Western University Scholarship@Western Paediatrics Publications Paediatrics Department 1-2020 The Cost-Utility of Measles-Mumps-Rubella Immunization Strategies During a Mumps Outbreak Kikanwa Anyiwe David Naimark Oliver Baclic Vinita Dubey Marina Salvadori See next page for additional authors Follow this and additional works at: https://ir.lib.uwo.ca/paedpub Part of the Pediatrics Commons Authors Kikanwa Anyiwe, David Naimark, Oliver Baclic, Vinita Dubey, Marina Salvadori, Man Wah Yeung, Matthew Tunis, and Beate Sander Web-Only Abstracts 41st Annual Meeting of the Society for Medical Decision Making Portland, Oregon, October 20–23, 2019 PS 1-1 ASSESSMENT OF LONG-TERM IMPACT OF BEDAQUILINE-CONTAINING REGIMENS ON BURDEN OF DRUG-RESISTANT TUBERCULOSIS IN INDIA, A STATE TRANSITION MODEL ANALYSIS Applied Health Economics (AHE) Abela Mpobela Agnarson1, Vandita Gupta2, Lalit Raute2, Ravi Potluri3, Hitesh Bhandari4, Amit Dhir4, Amit Kumar4, Chrispin Kambili5, Laurent Metz1 and Gunnar Mattson1, (1)New Brunswick, NJ, (2)Mumbai, India, (3)New York, NY, (4)Gurugram, India, (5)Raritan, NJ Purpose: To assess the impact of bedaquiline-containing regimens on the incidence, prevalence, and mortality burden of drug-resistant tuberculosis (DR-TB) in India, following the 2018 update of the World Health Organization (WHO) guidelines for the treatment of DR-TB that has prioritized the use of bedaquiline in DR-TB treatment regimens. Method: A state transition model that allows patient flow and interaction between three disease states (TB susceptible, latent TB, and active TB) and between drug-sensitive (DS) and DR-TB patients was developed in MS Excel. Model inputs were sourced from published literature or were derived to calibrate the model with metrics published by WHO. Future changes including faster and more accurate diagnosis, the introduction of shorter regimens leading to improved adherence were built in to estimate the baseline forecast over the period 2020 through 2040, without the introduction of bedaquiline. The model was then used to assess the impact of enhanced utilization of bedaquiline-containing regimens on the incidence, prevalence and mortality of DR-TB in India through 2040 in two scenarios differing in the treatment success rate of the regimens, 61%, and 80%, as compared to 46% success rate with standard-of-care treatment. A peak share of 95% for bedaquiline-based regimens was considered to be attained by 2024; 50% of such use was in the form of shorter regimens. Result: In the baseline scenario without bedaquiline, the model predicts annual incidence of DR- TB to decline by 1% to 10% in each five-year period from 2020 to 2040, prevalence by 3% to 11% and mortality by 7% to 16% (Table 1). Compared to the baseline, adoption of bedaquiline- based regimens resulted in a considerable drop in these metrics; the cumulative drop in incidence over the 2020-2040 period increased by a further 70% and 123% respectively in the two success rate scenarios, prevalence by 60% and 106% respectively, and mortality by 48% and 85% respectively (Table 1). E2 Medical Decision Making 40(1) Conclusion: The study assesses increased adoption of bedaquiline-containing regimens for DR- TB treatment to significantly reduce DR-TB burden in India, and provides added value to evidence-based DR-TB public health policy. The use of bedaquiline-containing regimens lessens DR-TB related illness and deaths, and potentially cuts down the chain of transmission. Table 1 PS 1-2 OBTAINING STATE-SPECIFIC COSTS FOR ECONOMIC MODELLING IN HEPATITIS C: A RETROSPECTIVE COSTING STUDY Applied Health Economics (AHE) Alexander Haines, MSc, Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada, Zhan Yao, IC/ES, Toronto, ON, Canada, Hla Hla Thein, MD, MPH, PhD, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, Toronto, ON, Canada, William W. L. Wong, PhD, School of Pharmacy, University of Waterloo, Kitchener, ON, Canada and Murray D. Krahn, MD, MSc, FRCPC, University of Toronto and University Health Network, Toronto General Hospital Research Institute, Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada Purpose: The most cited Canadian cost estimates used in hepatitis C (HCV) modelling studies are phased-based. This broad estimation of cost is not best suited for Markov modelling that uses more granular detail with regards to how HCV progresses. This study aimed to estimate the cost, to the Ontario healthcare payer, of nine HCV-related health states: no cirrhosis, compensated cirrhosis, decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), HCC & DC, liver transplantation, liver related death, other death, and cured HCV. Method: We performed a retrospective costing study using administrative health data