PSY33 Clinical and Economic Analysis of Eltrombopag in Chronic Idiopathic Thrombocytopenic Purpura in Context of Russian Health Care System

Abstract

rived from the 3 phase III clinical trials of tapentadol PR in osteoarthritis and lower back pain and published literature. Switch rates to 2nd line therapies and comedication costs were provided by the National Centre of Pharmacoeconomics based on the GMS database analysis. Costs of physician visits were obtained by applying local costs to the number of physician visits in each therapy line obtained from a retrospective analysis of the UK THIN database of GP patient records. Oneway deterministic and probabilistic sensitivity analyses were undertaken to assess the impact of parameter uncertainty. RESULTS: Mean annual total costs per patient from GMS Scheme perspective amount to 4,367€ for tapentadol vs. 4,381€ for oxycodone. Tapentadol generates 0.6316 QALYs compared to 0.6122 QALYs for oxycodone, resulting in tapentadol being a dominant treatment. For DP/LTI Scheme, tapentadol had an ICER of 1,662 €/QALY gained. Results were robust in a broad range of sensitivity analyses. Probability that tapentadol is cost-effective vs. oxycodone at threshold of 20,000 €/QALY gained exceeded 95%. CONCLUSIONS: Compared to oxycodone CR, the most commonly used oral drug for chronic severe non-cancer pain in Ireland, tapentadol PR appears to be a highly cost-effective treatment option. OBJECTIVES:To assess the cost-effectiveness of tapentadol PR compared to opioids (morphine, oxycodone, transdermal buprenorphine [TDB] and transdermal fentanyl [TDF]) for the treatment of severe chronic non-cancer pain from the societal perspective in Portugal. METHODS: A one year Markov transition state model with monthly cycles was built. Four health states were defined: 'no withdrawal and no adverse events treated', 'occurrence of adverse events (AEs) with need for medical treatment', 'withdrawal due to AEs', and 'withdrawal due to lack of efficacy'. If patients did not adequately respond to treatment or withdraw, switching to alternative second line opioid (morphine, hydromorphone, TDB or TDF) was considered. Third line therapy was the absorption state. Data regarding efficacy, tolerability and utility values (EQ-5D) were derived from clinical trials and published literature. Switch rates to subsequent opioid therapies and resource consumption were estimated by clinical experts. Costs were calculated from the societal perspective. Direct costs were calculated based on official Portuguese prices/tariffs, indirect costs derived from the National Health Survey. One-way and probabilistic sensitivity analyses were conducted. RESULTS: Mean annual total costs per patient amounted to 3793 € for morphine, 3,804€ for TDF, 3891 € for TDB, 3964 € for oxycodone, and 4117 € for tapentadol. Total QALYs generated were 0.6102 (morphine), 0.6062 (TDF), 0.6026 (TDB), 0.6096 (oxycodone), and 0.6287 (tapentadol). The resulting ICERs (€/QALY gained) for tapentadol yield 7,995 versus oxycodone, 8,685 versus TDB, 13,943 versus TDF, and 17,547 versus morphine. Varying costs, probabilities, and utilities by Ϯ50%, Ϯ10%, and Ϯ10%, respectively, resulted in an ICER range fr...