National Health Service Reference Costs Research Articles

HOW MUCH DO HIP ARTHROPLASTIES COST? THE BURDEN AND BUDGET IMPACT OF IMPLANTS AND HIP ARTHROPLASTY ON THE NATIONAL HEALTH SYSTEM FOR ENGLAND AND WALES

Total hip replacement (THR) is one of the most common and cost-effective elective surgical procedures. In the National Health Service (NHS) of England and Wales a myriad of implants for THR are offered at a variety of locally negotiated prices. This study aims to estimate the total burden of elective THR to the NHS, expenditure on implants, and different scenarios of cost changes if implant selection changed for different patient groups.Using National Joint Registry (NJR) data and NHS reference costs, we estimated the number and expenditure of NHS funded primary and revision THR in the 10-year period 2008–2017 and forecasted the number and expenditure on THR over the next decade. Using NJR average NHS Trust prices for the different implant combinations we estimated the average cost of implants used in THRs and estimated the budget impact on NHS providers from switching to alternative implants.The NHS spent over £4.76 billion performing 702,381 THRs between 2008–2017. The average cost of implants was £1,260 per surgery, almost a fifth of the cost of primary THR. Providing cemented implant combinations in primary elective THRs may potentially save up to £281 million over the next 10 years, whilst keeping 10-year revision risks low.The NHS is likely to spend over £5.6 billion providing primary elective THR over the next decade. There are efficiency savings to realise in the NHS by switching to more cost-effective implant combinations available for patients undergoing primary elective THR surgery, but these will need to be balanced against the risks inherent to a change in selection of implants and surgical practice. The HIPPY programme will be conducting practice surveys, discrete choice experiments and a large randomised controlled trial of cemented, uncemented and hybrid fixation in THR for patients under 70 to answer uncertainties.

A retrospective observational study on characteristics, treatment patterns, and healthcare resource use of patients with myasthenia gravis in England.

There are limited data on the real-world healthcare resource use (HCRU) and management costs of myasthenia gravis (MG) in England. This study aims to assess the burden of disease for patients with MG in England. A retrospective, observational cohort study of adult patients diagnosed with MG, using data from the Hospital Episode Statistics data warehouse. Patients with a first-ever recorded diagnosis of MG between 30 June 2015 and 30 June 2020 were followed up until 30 June 2021 or death, whichever occurred first. Post-diagnosis patient characteristics, treatment patterns, HCRU, and costs were described. Costs were evaluated using National Health Service reference costs. A total of 9087 patients with a median follow-up time of 2.9 years (range, 1.7-4.3 years) were included. The mean age at diagnosis was 66.5 years and 53% of the patients were male. A large proportion of patients (72.8%) were admitted as inpatients during follow-up with a mean number of 1.3 admissions. Patients hospitalized for MG-related complications spent a mean of 9.7 days per patient-year in the hospital. During follow-up, 599 (6.6% of the total cohort) and 163 (1.8%) patients had a record of rescue therapy with intravenous immunoglobulin (IVIg) and plasma exchange (PLEX), respectively. Rituximab was administered to 81 (0.9%) patients and 268 (2.9%) patients underwent thymectomy. In those patients receiving rescue therapy or rituximab, >10% received at least three cycles of the same treatment. The average annual cost of hospital admissions across all patients treated with IVIg, PLEX, and rituximab were £907,072, £689,979, and £146,726, respectively. A majority of MG patients required hospitalization or accident and emergency attendance, resulting in high HCRU and costs. A subset of patients required rescue therapy (including IVIg and PLEX), rituximab administration, ventilation, or thymectomy.

