VA L U E I N H E A LT H 1 6 ( 2 0 1 3 ) A 6 6 5 – A 7 2 8 A705

2011. One-year costs were identified by applying cost data to medical informa- each generic was used to estimate one month’s cost of hypertension treatment;
tion obtained by review of medical records. Costs included those for medications, considering the maximum and minimum dosage for each generic. The affordability
laboratory and diagnostic tests, clinic visits, emergency room visits and hospital of treatments was calculated by comparing the total cost of medicines to the daily
stays. Contemporary data were obtained from epidemiological studies, government official minimum wage ($63.12MXN, 2013 prices) Results: The number of days’
datasets, and other sources to estimate prevalence. National costs (US dollar 2012) wages required to pay one month of antihypertensive therapy ranged from: 0.08-
of treatment for PAH were estimated by extrapolation of mean cost estimate per 4.18 for diuretics, 0.67-1.90 for beta blockers, 1.7-3.99 for calcium channel blockers,
person to national incidence data for PAH. Because of uncertainties surrounding 0.71-3.31 for ACE inhibitors and 2.38-8.11 for ARBs. Conclusions: Cost could be
some of our estimates such as prevalence, one way sensitivity analyses were under- a substantial barrier for permanence in antihypertensive treatment, so that should
taken. Results: A total of 113 PAH patients were identified and their demographic be discussed measures to prevent this from happening.
and clinical characteristics, patterns of care were examined. The mean age was 38
years, and 83% were female. The average per patient annual cost was $ 10,869 with- PCV20
out specific treatment (min $ 137; max $155,928). The annual cost for the treatment Treatment Costs of Ischemic Stroke Prevention and Management
of a single PAH patient per year with specific therapy (Bosentan) was calculated in in Patients with Atrial Fibrillation (AF) in Latin America: Argentina,
$31.433. Aggregate national health care expenditures for treatment of PAH were Brazil, Chile, and Venezuela
USD 46.6 million In multivariate analysis, length of hospital stay, stay in ICU, were Soriano M.A.1, Leyva-Bravo V.1, González-Rojas G.L.1, Medina-Farina M.2, Duarte M.A.3
all significant independent predictors of treatment. Conclusions: There is a cor- 1IMS Health, Mexico City, Mexico, 2Hospital Barros Luco, Santiago, Chile, 3Hospital Militar Carlos
relation between the cost of HAP and disease severity with hospitalization owing Arvelo, Caracas, Venezuela
to disease severity being a major contributor to cost. With the expected increase in Objectives: AF is the most common chronic cardiac arrhythmia worldwide. Most
the incidence of PAH in Mexico over the coming decades, these results emphasize patients with AF need life-long treatment to be protected from ischemic stroke. The
the need for effective preventive and acute medical care. aim was to conduct a high level cost assessment for stroke prevention and manage-
ment in patients with AF [SPAF & SMAF] in 4 Latin American countries. Methods:
PCV17 Overall the costs of SPAF & SMAF were determined through 59 face-to-face interviews
Cost-Of-Illness Study of Patients Subjected to Cardiac Rhythm with cardiologists in Argentina, Brazil, Chile and Venezuela. Treatment costs were
Management Devices Implantation: Results from a Single Tertiary estimated using benchmarks from major private and public hospitals in each coun-
Centre try. Results: On average, the largest component of real-life medical expenditures
Fanourgiakis J. for SPAF, under appropriate treatment given CHADS2 scores, was prescription drugs,
University of Crete, Heraklion, Greece which ranged from 68% in private to 75% in public. Annual SPAF treatment ranged in
Objectives: To estimate the procedure (implantation) cost, the total hospitalization price from US$425 in Argentina to US$1,935 in Chile in private institutions and US$85
cost and annual follow-up cost, in patients subjected to pacemaker (PM) and implant- in Brazil to US$1,199 in Venezuela in public institutions. Moreover, overall treatment
