Total Lifetime Costs Research Articles

The health and economic burden of haemophilia in Belgium: a rare, expensive and challenging disease

BackgroundHaemophilia is a rare hereditary haemorrhagic disease that requires regular intravenous injections of clotting factor (CF) concentrates. This study sought to estimate the health and economic burden of haemophilia in Belgium. This is the first study of its type to be conducted, and reflects the Belgian authorities’ growing interest for haemophilia as part of their priority planning for rare and chronic diseases.MethodsA probabilistic model was developed in order to estimate the lifetime haemophilia burden for the 2011 birth-year Belgian cohort. The health burden was initially expressed in terms of disability-adjusted life years (DALYs), the number of healthy life years lost due to living with disability and dying prematurely. An incidence perspective was used in line with World Health Organization recommendations. The economic burden calculated from direct and indirect haemophilia-related costs was expressed in euros. Data were drawn from the literature if none were available from federal institutions or health insurance. Disability weights for DALY calculation were derived using generic quality-of-life tools such as SF-6D from the SF-36 (36-item Short-Form Health Survey; for adults) and KINDL (generic quality-of-life instrument; for children) compared to population norms. Analyses were stratified according to haemophilia type and severity.ResultsIn Belgium, haemophilia resulted in 145 undiscounted and unweighted DALYs in total (95% credible interval [CrI] = 90-222), which represents an average of 11 DALYs per incident case with haemophilia (95% CrI = 8-15) during his life, varying according to haemophilia severity (17 DALYs for severe haemophilia, 12 DALYs for moderate, and 4 DALYs for mild). Mean total lifetime costs reached €7.8 million per people with haemophilia, 94.3% being direct costs and 5.7% indirect costs. Clotting factors accounted for 82.5% of direct costs.ConclusionsHaemophilia represents both an economic and health burden, especially regarding individual health on an individual patient level. Initiatives to counteract this burden should be clearly identified and given full support, as this burden is likely to increase in the future, especially from an economic perspective. Our study may also contribute towards a better global evaluation of haemophilia in the future.

Chagas disease in Australia and New Zealand: risks and needs for public health interventions

International migration has changed the global distribution of Chagas disease, with the emerging importance of non-endemic regions. We aimed at better documenting the Australia and New Zealand risk of Chagas disease and needs for interventions. We reviewed Chagas disease-related evidences, policies and practices in Australia and New Zealand and calculated the estimated prevalence. Australia hosts a rapidly growing population at risk and had 1928 infected residents in 2011; New Zealand had 98 in 2006. These figures underestimate the real situation, as they do not consider non-permanent residents. The only existing policy in both countries is the identification of blood donors with a history of or a risk of infection via questionnaire. There is no programme of detection and care of patients. The lifetime economic burden of disease for society is potentially very high. Chagas disease is an emerging health risk with potential high human and economic costs in Australia and New Zealand in the absence of public health attention. Implementing strategies to screen high-risk groups and prevent transmission should be considered. Moreover, migration between the Western Pacific and Chagas endemic regions and the presence of vectors means this risk applies in the whole region.

Cost and Cost-Effectiveness of the Mediterranean Diet: Results of a Systematic Review

The growing impact of chronic degenerative pathologies (such as cardiovascular disease, type 2 diabetes and Alzheimer’s disease) requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes, especially related to the Mediterranean diet, have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature, to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy, a net gain in health and a reduction in total lifetime costs.

Lifetime Costs for Peritoneal Dialysis and Hemodialysis in Patients in Taiwan

This study compared the lifetime costs for peritoneal dialysis (PD) and hemodialysis (HD) patients in Taiwan. Using the National Health Insurance (NHI) database of all end-stage renal disease patients on maintenance dialysis registered from July 1997 to December 2005, we matched eligible PD patients with eligible HD patients on age, sex, and diabetes status. The matched patients were followed until 31 December 2006. Patients were excluded if they were less than 18 years of age, had been diagnosed with cancer before dialysis, or had been dialyzed at centers or clinics other than hospitals. Outcomes-including life expectancy, total lifetime costs, and costs per life-year paid by the NHI-were estimated and compared. The 3136 pairs of matched PD and HD patients had a mean age of 53.2 ± 15.4 years. The total lifetime cost for PD patients (US$139 360 ± US$8 336) was significantly lower than that for HD patients (US$185 235 ± US$9 623, p < 0.001). Except for patients with diabetes (who had a short life expectancy), the total lifetime cost was significantly lower for PD patients than for HD patients regardless of sex and age (p < 0.01). In Taiwan, the total lifetime costs paid by the NHI were lower for PD than for HD patients.

