Cost Effectiveness and Budget Impact Analyses of Influenza Vaccination for Prisoners in Thailand: An Application of System Dynamic Modelling

Influenza outbreaks in Thai prisons were increasing in number every year and to address this, the Thai Ministry of Public Health (MOPH) initiated a policy to promote vaccination for prisoners. The objective of this study was to assess the cost effectiveness and budget impact of the influenza vaccination policy for prisoners in Thailand. The study obtained data from the Division of Epidemiology, Department of Disease Control (DDC), MOPH. Deterministic system dynamic modelling was exercised to estimate the financial implication of the vaccination programme in comparison with routine outbreak control. The incremental cost-effectiveness ratio (ICER) was calculated via a DDC perspective. The reproductive number was estimated at 1.4. A total of 143 prisons across the country (375,763 prisoners) were analysed. In non-vaccination circumstances, the total healthcare cost amounted to 174.8 million Baht (US$ 5.6 million). Should all prisoners be vaccinated, the total healthcare cost would reduce to 90.9 million Baht (US$ 2.9 million), and 46.8 million Baht (US$ 1.5 million) of this is related to the vaccination. The ICER of vaccination (compared with routine outbreak control) varied between 39,738.0 to 61,688.3 Baht per disability-adjusted life year (DALY) averted (US$ 1281.9–1989.9). Should the vaccination cover 30% of the prisoners, the ICER would be equal to 46,866.8 Baht (US$ 1511.8) per DALY averted with the budget burden amounted to Baht (US$ 4.8 million). The vaccination programme would become more cost-effective if the routine outbreak control was intensified. In summary, the vaccination programme was a cost-effective measure to halt influenza outbreak amongst prisoners. Further primary studies that aim to assess the actual impact of the programme are recommended.

Short-Term and Long-Term Economic Burden Following Allogeneic Hematopoietic Stem Cell Transplant (HSCT) in Adult Patients with Diffuse Large B-Cell Lymphoma (DLBCL)

Introduction: DLBCL is the most common form of non-Hodgkin's lymphoma accounting for more than 30% of the new lymphoma cases in adults in the US.First-line treatment of patients with DLBCL typically includes immunochemotherapy with or without radiation therapy. Autologous HSCT is recommended in relapsed and refractory patients with chemosensitive disease. Allogeneic HSCT, a highly specialized procedure associated with intensive medical resources and costs, is generally considered for patients with refractory disease or who relapse following autologous HSCT.The objective of this study was to describe the short-term and long-term economic burden following an allogeneic HSCT procedure for adult patients with highest risk DLBCL. Methods : Adult patients (≥18 years old) with DLBCL who underwent an allogeneic HSCT in a hospital setting were selected from two large US administrative claims databases (Q1 2006 to Q2 2015). Selected patients had continuous healthcare plan enrollment for ≥90 days prior to and ≥30 days after the date of the HSCT (index date). To characterize the short-term and long-term economic burden following allogeneic HSCT, healthcare resource utilization (HRU) and direct healthcare costs were measured and described over five study periods: 1) between the index date and the HSCT hospitalization discharge date, 2) during the first 100 days following the index date, and 3) during the first, 4) second, 5) third year following the index date. For each study period, HRU and costs were assessed among patients with continuous healthcare plan enrollment during the entire study period. Healthcare costs were measured from payers' perspective, reflecting the total amount reimbursed by the private payer and the amount covered by the coordination of benefits, excluding deductibles and copayments. Healthcare costs were adjusted for inflation and reported in 2015 USD. Results: A total of 101 adult patients with DLBCL who received an allogeneic HSCT were identified. The average age was 54 years old at the time of the index date and 62% of patients were male. The median duration of the HSCT hospitalization was 24 days. The mean follow-up period after the index date was 1.3 years. Results showed substantial HRU and costs following the allogeneic HSCT. The more intensive HRU and the highest healthcare costs were observed during the first year following the HSCT; patients had a mean of 2.5 inpatient admissions (including the hospitalization for the HSCT) for a total of 38 inpatients days and 68 days of outpatient services (apart from home care services), including 43 days with laboratory or imaging services. The mean total healthcare cost during the first year following the index date was $455,741 (median of $416,744; interquartile range from $301,344 to $575,662) - and the mean total healthcare cost during the hospitalization for the HSCT was $248,390 (median of $200,945; interquartile range from $156,908 to $281,279). Results also showed that although HRU and costs tend to decrease over time, they remain high even 3 years after the HSCT (Figure 1): during the third year following the index date, patients had a mean total healthcare cost of $72,957 (median of $76,749; interquartile range from $20,341 to $100,422), and mean of 27 days with outpatient services (apart from home care services), including 13 days with laboratory or imaging services. Conclusion: Findings from this study showed that among adult patients with DLBCL, short-term and long-term economic burden following an allogeneic HSCT procedure is substantial. Figure 1 Total healthcare cost following the allogeneic HSCT procedure Figure 1. Total healthcare cost following the allogeneic HSCT procedure Disclosures Maziarz: Incyte: Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Athersys: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Hao:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Guerin:Analysis Group, Inc: Employment; Novartis Pharmaceuticals Corporation: Consultancy, Other: Annie Guerin is an employee of Analysis Group, which has received consultation fees from Novartis Pharmaceuticals Corporation. Gauthier:Analysis Group, Inc.: Employment; Novartis Pharmaceuticals Corporation: Consultancy, Other: Genevieve Gauthier is an employee of Analysis Group, which has received consultation fees from Novartis Pharmaceuticals Corporation. Gauthier-Loiselle:Analysis Group, Inc.: Employment; Novartis Pharmaceuticals Corporation: Other: Marjolaine Gauthier-Loiselle is an employee of Analysis Group, which has received consultation fees from Novartis Pharmaceuticals Corporation. Thomas:Novartis Pharmaceuticals Corporation: Employment. Eldjerou:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership.

