Boulanger, L.

Chen, S.Y

Jen, M.H.

Li, C.Y.

Liang, F.W.

Lu, T.H.

Tsai, C.F.

Wasiak, R.

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PCN70 Chemotherapy Treatment Patterns, Health Care Costs, and Mortality of Lung Cancer Patients in Taiwan – A Longitudinal Study Between 2000 and 2008 

A404  VA L U E  I N  H E A LT H  1 6  ( 2 0 1 3 )  A 3 2 3 – A 6 3 6  
platinum-based agents 20.3%, UFUR 8.3%, taxanes 7.7%, etoposide 7.5%). Close to 
three quarters (74.8%) of treated patients received combination therapy with plat-
inum-based agents. Of 1,221 patients treated with platinum-based combination 
therapy, the therapy most commonly used includes gemcitabine (37.5%), taxanes 
(21.5%), and vinorelbine (18.2%), while 21.4% of patients received two or more other 
agents. We observed longer median survival in patients with a higher number of 
chemotherapy agents received. ConClusions: Lung cancer patients in Taiwan 
incurred considerable health care costs after diagnosis. More than half of patients 
were treated with chemotherapy, in particular with multiple chemotherapy agents. 
Future research comparing cost-effectiveness among different treatment options 
is warranted.
PCN71
AustrAliAN stANdArd Costs ANd CoNsequeNCes of four 
ChemotherAPy Adverse eveNts
Pearce A.M., Haas M., Viney R.
University of Technology, Sydney, Ultimo, Australia
objeCtives: This work aimed to develop rigorous models of the Australian costs of 
four common chemotherapy adverse event (diarrhoea, vomiting, anaemia and neu-
tropenia), which provide standard cost estimates and can be used in future models 
of chemotherapy cost effectiveness. Methods: Decision analytic modelling was 
used to identify the costs and consequences of AEs. These are not only stand alone 
models, but also form decision tree sections to be incorporated into larger models 
of chemotherapy cost effectiveness. Model structures are based on best-practice 
clinical pathways, and incorporate efficacy of side effect treatment, quality of life 
and chemotherapy dose. Literature reviews identified clinical inputs. Costs of treat-
ment were obtained from standard Australian sources such as the Pharmaceutical 
Benefits Schedule. The perspective was the Australian health care system. One-way 
sensitivity analyses explored uncertainty in the models. Results: The base case 
average cost per patient of diarrhoea ranged from $19 (mild AE) to $4,821 (severe AE); 
those for anaemia ranged from $51 (mild AE) to $17,100 (moderate AE) depending on 
the type of chemotherapy and anaemia treatment. Vomiting prevention base case 
costs ranged from $0.84 (low risk chemotherapy) to $157.55 (high risk chemotherapy 
requiring breakthrough and refractory management). Neutropenia base case costs 
ranged from $2,235 (outpatient management) to $12,054 (intensive care required). 
Where possible, the impact on quality of life and chemotherapy total dose was also 
modelled. Estimates of AE costs vary widely in the literature, however our estimates 
appear consistent with studies of similar methodology. ConClusions: The four 
models presented represent best-practice modelling techniques for chemotherapy 
AEs. Each has been designed to enable either the results or the model structure to 
be incorporated into larger models of chemotherapy cost effectiveness. This allows 
model builders to incorporate rigorous, Australian-specific estimates of the costs and 
consequences of chemotherapy AEs into models of chemotherapy cost effectiveness.
PCN72
hormoNAl reCePtor Positive, her2 NegAtive metAstAtiC BreAst 
CANCer (mBC hr+her2-): Pre ANd Post-ProgressioN Costs uNder the 
PuBliC heAlth CAre system (sus) ANd soCietAl PersPeCtives iN BrAzil
Haas L.C.1, Fernandes R.A.1, Bines J.2, Caldas A.3, Valentim J.3
1ANOVA, Rio de Janeiro, Brazil, 2Clementino Fraga Filho Hospital, Federal University of Rio de 
Janeiro, Rio de Janeiro, Brazil, 3Novartis Biociências SA, São Paulo, Brazil
objeCtives: To estimate direct medical costs and productivity costs of hormonal 
receptor positive, HER2 negative metastatic breast cancer (MBC HR+ HER2-) under 
the public health care system (SUS) and societal perspectives in Brazil, being MBC 
cost data very scarce in Brazil so far. Methods: A systematic literature review was 
performed in the following databases: Cochrane, MEDLINE via Pubmed, LILACS, 
EMBASE and CRD until FEB 2013. Gray literature was also included. National guide-
