At IMSS, sunitinib+BSC would provide substantial clinical benefits to patients suffering unresectable pancreatic NET, although the latter would increase medical costs of treatment and clinical follow up.

males, 10% and 7% were children and females respectively. Majority of the males (79%) were between the ages of 15-35 years of age. On an average the direct cost incurred to treat the injured cases (103) was PKR13,000 excluding subsidy of at least PKR53,000. The total cost was PKR66,000 (USD805) and this cost shall be considered as minimum cost. CONCLUSIONS: Motorcycle accidents are incurring huge economic burden on society. The morbidity and mortality can be reduced by legislative action concerning helmet use, licensing and rigid enforcement of traffic laws. Rehabilitation services for the victims to get fully recovered may also be provided to reduce the future economic loss. OBJECTIVES:Orthopedic surgery has been associated with significant risk of develop deep vein thrombosis (DVT). The objective of this study was to estimate the cost-effectiveness of thromboprophylaxis therapies for prevention of DVT associated in patients undergoing hip surgery from an institutional perspective (Mexican Social Security Institute, IMSS). METHODS: Economic and health consequences of thromboprophylaxis were assessed through a six-state Markov model (one-year time horizon, one-week cycles). Effectiveness measure was reduction in DVT (per 1000 patients). Effectiveness was estimated by local meta-analysis. Doses of alternatives compared were: warfarin (basecase, 5mg 30d); dalteparin (not listed in Mexican formulary, 5000 IU/day 30d); acenocoumarol (4 mg/day 30d); enoxaparin (40 mg/day 30d); nadroparin (5700 IU/day 30d) and unfractionated heparin (UFH) plus warfarin (10000 IU/day 10dϩwarfarin 5 mg/day 20d). No prophylaxis was assessed too. Resource use and unit costs were extracted from IMSS databases (dalteparin cost was provided by the manufacturer). Costs included outpatient and inpatient services, medication costs, imaging and laboratory tests. Univariate sensitivity analysis was performed. Acceptability curves were constructed. RESULTS: DVT cases per alternative were: warfarin 61 (CI 95% 60 -62); dalteparin 33 (32-34); acenocoumarol 80 (78 -82); enoxaparin 57 (56 -58); nadroparin 67 (66 -68);

Efficacy data were computed from all randomized trials (RT) that guided on-label uses of bevacizumab (K-Ras mutated), panitumumab and cetuximab. Non-significant outcomes and toxicity as predictor of efficacy were excluded. Prices for drugs in Spain were assumed to represent the best-value for each drug including all possibilities to reduce pharmacy costs. For 1st line, median duration of therapy reported by RT was used to calculate the final budget. 70kg and 1.7 m were used as reference for patient dose calculations. RESULTS: We simulated 3 main scenarios based on the possibilities of therapy for K-Ras wild type (wt) patients assuming that all patients harboring a K-Ras mutated tumor received bevacizumab based chemotherapy. So, in scenario A K-Ras wt patients received weekly cetuximab combined with FOLFOX, ORR reaches 54% and global cost per RR sums €20,026. Scenario B: administering panitumumab-FOLFOX yields 51% ORR and € 19,861 per RR. Scenario C: cetuximab biweekly combined with FOLFOX yields 54% and €19,726. ICER for scenario A vs B is estimated at € 22,835 per additional response. ICER for scenario C vs B is estimated at € 968 per additional response. CONCLUSIONS: First-line oxalipatin combinations of cetuximab for wt and bevacizumab for mutated patients optimize response rate rather than panitumumab and bevacizumab schedules. Efficiency of this therapeutic approach could be improved with biweekly cetuximab administration. Marginal cost differences between cetuximab and panitumumab therapies are exceeded by efficacy gap as measured by response rates in RT.

and net monetary benefit calculations. Sensitive variables include abiraterone costs and neutropenia costs of mitozantrone. Even assuming most patients are severely ill to match sites with sicker populations, the relative cost-effectiveness does not change; abiraterone favored and cabazitaxel always above tolerable thresholds. CONCLUSIONS: Abiraterone is the most cost effective given WTP of $100,000. Despite slightly higher survival with cabazitaxel, it is never cost-effective with high drug and neutropenia costs. Even for care sites with relatively ill patients, abiraterone remains cost-effective.

the number of patients achieving major molecular and complete cytogenetic responses. Fewer patients treated with nilotinib progressed to advance or blast phase than with imatinib. The objective of this analysis was to assess, from a HK societal perspective, the cost and quality-adjusted-life-years (QALYs) of imatinib versus nilotinib in newly-diagnosed Phϩ CML-CP. METHODS: A literature-based Markov model was developed to estimate the lifetime QALYs and costs of typical 47 yearold CML-CP patients initiating first-line (FL) therapy. Two periods were considered: the first year, reflecting the ENESTnd data, and all subsequent years (until all patients had died/reached 100 years), based on stratified disease progression data from the International Randomized Study of Interferon and STI571 (IRIS) study. Patients who discontinued FL therapy were modeled to receive one additional tyrosine kinase inhibitor (TKI). Prognosis after FL therapy discontinuation was modeled using published studies. Local demographics and costs were used to populate the model. Quality of life was assumed to vary by disease stage and treatment status (on/off TKI). The threshold used to define a cost-effective therapy was the WHO's 3 x GDP/capita (i.e., HKD247,712; USD31,758; USD1 ϭ HKD7.8). RESULTS: Compared to imatinib, nilotinib results in a gain of 2.32 life years and 2.30 QALYs. The cost/life year gain was HKD156,042 (USD20,005) and incremental cost/ QALY was HKD157,313 (USD20,168). Univariate sensitivity analysis showed results were generally robust. Key drivers were the duration of analysis, discount rates, age at therapy initiation, and inclusion/exclusion of indirect costs. In probabilistic sensitivity analysis, 95% of model replications cost ՅHKD 180,000 (USD23,077)/QALY gained. CONCLUSIONS: Using local and non-local data, this analysis suggests that nilotinib is cost-effective compared to imatinib as FL treatment for CML-CP patients from a HK societal perspective.