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The Effectiveness and Cost Effectiveness of Pit and Fissure Sealant for Prevention of Dental Caries in School-Age Children in China
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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
before and after the index date for both cohorts. Study outcomes, including health care costs and utilizations were compared between the cataract and comparison cohorts. Results: After 1:1 matching, a total of 345,937 patients were matched from the cataract and comparison cohorts, and baseline characteristics were proportionate. A higher percentage of patients in the cataract cohort had inpatient stays (16.00% vs. 14.32%, p< 0.0001), emergency room visits (20.35% vs. 16.89%, p< 0.0001), physician office visits (99.05% vs. 74.71%, p< 0.0001), outpatient hospital visits (74.84% vs. 55.15%, p< 0.0001), and durable medical equipment (DME) use (32.67% vs. 23.51%, p< 0.0001), but a lower percentage of patients had prescription claims for part D drug events (54.41% vs. 60.32%, p< 0.0001). Cataract patients also incurred higher inpatient costs ($3,357 vs. $3,029, p< 0.0001), physician office costs ($3,029 vs. $1,811, p< 0.0001), outpatient hospital costs ($5,355 vs. $3,448, p< 0.0001), and total costs ($15,141 vs. $11,914, p< 0.0001) compared to patients without a cataract diagnosis. Conclusions: Cataract diagnosis was associated with higher health care resource utilization and a higher economic burden. PSS12 Cost Effectiveness of Nivolumab-Ipilimumab Combination Therapy Compared to Monotherapy for Metastatic Melanoma from a US Societal Perspective Tran DM, McDowell LC, Oh A, Barcelon JA, Keyvani D, Merino O, Wilson L University of California, San Francisco, San Francisco, CA, USA
Objectives: Develop a Markov model to determine the cost-effectiveness of nivolumab, ipilimumab, and nivolumab-ipilimumab combination as first-line therapy in metastatic melanoma accounting for differential effectiveness of PD-L1 positive and negative states. Methods: A three-state Markov model (PD-L1 positive stable disease, PD-L1 negative stable disease, and progression/death) was developed using a US societal perspective with a lifetime time horizon of 14.5 years. Transition probabilities were progression-free survival data from the CheckMate-067 trial. Costs were expressed in 2015 US dollars and were determined using national sources. Adverse event (AE) management was determined using immune-related AE (irAE) data from CheckMate-067, irAE management guides for nivolumab and ipilimumab, and treatment guidelines. Utilities were obtained from published literature, using melanoma-specific studies when available, and were weighted based on incidence and duration of health states. Probabilistic sensitivity analyses were conducted. Results: In the base case, ipilimumab monotherapy was dominated by nivolumab monotherapy while nivolumab-ipilimumab combination therapy had an ICER of $883,994/QALY compared to nivolumab. The cost of ipilimumab would have to decrease to < $4,500 per dose for combination therapy to be costeffective, and to < $2,720 (a 90% reduction) to be more cost-effective than nivolumab alone. Conclusions: At a willingness-to-pay threshold of $100,000/QALY, and using progression-free survival and current drug prices, nivolumab-ipilimumab combination therapy would not be cost-effective compared to nivolumab monotherapy, the most cost-effective option. PSS13 Cost-Effectiveness Analysis of Ustekinumab and Adalimumab in Psoriatic Patients Previously Treated with Etanercept in a RealWorld Setting García Gil S, González García J, Nazco Casariego GJ, González de la Fuente G, Calzado Gómez G, Guitérrez Nicolas F Complejo Hospitalario Universitario de canarias, San Cristobal de La Laguna, Spain
