Average Annual Treatment Cost Research Articles

Annual epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data

BackgroundHealth services utilization related to hip osteoarthritis imposes a significant burden on society and health care systems. Our aim was to analyse the epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data.MethodsData were extracted from the nationwide financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. The analysed data included annual patient numbers, prevalence, and age-standardized prevalence per 100,000 population in outpatient care, health insurance costs calculated for age groups and sexes for all types of care. Patients with hip osteoarthritis were identified using code M16 of the International Classification of Diseases (ICD), 10th revision. Age-standardised prevalence rates were calculated using the European Standard Population 2013 (ESP2013).ResultsBased on patient numbers of outpatient care, the prevalence per 100,000 among males was 1,483.7 patients (1.5%), among females 2,905.5 (2.9%), in total 2,226.2 patients (2.2%). The age-standardised prevalence was 1,734.8 (1.7%) for males and 2,594.8 (2.6%) for females per 100,000 population, for a total of 2,237.6 (2.2%). The prevalence per 100,000 population was higher for women in all age groups. In age group 30–39, 40–49, 50–59, 60–69 and 70 + the overall prevalence was 0.2%, 0.8%, 2.7%, 5.0% and 7.7%, respectively, describing a continuously increasing trend. In 2018, the NHIFA spent 42.31 million EUR on the treatment of hip osteoarthritis. Hip osteoarthritis accounts for 1% of total nationwide health insurance expenditures. 36.8% of costs were attributed to the treatment of male patients, and 63.2% to female patients. Acute inpatient care, outpatient care and chronic and rehabilitation inpatient care were the main cost drivers, accounting for 62.7%, 14.6% and 8.2% of the total health care expenditure for men, and 51.0%, 20.0% and 11.2% for women, respectively. The average annual treatment cost per patient was 3,627 EUR for men and 4,194 EUR for women.ConclusionsThe prevalence of hip osteoarthritis was 1.96 times higher (the age-standardised prevalence was 1.5 times higher) in women compared to men. Acute inpatient care was the major cost driver in the treatment of hip osteoarthritis. The average annual treatment cost per patient was 15.6% higher for women compared to men.

Analysis of affordability differences for rare diseases in China: a comparison across disease types and regions

BackgroundChina has implemented policies to make rare diseases more affordable. While previous studies evaluated overall affordability, few have examined affordability differences across regions and disease types. Given the vastness of China and varying medical policies across cities, this study assesses the affordability of rare diseases based on China’s First List of Rare Diseases (CFLRD), National Reimbursement Drug List (NRDL), and outpatient chronic and special disease policies in each prefecture.MethodSix rare diseases were selected and the average annual treatment cost of all relevant drugs in NRDL was calculated for each disease. Based on the WHO/HAI standardized approach, the study analyzed 289 cities with outpatient chronic and special disease policies, measured the security levels by the actual reimbursement ratio of Basic Medical Insurance (BMI) and affordability by the ratio of individual expenses after reimbursement to the annual disposable income of urban residents in the province. The security levels and affordability differences across disease types and provinces were analyzed using the Mann-Whitney U test and the K-W test.ResultThe affordability of rare diseases varied significantly on the disease types and annual treatment cost. Diseases with an annual treatment cost below 100 000 yuan are affordable to all prefectures even with low reimbursement rates, while those with a higher treatment cost were not affordable in at least 80% of prefectures even though the reimbursement ratio is high. The affordability of the same disease varies significantly across provinces and municipalities. Outpatient chronic and special diseases insurance and critical illness insurance, and the inconsistencies between them, result in regional differences.ConclusionAlthough China has made progress in improving the affordability of rare diseases, significant differences persist between cities and diseases. The study suggests the optimization of the BMI system and explores independent funds and innovative insurance models to enhance the affordability of rare diseases, particularly those with extremely high treatment costs.

Access to biologics and Janus kinase inhibitors for treatment of rheumatic diseases in the biosimilars era in Poland: a nation-level study.

