Comparison of Catheter Ablation Versus Medical Treatment for

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from public data and costs published in United States Dollar were converted to 2016 Brazilian Real (BRL). The time horizon was 1 year considering Brazilian public provider perspective and a one-way sensitivity analysis was performed.  Results: The budget impact tool suggested a potential saving of 59.776,11 BRL, which correspond 7% of reduction compared to the usual care. This result could be achieved due to a reduction of 14% and 11% on the treatment costs of thrombosis and hemorrhage, respectively, and an incremental of 5% on the diagnosis costs when moving from centralized test to point-of-care test.  Conclusions: An organized management with point-of-care test, for patients under chronic warfarin therapy, could lead to important savings for a Brazilian public healthcare provider due to the potential reduction of complications occurrence, such as thrombosis and hemorrhage, through increasing the number of patients within the Target Therapeutic Range (TTR) for anticoagulation. PMD8 Análisis De Impacto Presupuestario Comparando 2 Métodos De Screening De Cáncer De Cuello Uterino EN EL Sector Público De Argentina Lifschitz E1, Tatti SA1, Fleider L1, Simonovich VA2 de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina, 2Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

1Facultad

Objectives: Comparar el impacto presupuestario del screening primario de cáncer de cuello uterino mediante test de HPV con genotipificación (cobas® HPV) con un intervalo de tamizaje de 5 años versus el uso de Citología con tinción Papanicolaou con regularidad anual.  Methods: Se analizó el impacto de ambas estrategias en el grupo de mujeres de 30-65 años, sin cobertura de seguros en Argentina, desde la perspectiva del financiador. Se utilizó una metodología basada en un árbol de decisiones, considerando 2 ciclos de screening. Se evaluaron solamente los costos directos del screening, diagnóstico y tratamiento en la población incluida. Los costos se calcularon a partir del Nomenclador del Hospital Público de Gestión Descentralizada, así como la disposición a pagar del Programa Nacional de Prevención del Cáncer cérvico-uterino.  Results: La población cribada ascendió a 1.652.602 mujeres. El costo anual del screening con cobas® HPV resultó 66% menor que utilizando Citología con tinción Papanicolaou, aunque el costo total en 2 ciclos de screening resultó mayor con la estrategia de test de HPV con genotipificación (comparando 10 años vs 2 años). La estrategia con cobas® HPV evidenció mejores resultados clínicos, con mayor porcentaje de detección de cáncer cérvico-uterino, CIN-3 y CIN-2 (83,3%, 84,0% y 79,6% vs 57,7%, 57,7% y 53,2%, respectivamente), así como menor incidencia y mortalidad anual que al utilizar Citología con tinción Papanicolaou como método de screening primario.  Conclusions: El costo anual del screening con test de HPV con genotipificación para el sector público en Argentina es menor que el que genera realizarlo mediante Citología con tinción Papanicolaou. Los mejores resultados clínicos permitirían estimar que la estrategia de cribado con cobas® HPV es más costo-efectiva, teniendo en cuenta el impacto de la muerte prematura en la productividad del país y, más aún, siendo el propio Estado el sector involucrado en el presente análisis. PMD9 Análisis De Impacto Presupuestario Comparando 2 Métodos De Screening De Cáncer De Cuello Uterino (CCU) EN EL Sector Privado De Argentina Roa R1, Jorgensen N2, Denamiel JP1 ISALUD, Buenos Aires, Argentina, 2Superintendencia de Servicios de Salud (SSS), Buenos Aires, Argentina

