- Email: [email protected]
What Is The Scope And Quality of Economic Evidence Available for Atopic Eczema? A Systematic Review
A740
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1
50 procedures. Conclusions: At the center and clinician level, LC may influence the early performance of novel devices affecting both costs and patients’ outcomes. Incorporation of the LC in economic evaluations and HTA reports can be relevant for certain types of technologies, and may even affect coverage decisions. Based on the number of procedures needed to gain sufficient experience, it might also inform the design of health service provision that maximize health gains. Data allowing the estimation of the LC from clinical studies and real-world registries should be made available. PRM54 Montecarlo Model As A Tool In Estimation of Economic Burden of A Disease Through The Prediction of Biological Characteristics of Tumor In Breast Cancer Balderas-Peña L1, Sat-Muñoz D2, Martinez-Herrera B3, Avalos-Nuño J4, Gonzalez-Barba F1, Cruz-Corona E1, Ortiz-González F5 1UMAE Hospital de Especialidades Centro Médico Nacional de Occidente IMSS, Guadalajara, Jalisco, Mexico, 2Universidad de Guadalajara. Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico, 3Hospital General de Zona No. 2 “Dr. Francisco Padrón Puyou”, San Luis Potosí, SLP, Mexico, 4UMAE Hospital de Gineco-Obstetricia Centro Médico Nacional de Occidente IMSS, Guadalajara, Jalisco, Mexico, 5Unidad Médica de Alta Especialidad Hospital de Especialidades. Centro Médico Nacional de Occidente, Guadalajara, Jalisco, Mexico
Introduction: The third-party payer whom provide health services around the world need mathematical and methodological tools to estimate the future expenditures related health services in different populations. We use breast cancer data to generate a predictive mathematical model as help to estimate the health services’ cost in the context of a developing country as Mexico. Objectives: To evaluate the concordance between observed and calculates expenditures in the treatment of a sample of breast cancer patients attended in a Mexican public health institution. Methods: Were reviewed the clinical records from 407 breast cancer women to calculate through micro-costing, the total expenditure in health during their treatment. After that was generated the Montecarlo mathematical predictive model to try to estimate the health services expenditure in a 100 women hypothetical sample, simulating the clinical characteristics, as primary tumor size, clinical stage, histologic features, lymphatic ganglia, surgery, radiotherapy and chemotherapy kind, metastases, metastasis anatomic localization, and recurrence treatment. Chi squared and student T test for independent samples were used to estimate p value between studied patients and hypothetical population. Results: Were not found statistical differences between clinical stage ((p= 0.865), tumor receptors (p= 0.893), and kind of metastases between patients sample and hypothetical sample (p= 0.699). The mean cost for the breast cancer women sample was $251,454.43 MXN, and for hypothetical sample $329,503.85 MXN (p< 0.05), however we did not find differences in surgical procedures cost (p= 0.441) Conclusions: The Montecarlo predictive model could be a useful tool to estimate the health services expenditure and to calculate a budget close to real cost. PRM55 Modeling Techniques for Fitting Healthcare Resource Use Costs Derived From Patient Reported Counts of Hospital, ER, And PCP Visits Liebert R, Sanders A, Kudel I Kantar Health, New York, NY, USA
Objectives: Determine the optimal method of modeling a zero-inflated outcome by comparing generalized linear models (GLMs) that vary based on the distribution (negative binomial and Tweedie) and the inclusion of an offset. Methods: Participants of the 2016 EU5 (France, Germany, Italy, Spain, and the United Kingdom) administration of the National Health and Wellness Survey who self-reported cardiovascular disease (CVD; n= 3,685) were compared to those without CVD (controls; n= 76,915) on costs derived from counts of hospitalizations, emergency room, and primary care provider (PCP) visits occurring in the preceding six months. Four different GLMs were fit for each outcome; negative binomial and Tweedie models with and without using an offset. The negative binomial is widely used, but the Tweedie distribution is a reasonable option because it allows for more flexible modeling of zeros and extreme values. Using an offset allows for the modeling of self-reported counts directly. Fit indices (lower scores are better) included the Akaike information criterion (AIC), mean absolute error (MAE), and root mean square error (RMSE). GLM parameters comparing CVD and control groups on the aforementioned outcomes were also reviewed to determine if modeling options affected statistical significance. Results: GLMs utilizing offsets outperformed models without them for all cost outcomes (average improvement