Private Health Care System Research Articles

Public Health Policy of India and COVID-19: Diagnosis and Prognosis of the Combating Response

(1) Background: Society and public policy have been remained interwoven since the inception of the modern state. Public health policy has been one of the important elements of the public administration of the Government of India (GOI). In order to universalize healthcare facilities for all, the GOI has formulated and implemented the national health policy (NHP). The latest NHP (2017) has been focused on the “Health in All” approach. On the other hand, the ongoing pandemic COVID-19 had left critical impacts on India’s health, healthcare system, and human security. The paper’s main focus is to critically examine the existing healthcare facilities and the GOI’s response to combat the COVID-19 apropos the NHP 2017. The paper suggests policy options that can be adopted to prevent the further expansion of the pandemic and prepare the country for future health emergency-like situations. (2) Methods: Extensive literature search was done in various databases, such as Scopus, Web of Science, Medline/PubMed, and google scholar search engines to gather relevant information in the Indian context. (3) Results: Notwithstanding the several combatting steps on a war-footing level, COVID-19 has placed an extra burden over the already overstretched healthcare infrastructure. Consequently, infected cases and deaths have been growing exponentially, making India stand in second place among the top ten COVID-19-infected countries. (4) Conclusions: India needs to expand the public healthcare system and enhance the expenditure as per the set goals in NHP-17 and WHO standards. The private healthcare system has not been proved reliable during the emergency. Only the public health system is suitable for the country wherein the population’s substantial size is rural and poor.

COVID-19 and its effects upon orthopaedic surgery: The Trinidad and Tobago experience.

The World Health Organisation (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. COVID-19 is not the first infectious disease to affect Trinidad and Tobago. The country has faced outbreaks of both Chikungunya and Zika virus in 2014 and 2016 respectively. The viral pandemic is predicted to have a significant impact upon all countries, but the healthcare services in a developing country are especially vulnerable. The Government of Trinidad and Tobago swiftly established a parallel healthcare system to isolate and treat suspected and confirmed cases of COVID-19. Strick ‘lockdown’ orders, office closures, social distancing and face mask usage recommendation were implemented following advice from the WHO. This approach has seen Trinidad and Tobago emerge from the second wave of infections, with the most recent Oxford COVID-19 Government Response Tracker report indicating a favourable risk of openness index for the country. The effects of the pandemic on the orthopaedic services in the public and private healthcare systems show significant differences. Constrained by shortages in personal protective equipment and inadequate testing facilities, the public system moved into emergency mode prioritizing the care of urgent and critical cases. Private healthcare driven more by economic considerations, quickly instituted widespread safety measures to ensure that the clinics remained open and elective surgery was not interrupted. Orthopaedic teaching at The University of the West Indies was quickly migrated to an online platform to facilitate both medical students and residents. The Caribbean Association of Orthopedic Surgeons through its frequent virtual meetings provided a forum for continuing education and social interaction amongst colleagues. The pandemic has disrupted our daily routines leading to unparalleled changes to our lives and livelihoods. Many of these changes will remain long after the pandemic is over, permanently transforming the practice of orthopaedics.

Abstract P34: Health care disparities and outcomes of cancer patients with COVID-19: A pooled analysis of two Brazilian tertiary centers

