Assasi, N

Blackhouse, G

Gaebel, K

Goeree, R

Irvine, EJ

Marshall, J

Robertson, D

Xie, F

Elsevier - Publisher Connector 

PGI26 CANADIAN COST-UTILITY ANALYSIS OF INITIATION AND MAINTENANCE TREATMENT WITH ANTI-TNF DRUGS FOR REFRACTORY CROHN'S DISEASE 

Abstracts A73
PGI23
COST EFFECTIVENESS ANALYSIS OF RIFAXIMIN FOR THE TREATMENT 
OF ACUTE HEPATIC ENCEPHALOPATHY
Rivas R1, Cerezo O2, Zapata L1
1Guia Mark, Mexico, DF, Mexico, 2Instituto Nacional de Cancerología, Mexico, DF, Mexico
OBJECTIVES: Cirrhosis and its complications, such as hepatic encephalopathy (HE) 
are the sixth cause of general mortality in Mexico. The objective of this study is to 
evaluate a cost-effectiveness relationship of medications used to treat hepatic 
encephalopathy from the perspective of the Mexican Institute of Social Security 
(IMSS). METHODS: Cost-effectiveness analysis of treatments used for acute hepatic 
encephalopathy, based in a decision tree model, and considering a temporal horizon 
of 14 days, from the perspective of public health institutions. Existing relevant 
therapeutic alternatives available at the IMSS are: lactulose, L-ornithine L-aspartate 
(LOLA), neomycin and rifaximin (the new alternative). Proposed effectiveness measure 
based on available published studies and based on evidence: Percentage of patients 
with improvement in signs and symptoms of hepatic encephalopathy. Only direct 
medical costs are considered for the analysis, obtained from unitary medical attention 
costs reported by IMSS. A univariated sensitivity analysis, using relevant variables 
(price and effectiveness) and discount’s rates escenarios were performed. RESULTS: 
Treatment costs for each alternative (1 USD = 13.5 MXN $) totaled: lactulose 
US$3294, LOLA US$3297, neomycin US$3301 and rifaximin US $3312. In relation 
to effectiveness, the percentage of patients who presented improved signs and 
symptoms for each alternative is as follows: lactulose and LOLA 55%, neomycin 64% 
and riﬁxamin 90%. Cost effectiveness ratios are: lactulose US$5991, LOLA $5995, 
neomycin US$5157 and riﬁxamin US$3680. The incremental cost effectiveness 
analysis indicates that LOLA and neomycin are surpassed by lactulose and rifaximin, 
which are located on the efﬁciency line. Rifaximin can lessen hospital stays by at least 
one day and cut down at least one medical consultation. If these factors are taken into 
account for the sensitivity analysis, rifaximin takes the lead as dominating alternative. 
CONCLUSIONS: Rifaximin is a highly cost effective alternative for treating acute 
hepatic encephalopathy from an institutional perspective in Mexico.
PGI24
COST UTILITY ANALYSIS OF CERTOLIZUMAB PEGOL VERSUS 
NATALIZUMB MAINTENANCE THERAPY FOR CROHN’S DISEASE
Wu B
University of Florida, Gainesville, FL, USA
OBJECTIVES: To determine whether certolizumab pegol was a cost-effective strategy 
compared with natalizumab for patients with moderate to severe Crohn’s disease. 
METHODS: A Markov model was constructed to simulate the progression of adult 
Crohn’s patients. Transitions were estimated from published clinical trials of certoli-
zumab pegol and natalizumab. The costs were discounted at 3% over 5 years. The 
primary effectiveness measurement was quality-adjusted life years. One-way and 
probabilistic sensitivity analyses were performed by varying the transition probabili-
ties, costs and health state preferences. RESULTS: The treatment with natalizumab 
yielded 39.295 more quality-adjusted life years compared with the treatment with 
certolizumab pegol. The incremental cost-effectiveness ratio was $164,431/quality-
adjusted life year at 5 years. Sensitivity analysis demonstrated that the model ﬁndings 
were robust and remained in the 95% conﬁdence interval of $70,594 - $393,281. As 
one of the most inﬂuential variables, a reduction in the unit price of natalizumab by 
13.8% resulted in an incremental cost-effectiveness ratio below $80,000 per quality-
adjusted life year. CONCLUSIONS: The treatment with natalizumab yielded more 
