Average Treatment Cost Research Articles

How Economic Analysis Increases the Awareness of Clinical Services: A Case of Diabetes Mellitus at a Teaching Hospital in Myanmar

ObjectivesMyanmar faces a growing epidemic of type 2 diabetes mellitus, which has significant impact on the individual health and health service system; nevertheless, reliable cost estimate for treating diabetes is still unknown. Therefore, this study aimed to explore the treatment cost of hospitalization by type 2 diabetes mellitus and the association of complications and comorbidities with the treatment cost. MethodsThe retrospective incidence-based cost of illness analysis was performed at the diabetes ward of 800-bed teaching hospital in Yangon, Myanmar. The data were retrieved from hospital financial reports and patient’s medical records for the fiscal year 2017 to 2018. Data was analyzed by using descriptive statistics and multivariate statistics. One-way sensitivity analysis was used to assess the uncertainty of input parameters. ResultsThis study involved 87 inpatients with type 2 diabetes mellitus with an average length of stay of 16.1 ± 12.6 days. Of the study sample, 67% had complications whereas 74% had comorbidities. The average treatment cost per admission was $718.7 (equal to 58% of gross domestic product - GDP per capita) at 2018 prices. Based on the multiple regression analysis, cost savings per admission were $276.5, $307.3, and $319.5 from preventing foot ulcer, nephropathy, and retinopathy, respectively. ConclusionsThis study found that the treatment of diabetes is costly because of its preventable health consequences. Better disease management to prevent complications results in considerable cost savings. This quantitative evidence would increase awareness in health service system.

Utilization and Cost Effectiveness of First-Line Yttrium-90 Ibritumomab Tiuxetan in Low-Grade Follicular and Marginal Zone Lymphomas Compared to Standard of Care Bendamustine Plus Rituximab: A Real-World Experience

BackgroundYttrium-90 ibritumomab tiuxetan [(90)Y-IT; Zevalin] is a radio-immunoconjugate (RIC) which targets CD20. This study evaluates the utilization and cost-effectiveness of (90)Y-IT in the first line treatment for patients with previously untreated low-grade FL (UFL) and marginal zone lymphoma (UMZL) treated at our institution with (90)Y-IT.MethodsWe utilized the Advanced Text Explorer (ATE) and the Lymphoma SPORE databases to identify two groups of patients with UFL, WHO grade 1-2, and UMZL who received treatment with either (90)Y-IT or bendamustine plus rituximab (BR) at Mayo Clinic Cancer Center between January 2003 and December 2019. We excluded all patients who had >25% bone marrow involvement with lymphoma for the BR group as this was a requirement for (90)Y-IT treatment. Inverse propensity weighting was utilized to balance the groups for baseline patients and disease characteristics. We use progression-free survival (PFS) as a denominator for the cost effectiveness/utilization evaluation. We identified meaningful and retrospectively measurable outcomes to compare between the groups. we extracted the following data; number of clinic visits in the first year after therapy, emergency room visits, number of hospital admissions, number of hospitalization days, numbers of days on the floor and ICU, number of infections, number of neutropenic fever hospitalizations, number of C-difficile events, number of blood products transfusions, overall use of growth factors due to therapy induced neutropenia, average number of times a growth factor was used, and the number of therapeutic use days. We defined days of therapeutic use as the number of days a treatment was administered on. We also calculated the average cost of the induction treatment when utilizing either (90)Y-IT or BR. The therapeutic cost included only the cost of the medications/therapies and their administration.ResultsOur cohort consists of a total of 143 patients - 64% (92/143) received BR and 36% (51/143) received (90)Y-IT (see Table-1 for clinical characteristics).The median follow-up from the time of therapeutic administration for the (90)Y-IT group was 5.3 years (95% CI; 4.2, 6.2) with one death and 4.7 years (95% CI; 3.9, 4.9) for the BR group with 6 deaths. The ORR was 100% in (90)Y-IT group with 94% achieving complete response (CR) while ORR in the BR group was 98% with 95% achieving CR. Rituximab maintenance was utilized in 33% of BR patients compared to only 6% in patients who received (90)Y-IT, p=0.002. After utilizing inverse propensity weighting (Figure-1), 5 years PFS was 76% for the (90)Y-IT group and 75% for the BR group, p=0.63 (Figure-2).We evaluated the average treatment effect of (90)Y-IT compared to BR on utilization outcomes, Table-2. (90)Y-IT required an average of 4.5 clinic visits less within the first year after treatment compared to BR group, p<0.001. (90)Y-IT patients had an average of 10 days less of therapeutic use days compared to the BR group, p<0.001. Patienta had similar admission rates to the hospital in both groups. However, when patients were admitted to the hospital in the first year after treatment, those who received (90)Y-IT spent an average of 1.5 days less in the hospital compared to the BR group, p=0.046. The overall use of growth factors was 40% less in the (90)Y-IT group as compared to the BR group, p<0.001. The therapeutic cost of induction of (90)Y-IT was 54% less than that of 6 cycles of BR.Transformation to a high grade of lymphoma was seen in 4 patients in the BR group and 2 patients in the (90)Y-IT group. There was only one case of myelodysplastic syndrome in the BR group and none in the (90)Y-IT group.ConclusionRadio-immunoconjugate therapy with (90)Y-IT is a very convenient and cost-effective treatment for low-grade UFL and UMZL. This is especially important amidst the COVID-19 pandemic as it requires less contact with the health system with decreased number of therapeutic days, clinic visits, use of growth factors and number of hospitalization days. The cost of the therapeutic agents and their administration was also significantly lower for the (90)Y-IT which could help reducing the burden on the health system. [Display omitted] DisclosuresCerhan: Regeneron Genetics Center: Other: Research Collaboration; Genentech: Research Funding; Celgene/BMS: Other: Connect Lymphoma Scientific Steering Committee, Research Funding; NanoString: Research Funding. Tun: Mundipharma, Celgene, BMS, Acrotech, TG therapeutics, Curis, DTRM: Research Funding; Gossamer Bio, Acrotech: Consultancy. OffLabel Disclosure:We are describing the use of Yttrium-90 ibritumomab tiuxetan in the first line setting in comparison to the bendamustine plus rituximab which is the standard of care

