Estimates Of Direct Costs Research Articles

PCN237 - Risk-Sharing Agreement: A Model For Her2 (+) Breast Cancer Suitable For The Chilean Context

A new coverage system for high-cost drugs is operating in Chile. The system covers the treatment with Traztuzumab (TZ) for metastasic and early HER2 (+) breast cancer (mBC and eBC). Pertuzumab (PT) in mBC is a complementary technology that can be considered for coverage. Among criteria for the evaluation, Risk-Sharing Agreements (RSA) have been added as requisite. The following work aims to present a model of RSA for HER2 (+) mBC breast cancer suitable for the Chilean context. Epidemiological data was analyzed to model demand side (mBC and eBC cases). Additionally, clinical trials were studied in terms of inclusion and exclusion criteria, treatment protocols, outcomes (Progression-Free Survival - PFS), horizons and persistent uncertainties. Supply-side was described with the aim to the estimation of direct costs of treatment. Key variables for the RSA were identified and finally, scenarios were identified and proper comparisons were conducted. The proposed RSA “Discount conditional to global treatment” entails a price decrease in TZ in eBC, which is the main expenditure component. This discount is conditional on the adoption of PT for mBC. When the payer accepts the incorporation of PT, the manufacturer activates a discount in TZ for mBC as well. If the payer incorporates PT without a RSA, its adoption would imply an increased expenditure for the system (+7.73%). Nonetheless, if the payer incorporates PT with this RSA, the system would experience savings (-10.22%). Recommendations for RSAs proposals were properly followed. These results were submitted to the authority, and expectations on the acceptance of the model are high, based on a wide national experience with the disease, increase in PFS, minimal transaction-costs associated and important expected savings.

Conjoint Analysis of Treatment Preferences for Nondisplaced Scaphoid Fractures.

We used conjoint analysis to assess the relative importance of factors that influence a patient's decision between surgical or nonsurgical management of a nondisplaced scaphoid fracture. Our hypothesis was that out-of-pocket costs will have a greater influence on decision making than the time spent in a cast or brace, degree of soreness, or the risk of treatment failure. Two-hundred and fifty participants were recruited using Amazon Mechanical Turk and asked to assume that they had experienced a nondisplaced scaphoid waist fracture. They then indicated their relative preferences among 13 pairs of alternatives with variations in the following attributes: time in a cast, time in a brace, duration of ongoing soreness, risk of treatment failure (by which we meant scaphoid nonunion), out-of-pocket costs based on estimates of direct costs ($500-2,500), and apprehension about surgery. A conjoint analysis was used to determine the relative importance of these factors when choosing between surgical or nonsurgical management. The factor with the greatest influence on treatment choice was the cost of the procedure. After assessing the respondent's apprehension to undergo surgery, a sensitivity analysis showed the proportion of respondents who would choose surgery given different outcomes. To make the predicted share of those who are "not worried" about surgery equal to those who are "somewhat worried" or "a little worried" would require that the cost of surgery increase by $2,700. In addition, 2 weeks in a cast, 3 weeks in a brace, 2 months of soreness, or a 2% increase in the risk of fracture nonunion generates the same surgical choice probability as a $2,000 increase in the out-of-pocket cost of surgery. As conceptualized in this conjoint analysis, out-of-pocket costs and apprehension about surgery seem to have a greater impact on a decision for surgery than the time spent in a brace or cast and the risk of treatment failure. Economic and decision analysis III.

Choosing wisely after publication of level I evidence in breast cancer radiotherapy.