The incidence and cost implications of surgical site infection following lymph node surgery for skin malignancy

Lymph node surgery is commonly performed in the staging and treatment of metastatic skin cancer. Previous studies have demonstrated sentinel lymph node biopsy (SLNB) and, particularly, lymph node dissection (LND) to be plagued by high rates of wound complications, including surgical site infection (SSI) and seroma formation. This study evaluated the incidence of wound complications following lymph node surgery and provided the first published cost estimate of SSI associated with lymph node surgery in the UK. A retrospective cohort study of 169 patients with a histological diagnosis of primary skin malignancy who underwent SLNB or LND of the axilla and/or inguinal region at a single tertiary centre over a 2 year period was conducted. Demographic, patient risk factor, and operation characteristics data were collected and effect on SSI and seroma formation was analysed. Cost-per-infection was estimated using National Health Service (NHS) reference and antibiotic costs. A total of 146 patients underwent SLNB with a SSI rate of 4.1% and a seroma incidence of 12.3%. Twenty-three patients underwent LND with a SSI rate of 39.1% and a seroma incidence of 39.1%. Seroma formation was strongly associated with the development of SSI in both the SLNB (odds ratio (OR) =18.0, p<0.001) and LND (OR = 21.0, p=0.007) group. The median additional cost of care events and treatment of SSI in the SLNB and LND groups was £199.46 and £5187.04, respectively. SSI remains a troublesome and costly event following SLNB and LND. Further research into perioperative care protocols and methods of reducing lymph node surgery morbidity is required and could result in significant cost savings to the NHS.

P-001 RISK FACTORS, HEALTHCARE RESOURCE USE AND COSTS ASSOCIATED WITH INCISIONAL HERNIA REPAIR IN ENGLAND USING HOSPITAL EPISODE STATISTICS

Abstract Aim To evaluate the burden of incisional hernia (IH) to patients and healthcare services in England. Material &amp; Methods We conducted a retrospective observational study in Hospital Episode Statistics including adult patients who underwent stoma, transplant, or aortic surgery (index) between 01/04/2017 and 31/03/2022. We followed patients for development of incisional (including parastomal) hernia necessitating repair within 2 years post-index operation, describing patients by surgery type, number of comorbidities (prior abdominal surgery, chronic lung disease, diabetes, immunosuppressed status, obesity, smoker), and financial year. We evaluated costs associated with inpatient, outpatient, and Accident &amp; Emergency attendances within 2 years post-index operation using National Health Service reference costs. Results Of 430,339 patients (132,584 stoma, 3,247 transplant, 294,508 aortic surgery), 24,949 developed IH requiring repair (6.74% overall, 13.74% stoma, 5.51% transplant, 2.80% aortic surgery). Operative IH was observed in 11.46%, 5.54%, and 1.94%, for patients with 0–2 comorbidities following stoma, transplant, and aortic surgery, respectively; for patients with 5–6 comorbidities, 29.70%, 5.97%, and 6.91% underwent repair of IH. For all years, costs were higher for patients with IH versus those without IH. Costs varied by surgery type and number of comorbidities and were driven by non-elective admissions. The difference in mean total costs for IH versus non-IH following surgery performed in 2017 was £16,350 for stoma, £19,268 for transplant, and £54,518 for aortic surgery. Conclusions Rates of IH repair increase alongside the number of comorbidities. A large number of patients require IH repair within 2 years of surgery, increasing the cost of care.

Cost-effectiveness comparison of delayed versus immediate coloanal anastomosis following ultralow anterior resection for rectal cancer.

Following ultralow anterior resection for distal rectal cancers, a coloanal anastomosis is usually created along with a defunctioning ileostomy (DI). Recent evidence suggests that abdominoperineal pull-through with delayed coloanal anastomosis (DCAA) is a viable alternative to immediate coloanal anastomosis (ICAA), minimizing the risk of anastomotic leakage and avoiding the need for stoma creation with the risk of stoma-associated morbidity. However, DCAA requires a longer initial hospitalization. We aimed to perform a cost-effectiveness analysis to compare DCAA versus ICAA for elective rectal cancer surgery. A decision tree model was used to compare the cost-effectiveness of the two strategies. Cost data were obtained from the 2019 to 2020 United Kingdom National Health Service reference costs. Model probabilities were derived from published studies. Univariate and probabilistic sensitivity analyses were used to evaluate the robustness of the results. DCAA was the overall cheaper strategy at £13 541 compared with £14 856 for ICAA in the base case analysis. This was explained by the decreased overall costs of hospitalization/surgery, reduction in costs associated with anastomotic or stoma-related complications, specifically dehydration-induced hospital readmissions and avoidance of stoma maintenance costs. Sensitivity analysis demonstrated that DCAA remained consistently more inexpensive except when the duration of total parenteral nutrition exceeded 14 days. Despite a longer index hospitalization with higher initial costs, this economic analysis demonstrates that DCAA without stoma is overall more cost-effective compared with ICAA with DI following ultralow anterior resection. Cost savings should be considered an additional benefit when selecting the DCAA approach for rectal cancer surgery.

