Objectives: To estimate the total costs of treating head and neck cancers, specifically oropharyngeal, laryngeal and oral cavity cancer, in secondary care facilities in Conclusions:In 4 years, the number of patients with oropharyngeal cancer receiving some form of inpatient care increased by more than half, and associated costs increased by three quarters. This reinforces the case for prevention and early detection strategies to help contain this epidemiological and economic burden. | INTRODUCTIONHead and neck cancers, originating from the upper aero-digestive tract, are amongst the top ten malignancies globally for both incidence and mortality. 1 In the most recent National Audit of cases inAll authors contributed equally to this work. Changes in treatment costs for the different cancer subsites (oropharyngeal, laryngeal and oral cavity) over this time period were examined. Particular attention was paid to oropharyngeal cancer, for which it is thought costs may have risen at a faster rate relative to other subsites because of the improved survival profile of the growing proportion of squamous cell carcinoma (SCC) cases, assumed to be HPV positive. These cases can have more complex presentations and diagnostic pathways, which in turn lead to higher resource use.

BackgroundAnal cancer requires a multidisciplinary approach to treatment with often complex interventions. Little is known regarding the associated costs and resource use.MethodsPatient records were extracted from a national hospital database to estimate the number of patients treated for anal cancer in England. Identified resource use was linked to published UK cost estimates to quantify the reimbursement of treatment through the Payment by Results system. A mathematical model was developed simultaneously to validate findings and to calculate the average 10-year cost of treating a squamous cell anal carcinoma case from diagnosis. The model utilised data from the Association of Coloproctology of Great Britain and Ireland's anal cancer position statement.ResultsOn average, 1,564 patients were admitted to hospital and 389 attended an outpatient facility per year. The average annual cost per inpatient and outpatient ranged from £4,562-£5,230 and £1,146-£1,335, respectively. Based on the model estimates, the inflated cost per case was between £16,470-£16,652. Results were most sensitive to the mode of admission for primary treatment and the costs of staging/diagnosis (inflated range: £14,309-£23,264).ConclusionsDespite limitations in the available data, these results indicate that the cost of treating anal cancer is significant. Further observational work is required in order to verify these findings.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1123) contains supplementary material, which is available to authorized users.

BackgroundPenile cancer is a rare malignancy in Western countries, with an incidence rate of around 1 per 100,000. Due to its rarity, most treatment recommendations are based on small trials and case series reports. Furthermore, data on the resource implications are scarce. The objective of this study was to estimate the annual economic burden of treating penile cancer in England between 2006 and 2011 and the cost of treating a single case based on a modified version of the European Association of Urology penile cancer treatment guidelines.MethodsA retrospective (non-comparative) case series was performed using data extracted from Hospital Episode Statistics. Patient admission data for invasive penile cancer or carcinoma in situ of the penis was extracted by ICD-10 code and matched to data from the 2010/11 National Tariff to calculate the mean number of patients and associated annual cost. A mathematical model was simultaneously developed to estimate mean treatment costs per patient based on interventions and their associated outcomes, advised under a modified version of the European Association of Urologists Treatment Guidelines.ResultsApproximately 640 patients per year received some form of inpatient care between 2006 and 2011, amounting to an average of 1,292 spells of care; with an average of 48 patients being treated in an outpatient setting. Mean annual costs per invasive penile cancer inpatient and outpatient were £3,737 and £1,051 respectively, with total mean annual costs amounting to £2,442,020 (excluding high cost drugs). The mean cost per case, including follow-up, was estimated to be £7,421 to £8,063. Results were sensitive to the setting in which care was delivered.ConclusionsThe treatment of penile cancer consumes similar levels of resource to other urological cancers. This should be factored in to decisions concerning new treatment modalities as well as choices around resource allocation in specialist treatment centres and the value of preventative measures.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2669-2) contains supplementary material, which is available to authorized users.

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in FY2016. Compared to foreign countries, a lack of resources for conducting the analysis has been pointed out in Japan. However, pharmaceutical and medical device industries are urged to seek practical approaches utilizing best available resources. The objective of this study was to review articles for cost-effectiveness analysis of major depression disease (MDD) and to evaluate analytical approaches that can be applied to Japanese environment. MethOds: The literature search was conducted in MEDLINE and JDream III. Inclusion criteria are studies of 1) treatment for MDD, 2) cost-effectiveness analysis (CEA), 3) published in the past 10 years. Studies were assessed for the followings: country, model structure and simulation method, time horizon, perspective, source of key parameters, results, and key drivers determined from sensitivity analysis. Results: Twenty-three studies were reviewed in details. Markov (6 articles) and decision-tree (8 articles) models were adopted, and time horizon were relatively short, ranging from 8 weeks to 5 years. Thirteen studies included costs of productivity loss. Costs were based on literature or expert opinion in 21 studies. Utility scores were referred to other studies (17 articles). Parameters which became key drivers for these analyses varied among studies. cOnclusiOns: Data collection methods adopted in prior studies were considered applicable to CEA for UC treatment in Japan. Cost data can be obtained not only from questionnaire survey to doctors but commercial database. Because evidence on utility scores of Japanese population is still limited, further studies will be needed, especially on MDD patients in depression, remission, and relapse phase of treatment.