By reducing treatment costs, biosimilars provide an opportunity to improve accessibility to highly effective drugs. This study aimed to evaluate access to biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKis) among patients with rheumatic musculoskeletal diseases within a 10 year timeframe in Poland. We performed a retrospective analysis using a nationwide public payer database. By 2022, 11 102, 6602, and 4400 patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) were treated with bDMARDs or JAKis. Peak drug utilization was observed for adalimumab, followed by etanercept and tocilizumab. Within the study timeframe, the estimated access to innovative drugs increased from 0.8%, 1.4%, and 0.8% to 3.2%, 8.7%, and 3.5% for RA, PsA, and axSpA patients, respectively. Affordable tumor necrosis factor inhibitors (TNFis) still predominate among innovative therapeutics, but their market share declined from 87% to 46%. The number of patients treated with other bDMARDs/JAKis almost doubled within the prespecified timeframe. Overall, the average annual treatment cost per patient decreased by 60%, from 7315 EUR to 2886 EUR. Despite recent safety warnings, JAKis appear to be increasingly utilized. Additional analyses regarding the COVID‑19 pandemic showed impaired access to intravenous therapies, but not subcutaneous or oral formulations. In Poland, biosimilars‑related savings improved availability of higher‑priced innovative drugs rather than less costly TNFis. Data‑driven resource allocation and dedicated policy solutions facilitating access to affordable biologics are recommended.

PACTA-Ped: Antimicrobial stewardship programme in a tertiary care hospital in Spain

IntroductionFighting against antimicrobial resistance is a current priority, and further efforts need to be made to improve antimicrobial prescribing and reduce the spread of infections in paediatric care settings. MethodsWe conducted a prospective longitudinal study on the use of antimicrobials from the time the antimicrobial stewardship programme (ASP) was introduced in January 2016 to December 2017 (period 2 [P2]) in our children’s hospital. We compared the obtained results on antimicrobial prescribing with retrospective data from the period preceding the introduction of the ASP (2014–2015, period 1 [P1]). The sample consisted of paediatric inpatients who received broad-spectrum antimicrobials, antifungals or intravenous antibiotherapy lasting more than 5 days. We compared the use of antimicrobials in P1 versus P2. ResultsA total of 160 patients were included during P2. The antibiotics for which a recommendation was made most frequently were meropenem (41.6%) and cefotaxime (23.4%). In 45% of care episodes, the consultant recommended “no change” to the prescribed antimicrobial. The final rate of acceptance of received recommendations by the prescribing physicians was 89%. We found average decreases of 27.8% in the days of treatment per 1000 inpatient days and 22.9% in the number of antimicrobial starts per 1000 admissions in P2. The use of carbapenems, cephalosporins and glycopeptides decreased in P2 compared to P1. The average annual cost of antimicrobial treatment decreased from є150 356/year during P1 to є98 478/year in P2. ConclusionOur ASP achieved a significant decrease in the use of broad-spectrum antibiotics and antifungals. The costs associated with antimicrobial prescribing decreased following the introduction of the ASP, which was a cost-effective action in this study period.

PACTA-Ped: programa de optimización de antimicrobianos en un hospital de tercer nivel en España

IntroductionFighting against antimicrobial resistance is a current priority, and further efforts need to be made to improve antimicrobial prescribing and reduce the spread of infections in paediatric care settings. MethodsWe conducted a prospective longitudinal study on the use of antimicrobials from the time the antimicrobial stewardship programme (ASP) was introduced in January 2016 to December 2017 (period 2 [P2]) in our children's hospital. We compared the obtained results on antimicrobial prescribing with retrospective data from the period preceding the introduction of the ASP (2014–2015, period 1 [P1]). The sample consisted of paediatric in patients who received broad-spectrum antimicrobials, antifungals or intravenous antibiotherapy lasting more than 5 days. We compared the use of antimicrobials in P1 versus P2. ResultsA total of 160 patients were included during P2. The antibiotics for which a recommendation was made most frequently were meropenem (41.6%) and cefotaxime (23.4%). In 45% of care episodes, the consultant recommended “no change” to the prescribed antimicrobial. The final rate of acceptance of received recommendations by the prescribing physicians was 89%. We found average decreases of 27.8% in the days of treatment per 1000 inpatient days and 22.9% in the number of antimicrobial starts per 1000 admissions in P2. The use of carbapenems, cephalosporins and glycopeptides decreased in P2 compared to P1. The average annual cost of antimicrobial treatment decreased from €150 356/year during P1 to €98 478/year in P2. ConclusionOur ASP achieved a significant decrease in the use of broad-spectrum antibiotics and antifungals. The costs associated with antimicrobial prescribing decreased following the introduction of the ASP, which was a cost-effective action in this study period.

Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe.