of 210,638, € 83, and € 23,149 for AIC, MAE, and RMSE, respectively). Among those utilizing offsets, Tweedie outperformed on MAE and RMSE (average improvement of € 253 and € 70,209, respectively) while the negative binomial models had a slightly lower AIC (average improvement of 4,231). Additionally, Tweedie model parameter estimates had smaller confidence intervals and detected a significant effect of CVD on PCP visit costs (p< .05). Conclusions: GLMs with a Tweedie distribution and offsets are the preferred choice because they demonstrated better fit and impacted substantive interpretation of model parameters. PRM56 What Is The Scope And Quality of Economic Evidence Available for Atopic Eczema? A Systematic Review Sach TH1, McManus E1, Levell N2, McOwan F3, Parris J3, Roberts A3, Thomas K3 of East Anglia, Norwich, UK, 2Norfolk and Norwich University Hospital, Norwich, UK, 3University of Nottingham, Nottingham, UK
1University
Objectives: Atopic eczema is a chronic inflammatory skin disease, resulting in itchy, dry skin. Whilst the clinical effectiveness evidence for eczema is collated in the Global Resource of Eczema Trials (GREAT) database there is currently no such resource for economic evidence. Therefore, we undertook a systematic review
with the aim of identifying the scope and quality of economic research for atopic eczema. Methods: A systematic literature search was conducted on 22nd May 2017. Studies eligible for inclusion were primary empirical studies either reporting the results of a cost of illness study or evaluating the cost, utility or full economic evaluation of preventions or interventions for eczema. Two reviewers independently assessed studies for eligibility and performed data abstraction collecting details of the study characteristics, costing and outcome methods, and quality assessment. Methodological quality was assessed using the CHEERS checklist. Further details can be found on PROSPERO (CRD42015024633). Results: 77 studies were found, of which 33 (42.9%) were judged to be full economic evaluations, 26 (33.8%) were cost of illness studies, 12 (15.6%) were cost analyses, 5 (6.5%) were utility or willingness to pay studies, and one (1.3%) was a feasibility study. The interventions: tacrolimus, pimecrolimus, and barrier creams had the most economic evidence available (19 studies). Partially hydrolysed infant formula was the most commonly evaluated prevention (10 studies). The time frame for analyses ranged from 3 weeks to 14 years. According to the CHEERS checklist, the studies were of reasonable reporting quality with the majority of studies fulfilling more than 70% of criteria. Conclusions: The current level of economic evidence within eczema is much lower than that available for clinical outcomes. The limited range of interventions evaluated and the heterogeneity of methods used in the existing evidence suggest further economic research is needed to support commissioners making health funding decisions. PRM57 Classification of Causes of Hospitalization For Heart Failure Patients In Cost-Effectiveness and Cost-Utility Evaluations of Pharmacotherapeutic, Surgical, and Managed-Care Interventions: Systematic Review Alsaid N1, Sweitzer N2, Ramos K3, Erstad B4, Slack M4, Abraham I1 1Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona (Tucson, AZ, USA), Tucson, AZ, USA, 2Sarver Heart Center, University of Arizona (Tucson, AZ, USA), Tucson, AZ, USA, 3College of Medicine, University of Arizona (Phoenix, AZ. USA), Phoenix, AZ, USA, 4Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona (Tucson, AZ, USA), Tucson, AZ, USA
Objectives: Most heart failure (HF) patients are hospitalized frequently and for a variety causes. The operational definition of these causes may affect costeffectiveness and cost-utility estimates. We aimed to systematically review causes of hospitalizations and their definitions used in economic evaluations (EE). Methods: We searched PubMed for the 1994-2017 period for Englishlanguage cost-effectiveness/utility studies with HF as primary disease using decision tree analysis, markov modeling, monte-carlo simulation, trial-based models, or other models enabling determination of (quality-adjusted) life years (LY/QALY) and incremental cost-effectiveness/utility ratios (ICER/ICUR). HF hospitalization reasons included: HF, cardiovascular (CV), any-cause, HF&CV, procedure, or notspecified. Studies were classified as focused on pharmacotherapeutic, managedcare, or surgical interventions. Results: Of 1400 records, 1145 were excluded per title and abstract: 331 irrelevant publications; 521 cost-analysis/budget impact reports; 192 studies reporting LY/QALY but not ICER/ICUR, or not comparing treatments economically. Of the 255 reports assessed full-text, 192 were excluded for not reporting ICER/ICUR, yielding 63 studies. Of the 25 pharmacotherapeutic EEs, 11 defined hospitalization cause as HF, 3 CV, 3 HF&CV, 6 any-cause, 2 not-specified (others 0). Of the 16 managed-care EEs, 5 defined