quality-adjusted life years compared with the treatment with certolizumab pegol in 
moderate and severe Crohn’s patients. However, the cost was considerable.
PGI25
PHARMACOECONOMIC ANALYSIS OF THE EFFECTS OF SECONDARY 
BACTERIAL RESISTANCE IN THE MULTI-DEPARTMENTAL HOSPITAL 
ON TREATMENT EFFICACY IN COMPLICATED ABDOMINAL 
INFECTIONS
Kolbin AS1, Sidorenko S2, Zagorodnikova K1, Klimko N3, Koroleva O1
1Saint -Petersburg State University, Saint Petersburg, Russia, 2Ñhildren Infections Research 
Institute, Saint Petersburg, Russia, 3Saint - Petersburg Medical Academy of Postgraduate 
Education, Saint Petersburg, Russia
OBJECTIVES: To evaluate the clinical-economic value of ertapenem therapy in 
patients with complicated abdominal infections (CAI) vs. standard combination 
therapy considering the development of bacterial resistance in the Russian settings 
METHODS: The pharmacoeconomic analysis utilized the cost-effectiveness analysis 
(CER). If the efﬁcacy and the cost of any of the studied regimens exceeded those of 
the other regimen, an incremental analysis was carried out (ICERs). The decision 
analytic model was based on the clinical studies of CAI treatment. Efﬁcacy and safety 
data were based on additional analyses of a randomised, double blind, multinational 
trial of ceftriaxone plus metronidazole, ciproﬂoxacin plus metronidazole, ertapenem. 
For the assessment of the effects of secondary bacterial resistance on treatment efﬁcacy 
in CAI we utilized results obtained with a “susceptible – infected – susceptible” model 
(SIS-model) for development of antimicrobial resistance (i. e. reduction of the suscep-
tibility /effectiveness ratio observed with time), for ceftriaxone / metronidazole, cip-
roﬂoxacin / metronidazole, ertapenem. To evaluate the degree of inaccuracy of the 
results, sensitivity analyses were performed. RESULTS: It was established that the 
mode of starting treatment of CAP combination therapy ciproﬂoxacin / metronidazole 
was more expensive ($3153) in comparison with the use of ertapenem ($2860) and 
ceftriaxone/metronidazole ($2579). The CER established that the mode of starting 
treatment of CAP with ertapenem was both more effective and less expensive in 
comparison with the use of ciproﬂoxacin / metronidazole. The SIS-model showed that 
sensitivity to ertapenem bacterial agent is kept signiﬁcantly longer then to ceftriaxone 
/ metronidazole and ciproﬂoxacin / metronidazole (up to 60 month).The analysis of 
the alternative, whose cost of treatment of CAR was equal in all groups, has shown 
that the strategy using ertapenem was dominating. CONCLUSIONS: At CAI, such as 
a secondary peritonitis when the basic activators are Escherichia ñoli, Klebsiella 
pneumoniae and Bacteroides Fragillis it is more expedient to begin treatment with 
ertapenem.
PGI26
CANADIAN COST-UTILITY ANALYSIS OF INITIATION AND 
MAINTENANCE TREATMENT WITH ANTI-TNF DRUGS FOR 
REFRACTORY CROHN’S DISEASE
Blackhouse G1, Xie F1, Assasi N1, Gaebel K2, Marshall J3, Irvine EJ4, Robertson D1, 
Goeree R1
1PATH Research Institute, McMaster University, Hamilton, ON, Canada, 2St Joseph’s 
Healthcare, Hamilton, ON, Canada, 3Hamilton Health Sciences,McMaster University, 
Hamilton, ON, Canada, 4St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
OBJECTIVES: Crohn’s disease (CD) is a chronic inﬂammatory disease of the gastroin-
testinal tract which can cause abdominal pain, diarrhea and weight loss. Anti-TNFα 
drugs are being used more often and earlier in the disease course of patients with CD 
who have aggressive disease. However, these medications are quite expensive. The 
objective of this study is to evaluate the cost-utility of two anti-TNF drugs (inﬂiximab, 
adalimumab) for refractory CD. METHODS: A Markov model was used to estimate 
the costs and utilities (QALYs) of three treatments (usual care, inﬂiximab, adalimu-
mab) over a 5 year time horizon. After initial treatment, patients can achieve complete 
