Societal And-Economic Burden of Iron Deficiency Among Swiss Women – Results from a Household Survey

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inhabitants, age= 61.19, men= 80.4%) and 736 for oral cavity or oropharynx cancers unspecified (incidence= 1.1/100,000 inhabitants, age= 63.7, men= 74.9%). Main treatments were mutilating surgery, chemotherapy and radiotherapy, highly impacting the quality of life and daily activities of patients. Over the 3-year period, the mean costs per patient, including hospital, outpatient and daily allowances costs, were € 31,930 (cervix), € 29,360 (vulva), € 32,512 (vagina), € 27,237 (anus), € 39,676 €  (oral cavity) and € 37,469 (oropharynx). Thus the total management cost of all these cancers amounts for more than € 500 million of the French health insurance expenditures.  Conclusions: This study provides the most updated epidemiological and cost data concerning cancers potentially related to HPV in France. It shows that they have heavy consequences for patients and represent a significant burden for healthcare insurance. These data could help to assess the potential impact of HPV vaccination. PHS35 New Data on the Burden of Abnormal Pap Smears and Hospitalised Pre-Cancerous Lesions in France (EGB AND PMSI DATABASES ANALYSIS) Catella L1, Cancalon C1, Lafourcade A2, de Rycke Y2, Guillo S2, Tubach F3, Dalichampt M4, Jacquard A5, Largeron N6, Dahlab A6, Uhart M6, Bresse X6, Bergeron C7, Borne H8, Bénard S1 1st[è]ve consultants, Oullins, France, 2NSERM UMR 1123 ECEVE, Hôpital Bichat Claude Bernard, Paris, France, 3APHP, Département d’Epidémiologie et Recherche Clinique CIC-EC 1425, Centre de Pharmacoépidémiologie (Cephepi); University Paris Diderot, Sorbonne Paris Cité, Unité Mixte de Recherche (UMR) 1123: Epidémiologie clinique, évaluation économique et population, Paris, France, 4Biostatistician, Nantes, France, 5Sanofi Pasteur MSD France, Lyon, France, 6Sanofi Pasteur MSD, Lyon, France, 7Laboratoire Cerba, Saint-Ouen-l’Aumône, France, 8Gynecologist, Paris, France

Objectives: HPV infection can lead to cervical intraepithelial neoplasia (CIN), which can progress in cervical cancer (CC) if untreated. Screening prevents CC by detecting and removing CIN lesions detected as abnormal pap smears. We conducted a study to update figures related to the diagnosis and treatment pathways related to these lesions based on representative claims databases in France.  Methods: A retrospective, cross-sectional, observational study was performed using the “Echantillon généraliste des bénéficiaires” (EGB) and the French hospital discharge database (PMSI) of year 2013. EGB, which includes data related to primary and secondary care in a sample of French people, allowed to collect data on screening and procedures used for the management of abnormal pap smears (no ICD-10 codes are available). PMSI, which includes exhaustive secondary care data, allowed to extract patients with hospitalizations for CIN (ICD-10 codes: N87* and D06*).  Results: Analysis of the EGB shows important healthcare consumptions in primary care with 5,097,960 pap smears, 369,967 colposcopies, 131,172 HPV tests and 15,162 laser excisions. Analysis of the PMSI database indicates that 34,067 women were hospitalized with a diagnosed CIN, (7,388 CIN1, 25 368 CIN2+ and 1,311 unspecified CIN. Overall 28,196 conizations were registered, other major treatments in hospital were laser excisions and removal surgeries. Mean costs per stay were 1,032.11±811.95€  for CIN1, 1,177.27±1,046.87€  for CIN 2 and 1,544.04±1,397.78€  for unspecified CIN.  Conclusions: This study is the first to combine robust data coming from two national databases in France. Although all procedures are not recorded in the EGB, it highlights the burden related to screening and diagnosis of abnormal pap smears, as well as the burden of CIN’s management in hospitals even though it represents only a part of the management of all CIN. The evaluation of costs concerns patients that are treated, since most of CIN1 are only monitored. PHS36 Study Care Costs and Use of Health Technologies for Patients with Hemophilia a Health System Affiliates in Colombia Acuna L1, Bryon A2, Espin J3 de Alto Costo, Bogota, Colombia, 2HEORT, Bogota, Colombia, 3Andalusian School of Public Health, Granada, Spain