Abstract Background: Patients with cancer, both active and previously treated, are at a higher risk of developing severe outcomes from COVID-19. During the pandemic, health care systems (HCS) have adapted the delivery of care, and disparities between private and public systems became even more striking. In Brazil, where 70% of the population depends on the public system, ICU demands largely exceed the capacity in most public centers, whereas in private centers the situation is less challenging. Herein we compare outcomes of patients with cancer and COVID-19 treated in the public and private HCS in Brazil. Methods: We used data from adult patients with solid malignancies who tested positive for COVID-19 and were admitted to two tertiary centers in the state of São Paulo. Patients who tested positive for SARS-CoV2 RNA real-time polymerase chain reaction (RT-PCR) were included. We collected data on baseline clinical conditions, cancer and treatment. Patients were classified by HCS: public system (public) versus (vs) private insurance coverage (private). The co-primary endpoints were all-cause mortality and a composite endpoint consisting of intensive-care-unit (ICU) admission, mechanical ventilation or death (ICU-MV-D). Chi-square, Fisher´s exact test and Mann-Whitney U test were used when appropriate. We assessed the association between outcomes and HCS using logistic regression analyses, adjusting for age, sex, current anticancer treatment and comorbidities. Results: From March 16 to October 20 2020, 124 patients were identified. Of those, 90 (72%) were from the public and 34 (28%) from the private HCS. There were no statistical differences in sex, smoking, primary tumor siteand staging between patients from both HCS. Conversely, patients treated in the private system were older [66 (SD 13.8) vs 74 (SD 15.1), p=0.004], had more comorbidities (64.7% vs 37.8% p=0.009), and were on anticancer treatment more frequently (64.7% vs 34.4% p=0.004) compared to public patients. There were no differences in all-cause mortality (public 40% vs private 44.1% p=0.69) between patients treated at the different HCS. Nevertheless, in the composite outcome, private system was significantly associated with increased risk of ICU-MV-D compared to the public system (79.4% and 57.8% p=0.030, respectively). The median time from COVID-19 diagnosis to ICU-MV-D was 13 vs 8 days (p=0.031) and to death was 25 vs 24 days (p=0.24), respectively for public and private HCS patients. In the multivariable logistic regression, HCS was not associated with death [adjusted odds ratio (aOR)=1.16 p=0.75] or ICU-MV-D (aOR=0.55, p=0.27). Conclusion: While patients in the private system were older and had more comorbidities, there were no differences in inpatients all-cause mortality between private and public systems. However, private patients were associated with increased ICU-MV-D. We hypothesize that these findings may reflect disparities in ICU availability, known to be higher in the private system. Further studies investigating this hypothesis are warranted. EDR and DVA co-senior authors. Citation Format: Marina Topanotti, Larissa L. Furlan, Catarina Marchon, Pedro Amaral, Barbara C. Beneton, Luiza A. Fadul, Maria Lucia Salomao, Suzana M. Lobo, Aline F. Fares, Daniel V. Araújo, Eliza D. Ricardo. Health care disparities and outcomes of cancer patients with COVID-19: A pooled analysis of two Brazilian tertiary centers [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P34.

Impfen gegen Influenza – Internationale Bestandsaufnahme und Perspektiven für Deutschland

BackgroundThe current SARS-CoV-2 pandemic requires high influenza vaccination rates for the chronically ill in order to avoid additional strain on the health care system. Despite clear evidence of the safety and effectiveness of influenza vaccination, vaccination coverage has internationally remained at inadequate levels in recent years. The general practitioner is of central importance for the care of this population. Therefore, the aim of this systematic review was to evaluate various measures in general practice to increase seasonal influenza vaccination rates for the chronically ill, taking into account various international health systems. MethodsA systematic literature search was carried out in MEDLINE, CENTRAL, EMBASE and ERIC as well as manually in trial registers and literature lists. Only randomized controlled studies were taken into account. The methodology was defined in advance in a study protocol and published (PROSPERO CRD42018114163). ResultsA total of 14 studies within the framework of a national health service (United Kingdom), a state (Australia) and social (Switzerland) health insurance system and a private health care system (USA) were included in our review. Analog patient reminders and automated physician reminders as well as changes in professional roles have led to a significant increase in influenza vaccination rates, but only in the private health care system. In the national health service, none of the interventions we analyzed achieved a significant increase in vaccination rates, although the National Health Service in the United Kingdom documented relatively good basic influenza vaccination rates before the studies were carried out, regardless of the intervention. Good results were achieved in the social and state health insurance systems of Switzerland and Australia by training events for practice teams and SMS reminders. ConclusionsIn Germany, training events for medical teams and centrally organized invitation and monitoring systems might improve vaccination rates among the chronically ill. That the federal government pays for the vaccination costs seems to ensure a good basic influenza vaccination coverage for indicated patients in various health systems.

COVID-19: Opportunity to Re-Imagine Our Response to a National Medical Crisis

The US is facing the most significant health challenge since the 1918-1919 flu pandemic. A response commensurate with this challenge requires engaged leadership and organization across private and public sectors that span federal agencies, public and private healthcare systems, professional organizations, and industry. In the trauma and emergency care communities, we have long discussed the tension between competition in healthcare and the need for regional cooperation to respond to large-scale disasters. The response to COVID-19 has required unprecedented coordination of private and public sector entities. Given the competitive nature of the US health system, these sectors do not regularly work together despite the requirement to do so during a national emergency. This crisis has exposed how structural aspects of the present healthcare system have limited our ability to rapidly transition to a whole-nation response during a national crisis. We propose a renewed focus on the intersection of the healthcare system and national security, with the express goal of creating a public-private partnership focused on leveraging our healthcare infrastructure to support the national security interests of the US.

