Intravenous Fluids for Children: Cost and Threshold Analysis to Inform the National Institute for Health and Care Excellence (NICE) Clinical Guideline Recommendation

Intravenous Fluids for Children: Cost and Threshold Analysis to Inform the National Institute for Health and Care Excellence (NICE) Clinical Guideline Recommendation

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6 Chang C1, Barone J2, Je S1, Lee S1, Suh D1 1Chung-Ang University, Seoul, South Korea, 2...

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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6

Chang C1, Barone J2, Je S1, Lee S1, Suh D1 1Chung-Ang University, Seoul, South Korea, 2Rutgers University, Piscataway, NJ, USA

Objectives: To estimate and compare annual direct medical costs associated with diabetic complications in patient with type 2 diabetes in the USA and South Korea.  Methods: Data were obtained from the 2010-2012 Medical Expenditure Panel Survey (MEPS), which is a nationally representative sample of ambulatory population in the US, and the 2010-2012 Korea Health Panel (KHP) which contains health service use and expenditures for a representative sample of Korea. Using ICD-9 CM codes and KCD-6 code, patients were classified as patients with microvascular complications only (nephropahty, neuropathy, retinopahty, or peripheral vascular disease), macrovascular complications only (cardiovascular disease and cerebrovascular disease), both complications, and without complications. Direct medical costs included costs associated with hospitalization, outpatient visits, emergency room visits, and drugs. To compare costs of diabetic patients with and without complications, direct medical costs were estimated using the generalized linear model (GLM) with log link function and gamma distribution after adjusting for patient characteristics.  Results: Among 5,986 and 3,111 patients with diabetes in the US and Korea, respectively, 87.9% and 66.9% patients had no complications; 4.4% and 12.3% patients had microvascular complications only; 7.6% and 15.8% had macrovascular complications only; and 0.2% and 5.0% had both complications. The average annual direct medical costs per patient were $8,782(95%CI:$8,308-$9,256) in the US and $1,910(95%CI:$1,771-$2,050; US$1= KRW1,000) in Korea. After adjusting for patients’ characteristics, annual direct medical costs associated with microvascular complications were 2.26(US) and 1.98(Korea) times greater; macrovascular complications were 2.75(US) and 1.60 times(Korea) greater, while both complications were 5.39(US) vs. 2.97(Korea) times greater than those without complications, respectively.  Conclusions: Direct medical treatment costs in patients with diabetic microvascular or macrovascular complications were significantly higher than those without diabetes complications, and the magnitudes of additional costs are different between US and Korea. Providing proper treatment of diabetes to prevent or delay diabetic complications is important to minimize treatment costs of diabetes. PHS19 Intravenous Fluids for Children: Cost and Threshold Analysis to Inform the National Institute for Health and Care Excellence (NICE) Clinical Guideline Recommendation Dawoud D1, Fenu E1, Griffin EA1, Wonderling D1, Ritchie G1, Crean P2 1National Guideline Centre, Royal College of Physicians, London, UK, 2Royal Belfast Hospital for Sick Children, Belfast, UK

