Cost-minimization Study Research Articles

Pharmacoeconomic Analysis of Treating Lung Cancer with Different Regimens Using the Cheapest and Costliest Brand and the Generic Jan Aushadhi Drugs Marketed in India

Abstract Background/Purpose of the Study The costs of chemotherapy drugs which are vital in the treatment of lung cancer can be exorbitant. The current study was undertaken to ascertain cost minimization analysis by comparing costliest and cheapest branded with Jan Aushadhi (JA) drugs marketed in India. Methods The cost of costliest, cheapest branded, and JA drugs were collected from the designated reference sites. The cost difference, cost ratio, and percentage of cost variation were calculated as per cost minimization study guidelines. Results The results of the analysis suggest that the JA drugs were much cheaper than the branded drugs and when used in regimens resulted in substantial cost savings. The biggest financial advantage was seen in the commonly used cisplatin–pemetrexed regimen where cost saving of Rs. 268,002 was observed for the whole treatment of six cycles. Using JA drugs also reduced the cost for the targeted therapy with gefitinib and erlotinib. Conclusion The cost minimization study, which is the first in this field of lung cancer, clearly indicates the usefulness of JA drugs in reducing financial costs for the patient.

Tratamiento médico del aborto del primer trimestre: igual eficacia, más eficiencia

BackgroundEarly pregnancy loss occurs in 10-20% of all clinical pregnancies, 85% being prior to week 12 of amenorrhea. Miscarriage entails a very significant burden on healthcare resources, reaching a national economic cost in the United Kingdom of £471 million per year (€533.06 million), a figure that can be extrapolated to other industrialized countries. According to a recent systematic review, there are no well-designed trials in first-trimester pregnancies that provide consolidated evidence on what is the best first-trimester abortion treatment method, and there are different studies that have tried to demonstrate cost reduction with contradictory results. Material and methodsAn observational, retrospective and longitudinal design study was carried out. 892 patients diagnosed with spontaneous abortion during the first trimester of pregnancy were reviewed, in the period between January 2013 and December 2016.In our study, we wanted to evaluate the efficacy of vaginal misoprostol as a medical treatment for spontaneous abortion in the first trimester, in comparison with obstetric curettage-evacuator, and to quantify the difference in the costs of both procedures through a cost minimization study. costs. ResultsOf the 892 recruited patients, medical treatment with misoprostol was performed in 517 (57.95%) and surgical treatment by curettage in 375 (42.05%).The effectiveness of medical treatment was 82% (426/517). With respect to surgical treatment the effectiveness of 100%. The success rate of medical treatment was higher in the subgroup of patients with incomplete abortion (92.9%), compared to the anembryonic gestation (85.7%) and delayed abortion (78.2%) groups. ConclusionsThe medical treatment of abortion is a safe management and accepted by the patients. The adequate selection of candidate patients leads to an increase in the success rate and a decrease in costs. In our study, an important total saving of €576,847.92 (37.14%) with respect to surgical treatment will be reduced. Given that the effectiveness is comparable and patient satisfaction is high, although it could be improved, we believe that with adequate information and homogenization of the applied treatment, it is safe.

Cost-minimization analysis of escitalopram, fluoxetine, and amitriptyline in the treatment of depression.

Escitalopram, fluoxetine, and amitriptyline are the drugs commonly used in the treatment of depression. The pharmacoeconomic evaluation of these drugs becomes relevant as they are prescribed for a long period of time, and depression causes a significant economic burden. The cost-minimization study would contribute to bringing down the annual treatment costs, leading to better medication adherence and ultimately better patient outcomes. All drug prices are mentioned in Indian National Rupee (INR). All expenses are based on 2022 pricing. No cost discounting was used because all expenditures were calculated over a year. We considered hypothetical scenarios where the patient was prescribed the lowest possible dose for depression, an equivalent antidepressant dose, a defined daily dose, and the maximum acceptable therapeutic dose for depression. Annual average treatment costs of amitriptyline, escitalopram, and fluoxetine in patients with depression at baseline with equivalent dosing as mono-drug therapy were 2765.53, 2914.78, and 1422.72 rupees (INR), respectively. Savings were high when the patient was shifted to fluoxetine from either escitalopram or amitriptyline. The savings from switching to fluoxetine were 50.66% and 56.42% from escitalopram and amitriptyline, respectively. The choice of an antidepressant depends on multiple aspects, among which the cost of treatment plays a crucial role. Among the drugs compared, fluoxetine seems to offer greater value for money. The study emphasizes that selective serotonin reuptake inhibitors are the most commonly prescribed antidepressants not only because of their favorable pharmacological profile but also because of their affordability.