A comparison study between public and private healthcare sector medicine prices in South Africa

Abstract Objectives The objectives of the study were to compare price trends, determine price differentials, and equate the average price index of a basket of medicines between the public and private healthcare sectors in South Africa. Methods A price list consisting of 32 essential medicines available in both the public and private healthcare systems of South Africa was chosen for this study. The price of medicines for the private sector were obtained from the Medicine Price Registry-Open Up website for the period 2014–2018. Public sector medicine prices were obtained from the Department of Health website for the corresponding period. Observations and price trends were identified and analyzed using Microsoft Excel version 2016. Key findings A total of 74 medicine brands were analyzed in the study. It was found that the prices across both sectors had increased over time, however, the majority of brands (87%) displayed higher prices in the private sector in comparison to the public sector. On average, the price differential between the private and public sector medicines were 395.47%. Conclusions The study found varying price differences between medicines in the public and private sectors because of the different methodologies used in each. The reasons for changes in medicine prices across the years in both sectors, could not always be clearly determined as both sectors lacked complete transparency in the processes applied to establish medicine prices. Therefore, more transparent medicine price systems need to be considered for the future of South Africa’s healthcare system as the country transitions toward universal health coverage.

Introduction. A mixed model of hospital services: Catalonia, 1870s-2010s

This special issue aims to contribute to current knowledge held on mixed hospital systems from a historical perspective, as there is nowadays much debate on the sustainability and efficiency of public and private healthcare systems in the world in the COVID-19 pandemic. By focusing on the evolution of mixed hospital systems through the case study of the history of such systems in Catalonia in the last century, the authors of this special issue show that mixed hospital systems take a long period of time to be used, and trusted, by the population. It is also considered how public healthcare regulators can create a diversity of mechanisms that facilitate access by the population to healthcare services in times of external shocks such as pandemics. This introductory text begins with a section about the international context which explains the relevance of mixed hospital systems, which is followed by a summary of the main historical points regarding the Catalan model of mixed hospital provision since the 19th century. It also highlights the most significant contributions of the seven articles of this special issue, which consider how the Catalan society confronted social, economic, and political changes and how those actions led to configure a distinctive mixed model of hospital system. Finally, this text also sheds light on areas of research regarding the rich history of hospital healthcare that still need to be addressed.

Integration of StopHF Model in Primary Healthcare System In Pakistan

Pakistani healthcare system consist of rural health centre (RHC), basic health unit (BHU) connected to district headquarter hospital which offer specialist services. RHC and BHU form the basis of primary care in Pakistan. There is another parallel private healthcare system which serve 70% of the population. Due to lack of facilities in primary healthcare system most of the population attends private healthcare. Private healthcare system serves 70% of the general population in Pakistan and most of the patients would prefer to attend private clinic and private hospitals for minor or major illnesses. These private clinic also serve a major part in primary prevention and management of cardiovascular diseases. Primary prevention plays an important role in management of cardiovascular disease. In STOP-HF first-of-its-type research study, the investigators recruited 1374 individuals with cardiovascular risk factors from a nurse-lead healthcare cardiovascular screening program in the catchment area of St. Vincent's University Hospital, Dublin, Ireland, between January 2005 to December 2009. This study demonstrated reduction in adverse cardiovascular events using BNP guided risk stratification of patients with cardiovascular risk factors. STOP-HF offers an excellent design to the global community on how to incorporate simple screening testing with secondary and tertiary healthcare system. Pakistani healthcare system can utilise STOP-HF model for the management of cardiovascular risk factor using BNP testing for identifying high risk population and early diagnosis and management of heart failure.

Cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole or letrozole as monotherapy in first-line treatment of postmenopausal women with HR+/HER2- locally advanced or metastatic breast cancer: a Brazilian private payer perspective.

