Short And Long Term Costs Associated With Different Cardiovascular Events In Belgium

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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6

Sociale, Edinburgh, UK, 4Open University of Cyprus, Latsia, Nicosia, Cyprus, 5EOPYY-National Organization for Health Care Provision, Marousi, Greece, 6National and Kapodistrian University of Athens, Athens, Greece

Objectives: To highlight the burden of diseases by linking health expenditure data with patient characteristics, and to enable analysis of the impact of current demographic changes on health expenditure  Methods: We adopted a top down approach using the 2012 and 2013 Greek SHA (obtained from ELSTAT). Moreover, we obtained volume (e.g. visits, examinations, discharges) and value data by ICD10 chapter level, from EOPYY, to develop “keys” that were applied to the System of Health Accounts -SHA matrix in order to allocate health expenditure to main diseases, age groups and gender.  Results: Out of € 17.2bl in 2012 and € 15.9bl in 2013 Current Health Expenditure-CHE, we attributed € 15.6bl in 2012 and € 14.2bl in 2013 to specific disease categories. Almost, 65% of CHE (in 2013) was devoted to six out of twenty-two disease categories; Circulatory (18.4%), Digestive including dental care (10.8%), Neoplasms (10.2%), Endocrine, Nutritional and Metabolic diseases (9.7%), diseases of the Musculoskeletal system (7.7%) and Mental disorders (7.1%). Notably, 66% of pharmaceutical expenditure (~€ 4.5bl in 2013) was devoted to only four disease categories; Circulatory (24.4%), Endocrine, Nutritional and Metabolic (20%), Neoplasms (12.4%) and Mental disorders (9.4%).A large proportion, 46.2% of CHE, was spent on treating 65+ age groups, representing about 20% of the population. The share of CHE devoted to women/men (53.7% / 46.3%) was almost equivalent to the population gender ratio (in both years). However, gender differences were observed in health service utilization patterns; men spent almost 46% on inpatient care, 31% on pharmaceutical care and 18% on outpatient care in 2013, while women spent 39% on inpatient care, 33% on pharmaceutical care and 22% on outpatient care in the same year.  Conclusions: Increased expenditure for chronic diseases and the elderly underline the need to reorganise care around major patient conditions, by developing efficient integrated health care networks. PHP106 Budget Impact Analysis Of Secukinumab In Moderate To Severe Plaque Psoriaris, Ankylosing Spondylitis And Psoriatic Arthritis In France Duteil E, Rachdi L, Cariou C, Benjamin K, Leiba G, Duco J Novartis Pharma, Rueil-Malmaison, France

Objectives: To assess the budget impact of the introduction of secukinumab, the first anti-IL 17a in the biologics arsenal for patients with moderate to severe plaque psoriasis (PP), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in France over the next 6 years.  Methods: A budgetary impact model was developed to estimate healthcare costs of the addition of secukinumab in the biologics arsenal to treat PP, AS and PsA, during a 6-year period under a French collective perspective. Nine biologics of which 3 biosimilars were implemented in the model: etanercept (originator and biosimilar), adalimumab (originator and biosimilar), infliximab (originator and biosimilar), certolizumab, golimumab and ustekinumab. Health care consumption was valued using French databases. As the model used differential costs, only treatment costs were included. Infliximab was the only biologic treatment with a hospital-based administration. Due to this specificity, the cost of the administration (GHM 28Z17Z) was added to the cost of infliximab. Costs were expressed in euros (€ , 2016) and no discount rate was applied.  Results: The number of patients estimated to be treated by secukinumab over the next 6 years was 24,979;  29  187 and  14,896  in PP,  AS  and  PsA  respectively. The incremental cost of the introduction of secukinumab added 0.4 million €  (M€ ) the first year and saved 10.1 M€ , 14.9 M€ , 14.7 m€ , 21.3 M€  and 23.0 M€   in the second, third, fourth, fifth and sixth year respectively. Regarding the 6-year period, secukinumab utilization lead to save 83.6 M€  in the collective perspective.  Conclusions: The introduction of secukinumab in the treatment of PP, AS and PsA would imply a budget impact decrease of 83.6 M€  for the healthcare system and society in the French setting. PHP107 Cost-Sharing In Healthcare: An Approach For Pharmaceutical Care In Greece Kyriopoulos I, Petropoulou A, Naoum V, Oikonomou N, Athanasakis K, Kyriopoulos J National School of Public Health, Athens, Greece