cause as HF, 1 CV, 6 any-cause, 4 as not-specified (others 0). Of the 22 surgical EEs, 5 defined cause as HF, 1 CV, 6 any-cause, 9 procedures, 1 as not-specified (others 0). Omnibus contingencytable analysis yielded p= 0.002. Conclusions: There is significant variation in the definitions of cause of hospitalization of HF patients in EEs in general as well as across and within intervention types. Because differential costs and utilities may be associated with definitions, the cause used in EEs may vary in terms of the estimated ICER and ICUR and thus affect decision-making regarding treatment or resource allocation. PRM58 The Dynamics of Child Mental Health Care Dijk HH, Freriks RD, Mierau JO University of Groningen, Groningen, The Netherlands
Objectives: We aim to estimate the persistence of mental health care for a population of Dutch children born between 2000 and 2012. The relationship between mental health and care is complex, with multiple mechanisms affecting both individual mental health and the amount of care an individual receives. Therefore, we develop a theoretical model to provide a structural interpretation for the true state-dependence of child mental health care. Methods: We use administrative data from the Psychiatric Case Registry Northern Netherlands (PCR-NN), which is a longitudinal record of patient contacts with psychiatric institutions between 2000 and 2012. The sample contains 206,283 patient contacts corresponding to 20,193 individuals. We transformed the PCR-NN into a dynamic panel data set, and obtained consistent and unbiased estimates by using difference General Method of Moments (GMM). Results: All estimation results show a positive coefficient smaller than unity, which indicates that the process is stable. An exogenous increase of 10 care moment in the present year is associated with approximately 4 additional care moments in the future. In addition, we find that the role of spurious state-dependence is small. Estimates are robust to numerous sensitivity analyses. Conclusions: Through the structural interpretation of the model, we can conclude that the persistence of health is likely stronger than the combination of the healing effect of care and the rate at which health problems lead individuals to receive care, but that the process is stable. In other words, if children experience an exogenous adverse mental health event, they will receive an increased number of care moments for a few years, but this effect will weaken over time so that eventually they will receive a base level of care again.
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1
50 procedures. Conclusions: At the center and clinician level, LC may influence the early performance of novel devices affecting both costs and patients’ outcomes. Incorporation of the LC in economic evaluations and HTA reports can be relevant for certain types of technologies, and may even affect coverage decisions. Based on the number of procedures needed to gain sufficient experience, it might also inform the design of health service provision that maximize health gains. Data allowing the estimation of the LC from clinical studies and real-world registries should be made available. PRM54 Montecarlo Model As A Tool In Estimation of Economic Burden of A Disease Through The Prediction of Biological Characteristics of Tumor In Breast Cancer Balderas-Peña L1, Sat-Muñoz D2, Martinez-Herrera B3, Avalos-Nuño J4, Gonzalez-Barba F1, Cruz-Corona E1, Ortiz-González F5 1UMAE Hospital de Especialidades Centro Médico Nacional de Occidente IMSS, Guadalajara, Jalisco, Mexico, 2Universidad de Guadalajara. Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico, 3Hospital General de Zona No. 2 “Dr. Francisco Padrón Puyou”, San Luis Potosí, SLP, Mexico, 4UMAE Hospital de Gineco-Obstetricia Centro Médico Nacional de Occidente IMSS, Guadalajara, Jalisco, Mexico, 5Unidad Médica de Alta Especialidad Hospital de Especialidades. Centro Médico Nacional de Occidente, Guadalajara, Jalisco, Mexico
Introduction: The third-party payer whom provide health services around the world need mathematical and methodological tools to estimate the future expenditures related health services in different populations. We use breast cancer data to generate a predictive mathematical model as help to estimate the health services’ cost in the context of a developing country as Mexico. Objectives: To evaluate the concordance between observed and calculates expenditures in the treatment of a sample of breast cancer patients attended in a Mexican public health institution. Methods: Were reviewed the clinical records from 407 breast cancer women to calculate through micro-costing, the total expenditure in health during their treatment. After that was generated the Montecarlo mathematical predictive model to try to estimate the health services expenditure in a 100 women hypothetical sample, simulating the clinical characteristics, as primary tumor size, clinical stage, histologic features, lymphatic