1Cuenta

Objectives: The aim was to determine the consumption of resources at all three levels of risk patients (Mild (L), Moderate (M) and Severe (S)) and the economic impact of the specialized management of patients in each insurer.  Methods: To collect and analyze the costs of care and medicines for patients with hemophilia A in Colombia the registration system information Colombian Fund High-Cost Diseases, which has 64 variables from 2015 to follow up was used risk management in 48 insurers.  Results: A measurement of the costs generated in the report of February 1, 2014 to January 31, 2015. 45 insurers join 1.436 (94 %) haemophilia type A (from 1.525 reported) were identified. They are L: 21.2%, M: 32.6%, S: 41.7%. (Unknown: 4.6%). The range of enrollment of patients by insurer was between a minimum: 1, maximum: 238. The average cost of care ( drug ) is US $ 85.305,54. It was identified that the average care accounted for 10% of the costs of insurance and in relation to drugs , which were included in care plans are: 84% (Factor VIII) and those whose were outise any care plan represented 6%.  Conclusions: It is clear that management costs hemophiliacs are attributed mostly to prophylaxis and management of bleeding. The range of membership significantly affects an extrapolation of the results by the insurer. This study identifies efficient options in the treatment of hemophilia for possible future risk adjustments. PHS37 Health Insurance Treatment Cost of Colorectal Cancer in Hungary I1, Zemplényi A1, Horváthné

Z1, Vajda

R1, Kovács A2, Budai A2, Endrei

D1

Boncz Kívés of Pécs, Pécs, Hungary, 2National Public Health and Medical Officers Service (ÁNTSZ), Budapest, Hungary

1University

Objectives: A colorectal cancer pilot screening programme was introduced in Hungary in 2013. The aim of our study is to calculate the annual health insurance treatment cost of colorectal cancer (CRC) in Hungary.  Methods: The data derive from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the health insurance treatment cost and the number of patients for the year 2014. The following cost categories were included into the study: out-patient care, in-patient care, CT-MRI, PET, home care, transportation, general practitioner,

drugs and medical devices. Colorectal cancer was identified with the following codes of the International Classification of Diseases 10th revision: C18-C21 (malignant cancer), D01.0-01.4 (in situ) and D12 (benign).  Results: The Hungarian National Health Insurance Fund Administration spent 22.53 billion Hungarian Forint (HUF) (72.98 million EUR) for the treatment of colorectal cancer patients. Most of this expenditures was related to malignant (94.1%) CRC while in situ (0.1%) and benign (5.8%) cancer represents smaller proportion. Acute inpatient care proved to be the major cost driver of CRC with an annual expenditure of 16.15 billion HUF (52.32 million EUR) representing 71.7% of total health insurance expenditure. Expenditures for pharmaceutical (1.7 billion HUF; 5.53 million EUR), medical devices (1.53 billion HUF; 4.96 million EUR) and CT/MRI examinations (1.3 billion HUF; 4.2 million EUR) are also important cost elements accounting for 7.6%, 6.8% and 5.8% of total health insurance expenditures, respectively.  Conclusions: Colorectal cancer represents a significant burden for the Hungarian health insurance system. Introduction of CRC pilot screenning programme might change the health insurance expenditures of colorectal cancer. PHS38 Quantifying the Economic Burden of Chronic Spontaneous Urticaria in Portugal – What is the Impact on the Portuguese NHS and in the Society Moital I1, Carrasco J2, Rodrigues Martins A1 1Novartis Farma, Porto Salvo, Portugal, 2Novartis Farma Portugal, Porto Salvo, Portugal

