than olanzapine in conventional table form. PMH17 COST-EFFECTIVENESS OF LONG ACTING METHYLPHENIDATE-OROS IN ADHD YOUTHS WITH SUBOPTIMAL SYMPTOM CONTROL ON IMMEDIATE-RELEASE METHYLPHENIDATE IN THE NETHERLANDS

Faber A1, Van Agthoven M2, Kalverdijk L3, Tobi H1, De Jong-van den Berg L1, Annemans L4, Postma MJ1 1 University of Groningen, Groningen, The Netherlands, 2Janssen-Cilag BV, Tilburg, The Netherlands, 3University Medical Centre Groningen, Groningen, The Netherlands, 4Health Economics and Outcomes Research, Brussels, Belgium OBJECTIVES: To estimate the cost-effectiveness of treatment with long acting methylphenidate-OROS for youths with attention-deficit hyperactivity disorder (ADHD) for whom treatment with immediate-release (IR) methylphenidate is suboptimal. METHODS: We developed a Markov model to obtain an incre-

A315

Abstracts mental cost-effectiveness ratio (ICER). The analysis covered 10 years, with a Markov cycle of one day. Costs included medication, consultations and treatment interventions and additional costs for attending special education. Quality-adjusted life years (QALY) were used as effectiveness measures. Outcome probabilities were taken from the medical literature and an expert panel of five child psychiatrists and pediatricians. Univariate sensitivity analyses were performed to assess the robustness of the base case estimate. Multivariate sensitivity analysis was used to estimate a worst and best case ICER. RESULTS: The incremental cost-effectiveness ratio of methylphenidate-OROS treatment compared to IR-methylphenidate in youths with ADHD for whom treatment with IR-methylphenidate is suboptimal, was 2004 euros per QALY. Total costs after 10 years were 15,739 euros for the IR-methylphenidate pathway and 16,015 euros for the methylphenidate-OROS pathway. In the univariate sensitivity analysis, the ICER was sensitive to changes in resource use and the probability of stopping stimulant treatment in favor of IR-methylphenidate. An ICER of 0 was reached with a 6.2% price reduction of methylphenidate-OROS. CONCLUSIONS: Methylphenidate-OROS is a cost-effective treatment for youths with ADHD for whom treatment with IR-methylphenidate is suboptimal. With regard to the cost items evaluated in this analysis, higher medication costs of methylphenidate-OROS were compensated by savings on resource use, yielding similar 10-year costs compared to treatment with IR-methylphenidate. Future cost-effectiveness analyses should retrieve estimations for model parameters from clinical trials or large databases and include direct non-medical costs associated with methylphenidate treatment. PMH18 DIRECT COST OF DEPRESSION—ANALYSIS OF A GERMAN CLAIMS DATABASE

Gothe H1,Volmer T2, Höer A1, Mangiapane S1, Runge C2, Glaeske G3, Häussler B1 1 IGES GmbH, Berlin, Germany, 2Wyeth Pharma GmbH, Münster, Germany, 3ZeS, Centre of Social Policy Research, Faculty 11: Human and Health Sciences, University of Bremen, Germany, Bremen, Germany OBJECTIVES: To retrospectively evaluate 1-year direct health care cost (antidepressants, hospital stays, rehabilitation) of patients with depression based on claims data. METHODS: Billing data of a German sickness fund with 4.7 million life years insured were used for the period from 2001 to 2003. Beneficiaries were included, if they were covered at least three months by the health insurance and had either an inpatient or sick leave diagnosis of depression (ICD 10: F32, F33) or at least two prescriptions of an antidepressant (ATC: N06A*) during this period. For each patient direct health care cost was derived from the database for the individual observation period and standardized subsequently to obtain 1-year cost. RESULTS: Out of 1.54 million beneficiaries n = 75.078 fulfilled the inclusion criteria (mean age: 48 ± 15 years; 57 % female). Total 1-year cost of illness amounted to €363 per patient (SD: €1584) as actuarial data. The median reimbursed cost of treating depression accounted for €31, the maximum was €57,404 p.a. per patient, representing that the majority of the patients caused relatively low expenditures and only a small group generated high health care cost. Stratification of total cost shows that inpatient care due to depression caused higher average cost per patient and year (212 ± €1479) than antidepressant therapy administered by office-based physicians (93 ± €177) or rehabilitation (54 ± €389). CONCLUSION: The study confirms that hospitalization is the main cost driver of depression. This is in line with current liter-

