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A641and capecitabine monotherapy in terms of incidence of diarrhea, vomiting, stomatitis/mucositis. The hand-foot syndrome occurrred in less than 5% in case of tegafur. Tegafur (in monotherapy or in combination with calcium folinate) is less costly than capecitabine. The difference in costs in favor of tegafur monotherapy amounted to € 1,956.97 per 1 patient per 6 months or € 3,778.53 per year; of tegafur + calcium folinate -€ 2,168.12 and € 4,220.06 per 1 patient per 6 and 12 months, respectively. ConClusions: Tegafur is a cost-saving option compared with capecitabine with similar efficacy and safety.objeCtives: There is new RCT phase 3 clinical evidence that bendamustinrituximab (B-R) is more effective in terms of progression free survival compared to the standard of care CHOP-rituximab (CHOP-R) in indolent non-Hodgkin lymphoma (iNHL). Based on this RCT, we performed a cost-utility analysis of B-R compared to CHOP-R in the treatment of follicular iNHL (stage III and IV) in the Czech Republic. Methods: We developed a life-time Markov cohort model with 28-day cycle length and 5 health states, i.e. on treatment, rituximab maintenance (R-M), stable disease, progression and death. Additionally, we modeled adverse effects of treatment and four sub-states during progression (observation, imunochemotherapy, R-M, post R-M). Transition probabilities and utilities were derived from published literature. Resource use (costs) was calculated from health care payer's perspective in cooperation with major Czech hemato-oncologic experts. Costs and outcomes were discounted by 3.5%. Probabilistic sensitivity analysis (PSA) with 1000 iterations using a willingness to pay (WTP) threshold equal to 3 times GDP per capita (40 100 EUR) in the Czech Republic was performed. Results: Over a life-time horizon, B-R compared to CHOP-R brings additional 1.21 QALY (7.47 vs. 6.26) and 1.31 LYG (9.74 vs. 8.43). The incremental total costs were 1,368 EUR (total life time costs for B-R and CHOP-R were 43,080 EUR and 41,712 EUR, respectively). ICERs thus equal to 1,133 EUR/QALY and 1,044 EUR/LYG. The results of the PSA show that B-R is costeffective in 100% iterations under the WTP threshold; and simultaneously in 99.3% iterations is cost-effective while using threshold equal to 7,300 EUR. ConClusions: B-R proved that it is a highly cost-effective therapy in patients with follicular iNHL. The higher costs of initial bendamustin treatment are in the long-term horizon offset by substantial savings of progression costs. There is 100% probability of B-R being cost-effective at the selected WTP threshold.

Phantom pain is multifactioral and has a complex treatment. Morphine, gabapentinoids, ketamine and regional analgesia have proven efficacy as part of multimodal Pharmacological treatment may not be effective. Prevention and treatment of post-amputation pain with specific and directed interventions should be a main concern of the anesthesiologist. Perioperative psychological support, and alternative therapeutics should be considered as part of a multimodal treatment scheme.

Objectives: To evaluate European physicians' treatment preferences for preventing skeletal-related events (SREs) in patients with bone metastases from solid tumors. MethOds: Physicians completed an online discrete-choice experiment survey consisting of 10 choices between pairs of hypothetical medication profiles for a putative patient. Each profile included five attributes within a pre-defined range (based on prescribing information for the available bone-targeted agents [BTA]): months until first SRE (10, 18 and 28 months); months until worsening of pain (3, 6 and 10 months); annual risk of osteonecrosis of the jaw (ONJ; 0, 1 and 5%); annual risk of renal impairment (0, 4 and 10%); and mode of administration (oral tablet, subcutaneous injection, 15-minute infusion and 120-minute infusion). Choice questions were based on an experimental design with known statistical properties. The survey was pretested with 8 physicians using open-ended interviews. A separate main-effects random parameters logit model was estimated for each country. Results: Physicians from France (n= 191), Germany (n= 192) and the UK (n= 197) completed the survey. Among the attributes included in the survey, months until first SRE and the risk of renal impairement were the most important attributes in France and the UK, whereas in Germany months until first SRE and a delay in worsening of pain were the most important. For all these attributes, better levels were significantly preferred to worse levels (p< 0.05). In all three countries, a 120-minute infusion every 4 weeks was the least preferred mode of administration (p< 0.05). The annual risk of ONJ was judged by physicians to be the least important attribute in all three countries. cOnclusiOns: Physicians generally make treatment decisions regarding choice of BTA for patients with bone metastases based on intent to delay the onset of SREs, managing risk of renal impairment and preventing the worsening of pain.

prices fixed by negociation between the Comité Economique des Produits de Santé and the manufacturers. The average discount ranges from 11% to 73%. The average EMI varies between 1.42 and 2.69 € excluding value added tax (EVAT) per 1000 international units and between 0.09 and 0.22 € EVAT per microgram according to the medicinal product. The average amount refunded to HF can be estimated at january 1, 2012 at 3.37 M€ , or 22.6% of the total budget. We assessed annual prices trends based on starting dates of contract, and we could figure out EMI trends. According to the product, the EMI quickly decline, remain broadly stable or increase. ConClusions: Many of top-selling biologics are due to lose patent protection over the next years. The emergence of competition in pharmaceutical market contributes to better control expenditure in our health system. The great potential for cost savings concerning erythropoietic factors in our study could be investigated in other class of medicinal products.

A7152012 el consumo de ATB aumentó un 32% (de 7.4 a 9.8 DHD). El patrón de consumo total estuvo dado principalmente por las penicilinas de amplio espectro (53%, 61.1 DHD), siendo la amoxicilina el ATB más usado (44%, 50,5 DHD). ConClusiones: Las medidas regulatorias permitieron disminuir el consumo y los costos/DDD de ATB en Chile. Sin embargo, el aumento progresivo observado indica la necesidad de revisar la calidad en la utilización de los ATB y el cumplimiento de la regulación vigente.

To evaluate clinical and economic value of ipilimumab in the treatment of advanced melanoma compared with drugs available for the treatment of advanced cancer. MethOds: An analysis was performed comparing ipilimumab and other drugs for advanced cancer regarding overall survival (OS) and costs associated with improvement in survival. Parameters analyzed were: improvement in median/mean OS, improvement on survival rate at 1 year and the number needed to treat (NNT) to avoid one death. Monthly costs for improvement in mean OS were evaluated. Efficacy data were obtained from clinical trials. Medications costs were obtained from official price lists, such as Banco de Dados de Preços do Sistema de Saúde do Ministério da Saúde Brasileiro and Lista da Câmara de Regulação do Mercado de Medicamentos da Agência Nacional de Vigilância Sanitária (CMED). Results: Improvement in median OS ranged from +2.8 (sorafenib) to +4.8 (transtuzumab), and improvements in mean OS ranged from +1.6 (sorafenib) to +6.1 (ipilimumab). Only ipilimumab showed better mean OS compared with the median OS (6.1 vs. 3.7). This demonstrates the effect of ipilimumab in prolonging OS in long term, which is observed in a considerable proportion of patients treated with this drug. Major improvement in the survival rate in 1 year occurred with ipilimumab (20%). The NNT to prevent 1 death ranged from 7 (ipilimumab) to 61 (bevacizumab for lung cancer). Costs per month of mean OS improvement ranged from BRL 34,906 (sorafenib) to BRL 64,410 (bevacizumab for lung cancer). cOnclusiOns: This comparative analysis of drugs used for treatment of advanced cancer used key parameters for decision making in health sciences. The results suggest that ipilimumab delivers superior clinical and economic benefits when compared with other drugs available in Brazil for the treatment of advanced cancer.

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