BackgroundRecent trials in early-stage breast cancer support hypofractionated whole-breast radiotherapy (WBRT) as part of breast-conserving therapy (BCT). Evidence also suggests that radiotherapy (RT) omission may be reasonable for some patients over 70 years. Among radiation-delivery techniques, intensity-modulated RT (IMRT) is more expensive than 3-dimensional conformal RT (3DCRT). Based on this evidence, in 2013, the American Society for Radiation Oncology (ASTRO) recommended hypofractionated schedules for women aged ≥50 years with early-stage breast cancer and avoiding routine use of IMRT for WBRT. To assess response to level I evidence and adherence to ASTRO recommendations, we evaluated the pattern of RT use for early-stage breast cancer at our National Comprehensive Cancer Network institution from 2006 to 2008 and 2011 to 2013 and compared the results with national trends.MethodsData from a prospective database were extracted to include patients treated with BCT, aged ≥50 years, with histologic findings of invasive ductal carcinoma, stage T1-T2N0M0, estrogen receptor-positive, and HER2 normal. We retrospectively reviewed the medical records and estimated costs based on 2016 Hospital Outpatient Prospective Payment System (technical fees) and Medicare Physician Fee Schedule (professional fees).ResultsAmong 55 cases from 2006 to 2008, treatment regimens were 11% hypofractionated, 69% traditional schedule, and 20% RT omission (29% of patients were aged >70 years). Among 83 cases from 2011 to 2013, treatment regimens were 54% hypofractionated, 19% traditional schedule, and 27% RT omission (48% of patients were aged >70 years). 3DCRT was used for all WBRT treatments. Direct medical cost estimates were as follows: 15 fractions 3DCRT, $7,197.87; 15 fractions IMRT, $11,232.33; 25 fractions 3DCRT, $9,731.39; and 25 fractions IMRT, $16,877.45.ConclusionDespite apparent resistance to shorter radiation schedules in the United States, we demonstrate that rapid practice change in response to level I evidence is feasible. Wider adoption of evidence-based guidelines in early-stage breast cancer may substantially lower health care costs and improve convenience for patients without sacrificing oncologic outcomes.

The economic burden of overactive bladder in the United States: A systematic literature review.

Overactive bladder (OAB) affects up to 17% of the United States (US) population. This study aimed to synthesize estimates of direct and indirect costs of OAB in the US and compare costs among those with and without OAB. A systematic review was performed using MEDLINE/PubMed and Embase, from 2003 to 2016, following PRISMA guidelines. The target population was adults with idiopathic OAB or urge urinary incontinence from the US. Data were extracted on study and patient characteristics, all-cause and OAB-specific direct costs, resource use, and indirect costs. Costs were inflated to a common price year of 2016 USD. Eighteen studies were included. Mean insurer paid all-cause total direct healthcare costs ranged from 8168 to 15 569 USD, and OAB-specific costs ranged from 656 to 860 USD per-patient annually. Estimates of the incremental costs for OAB patients compared to non-OAB comparators ranged from 43% to 117%. One study estimated total annual indirect costs of OAB at 11 134 USD per-patient. The range of direct healthcare costs reported for managing patients with OAB varied, but was relatively small given the differing contributing data sources, study designs, and cost definitions. Direct costs were consistently higher among patients with OAB versus non-OAB comparisons, from a 1.4- to >2-fold increase annually. OAB-specific costs made up a small proportion of all-cause costs, highlighting the clinical and economic impact of OAB-related conditions such as falls, urinary tract infection, and depression. Few studies were identified that examined the indirect costs of OAB in the US.

Resilience to a Cyber-Attack on the Automobile Industry: A Computable General Equilibrium Approach

The overall objective of this research is to improve risk management for cyber-threats among both private and public sectors through better understanding of the economic consequence of cyber-attacks and the benefits of various cyber resilience tactics in reducing these consequences. This is carried out in 3 stages: 1) estimation of direct effectiveness and costs of post-attack cyber resilience tactics; 2) adaptation of a state-of-the-art economic impact modeling approach to estimate cyber-attack consequences and resilience potential at both the microeconomic and macroeconomic levels; and 3) an empirical assessment of cyber-resilience in the U.S. Automobile Industry using the economic model to provide insights for decision makers to enhance resilience to cyber-attacks.

The Annual Economic Burden of Syphilis: An Estimation of Direct, Productivity, and Intangible Costs for Syphilis in Guangdong Initiative for Comprehensive Control of Syphilis Sites.

