Hsu, J.C.

Tang, D.

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 V A L U E  I N  H E A L T H  1 6  ( 2 0 1 3 )  A 1 - A 2 9 8  A283 
 
 
surgical procedures, but also the administration of medicines to control lipids, 
blood pressure, antidepressants and even hypoglycemia, and even then those 
expenditures does not consider the indirect expenses such as transportation and 
escort the patient to the hospital and absence from work.  
 
PCV63  
ESTIMATING THE COSTS OF CARDIAC REHABILITATION PROGRAMS IN  
HEART FAILURE (HF) IN COLOMBIA: CONSTRUCTION BASED ON EXPERT 
CONSENSUS  
Rincon M1, Tamayo D2, Rojas M2, Dennis R1, Brophy J3 
1Fundacion Cardioinfantil, Bogota, Colombia, 2Universidad Javeriana, Bogota, Colombia, 3McGill 
University, Montreal, QC, Canada  
OBJECTIVES: To determine the components and the costs of an exercised-based 
rehabilitation program for patients with chronic systolic HF, from the point of 
view of the provider of the service. METHODS: Systematic review of the 
literature and expert consensus. Identification of components of HF 
rehabilitation programs, based on the literature, and Delphi rounds of experts for 
consensus. Only variable costs associated with the components of the program 
were estimated, based on the Colombian 256 agreement of 2001 (the Colombian 
norm that set the tariff for reimbursement for health care services) plus 23%, 
30%, or 48%, to approximate the range of costs in current (2012) health care 
package negotiations in Colombia between providers and payers. For 2012, 
US$1=COL$1,783. RESULTS: Based on expert consensus of cardiologists and 
physical therapists, 18 components of the rehabilitation program were identified. 
After the second round, over 80% agreement was obtained for the remaining 
three components, and an additional component was identified. After the third 
round, consensus was obtained for a program of 36 rehabilitation sessions and 
19 components. With the base-case scenario of agreement 256 plus 30%, the cost 
per session of the program was inversely proportional to the number of patients 
in each session: COL $96,903 for one patient, and COL $11,623 for 15 patients. For 
a program with 10 patients per session, the costs of a program may range from 
COL$ 471,130 to COL $656,554, depending on the agreement type. CONCLUSIONS: 
Agreement is critical to unify criteria on the components of a rehabilitation 
program that is both effective and safe for patients with HF. From the point of 
view of the provider, variable costs associated with implementation are sensitive 
to the number of patients per session. This study should set the basis for the 
estimation of the cost-effectiveness of rehabilitation programs in heart failure.  
 
PCV64  
ECONOMIC EVALUATION OF INFLUENZA VACCINATION IN PREVENTING 
HOSPITALIZATION IN CARDIOVASCULAR DISEASE PATIENTS  
Peasah SK1, Meltzer M2 
1Centers for Disease and Prevention, Atlanta, GA, USA, 2Centers for Disease Control and 
Prevention, Atlanta, GA, USA  
OBJECTIVES: Although the Advisory Committee for Immunization Practices 
(ACIP) and other organizations recommend annual influenza vaccination for 
cardiovascular disease patients (CVD), the vaccination rate is low in this risk 
group. Economic assessment of vaccination will aid public officials plan 
campaigns to increase coverage. METHODS: We estimated using a Monte Carlo 
(probabilistic) spreadsheet-based decision tree, the cost-effectiveness of 
vaccination to prevent hospitalization and death in all 27.1 million CVD patients 
in the US. We then estimated the benefit-cost ratios (BCR) associated with 
hospitalization and death averted by increasing coverage rates by 10% in all 
adult CVD patients from the current rates of 45% and 65% (for ages <65 years and 
≥65 years, respectively). Finally, we estimated the BCR associated with reaching 
the healthy people 2020 goal of vaccinating 90% of person’s ≥65 years and 80% of 
adults’ <65 years. We obtained treatment cost data from Marketscan database 
(2005-2010) and epidemiological data from the literature. We performed the 
analysis from the health care perspective including only cost associated with 
hospitalization and vaccination and reporting median cost values. RESULTS: 
Vaccination of all 27.1 million CVD patients’ would result in the following: 20,738 
(S.D 48,387)) quality-adjusted life years (QALY) saved, $10,107 (95% CI: cost-
savings (CS) to $70,554) / QALY saved, $31,563 (CI: CS to $151,900)/ hospitalization 
averted, and $76,588 (CI: CS to $534,658)/ premature death averted. The base case 
BCR is 0.52. A 10% increase in vaccination rate costing $41.2million (S.D $7.2 
million) would result in hospitalization-related savings of $28 million (S.D. $165 
million) (BCR=0.68). Achieving healthy 2020 goal would cost $257 million (S.D. $45 
million) and result in $ 216 million (S.D. $1.4 billion) hospitalization savings 
(BCR=0.84). CONCLUSIONS: Increasing vaccination coverage rate among CVD 
patients will avert hospitalization and most likely deaths, but with variability in 
economic impact.  
 