ganglia, surgery, radiotherapy and chemotherapy kind, metastases, metastasis anatomic localization, and recurrence treatment. Chi squared and student T test for independent samples were used to estimate p value between studied patients and hypothetical population. Results: Were not found statistical differences between clinical stage ((p= 0.865), tumor receptors (p= 0.893), and kind of metastases between patients sample and hypothetical sample (p= 0.699). The mean cost for the breast cancer women sample was $251,454.43 MXN, and for hypothetical sample $329,503.85 MXN (p< 0.05), however we did not find differences in surgical procedures cost (p= 0.441) Conclusions: The Montecarlo predictive model could be a useful tool to estimate the health services expenditure and to calculate a budget close to real cost. PRM55 Modeling Techniques for Fitting Healthcare Resource Use Costs Derived From Patient Reported Counts of Hospital, ER, And PCP Visits Liebert R, Sanders A, Kudel I Kantar Health, New York, NY, USA
Objectives: Determine the optimal method of modeling a zero-inflated outcome by comparing generalized linear models (GLMs) that vary based on the distribution (negative binomial and Tweedie) and the inclusion of an offset. Methods: Participants of the 2016 EU5 (France, Germany, Italy, Spain, and the United Kingdom) administration of the National Health and Wellness Survey who self-reported cardiovascular disease (CVD; n= 3,685) were compared to those without CVD (controls; n= 76,915) on costs derived from counts of hospitalizations, emergency room, and primary care provider (PCP) visits occurring in the preceding six months. Four different GLMs were fit for each outcome; negative binomial and Tweedie models with and without using an offset. The negative binomial is widely used, but the Tweedie distribution is a reasonable option because it allows for more flexible modeling of zeros and extreme values. Using an offset allows for the modeling of self-reported counts directly. Fit indices (lower scores are better) included the Akaike information criterion (AIC), mean absolute error (MAE), and root mean square error (RMSE). GLM parameters comparing CVD and control groups on the aforementioned outcomes were also reviewed to determine if modeling options affected statistical significance. Results: GLMs utilizing offsets outperformed models without them for all cost outcomes (average improvement of 210,638, € 83, and € 23,149 for AIC, MAE, and RMSE, respectively). Among those utilizing offsets, Tweedie outperformed on MAE and RMSE (average improvement of € 253 and € 70,209, respectively) while the negative binomial models had a slightly lower AIC (average improvement of 4,231). Additionally, Tweedie model parameter estimates had smaller confidence intervals and detected a significant effect of CVD on PCP visit costs (p< .05). Conclusions: GLMs with a Tweedie distribution and offsets are the preferred choice because they demonstrated better fit and impacted substantive interpretation of model parameters. PRM56 What Is The Scope And Quality of Economic Evidence Available for Atopic Eczema? A Systematic Review Sach TH1, McManus E1, Levell N2, McOwan F3, Parris J3, Roberts A3, Thomas K3 of East Anglia, Norwich, UK, 2Norfolk and Norwich University Hospital, Norwich, UK, 3University of Nottingham, Nottingham, UK
1University
Objectives: Atopic eczema is a chronic inflammatory skin disease, resulting in itchy, dry skin. Whilst the clinical effectiveness evidence for eczema is collated in the Global Resource of Eczema Trials (GREAT) database there is currently no such resource for economic evidence. Therefore, we undertook a systematic review
with the aim of identifying the scope and quality of economic research for atopic eczema. Methods: A systematic literature search was conducted on 22nd May 2017. Studies eligible for inclusion were primary empirical studies either reporting the results of a cost of illness study or evaluating the cost, utility or full economic evaluation of preventions or interventions for eczema. Two reviewers independently assessed studies for eligibility and performed data abstraction collecting details of the study characteristics, costing and outcome methods, and quality assessment. Methodological quality was assessed using the CHEERS checklist. Further details can be found on PROSPERO (CRD42015024633). Results: 77 studies were found, of which 33 (42.9%) were judged to be full economic evaluations, 26 (33.8%) were cost of illness studies, 12 (15.6%) were cost analyses, 5 (6.5%) were utility or willingness to pay studies, and one (1.3%) was a feasibility study. The interventions: tacrolimus, pimecrolimus, and barrier creams had the most economic evidence available (19 studies). Partially hydrolysed infant formula was the most commonly evaluated prevention (10 studies). The time frame for analyses ranged from 3 weeks to 14 years. According to the CHEERS checklist, the studies were of reasonable reporting