ISPOR Second Annual European Conference Contributed Abstracts

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<ul><li><p> Volume 2 Number 5 1999</p><p>VALUE IN HEALTH</p><p> ISPOR 1098-3015/99/$14.00/350 350408</p><p>350</p><p>ISPOR Second Annual European Conference Contributed Abstracts</p><p>Contributed Podium Presentations</p><p>ECONOMIC &amp; OUTCOMES STUDY RESULTS OF CARDIOVASCULAR DISEASE</p><p>CV1</p><p>LONG TERM COMPLIANCE WITH ANTIHYPERTENSIVE DRUG THERAPY IN A MANAGED CARE ORGANIZATION</p><p>Simons R</p><p>Millennium Biostatistics &amp; Health Economics, Millburn, NJ, USA</p><p>Evidence is accumulating that long term compliance (LTC)may be better with newer antihypertensive agents that havebetter safety profiles.</p><p>OBJECTIVES:</p><p> To evaluate whether newer, better tolerateddrugs improve LTC with antihypertensive medications.</p><p>METHODS:</p><p> We used pharmacy and healthcare adminis-trative claims data from United Healthcare (19941997)to compare retrospectively LTC by antihypertensive drugclass. The study population consisted of hypertensive pa-tients on monotherapy from six U.S. HMOs, and enrolledin the plan for the duration of the 18 months of follow up.We assessed patients on diuretics, beta-blockers (BB),CCBs, ACEs, and ARBs. We estimated a two-stage modelthat measures LTC by drug class while adjusting for physi-cians decisions to select a particular drug due to the pa-tients medical history. Logistic regressions were used firstto estimate physicians prescribing decisions based on thepatients medical profile. Second, Cox regression was usedto estimate LTC for each drug class while controlling forphysicians choices, plan type, HMO geographic location,and patient demography.</p><p>RESULTS:</p><p> The study entry criteria provided for analysisof 9,002 patients with mean age of 54 years and 52%male. By drug, patients were distributed as diuretics 342(3.7%), BB 316 (3.5%), ACEs 3516 (39.0), CCBs 4514(50.1%), and ARBs 314 (3.4%). LTC was significantlybetter for patients treated with ACEs and CCBs comparedto diuretics and BB (61% vs 37% at 1 yr). ARBs showedthe most favorable LTC (90% at 1 yr). The log rank testsindicated that LTC were statistically different (better) forpatients treated with ACEs and CCBs compared to diuret-</p><p>ics and BB (p </p><p>,</p><p> 0.001) and statistically different (better)for patients treated with ARBs compared to ACEs andCCBs (p </p><p>,</p><p> 0.001).</p><p>CONCLUSION:</p><p> These results indicate that choice of anti-</p><p>hypertensives plays an important role in LTC and neweragents with improved tolerability like ARBs provided thebest LTC.</p><p>CV2</p><p>AN ECONOMIC ASSESSMENT OF DALTEPARIN VERSUS WARFARIN IN TOTAL HIP REPLACEMENT</p><p>Pleil A</p><p>1</p><p>, Calais M</p><p>1</p><p>, Vreeland M</p><p>2</p><p>, Reinhart S</p><p>2</p><p>, Mummert L</p><p>2</p><p>, Trotter J</p><p>2</p><p>1</p><p>Pharmacia &amp; Upjohn, Stockholm, Sweden; </p><p>2</p><p>Ovation Research Group, Highland Park, IL, USA</p><p>OJECTIVES:</p><p> To assess the relative cost-efficacy of low-molecular-weight heparin thromboprophylaxis using dalte-parin continued beyond hospitalization and warfarin duringhospitalization in patients undergoing total hip replace-ment (THR) surgery.</p><p>METHODS:</p><p> Patients in this double blind, multi-centerclinical trial received either initial (P1) or extended (P2)thromboprophylaxis post arthroplasty. P1 patients wererandomized to receive dalteparin pre-operatively (Dpre),dalteparin post-operatively (Dpost), or warfarin (Warf) for6 </p><p>6</p><p> 2 days. In P2, patients continued with dalteparin (Dpre,Dpost) or placebo (Warf) through 35 </p><p>6</p><p> 2 days. Economicoutcomes were based on medical interventions associatedprimarily with suspected deep vein thrombosis (DVT) and/or symptoms of pulmonary embolism (PE) with onset dur-ing the study. Total inpatient length of stay (LOS) was in-cluded in calculations of total costs. The thromboprophy-laxis treatment regimen and a composite intervention forall major events were valued based on local resource costs.These costs were then applied to specific patient cases.