Cost analysis for mirabegron use in the treatment of children with neurogenic bladder

Mirabegron is a beta-3 adrenergic receptor agonist that received FDA approval in 2021 to treat neurogenic detrusor overactivity (NDO) in children ages three years and older. Despite its safety and efficacy, access to mirabegron frequently remains restricted by payor coverage policies. This cost minimization study sought to determine the cost implications from a payor perspective of mirabegron use at different points in the treatment pathway for pediatric NDO. A Markov decision analytic model was constructed to assess the costs for eight treatment strategies over a 10-year period, using six-month cycles (Table). Five strategies involve mirabegron use as first-, second-, third-, or fourth-line therapy. Two strategies, including the "base case," entail use of anticholinergic medications followed by onabotulinum toxin type A (Botox) injection and augmentation cystoplasty. A strategy involving first-line Botox was also modeled. The effectiveness, adverse event rates, attrition rates, and costs associated with each treatment option were obtained from the clinical literature and adjusted to a six-month cycle. Costs were adjusted to 2021-dollar value. A discount rate of 3% was used. To quantify uncertainty, costs and treatment transition probabilities were modeled as gamma and PERT distributions, respectively. One-way sensitivity analyses were performed. Probabilistic sensitivity analysis (PSA) was conducted using a Monte Carlo simulation with 100,000 iterations. Analyses were performed using Treeage Pro (Healthcare Version). The least costly strategy involved first-line mirabegron (expected cost $37,954). All strategies involving mirabegron were less costly than the base case ($56,417). On PSA, first-line mirabegron was the least costly strategy in 88.9% of cases (mean $37,604, 95% CI: $37,579-37,628); in 100% of cases, the least costly strategy involved mirabegron use. Cost savings associated with mirabegron use were attributable to decreased use of augmentation cystoplasty and Botox injections. This is the first study to compare costs across multiple strategies involving mirabegron to treat pediatric NDO. Mirabegron use likely yields cost savings for the payor: the least costly strategy involved first-line mirabegron, and all pathways incorporating mirabegron were less costly than those without mirabegron use. These findings provide an updated cost analysis for the treatment of NDO by investigating mirabegron use alongside more established treatment options. Use of mirabegron for the treatment of pediatric NDO is likely associated with cost savings as compared to treatment pathways without mirabegron. Expansion of payor coverage for mirabegron, as well as clinical studies to study first-line mirabegron use, should be considered.

The cost of implementing measles campaign in Nigeria: comparing the stand-alone and the integrated strategy

BackgroundEffective integration, one of the seven strategic priorities of the Immunization Agenda 2030, can contribute to increasing vaccination coverage and efficiency. The objective of the study is to measure and compare input costs of “non-selective” measles vaccination campaign as a stand-alone strategy and when integrated with another vaccination campaign.MethodsWe conducted a cost-minimization study using a matched design and data from five states of Nigeria. We carried-out our analysis in 3 states that integrated measles vaccination with Meningitis A and the 2 states that implemented a stand-alone measles campaign. The operational costs (e.g., costs of personnel, training, supervision etc.) were extracted from the budgeted costs, the financial and technical reports. We further used the results of the coverage surveys to demonstrate that the strategies have similar health outputs.ResultsThe analysis of the impact on campaign budget (currency year: 2019) estimated that savings were up to 420,000 United States Dollar (USD) with the integrated strategies; Over 200 USD per 1,000 children in the target population for measles vaccination (0.2 USD per children) was saved in the studied states. The savings on the coverage survey components were accrued by lower costs in the integration of trainings, and through reduced field work and quality assurance measures costs.ConclusionsIntegration translated to greater value in improving access and efficiency, as through sharing of costs, more life-saving interventions are made accessible to the communities. Important considerations for integration are resource needs, micro-planning adjustments, and health systems delivery platforms.

