National Health Insurance Perspective Research Articles

Évaluation médicoéconomique du PRADO-BPCO, programme d’accompagnement post-exacerbation

The "Programme d'Accompagnement du retour à Domicile" (PRADO) COPD is a home discharge support program dedicated to organizing care pathways following hospitalization for COPD exacerbation. This study aimed at assessing its medico-economic impact. This was a retrospective database study of patients included in the PRADO BPCO between 2017 and 2019. Data were extracted from the National Health Data System. A control group was built using propensity score matching. Morbi-mortality and costs (national health insurance perspective) were measured during the year following hospitalization. While the proportion of patients with a care pathway complying with recommendations from the National Health Authority was higher in the PRADO group, there was no significant effect on mortality and 12-month rehospitalization. In the PRADO group, the rehospitalization rate was lower when the care pathway was optimal. Healthcare costs per patient were 670 € higher in the PRADO group. The PRADO COPD improves quality of care but without decreasing rehospitalizations and mortality, although rehospitalizations did decrease among PRADO group patients benefiting from an optimal care pathway.

Real-world economic burden of hepatitis C and impact of direct-acting antivirals in France: A nationwide claims data analysis.

The economic impact of managing patients with hepatitis C virus (HCV) infection remains unknown. This study aimed to assess the economic burden of chronic HCV infection from a national health insurance perspective and the impact of direct-acting antivirals (DAAs) using nationwide real-world data. Patients with chronic HCV infection were identified from the French Health Insurance Claims Databases (SNDS) and matched for age and sex to the general population. Health resource utilization and reimbursements were summarized according to healthcare expenditure items from 2012 to 2021. The economic burden attributable to chronic HCV infection was evaluated over a 10-year period. Finally, the impact of DAAs was estimated using economic data derived from the SNDS. A total of 145 187 patients with chronic HCV infection were identified. Among the patients eligible for DAA therapy, 81.5% had received DAA by the end of 2021. Over a 10-year period, managing patients with chronic HCV infection resulted in an additional cost of €9.71 billion (95% confidence interval [CI]: €9.66-€9.78 billion) or €9191 (95% CI: €9134-€9252) per patient per year compared to the general population. After DAA therapy, patients with chronic HCV infection had a higher economic burden than the general population, with an additional cost of €5781 (95% CI: €5540-€6028) per patient at the fifth-year post-DAA therapy. A significant economic burden persists among patients with HCV infection after DAA treatment. The high proportion of patients not treated with DAA therapy supports reinforcing policies for universal access.

EE223 Estimation of the T-Cell Engagers (Bi-Specific Monoclonal Antibodies and Chimeric Antigen Receptor [CAR T-CELL]) Therapy Administration Pathways From French Hospitals and National Health Insurance Perspective and Financial Impact

EE223 Estimation of the T-Cell Engagers (Bi-Specific Monoclonal Antibodies and Chimeric Antigen Receptor [CAR T-CELL]) Therapy Administration Pathways From French Hospitals and National Health Insurance Perspective and Financial Impact

Cost-effectiveness analysis of secukinumab versus standard of care in the treatment of psoriatic arthritis: A Vietnam National health insurance perspective

Psoriatic arthritis (PsA) is a chronic, systemic inflammatory disease. This study assessed the cost-effectiveness of secukinumab, an interleukin-17A inhibitor, versus standard of care (SoC) from Vietnam’s National Health Insurance (NHI) perspective. Model-based cost-effectiveness analysis, the structure was a 3-month decision tree leading into a Markov model. Clinical parameters, including responses at 3 months, were from the FUTURE 2 trial. Cost parameters were from real data at the National Hospital of Dermatology and Venereology and a research period. The outcome included total costs and quality-adjusted life years (QALYs) over a life-time horizon (3.5% annual discount for both outcomes and cost), and incremental cost-effectiveness ratios (ICER). The robustness of the study findings was evaluated via sensitivity analysis. Patients treated with secukinumab achieved with QALY gain 1.16 versus SoC, but associated with higher total costs was 211.3 million VND over lifetime horizon. ICER for secukinumab vs SoC was 181.6 million VND lower than a willingness to pay threshold recommended in Vietnam (3GDP per capita equal to 286.8 million VND). Deterministic sensitivity analysis indicated that parameters related to Health Assessment Questionnaire scores were most influential. At the willingness to pay threshold of three times the GDPpc, the probability of secukinumab being cost-effective was 90.3% in the probabilistic sensitivity analysis. Secukinumab is a cost-effectiveness treatment versus SoC for PsA patients from the National health insurance’s perspective of Vietnam.