Objectives: The best treatment strategy for psoriatic patients previously treated with etanercept is unknown. With multiple agents available, studies about the cost and cost-effectiveness of biologic options to quantify the relative value of each of these treatments are necesary. The aims of this study is to compare the cost per responder of ustekinumab versus adalimumab after etanercept therapy under real-world conditions as a second line therapy after etanercept treatment from the Spanish Health System perspective. Methods: A single-centre, retrospective, observational, comparative study in a real-world setting was carried out from 1 november 2011 to 31 March 2013. Effectiveness of the treatment was defined as the percentage of patients in each treatment group who achieved ≥ 75% improvement from baseline PASI score (PASI 75) at week 16. Recommended dosing schedule and 2016 drugs cost were take in consideration from approved sale prices in Spain. Indirect costs, costs associated with administration, laboratory services, or adverse events were not included. To calculate the cost per responder at week 16, the total cost of treatment for ustekinumab and adalimumab for 16 weeks were divided by the PASI 75 response rates. Results: 28 psoriasis patients were included in the study: 11 (39.3%) patients received adalimumab and 17 (60.7%) received ustekinumab as a second line therapy. After 16 weeks of treatment, 76.5% of ustekinumab-treated patients (13/17) achieved a PASI 75 response compared with 36.4% (4/11) in adalimumab group (P= 0.034). At week 16, the cost per responder was 10.774 € for ustekinumab and 14.124,83 € for adalimumab (increase of 4.117 € per responder). Conclusions: Ustekinumab had greater effectiveness when compared with adalimumab for the treatment of psoriatic patients after etanercept therapy. The cost-effectiveness analysis presented here demonstrates that the cost per responder of ustekinumab is lower than etanercept under the Spanish Health System perspective. PSS14 Cost Effectiveness of Dose Optimized Ustekinumab Versus Switching to Anti-Tnfs Following Partial Response to Ustekinumab Every Twelve Weeks in Patients with Moderate to Severe Plaque Psoriasis Poulin Y1, Lathia
U2, Griffin
EA3, Perampaladas
K3
1Université Laval and Centre de Recherche Dermatologique du Québec métropolitain, Quebec City, UK, 2Janssen Inc., Toronto, ON, Canada, 3Health Thinking Analytics Ltd, Devon, UK
Objectives: To inform treatment decision making following inadequate response to first-line biologics in plaque psoriasis, a chronic, recurrent, autoimmune disorder.
Methods: Markov modelling was used to estimate ten-year incremental costs and QALYs for two treatment strategies following partial response [PASI ≥ 50 and < 75] to ustekinumab dosed every twelve weeks. Patients either continued on ustekinumab at an ‘optimized’ dosing of every eight weeks (45mg and 90mg) or ‘switched’ to antiTNF treatment. Lack of published RCT data for second-line response to anti-TNFs resulted in the conservative selection of infliximab (a highly efficacious anti-TNF) to represent the anti-TNF class. Patients transitioned between ‘Response’ (higher utility) and ‘Best Supportive Care’ health states. Response (defined as PASI≥ 75) rates in a 26 week trial period were: ustekinumab 45mg = 44%, 90mg = 55% (n= 91 and n = 75 respectively, PHOENIX trials); anti-TNF class = 72%, (n= 94, EXPRESS II bio-experienced infliximab patients). Real world evidence informed treatment specific drug survival rates. Costs included biologics, supportive treatments, outpatient and inpatient care, and lost productivity. Input variables were subject to deterministic and probabilistic testing. Costs and QALYs were discounted at 5% p.a. and the ICER was used to compare strategies. Results: In a probabilistic incremental analysis anti-TNF treatment was less costly per patient (45mg: CAN$149,577 versus CAN$181,234; 90mg: CAN$152,055 versus CAN$190,416) but attained fewer QALYs (45mg: 2.68 versus 3.21; 90mg: 2.68 versus 3.68) since survival on treatment was lower with anti-TNF by year three (45mg: 26.5% versus 35.7%; 90mg: 26.5% versus 44.4%). Dose optimization of ustekinumab reduced resource use and patients were more economically productive. The ICERs for ‘optimized’ versus ‘switched’ strategies were CAN$59,369 [95%CI $32,972-$254,949] in the 45mg analysis and CAN$38,028 [95%CI: $22,789-$72,538] in the 90mg analysis. Conclusions: At the commonly accepted thresholds of CAN$50,000 and CAN$100,000 per QALY gained, dose optimizing ustekinumab is likely to be cost-effective versus switching to antiTNF therapy in partial responders to ustekinumab. PSS15 The Effectiveness and Cost Effectiveness of Pit and Fissure Sealant for Prevention of Dental Caries in School-Age Children in China Yang L, Li X Peking University, Beijing, China
