Bos, JM

Jager, JC

Postma, MJ

Rlimke, HC

Welte, R

Elsevier - Publisher Connector 

 296
 
Abstracts
 
CV3
 
IMPACT OF CARVEDILOL ON INPATIENT 
RESOURCE USE AND COSTS IN HEART FAILURE
Vera-Llonch M
 
1
 
, Oster G
 
1
 
, Lukas M
 
2
 
, Fowler M
 
3
 
, for the U.S. 
Carvedilol Heart Failure Study Group
 
1
 
Policy Analysis Inc., Brookline, MA, USA; 
 
2
 
SmithKline Beecham 
Pharmaceuticals, Philadelphia, PA, USA; 
 
3
 
Stanford University 
School of Medicine, Stanford, CA, USA
 
OBJECTIVE:
 
 To examine the impact of carvedilol on the
utilization and cost of inpatient care in patients with
chronic heart failure. METHODS: A health-economic
evaluation of carvedilol was undertaken in conjunction
with the US Carvedilol Heart Failure Trials Program, in
which 1094 patients with NYHA Class II–IV heart fail-
ure were randomized to treatment with carvedilol or pla-
cebo (696 and 398 respectively) as an adjunct to conven-
tional therapy (digitalis, diuretics, ACE inhibitors). Patients
were treated for up to 15 months (mean  6.5 months).
Measures of interest included the numbers of hospitaliza-
tions, days spent in special-care units and in hospital
overall, the utilization of selected cardiovascular proce-
dures, and the cost of cardiovascular-related inpatient
care. Resource utilization data were collected for all hos-
pitalizations occurring between randomization and the
end of follow-up. Costs were estimated based on ob-
served levels of resource use and secondary data sources.
RESULTS: The mean number of heart failure admissions
was 53% lower among patients randomized to carvedilol
(0.07 vs 0.15 for placebo [P  0.03]); comparable reduc-
tions for cardiovascular and all-cause admissions were
30% (0.21 vs 0.30 [P  0.02]) and 25% (0.30 vs 0.40
[P  0.003]) respectively. For heart failure admissions,
mean length of stay and the mean number of ICU/CCU
days were reduced by 37% (6.8 vs 10.8 days [P  0.03])
and 83% (0.7 vs 4.3 [P  0.001]) respectively; for car-
diovascular admissions, comparable reductions were 32%
(7.4 vs 10.8 days [P  0.30]) and 73% (1.5 vs 5.6 [P 
0.05]) respectively. Utilization of selected cardiovascular
procedures was also nominally lower among patients re-
ceiving carvedilol. Estimated costs of inpatient care for
heart failure and cardiovascular admissions were 81% (P 
0.02) and 57% (P  0.02) lower respectively among
carvedilol patients. CONCLUSION: In chronic heart
failure patients receiving conventional therapy, addition
of carvedilol reduced inpatient resource utilization and
costs over the period of study.
INFECTIOUS DISEASE
 
ID1
 
MODELLING THE COSTS AND EFFECTS OF CMV 
MANAGEMENT STRATEGIES IN TRANSPLANT 
RECIPIENTS AS A SUPPORT FOR CURRENT AND 
FUTURE DECISION-MAKING
 
Annemans L
 
1,2
 
, Moeremans K
 
1
 
, Kubin M
 
3
 
1
 
HEDM, Meise, Belgium; 
 
2
 
Brussels Free University, Brussels, 
Belgium; 
 
3
 
Bayer, Leverkusen, Germany
 
OBJECTIVES:
 