Newcard telemonitoring system improves survival at a lower cost than traditional approaches in chronic heart failure patients as assessed by data extract from the French National Health Data System

Abstract Background Despite widespread use of telemonitoring (TLM) for chronic heart failure (CHF) patients, outcome data remain scarce and medico – economic assessment not routinely addressed. In this setting, the French National Health Data System (SNDS) can be used to comprehensively collect health care costs for the entire French population whatever the type of TLM system. Purpose The aim of this study is to assess the health economic impact of telemonitoring among 1057 patients presenting heart failure matched with a control group selected in the SNDS Methods All patients TLM at least 3 months between 2017 and 2020 were included. For each patient identified by his single social security number (case), anonymised data was retrieved from the SNDS. A control group (CG) was randomly selected from an exhaustive extraction of SNDS of patients with heart failure without TLM. This CG was matched in a 1:3 ratio to TLM patients using a propensity score including baseline characteristics (i.e. gender, age group, social disadvantage index, presence of comorbidities (renal insufficiency, coronary disease, diabetes, cancer), presence of treatments (beta blockers, Sacubitril, aldosterone antagonists, aspirin/Clopidogrel, anticoagulants)). Costs were evaluated using French National Health Insurance perspective using €2022. Binomial negative GEE models were used on matched data sets to assess differences. Results The matching rate between patients included in the TLM arm and the SNDS database was excellent at 99%. Hence, 1,057 TLM patients were matched to 3,171 patients with heart failure. In the telemonitoring group (TLM), patients were 74 years old (±12,3), 68.4 % male, mean left ventricular ejection fraction 41 % and the mean follow-up by the TLM system was 618 days. At 1-year, 2-year and 3-year follow-up, survival rates were respectively of 96%, 91% and 87% for TLM patients vs 93%, 83% and 76% among CG patients (p<0.0001, figure 1). At 6 months, the monthly cost for managing patients was 1,403.2 € in the TLM group vs 1,251.5 € in the CG (p=0.0064). At 12 months, 949.52 € in the TLM group vs 1,114.40 in the CG (p<0.0001). At 24 months, 591.31 € in the TLM group vs 1,064.20 in the CG (p<0.0001). Conclusion While using common evaluation methods seems to be unsatisfactory, economic evaluation both costs and outcomes of an intervention could be more appropriate. The French SNDS is a powerful tool to implement such a type of study. The results presented here show on one hand a significant decrease in mortality in the TLM. On the economic hand, we show here an increase in cost during the first 6 months of the telemonitoring balanced with a significant decrease at 12 and 24 months. Especially, those data place telemonitoring of heart failure as a real improvement in the care pathway which needs time to be effective but is able to have an effect even on the mortality rate

Management of perioperative iron deficiency anemia as part of patient blood management in France: A budget impact model-based analysis based on real world data.