Objectives: To evaluate the preventive effectiveness and cost-effectiveness of pit and fissure sealant for prevention of dental caries among school-age children from four provinces in China. Methods: The data were collected in a three-year dental prevention programme among school-age children in piloting schools of Hebei, Guangxi, Jilin and Liaoning of China. Health outcomes were measured as DMFT and the prevalence of caries. DID (difference in difference) model was used to evaluate the net effect change of pit and fissure sealant by controlling other cofounding factors. From a societal perspective, cost-effectiveness analysis was used to evaluate the pit and fissure sealant caries and Sensitivity analyses were conducted to assess the robust of results. Results: Comparing to no intervention, pit and fissure sealant caries could reduce DMFT with 0.366 and drop the prevalence of caries with 75.1% (p < 0.001). In the analysis of cost-effectiveness, the incremental cost per DMFT avoided over the three-year period was RMB149.29 and the one for a percentage point of the prevalence of caries was RMB 4.50. Conclusions: Pit and fissure sealant is effective in preventing the occurrence of dental caries in school-age children. Compared to control group, pit and fissure sealant is more cost-effectiveness. PSS16 Cost-Utility of Ustekinumab in the Treatment of Moderate to Severe Psoriasis in Colombia Ojeda C1, Hernandez N2, Giraldo CV3, Argote AC4, Coronell S5, Roa M6 La Samaritana, Bogota, Colombia, 2Private Practice, Bogota, Colombia, 3Universidad El Bosque, Bogota, Colombia, 4Hospital San José, Bogota, Colombia, 5Cafesalud/Colmedica, Bogota, Colombia, 6Janssen Cilag, Bogota, Colombia
1Hospital
Objectives: To evaluate the cost-utility of ustekinumab in moderate to severe psoriasis compared with the use of infliximab, adalimumab and etanercept. To determine benefits of Ustekinumab in controlling the disease in the long term in patients unresponsive or intolerant. Methods: Cost-utility analysis from the perspective of the third-party payer considering final outcome the quality-adjusted life-years (QALYs) and as a measure of effectiveness the rate of Psoriasis Area Severity Index (PASI) 50, 75 and 90, and quality of life according to the response. A Markov model with a time horizon to ten years was applied. The selection of comparators included in the analysis was performed by integrating a modified Delphi panel, in which profile information of the patient, treatment regimens and medical monitoring was collected. Direct medical costs are considered only: cost of initial management with the health technologies to compare; and treatment with a second biological after fails or no response to initial treatment. A sensitivity analysis on prices on key variables of the model was performed. Results: From the evaluation model the total cost of care per patient for 10-year period according to the selected treatment were (USD): ustekinumab $44.672; infliximab $45.437; adalimumab $49.063; etanercept 50 mg $51.721, and etanercept 25mg $46.711. The model simulates QALYs associated with increases in utility derivatives PASI response achieved by each comparator: 7.34, 6.19, 6.83, 6.45 and 6.32 QALYs with ustekinumab, infliximab, adalimumab, etanercept 50mg and etanercept 25mg, respectively. The ICUR of ustekinumab compared to all alternatives was dominant. Conclusions: The results of the cost-utility analysis shows that the use of ustekinumab in the treatment of adult patients with psoriasis unresponsive or intolerant to treatment with corticosteroids, cyclosporine or phototherapy is a dominant strategy in the long term regarding the use of anti-TNF. PSS17 Assure-Csu: Assessing the Impact of Chronic Spontaneous / Idiopathic Urticaria on Work Productivity and Activity McBride D1, Balp M2, Abuzakouk M3, Berard F4, Canonica GW5, Gimenez-Arnau A6, Grattan C7, Knulst AC8, Hollis K9, Khalil S2, Lacour J10, Lynde C11, Marsland A12, Nakonechna A13, Ortiz de Frutoz FJ14, Oude Elberink J15, Proctor C9, Sussman G16, Weller K17, Maurer M17