PCV65  
QUANTITATIVE RISK-BENEFIT ANALYSIS OF ORAL PHOSPHODIESTERASE TYPE 
5 INHIBITORS ON ERECTILE DYSFUNCTION TREATMENT  
Hsu JC1, Tang D2 
1National Cheng Kung University, Taipei, Taiwan, 2University of Arizona, Tucson, AZ, USA  
OBJECTIVES: Erectile dysfunction is a common male sexual disorder worldwide. 
Three oral medications – sildenafil, vardenafil, and tadalafil – have been used to 
treat erectile dysfunction. This study aimed to conjointly evaluate the 
therapeutic risks and benefits of the three medications to assist decision making 
of prescribing from the perspective of both physicians and patients. METHODS: 
A decision model was created to compare the risk-benefit of the aforementioned 
medications. Using published meta-analysis data, we performed a probabilistic 
Monte Carlo simulation to estimate the joint distribution of each type of adverse 
event (i.e., risk; categories included: any adverse event, serious cardiovascular 
(CV) events, headache, flushing, and dyspepsia) and effectiveness (defined as 
proportion of patients with improved erections). The incremental risk-benefit 
ratios (ICBRs) were calculated, and the results were illustrated by incremental 
risk–benefit planes. To account for differential risk preferences across patients, 
the results were also illustrated using risk–benefit acceptability curves and net-
benefit curves. RESULTS: When risk was defined as having any adverse event, 
serious CV event, or headache, sildenafil was dominated by vardenafil (ICBR= 
-1.00, -0.20, and -3.20, respectively); tadalafil showed increasing risk and benefit 
as compared to vardenafil (ICBR=0.83, 0.03, and 0.13, respectively). Tadalafil 
dominated sildenafil and vardenafil when balancing between the risk of 
flushing/dyspepsia and the drug efficacy. CONCLUSIONS: Based on patients’ 
concern of various categories of adverse events and assuming negligible concern 
over medical costs, vardenafil or tadalafil may be preferred over sildenafil.  
 
PCV66  
ESTIMATING COSTS SAVINGS FROM A CME ACTIVITY TO PREVENT  
BLEEDING-RELATED COMPLICATIONS AND TRANSFUSION  
Ravyn D1, Ravyn V2, Lowney R1, Ferraris VA3 
1CMEology, West Hartford, CT, USA, 2University of Colorado, Aurora, CO, USA, 3University of 
Kentucky, Lexington, KY, USA  
OBJECTIVES: In 2011, investments in continuing medical education (CME) 
exceeded $2 billion. Few studies report the economic impact of CME activities. 
Greater understanding of the economic value of CME assists stakeholders and 
health care cost payers in resource allocation. It is not feasible to obtain patient-
level data after each CME activity. We developed a model to estimate the 
potential health care cost savings associated with CME activity outcomes. 
METHODS: We evaluated data from a certified CME symposium for surgeons 
that reviewed the Society for Thoracic Surgeons (STS) blood conservation 
guidelines. The activity promoted prevention of bleeding-related complications 
(BRCs). We estimated the potential savings of averted BRCs from the provider 
perspective predicted by participants' self-reported commitment to change 
(CTC). Model parameter estimates were from: 1) costs of BRCs in 103,826 cardiac 
operations; 2) costs of reoperation for bleeding in 133,001 coronary artery bypass 
graft surgeries; 3) operative volume from the STS workforce report. The base case 
was 3 in 10 participants preventing one BRC in 2% of operations over 1 year. 
Probabilistic sensitivity analysis (PSA) using second-order Monte Carlo 
simulations was used to model parameter uncertainty. Results were 
standardized to 2012 $US using the medical care component of the Consumer 
Price Index. RESULTS: 93.8% of participants (n=133) reported CTC, a validated 
measure of behavior change. For BRCs, the savings for the base case was 
$1,500,112. PSA estimated the mean savings as $1,502,769 (95% CI, $869,860–
$2,359,068). For reoperation for bleeding, the savings for the base case was 
$2,974,497. PSA estimated the mean savings as $2,959,117 (95% CI, $1,135,992–
$5,566,487). CONCLUSIONS: Plausible economic estimates suggest that CME-
related learning favorably impacting clinical practice yields substantial cost 
savings. Model prediction of averted costs associated with CME allows 
estimation of the economic impact on surgical outcomes in the absence of 
patient-level outcomes data related to CME activities.  
 
