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Daniel Asrat Kassa,1 Solomon Mekonnen,2 Adane Kebede,1 Tsegaye Gebremedhin Haile1 1Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Tsegaye Gebremedhin HaileDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, EthiopiaTel +251-921279362Email tsegishg27@gmail.comPurpose: Hemodialysis is a renal replacement therapy for end-stage renal disease (ESRD) patients who consume substantial healthcare resources, which increases the economic burden. Plenty of factors affects the cost of hemodialysis treatment, particularly in resource-limited settings. Moreover, the demand for hemodialysis may decrease as the cost increases, but there is limited evidence in Ethiopia. Thus, this study aimed to estimate the cost of hemodialysis treatment among ESRD patients in the tertiary hospitals of Addis Ababa City and Amhara region, Ethiopia.Patients and Methods: An institutional-based cross-sectional study was conducted among 172 ESRD patients undergoing hemodialysis treatment. A structured questionnaire and patients’ medical chart were used to estimate the costs, and the human capital approach was applied to calculate the indirect costs. A generalized linear model (GLM) was fitted after the modified park test to identify the associated factors. In the final GLM, a p-value of < 0.05 and a 95% CI were used to declare the significant variables.Results: The mean annual cost of hemodialysis treatment was 121,089.27ETB ($4466.59) ± 33,244.99 ($1226.29). The direct and indirect costs covered 77.0% and 23.0% of the total costs, respectively. Age (ex(b): 1.01, p-value < 0.001), highest wealth status (ex(b): 1.09, p-value: 0.008), eight (ex(b): 1.27, p-value < 0.001) and 12 visits/month (ex(b): 1.34, p-value < 0.001), anemia (ex(b): 1.13, p-value < 0.001), and comorbidity (ex(b): 1.09, p-value: 0.039) were the factors associated with the costs of hemodialysis treatment.Conclusion: The annual cost of hemodialysis treatment among ESRD patients was high compared to the national per capita health expenditure, and two-thirds covered by the direct medical costs. Old age, high wealth status, more visits, anemia, and comorbidity were factors associated with the costs of hemodialysis. Therefore, the healthcare system must make a great effort for cost reduction and reduce the patients with kidney disease before they reach end-stages.Keywords: burden of ESRD, direct costs, indirect costs, GLM, hemodialysis, Ethiopia

Background Hypertension is a common vascular disease and the main risk factor for cardiovascular diseases. Since the incidence of hypertension is rising in Ethiopia, one may expect that the household's cost of healthcare services related to the disease will increase in the near future. Yet the cost associated with the disease is not known. We aimed to estimate the total cost of hypertension illness and identify associated factors among patients attending hospitals in Southwest Shewa zone, Oromia regional state, Ethiopia. Patients and methods An institution-based cross-sectional study design was employed to conduct the study from 13 August to 2 September 2018. All hypertensive patients aged 18 years and older who were on follow-up were eligible for this study. The total cost of hypertension illness was estimated by summing the direct and indirect costs. Bivariate and multivariate linear regression analyses were performed to identify factors associated with hypertension costs of illnesses. Results A total of 349 patients participated in the study. The mean monthly total cost of hypertension illness was US$ 22.3 (95% CI, 21.3-23.3). Direct and indirect costs constitute 51% and 49% of the total cost, respectively. The mean direct cost of hypertension illness per patient per month was US$ 11.39 (95% CI, 10.6-12.1). Out of these, drugs comprised higher cost (31%), followed by food (25%). The mean indirect cost per patient per month was US$ 10.89 (95% CI, 10.4-11.4). In this study, the primary educational status, family size (4-6 and >6), distance from hospital (≥10 km), the presence of a companion and stage of hypertension (stage two) of patients were identified as the predictors of the cost of hypertension illnesses. Conclusion The cost of hypertension illness was very high when compared to the monthly income of households, exposing patients to catastrophic costs. Hence, the government should give due attention to protect patients from catastrophic health expenditures.