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
before and after the index date for both cohorts. Study outcomes, including health care costs and utilizations were compared between the cataract and comparison cohorts. Results: After 1:1 matching, a total of 345,937 patients were matched from the cataract and comparison cohorts, and baseline characteristics were proportionate. A higher percentage of patients in the cataract cohort had inpatient stays (16.00% vs. 14.32%, p< 0.0001), emergency room visits (20.35% vs. 16.89%, p< 0.0001), physician office visits (99.05% vs. 74.71%, p< 0.0001), outpatient hospital visits (74.84% vs. 55.15%, p< 0.0001), and durable medical equipment (DME) use (32.67% vs. 23.51%, p< 0.0001), but a lower percentage of patients had prescription claims for part D drug events (54.41% vs. 60.32%, p< 0.0001). Cataract patients also incurred higher inpatient costs ($3,357 vs. $3,029, p< 0.0001), physician office costs ($3,029 vs. $1,811, p< 0.0001), outpatient hospital costs ($5,355 vs. $3,448, p< 0.0001), and total costs ($15,141 vs. $11,914, p< 0.0001) compared to patients without a cataract diagnosis. Conclusions: Cataract diagnosis was associated with higher health care resource utilization and a higher economic burden. PSS12 Cost Effectiveness of Nivolumab-Ipilimumab Combination Therapy Compared to Monotherapy for Metastatic Melanoma from a US Societal Perspective Tran DM, McDowell LC, Oh A, Barcelon JA, Keyvani D, Merino O, Wilson L University of California, San Francisco, San Francisco, CA, USA
Objectives: Develop a Markov model to determine the cost-effectiveness of nivolumab, ipilimumab, and nivolumab-ipilimumab combination as first-line therapy in metastatic melanoma accounting for differential effectiveness of PD-L1 positive and negative states. Methods: A three-state Markov model (PD-L1 positive stable disease, PD-L1 negative stable disease, and progression/death) was developed using a US societal perspective with a lifetime time horizon of 14.5 years. Transition probabilities were progression-free survival data from the CheckMate-067 trial. Costs were expressed in 2015 US dollars and were determined using national sources. Adverse event (AE) management was determined using immune-related AE (irAE) data from CheckMate-067, irAE management guides for nivolumab and ipilimumab, and treatment guidelines. Utilities were obtained from published literature, using melanoma-specific studies when available, and were weighted based on incidence and duration of health states. Probabilistic sensitivity analyses were conducted. Results: In the base case, ipilimumab monotherapy was dominated by nivolumab monotherapy while nivolumab-ipilimumab combination therapy had an ICER of $883,994/QALY compared to nivolumab. The cost of ipilimumab would have to decrease to < $4,500 per dose for combination therapy to be costeffective, and to < $2,720 (a 90% reduction) to be more cost-effective than nivolumab alone. Conclusions: At a willingness-to-pay threshold of $100,000/QALY, and using progression-free survival and current drug prices, nivolumab-ipilimumab combination therapy would not be cost-effective compared to nivolumab monotherapy, the most cost-effective option. PSS13 Cost-Effectiveness Analysis of Ustekinumab and Adalimumab in Psoriatic Patients Previously Treated with Etanercept in a RealWorld Setting García Gil S, González García J, Nazco Casariego GJ, González de la Fuente G, Calzado Gómez G, Guitérrez Nicolas F Complejo Hospitalario Universitario de canarias, San Cristobal de La Laguna, Spain