Cost-Utility Analysis of Major System Change in Specialist Cancer Surgery in London, England, Using Linked Patient-Level Electronic Health Records and Difference-in-Differences Analysis.

BackgroundStudies have shown that centralising surgical treatment for some cancers can improve patient outcomes, but there is limited evidence of the impact on costs or health-related quality of life.ObjectivesWe report the results of a cost-utility analysis of the RESPECT-21 study using difference-in-differences, which investigated the reconfiguration of specialist surgery services for four cancers in an area of London, compared to the Rest of England (ROE).MethodsElectronic health records data were obtained from the National Cancer Registration and Analysis Service for patients diagnosed with one of the four cancers of interest between 2012 and 2017. The analysis for each tumour type used a short-term decision tree followed by a 10-year Markov model with 6-monthly cycles. Costs were calculated by applying National Health Service (NHS) Reference Costs to patient-level hospital resource use and supplemented with published data. Cancer-specific preference-based health-related quality-of-life values were obtained from the literature to calculate quality-adjusted life-years (QALYs). Total costs and QALYs were calculated before and after the reconfiguration, in the London Cancer (LC) area and in ROE, and probabilistic sensitivity analysis was performed to illustrate the uncertainty in the results.ResultsAt a threshold of £30,000/QALY gained, LC reconfiguration of prostate cancer surgery services had a 79% probability of having been cost-effective compared to non-reconfigured services using difference-in-differences. The oesophago-gastric, bladder and renal reconfigurations had probabilities of 62%, 49% and 12%, respectively, of being cost-effective at the same threshold. Costs and QALYs per surgical patient increased over time for all cancers across both regions to varying degrees. Bladder cancer surgery had the smallest patient numbers and changes in costs, and QALYs were not significant. The largest improvement in outcomes was in renal cancer surgery in ROE, making the relative renal improvements in LC appear modest, and the probability of the LC reconfiguration having been cost-effective low.ConclusionsProstate cancer reconfigurations had the highest probability of being cost-effective. It is not clear, however, whether the prostate results can be considered in isolation, given the reconfigurations occurred simultaneously with other system changes, and healthcare delivery in the NHS is highly networked and collaborative. Routine collection of quality-of-life measures such as the EQ-5D-5L would have improved the analysis.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40258-022-00745-w.

Healthcare utilization and costs in chronic cough

Background Chronic cough is a common reason for medical consultations and is associated with considerable physical and psychological morbidity. This study investigated healthcare use and cost in chronic cough and assessed its relationship with cough severity, health status, objective cough frequency (CF), and anxiety and depression. Methods This was a prospective study of consecutive patients with chronic cough from a specialist clinic who completed a cough severity visual analogue scale (VAS), cough-specific health status (Leicester Cough Questionnaire; LCQ) and general health status EuroQol EQ-5D-5L, Generalized Anxiety Disorder (GAD7), Patient Health Questionnaire (PHQ9), and 24-hour objective CF monitoring with Leicester Cough Monitor (LCM). Case notes were reviewed for cough-specific healthcare use 12 months before and after the first cough clinic consultation. Resource use included general practitioner and hospital clinic visits, investigations, and treatments. Unit costs for healthcare use were derived predominantly from National Health Service Reference Costs. Results One hundred participants with chronic cough were recruited (69% female, median duration 3 years, mean age 58 years). The diagnoses of cough were unexplained (57%), refractory (27%), and other (16%). Cough severity, health status, and CF were: median (IQR) VAS = 59.5 (30–79) mm, mean (SD) LCQ = 11.9 (4.0), mean (SD) EQ-5D-5L = 0.846 (0.178), and geometric mean (SD) CF = 15.3 (2.5) coughs/hr, respectively. The mean (SD) total cost per individual for cough-related healthcare utilization was £1,663 (747). Diagnostic investigations were the largest contributor to cost (63%), followed by cough clinic consultations (25%). In multivariate analysis, anxiety (GAD7) and cough-related health status (LCQ) were associated with increased cost (p ≤.001 and .037). Conclusion Healthcare cost associated with chronic cough are largely due to diagnostic investigations and clinic consultations. The predictors of costs were health status (LCQ) and anxiety. Further studies should investigate the optimal management protocols for patients with chronic cough.