Objectives: Chronic Spontaneous Urticaria (CSU) affects significantly the patients QoL and its ability to do day-today activities but because of the intermittent symptomology and low mortality the impact associated to CSU is often underestimated. Estimate the health care resource use and direct treatment cost associated to the management of CSU in Portugal.  Methods: A structured questionnaire was developed assessing standard clinical practice in CSU. Resource utilization was characterized considering diagnosis, regular follow-up, diagnostic exams, pharmacologic treatment, treatment of acute events and work absenteeism. Resource use and costs were estimated for patients with severe, moderate, mild and controlled urticaria.  Results: A patient with severe CSU can cost up to € 2,081/year. Treating exacerbations can represent up to 43% of the total cost and work absenteeism corresponds to 23%. The cost of treating patients with moderate CSU can go up to € 1,240/year, for patients with mild CSU the cost is € 429/year and for controlled CSU, the cost is significantly lower, € 86/year.  Conclusions: The impact of CSU goes beyond esthetic and QoL considerations. There is a significant healthcare resource consumption and overall treatment costs are high and for patients with severe CSU the overall costs are comparable to other disease like diabetes (€ 1,653/patient year). PHS39 Colorectal Cancer Treatment Costs in Estonia Männik A1, Suuroja T2, Kiivet R1 1University of Tartu, Tartu, Estonia, 2The North Estonia Medical Centre, Tallinn, Estonia

Objectives: related to increasing incidence of colorectal cancer, treatment cost data helps to evaluate the burden to the health care system and enhances to establish effective public health intervention programme (eg screening). The objective was to calculate colorectal cancer treatment costs in Estonia.  Methods: anonymous hospitalized (into North Estonia Medical Centre) colorectal cancer patients’ data and prescriptions’ costs, were obtained from Estonian Health Insurance Fund for years 2011-2013. The hospitalized patients had ICD C18 to C21 in their treatment record first time in 2011 and cost for the first treatment year was calculated. In order to obtain cost data by the cancer stage, expert opinion was used and cancer stages (I, II-III and IV) were distinguished. The average treatment cost based on treatment invoices and prescription medicines cost was calculated. Data analysis was performed using software Stata 11.  Results: the sample of 329 patients (age range 40-95) had altogether 2873 treatment invoices. Cancer stage cost per patient were: I stage 5,990, II-III stage 10,383 and for IV stage 6,135 EUR. The II and III stages were not separated because no specific treatment or procedure was found to be set as criteria. The sum of first year’s treatment was altogether 2,179,053 EUR, which made 85,7% of all the 2011-2013 costs.  Conclusions: Cost calculations indicate that most of costs are formed during the first treatment year. Cancer treatment cost data can be used to evaluate cost-effectiveness of national screening programme. Colorectal cancer screening programmes are in place in many countries in Europe, and screening programme will be established in Estonia soon. The possible limitation of the study might be, that data from one hospital only was used, however this is the biggest hospital from the 2 higher level hospitals, which treat colorectal cancer patients. Therefore, it covers majority of colorectal cancer patients cost in Estonia. PHS40 Societal And-Economic Burden of Iron Deficiency Among Swiss Women – Results from a Household Survey Blank PR1, Szucs TD2, Schwenkglenks M2 of Zurich, Zurich, Switzerland, 2European Center of Pharmaceutical Medicine University of Basel, Basel, Switzerland 1University

Objectives: Symptomatic iron deficiency (ID) is a disorder affecting 10-20% of menstruating women. ID is diagnosed by measuring serum ferritin, a protein helping to store iron in the body. A deeper understanding of the association between ID and its societal and economic burden is relevant for patients, physicians, health care decision makers.  Methods: An online household survey was carried out among Swiss women aged 18-50 years suffering from debilitating symptoms due to ID. The data was population-weighted for age and region. ID-related days of sick-leave and the societal economic burden of the disease in the working female population were assessed as productivity losses on the labor market, via the human capital approach (HCA) and the friction cost method (FCM= HCA*0.8). To quantify the indirect costs via the HCA, the number of lost working days was multiplied by a cost of EUR258/day (exchange rate: EUR0.92= CHF1.00).  Results: The total sample included 1’010 individuals who received an ID diagnosis with a blood test in the



