VP46 German Claims Data In Rare Disease HTA: Diffuse Large B-cell Lymphoma

IntroductionIn rare disease areas representative data are scarce. Routine sick fund claims data provide a meaningful and reliable base for the in- and outpatient treatment landscape. This real-world data (RWE) from Germany was used to describe treatment patterns for Diffuse Large B-cell Lymphoma (DLBCL), the most frequent and aggressive non-Hodgkin lymphoma type in adults.MethodsClaims data from several sick funds of 4.8 Million insured were analyzed. Diagnosis of non-follicular Lymphoma (C83) was confirmed in 2.178 patients, DLBCL (C83.3) in 819 patients. The analysis was age- and gender-adjusted, observational period was 2014 and 2015. Treatments were analyzed for hospitalization and medication based on ATC-Code, Pharma Central Number and coded diagnoses (per ICD).ResultsMean age of DLBCL patients was 60.3 years, with two peaks at 50-54 and 70-74 years. Total costs for patients with DLBCL averaged 25.048 EUR versus 1.259 EUR in healthy insured. Charlson comorbidity index (CCI) of 4.58 indicates clinical relevance and severity. Comorbidities included several psychiatric diagnoses such as depression in every fifth patient. Mean 3.2 hospitalizations with average 31.5 hospital days were observed in DLBCL patients. Forty-seven percent of patients during observational time-frame did not receive oncological treatment, including relapsed / refractory patients. Only few patients received stem cell transplantation (2.6 percent) or radiation (3.9 percent). Most pharmacological treatments were Rituximab (RTX) + CHOP (57 percent), followed by RTX mono therapy (25 percent) or RTX in combination with Bendamustine (8 percent).ConclusionsDespite limitations in sick fund claims analyses, these provide a reasonable database for rare diseases. They allow standard treatment pathway- and longitudinal analyses. All DLBCL patients frequently required hospitalization and generated significant costs. A high unmet medical need exists for treatments other than palliative care, especially for a tolerable and effective outpatient therapy in elderly relapsed / refractory DLBCL.

Disease Fund Management on the example of the Social Insurance Institution for the period between 2008–2012

In Poland, after the economic transformation a lot of fields of business lines required adaptation, also in social security. On last years performed some changes in the insurances. The sick insurance in the common social insurance has been defined as obligatory for the employees, and voluntary at the request of the person. The cash expenditures for benefits from sick insurance of the contribution charges only the employee insured, also employers incur cost connected with the sickness of employees to pay the remuneration for inability for work. The unfavorable demographic conditions which determine making the decisions also in the past years, modification of rights and levels of benefits from sick insurance was introduced, which did not reduce, but quite contrary, increased expenses, especially for sick and maternity benefits. It means lack for balancing the sick fund and necessity to search an answer in the foreseeable future to the question whether the level of the contribution should not be reviewed and updated.

Longitudinal analysis of trastuzumab use in metastatic breast cancer

11513 Background: Six years after including Trastuzumab in the Israeli ‘National Health Basket‘ (NHB) for metastatic breast cancer (MBC), we evaluated its ‘real-life‘ use in terms of duration of treatment (DOT) and survival after initiation of treatment. Methods: The computerized database of Clalit Health Services’ (CHS), the largest Israeli sick fund, was used to determine DOT and survival (at Dec. 31, 2005), in all CHS patients with MBC that started Trastuzumab therapy during years 2000–2003. Results: * At Dec. 31, 2005. ** However, most received AC as adjuvant. Conclusions: A longitudinal analysis of Trastuzumab use shows a difference of 40–100% between the median and mean DOT. This difference is attributed to a sizeable proportion (∼15%) of patients that are “long-term responders” and are treated for more than 24 months. In these patients, we can assume that the HER-2 amplification is an essential transforming event. We recommend investigating the molecular characteristics of long-term responders. [Table: see text] No significant financial relationships to disclose.