from databases held at the Institute for Clinical and Evaluative Studies (IC/ES). We identified individuals with chronic HCV using Public Health Ontario laboratory data. Time from HCV diagnosis until the end of follow-up was allocated to nine mutually exclusive health states. States were defined using a validated set of diagnosis, procedure and death codes. Direct medical costs were calculated for each state based on resources utilized whilst spending time in said state. Result: Our results identified (n=48,239) individuals diagnosed with chronic HCV. The following is the average 30-day cost calculated for each health state presented alongside the frequently cited Canadian phased-based cost estimates by Krajden et al (2010). Abstracts: SMDM 41st Annual Meeting; Portland, Oregon E3 Conclusion: Our estimates are significantly higher than previous Canadian HCV estimates, but congruent with other published Ontario and international costs. Our study also provides a more detailed estimation of costs for HCV models that utilize a state-based approach. For example, individuals with advanced liver disease have a single cost estimate using the phased-based approach. Now they have five estimates based on the type of advanced liver disease they have, ranging from $1,487 to $8,753 per 30 days. This will improve the accuracy of economic evaluations used to evaluate strategies that tackle HCV. PS 1-3 ASSESSING THE COST-EFFECTIVENESS OF LENVATINIB AS A FIRST- LINE THERAPY FOR UNRESECTABLE HEPATOCELLULAR CARCINOMA IN CANADA Applied Health Economics (AHE) John J. Kim, Thomas McFarlane, BScPhm, PharmD, Stephen Tully, PhD and William W. L. Wong, PhD, School of Pharmacy, University of Waterloo, Kitchener, ON, Canada Purpose: In Canada, both lenvatinib and sorafenib are approved as first-line therapy for unresectable hepatocellular carcinoma (HCC) but only sorafenib is publicly funded through provincial special access programs. The objective of this study is to determine the comparative cost-effectiveness of lenvatinib and sorafenib as a first-line therapy for unresectable HCC in Canada. Method: A state-transition model of unresectable HCC from a Canadian health care system perspective was developed in the form of a cost-utility analysis. The model time horizon was five years and the analyses were performed following the guidelines for economic evaluation by the Canadian Agency for Drugs and Technologies in Health (CADTH). The efficacy of the model was informed by a global phase 3, open-label, non-inferiority trial (REFLECT). Costs and utilities were obtained from published literature. Probabilistic sensitivity analysis, deterministic sensitivity analysis, and subgroup analysis, using overall survival hazard ratios with stratification factors adjusted by baseline characteristics, were performed to test the robustness of the model. E4 Medical Decision Making 40(1) Effectiveness was measured in quality-adjusted life years (QALYs) and cost was measured in 2018 Canadian dollars. Result: Lenvatinib dominated sorafenib in the base case analysis with an incremental cost of - $23,719.34 and incremental effectiveness of 0.132 QALY, indicating a dominance due to greater effectiveness at a lower cost. A probabilistic sensitivity analysis of 10,000 replications indicated that lenvatinib remains a cost-saving measure in 64.87% of the simulations and cost-effective 76.12% of the time at a willingness-to-pay (WTP) threshold of $50,000. However, lenvatinib failed to dominate sorafenib when the cost of sorafenib was decreased by 57%. Further analysis of 15 patient subgroups outlined in the REFLECT trial showed that in all subgroups, lenvatinib was cost-saving in at least 49% of the simulations and cost-effective at a WTP of $50,000 in at least 67% of the simulations. Results of the subgroup analyses did not change the conclusion of the study (Table 1). Conclusion: Our analysis showed that lenvatinib was more effective at a lower cost than sorafenib indicating that lenvatinib may be a cost-saving measure in patients with unresectable HCC in Canada. However, it is important to consider that lenvatinib may fail to remain a cost- saving measure if a significantly cheaper generic sorafenib becomes available in Canada. Abstracts: SMDM 41st Annual Meeting; Portland, Oregon E5 PS 1-4 COST-EFFECTIVENESS OF IMMEDIATE VENTRICULAR ASSIST DEVICE IMPLANTATION IN PEDIATRIC HEART FAILURE PATIENTS Applied Health Economics (AHE) Anton L.V. Avanceña, MS1, David M. Peng, MD2, Josie Lee1, Kurt R. Schumacher, MD2, Ming-Sing Si, MD2 and David W. Hutton, PhD1, (1)University of Michigan School of Public Health, Ann Arbor, MI, (2)C.S. Mott Childrenʼs Hospital, Ann Arbor, MI Purpose: Pediatric patients with end-stage heart failure