1Universidad

Objectives: Estimar el impacto clínico y presupuestario del screening primario de CCU mediante un test de HPV con genotipificación 16/18 que detecta en simultáneo otros 12 tipos de HPV de alto riesgo.  Methods: Se utilizó una metodología basada en un árbol de decisiones para modelar el tamizaje y diagnóstico de CCU comparando 2 estrategias: (1) Citología con tinción Papanicolaou con regularidad anual; (2) test de HPV con genotipificación 16/18 y citología refleja (cobas® HPV) con un intervalo de tamizaje de 5 años. Se analizó el impacto de ambas estrategias en el grupo de mujeres de 30-65 años, con cobertura privada en Argentina, desde la perspectiva del financiador, considerando 2 ciclos de screening. Se evaluaron solamente los costos directos del screening, diagnóstico y tratamiento en la población incluida. Los datos epidemiológicos se obtuvieron del Instituto Nacional del Cáncer y del Instituto Catalán de Oncología. Los costos se calcularon a partir del Nomenclador del Hospital Público de Gestión Descentralizada, así como de la base de costos de Universidad ISALUD.  Results: La población cribada ascendió a 1.412.611 mujeres. El costo anual por paciente tamizado con cobas® HPV resultó 40% menor que utilizando Citología con tinción Papanicolaou, aunque el costo total en 2 ciclos de screening resultó mayor con la estrategia de HPV con genotipificación (10 vs 2 años). La estrategia con cobas® HPV evidenció mejores resultados clínicos, con mayor porcentaje de detección de CCU, CIN-3 y CIN-2 (83,3%, 84,0% y 79,6% vs 57,7%, 57,7% y 53,2%, respectivamente), así como menor incidencia y mortalidad anual que al utilizar Citología con tinción Papanicolaou como método de screening primario.  Conclusions: El costo anual por paciente tamizado con test de HPV con genotipificación para el sector privado en Argentina es 40% menor que el que genera realizarlo mediante Citología con tinción Papanicolaou. PMD10 Sensor Augmented Pum vs Multiple Daily Injections in Very Uncontrolled Diabetes Patients: Cost Model for Hypoglycemic Events, Imss Perspective Cerezo O1, Gasca R1, Valencia J2 1Medtronic, MX, Mexico, 2Medtronic, Miami, FL, USA

Objectives: Estimate through mathematical projections the budget impact between multiple daily injections vs Sensor-Augmented Pump on DT1 patients, considering the frequency of severe hypoglycemic events for both alternatives from the IMSS perspective. Nowadays the Mexican Institute of Social Security covers almost half

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of the Mexican population, that is the reason why the institution must consider alternatives that bring not only effectiveness, instead “value for money” due to cost cuttings and containment issues experienced during the last years.  Methods: The cost model considered population covered by the Mexican Institute of Social Security (IMSS), in this sense the target population (base case scenario) was chosen based on those patients with DT1 diagnosed and treated, in order to model the budget impact with and without the intervention. We conducted a pragmatic literature review and treatment comparison to find out hypoglycemic events frequency (event rate and event/patient/year). The time horizon was 12 months and the model only considered the medical direct costs.  Results: After split the population (based on coverage pop at IMSS, very uncontrolled patients, diagnosed and treated), the cost model considered 40,439 DT1 patients. Without intervention, it was modelled 15,468 hypoglycemic events ($6.9 million dollars. Every treatment scenario was weighted according to literature review inputs). With intervention on base case scenario and best case (77.81% and 90.24% reduction on severe events) the frequency of severe events were 3,432 and 1,509, respectively (which it means a total costs that oscillate between $1.5 million and $675k dollars)  Conclusions: The savings due to intervention (SAP) were described between $5.4 to 6.2 million of dollars. The analysis just account for those avoided acute events, we did not simulate those mid-term or long-term complications avoided neither indirect costs, items that could increase the effect size and costs savings due to SAP therapy on very uncontrolled DT1 patients. PMD11 Great Saphenous Vein Radiofrequency Ablation Versus Standard Stripping in The Management of Primary Varicose Veins: Economic Evaluation Into the Mexican Context Cerezo O1, Valls M2, Gonzalez Godinez I2, Valencia J3, Gay Molina JG2 D.F., Mexico, 3Medtronic, Miami, FL, USA