PCN94 - The Cost-Effectiveness of Bendamustine-Rituximab Versus Fludarabine-Rituximab for Patients with Indolent Non-Hodgkin’s Lymphoma (INHL) Who Have Progressed Following Treatment with Rituximab or a Rituximab-Containing Regimen in Colombia

To determine the cost-effectiveness of bendamustine-rituximab (Ben-R) versus fludarabine-rituximab (Fdb-R) in patients with iNHL who have progressed following treatment with rituximab or a rituximab-containing regimen in Colombia. An economic model was constructed from the Colombian health system perspective, with a 35-year (lifetime) horizon and a discount rate of 3%. The model included three health states, progression-free (PF), progressive disease (PD), and death, which were associated with utility weights of 0.81, 0.62 and 0, respectively. Clinical inputs (response rates, Kaplan-Meier curves, hazard ratios (HRs) and adverse event rates) were from the Stil NHL 2-2003 study. Resource use data were from interviews with three Colombian hematologists treating iNHL patients. Unit costs were from ISS and SISPRO report and were expressed as 2013 Colombian Pesos. Univariate and probabilistic sensitivity analyses were conducted to determine the key drivers of cost-effectiveness, and uncertainty around the results, respectively. Total lifetime cost of Ben-R was $291,192,912 and total cost of Fdb-R was $260,463,392. Ben-R patients accrued more LYs (6.47 vs. 5.15), QALYs (4.66 vs. 3.56), and PFLYs (3.57 vs. 2.05) compared to Fdb-R patients. The ICERs were $23,286,360 (cost per LY), $27,956,124 (cost per QALY) and $20,259,063 (cost per PF LY). Univariate sensitivity analysis revealed that the ICER per LY was most sensitive to the PFS and OS HRs for Ben-R vs Fdb-R, the number of treatment cycles, and the cost of bendamustine. Probabilistic sensitivity analysis with 1,000 iterations estimated that Ben-R had a 52% chance of being cost-effective, compared to Fdb-R, at a willingness to pay (WTP) of $59M per LY, rising to a plateau of about 93% at a WTP of $175M and above. At a willingness-to-pay of $59M (three times the GDP per capita of Colombia) Ben-R is a cost-effective alternative to Fdb-R.

Análisis de costo-efectividad de nilotinib, dasatinib e imatinib como terapia de primera línea en leucemia mieloide crónica en Colombia, 2012

Introduction: New tyrosine kinase inhibitor treatments for chronic myeloid leukemia based on nilotinib, dasatinib and imatinib have improved patient quality of life and have turned chronic myeloid leukemia from a fatal disease into a chronic disease.Objective: To evaluate the cost-effectiveness of nilotinib, 600 mg, and dasatinib, 100 mg, each compared to imatinib, 400 mg, as first-line therapy in chronic myeloid leukemia in Colombia from a third-party payer’s perspective.Materials and methods: A cost-effectiveness analysis was performed using a Markov model to evaluate a hypothetical cohort of one hundred 55 year-old patients with newly diagnosed chronic myeloid leukemia in the chronic phase, and the time horizon for the baseline case was established as being until the end of life. Progression-free life-years saved were considered the primary outcome. Transition probabilities for major molecular response, disease progression to accelerated phase or blast crisis, and chronic myeloid leukemia related deaths were analyzed in the model for each arm. A 3% discount rate was applied to all costs and patient outcomes. Model robustness was evaluated using both univariate and multivariate Montecarlo sensitivity analysis.Results: Nilotinib was higher in expected progression-free life-years saved (15.21 vs. 12.64 for imatinib), followed by dasatinib (14.91 vs. 14.54 for imatinib). Imatinib had lower total lifetime costs. The incremental cost-effectiveness ratio was US$ 33,120.36 in the nilotinib arm and US$ 514,939.08 in the dasatinib arm per progression-free life-years (PF-LYs) saved, each compared to imatinib. When analyzing nilotinib versus dasatinib indirectly, nilotinib was found to be dominant due to higher efficacy (2.25 PF-LYs) and lower costs (US$ 44,674) in the baseline case. The average estimated cost to manage disease progression per year was US$ 101,978.78, considered to be the threshold.Conclusion: In Colombia, using PF-LYs as the efficacy outcome, nilotinib is highly cost-effective when compared to imatinib and dominant vs. dasatinib in first-line therapy for CML in chronic phase.