Syphilis has continuously posed a great challenge to China. However, very little data existed regarding the cost of syphilis. Taking Guangdong Initiative for Comprehensive Control of Syphilis area as the research site, we aimed to comprehensively measure the annual economic burden of syphilis from a societal perspective. Newly diagnosed and follow-up outpatient cases were investigated by questionnaire. Reported tertiary syphilis cases and medical institutions cost were both collected. The direct economic burden was measured by the bottom-up approach, the productivity cost by the human capital method, and the intangible burden by the contingency valuation method. Three hundred five valid early syphilis cases and 13 valid tertiary syphilis cases were collected in the investigation to estimate the personal average cost. The total economic burden of syphilis was US $729,096.85 in Guangdong Initiative for Comprehensive Control of Syphilis sites in the year of 2014, with medical institutions cost accounting for 73.23% of the total. Household average direct cost of early syphilis was US $23.74. Average hospitalization cost of tertiary syphilis was US $2,749.93. Of the cost to medical institutions, screening and testing comprised the largest proportion (26%), followed by intervention and case management (22%) and operational cost (21%). Household average productivity cost of early syphilis was US $61.19. Household intangible cost of syphilis was US $15,810.54. Syphilis caused a substantial economic burden on patients, their families, and society in Guangdong. Household productivity and intangible costs both shared positive relationships with local economic levels. Strengthening the prevention and effective treatment of early syphilis could greatly help to lower the economic burden of syphilis.

Trends in healthcare expenditure among people living with HIV/AIDS in the United States: evidence from 10\xa0Years of nationally representative data

BackgroundWhile previous studies have examined HIV cost expenditures within the United States, the majority of these studies focused on data collected prior to or shortly after the advent and uptake of antiretroviral therapy, focused only on a short time frame, or did not provide cost comparisons between HIV/AIDS and other chronic conditions. It is critical that researchers provide accurate and updated information regarding the costs of HIV care to assist key stakeholders with economic planning, policy development, and resource allocation.MethodsWe used data from the Medical Expenditure Panel Survey-Household Component for the years 2002–2011, which represents a nationally representative U.S. civilian non-institutionalized population. Using generalized linear modeling, we estimated the adjusted direct medical expenditures by HIV/AIDS status after controlling for confounding factors.ResultsData were from 342,732 people living with HIV/AIDS. After adjusting for socio-demographic factors, comorbidities and time trend covariates, the total direct expenditures for HIV/AIDS was $31,147 (95% CI $23,645–$38,648) or 800–900% higher when compared to those without HIV/AIDS (i.e., diabetes, stroke, and cardiovascular disease). Based on the adjusted mean, the aggregate cost of HIV/AIDS was approximately $10.7 billion higher than the costs for those without HIV/AIDS.ConclusionsOur estimates of cost expenditures associated with HIV care over a 10-year period show a financial burden that exceeds previous estimates of direct medical costs. There is a strong need for investment in combination prevention and intervention programs, as they have the potential to reduce HIV transmission, and facilitate longer and healthier living thereby reducing the economic burden of HIV/AIDS.

Direct Medical Costs In The Year Of Mortality For Patients With Diabetes: A Population-Based Patient-Level Analysis

Estimates of direct medical cost associated with diabetes-related complications in the event and subsequent years have been quantified but costs in the mortality year have never been reported. This study aimed to estimate the direct medical costs of patients with diabetes mellitus (DM) in the year of mortality and the year before mortality. We analyzed a population-based, retrospective cohort study including all adults with DM managed under public sector between 2009 and 2013 in Hong Kong. Individuals died between January 1, 2010 and December 31, 2013 were included in analysis. Annual direct medical costs in year of mortality and the year before mortality per patient were analyzed by gender, the presence of co-morbidities, the presence of diabetic complications (heart disease, stroke, diabetic nephropathy, or diabetic retinopathy), and primary cause of death. A total of 6,919 met the eligibility criteria for analysis. The commonest cause of death among DM patients was neoplasms (2261, 32.7%), followed by diseases of respiratory system (1725, 24.9%) and diseases of circulatory system (1113, 16.1%). On average, the direct medical costs in the year of death were 2.075 times higher than those in the year before death (US$23,256.1 vs US$11,205.2, p<0.001). Female patients had slightly higher costs in the year of mortality (US$23,337.2 vs US$23,172.8) and the year before mortality (US$11,261.5 vs US$11,147.3) than male patients. The increase in Charlson index was associated with greater costs in the mortality year. Patients with any diabetic complications had greater costs in the year of mortality (US$25,909.3 vs US$20,625.2) and before mortality (US$13,218.7 vs US$9,208.5) than those without. This analysis provided new evidence on incorporating additional direct medical cost in the mortality year, and refining total cost estimation for studies on costing and cost-effectiveness analyses of health interventions for diabetes.