Purpose Advanced non-small-cell lung cancer (aNSCLC; stage IIIB/IV) presents a substantial clinical burden to society; reliable estimates of its economic burden are lacking. Therefore, this study aimed to quantify real-world health care resource utilization (HCRU) and costs of patients with squamous (SQ) and non-SQ (NSQ) aNSCLC who received two or more lines of treatment (2L+) in Europe, and to describe cost-predictors. Methods The LENS (Leading the Evaluation of Non-squamous and Squamous NSCLC) retrospective chart review study collected data from 2L+ patients with aNSCLC diagnosed between 07/2009 and 08/2011 (wave 1) or 07/2010 and 09/2012 (wave 2) in France, Germany, Italy, Spain, England, the Netherlands, and Sweden. Patients were followed from diagnosis through most recent visit/death. A weighted average of country-specific unit costs (2018 Euro) was applied to systemic anti-cancer therapy usage and HCRU (hospital/emergency department visit, surgery, radiotherapy, ancillary care, biomarker testing) to determine the total cost from aNSCLC diagnosis to death. Generalized linear models (gamma distribution, log link) were used to assess clinical and demographic predictors. Results Of 973 2L+ aNSCLC patients, median overall survival (OS) was 1.5 years from advanced diagnosis (range: 0.2-5.3; median OS: 1.4 [SQ], 1.6 [NSQ]), 79.0% died during follow-up. Weighted mean total per-patient costs were €21,273, ranging from €17,761 (England) to €30,854 (Sweden), and €15,446 (SQ) to €26,477 (NSQ). Systemic drug costs comprised 77.4% of total costs. Insurance status, presence of epidermal growth factor receptor (EGFR) mutation, SQ histology, age, alcohol abuse, and year of diagnosis were significant predictors for lower total costs per patient-month, Eastern Cooperative Oncology Group performance status (ECOG PS) ≥1 and country for higher costs. Conclusion In the era pre-immunotherapy, HCRU and costs were substantial in aNSCLC 2L+ patients, with most of the costs accrued prior to start of 2L. NSQ patients incurred significantly higher total costs than SQ patients in all participating countries.

Purpose The availability of different routes of administration of rituximab, with different dosing and times of infusion in the day care unit, raises the question of which formulation would be the best in terms of direct cost, particularly with the approval of new intravenous (IV) rituximab biosimilars. We aim to retrospectively compare the direct costs of IV and subcutaneous (SC) rituximab in lymphoma, considering drug cost, pharmacy handling and occupation in day care unit in Son Espases University Hospital during 2017, now that the IV biosimilar is available. Patients and methods The data were collected from Oncosafety®-AVIDA for doses and SAP® for economic data. The costs of occupation are published by the Local Health Service. Results In 2017, 527 cycles were prescribed for 103 patients with lymphoma: 141 IV and 386 SC. Median doses were 690 mg and 1400 mg with a median cost of the drug of 1458.45€ and 1334.77€ for IV and SC routes, respectively. The nurse handling costs were 4.49€ and 2.24€, respectively. The cost of the day care unit occupation was 493€ and 123€, respectively. Overall, the median total cost per cycle was 1955.94€ for the IV, 1460.01€ for the SC and 1729€ for the biosimilar (p