About 85% of Zimbabwe's >1.4 million people living with HIV are on antiretroviral treatment (ART). Further expansion of its treatment program will require more efficient use of existing resources. Two promising strategies for reducing resource utilization per patient are multi-month medication dispensing and community-based service delivery. We evaluated the costs to providers and patients of community-based, multi-month ART delivery models in Zimbabwe. We used resource and outcome data from a cluster-randomized non-inferiority trial of three differentiated service delivery (DSD) models targeted to patients stable on ART: 3-month facility-based care (3MF), community ART refill groups (CAGs) with 3-month dispensing (3MC), and CAGs with 6-month dispensing (6MC). Using local unit costs, we estimated the annual cost in 2020 USD of providing HIV treatment per patient from the provider and patient perspectives. In the trial, retention at 12 months was 93.0% in the 3MF, 94.8% in the 3MC, and 95.5% in the 6MC arms. The total average annual cost of HIV treatment per patient was $187 (standard deviation $39), $178 ($30), and $167 ($39) in each of the three arms, respectively. The annual cost/patient was dominated by ART medications (79% in 3MF, 87% in 3MC; 92% in 6MC), followed by facility visits (12%, 5%, 5%, respectively) and viral load (8%, 8%, 2%, respectively). When costs were stratified by district, DSD models cost slightly less, with 6MC the least expensive in all districts. Savings were driven by differences in the number of facility visits made/year, as expected, and low uptake of annual viral load tests in the 6-month arm. The total annual cost to patients to obtain HIV care was $10.03 ($2) in the 3MF arm, $5.12 ($0.41) in the 3MC arm, and $4.40 ($0.39) in the 6MF arm. For stable ART patients in Zimbabwe, 3- and 6-month community-based multi-month dispensing models cost less for both providers and patients than 3-month facility-based care and had non-inferior outcomes.

Determinants of drug expenditure in the Swiss healthcare market in 2006

BackgroundSeveral measures are in force in Switzerland to control the cost of drugs, but are not effective enough. There are many determinants influencing these expenditures, related to treatments, markets, physicians, patients and regions, but their impact on costs is not clear.MethodsWe applied a Bayesian multilevel model with five levels to adjust for patients, drugs’ market, and physicians ‘characteristics, treatment type, and district (i.e. Swiss canton). We used data of the Swiss drugs’ market in 2006, offering real choices for doctors and patients (multiple products for similar active substances), with a neutral position of pharmacists (no financial incentives).ResultsVariance partitioning of yearly drugs’ cost per insured showed that market level (delivered substance) contributed to 76% of the variance, treatment level (delivered product) to 20%, whereas patients’ and physicians’ levels accounted for only 2% each, without significant differences between Swiss cantons. After adjusting for covariables at each level, the model explained about 51% of the variation at the market and 20% at the treatment levels. We found that older but substitutable drugs, generics, larger size of the market and physician’s specialty were associated with lower expenditure, whereas drugs requiring a physician’s prescription, the number of prescribers per patient, patient’ age, male gender, and comorbidities increased expenditure. Our results show that for a specific medication the yearly cost of recently released drugs was 36 CHF higher than for similar and substitutable drugs introduced 15 years earlier, corresponding to one third of the average annual treatment cost observed in our dataset. Competition did not seem to be effective to reduce expenditure on the drug market.ConclusionThe main finding of this study is that recentness of drugs was associated with an increase in drug expenditure in 2006, even after adjustment for all non-controllable determinants. Further research is recommended to confirm those results with updated data.

Cost analysis comparison of rurioctocog alfa pegol compared to turoctocog alfa pegol in the prophylaxis of Haemophilia A in Italy

Background: Hemophilia-A is an X-linked genetic disorder arising from a mutation to the X chromosome and causing either a quantitative or qualitative deficiency in blood clotting factor-VIII (FVIII). Several recombinant extended half-life FVIII products (rFVIII-EHL) are in use in Italy for the treatment of hemophilia-A. Objective: To estimate the annual average cost of the prophylactic treatment of a patient with hemophilia-A in Italy with rurioctocog alfa pegol or turoctocog alfa pegol, with particular regard to potential dose adjustments as provided in the SPCs. Methods: The comparison between the two rFVIII-EHL, expressed in terms of average annual cost per patient treated, was conducted from the NHS perspective. The average annual consumption (IU/kg) of the two rFVIII-EHL was derived from the clinical trial of reference for in label prophylactic treatment. Adjustments of doses and administration intervals allowed in the SPCs were considered on the basis of the literature. The published ex-factory price considered for both rFVIII-EHL was € 0.72. A scenario analysis focused on possible dosing adjustments was conducted. Results: With regard to the average consumption associated with the posology in label, the average annual treatment cost is almost the same between the two rFVIII-EHL. Whereas taking into account the possible dose adjustments based on once-weekly administration, rurioctocog alfa pegol shows a considerably lower average annual treatment cost compared to turoctocog alfa pegol (– € 42,719). Conclusions: Rurioctocog alfa pegol would be the more sustainable option, based on the annual average cost, for the NHS in the prophylactic treatment of hemophilia-A.

