An Economic Evaluation of the Impact of Using Rapport-Based Interviewing Approaches With Child Sexual Abuse Suspects

Two studies examined whether rapport-based interviewing with child sexual abuse (CSA) suspects provides greater interview yield that could result in overall cost-savings to the investigation. First, multi-level modelling was applied to 35 naturalistic CSA suspect interviews to establish whether rapport-based interviewing techniques increase “yield” – defined as information of investigative value. The Observing Rapport Based Interviewing Technique (ORBIT coding manual was used to code interviews; it includes an assessment of both interpersonal adaptive and maladaptive rapport-based interviewer engagement as well as motivational interviewing (MI) strategies. The impact of these two strands (interpersonal and MI) on extracting information of investigative value (including strengthening a case for court and safeguarding) were examined. Adaptive interpersonal strategies increased case strengthening and safeguarding yield, with motivational interviewing having the largest impact on safeguarding yield. Both strategies increase the likelihood of gaining additional types of economic yield. Maladaptive interviewer strategies reduced case strengthening and different types of economic yield. In study two, literature-based economic estimates were applied to establish the potential cost benefits from following national ORBIT rapport training. Further training in adaptive and motivational interviewing could contribute cost savings between £19 and £78 million (annual unit costs) increasing to £238–£972 million (lifetime costs) for online CSA across England and Wales; and £157–£639 million (annual unit costs) increasing to £2–£8 billion (lifetime costs) for all CSA. Failure to commit training resource to this, or an alternative strategy, could mean the cost burden attributable to maladaptive interviewing (between £1 and £6 million for online CSA and £12 and £48 million for all CSA) is not successfully averted.

OP130 Economic Evaluation Of High-Cost Drugs For Relapsing-Remitting Multiple Sclerosis In Thailand

IntroductionDrugs for relapsing-remitting multiple sclerosis (RRMS) are costly and not included in the National List of Essential Medicines of Thailand yet. This study aims to conduct an economic evaluation of high-cost drugs for RRMS.MethodsThe Markov model was used to estimate lifetime costs and quality-adjusted life years (QALYs) gained. The treatment options include Interferon beta-1a (IFN) and Teriflunomide (TERI) (first-line), Fingolimod (FIN) and Natalizumab (NATA) (second-line), and Alemtuzumab (ALEM) (third-line) compared with usual care. The effectiveness of drugs was retrieved by network meta-analysis. The probability of health state transition was obtained from primary data. Treatment-related costs were derived from the national database. Other costs and utilities were obtained from the study in Thai RRMS patients.ResultsThe lowest lifetime costs option was usual care (THB2 million) (USD65,808), while the highest QALY gained option was IFN-NATA-ALEM (8.6 QALY gained). All treatment options were not cost-effective compared with usual care at the threshold of THB160,000 (USD5,300) per QALY gained. However, the option of IFN-NATA-ALEM yielded the lowest incremental cost-effectiveness ratio (ICER), which was THB4.4 million (USD144,778) per QALY gained.ConclusionsHigh-cost drugs were not cost-effective; nonetheless, the IFN-NATA-ALEM option could increase QALY gained with the lowest additional budget. The government should negotiate the price of IFN to decrease by eighty percent.

Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England: longitudinal matched-cohort study using the Clinical Practice Research Datalink

Background Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions. Aims To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions. Method This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively. Results There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year. Conclusions Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.

The lifetime cost estimation of human papillomavirus-related diseases in China: a modeling study