Objectives: To identify the optimal monitoring strategy for admitted children requiring intravenous (IV) fluids for maintenance from the English NHS perspective.  Methods: Nine strategies were defined, based on weight-measurement frequency and fluid-balance recording, including: no monitoring, twice-weekly weight-measurement/partial fluid-balance recording (current practice) and twicedaily weight-measurement/complete fluid-balance recording (most intensive monitoring). Each strategy’s cost was calculated as the sum of its components: weight-measurement and fluid-balance recording. The cost was based on the amount of time and the number and type of staff required. Costs were calculated in 2012-2013 GBP. The incremental cost and the estimated number of major complications that need to be averted to achieve cost neutrality, compared to current practice, were calculated. Sensitivity analyses were conducted including adding critical care costs, varying the time required and changing duration of therapy.  Results: The incremental cost of monitoring compared to no monitoring ranged from £107 to £224 per child, depending on the intensity of the strategy. The strategy recommended based on this analysis, was daily weight-measurement and complete fluidbalance recording (including fluid inputs and outputs). The incremental cost of this strategy compared to current practice was £76 per child. Thus, it would need to prevent 20 major complications per 1000 children, under basecase assumptions, to achieve cost neutrality. This estimate ranged from 7 to 30 major complications per 1000 children under the different assumptions examined. More intensive monitoring was found to offer no to very limited additional benefit at a higher incremental costs under all assumptions examined.  Conclusions: Of the strategies considered, daily weighing and complete fluid-balance recording was considered justifiable given the plausibility of the number of major complications to be avoided and the costs that would result from each complication. More intensive monitoring was not considered justifiable, given the limited additional benefit and the higher incremental cost. PHS20 A Comparative Cost Analysis on Peritoneal Dialysis Versus Hemodialysis in Taiwan Tang C1, Kuo C2, Huang K2, Sue Y2 of Health Care Administration, Taipei Medical University, Taipei, Taiwan, 2Taipei Medical University, Taipei, Taiwan

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Objectives: Taiwan has succeeded in raising the proportion of peritoneal dialysis (PD) versus hemodialysis (HD) after the National Health Insurance (NHI) payment scheme has been providing financial incentives since 2005. This study aims to compare the economic costs between the PD and HD modality from a societal perspective.  Methods: A cohort of patients receiving dialysis from the NHI Research Database was identified during 2009-2013. The 1:1 propensity score-matched 10,523 PD, and 10,523 HD patients were analyzed on their annual NHI-financed medical utilization and medical costs. Face-to-face interviews on 246 PD and 308 HD patients of 10 hospitals located in four regions of Taiwan were further carried out to collect data on their productivity losses, transportation time, and out-ofpocket payments. All costs were expressed in New Taiwan (NT) dollars.  Results: The total NHI-financed medical costs were significantly higher in the HD than the PD (NT$723,760 vs. NT$671,603; p< 0.001). Significantly higher productivity losses (NT$158,117 vs. NT$134,881; p= 0.022) and out-of-pocket payments (NT$55,943 vs. NT$41,670; p= 0.943) were found in HD vs PD, but the latter did not reach statistical

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significance. The total economic costs of the HD were higher than PD (NT$937,820 vs. NT$848,154).  Conclusions: From a societal perspective, the HD had higher annual NHI-financed costs, out-of-pocket costs, as well as productivity losses than the PD, which made the economic costs of the HD than PD in Taiwan.KEYWORDS: economic cost; medical utilization; peritoneal dialysis (PD); hemodialysis (HD); National Health Insurance (NHI); Taiwan PHS21 Cost Study of Respiratory System Diseases Gantugs Y1, Otgonbayar D2, Otgonbaatar D3, Tseden P3, Chimedsuren O3 1Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia, 2Mongolian Medical Education Association, Ulaanbaatar, Mongolia, 3MNUMS, Ulaanbaatar, Mongolia

Objectives: As of 2014, respiratory diseases has been ranked as first leading cause of morbidity in Mongolia. The leading cause of morbidity consists of respiratory, digestive system and cardiovascular disease with no particular difference in urban and rural areas. Objective of the study was to estimate cost of leading respiratory system diseases.  Methods: We collected cost data from 1327 patient charts due to respiratory diseases at the state tertiary, and secondary health care facilities. Indirect costs were estimated based on the hospital’s financial accounts. Direct cost information was collected from patient charts applying bottom up method. Total costs of each disease were estimated by the sum of direct and indirect costs. Microsoft EXEL program used for data analysis.  Results: In the tertiary health care facilities, the costs of most common respiratory diseases were less by 14.19% than estimated finance tariff by Health insurance fund. In the Aimag Hospitals and Regional Health Centers the most costly diseases was chronic laryngitis and laryngotracheitis (J37) for 390,202 MNT and the least costly disease was acute bronchiolitis (J21) for 135,432 MNT. As for the leading disease at District Health Centers, the most costly was pneumonia (J18) for 480,069 MNT and the least was acute laryngitis and trachetis (J04) for 76,419 MNT.  Conclusions: In the mean time, at all district, aimag and tertiary hospitals the same tariff of finance are applied from Health insurance fund. As the study result reveals that amount for patients of district health care centers are fair enough as opposed to that of other health care facilities such as aimag, regional health centers and clinical hospitals are insuffiient. Detailed analysis of the structure of costs should be applied in decision-making. PHS22 Comparing Costs from a Pragmatic Randomised Trial to Published Modelling-Based Estimates: An Example from Prostate-Cancer Screening Booth N University of Tampere, Tampere, Finland