Guided therapy selection in rheumatoid arthritis using a molecular signature response classifier: an assessment of budget impact and clinical utility.

BACKGROUND: Patients with moderate to severe rheumatoid arthritis (RA) can be treated with a range of targeted therapies following inadequate response to conventional synthetic disease-modifying antirheumatic drugs such as methotrexate. Whereas clinical practice guidelines provide no formal recommendations for initial targeted therapies, the tumor necrosis factor alpha inhibitor (TNFi) class is the prevalent first-line selection based on clinician experience, its safety profile, and/or formulary requirements, while also being the costliest. Most patients do not achieve adequate clinical response with a first-line TNFi, however. A molecular signature response classifier (MSRC) test that assesses RA-related biomarkers can identify patients who are unlikely to achieve adequate response to TNFi-class therapies. OBJECTIVE: To model cost-effectiveness of MSRC-guided, first-line targeted therapy selection compared with current standard care. METHODS: This budget impact analysis used data sourced from August to September 2020. The prevalence of each first-line targeted therapy was obtained using market intelligence from Datamonitor/Informa PLC Rheumatology Dashboard Forecast 2020, and the average first-year cost of treatment for each class was calculated using wholesale acquisition costs from IBM Micromedex RED BOOK Online. Average effectiveness for each class was based on manufacturer-reported ACR50 response rates (American College of Rheumatology adequate response criteria of 50% improvement at 6 months after therapy initiation). The impact of MSRC testing on first therapy selection was predicted based on a third party-generated decision-impact study that analyzed potential alterations in rheumatologist prescribing patterns after receiving MSRC test reports. Sensitivity analysis evaluated potential impacts of variation in first-year medication cost, adherence to MSRC report, and test price on the first-year cost of treatment. Cost for response (first-year therapy cost therapy divided by probability of achieving ACR50) was compared between standard care and MSRC-guided care. RESULTS: The estimated cost for first-year, standard-care treatment was $65,117, with 80% of patients initiating treatment with a TNFi. Cost for achieving ACR50 response was $177,046. After applying MSRC-guided patient stratification and therapy selection, the first-year cost was $56,543, net of test price, with 49.0% of patients initiating with a TNFi. First-year MSRC-guided care cost, including test price, was estimated at $117,103, a 33.9% improvement over standard care. Sensitivity analysis showed a net cost improvement for guided care vs standard care across all scenarios. Patients predicted to be inadequate TNFi responders, when modeled with lower-priced alternatives, were predicted to show increased ACR50 response rates. Those with MSRC test results indicating a first-line TNFi were predicted to show an ACR50 response rate superior to that for any other class. In this model, if implemented clinically, MSRC-guided care might save the US health care system more than $850 million annually and improve ACR50 by up to 31.3%. CONCLUSIONS: Precision medicine using MSRC-guided patient stratification and therapy selection may both decrease cost and improve efficacy of targeted RA therapies. DISCLOSURES: This work was funded in full by Scipher Medicine Corporation, which participated in data analysis and interpretation and drafting, reviewing, and approving the publication. All authors contributed to data analysis and interpretation and publication preparation, maintaining control over the final content. Arnell, Withers, and Connolly-Strong are employees of and have stock ownership in Scipher Medicine Corporation. Bergman has received consulting fees from AbbVie, Gilead, GlaxoSmithKline, Novartis, Pfizer, Regeneron, Sanofi, and Scipher Medicine and owns stock or stock options in Johnson & Johnson. Kenney, Logan, and Lim-Harashima are consultants for Scipher Medicine Corporation. Basu has nothing to disclose.