able cardioverter-defibrillator (ICD) implantation. Methods: A single-center, pro- costs in Chile were 5X higher than the least expensive country in each sector. For
spective, cost-of-illness study was conducted between August 2008 and July 2009. In SMAF, using rivaroxaban vs the common Vitamin K antagonists resulted in a 24%-46%
total, 464 consecutive patients were recruited (370 were subjected to PM implantation cost reduction for disease treatment at a national level due to better patient adher-
and 94 to ICD implantation). Resource data were assessed at patients’ enrolment in ence. This would decrease the stroke incidence/year, which would translate to US$143
the study and at 6th and 12th months of patients’ follow-up. Then, the procedure cost, M /yr in savings. Conclusions: AF is an important source of health care resource
the total hospitalization cost as well as the annual patients’ follow up costs were cal- utilization because of repeated medical examinations, extensive use of laboratory
culated using a bottom-up approach. Results: The mean (95% confidence interval) tests and pharmacological treatments. Private and public institution cost differences
procedure cost of PM and ICD implantation (including the costs of devices, electrodes, are common in all 4 countries. Improving access to novel drugs, such as rivaroxaban,
other supplies, and personnel’s time) was calculated to be € 1803 (€1758–€1858) and could help improve cost allocation, inducing a savings opportunity in each country.
€13 521 (€13 153–€ 13 892), respectively. The mean total hospitalization cost (includ-
ing procedure cost, hospitalization cost, cost of laboratory and imaging diagnostic PCV21
examinations and the indirect cost attributed to productivity lost due to patient’s Health-Economic Assessment of the Use of Catheter-Based Renal
hospitalization) was €3926 (€3711–€4167) for PM and €17 764 (€16 852–€18 692) for ICD. Denervation in Patients with Resistant Hypertension in Mexico
The mean annual cost (direct and indirect) was €1816 (€1433–€2421) for PM and €2819 Ceballos R.M.1, Sanchez-Kiobashi R.2, Gay J.G.3, Pietzsch J.B.4, Geisler B.P.4
(€2115–€3703) for ICD. No difference was detected in the annual cost between patients 1Medtronic, Mexico DF, Mexico, 2TI Salud, Mexico DF, Mexico, 3T.I. Salud, Mexico, México D.F.,
with initial implantation and replacement. Conclusions: These data revealed that Mexico, 4Wing Tech Inc., Menlo Park, CA, USA
although these devices are associated with a relatively high upfront cost, the annual Objectives: Catheter-based renal denervation (RDN) is a new therapy for resistant
societal cost following the implantation is low. Therefore, implantation of such devices hypertension, a condition that affects approx. 10-15% of hypertensive patients, in
should be encouraged since these devices reduce the morbidity and mortality without which blood pressure is uncontrolled despite the simultaneous use of three or more
a high economic burden to society. antihypertensive drugs. Our objective was to assess clinical and cost-effectiveness
of RDN compared to standard of care (SoC) from the Mexican public payer per-
PCV18 spective. Methods: A previously published lifetime Markov model was adapted
Economic Burden of Coronary Heart Disease in the Patients to the Mexican setting to predict clinical endpoints (death, myocardial infarction,
Attending National Heart Center, Kathmandu, Nepal stroke, heart failure, coronary heart disease, end-stage renal disease) and costs -
Dangi A.1, Lohani S.P.2 based on Mexican epidemiological and cost data. We evaluated the impact of a
1Nobel College, Pokhara University, Kathmandu, Nepal, 2Center for Health Research and 32 mmHg reduction in systolic blood pressure, from a baseline of 178 mmHg, in
International Relations, Nobel College, Pokhara University, Kathmandu, Nepal a 58-year old 43% female, 34% diabetic, and 16% smoking cohort, as observed in
Objectives: To calculate cost of illness due to coronary heart disease in the patients the Symplicity HTN-2 randomized controlled trial. Direct public health care costs
attending National Heart Center, Kathmandu, Nepal. Methods: Descriptive cross were estimated from the published literature and from governmental databases.
