Sylvie Gabriel

The Comparative Medical Costs of Atherothrombotic Disease in European Countries

AbstractBackground: The clinical manifestations of atherothrombotic disease include ischaemic heart disease (including myocardial infarction [MI]) and cerebrovascular disease (including ischaemic stroke [IS]). Although costs generated by the clinical manifestations of atherothrombotic disease represent an important economic burden for any healthcare system, very few economic comparative data are available. Objective: To: (i) assess management costs of the different practice patterns for acute and chronic phases for MI, IS and peripheral arterial disease (PAD) in eight European countries; and (ii) to simulate the cost of managing a patient with an atherothrombotic disease for 2 years in Europe. Study perspective: Healthcare system. Methods: Firstly, the medical costs of managing MI and IS were analysed during the acute phase and subsequent 6-month periods over a total of 2 years. In each case, a decision tree was designed to indicate resource use. Assumptions concerning patient management and resource use were based on currently available local and international literature, official national statistics and local expert opinions (Delphi panel). Costs were assessed using diagnosis-related groups (Austria, Italy, Portugal and Sweden), or hospital databases and national tariffs (Belgium, France, Spain and Switzerland). Secondly, these costs were correlated to data from a large randomised clinical trial to estimate the overall cost per patient with atherothrombotic disease over a 2-year period. Results: For MI, there was a 2-fold difference in costs between the eight countries (€9512–18 293), with 47–76% of costs devoted to acute management, 14–48% to follow-up management during the first year, and 4–17% to follow-up during the second year. For IS, there was a 10-fold difference (€5607–56 370), with 18–75% devoted to follow-up for the years 1995–1997. Conclusions: There are differences in the overall costs and cost breakdown in the clinical management patterns of MI and IS in Europe. These differences seem to arise as a result of local treatment pattern specificities as well as the availability of specific and well-adapted structures for patients’ rehabilitation. Further studies are necessary to fully explain these differences. The assessment of the total medical costs of managing an atherothrombotic patient over a 2-year period (MI, IS, established PAD) has to take into account the risk of ischaemic events in different vascular areas (MI, IS or major leg ischaemia).

Clinical characteristics, treatment patterns, and economic burden in patients treated for neuroendocrine tumors in the United States: a retrospective cohort study

Abstract Objective: To assess patient characteristics, treatment patterns, and healthcare resource utilization (HRU)/costs of individuals treated for neuroendocrine tumors (NETs) in the US. Methods: Using a US administrative claims database, this study identified commercially-insured adults newly diagnosed with carcinoid tumors (ICD-9-CM: 209.xx) or pancreatic islet cell tumors (ICD-9-CM: 157.4 and 211.7) between July 1, 2007 and December 31, 2010 (date of first observed diagnosis denoted the index date). Patients were required to have 6-month pre-index and 12-month post-index continuous enrollment, and treatment by medical and/or surgical therapy during the 12-month follow-up. Descriptive analyses were performed to assess demographic/clinical characteristics, treatment patterns, HRU, and total healthcare cost in two mutually exclusive cohorts, medical and surgical therapy. Results: This study included 625 individuals with NETs treated with medical therapy (mean age: 54.2 years; 53.4% female) and 831 treated with surgical therapy (mean age: 51.3 years; 52.6% female). Among the medical therapy cohort, carcinoid syndrome (72.3%), liver metastasis (62.6%), and diarrhea (28.3%) were the most prevalent symptoms/co-morbidities in the 12-month post-index period; 92.3% received octreotide long-acting release, 35.8% had hospitalization admissions, and 37.9% had emergency room visits. The total monthly healthcare cost increased from

Association Between Tumor Progression Endpoints and Overall Survival in Patients with Advanced Neuroendocrine Tumors

5629.7 in the pre-index period to

PCV1 AN ECONOMIC EVALUATION OF CLOPIDOGREL IN SECONDARY PREVENTION OF ISCHEMIC EVENTS: HIGH RISK POPULATIONS

9093.3 in the post-index period. Among the surgical therapy cohort, carcinoid syndrome (40.3%), nausea and/or vomiting (28.5%), and liver metastasis (24.3%) were the most prevalent symptoms/comorbidities in the 12-month post-index period; 31.4% received surgical resection or removal of large intestine, 94.7% had hospitalization admissions, and 45.5% had emergency room visits. The total monthly healthcare cost increased from

Budget impact analysis of botulinum toxin A therapy for upper limb spasticity in the United Kingdom.

2547.9 in the pre-index period to

Development of a Framework Based on Reflective MCDA to Support Patient–Clinician Shared Decision-Making: The Case of the Management of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NET) in the United States

8810.4 in the post-index period. Conclusion: Substantial clinical and economic burden exists among individuals with NET treated with medical or surgical therapies. Future research should investigate this treated sub-population considering a longer follow-up due to slow disease progression.

AbobotulinumtoxinA in the management of cervical dystonia in the United Kingdom: a budget impact analysis.

In observational cohorts of patients with metastatic neuroendocrine tumor (NET) treated with single‐agent somatostatin analogs or everolimus, longer times to disease progression and longer progression‐free survival were both associated with improved overall survival. These findings support the continued use of disease progression endpoints in NET clinical trials.