The cost of clinical management of SARS-COV-2 (COVID-19) infection by level of disease severity in Ghana: a protocol-based cost of illness analysis

BackgroundAs the global strategies to fight the SARS-COV-2 infection (COVID-19) evolved, response strategies impacted the magnitude and distribution of health-related expenditures. Although the economic consequence of the COVID-19 pandemic has been dire, and its true scale is yet to be ascertained, one key component of the response is the management of infected persons which its cost has not been adequately examined, especially in Africa.MethodsTo fill gaps in context-specific cost of treating COVID-19 patients, we adopted a health system’s perspective and a bottom-up, point of care resource use data collection approach to estimate the cost of clinical management of COVID-19 infection in Ghana. The analysis was based on the national protocol for management of COVID-19 patients at the time, whether in public or private settings. No patients were enrolled into the study as it was entirely a protocol-based cost of illness analysis.ResultWe found that resource use and average cost of treatment per COVID-19 case varied significantly by disease severity level and treatment setting. The average cost of treating COVID-19 patient in Ghana was estimated to be US$11,925 (GH¢68,929) from the perspective of the health system; ranging from US$282 (GH¢1629) for patients with mild/asymptomatic disease condition managed at home to about US$23,382 (GH¢135,149) for critically ill patients requiring sophisticated and specialised care in hospitals. The cost of treatment increased by some 20 folds once a patient moved from home management to the treatment centre. Overheard costs accounted for 63–71% of institutionalised care compared to only 6% for home-based care. The main cost drivers in overhead category in the institutionalised care were personal protective equipment (PPEs) and transportation, whilst investigations (COVID-19 testing) and staff time for follow-up were the main cost drivers for home-based care.ConclusionCost savings could be made by early detection and effective treatment of COVID-19 cases, preferably at home, before any chance of deterioration to the next worst form of the disease state, thereby freeing up more resources for other aspects of the fight against the pandemic. Policy makers in Ghana should thus make it a top priority to intensify the early detection and case management of COVID-19 infections.

Возможности оптимизации финансового обеспечения страховой стоматологической помощи льготному контингенту населения южного региона Кыргызстана

The results of studying of the Pregnant Women Oral cavity condition Indicators in the Southern region of the Kyrgyzstan and determining the Average cost of dental treatment are presented. On 100% prevalence of dental caries, DMFT Index — 2.2, the most frequently and intensively affected were women 20–29 years old (84%). The incidence of caries and its complications in the first molars was 55%. The average cost of treating one patient was 309.2 soms. The data can be used for planning payments for pregnant women, as a preferential contingent in Compulsory health insurance.

The Annual costs of treating genital warts in the Public Healthcare Sector in Peru

ObjectivesTo estimate the cost of six different techniques used to treat Genital Warts and the annual average cost of treating a typical GW patient in Peru. To estimate the annual economic burden diagnosing and treating GW in the Peruvian public healthcare system.MethodsWe developed a prevalence-based, cost-of-illness study from the provider’s perspective, the healthcare facilities under the purview of Peruvian Ministry of Health. We used an activity-based costing approach. We conducted primary data collection in three regions in Peru and supplemented it with governmental data. Uncertainty of the costing estimates was assessed via Monte Carlo simulations. We estimated the average cost and associated confidence intervals for six treatment options – three topical and three surgical – and the overall cost per patient.ResultsThe average treatment cost per patient was 59.9USD (95 %CI 45.5, 77.6). Given a population of 18.4 million adults between 18 and 60 years of age and a GW prevalence of 2.28 %, the annual cost of treating GW was 25.1 million USD (uncertainty interval 16.9, 36.6).ConclusionsThis study provides the first quantification of the economic burden of treating genital warts in Peru and one of the few in Latin America. The costing data did not include other healthcare providers or out-of-pocket expenditures, and hence we present a conservative estimate of the COI of GW in Peru. Our findings bring attention to the financial burden of treating GW, a vaccine-preventable disease.

COST EVALUATION OF STROKE THERAPY COMPARED TO INA-CBGs ON INPATIENTS AT ANUTAPURA HOSPITAL

ABSTRACTStroke is the third cause of death in the world after heart disease, cancer, and disability including disability categorized based on its severity: mild (I), moderate (II), and severe (III) severity. This study aims to determine the difference total cost of ischemic and hemorrhagic stroke therapy, each, with INA-CBGs rates. The method of data collection was conducted retrospectively taken from medical record data, and on patient medical expenses. The subject were ischemic and hemorrhagic stroke patients hospitalized from 2016-2017 at Anutapura Hospital who met the inclusion and exclusion criteria. There were 134 patients who met the inclusion criteria, 68% were ischemic stroke patients and 32% were hemorrhagic stroke patients. The result of research showed that there were significant differences in costs (p &lt;0.05) between hospital real costs and INA-CBGs rates. The average total real cost of treatment for ischemic stroke therapy was IDR 7,360,196.70 and the cost of the INA-CBGs was IDR 7,427,251.65 for 91 inpatients; and the average total cost of patients with hemorrhagic stroke therapy took IDR 10,606,834.34 with average of INA CBG’s rate at IDR 4,399,393.02 for 43 inpatients. The conclusion is both of stroke therapy proved significant difference compared to BPJS claimed amount of money.Keywords: pharmacoeconomic, cost analysis, ischemic stroke, haemorrhage stroke, INA-CBG’s rate.