PIN26 Lifetime cost estimation of human papillomavirus related diseases in China: a modelling study using real-world data

To estimate the lifetime costs of patients with HPV-related diseases in China. Real-world data were identified, screened and extracted under qualified procedure from hospital database (2012-2019). Markov models with six to eight health states were constructed to estimate lifetime costs of patients who developed into long-term diseases after infection, including cervical cancer (CC), vaginal cancer (VaC), vulvar cancer (VC), penile cancer (PC), anal cancer (AC), oral cavity cancer (OcC), oropharynx cancer (OrC) and larynx cancer (LC) . Transition probabilities were from published literatures. For short-term diseases like genital warts (GW) and recurrent respiratory papillomatosis (RRP), the average annual treatment costs were calculated. Nationwide costs were then extrapolated. Monte Carlo simulations and one-way sensitive analysis were conducted to control for uncertainties. We used 2021 as the baseline year, and 5% as the discounting rate. The lifetime cost per capita for localized, regional and distant CC are $24,845.1 (95%CI: 18,793.2∼30,897.0), $20,011.7 (95% CI:14,456.46∼25,567.0) and $18,205.7 (95%CI: 10,604.1∼25,807.3), respectively. For localized, regional and distant VaC, the lifetime cost are $19,278.9 (95%CI: 14,962.2∼23,595.6), $17,815.8 (95%CI: 13,214.7∼22,416.9) and $17,210.4 (95%CI: 12,172.3 ∼22,248.6), respectively. The base-case lifetime cost per capita for localized, regional and distant VC/PC/AC/OcC/OrC/LC are $22,405.0, $2,904.7, $19,995.2/$36,443.6, $33,718.0, $32,447.0/ $46,771.3, $42,195.5, $40,276.0/$25,576.0, $26,604.9, $27,005.8/$50,246.5, $49,730.5, $42,283.8/$59,597.1, $26,898.1, and $25,749.7, respectively. The base-case lifetime cost per capita for GW and RRP are $265.7 and $2,309.4, respectively. The lifetime costs are higher as compared with the non-lifetime costs used in Chinese economic evaluations of HPV vaccinations and have similar regularity with costs found in international studies. Our study is the first of its kind to use real-world data in estimating the HPV-related economic burden, and could provide references for future economic evaluations of HPV vaccination strategies.

Use of healthcare resources in a cohort of rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs or tofacitinib

Introduction/objectivesThe objective of this study is to describe the treatment patterns and use of healthcare resources in a cohort of Colombian patients with rheumatoid arthritis (RA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) or tofacitinib.MethodThis is a descriptive study from a retrospective cohort of patients diagnosed with RA who were treated with bDMARDs or tofacitinib after failure of conventional DMARDs (cDMARDs) or first bDMARD. Patients who were receiving pharmacological treatment between 01 January 2014 and 30 June 2018 were included. The analysis is through the revision of claim database and electronical medical records. Demographic and clinical data were collected. The costs of healthcare resources were estimated from the billing expense of healthcare service provider.ResultsWe evaluated 588 RA patients on treatment with bDMARDs (n = 505) or tofacitinib (n = 83), most of them were in combination with cDMARDs (85.4%). The 88.1% were females and mean age was 57.3 ± 12.5 years. The median evolution of RA since diagnosis was 9 years (IQR:4–17.2). The mean duration of use during follow-up of the bDMARDs or tofacitinib was similar, with a mean of 9.8 ± 1.9 months. It was identified that 394 (67.0%) discontinued therapy. The average annual direct cost of care per patient was USD 8997 ± 2172, where 97.2% was due to drug costs. The average annual cost of treatment per patient with bDMARDs was USD 8604 and tofacitinib was USD 6377.ConclusionsIn the face of a first failure of cDMARD, bDMARDs are frequently added. A high frequency of patients do not persist treatment during the first year of follow-up. The pharmacological treatment is the most representative cause of healthcare costs.Key Points• Rheumatoid arthritis is a disease with a high burden of comorbidities, complications, and worse health-related quality of life and is associated with elevated healthcare costs.• The biological disease-modifying antirheumatic drugs or tofacitinib medications are indicated for those with significant progression of the disease and when there is a need for alternatives to achieve low levels of activity and remission.• Patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs or tofacitinib represent a significant economic burden to the health system, especially in the costs derived from pharmacological treatment.

