K Moeremans

Cost Effectiveness of Darunavir/Ritonavir 600/100 mg bid in Protease Inhibitor-Experienced, HIV-1-Infected Adults in Belgium, Italy, Sweden and the UK

AbstractBackground: Two phase II trials (POWER 1 and 2) have demonstrated that darunavir co-administered with low-dose ritonavir (DRV/r) provides significant clinical benefit compared with control protease inhibitors (PIs) in highly treatment-experienced, HIV-1-infected adults, when co-administered with optimized background therapy (OBR). Objective: To determine whether DRV/r is cost effective compared with control PIs, from the perspective of Belgian, Italian, Swedish and UK reimbursement authorities, when used in treatment-experienced patients similar to those included in the POWER 1 and 2 trials. Methods: An existing Markov model containing health states defined by CD4 cell count ranges (>500, 351–500, 201–350, 101–200, 51–100 and 0–50 cells/mm3) and death was adapted for use in four European healthcare settings. Baseline demographics, CD4 cell count distribution and antiretroviral drug usage reflected those reported in the POWER 1 and 2 trials. Virological/immunological response rates and matching transition probabilities over the patients lifetime were based on results from the POWER trials and published data. After treatment failure, patients were assumed to switch to a tipranavir-containing regimen plus OBR. For each CD4 cell count range, utility values and HIV-related mortality rates were obtained from the published literature. National all-cause mortality data and published data on the increased risk of non HIV-related mortality in HIV-infected individuals were taken into account in the model. Data from observational studies conducted in each healthcare setting were used to determine resource-use patterns and costs associated with each CD4 cell count range. Unit costs were derived from official local sources; a lifetime horizon was taken and discount rates were selected based on local guidelines. Results: In the base-case analysis, quality-adjusted life-year (QALY) gains of up to 1.397 in Belgium, over 1.171 in Italy, 1.142 in Sweden and 1.091 in the UK were predicted when DRV/r-based therapy was used instead of control PI-based treatment. The base-case analyses predicted an incremental costeffectiveness ratio (ICER) of h11 438/QALY in Belgium, h12 122/QALY in Italy, h10 942/QALY in Sweden and h16 438/QALY in the UK. Assuming an acceptability threshold of h30 000/QALY, DRV/r-based therapy remained cost effective over all parameter ranges tested in extensive one-way sensitivity analyses. Probabilistic sensitivity analysis revealed a 95% (Belgium), 97% (Italy), 92% (Sweden) or 78% (UK) probability of attaining an ICER below this threshold. Conclusion: From four European payer perspectives, DRV/r-based antiretroviral therapy is predicted to be cost effective compared with currently available control PIs, when both are used with an OBR in treatment-experienced, HIV-1-infected adults who failed to respond to more than one PI-containing regimen.

Cost Effectiveness of Darunavir/Ritonavir 600/100 mg bid in Treatment-Experienced, Lopinavir-Naive, Protease Inhibitor-Resistant, HIV-Infected Adults in Belgium, Italy, Sweden and the UK