Cost-effectiveness analysis of vaborem for the treatment of carbapenem-resistant Enterobacteriaceae-Klebsiella pneumoniae carbapenemase (CRE-KPC) infections in the UK

ObjectiveThe study objective of this analysis was to determine the cost-effectiveness of vaborem (meropenem-vaborbactam) compared to the best available therapy (BAT) in adult patients with carbapenem-resistant Enterobacteriaceae—Klebsiella pneumoniae carbapenemase (CRE-KPC) infections from the perspective of the UK National Health Service (NHS) and Personal Social Services (PSS).MethodsA decision tree model was developed to conduct a cost-effectiveness analysis for Vaborem compared to BAT in CRE-KPC patients over a 5 year time horizon. The model structure for Vaborem simulated the clinical pathway of patients with a confirmed CRE-KPC infection. Model inputs for clinical effectiveness were sourced from the TANGO II trial, and published literature. Costs, resource use and utility values associated with CRE-KPC infections in the UK were sourced from the British National Formulary, NHS reference costs and published sources.ResultsOver a 5 year time horizon, Vaborem use increased total costs by £5165 and increased quality-adjusted life years (QALYs) by 0.366, resulting in an incremental cost-effectiveness ratio (ICER) of £14,113 per QALY gained. The ICER was most sensitive to the probability of discharge to long-term care (LTC), the annual cost of LTC and the utility of discharge to home. At thresholds of £20,000/QALY and £30,000/QALY, the probability of Vaborem being cost-effective compared to BAT was 79.85% and 94.93%, respectively.ConclusionDue to a limited cost impact and increase in patient quality of life, vaborem can be considered as a cost-effective treatment option compared to BAT for adult patients with CRE-KPC infections in the UK.

Single-use negative pressure wound therapy reduces costs in closed surgical incisions: UK and US economic evaluation.

Single-use negative pressure wound therapy (sNPWT) following closed surgical incisions has a demonstrable effect in reducing surgical site complications (SSC). However, there is little health economic evidence to support its widespread use. We sought to evaluate the cost-effectiveness of sNPWT compared with standard care in reducing SSCs following closed surgical incisions. A decision analytic model was developed to explore the total costs and health outcomes associated with the use of the interventions in patients following vascular, colorectal, cardiothoracic, orthopaedic, C-section and breast surgery from the UK National Health Service (NHS) and US payer perspective over a 12-week time horizon. We modelled complications avoided (surgical site infection (SSI) and dehiscence) using data from a recently published meta-analysis. Cost data were sourced from published literature, NHS reference costs and Centers for Medicare and Medicaid Services. We conducted subgroup analysis of patients with diabetes, an American Society of Anesthesiologists (ASA) score ≥3 and body mass index (BMI) ≥30kg/m2. A sensitivity analysis was also conducted. sNPWT resulted in better clinical outcomes and overall savings of £105 per patient from the UK perspective and $637 per patient from the US perspective. There were more savings when higher-risk patients with diabetes, or a BMI ≥30kg/m2 or an ASA≥3 were considered. We conducted both one-way and probabilistic sensitivity analysis, and the results suggested that this conclusion is robust. Our findings suggest that the use of sNPWT following closed surgical incisions saves cost when compared with standard care because of reduced incidence of SSC. Patients at higher risk should be targeted first as they benefit more from sNPWT. This analysis is underpinned by strong and robust clinical evidence from both randomised and observational studies.

Cost-effectiveness of single-use negative-pressure therapy compared with standard care for prevention of reconstruction failure in prepectoral breast reconstruction.