Objectives: The best treatment strategy for psoriatic patients previously treated with etanercept is unknown. With multiple agents available, studies about the cost and cost-effectiveness of biologic options to quantify the relative value of each of these treatments are necesary. The aims of this study is to compare the cost per responder of ustekinumab versus adalimumab after etanercept therapy under real-world conditions as a second line therapy after etanercept treatment from the Spanish Health System perspective. Methods: A single-centre, retrospective, observational, comparative study in a real-world setting was carried out from 1 november 2011 to 31 March 2013. Effectiveness of the treatment was defined as the percentage of patients in each treatment group who achieved ≥ 75% improvement from baseline PASI score (PASI 75) at week 16. Recommended dosing schedule and 2016 drugs cost were take in consideration from approved sale prices in Spain. Indirect costs, costs associated with administration, laboratory services, or adverse events were not included. To calculate the cost per responder at week 16, the total cost of treatment for ustekinumab and adalimumab for 16 weeks were divided by the PASI 75 response rates. Results: 28 psoriasis patients were included in the study: 11 (39.3%) patients received adalimumab and 17 (60.7%) received ustekinumab as a second line therapy. After 16 weeks of treatment, 76.5% of ustekinumab-treated patients (13/17) achieved a PASI 75 response compared with 36.4% (4/11) in adalimumab group (P= 0.034). At week 16, the cost per responder was 10.774 € for ustekinumab and 14.124,83 € for adalimumab (increase of 4.117 € per responder). Conclusions: Ustekinumab had greater effectiveness when compared with adalimumab for the treatment of psoriatic patients after etanercept therapy. The cost-effectiveness analysis presented here demonstrates that the cost per responder of ustekinumab is lower than etanercept under the Spanish Health System perspective. PSS14 Cost Effectiveness of Dose Optimized Ustekinumab Versus Switching to Anti-Tnfs Following Partial Response to Ustekinumab Every Twelve Weeks in Patients with Moderate to Severe Plaque Psoriasis Poulin Y1, Lathia
U2, Griffin
EA3, Perampaladas
K3
1Université Laval and Centre de Recherche Dermatologique du Québec métropolitain, Quebec City, UK, 2Janssen Inc., Toronto, ON, Canada, 3Health Thinking Analytics Ltd, Devon, UK
Objectives: To inform treatment decision making following inadequate response to first-line biologics in plaque psoriasis, a chronic, recurrent, autoimmune disorder.
Methods: Markov modelling was used to estimate ten-year incremental costs and QALYs for two treatment strategies following partial response [PASI ≥ 50 and < 75] to ustekinumab dosed every twelve weeks. Patients either continued on ustekinumab at an ‘optimized’ dosing of every eight weeks (45mg and 90mg) or ‘switched’ to antiTNF treatment. Lack of published RCT data for second-line response to anti-TNFs resulted in the conservative selection of infliximab (a highly efficacious anti-TNF) to represent the anti-TNF class. Patients transitioned between ‘Response’ (higher utility) and ‘Best Supportive Care’ health states. Response (defined as PASI≥ 75) rates in a 26 week trial period were: ustekinumab 45mg = 44%, 90mg = 55% (n= 91 and n = 75 respectively, PHOENIX trials); anti-TNF class = 72%, (n= 94, EXPRESS II bio-experienced infliximab patients). Real world evidence informed treatment specific drug survival rates. Costs included biologics, supportive treatments, outpatient and inpatient care, and lost productivity. Input variables were subject to deterministic and probabilistic testing. Costs and QALYs were discounted at 5% p.a. and the ICER was used to compare strategies. Results: In a probabilistic incremental analysis anti-TNF treatment was less costly per patient (45mg: CAN$149,577 versus CAN$181,234; 90mg: CAN$152,055 versus CAN$190,416) but attained fewer QALYs (45mg: 2.68 versus 3.21; 90mg: 2.68 versus 3.68) since survival on treatment was lower with anti-TNF by year three (45mg: 26.5% versus 35.7%; 90mg: 26.5% versus 44.4%). Dose optimization of ustekinumab reduced resource use and patients were more economically productive. The ICERs for ‘optimized’ versus ‘switched’ strategies were CAN$59,369 [95%CI $32,972-$254,949] in the 45mg analysis and CAN$38,028 [95%CI: $22,789-$72,538] in the 90mg analysis. Conclusions: At the commonly accepted thresholds of CAN$50,000 and CAN$100,000 per QALY gained, dose optimizing ustekinumab is likely to be cost-effective versus switching to antiTNF therapy in partial responders to ustekinumab. PSS15 The Effectiveness and Cost Effectiveness of Pit and Fissure Sealant for Prevention of Dental Caries in School-Age Children in China Yang L, Li X Peking University, Beijing, China
