The Cost-Effectiveness Of Screening For Severe Combined Immunodeficiency (SCID) In The UK NHS Newborn Bloodspot Screening Programme

VA L U E I N H E A LT H

p <  0.01).  Conclusions: There is no evidence to say that the optimised pathway reduced costs and readmissions rates, but the increasing costs can’t be assigned to it either. Researches must go further to investigate the organisational changes that occurred between 2013 and 2015. PHS47 The Cost-Effectiveness Of Screening For Severe Combined Immunodeficiency (SCID) In The UK NHS Newborn Bloodspot Screening Programme Bessey A, Leaviss J, Galvan de la Cruz C, Chilcott J, Wong R University of Sheffield, Sheffield, UK

Objectives: To assess the cost-effectiveness of including screening for severe combined immunodeficiency (SCID) in the NHS newborn bloodspot screening programme.  Methods: A decision tree model with life-table estimates of outcomes was built. Model structure and parameterisation were informed by systematic review and expert clinical judgment. A public service perspective was used and lifetime costs and quality adjusted life years (QALYs) were discounted at 3.5%. Standard treatment following screening was hematopoietic stem cell transplantation with additional treatment options for adenosine deaminase deficiency SCID. The model estimated the number of non-SCID cases identified incidentally. Probabilistic sensitivity analyses was undertaken. An exploratory disbenefit analysis was conducted for false positives and those diagnosed with non-SCID T-cell lymphopenia (TCL) who would have presented as healthy at birth.  Results: Screening for SCID was estimated to result in 310 (72-811) presumptive positive cases per year including 260 (25-760) false positives cases, 7 (1-21) preterm cases, 26 (9-50) non-SCID TCL cases and 17 (14-22) SCID cases. Screening would increase overall QALYs and costs and result in an incremental cost-effectiveness ratio (ICER) of £17,642. The increase in QALYs was driven by improved survival in the screened cohort with mortality reducing from 8 (5.3-12) deaths to 1.7 (0.6-4.1). Results were sensitive to a number of parameters including the cost of the screening test, the incidence of SCID and quality of life estimates. The disbenefit analysis estimated that to push the costeffectiveness over the £20,000 threshold the 6.5 (1.5-16) healthy at birth cases would need to experience a disbenefit of 2 QALYs and the false positive cases a disbenefit of over 12 quality adjusted days.  Conclusions: Screening for SCID is potentially cost-effective at £20,000 per QALY, key uncertainties relate to the impact of false positives and the identification of children with non-SCID TCL. PHS48 An Economic Model To Estimate The Direct Economic Value Of Reducing The Severity Of Sepsis In French And Us Hospitals Paoli CJ1, Coles CN2, Reynolds M1, Blanchet J1, Denham D1, Crouser ED3, Gitlin M2 Coulter, Brea, CA, USA, 2BluePath Solutions, Los Angeles, CA, USA, 3The Ohio State University Wexner Medical Center, Columbus, OH, USA

