Hiroshima, C

Inoue, S

Yamabe, K

Elsevier - Publisher Connector 

PCN113 Epidemiology and Burden of Multiple Myeloma in Japan: a Systematic Review 

 VA L U E  I N  H E A LT H  1 8  ( 2 0 1 5 )  A 3 3 5 – A 7 6 6  A449
Age-standardized incidence rates for PC ranged from 4.5 to 170.2 cases per 100,000 
males per year, and was 110.8 per 100,000 males per year in the EU. The annual per-
centage increase in PC ranged from 2.8% in Australia to 8.6% in China. The cost of 
PC management in Europe was highest in France (EUR 722 million). Key cost drivers 
were identified as the initial year of care, radical prostatectomy, and terminal care. 
Compared with other EU countries, higher use of radical prostatectomy and lower use 
of active surveillance in France result in a higher cost burden. ConClusions: The 
incidence of PC is increasing in the majority of countries with data available. The cost 
of illness is rising accordingly, and the cost differential between active surveillance 
and intervention is substantial. Selecting the optimal treatment per patient is likely 
to be an important aspect in limiting the increase in the PC burden.
PCN113
EPidEmiology aNd BurdEN of multiPlE myEloma iN JaPaN: a 
SyStEmatiC rEviEw
Yamabe K1, Inoue S2, Hiroshima C2
1Takeda Pharmaceutical Company Ltd., Tokyo, Japan, 2CRECON Medical Assessment Inc., Tokyo, 
Japan
objeCtives: Bortezomib (BOR), lenalidomide (LEN), thalidomide (THAL) are avail-
able to patients with multiple myeloma (MM) in Japan, and new drugs are also to 
be launched. Introduction of Health Technology Assessment in FY2016 is aimed in 
Japan. The severity and its expensive treatment cost of MM disease may become 
important subjects to be discussed although a lack of resources for assessing cost-
effectiveness of treatment has been pointed out in Japan. The objective of this study 
was to sort epidemiological data and information on currently available treatments 
for MM through a systematic review and to estimate an expected total medical cost 
for relapsed/refractory MM (RRMM) patients. Methods: The literature search was 
conducted in MEDLINE and Ichushi-Web. Eligible studies were those of Japanese 
patients and published in the past 10 years. Studies were assessed for the followings: 
incidence and prevalence rate, number of patients, mortality rate, development rate 
of acute myelogenous leukemia (AML), and clinical effectiveness of current therapies. 
Expected total medical cost per RRMM patient was calculated from a model with 
overall survival and progression-free survival of RRMM patients based on literature 
review, assuming salvage therapies were comprised of BOR, LEN, and THAL. Results: 
Annual incidence and 5-year prevalence rates of MM were reported as 1.3 to 5.4 and 
9.7 per 100,000 persons, respectively. Although mortality rates were reported, data 
on AML development of MM patients tended to lack. Clinical trials of BOR and THAL-
based treatments were found, while there was only one for LEN-based treatment. 
An expected total medical cost for RRMM patient was estimated to be over € 100,000 
(1,383,000 yen). ConClusions: While the study indicated large medical resources 
usage of MM and the necessity of cost-effective evaluation for MM treatments, few 
studies have revealed its burden. Further studies on current situation surrounding 
MM treatments are expected.
PCN114
thE CoSt-of-diSEaSE of mEtaStatiC/iNoPEraBlE gaStroiNtEStNal 
Stromal tumorS iN turkEy: aN ExPErt PaNEl aPProaCh for EStimatioN 
of CoStS
Deger C1, Telli F2, Gunaldi M3, Keskin S4, Saglam S5, Ozdemir O6, Sar C1, Parali E1, Erdal E1, 
Sumer F1, Ozel O1, Asan S1
1Bayer Turk Kimya San. Ltd. Sti., Istanbul, Turkey, 2Haydarpasa Numune Training and Research 
Hospital, Istanbul, Turkey, 3Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, 
Turkey, 4Memorial Sisli Hospital, Istanbul, Turkey, 5Istanbul Bilim University, Istanbul, Turkey, 
6Yorum Consulting Ltd., Istanbul, Turkey
objeCtives: Gastrointestinal stromal tumors (GIST) are rare but costly tumors 
with an estimated incidence of 1.5/100 000/year in Europe. Granting reimburse-
ment requires locally adapted cost effectiveness data in Turkey. This study was con-
ducted to estimate the costs-of disease and direct cost components of metastatic/
inoperable GISTs that did not respond to prior imatinib mesylate and sunitinib 