Electricity Interconnection in Chile: Prices versus Costs

Having a well-adapted transmission network is key for reaching a sustainable energy system, where generators and consumers participate in an efficient market. The purpose of the present research is to estimate the impact on the final prices of the interconnection of the two largest electrical systems in Chile. To this end, an econometric model is used in which prices, among other variables, are explained by the level of marginal costs in the system (opportunity cost), the degree of concentration in the market (market power), and the variability of marginal costs projected by the agents (risk). The data corresponds to bilateral contracts between generators and major clients, from 2006 to 2014. The basic results indicate that the interconnection would benefit final customers by reducing equilibrium contract prices, as a result of the decreased variability of expected marginal costs and a lower concentration of existing generating companies. This study’s main contribution is to focus on the benefits of electricity interconnection under conditions of competition and risk, instead of using the simple estimation of direct costs, as has traditionally been done.

DC-Obesity: A New Model for Estimating Differential Lifetime Costs of Overweight and Obesity by Socioeconomic Status.

The aim of this study was to quantify the magnitude of lifetime costs of overweight and obesity by socioeconomic status (SES). Differential Costs (DC)-Obesity is a new model that uses time-to-event simulation and the Markov modeling approach to compare lifetime excess costs of overweight and obesity among individuals with low, middle, and high SES. SES was measured by a multidimensional aggregated index based on level of education, occupational class, and income by using longitudinal data of the German Socioeconomic Panel (SOEP). Random-effects meta-analysis was applied to combine estimates of (in)direct costs of overweight and obesity. DC-Obesity brings attention to opposite socioeconomic gradients in lifetime costs due to obesity compared to overweight. Compared to individuals with obesity and high SES, individuals with obesity and low SES had lifetime excess costs that were two times higher (€8,526). In contrast, these costs were 20% higher in groups with overweight and high SES than in groups with overweight and low SES (€2,711). The results of this study indicate that SES may play a pivotal role in designing cost-effective and sustainable interventions to prevent and treat overweight and obesity. DC-Obesity may help public policy planners to make informed decisions about obesity programs targeted at vulnerable SES groups.

An economic analysis of a system wide Lean approach: cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012\u20132014

BackgroundThe costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This paper reports direct and indirect cost estimates for the initial phase of the province-wide implementation of Lean activities in Saskatchewan, Canada.MethodsIn order to obtain detailed information about each type of Lean event, as well as the total number of corresponding Lean events, we used the Provincial Kaizen Promotion Office (PKPO) Kaizen database. While the indirect cost of Lean implementation has been estimated using the corresponding wage rate for the event participants, the direct cost has been estimated using the fees paid to the consultant and other relevant expenses.ResultsThe total cost for implementation of Lean over two years (2012–2014), including consultants and new hires, ranged from $44 million CAD to $49.6 million CAD, depending upon the assumptions used. Consultant costs accounted for close to 50% of the total. The estimated cost of Lean events alone ranged from $16 million CAD to $19.5 million CAD, with Rapid Process Improvement Workshops requiring the highest input of resources.ConclusionsRecognizing the substantial financial and human investments required to undertake reforms designed to improve quality and contain cost, policy makers must carefully consider whether and how these efforts result in the desired transformations. Evaluation of the outcomes of these investments must be part of the accountability framework, even prior to implementation.

