Cost-effective Price Research Articles

A Regional Scale Hydrostratigraphy Generated from Geophysical Data of Varying Age, Type, and Quality

In the present study, we show how persistent management and collection of hydrological and geophysical data at a national scale can be combined with innovative analysis methods to generate decision support tools for groundwater and surface water managers. This is exemplified by setting up a regional scale groundwater model in an area with geophysical data of varying age, type, and quality. The structure for the regional model is derived from a newly developed resistivity clay-fraction cluster analysis. This modelling strategy can be used in combination with local detailed geological modelling thus utilizing the detailed expertise locally, while securing a cost-effective (price vs. performance) solution to the numerical simulations of the regional scale water balance. In this way we avoid unwanted boundary effects on the local model simulations due to the presence of artificial numerical boundaries located proximate to the areas of interest. In this application, it is particularly important that boundary conditions are remote, due to the presence of a dense network of buried valley structures. Simulated impacts of groundwater abstraction from two existing well-fields spread through the valley system far beyond the local focus areas of the study.

An economic case for a vaccine to prevent group A streptococcus skin infections

BackgroundGroup A streptococcus (GAS) causes an exceptionally diverse range of diseases, raising questions about the optimal product characteristics of a commercially viable vaccine. The objectives of this study were to (1) estimate the current health and economic burdens caused by 24 diseases attributable to GAS each year in Australia and (2) use these estimates to explore the value of a GAS vaccine for different clinical indications, age schedules, and population groups. MethodsFor objective 1, we estimated the population heath and economic burdens by synthesising data from administrative databases, nationally representative surveys, literature reviews, public reimbursement schedules, and expert opinion. For objective 2, we modelled the prospective lifetime burden of GAS for all infants from birth, for children from 5 years of age, and for adults from 65 years of age. A vaccine was assumed to reduce each GAS disease by 70% for a period of 10 years, and the difference in outcomes between vaccinated and non-vaccinated cohorts were used to calculate the cost-effective value of vaccination. ResultsThe annual health and economic burdens of GAS diseases totalled 23,528 disability-adjusted life years and AU$185.1 million in healthcare costs respectively; approximately half of each measure was due to cellulitis, followed by other skin infections and throat infections. Reducing the incidence of throat infections, skin infections, and cellulitis in non-Indigenous cohorts resulted in 30%, 33%, and 28% of the total vaccine value for an infant schedule (cost-effective vaccine price AU$260 per course); 47%, 26%, and 22% of the value for a child schedule (AU$289); and 2%, 15% and 74% for an adult schedule (AU$489). ConclusionsA vaccine that prevents GAS cellulitis and other skin infections, in addition to throat infections, would maximise its value and commercial viability, with a cost-effective price in line with other recently-licensed and funded vaccines in Australia.

Cost-effectiveness analysis of maternal immunisation against group B Streptococcus (GBS) disease: A modelling study

BackgroundThere is a considerable global burden of invasive group B streptococcal (GBS) disease. Vaccines are being developed for use in pregnant women to offer protection to neonates. ObjectiveTo estimate the potential impact and cost-effectiveness of maternal immunisation against neonatal and maternal invasive GBS disease in the UK. MethodsWe developed a decision-tree model encompassing GBS-related events in infants and mothers, following a birth cohort with a time horizon equivalent to average life expectancy (81 years). We parameterised the model using contemporary data from disease surveillance and outcomes in GBS survivors. Costs were taken from NHS sources and research studies. Maternal immunisation in combination with risk-based intrapartum antibiotic prophylaxis (IAP) was compared to the current standard practice of risk-based IAP alone from an NHS and Personal Social Services (health-provider) perspective. We estimated the cases averted and cost per QALY gained through vaccination. One-way sensitivity analysis, scenario analysis and probabilistic sensitivity analysis were performed. ResultsAn effective maternal immunisation programme could substantially reduce the burden of GBS disease. The deterministic analysis estimated the threshold cost-effective price for a GBS vaccine to be £54 per dose at £20,000/QALY (£71 per dose at £30,000/QALY). Results were most sensitive to assumptions on disease incidence, sequelae rate and vaccine efficacy. Probabilistic analysis showed 90.66% of iterations fell under the £30,000 threshold at a vaccine price of £55. Inclusion of modest prevention of stillbirths and/or, preterm births, carer health impacts, maternal GBS deaths and 1.5% discounting improved cost-effectiveness compared to the base case. Lowering vaccine strain coverage made the vaccine less cost-effective. A key limitation is that the properties of the final GBS vaccine are unknown. ConclusionsMaternal GBS immunisation is expected to be cost-effective, even at a relatively high vaccine price.

