11th annual european congress of the international society for pharmacoeconomics and outcomes...

11th Annual European Congressof the International Society forPharmacoeconomics andOutcomes Research (ISPOR)Athens, Greece, 8–11 November 2008

The 11th Annual European Congress of theInternational Society for Pharmacoeconomicsand Outcomes Research (ISPOR) was held re-cently in Athens, Greece, at the Hilton Athensand attracted around 1200 submissions, a 28%increase. The following is a selection of some ofthe research highlights from this meeting.

1. Rivaroxaban for VenousThromboembolism Preventionin Various Settings

The recently completed RECORD trials haveshown that rivaroxaban has better efficacy andsafety than enoxaparin when used prophylacti-cally for venous thromboembolism (VTE) aftermajor orthopaedic surgeries such as total hip re-placement (THR) and total knee replacement(TKR). Using data from the RECORD trials,five studies presented at ISPOR suggest that riv-aroxaban appears to be a cost-effective alter-native to enoxaparin for the prevention of VTEafter such surgeries. These studies were supportedby Bayer HealthCare.

Prophylactic anticoagulation therapy aftermajor orthopaedic surgeries is a standard prac-tice to reduce the incidence of VTE. Enoxaparin,a factor Xa inhibitor, has been the prophylacticagent of choice after THR and TKR; however,its use is limited by the requirement for sub-cutaneous administration. In this regard, newagents such as rivaroxaban, an oral direct factor

Xa inhibitor, appear to be promising candidatesnot affected by the limitations associated withparenteral administration of anticoagulants.

In RECORD 1 and 2, 35 days of oral rivar-oxaban was compared with 35 days of sub-cutaneous (SC) enoxaparin (RECORD 1) or with12 days of enoxaparin (RECORD 2) for THR,whereas, in RECORD 3, 12 days of oral rivar-oxaban was compared with 12 days of SC en-oxaparin for TKR. Compared with enoxaparin,rivaroxaban was associated with a 70% reductionin total VTE (composite: any deep-vein throm-bosis, non-fatal pulmonary embolism or all-causemortality) in RECORD 1, a 79% and 80% reduc-tion in total and symptomatic VTE, respectively,in RECORD 2, and a 49% and 66% reductionin total and symptomatic VTE, respectively, inRECORD 3.

The five studies presented at the congress useddata from the RECORD trials to evaluate thecost effectiveness of rivaroxaban in varioushealthcare settings.[1-5]

1.1 After Hip Surgery in Spain, Canadaand the UK

The first study, conducted from a Spanishhealthcare perspective, used a cost-utility modelpopulated by RECORD 1 and 2 data to comparerivaroxabanwith enoxaparin over 5 years.[1] Treat-ment for 35 days with rivaroxaban was dominantover treatment for 35 days with enoxaparin witha cost saving of h48.10 per patient and a small

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QALY gain, and was cost effective against the 12-day enoxaparin treatment with an incrementalcost per QALY of h3156. When both RECORD1 and 2 data were combined, rivaroxaban re-mained dominant over enoxaparin with a QALYgain of 0.011 and a cost saving of h12.24 per pa-tient. Following sensitivity analyses, rivaroxabanwas cost effective in 100% of cases and dominantin 60% of cases, compared with enoxaparin.

The second study was similar to the first, butit was conducted from a Canadian Ministry ofHealth perspective;[2] costs were expressed in$Can, year 2008 values, and included potentialsavings following oral administration. In this studytoo, rivaroxaban dominated the 35-day enoxaparintreatment with a cost saving of $Can282.58 perpatient and a small QALY gain, and was costeffective against the 12-day enoxaparin treatmentwith an incremental cost per QALY of $Can33 323;reduced outpatient administration costs were amajor contributing factor to the observed costsavings. In sensitivity analyses, rivaroxaban domi-nated enoxaparin in 98% of cases.

In the third study, conducted from a UKhealthcare perspective, cost effectiveness of riv-aroxaban versus enoxaparin was assessed over5 years using RECORD 1 and 2 data.[3] Costswere expressed in d, year 2008 values, includedpotential savings associated with administrationand monitoring. Rivaroxaban dominated boththe 35-day enoxaparin treatment (cost savingd67.82 per patient) and the 12-day enoxaparintreatment (cost saving d22.38 per patient; QALYgain 0.022); cost savings were mainly driven byreduced outpatient administration costs. In sen-sitivity analyses, rivaroxaban dominated in 98%and 55% of cases, compared with the 35-day and12-day enoxaparin treatment, respectively.