malate. Methods: Bayer Turkey Market Access team organized an “expert panel” 
composed of oncologists to discuss the local treatments, routine monitoring and 
adverse event management algorithms in metastatic/inoperable GIST patients. The 
panel reviewed the global and local literature and guidelines and also discussed 
the spectrum of frequently performed local clinical practices. All cost components, 
including medications, hospitalization, out-patient follow-up procedures and reha-
bilitation services were reviewed. End of 2014 local prices for medications and pro-
cedures were used as sources. Based on the answers of the physicians, the cost of 
healthcare resources regarding the conditions described were calculated from the 
perspective of the Turkish payer (SSI – Social Security Institution). Results: In met-
astatic/inoperable GIST patients, treatment should be continued indefinitely, since 
treatment interruption is generally followed by relatively rapid tumor progression 
in almost all cases, even when lesions have been previously surgically excised. The 
cost of routine monitoring in the follow-up of metastatic/inoperable GIST patients 
was estimated to be 62.40 TL/month during progression-free and post-progression 
periods, while it was 490.00 TL/month during the terminal phase. The greatest cost 
is estimated for hospitalization in the intensive care unit ranging from 200.00 to 
800.55 TL per incident. The most common adverse reactions were listed as hand and 
foot skin reaction (4%) and diarrhea (6.7%). ConClusions: The costs of the disease, 
which therefore are quite high, estimated here will provide the most reliable data 
reflecting current figures to Public Stakeholders. Despite these high expenditures, 
those treatments’ efficacy is not clinically proven.
PCN115
thE aNalySiS of iNPatiENtS CoSt of BrEaSt CaNCEr iN ChiNa, 2011
Song S, Wang Z, Zhang M
IMS consulting group, Shanghai, China
objeCtives: To analyze the inpatients direct medical costs and reimbursement 
rate of breast cancer based on national claimed database for urban employees and 
compare on the cost of different types of treatment. Methods: Mechanical sam-
costs from a hospital centered view and four studies included costs from a third 
party payer view. Overall, the mean total treatment cost of pancreatic cancer treat-
ment ranged from € 8,037 to € 38,232 per patient. The cost of resectable disease ranged 
from € 19,890 to € 120,071 per patient. The cost of unresectable disease ranged from 
€ 14,899 to € 58,208. The cost of metastatic disease ranged from € 13,873 to € 43,679. 
The cost of laparoscopic distal pancreatectomy ranged from € 9,603 per patient to 
€ 15,433 per patient. The cost of open distal pancreatectomy ranged from € 10,944 per 
patient to € 22,790 per patient. 15 studies reported cost-effectiveness data. The incre-
mental cost-effectiveness ratio (ICER) of folfirinox compared to gemcitabine ranged 
from € 48,637 per quality adjusted life years (QALY) to € 62,657 per QALY. The ICER of 
surgery followed by chemotherapy compared to surgery alone ranged from € 34,636/
QALY to € 81,971/QALY. ConClusions: Surgery is an important cost-driving factor in 
pancreatic cancer treatment. Wide variations in cost are reported, probably reflecting 
the variation in health care systems.
PCN110
thE iNCrEaSiNg CoSt BurdEN of oBESity rElatEd CaNCEr to NhS 
ENglaNd
Dasika G, Pennington B, Nielsen SK
BresMed, Panaji, India
objeCtives: A 2014 study by Bhaskaran et al. found that an increase in BMI was asso-
ciated with an increased risk of cancer in 10 sites. The National Health Service (NHS) 
England cancer related expenditure for the cancers in these 10 sites from Bhaskaran 
et al. accounted for £2.78 billion in 2012/13. This study estimated the increasing cost 
burden of these cancers to NHS England relative to increasing BMI. Methods: The 
analysis used the primary care trust (PCT) expenditure for the financial year 2012/13 
of NHS England. The 10 cancers found by Bhaskaran et al. whose incidences increase 
as BMI increases were linked to the ‘cancers and tumours’ category of the cancer 
expenditure. We calculated the cancer expenditure attributable to obesity for each of 
the 10 cancers using risks reported by Bhaskaran et al. Bhaskaran et al. also reported 
hazard ratios (HRs) for incidence of each cancer for a 5kg/m2 increase in BMI – we 
used these HRs to estimate the increased cost of each of the 10 cancers for increase 