Treatment cost of HIV/AIDS in Turkey

PurposeThe purpose of this study is to estimate the average cost of treatment and investigate the related parameters of HIV/AIDS among patients based on their annual treatment regime during the 2017 in Izmir.Design/methodology/approachThe average annual direct cost of an HIV patient's treatment was estimated for 2017 at four university hospitals in a retrospective study in Izmir, Turkey. Inclusion criteria included confirmed HIV infection, age = 18 years, visited one of the hospitals at least three times a year and with at least one CD4+ T cell count. The average annual treatment cost per patient was calculated using accounting data for 527 patients from the hospitals' electronic databases.FindingsThe mean treatment cost per patient was US$4,381.93. Costs for treatment and care were statistically significantly higher (US$5,970.55) for patients with CD4+ T cell counts of fewer than 200 cells/mm3 than for other patients with CD4+ T cell counts above 200 cells/mm3. The mean treatment cost for patients who were 50 years old or older (US$4,904.24) was statistically significantly higher than for those younger than 50 years (US$4,216.10). The mean treatment cost for female patients (US$4,624.92) was higher than that of male patients ($US4,339.72), although the difference was not statistically significant. The main cost driver was antiretroviral treatment (US$3,852.38 per patient), accounting for almost 88% of all costs. However, the high burden of antiretroviral treatment cost is counterbalanced by relatively low care and hospitalization costs in Turkey.Originality/valueThe paper contributes to the literature by providing average annual treatment cost of an HIV-infected patient in Turkey by using a comprehensive bottom up approach. Moreover, cost drivers of HIV treatment are investigated.

The application of multi-criteria decision analysis to inform in resource allocation

Background: There is a perception held by payers that orphan products are expensive. As a result, the current health technology assessment systems might be too restrictive for orphan drugs, therefore potentially denying patients access to life-saving medicines. While price is important, it should be considered in relation to a broader range of disease-related product attributes that are not necessarily considered by many health technology assessment agencies. To overcome these challenges, multi-criteria decision analysis has been proposed as an alternative to evaluate technologies. Methods: A targeted literature review was conducted to identify the most frequently cited attributes in multi-criteria decision analysis (MCDA) in rare diseases. From the leading attributes identified, we developed a multi-criteria decision analysis framework with which to aggregate the orphan drug values. We subsequently reviewed and plotted the relationship between single attributes and the average annual treatment costs for 8 drugs used in the treatment of rare endocrine diseases. The annual treatment costs were based on UK list prices for the average daily dose per patient. Results: The five most frequently mentioned attributes in the literature were as follows: Disease severity, Unmet need (or availability of therapeutic alternatives), Comparative effectiveness or efficacy, Quality of evidence and Safety & tolerability. Results from the multi-criteria decision analysis framework indicate a wide range of average annual per-patients costs for drugs intended for the same diseases, and likewise for diseases with a similar level of Disease severity. Conclusions: Multi-criteria decision analysis may offer a viable alternative to support discussion in reimbursement decisions for orphan drugs. The analyses can be used to inform investigations on the application of MCDAs in rare diseases.

PMS46 USE OF HEALTHCARE RESOURCES IN A COHORT OF COLOMBIAN PATIENTS TREATED WITH BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS OR TOFACITINIB, 2014–2018

To compare the treatment patterns and use of healthcare resources in a cohort of Colombian patients with rheumatoid arthritis treated with biologic disease-modifying antirheumatic drugs (B-DMARDs) or tofacitinib. Descriptive study from a retrospective cohort of adult patients diagnosed with rheumatoid arthritis (RA) in a Colombian healthcare service provider (HSP) who are being treated with B-DMARDs or tofacitinib after failure conventional DMARDs (C-DMARDs) or first B-DMARD. Patients, aged ≥18 years, who were receiving pharmacological treatment for RA at HSP between 01 January 2014 and 30 June 2018 were included. Data were collected since patients index date defined as prescription of the drug of interest until 12 post-index date. Demographic, and clinical data were collected. The cost of healthcare resource were estimated from the billing expense of HSP. We evaluated 588 RA patients on treatment with B-DMARDs (505 patients) or tofacitinib (83 patients), most of them were in combination with C-DMARDs (85.4%). Female patients were more frequent (88.1%) and mean age of 57.3±12.5 years. The median evolution of the disease was 9 years (IQR: 4-17.2 years). The mean duration of use during follow up of the B-DMARDs or tofacitinib was similar with a mean of 9.8±1.9 months (292.7±61.3 days covered). It was identified that 394 (67.0%) discontinued therapy. The average annual direct cost for the care of RA per patient was USD 8,996.8±2,171.7 where 97.2% was due to drug costs. The average annual cost of treatment per patient with B-DMARDs was US$ 8,604 and tofacitinib was US$ 6,377. In the face of a first failure of C-DMARD, B-DMARD are frequently added, with a high rate of clinical improvement, but a high frequency of patients do not persist or stop treatment during the first year of follow-up. The pharmacological treatment is the most representative cause of healthcare resource in the management of RA.