Comparative analyses of holder pasteurization vs. HTST pasteurization for donor milk: a cost-minimization study applicable to human milk banks

BackgroundHigh-temperature short-time (HTST) pasteurization (72–75 °C, 15 s) is an alternative treatment to traditional Holder pasteurization (HoP) (62ºC, 30 min) for donor milk. HTST pasteurization guarantees the milk’s microbiological safety and retains more of its biologically and nutritionally active compounds, but the cost of implementing this technology for a human milk bank is unknown.MethodsA cost-minimization study was carried out on the facilities of a regional human milk bank in a public hospital. Total production costs (fixed plus variables) were quantified using HTST pasteurization and HoP in three hypothetical scenarios: (1) costs of the first 10 L of pasteurized milk in a newly opened milk bank; (2) costs of the first 10 L of pasteurized milk in an active milk bank; and (3) costs using the maximum production capacity of both technologies in the first two years of operation. The following costs were analyzed: health care professionals, equipment and software, external services, and consumables.ResultsIn scenario 1, the total production costs were € 228,097.00 for the HTST method versus € 154,064.00 for the HoP method. In scenario 2, these costs were similar (€ 6,594.00 for HTST pasteurization versus € 5,912.00 for HoP). The cost of healthcare professionals was reduced by more than half when pasteurization was carried out by the HTST method versus the Holder method (€ 84.00 and € 191.00, respectively). In scenario 3, the unit cost of milk pasteurized by the HTST method decreased from the first to the second year by 43.5%, while for the HoP method, it decreased by 30%.ConclusionsHTST pasteurization requires a high initial investment in equipment; however, it provides a significant minimization of production costs in the long term, pasteurizes large quantities of donor milk per working day and achieves a more efficient management of the time of the health care professionals in charge of the bank’s operation compared to HoP.

Value Challenge: A Bottoms-Up Approach to Minimizing Cost and Waste in Orthopaedic Surgery.

Orthopaedic surgical residents from an academic program with a Level I trauma center were queried during 2019 to 2022 regarding suggestions for cost containment opportunities. Based on feasibility and the estimated impact, 7 responses were selected to undergo cost-saving analyses. The proposed initiatives fell into 2 categories: minimizing waste and optimizing patient care. Eliminating nonessential physical therapy/occupational therapy consults led to the greatest estimated savings ($8.6M charges/year), followed by conserving reusable drill bits ($2.2M/year) and reducing computed tomography scans on lower extremity injuries ($446K/year). Current medical training provides limited formal education on cost-effective care. Efforts to mitigate the growing financial and environmental costs of health care should include encouraging and incorporating resident feedback into cost reduction strategies. This tactic will likely have a positive impact on the behavior of such resident surgeons as they enter practice and have more awareness of costs and value. V (cost-minimization study).

Breast cancer molecular diagnostics in Rwanda: a cost-minimization study of immunohistochemistry versus a novel GeneXpert® mRNA expression assay.