Patient Blood Management (PBM) is defined as a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment. As a corollary, it also reduces the utilization of allogeneic blood components. However, demonstrating cost-effectiveness depends on the health insurance system considered. This analysis aims to estimate the one-year budget impact of PBM in four elective surgical areas, from French National Health Insurance and hospital perspectives. A budget impact model was developed to estimate the difference in the cost of care between scenarios with and without PBM. The impact of hematopoiesis optimization (first pillar of PBM) was studied throughout the management of preoperative anemia and iron deficiency in four types of surgeries: orthopedic, cardiac & cardiovascular, vascular & thoracic, and urologic & visceral surgery. Estimation of model's parameters was based on data collected in 10 French hospitals, literature, and on data from the French national medico-administrative database. A total of 980,125 patients were modeled for all four therapeutic areas. Results shows that implementation of a PBM program could generate annual savings up to €1079 M from the French National Health Insurance perspective (€1018 M from the hospital perspective), and the sparing of 181,451 red blood cells units per year. The deterministic sensitivity analysis showed that PBM generates savings for both perspectives in most parameters tested. Implementing PBM programs could result in important savings for the health care system in France.

The increasing age of respiratory syncytial virus-related hospitalisation during COVID-19 pandemic in Lyon was associated with reduced hospitalisation costs

BackgroundPreventive measures applied during the COVID-19 pandemic have modified the age distribution, the clinical severity and the incidence of Respiratory Syncytial Virus (RSV) hospitalisations during the 2020/21 RSV season. The aim of the present study was to estimate the impact of these aspects on RSV-associated hospitalisations (RSVH) costs stratified by age group between pre-COVID-19 seasons and 2020/21 RSV season. MethodsWe compared the incidence, the median costs, and total RSVH costs from the national health insurance perspective in children < 24 months of age during the COVID-19 period (2020/21 RSV season) with a pre-COVID-19 period (2014/17 RSV seasons). Children were born and hospitalised in the Lyon metropolitan area. RSVH costs were extracted from the French medical information system (Programme de Médicalisation des Systémes d’Information). ResultsThe RSVH-incidence rate per 1000 infants aged < 3 months decreased significantly from 4.6 (95 % CI [4.1; 5.2]) to 3.1 (95 % CI [2.4; 4.0]), and increased in older infants and children up to 24 months of age during the 2020/21 RSV season. Overall, RSVH costs for RSVH cases aged below 2 years old decreased by €201,770 (31 %) during 2020/21 RSV season compared to the mean pre-COVID-19 costs. ConclusionsThe sharp reduction in costs of RSVH in infants aged < 3 months outweighed the modest increase in costs observed in the 3–24 months age group. Therefore, conferring a temporal protection through passive immunisation to infants aged < 3 months should have a major impact on RSVH costs even if it results in an increase of RSVH in older children infected later in life. Nevertheless, stakeholders should be aware of this potential increase of RSVH in older age groups presenting with a wider range of disease to avoid any bias in estimating the cost-effectiveness of passive immunisation strategies.

Efficiency and effectiveness of intensive multidisciplinary follow-up of patients with stroke/TIA or myocardial infarction compared to usual monitoring: protocol of a pragmatic randomised clinical trial. DiVa (Dijon vascular) study

IntroductionThe ongoing ageing population is associated with an increase in the number of patients suffering a stroke, transient ischaemic attack (TIA) or myocardial infarction (MI). In these patients, implementing secondary...

The Economic Burden of Disease in France From the National Health Insurance Perspective: The Healthcare Expenditures and Conditions Mapping Used to Prepare the French Social Security Funding Act and the Public Health Act.