BackgroundSingle-use negative-pressure wound therapy (sNPWT) has been reported to reduce the incidence of reconstruction failure in prepectoral breast reconstruction compared with standard surgical dressings. The aim of this economic evaluation was to investigate the cost-effectiveness of sNPWT compared with standard care for the prevention of reconstruction failure in prepectoral breast reconstruction in the UK.MethodA decision tree model was used to estimate the expected cost and effectiveness per patient. Effectiveness was measured both by the number of reconstruction failures avoided and the gain in quality-adjusted life-years (QALYs). The baseline incidence of reconstruction failure (8.6 per cent) was taken from a recently published study of 2655 mastectomies in the UK. The effectiveness of sNPWT used results from a clinical study comparing sNPWT with standard dressings. Previously published utility weights were applied. The cost of reconstruction failure was estimated from detailed resource data from patients with reconstruction failure, applying National Health Service reference costs. One-way, probabilistic, scenario and threshold analyses were conducted.ResultsThe undiscounted cost per patient associated with reconstruction failure was estimated to be £23 628 (£22 431 discounted). The use of sNPWT was associated with an expected cost saving of £1706 per patient, an expected increase in QALYs of 0.0187 and an expected 0.0834 reconstruction failures avoided. Cost-effectiveness acceptability analysis demonstrated that, at a threshold of £20 000 per QALY, 99.94 per cent of the simulations showed sNPWT to be more cost-effective than standard care.ConclusionAmong patients undergoing immediate prepectoral breast reconstruction, the use of sNPWT is more cost-effective than standard dressings.

PP459 Healthcare Resource Utilisation Of Anti-Neutrophil Cytoplasmic Antibody Associated Vasculitis Patients: Real-World Data From English Clinical Practice Research Datalink

IntroductionAnti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a rare, serious and often life-threatening disease. The use of available treatments options (immunosuppressants and glucocorticoids (GCs)) improves the prognosis of AAV greatly; however, GC use is associated with significant toxicity related morbidities and the management of AAV is costly. However, information of the costs associated with AAV in the United Kingdom is limited. This study aimed to quantify the burden of AAV using a large England and Wales source of real-world data, the Clinical Practice Research Datalink (CPRD) Hospital Episode Statistics (HES) linked database, to identify healthcare resource utilization and generate estimates of costs.MethodsIncident patients (n = 220) were included if ≥ eighteen years, with diagnosis read codes G754.00/G75A.00; ICD codes M31.3/M31.7 from January 1997 to December 2017. Costs were taken from Unit Costs of Social and Health Care, National Health Service reference costs and electronic drug tariff. Distinction was made between type of consultations, outpatient visits and inpatient admission based on Healthcare Resource Grouping. Costs were summarised as mean per member per year (PMPY) in 2016 prices and presented before and after diagnosis.ResultsIn the year preceding AAV diagnosis, mean costs PMPY were GBP12,012 [USD15,400], (GBP5,339 [USD6,845] inpatient, GBP766 [USD982] outpatient, GBP314 [USD403] GP, GBP5,594 [USD7,172] GP prescribing). In the year of AAV diagnosis (Y0) costs PMPY were GBP28,252 [USD36,220], GBP15,436 [USD19,790] inpatient, GBP1,863 [USD2,388] outpatient, GBP2,407 [USD3,086] GBP8,545 [USD10,956] GP prescribing). Costs in the years post-diagnosis remained higher than pre-diagnosis with a low of GBP22,839 [USD29,281] in Y4. The prescribing costs (GC, methotrexate and azathioprine) were the largest contributor in Y0-Y4 (GBP15,047 [USD19,291] Y1; GBP12,325 [USD15,801] Y4).ConclusionsDiagnosis of AAV is associated with increased healthcare costs, including higher inpatients costs in the year of diagnosis and subsequently higher prescribing costs in the community. Given the incidence (17.2 cases per million) and considering only costs in the year of diagnosis, an additional GBP15.6 million [USD24.6 million] of healthcare resource utilization occurs every year from new diagnoses of AAV. However, this will likely be underestimated due to the lack of secondary care prescribing data in CPRD-HES and prescribing of immunosuppressant treatments in this setting.