1Beckman

Objectives: In 2013, French (FR) and United States (US) hospitals managed an average of 152 and 316 sepsis hospitalizations annually per hospital. While no specific treatment can prevent all sepsis complications, early recognition and treatment is associated with reduced sepsis severity and mortality. This study estimates the benefits of reducing sepsis severity in France and the US.  Methods: A deterministic decision tree model was designed to counterfactually estimate the potential cost offsets of reducing sepsis severity. Model inputs included sepsis severity, mortality, length of stay, time in the ICU, and costs. Inputs were based on country-specific data for France and US using a focused literature review, PMSI data (France) and NIS (US) to inform population, clinical and economic variables. The current distribution of sepsis severity [sepsis (FR: 51%; US: 28%), severe sepsis (FR: 22%; US: 66%) and septic shock (FR: 27%, US: 6%)] is used to define the base case. To estimate the potential benefit of improving sepsis severity, the analysis simulated shifts in sepsis severity of 10%, 25%, and 50%, which results in a population shifting from higher (severe and septic shock) to lower levels of severity (sepsis). Analyses were conducted at the patient and hospital in 2017 currency.  Results: Reduction in sepsis severity resulted in substantial cost offsets. In FR, a 10%, 25% and 50% shift to lower sepsis severity levels resulted in annual savings per patient of € 207 to € 1,035 and per hospital of € 31,480 to € 157,399. In the US, a 10%, 25% and 50% shift to lower sepsis severity levels resulted in annual savings per patient of $593 to $2,967 and per hospital of $187,515 to $937,574.  Conclusions: Innovations in sepsis diagnosis and management that reduce the severity of sepsis in French and US hospitals may offer significant economic value to hospitals managing sepsis populations. PHS49 Cost-Effectiveness Of Inpatient Rehabilitation Compared To Home Discharge Following Longer Stay In General Or Neurological Ward, After Admission For The First Ever Stroke In Greece Vellopoulou K1, Kourlaba G2, Vagiona A3, Ntavelis A4, Maniadakis N1 1National School of Public Health, Athens, Greece, 2Collaborative Center of Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, Athens, Greece, 3ANAGENNISI Recovery and Rehabilitation Center S.A, Thessaloniki, Greece, 4ANIMUS, Larissa, Greece

Objectives: To assess the cost-effectiveness of Inpatient Rehabilitation (IR) versus home discharge following longer stay in general/neurological ward (non-IR) for patients being hospitalized for the first acute stroke in Greece, from a third-party payer perspective (EOPYY).  Methods: A decision analytic model consisting of a 1-month decision tree and 5-year Markov Model was developed in Excel. Decision tree consisted of four nodes: ‘Home Independent’, ‘Home Dependent’, ‘Hospital’, ‘Death’. Patients enter Markov model at the health state they exit the decision tree. In the Markov model, they may transit among five health states, at 1-year cycles, with assigned probabilities extracted from literature. The efficacy of IR was taken into consideration only at the 1st month. Resource utilization (i.e. medication, monitoring tests, outpatient rehabilitation, equipment etc) that depends on the health state/node of the model was extracted from experts using a questionnaire developed to serve the purpose of the present study. The respective unit costs, as well as the cost of IR and hospitalization for non-IR were obtained official local sources (€ ,2016).

20 (2017) A399–A811

A501

Life-years (LYs), quality-adjusted life-years (QALYs), and cost-effectiveness in terms of life-years gained (LYG) and QALY gained were evaluated. One-way (OWSA) and probabilistic sensitivity analysis (PSA) were conducted to evaluate the robustness of base-case analysis.  Results: An average patient transferred to IR, following hospitalization for 1st stroke, was estimated to have higher survival by 0.368 LYs and gained 0.288 QALYs compared to non-IR, at a higher cost of € 1,934. Incremental cost-effectiveness ratios were € 5,258/LYG and € 6,728/QALY gained relative to non-IR. The proportion of patients being home dependent following IR and re-hospitalized (non-IR) influenced the results. The probability of IR to be cost-effective exceeds that of 97% at a willingness-to-pay of € 34,000.  Conclusions: Given the assumptions and limitations of this analysis, IR seems to be a cost-effective option in Greece, for patients experiencing their first ever stroke. PHS50 Screening For Asymptomatic Atrial Fibrillation: Its Effectiveness And Cost-Effectiveness Of Repeated Ecg In Poland Petryszyn P1, Niewinski P1, Piotrowski P1, Staniak A1, Well M2, Ekk-Cierniakowski P3 Medical University, Wroclaw, Poland, 2Wroclaw Uiversity of Economics, Wroclaw, Poland, 3Warsaw School of Economics, Warsaw, Poland