PIN30 - AN ECONOMIC MODEL TO ESTIMATE THE COST-EFFECTIVENESS OF TRIVALENT INFLUENZA VACCINE HIGH DOSE FOR THE ELDERLY POPULATION IN ENGLAND AND WALES

A large RCT (FIM12) and several real world studies have shown trivalent influenza vaccine high dose (TIV HD) to be more effective than standard dose trivalent influenza vaccine (SD) in terms of reducing influenza cases and hospitalisations, including serious cardio-respiratory events (CREs), in the elderly population. The aim of this study was to estimate the public health and economic impact of switching from SD to TIV HD for adults aged ≥65 years in England and Wales using econometric modelling. An age-structured decision tree model comparing multiple vaccination strategies was designed in Microsoft Excel. Model outcomes included influenza cases, influenza-related GP consultations, hospitalisations, and deaths. Two alternative hospitalisation definitions were used; respiratory hospitalisations attributable to influenza, and CREs (possibly attributable to influenza). All analyses were conducted from the UK healthcare system perspective. The model was populated with FIM12 clinical trial data and demographic, epidemiological, and economic inputs appropriate to the UK setting. Deterministic sensitivity analysis (DSA) was performed to assess the robustness of results. In England and Wales, switching from SD to TIV HD (in adults aged ≥65 years) was associated with a reduction of 75,000 cases of confirmed influenza, 19,000 influenza-related hospitalisations, and 4,000 deaths, in an average influenza season. Using thresholds of £20,000 and £30,000/QALY, TIV HD was estimated to be cost-effective at £23.75 and £30.70 per dose, respectively. The cost-effective price at £20,000/QALY increased to £115.15 when accounting for the vaccination effect in reducing CREs. DSA showed that these results were most sensitive to relative vaccine efficacy against influenza hospitalisations whereas the remaining parameters had a low impact on model outcomes. The results suggest that the inclusion of TIV HD on the influenza vaccination schedule has the potential to be a highly cost-effective intervention for the UK healthcare system and would contribute positively to improving public health goals.

PR1 - Value-Based Pricing in Singapore: Is it a Race to the Bottom?

A review of the drug guidance recommendations released by the Agency of Care Effectiveness was conducted to assess the impact of the perceived value and price of a drug on subsidy decisions. The review encompassed all 19 appraisals published between May 2017 and March 2018. The factors considered by the Drug Advisory Committee were extracted and assessed. Of the 19 appraisals assessed, 5 led to recommendations for subsidy listing on the Standard Drug Lists, 11 led to recommendations for inclusion on the Medication Assistance Fund, and 3 led to no subsidy recommendation. For the 16 positive recommendations, there was either a therapeutic gap in treatment, the drug was considered the standard of care, the drug had a cost-effective price relative to alternatives, or a combination of these factors applied. Positive recommendations, when there were comparators, and the price relative to comparators was noted, were given for the cheapest drug in 88% of instances. In 1 appraisal (rivastigmine), the formulation was subsidised despite being the more expensive option, as it offered a novel drug delivery mode that might improve treatment adherence and relieve caregiver burden. Discounts were cited in 5 appraisals, 2 of which did not lead to positive recommendations – in both instances the drugs were not the cheapest option even with the discount. 3 other appraisals also appeared to have considered discounted drug prices. Discounts may thus not have been systematically reported in all appraisals. This research highlights that a therapeutic gap and cost relative to comparators are important criteria to inform subsidy recommendations in Singapore. In the absence of a clinical need or therapeutic gap, the cheapest therapies appear highly likely to receive a positive recommendation – discounts can lead to positive outcomes, but this appears less likely if the discounted drug is still not the cheapest option.