Cost Effectiveness of Denosumab versus Oral Bisphosphonates for Postmenopausal Osteoporosis in the US

In the US, 26 % of women aged ≥65 years, and over 50 % of women aged ≥85 years are affected with postmenopausal osteoporosis (PMO). Each year, the total direct health care costs are estimated to be $US12-18 billion. The cost effectiveness of denosumab versus oral bisphosphonates in postmenopausal osteoporotic women from a US third-party payer perspective was evaluated. A lifetime cohort Markov model was developed with seven health states: 'well', hip fracture, vertebral fracture, 'other' osteoporotic fracture, post-hip fracture, post-vertebral fracture, and dead. During each cycle, patients could have a fracture, remain healthy, remain in a post-fracture state or die. Relative fracture risk reductions, background fracture risks, mortality rates, treatment-specific persistence rate, utilities, and medical and drug costs were derived using published sources. Expected costs and quality-adjusted life years (QALYs) were estimated for generic alendronate, denosumab, branded risedronate, and branded ibandronate in the overall PMO population and high-risk subgroups: (a) ≥2 of the following risks: >70 years of age, bone mineral density (BMD) T score less than or equal to -3.0, and prevalent vertebral fracture; and (b) ≥75 years of age. Costs and QALYs were discounted at 3 % annually, and all costs were inflated to 2012 US dollars. Sensitivity analyses were conducted by varying parameters e.g., efficacies of interventions, costs, utilities, and the medication persistence ratio. In the overall PMO population, total lifetime costs for alendronate, denosumab, risedronate, and ibandronate were $US64,400, $US67,400, $US67,600 and $US69,200, respectively. Total QALYs were 8.2804, 8.3155, 8.2735 and 8.2691, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus generic alendronate was $US85,100/QALY. Risedronate and ibandronate were dominated by denosumab. In the high-risk subgroup (a), total costs for alendronate, denosumab, risedronate and ibandronate were $US70,400, $US70,800, $US74,000 and $US76,900, respectively. Total QALYs were 7.2006, 7.2497, 7.1969 and 7.1841, respectively. Denosumab had an ICER of $US7,900/QALY versus generic alendronate and dominated all other strategies. Denosumab dominated all strategies in women aged ≥75 years. Base-case results between denosumab and generic alendronate were most sensitive to the relative risk of hip fracture for both drugs and the cost of denosumab. In each PMO population examined, denosumab represented good value for money compared with branded bisphosphonates. Furthermore, denosumab was either cost effective or dominant compared with generic alendronate in the high-risk subgroups.

Affordability of electric vehicles for a sustainable transport system: An economic and environmental analysis

This paper compares the economic and environmental benefits of electric and hybrid electric vehicles with that of conventional vehicles. Without tax credits, only the hybrids without plug-in incur lifetime total costs equivalent to a conventional vehicle whereas the consumer affordability for all other vehicles is less encouraging and depends on changes in gasoline prices. With the provision of federal tax incentives, the lifetime total cost for all electric vehicle types that are driven for 120,000miles over 12 years was found to be generally affordable with no more than 5% higher in lifetime total cost than a conventional vehicle, except the hybrid electric plug-in equipped with a 35-mile electric driving range. Results of sensitivity analysis reveal that a greater lifetime driven mileage would promote further overall cost savings even at a greenhouse gas abatement cost as low as $42per ton. Our study has demonstrated the importance of an energy policy that includes tax credits to address the inadequacy of cost differentials and consumer affordability. The environmental benefits provided by the electric and hybrid electric vehicles should satisfy consumers' interest in protecting the environment, reducing the dependence on imported fossil fuels, and switching from traditional to alternative fuel vehicles.

Smoking Cessation Treatment and Outcomes Patterns Simulation: A New Framework for Evaluating the Potential Health and Economic Impact of Smoking Cessation Interventions

Most existing models of smoking cessation treatments have considered a single quit attempt when modelling long-term outcomes. To develop a model to simulate smokers over their lifetimes accounting for multiple quit attempts and relapses which will allow for prediction of the long-term health and economic impact of smoking cessation strategies. A discrete event simulation (DES) that models individuals' life course of smoking behaviours, attempts to quit, and the cumulative impact on health and economic outcomes was developed. Each individual is assigned one of the available strategies used to support each quit attempt; the outcome of each attempt, time to relapses if abstinence is achieved, and time between quit attempts is tracked. Based on each individual's smoking or abstinence patterns, the risk of developing diseases associated with smoking (chronic obstructive pulmonary disease, lung cancer, myocardial infarction and stroke) is determined and the corresponding costs, changes to mortality, and quality of life assigned. Direct costs are assessed from the perspective of a comprehensive US healthcare payer ($US, 2012 values). Quit attempt strategies that can be evaluated in the current simulation include unassisted quit attempts, brief counselling, behavioural modification therapy, nicotine replacement therapy, bupropion, and varenicline, with the selection of strategies and time between quit attempts based on equations derived from survey data. Equations predicting the success of quit attempts as well as the short-term probability of relapse were derived from five varenicline clinical trials. Concordance between the five trials and predictions from the simulation on abstinence at 12months was high, indicating that the equations predicting success and relapse in the first year following a quit attempt were reliable. Predictions allowing for only a single quit attempt versus unrestricted attempts demonstrate important differences, with the single quit attempt simulation predicting 19% more smoking-related diseases and 10% higher costs associated with smoking-related diseases. Differences are most prominent in predictions of the time that individuals abstain from smoking: 13.2years on average over a lifetime allowing for multiple quit attempts, versus only 1.2years with single quit attempts. Differences in abstinence time estimates become substantial only 5years into the simulation. In the multiple quit attempt simulations, younger individuals survived longer, yet had lower lifetime smoking-related disease and total costs, while the opposite was true for those with high levels of nicotine dependence. By allowing for multiple quit attempts over the course of individuals' lives, the simulation can provide more reliable estimates on the health and economic impact of interventions designed to increase abstinence from smoking. Furthermore, the individual nature of the simulation allows for evaluation of outcomes in populations with different baseline profiles. DES provides a framework for comprehensive and appropriate predictions when applied to smoking cessation over smoker lifetimes.