lines search and expert validation was carried out specifically for the direct medical 
cost estimations. Direct medical costs were stratified as pre and post-progression 
costs and terminal costs. Pre and post-progression costs considered outpatient, 
inpatient and monitoring costs. For post-progression, metastasis treatment costs 
were also estimated, including bone, lung, liver and brain metastasis. For the pro-
ductivity costs, the Human Capital method was chosen. Days of absenteeism were 
obtained from the literature and a Markov model was used to estimate the loss of 
productivity in 1 year (as the mean age of MBC in Brazil is 59 and official retirement 
at 60 years of age). Unit costs were obtained from Brazilian official lists and IBGE 
(income). All costs are expressed in 2012 Brazilian Real (BRL). Results: Pre, post-
progression and terminal costs of MBC HR+HER2-were estimated in BRL308, BRL731 
and BRL4.164 respectively, under SUS perspective. Post-progression metastasis treat-
ment costs presented an average of BRL12.047 under SUS perspective. The productiv-
ity costs were estimated in BRL26.056 under the societal perspective considering 
the available treatments at SUS for MBC HR+HER2- patients. ConClusions: MBC 
HR+HER2- post-progression costs impose a significant economic burden under SUS 
perspective as well as productivity losses to the society. Novel therapies that post-
pone progression in those patients may reduce costs associated.
PCN73
estimAtiNg the Cost of hPv-relAted diseAses iN turkey: A delPhi 
APProACh
Bakir M.1, Ayhan A.2, Arvas M.3, Kose M.F.4, Gungor M.5, Ortac F.6, Ozgul N.7, Yuce K.7, Ergun T.1, 
Gungor E.5, Altundag O.2, Saka G.8
1Marmara University School of Medicine, Istanbul, Turkey, 2Baskent University School of Medicine, 
Ankara, Turkey, 3Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey, 4Bahcesehir 
University School of Medicine, Istanbul, Turkey, 5Acibadem University School of Medicine, Istanbul, 
Turkey, 6Ankara University School of Medicine, Ankara, Turkey, 7Hacettepe University School of 
Medicine, Ankara, Turkey, 8Merck Sharp Dohme, Istanbul, Turkey
objeCtives: Very limited data is available on the cost and burden of HPV-related 
diseases in Turkey. The aim of our analysis is to evaluate the corresponding cost 
through understanding the current clinical practices, use of resources and treat-
in the USA in 2002. Inpatient care costs accounted for more than 60% of total 
cost. ConClusions: Although the economic impact of the VTE in cancer patients 
as well as the impact of VTE on patients’ quality of life is not well studied, the 
present review demonstrate that there is a substantial humanistic and economic 
burden associated with VTE in cancer patients.
PCN68
A miCro-CostiNg of the iNPAtieNt mANAgemeNt of feBrile 
NeutroPeNiA iN the irish heAlth CAre settiNg
McCullagh L.1, O’Brien C.2, Fogarty E.1, Walsh C.3, Dempsey O.3, Barry M.1, Kennedy M.J.2
1National Centre for Pharmacoeconomics, Dublin, Ireland, 2St James’s Hospital, Dublin, Ireland, 
3Trinity College Dublin, Dublin, Ireland
objeCtives: Febrile neutropenia (FN) is a potentially life-threatening complica-
tion of chemotherapy which generally prompts immediate hospitalisation. The 
study objective was to evaluate the resource use and cost of hospitalisation for 
FN within the Irish Health care setting. Micro-costing techniques were used. The 
health payer perspective was adopted. Methods: This was a single centre study. 
Adult cancer patients undergoing chemotherapy, who were subsequently admit-
ted for FN, were identified prospectively. Patient medical records were reviewed 
retrospectively. Results: Patient demographics and resource utilisation data (per-
taining to the management of FN) were obtained from a cohort of 32 patients (69% 
female, mean age = 58.8 years). Twenty-five percent of patients had more than one 
FN episode. In total, 42 FN episodes were captured; 60% of episodes had occurred 
within the first two cycles of chemotherapy. The bootstrap estimation was used to 
determine mean hospital length of stay (LOS) with standard deviation (± SD) and 
mean costs (± SD). The mean LOS was 7.3 (± 0.5) days. The mean cost per FN episode 
was € 8,915 (± 718). The major cost driver was hospital bed-stay (mean cost of € 6,851 
(± 549)). Other cost drivers included antibacterial treatment at € 760 (± 156), labora-
tory investigations at € 538 (± 47) and the requirement for blood bank products at 