Background:Identifying the most frequently treated and the costliest health conditions is essential for prioritizing actions to improve the resilience of health systems.Objectives:Healthcare Expenditures and Conditions Mapping describes the annual economic burden of 58 health conditions to prepare the French Social Security Funding Act and the Public Health Act.Design:Annual cross-sectional study (2015–2019) based on the French national health database.Subjects:National health insurance beneficiaries (97% of the French residents).Measures:All individual health care expenditures reimbursed by the national health insurance were attributed to 58 health conditions (treated diseases, chronic treatments, and episodes of care) identified by using algorithms based on available medical information (diagnosis coded during hospital stays, long-term diseases, and specific drugs).Results:In 2019, €167.0 billion were reimbursed to 66.3 million people (52% women, median age: 42 y). The most prevalent treated diseases were diabetes (6.0%), chronic respiratory diseases (5.5%), and coronary diseases (3.2%). Coronary diseases accounted for 4.6% of expenditures, neurotic and mood disorders 3.7%, psychotic disorders 2.8%, and breast cancer 2.1%. Between 2015 and 2019, the expenditures increased primarily for diabetes (+€906 million) and neurotic and mood disorders (+€861 million) due to the growing number of patients. “Active lung cancer” (+€797 million) represented the highest relative increase (+54%) due to expenditures for the expensive drugs and medical devices delivered at hospital.Conclusions:These results have provided policy-makers, evaluators, and public health specialists with key insights into identifying health priorities and a better understanding of trends in health care expenditures in France.

Hospital costs of Balloon Pulmonary Angioplasty (BPA) procedure and management for CTEPH patients: An observational study based on the French national hospital discharge database (PMSI).

Since 2014, Balloon Pulmonary Angioplasty (BPA) has become an emerging and complementary strategy for chronic thromboembolic hypertension (CTEPH) patients who are not suitable for pulmonary endarterectomy (PEA) or who have recurrent symptoms after the PEA procedure. To assess the hospital cost of BPA sessions and management in CTEPH patients. An observational retrospective cohort study of CTEPH-adults hospitalized for a BPA between January 1st, 2014 and June 30th, 2016 was conducted in the 2 centres performing BPA in France (Paris Sud and Grenoble) using the French national hospital discharge database (PMSI-MCO). Patients were followed until 6 months or death, whichever occurred first. Follow-up stays were classified as stays with BPA sessions, for BPA management or for CTEPH management based on a pre-defined algorithm and a medical review using type of diagnosis (ICD-10), delay from last BPA procedure stay and length of stay. Hospital costs (including medical transports) were estimated from National Health Insurance perspective using published official French tariffs from 2014 to 2016 and expressed in 2017 Euros. A total of 191 patients were analysed; mainly male (53%), with a mean age of 64,3 years. The first BPA session was performed 1.1 years in median (IQR 0.3-2.92) after the first PH hospitalisation. A mean of 3 stays with BPA sessions per patient were reported with a mean length of stay of 8 days for the first stay and 6 days for successive stays. The total hospital cost attributable to BPA was € 4,057,825 corresponding to €8,764±3,435 per stay and €21,245±12,843 per patient. Results were sensitive to age classes, density of commune of residence and some comorbidities. The study generated robust real-world data to assess the hospital cost of BPA sessions and management in CTEPH patients within its first years of implementation in France.

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

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

Real-world cost-effectiveness analysis of the fracture liaison services model of care for hip fracture in Taiwan

This study was to perform an economic evaluation to understand clinical outcomes and health resource use between hip fracture patients receiving hospital-based postfracture fracture liaison service (FLS) care and those receiving usual care (UC) in Taiwan. This cohort study included hospital-based data of 174 hip fracture patients who received FLS care (FLS group) from National Taiwan University Hospital, and 1697 propensity score-matched patients who received UC (UC group) of National Health Insurance claim-based data. Two groups had similar baseline characteristics but differed in hip fracture care after propensity score matching. Clinical outcomes included refracture-free survival (RFS), hip-refracture-free survival (HRFS), and overall survival (OS). Health resource use included inpatient, outpatient, and pharmacy costs within 2 years follow-up after the index of hip fracture. The economic evaluation of the FLS model was analyzed using the net monetary benefit regression framework based on the National Health Insurance perspective. The FLS group had longer RFS than the UC group, with an adjusted difference of 44.3 days (95% confidence interval: 7.2-81.4 days). Two groups did not differ in inpatient and outpatient costs during follow-up, but the FLS group had a higher expenditure than the UC group on osteoporosis-related medication. The probability of FLS being cost-effective was >80% and of increasing RFS, HRFS, and OS was 95%, 81%, and 80%, respectively, when the willingness-to-pay threshold was >USD 65/gross domestic product per day. FLS care was cost-effective in reducing refracture occurrence days for patients initially diagnosed with hip fractures.