Comparative analysis of cast-in-place post-tensioned and steel\u2013concrete composite bridge bent caps

The complexity of the IH-635 Managed Lanes Project, located in Dallas County, Texas, posed several technical and constructive challenges, leading to the adoption of solutions different from the traditional. Two alternative solutions for the pier cap on one of the bridge crossings over IH-35E in the IH-635 project were analyzed in this case study, a cast-in-place post-tensioned concrete cap and an innovative prefabricated steel–concrete composite cap. The approach was to use an estimation of direct costs for material and labor and consideration of construction time schedules. A supplementary numerical modeling confirmed that both alternatives behave elastically under imposed loads. The direct cost of material and labor for the two alternatives were close. However, the composite alternative required 13 days less construction time, resulting in substantial cost savings from traffic closing in the very busy traffic corridor. Traffic closing costs were substantially higher than the direct costs, especially for the post-tensioned cap. The quantification of the benefits allows more confidence in the utilization of the composites caps, leading to faster completion of bridge projects and substantial economic savings.

Expert panel on practice patterns in the management of cow’s milk protein allergy and associated economic burden of disease on health service in Turkey

Aims: To evaluate practice patterns in the management of cow’s milk protein allergy (CMPA) and associated economic burden of disease on health service in Turkey.Materials and methods: This study was based on experts’ views on the practice patterns in management of CMPA manifesting with either proctocolitis or eczema symptoms and, thereby, aimed to estimate economic burden of CMPA. Practice patterns were determined via patient flow charts developed by experts using the modified Delphi method for CMPA presented with proctocolitis and eczema. Per patient total 2-year direct medical costs were calculated, including cost items of physician visits, laboratory tests, and treatment.Results: According to the consensus opinion of experts, 2-year total direct medical cost from a payer perspective and societal perspective was calculated to be $US2,116.05 and $US2,435.84, respectively, in an infant with CMPA presenting with proctocolitis symptoms, and $US4,001.65 and $US4,828.90, respectively, in an infant with CMPA presenting with eczema symptoms. Clinical nutrition was the primary cost driver that accounted for 89–92% of 2-year total direct medical costs, while the highest total direct medical cost estimated from a payer perspective and societal perspective was noted for the management of an exclusively formula-fed infant presenting either with proctocolitis ($US3,743.85 and $US4,025.63, respectively) or eczema ($US6,854.10 and $US7,917.30, respectively). The first line use of amino acid based formula (AAF) was associated with total direct cost increment $US1,848.08 and $US3,444.52 in the case of proctocolitis and eczema, respectively.Limitations: Certain limitations to this study should be considered. First, being focused only on direct costs, the lack of data on indirect costs or intangible costs of illness seems to be a major limitation of the present study, which likely results in a downward bias in the estimates of the economic cost of CMPA. Second, given the limited number of studies concerning epidemiology and practice patterns in CMPA in Turkey, use of expert clinical opinion of the panel members rather than real-life data on practice patterns that were used to identify direct medical costs might raise a concern with the validity and reliability of the data. Also, while this was a three-step study with six experts included in the first stage (developing local guidelines for diagnosis, treatment, and follow-up of infants with CMPA in Turkey) and 410 pediatricians included in the second stage (a cross-sectional questionnaire-survey to determine pediatricians’ awareness and practice of CMPA in infants and children), only four members were included in the present Delphi panel, which allows a limited discussion. Third, lack of sensitivity analyses and exclusion of indirect costs and costs related to alterations in quality of life, behavior of infants, and general well-being of infants and their parents from the cost-analysis seems to be another limitation that may have caused under-estimation of relative cost-effectiveness of the formulae. Fourth, calculation of costs per local guidelines rather than real-life practice patterns is another limitation that, otherwise, would extend the knowledge achieved in the current study. Notwithstanding these limitations, the present expert panel provided practice patterns in the management of CMPA and an estimate of the associated costs, depending on the symptom profile at initial admission for the first time in Turkey.Conclusions: In conclusion, in providing the first health economic data on CMPA in Turkey, the findings revealed that CMPA imposes a substantial burden on the Turkish healthcare system from both a payer perspective and societal perspective, and indicated clinical nutrition as a primary cost driver. Management of infants presenting with eczema, exclusively formula-fed infants, and first line use of AAF were associated with higher estimates for 2-year direct medical costs.

