MO876ESTIMATING THE BUDGET IMPACT OF DAPAGLIFLOZIN FOR THE TREATMENT OF CHRONIC KIDNEY DISEASE FROM A UK PAYER PERSPECTIVE*

Background and Aims Chronic kidney disease (CKD) is a chronic and progressive disease which imposes a significant burden on patients and healthcare systems as the disease progresses, particularly in patients who reach end-stage kidney disease (ESKD). Dapagliflozin was established to be an efficacious treatment for CKD in the DAPA-CKD study, where it was associated with a significant reduction in the incidence of CKD progression, ESKD, hospitalization for heart failure (HHF) and death in comparison with standard care alone. A vital component of a new treatment's health economic evaluation is to assess its potential budget impact, particularly in conditions with high prevalence in the general population such as CKD. As such, this study's objective was to estimate the budget impact of introducing dapagliflozin for the treatment of CKD in the UK from an NHS perspective. Method A model was developed to estimate the three-year budget impact of the introduction of dapagliflozin in addition to standard care (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) vs. standard care alone for the treatment of CKD in the UK. The size of the eligible patient population was estimated based on overall CKD prevalence, and the proportion of all CKD patients who would have been eligible for inclusion in DAPA-CKD. In total, 929,000 patients were estimated to be eligible for treatment with dapagliflozin in the UK. The analysis assumed that 5% of CKD patients would receive treatment with dapagliflozin in the first year, increasing to 15% in the second year and 20% in the third year. The relative market share of individual components of background standard care was assumed to remain constant over time, with the distribution informed by the baseline characteristics from DAPA-CKD. Event rates from DAPA-CKD were used to predict the incidence of CKD progression (≥50% decline in estimated glomerular filtration rate), ESKD, HHF, acute kidney injury, hyperkalaemia and death to estimate cost-offsets associated with reduced event incidence. Published event and drug acquisition costs were applied to the incidence of modelled events. Results The introduction of dapagliflozin was estimated to reduce total three-year costs associated with CKD management by £114.0M, from £6.6B to £6.5B in the patient population eligible for treatment with dapagliflozin. Cost-savings were driven by a reduction in the incidence of CKD progression events (122.7K vs. 130.5K with and without the introduction of dapagliflozin, respectively), ESKD (99.2K vs. 103.8K) and HHF (44.2K vs. 41.3K) over a three-year time horizon. Cumulative three-year drug acquisition costs were estimated to increase by £177.4M following the introduction of dapagliflozin when used in addition to standard care. However, the cumulative cost-offsets associated with reduced incidence of clinical events was £291.3M over the three-year model time horizon, with reduced incidence of ESKD resulting in the largest cost-saving (£4.8B vs. £5.0B). Conclusion The introduction of dapagliflozin for the treatment of CKD is estimated to be cost-saving over a three-year horizon in comparison with standard care, even when considering additional drug acquisition costs. Dapagliflozin has the potential to significantly ameliorate the clinical and economic burden imposed by CKD on patients and the NHS.

MO551A COST-OFFSET ANALYSIS OF THE ROXADUSTAT DIALYSIS-DEPENDENT GLOBAL PHASE 3 PROGRAM: A CANADIAN HEALTHCARE PERSPECTIVE

Background and Aims Chronic kidney disease (CKD) is a costly public health issue, which affects 13.4% of the population globally. Anaemia is a common complication in patients with CKD resulting in reduced health-related quality of life and high healthcare costs. The objective of this analysis was to estimate the direct medical care cost offsets of the investigational agent roxadustat for the treatment of anaemia in patients with dialysis-dependent (DD) CKD from a Canadian healthcare perspective. Method Data from the roxadustat global phase 3 program were used to estimate the incidence of rescue therapy or iron supplementation use (i.e. intravenous iron, erythropoiesis-stimulating agents [ESAs] or red blood cell transfusions) and major adverse cardiovascular events (MACE+) for roxadustat compared with ESAs in DD patients with anaemia of CKD. MACE+ included myocardial infarction, stroke, unstable angina requiring hospitalization, congestive heart failure (CHF) requiring hospitalization, cardiovascular death and other death. Published Canadian cost data were used to estimate event costs. Drug acquisition costs for roxadustat and ESAs were not considered. A hypothetical cohort of 10,000 Canadian adult DD patients (90% undergoing haemodialysis, 10% undergoing peritoneal dialysis) with treatable anaemia was modelled to determine net medical care cost offsets annually and cumulatively compared with ESAs over a 4-year time horizon. Results Preliminary results for patients with DD CKD show that, compared with ESAs, roxadustat could produce sizeable net medical care cost offsets resulting from reductions in rescue therapy or iron supplementation use, specifically red blood cell transfusions, and from reductions in MACE+, specifically CHF hospitalizations. For the entire cohort of patients with DD CKD, cumulative medical care cost offsets for roxadustat were an estimated $162,609 for rescue therapy or iron supplementation use and $1,027,070 for MACE+ compared with ESAs. Conclusion This analysis provides evidence that treatment with roxadustat in DD patients with anaemia of CKD could result in considerable medical care cost offsets for roxadustat compared with ESAs.

Economic Assessment of a New Model of Care to Support Patients With Cancer Experiencing Cancer- and Treatment-Related Toxicities

PURPOSE: The aim of this economic assessment was to evaluate the impact of a new nurse-led model of care, the Symptom and Urgent Review Clinic (SURC), for patients with cancer experiencing disease- or treatment-related symptoms. METHODS: An economic assessment was undertaken to estimate costs of the SURC from the service funder perspective and to compare the cost with cost offsets stemming from the implementation of the SURC. The cost offsets focused on the changes in emergency department (ED) presentations and inpatient admissions during a comparable 6-month period before and after the SURC implementation. Costs were analyzed in 2018 Australian dollars, and return on investment was calculated by comparing the cost offsets in the ED and inpatient units with the cost of the SURC. RESULTS: After the implementation of the SURC, patients were less likely to present to the ED (7.2% v 8.5%; P = .01), and patients who did present to the ED were more likely to be admitted to inpatient units (78% v 71%; P = .03) for additional treatment. The post-SURC period had a net cost savings of $37,090 compared with the pre-SURC period. From the service funder perspective, the SURC achieved an investment return of $1.73 for every dollar invested in the new service. CONCLUSION: Our study establishes the economic credentials of a new care model using empirical linked hospital service data. The SURC presents a new cancer care service for policy consideration from an economic standpoint. It demonstrates an efficient approach to hospital resource allocation to deliver quality cancer care.