1. VALUE IN HEALTH 14 (2011) A233-A510 A263
multiple centres in UK, Italy, The Netherlands and Poland. For each country, pub- of health and resource use obtained with these two alternatives. Measures of
lished local costs have been applied to the resource use. Results have been strati- health outcomes used in the model were life years and quality adjusted life years.
fied by glomerular filtration rate (GFR) at one-year post-transplant. RESULTS: Probabilistic sensitivity analysis was performed to assess uncertainty in the pa-
Across these countries, the total three-year cost of post-transplant care varies rameters included in the Markov model. RESULTS: Preliminary results show that
depending on local treatment practices, from a minimum of €36,000 per patient in cost of laparoscopic-assisted surgery is higher than open surgery in close to 750 €.
Poland to a maximum of €77,000 in the The Netherlands. Consistently across all This difference decreased slightly in the immediate postoperative period due to the
countries, the average three-year costs decrease as a result of improved graft func- lower readmission rate. The difference in costs, coupled with the equivalence in
tioning status (increased GFR) at one year. The average three-year costs for a pa- long-term results obtained by the two techniques makes that any of them can be
tient with a GFRՆ45 at one year are 29% lower than those with Ͻ30GFR in the The considered efficient for our health system. Since considering a willingness to pay
Netherlands, 40% lower in Italy, 43% lower in Belgium, 50% lower in the UK, and between 20,000 and 30,000 € per quality-adjusted life year gained, none of the
51% lower in Poland. CONCLUSIONS: This study demonstrates that in five Euro- alternatives have above 60% chance to be the best option. CONCLUSIONS: The
pean countries, worsening post-transplant renal function contributes to substan- laparoscopic-assisted resection has shown results in terms of overall survival and
tive increases in resource use, with some variation across regions. Therefore man- recurrence similar to those achieved by open surgery in colorectal surgery patients.
agement strategies that promote renal function after transplantation are likely to The estimated cost for laparoscopic intervention is slightly higher than open sur-
provide important resource savings. Additional analyses are ongoing in Spain, gery, but seems to accelerate the postoperative recovery time. This implies that
Czech Republic, Hungary, Germany and Sweden to further confirm these observa- none of the two alternatives is clearly superior to the other in terms of efficiency.
tions. Therefore, each decision maker at hospital level will assess available human and
material resources, and its cost structure to use resources more efficiently.
PSU16
MINIMALLY INVASIVE SURGERY IN TOTAL HIP ARTHROPLASTY: A COST- PSU19
EFFECTIVENESS ANALYSIS THE DOORS-STUDY OF ON-PUMP VERSUS OFF-PUMP CORONARY ARTERY
Navarro espigares JL1, Hernandez torres E1, Ruiz arranz JL2 BYPASS GRAFTING: A POST HOC ANALYSIS OF METHODS FOR MULTIPLE
1
Hospital Universitario Virgen De Las Nieves, Granada, Spain, 2Area Sanitaria Serrania De IMPUTATION OF MISSING DATA IN ECONOMIC EVALUATION
Ronda, Ronda, Spain Ehlers L1, Fenger-grøn M2, Beck SS3, Houlind K4, Lauridsen J5
1
OBJECTIVES: The main objective of this study is to evaluate the cost-effectiveness Department of Business Studies, Aalborg, Denmark, 2Department of Clinical Epidemiology,
of total hip arthroplasty through anterolateral minimally invasive surgery (MIS) Aarhus University Hospital, Denmark & Research Unit for General Practice, Aarhus University,
and compare it with the traditional approach. METHODS: A study was conducted Aarhus, Denmark, 3HTA & Health Services Research, Centre for Public Health, Central Denmark
Region, Aarhus, Denmark, 4Dept. of Cardiothoracic and Vascular Surgery, Aarhus University
to compare traditional and minimally invasive surgical techniques for total hip
Hospital, Denmark, Aarhus, Denmark, 5The Research Unit of Health Economics, University of
arthroplasty in a population of 340 patients at two Spanish hospitals (the Virgen de Southern Denmark, Denmark, Odense, Denmark
las Nieves University Hospital of Granada and the Serranía de Ronda Hospital) OBJECTIVES: A cost-utility analysis was conducted alongside the Danish On-pump
during the year 2007. The design of the study was a prospective stochastic cost- Off-pump Randomization Study (DOORS) based on the intention to treat principle.