<p>Medication Profile and Treatment Cost Estimation Among Outpatients with Schizophrenia, Bipolar Disorder, Depression, and Anxiety Disorders in Indonesia</p>

PurposeThe present retrospective study aimed to determine the medication profile and estimate the treatment costs from medical records of new outpatients with schizophrenia, bipolar disorder, depression, and anxiety disorders from a healthcare perspective at a national referral hospital in Indonesia from 2016 to 2018.MethodsMedical records (including medical and administrative data) of 357 new outpatients with schizophrenia, bipolar disorder, depression, or anxiety disorders were collected from the hospital information system. The records of new outpatients with schizophrenia, bipolar disorder, depression, or anxiety disorders aged >18 years and had only received drugs for treatment were included. The medication profile was descriptively assessed, and estimated costs were calculated based on direct costs from a healthcare perspective.ResultsOverall, 173 medical records were further analyzed. The main drugs administered to the new outpatients were atypical and typical antipsychotics for schizophrenia, atypical antipsychotics and mood stabilizers for bipolar disorder, antidepressants and atypical antipsychotics for depression, and antidepressants and benzodiazepines for anxiety disorders. The average annual treatment costs per patient were IDR 3,307,931 (USD 236) for schizophrenia, IDR 17,978,865 (USD 1,284) for bipolar disorder, IDR 1,601,850 (USD 114) for depression, and IDR 1,190,563 (USD 85) for anxiety disorders.ConclusionThe most commonly prescribed drugs for schizophrenia were haloperidol and risperidone; for bipolar disorders, sodium divalproex and risperidone; for depression, fluoxetine and sertraline; and for anxiety disorders, sertraline and lorazepam. Considering the high prevalence and estimated treatment costs for mental disorders, special attention is required to prevent an increase in their prevalence in Indonesia.

Determining Breast Cancer Treatment Costs Using the Top Down Cost Approach.

Breast cancer is the most common type of cancer among women in Turkey, with approximately 15.000 breast cancer diagnoses each year. In this study, our goal was to determine annual direct medical costs of all breast cancer patients in Turkey with top down cost approach. Data regarding patients who have been diagnosed with breast cancer and received health services from any hospital in Turkey in 2014 were used for the purpose of the study. Data were obtained from the MEDULA System for a total of 126.664 patient. Treatment of costs of patients were calculated based on types of patient admissions (inpatient/outpatient/intensive care) and costs of drugs and medical equipment. Indirect costs and out of pocket costs were not included. Total medical costs of 126,664 patients was calculated as $116.792.107,9, with an average treatment cost per patient of $922,1. Based on types of patient admission, intensive care treatment had the highest average cost with $2.916.5. In metastatic breast cancer patients, average annual treatment cost per patient is $2.326,6, which is 2.8 times higher compared to non-metastatic breast cancer patients. In order to ensure effective resource allocation at micro and macro level, healthcare administrators have to learn costs of diseases with high incidence such as breast cancer. Results obtained from studies on disease costs calculated using the top down cost approach provide data on actual health services use and therefore are seen as important tools for healthcare administrators in terms of effective resource allocation.

National practice patterns and direct medical costs for prostate cancer in Korea across a 10\u2009year period: a nationwide population-based study using a national health insurance database