Short term policies to keep the door open for Paris climate goals

Climate policy needs to account for political and social acceptance. Current national climate policy plans proposed under the Paris Agreement lead to higher emissions until 2030 than cost-effective pathways towards the Agreements’ long-term temperature goals would imply. Therefore, the current plans would require highly disruptive changes, prohibitive transition speeds, and large long-term deployment of risky mitigation measures for achieving the agreement’s temperature goals after 2030. Since the prospects of introducing the cost-effective policy instrument, a global comprehensive carbon price in the near-term, are negligible, we study how a strengthening of existing plans by a global roll-out of regional policies can ease the implementation challenge of reaching the Paris temperature goals. The regional policies comprise a bundle of regulatory policies in energy supply, transport, buildings, industry, and land use and moderate, regionally differentiated carbon pricing. We find that a global roll-out of these policies could reduce global CO2 emissions by an additional 10 GtCO2eq in 2030 compared to current plans. It would lead to emissions pathways close to the levels of cost-effective likely below 2 °C scenarios until 2030, thereby reducing implementation challenges post 2030. Even though a gradual phase-in of a portfolio of regulatory policies might be less disruptive than immediate cost-effective carbon pricing, it would perform worse in other dimensions. In particular, it leads to higher economic impacts that could become major obstacles in the long-term. Hence, such policy packages should not be viewed as alternatives to carbon pricing, but rather as complements that provide entry points to achieve the Paris climate goals.

Health Technology Assessment and Its Use in Drug Policies: Singapore

IntroductionSingapore has a robust health care system that is well known for delivering good health outcomes. In the public health care sector, subsidies and financial assistance are provided for drugs listed on the Standard Drug List and Medication Assistance Fund. Additional financing mechanisms are also available to provide further support for patients in need.With new technologies entering the market at high costs, health technology assessment (HTA) is playing an increasingly important role to inform their relative value and determine how best to allocate finite health care resources to ensure long-term sustainability of the health care system. Role of HTANational HTA efforts are currently focused on informing subsidy decision making and improving patient access to cost-effective drugs. The Agency for Care Effectiveness (ACE) was established in 2015 to support the Ministry of Health Drug Advisory Committee make evidence-based recommendations for the public funding of drugs. Standardized HTA methods and processes have been developed in line with international best practice to ensure that ACE’s evaluations are conducted in a consistent and robust manner. Since ACE’s establishment, subsidies are now provided earlier within a drug’s life cycle, and value-based pricing has led to more cost-effective prices being negotiated with companies to improve affordability for patients and the public health care system. ConclusionTo achieve greater impact, Singapore needs to expand its HTA capacity beyond subsidy decision making and drive appropriate care in a sustainable manner for future generations.

A quick scoping review of efficacy, safety, economic, and health-related quality-of-life outcomes of short- and long-acting erythropoiesis-stimulating agents in the treatment of chemotherapy-induced anemia and chronic kidney disease anemia.

Erythropoiesis-stimulating agents (ESAs) are man-made forms of erythropoietin used in the treatment of anemia. This quick-scoping review of systematic literature reviews (SLRs) was conducted to define the clinical, economic, and health-related quality of life (HRQoL) outcomes for short-acting and long-acting ESAs in patients with chronic kidney disease-induced anemia (CKD-IA) and patients with chemotherapy-induced anemia (CIA). Embase, Medline, and the Cochrane Database of Systematic Reviews were searched from their establishment until October 2017. SLRs related to the use of short-acting and long-acting ESAs in the treatment of CIA and CKD-IA were included. Forty-eight studies met the inclusion criteria. The evidence suggests little difference in efficacy, HRQoL, and safety outcomes among ESA types. Cost-effectiveness and market price are likely to become determining factors driving the choice of agent. Comparative studies and costing models accounting for the utilization of biosimilars are needed to establish which ESAs are more cost-effective.