AbstractBackground: Using data from the phase IIb POWER trials, darunavir boosted with low-dose ritonavir (DRV/r; 600/100mg twice daily; bid)-based highly active antiretroviral therapy (HAART) was shown to be significantly more efficacious and cost effective than other protease inhibitor (PI)-based therapy in highly treatment-experienced, HIV-1-infected adults. Furthermore, in the phase III TITAN trial (TMC114-C214), DRV/r 600/100mg bid-based HAART generated a superior 48-week virological response rate compared with standard-of-care lopinavir/ritonavir (LPV/r; 400/100mg bid)-based therapy in treatment-experienced, lopinavir-naive patients, and in particular those with one or more International AIDS Society — USA (IASUSA) primary PI resistance-associated mutations at baseline. These patients had a broader degree of previous PI use/failure (0–≥2) than the POWER patients. Objectives: To determine whether DRV/r 600/100mg bid-based HAART is cost effective compared with LPV/r-based therapy, from the perspective of Belgian, Italian, Swedish and UK reimbursement authorities, when used in treatment-experienced patients similar to TITAN patients with one or more IASUSA primary PI mutations at baseline. Methods: An existing Markov model containing health states defined by CD4 cell count ranges (>500, 351–500, 201–350, 101–200, 51–100 and 0–50 cells/mm3) and an absorbing state of death was adapted for use in the above-mentioned healthcare settings. Baseline demographics, CD4 cell count distribution, antiretroviral drug usage, virological/immunological response rates and matching transition probabilities were based on data collected during the first 48 weeks of therapy in the modelled subgroup of TITAN patients and the published literature. After treatment failure, patients were assumed to switch to a followon combination regimen. For each health state, utility values and mortality rates were obtained from the published literature. Data from local observational studies (Belgium, Sweden and Italy) or the published literature (UK) were used to determine resource-use patterns and costs associated with each CD4 cell count range. Unit costs were derived from official local sources; a lifetime horizon was taken and discount rates were chosen based on local guidelines. Results: The base-case analysis predicted quality-adjusted life year (QALY) gains of 0.785 in Belgium, 0.608 in Italy, 0.584 in Sweden and 0.550 in theUK when DRV/r-based therapy was used instead of LPV/r-based treatment. The estimated base-case incremental cost-effectiveness ratios (ICERs) were €6964/QALY gained in Belgium, €9277/QALY gained in Italy, €6868 (SEK69 687)/QALY gained in Sweden and €14 778 (£12 612)/QALY gained in the UK. Assuming a threshold of €30 000/QALY gained, DRV/r-based therapy remained cost effective over most parameter ranges tested in extensive one-way sensitivity analyses. The variation of immunological response rates and the time horizon were identified as important drivers of cost effectiveness. Probabilistic sensitivity analysis revealed a greater than 70% probability of achieving an ICER below this threshold in all four healthcare settings. Conclusion: From the perspective of Belgian, Italian, Swedish andUKpayers, DRV/r 600/100mg bid-based HAART is predicted to be cost effective compared with LPV/r 400/100mg bid-based therapy, when used to manage treatment experienced, lopinavir-naive, PI-resistant, HIV-infected adults with a broad range of previous PI use/failure

Economic evaluation of the prevention and management of systemic fungal infections in neutropenic patients

Systemic fungal infections in neutropenic patients remain a clinical problem that is associated with morbidity and mortality. Continuing efforts are being made to develop improved (i.e., more effective or safe) drugs, and several new treatments have recently become available. These have increased the therapeutic options available to clinicians to address the problem of systemic fungal infections. Therapeutic choices are difficult when taking into account aspects of efficacy, safety and costs that are associated with the available alternatives. This review summarises the present status of health economic knowledge of the standard therapies that have been available for many years, and also reports on the most recent health economic evidence available for the newly developed treatment alternatives.

ES8 COST-EFFECTIVENESS OF DARUNAVIR/R IN HIGHLY TREATMENT-EXPERIENCED HIV/AIDS PATIENTS IN DIFFERENT EUROPEAN HEALTH CARE SETTINGS

government of £160,069 with a break-even point (ie. where the NPV becomes positive) at age 31. A child with similar characteristics, but conceived using IVF, has a lifetime NPV of £144,000 with a break-even point at age 33. Sensitivity analysis indicated that these results are sensitive to assumptions about the working age interval, inflation rate, discount rate, and increasing age related health costs. CONCLUSION: Despite modelling limitations, we conclude that under reasonable assumptions IVF costs are relatively insignificant vis-à-vis other costs and benefits to government. While the model does not forecast the full economic benefits associated with investment in IVF, it does demonstrate the potential long-term financial returns of improved access to IVF services.

Is adding maternal vaccination to prevent whooping cough cost-effective in Australia?

ABSTRACT Pertussis or whooping cough, a highly infectious respiratory infection, causes significant morbidity and mortality in infants. In adolescents and adults, pertussis presents with atypical symptoms often resulting in under-diagnosis and under-reporting, increasing the risk of transmission to more vulnerable groups. Maternal vaccination against pertussis protects mothers and newborns. This evaluation assessed the cost-effectiveness of adding maternal dTpa (reduced antigen diphtheria, Tetanus, acellular pertussis) vaccination to the 2016 nationally-funded pertussis program (DTPa [Diphtheria, Tetanus, acellular Pertussis] at 2, 4, 6, 18 months, 4 years and dTpa at 12–13 years) in Australia. A static cross-sectional population model was developed using a one-year period at steady-state. The model considered the total Australian population, stratified by age. Vaccine effectiveness against pertussis infection was assumed to be 92% in mothers and 91% in newborns, based on observational and case-control studies. The model included conservative assumptions around unreported cases. With 70% coverage, adding maternal vaccination to the existing pertussis program would prevent 8,847 pertussis cases, 422 outpatient cases, 146 hospitalizations and 0.54 deaths per year at the population level. With a 5% discount rate, 138.5 quality-adjusted life-years (QALYs) would be gained at an extra cost of AUS