Real-World Treatment Patterns, Healthcare Resource Utilization, and Costs in Patients with Newly Diagnosed Acute Myeloid Leukemia (AML)

Background: There is a scarcity of data about healthcare resource utilization (HRU), costs, and treatment patterns of patients (pts) with newly diagnosed AML, despite the prolonged hospitalizations associated with induction and consolidation chemotherapy. The initial decision whether to treat with intensive induction chemotherapy depends, primarily, on pt age, comorbidities, and performance status. For pts deemed eligible for induction chemotherapy, treatment generally consists of induction with an intensive chemotherapy regimen (e.g., cytarabine + anthracycline "7+3") and post-induction therapy (consolidation) for those who achieve a complete remission. Post-induction therapy may consist of repeated rounds of further cytotoxic chemotherapy or allogeneic HSCT. Methods: Adult pts with newly diagnosed AML who received induction chemotherapy in an inpatient (IP) setting within 14 days of diagnosis were identified from a US administrative claims database (2006-2015). Pts with acute promyelocytic leukemia (APL) or in clinical trials were excluded. Outcomes were analyzed between the beginning of the induction episode and an HSCT, death (IP discharge status of death), end of health plan enrollment/ data availability, or 180 days after the discharge date of the induction episode, whichever occurred first (i.e., observation period). Induction and consolidation episodes were identified using diagnosis related group (DRG) codes for chemotherapy with acute leukemia (DRG 837, 838, or 839) or procedure/drug codes for specified/unspecified chemotherapy for AML. Outcomes included treatment patterns (setting and duration of AML treatment episodes, and time between episodes), HRU (IP admissions, HSCT), and costs (USD 2015, amount reimbursed by private payers, coordination of benefits, and beneficiaries contributions [deductibles and copayments]). AML treatment costs are reported during induction and consolidation episodes and IP costs are reported between episodes. Results: A total of 631 pts (mean age = 56 years; 48% female) met the sample selection criteria. Among these, during the 12-month period preceding the index date, 18% had a diagnosis for MDS, 15% had a diagnosis for a malignancy other than lymphoid/hematopoietic neoplasms (mainly breast or skin malignancies), 14% received chemotherapy, 1% received radiation therapy, and the average Charlson comorbidity index score was 2.3. During the observation period, 2 out of 631 pts had a HSCT during the IP stay of the induction therapy (and were excluded from the cost analysis). A total of 73 (12%) pts had initial induction and subsequent re-induction therapy during the same IP episode. The median duration of IP episodes for pts who required initial induction therapy only was 27 days, the mean total healthcare cost was $113,969, and the mean cost per day was $5,177. The median duration of IP episodes for pts who required induction and re-induction therapy was 43 days, the mean total healthcare cost was $182,328, and the mean cost per day was $4,147. Among pts with post-induction treatment episodes, the first consolidation cycle occurred, on average, 26 days after the discharge date of the induction episode; 75% was in an IP setting, and 25% in an OP setting. In the IP setting, the median duration of the first cycle was 6 days, the mean total healthcare cost was $48,723, and the mean cost per day was $4,292. In the OP setting, the median duration of the first cycle was 4 days of treatment over 5 days, the mean total healthcare cost was $11,253, and the mean cost per day of treatment was $2,751. A proportion of 25% of pts had an IP admission between the end of the induction episode and the first consolidation cycle, and 43% between the first and