Dalgali, Y.

Senturk, A.

Tatar, M.

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PMS44 Cost-Effectiveness of Use of Barricaid® In Lumbar Discectomy Surgery in Turkey 

A380  VA L U E  I N  H E A LT H  1 7  ( 2 0 1 4 )  A 3 2 3 – A 6 8 6  
(BMD) testing with dual energy x-ray absorptiometry (DXA) and received five years 
alendronate therapy if the percent young adult mean (%YAM) for BMD was less 
than 70%. Lifelong drug therapy for secondary fracture prevention was assumed 
for patients who had a osteoporotic fracture. For the base-case analysis, we ran 
the model with different age groups (65-69, 70-74, and 75-79 years). Results: 
In the women aged 65-69 years, screening strategy incurred an additional life-
time cost of $1,486 per person and conferred an additional 0.029 QALY, resulting 
in an incremental cost-effectiveness ratio of $51,195per QALY gained. For those 
aged 70-74 and 75-79 years, ICER was estimated to be $23,375 and $17,742per 
QALY, respectively. Probabilistic sensitivity analysis showed that in women aged 
65-69,70-74 and 75-79 years, screening strategy was cost-effective in 48.9%, 58.9%, 
and 59.7% of the simulations, respectively, if society is willing to pay $50,000 per 
QALY. ConClusions: Osteoporosis screening and treatment strategy would be 
cost-effective in the Japanese women aged ≥70 years.
PMS44
CoSt-EffECtivEnESS of USE of BarriCaid® in LUMBar diSCECtoMy 
SUrgEry in tUrkEy
Tatar M.1, Senturk A.2, Dalgali Y.3
1Hacettepe University, Ankara, Turkey, 2Polar Polar Health Economics & Policy, Ankara, Turkey, 
3Intrinsic Therapeutics, Inc., Wouburn, MA, USA
objeCtives: While widely perceived as a successful procedure, discectomy surgery 
has a high failure rate over time. The overall risk of recurrent disc herniation varies 
between 2-18% in reported literature. The Barricaid® anular closure device was 
designed as an adjunct to lumbar limited microdiscectomy to block large anular 
defects while maintaining as much native nucleus within the disc space. Patients 
that are considered for anular closure have a minimum posterior disc height of 
5mm, and an intra-operatively measured anular defect between 5mm and 12mm 
wide. The aim of this study was determined as to assess the cost effectiveness of the 
use of Barricaid® in this group of patients in Turkey. Methods: A simple decision 
analysis model was used to assess the cost effectiveness of the use of Barricaid®. 
The primary clinical endpoint was determined as the number of prevented rehernia-
tions. According to the literature, the use of Barricaid® reduced the number of 
reherniations by 18%. Resource utilization data were obtained via expert clinical 
opinion and included pre-op, post-op and follow-up costs, etc. Unit costs were taken 
from the Social Security Institution’s official price list. Results were presented as 
incremental cost/number of prevented reherniations. The comparison was made 
between using and not using the Barricaid®. Results: According to the results of 
the cost effectiveness analysis, the incremental number of prevented reherniation 
was 4.398 with Barricaid® and incremental cost was 119.343.000 TL. The ICER was 
within the limits of the threshold recommended by the World Health Organization 
with 27.136 TL. ConClusions: Use of Barriciad® in lumbar discectomy surgery is 
a cost-effective treatment option in Turkey.
PMS45
PharMaCoEConoMiC EvaLUation of trEatMEnt With toCiLizUMaB in 
rUSSian ChiLdrEn With SyStEMiC JUvEniLE idioPathiC arthritiS
Ryazhenov V.V., Gorokhova S.G., Emchenko IV
I.M. Sechenov First Moscow State Medical University, Moscow, Russia
objeCtives: To evaluate the use of tocilizumab in Russian patients with systemic 
juvenile idiopathic arthritis (SJIA) in terms of cost-effectiveness and impact on 
social and economic burden of the disease. Methods: The model was based on 
TENDER clinical study (De Benedetti F et al., 2012). First, a pharmacoeconomical 
cost-efficiency of tocilizumab and a standard basic therapy of SJIA were com-
pared. The analysis included direct medical costs in two comparable groups (1st 
with routine administration of methotrexate and prednisolone, and 2nd with 
tocilizumab prescribed in case of refractoriness to NSAID and glucocorticoster-