remission, treatment response or remain in a drug refractory health state. Patients 
achieving remission or response remain at risk of relapse during each 3 month model 
cycle. Patients in the drug refractory health state can either stay in that health state 
or have surgery during each cycle. Estimated costs and utility values were then assigned 
to the various model health states. Model input parameters, including initial response 
rates, relapse rates and utility values were derived from the published literature. 
RESULTS: Usual care had both the lowest expected costs ($17,017) and QALYs 
(2.555), while inﬂiximab had both the highest expected costs ($54,084) and QALYs 
(2.721). The incremental cost per QALY moving from usual care to adalimumab and 
from adalimumab to inﬂiximab was estimated to be to be $193,305 and $451,165, 
respectively. CONCLUSIONS: Based on common willingness to pay thresholds, 
ant-TNF drugs would not be perceived as a cost effective treatment for refractory CD.
PGI27
OPEN VERSUS LAPAROSCOPIC PROCEDURES FOR 
CHOLECYSTECTOMY SURGERY: A COST-UTILITY ANALYSIS, UNDER 
THE BRAZILIAN PUBLIC PAYER PERSPECTIVE
Nasciben V1, Saggia MG1, Sanchez JF2
1Johnson & Johnson, Sao Paulo-SP, Brazil, 2Johnson & Johnson, Bogota, Colombia
OBJECTIVES: To assess the economic impact of the incorporation of the laparoscopic 
procedure in terms of costs, QALYs, reduction of the convalescence period and com-
plication rates under the Brazilian public payer perspective. METHODS: An analytic 
decision-tree model was built to estimate costs and outcomes of the cholecystectomy 
surgery comparing the main differences between open and laparoscopic techniques 
(minimally invasive procedures), based on Brazilian guidelines for HTA (Vianna, 
2007). LAP reduces the probability of nosocomial infection (NI) from 8.93% to 2.6% 
(Brill 2008), the length-of-stay (LOS) from 3 days to 1 day and return to work in 
22.51 days (Keus 2006) when compared to OP. Only direct medical costs (physician 
fees, hospital length-of-stay (LOS) and materials were based on public lists (SUS/
SIGTAP and SIMPRO, 2009). A panel of specialists was conducted to validate the 
model. One-month timeframe was considered, based on intra and post-operative 
periods; consequently a discount rate was not necessary. One-way sensitivity analyses 
were performed to assess the robustness of the results. RESULTS: In terms of out-
comes, for each 1000 surgeries the LAP procedure can reduce the number of NI cases 
in 53, sepsis in 4 and deaths in 2. Total costs (including complications and devices) 
were higher R$ 2,271 for LAP than OP (R$3135 versus R$864), mainly because of 
laparoscopic devices’ costs (R$2385). However, LAP technique allowed the reduction 
on complication costs in 34% (from R$231 for OP to R$151 for LAP). Due to lower 
complication rates, LAP showed a 0.1085 higher QALY than OP (0.8357 for OP vs. 
0.9443 for LAP). In the end, the incremental cost-utility ratio for the incorporation 
of the LAP procedure was R$20,920 per QALY. CONCLUSIONS: Findings suggest 
LAP approach to cholecystectomy as a safer and cost-effective choice for cholecystec-
tomy surgery, under the Brazilian public system.
PGI28
UTILIZATION AND COST OF PEGINTERFERON PLUS RIBAVIRIN 
COMBINATION THERAPY IN THE MANAGEMENT OF CHRONIC 
HEPATITIS C VIRUS IN EUROPE
Davis KL1, Mitra D1, Leteneux C2, Bapat B1, Naujoks C2
1RTI Health Solutions, Research Triangle Park, NC, USA, 2Novartis Pharma AG, Basel, 
Switzerland
OBJECTIVES: To document real-world utilization patterns and costs of peginterferon 
plus ribavirin combination therapy in the management of chronic hepatitis C virus 
(C-HCV) in Europe. METHODS: Patient charts from clinics in the UK, France, 
Germany, Spain, and Italy were retrospectively reviewed by 240 physicians (∼48 per 


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PGI26 CANADIAN COST-UTILITY ANALYSIS OF INITIATION AND MAINTENANCE TREATMENT WITH ANTI-TNF DRUGS FOR REFRACTORY CROHN'S DISEASE

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