Unlocking the potential of established products: toward new incentives rewarding innovation in Europe

OBJECTIVES: To focus on the Bulgarian market of M01 group for the period 1999–2001; the most consumptive active principles (APs) within M01; to determine the trend in M01 consumption and within. METHODS: M01 consumption at national level has been calculated by ATC/DDD methodology and expressed in DDD/1000/day. Data have been collected from: a) the import of wholesalers, b) the local industry sale reports for the domestic market. Comparison has been made with M01 consumption in Norway and Sweden (expressed in DDD/1000/day). RESULTS: M01 consumption at national level has been calculated as follows: 1999— 14,216; 2000—13,764; and 2001—15,565. The most consumptive APs within M01 were: Diclofenac (D) 1999—8,448; 2000—8,728; and 2001—9,753; Piroxicam (P) 1999—3,380; 2000—2,892; and 2001—2,761; Indometacin (Ind) 1999—1,457; 2000—1,061; and 2001—1,104; Ketoprofen (K) 1999—0,192; 2000— 0,439; and 2001—0,699; Tenoxicam (T) 1999—0,598; 2000—0,172; and 2001—0,699. Ibuprofen (Ib) consumption was: 1999—0,169; 2000—0,030; and 2001— 0. The coxib Rofecoxib (R) consumption was registered initially in 2001—0,054. CONCLUSIONS: M01 consumption 1999–2001 did not show significant variations. The national demand for M01 is approximately 14 DDD/1000/day. M01 consumption in Norway and Sweden was higher. D as the most consumptive AP at a national level was about 67% of M01 consumption due to 4 locally produced products. Dynamics within the group was: D and K increased slightly; Ind showed relatively steady-state position; P slightly decreased; the trend in T consumption could not be defined distinctly; Ib decreased in consumption; Coxibs were with limited place within M01. In comparison with Bulgaria, M01 consumption model in Norway and Sweden showed some differences. PAR7 MODELLED COST-EFFECTIVENESS AND COSTUTILITY ANALYSIS OF VARIOUS TREATMENT STRATEGIES IN OSTEOPOROTIC POSTMENOPAUSAL WOMEN IN POLAND Orlewska E, Lis J Medical University of Warsaw, Warsaw, Poland; Eli Lilly Polska, Warsaw, Poland

Assessing the burden of illness from cervical dystonia using the Toronto Western Spasmodic Torticollis Rating Scale scores and health utility: a meta-analysis of baseline patient-level clinical trial data.

Background Botulinum toxin A (BoNT-A) is an effective treatment for patients with upper limb spasticity (ULS), which is a debilitating feature of upper motor neuron lesions. BoNT-A preparations available in the UK are associated with different costs. Methods We developed a budget impact model to assess the effect of changing market shares of different BoNT-A formulations – abobotulinumtoxinA, onabotulinumtoxinA, and incobotulinumtoxinA – and best supportive care, from the UK payer perspective, over a 5-year time horizon. Epidemiological and resource use data were derived from published literature and clinical expert opinion. One-way sensitivity analyses were performed to determine parameters most influential on budget impact. Results Base-case assumptions showed that an increased uptake of abobotulinumtoxinA resulted in a 5-year savings of £6,283,829. Treatment with BoNT-A costs less than best supportive care per patient per year, although treating a patient with onabotulinumtoxinA (£20,861) and incobotulinumtoxinA (£20,717) cost more per patient annually than with abobotulinumtoxinA (£19,800). Sensitivity analyses showed that the most influential parameters on budget were percentage of cerebral palsy and stroke patients developing ULS, and the prevalence of stroke. Conclusion Study findings suggest that increased use of abobotulinumtoxinA for ULS in the UK could potentially reduce total ULS cost for the health system and society.

A retrospective study to assess resource utilization and costs in patients with post-stroke spasticity in the United Kingdom

IntroductionWell- or moderately differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are often slow-growing, and some patients with unresectable, asymptomatic, non-functioning tumors may face the choice between watchful waiting (WW), or somatostatin analogues (SSA) to delay progression. We developed a comprehensive multi-criteria decision analysis (MCDA) framework to help patients and physicians clarify their values and preferences, consider each decision criterion, and support communication and shared decision-making.MethodsThe framework was adapted from a generic MCDA framework (EVIDEM) with patient and clinician input. During a workshop, patients and clinicians expressed their individual values and preferences (criteria weights) and, on the basis of two scenarios (treatment vs WW; SSA-1 [lanreotide] vs SSA-2 [octreotide]) with evidence from a literature review, expressed how consideration of each criterion would impact their decision in favor of either option (score), and shared their knowledge and insights verbally and in writing.ResultsThe framework included benefit-risk criteria and modulating factors, such as disease severity, quality of evidence, costs, and constraints. Overall and progression-free survival being most important, criteria weights ranged widely, highlighting variations in individual values and the need to share them. Scoring and considering each criterion prompted a rich exchange of perspectives and uncovered individual assumptions and interpretations. At the group level, type of benefit, disease severity, effectiveness, and quality of evidence favored treatment; cost aspects favored WW (scenario 1). For scenario 2, most criteria did not favor either option.ConclusionsPatients and clinicians consider many aspects in decision-making. The MCDA framework provided a common interpretive frame to structure this complexity, support individual reflection, and share perspectives.FundingIpsen Pharma.