1.2 After Knee Surgery in Spain and the UK

The fourth study was conducted from ahealthcare perspective and used data fromRECORD 3 to assess the cost effectiveness oforal rivaroxaban versus SC enoxaparin in the UKand Spain in preventing VTE after TKR;[4] a5-year cost-utility model was constructed. TheUK analysis included potential savings from oral

administration, whereas in the Spanish analysis,drug administration costs were included in hos-pitalization charges. In both the UK and Spain,rivaroxaban was dominant over enoxaparin.Rivaroxaban-associated improved health outcomeswere similar for both countries. However, costsavings associated with rivaroxaban were d89.15per patient in the UK and h144.93 per patient inSpain; in the UK, the savings were mainly drivenby reduced costs of treating symptomatic VTEand related long-term complications, and oraloutpatient administration. Following sensitivityanalyses, rivaroxaban dominated enoxaparin in>99% of cases in both countries.

1.3 Cost Saving in Italy

The fifth study was a cost-consequence studyconducted from an Italian healthcare perspectiveand used a 5-year economic model to assess eco-nomic and clinical consequences of rivaroxabanversus enoxaparin;[5] data from RECORD 1, 2and 3 were combined. Costs (2008 values) ex-cluded the costs of rivaroxaban and enoxaparin.Results suggested that rivaroxaban was asso-ciated with an overall improvement of 0.021symptomatic VTE events per patient undergoingsurgery, and with a reduction in nondrug costs ofh81.32, compared with enoxaparin. The re-searchers estimated that rivaroxaban could beassociated with an overall total annual nondrugcost saving of about h7.6 million in Italy.

2. Other Cardiovascular DiseaseInterventions

2.1 Statin plus Niacin Combinationand Costs in the US

Researchers from the US presented datasuggesting that a comprehensive treatment ap-proach involving a combination of a statin andextended-release (ER) niacin can improve lipidvalues and lead to lower total medical costs.[6]

Clinical and economic data for the 12 monthsprior to and after initiation of combination ther-apy were evaluated for a retrospective cohort of845 patients (mean age 52.6 years) at primary orsecondary risk for cardiovascular disease (CVD).

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The mean changes in lipid values for low-densitylipoprotein (LDL) cholesterol, high-density lipo-protein (HDL) cholesterol and triglycerides were-10.81mg/dL, +2.73mg/dL and -22.67mg/dL,respectively.

Multivariate analysis revealed an increasedlikelihood of goal attainment for LDL cholesterol(odds ratio 1.56), HDL cholesterol (1.58) andtriglycerides (1.39) after initiation of statin andniacin therapy. Moreover, generalized estimatingequation (GEE) results suggested significantimprovements from pre-index in both annualCVD-attributable inpatient visits (17 vs 9 per 100patients; p < 0.0001) and total medical costs($US3214 vs $US2039; p < 0.0001).

2.2 Simvastatin plus Niacin in US Health PlanFormulary

Another US study found that the addition ofER niacin and simvastatin therapy to a healthplan formulary improved individual and com-bined optimal lipid values, thereby having thepotential to reduce the incidence of cardiovascular(CV) events and CV-related medical costs.[7]

Using data for primary and secondary riskpatients abstracted from the Health-Core In-tegrated Research Database, the researchersmodelled the effect of two hypothetical for-mularies (one with fixed-dose, ER niacin andsimvastatin, and one without) on costs and out-comes over a 3-year period. The results showedthat a revised formulary (containing ER niacinand simvastatin) would increase optimal lipidvalue attainment by 0.57% over 3 years, com-pared with the current formulary.

The cost for a 1% improvement in optimalLDL cholesterol, HDL cholesterol and trigly-ceride attainment was estimated at $US3103,$US952 and $US2047, respectively. There wouldbe an estimated cost of $US1147 for every 1%increase in combined optimal lipid value attain-ment with the revised versus current formulary.

