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lifetime horizon, with costs and outcomes discounted by 3.5% per year. Univariate
and multivariate probabilistic sensitivity analyses are conducted to investigate
parameter uncertainty. RESULTS: The incremental cost-effectiveness ratio
(ICER) for vedolizumab is estimated at £21,620/QALY compared with CT.
Sensitivity analyses showed that results are most sensitive to variation in the
CT arm transition probabilities from the moderately-severely active state and
from the remission state. The ICER was also sensitive to response assessed at
week six rather than week 8 and efficacy based on GEMINI II only. When
treatment with vedolizumab was continued for 2 or 3 years (instead of 1 year)
the ICER increased to £24,695/QALY and £26,207/QALY respectively. The
average probabilistic ICER shows vedolizumab to be £27,428/QALY gained (95%
CI ICER of -£7,883 to £82,947). CONCLUSIONS: The economic model predicts
that treatment with vedolizumab improves QALYs and is a cost-effective
alternative to CT for patients who have inadequate response to CT and TNF-a
antagonists. Vedolizumab has received positive recommendations from the
National Institute for Health and Care Excellence (NICE) and the Scottish Med-
icines Consortium (SMC) for the CT and anti-TNF failure population.
PSY115
A COST-EFFECTIVENESS ANALYSIS OF RAASI eENABLING PATIROMER
FOR THE TREATMENT OF HYPERKALEMIA IN AUSTRIA
Walter E, Eichhober G, Voit M
Institute for Pharmaeconomic Research, Vienna, Austria
OBJECTIVES: An increase in blood-serum-potassium levels is common in patients
with renal impairment or heart failure. Lifesaving RAAS-inhibitors (RAASi) such as
ACE inhibitors, AT1 receptor-antagonists and aldosterone-blockers lead to a
further rise in potassium levels. Discontinuation and downtitration of RAASi result
in increased morbidity, as RAASi prolong the time to complete renal insufficiency.
The purpose of this study was to extend the results of an 8-week OPALeHK RCT for
patiromer, a nonabsorbed potassium-binder, that showed significant reduction in
hyperkalaemia and RAASi dose maintenance in the patiromer group (94%)
compared to no-patiromer (placebo) arm (44%). The analysis was performed from
the Austrian healthcare-systems perspective. METHODS: A reported model by
Sutherland et al. (2017), composed of a decision-tree and a Markov process, was
used to simulate the treatment pathway of patients with chronic-kidney-disease
(CKD). The short-term decision-tree estimates the proportion of CKD patients
(potassium level, 5.0mmol/L) that continued/discontinued RAASi medication
after hyperkalemia. The endpoint of the decision-tree was linked with to Markov
model to simulate life-time follow-up. The model includes 6 states (stable CKD,
CKD disease-progression, cardiovascular (CV) events, post CV event, hospitaliza-
tion and death). The cohort definition was adopted from the OPALeHK trial. Monte-
Carlo simulation accounted for uncertainty. Direct costs and life expectancy were
obtained from local sources for 2018. QALYs and costs were discounted at 5% p.a.
RESULTS: Over lifetime, costs and outcomes associated with patiromer would
amount to 38,117.17Vand achieve 5.48 QALYs. Costs with no treatment are
27,157.66Vand obtain 4.90 QALYs. The results show that patiromer is associated
with a significant improvement in QALYs; 7 months in perfect health. The incre-
mental-cost-utility-ratios ICUR amounts to 18,979.23V.CONCLUSIONS: The re-
sults indicate that treatment with patiromer vs. no-patiromer, in addition to
enabling RAASi continuation, is potentially a cost-effective intervention for the
treatment of hyperkalaemia in patients with CKD stages 3-4 in Austria.
PSY117
ASSESSMENT OF SOCIAL AND ECONOMIC BURDEN OF CHRONIC
MYELOID LEUKEMIA IN BULGARIA
Kamusheva M, Tachkov K, Dimitrova M, Doneva M, Petrova G
Medical University-Sofia, Faculty of Pharmacy, Sofia, Bulgaria
OBJECTIVES: To evaluate the social and economic burden of chronic myeloid
leukemia (CML) in Bulgaria presented as disability adjusted life years (DALYs).
METHODS: A retrospective analysis was performed on the basis of officially pub-
lished information in the national cancer registry and local representative studies.