Objectives: Decision-analytic models are commonly used when assessing costeffectiveness, but a pragmatic trial utilising real-world electronic health records can offer detailed, long-term follow-up of healthcare costs at the individual level without the need for modelling. Here, we compare cost estimates derived from information collected ‘alongside’ a trial to costs estimates derived from models in the literature.  Methods: We perform a systematic literature review to retrieve information on healthcare costs of PSA-based systematic screening for prostate cancer estimated as part of published cost-effectiveness models. In addition, we link and statistically analyse a set of national registers covering prescription medication reimbursements, inpatient care and outpatient care to produce healthcare-cost estimates for men diagnosed with prostate-cancer during a 14-year follow-up of the 80000+ men in a prostate-cancer screening trial.  Results: The findings concerning the healthcare costs associated with systematic PSA-based screening vary in the literature. From our pragmatic trial-based data, the average cumulative costs were estimated to be less than 1600 euros for men in the control arm and less than 1800 euros for men in the screening arm (two-sided p-value: < 0.05). Comparing costs from a pragmatic randomised trial to modelling-based estimates of costs, the real-world cost estimates were significantly lower than those reported in models in the literature (two-sided p-value: < 0.001).  Conclusions: Although analysis of real-world data may able to provide a useful supplement to results from modelling studies, the validity of such analysis should be assessed on a case-by-case basis. In addition, although analysis using decision-analytic models may be an unavoidable fact of life, such analysis should also be assessed for validity on a case-by-case basis. Our results suggest that the way in which ‘cost-effectiveness’ results from modelling studies are interpreted could benefit from more analysis of costs collected alongside large pragmatic clinical trials. PHS23 Long-Term Health Care Cost in Patients with Symptomatic Peripheral Artery Disease: Results from a Swedish Nationwide Study Sigvant B1, Kragsterman B2, Falkenberg M3, Hasvold P4, Johansson S5, Rikner K6, Thuresson M7, Nordanstig J3 1Department of Vascular Surgery, Karlstad Central Hospital, Karlstad, Sweden, 2Uppsala University, Uppsala, Sweden, 3Sahlgrenska Academy, Gothenburg, Sweden, 4AstraZeneca, Södertälje, Sweden, 5AstraZeneca Gothenburg, Mölndal, Sweden, Gothenburg, Sweden, 6AstraZeneca Gothenburg, Mölndal, Sweden, Mölndal, Sweden, 7Statisticon, Uppsala, Sweden

Objectives: Long-term nationwide data on healthcare costs for patients with peripheral artery disease (PAD) are not widely studied. The aim was to investigate long-term healthcare costs for PAD in a clinical practice setting.  Methods: A retrospective cohort study including all patients with a first hospitalisation with PAD diagnosis at discharge identified in the mandatory Swedish National Patient Register from 2006-2014. These data were linked to the Cause of Death Register. Total healthcare costs (hospitalizations and hospital out-patients visits) and CV-related costs are reported (2015 Euros [€ ]) as mean per-patient yearly costs and cumulative costs over a follow-up of 6 years. Results were stratified by median age (≤ 76 or > 76) and high risk (≥  one of diabetes mellitus, MI, stroke, heart failure, or renal dysfunction)  Results: The study included 66,189 patients, with a total of 221,953