2.3 Evaluation of Irbesartan for Hypertensionin Greece

An analysis reported by researchers fromGreece concluded that, for different patient po-

pulations, irbesartan represents good value formoney in the Greek National Health Service(NHS) setting, compared with commonly usedalternatives.[8]

A Markov model was constructed to evaluateirbesartan in relation to losartan and valsartan inthe treatment of hypertension in Greece. For thebaseline cohort with mild-to-moderate disease(age 57 years, systolic blood pressure 147mmHg,cholesterol 6.00mmol/L, bodymass index 29kg/m2),irbesartan generated 12.67 QALYs, and a totalcost of h15 146, compared with 12.63 QALYsand h15 486 for losartan, and 12.64 QALYs andh15 613 for valsartan. In patients with severehypertension, irbesartan was likely to be moreeffective and less costly than the other two med-ications, suggesting economic dominance.

2.4 Amlodipine/Atorvastatin forCardiovascular Disease PrimaryPrevention in Korea

Another presentation at the meeting suggestedthat single pill amlodipine/atorvastatin re-presents a cost-effective strategy for the primaryprevention of CVD in Korea.[9]

A Markov model was designed to assess thecost effectiveness of a single pill combination ofamlodipine/atorvastatin for the primary preven-tion of CVD among a cohort of 171 adults aged‡55 years whowere CVD-free but whomet currentKorean criteria for treatment with the combi-nation therapy. Follow-up was simulated for40 years. The model showed that, compared withno treatment, single pill amlodipine/atorvastatinwould have an incremental cost-effectivenessratio (ICER) of about 1.4 million Korean Wonper QALY gained, and about 1.9 million KoreanWon per year of life saved (1000 Korean Wonis approximately equal to $US1). Sensitivityanalysis indicated these results to be robust, theresearchers noted.

2.5 High-Dose Atorvastatin versus StandardSimvastatin in Spain y

Even in a low-cost generics market, high-doseatorvastatin is a good option compared withstandard therapy with simvastatin, according to a

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presentation by researchers from Spain and theUK.[10] The IDEAL (Incremental Decrease inEvents through Aggressive Lipid Lowering) trialinvolved 8888 patients with a history of acutemyocardial infarction (MI) who were rando-mized to receive atorvastatin 80mg or simva-statin 20–40mg; median follow-up was 4.8 years.A within-trial pharmacoeconomic analysis wasdeveloped to estimate the cost per event avoided.Direct and indirect costs were included in themodel.

After 4.8 years, treatment with intensive ator-vastatin could avoid one in six CV events, com-pared with moderate simvastatin therapy amongpatients with congestive heart disease. Althoughatorvastatin has a higher acquisition cost thansimvastatin, this cost was offset by reduced hos-pitalizations and work days lost for atorvastatinrecipients. Using Spanish costs, the incrementalcost for atorvastatin to avoid one event (vs sim-vastatin) would be h15 168.

2.6 y and Medium-Dose Atorvastatinin the UK

Furthermore, according to another presenta-tion, high-dose atorvastatin (80mg) is likely to bemore cost effective than medium-dose ator-vastatin (40mg) in patients with acute coronarysyndrome in the UK.[11]

The investigators built a Markov model usingefficacy results based on a preliminary Bayesianmeta-analysis linking a decrease in LDL choles-terol levels to decreases in secondary cardiacevents (MI, stroke, cardiovascular death), drawingdata from the A to Z and PROVE-IT (Pravastatinor Atorvastatin Evaluation and Infection Ther-apy) trials and using priors from other statintrials. UK cost data embedded in the modelshowed that, at a 12% event risk during the first6 months and a 4% risk during later months, andan estimated 10% additional efficacy for high-doseversus medium-dose atorvastatin, the estimatednumber needed to treat (NNT) to avoid one eventwould be about 50. Costs per life-year gainedand per QALY gained were estimated at belowd10 000 for high-dose versus medium-doseatorvastatin.

The investigators reiterated that their analysisis preliminary, and that the results may alter fol-lowing reconsideration of the priors. In addition,they commented that subsequent probabilisticanalysis would be used to explore uncertaintiesaround the estimates.

3. Value of Human PapillomavirusVaccine in European Countries

Human papillomavirus (HPV) has been im-plicated as a causal factor in cervical cancer,which ranks as the number two cancer-relateddeath in women globally. HPV DNA is detectedin 99.7% of all such cancers, and safe, effectivevaccines against HPV are now being developedwith a view to administering these preventivevaccines to adolescent girls in many countries. Aswith any new therapies, the costs and benefitsassociated with the use of HPV vaccine are ofutmost concern to payers and patients alike.These issues were considered in several studiespresented at the meeting.