effectiveness analysis, where effectiveness data were collected over a one-year METHODS: A post hoc analysis of the problem of missing data was addressed by
period at individual patient levels and costs were gathered from the analytical multiple imputation using the conditional Gaussian as well as the chained equa-
accounting system of Virgen de las Nieves University Hospital. Effectiveness was tion approach. Both methods where applied using two different models (represent-
measured in functional terms (clinical) and self-perceived quality of life (SF-12 ing a data-driven respectively a clinical reasoning selection strategy). RESULTS:
survey) during the first 6 postoperative weeks. RESULTS: After 6 postoperative The cost-effectiveness acceptability curve for the complete case analysis (nϭ779)
weeks, in comparison with the conventional technique, a pattern in improvements showed 88 % probability of OPCAB being cost-effective at a threshold value of
for MIS was observed for length of hospital stay (hospitalization time was 4.97 days £30.000 per QALY. In analyses based on the conditional Gaussians approach and
shorter); for operative time (an average of 83.3 minutes for MIS patients and 97.8 the chained equations approach to multiple imputation the results was 73-75 %.
minutes for the control group); and for average length of skin incision (9.83 cm. for CONCLUSIONS: The result of the previously published complete-case analysis of
the MIS group and 16.2 cm. for the control group). The total cost of THA with MIS the cost-effectiveness of OPCAB versus CCABG was reinforced by this post hoc
was lower (4519.19 €) than the cost of traditional hip replacement (6722.46 €). In- analysis of the uncertainty due to missing data. The analysis showed that the
cremental effectiveness value in terms of quality of life was 0.11 points in the SF-12 conditional Gaussian approach and the chained equations approach produced
survey for MIS. The cost-effectiveness analysis reveals a strong dominance of MIS similar results Evidence about the long term cost-effectiveness of OPCAB versus
versus traditional THA. CONCLUSIONS: The study showed that the minimally in- CCABG is warranted.
vasive technique reduces inpatient resource utilization and improves self per-
ceived quality of life of patients compared with the traditional approach. The more Surgery – Patient-Reported Outcomes & Preference-Based Studies
beneficial incremental effectiveness ratio of MIS versus traditional THA supports
the recommendation for expanded use of minimally invasive surgery. PSU20
ESTIMATING PREFERENCES FOR ECONOMIC EVALUATION IN PATIENTS WITH
PSU17 LOCALIZED PROSTATE CANCER
COST-EFFECTIVENESS OF DSAEK VERSUS PK FOR CORNEAL Avila MM1, Becerra V1, Cunillera O1, Pardo Y2, Ferrer M3
ENDOTHELIALDISEASE 1
IMIM (Institut de Recerca Hospital del Mar), Barcelona, Catalunya, Spain, 2IMIM (Institut de
Patel S, Kaakeh R, Shtein R, Smith D Recerca Hospital del Mar), Barcelona, Barcelona, Spain, 3IMIM-Hospital del Mar, Barcelona,
University of Michigan, Ann Arbor, MI, USA Barcelona, Spain
OBJECTIVES: To perform a comparative cost-effectiveness analysis of Descemet’s OBJECTIVES: The high variability on preferences estimates for prostate cancer
stripping automated endothelial keratoplasty (DSAEK) and penetrating kerato- could be explained by differences in methods, techniques and obtaining popula-
plasty (PK) for corneal endothelial disease. METHODS: Systematic review of the tions. Our aim was to estimate the preferences and willingness to pay of patients in
peer-reviewed English literature through a search of PubMed to populate a 5 year the “Spanish Multicenter Study of Localized Prostate Cancer” at 5 years of follow-
model of a) quality adjusted life years (QALYs) associated with clinical outcomes of up, according to the treatment received (radical prostatectomy, external radiother-
the relatively new DSAEK procedure and the long-established PK procedure, and b) apy and brachytherapy). METHODS: Data analyzed were from the 5-year follow-up
third party payer (US Medicare 2010) costs associated with associated medical, evaluation of the “Spanish Multicenter Study of Localized Prostate Cancer”, in
