Real-World Health Care Expenditure In Hemophilia A Patients Using Standard and Extended Half-Life Recombinant Factor Viii Products

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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

strong opioids for cancer pain by the fifth year of the analysis is 16.350, of which 4.088 are expected to be using oxycodone. The calculated impact is BRL 18 million. The parameters that most affect the result of the analysis are: market share and average treatment period. However, the result is not expected to be significantly higher than estimated in the base case analysis.  Conclusions: According to published literature, oxycodone´s inclusion impact on PCDT is considered medium. PSY13 An Observational Retrospective Cohort Database Study To Estimate Costs Regarding Immunoglobulin Use for Itp Treatment In The Brazilian Public Healthcare System Figueiredo AC1, dos Santos RF2, Manfrin DF2, Lemos M2 paulo, Brazil, 2Amgen, São Paulo, Brazil

1Amgen, sao

Objectives: This study aims to estimate intravenous immunoglobulin (IVIg) costs (total cost/year and cost/patient/year) and treatment patterns of adult chronic immune thrombocytopenia (cITP) patients in the Brazilian Public Healthcare System (SUS), as well as general patient characteristics (age, gender).  Methods: An observational retrospective cohort study was performed in DATASUS (public database). In order to estimate cost of IVIg/year/patient, an enrollment period from January 2012 to December 2013 with a follow up period until December 2015 was defined. ICD-10 code (D69.3) was used to identify patients (patients less than 18 years were excluded), which were followed up for 2 years in order to obtain an average cost of IVIg/year/patient with cITP. In a secondary analysis, total immunoglobulin cost related to cITP was estimated in each year (2012-2015).  Results: 660 patients were eligible in the defined enrollment period, 68% were women and the average age was 43 years. Of these, 590 used immunoglobulin, which accounted for 99% of the total cITP cost. Average cost per patient with IVIg was around R$16,000/year. Average annual immunoglobulin cost was R$57,200 for those patients that needed at least 3 immunoglobulin usages in a year, around 8% of the patients. Their expenses represented 30% of the total cost per year. The annual spending by the Ministry of Health for immunoglobulin use ranges from R$ 9.5 million (2012) to R$ 16.6 million (2016).  Conclusions: IVIg acquisition represents a substantial cost for the Brazilian government. Patients with high frequency of immunoglobulin use represent a significant burden for SUS since IVIG is used mainly as rescue therapy and has a transitory efficacy. Therefore, this study suggests that there is a high unmet medical need in cITP patients for more efficacious treatments that could reduce the burden associated with immunoglobulin usage in the Public Health System. PSY14 Real-World Health Care Expenditure In Hemophilia A Patients Using Standard and Extended Half-Life Recombinant Factor Viii Products Chhabra A1, Tortella BJ2, Alvir J1, Estevez C2, Spurden D3, Hodge J1, McDonald M1, Pleil A4 1Pfizer Inc, New York, NY, USA, 2Pfizer Inc, Collegeville, PA, USA, 3Pfizer Limited, Surrey, UK, 4Pfizer Inc, San Diego, CA, USA