Background:The global burden of breast cancer (BC) is high, especially in advanced stages. CDK 4/6 inhibitors represent a paradigm shift in the treatment of advanced BC HR+/HER2−, given the clinically and statistically significant gain in overall survival associated with this new class of medications. Nevertheless, as an innovation, the incorporation of these drugs impacts healthcare budgets, requiring cost-effectiveness analyses for decision-making. The aim of this study was to evaluate the cost-effectiveness of ribociclib plus letrozole compared with palbociclib plus letrozole or letrozole as monotherapy for first-line treatment of postmenopausal women with HR+/HER2− locally advanced or metastatic BC (aBC) from a Brazilian private healthcare system perspective.Methods:A model including progression-free survival (PFS), progressed disease, and death health states was used to simulate lifetime costs and outcomes. PFS and overall survival were derived from the MONALEESA-2 trial (lifetime horizon). Healthcare costs included drug acquisition and monitoring, subsequent therapies, adverse events, and end-of-life costs. Effectiveness was measured in quality-adjusted life-years (QALYs). Deterministic and probabilistic sensitivity analyses were performed.Results:The total cost of treatment with ribociclib plus letrozole was USD 72,091.82 versus USD 92,749.64 for palbociclib plus letrozole. Total QALYs were 3.30 and 3.16, respectively. Base-case analysis showed ribociclib as dominant over palbociclib in first-line treatment of women with HR+/HER2− aBC, associated with cost savings and QALY gains. The total cost of treatment with ribociclib plus letrozole was USD 83,058.73 versus USD 29,215.10 for letrozole. Total QALYs were 3.84 and 2.61, respectively. Compared with letrozole, ribociclib plus letrozole was associated with an incremental cost of USD 53,843.64 and an incremental QALY gain of 1.23, with incremental cost-effectiveness ratio of USD 43,826.91 per QALY gained.Conclusions:As demonstrated by the cost-effectiveness dominance over palbociclib, ribociclib results in savings when used as first-line treatment in postmenopausal women with HR+/HER2− aBC, warranting incorporation in the private healthcare system.

SARS-CoV-2 genomic characterization and clinical manifestation of the COVID-19 outbreak in Uruguay

ABSTRACT COVID-19 is a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and declared by the World Health Organization a global public health emergency. Among the severe outbreaks across South America, Uruguay has become known for curtailing SARS-CoV-2 exceptionally well. To understand the SARS-CoV-2 introductions, local transmissions, and associations with genomic and clinical parameters in Uruguay, we sequenced the viral genomes of 44 outpatients and inpatients in a private healthcare system in its capital, Montevideo, from March to May 2020. We performed a phylogeographic analysis using sequences from our cohort and other studies that indicate a minimum of 23 independent introductions into Uruguay, resulting in five major transmission clusters. Our data suggest that most introductions resulting in chains of transmission originate from other South American countries, with the earliest seeding of the virus in late February 2020, weeks before the borders were closed to all non-citizens and a partial lockdown implemented. Genetic analyses suggest a dominance of S and G clades (G, GH, GR) that make up >90% of the viral strains in our study. In our cohort, lethal outcome of SARS-CoV-2 infection significantly correlated with arterial hypertension, kidney failure, and ICU admission (FDR < 0.01), but not with any mutation in a structural or non-structural protein, such as the spike D614G mutation. Our study contributes genetic, phylodynamic, and clinical correlation data about the exceptionally well-curbed SARS-CoV-2 outbreak in Uruguay, which furthers the understanding of disease patterns and regional aspects of the pandemic in Latin America.

A cost-effectiveness analysis of propofol versus midazolam for the sedation of adult patients admitted to the intensive care unit.

ObjetivoConstruir um modelo de custo-efetividade para comparar o uso de propofol com o de midazolam em pacientes críticos adultos sob uso de ventilação mecânica.MétodosFoi construído um modelo de árvore decisória para pacientes críticos submetidos à ventilação mecânica, o qual foi analisado sob a perspectiva do sistema privado de saúde no Brasil. O horizonte temporal foi o da internação na unidade de terapia intensiva. Os desfechos foram custo-efetividade por hora de permanência na unidade de terapia intensiva evitada e custo-efetividade por hora de ventilação mecânica evitada. Foram obtidos os dados do modelo a partir de metanálise prévia. Assumiu-se que o custo da medicação estava incluído nos custos da unidade de terapia intensiva. Conduziram-se análises univariada e de sensibilidade probabilística.ResultadosPacientes mecanicamente ventilados em uso de propofol tiveram diminuição de sua permanência na unidade de terapia intensiva e na duração da ventilação mecânica, respectivamente, em 47,97 horas e 21,65 horas. Com o uso de propofol, ocorreu redução média do custo de U$2.998,971 em comparação ao uso do midazolam. A custo-efetividade por hora de permanência na unidade de terapia intensiva evitada e por hora de ventilação mecânica evitada foi dominante, respectivamente, em 94,40% e 80,8% do tempo.ConclusãoOcorreu diminuição significante do custo associado ao uso de propofol, no que se refere à permanência na unidade de terapia intensiva e à duração da ventilação mecânica para pacientes críticos adultos.

