G. de Pouvourville

Access to care, socioeconomic deprivation and colon cancer survival

Background  The influence of socioeconomic environment on cancer survival has been established in numerous studies in the EU and the US, prognosis being constantly poorer for the most underprivileged patients.

Two-year vascular hospitalisation rates and associated costs in patients at risk of atherothrombosis in France and Germany : Highest burden for peripheral arterial disease

OBJECTIVES To obtain Western European perspectives on the economic burden of atherothrombosis in patients with multiple risk factors only (MRF), cerebrovascular disease (CVD), coronary artery disease (CAD), and in the under-evaluated group of patients with peripheral arterial disease (PAD), we examined vascular-related hospitalisation rates and associated costs in France and Germany. DESIGN The prospective REACH Registry enrolled 4693 patients in France, and 5594 patients in Germany (from December 2003 until June 2004). METHODS For each country, 2-year rates and costs associated with cardiovascular events and vascular-related hospitalisations were examined for patients with MRF, CVD, CAD, and PAD. RESULTS Two-year hospitalisation costs were highest for patients with PAD (3182.1€ for France; 2724.4€ for Germany) and lowest for the MRF group (749.1€ for France; 503.3€ for Germany). Peripheral revascularizations and amputations were the greatest contributors to costs for all risk groups. Across all PAD subgroups, peripheral procedures constituted approximately half of the 2-year costs. CONCLUSION Hospitalisation rates and costs associated with atherothrombotic disease in France and Germany are high, especially so for patients with PAD.

TREATMENT MAINTENANCE DURATION OF DUAL THERAPY WITH METFORMIN AND SITAGLIPTIN IN TYPE 2 DIABETES THE ODYSSEE OBSERVATIONAL STUDY

AIM The study compared the duration of maintenance of treatment in patients with type 2 diabetes (T2D) using dual therapy with either metformin and sitagliptin (M-Sita) or metformin and a sulphonylurea (M-SU). MATERIALS AND METHODS This observational study included adult patients with T2D who had responded inadequately to metformin monotherapy and therefore had started de-novo treatment with Met-Sita or Met-SU within the previous eight weeks. Patient follow-up and changes to treatment were performed according to their general practitioners usual clinical practice. The primary outcome was time to change in treatment for whatever cause. HbA1c and symptomatic hypoglycaemia were also documented. RESULTS The median treatment duration for patients in the M-Sita group (43.2 months) was significantly longer (P < 0.0001) than in the M-SU group (20.2 months). This difference persisted after adjusting for baseline differences and confounders. A similar reduction in HbA1c was noted in both arms (-0.6%), and the incidence of hypoglycaemia prior to treatment modification was lower with M-Sita (9.7%) than with M-SU (21.0%). Adverse events potentially related to treatment were reported in 2.8% (n = 52) and 2.7% (n = 20) of patients in the M-Sita and M-SU arms, respectively. CONCLUSION Under everyday conditions of primary diabetes care, dual therapy with M-Sita can be maintained for longer than M-SU. In addition, while efficacy, as measured by changes in HbA1c, was similar between treatments, the incidence of hypoglycaemia was lower in patients taking M-Sita.

UT1 VALUING EQ-5D USING TIME TRADE-OFF IN FRANCE

patients with T2DM in the UK had significantly lower (p 0.0001) physical summary scores than other EU countries. Patients experiencing depression symptoms were more likely to visit the ER [OR 1.74; 95% CI:(1.35, 2.23); p 0.0001], be hospitalized [OR 1.43; 95% CI:(1.11, 1.84); p 0.005] and had more physician visits in the last six months ( 5.37, p 0.0001). Patients in Spain had significantly more provider visits (p 0.05) and ER visits (p 0.0001) than UK patients, while patients in France were hospitalized more often than UK patients (p 0.05). CONCLUSIONS: Comorbid depression in patients with T2DM greatly decreases physical and mental summary scores of the SF-12, and increases resource use. Further research is needed to clarify associations between the two conditions, including geographical and cultural influences on health outcomes in this cohort.