Migraine Nurses in Primary Care: Costs and Benefits.

We examined the costs and benefits of introducing migraine nurses into primary care. Migraine is one of the most costly neurological diseases. We analyzed data from our earlier nonrandomized cohort study comparing an intervention group of 141 patients, whose care was supported by nurses trained in migraine management, and a control group of 94 patients receiving usual care. Estimates of per-person direct costs were based on nurses' salaries and referrals to neurologists. Indirect costs were estimated as lost productivity, including numbers of days of absenteeism or with <50% productivity at work due to migraine, and notional costs related to lost days of household activities or days of <50% household productivity. Analysis was conducted from the payer's perspective. After 9 months the direct costs were €281.11 in the control group against €332.23 in the intervention group (mean difference -51.12; 95% CI: -113.20-15.56; P = .134); the indirect costs were €1985.51 in the control group against €1631.75 in the intervention group (mean difference 353.75; 95% CI: -355.53-1029.82; P = .334); and total costs were €2266.62 in the control group, against €1963.99 in the intervention group (mean difference 302.64; 95% CI: -433.46-1001.27; P = .438). When costs attributable to lost household productivity were included, total costs increased to €6076.62 in the control group and €5048.15 in the intervention group (mean difference 1028.47; 95% CI: -590.26-2603.67; P = .219). Migraine nurses in primary care seemed in this study to increase practice costs but decrease total societal costs. However, it was a nonrandomized study, and the differences did not reach significance. For policy-makers concerned with headache-service organization and delivery, the important messages are that we found no evidence that nurses increased overall costs, and investment in a definitive study would therefore be worthwhile.

A comparison of clinical trial and model-based cost estimates in glaucoma – The case of repeat laser trabeculoplasty In Ontario

Economic evaluations of glaucoma interventions require accurate costs in addition to effectiveness data. However, the impact of different costing methods on cost estimates has not been investigated. Direct cost estimates alongside clinical trials may be labour-intensive and expensive, modelled cost using literature sources and institutional experience may be an alternative. We investigated modeled and directly collected costs of a trial comparing argon- and selective-laser trabeculoplasty (ALT and SLT) among glaucoma patients at St. Joseph’s Health Care in London, ON between 2013 and 2014, also comparing ministry and societal perspectives and cost drivers. Model and trial cost estimates differed minimally for the ministry perspective (8% and 4% for ALT and SLT) despite differences in modeled and observed parameter values and treatment pathways. Labour accounted for 90% of total cost. Costs were similar for the societal perspective although there was sensitivity to assumptions regarding patient time loss. Indirect costs were at least as large as direct medical costs. Modeled costs were an acceptable substitute for directly measured costs in this scenario.

Dalteparin or vitamin K antagonists to prevent recurrent venous thromboembolism in cancer patients: a patient-level economic analysis for France and Austria.

International guidelines recommend extended duration secondary prophylaxis in cancer patients who develop primary venous thromboembolism (VTE). Agent selection is guided in part by one large randomized trial (i.e., CLOT; Lee et al., N Engl J Med 349:146-53, 2003) which demonstrated that dalteparin reduced the relative risk of recurrence by 52% compared with oral vitamin K antagonists (VKA; HR=0.48, 95% CI, 0.30 to 0.77). In a subgroup analysis from that same trial, patients with renal impairment also derived benefit with dalteparin (VTE rates=3% vs. 17%; p=0.011). To measure the economic value of secondary VTE prophylaxis with dalteparin, a patient-level pharmacoeconomic analysis was conducted from the Austrian and French healthcare system perspectives. Chapter 1 Healthcare resource use collected during the CLOT trial was extracted and converted into direct cost estimates. Incremental cost differences between the dalteparin and VKA groups were then combined with health state utilities to measure the cost per quality-adjusted life year (QALY) gained. The dalteparin group had significantly higher costs than the VKA group in both countries (Austria: dalteparin=€2687 vs. VKA=€2012; France: dalteparin=€2053 vs. VKA=€1352: p<0.001). However, when the incremental costs were combined with the utility gain, dalteparin had a cost of €6600 and €4900 per QALY gained in Austria and France, respectively. The analyses in patients with renal impairment suggested an even better economic profile, with the cost per QALY gained being less than €4000 in both countries. Secondary prophylaxis with dalteparin is a cost-effective alternative to VKA for the prevention of recurrent VTE in patients with cancer.