Systematic Review: Economic Evaluation of Treatment for Human Epithelial Growth Factor Receptor 2-positive Metastatic Breast Cancer from a National Health Insurance Perspective

Background: Economic evaluation is often held from the societal perspective. Even it is important, as the therapy affects greatly to the patients’ life in society, economic evaluation from the payer perspective, is as important as it may help National Health Insurance (NHI) as the payer avert budget deficit as was observed in Indonesia. Unfortunately economic evaluation from the payer’s perspective is very rare to be done. This article compiles and reviews research articles of economic evaluation of therapy for human epithelial growth factor receptor 2-positive metastatic Breast Cancer (mBC) as an alternative to trastuzumab therapy, which has recently been removed from Indonesia’s National Health Insurance coverage. Methods: The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and PICO methodology (Population, Intervention, Comparison, and Outcome). Relevant articles were retrieved from online biomedical databases Scopus, PubMed, ScienceDirect, and SAGE Journals. Quality appraisal was performed using a standardized checklist which consisted of items in the CHEC checklist. Results: A total of six articles pertaining to economic evaluation of therapy for HER2-positive mBC from the NHI perspective (period: 2008–2018) were reviewed. Trastuzumab+chemotherapy showed the longest overall survival (OS, 37.8 months) with Progression-free Survival (PFS) of 12.7 months. Trastuzumab+docetaxel as 1st line therapy were associated with the longest PFS (19 months) with a total cost of US$ 12,732. With respect to therapy sequence, 1st line, trastuzumab+pertuzumab+docetaxel; 2nd line, trastuzumab+emtansine ; and 3rd line, lapatinib+capecitabine was associated with the highest quality-adjusted life year (QALY; 1.81) but also the highest total cost and incremental cost (US$360,880 and US$197,250, respectively). The sequence of 1st line, trastuzumab/docetaxel; 2nd line, T-DM1; and 3rd line, trastuzumab/lapatinib was associated the lowest QALY (1.27) but was the most cost-effective (total cost: $158,293). Lapatinib+capecitabine as 2nd line therapy and exemestane monotherapy were associated with the lowest total cost (US$3,190). Conclusion: Lapatinib+capecitabine as 2nd line therapy and exemestane monotherapy show potential as alternatives to trastuzumab therapy for HER-2 positive mBC.

Systematic Review: Economic Evaluation of Treatment for Human Epithelial Growth Factor Receptor 2-positive Metastatic Breast Cancer from a National Health Insurance Perspective

Background: Economic evaluation is often held from the societal perspective. Even it is important, as the therapy affects greatly to the patients’ life in society, economic evaluation from the payer perspective, is as important as it may help National Health Insurance (NHI) as the payer avert budget deficit as was observed in Indonesia. Unfortunately economic evaluation from the payer’s perspective is very rare to be done. This article compiles and reviews research articles of economic evaluation of therapy for human epithelial growth factor receptor 2-positive metastatic Breast Cancer (mBC) as an alternative to trastuzumab therapy, which has recently been removed from Indonesia’s National Health Insurance coverage. Methods: The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and PICO methodology (Population, Intervention, Comparison, and Outcome). Relevant articles were retrieved from online biomedical databases Scopus, PubMed, ScienceDirect, and SAGE Journals. Quality appraisal was performed using a standardized checklist which consisted of items in the CHEC checklist. Results: A total of six articles pertaining to economic evaluation of therapy for HER2-positive mBC from the NHI perspective (period: 2008–2018) were reviewed. Trastuzumab+chemotherapy showed the longest overall survival (OS, 37.8 months) with Progression-free Survival (PFS) of 12.7 months. Trastuzumab+docetaxel as 1st line therapy were associated with the longest PFS (19 months) with a total cost of US$ 12,732. With respect to therapy sequence, 1st line, trastuzumab+pertuzumab+docetaxel; 2nd line, trastuzumab+emtansine ; and 3rd line, lapatinib+capecitabine was associated with the highest quality-adjusted life year (QALY; 1.81) but also the highest total cost and incremental cost (US$360,880 and US$197,250, respectively). The sequence of 1st line, trastuzumab/docetaxel; 2nd line, T-DM1; and 3rd line, trastuzumab/lapatinib was associated the lowest QALY (1.27) but was the most cost-effective (total cost: $158,293). Lapatinib+capecitabine as 2nd line therapy and exemestane monotherapy were associated with the lowest total cost (US$3,190). Conclusion: Lapatinib+capecitabine as 2nd line therapy and exemestane monotherapy show potential as alternatives to trastuzumab therapy for HER-2 positive mBC.