Objectives: To evaluate the preventive effectiveness and cost-effectiveness of pit and fissure sealant for prevention of dental caries among school-age children from four provinces in China. Methods: The data were collected in a three-year dental prevention programme among school-age children in piloting schools of Hebei, Guangxi, Jilin and Liaoning of China. Health outcomes were measured as DMFT and the prevalence of caries. DID (difference in difference) model was used to evaluate the net effect change of pit and fissure sealant by controlling other cofounding factors. From a societal perspective, cost-effectiveness analysis was used to evaluate the pit and fissure sealant caries and Sensitivity analyses were conducted to assess the robust of results. Results: Comparing to no intervention, pit and fissure sealant caries could reduce DMFT with 0.366 and drop the prevalence of caries with 75.1% (p < 0.001). In the analysis of cost-effectiveness, the incremental cost per DMFT avoided over the three-year period was RMB149.29 and the one for a percentage point of the prevalence of caries was RMB 4.50. Conclusions: Pit and fissure sealant is effective in preventing the occurrence of dental caries in school-age children. Compared to control group, pit and fissure sealant is more cost-effectiveness. PSS16 Cost-Utility of Ustekinumab in the Treatment of Moderate to Severe Psoriasis in Colombia Ojeda C1, Hernandez N2, Giraldo CV3, Argote AC4, Coronell S5, Roa M6 La Samaritana, Bogota, Colombia, 2Private Practice, Bogota, Colombia, 3Universidad El Bosque, Bogota, Colombia, 4Hospital San José, Bogota, Colombia, 5Cafesalud/Colmedica, Bogota, Colombia, 6Janssen Cilag, Bogota, Colombia
1Hospital
Objectives: To evaluate the cost-utility of ustekinumab in moderate to severe psoriasis compared with the use of infliximab, adalimumab and etanercept. To determine benefits of Ustekinumab in controlling the disease in the long term in patients unresponsive or intolerant. Methods: Cost-utility analysis from the perspective of the third-party payer considering final outcome the quality-adjusted life-years (QALYs) and as a measure of effectiveness the rate of Psoriasis Area Severity Index (PASI) 50, 75 and 90, and quality of life according to the response. A Markov model with a time horizon to ten years was applied. The selection of comparators included in the analysis was performed by integrating a modified Delphi panel, in which profile information of the patient, treatment regimens and medical monitoring was collected. Direct medical costs are considered only: cost of initial management with the health technologies to compare; and treatment with a second biological after fails or no response to initial treatment. A sensitivity analysis on prices on key variables of the model was performed. Results: From the evaluation model the total cost of care per patient for 10-year period according to the selected treatment were (USD): ustekinumab $44.672; infliximab $45.437; adalimumab $49.063; etanercept 50 mg $51.721, and etanercept 25mg $46.711. The model simulates QALYs associated with increases in utility derivatives PASI response achieved by each comparator: 7.34, 6.19, 6.83, 6.45 and 6.32 QALYs with ustekinumab, infliximab, adalimumab, etanercept 50mg and etanercept 25mg, respectively. The ICUR of ustekinumab compared to all alternatives was dominant. Conclusions: The results of the cost-utility analysis shows that the use of ustekinumab in the treatment of adult patients with psoriasis unresponsive or intolerant to treatment with corticosteroids, cyclosporine or phototherapy is a dominant strategy in the long term regarding the use of anti-TNF. PSS17 Assure-Csu: Assessing the Impact of Chronic Spontaneous / Idiopathic Urticaria on Work Productivity and Activity McBride D1, Balp M2, Abuzakouk M3, Berard F4, Canonica GW5, Gimenez-Arnau A6, Grattan C7, Knulst AC8, Hollis K9, Khalil S2, Lacour J10, Lynde C11, Marsland A12, Nakonechna A13, Ortiz de Frutoz FJ14, Oude Elberink J15, Proctor C9, Sussman G16, Weller K17, Maurer M17