sectional survey was conducted. The total number of sample was 120. The sam- The incremental cost-effectiveness ratio (ICER) was computed as incremental costs
ple was selected by non-probability purposive sampling method. Data entry and per life-year gained, discounted at 3%. Deterministic sensitivity analyses were
analysis was done using SPSS 16.0. Categorical variables were compared using performed. Results: RDN was projected to reduce cardiovascular endpoints by
Independent Sample t-test and cross tabulation was done and chi- square test was 22-32% over 10 yrs., and 7-17% over lifetime. The lifetime ICER was estimated at
applied to show significant difference between variables. Results: Agriculture was MXN$ 194,128 (US$ 14,750) per LY gained, and had an incremental cost of MXN$
the main source of income of the coronary heart disease household and the aver- 117,916 (US$ 8,959) compared to SoC. Application of higher discount rates led to
age annual household income was NRs. 1, 54,000 (US $ 1792). The study estimated a measured increase in the ICER. Conclusions: Our model projections suggest
the average cost of illness to be NRs. 30,888.14 (US $ 360) for an outpatient episode that RDN reduces and delays cardiovascular events and is a cost-effective therapy
of coronary heart disease which was 20.05% of the average annual income of CHD in Mexico when considering most international willingness-to-pay thresholds, but
household. The average total time loss of the CHD household was 8.75 person days. remains above the current national government threshold of one GDP/capita of
The average total direct cost was NRs. 29,600 (US $ 344) of which medical cost was MXN$ 139,900 (US$ 10,630) per additional life year.
the largest component. The average monetary value of time loss by the household
was found to be 2,981.18 (US $ 35). Conclusions: The study found high cost of PCV22
illness due to centralised system of health [Link] findings of the study showed Cost-Effectiveness of Transcatheter Aortic-Valve Implantation for
that households struggled to cope and adopted unsustainable strategies that dam- Severe Symptomatic Aortic Stenosis in Inoperable Patients in the
aged asset and caused or sustained impoverishment. Thus, estimated cost appears Brazilian Public Health Care System
to be sustained economic burden on the individual household. Nishikawa A.M.1, Paladini L.1, Borges L.1, Queiroga M.2, Lemos P.2, Clark O.A.C.1
1Evidencias, Campinas, Brazil, 2Sociedade Brasileira de Hemodinâmica e Cardiologia

PCV19 Intervencionista (SBHCI), São Paulo, Brazil

Affordability of Antihypertensive Treatment in Mexico Objectives: Aortic stenosis is the most common valvular heart disease in the elderly
Lemus F., Rivas R. – its prevalence is estimated to be up to 5% in individuals over 75 years. Surgical
Minister of Health, Mexico, Mexico replacement of the aortic valve is considered the standard care and in the absence
Objectives: Hypertension (HT) is one of the most prevalent chronic diseases in of serious coexisting conditions, the procedure is associated with low operative mor-
Mexico. In the last two decades, a substantial increase in the prevalence of HT was tality. However, a significant proportion of patients can not undergo surgery due to
observed in Mexico from 25% in 1993 to 43.2% in 2006 in adult population (≥ 20 a high surgical risk associated with advanced age or with the presence of multi-
years old). Almost 50% of population is not under a social security scheme and ple coexisting conditions. Treatment with transcatheter aortic-valve implantation
many patients pay for medicines out-of-pocket. This study’s aim was to calculate (TAVI) is a therapy with potentially lower peri-procedure risk and has been used as
the affordability of different kinds of antihypertensive drugs in Mexico. Methods: a therapeutic option in this group of patients considered inoperable. Therefore, this
Price data for 5 classes of antihypertensive drugs (diuretics, beta blockers, calcium study aims to develop a cost-effectiveness analysis of TAVI in patients with severe
channel blockers, ACE inhibitors and angiotensin II receptor antagonists or ARBs) aortic stenosis who are not suitable for surgical treatment. Methods: A Markov
were obtained from public internet sources, and the lowest price identified for model was developed to compare the TAVI versus standard therapy (drug treatment