IntroductionIntroductionDespite the demonstrated efficacy, security as well as improved quality of life derived form the administration of specific enzymatic treatment for lysosomal diseases, it is not clear the economical impact, with scarce and contradictory results probably derived form the different methodology and highly heterogeneus Health System in each country.

A recent publication in Italy about economical impact of the same national Home Enzymatic Therapy Administration (HETA) scheme that is being applying now in Spain, has demonstrated that this starategy is cost-effective.

To estimate the economical impact of home enzymatic therapy (Ht) administration compared with that in the hospital (Hp) and ambulatory hospitalization (AHp) for Fabry and Gaucher diseases In those patients included in the Spanish HEA program for home infusion of velaglucerase and agalsidase alpha in the Comunidad Valenciana, a region in the southeastern coast of Spain.

HETA spanish national program is supportedby Shire Pharmaceuticals Iberica©

ObjectiveObjective

MethodologyMethodologyHETA Protocol

See posters #108 and #109.Pharmacoeconomical evaluation

Direct and indirect expenses have been estimated for three possible strategies for enzyme infusion:

In-Hospital (iHp)Usual Domiciliary-Hospitalitation (DHp) Home enzymatic Therapy Administration (HETA).

Calculations has been also made taking into account the disease of each patient (GD vs. FD) and laboral situation.Expenses were classified as those for the Health System, the individual and work.All estimations are calculated in euros for 26 per year infusion.

ResultsResults

Communicated as a poster

Expenditures Expenditure concept Calculation

Direct For the Health SystemDrug preparation, excluding the cost of the drugs

Ambulance Generalitat Valenciana Official Sanitary Services prices (AM0105 and HS0108)

Work-time of Hospital Pharmacist/s - According to the Generalitat Valenciana Official monthly salaries, the cost of 1 minute of work was estimated.

- Time for preparation of the drugs was estimated: For iHp andDHp: 45 and 85 min for Fabry and Gaucher patients

respectively. For HETA: 5 and 25 min for Fabry and Gaucher patients respectively.

Work-time of Hospital Pharmacist/s auxiliar workersWork-time of Hospital NurseryWork-time of Hospital Nursery auxiliar workersFungible sanitary material (Syringes…) Generalitat Valenciana Official Sanitary Services pricesIn-Hospital session Generalitat Valenciana Official Sanitary Services pricesDomiciliary Hospitalization session Generalitat Valenciana Official Sanitary Services prices

IndirectFor the patientDisplacement hospital ↔ home Displacement (Car taxes, Car wear, Fuel…) Captio Mileage Report 2015

For the societyLoss of working time/productivity Absence at the work place Encuesta Trimestral de Coste Laboral (ETCL) del Instituto Nacional de Estadística

(INE) para el 4º trimestre de 2015.

110. Home enzymatic infusion program for Gaucher and Fabry diseases. Economic impact evaluation of the experience in the Comunitat Valenciana in Spain.*Giner-Galvañ V1, Carrascosa-Piquer O2, Almela-Tejedo M3, Perpiñá-Henández J4, Cornejo-Uixeda S2, Sarrió-Montes G3, Sanz-García J1, Vicente-Navarro D1.

1Rare Diseases Unit. General Internal Medicine Department. Hospital Mare de Déu dels Lliris. Alcoy (Alicante). 2Hospitalary Pharmacy. Hospital La Ribera. Alzira (Valencia). 3Hospitalary Pharmacy. Hospital Mare de Déu dels Lliris. Alcoy (Alicante).4General Internal Medicine Department. Hospital La Ribera. Alzira. Valencia. Spain.*Presenting and corresponding author: giner_vicgal@gva.es

Internal Medicine DepartmentRare Diseases UnitAlcoi (Alicante). Spain.

Patient

iHP DHp HETAHealth system

Displacement Laboral Total Health

systemDisplacem

ent Laboral Total Health system

Displacement Laboral Total

Alcoy’s HospitalF1 3,021.20 84.50 2,148.64 5,254.3

4 3,422.64 0 2,148.64 5,571.28 0 0 0 0

F2 3,021.20 84.50 2,148.64 5,254.34 3,422.64 0 2,148.64 5,571.2

8 0 0 0 0

F3 3,021.20 84.50 2,148.64 5,254.34 3,422.64 0 2,148.64 5,571.2

8 0 0 0 0

F4 3,021.20 84.50 2,148.64 5,254.34 3,422.64 0 2,148.64 5,571.2

8 0 0 0 0

G1 3,021.20 84.50 0 3,105.7 3,422.64 0 0 3,422.64 0 0 0 0

G2 3,021.20 84.50 0 3,105.7 3,422.64 0 0 3,422.64 0 0 0 0

Total 18,127.2 507 8,594,5

627,228,

820,535,

84 0 8,594.56

29,130.4 0 0 0 0

Alzira’s HospitalF5 3,021.20 84.50 2,148.64 5,254.3

4 3,422.64 0 2,148.64 5,571.28 0 0 0 0

F6 3,021.20 84.50 2,148.64 5,254.34 3,422.64 0 2,148.64 5,571.2

8 0 0 0 0

G3 3,021.20 84.50 2,148.64 5,254.34 3,422.64 0 2,148.64 5,571.2

8 0 0 0 0

G4 3,021.20 84.50 2,148.64 5,254.34 3,422.64 0 2,148.64 5,571.2

8 0 0 0 0

Total 12,084.8 338 8,594.5

621,017.

213.690,

6 0 8,594.56

22,285.1 0 0 0 0

Both HospitalsBoth Hospitals

TotalTotal 30,21230,212 845845 17,189.117,189.166

48,24648,246.0.0

34,226.434,226.444 00 17,189.217,189.2 51,41551,415

.5.5 00 00 00 00

Table 1. Estimation of expenditures for each enzyme administration strategy (iHP: in-Hospital. DHp: Domicialiry hospitalization. HETA: Home enzyme Therapy Administration) and concepts for each patient and hospital. Results are expressed as Euros/year assuming 26 infusion/yr.

Graph 1. Proportional Comparative potentail

savings for each concept. A: iHP vs. HETA. B: DHp vs.

HETA.

A

B

Laboral

Health System

Laboral

Health SystemDisplac.

An electronical Excel©-based tool has been created to calculate and compare the infusion-related expenditures for each patient with GD or FD, in each medical center.

This project is being extended to all patients actually included in the Spanish national HETA program.

ConclusionsConclusionsHETA program t is an effective strategy for the treatment of GD and FD with a significant economical saving to be added to the very positive opinion of patients (Poster #109).

The creation of a very simple electronical tool to estimate infusion-related expenditures with different strategies can be an interesting way to compare the convenience of one infusion strategy respect to the others, than can be different dependig on the kind of Health System organization.BibliographyBibliographyi. Hughes DA, Milligan A, Mehta A. Home therapy for lysosomal storage disorders. Br J Nutr. 2007; 16 (22):1386-9.

Thickson ND. Economics of home intravenous services. Pharmacoeconomics.1993;3(3):220-7.

Guest JF, Concolino D, Di Vito R, Feliciani C, Parini R, Zampetti A. Modelling the resource implications of managing adults with Fabry disease in Italy. Eur J Clin Invest. 2011;41(7):710-8.

Guest JF, Jenssen T, Houge G, Aaseboe W, Tøndel C, Svarstad E. Modelling the resource implications of managing adults with Fabry disease in Norway favours home infusion. Eur J Clin Invest. 2010;40(12):1104-12.