The results of this study build on previous results of the AMPP Study, demonstrating that headache-related direct, indirect, and total costs are significantly greater among individuals with chronic migraine than with episodic migraine in the United States.

ObjectiveTo describe headache-related health resource usage in chronic and episodic migraine across six countries.MethodsA web-based questionnaire eliciting data on several topics, including health resource usage, was administered to panellists with migraine from the USA, Canada, UK, Germany, France and Australia. Respondents were grouped into episodic and chronic migraine, based on reported headache phenotype and headache-day frequency. ORs were calculated, comparing usage in each country to that in the US, controlling for chronic versus episodic migraine and other factors.ResultsRelative to the USA, the odds of visiting a provider for headache during the preceding 3 months were significantly higher in all countries, except Germany. Respondents in France were more likely to report having a provider they typically visited for headache-related care. The odds of visiting the emergency department for headache were significantly lower in France, the UK and Germany, and hospitalisation for headache was significantly more frequent in Canada and Australia. Respondents from all countries, except Canada, were more likely to report currently using a prescription-acute treatment, and those from France were more likely to report trying more than three acute treatments. Preventive treatment use did not differ significantly.ConclusionsHeadache-related resource usage differed significantly between the USA and other countries. US respondents were generally less likely to report recent provider visits and use of prescription-acute treatments. They were more likely to report emergency department visits than in European countries, but less likely to report hospitalisation than in Canada and Australia.

Purpose: The Centers for Medicare and Medicaid Services (CMS) recently issued a national coverage determination that provides reimbursement for low-dose computed tomography (CT) lung cancer screening for enrollees age 55 to 77 years with Ն 30 -pack-year smoking history who currently smoke or quit in the last 15 years. The clinical, resource use, and fiscal impacts of this change in screening coverage policy remain uncertain. Methods:We developed a simulation model to forecast the 5-year health outcome impacts of the CMS low-dose CT screening policy in Medicare compared with no screening. The model used data from the National Lung Screening Trial, CMS enrollment statistics and reimbursement schedules, and peer-reviewed literature. Outcomes included counts of screening examinations, patient cases of lung cancer detected, stage distribution, and total and per-enrollee permonth fiscal impact. Results:Over 5 years, we project that low-dose CT screening will result in 10.7 million more low-dose CT scans, 52,000 more lung cancers detected, and increased overall expenditure of $6.8 billion ($2.22 per Medicare enrollee per month). The most fiscally impactful factors were the average cost-per-screening episode, proportion of enrollees eligible for screening, and cost of treating stage I lung cancer. Conclusion:Low-dose CT screening is expected to increase lung cancer diagnoses, shift stage at diagnosis toward earlier stages, and substantially increase Medicare expenditures over a 5-year time horizon. These projections can inform planning efforts by Medicare administrators, contracted health care providers, and other stakeholders.

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A75 lung cancer (NSCLC). Methods: A Markov Model was developed to evaluate the disease progression of a cohort of patients with ALK +ve advanced NSCLC in a three year period, that will be treated with Crizotinib. The model compares scenarios With and Without Crizotinib. The difference in total costs is the net impact of Crizotinib on the health care budget. Local epidemiologic data was used. Costs were estimated from Panama Public Health System ($US, 2012) and included costs of treatment, administration and monitoring, palliative care, and severe adverse events. The base case scenario assumes 100% testing rate for ALK in incident patients and 100% market share for crizotinib in ALK+Ve advanced NSCLC patients. Sensitivity analyses were performed for 80-100% market share [3] Results: In a three year period, 23 patients received Crizotinib (from a cohort of 609 advanced NSCLC patients). Cost related to drug acquisition and management of adverse in a world "With" and "Without" Crizotinib during three years are $13.426.918 and $12.670.537 respectively which represents $756.381 of budget impact associated with the insertion of Crizotinib in the market, however it shows savings in terms of drug administration, monitoring costs and progression cost, with an estimated of $471.952