Cost-utility of First-line Disease-modifying Treatments for Relapsing–Remitting Multiple Sclerosis

PurposeThis study evaluated the cost-effectiveness of first-line treatments of relapsing–remitting multiple sclerosis (RRMS) (dimethyl fumarate [DMF] 240 mg PO BID, teriflunomide 14 mg once daily, glatiramer acetate 20 mg SC once daily, interferon [IFN]-β1a 44 µg TIW, IFN-β1b 250 µg EOD, and IFN-β1a 30 µg IM QW) and best supportive care (BSC) in the health care payer setting in Finland. MethodsThe primary outcome was the modeled incremental cost-effectiveness ratio (ICER; €/quality-adjusted life-year [QALY] gained, 3%/y discounting). Markov cohort modeling with a 15-year time horizon was employed. During each 1-year modeling cycle, patients either maintained the Expanded Disability Status Scale (EDSS) score or experienced progression, developed secondary progressive MS (SPMS) or showed EDSS progression in SPMS, experienced relapse with/without hospitalization, experienced an adverse event (AE), or died. Patients׳ characteristics, RRMS progression probabilities, and standardized mortality ratios were derived from a registry of patients with MS in Finland. A mixed-treatment comparison (MTC) informed the treatment effects. Finnish EuroQol Five-Dimensional Questionnaire, Three-Level Version quality-of-life and direct-cost estimates associated with EDSS scores, relapses, and AEs were applied. Four approaches were used to assess the outcomes: cost-effectiveness plane and efficiency frontiers (relative value of efficient treatments); cost-effectiveness acceptability frontier, which demonstrated optimal treatment to maximize net benefit; Bayesian treatment ranking (BTR); and an impact investment assessment (IIA; a cost-benefit assessment), which increased the clinical interpretation and appeal of modeled outcomes in terms of absolute benefit gained with fixed drug-related budget. Robustness of results was tested extensively with sensitivity analyses. FindingsBased on the modeled results, teriflunomide was less costly, with greater QALYs, versus glatiramer acetate and the IFNs. Teriflunomide had the lowest ICER (24,081) versus BSC. DMF brought marginally more QALYs (0.089) than did teriflunomide, with greater costs over the 15 years. The ICER for DMF versus teriflunomide was 75,431. Teriflunomide had >50% cost-effectiveness probabilities with a willingness-to-pay threshold of <€77,416/QALY gained. According to BTR, teriflunomide was first-best among the disease-modifying therapies, with potential willingness-to-pay thresholds of up to €68,000/QALY gained. In the IIA, teriflunomide was associated with the longest incremental quality-adjusted survival and time without cane use. Generally, primary outcomes results were robust, based on the sensitivity analyses. The results were sensitive only to large changes in analysis perspective or mixed-treatment comparison. ImplicationsThe results were sensitive only to large changes in analysis perspective or MTC. Based on the analyses, teriflunomide was cost-effective versus BSC or DMF with the common threshold values, was dominant versus other first-line RRMS treatments, and provided the greatest impact on investment. Teriflunomide is potentially the most cost-effective option among first-line treatments of RRMS in Finland.

The Cost of Postoperative Pancreatic Fistula Versus the Cost of Pasireotide: Results from a Prospective Randomized Trial.