COVID-19: economic aspects of influenza vaccine prevention

Relevance. A viral pandemic caused by the SARS-CoV-2 coronavirus has led to the development of a new coronavirus disease-2019 (COVID-19). The COVID-19 pandemic has forced the mobilization of all available health system resources. There are separate publications on reducing the risk of developing coronavirus infection in people vaccinated against influenza. Objective: to study the cost-effectiveness of influenza vaccination in the conditions of the» first « wave of COVID-19. Materials and methods. The archival data of 2,452 people from among the sick employees of JSC «Russian Railways» were analyzed. The control group consisted of 2,911 employees who were not infected with COVID-19, comparable by gender, age and territory of residence. Scores on the Charlson comorbidity scale were calculated for all individuals. The pharmacoeconomical cost of the patient’s treatment was predicted using the Markov model. Results. Having a flu shot reduced the likelihood of getting COVID-19 by 1.3 times. In the presence of a diagnosis of coronavirus infection, inpatient treatment for influenza vaccinated patients was required 2 times less often than for unvaccinated patients. Compared to the situation of the absence of vaccinated persons, in the «first wave», the estimated cost savings for the treatment of patients with coronavirus infection amounted to 124 million rubles. When the number of points on the comorbidity scale increased from 1 to 8, the average cost of treatment of patients without previous influenza vaccination increased by 2 times, and in the presence of vaccination, the average cost of treatment increased by 1.7 times. Conclusion. Thus, this study shows that influenza vaccination is cost-effective against COVID-19. The effect is achieved by reducing the likelihood of getting a coronavirus infection in the presence of a flu shot.

Treatments costs associated with inpatient clinical deterioration

AimsThis study aimed to quantify the health economic treatment costs of clinical deterioration of patients within 72 h of admission via the emergency department. MethodsThis study was conducted between March 2018 and February 2019 in two hospitals in regional New South Wales, Australia. All patients admitted via the emergency department were screened for clinical deterioration (defined as initiation of a medical emergency team call, cardiac arrest or unplanned admission to Intensive Care Unit) within 72 h through the site clinical deterioration databases. Patient characteristics, including pre-existing conditions, diagnosis and administrative data were collected. Results1600 patients clinically deteriorated within 72 h of hospital admission. Linked treatment cost data were available for 929 (58%) of these patients across 352 Australian Refined Diagnosis Related Groups. The average (standard deviation) treatment costs for patients who deteriorated within 72 h was $26,778 ($34,007) compared to $7727 ($12,547). The average hospital length of stay of the deterioration group was nearly 8 days longer than patients without deterioration. When controlling for length of stay and Australian Refined Diagnosis Related Group codes, the incremental cost per episode of deterioration was $14,134. ConclusionClinical deterioration within 72 h of admission is associated with increased treatment costs irrespective of diagnosis, hospital length of stay and age. Implementation of interventions known to prevent patient deterioration require evaluation.

Costs comparison of treating diabetic macular edema with aflibercept, ranibizumab or dexamethasone at 1 year in France (INVICOST study).

Purpose:INVICOST, a medico-economic analysis, compared costs of managing treatment-naive patients with diabetic macular edema (DME) receiving intravitreal injections (IVIs) of aflibercept (AFL), dexamethasone implant (DXI) or ranibizumab (RAN) over 1 year.Methods:Healthcare resource use and associated costs were estimated using individual patient data from INVICTUS, a prospective, open-label, monocentric study. Healthcare costs comprised direct medical costs such as drug acquisition and administration, consultations and ophthalmological procedures. Costs were assessed from the French National Health Insurance perspective using published national tariffs expressed in 2019 euros.Results:Of the 60 treated eyes, 48 had no treatment switch; 14 received AFL, 19 received DXI and 15 received RAN. AFL-treated eyes received an average of 6.5 IVIs, DXI-treated patients received 2 IVIs and RAN-treated received 6.8 IVIs. All treated eyes received an initial prescription for adjunctive ocular medications and 349 follow-up procedures were performed including an average of 3.9 optical coherence tomography and 3.2 retinography procedures per eye. Average total direct cost of per-eye treatment was €4516 (€1128–€8257). Average cost was €5782 for eyes treated with AFL, €2779 with DXI and €5536 with RAN. Drug therapy was the cost driver: €4394 (76%) for AFL, €1915 for DXI (69%) and €4268 (77%) for RAN.Conclusion:The difference in total treatment cost is largely explained by the significantly lower frequency of IVI and annual cost of therapy with DXI, compared with AFL and RAN. INVICOST is the first study comparing treatment costs with AFL, DXI and RAN in France in current clinical practice.

Applicability of protocols from high-income countries in a resource limited setting; real world data of histopathology, clinical features and long-term outcome of Hodgkin Lymphoma in Sri Lanka.

Background:: There is a significant disparity in global cancer care and out-come between countries. We aimed to provide data on characteristics, average cost of treatment and survival estimates in patients with Hodgkin Lymphoma in Sri Lanka.Methods: All patients diagnosed with Hodgkin Lymphoma between 01.05.2013 and 01.10.2020 were included in the analysis.Findings: Classical Hodgkin Lymphoma(cHL) diagnosed in 85%; 68% presented with B symptoms and 61% had advanced stage of disease. Treatment was discontinued by 23% either before or just after starting treatment of whom 72% percent were females. The complete response (CR) rate of patients who continued treatment was 86% while the estimated five-year survival rate is 92%. Seventeen percent of these patients died but only two percent due to Hodgkin Lymphoma or associated treatment in the group which continued treatment compared to 45% in the group who defaulted treatment (p-value 0.0002). Five-year survival rate of patients who defaulted treatment was 50% while patients who continued treatment have an estimated five-year survival rate of 90%. Average cost of first line treatment was between US$ 2280 and US$ 7642. First treatment failure may incur substantially higher health care costs.Interpretation: This is the only well characterized study on long-term survival of patients with Hodgkin Lymphoma in Sri Lanka. We have shown that it is possible to successfully apply western treatment and supportive care protocols to the local population. This published data will help to bench mark and improve the treatment and develop blood cancer care in the local setting.

