Vortragssitzung
Economic Evaluation 2
Vorträge
Cost of illness of high risk for stroke and bleeding in patients with atrial fibrillation
Eric Faß, WIG2 Institut
Einleitung / Introduction
Atrial fibrillation (AF) is one of the most frequent cardiac disorders, associated with increased stroke risk, mortality and hospitalization rates. Due to demographic ageing increasing AF-prevalence as well as associated healthcare costs are expected. Although oral anticoagulants (OACs) and novel oral anticoagulants (NOACs) can prevent stroke effectively, they are contraindicated for some patients with certain risk factors, due to the increased drug-induced risk of severe bleeding. Percutaneous catheter-based left atrial appendage closure (LAAC) is a potential alternative for stroke prevention and can eliminate the need for permanent blood thinners, especially in this high-risk group. Even though evidence regarding effectiveness of LAAC exists, more research in high-risk AF patients is needed. The multicenter clinical trial CLOSURE-AF-DZHK16 closes this research gap, by analyzing the net clinical benefit of LAAC in this high-risk group compared to the best possible medical therapy (including NOAC, when feasible). The associated substudy EvaClosure focuses on the health economic evaluation of LAAC. This cost-of-illness study is the first part of EvaClosure, comparing utilisation and healthcare costs of high-risk AF patients to AF patients who are not at high risk. The results provide comprehensive insights into cost dimensions and cost drivers associated to high risk of stroke and bleeding in AF patients. The results will be incorporated in further health economic modelling within EvaClosure and will refine estimates of the economic burden of AF.
Methode / Method
We assess the high-risk cost-of illness from an SHI perspective in a retrospective controlled study by using longitudinal data from a large German statutory health insurance (N > 3.2 million). Applying inclusion and exclusion criteria alike to those of CLOSURE-AF, patients with AF as well as high risk of stroke (CHA2DS2VASc-Score ≥ 2) and bleeding (HAS-BLED-Score ≥ 3) at baseline (2016-2018) are identified. Differences in healthcare costs between the high-risk population and a propensity-matched non-high-risk control group with similar age, sex, and comorbidity profiles are analyzed in a 1-year follow-up. Costs will be captured on outpatient physician-, hospital- and rehabilitation services, inpatient care, drug expenditures, medical aids, disability- and sick-leave payments. To account for potential group-specific differences due to unobservable heterogeneity we use a difference-in-differences estimation. To identify the main cost predictors, zero-inflated negative binomial regression models are applied.
Ergebnisse / Results
Data collection will be completed by 11/2021 and analyses are ongoing, so preliminary results will only be available at the conference in 03/2022.
AutorInnen
Eric Faß, WIG2 Institut
Marco Müller, WIG2 Institut
Franziska Claus, WIG2 Institut
Ulf Landmesser, Charité – Universitätsmedizin Berlin
Ines Weinhold, WIG2 Institut
Precision medicine in chronic inflammation – a review of methodological issues in economic evaluations
Natalie Baier, Kiel Institut für Weltwirtschaft
Einleitung / Introduction
Precision Medicine (PM) has created new opportunities for improving the treatment of a range of chronic inflammatory diseases. Addressing the heterogeneity of patients through stratification and treatment adjustments over time, PM promises to overcome the limits of conventional one-size-fits-all treatments. A key question for economic evaluations is whether the potential benefits can outweigh any additional costs that the practice of PM may entail. Designing economic evaluations so that they can answer this question is far from trivial. PM’s individualized diagnostics and dynamic treatment pathways challenge established approaches to economic evaluation in multiple ways, making substantial innovation in evaluation methods necessary. Our aim is thus to provide an overview of the methodological challenges, to survey recent economic evaluation studies of PM for chronic inflammatory diseases and to evaluate if the identified studies have addressed these challenges.
Methode / Method
We first identified general methodological challenges in the economic evaluation of precision medicine by reviewing existing literature. In a second step, a literature review on studies evaluating PM in chronic inflammation was performed. We searched PubMed with a combination of terms related to PM, chronic inflammatory diseases and economic evaluations and included studies published between 2010 and 2021.
Ergebnisse / Results
Identified methodological challenges are related to the study framework (including e.g. the intervention, the perspective, and discounting), the problem of data availability, the definition of outcomes parameters as well as the complexity of PM that can increase the degree of uncertainty in economic evaluations. The 19 reviewed disease-specific evaluation studies have rather selectively addressed only a few aspects of these methodological challenges and vary substantially in the extent to which they go beyond conventional evaluation approaches.