PBI8 Use of Biosimilars in Haematology in France: A Descriptive Study Based on a French Medico-Administrative Database

Two biosimilars (Truxima® and Rixathon®) from the reference product Mabthera® (rituximab) indicated in non-Hodgkin’s lymphoma (nHL) and chronic lymphocytic leukaemia (CLL) were introduced in France by the end of 2017. The objective of this study was to describe the financial impact of the introduction of these two biosimilars in France. The EGB (Echantillon Généraliste de Bénéficiaires) database, a 1/97th random sample of the French healthcare insurance database linked with the hospital discharge database (PMSI) was used. Patients were identified for the years 2017 and 2018 through admissions with haematologic diagnosis (follicular lymphoma, non-follicular lymphoma, non-Hodgkin’s lymphoma, malignant immunoproliferative diseases and chronic lymphocytic leukaemia). The impact was assessed by comparing market shares of the reference product from 2017 to 2018 in terms of number of unique patients and total number of admissions. The financial impact was extrapolated to the national level from the national health insurance perspective. The study identified 195 and 215 patients for 2017 and 2018 respectively, with either a diagnosis of nHL or CLL and receiving at least one dose of rituximab. In 2017, Mabthera® was administered mostly to patients with other non-follicular lymphoma (40%) and follicular lymphoma (26%). The cost of Mabthera® was estimated at €472 million in 2017. By 2018, unique patients who were administered Mabthera® decreased by 35%, and financial cost by 65% (€303 million). In 2018, biosimilars were administered for 53% in other non-follicular lymphoma, 33% in follicular lymphoma, 66% in CLL, 52% in other non-Hodgkin's lymphoma, and 77% in Malignant immunoproliferative diseases, for cost of €202 million. Biosimilars were administered only in regional public hospitals and mostly in outpatient admissions. These results show that introduction of biosimilars of rituximab induced €100 million savings from the national health insurance perspective.

PRO54 Economic Burden of Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA) for ANCA-Associated Vasculatis (AAV) Patients in France