Objectives: The participation of patients in the cost of pharmaceutical care in Greece has risen from 11.5% in 2008 to 27% in 2014, which mainly affects those with low income and/or chronic diseases. Aim of the present study is to develop an algorithm that will redistribute the burden of cost-sharing in pharmaceuticals, taking into account income and the severity of selected diseases.  Methods: To achieve consensus among two panels of experts on the determination of borderline “near” poverty, population groups that should be excluded from the participation in medication cost based on socioeconomic criteria, and the co-insurance rates according to the burden of selected diseases, the Delphi method was used. The members of each panel evaluated the items three times, with knowledge of the group responses from the previous rounds.  Results: Income in need of protection was set at 133% of the poverty line. It was proposed that current cost- sharing tiers (0% for heavy diseases, 10% for moderate diseases and 25% for the rest of the diseases) remain unchanged, but redistribution of the tiers was suggested. The algorithm for the estimation of cost-sharing rate was formed as C= 0.25*DBi*(1+ICj) where C: participation rate, DBi: the burden of the disease for each i state , i: light (1,0), moderate (0,4), severe (0,0), ICj: income category, j: very high (0,4), high (0,2), moderate (0,0), low (-0,2), very low (-0,4).  Conclusions: It is important that fair burden- sharing policies are implemented and that any imbalances relating to the availability and use of pharmaceuticals are restored, as they often raise barriers to patients’ compliance. The adoption of “unequal” policies may be the key to achieve “equity”.

PHP108 Short And Long Term Costs Associated With Different Cardiovascular Events In Belgium Caekelbergh K1, Chevalier P1, Lamotte M1, Kutikova L2, Schutyser E3, Annemans L4 Health, Zaventem, Belgium, 2Amgen (Europe) GmbH, Zug, Switzerland, 3nv Amgen sa, Brussels, Belgium, Brussels, Belgium, 4University of Ghent, Ghent, Belgium

1IMS

Objectives: To evaluate the short- (first year) and long-term (second year) cost of cardiovascular events (CVEs) in Belgium.  Methods: The analysis included myocardial infarction (MI, excluding revascularization), unstable angina (UA, excluding revascularization), heart failure (HF), ischemic/hemorrhagic stroke (IS/HS) and transient ischemic attack (TIA). Coronary revascularization procedures (weighted average of coronary artery bypass grafting [CABG] and percutaneous coronary intervention [PCI]) were also evaluated. Index hospitalization costs (year 2012) as well as re-hospitalization costs up to 2 year after the index hospitalization were derived from the Belgian IMS real-world Hospital Disease Database (HDD). Other follow-up costs (rehabilitation, outpatient visits and ambulatory resource use [tests, imaging and drugs]) over 2 years were assessed by an independent 2-round expert-panel in 2014 (5 cardiologists, 6 neurologists). Costs of fatal CVEs were evaluated through the HDD. The combined perspective of public health care payer and patient was applied. Costs (€  in 2014) were calculated as unit costs (official listings) multiplied by the number of resources used.  Results: Total costs in the first year after CVEs ranged between € 7,683 (UA) and € 33,790 (HS). Costs for TIA, MI, HF and IS were € 8,198, € 11,119, € 17,210 and € 24,640, respectively. Follow-up costs over the second year ranged from € 2,781 (UA) to € 7,617(HS). Other CVEs costed € 3,315 (TIA), € 3,746 (MI), € 7,233 (HF) and € 7,399 (IS) in year 2. Hospitalization costs were the most important cost driver, independent of CVE type. Follow-up costs tended to be higher in patients with increased CVE risk. Revascularization costs were € 13,373 and € 2,763 during the first and second year of follow-up, respectively. Fatal events costed € 4,698 (HS), € 5,424 (UA), € 6,122 (MI), € 7,643 (IS) and € 10,344 (HF). Patient co-payment varied between 3-11%.  Conclusions: CVEs account for a significant economic burden in Belgium. Hospitalizations are the most important cost driver. Prevention of hospitalizations could lead to important savings. PHP110 A Review Of The Quality And Accuracy Of Budget Impact Models For High Cost Drugs In Ireland Lucey S1, Tilson L1, Fogarty E1, Walshe V2, Barry M1 1National Centre for Pharmacoeconomics, Dublin, Ireland, 2Health Service Executive, Cork, Ireland