</p><p>RESULTS:</p><p> A total of 425 patients in the United States(U.S.) and 705 patients in Canada were in P1; 93 U.S. and532 Canadian patients continued to P2. The incidence ofsuspected DVT was higher in the Warf group in P1 and P2(p </p><p>5</p><p> .002; p </p><p>5</p><p> .001). No differences were detected inLOS. In P1 and P2 respectively, more dalteparin patientsreceived blood transfusions (p </p><p>5</p><p> .001; p </p><p>5</p><p> .001). Overallper patient costs (U.S. dollars) were similar in P1 (Dpre </p><p>5</p><p>$6667, Dpost </p><p>5</p><p> $6467, Warf </p><p>5</p><p> $6339) and in P2 (Dpre </p><p>5</p><p>$6060, Dpost </p><p>5</p><p> $5976, Warf </p><p>5</p><p> $5718). Incremental cost-efficacy for dalteparin ranged (in U.S. dollars) from $1799to $4661. An analysis by country yielded similar results.</p></li><li><p> Abstracts</p><p>351</p><p>CONCLUSIONS:</p><p> Despite the higher acquisition cost,thromboprophylaxis with dalteparin is cost-efficacious ver-sus warfarin in preventing DVT after THR.</p><p>CV3</p><p>A COST COMPARISON STUDY OF AMLODIPINE AND ENALAPRIL AS TREATMENT FOR HYPERTENSION IN THE UNITED STATES</p><p>Doyle J, Arikian S, Casciano J, Amsel A, Casciano R</p><p>The Analytica Group, New York, NY, USA</p><p>OBJECTIVES:</p><p> To compare the cost-effectiveness for treat-ment of mild and moderate hypertension using either am-lodipine or enalapril in the United States. The study isbased on data from a randomized controlled clinical trial,conducted with 461 patients.</p><p>METHODS: </p><p>We used the raw data from a one-year,double blind clinical trial of amlodipine versus enalaprilto quantify the treatment dosages associated with eachpatient group. The amlodipine group consisted of 231patients, and the enalapril group included 230 patients.Within the clinical trial, there were no between group sig-nificant differences for age, gender, concomitant medica-tions and current illness at randomization. Mean dosagesof amlodipine and enalapril, as well as the frequency anddosage of diuretic use, were calculated between groupsbased on age, gender and study phase, and were used toestimate the cost of treatment. Efficacy and adverse eventrates were also calculated for each group to compare theoutcomes of the therapy.</p><p>RESULTS:</p><p> Amlodipine ($551.62 per patient annual drugtreatment cost) was less expensive in treating the hyper-tensive patients within the study as compared to enalapril($663.48 per patient annual drug treatment cost). Fur-thermore, a drug price sensitivity test found that with asmuch as a 17% reduction in the cost of enalapril, amlo-dipine would remain a lower or equivalent treatment interms of cost. The mean final visit dose amounts of drugper patient were 7.2 mg/day for amlodipine, and 28 mg/day enalapril. The total reduction in sitting DBP was16.9 mmHg with amlodipine and 16.2 mmHg with enal-april. However, significantly (p </p><p>,</p><p> 0.05) more patients inthe enalapril group (n </p><p>5</p><p> 46, 20%) required the use of adiuretic (HCTZ) to attain control of DBP than in the am-lodipine group (n </p><p>5</p><p> 27, 11.7%). Finally, there were nosignificant differences (p </p><p>,</p><p> 0.05) in adverse events be-tween groups (amlodipine </p><p>5</p><p> 21.2%; enalapril </p><p>5</p><p> 17.4%).Yet, the type of adverse event differed by drug where asignificant effect (p </p><p>,</p><p> 0.001) of amlodipine and edema(15.2%) was found, and a significant effect (p </p><p>,</p><p> 0.001)for enalapril and cough (7.4%) was found.</p><p>CONCLUSION:</p><p> This study suggests that amlodipine is aless costly therapy compared to enalapril, and hence apotentially more cost-effective treatment for mild andmoderate hypertension.