BackgroundA complete enumeration study was conducted to evaluate trends in national practice patterns and direct medical costs for prostate cancer (PCa) in Korea over a 10-year retrospective period using data from the Korean National Health Insurance Service.MethodsReimbursement records for 874,924 patients diagnosed between 2002 and 2014 with primary PCa according to the International Classification of Disease (ICD) 10th revision code C61 were accessed. To assess direct medical costs for patients newly diagnosed after 2005, data from 68,596 patients managed between January 2005 and 31 December 2014 were evaluated.ResultsFrom 2005 to 2014, the total number of PCa patients showed a 2.6-fold increase. Surgery and androgen deprivation therapy were the most common first-line treatment, alone or within the context of combined therapy. Surgery as a monotherapy was performed in 23.5% of patients in 2005, and in 39.4% of patients in 2014. From 2008, the rate of robot-assisted RP rose sharply, showing a similar rate to open RP in 2014. Average total treatment costs in the 12 months post-diagnosis were around 10 million Korean won. Average annual treatment costs thereafter were around 5 million Korean won. Out-of-pocket expenditure was highest in the first year post-diagnosis, and ranged from 12 to 17% thereafter.ConclusionsBetween 2005 and 2014, a substantial change was observed in the national practice pattern for PCa in Korea. The present data provide a reliable overview of treatment patterns and medical costs for PCa in Korea.

Healthcare Resource Utilization and the Cost of Care for Mucopolysaccharidosis I Patients in Iran

BackgroundMucopolysaccharidosis I (MPS-I) is one of the most common types of MPS and lysosomal storage diseases, which impose considerable amount of economic burden on society. ObjectivesThe aim of this study was to examine the cost drivers in the treatment of MPS-I patients in Iran. MethodsThis is a cost-analysis study. The prevalence approach was used to evaluate costs from the healthcare payer's perspective. The number of patients found to have α-L-iduronidase deficiency was identified using the national registry database of the Ministry of Health (MOH). The direct medical costs of the patients were evaluated. Prescriptions; medical interventions; inpatient, outpatient, and diagnostic services, and also their costs were extracted from the patient's profiles in Iran Food and Drug Administration (IFDA). The prices of the medical services were taken out from Iranian medical tariff book 2014-15. Data extraction was performed from January 2017 to March 2018. ResultsSixty-six patients were registered as MPS-I in MOH databases. The average annual healthcare cost for every patient was $87 971.99, 96.9% of which was allocated to medication therapy. Therapeutic and diagnostic services costs (2.4% and 0.7% correspondingly) were ranked second and third, respectively, but with huge differences in medication cost. ConclusionsThe average annual cost of treatment for MPS-I patients is as high as 16.2 times the GDP per capita in Iran. The highest share of the cost belongs to medication. Selecting appropriate strategies for reducing the birth of a child with MPS could support allocative efficiency of the limited resources effectively.

PSY149 - IQVIA PATIENT DATA ASSESSMENT: REAL WORLD EVIDENCE IN THE MANAGEMENT OF MODERATE-TO-SEVERE PLAQUE PSORIASIS

Biologics changed treatment paradigm of many auto-immune diseases since their launch in early 2000s. These products were particularly relevant for Psoriasis, a chronic inflammatory skin disease with significant impact on patients’ quality of life. With several products entering this market, it is critical to understand current clinical practice and patient response in the real-world setting. This study aims at identifying Psoriasis patients followed by IQVIA patient data, analyzing treatment dynamics and estimate the average treatment duration and cost in 2016. IQVIA Portugal receives anonymized longitudinal patient data from 16 different hospitals - a record of every pharmaceutical product dispensed in hospitals since 2011. This panel covers approximately 40% of all treated patients. Auto-immune biologics (AIB) have several indications in dermatology, rheumatology and gastrointestinal-related diseases. As IQVIA Portugal patient data does not discriminate diagnosis, Psoriasis patients were selected by analyzing the relevant medical ward in which these products were dispensed. Patient data enabled the analysis of the entire treatment course, from naive to drop-out, monitoring switch and wash-out periods, assessing treatment length, compliance, real dosage, intake frequency and treatment costs. During 2016, IQVIA followed 895 Psoriasis treated patients. On a yearly basis, 14% of the followed patients were bio-naïve and only 5% changed their treatment to another biologic. Psoriasis patients seem to persist longer on 2nd treatment than on 1st, as median treatment durations were ∼12 months in 1st and ∼19 months in 2nd regimens. In 2016, the average annual treatment cost per patient was 11.591 ±1.012 euros. AIB re-shaped severe Psoriasis management and are now widely used, significant increasing treatment costs. Portuguese Healthcare system is struggling financially to provide high-quality care, being critical to fully understand treatment dynamics, patients’ response and treatment costs. This real-world information is an important tool to shape clinical practice and enable a better budget management.