surgical and pharmaceutical services. RESULTS: Five year follow-up focusing on which patients completed the preference questionnaire. The estimation of prefer-
standard therapy and complications yeilds 2.99 QALYs associated with DSEAK and ences was conducted using the indirect method (from the SF-6D index), and the
1.94 QALYs with PK, a difference of 1.05. Following slightly higher sugical costs of direct method using the Standard Gamble (SG) and Time Trade-Off (TTO) tech-
$US7925 for DSEAK and $US7544 for PK, total five year costs are $US10,104 associ- niques. We also assessed the patients’ Willingness-to Pay (WTP). The three treat-
ated with DSEAK and $US9840 with PK, a difference of $US264. The ICUR is $US251. ment groups were compared using the Kruskall Wallis test. RESULTS: Of the 441
Sensitivity analyses of differeing disc dislocation rates, astigmtism complication patients enrolled, 105 were treated with radical prostatectomy, 137 with external
rates and cost parameters yield ICURs in the range of $US0 to $US500. radiotherapy and 199 with prostate brachytherapy. Most patients were married or
CONCLUSIONS: Using the literature on outcomes and costs for treatments of cor- living with a partner (89.6%), were retired (76%) and had completed primary or
neal endothelial disease, a five year model yields robust results siggesting that secondary studies (53.5%). Utilities measured with the SF-6D showed no statisti-
DSEAK is slightly more expensive procedure than PK to third party payers, but with cally significant differences by treatment group (p ϭ 0.356). The utilities measured
favorable quality adjusted life year resulting making DSEAK a cost-effective option by TTO presented the greatest differences according to treatment: mean of 0.94 in
under all scenarios considered. the radical prostatectomy group, 0.99 in external radiotherapy and 0.98 in brachy-
therapy (p Ͻ0.001). The willingness to pay also showed significant differences:
PSU18 mean of 58.4 € in the radical prostatectomy group, 32.04 € in external radiotherapy
COST-UTILITY ANALYSIS OF LAPAROSCOPIC VERSUS OPEN SURGERY FOR and 28.8 € in brachytherapy (p Ͻ0.01). CONCLUSIONS: The estimates of preferences
COLORECTAL CANCER vary according to the method and the technique used to obtain them. Both the
Callejo D, Guerra M, Reza M, Maeso S, Blasco JA utilities obtained by the direct method and the ones through willingness to pay
Agencia Laín Entralgo, Madrid, Spain
indicate that radical prostatectomy is the worst valued treatment, prostate brachy-
OBJECTIVES: To assess the comparative efficiency of laparoscopic versus open
therapy being the most valued by patients with localized prostate cancer.
surgery in colorectal cancer patients. METHODS: To establish relative efficacy of
laparoscopic versus open surgery in all measures that could have clinical or eco- PSU21
nomic relevance. Using previous systematic reviews and updating their contents SPEECH PROBLEM AND HEALTH-RELATED QUALITY OF LIFE IN HEAD AND
with the new information published after. Meta-analysis technique is used to sum- NECK CANCER SURVIVORS AFTER FIVE YEARS OF TREATMENTS
marize the information. A Markov model is developed to estimate progress in time Payakachat N1, Suen JY2

2. MINIMALLY INVASIVE SURGERY IN TOTAL HIP ARTHROPLASTY. A COST-EFFECTIVENESS ANALYSIS1
Navarro Espigares, JL2; Hernández Torres, Elisa; Ruiz Arranz, JL
University Hospital Virgen de las Nieves (Granada, Spain). http://www.hvn.es/index.php
BACKGROUND Table 1: Clinical Results
 In recent years there has been a growing interest in developing minimally
Variable THA MIS Dif. p
invasive techniques (MIS), which have moved to the hip surgery with the
objective of breaking less soft tissue, reduce blood loss, improve aesthetics and N 50 50
speed rehabilitation Length of hospital stay 8.72 4.30 4.42 0,00
 The published literature contains objective evidence of the positive impact of MIS Operational Time 94.64 91.80 2.84 0,60
on the effectiveness in relation to functional outcomes, hospital stay and surgical Lenght of incision 15.56 9.86 5.70 0,00
aggressiveness of the intervention, with a greater number of effectiveness
studies that support MIS than studies on complications and disadvantages of this Table 2: Quality of life results (SF-12)
technique.