To compare the financial and time cost of breast cancer biomarker analysis by immunohistochemistry with that by the Xpert® STRAT4 assay. We estimated costs (personnel, location, consumables and indirect) and time involved in breast cancer diagnosis at the Butaro Cancer Centre of Excellence, Rwanda, using time-driven activity-based costing. We performed a cost-minimization analysis to compare the cost of biomarker analysis for estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 status with immunohistochemistry versus STRAT4. We performed sensitivity analyses by altering laboratory-specific parameters for the two methods. We estimated that breast cancer diagnosis in Rwanda costs 138.29 United States dollars (US$) per patient when conducting biomarker analysis by immunohistochemistry. At a realistic immunohistochemistry antibody utilization efficiency of 70%, biomarker analysis comprises 48.7% (US$67.33) of diagnostic costs and takes 33min. We determined that biomarker analysis with STRAT4 yields a reduction in diagnosis cost of US$7.33 (10.9%; 7.33/67.33), and in pathologist and technician time of 20min (60.6%; 20/33), per patient. Our sensitivity analysis revealed that no cost savings would be made in laboratories with antibody utilization efficiencies over 90%, or where only estrogen and/or progesterone receptor status are assessed; however, such operational efficiencies are unlikely, and more laboratories are pursuing human epidermal growth factor receptor-2 analysis as targeted therapies become increasingly available. Breast cancer biomarker analysis with STRAT4 has the potential to reduce the required human and capital resources in sub-Saharan African laboratories, leading to improved treatment selection and better clinical outcomes.

Asynchronous tele-expertise (ASTE) for prenatal diagnosis is feasible and cost saving: Results of a French case study.

The objective of this study was to assess the potential of the use of asynchronous tele-expertise (ASTE) to provide prenatal diagnosis from a medical and economic point of view. Patients screened by a midwife at a primary center. A technical and clinical evaluation was conducted retrospectively, and a cost minimization study compared asynchronous tele-expertise to face-to-face consultations that would have been performed without ASTE. In our study we assessed the feasibility of ASTE, what were the origins of the requests for expertise, whether patients need to be moved and the reasons for doing so, and the costs of tele-expertise and conventional consultation. In this retrospective analysis 322 advices from 260 patients were interpreted remotely via a platform. The results revealed a 90.68% feasibility of transmitting in a satisfactory and interpretable way ultrasound images and videos via the tele-expertise platform (292/322 files). In our series, asynchronous analysis allowed the required physician to make an accurate diagnosis and identify 74 (28.5%, 95% CI [23% -33.9%]) pregnancies associated with malformations and rule out abnormalities in 186 (71.5%, 95% CI [66.1% -77%]) of the cases. The ASTE was not associated with face-to-face consultations for 72.7% (189/260) of the patients, who without moving, were able to have access to a precise diagnosis by ruling out the presence of anomalies in 163/189 of these patients and confirming them in 26/189 patients. The practice of ASTE would result from a societal point of view, an average saving of 61.8% (€ 120.57) per patient compared to a face-to-face consultation. The use of asynchronous tele-expertise (ASTE) using fetal ultrasound, is feasible and may contribute to increased diagnostic accuracy while generating a significant reduction in costs for society.

Cost Minimization Study of Analgesics Prescribed to Outpatients Undergoing Periodontal Treatment

Aims: Drug use reviews are useful quantitative tools for assessing options for drug prescribing in dental pain. Regular drug use pattern evaluations help to identify current medication usage patterns, improve treatment efficacy, reduce adverse effects, and advise prescribers. The goal of this study was to look at the analgesics prescribed to outpatients in the department of periodontics to see if they could be cut back on costs.
 Methodology: A prospective cross-sectional drug utilisation evaluation was conducted among outpatients in the department of periodontics of a dental college in Himachal Pradesh from August 2020 to July 2021. In order to determine prescriber adherence to WHO guidelines, the proportion of analgesics written in generic names and from the NLEM 2015 were determined. The costs of prescribed analgesics (brand name and generic name) were calculated to determine the patient's out-of-pocket expenses.
 Result: The prescribed analgesics cost 74632.75 INR. The Aceclofenac/ paracetamol/ serratiopeptidase combination was the most commonly recommended analgesic. If all medicines were prescribed with generic names, the cost of analgesics could be cut by 85%.
 Conclusion: Prescriptions for brand names were the primary cause of the prescription's high cost. The use of generic drugs should be expanded. In order to satisfy WHO requirements, it is necessary to increase the number of medications prescribed in line with NLEM.