A Generic Model for Follicular Lymphoma: Predicting Cost, Life Expectancy, and Quality-Adjusted-Life-Year Using UK Population–Based Observational Data

ObjectivesTo use real-world data to develop a flexible generic decision model to predict cost, life expectancy, and quality-adjusted life-years (QALYs) for follicular lymphoma (FL) in the general patient population. MethodsAll patients newly diagnosed with FL in the UK’s population-based Haematological Malignancy Research Network (www.hmrn.org) between 2004 and 2011 were followed until 2015 (N = 740). Treatment pathways, QALYs, and costs were incorporated into a discrete event simulation to reflect patient heterogeneity, including age and disease management. Two scenario analyses, based on the latest National Institute for Health and Clinical Excellence (NICE) guidelines (rituximab induction therapy for newly diagnosed asymptomatic patients and rituximab maintenance therapy for patients between treatments), were conducted and their economic impacts were compared to current practice. ResultsIncidence-based analysis revealed expected average lifetime costs ranging from £6,165 [US$7,709] to £63,864 [US$79,862] per patient, and average life expectancy from 75 days to 17.56 years. Prevalence-based analysis estimated average annual treatment costs of £60–65 million [US$75-80 million], accounting for approximately 10% of the United Kingdom’s annual National Health Service budget for hematological cancers as a whole. Assuming that treatment effects reported in trials are applicable to all patient groups, scenario analyses for two recent NICE guidelines demonstrated potential annual cost savings for the United Kingdom that ranged with uptake frequency from £0.6 million to £11 million [US$0.75-2.75 million]. ConclusionsCosts, survival, and QALYs associated with FL vary markedly with patient characteristics and disease management. Allowing the production of more realistic outcomes across the patient population as a whole, our model addresses this heterogeneity and is a useful tool with which to evaluate new technologies/treatments to support healthcare decision makers.

PD44-07 PEYRONIE'S DISEASE: THE IMPACT OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM ON DIAGNOSIS, TREATMENT, AND COST

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease I1 Apr 2018PD44-07 PEYRONIE'S DISEASE: THE IMPACT OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM ON DIAGNOSIS, TREATMENT, AND COST Andrew Sun, Shufeng Li, and Michael Eisenberg Andrew SunAndrew Sun More articles by this author , Shufeng LiShufeng Li More articles by this author , and Michael EisenbergMichael Eisenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease (PD) is characterized by fibrous penile plaque formation that interferes with sexual function and quality of life. Many treatments have been proposed, the most recent being collagenase clostridium histolyticum (CCH) injections (FDA approved in 2014). Currently only verapamil, CCH, and surgical approaches are recommended by AUA guidelines. Given mixed evidence for efficacy of verapamil, invasive nature of surgery, and novel mechanism of CCH, there is significant interest in CCH use. We sought to evaluate the impact of CCH on the prevalence, treatment, and cost of PD. METHODS Optum is a national database with information from adjudicated and paid insurance claims of privately-insured individuals, covering between 6 and 7 million males from 2004 to 2016. We extracted data on PD diagnosis (ICD-9 607.95 and ICD-10 N48.6) and treatments. Both individual years and eras before and after CCH use (2004-2013 vs 2015-2016) were analyzed for prevalence of PD, overall rate of PD treatment, rate of penile injections, rate of CCH use, rate of surgical PD procedures, and cost associated with treatment. Analyses were conducted using SAS (version 9.3). RESULTS The annual prevalence of PD rose from 0.03% in 2004 to 0.08% in 2011 and remained stable thereafter. Among men >50, the prevalence remained between 13-14% after 2011. However, annual rates of PD treatment increased from an average of 11.1% for 2004-2013 to a high of 14.8% in 2015. Corresponding to this, annual penile injection rates increased from an average of 5.5% from 2004-2013 to 9.5% for 2015-2016. By 2016, CCH was 74.9% of all penile injections. Average annual rates of penile plication (3.3% vs 3.4%), penile grafting (1.0% vs 0.51%), and penile prosthesis (12.1% vs 12.1%) among men with a PD diagnosis remained stable for the same eras. The average annual cost of PD treatment per man increased from $1824.16 in 2004 to $4010.92 in 2016 (inflation adjusted). This was most pronounced from 2013 to 2016 where an average increase of $361.41 per year was observed, versus $122.50 for the years prior. CONCLUSIONS The prevalence of PD stabilized in 2011 and did not increase after CCH became available in 2014. Over the same period, the proportion of men receiving treatment for PD increased, associated with more injections and CCH use. In addition, the cost of treating PD increased more rapidly after CCH became available. Further research into CCH use is needed to assess if the increase in treatment has improved outcomes of men with PD. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e883 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andrew Sun More articles by this author Shufeng Li More articles by this author Michael Eisenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...