Compliance to the South African ventral hernia guidelines: inaugural results from the HIG(SA) registry

ABSTRACT BACKGROUND: The Hernia Interest Group (HIG) of South Africa (SA), following the publication of their inguinal and ventral hernia guidelines (in 2015 and 2016 respectively), developed a hernia registry, the HIG(SA) hernia registry METHODS: A retrospective analysis of the prospectively maintained HIG(SA) hernia registry from 1 February 2019 to 29 February 2020. Compliance to six recommendations made in the HIG(SA) ventral hernia guidelines were assessed in both the public and private healthcare systems RESULTS: Three hundred and fifty-three ventral hernia repair cases were included in the study. Fifty-four per cent were private and 46% were public sector cases. Laparoscopic repair for patients with a BMI &gt; 35 kg/m2 occurred in 38% of eligible cases and a minimum 5 cm of mesh overlap was achieved in 50% of cases. Overall, 80% of elective cases occurred in non-smokers; 97% of the intraperitoneal on-lay mesh (IPOM) repairs used composite mesh; 96% of ventral hernias with defects of larger than 2 cm and 95% of incisional hernias were repaired with mesh. Non-smokers undergoing repair numbered 72% in public and 85% in private practice, p = 0.01 CONCLUSION: Ventral hernia repair practices in SA facilities overall had good compliance to four out of the six HIG(SA) ventral hernia guidelines highlighted for the purposes of this study. The two guidelines that had poor compliance overall were 'laparoscopic repair for patients with a BMI of &gt; 35 kg/m2' and 'ensuring a mesh overlap of 5 cm'. The public sector had higher rates of current smokers undergoing elective ventral hernia repair Keywords: registry, low-middle income countries, ventral hernia, hernia guidelines

An assessment of the adequacy of iron deficiency anaemia management in the Namibian private healthcare system.

Anaemia, a condition characterized by reduced oxygen-carrying capacity, is a widespread public health problem with major consequences for human health as well as social and economic development. Prompt and accurate diagnosis as well as effective management of iron deficiency anaemia (IDA) is important to prevent the undesired adverse clinical outcomes. The purpose of the study was to assess the adequacy of IDA diagnosis and management within the Namibian private healthcare system. In this study, we used a quantitative, descriptive research design and data collection methods. The design was also nonexperimental in nature, employing a survey instrument to collect data. In total, 51 questionnaires were administered to private medical practitioners. The surveyed medical practitioners used different Standard Treatment Guidelines (STGs) in managing IDA cases, with the majority (76.5%) using the Namibia STGs. The other guidelines and their usage rates were as follows: World Health Organization guidelines (39.2%), Standard Treatment Guidelines and Essential Medicine List for South Africa (19.6%) and Essential Medicine List and Standard Treatment Guidelines for Zimbabwe (19.6%). Most of the medical practitioners used Namibian STGs although others used other treatment guidelines at their discretion. The study concluded that medical practitioners follow different guidelines and reference documents when dealing with patients with suspected IDA. Adherence to a single reference document would enable standardization of clinical practice. Management of IDA in the Namibian private healthcare system could be improved. To ensure adequate IDA management and prompt resolution of iron deficiency anaemia, we recommended the need to review the Namibia Standard Treatment guidelines and to ensure that training on the guidelines is offered.