An economic analysis of axitinib and sorafenib for second-line treatment of cytokine-refractory patients with advanced renal cell carcinoma in the United States (US).

e15601 Background: Cytokines are a first-line treatment option for a subset of advanced RCC patients in the US. After progression on cytokines, NCCN guidelines recommend targeted agents, such as axitinib and sorafenib. Subgroup analysis of post-cytokine patients in the phase III AXIS trial found that axitinib increased median progression free survival (PFS) compared with sorafenib (12.0 vs. 6.6 months, p&lt;0.0001), while overall survival (OS) showed no difference (29.4 vs. 27.8 months, p=0.144). An economic analysis for this subgroup was conducted from a US healthcare payer perspective. Methods: A cohort partition model with monthly cycles was constructed to estimate direct medical costs and health outcomes, discounted at 3.0% per annum, over cohort lifetime. Patients were apportioned into 3 health states (progression-free, progressed and dead) based on OS and PFS Kaplan-Meier curves for the post-cytokine subgroup in the AXIS trial. Active treatment was applied until progression, followed by best supportive care (BSC) alone thereafter. The wholesale acquisition costs were based from RedBook. Adverse event (AE) management costs were obtained from published studies. AE rates and utility values were informed by the AXIS trial. Administrative claims data from MarketScan Database were analyzed to estimate costs for BSC and routine care of second-line advanced RCC patients. Results: The total per-patient lifetime costs were estimated to be $242,750 for axitinib and $168,880 for sorafenib and most of the cost difference (84%) was due to the higher total medication cost of axitinib. The cost difference was sensitive to dose intensity and length of treatment. The difference in quality-adjusted life-years (QALY) for axitinib versus sorafenib was minor (1.3 versus 1.2) and the incremental cost-effectiveness ratio (ICER) for axitinib compared with sorafenib was $683,209/QALY. Conclusions: For cytokine-refractory advanced RCC patients, axitinib resulted in an ICER &gt; $650,000/QALY versus sorafenib due to high drug costs and lack of OS benefit, indicating that axitinib may not present good value for money as 2nd line treatment when compared to sorafenib in the US.

PMS30 - Is Denosumab Cost-Effective Compared To Oral Bisphosphonates For The Treatment Of Male Osteoporosis (Mop) In Sweden?

PMS30 IS DENOSUMAB COST-EFFECTIVE COMPARED TO ORAL BISPHOSPHONATES FOR THE TREATMENT OF MALE OSTEOPOROSIS (MOP) IN SWEDEN? Parthan A1, Kruse MM1, Agodoa I2, Tao CY1, Silverman SL3, Orwoll E4 1OptumInsight, Cambridge, MA, USA, 2Amgen Inc., Thousand Oaks, CA, USA, 3CedarsSinai Hospital, Beverly Hills, CA, USA, 4Oregon Health & Science University, Portland, OR, USA OBJECTIVES: Cost-effectiveness of denosumab versus oral bisphosphonates in MOP was evaluated from a third-party payer perspective in Sweden. METHODS: A lifetime cohort Markov model was developed to reflect osteoporotic health states. During each cycle, patients could have a fracture, remain healthy, remain in a post fracture state or die. Background fracture risks, mortality rates, persistence rates, utilities, medical and drug costs were derived using published sources. Bone mineral density (BMD) improvements have been shown to be similar between MOP and post-menopausal osteoporotic (PMO) populations, and a recent fracture trial showed zoledronate to have effects in men similar to those reported previously in women; therefore efficacy data from PMO women were used. Lifetime expected costs and quality-adjusted life-years (QALYs) were estimated for denosumab, generic alendronate, generic risedronate, and ibandronate. Patients in the model were 65-year-old men, with BMD T-score≤1.90 and prevalent vertebral fracture of 22.7%. In the base-case, the model assumed patients could receive treatment effects up to 2 years after discontinuation (offset time). Costs and QALYs were discounted at 3% annually. Extensive sensitivity analyses were conducted. RESULTS: Total lifetime costs for alendronate, denosumab, risedronate, and ibandronate were €45,118, €45,396, €45,526, and €46,523, respectively. Total QALYs were 9.86, 9.91, 9.85, and 9.83, respectively. Denosumab had an incremental cost-effectiveness ratio (ICER) of €5,283 compared to alendronate and dominated risedronate and ibandronate. Results were most sensitive to changes in relative risk (RR) of hip fracture with denosumab, cost of denosumab and RR of vertebral fracture with denosumab. The probability of denosumab being cost-effective compared to oral bisphosphonates at a threshold of €66,000/QALY was 85.5%. In a sensitivity analysis of offset time of 5 years for oral bisphosphonates, denosumab had an ICER of €10,382 compared to alendronate. CONCLUSIONS: Denosumab is costeffective compared to branded and generic oral bisphosphonates in the Swedish MOP population.