3.1 The Netherlands

A multinational group of researchers reportedthat immunization of 12-year-old Dutch girlsagainst HPV infection is a cost-effective strategyin protection against cervical cancer.[12] The re-searchers adapted an existing Markov model tothe Netherlands; in the base-case analysis, 100%HPV vaccine coverage was assumed among girlsaged 12 years at a price of h100 per dose. Ac-cording to the model, the addition of an HPVvaccine to the Dutch cervical cancer screening pro-gramme would cost about h31.5 million annually.However, cervical intraepithelial neoplasia (CIN)and cervical cancer costs would be reduced byh11.5 million with the vaccine, and 2907 life-yearswould be saved, for an ICER of h22 700 per life-year gained (LYG) [h18 500 per QALY] versusno HPV vaccination (discounted at 4% for costsand 1.5% for outcomes).

The researchers commented that, althoughthey made several assumptions, their estimatedICER corresponds with previous analyses relat-ing to cervical cancer vaccination.

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3.2 Spain

Vaccination against HPV has been re-commended for girls aged 11–14 years in Spain.Researchers from that country reported results ofan analysis to determine the cost effectiveness ofthe bivalent HPV-16/18 vaccine Cervarix� in thecurrent Spanish setting with cervical cancerscreening.[13]

Their Markov model (calibrated to Spanishepidemiological endpoints) showed that, assum-ing screening practices remain unchanged, vaccinat-ing all 12-year-old girls would result in decreasesof 79.1% and 79.5% in the number of cervicalcancer cases and deaths, respectively. They con-cluded that, at a discount rate of 3% for costs andoutcomes, the introduction of Cervarix� wouldbe expected to cost an additional h31 749 perQALY gained, and at discount rates of 4% forcosts and 1.5% for outcomes, would cost h14 707per QALY gained.

3.3 Finland

HPV is currently responsible for significanthealthcare costs in Finland, and vaccination of12-year-old girls against HPV would be an ef-fective and economically profitable method toreduce the burden of the HPV-related diseases,according to investigators from Finland andFrance.[14] The results of a analysis were pre-sented in which they used Finnish nationalhealthcare, social insurance and cancer registriesto evaluate the costs associated with cervicalcancers, cervical lesions and genital warts diag-nosed between 2001 and 2005. An incidence-basedmodel was developed to evaluate the effectsof HPV-6, -11, -16 and -18 vaccination among12-year-old girls, from the perspectives of thehealthcare payer and society.

They estimated that HPV vaccination wouldcost an additional h11 122 per QALY gained(costs discounted at 3.5% and health benefits at1.5%) compared with the current screeningstrategy. This figure would render such vaccina-tion cost effective, based on the h50 000/QALYthreshold generally adopted by developedcountries.

4. Other Cancer Interventions

4.1 Trastuzumab for Early Breast Cancer inPortugal and the Netherlands

Two Markov model-based studies indicatedthe use of 1 year of trastuzumab therapy to treatearly breast cancer was cost effective comparedwith standard care.

In the first study, researchers estimated thecost effectiveness of 1 year’s trastuzumab versusstandard care (observation following standardadjuvant chemotherapy) in early-stage breastcancer in Portugal.[15] Themodel assumed a hypo-thetical cohort of patients similar to thoseincluded in the HERA (HERceptin Adjuvant)study, and considered both the healthcare payerand the societal perspectives. Trastuzumab ther-apy increased discounted life expectancy by 2.11years (14.95 vs 12.84 years) and by 2.01 QALYs,compared with standard care. Direct and indirectcosts were h61 839 and h19 759 with trastuzumab,and h40 559 and h25 391 with standard care,corresponding to ICERs of h10 067 and h10 595(direct costs only) and h7789 and h7400 includ-ing indirect costs, per LYG and per QALY,respectively.

The second study was a cost-effectivenessanalysis from the Netherlands that again esti-mated the use of trastuzumab for 1 year com-pared with observation.[16] From a healthcareperspective, the ICER for trastuzumab for a55-year-old patient was estimated to be h19 463 perQALY. From a societal perspective, the ICERwas h14 867. As expected, the ICERs improvedwith younger age. Overall, the Dutch cost-effectiveness estimate was well below the Dutchinformal threshold of h80 000 per QALY.