1Medtronic, MX, Mexico, 2T.I. Salud, Mexico

Objectives: Assess varicose great saphenous vein treatment alternatives comparing SoC vs radiofrequency ablation, through health economic evaluation into the healthcare public institutions at Mexico  Methods: Health economic evaluation was designed under cost-minimization analysis to compare Stripping vs Radiofrequency Ablation-RFA (Closure Fast ®) considering total cost per patient. Previously a systematic review and its meta-analysis were executed to demonstrate similar efficacy (assessed through neovascularization, recurrence, technical failure and recanalization). We took into the account the mean cost per patient (medical direct costs associated with each alternative). The healthcare resource pattern was collected using DRG (released by the own healthcare public sector at Mexico). The base case analysis considered for RFA costs: catheter, generator and stiletto. The generator has been offered under lending contracts. The results were estimated on US dollars (exchange rate, 2017: 1dlls – 19.08 MXN pesos): total cost per patient for each alternative.  Results: Derived from systematic review and its meta-analysis, we did not find statistical difference between alternatives. The cost per patient under SoC was $1,213.00 dlls and considering RFA under lending contract the cost per patient was $ 986 dlls (without inpatient day, where the vast majority of the patients fall) and $1,632 dlls (considering an inpatient hospitalization day, which is not the rule for patients under RFA treatment) . We executed sensitivity analysis (uni, multivariate and probabilistic), and the results were consistent with the base case scenario. Finally the budget impact analysis considered a hypothetical incremental market share vs SoC (stripping) into the healthcare public institutions (50, 75 and 100%). So, the budget impact oscillates between 0.002% and 0.27% depending on the scenario and healthcare institution.  Conclusions: Choose RFA (Closure Fast ®) bring to the patients not only clinical outcomes, besides better QoL and aesthetics results, achieving lesser post-surgical pain and offer “value for money” into the Mexican context. PMD13 Economic Assessment of NT-PROBNP Test for Acute Heart Failure at Brazilian Private Payer Perspective Carvalho JP, D’Innocenzo M, Figueira SF Roche Diagnostics Brazil, São Paulo, Brazil

Objectives: This study purpose to evaluate the economic impact NT-proBNP test to support the Heart Failure diagnosis and management of patients presenting dyspnea in the Emergency Department at Brazilian private payer perspective.  Methods: An economic tool was developed based on peer-reviewed published data to compare the standard clinical assessment versus the clinical assessment guided by NT-proBNP test, the time horizon considered was 60 days. The direct medical costs were based on the CBHPM 2016 list (Classificação Brasileira Hierarquizada de Procedimentos Médicos). The one-way sensitivity analysis was performed with a variation of 20%, in which the best case scenario was developed with a reduction of 20% in all parameters and the worst case scenario with 20% increase on them.  Results: The economic model suggests that the inclusion of NT-proBNP test at Emergency Department in base case scenario could save 1,301.06 BRL per patient, attributable to the reduction in the amount of echocardiography tests performed and in the average hospitalization length. Additionally, the economic model suggests a saving of 832.68 BRL and 1,873.53 BRL at the best and the worst case scenario, respectively. Also the one-way sensitivity analysis demonstrated that the results achieved are robust.  Conclusions: The current analysis indicates that the use of NT-proBNP test could improve the management of patients with acute Heart Failure at the Emergency Department which may result in improved therapeutic decisions and savings for Brazilian private healthcare system. PMD14 Comparison of Catheter Ablation Versus Medical Treatment for Paroxysmal Atrial Fibrillation: Healthcare Utilization and Costs Analysis (Preliminary Results) Oliveira D1, Oliveira FM1, Luque A2, Junqueira Junior SM1 1Johnson & Johnson Medical Brazil, São Paulo, Brazil, 2Johnson&Johnson Medical Brazil, Sao Paulo, Brazil