Data for the relevant survival and the average year of diagnosis of patients with
CML in the country were gathered and analyzed. DALYs were calculated as the sum
of the Years of Life Lost (YLL) and the Years Lost due to Disability (YLD). Disability
weight, the average life expectancy and the median survival were assumed to be
0.049 (0,031-0,072) as it is in case of controlled phase of CML, 88 years of age as per
WHO methodology and 25 years according to expert opinions, respectively. The
average age of CML diagnosis for Bulgarian population is 53±16 years according to
nationally representative study conducted between 2012 and 2014. DALYs were
multiplied by the GDP/capita so as to find the economic burden of the disease.
RESULTS: On average a patient with CML in controlled phase spends 10.89 years of
his remaining life in disability due to the disease. Taking into account annual
working income we found that the costs of lost productivity per patient are sup-
posed to be around 66 398.5 (63 623 e69 906) V.CONCLUSIONS: The current study
is the first Bulgarian one which evaluates the social burden of CML after placing
innovative tyrosine kinase inhibitors on the Bulgarian market. The disease appears
to have high social and economic burden which is comparable with the burden of
other non-communicable chronic diseases in Bulgaria.
PSY118
RESOURCE USE AMONG BIOLOGICAL THERAPY INITIATORS WITH
CROHN’S DISEASE IN FINLAND
Hallinen T
1
, Soini E
1
, Mankinen P
1
, Jussila A
2
,afBj
€
orkesten C
3
, Kemppainen H
4
,
Valgarðsson S
5
, Nissinen R
6
, Veckman V
6
, Naessens D
7
, Molander P
3
1
ESiOR Oy, Kuopio, Finland,
2
Tampere University Hospital, Tampere, Finland,
3
University of Helsinki and Helsinki University Central Hospital, HUS, Finland,
4
University of Turku and Turku University Central Hospital, Turku, Finland,
5
Janssen-
Cilag AS, Lysaker, Norway,
6
Janssen-Cilag Oy, Espoo, Finland,
7
Janssen Pharmaceutica
NV, Antwerpen, Belgium
OBJECTIVES: To assess the health care resource and bio logical therapy use pat-
terns in Crohn’s dis ease in Finland. ME THODS: As part of the registered
RECREFO-study, four Finnish clinics collected real-world data of ad ult patients
with Crohn’s disease (N¼186) who initiated biolog ical therapy between January
1st 2010 and June 30th 2016. The collected dat a included patient characteristics,
drug treatments, and healthcare resour ce use. RESULTS: Of th e study popula-
tion, 35.5% started adalimumab, 57.0% started infliximab and 7.5% sta rted
vedolizumab. Dose adjustments duri ng maintenance treatment (35.9% with
adalimumab, 30.3% with infliximab, 0% wi th vedolizumab) and t reatment dis-
continuations (34 .9% with adalimum ab, 32.1% with infliximab, 14.3% with
vedolizumab) were c ommon. Concomitan t drug use at baseline di ffered between
biological thera pies: thiopurines were significantly m ore common among inflix-
imab initiators an d methotrexate among vedolizumab initiators, whereas corti-
costeroids were less common among ad alimumab initia tors. During foll ow-up,
the use of oral cortic osteroids decreased significa ntly (p<0.05): from 13.6% to 3.0%
for adalimumab use rs, from 30.2% to 4.7% for infliximab users and from 42.9% to
7.1% for vedolizumab users. Most patient s had imaging examinations (88.7%),
healthcare (87. 6%) and drug-related visits (86.0%), and phone (93.5%) and elec-
tronic/paper cont acts (82.3%). Among the patients with respective resource use,
the following average use was obse rved: imagings 3. 3 (standard deviation SD 2.2,
follow-up 1159 days), health care visit s 5.7 (SD 4.1, follow-up 1142 days ), drug-
related visits 11. 7 (SD 10.3; follow-up 989 days), phone contacts 10.8 (SD 7.9;
follow-up 1097 days), and electronic/paper contacts 6.4 (SD 5.3; follow- up 1162
days). Hospital ization occurred in 26.3% of p atients for an average of 14. 6 days (SD
18.9; follow-up 13 92 days). CONCLUSIONS: Among patients with Crohn’s dis ease
in a real-life setti ng, biological t herapy dose adjustments and discont inuations
were common, conco mitant baseline medication differed between bi ological
treatments, and oral corticosteroid treatment use dec reased after initiation of
biological thera py.
PSY119
TREATMENT PATTERN ANALYSIS AND HEALTHCARE RESOURCE
CONSUMPTION ON PATIENTS AFFECTED BY PSORIASIS IN APULIA
REGION (ITALY).