oids). The efficacy of therapies was evaluated according to ACR criteria. After that, 
the influence of tocilizumab on cost and burden of illness was assessed. The 
analysis included direct medical costs and government expenditures on hospi-
talization, work incapacity insurance, monthly social pensions, benefits for care 
for a disabled children below 18 y. o. and GDP losses. 12-week time horizon was 
adopted in the CEA model, and a 1-year horizon for the assessment of burden 
of illness. Results: The cost-effectiveness in terms of ACR 90 and 70 was 4 428 
262.96 and 2 952 175.31 RUB for the group of standard treatment, and 1 166 111.66 
and 615 218.74 RUB for tocilizumab group. Tocilizumab demonstrated the same 
benefits in terms of ACR 50, 30. Analysis of burden of illness revealed a different 
structure of financial expenditures in considered strategies: pharmacotherapy 
constituted > 50% costs in tocilizumab group, but hospitalization costs were 12 
times less than in standard therapy. Annual budget losses due to social burden of 
this disease were 426 144.63 RUB per patient in the group of standard treatment 
and 226 729.10 RUB in tocilizumab group. ConClusions: The use of tocilizumab 
in SJIA is justified by better cost efficiency and reduced of social and economic 
losses of state budget connected with the burden of the disease.
PMS46
CoSt-EffECtivEnESS anaLySiS of EtanErCEPt in thE trEatMEnt of 
rhEUMatoid arthritiS in PortUgaL
Mateus C.1, Moura A.2
1Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal, 2Escola 
Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
objeCtives: The present study aims to estimate the cost-effectiveness of etaner-
cept compared to golimumab in the treatment of patients with Rheumatoid 
Arthritis (RA) in Portugal. Methods: A model was adapted to assess the cost-
effectiveness of etanercept in the treatment of RA. We performed a comparison 
of the combination of etanercept + methotrexate and golimumab + methotrexate. 
Dosage of etanercept was 50mg on a weekly basis, whereas for golimumab it was 
50 mg once a month. The model is an individual simulation model and takes 
a lifetime perspective. Outcomes are expressed in QALYs, using the HAQ score 
€ 4,471 per event averted. Probabilistic and univariate sensitivity analyses were 
robust and confirmed results of the base case scenario. ConClusions: This eco-
nomic evaluation modeling suggests that celecoxib may be considered as a cost-
effective alternative vs. t-NSAIDs in the treatment of osteoarthritis in daily practice 
in the Spanish NHS.
PMS41
thE CoSt-EffECtivEnESS of BioLogiC dMardS in PatiEntS With SEvErE 
or MiLd-to-SEvErE rhEUMatoid arthritiS aftEr ConvEntionaL 
dMardS
Wailoo A.J.1, Stevenson M.2, Tosh J.2, Hernández M.2, Stevens J.W.2, Archer R.2, Simpson E.2, 
everson Hock E.2, Scott D.3, Young A.4, Paisley S.5, Williams K.5
1NICE Decision Support Uni, Sheffield, UK, 2University of Sheffield, Sheffield, UK, 3KCL, London, 
UK, 4adam. young@nhs. net, Heertford, UK, 5The University of Sheffield, Sheffield, UK
objeCtives: To estimate the cost-effectiveness of biologic disease modifying anti-
rheumatic drugs (bDMARDs) following failure of conventional disease modifying 
anti-rheumatic drugs (cDMARDs) in patients with severe or mild-to-severe active 
rheumatoid arthritis from a UK, NHS perspective, as part of an ongoing National 
Institute of Health and Care Excellence (NICE) appraisal. Methods: Systematic 
review of clinical effectiveness of seven bDMARDs: abatacept; adalimumab; cer-
tolizumab pegol; etanercept; golimumab; infliximab; and tocilizumab. Network 
meta-analyses (NMA) of randomised controlled trials (RCTs) reporting European 
League Against Rheumatism (EULAR) response and for RCTs reporting American 
College of Rheumatology (ACR) outcome data. An individual patient model was 
constructed to estimate costs and outcomes in terms of quality adjusted life years 
(QALY). Large observational databases, published literature and the results of the 
NMAs were used to provide data for the model. Following failure of two cDMARDs 
two broad strategies were evaluated i) a bDMARD, followed by, if necessary, rituxi-
mab then tocilizumab then cDMARDs and ii) remaining on cDMARDs. Results: 
The estimated incremental costs per QALY of bDMARD strategies compared with 