4.2 Adjunctive Rituximab for FollicularLymphoma in Spain

Rituximab has recently received Europeanapproval for use in combination with any chemo-therapy. The addition of rituximab to CVP(cyclophosphamide, vincristine, prednisolone),MCP (melphalan, chlorambucil, prednisone) orCHOP (cyclophosphamide, doxorubicin, vin-cristine, prednisolone) regimens increases quality-



adjusted life expectancy and is cost effective,according to results presented by researchersfrom Spain.[17] Their study used a Markov modelbased on three randomized controlled clinicaltrials comparing the addition of rituximab to theabove chemotherapy regimens, compared withchemotherapy alone, in patients with advancedfollicular lymphoma. The trial endpoints wereprogression-free survival and overall survival.Medication and supportive care costs andQALYs were estimated over a time period of10 years. From a SpanishNHS perspective, addingrituximab to chemotherapy increased QALYs by0.795, 1.129 and 0.971 years for CVP, MCP andCHOP, respectively, compared with chemo-therapy alone. The incremental cost per QALYgained was h10 190, h6092 and h7855 for CVP,MCP and CHOP, respectively. The incrementalcost per LYG was h10 168, h6348 and h8190, forCVP, MCP and CHOP, respectively.

4.3 Dasatinib Dominates Imatinib for ChronicMyeloid Leukaemia in Europe

Treatment of chronic myeloid leukaemia(CML) with dasatinib appears to provide betterefficacy at a lower cost than imatinib in Centraland Eastern Europe, according to the results of acost analysis presented at the conference.[18] Re-searchers assessed the cost needed to achieve onecomplete cytogenic response with dasatinib140mg compared with imatinib 600 and 800mgin patients with imatinib-resistant CML. Theanalysis was conducted using the NNT to achieveone complete cytogenic response; the incrementalcost of achieving this in 15 months was evaluated.To achieve one cytogenic response, the NNT was6.25 patients for imatinib and 2.5 for dasatinib.The costs to achieve one response during15 months of treatment were h363 172 (CzechRepublic), h218 492 (Hungary) and h334 146(Romania) lower for dasatinib compared withimatinib 800mg. Dasatinib retained its economicadvantage when compared with imatinib 600mg.The incremental costs to achieve one completecytogenic response between imatinib 600mg anddasatinib were h228664 (CzechRepublic), h218492(Hungary) and h205 316 (Romania).

4.4 Erlotinib Switch in Non-Small-Cell LungCancer May Provide Savings in Portugal

It was reported in another presentation thatswitching fromdocetaxel or pemetrexed to erlotinibas second- or third-line treatment for non-small-cell lung cancer (NSCLC) could provide annualsavings for the Portuguese NHS that would rangebetween h135 046 and h1 755 602 (docetaxelreplacement) and h291 801 and h3 793 409(pemetrexed replacement), with a gain in terms ofQALYs.[19] The cost-minimization and cost-utilityanalysis employed a Markov model to evaluatethe costs and benefits of second- and third-linetreatment with erlotinib in advanced or meta-static NSCLC compared with docetaxel, peme-trexed or best supportive care. A time horizon of2 years was used. Costs were updated to 2008,and an annual discount of 5% was applied tocosts and utilities. Erlotinib treatment was asso-ciated with a lower per-patient cost (h26 478)compared with docetaxel (h29 262) or peme-trexed (h32 762) and a higher per-patient costcompared with best supportive care (h16 112).QALYs per patient were higher with erlotinib(0.250) than with docetaxel (0.225), pemetrexed(0.241) or best supportive care (0.186). In thecost-utility analysis, erlotinib was dominant,being less expensive and more effective thandocetaxel and pemetrexed. The base-case analysisresults were confirmed by a sensitivity analysis.

5. Overactive Bladder Treatments

5.1 Solifenacin versus Tolterodine in Italy

Italian researchers used a Markov model tocompare the cost effectiveness of solifenacin5mg/day, ER tolterodine 4mg/day and no treat-ment over a 52-week time horizon.[20] Only directhealthcare costs were included, and the base-casescenario was from the patient perspective. Bothsolifenacin and tolterodine were associated withsignificant gains in symptoms and quality of lifeat costs of h540–640/patient/year and h680–780/patient/year, respectively. Solifenacin dominatedtolterodine and had an incremental cost-utilityratio (ICUR) of h7600–18 600/QALY gained,

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compared with no treatment. Should a decisionfor reimbursement be made by the Italian NHS,the ICUR decreased to h600–2400/QALY, whichthe researchers described as favourable.