SF12 Dimension Measurement Technique N Average SD Dif. p
OBJECTIVES PHYSICAL Basal THA 50 29.44 5.06 -2.34 .00
MIS 50 31.78 3.12
 The main objective of this work is to determine the cost-effectiveness of total hip Post-interv. THA 46 32.81 6.42 -4.08 .00
MIS 50 36.89 4.95
arthroplasty by means of minimal invasive surgery (MIS) in comparison with Difference THA 46 3.38 8.49 -1.73 .20
MIS 50 5.11 6.46
traditional surgical techniques (THA). MENTAL Basal THA 50 52.38 5.98 0.41 .67
MIS 50 51.97 5.35
METHODS Post-interv. THA 46 49.44 5.61 2.93 .00
MIS 50 46.52 3.78
Difference THA 46 -2.93 7.70 2.52 .04
 A study was conducted to compare traditional and minimally invasive surgical
MIS 50 -5.45 5.43
techniques for total hip arthroplasty in a population of 340 patients at two
Spanish hospitals (the Virgen de las Nieves University Hospital of Granada and Table 3: Cost per episode
the Serranía de Ronda Hospital) during the year 2007.
THA MIS Dif. p†
 The design of the study was a prospective stochastic cost-effectiveness analysis, N 50 50
where effectiveness data were collected over a one-year period at individual Average 8,739.20 5,314.94 3424.26 0.00
SD 3,226.83 358.63
patient levels and costs were gathered from the analytical accounting system of
IC 95% L. Inf 7,822.14 5,213.02 2513.09
Virgen de las Nieves University Hospital. Effectiveness was measured in L. Sup 9,656.25 5,416.86 4335.44
functional terms (clinical) and self-perceived quality of life (SF-12 survey) during Min 5,082.52 5,082.52
the first 6 postoperative weeks. Max 22,901.08 5,857.24
RESULTS Table 4: Deterministic cost-effectiveness analysis
 After 6 postoperative weeks, in comparison with the conventional technique, a Variable Δ Effectiveness Δ Cost CEIR
pattern in improvements for MIS was observed for length of hospital stay Length of hospital stay 4.42 Sig. 3,424.26 Sig. 774.72
(hospitalization time was 4.42 days shorter); for operative time (an average of
Operative Time 2.84 NS 3,424.26 Sig. 1,205.73
94.80 minutes for MIS patients and 94.64 minutes for the control group); and for
length incision 5.70 Sig. 3,424.26 Sig. 600.75
average length of skin incision (9.86 cm. for the MIS group and 15.56 cm. for the
SF12 Physical -1.73 Sig. 3,424.26 Sig. -1,977.06
control group) (Table 1).
 Differential effectiveness value in terms of quality of life was -1,73 and 2,52 in Mental 2.52 NS 3,424.26 Sig. 1,359.75
physical and mental dimensions of the the SF-12 survey respectively (Table 2). Illustration: Cost-effectiveness plane
4.000,00
 The total cost of THA with MIS (5,314.94€) was lower than the cost of traditional SF12
Physical
SF12 Mental Stay
length of
Surgical incision
hip replacement (8,739.20€) (Table 3). 3.000,00 Time
 The cost-effectiveness analysis reveals a strong dominance of MIS versus 2.000,00
traditional THA (Table 4, Illustration). 1.000,00
CONCLUSIONS
Var. Costs
0,00
-4,00 -2,00 0,00 2,00 4,00 6,00 8,00
 The study showed that the minimally invasive technique reduces inpatient -1.000,00
resource utilization and improves self perceived quality of life of patients
-2.000,00
compared with the traditional approach. The more beneficial incremental
-3.000,00
effectiveness ratio of MIS versus traditional THA supports the recommendation
for expanded use of minimally invasive surgery. -4.000,00
Var. Effectiveness
1 Research project funded by Instituto de Salud Carlos III. PI060668 Project : Análisis coste-efectividad de la artroplastia total de cadera con cirugía
mínimamente invasiva versus abordaje tradicional. 2 Contact information: José Luis Navarro Espigares. Hospital Universitario Virgen de las Nieves.
Avenida Fuerzas Armadas. 18014 Granada – Spain. E: josel.navarro.sspa@juntadeandalucia.es
ISPOR 14TH ANNUAL EUROPEAN CONGRESS. 4-8 NOVEMBER, 2011. MADRID (SPAIN)