Background Patients with highly active relapsing-remitting multiple sclerosis inadequately responding to first-line therapies (interferon-based therapies, glatiramer acetate, dimethyl fumarate, and teriflunomide, known collectively as "BRACETD") often switch to natalizumab or fingolimod. Objective The aim was to estimate the comparative effectiveness of switching to natalizumab or fingolimod or within BRACETD using real-world data and to evaluate the cost-effectiveness of switching to natalizumab versus fingolimod using a United Kingdom (UK) third-party payer perspective. Methods Real-world data were obtained from MSBase for patients relapsing on BRACETD in the year before switching to natalizumab or fingolimod or within BRACETD. Three-way-multinomial-propensity-score-matched cohorts were identified, and comparisons between treatment groups were conducted for annualised relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M). Results were applied in a cost-effectiveness model over a lifetime horizon using a published Markov structure with health states based on the Expanded Disability Status Scale. Other model parameters were obtained from the UK MS Survey 2015, published literature, and publicly available UK sources. ResultsThe MSBase analysis found a significant reduction in ARR (rate ratio [RR] = 0.64; 95% confidence interval [CI] 0.57-0.72; p < 0.001) and an increase in CDI6M (hazard ratio [HR] = 1.67; 95% CI 1.30-2.15; p < 0.001) for switching to natalizumab compared with BRACETD. For switching to fingolimod, the reduction in ARR (RR = 0.91; 95% CI 0.81-1.03; p = 0.133) and increase in CDI6M (HR = 1.30; 95% CI 0.99-1.72; p = 0.058) compared with BRACETD were not significant. Switching to natalizumab was associated with a significant reduction in ARR (RR = 0.70; 95% CI 0.62-0.79; p < 0.001) and an increase in CDI6M (HR = 1.28; 95% CI 1.01-1.62; p = 0.040) compared to switching to fingolimod. No evidence of difference in CDW6M was found between treatment groups. Natalizumab dominated (higher quality-adjusted life-years [QALYs] and lower costs) fingolimod in the base-case cost-effectiveness analysis (0.453 higher QALYs and £20,843 lower costs per patient). Results were consistent across sensitivity analyses.

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A457 6.6), both p< 0.05. A greater proportion of schizophrenia caregivers reported at least one emergency room visit (26.1% vs. 20.2%) and hospitalization (20.4% vs. 14.3%) than other caregivers, both p< 0.05. No significant difference was found on work-related impairment, probably due to the small sample of employed respondents. ConClusions: Schizophrenia caregivers reported greater activity impairment and more resource use than non-caregivers and caregivers of adults with other conditions. Better family and social support systems may help reduce the burden for schizophrenia caregivers.objeCtives: To investigate medication usage patterns, health care resource utilization and direct medical costs of patients with Major Depressive Disorder (MDD) in Beijing, China. Methods: Data were randomly extracted from Beijing Urban Employee Basic Medical Insurance Database. Patients who were aged ≥ 18 years, with at least 1 primary diagnosis of MDD and 12-month continuous enrollment after their first observed MDD diagnosis between 2012 and 2013 were identified. Those with a diagnosis of schizophrenia, bipolar disorder or cancer within the study period were excluded. Descriptive statistics were used to describe patient profiles, medication usage, health care resource utilization and costs. Results: A total of 8484 patients were included with mean (±SD) age of 57.15 (±15.34) years, 63.02% female and 94.47% having co-morbidities. 71.35% of patients were treated with antidepressant medications, including 60.53% of patients with SSRIs, followed by NaSSA (8.96%) and SNRIs (8.26%). Concomitant medications were prescribed for 76.78% of patients. Only 0.42% of patients experienced ≥ 1 MDDrelated hospitalizations during the 1-year follow up and the average annual number of hospitalization was 1.22 (±0.64) for those hospitalized patients. The length of stay was 33.38 (±30.6) days per hospitalization and 36.61 (±40.04) days per patient-year. All patients had ≥ 1 MDD-related outpatient visits. The mean annual number of outpatient visits was 3.06 (±2.99). The mean annual direct medical cost for all MDD patients was 1694.05 (±2513.71) RMB with 48.54% for antidepressant medications, and that for hospitalized patients was 21290.97 (±16121.61) RMB with 15.03% for antidepressant medications and 66.45% for non-drug medical costs. ConClusions: In Beijing China, most MDD patients also had comorbid conditions and were mainly treated in the outpatient setting. SSRIs were the most commonly used antidepressants. The economic burden of MDD was considerable. PMH24 atoMoxetine for tHe treatMent of newly diagnosed adUlts witH adHd -a cost effectiveness analysis in sPain