PGI44 A health technology-related cost description concerning italian IBD centres dealing with Crohn’s disease: results from SOLE study. C. Lazzaro , M. Cappello , C. Cortelezzi , G. Costantino , G. Fiorino , M. Mastronardi , M. Giannotta , B. Galletti , M. Cicala , 10 11 12 13 14 S. Vadalà di Prampero , G. Gualberti , F. Caprioli , A. Gasbarrini , G. Fattore 1 2 3 4 5 6 7 8 9 Studio di Economia Sanitaria, Milan, Italy, Gastroenterology, Università di Palermo, Palermo, Italy, Gastroenterology, AOU di 4 5 Circolo - Fondazione Macchi, Varese, Italy, Internal Medicine, Università di Messina, Messina, Italy, Gastroenterology, Istituto 6 7 Clinico Humanitas, Rozzano, Italy, Gastroenterology, IRCCS “S. De Bellis”, Castellana Grotte, Italy, Gastroenterology Azienda 8 9 Ospedaliero Universitaria di Careggi, Florence, Italy, Gastroenterology, Ospedale S. Salvatore, L’Aquila, Italy, Gastroenterology, 10 Università Campus Bio Medico, Roma, Italy, Gastroenterology, Azienda Ospedaliero-Universitaria S. Maria della Misericordia 11 12 13 di Udine, Udine, Italy, AbbVie srl, Campoverde, Italy Gastroenterology, Università degli Studi di Milano, Milan, Italy, Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore – Policlinico Universitario “A. Gemelli”, Rome, Italy, 14 Department of Policy Analysis and Public Management, Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, Milan, Italy 1 2 3 Presented at the 17th ISPOR Annual European Congress, Amsterdam, 8-12 November 2014 Table 2. Health technologies available in SOLE centres. OBJECTIVES • To investigate the health technology-related costs of Italian inflammatory bowel disease (IBD) centres dealing with Crohn’s disease (CD). Technology Number of centres with technology METHODS Low complexity Mild complexity Moderate complexity High complexity Total (%)a • Following the hospital standpoint, a questionnaire-supported cost description1 was performed on a convenience sample of 38 Italian IBD centres participating in the ongoing Survey on Quality Of Life in Crohn’s PatiEnts (SOLE) study during 2012. Endoscopy 2 2 1 30 35 (92.1) Capsule Endoscopy 1 2 1 26 30 (78.9) • Consistently with its average useful life, a 5-year straight-line depreciation approach1 was adopted for calculating the yearly cost for each health technology. Ultrasonography - 1 - 12 13 (34.2) Endoscopic Ultrasonography - - - 6 6 (15.8) Manometer 3 (7.9) - - - 3 3 (7.9) Contrast-Enhanced Ultrasound - - - 1 1 (2.6) Enteroscopy - - - 1 1 (2.6) Endoscopic Ultrasound - - - 1 1 (2.6) eWORM Robotic Colonoscopy - - - 1 1 (2.6) Pelvic Pavement Rehabilitation 1 - - - 1 (2.6) Infusion Pump 1 - - - 1 (2.6) Half of centres (19/38) were public teaching hospitals, whereas 39.5% (15/38) were regional referral centres for CD (Table 1). Transanal Ultrasound - - - 1 1 (2.6) Table 1. SOLE centres classification according to institutional indicators. Breath Test - - - 1 1 (2.6) Endoscopic Retrograde - - - 1 1 (2.6) Cholangiopancreatography (ERCP) - - - 1 1 (2.6) Impedance-pH Meter - - - 1 1 (2.6) • Cost description was undertaken either considering all centres as an undifferentiated sample, or stratifying them according to their complexity. • Complexity criteria included: - number of beds for inward and day-hospital; - personnel dedicated to CD patients; number of cross-border CD patients; - availability of dedicated rooms for biological drugs administration; - feasibility of electronic patient forms. • Costs (€2012) were reported as mean (standard deviation, SD). RESULTS Type of centre Number of centres (%) Public teaching hospital 19 (50.0) Self-governing hospital 8 (21.1) Private research-oriented hospital 3 (7.9) Local Health Authority-managed