Integration of food waste composting and vegetable gardens in a university campus

Local composting (household, community and small scale applications) is considered a sustainable option for bio-waste recovery and is receiving increasing demand from society. Higher education institutions are no exception, but detailed and comprehensive long-term studies on composting programs on university campuses are lacking. The local composting program of the University of A Coruña (UDC) offers a decentralized service for the treatment of food waste from 11 university canteens using static and dynamic composters located in 9 different composting areas. Considering the three pillars of sustainability, this work describes the characteristics of the different composting technologies used and their investment and operational costs, the routine monitoring process and product quality, the integration of the composting systems as living labs for biotechnology and environmental engineering courses, and the use of compost in the university vegetable gardens. The agents involved in the project are the canteen staff, the university gardening company, external composting operators, university researchers and teachers, sustainability scholarship students and volunteer people. Organic waste is usually delivered directly by canteen staff to composters. The gardening service provides green waste from UDC campus (crushed pruning) that is used as bulking material. The monitoring and maintenance of the composting areas is currently in charge of external staff provided by a local NGO dedicated to cooperation and job reintegration of the unemployed. The service also allows the incorporation of volunteers and scholarship students as operators and process monitoring supervisors. The main result of this project was the prevention of a large amount of waste that did not require collection and transportation, or disposal or incineration. This is being done in an economically sustainable way, as decentralized composting costs have been lower than the average costs of municipal solid waste treatment in the region. The lower investment costs of static composters largely offset the higher labour costs and result in lower overall costs than those of the dynamic composter. The dissemination of composting practice to society was another important outcome of the project.

Real World Management of Multiple Myeloma in Asia: Treatment Pattern and Cost

Introduction:Multiple myeloma (MM) is the second most common hematologic malignancies in the world. New approved therapeutic agents have improved the survival rates of myeloma patients. However, it is often unclear what is the best treatment in different settings, and the treatment cost is rising. In this study, we assess the way MM is treated in a developed country in Asia.Methods:A retrospective study of newly diagnosed MM patients from June 2009 to April 2017 from Singapore was conducted. The analysis focused on the age of patient, medication regimes used for different lines of treatment, whether autologous stem cell transplant (SCT) was received and the estimated cost of treatment. Treatment free period (TFP) was measured as time from the end date of previous treatment to the start date for the next treatment. The time to next treatment (TTNT) was measured from the start date of the first treatment to the start date of the next line of treatment.Results:A total of 143 patients were included in the analysis. Among the 96 (67.1%) patients under 65 years old, only 73 (76%) received autologous SCT treatment. Overall, 56 (39.2%) of the patients progressed and received second (2nd) line treatment, while 21 (14.7%) and 9 (6.3%) received 3rd and 4th line treatment respectively. The most frequently used drugs for 1st line treatment were Bortezomib (75.5%), Dexamethasone (87.4%), Thalidomide (63.6%) and Cyclophosphamide (53.8%). This reflects that the 2 most commonly used regimens for 1st line treatment are VCD and VTD. For 2nd line treatment, Lenalidomide (50%) and Dexamethasone (94.6%) were the main drugs used, reflecting that RD was the predominant regimen used in this phase. For 3rd line treatment, Dexamethasone (100%), Pomalidomide (38.1%), Cyclophosphamide (33.3%) and Lenalidomide (33.3 %) were the main drugs used.Focusing on individual drugs, while Lenalidomide was only used 7.7% of the time for 1st line treatment, usage increased to 50% and 33.3% for 2nd and 3rd line treatment respectively. For Pomalidomide, while usage was low at 0% and 7.1% for 1st and 2nd line treatment respectively, it increased to 38.1% for 3rd line treatment. Bortezomib, Thalidomide and Cyclophosphamide were predominantly used as 1st line treatment choices, with usage rates of 75.5%, 63.6% and 53.8% respectively. Their usage rates were significantly reduced in 2nd and 3rd line treatment.The average treatment cost per TFP (weeks) among 56 patients who progressed to 2nd line treatment was $673.81/week. The average cost increased to $2,239/week and $11,556.56/week for the patients who received 3rd and 4th line treatment respectively. For SCT patients (30 patients progressed to 2nd line, 7 patients to 3rd line, and 4 patients to 4th line), the average cost per TFP was $705.87/week, $2,078.66/week and $35,854.20/week for 2nd, 3rd and 4th line of treatment respectively. For non-SCT patients (26 patients progressed to 2nd line, 14 patients to 3rd line, and 5 patients to 4th line), the average cost per TFP was $603.64/week, $2,333.25/week and $5,959.72/week for 2nd, 3rd and 4th line of treatment respectively.The average TTNT per patient for 1st, 2nd and 3rd treatment line progression was 128.8, 58.7 and 75.5 weeks respectively. The average TTNT per SCT patient was 142.4, 65.6 and 74.9 weeks for 1st, 2nd and 3rd treatment line progression respectively, as compared to 113.1, 55.2 and 75.9 weeks for non-SCT patients. Overall, the average treatment cost per week of TTNT was $409.18, $798.10 and $2,167.92 for 1st, 2nd and 3rd treatment line progression respectively - the average cost for SCT patients was $496.91, $736.23 and $2,855.34, while the average cost for non-SCT patients was $281.81, $834.81 and $1,625.58 respectively.Conclusions:Treatment for multiple myeloma remains expensive. While the benefits of subsequent lines of treatment decreases, the average treatment cost increases. With the increasing availability of expensive but yet more effective treatments, these could be incorporated early into the treatment regimen to maximise therapeutic benefit. Despite the higher cost of these drugs, cost-effectiveness could be improved, or at least remain similar if TTNT can be greatly prolonged. [Display omitted] DisclosuresChng:Janssen China R&D: Research Funding.