Patient-initiated follow-up for low-risk endometrial cancer: a cost-analysis evaluation

ObjectiveRisk stratification has resulted in patient-initiated follow-up being introduced for low-risk endometrial cancer in place of routine hospital follow-up. The financial benefit to the patient and the healthcare economy of...

Ticagrelor Removal by CytoSorb® in Patients Requiring Emergent or Urgent Cardiac Surgery: A UK-Based Cost-Utility Analysis.

BackgroundAcute coronary syndrome patients receiving dual antiplatelet therapy who need emergent or urgent cardiac surgery are at high risk of major bleeding, which can impair postoperative outcomes. CytoSorb®, a blood purification technology based on adsorbent polymer, has been demonstrated to remove ticagrelor from blood during on-pump cardiac surgery.ObjectiveThe aim of this study was to evaluate the cost utility of intraoperative removal of ticagrelor using CytoSorb versus usual care among patients requiring emergent or urgent cardiac surgery in the UK.MethodsA de novo decision analytic model, based on current treatment pathways, was developed to estimate the short- and long-term costs and outcomes. Results from randomised clinical trials and national standard sources such as National Health Service (NHS) reference costs were used to inform the model. Costs were estimated from the NHS and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSAs) explored the uncertainty surrounding the input parameters.ResultsIn emergent cardiac surgery, intraoperative removal of ticagrelor using CytoSorb was less costly (£12,933 vs. £16,874) and more effective (0.06201vs. 0.06091 quality-adjusted life-years) than cardiac surgery without physiologic clearance of ticagrelor over a 30-day time horizon. For urgent cardiac surgery, the use of CytoSorb was less costly than any of the three comparators—delaying surgery for natural washout without adjunctive therapy, adjunctive therapy with short-acting antiplatelet agents, or adjunctive therapy with low-molecular-weight heparin. Results from the PSAs showed that CytoSorb has a high probability of being cost saving (99% in emergent cardiac surgery and 53–77% in urgent cardiac surgery, depending on the comparators). Cost savings derive from fewer transfusions of blood products and re-thoracotomies, and shorter stay in the hospital/intensive care unit.ConclusionsThe implementation of CytoSorb as an intraoperative intervention for patients receiving ticagrelor undergoing emergent or urgent cardiac surgery is a cost-saving strategy, yielding improvement in perioperative and postoperative outcomes and decreased health resource use.Electronic supplementary materialThe online version of this article (10.1007/s41669-019-00183-w) contains supplementary material, which is available to authorized users.

P6542Early Prolonged Ambulatory Cardiac monitoring in Stroke (EPACS): an open-label randomised controlled trial and economic evaluation

Abstract Background Cardioembolism in paroxysmal atrial fibrillation (PAF) is a preventable cause of transient ischaemic attack (TIA) or ischaemic stroke, however, due its transient nature, a short-duration Holter monitor may miss a significant proportion of events. Methods We conducted an open-label randomised controlled trial of cardiac monitoring after a TIA or ischaemic stroke comparing a 14-day ECG monitoring patch with short-duration Holter monitoring for the detection of PAF. The primary outcome was the detection of one or more episodes of ECG-documented PAF lasting at least 30 seconds within 90 days in each of the study arms. A budget impact analysis from the healthcare perspective was performed to assess the theoretical economic implications of the patch-based service versus Holter monitoring. Based on the AF detection rates found in this study, Hospital Episode Statistics data for the incidence of stroke and TIA (October 2016-September 2017) and National Health Service reference costs, the cost-effectiveness of the patch-based service versus Holter monitoring was calculated. The Sentinel Stroke National Audit Programme estimate of £13,452 was used as the mean year one direct medical cost of a stroke. Results From February 2016 through February 2017, 43 (76.8%) of the 56 patients assigned to the patch-based monitoring group and 47 (78.3%) of the 60 patients assigned to the short-duration Holter monitoring group had successful monitor placement with 90 days of follow-up (Figure 1). Of the 26 protocol failures between the two groups, 23 (88.5%) were due to patient refusal for outpatient short-duration Holter monitor placement, whilst only 1 (3.8%) was due to unsuccessful patch placement. The rate of detection of PAF at 90 days was 16.3% in the patch-based monitoring group (7 patients) compared to 2.1% in the short-duration Holter monitoring group (1 patient), with an odds ratio of 8.9 (95% CI 1.1–76.0; P=0.026). Implementation of the patch-based service at our hospital would result in 10.8 more strokes avoided per year compared to current practice with short-duration Holter monitoring. This would equate to a yearly saving in direct medical costs of £57,481, increasing to £106,342 over 5 years. When social care costs are included, incremental savings of £154,716 can be achieved in the first year and £410,449 at 5 years. In addition, an analysis of the potential reduction in outpatient follow-up appointment costs resulted in a further saving of £56,149, giving a total potential saving of £113,630 over the first year with the use of the patch-based service compared to short-duration Holter monitoring, increasing to £162,491 over 5 years. Figure 1. Study participant flowchart Conclusions Early, prolonged, patch-based monitoring after an index stroke or TIA is superior to short-duration Holter monitoring in the detection of PAF and likely cost-effective for preventing recurrent strokes. Acknowledgement/Funding Bristol-Myers Squibb-Pfizer alliance (Grant Number CV185-475)