Perrone V
1
, Sangiorgi D
1
, Naclerio M
2
, Degli Esposti L
1
1
CliCon S.r.l. Health, Economics &Outcomes Research, Ravenna, Italy,
2
Novartis Farma
Italy, Origgio (VA), Italy
OBJECTIVES: To analyze the therapeutic and diagnostic pathways for patients
affected by psoriasis in Apulia, and to estimate the healthcare resource con-
sumption and related costs for the Italian regional Health System. METHODS: An
observational retrospective cohort analysis of administrative database “EDOTTO”
of Apulia Region was performed; patients 18 years were included if they met one
of the following criteria: hospitalization discharge diagnosis of psoriasis (ICD-9-CM
696.1), or exemption code for psoriasis (045.696.1), or a first prescription of a topical
antipsoriatic drug (ATC D05A) between 01/01/2010 and 31/12/2015. All patients
were followed up for 12 months [from index date (ID) (first match with one of the
inclusion criteria) until December 2016]. Type of antipsoriatic drug (topical,
DMARD, and biologic), persistence in treatment and annual cost of illness related
to the therapeutical strategy applied were analyzed. RESULTS: . 30,010 patients
were included in the analysis, mean age was 54.3 years and 55.3% were male. At the
ID, most of them (89.5%) were treated with a topical antipsoriatic drug, 13.7% with a
DMARD drug and 3.9% with a biologic drug (mainly etanercept and adalimumab).
More than half (55.7%) of the patients was not treated with any antipsoriatic drug
before ID, whereas this proportion decreased to 2.8% in the follow up period.
Persistence to ID treatment was 79% for biologics, 64% for DMARDs and 30% for
topical drugs. The mean annual healthcare costs according to treatment at ID were
V17,454 for patients treated with biologics, V2,168 for DMARDs, V1,431 for topical
drugs. CONCLUSIONS: This real-world study in Apulia Region showed that, first
therapeutical approach in psoriasis patients was topical drugs, however, greater
persistence in treatment was observed with biologic drugs. Further research using
a larger sample of patients is needed to confirm and contextualize our findings.
PSY120
ECONOMIC BURDEN OF SYMPTOMATIC MULTIPLE MYELOMA ON THE
ITALIAN HEALTH CARE SYSTEM: FOCUS ON THE MAIN DRIVER COSTS.
Perrone V
1
, Saragoni S
1
, Andretta M
2
, Costantini A
3
, Di Turi R
4
, Gambera M
5
,
Nava E
6
, Degli Esposti L
1
1
CliCon S.r.l. Health, Economics &Outcomes Research, Ravenna, Italy,
2
UOC HTA,
Azienda Zero - Regione Veneto, Verona, Italy,
3
Hospital Pharmacy, “Santo Spirito”
Hospital, Pescara, Italy,
4
Local Health Unit of Rome 3, Rome, Italy,
5
Local Pharmaceutical
Service, Bergamo Health Care Agency AT, Bergamo, Italy,
6
Department of Pharmacy,
Local Health Unit Naples 3 South, Torre del Greco, Italy
OBJECTIVES: The increasing focus on the cost of multiple myeloma (MM) treat-
ment, which is driven mainly by the introduction and availability of novel agents,
the objective of this study was to estimate the economic burden of symptomatic
MM in Italy. METHODS: A retrospective analysis using data from the administra-
tive databases of five Italian Local Health Units was performed. MM patients with
at least 1 main diagnosis code for MM between January 2011 and June 2013 were
identified from hospital records. The date of the first diagnosis claim for MM was
defined as index-date. Smoldering patients with no claims of MM-specific therapy
were excluded. Patients were followed up for three years or until death, whichever
occurred first. Follow-up costs were calculated per patient per year (PPPY), overall
and for each year of follow-up using Italian prices and tariffs. Total costs were
categorized into drugs, outpatient services and direct hospitalization costs.
RESULTS: 703 patients with symptomatic MM were entered into the study cohort,
mean ageof 68 years; 54% male.The average PPPYcost was V18,753.13,mainly driven
by costs of hospitalizations (32.5% drugs, 56.8% hospitalizations, 10.7% outpatient
services, respectively). 113 patients had stem cell transplant (SCT) during the hos-
pitalization-index, mean age of 59 years; 62% male.Among those, 71 (62.8%) had a
VALUE IN HEALTH 21 (2018) S1eS481S456