Prs50 - Cost-Effectiveness Analysis of Surfactant Therapy for the Treatment of Respiratory Distress Syndrome Newborn in the Russian Federation

Abstract

effectiveness of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) vs. FF/VI was thus assessed from a Quebec societal perspective, leveraging data from the IMPACT trial (NCT02164513). METHODS: A validated linked risk equation, COPD disease progression, model (Briggs 2017 Med Decis Making 37:4) was populated with baseline characteristics, efficacy and medication use from IMPACT. Quebec healthcare resource and societal and drug costs were applied, with future costs and health outcomes discounted at 1.5% annually. The analysis was probabilistic, with a lifetime horizon. Outputs included exacerbation rates, costs (2017 CAD), life-years (LYs), qualityadjusted life years (QALYs) gained and incremental cost effectiveness ratio (ICER) per QALY. Sensitivity analyses explored the robustness of results by varying parameter values and assumptions. RESULTS: Compared with FF/VI, FF/UMEC/VI resulted in fewer moderate and severe exacerbations (10.52 and 3.38 versus 11.12 and 3.48), translating to fewer total per patient per year exacerbations (1.53 versus 1.62). Overall mean (95% CI) incremental costs were $2,489 ($1,861, $3,212) for FF/UMEC/VI compared with FF/VI but total indirect non-drug costs were lower ($4,428 versus $4,608). Incremental LYs (undiscounted, 95% CI) and QALYs were 0.14 (0.07, 0.21) and 0.13 (0.09, 0.18), resulted in an ICER of $18,887 ($14,625, $25,587) per QALY. The probability of FF/UMEC/VI being cost-effective compared with FF/VI was 100%, at a willingness-to-pay WTP) threshold of $50,000 per QALY. Across all scenarios considered the ICER ranged from $14,281 to $23,798, remaining below the WTP threshold. Results were most sensitive to time horizon, efficacy of treatment postdiscontinuation and changing FF/VI cost. CONCLUSIONS: FF/UMEC/VI was predicted to improve health outcomes and to be a cost-effective option for treatment of patients with moderate/severe COPD and a history of exacerbations, compared with FF/ VI in Quebec.OBJECTIVES: Idiopathic pulmonary fibrosis (IPF) is one of the rare interstitial lung disorders. For a long time, patients with IPF received symptomatic treatment. A few years ago, pirfenidone and nintedanib were introduced for treating IPF in Russia. The aim of the study is to perform health-economic evaluation of pirfenidone and nintedanib in patients with IPF. METHODS: Cost-effectiveness analysis and sensitivity analysis were performed. One-year survival and exacerbation frequency rate were included into the model as the effectiveness criteria. Decision tree model was used. All direct costs were calculated from the healthcare system perspective. Direct costs accounted for pirfenidone and nintedanib costs, cost of in-patient treatment of IPF exacerbation and cost of adverse events (AEs) correction during therapy. Price elasticity analysis of pirfenidone was performed. RESULTS: The base case scenario showed that pirfenidone is as effective as nintedanib in patients with IPF (probability of being survive during 1 year was 98.9% and 96.4%, exacerbation rates were 2,4% and 2,4%...

Health Economic Studies of Surfactant Replacement Therapy in Neonates with Respiratory Distress Syndrome: A Systematic Literature Review

“…The interventions or comparators identified in the studies were surfactants such as poractant alfa, beractant, calsurf and calfactant [ 3 , 24 – 30 ]. Four of the studies in the SLR reporting on economic evaluations included a healthcare sector perspective [ 24 – 27 ]. The perspective taken by Krasnova et al was not reported [ 28 ].…”

“…The perspective taken by Krasnova et al was not reported [ 28 ]. The sources of clinical and cost data were derived from real-world settings [ 3 , 28 ], pharmacy information systems, electronic medical records [ 30 ], a prior clinical study, hospital data [ 24 , 29 ] and a meta-analysis [ 27 ].…”

“…Two studies from Russia [ 27 , 28 ] analysed beractant and poractant alfa for treatment of RDS by using decision-tree models. Yagudina et al reported that the cost-effectiveness ratios per life saved with beractant and poractant alfa were €5087 and €4585, respectively.…”

“…Additionally, the data indicate that surfactant administration via less invasive surfactant administration (with or without CPAP) is a cost‑effective alternative compared with no surfactant (CPAP only) for preterm infants with RDS [ 25 , 26 ]. Additionally, evidence included in this SLR indicates that poractant alfa has a better cost‑effectiveness ratio compared with beractant [ 27 ]. Studies implementing decision-tree modelling to investigate the pharmacoeconomic impact of surfactant therapy in infants with RDS reported that poractant alfa was cost-effective and cost-saving compared with beractant at both the 100 mg/kg and 200 mg/kg doses [ 27 , 28 ].…”

“…Additionally, evidence included in this SLR indicates that poractant alfa has a better cost‑effectiveness ratio compared with beractant [ 27 ]. Studies implementing decision-tree modelling to investigate the pharmacoeconomic impact of surfactant therapy in infants with RDS reported that poractant alfa was cost-effective and cost-saving compared with beractant at both the 100 mg/kg and 200 mg/kg doses [ 27 , 28 ]. While these studies were conducted in Russia and may not be generalizable to healthcare institutions worldwide, further global investigations exploring the impact of surfactant use on economic burden are needed to establish how infants with RDS may be treated safely and cost-effectively.…”