hospital 3 (7.9) Private teaching hospital 2 (5.3) Public research-oriented hospital 1 (2.6) Classified private hospital 1 (2.6) Other private hospital 1 (2.6) Percentages calculated on the overall number of 38 centres a • Considering the undifferentiated sample, mean yearly cost for health technologies amounts to €23,557.50 (€24,277.90). • High complexity centres report the highest mean yearly cost of €25,580.38 (€25,706.92), whereas the lowest mean yearly cost of €5,113 (€0) refers to the unique moderate complexity center (Figure 3). Figure 3. Mean yearly costs for health technologies available in SOLE centres. 30000 25000 Figure 1. Geographical distribution of SOLE study centres. 5 15000 0 2 5,133.00 All Center 1 1 9,366.67 5000 31.6% 2 21,700.00 10000 North 1 1 8 South 39.5% 2 4 High complexity Moderate complexity Mild complexity Low complexity Type of centre 28.9% 2 25,580.38 20000 € 2012 • Study sites were located in Northern (12/38, 31.6%), Central (11/38, 28.9%) and Southern (15/38, 39.5%) Italy (Figure 1), and could be classified as high (32/38, 84.2%), moderate (1/38, 2.6%), mild (3/38, 7.9%), and low (2/38, 5.3%) complexity centres (Figure 2). 23,577.50 • Regardless of IBD centres complexity, the cost-driver was endoscopy, which accounts for a percentage of the mean yearly cost that ranges from 36.9% (high complexity) to 97.8% (moderate complexity). • Low complexity centres reported remarkable mean cost due to their limited number. CONCLUSIONS 3 • SOLE results show that when Italian IBD centers complexity is taken into account, remarkable differences exist about the mean yearly cost for health technologies available for managing CD patients. 1 1 Numbers represent numbers of centres in each Region • IBD centres complexity is not always consistent with the mean yearly cost for health technologies available, due to shared-apparels patterns with other hospital units. • IBD centers complexity is consistent with the quality/quantity of the health technologies available. 4 REFERENCES Figure 2. Numbers and percentage of SOLE centres according to complexity. 40 ACKNOWLEDGEMENTS 32 (84.2) N (%) 30 20 10 1 (2.6) 3 (7.9) 2 (5.3) Mild Low 0 High Drummond MF, Schulper MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes (3rd ed). Oxford, UK: Oxford University Press, 2005. 1 Moderate Centre complexity • Endoscopy, capsule endoscopy and ultrasonography were the most widespread health technologies available in 92.1%, 78.9% and 34.2% centres, respectively (Table 2). Investigators/Centres not included in the authorship, here below for acknowledgement (previous authorization): S. Ardizzone (Milano), A. Armuzzi (Roma), M. Baldoni (Perugia), L. Biancone (Roma), F. Bossa (San Giovanni Rotondo), F. Castiglione (Napoli), E. Corazziari (Roma), F. Costa (Pisa), M. Daperno (Torino), G. Delle Fave (Roma), A. Geccherle (Negrar), G. Iaquinto (Avellino), P. Leo (Cosenza), L. Marzio (Pescara), M. Meregaglia (Milano), P. Occhipinti (Novara), A. Orlando (Palermo), C. Papi (Roma), B. Principi (Bari), A. Privitera (Catania), G. Riegler (Napoli), F. Rizzello (Bologna), V. Savarino (Genova), M. Scribano (Roma), G. Sturniolo (Padova), P. Usai (Cagliari), M. Vecchi (San Donato Milanese). DISCLOSURE This study was sponsored by AbbVie. AbbVie contributed to the study design, research, and interpretation of data, writing, reviewing, and approving the publication. Author G. Gualberti is an employee of AbbVie. Author C. Lazzaro is an AbbVie consultant. All other author’s institutions received payment from AbbVie for participation in the study. No payments were made for drafting or reviewing this publication. AbbVie has a contract with CERGAS for consultancies.