PRS34 - Economic Value of Precision Medicine: An Example of Asthma

Precision medicine is an emerging approach, under which treatments are optimised after accounting for individuals’ genotypic, phenotypic, and/or environmental characteristics. We assess the economic value of precision medicine, using an example of patients with asthma who are receiving GINA (Global Initiative for Asthma) step 2 treatment in the US. A Markov model was developed to estimate the costs and benefits across the natural history of asthma, represented by five GINA steps. In the model, patients could step up/down the treatment, experience an exacerbation, remit or die. A new treatment X (Tx) could expedite step-downs, delay step-ups, and reduce exacerbations among patients with a specific genotype (GT). Those who tested positive for GT will receive Tx, and the rest, standard of care (SoC). To assess the value of Tx when compared to using SoC alone, its efficacy, the sensitivity/specificity of GT testing, and GT prevalence in patients were varied to estimate the cost-effective price of Tx (at a willingness-to-pay threshold of $50,000 per a quality-adjusted life year [QALY]). Parameters were estimated from the literature. Costs and QALYs were discounted at 3.0% per year. The cost-effective price of Tx was higher when GT was more prevalent and the diagnostic test more precise. Following a cohort of asthma patients, at an efficacy level of 50%, the monthly cost-effective price of Tx increased from $170 to $405, if the prevalence of GT and the sensitivity/specificity of GT testing both increased from 25% to 75%. The cost-effective price was most sensitive at high prevalence/low precision, and low prevalence/high precision of the genotype/its diagnostic test respectively. The economic value of precision medicine depends not only on the treatment efficacy, but also the prevalence of the genotypes/phenotypes of interest, and in our example, even more so, on the accurate identification of eligible patients.

Steering the Climate System: An Extended Comment

Lemoine and Rudik (2017) argue that it is efficient to delay reducing carbon emissions, because there is substantial inertia in the climate system. However, this conclusion rests upon misunderstanding the relevant climate physics: there is no substantial lag between CO2 emissions and warming, which policy could rely upon. Applying a mainstream climate physics model to the economics of Lemoine and Rudik (2017) invalidates the article’s implications for climate policy: the cost-effective carbon price that limits warming to a range of targets including 2 oC starts high and increases at the interest rate.

Thresholds for decision-making: informing the cost-effectiveness and affordability of rotavirus vaccines in Malaysia.

Cost-effectiveness thresholds (CETs) based on the Commission on Macroeconomics and Health (CMH) are extensively used in low- and middle-income countries (LMICs) lacking locally defined CETs. These thresholds were originally intended for global and regional prioritization, and do not reflect local context or affordability at the national level, so their value for informing resource allocation decisions has been questioned. Using these thresholds, rotavirus vaccines are widely regarded as cost-effective interventions in LMICs. However, high vaccine prices remain a barrier towards vaccine introduction. This study aims to evaluate the cost-effectiveness, affordability and threshold price of universal rotavirus vaccination at various CETs in Malaysia. Cost-effectiveness of Rotarix and RotaTeq were evaluated using a multi-cohort model. Pan American Health Organization Revolving Fund's vaccine prices were used as tender price, while the recommended retail price for Malaysia was used as market price. We estimate threshold prices defined as prices at which vaccination becomes cost-effective, at various CETs reflecting economic theories of human capital, societal willingness-to-pay and marginal productivity. A budget impact analysis compared programmatic costs with the healthcare budget. At tender prices, both vaccines were cost-saving. At market prices, cost-effectiveness differed with thresholds used. At market price, using 'CMH thresholds', Rotarix programmes were cost-effective and RotaTeq were not cost-effective from the healthcare provider's perspective, while both vaccines were cost-effective from the societal perspective. Using other CETs, both vaccines were not cost-effective at market price, from the healthcare provider's and societal perspectives. At tender and cost-effective prices, rotavirus vaccination cost ∼1 and 3% of the public health budget, respectively. Using locally defined thresholds, rotavirus vaccination is cost-effective at vaccine prices in line with international tenders, but not at market prices. Thresholds representing marginal productivity are likely to be lower than those reflecting human capital and individual preference measures, and may be useful in determining affordable vaccine prices.

