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- ItemPBI17 Cost-efectiveness analysis of biological agents to moderate to severe plaque psoriasis treatment from the brazilian public health system perspective(Value in Health, 2020) Senna, K; Zimmerman, IR; Meirelles, I; Santos, MObjectives: Psoriasis is a chronic inflammatory disease that affects mainly the skin and joints leading to social difficulties. The Brazilian Clinical Protocol of Psoriasis recommends biological agents in case of contraindication, intolerance or failure to non-biological systemic treatment. This study aimed to analyze the efficiency of nationally licensed biological agents for the treatment of moderate to severe plaque psoriasis, from the Brazilian Public Health System perspective. Methods: We developed a decision tree model attached to a Markov model to estimate costs per Quality Adjusted Life Years (QALY) of six biological treatment strategies (ixequizumab; secuquinumab; ustequinumab; risanquizumab; adalimumab and infliximab) for plaque psoriasis moderate to severe in adults. For each treatment strategy, we conducted deterministic and probabilistic sensitivity analysis and a cost-effectiveness threshold analysis using the efficiency frontier approach. Results: Analyzing the efficiency frontier, we detected the dominance of infliximab and secuquinumab by adalimumab, ustequinumab and ixequizumab. Adalimumab is the most cost-effective strategy up to a willingness-to-pay of approximately $37.424/QALY followed by ustequinumab up to a willingness-to-pay of $65.492/QALY. Conclusions: The treatment effectiveness, expressed in QALY, is similar between the biological agents assessed, but we observed expressive differences in incremental costs. Adalimumab, followed by ustequinumab and, finally, ixequizumab are more likely to be costeffective per willingness-to-pay. Following the efficiency profile of available treatments at Brazilian Public Health System, it would be necessary a price reduction of risanquizumab, secuquinumab and ixequizumab in 55.1%, 10.74% and 9.1%, respectively.
- ItemPCN163 Developing attributes and attribute-levels for a discrete choice experiment on lung cancer patient’s preferences for drug therapies(Value in Health, 2017) Monteiro, Andrea Libório; Santos, Marisa; Fontes, LSOBJECTIVES: Stated preferences experiments validity depends largely on the proper specifications of attributes and levels. Hence, patients and physicians engagement is critical to assure that the information being valued on the experiment is both important to patients and decision-relevant. This study reports the systematic approach undertaken targeting the definition of attributes and attribute levels for a discrete choice experiment created to elicit lung cancer patient’s preferences for drug therapies. METHODS: A literature review was undertaken aiming to identify conceptual attributes and attribute-levels. The finding of this review helped to define the qualitative component. The qualitative component included 3 focus groups, on which 8 patients and 3 oncologists were engaged on discussions aiming to identify context specific attributes. All inter- views were recorded, transcribed and analyzed by the research team. The resulting draft-proposal of attributes and attribute-levels was thoroughly dis- cussed and further developed by a group of experts. RESULTS: The first round of results derived 10 attributes. Attribute-levels were defined according with the literature, the results from the qualitative component and experts opinions. After a round of discussion with experts on the field three attributes were discarded. The final proposal consists in seven attributes that were defined as follows: Fatigue/tiredness, diarrhea, skin rash, risk of hospitalization, mode of adminis- tration (route of drugs administration), access and overall survival. CONCLUSIONS: The results reported in this manuscript will add to the body of knowledge on the application of qualitative methods to derive attributes and attribute-levels for a stated preferences experiment.
- ItemPCN239 Cost-utility of the CDK 4/6 inhibitors for postmenopausal women with HR-positive, HER2-negative advanced breast cancer in Brazil: a Dime Project(Value in Health, 2020) Schroeder, L; França, AC; Padilla, M; Meirelles, I; Silva, AS; Magliano, C; Santos, MObjectives: Several trials have demonstrated the benefit of CDK 4/6 inhibitors for postmenopausalwomenwith HR-positive, HER2-negative advanced breast cancer. This research aims to compare the cost-utility of the CDK 4/6 inhibitors in patients who had no prior systemic therapy in the advanced setting. Methods: A systematic review was carried out to extract the efficacy and safety data from the pivotal trials selected. An indirect comparison was performed to identify the Hazard Ratio for CDK inhibitors versus letrozole. ROB2 and GRADE analyses evaluated the risk of bias and the confidence in the evidence. A Markov model was constructed to estimate the incremental cost in American dollars per quality-adjusted life years (QALY) of treatments from a Brazilian public healthcare system perspective over a lifetime horizon and with a 5% annual discount rate. Deterministic and probabilistic sensitivity analyses evaluated the robustness of the results. Results: There is high-quality evidence that the CDK 4/6 inhibitors consistently increase close to 10 months in progression-free survival, with a tolerable safety profile. There are no head-to-head studies between the CDK 4/6 inhibitors, and the indirect comparison did not identify clinical superiority in any of them. The most cost-effective technology was ribociclib ($64,425/QALY), followed by Abemaciclib ($81,530/QALY) and Palbociclib ($85,321/QALY). The univariate analysis showed that the incremental cost-effectiveness ratio(ICER) was sensitive to the parameters of utility gains and the cost of the intervention. The one thousand-probabilist simulation showed that all ICER values were above a threshold of $35,000/QALY. Conclusions: In Brazil, even though there is no established willingness-to-pay threshold, the estimated ICER for the CDK 4/6 inhibitors will represent an obstacle to their incorporation into the Brazilian healthcare system.