The two phenotypes of ANCA-associated vasculitis (AAV), Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA) are rare autoimmune diseases causing necrosing of blood vessels. The annual incidences rates are 2.1-14.4 and 2.4-10.1 per million in Europe for GPA and MPA, respectively. These multisystem inflammatory diseases result in life-threatening or organ-threatening disease with an increased mortality ratio of 2.6. A study was set up to assess the therapeutic management of GPA/MPA patients and its associated economic burden in France. A retrospective cohort study was conducted using the French National Healthcare databases (SNDS). The study population included GPA/MPA patients identified through relevant ICD-10 codes (M313/M317) in the period 2010-2018. Induction and maintenance treatment phases were defined through algorithms built from specific treatments and validated by a group of expert clinicians. Resources utilization were considered from the National Health Insurance perspective. A Kaplan-Meier model has been used to assess survival. The study cohort consisted of 6,581 GPA/MPA patients. The majority of patients had GPA only (4,445). Incident patients represented 2,605 patients, among which 1,578 were GPA only. They were aged 65 years old in median and 54.3% were men. Main treatments during induction and maintenance phases were glucocorticoids (95.5% and 98.3% for GPA and MPA, respectively), cyclophosphamide (47.6% and 0%), rituximab (18.7% and 30.9%), oral azathioprine (20.7% and 31.5%) and plasmatic exchange (21.0% and 0%). Standardized mortality rate was 2.21 in 2018. The average annual cost per GPA/MPA patient was 26,560±53,428€. The cost breakdown showed that the most important component was due to hospitalizations (61%) followed by medicines (9%). This study assessed a number of GPA and MPA patients in France during a large period of time and described the evolution of therapeutic management of patients. It demonstrates the major economic burden of the two phenotypes of AAV.

PCV25 Hospital Costs of Balloon Pulmonary Angioplasty (BPA) Procedure and Management for Chronic Thromboembolic Hypertension Patients: An Observational Study Based on the French National Hospital Discharge Database (PMSI)

To assess the hospital cost of BPA sessions and management in patients with CTEPH in France. An observational retrospective cohort study was conducted using the French national hospital discharge database (PMSI-MCO). All adult patients hospitalized for a BPA between January 1st, 2014 and June 30th, 2016 in the 2 centres performing BPA in France (Paris Sud and Grenoble University hospitals) were included. Patients were followed until 6 months or death, whichever occurred first. Follow-up stays were classified as stays with BPA sessions, for BPA management or for CTEPH management based on a pre-defined algorithm and a medical review using type of diagnosis (ICD-10), delay from the last BPA procedure stay and length of stay. Costs were determined from National Health Insurance perspective. Hospital costs (including medical transports) were estimated using published official French tariffs from 2014 to 2016 and expressed in 2017 Euros. Over the study period, a total of 191 patients were analysed; mainly male (53%), with a mean age of 64.3 years and without previous surgery (3%) when going back to 2006. The first BPA session was performed 1.1 years (median; min-max: 0.0-10.0) after the first PH hospitalisation. A mean of 3 stays with BPA sessions per patient were reported with a mean length of stay of 7.8±4.5 days for the first stay and 5.8±2.3 days for successive stays. The hospital cost attributable to BPA sessions + management was €8,792±3,414 per stay, €21,221±12,819 per patient and represented a total of €4,053,303 over the study period. Results were sensitive to age classes, density of city of residence and some comorbidities. The study allows assessing in real-life the hospital cost of BPA sessions and management in CTEPH patients, especially relevant at a time when the position of BPA in the therapeutic algorithm is regularly re-assessed.

PCN161 Disease Burden of Multiple Myeloma (MM) in France: A Descriptive Study Based on a French Medico-Administrative Database

Multiple Myeloma (MM) is a malignant hemopathy. The disease is identified by a severe proliferation of plasma cell in bone marrow for which there is still a lack of economic evidence. The objective of this study is to estimate the MM burden disease in the French setting. The EGB (Echantillon Généraliste de Bénéficiaires) database, a 1/97th random sample of the French healthcare insurance database linked with the hospital discharge database (PMSI) was used for this study. Retrospective data between 2014 and 2017 were considered to identify incident cases of MM. The index admission was the first admission with principal diagnosis for MM (ICD-10: C90) and patients had to be clear of MM admission in the 5 previous years. Healthcare costs were analyzed from the national health insurance perspective. The study period included the first-year period following the initial diagnosis, and the second-year period following the initial diagnosis. Additional costs attributable to the disease were estimated by comparing the incident CLL cohort to a matched cohort, on age and gender, with a 1:5 ratio. The study identified 150 incident cases with a mean age of 73 years (SD: 11), 47% were women, 16% had severe comorbidities (Charlson index ≥3) and 33 deaths (22%) were observed during the study period. Monthly additional cost during the first-year period was estimate at €5,259. Main drivers of costs were admissions (€2,478) and pharmaceuticals (€2,366) and 28 patients (19%) had transplantation (autograft or allograft). Monthly additional cost for the second year of follow-up was estimated at €1,407. This study confirms the significant economic burden of CLL disease in France and provide up-to-date economic data that could support decision making.