quality with the majority of studies fulfilling more than 70% of criteria. Conclusions: The current level of economic evidence within eczema is much lower than that available for clinical outcomes. The limited range of interventions evaluated and the heterogeneity of methods used in the existing evidence suggest further economic research is needed to support commissioners making health funding decisions. PRM57 Classification of Causes of Hospitalization For Heart Failure Patients In Cost-Effectiveness and Cost-Utility Evaluations of Pharmacotherapeutic, Surgical, and Managed-Care Interventions: Systematic Review Alsaid N1, Sweitzer N2, Ramos K3, Erstad B4, Slack M4, Abraham I1 1Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona (Tucson, AZ, USA), Tucson, AZ, USA, 2Sarver Heart Center, University of Arizona (Tucson, AZ, USA), Tucson, AZ, USA, 3College of Medicine, University of Arizona (Phoenix, AZ. USA), Phoenix, AZ, USA, 4Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona (Tucson, AZ, USA), Tucson, AZ, USA
Objectives: Most heart failure (HF) patients are hospitalized frequently and for a variety causes. The operational definition of these causes may affect costeffectiveness and cost-utility estimates. We aimed to systematically review causes of hospitalizations and their definitions used in economic evaluations (EE). Methods: We searched PubMed for the 1994-2017 period for Englishlanguage cost-effectiveness/utility studies with HF as primary disease using decision tree analysis, markov modeling, monte-carlo simulation, trial-based models, or other models enabling determination of (quality-adjusted) life years (LY/QALY) and incremental cost-effectiveness/utility ratios (ICER/ICUR). HF hospitalization reasons included: HF, cardiovascular (CV), any-cause, HF&CV, procedure, or notspecified. Studies were classified as focused on pharmacotherapeutic, managedcare, or surgical interventions. Results: Of 1400 records, 1145 were excluded per title and abstract: 331 irrelevant publications; 521 cost-analysis/budget impact reports; 192 studies reporting LY/QALY but not ICER/ICUR, or not comparing treatments economically. Of the 255 reports assessed full-text, 192 were excluded for not reporting ICER/ICUR, yielding 63 studies. Of the 25 pharmacotherapeutic EEs, 11 defined hospitalization cause as HF, 3 CV, 3 HF&CV, 6 any-cause, 2 not-specified (others 0). Of the 16 managed-care EEs, 5 defined cause as HF, 1 CV, 6 any-cause, 4 as not-specified (others 0). Of the 22 surgical EEs, 5 defined cause as HF, 1 CV, 6 any-cause, 9 procedures, 1 as not-specified (others 0). Omnibus contingencytable analysis yielded p= 0.002. Conclusions: There is significant variation in the definitions of cause of hospitalization of HF patients in EEs in general as well as across and within intervention types. Because differential costs and utilities may be associated with definitions, the cause used in EEs may vary in terms of the estimated ICER and ICUR and thus affect decision-making regarding treatment or resource allocation. PRM58 The Dynamics of Child Mental Health Care Dijk HH, Freriks RD, Mierau JO University of Groningen, Groningen, The Netherlands
Objectives: We aim to estimate the persistence of mental health care for a population of Dutch children born between 2000 and 2012. The relationship between mental health and care is complex, with multiple mechanisms affecting both individual mental health and the amount of care an individual receives. Therefore, we develop a theoretical model to provide a structural interpretation for the true state-dependence of child mental health care. Methods: We use administrative data from the Psychiatric Case Registry Northern Netherlands (PCR-NN), which is a longitudinal record of patient contacts with psychiatric institutions between 2000 and 2012. The sample contains 206,283 patient contacts corresponding to 20,193 individuals. We transformed the PCR-NN into a dynamic panel data set, and obtained consistent and unbiased estimates by using difference General Method of Moments (GMM). Results: All estimation results show a positive coefficient smaller than unity, which indicates that the process is stable. An exogenous increase of 10 care moment in the present year is associated with approximately 4 additional care moments in the future. In addition, we find that the role of spurious state-dependence is small. Estimates are robust to numerous sensitivity analyses. Conclusions: Through the structural interpretation of the model, we can conclude that the persistence of health is likely stronger than the combination of the healing effect of care and the rate at which health problems lead individuals to receive care, but that the process is stable. In other words, if children experience an exogenous adverse mental health event, they will receive an increased number of care moments for a few years, but this effect will weaken over time so that eventually they will receive a base level of care again.