Resource Utilization Using Micro-Costing Method and Cost Effectiveness Analysis of Treatment of Acute Promyelocytic Leukemia with Generic Arsenic-Trioxide

We have previously reported on the challenges of treating AML in India, the major challenge being the cost of treatment (Chepsy et al. BJH 2015). With conventional treatment of AML it is recognized that the major part of this cost is not related to the cost of the individual chemotherapeutic drugs, but rather from the high cost of supportive care to take patients through repeated cycles of prolonged neutropenia induced by conventional chemotherapy. In contrast with arsenic trioxide (ATO) based regimens in acute promyelocytic leukemia (APL), when expensive patented ‘innovator’ ATO was used, the reported 3 year direct pharmacy cost of drugs was higher with an ATO+ATRA regime compared with a conventional ATRA+chemotherapy regimen (Euro 46,700 Vs 6,700), though the cost of supportive care was a third of conventional therapy (Kruse M et al. PLoS One. 2015). There is limited data on the cost effectiveness of using generic ATO, as available in India, in the treatment of APL (10 mg vial costs US $7 in India versus US $ 676 in North America)In a single center, retrospective study, 30 newly diagnosed APL (ND-APL) patients, treated with ATO and 16 relapsed APL (R-APL) patients, treated on a phase II trial with a ATO based regimen followed by an autologous stem cell transplant (regimens as previously reported by us; Mathews et al. Blood 2012 and Mathews et al. Blood 2016 abstract) were evaluated. In the absence of patients being treated at our center with a conventional ATRA+chemotherapy regimen (APL-CT) the cost of treatment for APL with such a regimen was assumed to be similar to the cost that would be incurred to treat a non-M3 AML patient at our center with a conventional AML chemotherapy schedule. Incremental cost effectiveness ratio was calculated using weighted costs with weighing factor obtained from survival data for 60 patients from our database for APL ATO group and from the AIDA 2000 trial for APL-CT group.A three phase micro-costing method (figure 1) used four cost centers involved in providing patient care: (i) chemotherapy administration (ii) supportive care (iii) treatment of complications (iv) laboratory services. For each of these cost centers there were four cost drivers: (i) drugs / reagents (ii) personnel (iii) ward (iv) instruments / overheads. The actual cost of cost drivers was found out by micro-costing and summed up to obtain the unit cost of each cost center (m). Each time a patient used a cost center this unit cost would be incurred. Next, the frequency of utilization (n) of each cost center was found out from the patient database and multiplied by the unit cost of the cost center to obtain the total cost of treatment in each protocol (m x n) (For illustration and international comparison all cost were converted to US$).In ND-APL patients, the mean cost of induction and consolidation was $5078.5±1581 and $902±212 respectively while in APL-CT it was $9812.1±3239 and $11803.1±4872 respectively (exchange rate 1 US$=61.87 Indian rupees). Our data illustrated that APL-CT group incurred higher costs mainly due to the greater duration of in-patient care that was required in this group and since they had higher rate of infectious complications (Table 1). During maintenance phase, in ND-APL, there were no in-patient stays and the entire chemotherapy was given on outpatient basis and the average cost was $2074±146 and the cost of following up these patients for an additional three years was $704.6±289. The mean lifetime cost of treatment of ND-APL using ATO was $8759.2±2078 while using APL-CT was $24393±5528. In R-APL patients, the total cost of re-induction and consolidation was $3498±1220 and $2274±372 respectively. The mean cost of an autologous-SCT was $4318±159. The average lifetime cost of treatment of relapsed APL patients using ATO based regimen followed by an autologous SCT was $12269.7±4915. The weighted cost per living for ATO and CT was estimated to be $12426 and $28330 respectively. The incremental cost effectiveness ratio showed ATO to be cheaper by $13359 for each life saved compared to conventional chemotherapy.ATO based regimen in ND-APL and R-APL are associated with significant reduction in resource utilization and costs of treatment and is also cost-effective as compared to conventional ATRA+chemotherapy. With the world still debating the best treatment for APL, generic ATO based regimen offers a significant opportunity for resource constrained countries to treat all patients with a diagnosis of APL. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus-Cost effectiveness of outpatient treatment.