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last 2 years (mean age:33.5 years). The majority of women were in the work-force (96.5%); 55.2% had a full-time and 41.3% a part-time employment. Most named symptoms were “being tired or exhausted” (96.0%) and reduced physical energy level (21.0%). On average, 28.5% of participants in the work-force had to take sick leaves due to ID symptoms within a period of 2 years (mean: 5.2 days, i.e. 2.6 days/ year). Assuming an ID prevalence in the total female population ranging between 10-20%, the estimated annual indirect costs in Switzerland would range between EUR32-64 million (HCA) or EUR25-51 million (FCM), respectively.  Conclusions: The societal and economic burden of sick-leave of working women due to debilitating symptoms of ID in Switzerland is substantial. Timely, correct diagnosis and treatment of ID may contribute to reducing this burden. Further studies are needed in this area to validate our results. PHS41 Advanced Renal Cell Carcinoma in Previously Treated Patients: Measuring Healthcare Use, Productivity Loss and Costs Sousa G1, Mansinho H2, Figueiredo A3, Fraga A4, Sousa N5 1IPO Coimbra, Coimbra, Portugal, 2Hospital Garcia de Orta, Almada, Portugal, 3Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 4Hospital Geral de Santo António, Porto, Portugal, 5IPO Porto, Porto, Portugal

Objectives: To characterize health care resource use by disease stage, productivity loss due to disease and healthcare costs in patients with advanced renal cell carcinoma (RCC) treated with at least one previous regimen.  Methods: Delbecq panel involving five Portuguese Oncology/Urology experts. Identification of resources based on current clinical practice. Unitary costs from NHS official Portuguese sources. Costs are in 2016 euros.  Results: Patients with advanced RCC treated with at least one regimen average 63 years and 20-25% are female. About 65% receive 2nd line treatment (70% everolimus) and only 10% a 3rd line (50% everolimus). In PFS, on average, one monthly oncology/urology visit, one monthly complete blood count/biochemistry and one quarterly CT-scan are required. Towards PD, on average, patients require one bimonthly oncology/urology visit, one bimonthly complete blood count/biochemistry, a bimonthly pain consultation (30% of the patients), a psychology/psychiatry appointment (10%), a nurse visit (10%), daily homecare (10%), hospitalization (5%) and concomitant drugs. Some patients also receive radiotherapy and/or radiosurgery or craniotomy. At end-of-life, 50% of the patients are at hospital, 20% at palliative care units, 20% at Integrated Continuing Care National Network, 5% at hospices and 5% at home. NHS monthly costs for PFS state, PD and end-of-life are € 60, € 429 and € 9,612 per patient, respectively (excluding drug related costs). Costs to manage adverse events related with current available treatments ranged € 21 to € 3,036 per event. Loss of productivity was estimated at 5/10 days/month due to RCC or RCC treatment.  Conclusions: These results illustrate the economic burden of advanced RCC and provide insight on current clinical practice for these patients in Portugal. The increase in cost as disease progresses between stages was mainly accounted for increase resource use and in-hospital treatment. This information may ultimately impact the economic health technology assessment of innovative technologies on this disease. PHS42 Towards Better Coordination and More Efficient Patient Pathways in Copd Devillier P1, Dorizon D2, Nachbaur G2, Hudry J2, Antoun Z2 1UPRES EA220, Hôpital Foch, Suresnes, France, 2GlaxoSmithkline, Marly le roi, France

