ELTROMBOPAG AS FIRST-LINE TREATMENT IN SEVERE APLASTIC ANEMIA: A COST-EFFECTIVENESS ANALYSIS FROM THE BRAZILIAN PUBLIC HEALTHCARE SYSTEM PERSPECTIVE

17068 Background: Patients receiving imatinib had a significant survival advantage compared with patients receiving IFN therapy (Roy et al. Blood 2006; Kantarjian et al. Blood 2006). Although reimbursed as second line therapy for CP CML patients who did not respond to INF-a, IM was not considered for public reimbursement as first line treatment in Brazil based on drug costs. An economic evaluation considering the mortality risk reduction with first line IM versus INF was performed under the Brazilian Public Healthcare System perspective, comparing the costs to avoid one death of a chronic phase CML patient over a 5-year period. Methods: Risk of death in 5 years was defined by survival rates in the 60 month follow-up of IRIS for IM (Rim= 10%) (Druker et al. JCO 2006), MD Anderson cohort of CML patients treated with INF-a for INF-a (RINF-a= 38%) (Cortes et al. American J. Med 1996) and a population based-survey in Norway for the natural course of the disease (Rnon-treatment= 67%). IRIS INF group survival rate was not used due to high crossover to IM in the trial. Risk of death in the natural course of the disease was the basis for the absolute risk reduction (ARR) calculation (ARRim= 57%; ARRINF-a= 29%). Number need to treat (NNT) was obtained by the inverse of ARR value for each first line treatment (NNT =1/ARR). Costs were estimated based on the Brazilian public healthcare reimbursement payment (APAC-SUS) for chronic phase CML treatment. A base case economic model of 100 patients for each treatment option was constructed focused on drug costs and adverse events (AE) from the IRIS study for both groups. Clinical guidelines from two public hematology centers were used to estimate AE treatment costs. Costs were discounted at a 6% annual rate. Results: The treatment costs and NNTs for a 5-year period are US$ 62,135 and 3.45 for INF-a, and US$ 93,397 and 1.75 for IM, respectively. The costs to avoid one death over a 5-year period are US$ 214,368 for INF-a and US$ 163,445 for IM. Conclusions: The costs for avoiding one death of a chronic phase CML patient over a 5-year period is US$ 50,923 higher with first line INF-a than it would be with first line imatinib. [Table: see text]

Download Full-text

PRO38 COST-EFFECTIVENESS ANALYSIS OF EMICIZUMAB VERSUS BYPASSING AGENTS IN PATIENTS WITH HEMOPHILIA A WITH INHIBITORS IN THE BRAZILIAN PUBLIC HEALTHCARE SYSTEM PERSPECTIVE

Value in Health ◽

10.1016/j.jval.2019.09.2368 ◽

2019 ◽

Vol 22 ◽

pp. S847

Author(s):

P. Souza ◽

G.R. Puopolo ◽

R. Leme-Souza

Keyword(s):

Cost Effectiveness ◽

Healthcare System ◽

Hemophilia A ◽

Cost Effectiveness Analysis ◽

Public Healthcare ◽

System Perspective ◽

Healthcare System Perspective ◽

Public Healthcare System ◽

Effectiveness Analysis ◽

Bypassing Agents

Download Full-text

PP329 An Australian Cost-Effectiveness Analysis Of The EluviaTM Drug-Eluting Stent For Treatment Of Symptomatic Lower-Limb Peripheral Artery Disease

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320001592 ◽

2020 ◽

Vol 36 (S1) ◽

pp. 28-29

Author(s):

William A. Gray ◽

Thathya V. Ariyaratne ◽

Robert I. Griffiths ◽

Peter W.M. Elroy ◽

Stacey L. Amorosi ◽

...

Keyword(s):

Cost Effectiveness ◽

Healthcare System ◽

Lower Limb ◽

Sensitivity Analyses ◽

Public Healthcare ◽

System Perspective ◽

Healthcare System Perspective ◽

Drug Eluting ◽

Zilver Ptx ◽

Cost Parameters

IntroductionDespite advances in endovascular interventions, including the introduction of drug-eluting stents (DES), high target lesion revascularization (TLR) rates still burden the treatment of symptomatic lower-limb peripheral arterial disease (PAD). EluviaTM, a novel, sustained-release, paclitaxel-eluting DES, was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX® stent, in the IMPERIAL randomized controlled trial. This evaluation estimated the cost-effectiveness of Eluvia when compared with Zilver PTX in Australia, based on 12-month clinical outcomes from the IMPERIAL trial.MethodsA state-transition, decision-analytic model with a 12-month time horizon was developed from an Australian public healthcare system perspective. Cost parameters were obtained from the Australian National Hospital Cost Data Collection Cost Report (2016–17). All costs were captured in Australian dollars (AUD), where AUD 1 = USD 0.69 (June 2020). Complete sets of clinical parameters (primary patency loss, TLR, amputation, and death) and cost parameters from their respective distributions were bootstrapped in samples of 1,000 patients, for each intervention arm of the model. One-way and probabilistic sensitivity analyses were performed.ResultsAt 12 months, modeled TLR rates were 4.5 percent for Eluvia and 8.9 percent for Zilver PTX, and mean total direct costs were AUD 6,537 [USD 4,511] and AUD 6,908 [USD 4,767], respectively (Eluvia average per patient savings; overall cohort=AUD 371 [USD 256]; diabetic cohort=AUD 625 [USD 431]). In probabilistic sensitivity analyses, Eluvia was cost-effective relative to Zilver PTX in 92.0 percent of all simulations at a threshold of $10,000 per TLR avoided. Eluvia was more effective and less costly (dominant) than Zilver PTX in 76.0 percent of simulations.ConclusionsIn the first year after the intervention, Eluvia was more effective and less costly than Zilver PTX, making Eluvia the dominant treatment strategy for treatment of symptomatic lower-limb PAD, from an Australian public healthcare system perspective. These findings should be considered when formulating policy and practice guidelines in the context of priority setting and making evidence-based resource allocation decisions for treatment of PAD in Australia.

Download Full-text