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Objectives: The authors performed a healthcare utilization and cost comparison of RF ablation versus medical treatment among AF patients in the Brazilian private healthcare system.  Methods: Data were analyzed from the Orizon database. The study population consisted of 165 consecutive patients who underwent RF ablation procedures for AF. Healthcare utilization and costs were measured from 2 years before to 2 years after the procedure. That is the preliminary results from the 50 first patients analyzed.  Results: Considering a total of AF patients who underwent catheter ablation, 45 had at least 3 months follow-up prior the ablation and 45 had at least 3 months follow-up post ablation. There was no difference in the 2-years estimated number of outpatient visits prior and after ablation (4.8 visits (± 4.3) vs. 3.9 visits (± 4.4), p= 0.29), but the outpatient’s costs (including appointments and exams) were lower after ablation procedure (R$ 2,732.17 (± 3,299) vs. R$ 1,642.05 (± 1,326), p= 0.02). The 2-years estimated emergency care visits and costs were lower after ablation procedure (2.02 visits (± 2.23) vs. 0.96 visits (± 1.98), p= 0.006) and (R$ 3,781.03 (± 5,784) vs. R$ 499.90 (± 1,489), p= 0.0003), respectively. Patients before ablation had a higher risk of overall complications and arrhythmia in the ER visits (OR 4.5 – CI 95% 1.8 to 11 – p= 0.0009) and (OR 17.2 – CI 95% 3.7 to 79.8 – p= 0.0001), respectively. There was no difference regarding stroke and angina pectoris in the ER visits (p= 0,49 and p= 0,71), respectively.  Conclusions: Catheter ablation in AF patients reduces outpatients costs, emergency room utilization and costs and the risk of overall complications and arrhythmia ER related visits, but doesn’t reduce the risk of stroke and angina pectoris ER related visits. PMD15 Estimations of Resource use, Costs, Clinical and Epidemiological Outcomes of Continuous and Intermittent Renal Replacement Therapies Garay OU1, Palacios A1, Tapia-Lopez E1, Hernández-Vásquez A1, Garcia Marti S1, Pichon-Riviere A1, Augustovski F2, Bardach A3 1Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina, 2Institute for Clinical Effectiveness and Health Policy (IECS), CABA, Argentina, 3National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina

Objectives: To estimate resource use, costs, clinical and epidemiological outcomes associated to the treatment of Acute Kidney Injury (AKI) at Intensive Care Unit (ICU) with Continue or Intermittent Renal Replacement Therapies (CRRT or IRRT) in Argentina to feed a Cost-Effectiveness (CE) model that compares long-term economic and health outcomes.  Methods: After validation of model and assumptions with local experts, a list of parameters where defined. The perspective was stated as of the insurance for the elderly (PAMI). Costs of daily CRRT, IRRT, Dialysis Dependence (DD) and Independence (DI) were estimated using a macro-costing approach, in ARS 2017. Clinical and epidemiological parameters were obtained from a review of studies indexed in PubMed, Cochrane Library, EMBASE, LILACS and relevant grey literature. Epidemiological parameters were survival rates at days 0, 60 and 180 and for DD at 90 and 1,095 from hospital discharge. Quality-of-life weights included were AKI patients at UTI, with DD and DI; Length of Stay (LoS) in ICU; therapy duration and percentage of patients switching from CRRT to IRRT.  Results: Costs of daily CRRT, IRRT, DD and DI were $7,066.8, $1,963.0, $766.3 and $3.4 respectively. Survival at days 0, 60 and 180 were 0.655, 0.46 and 0.37 respectively for both therapies. DD at 90 and 1,095 days were 0.164 and 0.217 for CRRT and 0.208 and 0.266 for IRRT. LoS in ICU and therapy duration were 12.0 and 7.0 for both therapies and the switch of therapies 33.8%.  Conclusions: No local-relevant literature was found. Evidence suggests no difference in survival rates, nevertheless the DD appears to be lower in CRRT than in IRRT. Daily costs of CRRT resulted higher than IRRT. This results will be used in the next phase, after a validation with a local expert panel, to derive CE results in Argentina, and can be extended to other countries in the region. PMD16 Cost Associated with Ballon-Expandable Valve vs Self-Expandable Valves in Patients Undergoing Transcatheter Aortic Valve Replacement Ferreira CN1, PaloniEd 2, Rodrigues SR3, Brunet VA2 Lifesciences Latam, São Paulo, Brazil, 2Orizon, Barueri, Brazil, 3Universidade de São Paulo, São Paulo, Brazil 1Edwards

Objectives: Transcatheter aortic valve implantion (TAVI) is an effective alternative to surgical valve replacement for inoperable patiens with aortic stenosis (AS). This analysis assemed the cost per lenght of stay wheter the ballon-expandable (BE) valve and self-expandable (SE) valve.  Methods: An administrative claims database containing over 18 million lives (ORIZON, Brazilian Private Health Care, Fee-for-service) was assessed (from jan/2015 until dec/2016), of patients who underwent a BE valve replacement (n= 30) and SE valve replacement (n= 54). After group identification, the average length of stay (LOS), cost and median differences between groups were assessed thru Kruskal-Wallis method. A significance level of 5% was adopted.  Results: The average cost per lenght of stay the day was BRL 7,553 and BRL 10,906 for BE and SE (p