PMD57 - HEALTHCARE RESOURCE UTILIZATION AND COSTS AMONG PATIENTS WITH AND WITHOUT INFECTION AFTER INTRAMEDULLARY NAILING FOR A TIBIAL SHAFT FRACTURE IN ENGLAND

To evaluate the healthcare resource use and costs among patients with and without infection after Intramedullary nailing (IMN) for tibial shaft fractures (TSF). A retrospective cohort design using the Clinical Practice Research Data-Hospital Episode Statistics linkage data from England was used. Patients undergoing IMN treatment for TSF were identified, with the first date of procedure being the index date. Patients were categorized into two groups based on presence of post-surgical infection identified two days post-index through 30 and 365 days post-index. The outcomes of interest were hospital length of stay (LOS), readmission rates and all-cause direct healthcare costs over 30 and 365 days post-index. The National Health Service reference costs were assigned to healthcare resource utilization. Wilcoxon rank-sum test and chi-square test were used to detect differences between the two groups. A total of 803 patients with IMN for TSF were identified. Patients were predominantly male (73.2%), mean (±SD) age of 40.9 (±17.1) years, and a mean (±SD) Charlson Comorbidity Index of 0.04 (±0.23). The rates of post-surgical infection were 7.1% and 11.5% at 30 and 365 days post-index, respectively. Patients with infection had significantly higher mean LOS [(10.2 vs 6.8, p<0.001 at 30 days) (28.9 vs 11.3, p<0.0001 at 365 days)] and readmission rates [(40.4% vs 6.3%, p<0.001 at 30 days) (74.7% vs 35.7%, p<0.001 at 365 days)] compared to patients without infection. The mean direct healthcare costs were significantly higher among patients with infection compared to patients without infection during both 30 (£9,189 vs £6,517, p<0.001) and 365 days (£17,187 vs £8,433, p<0.001) follow-up. Healthcare resource utilization and costs are significantly increased among patients with infection compared to patients without infection at 30 and 365 days after IMN for TSF. Preventive strategies to avoid infections could lead to substantial cost savings.

Can peer support be cost saving? An economic evaluation of RAPSID: a randomized controlled trial of peer support in diabetes compared to usual care alone in East of England communities

BackgroundDiabetes peer support, where one person with diabetes helps others, may improve diabetes management. The objective of this study was to perform a cost analysis of peer support strategies used...

Burden, duration and costs of hospital bed closures due to acute gastroenteritis in England per winter, 2010/11–2015/16