Cost estimate and budget impact analysis of implementing the new guidelines for management of hepatitis C virus in China: a micro-costing study

BackgroundNew international guidelines, local experts, and the WHO China Office recommend a standardised package of treatment for hepatitis C virus, using sofosbuvir as the direct-acting antiviral drug due to its high efficacy and ease of use. Unlike currently available injection-based treatments (interferon or peginterferon-based therapy), sofosbuvir is taken orally, with improved treatment adherence expected. However, sofosbuvir is currently not in the market in China, and would be unaffordable to many patients. We aimed to assess the average cost of care for chronic hepatitis C virus in China with current injection-based therapies compared with the cost of sofosbuvir-based treatment, and the budget impact of introducing new guidelines for treatment of chronic hepatitis C virus with sofosbuvir. MethodsA micro-costing multilevel and multicentric study collecting data on all care activities for chronic hepatitis C virus was designed and sent to a random sample of tertiary provincial hospitals in the east, central, west, and northwest regions of China. Snowball sampling was utilised to contact tertiary city hospitals, secondary city hospitals, and secondary county hospitals. 16 hospitals filled out the survey of 16 invited to take part. Average cost per patient per year was assessed; because large standard deviation in costs indicated large variations in the sample, we weighted costs by the number of patients with chronic hepatitis C virus (as a proportion of all patients in the country). Because there is no current price for sofosbuvir, we used a cost-effective price compared with the current regimen of peginterferon in China, the price of sofosbuvir in India, and the price of sofosbuvir in Brazil. We conducted a one-way sensitivity analysis on weights and treatment drug cost, and a computer-based budget impact analysis. FindingsThe average yearly cost for each patient (weighted by patient load per hospital) was ¥45 700. The cost of the standard package regimen (using the cost-effective sofosbuvir price) was ¥31 700 per patient, although this fell to ¥11 400 using the current price of sofosbuvir in India and rose to ¥75 000 using the price of sofosbuvir in Brazil. Pre-assessment and monitoring costs were much higher than the standard package (more than four times). Patients paying all costs of care paid ¥45 700 per year under the current practice, ¥31 748 under the standardised care using the cost-effective sofosbuvir price, and ¥11 360 using the Indian sofosbuvir price. These costs compared with the threshold for catastrophic health expenditure of ¥20 167 for average households, ¥28 844 for urban households, and ¥9892 for rural households, suggesting that rural patients cannot afford full chronic hepatitis C care. If a public payer were to cover all care costs for patients with hepatitis C virus in China (100 000 individuals), it would cost ¥4·6 billion for current care practices (including ¥4·1 billion for currently used antiviral treatments only) and ¥1·1 billion for standardised care (¥1·0 billion for standard-package antiviral treatments only), equivalent to 0·48% of the Ministry of Finance health expenditure for 2013 for the current package and 0·12% for the standard package. The total cost after 5 years would be ¥22·9 billion for the current package (including ¥20·4 billion for antiviral drugs) and ¥5·7 billion for the standard package (including ¥5·1 billion standard package for antiviral drugs). Based on the one-way sensitivity analysis, the sofosbuvir regimen price was the biggest cost-driver, followed by the target population. InterpretationAt present, care for chronic hepatitis C virus is unaffordable for Chinese patients. Considering that current treatment costs are unaffordable for patients, and that better and curative therapies are available that could save lives and resources in the long run, it is reasonable for China to consider funding or reimbursing standardised care for hepatitis C virus with evidence-based therapies. FundingWorld Health Organization China.