Objectives: Within a challenging French healthcare system, where a coordinated patient pathway would address needs of patients, healthcare professionals (HP) and payers, the study aims to identify concrete, sustainable and incentive solutions to optimise COPD pathways efficiency.  Methods: A multidisciplinary team identified and prioritized measures to improve COPD pathway management. For each measure, costs for implementation, healthcare savings (including hospitalization) and the return on investment (ROI) were estimated based on published works conducted in COPD in France when available, in other chronic diseases or countries otherwise. These estimates accounted for the targeted COPD population, the acceptance and adherence rates and ranges were set when several references were available. ROI for combinations of measures was also computed with a weighted impact on gains while costs were summed up.  Results: The prioritized measures were M1) Reinforcing interprofessional/HP-patient coordination via hospital/ambulatory coordinators and platforms for information exchange; M2) Encouraging pulmonary rehabilitation with physiotherapists’ home visits or phone coaching ; M3) Promoting community-based therapeutic patient education via HPs (additional training, fees) and e-learning; M4) Providing patients with individual monitoring using mobile applications, devices connected to telemedicine, pharmaceutical consultations, disease management programs; M5) Motivating patients with pedometers, sport club membership or smoking cessation financial support. A high ROI (2.2–12.5) was obtained for M1 with reinforced coordination for stage ¾ COPD with a saving of 16347145€ / patient/ year and platform use (ROI: 1.8). The average ROI for M2, M3, M4, M5 was respectively 10, 5.4, 2.4 and 2.5. Overall costs of implementation were estimated at 335-435 MEuros (2.8-3.7% COPD costs). A combination of the more effective measures of M1/M2/M4/M5 lead to a combined ROI 1.97 -6.67.  Conclusions: Funding of the solutions would represent less than 5% increase in disease management cost offset by the savings expected from a more efficient organization. PHS43 Outcomes for Older Patients with Acute Myeloid Leukemia (AML): Multiple Hospitalizations and High Mortality Rates Sacks NC1, Miller DJ2, Louie AC2, Chiarella MT2, Cyr P1, Sharma A1, Liu Y1 1Precision Health Economics, Boston, MA, USA, 2Celator Pharmaceuticals, Inc., Ewing, NJ, USA

Objectives: Acute Myeloid Leukemia (AML) disproportionately affects older patients. Mortality rates are high, and treatment often requires multiple hospitalizations, including those with chemotherapy. Nonetheless, treatment pathways for older AML patients are not well understood. The objective of this study is to charac-

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terize hospitalizations, mortality, and chemotherapy treatment in the US for older adults with newly diagnosed AML.  Methods: We used 2010-2012 Medicare Limited Data Set files to identify patients with newly diagnosed AML (ICD-9 205.0) who were continuously enrolled in Medicare Fee-for-Service for 6+ months before and 12+ months after diagnosis, or until they died. We calculated monthly mortality and hospitalization rates and hospitalization payments for all patients, and separately, for those who received chemotherapy (identified using MS-DRGs, HCPCS, revenue center, and ICD9 procedure codes).  Results: Of 8,701 patients, 65% (5,641/8,701) died within 6 months after diagnosis; only 22% (1,941/8,701) survived at least 12 months. Monthly hospitalization rates were higher for patients who died within 6 months (.85/month), compared to those who survived (.35/month). Study patients had 19,738 hospitalizations; 5,757 included chemotherapy. Among patients treated with chemotherapy (3,071), 36% survived 12+ months (vs. 16% of untreated patients), but their initial hospitalizations (H) had higher payments, longer lengths-of-stay and higher ICU admission rates, compared to untreated patients (e.g., H1: Mean [SD]/ Median: $38,695 [36,524]/$31,118; 19.3d [16.0]/15d; 31.6%; vs. $16,441 [15,954]/$12,109; 6.4d [6.6]/5d; 29.3%). Treated patients’ subsequent hospitalizations were shorter, with fewer ICU stays and lower payments (e.g., H4: N= 1,234; $22,008 [23,761]/$12,562; 9.0d [9.5]/5d; 23.4%).  Conclusions: Hospitalizations for AML patients are frequent, especially in the 6 months following diagnosis. Payments for hospitalizations for patients treated with chemotherapy are higher than for untreated, but provide value in longer patient survival. Initiatives to extend chemotherapy to higher risk patients, coupled with programs to support outpatient chemotherapy for some patients, could potentially improve survival and quality-of-life. PHS44 Facing Challenges for a Cost Comparison of Day Surgical and Inpatient Varicose Vein Surgery Fischer S Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria

