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HIGH DOSES OF TREPROSTINIL ENTAIL LOWER HOSPITALIZATION COSTS IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION IN NINE EUROPEAN COUNTRIES

European Statement

Introductory Statements and Governance

Author(s)

Irene Lizano, Ferran Montpart, Elisenda Pomares, Guillem Saborit-Canals, Míriam Fernández

Why was it done?

Treprostinil is a prostacyclin analogue indicated for the treatment of PAH. A recent retrospective study analyzed drug safety events observed in the clinical trials of oral and subcutaneous (SC) treprostinil. This analysis showed that higher treprostinil doses were associated with lower PAH-related hospitalization rates, compared to lower doses.

What was done?

To estimate annual pulmonary arterial hypertension (PAH)-related hospitalization costs in patients treated with different treprostinil doses in nine European countries (Belgium, France, Germany, Italy, Poland, Portugal, Spain, The Netherlands and the United Kingdom).

How was it done?

A cost estimation model was developed to calculate hospitalization costs in patients with PAH who were treated with treprostinil at different doses. Annual hospitalization rates were gathered from a retrospective analysis of an oral and SC treprostinil global safety database. Patients were categorized into three groups based on total daily dose: low, medium and high. Low dose was defined as <4.0 and <1.9 mg/day (9.0 and >7.6 mg/day (>30 ng/kg/min). PAH-related hospitalization costs were included and, when not available, heart failure-related costs were considered as it is the main cause of hospitalization in PAH patients. Mean annual hospitalization costs per dose were calculated using annual PAH-related hospitalization rates (0.9 for low dose, 0.4 for medium dose, and 0.3 for high dose) and unit costs per hospitalization in each country. All costs were obtained from national databases or published literature and were expressed in 2021 euros.

What has been achieved?

Mean annual PAH-related hospitalization costs ranged from €1,649 to €8,382 for low dose, from €733 to €3,726 for medium dose, and from €550 to €2,794 for high dose. Thus, hospitalization costs for high-dose patients were 3 times lower than for low-dose patients (mean difference €2,610) and 1.3 times lower than those for medium-dose patients (€435).

What next?

High doses of treprostinil result in lower hospitalization costs than low and medium doses in patients with PAH. Therefore, an appropriate drug titration might lead to potential cost savings in various European settings.

HOW TO SECURE THE COLD CHAIN MANAGEMENT OF TEMPERATURE-SENSITIVE PRODUCTS IN THE HOSPITAL AND WHAT IS THE ECONOMIC IMPACT?

European Statement

Patient Safety and Quality Assurance

Author(s)

Cyril Magnan, Elise Betmont, Guillaume Saint Lorant, Hubert Benoist

Why was it done?

Evaluate the economic impact of improvement actions taken since 2017 on TSPs management.

What was done?

Cold chain is a major issue in the pharmaceutical industry as a growing number of its products are temperature-sensitive and also in hospitals. In 2017, 27 cold chain breaks were declared by care units (CU) within a French teaching hospital, resulting in a risk for patient care and a potential loss of 40,363 euros, of which 18,505 euros (45%) could be avoided. Following this first study, a set of measures have been implemented in our establishment in order to secure the cold chain.

How was it done?

Potential losses and avoided losses of TSPs have been analyzed continuously since 2017 according to the same methods in a teaching hospital with 1,600 beds. In case of a thermal excursion (ET), the pharmacy is, according to the institutional procedure, immediately warned by an electronic alarm day and night or by a call from the care service, making it possible to define the action required from the service concerning the methods of keeping TSPs.

What has been achieved?

Since 2017, a mobile isothermal enclosure has been implemented for the transport of TSPs during the day in the CU. Connected temperature-monitoring sensors have been installed on so-called “at-risk” refrigerators. The alarm reports to the pharmacy was instituted in order to intervene as quickly as possible. Part of the refrigerators has been renewed and awareness has been raised among all CUs for the good traceability of temperature readings, allowing a drop from 24% in 2018 to 65% of compliant traceability in 2019. Following these improvement actions, 53 ETs with a potential loss of 53,769 euros were declared in 2019, of which 39,753 euros of losses could be avoided. Currently, 74% of ET losses can be avoided compared to 43% in 2017.

What next?

This economic assessment of the potential losses and the avoided losses of PTs shows the positive impact of the various improvement measures taken since 2017 as well as education of the UDS to secure TSPs. A regional awareness was implemented thanks to a collaboration with the regional health agency in order to promote TSPs management in the hospitals.

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