Economic evaluation of telmisartan, valsartan and losartan in combination with hydrochlorothiazide for treatment of mild-to-moderate hypertension in Greece: a cost-utility analysis

Objectives To evaluate the cost-utility of combined therapy of telmisartan with hydrochlorothiazide (HCTZ) compared to commonly used alternatives, losartan/HCTZ and valsartan/HCTZ, in patients with mild-to-moderate hypertension in Greece. Methods A Markov model was constructed from the third-party-payer perspective. The cycle length of the model was one year. Risk equations derived from the HellenicSCORE and Framingham Heart Study were used to estimate transition probabilities between states. Treatment effectiveness and utility values were obtained from published clinical trials and studies. Costs assigned to each health state were obtained from real data and reflected the years 2012. Key findings The model predicted that discounted quality-adjusted life-years (QALYs) were higher in the telmisartan/HCTZ group compared to losartan/HCTZ group by 0.09 and 0.03 in men and women, respectively. Moreover, telmisartan/HCTZ was found to be related to higher total lifetime costs per patient than losartan/HCTZ by €98 and €276 in men and women, respectively. Similarly, the comparison between telmisartan/HCTZ and valsartan/HCTZ revealed that the former is more effective (QALYs, gained 0.12 and 0.04, in men and women, respectively) and more costly by €536 and €780 in men and women, respectively. Based upon a willingness-to-pay threshold of €30 000 per QALY gained, telmisartan/HCTZ was found to be cost-effective as the incremental cost-effectiveness ratios were estimated at €3002 and €4806 per QALY gained in men and €10 856 and €25 837 in women. Conclusion The analysis revealed that telmisartan/HCTZ may be a cost effective alternative to generic losartan/HCTZ and valsartan/HTCZ for treatment of mild-to-moderate hypertension in the Greek setting.

Measures for improving the adoption of higher efficiency appliances in Indonesian households: An analysis of lifetime use and decision-making in the purchase of electrical appliances

One approach to decreasing electricity consumption is to facilitate the replacement of older appliances with new, higher-efficiency. The objectives of this paper are to compare and analyse the replacement of appliances in two cities of Indonesia – Yogyakarta and Bandung – that are characterised by different cultural backgrounds, ethnicities, and decision-making processes in the household purchase of electrical appliances. A questionnaire survey method was employed to obtain information on behavioural economics and human psychosocial variables such as attitudes, beliefs and perceived benefits regarding the replacement and purchase of electrical appliances. The results show that refrigerators in Yogyakarta have a longer lifetime than in Bandung. However, in Bandung, air conditioners, electric fans, rice cookers, and water pumps have a longer lifetime than in Yogyakarta. These differences in the lifetime of appliances can be attributed to the cultural differences within the two cities that are reflected in the manner in which people use electrical appliances as well as to their lack of knowledge regarding appliance operation. An analysis of the factors influencing the purchase of appliances indicated that people in Yogyakarta show a greater awareness of the benefits of adopting higher-efficiency appliances than do persons in Bandung. The following suggestions could be implemented to improve the strategy of encouraging the adoption of higher-efficiency appliances: (1) in Yogyakarta, energy labelling could be applied to assist customers in understanding the rate of energy consumption of selected appliances; (2) in Bandung, the store sales staff could be trained to adapt their promotional messages to persuade people to purchase high-efficiency appliances and to promote the adoption of higher-efficiency models; and (3) the price of appliances could be correlated with the rate of energy consumption, and the total lifetime cost of use should be displayed in the store and included in promotional materials.