Regional Differences In Potential Savings For The Medical Treatment Of Advanced Prostate Cancer In The German Health Care System

Gonadotropin-releasing hormone analogues (GnRH-analogues) are well established for treating advanced prostate cancer. In 2015 and 2016, four GnRH-analogues were available in Germany: Buserelin, Goserelin, Leuprorelin and Triptorelin. Only Leuprorelin had generics. Four of 17 regions of physicians’ associations (KV) in the statutory health insurance (SHI) had quotas promoting Leuprorelin in 2015 and 2016 (“Quota-KVs”). Four regions introduced quotas in 2017 (“New-KVs”). This research investigates the regional differences in market penetration and potential savings. QuintilesIMS provided monthly SHI prescription data per region, sickness fund and package for 2015 and 2016. Pharmacy sales prices and defined daily doses (DDD) were used for sales respectively volume. Total sales were 207.7m (212.3m) Euro and volume was 37.6m (38.3m) DDD in 2015 (2016). The average quarterly market share (sales) of Leuprorelin differed regionally between 60.5% and 75.7%. Within the Leuprorelin market, the average generics’ share varied between 5.9% and 33.6%. In the “Quota-KVs”, the average share was 23.9% compared to 12.2% in the “New-KVs” and 14.3% in the remaining nine. Leuprorelin generics had a more cost-effective average price level (4.51 Euro/DDD) than other Leuporelin products (5.38 Euro/DDD) and GnRH-analogues (6.02 Euro/DDD). SHI could have saved 20.6m Euro or 4.9% of sales in 2015 and 2016, when the highest quarterly market shares (DDD) of Leuprorelin in a KV (79.7%) and generics within Leuprorelin (45.8%) would have been achieved over all quarters and KVs. Average potential savings per KV varied between 2.0% and 6.9%. Average potential savings would have been 3.5% in “Quota-KVs” and 5.7% in “New-KVs” as well as the remaining nine. The analysis shows a low market share for generics and a strong deviation between regions. Quotas push market penetration for generics. Regions with lower shares have recently introduced them. Substantial savings can be achieved without any loss of clinical effectiveness.

PHARMACOECONOMIC EVALUATION FOR DENGUE VACCINE PRICING FOR MALAYSIA: TOWARDS AFFORDABILITY, COST EFFECTIVENESS AND SUSTAINABILITY

Objective: Malaysian health ministry is currently evaluating the licensing of dengue vaccine Dengvaxia using a set of criteria including safety, efficacy and cost-effectiveness. The purpose of this research is to formulate a model framework to assist transparent decision-making.Methods: To quantify the cost-effective price of vaccine, pharmacoeconomic evaluation models are commonly used. We review in this paper dengue economic burdens and pharmacoeconomic models, with particular reference to cost-effectiveness.Results: A major weakness in current pharmacoeconomic models is the omission of cost of vaccine production, which is two orders of magnitude lower than the market price. This paper proposes an inclusive model that yields a highly cost-effective threshold price of dengue vaccine at USD 5 per dose for Malaysia.Conclusion: At USD 5 per dose, Dengue vaccine will be fair, Affordable and sustainable.

Is it all about price? Why requests for government subsidy of anticancer drugs were rejected in Australia.

Australians access anticancer drugs predominantly through the Pharmaceutical Benefits Scheme (PBS). To determine why the Pharmaceutical Benefits Advisory Committee (PBAC) rejects submissions to list anticancer drugs on the PBS. We reviewed publicly available information about submissions made to the PBAC for PBS listing of anticancer drugs from 2005 to 2014. Submission characteristics, including clinical and economic evidence, PBAC recommendations, and the reasons offered for rejection were recorded. Two reviewers independently categorised the reason for rejection offered by the PBAC. Logistic regression was used to determine submission characteristics associated with rejection. We identified 213 submissions for 110 unique indications of 60 anticancer drugs. The overall rejection rate was 56% (119/213). Of the 110 indications assessed, 69% (76/110) were rejected at least once. The annual rejection rate ranged from 50 to 73% with little evidence of a trend over time (P = 0.2). Submission characteristics strongly associated with rejection in multivariable analysis included: PBAC judged the clinical evidence to be problematic or uncertain (P < 0.001); PBAC judged the economic evidence to be problematic or uncertain (P < 0.001); and, inactive comparator used (P < 0.001). The most frequent reasons for rejection offered by the PBAC was 'inadequate cost-effectiveness or drug price too high' (75/109, 69%). Inadequate cost-effectiveness and PBAC uncertainty about the clinical and economic evidence were the most frequent reasons for rejection. Clarity of information about PBAC deliberations and their reasons for rejection are important for patients and doctors grappling with decisions about the use of expensive unfunded anticancer drugs.