</p><p>CV4</p><p>THE COST OF HYPERTENSION AND ITS CORRELATES IN EMILIA ROMAGNA REGION (ITALY): RESULTS FROM THE GREAT STUDY</p><p>Ambrosioni E</p><p>1</p><p>, Belisari A</p><p>2</p><p>, Bustacchini S</p><p>3</p><p>, Costa FV</p><p>1</p><p>, Greco S</p><p>2</p><p>, Ruffo P</p><p>3</p><p>, Mantovani LG</p><p>2</p><p> and the GREAT (GRoup on Economic Assessment of hyperTension) investigators</p><p>1</p><p>Clinica Medica III, Policlinico S. Orsola, Universita di Bologna, Bologna, Italy; </p><p>2</p><p>Centro di Farmacoeconomia, Instituto di Scienze Farmacologiche, Universita di Milano, Milan, Italy; </p><p>3</p><p>Pfizer Italiana, Rome, Italy</p><p>OBJECTIVE:</p><p> Evaluation of the economic impact of hy-pertension and its correlates.</p><p>METHODS:</p><p> Twenty-seven GPs and 9 specialist centersparticipated in this longitudinal study. Information onlifestyle, SBP, DBP, comorbidities, diagnostic and lab ex-ams, hospitalizations, physicians visits, drug and medicaltherapies was collected. We report on healthcare costs(hospitalizations excluded), quantified in the perspectiveof the Italian National Health Service (NHS), by meansof tariffs expressed in Italian Lire 1998, and referred to athree-month period. We used multivariate linear regres-sion to investigate the association between healthcarecosts, drug cost (or proper transformations) and the levelof SBP and DBP. P </p><p>,</p><p> 0.05 were considered statisticallysignificant.</p><p>RESULTS:</p><p> 416 patients were assessed, 210 women (meanage 63 </p><p>6</p><p> 15) and 206 men (61 </p><p>6</p><p> 12). The mean levels ofSBP and DBP were 149 </p><p>6</p><p> 11 and 90 </p><p>6</p><p> 9 mmHg for menand 149 </p><p>6</p><p> 15 and 88 </p><p>6</p><p> 9 mmHg for women. The totalthree months cost of hypertension care was Lit 294.221for men and Lit 253.938 for women (NS, Mann WhitneyU test). Drugs represented the largest part of costs (58%),possibly due to the short time span. We found that newpatients tend to be less costly (P </p><p>5</p><p> 0.006). Patients en-rolled by specialists centers (P </p><p>,</p><p> 0.001); patients with co-morbidities (P </p><p>,</p><p> 0.001); smokers (P </p><p>5</p><p> 0.002) and previ-ously hospitalized patients were more costly (P </p><p>,</p><p> 0.001).No influence of age and sex was detected. The health carecost of hypertension was associated with the level of SBP(P </p><p>5</p><p> 0.007) and DBP (P </p><p>,</p><p> 0.001). The cost of drug ther-apy was significantly higher in patients with higher SBPand DBP levels (P </p><p>,</p><p> 0.001 and P </p><p>5</p><p> 0.005 respectively).</p><p>DISCUSSION:</p><p> Hypertension is a quite costly disease.Healthcare costs of hypertension and the costs of anti-hypertensive drug therapy are associated with the levelboth of SBP and DBP. Interventions effective in controllingSBP and DBP are likely to affect costs.</p><p>CV5</p><p>SIMULATED LIFETIME COSTS TO NATIONAL HEALTH SERVICE (NHS) OF BIOLOGICAL AND MECHANICAL HEART VALVE REPLACEMENT IN YOUNGER VERSUS OLDER PATIENTS</p><p>Griffiths R, Duff S, Prosek B, Llana T</p><p>Covance Health Economics and Outcomes Services Inc., Washington, DC, USA</p></li><li><p> 352</p><p>Abstracts</p><p>BACKGROUND:</p><p> Selection of biological versus mechani-cal heart valve replacement entails tradeoffs in the risk andexpected cost of post-operative bleeding, embolic eventsand reoperation. Additionally, the risk of these events var-ies by age at implant.</p><p>OBJECTIVE:</p><p> To identify the direct medical costs to theNHS of biological and mechanical valve replacement inyounger versus older patients.</p><p>METHODS:</p><p> A Markov decision-analytic model was con-structed to identify the cumulative lifetime costs of valvereplacement and related events in a simulated cohort of10,000 patients followed from valve implantation untildeath. Events included bleeding, embolism, endocarditis,structural valve deterioration, reoperation and death. Eventrates were modeled using linear, and non-linear statisticalhazard functions based on clinical series reported in theliterature. Medical resource use related to events was es-timated based on clinical expert opinion. Costs were as-signed to each event using standard lists of NHS costs.