PCV67  
EVALUATION OF ECONOMIC AND MEDICAL CONSEQUENCES OF THE  
ROTARY LEFT VENTRICULAR ASSIST DEVICE WITH A DISCHARGE AT HOME IN 
FRANCE  
Molinier L1, Ferlicoq L2, Dutheil JJ3, Duveau D4, Flecher E5, Leprince P6, Massetti M3, 
Parienti JJ3, Sabatier R3, Trochu JN4, Khayat A3 
1INSERM-University Hospital of Toulouse, Toulouse, France, 2University hospital of Toulouse, 
Toulouse, France, 3University Hospital of Caen, Caen, France, 4University Hospital of Nantes, 
Nantes, France, 5University Hospital of Rennes, Rennes, France, 6Hospital of La pitié Salpêtrière, 
Paris, France  
OBJECTIVES: Advanced heart failure (HF) is a leading cause of death in developed 
countries with a one-year mortality rate estimated at 40% after the first 
hospitalization. In France, HF affects 150 000 persons with annual costs of up to 
1,6 billon euros. Cardiac transplantation is the most effective treatment. 
However, because of a limited donor organ supply, innovative technics as left 
ventricular assist devices (LVAD) are developed as bridge to transplantation for 
over 10 years. The aim of this study is to assess the medical and economic 
consequences of LVAD in adults with advanced HF in France. METHODS: 
Between April 2008 and November 2011, 55 patients were included in this study 
in 14 French hospitals and were followed during one year after implantation. The 
primary medical outcome was the discharge at home and secondary medical 
outcome was the final situation of patient. This prospective economic analysis 
adopted the health care payer’s perspective and took into account direct medical 
and non-medical costs. RESULTS: This intermediate analysis included 21 
patients. LVAD used are HeartMate II (n=12), Jarvik 2000 (n=8) and Ventrassist 
(n=1). On the 21 patients, 15 were discharged at home spending an average of 265 
days (8.7 months) at home. During the follow-up period, 4 patients were 
transplanted, 6 patients died, and 11 were still on device at home. The mean 
total cost per implanted patient was €161,843 (±36,533). The device and initial 
hospitalization are the most important costs and represent respectively 58% and 
30% of the total cost. One day spent at home costs in average €59 CONCLUSIONS: 
Continuous-flows LVAD represent a costly strategy in the HF treatment. 
However, LVAD allow the patient to be discharged at home instead of awaiting 
heart transplantation at hospital.  
 
PCV68  
ECONOMIC COMPARISON OF HEMOSTATIC AGENTS IN CARDIAC SURGERY  
Sugarman R1, Tackett S2, Li-McLeod J3, Kreuwel H2, Alvarez P1, Nasso G4 
1United BioSource Corporation, Lexington, MA, USA, 2Baxter Healthcare, Westlake Village, CA, 
USA, 3Baxter, Westlake Village, CA, USA, 4Anthea Hospital, GVM Care & Research, Bari, Italy  


PCV65 Quantitative risk-benefit analysis of oral phosphodiesterase type 5 inhibitors on erectile dysfunction treatment 

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PCV65 Quantitative risk-benefit analysis of oral phosphodiesterase type 5 inhibitors on erectile dysfunction treatment

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