Zusammenfassung / Conclusion
The focus of this survey is on methodological challenges that distinguish economic evaluations of precision medicine from evaluations of conventional medicine. There are still substantial gaps between recommended methods for the evaluation of PM applications and existing evaluation studies. To overcome these gaps, two things are needed: (1) more sophisticated modeling methods for the complex patient pathways that can arise in PM applications and (2) better methods for the valuation of outcomes from clinical applications of PM. Once these better methods are available, the practice of economic evaluations should be improved.
AutorInnen
Natalie Baier, Kiel Institut für Weltwirtschaft
Espen Elias Groth, LungenClinic Grosshansdorf
Anette Friedrichs, Universitätsklinikum Schleswig-Holstein, Campus Kiel
Michael Stolpe, Kiel Institut für Weltwirtschaft
Cost-effectiveness of a group-based lifestyle-integrated functional exercise program after 12 months follow-up
Sophie Gottschalk
Einleitung / Introduction
Interventions aimed at reducing falls and physical inactivity could alleviate the economic burden attributable to these factors. The study aimed to analyze the cost-effectiveness of a group-delivered version of the Lifestyle-integrated Functional Exercise Program (gLiFE) compared with an individually-delivered (LiFE) program version over a 12-month time horizon.
Methode / Method
The analysis was based on 309 community-dwelling older adults (70+ years) at risk of falling recruited around Heidelberg and Stuttgart (Germany) to participate in the LiFE-is-LiFE randomized non-inferiority trial. Cost-effectiveness of gLiFE was assessed over 12 months using different effect measures (quality-adjusted life years [QALY, EQ-5D-5L], physical activity (PA) [mean number of steps/day], and falls) and cost perspectives (societal and payer’s). Incremental cost-effectiveness ratios (ICER) were determined, and cost-effectiveness acceptability curves (CEAC) were constructed.
Ergebnisse / Results
The cost-effectiveness of gLiFE compared to LiFE was uncertain for increasing QALY or preventing falls, whereas depending on the willingness to pay (WTP) and cost perspective, the probability of cost-effectiveness for increasing PA was high, but still uncertain at most WTP values in the intention-to-treat sample. Based on the per protocol sample, gLiFE was cost-effective for improving PA at WTP per 1,000 steps/day ≥€4,000 (societal) or ≥€1,800 (payer’s perspective).
Zusammenfassung / Conclusion
For giving definite recommendations to decision makers, the cost-effectiveness should be evaluated compared to a regular care group and over a longer time horizon.
AutorInnen
Sophie Gottschalk, Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung
Hans-Helmut König
Michael Schwenk
Corinna Nerz
Clemens Becker
Jochen Klenk
Carl-Philipp Jansen
Judith Dams
Budget impact analysis of a lifestyle-integrated functional exercise program for older people in Germany: A Markov model based on data from the LiFE-is-LiFE trial
Judith Dams, Universitätsklinikum Hamburg-Eppendorf
Einleitung / Introduction
In recent decades, fall prevention programs have been implemented to reduce falls in older people. A recent cost-effectiveness analysis compared a group-delivered Lifestyle-integrated Functional Exercise Program (gLiFE) with an individually-delivered program (LiFE) in community-dwelling people (aged ≥70) at risk of falling. In addition, the current study aimed to analyze the budget impact for the statutory health and long-term care insurance as potential payers of gLiFE and LiFE compared to standard care for Germany.
Methode / Method
A Markov model was designed to reflect care needs of community-dwelling persons. Costs for outpatient physician, hospitalization, rehabilitation, formal care and intervention costs were assessed from a payer’s perspective. The budget impact for the nationwide implementation of gLiFE and LiFE was determined over 5 years. Impact of parameter uncertainties was assessed in sensitivity analyses.
Ergebnisse / Results
The budget impact due to intervention costs was €516 million for LiFE and €188 million for gLiFE. Over a 5-year time horizon, €35.0 billion in health care expenditure was incurred for persons with standard care, €35.4 billion for persons with LiFE, and €35.1 billion for persons with gLiFE. Parameter uncertainties in the costs of formal care, uptake of an intervention offer, and in the intervention effects had a major influence.
Zusammenfassung / Conclusion
The current budget impact analysis found that cost were increased for gLiFE and LiFE compared with standard care, with gLiFE having a lower budget impact compared with LiFE. Future research should account for benefits or aspects of fall prevention beyond falls (e.g., physical activity, social aspects, and personal preferences of participants).