SummaryBackgroundBed closures due to acute gastroenteritis put hospitals under pressure each winter. In England, the National Health Service (NHS) has monitored the winter situation for all acute trusts since 2010/11.AimTo estimate the burden, duration and costs of hospital bed closures due to acute gastroenteritis in winter.MethodsA retrospective analysis of routinely collected time-series data of bed closures due to diarrhoea and vomiting was conducted for the winters 2010/11 to 2015/16. Two key issues were addressed by imputing non-randomly missing values at provider level, and filtering observations to a range of dates recorded in all six winters. The lowest and highest values imputed were taken to represent the best- and worst-case scenarios. Bed-days were costed using NHS reference costs, and potential staff absence costs were based on previous studies.FindingsIn the best-to-worst case, a median of 88,000–113,000 beds were closed due to gastroenteritis each winter. Of these, 19.6–20.4% were unoccupied. On average, 80% of providers were affected, and had closed beds for a median of 15–21 days each winter. Hospital costs of closed beds were £5.7–£7.5 million, which increased to £6.9–£10.0 million when including staff absence costs due to illness.ConclusionsThe median number of hospital beds closed due to acute gastroenteritis per winter was equivalent to all general and acute hospital beds in England being unavailable for a median of 0.88–1.12 days. Costs for hospitals are high but vary with closures each winter.

A cost utility analysis on weaning patients with short bowel off parenteral nutrition following restoration of bowel continuity

Summary Introduction Home parenteral nutrition (HPN) is an expensive therapy. Restoring bowel continuity has been shown to wean patients off HPN. The aims of this study were to estimate the economic impact and QALY gained after restoring bowel continuity in adult patients with short bowel and intestinal failure due to mesenteric infarction. Method A Markov cohort model was constructed to simulate patients undergoing bowel restoration following mesenteric infarction. Probabilities associated with restoration of bowel continuity were determined using published data. Costs were estimated using the National Health Service (NHS) reference costs (2013–14). Utilities were determined from literature and opinion of experts. Results The expected QALY at 1 year following restoring bowel was 0.47. This increased to 3.29 at 5 years. The marginal cost per QALY gained calculated for the first year following restoration of bowel continuity was £95959.72 and this decreases to £10797.63 at 5 years. Conclusion Restoring bowel continuity reduces the overall costs associated with HPN and it results in increased QALY over time.

PSS15 - Budget Impact of Apremilast for Moderate to Severe Plaque Psoriasis in the UK

Apremilast is an orally administered, small-molecule phosphodiesterase-4 inhibitor. It has a novel mechanism of action, targeting multiple steps implicated in the pathogenesis of psoriasis. Apremilast was approved by the European Medicines Agency in 2015 for the treatment of moderate-to-severe chronic plaque psoriasis (PsO) in adult patients who failed to respond to or have a contraindication to, or are intolerant to other systemic therapies. We assessed the budget impact of introducing apremilast in the current treatment portfolio for psoriasis from the UK payer perspective. A 5-year budget impact model was developed using a prevalence-based approach. The target population was estimated based on the total UK population, annual population growth rate, prevalence of PsO, and proportion of patients with moderate-to-severe disease. The total psoriasis population was divided into 3 categories: untreated patients, patients receiving ≥1 conventional systemic non-biologic therapy (SNBT), and patients on biologics. Biologic treatments included adalimumab, etanercept, infliximab, secukinumab, and ustekinumab. Biosimilars for etanercept and infliximab were also considered. Drug costs were quoted from the British National Formulary (BNF) and the Monthly Index of Medical Specialties (MIMS). Administration costs were obtained from the National Clinical Guideline Centre (NCGC); physician visit and laboratory test costs were informed by National Health Service (NHS) reference costs, the NCGC, and literature values. Over a 5-year period, the number of patients treated with apremilast was estimated to increase from 69 to 1,980. Inclusion of apremilast decreased the total budget by 2.19% (£735,221,377 vs. £751,645,055) relative to the world without. In the final year, drug acquisition costs decreased by 4.43% (£124,099,644 vs. £129,856,022), administration costs by 18.67% (£671,543 vs. £825,667), and monitoring costs by 2.81% (£21,291,886 vs. £21,907,514), yielding a net cost saving of 4.28%. Inclusion of apremilast in the PsO treatment regimen in the UK was cost saving in all respects

Specifying the ovarian cancer risk threshold of ‘premenopausal risk-reducing salpingo-oophorectomy’ for ovarian cancer prevention: a cost-effectiveness analysis

BackgroundRisk-reducing salpingo-oophorectomy (RRSO) is the most effective intervention to prevent ovarian cancer (OC). It is only available to high-risk women with >10% lifetime OC risk. This threshold has not been...