Programa Stewardship: Otimizando A Terapia Antimicrobiana Com Eficiência Em Um Hospital De Ensino De Referência Em Fortaleza, Ceará

A932

VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 8 5 3 – A 9 4 3

PIN32 A Sistematic Review Of The Cost-Effectiveness Of Vaccinating Elderly With The 23-Valent Pneumococcal Polysaccharide Vaccine (Ppv23) Nishikawa AM1, Mainardi GM1, Novaes HM2, Sartori AM3, De Soarez PC4 1University of São Paulo, São Paulo, Brazil, 2University of Sao Paulo, Sao Paulo, Brazil, 3Sao Paulo University, São Paulo, Brazil, 4Universidade de São Paulo, São Paulo, Brazil

Objectives: To systematically review the available literature on cost-effectiveness of PPV23 in adults aged > 60 years.  Methods: We searched the MEDLINE, LILACS, Bireme, Cochrane, EMBASE, NHSEDD and Centre for Reviews and Dissemination (CRD) databases for full economic evaluations of PPV23 published up to March 2016. Two independent reviewers screened the articles for relevance and extracted the data. Main study characteristics and methods (clinical and epidemiological data, cost and incremental cost-effectiveness ratios (ICERs) were extracted and compared. Costs were updated to US$2016.  Results: Twenty-seven studies were reviewed. The studies were published from 1980 to 2016. Most were conducted in Europe and US (81.5%); three studies were conducted in Latin America (Brazil, 2; Colombia, 1). All studies compared VPP23 to not-vaccinating and three studies also compared VPP23 to pneumococcal conjugate 13-valent vaccine (PCV13). All studies used static models. Most use a lifetime (44.4%) or 5 to 6 year’s time horizon (33.3%). Just 3 studies considered herd protection from children immunization with PCV13 in the model. Most studies considered PCV23 cost-effective (less than US$50,000 per LYG or QALY) and sometimes cost-saving (results ranging from cost-saving to 101,670/QALY).  Conclusions: This systematic review revealed that the costeffectiveness results have conflicting results, from cost-saving to not cost-effective at all. Assumptions regarding vaccine effectiveness, particularly for non-invasive pneumonia, and waning immunity varies greatly among different studies and impact the results. PIN33 Systematic Review Of Economic Evaluation Studies For Dengue Vaccine: How Valid Are The Results? De Soarez PC1, Silva AB1, Randi BA1, Novaes HM2, Sartori AM1 Paulo University, São Paulo, Brazil, 2University of Sao Paulo, Sao Paulo, Brazil

PIN35 An Economic Evaluation Of Single Tablet Regimens Of Antiretroviral Therapy For Treatment-Naitve Hiv-Infected Patients Chou C1, Terris-Prestholt F2, Miners A3 1Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, 2London School of Hygiene and Tropical Medicine, London, UK, 3London School of Hygiene & Tropical Medicine, London, UK

Objectives: Antiretroviral therapy (ART) has considerably changed the life expectancy and life quality of HIV-infected patients. However, uprising epidemic of HIV infection and the new recommendation of early ART initiation cause a heavy financial burden. Cost-effectiveness of ART should consequently be considered. Single-tablet regimen (STR), one pill that contains a combination of multiple antiretroviral agents, is a recent advance in HIV treatment and widely used now. The objective of this study is to perform a cost-utility analysis of STR using a decision model to assess the cost-effectiveness of tenofovir disoproxil fumarate/ emtricitabine/rilpivirine (TDF/FTC/RPV) compared to tenofovir disoproxil fumarate/ emtricitabine/efavirenz (TDF/FTC/EFV) for asymptomatic, treatment-naïve HIVinfected patients.  Methods: A Markov model with a hypothetical cohort of 1000 HIV-infected patients having initial viral load ≤  100,000 copies/ml was designed. Quality-adjusted life year (QALY) was used as the health outcome and incremental cost-effectiveness ratio (ICER) comparing the two STRs was calculated. The willingness-to-pay (WTP) threshold of 70000USD was adopted. Most of the parameters in the model were considered stochastic, and the uncertainty was taken into account by deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA).  Results: The calculated ICER per QALY was 13521.6USD. In terms of uncertainty, the ICER was sensitive to all parameters in the model. DSA showed that the most significant parameter of transition probability was the treatment efficacy of the two STRs. The utility in the first cycle and the costs of two STRs were also found influential. PSA demonstrated that the probability of cost-effectiveness was 61% at the WTP of 70000USD.  Conclusions: The ICER per QALY (13521.6USD) of TDF/FTC/RPV to TDF/FTC/EFV comprised a relatively small fraction of the adopted WTP (70000USD), but there was significant uncertainty coming from the treatment efficacy and costs. TDF/FTC/RPV may be more cost-effective compared to TDF/FTC/ EFV for treatment-naïve HIV-infected patients.

