Objective: To evaluate the cost-effectiveness of alemtuzumab compared with fingolimod, natalizumab, ocrelizumab, and generic glatiramer acetate 20 mg among patients with relapsing multiple sclerosis (RMS) in the United States. Study Design: Markov model with annual periods from payer perspective. Methods: The modeled population represented pooled patients from the CARE-MS I and II trials. Therapies' comparative efficacy at reducing relapses and slowing disability worsening was obtained from network meta-analyses. Safety information was extracted from package inserts. Withdrawal rates, treatment waning, resource use, cost, and utility inputs were derived from published studies and clinical expert opinion. To project the natural history of disease worsening, data from the British Columbia cohort was used. Results: Alemtuzumab dominated comparators by accumulating higher total qualityadjusted life-years (QALYs) (8.977) and lower total costs ($421 996) compared with fingolimod (7.955; $1 085 814), natalizumab (8.456; $1 048 599), ocrelizumab (8.478; $908 365), and generic glatiramer acetate (7.845; $895 661) over a 20-year time horizon. Alemtuzumab's dominance was primarily driven by savings in treatment costs because alemtuzumab has long-term duration of response and is initially administered as 2 annual courses, with 36.1% of patients requiring retreatment over 5 years, whereas comparators are used chronically. In model scenarios where alemtuzumab's long-term duration of response was assumed not to hold and therapy had to be administered annually, probabilistic sensitivity analyses showed that alemtuzumab remained cost-effective versus ocrelizumab at a willingness-to-pay threshold of $100 000/QALY in 74% to 100% of model runs. Conclusions: Alemtuzumab was a cost-effective therapy. Model results should be used to optimize clinical and managed care decisions for effective RMS treatment.

received DMT. Patients with DMT were less likely to have a corticosteroid claim than patients not receiving DMT (39% vs 62%), and less likely to have an ER visit (39% vs 54%) or hospitalization episode (18% vs 29%).

Objectives: To determine the cost-effectiveness of delayed-release dimethyl fumarate (DMF) 240mg vs. glatiramer acetate 40mg (GA) for the treatment of relapsing-remitting multiple sclerosis (RRMS) in FONASA. MethOds: A cohort Markov model was developed based on the Kurtzke Extended Disability Status Scale (EDSS) to simulate progression through 21 health states: 20 levels of disability (10 for RRMS and 10 for secondary progressive MS) and death. Patients entered the model with a baseline EDSS distribution score, progressed and relapsed according to the natural history of disease in a 30-year time horizon using a 3% discount rate. Natural transitions were delayed differentially by treatment applying hazard ratios (HRs). The main effectiveness outcomes were quality-adjusted life-years (QALYs), which incorporated time spent in each EDSS state, incidence of AEs and incidence of relapses. Costs included drug acquisition, administration, monitoring, relapses and AEs expenses. Resource consumption was derived based on opinions from clinical experts and published data. Unit costs were retrieved from the Chilean unitary costs from Compraspublicas website, FONASA "Aranceles MAI 2016" costs and manufacturer cost for DMF to represent payer perspective. All costs are shown in 2016 Chilean pesos. Results: The 30-year cost per RRMS patient was CLP$95,189,737 for DMF and CLP$102,105,874 for GA. DMF demonstrated to increase the QALYs over GA by 0.35 (7.77 vs. 7.42). Therefore, the lower cost and higher QALYs of DMF with respect to GA situate DMF as a dominant therapy versus GA. Univariate sensitivity analysis revealed that the ICER was most sensitive to disability progression efficacy and treatment acquisition costs. Probabilistic sensitivity analysis with 5,000 iterations showed robustness in the deterministic outcome. cOnclusiOns: DMF is dominant in QALYs versus GA 40mg for the treatment of RRMS under FONASA perspective. disclOsuRes: Support provided by Biogen PND38 CosT-effeCTiveNess of levofloxaCiN iNhalaTioN soluTioN vs. azTReoNam iNhalaTioN soluTioN aND TobRamyCiN DRy PowDeR foR iNhalaTioN iN CysTiC fibRosis PaTieNTs iN sweDeNMedic G, Franck-Larsson K, Wille M, Rodahl S, Hemels M Raptor Pharmaceuticals Europe B.V., Objectives: To conduct an economic evaluation of Levofloxacin Inhalation Solution (LIS) compared to tobramycin in dry powder (TIP), and aztreonam lysine inhalation solution (AZLI) in Sweden for the treatment of chronic Pseudomonas aeruginosa lung infection in cystic fibrosis (CF) patients. MethOds: A 24-week cycle Markov model was developed to estimate the expected costs and QALY gains over lifetime. The model simulated the disease progression of CF patients as measured by the decrease in FEV1 percent predicted. Lung transplantation and death were also integrated in the model. The base case analysis was conducted from both Swedish societal and health care perspectives at three time horizons (3-years, 5-years, and lifetime). Costs were in 2016 Swedish Kronor (1 SEK≈0.11 Euro). Results: LIS was dominant vs. TIP over...

A 3 4 7 -A 7 6 6 A629 the impact of increased HCBS investment on elderly Medicaid beneficiaries' care pathways. In this paper, we explore the impact of state Medicaid HCBS investment on the elderly beneficiaries' risks of nursing home admission using four waves of the Health and Retirement Study (2006-2013). Methods: We use a simulated instrument of Medicaid eligibility that depends only on the state's eligibility rules. We draw a random sample of 5,000 observations from our sample at wave 10 (2010-2011), and calculate the fraction of elders who would be eligible for Medicaid HCBS in each state. We then instrument the actual eligibility variable with that simulated instrument. Results: We find that Medicaid eligibility significantly increases higher risk of nursing home admission (1% level). On average, an increase in the Medicaid generosity for HCBS reduces the effect of Medicaid eligibility on the use of nursing homes. For a $1 increase in Medicaid per-capita spending towards HCBS, the average reduction in the predicted conditional probability of nursing home admission is 0.002 percentage points. ConClusions: Our results support the idea that investing in HCBS can lead to long-term cost savings, which is useful in the perspective of framing a Federal-level strategy to develop a high performing system of LTSS for elderly people.objeCtives: Evidence-based and successful policy requires making investment decisions -on all level of health care investments -should be based on objective and verifiable methods. Health technology assessment (HTA) plays an important role in evidence-based decision-making and by the help of HTA optimal health outcomes and efficient use of available resources could be achieved. Methods: A literature review was conducted to define the number of health care investments that was introduced to Hungary between 2010 and 2015 and real, independent HTA Department managed assessments were introduced with validated methods to define the effects of investments on long-term from policy point of view. The aim of the literature review was also to show the opportunities of the involvement of HTA Department, Hungary into the coming EU or member state financed projects e.g. in primary care, screening or public health programs to avoid developing diabetes and the need for expensive interventions. Results: According to the literature review the role of HTA is more and more important in all level of decision making. Despite the investment decision making and assessment of programs are not based on HTA. The Hungarian HTA Department was not involved into any program assessment till the end of 2015 when the Health Services Management Training Centre (HSMTC) of Semmelweis University initiated a cooperation aiming the HTA of diabetes, hypertension and smoking interventions of the Public Health focused Primary Care Model Program of the Swiss-Hungarian Cooperation. ConClusions: More transparency in EU financed health-care related programs ensure an unbiased decision-making process. By the help of the HTA Department...

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