A cost-minimization analysis comparing teledermoscopy and face-to-face evaluations of suspicious skin lesions in Southern Denmark.

Skin cancers are common in European populations and generate considerable costs. In Denmark, patients with suspicious skin lesions will usually consult their general practitioner who may refer the patient to a dermatologist or plastic surgeon if necessary. However, it is also possible for the general practitioner to take and send dermoscopic and macroscopic photographs of the suspicious skin lesion for evaluation by a dermatologist, so-called teledermoscopy. This study aims to calculate and compare costs of teledermoscopy and standard care in the form of face-to-face evaluation by a dermatologist of suspicious skin lesions referred by general practitioners in the Region of Southern Denmark. A cost-minimization study was performed. Investment costs, costs in general practice, hospital-associated costs and patient costs were included to calculate the average cost per patient episode. The overall cost of teledermoscopy was €17.2-€23.1 higher than that of standard care. However, hospital-associated costs and patient costs were reduced. The total cost of teledermoscopy was slightly higher than the cost of standard care. Sensitivity analyses indicated that the number of preventable face-to-face evaluations and the distance to the dermatologist were the two factors that influenced costs the most.

Total intravenous anesthesia vs inhalational anesthesia in patients undergoing surgery under general anesthesia. Cost-minimization study

Introduction: The methods most frequently used at the present time in Colombia for the administration of general anesthesia are based on halogenated and intravenous drugs. However, in view of the lack of differential clinical outcomes, the existence of cost variations between the two is not clear.
 Objective: To determine the expected cost of the use of both techniques in patients taken to surgery, within the framework of the Colombian national health system.
 Methods: A cost minimization study was carried out using the decision tree as the analytical model. A time frame of 6 postoperative hours was used as the assumption. Only direct healthcare-related costs were included using a case study approach. An econometric model was used based on the frequency with which each technology is applied and the type of drug used, and a deterministic and probabilistic sensitivity analysis was performed.
 Results: For the case study, total intravenous anesthesia (TIVA) is more costly than the inhalational technique, with an incremental cost of $102,718 per patient. The deterministic analysis shows that both the incidence of postoperative nausea and vomiting (PONV) as well as the use of target controlled infusion (TCI) techniques are the main cost determinants. The probabilistic analysis shows that the cost difference can even be nil in more than 50% of the simulated settings, when the difference in the risk of PONV is higher.
 Conclusions: Although the total intravenous technique can be more costly than the inhalational technique, this difference is offset by a lower cost of the postanesthesia care unit, given the lower risk of postoperative nausea and vomiting.

Multiple-access versus telemedicine home-based sleep apnea testing for obstructive sleep apnea (OSA) diagnosis: a cost-minimization study.

PurposeThe aim of the present study was to compare two clinical pathways: the multiple-access outpatient pathway versus the telemedicine pathway.MethodsThe multiple-access outpatient pathway and the telemedicine pathway were both performed with WatchPAT and implemented in a real-life healthcare scenario, adopting a cost-minimization approach. A cost-minimization analysis was undertaken to assess the economic impact of the two alternatives. The cost analyses were performed in euros for the year 2021 adopting the patient, the hospital, and the societal perspectives. Given the chosen perspectives, direct medical costs, direct nonmedical costs, and indirect costs were considered. In addition, a univariate sensitivity analysis was conducted.ResultsFrom a hospital perspective, the telemedicine approach was estimated to cost €49 more than the multiple-access alternative. Considering the patient perspective, the telemedicine approach was estimated to cost €167 less than the multiple-access pathway. Considering the societal perspective, the telemedicine approach is estimated to cost €119 less than the multiple-access pathway.ConclusionThe adoption of telemedicine home sleep apnea testing could improve the efficiency of the healthcare processes if considering the direct and indirect costs incurred by patients and not only by healthcare providers.