Objectives: Management of hemophilia A includes replacement of factor VIII (FVIII) by intravenous infusion. The recent introduction of an extended half-life (EHL) FVIII product has enabled comparison of health care expenditure and volumes of factor dispensed for hemophilia A patients switching from a standard half-life (SHL) to EHL FVIII product.  Methods: The Truven Health Marketscan® Databases (Jan 2010- Jul 2016) were used to identify medication prescription claims and health care expenditure for patients with claims data for at least 3 months and up to one year before and after switching from an SHL to an EHL product. Total healthcare expenditure included FVIII replacement and hemophilia-related in-patient and out-patient expenditure. Data were analyzed 12 months prior to and after switch in FVIII product.  Results: 21 patients (1-52 years old) had data in the quarter immediately before and after the switch. Total healthcare expenditure was higher after switching from SHL to EHL. FVIII replacement accounted for 84%-100% of quarterly total healthcare expenditure. Median quarterly total healthcare expenditures were $92,682; $84,116; $85,492; $59,918 (SHL) and $186,325; $117,703; $103,921; $103,921 (EHL) while median quarterly FVIII expenditures were $78,289; $84,116; $85,492; $57,418 (SHL) and $185,257; $117,703; $103,921 and $103,921 post switch (EHL) in the 12-10, 9-7, 6-4, 3-1 and 1-3, 4-6, 7-9, 10-12 months pre- and post-switch, respectively. Median quarterly FVIII international units (IUs) dispensed were 66,048; 64,515; 64,148; 42,990 (SHL) and 73,923; 64,512; 54,894; and 59,814 (EHL) respectively in these periods.  Conclusions: This analysis suggests that switching from an SHL to an EHL product is associated with increased total health care expenditure and variability, including more EHL IU dispensed than SHL in quarters pre- and post-switch. Further real world analyses incorporating larger numbers of patients should be explored. PSY15 Burden of Disease for Rheumatoid Arthritis In Argentina, Brazil, Colombia, Mexico and Venezuela Papadimitropoulos M1, Castelar G2, Brnabic A3, Vorstenbosch EC4, Garcia EG5, Botello BS5, Hernandez P6, Goncalves L7, Gaich CL8 1Eli Lilly and Company, Canada; University of Toronto, Toronto, ON, Canada, 2Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 3Eli Lilly and Company, Sydney, Australia, 4Parc Sanitari Sant Joan de Deu, Barcelona, Spain, 5Eli Lilly and Company, Mexico City, Mexico, 6Compañía Farmacéutica Eli Lilly de Centroamérica, S.A, Este San José, Costa Rica, 7Eli Lilly and Company, São Paulo, Brazil, 8Eli Lilly and Company, Indianapolis, IN, USA

Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune disease which, when left untreated, may result in the destruction of multiple joints. The condition also can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. The objective of this study is to conduct a systematic review on disease burden for RA in five Latin-American countries, namely Argentina, Brazil, Colombia, Mexico and Venezuela.  Methods: PubMed/Medline, Embase, Web of Science and grey literature databases (BASE, SciELO and PDF Search Engine) were searched for publications in English, Spanish or Portuguese at November 10th 2016. Additionally, regional journals and professional and patient association web pages

were consulted. The AMSTAR quality criteria were taken into account.  Results: A total of 1585 records were retrieved. The Global Burden of Disease initiative 2015 estimated that RA accounted for 0.26% of World Disability Adjusted Life Years (DALY’s). For Latin America, these figures were higher: Argentina 0.63%, Brazil 0.33%, Colombia 0.51%, Mexico 0.71% and Venezuela 0.51%. The estimated prevalence of RA for these countries ranged from 0.38% (Brazil) to 0.73% (Mexico). RA has a negative impact on physical, mental and emotional wellbeing. Compared to healthy subjects, or patients with osteoarthritis or diabetes mellitus, RA patients had more impaired SF-36 scores. SF-36 physical and mental health scores ranged from 34 (Brazil) to 42 (Argentina) and from 44 (Argentina, Colombia) to 47 (Brazil, Mexico), respectively. The estimated annual medical costs in Colombia were US$1,689, $1,805 and $23,441 for mild, moderate and severe RA, respectively. Data from other countries were similar.  Conclusions: The burden of RA in Latin America is large. However, evidence is still scarce and more studies are needed to evaluate the full cost and impact of the disease in Latin American countries. PSY16 Idiopathic Pulmonary Fibrosis: Where The Functional Health Deterioration and The High Economic Impact Are Inseparable. Challenges In A Latin American Country Moreno-Silva NA, Diaz-Toro YR Productos Roche S.A. Colombia, Bogotá, Colombia