IntroductionSkin and soft tissue infections (SSTI) caused by Panton-Valentine leukocidin (PVL)-producing strains of Staphylococcus aureus (PVL-SA) are associated with recurrent skin abscesses. Secondary prevention, in conjunction with primary treatment of the infection, focuses on topical decolonization. Topical decolonization is a standard procedure in cases of recurrent PVL-SA skin infections and is recommended in international guidelines. However, this outpatient treatment is often not fully reimbursed by health insurance providers, which may interfere with successful PVL-SA decolonization.AimOur goal was to estimate the cost effectiveness of outpatient decolonization of patients with recurrent PVL-SA skin infections. We calculated the average cost of treatment for PVL-SA per outpatient decolonization procedure as well as per in-hospital stay.MethodsThe study was conducted between 2014 and 2018 at a German tertiary care university hospital. The cohort analyzed was obtained from the hospital’s microbiology laboratory database. Data on medical costs, DRG-based diagnoses, and ICD-10 patient data was obtained from the hospital’s financial controlling department. We calculated the average cost of treatment for patients admitted for treatment of PVL-SA induced skin infections. The cost of outpatient treatment is based on the German regulations of drug prices for prescription drugs.ResultsWe analyzed a total of n = 466 swabs from n = 411 patients with recurrent skin infections suspected of carrying PVL-SA. PVL-SA was detected in 61.3% of all patients included in the study. Of those isolates, 80.6% were methicillin-susceptible, 19.4% methicillin-resistant. 89.8% of all patients were treated as outpatients. In 73.0% of inpatients colonized with PVL-SA the main diagnosis was SSTI. The median length of stay was 5.5 days for inpatients colonized with PVL-SA whose main diagnosis SSTI; the average cost was €2,283. The estimated costs per decolonization procedure in outpatients ranged from €50-€110, depending on the products used.ConclusionOur data shows that outpatient decolonization offers a highly cost-effective secondary prevention strategy, which may prevent costly inpatient treatments. Therefore, health insurance companies should consider providing coverage of outpatient treatment of recurrent PVL-SA skin and soft tissue infections.

Cost analysis of critical patient care at a pediatric intensive care unit of a tertiary care public hospital in an urban metropolis of India

Background: The cost of critical care is widely recognized as being high. However, it remains a challenge to accurately assess the cost of intensive care due to a lack of standardized methodology. There is also considerable heterogeneity with regard to allocation of resources and distribution of critical care services.Methods: We conducted a prospective study to analyse diagnosis-based costs of paediatric patient care at a pediatric intensive care unit (PICU) in a public hospital in Mumbai on the basis of identified cost components; direct (fixed and variable) and indirect costs.Results: Out of 167 (102 boys, 61%) patients enrolled, 65 (39%) were aged 1-7 months. They spent an average of 4±1.46 bed days in the PICU. The cost of direct fixed components (salaries, capital equipment, disposables) was Rs. 64,48,200 for six months. The maximum cost of direct variable components spent by the hospital (physiotherapy intervention, expert opinion, investigations, medicines, blood products, piped gases) amounted to Rs. 548.63/patient/day for treatment of non-infectious diseases. Cost of indirect components (building maintenance) was Rs. 12,500/six months. Linear regression analysis showed 83-99.99% dependency of treatment cost to diagnosis and bed days. The average cost of treatment of infectious and non-infectious diagnoses/patient/day spent by the hospital was Rs. 260 and Rs. 548.63 respectively as compared to Rs. 169.96 and Rs. 356.21 spent by the patients.Conclusions: Our study showed that majority of the treatment costs depended on the diagnosis and number of bed days of the patients. Also being a tertiary care public hospital, 60% of the treatment costs were borne by the hospital. Thus, our study attempts to quantify, in financial terms, the expenditure involved in running a paediatric ICU in a tertiary care public hospital so as to assist doctors and healthcare decision makers in the allocation of resources.

Impact of Antimicrobial Stewardship Program on Vancomycin Usage: Costs and Outcomes at Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam.

BackgroundNowadays, with the emergence of vancomycin-resistant strains, the clinical use of vancomycin has been followed closely by applying the antimicrobial stewardship program (ASP) to enhance effectiveness in treatment and reduce cost burden for patients.MethodsA descriptive cross-sectional study at the Hospital for Tropical Diseases was conducted to assess the inpatient status assigned to intravenous vancomycin and factors associated with the cost of treatment during two periods of implementing ASP, which were i) from April 1, 2016 to March 31, 2018 (previous ASP-pASP) and ii) from June 1, 2018 to March 31, 2020 (new ASP-nASP).ResultsAmong 1375 patients who met the sampling criteria, there were 601 and 774 patients in pASP and nASP, respectively. The rate of no improvement/mortality in the pASP was higher than that in nASP (37.10% vs 25.98%, p <0.05). The proportion of patients with two or more infection episodes in nASP is lower than that in pASP (9.83% vs 18.64%, p<0.05). Besides, nASP has higher length of therapy (LOT) and higher day of therapy (DOT). The average treatment cost in the pASP is higher than that in the nASP, 1891.22 (95% CI, 1713.46–2068.98) USD vs 1775.55 (95% CI, 1576.22–1974.88) USD. There are seven factors (p<0.05) that associate with the total cost of treatment (age, number of infection episodes, length of stay, discharge status, clinical department, LOT, DOT) in pASP. On the other hand, the nASP has five factors (p<0.001), in which the log(LOT) and age are not as statistically significant (p=0.5127 and 0.3852, respectively) as in the pASP model.ConclusionThe implementation and improvement of the ASP at the Hospital for Tropical Diseases have initially shown benefits for patients using intravenous vancomycin. Specifically, the ASP helps to reduce treatment costs, improve patient outcomes, reduce length of stay and decrease the average daily dose of vancomycin.