Cost impact of procalcitonin-guided decision making on duration of antibiotic therapy for suspected early-onset sepsis in neonates

BackgroundsThe large, international, randomized controlled NeoPInS trial showed that procalcitonin (PCT)-guided decision making was superior to standard care in reducing the duration of antibiotic therapy and hospitalization in neonates suspected of early-onset sepsis (EOS), without increased adverse events. This study aimed to perform a cost-minimization study of the NeoPInS trial, comparing health care costs of standard care and PCT-guided decision making based on the NeoPInS algorithm, and to analyze subgroups based on country, risk category and gestational age.MethodsData from the NeoPInS trial in neonates born after 34 weeks of gestational age with suspected EOS in the first 72 h of life requiring antibiotic therapy were used. We performed a cost-minimization study of health care costs, comparing standard care to PCT-guided decision making.ResultsIn total, 1489 neonates were included in the study, of which 754 were treated according to PCT-guided decision making and 735 received standard care. Mean health care costs of PCT-guided decision making were not significantly different from costs of standard care (€3649 vs. €3616). Considering subgroups, we found a significant reduction in health care costs of PCT-guided decision making for risk category ‘infection unlikely’ and for gestational age ≥ 37 weeks in the Netherlands, Switzerland and the Czech Republic, and for gestational age < 37 weeks in the Czech Republic.ConclusionsHealth care costs of PCT-guided decision making of term and late-preterm neonates with suspected EOS are not significantly different from costs of standard care. Significant cost reduction was found for risk category ‘infection unlikely,’ and is affected by both the price of PCT-testing and (prolonged) hospitalization due to SAEs.

Cost comparisons of endoscopic and surgical resection of stage T1 rectal cancer

Background and study aims Management of T1 rectal cancer is complex and includes several resection methods, making cost comparisons challenging. The aim of this study was to compare costs of endoscopic and surgical resection and to investigate hypothetical cost scenarios for the treatment of T1 rectal cancer. Patients and methods Retrospective population-based cost minimization study on prospectively collected data on T1 rectal cancer patients treated using endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), open, laparoscopic, or robotic resection, in Skåne County, Sweden (2011–2017). The hypothetical cost scenarios were based on the distribution of high-risk features of lymph node metastases in a national cohort (2009–2017). Results Eighty-five patients with T1 RC undergoing ESD (n = 16), TEM (n = 17), open (n = 35), laparoscopic (n = 9), and robotic (n = 8) resection were included. ESD had a total 1-year cost of 5165 € and was significantly ( P < 0.05) less expensive compared to TEM (14871€), open (21 453 €), laparoscopic (22 488 €) and robotic resection (26 562 €). Risk factors for lymph node metastases were seen in 68 % of 779 cases of T1 rectal cancers included in the national cohort. The hypothetical scenario of performing ESD on all T1 RC had the lowest total 1-year per patient cost compared to all other alternatives. Conclusions This is the first study analyzing total 1-year costs of endoscopic and surgical methods to resect T1 rectal cancer, which showed that the cost of ESD was significantly lower compared to TEM and surgical resection. In fact, based on hypothetical cost scenarios, ESD is still justifiable from a cost perspective even when all high-risk cases are followed by surgery in accordance to guidelines.

Telemedicine efficiently improves access to hepatitis C management to achieve HCV elimination in the penitentiary setting

IntroductionLinkage to care for hepatitis C includes a new tool: teleconsultation. Micro-elimination in prison is a recommendation and is feasible. An economic evaluation of telemedicine for hepatitis C virus (HCV) treatment in prisons has not yet been performed. This study aimed to provide a cost-minimization analysis comparing two strategies of HCV treatment in a prison: telemedicine clinical practice (TCP) and the usual clinical practice (UCP). MethodsAn observational cost-minimization study was carried out on a cohort of inmates who received anti-HCV treatment in El Dueso prison (May 2016–November 2017). A decision tree was constructed, incorporating different clinical profiles according to the severity of the disease, the results of diagnostic tests, and treatment outcomes as well as the costs of each profile. Satisfaction with telemedicine was evaluated through an 11-question questionnaire with a 5-point Likert scale. ResultsSeventy-five inmates were treated and underwent TCP with a follow-up of one year. The average cost per patient with the TCP strategy was €1,172 (€1,151 direct costs). Had UCP been carried out, the cost would have been €1,687 (€1,630 direct). Telemedicine consultation practice produced savings of €516 (30.6%) per patient, with total savings of €38,677. The transfer costs from prison to hospital represented the most important saving item, accounting for 99.3% of the TCP-related savings. The questionnaire revealed high levels of satisfaction with TCP, with a median score of 5 in each question. Sustained virological response rates were 94.7% after the first treatment and 100% after retreatment of the four relapses. ConclusionTelemedicine consultation practice is a more efficient strategy than UCP, mainly due to the reduction of transfer costs while preserving effectiveness and user satisfaction.