CAPECO: Cost evaluation of community acquired pneumonia managed in primary care

BACKGROUND Estimating the economic burden of community acquired pneumonia (CAP) managed in ambulatory setting is needed in France since no data are available. METHOD A retrospective study (CAPECO) was conducted based on a prospective French study describing patients with suspected CAP managed in primary care (CAPA). The aim of the CAPECO study was to estimate and explain medical costs of a disease episode in CAP patients only followed in ambulatory care and in hospitalised patients. Primary endpoints were the direct medical costs, impact on productivity and costs of incident CAP over one year. Secondary endpoint was to describe predictive factors of costs, hospital admission and stay length. RESULTS In this cohort of 886 patients, resulting in an incidence of CAP of 400 per 100,000 inhabitants per year, the mean direct medical cost of a disease episode of CAP was € 118.8 for strictly ambulatory patients with an equal weight for medical time, drugs, diagnostic procedures and tests. This direct cost was € 102.1 before admission for patients who were finally hospitalised. The mean cost of hospital admissions was € 3522.9. Main predictive factors of hospital admission and stay length were respectively a history of chronic respiratory disease and older age. Factors of direct medical cost were prescribing X-ray examination and having a positive X-ray. The impact of a disease episode on productivity was € 1980 (sd 1400) per ambulatory episode and € 5425 (sd 4760) per episode leading to hospital admission. CONCLUSION Costs per ambulatory episode were modest but increased substantially in hospitalised patients, who were more numerous when chronic respiratory disorders were present and in the elderly. Indirect costs were significant. Deciders should thus consider both direct and indirect costs when assessing preventive interventions in the context of this disease.

A New Cost-Effectiveness Modelling Approach In Chronic Heart Failure With Reduced Ejection Fraction

Objectives: As new therapies for chronic heart failure with reduced ejection fraction (HFrEF) emerge, health technology assessments (HTAs) will require cost-effectiveness analyses to inform decision making. The objective was to develop a model framework for evaluating the cost-effectiveness of LCZ696, a novel oral therapy proposed for the treatment of HFrEF. Methods: A systematic literature review was performed. Searches were conducted in MEDLINE, EMBASE, EconLit, and Cochrane Library databases, with supplementary hand searching of conferences and HTA websites. Of 63 distinct analyses identified, 33 used decision-analytic models. Structures were most commonly described as Markov models (n=27), but methods employed were heterogeneous. The health states most frequently employed were ‘alive’ and ‘dead’, with outcomes such as hospitalization or New York Heart Association (NYHA) class distribution most commonly considered within the ‘alive’ state. Results: A 2-state Markov model with ‘alive’ and ‘dead’ states was developed using three multivariate regression models to predict the risks of mortality, hospitalisation and the trajectory of health-related quality of life over time within the ‘alive’ state. NYHA class was not used as a basis for health states, as the extrapolation of clinical improvements beyond the observed data was considered clinically implausible. Parametric survival models, negative binomial models and multilevel models are used to predict mortality, hospitalisation, and HRQL, respectively, allowing extrapolation to a lifetime time horizon. The model of HRQL attempts to capture the effects of baseline characteristics, hospitalisation, adverse events and time on EQ-5D. Clinical experts were consulted to validate the regression models and their respective predictions. Conclusions: The new framework employs similar methods to decision analytic models developed previously in heart failure, however models health-related quality of life as a function of time directly, thereby providing a parsimonious approach with improved clinical plausibility compared to other model structures in the literature.