PCN167 Estimation of the Financial Impact of Chimeric Antigen Receptor (CAR) T-Cell Therapy for French Hospitals

CAR T-cell therapy, a potentially revolutionary treatment for diffuse large B-cell lymphoma (DLBCL), comprises a multistep process that requires specific patient monitoring and hospital resource mobilization. In France, funding of CAR T-cell therapy currently relies on existing disease-specific diagnosis-related groups (DRGs), similar to those used for hospital stays unrelated to CAR T-cell therapy, and includes a fixed sum of €15,000 for the first 400 patients. These DRGs may be insufficient to capture the true costs of these novel therapies. We estimated the financial impact, excluding drug cost, of administering CAR T-cell therapy for French hospitals. The patient pathway for CAR T-cell therapy includes 6 steps: eligibility assessment, leukapheresis, bridging chemotherapy, lymphodepleting chemotherapy, CAR T-cell infusion, and patient follow-up. We identified the healthcare resources required for each step, valued those resources from the perspectives of the hospital and the national health insurance, and then calculated the financial impact of CAR T-cell therapy as the difference between the 2 perspectives. Our base-case analysis was modeled on 1 experienced CAR T-cell therapy center primarily administering approved CAR T-cell therapies, which outsourced some aspects of care to its local hospital network. Scenarios for alternative patient management were also considered. In the base-case analysis, the cost of CAR T-cell therapy administration for patients with DLBCL was estimated at €42,398 from the hospital perspective and €22,857 from the national health insurance perspective, resulting in a €19,540 loss per patient for the CAR T-cell therapy administration hospital. Alternative scenarios resulted in financial losses of €18,347 to €20,722 per patient. With estimated losses of €18,347 to €20,722 per patient, CAR T-cell therapy administration is expected to have a significant impact on hospital finances. Our results indicate that the DRG fixed sum is insufficient to support the implementation of CAR T-cell therapy in French hospitals.

Cost-effectiveness of preoperative magnetic resonance imaging to optimize surgery in ductal carcinoma in situ of the breast

PurposeComplete surgical excision is the main factor for successful breast-conserving surgery in patients with ductal carcinoma in situ (DCIS) of the breast. Preoperative magnetic resonance imaging (MRI) may allow surgery optimization in this indication. From an economic standpoint, systematic preoperative MRI is associated with an extra cost, which may be offset by a decrease in the number of re-interventions. We performed an economic evaluation alongside IRCIS randomised controlled trial (NCT01112254) to determine whether systematic preoperative MRI in DCIS is a cost-effective strategy. Methods360 patients were included in IRCIS trial. Costs were assessed from the French national health insurance perspective. Resource use was prospectively collected during a 6-month period after randomisation. We estimated the mean cost per averted re-intervention. ResultsDespite extra costs due to MRI and additional biopsies, difference in total costs between arms was not statistically significant (mean cost of €9980 in MRI arm and €9682 in no MRI arm, cost difference: €298 [CI95% : −470; 1063]). There was a non-significant decrease in the rate of re-hospitalisations for positive or close margins (20% in MRI arm versus 27% in No MRI arm, difference −7% [CI95% : −17; 3]). At a willingness to pay of €500 to avert a re-intervention, the probability that MRI strategy is cost-effective was 93%. ConclusionSystematic preoperative MRI in patients with DCIS of the breast may be a cost-effective strategy. However, the modest clinical benefit associated with such a strategy limits the interest for this procedure in routine practice given the current MRI techniques.