Cost–utility analysis of oral deferasirox versus infusional deferoxamine in transfusion‐dependent β‐thalassemia patients

Deferasirox (DFX) is a novel iron chelator that has been shown to have similar efficacy and safety compared with deferoxamine (DFO) in patients with β-thalassemia. The aim of this study was to determine the cost utility of DFX versus DFO in β-thalassemia major patients from Iran's society perspective. A Markov model has been developed to determine lifetime cost and quality-adjusted life-years (QALYs) of patients. To estimate the annual cost of each method, a cross-sectional study was conducted among two groups of patients who received DFO and DFX (n = 100 and n = 45, respectively). Also a time trade-off method was used to estimate the utility of two strategies. Finally a one-way and probabilistic sensitivity analysis was conducted to examine the strength of the results. Our base-case analysis showed that estimated total lifetime costs per patient for DFX and DFO were 47,029 international dollar ($Int) and $Int143,522, respectively, while the estimated total discounted QALYs per person were 12.28 and 7.76, respectively. Calculated incremental cost-effectiveness ratio showed that DSX is a dominant therapy and its estimated lifetime net monetary benefit was $Int273,528. We conclude that the use of DFX instead of DFO represents a cost-effective use of resources for treatment of iron overload in patients with β-thalassemia from Iran's society perspective.

The Lifetime Direct Cost of Periodontal Treatment: A Case Study From a Norwegian Specialist Practice

Successful periodontal treatment requires a commitment to regular lifelong maintenance and may be perceived by patients to be costly. This study calculates the total lifetime cost of periodontal treatment in the setting of a specialist periodontal practice and investigates the cost implications of choosing not to proceed with such treatment. Data from patients treated in a specialist practice in Norway were used to calculate the total lifetime cost of periodontal treatment that included baseline periodontal treatment, regular maintenance, retreatment, and replacing teeth lost during maintenance. Incremental costs for alternative strategies based on opting to forego periodontal treatment or maintenance and to replace any teeth lost with either bridgework or implants were calculated. Patients who completed baseline periodontal treatment but did not have any additional maintenance or retreatment could replace only three teeth with bridgework or two teeth with implants before the cost of replacing additional teeth would exceed the cost of lifetime periodontal treatment. Patients who did not have any periodontal treatment could replace ≤ 4 teeth with bridgework or implants before a replacement strategy became more expensive. Within the limits of the assumptions made, periodontal treatment in a Norwegian specialist periodontal practice is cost-effective when compared to an approach that relies on opting to replace teeth lost as a result of progressive periodontitis with fixed restorations. In particular, patients who have initial comprehensive periodontal treatment but do not subsequently comply with maintenance could, on average, replace ≤ 3 teeth with bridgework or two teeth with implants before this approach would exceed the direct cost of lifetime periodontal treatment in the setting of the specialist practice studied.

Economic burden of human papillomavirus-related diseases in Italy.

IntroductionHuman papilloma virus (HPV) genotypes 6, 11, 16, and 18 impose a substantial burden of direct costs on the Italian National Health Service that has never been quantified fully. The main objective of the present study was to address this gap: (1) by estimating the total direct medical costs associated with nine major HPV-related diseases, namely invasive cervical cancer, cervical dysplasia, cancer of the vulva, vagina, anus, penis, and head and neck, anogenital warts, and recurrent respiratory papillomatosis, and (2) by providing an aggregate measure of the total economic burden attributable to HPV 6, 11, 16, and 18 infection.MethodsFor each of the nine conditions, we used available Italian secondary data to estimate the lifetime cost per case, the number of incident cases of each disease, the total economic burden, and the relative prevalence of HPV types 6, 11, 16, and 18, in order to estimate the aggregate fraction of the total economic burden attributable to HPV infection.ResultsThe total direct costs (expressed in 2011 Euro) associated with the annual incident cases of the nine HPV-related conditions included in the analysis were estimated to be €528.6 million, with a plausible range of €480.1–686.2 million. The fraction attributable to HPV 6, 11, 16, and 18 was €291.0 (range €274.5–315.7 million), accounting for approximately 55% of the total annual burden of HPV-related disease in Italy.ConclusionsThe results provided a plausible estimate of the significant economic burden imposed by the most prevalent HPV-related diseases on the Italian welfare system. The fraction of the total direct lifetime costs attributable to HPV 6, 11, 16, and 18 infections, and the economic burden of noncervical HPV-related diseases carried by men, were found to be cost drivers relevant to the making of informed decisions about future investments in programmes of HPV prevention.

