O-1 ECONOMIC IMPACT OF LONG-TERM ALBUMIN INFUSIONS IN PATIENTS WITH DECOMPENSATED CIRRHOSIS AND UNCOMPLICATED ASCITES FROM THE BRAZILIAN PUBLIC AND PRIVATE HEALTHCARE SYSTEMS PERSPECTIVES
Carlos Terra1,2, Elisabet Viayna3, Laura Ayzin4, Cristina Fuster5, Susana Aceituno6, Maria Soler6, Claudio Tafla7
1 Liver Unit, Gastroenterology Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
2 Liver Unit of Casa de Saúde São José, Rio de Janeiro, Brazil
3 Health Economics and Outcomes Research, Scientific and Medical Affairs, Grifols S.A., Sant Cugat Del Vallès, Spain
4 International Market Access, Grifols International, Sant Cugat Del Vallès, Spain
5 Scientific and Medical Affairs, Grifols S.A., Sant Cugat Del Vallès, Spain
6 Health Economics and Outcomes Research, Outcomes’10, Castellón de La Plana, Spain
7 Medical Director, Nilo Saúde, Sao Paulo, Brazil
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=> array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0002" ] ] ] 1 => array:3 [ "nombre" => "Elisabet" "apellidos" => "Viayna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0003" ] ] ] 2 => array:3 [ "nombre" => "Laura" "apellidos" => "Ayzin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "aff0004" ] ] ] 3 => array:3 [ "nombre" => "Cristina" "apellidos" => "Fuster" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">5</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Susana" "apellidos" => "Aceituno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">6</span>" "identificador" => "aff0006" ] ] ] 5 => array:3 [ "nombre" => "Maria" "apellidos" => "Soler" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">6</span>" "identificador" => "aff0006" ] ] ] 6 => array:3 [ "nombre" => "Claudio" "apellidos" => "Tafla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">7</span>" "identificador" => "aff0007" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Liver Unit, Gastroenterology Department, Rio de Janeiro State University, Rio de Janeiro, Brazil" "etiqueta" => "1" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Liver Unit of Casa de Saúde São José, Rio de Janeiro, Brazil" "etiqueta" => "2" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Health Economics and Outcomes Research, Scientific and Medical Affairs, Grifols S.A., Sant Cugat Del Vallès, Spain" "etiqueta" => "3" "identificador" => "aff0003" ] 3 => array:3 [ "entidad" => "International Market Access, Grifols International, Sant Cugat Del Vallès, Spain" "etiqueta" => "4" "identificador" => "aff0004" ] 4 => array:3 [ "entidad" => "Scientific and Medical Affairs, Grifols S.A., Sant Cugat Del Vallès, Spain" "etiqueta" => "5" "identificador" => "aff0005" ] 5 => array:3 [ "entidad" => "Health Economics and Outcomes Research, Outcomes’10, Castellón de La Plana, Spain" "etiqueta" => "6" "identificador" => "aff0006" ] 6 => array:3 [ "entidad" => "Medical Director, Nilo Saúde, Sao Paulo, Brazil" "etiqueta" => "7" "identificador" => "aff0007" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para9001" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="fig0001"></elsevierMultimedia></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0001">Introduction and Objectives</span><p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Liver cirrhosis is among the most common liver-related causes of death and is associated with severe complications that entail a major burden for patients and healthcare systems. The ANSWER trial showed that long-term human albumin infusions (LTA) (40g twice/week for two weeks followed by 40g/week for up to 18 months) added to standard medical treatment (SMT) managed to significantly reduce mortality and disease-related complications in patients with cirrhosis and uncomplicated ascites. Assess the economic impact of implementing LTA following the ANSWER protocol in patients with cirrhosis and uncomplicated ascites in Brazil from the public (SUS) and private (ANS) healthcare systems perspectives.</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Materials and Methods</span><p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Cost/patient/year was calculated for patients treated with LTA+SMT and compared to those treated with SMT only. Incidence of clinical complications and healthcare resource utilization (HCRU) were gathered from the ANSWER trial. Pharmacological costs (spironolactone, furosemide, human albumin) were gathered from the “Health Care Price Bank” and CMED. Costs of clinical complications (spontaneous bacterial peritonitis, other bacterial infections, hepatic encephalopathy, renal dysfunction, hepatorenal syndrome, refractory ascites) and other HCRU (LTA administration visit, large volume paracentesis, hospitalizations) were gathered from the literature and ANS. All costs were transformed to 2021 Brazilian Reals (R$). A univariate sensitivity analysis was performed by applying a 20% increase/decrease to all variables.</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Results</span><p id="spara003" class="elsevierStyleSimplePara elsevierViewall">The overall cost for patients treated with LTA+SMT was R$118,759 and R$189,675 lower than that for patients treated with SMT only for SUS and ANS, respectively. The additional cost of LTA (R$30,767 and R$59,897, respectively) was compensated by a reduction in complications and HCRU (R$149,526 and R$249,572, respectively).</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Conclusions</span><p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Our study suggests that should the clinical outcomes of the ANSWER trial translate to real-world effectiveness, LTA administration to patients with cirrhosis and uncomplicated ascites may lead to cost savings for the SUS and ANS in Brazil.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Introduction and Objectives" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Materials and Methods" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusions" ] ] ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0001" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr25.jpeg" "Alto" => 1764 "Ancho" => 1667 "Tamanyo" => 189667 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Unlabelled imag" "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/00000028000000S1/v2_202308150516/S1665268123001163/v2_202308150516/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/16652681/00000028000000S1/v2_202308150516/S1665268123001163/v2_202308150516/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268123001163?idApp=UINPBA00004N" ]
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