The objective of this study was to determine the costs of clinically significant postoperative pancreatic fistula (POPF) and to evaluate the cost-effectiveness of routine pasireotide use. We recently completed a prospective randomized trial that demonstrated an 11.7% absolute risk reduction of clinically significant POPF with use of perioperative pasireotide in patients undergoing pancreaticoduodenectomy or distal pancreatectomy [POPF: pasireotide (n = 152), 9% vs placebo (n = 148), 21%; P = 0.006]. An institutional modeling system was utilized to obtain total direct cost estimates from the 300 patients included in the trial. This system identified direct costs of hospitalization, physician fees, laboratory tests, invasive procedures, outpatient encounters, and readmissions. Total direct costs were calculated from the index admission to 90 days after resection. Costs were converted to Medicare proportional dollars (MP$). Clinically significant POPF occurred in 45 of the 300 randomized patients (15%). The mean total cost for all patients was MP$23,400 (MP$8,000 - MP$202,500). The mean cost for those who developed clinically significant POPF was MP$39,700 (MP$13,800 - MP$202,500) versus MP$20,500 (MP$8,000 - MP$62,900) for those who did not (P = 0.001). The mean cost of pasireotide within the treatment group (n = 152) was MP$3,300 (MP$300 - MP$3,800). The mean cost was lower in the pasireotide (n = 152) group than the placebo (n = 148) group; however, this did not reach statistical significance (pasireotide, MP$22,800 vs placebo, MP$23,900: P = 0.571). The development of POPF nearly doubled the total cost of pancreatic resection. In this randomized trial, the routine use of pasireotide significantly reduced the occurrence of POPF without increasing the overall cost of care.

P3.07-010 Economic Evaluation of Gefitinib vs. Erlotinib for First Line in NSCLC EGFRm under the Perspective of Brazilian Health System: Topic: Therapy and Economics

About 28,220 new cases of lung cancer are going to be diagnosed in Brazil in 2016. The epidermal growth factor receptor (EGFR) is a transmembrane protein with tyrosine kinase activity associated with growth, survival, proliferation and differentiation in different human cells. Approximately 25.5% of patients with non-small lung cancer cells (NSCLC) in Brazil present activating mutations in EGFR gene, which confers sensitivity to tyrosine kinase inhibitors (gefitinib and erlotinib). Given the similarity in efficacy observed in RCTs, an economic evaluation under the perspective of the public and private sectors in Brazil was performed using a Markov model. Estimation of direct medical costs was calculated in a group of advanced NSCLC patients with EGFR mutations, undergoing first line treatment with one of the target therapies. A discount rate of 5% was applied on future costs/benefits and the rate of adverse events was extracted from a meta-analysis to estimate its costs. According to the model, patients with locally advanced or metastatic NSCLC who have EGFR activating mutations undergoing treatment first line with gefitinib required less resource versus erlotinib in both perspectives as shown in Table 1, mainly due to the price difference between the drugs (USD 984.22 versus USD 2,033.15 in the public and USD 1,440.31 versus USD 2,439.78 in the private).Table 1Estimated total costs for first line treatment with gefitinib or erlotinibStrategyTreatment Costs (USD)Incremental Costs (USD)Private SectorGefitinib26,637.12-Erlotinib42,110.0015,472.88Public SectorGefitinib16,134.00-Erlotinib32,045.4015,911.40Exchange rate 1 USD = 3.30 BRL (July/2016) Regarding costs related only to the management of adverse events, both strategies were similar in the public perspective (USD 94.15 for gefitinib versus USD 98.21 for erlotinib); however, gefitinib costs were lower than erlotinib (USD 625.27 versus USD 941.32, respectively) in the private sector. Open table in a new tab Exchange rate 1 USD = 3.30 BRL (July/2016) Regarding costs related only to the management of adverse events, both strategies were similar in the public perspective (USD 94.15 for gefitinib versus USD 98.21 for erlotinib); however, gefitinib costs were lower than erlotinib (USD 625.27 versus USD 941.32, respectively) in the private sector. First line treatment with gefitinib was dominant in comparison with erlotinib for NSCLC patients with EGFR mutation in both public and private sectors in Brazil.

Estimación de costos directos por estadio en cáncer colorectal en Chile

Estimación de costos directos por estadio en cáncer colorectal en Chile