Cost-Effectiveness of Ruxolitinib Versus Best-Available Therapy for Medical Treatment of Myelofibrosis: Canadian Societal Perspective

AbstractAbstract 4255 Background:Ruxolitinib demonstrated significant clinical benefits for patients (pts) with myelofibrosis (MF) in two phase 3 COMFORT studies. Nevertheless, in countries where health technology assessments are conducted, cost-effectiveness is an important consideration. Economic evaluations play an increasingly important role in reimbursement decisions for new treatments. To help inform such decisions, an evaluation of the cost-effectiveness (CE) of adding ruxolitinib as a treatment for MF was conducted from a Canadian societal perspective. Methods:A Markov model was built to estimate the costs, health outcomes, and CE of ruxolitinib compared with investigator-selected best available therapy (BAT), which included conventional therapies or no treatment. Data were derived from pts enrolled in the COMFORT-II study and included high-risk or intermediate-2–risk pts according to the International Working Group for Myelofibrosis Research and Treatment risk categorization. For this analysis, response was defined as a ≥ 35% reduction in spleen volume (COMFORT-II primary endpoint) or absence of constitutional symptoms. Survival assumptions were derived from a historical comparison of patients in the phase 1/2 study (Verstovsek et al, Blood. 2012) that showed a benefit for those achieving a ≥ 50% reduction in spleen length (equivalent to 35% spleen volume reduction). The model simulated disease progression in a cohort of pts with MF through 4 different health states with a 12-week cycle and a lifetime time horizon: 1) responder; 2) nonresponder; 3) leukemic transformation (LT); and 4) death. In each time cycle, pts incurred cost and utility estimates associated with their health state. The model considered the resource and utility implications arising from treatments aimed at directly treating splenomegaly, namely splenic irradiation and splenectomy. The outcomes of the Markov model included costs over the time horizon (drug costs, costs linked to the management of adverse events, other medical costs, indirect costs), life years, quality-adjusted life years (QALYs), and time spent as a responder to treatment. Both a 1-way sensitivity analysis and a probabilistic sensitivity analysis were performed, using estimated ranges and probability distributions for each input parameter. Results:The results showed that ruxolitinib-treated pts with MF had a better clinical outcome but at an increased cost. The total average lifetime cost of treating a pt receiving ruxolitinib was $494,859 CAD, with drug costs of $205,484 and other medical costs of $217,527, the majority of which were resource costs. The total average lifetime cost of treating a pt receiving BAT was $421,755, of which $59,289 was drug costs. Indirect costs were higher for BAT pts, at $96,458, exceeding the figure of $71,848 for ruxolitinib pts (Table). The clinical results showed longer average overall survival for pts receiving ruxolitinib compared with pts receiving BAT (Verstovsek et al, Blood. 2012). The ruxolitinib-treated pts had 4.01 QALYs compared with 2.82 QALYs for those in the BAT arm. The overall incremental CE ratio (ICER) was $61,444 per QALY. The key model drivers were the resource cost for nonresponders and improved mortality in the intermediate-2–risk group. Adopting a $100,000 per QALY willingness-to-pay threshold showed that 100% of the simulations for ruxolitinib therapy would be cost-effective compared with BAT for the treatment of MF. The mean ICER from the simulations was $59,216 per QALY, which was similar to the deterministic average of $61,444. Conclusions:There has been a high, unmet need for an effective therapeutic option for pts with MF. The COMFORT-II study has shown that ruxolitinib is clinically effective and superior to BAT at reducing splenomegaly and disease-related symptoms and improving health-related quality of life. The present analysis suggests that compared with BAT, ruxolitinib is an economically acceptable treatment option. Continued long-term evaluation of survival and potential reduction in rates of LT will also impact the future CE of ruxolitinib.TableComparison of Total Lifetime CostsRuxolitinibBATTotal average lifetime cost$494,859$421,755Drug costs$205,484$59,289Other medical costs$217,527$266,008Indirect costs$71,848$96,458Total average patient outcomesQALY4.012.82ICER$61,444/QALY Disclosures:El Ouagari:Novartis Pharma: Employment. Knight:Novartis Pharmaceuticals Corporation: Consultancy; Novartis Pharmaceuticals Canada: Consultancy. Mendelson:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership.

PDB38 Cost-Effectiveness of Insulin Detemir in People With Type 2 Diabetes in Romania

To assess cost-utility of switching type 2 diabetes patients to an insulin detemir-based regimen after failure to achieve adequate control on 1) oral antidiabetic agents (OADs) alone, or OAD in combination with 2) neutral protamine Hagedorn (NPH) insulin, or 3) insulin glargine in Romania. The CORE Diabetes Model was used to model the long-term consequences. Efficacy results at the beginning and at the end of the study as well as baseline demographics of the patient cohort (subgroup analysis of the German cohort of PREDICTIVE study) were used. The perspective was the health care services payer over life time (35-years). The analysis used model default health state utility values. Cost data were derived from DRG Data from the Center for Research and Evaluation of Healthcare Services (Romania), CaNaMed National Catalogue of Medicines Prices (official tariff lists) and expert opinion. In the 1st analysis (insulin detemir ± OADs vs. OADs) QALYs increased by 0.399 years with insulin detemir. Total lifetime costs increased by EUR 4,413 resulting in an incremental cost per QALY gained of EUR 11,050. In the 2nd analysis insulin detemir increased quality-adjusted life expectancy by 0.394 QALYs and total costs by EUR 2,340, with incremental cost per QALY gained of EUR 5,943. Transferring from insulin glargine ± OADs to insulin detemir ± OADs (3rd analysis) increased QALYs by 0.319 years. Total costs increased by EUR 689 resulting in an incremental cost per QALY gained of EUR 2,160. Based on efficacy data from an observational study and a validated health economics model, insulin detemir was cost effective when compared to OAD alone, or insulin NPH ± OAD, or insulin glargine ± OAD for the treatment of type 2 diabetes in the Romanian health care setting.