Cost-effectiveness of dengue vaccination in Brazil

Objective: To define the economic value of a tetravalent dengue vaccine in Brazil by estimating the cost-effectiveness vaccine price threshold per dose. Methods: A dengue dynamic transmission model was used to estimate the public health impact of dengue vaccination and related economic parameters. Two vaccination strategies were assessed: routine vaccination at 9 years old plus ei[1]ther a catch-up campaign of 7 cohorts (10 to 16 years old; R9&amp;10-16) or 16 cohorts (10 to 25 years old; R9&amp;10-25). Brazilian-specific demographic, epidemiological and economic data were used. The economic impact over 10 years was estimated from the public payer and societal perspectives. All costs were expressed in BRL2016. Results: Over 10 years, the R9&amp;10-16 and R9&amp;10-25 vaccination strategies would prevent 9 million and 15 million dengue cases, respectively, avoiding 269,906 (95% CI: 410,097–154,653) and 434,334 (95% CI: 547,052–304,799) disability-adjusted life years. This would result in savings of up to BRL7.4 billion (US$2.1 billion) from a societal perspective with the larger vaccination program. The cost-effective vaccine price threshold per dose for the R9&amp;10-16 and R9&amp;10-25 strategies would be BRL187.5 (95% CI: 109–276) (US$52.1) and BRL183.6 (95% CI: 129–230) (US$51.0), respectively, from the public payer perspective, and BRL221.5 (95% CI: 129–326) (US$61.5) and BRL216.8 (95% CI: 153–271) (US$60.2), respectively, from the societal perspective. Conclusion: The high threshold of vaccine price per dose demonstrates the significant economic value of dengue vaccination in Brazil, even for a large program with 16 catch-up cohorts.

Health outcomes of bedaquiline in the treatment of multidrug-resistant tuberculosis in selected high burden countries

BackgroundLess than one-third of patients who are estimated to be infected with multidrug-resistant tuberculosis (MDR-TB) receive MDR-TB treatment regimens, and only 48% of those who received treatment have successful outcomes. Despite current regimens, newer, more effective and cost-effective approaches to treatment are needed. The aim of the study was to project health outcomes and impact on healthcare resources of adding bedaquiline to the treatment regimen of MDR-TB in selected high burden countries: Estonia, Russia, South Africa, Peru, China, the Philippines, and India.MethodsThis study adapted an existing Markov model to estimate the health outcomes and impact on total healthcare costs of adding bedaquiline to current MDR-TB treatment regimens. A price threshold analysis was conducted to determine the price range at which bedaquiline would be cost-effective.ResultsAdding bedaquiline to the background regimen (BR) resulted in increased disability-adjusted life years (DALYs) averted, and reduced total healthcare costs (excluding treatment acquisition costs) compared with BR alone in all countries analyzed. Addition of bedaquiline to BR resulted in savings to healthcare costs compared with BR alone in all countries analyzed, with the highest impact expected in Russia (US$194 million) and South Africa (US$43 million). The price per regimen at which bedaquiline would be cost-effective ranged between US$23,904-US$203,492 in Estonia, Russia, Peru, South Africa, and China (high and upper middle-income countries) and between US$6,996-US$20,323 in the Philippines and India (lower middle-income countries); however, these cost-effective prices do not necessarily address concerns about affordability.ConclusionsAdding bedaquiline to BR provides improvements in health outcomes and reductions in healthcare costs in high MDR-TB burden countries. The range of prices per regimen for which bedaquiline would be cost-effective varied between countries.