Cost-effectiveness of DRV/r 600/100 mg BID in treatment-experienced, LPV/r-naïve, PI-resistant, HIV-infected adults in the UK, Belgium, Italy and Sweden

4.44 million and an incremental cost-effectiveness ratio of AUS

PCN43 CRITICAL APPRAISAL OF SCIENTIFIC POSTERS COMPARING ANEMIA TREATMENTS IN CANCER PATIENTS: APPLYING ISPORTASK FORCE GUIDELINES ON METHODOLOGICAL QUALITY OF RETROSPECTIVE STUDIES

32,065 per QALY gained. Sensitivity and scenario analyses demonstrated that outcomes were most sensitive to assumptions around vaccine effectiveness, duration of protection in mothers, and disutility of unreported cases. In conclusion, dTpa vaccination in the third trimester of pregnancy is likely to be cost-effective from a healthcare payer perspective in Australia.

PMH13 STUDY DESCRIPTION AND BASELINE RESULTS OF THE SCHIZOPHRENIA OUTCOMES SURVEY (SOS) OBSERVATIONAL STUDY IN BELGIUM

Purpose of the study The Phase III TITAN trial (TMC114-C214) evaluated darunavir/ritonavir (DRV/r) 600/100 mg BID vs. lopinavir/ ritonavir (LPV/r) 400/100 mg BID in treatment-experienced, LPV/r-naïve, HIV-infected adults. We determined the cost-effectiveness of DRV/r vs. LPV/r from the perspective of British, Swedish, Italian and Belgian payers in the TITAN trial subgroup with at least one IAS-USA primary protease inhibitor (PI) mutation at baseline. These patients had less advanced HIV disease and a broader degree of prior PI use/failure (0≥2) than those in the DRV Phase IIb POWER trials (≥2).

Second line pharmacological management of paroxysmal and persistent atrial fibrillation in france: a cost analysis.

Two independent reviewers used the methodological criteria published by the ISPOR Task Force on Retrospective Data to assess the quality of four posters presenting the results of retrospective database studies on the use of erythropoiesis-stimulating agents (epoetin alfa, epoetin beta, or darbepoetin alfa) for treating patients with cancer. A third reviewer consolidated the results. Overall, from the information reported in the four posters, their methodological quality ranged from poor to very poor; only a few of the criteria were satisfactorily addressed. The quality of the data sources and the research design received very poor scores. Key elements such as selection bias were not considered. These findings caution against the use of posters without appropriate assessment of their methodological quality. The ISPOR guidelines for the evaluation of retrospective analyses are a useful tool for assessing the quality of scientific posters.

Assessment of the economic value of the INTERCEPT blood system in Belgium

combined inand outpatient observational study in Germany. 646 adult schizophrenia patients treated with either olanzapine (N = 416) or haloperidol (N = 230) were enrolled in the study and quarterly observations on the disease course, resource consumption and quality of life are made during the follow-up period. RESULTS: In both treatment groups nearly 50% of the patients were female, had been diagnosed around the age of 30 years, and were overweight (BMI > 25). Hospital inpatients and hospital day care patients were more severely ill (N = 230, >50% with CGI clearly ill or worse) than outpatients (N = 416, >50% with CGI moderate or better). For both treatment groups the global disease severity was similar (approximately 70% moderate or worse, 15% severe or worse) as well as the existence of positive symptoms (about 64% had current positive symptoms in both groups). Olanzapine patients were younger (mean 39 vs. 46 years). Current negative symptoms (90% vs. 98%) and cognitive symptoms (88% vs. 95%) were less common for olanzapine patients than for haloperidol patients, whereas depressive symptoms were more common (75% vs. 69%). More olanzapine patients were able to care for themselves (87% vs. 78%) and lived at home without care (57% vs. 40%). More olanzapine patients were employed (32% vs. 18%) and fewer were in early retirement (27% vs. 46%). CONCLUSIONS: At time of enrolment in the GEO observational study olanzapine and haloperidol-treated patients had schizophrenia of similar severity but different disease course. Fewer olanzapine patients had negative or cognitive symptoms whereas more had depressive symptoms. More olanzapine patients were employed and able to care for themselves, whereas more haloperidol patients were in early retirement.