Estimating the lifetime economic burden of Parkinson's disease in Singapore

We aimed to estimate the lifetime cost of Parkinson's disease (PD) from the societal perspective. A convenience sample of English or Chinese-speaking patients with PD was recruited from a PD and Movement Disorders Centre in Singapore to complete a financial burden questionnaire. Sociodemographic and clinical data were retrieved from hospital databases. Markov cohort model analysis was performed (cycle length, 1-year; duration, death or reached 100 years old). Patients were assumed to progress from one Markov state to the next state or death without skipping states or regressing. All model parameters were based on published local data. In 195 patients with PD (median age: 68.9, male: 51.8%), the simulated lifetime cost of PD was Singapore Dollar (SGD) 60,487 (EUR purchasing power parity 56,253) per patient. Direct medical, non-medical and indirect cost accounted for 18.8%, 12.8% and 68.4% of total lifetime cost, respectively. The top three components of total lifetime cost were productivity losses (67.6%), pharmacotherapy (11.4%) and home care (8.7%). One-way sensitivity analysis and probabilistic sensitivity analyses revealed that estimates were sensitive to cost at H&Y stage 1, 2 and 2.5 and productivity losses. The lifetime cost of PD is evaluated for the first time. This cost is substantial and comparable to the lifetime cost of intracerebral haemorrhage in at least one study. Our study identified several priority areas for research and policy formulation: reducing productivity losses, reducing cost of pharmacotherapy, avoiding hospitalization and reducing home care cost.

704P - Cost-Effectiveness of Three-Years of Adjuvant Imatinib in Gastrointestinal Stromal Tumors (GIST) in Canada

ABSTRACT Background Recent clinical trial data have demonstrated that 3 years (yrs) of adjuvant imatinib therapy for patients with surgically resected GIST leads to a significant improvement in recurrence free survival & overall survival vs. 1 yr of therapy. The objective of this study is to assess cost-effectiveness of treating with 3 yrs vs. 1 yr of adjuvant imatinib in Canada from a payer's perspective. Methods A Markov model was developed to predict GIST recurrence, treatment (txt) costs, & quality-adjusted survival over a lifetime horizon. Patients transitioned between 3 health states: free of GIST recurrence, GIST recurrence, & death. Monthly recurrence & mortality rates for 3 yr & 1 yr imatinib were derived from SSGXVIII/AIO clinical trial. The 5 yr recurrence rate observed in the trial was extrapolated for the remaining duration of the model horizon. First recurrence after active txt was treated with imatinib 400 mg daily and recurrence during active txt was treated with 800mg daily. For subsequent disease progression, patients were treated with imatinib 800mg, sunitinib or best supportive care. After 5 years, txt specific mortality rate was applied for patients with recurrence. Costs & utilities were derived from published literature. Expected costs & quality-adjusted life years (QALYs) were estimated for each txt strategy. Costs & QALYs were discounted at 5% per yr. Extensive sensitivity analyses were conducted. Results Patients on 3 yrs of imatinib had higher QALYs (7.70 vs 6.54) vs. 1yr of imatinib. Total lifetime cost per patient was $182,000 with 3 yrs vs. $134,500 for 1 yr of imatinib therapy. Incremental cost effectiveness ratio of 3 yrs of imatinib vs 1 yr of imatinib was $40,877/QALY. Model results were sensitive to rate of GIST recurrence beyond 5 yrs. At a threshold of $100,000 or $50,000/QALY, 3yr imatinib therapy was cost-effective in 100% of simulations vs. 1 yr of imatinib. Conclusions Model results suggest that treating patients with 3 yrs of imatinib is cost-effective vs. 1 yr of imatinib below the commonly used threshold in Canada. Both clinical & economic results suggest treating surgically resected GIST patients with 3 yrs of imatinib would result in improved quality-adjusted & overall survival. Disclosure A. Parthan: Study was sponsored by Novartis and I have consulting relationship with Novartis. M. Sanon: The study was sponsored by Novartis and I had consultancy relationship with Novartis at the time of the study. J. Coombs: Employed at Novartis and holds Stock for Novartis. K. El Ouagari: employed at Novartis and owns stocks for Novartis