</p><p>RESULTS:</p><p> For aortic valve replacement, the expected life-time costs were 6,812 (biological) and 8,873 (mechani-cal) for persons aged 60, versus 6,281 (biological) and8,137 (mechanical) for persons aged 70 at implant, re-spectively. In the mitral position, costs were 6,968 (biolog-ical) and 8,760 (mechanical) versus 6,299 (biological)and 7,989 (mechanical) in persons aged 60 versus 70 atimplant respectively. Results were most sensitive to bleed-ing, embolic and reoperation event rates, but less sensitiveto the cost per event.</p><p>CONCLUSION:</p><p> The expected lifetime cost of biologicvalve replacement was lower than mechanical valve re-placement for both age groups and valve positions. Thissuggests the economic impact of anticoagulation therapy,bleeding and embolic events, which occur at higher rates inthe mechanical valve, is greater than the economic impactof structural valve deterioration leading to reoperation,which is greater in the biological valve.</p><p>CV6</p><p>COST-EFFECTIVENESS OF STATINS: MOVING BEYOND THE PRIMARY AND SECONDARY PREVENTION DISTINCTION</p><p>Caro J, for the CORE Study Group</p><p>Caro Research Boston, MA, USA</p><p>BACKGROUND:</p><p> Economic analyses of cardiovascular dis-ease (CVD) prevention with statins have generated contro-versy on the most efficient allocation of health care funds:primary prevention, secondary or both? Previous analyseshave focused on one setting or the other. Comparing thesetwo oversimplifies the task of allocating health care re-sources and may lead to unjustified decisions concerningappropriate statin use. Instead, an integrated view acrossthe continuum of risk is required.</p><p>METHODS:</p><p> An economic model of CVD prevention withpravastatinContinuum of Risk Evaluation (CORE)based on West of Scotland Coronary Prevention Study (pri-mary prevention) and Cholesterol and Recurrent Events</p><p>(secondary prevention) study data is detailed. The modelsimulates 10,000 individuals at various stages of CVD(prior manifestation of CVD through multiple events). Allevents are tallied in monthly cycles with costs and life ex-pectancy implications applied appropriately.</p><p>ANALYSES:</p><p> Analyses were completed for various popula-tions and treatment strategies to help determine the mostcost-effective scenarios. For the purpose of these analyses,populations were described in terms of the proportion ofindividuals at various disease stages at the start of follow-up. Treatment strategies were defined on the basis of therisk cut-off at which treatment is initiated for individualswithout pre-existing disease. Analyses were conducted fol-lowing the NCEP and Canadian treatment guidelines.</p><p>CONCLUSION:</p><p> An integrated approach to prevention ofCVD is an area that has not been explored in term of itseconomic impact. CORE permits realistic analysis of pol-icy decisions which involve the entire continuum of riskrather then isolated consideration of specific, but arbi-trary, stages of disease.</p><p>CV7</p><p>AMLODIPINE REDUCES HOSPITALIZATION ASSOCIATED WITH TREATMENT OF CARDIOVASCULAR DISEASES IN PATIENTS WITH CLINICAL CORONARY ARTERY DISEASE</p><p>Chen G, Byington R, Moran M</p><p>Department of Public Health Sciences and Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA</p><p>OBJECTIVE:</p><p> To examine whether amlodipine can reducehospitalization associated with treatment of cardiovascu-lar disease (CVD) in patients with angiographic evidenceof coronary artery disease. Amlodipine is a long acting cal-cium channel antagonist that has been proven to be effec-tive in treating cardiovascular diseases.</p><p>METHOD:</p><p> We used clinical data derived from the Pro-spective Randomized Evaluation of Vascular Effects ofNorvasc Trial (PREVENT). PREVENT was a 3-year, ran-domized, masked, placebo-controlled, multicenter, clinicaltrial originally designed to test the antiatherogenic effect ofthe calcium channel blocker amlodipine in 825 patientswith coronary artery disease (417 patients for amlodipineand 408 patients for placebo). The outcome measures wereclinical CVD events associated with hospital care which in-cluded congestive heart failure (CHF), myocardial infarc-tion (MI), stroke, a...</p></li></ul>

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