5.2 Solifenacin versus Tolterodine,Fesoterodine in the UK

Two UK-based studies presented at the con-gress suggested that solifenacin was more costeffective than tolterodine and fesoterodine, re-spectively, whereas a third study found fesoter-odine to be the most cost-effective treatment ofthe three.

The first study was based on a 1-year decision-tree model, from the UK NHS perspective. Soli-fenacin 5–10mg was compared with tolterodineER 4mg in this cost-utility analysis.[21] Costs in-cluded were those associated with direct treat-ment and were reported in 2007–8 values. TheICERs for urgency, frequency and incontinenceoutcomes were d6406, d9065 and d14 374 perQALY gained, respectively. In sensitivity ana-lyses, ICERs remained below the threshold ofd30 000/QALY. The researchers concluded thatsolifenacin is likely to be a cost-effective strategy,compared with tolterodine, in the UK NHS.

In the second cost-utility analysis, also con-ducted from the UK NHS perspective, solifena-cin 5–10mg was compared with fesoterodine48mg in a 1-year decision-tree model (2007–8 va-lues).[22] In the base-case scenario, solifenacin wasmore effective and less costly than fesoterodinefor frequency and urgency outcomes. Fesoter-odine was more effective for incontinence out-comes, but at an ICER of d84 686/QALY gained.Based on a threshold of d30 000/QALY gained,fesoterodine does not provide a cost-effectivetreatment option relative to solifenacin, accord-ing to the researchers.

In contrast, the third study, undertaken byresearchers from the UK, the US and France,found that fesoterodine was a cost-effectivetreatment for overactive bladder, compared withtolterodine and solifenacin.[23] This 52-week cost-utility analysis, involving medical, out-of-pocketand productivity costs and based on data from arandomized controlled trial, compared fesotero-

dine 4mg/day, fesoterodine 8mg/day, tolterodineER 4mg/day and solifenacin (dosage not stated).Fesoterodine 8mg/day was associated with thegreatest gains in QALYs and the lowest overallcosts (table I).

6. Cost Effectiveness of Ranibizumab forAge-Related Macular Degeneration inAustria

Another presentation indicated that the use ofranibizumab to treat age-related macular degen-eration (AMD) is cost effective in Austria.[24] TheMarkov model-based study evaluated the costeffectiveness of ranibizumab versus verteporfin inthe treatment of AMD and was adapted to theAustrian situation. The clinical data included werebased on three clinical trials (MARINA [MinimallyClassic/Occult Trial of the Anti-VEGF AntibodyRanibizumab In the Treatment of NeovascularAMD], ANCHOR [Anti-VEGFAntibody for theTreatment of Predominantly Classic Choroi-dal Neovascularization in AMD] and PIER[Phase 3b, Multi-Center, Randomized, Double-Masked, Sham Injection-Controlled Study of theEfficacy and Safety of Ranibizumab in Subjectswith Subfoveal Choroidal Neovascularizationwith or without Classic CNV Secondary toAMD]). The effectiveness of the two drugs wasassessed using vision-years (VYs) and QALYs.Costs were reported in h, year 2007 values.

Over the 10-year time period considered, ra-nibizumab therapy was associated with a gain of4.2 QALYs versus 3.91 for verteporfin therapy.The ICER for ranibizumab compared with ver-teporfin was h15 647. With regard to VYs gained,the ICER was h3642. The results were unchangedafter a sensitivity analysis.

Table I. Costs and benefits of overactive bladder treatments

Strategy QALYs gained Overall costs (d)

Tolterodine 0.0111 1424

Solifenacin 0.0115 1344

Fesoterodine 4mg 0.0124 1362

Fesoterodine 8mg 0.0143 1294



7. Rufinamide Option for Lennox-GastautSyndrome

According to the results of a cost-effectivenessanalysis, rufinamide should be considered as atreatment option for Lennox-Gastaut syndrome(LGS), particularly because treatment choice isimportant for this devastating and rare condition.[25]

The analysis used a Markov model to deter-mine the cost effectiveness of rufinamide relativeto topiramate and lamotrigine as adjunctivetherapy for LGS. Safety and efficacy data wereobtained from the literature. QALY benefits ac-cumulated over 3 years were calculated usingLGS-related health-state utilities obtained from autility study carried out using the time trade-off(TTO) method and EQ-5D questionnaires. Costswere estimated from the perspective of the UKNHS and personal social services.