Willingness-to-Pay and Benefit–Cost Analysis of Botulinum Toxin for the Treatment of Rosacea in China: Findings from a Web-Based Survey

PurposeBotulinum toxin (BTX) is a new treatment approach primarily aimed at relieving flushing and erythema for rosacea, but it is expensive and lacks economic benefit evaluation studies.This study aimed to investigate willingness-to-pay (WTP) of BTX treatment and conduct benefit–cost analysis (BCA) to assess if BTX treatment for rosacea is recommendable from a viewpoint of economics in China.MethodsWTP of BTX treatment in rosacea and information of sociodemographic and clinical characteristics were inquired via an online questionnaire among the Chinese rosacea patients. The WTP was inquired by photos of three cases with different severities of rosacea before and after BTX treatment. The benefit–cost ratio (BCR) was calculated by dividing WTP by cost. Factors associated with WTP were identified using logistic regression models.ResultsThe average costs of BTX treatment were USD410.09. The mean WTP for Case 1, Case 2, and Case 3 was USD295.53, 307.91, and 311.78, respectively (p<0.05 for Case 1 vs Case 3). 44.31% to 47.52% of Chinese rosacea patients were willing to pay for the BTX treatment. The BCRs were 0.72, 0.75, and 0.76 for Case 1, Case 2, and Case 3, respectively. A positive correlation between WTP and visiting frequency in the past year (OR=1.181–1.200, p=0.015–0.032, for Cases 1 and 2) or Dermatology Life Quality Index (DLQI) score (OR=2.022–2.266, all p<0.01) was observed, but duration (OR=0.521–0.564, p<0.05, for Cases 1 and 2) of rosacea was negatively correlated with WTP.ConclusionFor rosacea patients with poor quality of life, and those with high visiting frequency, BTX should be regarded as a recommendable new treatment in China.

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.

MO1055JUDICIOUS DIALYSIS DISCONTINUATION IN CHRONIC KIDNEY DISEASE: LENDING MORE TIME TO ECONOMICALLY BURDENED PATIENTS IN DEVELOPING COUNTRY

Abstract Background and Aims Chronic kidney disease (CKD) is important public health problem owing to its high prevalence, morbidity, mortality and socio-economic burden. Patients with end stage kidney disease need to be on kidney replacement therapy which significantly impacts livelihood. Annual average cost of treatment for patients on dialysis is reported to be USD 3151 in developing country like India. It’s quiet high given per capita income of USD 1670 Method One hundred fifty one CKD Stage 5D patients from Punjab and Rajasthan states, North India were studied in this cross-sectional study. Patients initiated on dialysis within 3 months or protein energy wasting (as per criteria proposed by ISRNM) were excluded. Asymptomatic willing patients, clinically stable for at least 3 months and with pre-dialysis serum Creatinine &amp;lt;6mg/dl, serum potassium &amp;lt;5mg/dl were given a trial for dialysis discontinuation after informed written consent. Biochemical and hemodynamic parameters were measured weekly for 4 weeks and later once monthly. Patients who developed uremic features or rapid rise in serum creatinine were restarted on dialysis. Results Fourteen (9.27%) asymptomatic patients with well controlled blood pressure were discontinued from dialysis. Out of them, thirteen patients were on hemodialysis and one on peritoneal dialysis. Twelve (85.71%) out of them were presumed chronic interstitial nephritis while two (14.28%) were autosomal dominant polycystic kidney disease. Mean age of patients was 52.5 years (SD ±18.14 years). Most patients (11/14) were on three or more anti-hypertensive. Mean dialysis vintage was 8.14 months (range 4-16 months). Most patients were non-compliant to dialysis (Mean frequency once in seven days). Two patients were on once in two week dialysis schedule. Mean 24 hour urine output (calculated over 1 week) was 1500ml. Mean baseline serum creatinine was 4.4 mg/dl (SD ±1.06 mg/dl). Mean pre-dialysis serum potassium was 4.5 mg/dl (SD ±0.42 mg/dl). Post-discontinuation serum creatinine levels has been outlined in figure 1. Mean distance of dialysis centre from residence was 83.43 Km (range 1-240 km). One patient need to be restarted on dialysis at fourth week of dialysis discontinuation. Rest patients remained symptom-free and tolerated well. Conclusion CKD Stage5D patients should be regularly screened for residual renal function. Recovery of renal function could be seen in some (&amp;lt;10%) cases. Dialysis discontinuation in these cases would decrease their financial and stress burden. However, these cases should be monitored closely and followed-up regularly