 We developed a generic decision analyti-
cal model to predict health and economic outcomes of
different management options for cytomegalovirus (CMV)
infection and disease in bone marrow and solid organ
transplant patients. METHODS: The model considers
the most prevalent management strategies, thereby em-
phasizing the important difference between “infection”
and “disease”: 1. prophylaxis and testing for infection,
followed by pre-emption in case of infection; 2. only
testing for infection followed by pre-emption in case of
infection; and 3. wait, and treat once disease occurs.
Clinical data was obtained from randomised controlled
studies. A Bayesian analysis was applied to distinguish ef-
fectiveness of current management options for CMV in-
fection versus CMV disease, an aspect that is currently
underreported in literature. For each of the three strate-
gies and in each transplant type, different management
options and resource use data was obtained from key ex-
perts in large transplant centres in France, Germany, and
the UK. Unit cost data was obtained from official sources
from the health care payer’s perspective. Time horizon
was one year. RESULTS: The model produces results for
a variety of scenarios and management options. In gen-
eral, prophylaxis is cost-effective in BMT (16,000 Euro/
LYG; SE  6,900) and dominant in liver transplants
compared to alternative strategies, while in renal trans-
plants, test and pre-empt is more preferable. Some partic-
ular current strategies such as acyclovir IV prophylaxis in
bone marrow and IV immune globulin prophylaxis in re-
nal transplants are not supported by the results. Sensitiv-
ity analyses show at the same time the robustness of cur-
rent conclusions and the potential options for disease
management. CONCLUSIONS: This model provides an
exhaustive description of management options for CMV
in transplant patients, and is useful both in current deci-
sion-making for optimal disease management, as well as
in the assessment of future targets for research.
 
ID2
 
COST-EFFECTIVENESS ANALYSIS OF 
HEXAVALENT MENINGOCOCCAL B
OUTER-MEMBRANE-VESICLE VACCINE
 
Bos JM
 
1
 
, Rümke HC
 
2
 
, Welte R
 
3
 
, Postma MJ
 
1
 
, Jager JC
 
3
 
1
 
Groningen University Institute for Drug Exploration/
Groningen Research Institute of Pharmacy (GUIDE/GRIP), 
Groningen, The Netherlands; 
 
2
 
Laboratory of Clinical Vaccine 
Research, National Institute of Public Health and the 
Environment, Bilthoven, The Netherlands; 
 
3
 
Department of 
Health Services Research, National Institute of Public Health 
and the Environment, Bilthoven, The Netherlands
OBJECTIVE: To estimate the cost-effectiveness and pro-
gram costs of vaccination with hexavalent meningococcal
B outer-membrane-vesicle (OMV) vaccine within the
framework of the Dutch vaccination program for new-
borns. METHODS: A pharmacoeconomic decision-anal-
ysis model was applied, linking epidemiological and eco-
nomic data. Epidemiological data were obtained from
 Abstracts
 
297
 
the Netherlands Reference Laboratory for Bacterial Men-
ingitis. Standard methods for cost-effectiveness analysis
were used. Analysis was done from a societal perspective,
including direct and indirect costs of productivity loss
(friction-costs method; price levels in 1998 €; discount
rate of 4%). Cost-effectiveness ratios were expressed in
net costs per quality adjusted life year (QALY) gained.
Sensitivity analysis was performed on several key param-
eters of the model. RESULTS: In the base-case, through
vaccination 480 QALYs are gained, while total net costs
of the program are €5,546,923. The cost-effectiveness ra-
tio is €11,600 per QALY gained. Sensitivity analysis indi-
cates a cost-effectiveness range of €5,841 to 30,543 per
QALY gained. CONCLUSIONS: Vaccination of all new-
borns with meningococcal OMV vaccine has an accept-
able cost-effectiveness ratio compared to other interven-
tions in the Netherlands.
 
ID3
 
PRELIMINARY EVALUATION OF THE CLINICAL 
AND ECONOMIC BENEFITS OF UNIVERSAL 
VARICELLA VACCINATION OF CHILDREN IN 
GERMANY
Banz K
 
1
 
, Staginnus U
 
2
 
, Wagenpfeil S
 
3
 
, Neiss A
 
3
 
, Goertz A
 
4
 
, 
Bisanz H
 
4
 
, Wutzler P
 
5
 
1
 
OUTCOMES International, Basle, Switzerland; 
 
2
 
SmithKline 
Beecham Biologicals, Rixensart, Belgium; 
 
3
 
Institute for Medical 
Statistics and Epidemiology, Technical University Munich, 
Munich, Germany; 
 
4
 
SmithKline Beecham Pharma, Munich, 
Germany; 
 
5
 
Institute for Antiviral Chemotherapy, Friederich-
Schiller University Jena, Erfurt, Germany
 
OBJECTIVE:
 