Multi-Layered Clustering for Power Consumption Profiling in Smart Grids

Smart Grids (SGs) have many advantages over traditional power grids as they enhance the way electricity is generated, distributed, and consumed by adopting advanced sensing, communication, and control functionalities that depend on power consumption profiles of consumers. Clustering algorithms ( e.g. , centralized clustering) are used for profiling individuals’ power consumption. Due to the distributed nature and ever growing size of SGs, it is predicted that massive amounts of data will be created. However, conventional clustering algorithms are neither efficient enough nor scalable enough to deal with such amount of data. In addition, the cost for transferring and analyzing large amounts of data is high both computationally and communicationally. This paper thus proposes a power consumption profiling model based on two levels of clustering. At the first level, local power consumption profiles are derived, which are then used by the second level in order to create a global power consumption profile. The followed approach reduces the communication and computation complexity of the proposed two level model and improves the privacy of consumers. We point out that having a good knowledge of the local power profiles leads to more effective prediction model and cost-effective power pricing scheme, especially in a heterogeneous grid topology. In addition, the correlations between the local and global profiles can be used to localize/identify power consumption outliers. Simulation results illustrate that the proposed model is effective in reducing the computational complexity without much affecting its accuracy. The reduction in computational complexity is about 52% and the reduction in the communicational complexity is about 95% when compared with the centralized clustering approach.

PCN209 - Insights into the Pan-Canadian Pharmaceutical Alliance’s Decision not to Collectively Negotiate Pricing for Drug Products

The pan-Canadian Pharmaceutical Alliance (pCPA) conducts joint price negotiations with provinces/territories and manufacturers for drugs being considered for reimbursement through public drug plans. However, not all drugs reviewed by the Common Drug Review (CDR) and pan-Canadian Oncology Drug Review (pCODR) undergo joint negotiations. This analysis examined factors that may have influenced pCPA’s decision not to negotiate drug prices collectively. A list of the drugs not jointly negotiated by the pCPA was obtained from www.pmprovincesterritoires.ca. Final CDR and pCODR recommendation reports (publicly accessible at www.cadth.ca and reimbursementdecisions.com) corresponding to the pCPA drug list were subsequently reviewed. As of December 31, 2015, the pCPA did not conduct joint price negotiations for 34 drugs; 29 (85%) were reviewed by CDR and 5 (15%) by pCODR. Among CDR products, 23 (79%) received a ‘do not list’, 4 (14%) a ‘do not list at the submitted price’, and 2 (7%) a ‘list with clinical criteria/conditions’ recommendation. Uncertainty in the comparative clinical benefit of the drug was cited as the primary limitation in the majority (79%) of CDR recommendations, followed by concerns related to cost effectiveness and/or product price. All pCODR products received a negative recommendation because of uncertain/insufficient clinical benefit and uncertain cost effectiveness. The majority of products that the pCPA did not jointly negotiate received negative recommendations from CDR or pCODR due to concerns regarding clinical benefit. This study highlights the value placed on robust clinical data in reimbursement recommendations and price negotiations.

Bio-plastic (poly-hydroxy-alkanoate) production from municipal sewage sludge in the Netherlands: a technology push or a demand driven process?

Valorisation of components from municipal 'waste' water and sewage sludge gets more and more attention in order to come to a circular economy by developing an efficient 'waste' to value concept. On behalf of the transition team 'Grondstoffenfabriek' ('Resource factory') a preliminary research was performed for all the Dutch water boards to assess the technical and economical feasibility of poly-hydroxy-alkanoate (PHA)-production from sewage sludge, a valuable product to produce bio-plastics. This study reveals that the production of bio-plastics from sewage sludge is feasible based on technical aspects, but not yet economically interesting, even though the selling price is relatively close to the actual PHA market price. (Selling price is in this particular case the indicative cost effective selling price. The cost effective selling price covers only the total production costs of the product.) Future process optimization (maximizing the volatile fatty acids production, PHA storage capacity, etc.) and market developments are needed and will result in cost reductions of the various sub-processes. PHA-production from sewage sludge at this stage is just a technology; every further research is needed to incorporate the backward integration approach, taking into account the market demand including associated product quality aspects.