Healthcare Systems and Variation in Healthcare Utilization at the End of Life Across Countries

With rapid population ageing, providing better end-of-life care (EOLC) is becoming a source of social demand and financial pressure for public and private budgets in many countries. This paper uses data from harmonized end-of-life interviews in the HRS family of studies to assesses variation in health care utilization across different income groups and how they differ across different health care systems. Hospital stay did not vary across health care systems, but nursing home stays were lower in countries with either national or statist social health insurance systems. Hospice use was low in all countries, but particularly in national and social health insurance systems. Lower income was associated with greater use of nursing homes in both the private and social health care systems. Low income was also associated with greater use of hospice in national health service, but lower use in social health service.

Access to Oral Chemotherapy Treatments in the Brazilian Private Healthcare System

In the Brazilian epidemiological scenario, neoplasms represents an important cause of mortality. Its impact has repercussions...

Drug Utilization and Drug Pricing in the Private Primary Healthcare System in Malaysia: An Employer Price Control Mechanism.

Uncontrolled drug pricing in the private healthcare system in Malaysia leads to high drug prices; however, its impact on employee drug utilization and employer reimbursement coverage is unclear. This study examined patterns of drug pricing and drug utilization among employees covered by employer medical insurance. A drug price control mechanism was also devised for the employer to ensure fair benefits to all parties without compromising the quality of patient care. This retrospective study was conducted among International Islamic University Malaysia (IIUM) community members who sought outpatient treatment at the IIUM panel of health clinics serviced by general practitioners from January 2016 to September 2019. Prescription data (drug type, dose, quantity, duration, price, and manufacturer), patient characteristics (age, sex, and diagnosis) and total charges were extracted from the claims database of PMCare, the insurance company managing IIUM medical claims. Patterns of commonly prescribed drugs, drug pricing, profit margins, and total charges per clinic visit were evaluated. Descriptive statistics were used, and all analyses were performed using Stata v15.1. There were a total of 161,146 prescriptions for 10,150 patients in the IIUM community during the study period (48.85% women, mean ± standard deviation; age: 26.33 ± 17.63 years). The most commonly prescribed drug was paracetamol (25.3%), followed by chlorpheniramine (9.46%), cetirizine (7.3%), diphenhydramine (6.13%), loratadine (4.57%), and diclofenac (4.36%). Generic paracetamol (500 mg), which serves as a prime example for details on drug pricing, is commonly charged between Ringgit Malaysia (RM) 5 and 10 for 10 tablets with a profit between 2,400 and 4,900% according to the average cost price of RM 0.20 per 10 tablets. Most patients were charged within the approved coverage limit of RM 45 per clinic visit, with only 2.41% of patients being charged with costs that exceeded this limit. Uncontrolled drug pricing in the private healthcare system in Malaysia indicates that drug prices differ greatly across private healthcare providers most of the prices were charged with high profit margins. Employers may consider a multilayer capping system to prevent inappropriate drug pricing, which will inevitably benefit patients clinically and economically and provide greater patient access to better drug treatment.

Cost-effectiveness of moderate-to-severe psoriasis biologic treatments in Brazilian private healthcare system: cost-per-responder results derived from a network metanalysis

Objective: To assess the cost-per-responder (CpR) of biologic therapies available in Brazil to treat moderate-to-severe plaque psoriasis (PsO) from the private healthcare system’s perspective. Methods: Number needed to treat (NNT) and (CpR) analyses were performed to evaluate biologic therapies’ cost-effectiveness for moderate-to-severe PsO available in Brazil. The effectiveness of biologic treatments for moderate-to-severe PsO was assessed based on a previously published metanalysis, which included studies considering PsO patients and outcomes of interest (PASI 75, 90, and 100). The clinical efficacy data in terms of estimated NNT based on the network metanalysis (NMA) results were combined with drug treatment costs to determine the CpR for each treatment arm in 3-time horizons: the primary response period, 1-year, and 2-years. Results: Risankizumab was the most cost-effective option when NMA base case scenario data was used to calculate NNT in all PASI response for both the primary response period and 1- and 2-years follow-up durations. Differences in CpR between risankizumab and other biologic drugs increased with more significant PASI improvements. CpR sensitivity analysis also confirmed these findings, indicating that risankizumab has a better performance for PASI 100, and both risankizumab and guselkumab are very similar in terms of cost per additional PASI 75 and PASI 90 responder. Conclusions: Risankizumab was estimated to have a lower cost per PASI 75, 90, and 100 responders in most simulated scenarios (primary response period [12-16 weeks], 1-year and 2-years), among the evaluated biologic therapies.