Objectives To estimate the lifetime treatment costs of patients with human papillomavirus (HPV) infection-related diseases in China and to provide cost estimates for the economic evaluation of HPV intervention strategies. Methods We extracted real-world hospital data from 2012 to 2019 and screened for subjects who met the criteria of clinical diagnosis of HPV-related diseases to obtain country-specific inputs into a Markov decision model. The model simulated lifetime treatment costs for HPV from the perspective of a national payer. A 5% discount rate was applied. Costs were converted and inflated to 2020 US dollars (USD) Results Using 2021 as the base year, the lifetime costs per patient for carcinoma in situ, local metastasis, and distant metastasis cervical cancer are $24,208 (95%CI: 18,793–30,897), $19,562 (95%CI: 14,456–25,567), and $17,599 (95%CI: 10,604–25,807), respectively. For carcinoma in situ, local metastasis, and distant metastasis vaginal cancer, the lifetime costs are $17,593 (95%CI: 14,962–23,596), $17,120 (95%CI: 13,215–22,417), and $22,411 (95%CI: 12,172–22,249), respectively. The base-case lifetime cost per patient for different stages of vulvar cancer/penile cancer/anal cancer/oral cancer/oropharyngeal cancer/laryngeal cancer falls within $17,120–$58,236. Conclusions Using real-world data, we calculated lifetime treatment costs of HPV-related cancer in China and found that the lifetime cost for patients exceeded $17,000 for various stages of disease. The national burden of HPV-related disease could be significantly reduced by eliminating HPV infection.

Estimating the broader fiscal consequences of acute hepatic porphyria (AHP) with recurrent attacks in Belgium using a public economic analytic framework

Background Acute hepatic porphyria (AHP) is a rare, debilitating disease characterized by potentially life-threatening attacks often resulting in chronic symptoms that negatively impact daily functioning and quality of life. Symptoms of AHP prevent many individuals from working and achieving lifetime work averages. The aim of this study was to apply a public economic framework to evaluate AHP in Belgium, taking into consideration a broad range of costs that are relevant to government in relation to social benefit payments and lifetime taxes paid. Methodology A public economic framework was developed exploring lifetime costs for government attributed to an individual with AHP and recurrent attacks in Belgium. Work-activity and lifetime direct taxes paid, indirect consumption taxes and requirements for public benefits were estimated based on established clinical pathways for AHP and compared to the general population (GP). The model includes AHP-related healthcare costs and non-AHP healthcare costs for the GP. Results Lifetime earnings are reduced in an individual with AHP by €347,802 per person (p.p.), translating to reduced lifetime taxes paid of €183,187 for an AHP individual compared to the GP. We estimate increased lifetime disability benefit support of €247,242 for an AHP individual compared to GP. Lifetime healthcare costs for a person with AHP were estimated to be €3,030,316 due to frequent hospitalisations associated with porphyria attacks compared to the GP. The lifetime costs for a person with 12 attacks per annum factoring in transfers, taxes and healthcare costs are estimated to be €3,460,745 p.p. Eliminating AHP attacks after 10 years of active disease, thus, enabling a person to return to work increases lifetime earnings by €224,575 p.p. Increased work activity in such individuals would generate an estimated €118,284 p.p. over their lifetime. The elimination of AHP attacks could also lead to reductions in disability payments of €179,184 p.p. and healthcare cost savings of €1,511,027 p.p. Conclusions Due to severe disability resulting from constant attacks, AHP patients with recurrent attacks incur significant public costs. Lifetime taxes paid are reduced as these attacks occur during peak earning and working years. In those patients, reducing AHP attacks can confer significant fiscal benefits for government, including reduced healthcare costs, reduced disability payments and improved tax revenue.

Healthcare utilization and costs in hepatocellular carcinoma (HCC) patients treated at a large referral center in Washington (WA) State.