The base-case analysis using TTO utilitiessuggested that, over 3 years, rufinamide was as-sociated with an incremental cost per QALY ofd20 538 compared with topiramate and d154 831compared with lamotrigine. Using EQ-5D uti-lities, a secondary analysis found that rufinamidewas associated with an incremental cost perQALY of d12 034 compared with topiramate andd56 466 compared with lamotrigine.

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170 Meeting Report


International Society for Pharmacoeconomics and Out-comes Research; 2008 Nov 8-11; Athens, 431

15. Macedo A, Monteiro I, Ray JA, et al. Cost-effectiveness oftreatment with trastuzumab in patients with early breastcancer from the Portuguese societal perspective [poster no.PCN40]. 11th Annual European Congress of the Inter-national Society for Pharmacoeconomics and OutcomesResearch; 2008 Nov 8-11; Athens, 472

16. Essers BA, Tjan Heijnen V, Severens JL, et al. Economicevaluation of trastuzumab for the adjuvant treatment ofHER2 positive early breast cancer in The Netherlands[poster no. PCN41]. 11th Annual European Congress ofthe International Society for Pharmacoeconomics andOutcomes Research; 2008 Nov 8-11; Athens, 472

17. Rubio-Terres C, Gomez-Codina J, Rıos Herranz E, et al.Pharmacoeconomic analysis of the addition of rituximabto first-line chemotherapy treatment regimens in Spanishpatients with advanced follicular lymphoma [poster PCN69].11th Annual European Congress of the InternationalSociety for Pharmacoeconomics and Outcomes Research;2008 Nov 8-11; Athens, 481

18. Nagy B, Kutikova L, Stastny M, et al. An economic eva-luation of dasatinib (Sprycel�) in chronic phase chronicmyeloid leukemia in central and eastern Europe [poster no.CN8]. 11th Annual European Congress of the Inter-national Society for Pharmacoeconomics and OutcomesResearch; 2008 Nov 8-11; Athens, 358

19. Negreiro F, Pereira C, Pereira H, et al. Economic analysis oferlotinib, docetaxel, pemetrexed and best supportive careas 2nd or 3rd line treatment of non-small cell lung cancer[poster no. PCN52]. 11th Annual European Congress ofthe International Society for Pharmacoeconomics andOutcomes Research; 2008 Nov 8-11; Athens, 476

20. Pradelli L, Iannazzo S. Pharmacoeconomic evaluationof solifenacin in the treatment of overactive bladder syn-

drome in Italy [poster no. PUK4]. 11th Annual EuropeanCongress of the International Society for Pharmacoeco-nomics and Outcomes Research; 2008 Nov 8-11; Athens,650-1

21. Cardozo L, Thorpe A, Grishchenko M, et al. A cost-utilityanalysis of solifenacin 5mg and solifenacin 10mg versustolterodine ER 4mg in the pharmacological treatment ofpatients with overactive bladder [poster no. PUK11]. 11thAnnual European Congress of the International Societyfor Pharmacoeconomics and Outcomes Research; 2008Nov 8-11; Athens, 653

22. Cardozo L, Thorpe A, Grishchenko M, et al. A cost-utilityanalysis of solifenacin 5mg and 10mg versus fesoterodine4mg and 8mg in the pharmacological treatment of patientswith overactive bladder in the UK NHS [poster PUK12].11th Annual European Congress of the International So-ciety for Pharmacoeconomics and Outcomes Research;2008 Nov 8-11; Athens, 653

23. Kelleher C, Snedecor SJ, Botteman MF, et al. Fesoterodineis cost-effective for the treatment of overactive bladder:results of an economic model [poster no. PUK8]. 11thAnnual European Congress of the International Societyfor Pharmacoeconomics and Outcomes Research; 2008Nov 8-11; Athens, 652

24. Walter E, Brennig C, Moeremans K, et al. Pharmacoeco-nomic evaluation of ranibizumab in the treatment of age-relatedmacular degeneration in Austria [poster no. PSS26].11th Annual European Congress of the International So-ciety for Pharmacoeconomics and Outcomes Research;2008 Nov 8-11; Athens, 617

25. Yi Y, Verdian L, Jansen JP. Rufinamide in the adjunctivetreatment of Lennox-Gastaut syndrome: a cost effectivenessanalysis [poster no. PND18]. 11th Annual European Con-gress of the International Society for Pharmacoeconomicsand Outcomes Research; 2008 Nov 8-11; Athens, 605



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