Towards Better Coordination and More Efficient Patient Pathways in Copd

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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