e16149 Background: Though the treatment landscape for HCC has changed significantly in the last several years with the refinement of liver-directed therapy techniques and the introduction of multiple new drugs, few studies have investigated the impact of the changing treatment landscape on lifetime treatment costs, particularly in Barcelona Clinic Liver Cancer (BCLC) stage C disease. We therefore sought to investigate real-world clinical characteristics, treatment patterns, healthcare use, and costs in patients with HCC treated at a single high-volume institution in WA. Methods: We conducted a retrospective cohort study of patients diagnosed with HCC between 2007 and 2018 at a single clinical cancer center using a database containing abstracted data from the electronic medical record (EMR) linked to cancer registry data and health claims from commercial insurance plans, Medicare, and Medicaid. We described clinical characteristics, including BCLC stage and Child Pugh score, and treatment patterns. We investigated the mean per patient lifetime treatment costs by BCLC stage using Kaplan-Meier cost estimator methods. Results: The final cohort included 215 patients, majority white (71%), male (68%), and with underlying hepatitis C (61%). Most patients had either Child Pugh A (76%) or B (20%) liver disease and BCLC A (45%), B (20%), or C (19%) stage HCC. Only 40% of BCLC C patients received systemic chemotherapy. Mean per patient lifetime costs were highest in BCLC A ($289,318) and BCLC C ($255,430) patients and lowest in BCLC D ($123,701) patients (Table). Surgical costs, hospital costs, imaging, and outpatient visits were the major contributors to total lifetime costs in BCLC A patients. Chemotherapy costs were highest in BCLC C patients, but still were not the predominant area of spending. Conclusions: In a WA state cohort of HCC patients, mean lifetime costs were highest in patients with BCLC A disease, largely driven by surgery and hospital costs. As utilization of newer and less toxic therapies in BCLC C patients increases, mean lifetime costs in this group may surpass other stages.[Table: see text]

A cost-utility analysis of combined durvalumab and tremelimumab in patients with refractory metastatic colorectal cancer (mCRC) and high plasma tumour mutation burden (pTMB): A Canadian Cancer Trials Group (CCTG) study.

e15581 Background: The randomized phase II CCTG CO.26 clinical trial investigated the use of combined durvalumab and tremelimumab vs. best supportive care (BSC) for patients with mCRC and suggested an increase in overall survival (OS). The largest benefit was seen in patients who were microsatellite stable (MSS) with a pTMB ≥ 28 variants per megabase. Considering significantly higher adverse event rates and costs associated with durvalumab and tremelimumab, it is important to evaluate its cost-effectiveness. Accordingly, we performed a cost-utility analysis of durvalumab and tremelimumab compared to BSC in the intention-to-treat (ITT) and biomarker-enriched populations using CO.26 trial data. Methods: We developed a 4-state microsimulation model to evaluate the expected health outcomes in life-years (LYs), quality-adjusted life-years (QALYs) and costs of the treatment group compared to BSC over a lifetime horizon (5 years). The incremental cost-utility ratio (ICUR) was used to compare treatment strategies. Direct trial data from CO.26 were used to inform model inputs, including OS curves, progression-free survival (PFS) curves, and adverse event rates. As health state utilities were not collected in CO.26, values from the CORRECT trial, a multi-centre randomized placebo-controlled phase III study for regorafenib in mCRC, were used. Costs of therapy, hospitalization due to adverse events, end-of-life care, and physician costs were derived from the literature and publicly available sources (in 2020 Canadian dollars). Since the monthly price of tremelimumab was unavailable, it was approximated with the price of another CTLA-4 inhibitor, ipilimumab. The base-case analysis evaluated these treatment strategies in the ITT population. Scenario analyses evaluated the cost-effectiveness in biomarker-enriched populations. Costs and effects were discounted at 1.5% as per Canadian guidelines. Results: In the base-case, expected LYs for combined durvalumab and tremelimumab and BSC were 0.75 and 0.51 (incremental (Δ) 0.24) respectively. Expected QALYs were 0.47 and 0.33 (Δ 0.14). Expected lifetime costs were $60 500 and $15 500 (Δ $45 000) for an ICUR of $320 000/QALY. In the biomarker-enriched subgroup, the expected LYs were 0.67 and 0.33 (Δ 0.34), expected QALYs were 0.43 and 0.22 (Δ 0.21), and expected lifetime costs were $62 000 and $15 200 (Δ $47 000). This represents an increase in the incremental QALYs by 50% and costs by 5% for an ICUR 30% lower than the base case at $220 000/QALY. Conclusions: Combined durvalumab and tremelimumab is not considered cost-effective in refractory mCRC under conventional willingness-to-pay thresholds. Cost-effectiveness is improved with biomarker enrichment for high pTMB, driven by the greater derived health outcomes in this subgroup.