second consolidation cycles. In addition, during the observation period, a total of 97 (15%) pts had an allogeneic HSCT; 31 (5%) after the induction episode, 39 (6%) after the first consolidation cycle, and 27 (4%) after the second consolidation cycle. (Table) Conclusions: This is the first exploratory study reporting treatment patterns, HRU, and costs of AML management. Despite lack of granular information on the type of treatment administered, this study describes the setting, duration, and HRU and costs associated with induction and consolidation therapy for AML. Study findings suggest that in a sample of commercially insured pts with newly diagnosed AML, there is substantial heterogeneity in the management and costs of AML. Table Table. Disclosures Stein: Agios Pharmaceuticals: Other: Advisory Board, Research Funding; Seattle Genetics: Research Funding; Celgene: Other: Advisory Board, Research Funding; Novartis: Consultancy. Latremouille-Viau:Analysis Group: Employment; Novartis: Other: Author is an employee of Analysis Group which has received consulting fees from Novartis. Guerin:Novartis: Other: I am an employee of Analysis Group, Inc., which has received consulting fees from Novartis for the conduct of this study; Analysis Group, Inc.: Employment. Shi:Novartis: Other: I am an employee of Analysis Group, Inc., which has received consulting fees from Novartis for the conduct of this study; Analysis Group, Inc.: Employment. Gagnon-Sanschagrin:Analysis Group, Inc: Employment; Novartis: Other: Author is an employee of Analysis Group which has received consulting fees from Novartis. Bonifacio:Novartis: Employment. Joseph:Novartis: Employment; Amgen: Other: Stocks/stock option; Pfizer: Other: Stock/stock option.

Healthcare resource utilization and cost in dementia: are there differences between patients screened positive for dementia with and those without a formal diagnosis of dementia in primary care in Germany?

ABSTRACTBackground:It is well-known that dementia is undiagnosed, resulting in the exclusion of patients without a formal diagnosis of dementia in many studies. Objectives of the present analyses were (1) to determine healthcare resource utilization and (2) costs of patients screened positive for dementia with a formal diagnosis and those without a formal diagnosis of dementia, and (3) to analyze the association between having received a formal dementia diagnosis and healthcare costs.Method:This analysis is based on 240 primary care patients who screened positive for dementia. Within the baseline assessment, individual data about the utilization of healthcare services were assessed. Costs were assessed from the perspective of insurance, solely including direct costs. Associations between dementia diagnosis and costs were evaluated using multiple linear regression models.Results:Patients formally diagnosed with dementia were treated significantly more often by a neurologist, but less often by all other outpatient specialists, and received anti-dementia drugs and day care more often. Diagnosed patients underwent shorter and less frequent planned in-hospital treatments. Dementia diagnosis was significantly associated with higher costs of anti-dementia drug treatment, but significantly associated with less total medical care costs, which valuated to be € 5,123 compared, to € 5,565 for undiagnosed patients. We found no association between dementia diagnosis and costs of evidence-based non-medication treatment or total healthcare cost (€ 7,346 for diagnosed vs. € 6,838 for undiagnosed patients).Conclusion:There are no significant differences in total healthcare cost between diagnosed and undiagnosed patients. Dementia diagnosis is beneficial for receiving cost-intensive anti-dementia drug treatments, but is currently insufficient to ensure adequate non-medication treatment for community-dwelling patients.