1Wroclaw

Objectives: Atrial fibrillation (AF) is the most common arrhythmia in humans. AF increases the risk of ischemic stroke up to 5-fold. Fortunately, this is highly preventable with appropriate oral anticoagulant (OAC) therapy. However, many patients with AF, despite the presence of risk factors, are not taking OACs, because they are not aware of the occurrence of arrhythmia prior to stroke. Therefore, it seems that the screening for AF in a broad population aimed at the earliest possible detection of asymptomatic arrhythmias, and the implementation of OAC treatment when necessary, could prevent many strokes. To assess the effectiveness of active screening for previously undiagnosed AF when compared to the standard care as well as to estimate the cost-effectiveness of repeated ECG in comparison with the lack of screening in Polish population with average risk of AF.  Methods: We searched multiple databases for studies comparing systematic or opportunistic screening using ECG or pulse palpation, compared to no screening in populations age ≥ 40 years living in community or attending GP practices. The primary outcome was the incidence of previously undiagnosed AF. The cost-effectiveness analysis of screening in 67-year-old individuals was based on a lifelong decision analytic Markov model.  Results: 1056 articles were found and 23 that fulfilled our inclusion criteria were taken into meta-analysis (n= 83 323, mean age 64.3, 48.4% males). The incidence of newly detected, clinically silent, AF was 1.5% (95% CI 1.1-1.9%). In the base-case scenario, screening of 1000 individuals resulted in 7 more qualityadjusted life-years (QALYs) and 2 fewer strokes. ICER was 74 001 PLN per one stroke prevented.  Conclusions: It has been shown that active screening for undiagnosed AF is more effective than standard care and that screening with the use of repeated ECG in 67-year old individuals may be cost-effective in Poland. PHS51 A Novel Atrial Fibrillation Evaluation Modelling Solution For NHS Xydopoulos G1, Fordham R1, Khanbai Z2 of East Anglia, Norwich, UK, 2Royal Brompton and Harefield Specialist Care, London, UK

1University

Objectives: Approximately every fifth stroke in UK is due to AF and costs the UK National Health Service are between $12,000 and $17,500 per stroke. The aim of this study was to undertake a retrospective health economic analysis of the cost-effectiveness and implications related to opportunistic Atrial Fibrillation (AF) screening in primary care and the detection of previously undiagnosed AF cases in patients, and create a novel modelling solution that can empower individual users and organisations in England, Wales and Northern Ireland in their decision making, technology assessment, comparison of various anticoagulation drug groups cost effectiveness decisions  Methods: A model was built on Microsoft Excel suite and it combined advance Excel Functions Data with Visual Basic Macros with assumptions based on a feasibility study and a new patient pathway on which community pharmacist perform opportunistic AF checks using one lead mobile ECG device. Apart from Cost-Effectiveness, Return of investment and QALYS of the new pathway was also calculated. Finally, the model was tested using through a cost assessment scenario utilizing input data from various well-established sources: Background research into the NHS and NICE guideline content, current clinical practice, published information and available data. Gathering expert opinion. Testing the model, including the assumptions and outcomes.  Results: Our results suggested that the opportunistic AF checks can be cost-effective for the NHS presenting a ROI of 60% and the model presents quick and accurate results without sacrificing customisation options.  Conclusions: this innovative modelling solution can provide policy makers with an accurate estimation of the costs related to AF incidences in various CCG population mixtures without sacrificing customisation options empowering users with the flexibility to adopt the model to their own variables findings and organisation. PHS52 One Size Does Not Fit All: What Are The Appropriate Screening Intervals For People At Risk Of Diabetic Retinopathy Winfield TG1, Thomas R1, Luzio S1, Anderson P1, Dunstan F2, Peter R3, Owens D1 1Swansea University, Swansea, UK, 2Cardiff University, Cardiff, UK, 3Neath Port Talbot Hospitral Hospital, Swansea, UK

Objectives: Most of the current evidence based for screening is based on T2DM populations.This study explored the impact of increasing screening intervals for diabetic retinopathy (DR) for people with either type 1 diabetes (T1DM) or type 2 diabetes (T2DM) without DR.  Methods: Cost utility analysis (CUA) was undertaken comparing either annual or biennial screening for DR in people with either T1DM or T2DM and no DR, attending the national Diabetic Eye Screening Wales (DESW) program. Data from DESW and Primary Care were linked using secure anonymised information linkage. Regression analysis estimated risks of DR progression requiring