€ 525 (± 189). ConClusions: To our knowledge, this is the first investigation of the 
cost of chemotherapy induced FN within the context of the Irish Health care setting. 
Our results will be used in cost-effectiveness analyses of novel chemotherapeutic 
agents and interventions which prevent or treat FN.
PCN69
the Cost of NsClC iN frANCe
Martin M.1, Mcguire A.2, Marty R.3, Lenz C.4
1OptumInsight, Uxbridge, Middlesex, UK, 2London School of Economics, London, UK, 3HEVA HEOR, 
Lyon, France, 4Pfizer, Berlin, Germany
Though lung cancer, and the most common subtype, non-small cell lung cancer 
(NSCLC), occur frequently, there are limited data quantifying the economic burden 
of these cancers in Europe.objeCtives: To describe the burden of NSCLC in three 
European countries using patient-level data from commercially available health 
care data. Methods: Patient-level data were obtained for France from the PMSI 
(French National discharge database; containing data from publicly-funded hos-
pitals) from 2008 to 2011 while excluding patients with a prior-hospitalization for 
lung cancer in the preceding 24-month period (2006-2007). As NSCLC does not have 
a separate ICD-10 code, expert opinion was used to eliminate patients diagnosed 
with non-NSCLC, based on particular procedures and tests. Hospital resource 
use was valued using French DRG tariffs. Chemotherapy regimens were valued 
using official rates. Results: A total of 61,144 patients were identified with lung 
cancer in 2008. 19,099 were excluded because of prior lung cancer diagnoses. Of 
this cohort of 42,043 patients, 25,054 were exclusively treated in the public setting; 
15,061 were identified as NSCLC and were considered in this analysis. Hospital-
related costs cumulated over the follow-up period were estimated at € 337,382m, 
with chemotherapy costs representing 9%. Mean cumulated hospital-related 
cost per-patient were estimated at € 22,401 over the follow-up period. Terminal 
care represented a mean per-patient cost of € 10,440. Adverse events triggering 
hospital-expenses represented a mean per-patient cost of € 5,694. Patients ≤ 55 
years incurred higher costs per-person over the follow-up period than patients > 55 
years; € 25,386 vs. € 21,368. These extra costs were mostly driven by chemotherapy 
costs(€ 13,287 vs. € 10,561). Patient with metastases incurred higher costs over the 
follow-up period than patients without these, € 23,118 vs. € 21,934. ConClusions: 
This is one of the first analyses quantifying the economic burden of NSCLC. The 
burden for France is substantial. Subsequent analyses will allow for comparisons 
of this burden across other countries.
PCN70
ChemotherAPy treAtmeNt PAtterNs, heAlth CAre Costs, ANd 
mortAlity of luNg CANCer PAtieNts iN tAiwAN – A loNgitudiNAl 
study BetweeN 2000 ANd 2008
Liang F.W.1, Chen S.Y2, Tsai C.F.1, Jen M.H.3, Li C.Y.1, Wasiak R.3, Boulanger L.2, Lu T.H.1
1National Cheng Kung University, Tainan City, Taiwan, 2Evidera, Lexington, MA, USA, 3Evidera, 
London, UK
objeCtives: To examine chemotherapy treatment patterns, health care costs, 
and mortality of lung cancer patients in Taiwan. Methods: This study analyzed 
medical and pharmacy claims from a random sample of one million taken from 
all beneficiaries covered under Taiwan’s national health insurance in 2000. Newly 
diagnosed lung cancer patients between 2000 and 2008 (first observed diagnosis as 
the index date) were identified based on medical claims with associated diagnoses. 
Patients were followed until death or the end of 2008. Per patient per month [PPPM] 
total health care costs (in USD) and median survival were reported. Chemotherapy 
treatment patterns during the follow-up were examined. Results: This study 
included 3,343 lung cancer patients (mean age: 67.1 years; 34.5% female; 35.4% 
secondary lung cancer). Median survival was 8.1 months. PPPM costs were $2,322 
USD (interquartile range $450-$2,902). Lifetime costs from diagnosis among those 
who died during the study period were $12,788 USD (interquartile range $2,674-
$17,546). Of the 1,633 patients who received chemotherapy during the follow-up, 
375 received only one chemotherapy agent (gemcitabine 35.7%, vinorelbine 20.5%, 


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PCN70 Chemotherapy Treatment Patterns, Health Care Costs, and Mortality of Lung Cancer Patients in Taiwan – A Longitudinal Study Between 2000 and 2008

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