 To provide a preliminary assessment of the
economic value of vaccinating 1-year old children against
varicella in Germany. METHODS: We developed a deci-
sion-analytic model to compare the clinical and economic
outcomes of a universal varicella vaccination program
versus no vaccination in infants. The model predicts the
clinical effects, direct and indirect costs, and the cost-effec-
tiveness of mass vaccination. Model input data were
mainly derived from a large survey conducted across Ger-
many and were complemented by literature data and ex-
pert estimates. In the survey, pediatricians, GP’s and
internists provided information extracted from 1334 ran-
domly selected varicella patient records. Epidemiological
data but also medical resource utilization such as physi-
cian consultations, medication, and hospitalization due
to disease complications was captured. Additionally,
work loss of caregivers and infected employed individu-
als was retrieved from the records. Since the survey was
completed only very recently, the analysis of the model
input data is preliminary. Valuation of the resources used
was done by applying unit costs obtained from official
medical tariff lists, drug compendiums, and other statis-
tics. Vaccine efficacy was assumed to be between 90%
and 97%, and vaccination coverage between 50% and
80%. Future costs were discounted at 5%. The perspec-
tive taken is that of the society. RESULTS: The prelimi-
nary findings presented here apply to a timeframe of 30
years. Over that period, the model predicts that universal
children vaccination could prevent between 7.4 and 11.2
million varicella infections, and between 53,000 and
88,000 major complications depending on the assump-
tions taken. Universal vaccination also appears to be eco-
nomically worthwhile with a benefit-cost ratio of be-
tween 2.1 and 1.9. CONCLUSIONS: These preliminary
results suggests that universal varicella vaccination pro-
vide significant clinical and economic benefits to the Ger-
man society. A final analysis is in process, which will be
an important information source for healthcare decision-
makers.
MULTIPLE DISEASES
 
MD1
 
AVOIDABLE HOSPITALIZATION: TRENDS AND 
ETHNIC VARIATIONS IN SINGAPORE, 1991–1998
 
Ng TP, Niti MP
 
Department of Community, Occupational and Family 
Medicine, National University of Singapore, Singapore
 
OBJECTIVE
 
: To assess avoidable hospitalization as an
outcome indicator of access to and quality of primary
care by examining trends and gender and ethnic varia-
tions. METHOD: Aggregated nationwide data on annual
hospital discharges in Singapore from 1991 to 1998 were
collected from the Central Claims Processing System
(CCPS) database. They included total hospitalizations
(excluding maternity and psychiatric disorders) and hos-
pitalizations for chronic diseases, which are avoidable by
timely, appropriate and effective primary care (ambula-
tory care sensitive (ACS) conditions): asthma, congestive
heart failure, chronic obstructive pulmonary disease, dia-
betes mellitus and hypertension. Directly age-standard-
ized rates were adjusted for gender and ethnic differences
in total hospitalizations. RESULTS: From 1991 to 1998,
(total of 1,479,494 hospitalizations), 6.7% were for ACS
conditions. Overall, the annual rate of avoidable hospi-
talization was 29.4 per 10,000 population. Women had
lower rates of avoidable hospitalizations than males
(22.4 versus 29.5 per 10,000), as well as for total hospi-
talizations (496.2 versus 515.5 per 10,000). Adjusted for
total hospitalization, males were 1.3 times more likely
than females to be hospitalized for ACS conditions.
Compared to Chinese, Indian and Malays had higher
rates of avoidable hospitalizations (21.7, 65.5 and 56.1 per
10,000 respectively). Adjusting for their higher rates of
total hospitalization, they were 1.7 and 1.8 times respec-
tively more likely than Chinese to be admitted for ACS
conditions. Avoidable hospitalization decline (adjusted
for total hospitalization) was 9.1% overall; greater in
males (11.8%) than in females (5.3%); greater for
Chinese (15.8%), than Malays (1.1%) and Indians
(increase of 4.3%). Among Malays and Indians,
women showed marked increases of avoidable hospital-
izations, 10.8% and 8.1% respectively. CONCLU-


ID2: COST-EFFECTIVENESS ANALYSIS OF HEXAVALENT MENINGOCOCCAL B OUTER-MEMBRANE-VESICLE VACCINE 

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ID2: COST-EFFECTIVENESS ANALYSIS OF HEXAVALENT MENINGOCOCCAL B OUTER-MEMBRANE-VESICLE VACCINE

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