PMD13 A REAL-WORLD COST-MINIMIZATION ANALYSIS COMPARING THE USE OF DIFFERENT ENDOSCOPIC STAPLERS IN THORACOSCOPIC LOBECTOMY

Public hospitals in China are under increasing pressure to control healthcare expenditure growth. This has led to a tendency to procure consumable medical supplies based on acquisition price. However, procurement decisions should be based on an economic evaluation of the whole episode of care instead. This study aimed to investigate the overall impact of different endoscopic staplers on hospitalization costs of thoracoscopic lobectomy. This study used data from electronic medical records (EMR) of one of the largest research hospitals in Anhui Province. Patients who underwent VATS from 2016 to 2017 were selected. Based on types of stapler and cartridge used, patients were retrospectively grouped into two cohorts. Baseline characteristics of the two cohorts were evaluated to identify any significant differences. Hospitalization cost components were used as input for a cost-minimization analysis (CMA) model to calculate an episodic cost differential between the two cohorts. A probabilistic sensitivity analysis was performed to assess robustness of base case results. Base case analysis showed that lower overall episodic costs were achieved in the cohort with more expensive staplers. The mean episodic cost differential was more than $300. Sensitivity analysis indicated that the cohort with more expensive staplers had lower overall episodic costs in more than 85% of cases. This cost-minimization study has demonstrated that the economic impact of different medical supplies went beyond acquisition costs and extended to the overall hospitalization cost. This signifies that procurement decisions based solely on price may have unintended consequences. Hospital management would benefit from comprehensive value assessments when deciding on procurement strategies for consumable medical supplies.

PCN97 ANALYSIS OF THE OPERATING COSTS FROM THE CHEMOTHERAPY SERVICES IN THE COSTA RICAN SOCIAL SECURITY (CCSS) RELATED TO THE ADMINISTRATION OF MEDICINES INTRAVENOUS COMPARED TO SUBCUTANEOUS: VALIDATION IN THE CASE OF TRASTUZUMAB

To estimate the average operating cost per minute (AOCM) of one unit for administration of chemotherapy (UAC) in the CCSS, assess the existing installed capacity (IC), and its use, in order to use this data as input in the cost minimization study of two preparations of the monoclonal antibody trastuzumab for the adjuvant treatment of HER 2+ breast cancer, one to be administered intravenously and other one subcutaneously. We used the building, maintenance and equipment costs registered in the UAC from one national reference hospital, recently built, assessed its IC and from that information determined the AOCM; then, we described all the process from the arrival of patient, the preparation of medication, administration and discharge, for each route of administration, and then, compared each other, estimating its cost. We determined the AOCM in $0,44 US dollars per minute, 87% of it is defined by human resources. The current demand on UAC has an annual growth of 6,3%, IC is insufficient to attend this demand in normal working hours, so it is required extraordinary shifts. The time needed to administer one treatment with intravenous trastuzumab is five times greater than with the subcutaneous preparation. The use of subcutaneous preparation of trastuzumab offers an advantage to CCSS in terms of opportunity and financial costs, derived from a diminished time required to prepare and administer medication, which is critical considering that IC has been surpassed.