1Sao

Objectives: To review the literature on economic evaluation of dengue vaccination to produce evidence to support a local cost-effectiveness study and to subsidize the decision to introduce a dengue vaccine in the Brazilian National Immunization Program (NIP). Methods: We systematically searched multiple databases (MEDLINE (via PubMed), EMBASE, SCOPUS, NHS Economic Evaluation Database (NHS EED), HTA Database (via Centre for Reviews and Dissemination CRD) and LILACS), selecting full HEEs of dengue vaccine. Two independent reviewers screened articles for relevance and extracted the data. The methodology for the quality reporting was assessed using CHEERS checklist. We performed a qualitative narrative synthesis.  Results: Eight studies were reviewed. They were conducted in Asian and Latin America countries. All studies were favorable to the incorporation of the vaccine. However, the values and assumptions assumed for vaccine efficacy, safety and duration of protection, as well as the choice of the study population and the type of model used in the analyses, associated to an insufficient reporting of the methodological steps, affect the validity of the studies results. The quality reporting appraisal showed that the majority of the studies reported less than 50% of the CHEERS checklists’ items.  Conclusions: This systematic review shows that the economic evaluation of dengue vaccination are not adherent to key recommended general methods for economic evaluation. The presented cost-effectiveness results should not be transferred to other countries. It is recommended to conduct studies with local epidemiological and cost data, as well as assumptions about vaccination that reflect the results observed in clinical trials. PIN34 Health Economic Analysis Of Pneumococcal Conjugated Vaccines For Mexico, Under A Technical Parity Scenario Gomez J1, Carreno Manjarrez R2, Cortes-Alcala R2, Olbrecht J3, DeAntonio R4 1GSK, Victoria, Argentina, 2GSK, Mexico, Mexico, 3GSK, Wavre, Belgium, 4GSK, Panama

City,

Panama

Objectives: To update the cost-effectiveness analysis of 2 Pneumococcal Conjugated Vaccines (PCV) (PCV-13 and PHiD-CV) previously published for Mexico, with a scenario of no superiority between them (“technical parity”) based on the recent systematic review about impact and effectiveness of these PCVs in children from 5 countries in Latin America (de Oliveira et al.,PLoS ONE, 2016, 11 (12): e0166736).  Methods: Our previous cost-effectiveness & cost-utility analysis of implementing a PCV program in the Mexican pediatric population was completed with this new scenario of no superiority between PCVs on Invasive Pneumococcal Disease (IPD) and pneumonia in children less than 5 years of age. On this scenario, all original inputs remained the same, even the price parity between vaccines, but the vaccine effectiveness against IPD and pneumonia were considered equal between PCVs. The robustness of the conclusions was assessed through a sensitivity analysis that included all of the parameters considered by the model.  Results: In this scenario, PHiD-CV was dominant over PCV-13 in the “cost-utility analysis”; generating more quality-adjusted life years at a lower cost and a lower incremental cost-utility ratio, based on a better profile against acute otitis media. On the “costeffectiveness analysis”, both vaccines generated equal number of life years gained, but PCV-13 at a higher cost. Although both vaccines produced equivalent health outcomes, in this scenario of technical parity against IPD and pneumonia between vaccines, the analysis predicted that PHiD-CV would save 367 / 422 million “2013 Mexican pesos” (discounted / undiscounted), per vaccinated cohort as compared with PCV-13.  Conclusions: Even though PCV-13 and PHiD-CV were both costeffective when used to implement a pediatric vaccination campaign for Mexico, PHiD-CV had a better cost-utility / effectiveness profile based on the demonstrated differential effect against acute otitis media.