a cDMARD alone strategy were typically over £50,000 regardless of the severity 
of rheumatoid arthritis or whether the EULAR or the ACR RCTs were used. The 
cost per QALY is greater for those who receive bDMARD monotherapy. One key 
parameter affecting the results was the estimated trajectory of HAQ progres-
sion whilst a patient received cDMARDs; using rates previously assumed in NICE 
appraisals reduced estimates to approximately £30,000. ConClusions: bDMARDs 
are unlikely to be as cost-effective as has been estimated previously. The costs 
per QALYs generated within our base case analyses are greater than commonly 
reported cost-effective thresholds in England and Wales.
PMS42
a CoSt-EffECtivEnESS anaLySiS for totaL knEE arthroPLaSty 
tELErEhaBiLitation: Proof of ConCEPt of a dECiSion ModEL
Fusco F.1, Turchetti G.2
1Scuola Superiore Sant’Anna, Pisa, Italy, 2Scuola Superiore Sant’Anna, Pisa, Italy
objeCtives: The study aims to assess the cost-effectiveness of telerehabilitation 
for Total Knee Arthroplasty (TKA) patients in Italy. TKA was performed 64,936 
times in Italy in 2012, reasonably leading to the same number of rehabilitation 
processes. The most recent cost analysis showed rehabilitation to account for Euro 
158 million per year. Therefore, new strategies aiming at optimizing resources 
and preserve patients’ wellbeing are claimed. Methods: A four-state Markov 
model (successful TKA; revision; successful revision; death) forecasted costs 
and clinical outcome over 10 years (cycle length: 1 year) for 1,000 individuals 
undergoing usual care rehabilitation (UC) or a mixed UC-telerehabilitation (UC-T) 
program. Published literature provided transition probabilities and clinical out-
come (active knee flexion Range Of Motion-ROM); while UC and telerehabilitation 
costs were estimated through Italian tariffs and panel of experts. Each surgery 
was assumed to lead to rehabilitation or telerehabilitation, resulting in direct 
medical and indirect costs (human capital approach). Results were adjusted 
applying half-cycle correction method and discount rate of 3%. A Probabilistic 
Sensitivity Analysis described parameters uncertainty and results were reported 
using Incremental Cost-Effectiveness Ratios (ICER) from societal and Italian-NHS 
perspectives. Results: Expected mean health care costs for UC were 1,253.2€ /
patient over ten years, and UC-T costs were on average 33.7€ /patient higher (95%CI 
€ 10.8). ROM-degrees for UC and UC-T were respectively 24.5 and 26.8 (mean dif-
ference= 2.3, 95%CI 0.002). The resulting ICER was 14.5€ /ROM-degree (Italian-
NHS perspective). Adopting a societal perspective, UC-T was more effective yet 
appeared cheaper than UC (respectively 1,429 and 1,457€ /patient, mean differ-
ence -28/patient (95% CI € 10.8)). ConClusions: Although the preliminary results 
have shown that UC-T could be a cost-saving procedure if societal perspective is 
adopted; these findings are uncertain due to the model assumptions. Therefore, 
further investigations with patient-level data and generic outcome measures 
(e. g. QALY) are required to draw definitive conclusions about cost-effectiveness 
in telerehabilitation.
PMS43
hEaLth EConoMiC EvaLUation of oStEoPoroSiS SCrEEning and 
trEatMEnt StratEgy in thE ELdErLy JaPanESE WoMEn
Yoshimura M.1, Moriwaki K.2, Noto S.3, Takiguchi T.3
1Graduate School of Health and Welfare, Niigata Universitiy of Health and Welfare, Niigata, Japan, 
2Kobe Pharmaceutical University, Kobe, Japan, 3Niigata University of Health and Welfare, Niigata, 
Japan
objeCtives: The objective of this study was to estimate the cost-effectiveness of 
osteoporosis screening and treatment with alendronate in the Japanese women 
aged ≥65 years without a fragility fracture history. Methods: A Markov model 
with ten health states (no event, seven types of post-fracture, bedridden, and 
death) was developed to predict lifetime costs and quality-adjusted life years 
(QALY) of screening and treatment strategy, comparing with no screening. In the 
screening arm, 1,000 hypothetical cohort experienced a bone mineral density 


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PMS44 Cost-Effectiveness of Use of Barricaid® In Lumbar Discectomy Surgery in Turkey

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