PRS22 Exacerbation-Related Costs and Health Resource Use in COPD Patients in the Brazilian Private Healthcare System

Describe patient characteristics, exacerbation-related health resource use (HRU) and associated costs for COPD patients in the Brazilian private healthcare system (PHS) between 2015 and 2019. Retrospective cohort study assessing Brazilian health claims data from Orizon. Patients aged ≥40 years, who had a COPD claim with ICD-10 J40 to J44 and 2 years of available data after the first COPD claim were included, also classified during the first year. HRU and costs were assessed in the second year of the patients’ follow-up. COPD exacerbation was defined as an emergency visit (EV) or hospital admission (HA) related to the following ICD-10: J00-J06, J09-J11, J12-J18, J20-J22, J40-J47, J80, J96. Mean and standard deviation (SD) for the HRU costs were calculated and adjusted according to the Broad National Consumer Price Index (IPCA) to reflect 2019 prices in Brazilian currency (R$). 1,254 COPD patients were assessed, predominatly women (55.11%), median age 65 years and had a severe COPD exacerbation in the first year (65,8%). Ambulatory visits were the most prevalent first COPD event (64.27%), followed by EV (19.62%) and HA (10.61%). In the second year of follow-up, 7.5% of patients had at least one exacerbation; among these, 7% had at least one EV and 3.6% had at least one HA related to COPD. 37.8% of all HA were followed by an intensive care unit (ICU) stay. EV and HA related to COPD cost R$ 755,45 (SD = R$ 818,94) and R$ 30.591,00 (SD = R$ 34.711,42), respectively. HA with ICU stay cost 70% more (R$ 53.190,00, SD = R$ 47.532,36) than general hospitalization. COPD exacerbation places a high economic burden on the Brazilian PHS, especially regarding hospitalization and ICU stay. Strategies should be implemented to minimize the number and severity of such events in the longer term.

PDG23 Budget IMPACT Analysis of Eltrombopag Olamina for Immune Thrombocytopenia (ITP) in the Brazilian Private Healthcare System (BPHS)

Immune thrombocytopenia (ITP) patients who have major bleeding complications require urgent platelet count increase with immunoglobulin rescue therapy (IRT), which is a procedure related to high cost impact for healthcare systems. Therefore, this study aimed to estimate the budget impact of including eltrombopag olamine for ITP patients who had insufficient response to corticosteroids, immunoglobulins or splenectomy in the Brazilian Private Healthcare System (BPHS). A budget impact model was developed to estimate total cost of including eltrombopag olamine in BPHS. To determine the eligible patient population, an epidemiological approach was adopted, considering total of adult beneficiaries in BPHS, ITP prevalence of 16.5/100,000 inhabitants, patients who need treatment (50%) and ITP patients who are refractory to first-line treatment (85%). Watch and rescue (WR) was the comparator. Estimated per year usage of IRT was estimated in 4.5 (Weitz, 2012). Reduction of IRT usage in consequence of eltrombopag administration was obtained from Elgebaly, 2016. A five-year time horizon was considered. Cost of treatment considered direct medical costs obtained from the Brazilian official price list - considering factory price (18% VAT) and calculated according to the average eltrombopag dosage published in RAISE study. Average costs related to IRT were obtained from an analysis of the Brazilian private market database published by Kim, 2019. Market share of eltrombopag was estimated in 40% in the first year after incorporation and 80% in the fifth year. WR resulted in a cost of BRL281,338 per patient/year, on the other hand, treatment with eltrombopag cost BRL243,628. Cost of treatment per patient/year showed the use of eltrombopag resulted in savings of BRL37,710. In ITP total population eligible to treatment, eltrombopag inclusion promoted an accumulated economic saving of BRL272,2 million in five years. Eltrombopag would lead to savings to BPHS generated by reduction in need of IRT in comparison to WR scenario.

PCN101 Budget IMPACT Analysis of Treatment-Free Remission (TFR) of Nilotinib Therapy in Chronic Myeloid Leukemia (CML) Patients in the Brazilian Private Healthcare System (BPHS)

PCN101 Budget IMPACT Analysis of Treatment-Free Remission (TFR) of Nilotinib Therapy in Chronic Myeloid Leukemia (CML) Patients in the Brazilian Private Healthcare System (BPHS)