PIN36 Programa Stewardship: Otimizando A Terapia Antimicrobiana Com Eficiência Em Um Hospital De Ensino De Referência Em Fortaleza, Ceará Reis HP1, Castro K1, Andrade CC1, Neto JA1, Barros A1, Rodrigues JL2, Girao ES3, Pontes LB3, Pitta A2, Fonteles MM4, Ponciano AM1 1UFC, Fortaleza, Brazil, 2Universidade Federal do Ceará, Fortaleza, Brazil, 3HUWC, Fortaleza, Brazil, 4Federal University of Ceará, Fortaleza, Brazil

Objectives: determinar o custo evitado com antimicrobianos (ATM) através das estratégias de racionalização do Programa Stewardship (STWDSP) em um Hospital de ensino de referência no Ceará, Brasil.  Methods: estudo prospectivo (follow-up) com dados de mundo real, realizado em um Hospital de referência de ensino em Fortaleza/CE, através do Programa Stewardship (STWDSP) de Gestão Clínica de ATM, entre novembro/2016 a janeiro/2017. Aplicou-se os pressupostos do Protocolo Stewardship da Sociedade Americana de Doenças Infecciosas (IDSA, 2016). Utilizou-se como fontes os prontuários e sistema informatizado da instituição (microbiológico e o logístico). As sugestões foram realizadas nas discussões interdisciplinares do time com o médico assistente. O custo-evitado teve como base o custo do total do esquema proposto inicial e o custo real após validada a estratégia STWDSP discutida. Foi utilizado o preço de cadastro do ATM institucional. Os dados eram registrados em um instrumento de monitorização de ATM contemplando parâmetros clínicos, da farmacoterapia antimicrobiana e microbiológicos. Aprovado pelo Comitê de Ética da Universidade Federal do Ceará  Results: As estratégias selecionadas foram: Auditoria interdisciplinar e feedbacks; Protocolo de restrição para dispensação de ATM de reserva; Gestão do tempo de tratamento; Descalonamento; Switch therapy (terapia sequencial oral e Step down para Ertapenem) e Educação permanente. No período foram acompanhados 12 pacientes que usaram ATM reserva/estratégico (clínica médica, cardiologia e transplante renal). Média de idade 55 ± 17 anos, 67% do sexo masculino. A principal indicação foi para pneumonia hospitalar (52,63%). As estratégias mais efetivadas foram redução do tempo tratamento e terapia seqüencial oral. Houve um custo médio evitado de R$ 2.136,86/ paciente (29,58%).  Conclusions: Neste trabalho o STWSDP mostrou ser uma eficiente ferramenta de Gestão Clínica, otimizando o uso de ATM, promovendo a interdisciplinaridade e reduzindo o custo dessa farmacoterapia. Sugere-se uma maior sensibilização de todos os envolvidos, especialmente o prescritor, para ampliação das estratégias de racionalização propostas. PIN37 Economic Evaluation Of Cobicistat-Boosted Darunavir In Hiv-Infected Patients In Mexico Guirant Corpi L, Olivares N, Fritz K, Aguirre A Janssen Mexico, Mexico City, Mexico

Objectives: Cobicistat (cobi) is a new booster alternative whose physicochemical properties allow the co-formulation with darunavir to obtain the fixed dose combination of darunavir/cobicistat 800/150 mg (DRV/cobi) in a single tablet per day. This analysis aims to present the economic evaluation of darunavir in a daily dose of 800 mg boosted with 150 mg of cobi or with 100 mg of ritonavir (rtv) in the Mexican context.  Methods: A complete economic evaluation was carried out through a cost minimization analysis since DRV/cobi and darunavir boosted with rtv (DRV+rtv) have shown bioequivalence in published studies. The efficacy of DRV/cobi is directed only by darunavir as it is the component with antiviral activity; cobi works as an enhancer to achieve optimal concentrations of darunavir in blood. Therefore, the efficiency shown by DRV+rtv is extrapolated to DRV/cobi. The costs of the drugs to calculate the annual cost of treatment were obtained from published sources