Objectives: Day surgery could be an appropriate alternative to reduce costs in health care. However, before calculating the cost-saving potential, the selection of data is crucial for an adequate cost calculation. Therefore, varicose vein surgery was chosen as an example to show the results of using different data sources for calculating costs of day surgical and inpatient treatment.  Methods: For the first approach, meta data from the Austrian “Dokumentations- und Informationssystem für Analysen im Gesundheitswesen“ has been used. Generated lump sums from hospital reimbursement, total costs that occurred in the departments and number of patients were considered in an equation. For the second approach, we used data from individual hospitals to calculate the costs for the surgery itself and nursing. The third approach contained the adaption of international cost data, by an adjustment for inflation and prices.  Results: The calculated costs of varicose vein surgery differed between 859 and 4,664 Euros for a day case and 1,720-2,330 Euros for an inpatient treatment – depending on the used approach. The main strength of the first approach is that it can be done relatively quickly. However, the validity of the calculated costs is low. The use of hospital data takes more time, though, the quality of the data is much better. The main weakness of this approach is that these costs are hospital specific and a generalisation for other hospitals is difficult. The fast acquisition of the international reference costs is a strength, though, the costs are from a different health care system and therefore, the transferability of the costs is limited.  Conclusions: The results have shown that an examination of administrative data is indispensable for proper evidence. Thus, administrative data is more often used for such analysis. Calculations of costs that are adjusted to national circumstances are required. Actually, in Austria those calculations are rare. PHS45 Hospitalization Cost and Length of Stay Associated with HPVRelated Diseases Tsakeu E1, Petit C2, Chevalier P1 1IMS Health, Zaventem, Belgium, 2Sanofi-Pasteur MSD, Diegem, Belgium

Objectives: Human Papillomavirus (HPV) infection can lead to severe diseases, namely cervical intraepithelial neoplasia (CIN), vaginal intra-epithelial neoplasia (VaIN), cervical cancer (CC), cancer of the vulva (VuC), vagina (VaC), anus (AC), penis (PC), and head and neck (H&N), and genital warts (GWs). This study used retrospective data to assess the total length of stay (LOS) and hospitalization cost per patient over the 12-month period following the first diagnosis of HPV-related disease in Belgium.  Methods: The average hospitalization cost (from the total Healthcare Payer perspective) and cumulated LOS (in days) over the 12-month period following initial diagnosis of HPV-related disease were estimated using the longitudinal IMS Real-World Data Hospital Belgium database (years 2013 and 2014), including data (diagnoses, procedures, costs) on 25% of Belgian hospital beds. Eligible patientswere selected based on ICD-9-CM (primary/ secondary) diagnostic codes corresponding to CIN (233.1), CC (180), VaC (233.31), VuC (184.1-184.4), PC (187), AC (154.2, 154.3), H&N (140-149) and GWs (078.11).  Results: A total of 7,754 patients with HPV-related diseases were retrieved, 34.5% being male. In female patients, the average 12-month cost (LOS) was €  1,389 (o.8 day, N= 2,167) for CIN, €  5,840 (5.3 days, N= 12) for VaIN, €  12,689 (14.5 days, N= 644) for CC, €  16,353 (20.3 days, N= 90) for VaC, €  15,815 (21.3 days, N= 237) for VuC, € 20,583 (24.9 days, N= 83) for AC, € 14,808 (16.0 days, N= 551) for H&N and €  1,724 (1.7 day, N= 1,028) for GWs. In male patients, the average cost was €  16,561 (19.5 days, N= 82), €  18,256 (21.3 days, N= 53), €  17,452 (19.2 days, N= 1,370) and € 1,738 (1.7 day, N= 1,095) for PC, AC, H&N and GWs respectively.  Conclusions: This study provides strong evidence of the high in-hospital follow-up cost associated with HPV-related diseases. Complementary analyses would be required to assess the additional costs resulting from ambulatory cares. PHS46 Clinical and Economic Benefits of a Community Pharmacy Vaccination Strategy Gallagher J1, Byrne S1, O’Dwyer S2, O’Reilly P2, McCarthy S1