Andrea Morsanutto

The burden of multiple myeloma: assessment on occurrence, outcomes and cost using a retrospective longitudinal study based on administrative claims database

Objective : Multiple myeloma (MM) is a malignancy of plasma cells that results in an overproduction of light and heavy chain monoclonal immunoglobulins. Multiple myeloma imposes a significant economic and humanistic burden on patients and society. The present study is aimed at assessing the burden of multiple myeloma in both epidemiologic and economic terms. Methods : A retrospective, naturalistic longitudinal study on the occurrence, outcome and cost of multiple myeloma using an administrative database, was performed. We selected residents of a North-eastern Region of Italy, who had their first hospital admission for multiple myeloma during the period 2001-2005. This group was followed up until 31-12-2006, death or transfers to other regional health services. Direct medical costs were quantified within the perspective of the Regional Health Service. Results : During the period 2001-2005, out of a population if 1.2 million inhabitants, we observed 517 incidents of patients diagnosed with MM (52% female). During the period of observation, 364 (70.4%) subjects died. Total health care costs per patient over the maximum of follow-up were estimated to be 76,630 Euro for subjects younger than 70 years old and 22,892 Euro in the older group. Conclusions : Multiple myeloma imposes a significant epidemiological and economic burden on the healthcare system.

PCV27 COSTS AND OUTCOMES AFTER FIRST HEART FAILURE HOSPITAL ADMISSION: A LONGITUDINAL STUDY USING ADMINISTRATIVE DATABASES

METHODS: A within trial study was designed. Survival gains were estimated using an extraction of comparable patients from the Saskatchewan Health Data Base. A piecewise regression model yielded death rates adjusted on patients’ characteristics. Resource use was collected alongside the clinical trial. Only direct medical costs were considered. Hospital costs were calculated using French DRG costs, and the National Fee Schedule for outpatient diagnostic procedures. All costs were in 2003 Euros. A sensitivity analysis using bootstrap was used to build a confidence interval for the Incremental Cost-Effectiveness Ratio, and an acceptability curve. Costs and outcomes were discounted at five percent. RESULTS: Overall mortality over the trial period was 478 (14.4%) in the treatment group vs. 554 (16.7%) in the placebo group (p = 0.008). Combined CV deaths and hospitalisations were 885 (26.7%) in the treatment group, vs. 993 (30.3%) in the placebo group (p = 0.002). The discounted gain of survival was 3.2 weeks. The incremental cost per life year saved was €15,382 (95% IC: €8274–€42,723). Following the sensitivity analysis, 74% of the values of the ICER fell under a €50,000 per life-year saved. CONCLUSIONS: In France, the ICER compares with those of heart transplantation (€17,626) and of rt-PAs in the prevention of thrombotic events during the acute phase of AMI (€12,190). The main limitation of the study is the restriction to the duration of the trial. Sub-group analysis was not performed in the EPHESUS trial, and it was not possible to compute an ICER for severe heart failure patients, for which one can expect a lower cost per life-year saved.

Epidemiological and economic aspects of diabetes in the Campania Region, Italy

Aim: to assess the economic and epidemiologic impact of diabetes in Campania, a region of approximately 5.7 million inhabitants in the south of Italy. Method: we collected, from an electronic database, all prescriptions for antidiabetic drugs reimbursed in the first half year of 2005 in 8 local health authorities (60% of the overall population) of Campania. The diabetic cohort was defined as the population of subjects receiving at least 2 prescriptions of an antidiabetic agent in 6-month, classified according to their therapeutic role using Anatomic Therapeutic Chemical (ATC) classification. Characterization is given of the patients and their antidiabetic medication. Subsequently, the prescription of concomitant treatment, in comparison with a control group, is presented. Drugs cost and drugs consumption were quantified using NHS prospective (expressed in Euro 2005) and Defined Daily Dose system (DDD) respectively. Results: the diabetic cohort included 183,614 subjects (5.3% of the observed population), mean age was 65.0 years and female represented 54.8% of the sample. Total cost for diabetic patients represents 16.8% of the total drug expenditure. The average drug/cost/patient was € 355.7; only 19.0% was spent for antidiabetic drugs. The reported use of medication was higher for subjects with diabetes compared with the control population regarding overall use (2,363.5 versus 1259.8 DDD/1,000 inhabitants/die), the use of cardiovascular drugs (1,499.3 versus 663.5 DDD/1,000 inhabitants/day), use of haematologic drugs (277.1 versus 120.3 DDD/1,000 inhabitants/day), and use of ophthalmological drugs (48.3 versus 21.0 DDD/1,000 inhabitants/day). Discussion: chronic-degenerative pathologies, such as diabetes, implies a relevant social and economic impact. Expenses that are associated to the treatment and the prevention of complications, in particular cardiovascular problems, are registered among the main items listed in the healthcare budget.