Robert S. Kirsner Gary Delhougne Richard J. Searle

The purpose of this economic evaluation was to determine the cost-effectiveness of single-use negative pressure wound therapy (sNPWT) compared with traditional NPWT (tNPWT) for the treatment of VLUs and DFUs in the United States. A Markov decision-analytic model was used to compare the incremental cost and ulcer weeks avoided for a time horizon of 12 and 26 weeks using lower extremity ulcer closure rates from a published randomized controlled trial (N = 161) that compared sNPWT with tNPWT. Treatment costs were extracted from a retrospective cost-minimization study of sNPWT and tNPWT from the payer perspective using US national 2016 Medicare claims data inflated to 2018 costs and multiplied by 7 to estimate the weekly costs of treatment for sNPWT and tNPWT. Two (2) arms of the model, tNPWT and sNPWT, were calculated separately for a combination of both VLU and DFU ulcer types. In this model, a hypothetical cohort of patients began in the open ulcer health state, and at the end of each weekly cycle a proportion of the cohort moved into the closed ulcer health state according to a constant transition probability. The costs over the defined timescale were summed to give a total cost of treatment for each arm of the model, and then the difference between the arms was calculated. Effectiveness was calculated by noting the incidence of healing at 12 and 26 weeks and the total number of open ulcer weeks; the incremental effectiveness was calculated as sNPWT effectiveness minus tNPWT effectiveness. Data were extracted to Excel spreadsheets and subjected to one-way sensitivity, scenario (where patients with unhealed ulcers were changed to standard care at 4 or 12 weeks), probabilistic, and threshold analyses. sNPWT was found to provide an expected cost saving of $7756 per patient and an expected reduction of 1.67 open ulcer weeks per patient over 12 weeks and a cost reduction of $15 749 and 5.31 open ulcer weeks over 26 weeks. Probabilistic analysis at 26 weeks showed 99.8% of the simulations resulted in sNPWT dominating tNPWT. Scenario analyses showed that sNPWT remained dominant over tNPWT (cost reductions over 26 weeks of $2536 and $7976 per patient, respectively). Using sNPWT for VLUs and DFUs is likely to be more cost-effective than tNPWT from the US payer perspective and may provide an opportunity for policymakers to reduce the economic burden of lower extremity ulcers.

Abstract P6-13-02: Subcutaneous trastuzumab for the treatment of HER2+ breast cancer in Canada: A cost-minimization study

Abstract Background: There is an urgent need to alleviate the pressure on healthcare resources and decrease treatment burden for patients. Recently, a new fixed dose subcutaneous (SC) formulation of trastuzumab was approved by Health Canada for use in HER2-positive breast cancer (HER2+ BC) patients. Studied in multiple trials and treatment settings, the totality of evidence demonstrated similar safety and efficacy to the IV formulation as well as a strong preference for trastuzumab SC by patients and health care professionals. Objective: To estimate the incremental costs/savings associated with the use of trastuzumab SC for the treatment of HER2+ BC if reimbursed with the same provincial funding criteria as trastuzumab IV in Ontario, Canada. Methods: An Excel-based cost-minimization and budget impact model was developed to determine the economic impact of trastuzumab SC in comparison to trastuzumab IV in Ontario. Direct medical costs in the analysis included drug acquisition, drug preparation, drug administration, central venous access device (CVAD), and systemic therapy suite costs. Results: Early and metastatic HER2+ BC patients treated with trastuzumab SC are expected to generate a net cost savings to the health system compared to treatment with trastuzumab IV. Savings are estimated at $11,943 per eBC patient and $11,943 per mBC patient, representing total savings of $15.8M in Year 1, $19.4M in Year 2, and $23.0M in Year 3. The use of trastuzumab SC in these populations enhances the ability of the payer to manage drug and medical resources, while offering a therapy that is aligned with patient and clinician preferences. Citation Format: Megan Coombes, Lori Yin, Ingrid Liu, Norman Shek, Flavia Rusu, Som Mukherjee. Subcutaneous trastuzumab for the treatment of HER2+ breast cancer in Canada: A cost-minimization study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-13-02.