ature. There is also evidence that adequate antidepressant treatment prevents from hospital stays. Though, the findings reveal a distinct imbalance between inpatient and outpatient cost, especially for antidepressant pharmacotherapy. Keeping patients in an ambulatory care setting, supported by an optimized pharmacotherapy, might contribute to reduced overall health care spending per patient. PMH19 IMPACT OF REMISSION IN MAJOR DEPRESSIVE DISORDER ON ECONOMIC BURDEN OF ILLNESS IN SWEDEN

Sobocki P1, Ekman M1, Ågren H2, Runeson B2, Jönsson B3 Stockholm Health Economics, Stockholm, Sweden, 2Karolinska Institutet, Stockholm, Sweden, 3Stockholm School of Economics, Stockholm, Sweden OBJECTIVES: It is suggested that full remission should be the primary goal of depression treatment. However, few previous studies have directly measured the impact of remission on economic disease burden. The aims of this study were to compare costs of patients in remission with patients not achieving remission after an episode of major depressive disorder (MDD) in a Swedish primary care setting, and to determine effect of remission on overall cost of illness. METHODS: The cost of illness in remitters and non-remitters was estimated based on of a naturalistic longitudinal survey (HEADIS—Health Economic Aspects of Depression in Sweden). Records from 447 patients with a mean follow-up of 6 months were collected from 56 primary care centre, and the resource use was analyzed for patients having at least one follow-up visit. Unit costs were derived from standard Sweden sources. Swedish prevalence estimates were applied to per patient cost estimates to assess overall burden of illness among remitters and non-remitters. RESULTS: Full remission was achieved by 52% of the patients at end of follow-up. For non-remitters and remitters, total annual per patient costs amounted to SEK 128,000 and SEK 78,000, respectively. With MDD prevalence of 5% and Swedish 2005 population exceeding 9 million, overall burden of illness was SEK 46 billion. Increasing the proportion of remitters by 10% would decrease an overall burden of illness by 5%, to SEK 44 billion. CONCLUSIONS: Remission substantially affects economic burden of depression, decreasing total per patient cost by almost 40%. With high prevalence of MDD in Sweden, any strategy that will increase the remission rate will also markedly reduce the overall burden of illness. This indicates importance of full remission as the primary goal of treatment of depression and strengthens evidence that antidepressant treatments leading to rapid remission may be most beneficial. 1

PMH20 TREATMENT PATHWAYS AND COST ASSESSMENT OF SCHIZOPHRENIA IN GREECE: A PRIMARY ANALYSIS

Aggelopoulos E1, Geitona M2, Zaharakis K3, Kakavas P4, Karpouza V5, Kesidou S6, Kousoulakou C7, Bilanakis N8, Ollandezos M9, Papamichael E10, Papanicolaou S11, Chaidemenos A12, Chamogeorgakis T13, Kyriopoulos J9 1 Eginitio Hospital, University of Athens, Athens, Greece, 2University of Thessaly, Volos, Greece, 3Ygeia Hospital, Athens, Greece, 4Sinouri Hospital, Athens, Greece, 5Psychiatric Hospital of Thessaloniki, Thessaloniki, Greece, 6Social Insurance Institute, Athens, Greece, 7 Institute foe Economic and Industrial Research, Athens, Greece, 8 University Hospital of Ioannina, Ioannina, Greece, 9National School of Public Health, Athens, Greece, 10General Public Hospital Nikea, Piraeus, Greece, 11Janssen-Cilag Pharmaceutical SACI, Athens, Greece, 12 Psychiatric Hospital of Attica, Athens, Greece, 13Psychiatric Hospital of Athens, Dromokaitio, Athens, Greece