utilities for pazopanib and placebo were from PALETTE. Lacking a connected evidence network, estimates of relative effectiveness for trabectedin and ifosfamide were from an unadjusted indirect treatment comparison vs. pazopanib. Costs were from NHS reference costs and other published sources. RESULTS: Compared with placebo, pazopanib is estimated to increase QALYs by 0.130 and costs by £8,072; the incremental cost effectiveness ratio (ICER) for pazopanib vs. placebo is estimated to be £63k/QALY gained. For most parameters, the ICER changed Ͻ30% with ϩ/Ϫ50% changes in the parameter value. Compared with trabectedin and ifosfamide, pazopanib provides equal or more QALYs at a lower cost. CONCLUSIONS: From a UK health care system perspective, pazopanib may not be cost-effective vs. placebo in patients with advanced/metastatic STS based on criteria typically used to evaluate therapies in the UK. Pazopanib may be cost-effective vs. trabectedin and ifosfamide, although there is substantial uncertainty associated with these comparisons. OBJECTIVES:Eurtact trial was the first randomized phase III trial evaluating efficacy and safety of erlotinib vs chemotherapy in the first-line treatment of EGFR mutϩ Caucasian patients. This trial showed an increase in the median PFS of 4,5 months with erlotinib vs chemotherapy. Based on this study, we aimed to assess the cost-effectiveness of erlotinib versus platinum based chemotherapy in the first-line treatment of advanced NSCLC patients with activating EGFR mutations. METHODS: A health economic cost-effectiveness analysis was developed incorporating a Markov model simulating the evolution of a cohort of advanced NSCLC patients with activating EGFR mutations. Three health states were included: Progression Free Survival (PFS), Progression and Death. The time horizon was 7 years. Outcomes were life years gained (LYG). Resource utilization related to each health state was estimated by a Spanish Expert Panel. Cost were expressed in € 2012 and include drug and administration costs, and drug-related adverse events management cost. This analysis was performed taking into account the Spanish National Health System's perspective. Patient data on progression-free and overall survival were obtained from the EURTAC study. Probabilistic sensitivity analyses were conducted to incorporate parameter uncertainties. RESULTS: Erlotinib treated patients achieved a mean of 2.161 LYG compared to 1.555 LYG in patients receiving chemotherapy. Total mean treatment cost with erlotinib and chemotherapy was €22,458 and €5,335 respectively. The incremental cost-effectiveness ratio (ICER) per LYG was €28,261. Since erlotinib treatment is prolonged until disease progression and chemotherapy is stopped at 4 cycles, treatment duration is one of the cost-driver of the model. CONCLUSIONS: Erlotinib treatment of NSCLC patients with activating EGFR mutations is associated with an increased life expectancy and is a costeffective therapeutic option in Spain. OBJECTIVES:Hormone refractory prostate cancer has generally poor ...

OBJECTIVES:In the UK, access to anti-TNF therapies for the treatment of rheumatoid arthritis (RA) is standardized by National Institute for Clinical Excellence guidance. Certolizumab pegol (CZP) studies in RA demonstrate that patient response to therapy at 12 weeks predicts clinical outcome at 1 year. In the UK, CZP is available via a Patient Access Scheme (PAS), providing CZP free for the first 12 weeks. This analysis examines persistency and potential cost savings realised with a 12 week CZP decision. METHODS: A retrospective analysis examined 2,744 patients receiving CZP between March 2010 and March 2012 from Healthcare at Home, a UK home health care service provider. Persistence was defined as patients (%) continuing to receive CZP deliveries, calculated at specific time points. Treatment start was first delivery date and patients were censored according to this. A simple cost analysis was performed. RESULTS: At 13, 26, 39 and 52 weeks, persistence rates were 93%, 79%, 70% and 65% in naive (no prior anti-TNF) and 88%, 68%, 56% and 48% in switch (Ն1 prior anti-TNF) patients respectively. Analyzing first-line biologic drug costs only, the NHS would save £2,363.14/patient in the first year if CZP were used instead of adalimumab (assuming similar persistence); largely due to the PAS. Stopping treatment for non-responders at Week 12 (CZP) vs Week 24 (adalimumab), could allow the UK NHS to re-invest £ 2145/patient. CONCLUSIONS: In this UK cohort, CZP persistence was higher in naive pts. Reinforcing a 12 week treatment decision could result in more efficient spend on drugs and rapid initiation of alternative treatment in non-responders.

OBJECTIVES: Depression is a major health problem. Previous studies on the cost of depression have mainly taken a primary care perspective. Such studies do not include all patients with depression, and should be completed by cost estimates from psychiatric care. The objectives of this study were to estimate the annual societal cost of depression per patient in psychiatric care in Sweden, and to relate costs to disease severity, depressive episodes, hospitalization, and patient functioning. METHODS: Retrospective resource use data in inpatient and outpatient care for 2006-2008, as well as ICD-10 diagnoses and Global Assessment of Functioning (GAF), were obtained from Northern Stockholm psychiatric clinic with a catchment area including 47% of the adult inhabitants in Stockholm city. This data set was combined with national register data on prescription pharmaceuticals and sick leave to estimate the societal cost of depression. RESULTS: The study included 10,593 patients (63% women). The average annual societal cost per patient was around USD 21,000 in 2006-2008. The largest cost item was indirect costs due to productivity losses (89%), and the second largest was outpatient care (6%). Patients with mild, moderate or severe depression had an average cost of approximately USD 18,000, USD 21,000, and USD 29,000, respectively. Total costs were significantly higher during depressive episodes, for patients with co-morbid psychosis or anxiety, for hospitalized patients, and for patients with low GAF scores. CONCLUSIONS:The largest share of societal costs for patients with depression in psychiatric care is indirect. The total costs were higher than previously reported from a primary care setting, and strongly related to hospitalization, episodes of active depression, and global functioning. This suggests that effective treatment and rehabilitation that avoid depressive episodes and hospitalization may not only improve patient health, but also reduce the societal cost of depression.

OBJECTIVES: Define the treatment patterns and associated costs to treat metastatic prostate cancer in Brazilian private health care system. METHODS: In a nationwide oncology claims database of 3.5 million lives, from August 2010 to July 2011, 67 patients were identified with metastatic prostate cancer using chemotherapy. Patients using hormone therapy were excluded. The database gathered information regarding the treatment patients were submitted, to average duration and medication dosage. RESULTS: Patients were on average 71 years old, weighted 78 kilograms and measured 1.70 meters. Among the 67 patients, only 5 (7%) were submitted to first line treatment with mitoxantrone and 62 (93%) with docetaxel; 58% of all patients took a second line treatment. From the 62 patients that started with docetaxel (121.5 mg average dose for each of the 6.5 cycles (21days)), 28 had a second line treatment with mitoxantrone (20mg average dose for each of the 3.9 cycles (21days)) with total average cost/patient of R$ 39,698 (USD 22,056); 7 were retreated with docetaxel (60mg average dose for each of the 6 cycles (7days)). From the 5 patients that started with mitoxantrone (20.6mg average dose for each of the 3.2 cycles (21 days)), 4 continued the treatment with docetaxel (60mg average dose for each of the 3 applications (21 days)) with a total average cost/patient of R$ 12,795 (USD 7,107). CONCLUSIONS: The database suggests that docetaxel is the most commonly used first line treatment to metastatic prostate cancer in the Brazilian private health care system. Forty-two percent of the patients were not submitted to a second pattern in the period studied, being that 18% of the ones that had a second line treatment were retreated with the same medication (docetaxel).

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