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PRS1 |
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ECONOMIC EVALUATION OF
CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN LOCAL
HONG KONG HOSPITALS: A COMPARISON BETWEEN
TIOTROPIUM AND IPRATROPIUM
Lee VWY1, Hui DS2, Cheng HM1, Ho JY1, Li
LM1, Wong WW1, Yung GK1, Lee KK1
1The Chinese University of Hong Kong, Shatin, Hong
Kong, China, 2Department of Medicine &
Therapeutics, The Chinese University of Hong Kong,
Shatin, Hong Kong, China
OBJECTIVE:
Chronic Obstructive Pulmonary Disease
(COPD) is a disabling disease that has put
significant burden to the society and its
management has not evolved a lot until the launch
of tiotropium in 2001. COPD is currently the
fourth leading cause of death and is projected to
rank the fifth as burden of diseases in 2020
worldwide. Local economic studies were limited and
cost effectiveness analysis on local population
between tiotropium and ipratropium was also
unavailable. METHODS:
The study consisted of a
cost of illness analysis and a cost-effectiveness
analysis between tiotropium and ipratropium. Cost
of illness was conducted on a cohort of 173 COPD
patients and only direct medical costs were
included in our study. Modeling method was used to
evaluate the cost-effectiveness of tiotropium with
local cost data. RESULTS:
The annual cost of
illness was $69,985 per patient with
hospitalization cost being major cost driver.
Medications accounted for less than three percents
of the total direct costs. The use of tiotropium
can reduce the total direct cost by 12%; however,
statistical significance cannot be demonstrated.
CONLUSIONS:
COPD imposed significant financial
burden to the public healthcare system with most
of the costs spent in hospitalization and
tiotropium has the potential to reduce the
economic burden of COPD.
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PRS2 |
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COST-EFFECTIVENESS OF
DOMICILIARY OXYGEN THERAPY FOR CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Shimbo T1, Fukuhara S2, Sato S2, Chin K2,
Fukuoka A3, Kimura H3, Akashiba T4, 1International
Medical Center of Japan, Shinjyuku-ku, Tokyo,
Japan, 2Kyoto University, Sakyo-ku, Kyoto, Japan,
3Nara Medical University, Kashihara, Nara, Japan,
4Nihon University Itabashi Hospital, Itabashi-ku,
Tokyo, Japan OBJECTIVE:
To
determine cost-effectiveness of domiciliary oxygen
therapy (DOT) for patients with severe chronic
obstructive pulmonary disease (COPD). DOT improves
survival of patients with severe COPD, and has
been rapidly utilized over Japan for the last
decade. It is prescribed even for patients with
milder COPD who do not fulfill the application
criteria of DOT. METHODS:
With a Markov model, the
incremental cost-effectiveness ratio between DOT
and the conventional therapy without DOT was
evaluated from the societal perspective.
Effectiveness of DOT was derived from randomized
controlled trials reported in the literature.
Utility of patients was investigated with EQ-5D
for 25 patients with COPD, although DOT was
assumed not to improve quality of life of the
patients. Costs of DOT, outpatient clinic,
admission around fatal events were estimated based
on the national medical insurance reimbursement
table and national statistics. The cost of care
giving by family members was also counted based on
the opportunity cost of the time for caring.
One-way and probabilistic sensitivity analysis
using second-order Monte-Carlo simulation was
done. RESULTS:
We estimated the hazard ratio of
DOT on mortality is 0.49. Utility of COPD was 0.54
(95%CI, 0.40-0.68). The incremental
cost-effectiveness ratio (ICER) of DOT was
$54,100/QALYs (assuming one dollar is 110 yen),
which is considered to be comparable with other
common medical practices in Japan. This estimate
was sensitive to effectiveness of DOT. If the
hazard ratio of DOT was 0.86, ICER would change to
$157,900/QALYs. Probabilistic sensitivity analysis
revealed ICER of DOT was under $50,000/QALYs in
36.3% of sampling simulations, and under $80,000/QALYs
in 78.9% of them. CONLUSIONS:
DOT for severe COPD
patients is a cost-effective intervention.
However, if it is used for milder cases in which
effectiveness of DOT is not clear, ICER could be
sharply increased according to the results of
sensitivity analysis.
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PRS3 |
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INCORPORATING JAPANESE
CULTURAL DIFFERENCES IN DEVELOPING A PATIENT
REPORTED IMPACT OF COUGH AND SPUTUM IN CHRONIC
(OBSTRUCTIVE) BRONCHITIS – SIMULTANEOUS
DEVELOPMENT OF THE CASA-Q
Crawford B1, Buie W1, Tetzlaff K2, Monz
BU3, Breugelmans R4, 1Mapi Values, Boston, MA,
USA, 2Boehringer Ingelheim, Biberach/Riss,
Germany, 3Boehringer Ingelheim International,
Ingelheim, Germany, 4Tokyo Medical University,
Tokyo, Japan It is suspected
that questionnaires developed in Western languages
and translated into Asian languages fail to
capture relevant cultural differences. In the
development of a new questionnaire (Cough and
Sputum Assessment Questionnaire(CASA-Q), Japanese
patients were included in the process to account
for cultural differences. Cough and sputum are
leading symptoms of chronic (obstructive)
bronchitis, yet the impact of these symptoms has
never been measured adequately or in a way
comparable across diverse cultures. Existing
instruments capture the impact of the condition on
quality of life, rather than focusing on symptoms
and targeting aspects important to patients.
OBJECTIVE:
To develop in five countries, a
self-administered instrument that captures
concepts relevant to chronic (obstructive)
bronchitis patients who suffer from cough and
sputum. METHODS:
A simultaneous development
process was used to develop the CASA-Q.
Face-to-face interviews were conducted with
patients in five countries (France, Germany,
Japan, Spain, US). After transcription and
domain-mapping, an international item generation
meeting was conducted and a draft questionnaire
simultaneously created in five languages.
Expressions of concepts in each culture were
identified to develop the draft questionnaire.
This draft was reviewed by clinical respiratory
experts and cognitively debriefed with patients in
each language. RESULTS:
The conceptual model
addressed two complementary aspects: symptoms
(cough/sputum) and their respective impact. Core
symptoms were described similarly in each
language. Expressions of the impact of these
symptoms were generally consistent across
cultures. Social impact was expressed differently
by Japanese and Western respondents (concern
regarding one’s symptoms before manifestation
versus self-embarrassment after the fact). The
final questionnaire is comprised of 6 items for
symptoms and 19 items for impact. The ease of
understanding and relevance of each question was
found acceptable across languages. CONLUSIONS:
The simultaneous development process allowed us to
incorporate potential cultural differences into a
patient-based questionnaire relevant to the
international assessment of chronic bronchitis. |
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