services used per patient and related costs at two-year follow-up were examined ... Data were gathered with a standardised data extraction form by searching ...
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9th HTAi Annual Meeting
222. Service utilization, predictors and costs among high-risk patients with cardiovascular disease: using real world data from the Australian REACH registry Zanfina Ademia, Christopher Reidb, Deepak Bhattc, Philippe Gabriel Stegd and Danny Liewa University of Melbourne. Australia. bMonash University. Australia. Harvard University. USA. dHôpitaux Universitaires Paris Nord Val de Seine. France.
a c
Background: Cardiovascular disease remains one of the most common health problems in the world, both in terms of morbidity and mortality. Very few studies have reported follow-up data on costs and disease predictors. Objectives: This study aims to quantify the resource utilization predictors and cost of cardiovascular disease using the Australian Reduction of Atherothrombosis for Continued Health (REACH) registry. Methods: This study describes two-year cost data estimated using a bottom-up costing approach, and presents patterns of resource utilization based on types of vascular disease. The multivariate predictors of number of hospitalization, medication and other health services used per patient and related costs at two-year follow-up were examined using generalized linear models (GLM). Government reimbursement data from 2011 was used to calculate direct health care costs. Results: Overall 2873 of the total 68 236 patients in the REACH registry cohort were enrolled from Australia. The two-year follow-up data was available for 2856 (99.4%) patients with or at high risk of atherothrombosis. Overall, the mean (SD) direct expenditure over 24 months of follow-up per person was $7544 ($10 758). In the adjusted model, patients with CAD and PAD incurred +A$1255 (95% CI $199 to $2310) and +A$4942 (95% CI $3509 to $6375) more in mean total costs compared to CerVD patients respectively. A history of atrial fibrillation (AF), peripheral arterial disease (PAD) and diabetes was associated with higher resource utilization. Discussion: Our analysis has found that significant predictors of resource utilization and medical costs were PAD, AF, and diabetes. The results highlight the need for policies that target reducing the number of co-morbidities, which will decrease the incidence of PAD, AF and diabetes in population, given current and projected burden. This data provide the necessary framework for economic evaluations of health interventions.
424. Relative effectiveness of pharmaceuticals Sarah Kleijnen and Wim Goettsch College voor zorgverzekeringen. Netherlands. Introduction: Assessment of the effectiveness compared with alternative treatment(s) plays an important role in many jurisdictions in determining the reimbursement status of pharmaceuticals. This type of assessment is often referred to as a relative effectiveness assessment (REA) and is carried out by many jurisdictions at more or less the same time. Increased sharing of information across jurisdictions may save costs and reduce duplication. The objective of this study is to explore the main similarities and differences in the major methodological aspects of REA in multiple jurisdictions. Methods: Thirty-five jurisdictions were included in the analysis. Data were gathered with a standardised data extraction form by searching publicly available information and by eliciting information from representatives at relevant organisations. Results: Of the initially included 35 jurisdictions, data was gathered for 29 jurisdictions (26 European and three English speaking non-
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European jurisdictions). There seem to be substantial similarities on the choice of comparator, the role of indirect comparisons and preferred endpoints in REAs (except for the use of utility values). However, jurisdictions differ in whether effectiveness (usual circumstances of health care practice) is estimated in case no (comparative) effectiveness data are available and how this done. National methodological guidelines on REA vary across jurisdictions in the level of detail provided. Discussion: Some important methodological aspects for REA are approached in a similar way in many jurisdictions, indicating that collaboration on assessments may be feasible. Enhanced collaboration in the development of methods and best practices for REA between jurisdictions will be a necessary first step. Important topics for developing best practice are indirect comparisons and how to handle the gap between efficacy and effectiveness data in case good quality comparative effectiveness data is not yet available at the time of reimbursement decisions.
575. Horizon scanning for HTA methodological priorities: international co-operation needed Tarang Sharmaa, Sarah Garnera, Bhash Naidooa, Peter Littlejohnsb and Moni Choudhurya a National Institute for Health and Clinical Excellence (NICE). UK. bSchool of Medicine. Kings College London. UK.
Background: The methodology for HTA has evolved rapidly over the last decade. Whilst the basic methodology is well established, there is still controversy about ‘best practice’ and challenges frequently arise in the context of specific technologies. Inadequacies in the evidence base have required the exploration of new methods such as indirect comparisons/network meta-analysis. Priorities for Research: NICE, in collaboration with the UK’s Medical Research Council have developed a formal framework for prioritising methodological uncertainties on an annual basis. An internal methods advisory group with support from a network of external research experts identified 45 key methodological uncertainties. These were clarified and prioritised into themes that included modelling service delivery, using qualitative evidence to capture patients experience, extrapolating data for co-morbid and paediatric populations and using observational data from large datasets for decision-making. The prioritisation framework and the final list of research priorities will be presented for consideration and comment. Need for co-operation: It is becoming increasingly competitive to obtain research funding, particularly with the current economic climate. It is therefore essential that a formal process of prioritisation of methods research be established within organisations. Many HTA organisations do not have access to funding to enable in-house methodological development. International collaboration would help identify priorities and potential funding routes. There should be shared responsibility to ensure that key research is undertaken and co-operation to allow sharing of information to avoid duplication and improve efficiency.
692. Parametric Survival Analysis in Health Economics Patricia Klarmann Ziegelmanna and Leticia Herrmannb Federal University of Rio Grande do Sul and IATS. Brazil. bFederal University of Rio Grande do Sul. Brazil. a
Background: A large number of economic evaluations have life survival as a primary endpoint and clinical trials data are common used
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