ObjectivesTo assess cost implications per patient, per year, and to predict the potential annual budget impact when patients with bone metastases secondary to solid tumours at risk of skeletal-related events (SREs) transition from zoledronic acid (ZA; 4 mg every 3–4 weeks) to denosumab (120 mg every 4 weeks) in Austria, Sweden and Switzerland.MethodsCountry specific costs for medication and administration, patient management and SREs (defined as pathologic fracture, radiation to bone, surgery to bone and spinal cord compression) were assessed over a 1-year time horizon. Drug administration and patient management costs were taken from available public sources. SRE costs were based on local unit costs applied to country specific healthcare resources obtained from a multinational retrospective chart review study. Due to lack of real world data for the included countries, SRE rates were derived from phase III clinical trials in patients with advanced cancer and bone metastases. These trials demonstrated that denosumab was superior to ZA in the reduction of SREs.ResultsEstimated total annual cost savings for each patient transitioned from ZA to denosumab varied by country and cancer type, ranging from €1583 to €2375 in Austria, from €1980 to €2319 in Sweden (9.1 SEK/€) and from €3408 to €3857 in Switzerland (1.2 CHF/€). Cost savings were mainly driven by the lower SRE related costs and lower administration costs of denosumab compared with ZA.ConclusionsDenosumab offers superior efficacy compared with ZA in patients with solid tumours and bone metastases. Cost savings are predicted in the Austrian, Swedish and Swiss healthcare systems following treatment transition from ZA to denosumab.

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SA showed lower cost per responder for SFOH, when relative PB was varied, for both countries. The average annual cost-savings of preventing one patient from switching to IV from oral VDRAs were EUR217 (Belgium) and EUR72 (Netherlands). ConClusions: SFOH appears to attain in-range sPhos at a lower cost compared to SEV and may result in additional cost-savings due to less patients switching from oral to costlier IV VDRAs, suggesting favorable cost-effectiveness.

The aim of this research is to assess the humanistic and economic burden of focal drug-refractory epilepsy in Europe. MethOds: A PubMed literature review was performed to identify publications from January 2004 to December 2014 on prevalence and incidence, impact on quality of life and associated costs of epilepsy. Results: In Europe around 6 million people have epilepsy, with 30-45% of patients being drug-refractory and 70% of those having focal drug-refractory epilepsy. The prevalence and incidence rate of epilepsy is 457 and 43.87 per 100.000 persons, respectively. Epilepsy is associated with psychiatric comorbidities, chronic somatic conditions, significantly lower quality of life and 2-11 times higher all-cause mortality than the general population. In 2004 health care expenditures for the treatment of epilepsy accounted for 0.2% of the total European national income and the annual cost per patient varied from € 2.000 to € 11.500. In 2010, the yearly cost of epilepsy ranged from € 13.8 to € 20 billion. The cost of epilepsy depends on the severity and frequency of seizures and if patients are drug-refractory (20% to 40% of drug-refractory patients account for 80% of the costs). The main cost drivers of epilepsy treatment are hospitalizations, antiepileptic drug costs and indirect costs (due to high unemployment rate; 46% compared with 19% for the matched control population). Standard therapy for drug-refractory focal epilepsy is open surgery which is highly effective but also highly invasive and requires strict screening criteria. Minimally invasive surgical techniques are an alternative to open surgery and have shown promising clinical benefits with lower neurological impairment and less hospital stays compared with open surgery. cOnclusiOns: This data highlights the high humanistic and economic burden of focal drug-refractory epilepsy in Europe, and the need for new procedures to improve health outcomes and reduce health care resource utilization.

Treatment options include phosphorus and sodium restrictions in diet, increase dialysis frequency and the use of phosphorus chelants, such as Sevelamer (carbonate of clorhidrate). Both alternatives have similar efficacy and safety in the treatment of this pathology. It was developed a complete and a parcial economic evaluation study of sevelamer carbonate (SCa) in the treatment of hyperphosphatemia in patients with CRD in comparison with sevelamer clorhidrate (SCl). METHODS: A cost-minimization analysis (CMA), from the IMSS perspective, was developed to compare the resource use with SCa and SCl in the treatment of hyperphosphatemia in patients with CRD. The study considered a time horizon of 1 year and costs published by public health institutions. Deterministic sensitivity analysis were performed on the variables that could generate uncertainty. A budget impact analysis (BIA) was developed to evaluate the costs associated with the use of SCa in this target population, from IMSS perspective, considering a 5 year-horizon, annual cycles, and a market share of SCa increased 10% per year. Costs are expressed in Mexican pesos. RESULTS: The CMA demonstrated that the annual cost of treatment with SCa is $34,224.83 and with SCl is $34,775.62, resulting in a cost-saving per patient with of $550.78 with SCa. The BIA showed that the introduction of SCa in the market produce an average cost saving per year of $1,126,556.65 which represents 0.002% of the IMSS assigned drug budget. CONCLUSIONS: The use of SCa represents not only health but also economic benefits in the treatment of hyperphosphatemia in patients with CRD, specifically from the IMSS perspective.