Objectives: The role of the National Centre for Pharmacoeconomics (NCPE) is to evaluate cost-effectiveness and budget impact of all new medicines in Ireland. This is particularly relevant for high cost drugs reimbursed on the Community Drug Schemes where expenditure has risen from € 315m (2009) to € 485m (2014). The objectives of this study were to analyse the quality of budget impact models submitted to the NCPE for high cost drugs and to examine the difference in actual versus company-predicted expenditures.  Methods: Quality was assessed using five criteria from NCPE submission guidelines. These consist of eligible population, gross and net budget impact, additional costs and offsets and sensitivity analysis. Quality scores were rated from one to five. Drugs which were reimbursed under the high-tech drug scheme between 2013 and 2015 were included. Actual expenditure data was extracted from the Health Service Executive- primary care reimbursement service database and compared with forecasted figures from company submissions. Submissions without budget impact information were excluded.  Results: Eighteen drugs were included in the quality assessment:11 were rapid review submissions and 7 were full pharmacoeconomic assessments. The average score for rapid reviews was 44%. Full evaluations scored 91%. Eighteen drugs were included in the expenditure analysis. Nine companies underestimated the budget impact and nine overestimated. The cumulative expenditure on these drugs between 2013 and 2015 was € 47.3 million compared with an estimated expenditure of € 42.3 million representing an overall underestimation of € 5.03 million in company submissions. The most significant overestimate was € 2.6 million and related to a drug for pulmonary arterial hypertension. The biggest underestimate was € 3.5 million for a prostate cancer treatment.  Conclusions: Guidelines relating to budget impact for rapid reviews need to be implemented to ensure greater consistency in quality of submissions. A reduction in ambiguity may limit the discrepancies between predicted and actual budget impacts. PHP111 Cost Of Total Parenteral Nutrition Services At Ministery Of Health In Saudi Arabia Alomi YA1, Fallatah AO2, Al-Smail EH2, Al-Yahya MF2, Al-Shubbar NA2, Al-Enazi AD2, Al-Qatany K2, Al-Enazi AH2, Hetete NM2, Alotibi NM3 1Ministry of Health, RIYADH, Saudi Arabia, 2King Salman Hospital, RIYADH, Saudi Arabia, 3Riyadh Health Affairs, MOH, RIYADH, Saudi Arabia

Objectives: The Total Parenteral nutrition (TPN) cost estimation is a part of the PharmacoEconomic program at MOH in Saudi Arabia. The study explored the cost calculations of TPN services by using American Model with local cost.  Methods: Simulation including all 6-month 2015 of TPN services for neonates, pediatrics, and adults patients. It was at 300-Bed Hospital (King Salman Hospital) in Riyadh, Saudi Arabia. Physician or Pharmacist Prescribed TPN. The pharmacist reviews and prepared TPN. The nurse administers TPN, and follows up by doctor or pharmacist. TPN prepared through sterile 797 standards and automated compounding facilities. The cost drives from Ministry of Health information database. The cost Model calculated based on variable expenses including personal cost, material and supply cost. Fixed costs including direct cost, non-salary cost, and overhead cost. All cost used US dollar currency and local prices.  Results: The total number patients were 112 with 1631 TPN orders. The estimated cost of TPN services for adult per day was (691.3 USD). The estimated cost of TPN services for pediatrics per day was (773.8 USD). The estimated cost of TPN services for neonates was (863.57 USD).The majority