in population BMI. Results: We calculated that the 2012/13 cost burden of the 10 
cancers attributable to obesity was £0.32 billion. If the mean population-wide BMI 
increased by 5 kg/m2 we estimated that the cost burden of 10 cancers attributable to 
obesity would have increased to £0.41 billion from £0.32 billion in 2012/13. The cost 
burden would increase most dramatically for uterus cancer, with a predicted increase 
of 62%. ConClusions: Cancers attributable to obesity have a high cost burden. A 
population-wide increase in BMI would result in higher incidence of 10 cancers. The 
cost to NHS England would increase dramatically, with the required budget increasing 
by more than 25% for an increase in BMI of 5kg/m2.
PCN111
mEdiCal CoSt aSSoCiatEd with trEatmENt aNd follow-uP of 
PaNtiENtS with hEad aNd NECk CaNCEr
De Paepe A1, Vandeneede N1, Strens D2, Specenier P3
1Antwerp University, Antwerp, Belgium, 2Realidad, Grimbergen, Belgium, 3Antwerp University 
Hospital, Edegem, Belgium
objeCtives: To summarize the existing literature regarding the medical cost associ-
ated with treatment and follow-up of head and neck cancer. Methods: PubMed 
was used as search engine to retrieve publications in Medline using the search term 
“(head and neck cancer) AND (cost)” with a publication date filter (from January 1st 
2000 up to September 1st 2014) and language filter (English). This search yielded 
2,635 publications of which 97 were relevant for this review. Cost were recalculated 
in Euros (€ ) using the June 5 2015 currency rate of $1 = € 0.8914. Results: In six stud-
ies total treatment cost from diagnosis to discharge ranged from € 15,214 per patient 
to € 21,665 per patient. In four studies total medical cost including treatment and 
follow-up ranged from € 29,434 per patient to € 76,277 per patient. The reconstruction 
cost ranged from € 8,797 per patient to € 48,115 per patient. In three studies the cost 
of surgery performed by a high-volume surgeon ranged from € 7,869 per patient to 
€ 24,233 per patient and by a low-volume surgeon ranged from € 9,146 per patient to 
€ 22,067 per patient. In two studies the median cost for stage I disease ranged from 
€ 3,264 per patient to € 11,205 per patient, for stage II disease ranged from € 5,230 per 
patient to € 20,473 per patient, for stage III disease ranged from € 9,196 per patient 
to € 28,429 per patient and for stage IV disease ranged from € 10,222 per patient to 
€ 45,373 per patient. In three studies the Incremental Cost effectiveness Ration (ICER) 
of cetuximab plus radiotherapy compared to radiotherapy alone ranged from € 7,530 
per QALY to € 14,624 per QALY. ConClusions: The literature on the costs associated 
with the treatment of head and neck cancer is extensive. Wide variations in cost are 
reported, probably reflecting the variation in health care systems.
PCN112
CliNiCal aNd ECoNomiC BurdEN of ProStatE CaNCEr
Saunders R1, Plun-Favreau J2, Takizawa C2, Valentine WJ3
1Ossian Health Economics and Communications GmbH, Basel, Switzerland, 2Genomic Health 
International, Geneva, Switzerland, 3Ossian Health Economics and Communications, Basel, 
Switzerland
objeCtives: Screening programs have resulted in prostate cancer (PC) diagnoses 
increasing and being made both earlier in the disease state and the patient’s life. 
Understanding the clinical and cost burden of PC and its associated treatment options 
is imperative for optimization of healthcare resources. Methods: A structured lit-
erature review of three publication databases (PubMed, EMBASE, and the Cochrane 
Library) was undertaken. Literature review was focused on publications with a major 
focus on “Prostatic Neoplasms” or containing the term “Prostate Cancer”. Secondary 
search criteria restricted results to contain information on epidemiology, cost of ill-
ness, adverse events, or treatment protocols. To ensure that recent estimates and 
practice guidelines were evaluated, literature was restricted to those published on 
or after January 1, 2009. Abstract screening selected publications reporting data from 
European countries and other nations with developed healthcare systems. Results: 


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PCN113 Epidemiology and Burden of Multiple Myeloma in Japan: a Systematic Review

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