Objectives: To identify the main cost drivers associated with Idiopathic Pulmonary Fibrosis-IPF in the international context to make evident the healthcare attention challenges in Colombia.  Methods: The comprehensive review of the literature in the following databases: Medline, Embase, Econlit and Health Technology Assessment Database and, the search of “grey” literature published between January 1990 and February 2017, was conducted. The inclusion criteria were: IPF and its association with comorbidities, use of healthcare services and direct costs from the third payer perspective. A statistical analysis was performed using measures of central tendency. Finally, the identified evidence was used as reference to make recommendations regarding the management of IPF in Colombia.  Results: Nine articles in indexed journals and 8 posters in specialized medical congresses were identified. The evidence included population registers up to 2011. The median of the main comorbidities was: 30.6% for pulmonary infections, 32% for coronary diseases and 25.3% for cardiovascular problems. Functional deterioration and loss on quality of life resulted in a high use of healthcare services such as referrals to specialists, emergency consultations and hospitalization. The median annual cost for patient was US $ 58,164 associated with assisted ventilation, hospitalizations, and emergency room visits.  Conclusions: Nine articles in indexed journals and 8 posters in specialized medical congresses were identified. The evidence included population registers up to 2011. The median of the main comorbidities was: 30.6% for pulmonary infections, 32% for coronary diseases and 25.3% for cardiovascular problems. Functional deterioration and loss on quality of life resulted in a high use of healthcare services such as referrals to specialists, emergency consultations and hospitalization. The median annual cost for patient was US $ 58,164 associated with assisted ventilation, hospitalizations, and emergency room visits. PSY17 Direct Costs of Health Care of Cystic Fibrosis, The Case of A Health Insurer In Colombia Hoyos-Beltrán FJ1, Guarin NE1, Moreno JA1, Muñoz-Galindo IM1, Arevalo HO1, Diaz JA2 EPS, Bogotá D.C., Colombia, 2Universidad Nacional de Colombia, Bogotá D.C., Colombia

1Salud Total

Cystic fibrosis (CF) is an autosomal recessive disease, caused by a gene mutation, with the inability to transport chloride in epithelial cells, mainly affecting lungs, pancreas and intestine. It is a chronic orphan disease, progressive and high cost that affects more frequently Caucasian population, with a prevalence of 1/2,000 to 1/2,500 in the world. Objectives: To estimate the direct costs associated with the care of CF patients affiliated to a health insurer in Colombia during the period 2010-2015.  Methods: A retrospective study was conducted of a dynamic cohort of 40 patients distributed in 10 cities of the national territory and affiliated to a health insurer in Colombia, during January 2010 to December 2015. The demographic characteristics of the cohort are described and the average annual costs per health service and per patient were estimated. The costs were adjusted by inflation and expressed in American dollars for the year 2017.  Results: The prevalence of CF was 1.96 per 100,000 persons, 60% were men, the mean age was 9.8 years (SD 5.7 years), the cities with the highest concentration of patients were Bogota (27.5%), Ibagué (20%) and Medellín (15%). The average cost of annual attendance of patients in the cohort was $434.674, distributed in: drugs (68.7%), followed by hospitalization with (6.5%), critical care (4.6%), household medicine (3.6%), diagnostic and therapeutic procedures (2.9%) and clinical laboratory (2.0%). The average cost per patient annual was $9.555 (2010), $9.506 (2011), $8.666 (2012), $12.108 (2013), $12.609 (2014) and $12.757 (2015).  Conclusions: The average annual cost per patient of CF in the cohort evaluated is equivalent to the annual per capita premium of 50.2 patients by 2015. There is evidence of an increase in the cost per patient between 2012 and 2013 that could correspond to the introduction of new technologies in the Colombian market. PSY18 Antibiotics Treatment Patterns As A Costs And Resource Utilization Predictor Among Patients Submitted To Bariatric Surgery: Analysis of A Large Health Insurance Claims Database Luque A, Junqueira Junior SM, Oliveira D, Oliveira FM Johnson & Johnson Medical Brazil, São Paulo, Brazil

Objectives: Bariatric surgery has predictable outcomes. However, additional treatments might be necessary in some cases, such as the antibiotics treatments that could lead to higher costs and utilization resources, independent of the reimbursement model and length of stay.The aim of this study is to evaluate the feasibility to identify antibiotic patterns and its association with higher costs in a large health