PG13 PHARMACOECONOMIC ASSESSMENT OF LANREOTIDE IN THE MANAGEMENT OF POST-OPERATIVE DIGESTIVE FISTULAS

PGI13 PHARMACOECONOMIC ASSESSMENT OF LANREOTIDE IN THE MANAGEMENT OF POST-OPERATIVE DIGESTIVE FISTULAS De Pouvourville G, Levesque K, Nestrigue C, Maurel F, Brignone M, Ménégaux F, Buscail L, Levesque E,Tilleul P ESSEC Business School, Cergy-pontoise, France, IMS Health, Puteaux, France, Hopital Saint antoine, APHP, Paris, France, Pitié Salpêtrière Hospital, Paris, France, Rangueil Hospital,Toulouse, France, Paul Brousse Hospital,Villejuif, France, St-Antoine Hospital, Paris, France OBJECTIVES: Post-operative fistulas are a serious complication of gastrointestinal tract surgery that can highly increase the length of hospitalization stays. Somatostatin, such as lanreotide, are being used to reduce time elapsed for fistula closure. In France, non expensive drugs are directly financed through DRG tariff. In this context, the objective of the study was to evaluate, from a public hospital perspective, whether the additional costs associated with lanreotide treatment could be counter-balanced by its impact on health resources consumption and length of stay compared to conventional care management and natural somatostatin. METHODS: We assumed that the treatment duration corresponds to the time required for fistula closure and data used were based on published clinical trials findings. Hospital stays were identified from the French national hospital database (PMSI) and costs of stays were determined through the French national hospital costs database (ENC). Daily average cost of stay was estimated considering both, length of stay, fix and variable costs within the ENC and was weighed by the number of stays in each identified DRG. RESULTS: The analysis was based on 2193 hospitalizations representing 74% of the stays with a fistula diagnosis. The average daily cost of stay was evaluated to €170. Based on the clinical data available, the time for fistula closing was comparable for both drug treatments (12 days for lanreotide and natural somatostatine) and, 18 days for the conventional treatment. Thus, the total costs of stay including the cost of drug were of €2929 for the lanreotide, €7747 for the natural somatostatine and of €2981 for the conventional treatment. CONCLUSIONS: The decreased fistula closing time associated with lanreotide treatment can potentially lead to a reduction of the hospitalization length of stay which can compensate the overcost of the drug.

PCV24 COST-EFFECTIVENESS ANALYSIS OF ALDOSTERONE BLOCKADE WITH EPLERENONE IN PATIENTS WITH HEART FAILURE AFTER ACUTE MYOCARDIAL INFARCTION (EPHESUS) IN THE FRENCH CONTEXT

OBJECTIVE: beta-blockers have provided evidence of improving survival in chronic heart failure patients. Specifically, the Cardiac Insufficiency Bisoprolol Study II has shown a significant reduction in mortality and morbidity among patients with moderate to severe chronic heart failure treated with bisoprolol. Our aim was to investigate the economic consequence of bisoprolol therapy in chronic heart failure patients in Italy. METHODS: Data were derived from the Cardiac Insufficiency Bisoprolol Study II trial. We conducted a cost-effectiveness analysis, comparing standard care with bisoprolol vs. standard care with placebo in the perspective of the Italian National Health Service. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary; specialist visits for initiation and up-titration of bisoprolol therapy and hospitalizations were quantified based on the Italian National Health Service tariffs (2005). Effects were measured in terms of mortality and morbidity reduction (number of deaths, life years gained and frequency of hospitalizations). We considered an observational period of 1.3 years, i.e. the average follow-up recorded in the trial. Discounting was not performed because of the relatively short follow-up of patients. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. We also conducted a threshold analysis. RESULTS: The overall cost of care per 1.000 patients treated for 1.3 years was estimated in €2,075,548 in the bisoprolol group and in €2,396,265 in the placebo group, resulting in a net saving of €320,718. The number of additional patients alive with bisoprolol was 55 per 1000 patients; the number of life years gained was 36 at 1.3 year. CONCLUSIONS: Bisoprolol therapy is dominant since it is both less costly and more effective than standard care. Results of sensitivity analysis showed that bisoprolol therapy remains dominant even to changes in unit cost of drug and hospitalizations.