Jason Foo,1 Mohamad Maghnie,2 Annamaria Colao,3 Ioanna Vlachaki,4 Giorgio Colombo5,61Global Health Economics, Mapi Group (An ICON plc Company), Houten, The Netherlands; 2Department of Pediatrics, IRCCS Istituto Giannina Gaslini Institute, University of Genova, Genova, Italy; 3Department of Clinical Medicine and Surgery, University Federico II of Naples, 80131 Napoli, Italy; 4Global Health Economics, ICON plc, London, UK; 5Department of Drug Science, Pavia University, Pavia, Italy; 6SAVE Studi – Health Economics & Outcomes Research, Milan, ItalyCorrespondence: Jason FooGlobal Health Economics, Mapi Group (An ICON PLC Company), De Molen 84, Houten 3995 AX, The NetherlandsEmail jcfoo1@hotmail.comBackground: The objective of this analysis was to evaluate the cost-consequence of recombinant human growth hormone (r-hGH) administered via the easypod auto-injector (Merck, Darmstadt, Germany) versus conventional devices in children with growth hormone deficiency in Italy.Methods: A patient-level simulation, decision-analytical model was developed to estimate the average height gains and growth hormone treatment costs for a cohort of boys and girls until their bone maturation age. The calculations were performed using listed growth hormone drug prices (base case) and a scenario analysis was also conducted using published tender prices. Costs were discounted at 3%.Results: Due to improved adherence and earlier identification of poor responders, patients receiving somatropin with easypod gained, on average, 3.2 cm more than patients receiving other r-hGH treatments. Somatropin with easypod had the second highest total cost including wastage (€96,710), but had the second lowest cost per cm gained (€7699/cm). In the scenario analysis, somatropin with easypod had the lowest cost per cm gained (€4708/cm) amongst all of the compared treatments.Conclusion: Somatropin with easypod can be cost-saving versus all other r-hGH treatments except Omnitrope when listed drug prices are considered and can be cost-saving versus all other r-hGH treatments when tender drug prices are considered. The easypod device also facilitates cost savings in terms of reduced wastage.Keywords: easypod, growth hormone treatment, growth hormone deficiency, cost-consequence analysis

Objective: To estimate the budget impact of avelumab as a treatment option for patients with treatment-naive first-line (1L) and previously treated second-line or later (2L+) metastatic Merkel cell carcinoma (mMCC) in the US. Methods: A budget impact model was developed to evaluate the addition of avelumab for the treatment of mMCC patients using a hypothetical 30 million-member US health plan over a 3-year time horizon (2019-2021). The comparator treatments included in the analysis were pembrolizumab and nivolumab (other immuno-oncology agents); and the chemotherapies routinely used in the eligible mMCC population. Model inputs included market share uptake of avelumab and other comparators, duration of treatments, and costs (drugs, health care resource utilization, adverse events). The model was evaluated from a commercial payer perspective. Sensitivity analyses were conducted to test uncertainties arising from the input values used in the model. Results: In a hypothetical commercial health plan of 30 million members, 285 patients with mMCC were identified over 3 years; 43 patients received avelumab as a 1L treatment over 3 years. In a world without avelumab, the total health care costs of treating patients with mMCC over 3 years were estimated to be US$11,710,115 from a commercial health plan perspective. With avelumab, there were estimated savings of $2,643,173 considering the total costs related to the treatment of mMCC over 3 years (23% reduction in the budget). The incremental cost per member per month over 3 years was -$0.0025. Conclusion: The model results indicate that the adoption of avelumab as a treatment option for mMCC would likely result in minimal budget impact from a US health plan perspective. Patients with mMCC, a rare condition with a poor prognosis and high unmet need, may benefit greatly from recently approved immunotherapies.

Elsabet Adane,1 Asmamaw Atnafu,2 Andualem Yalew Aschalew2 1University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Andualem Yalew Aschalew P. O. Box 196, Gondar, EthiopiaTel +251 918151825Email yalewandualem@gmail.comPurpose: Non-communicable diseases impose a significant social, economic and health burden. Hypertension, the leading contributor to the global burden of disease and a growing public health problem worldwide, is one of the most serious non-communicable diseases. In Ethiopia, empirical evidence on the economic burden of hypertension is limited. Therefore, this study aimed to measure the cost of hypertension and associated factors at the University of Gondar comprehensive specialized hospital, northwest Ethiopia.Patients and Methods: An institution-based cross-sectional study was conducted on 442 adult hypertensive patients using a semi-structured questionnaire to estimate the direct and indirect costs of hypertension. The human capital approach was used to calculate indirect costs. A generalized linear model was fitted to identify factors associated with the cost of hypertension at a 95% confidence level and < 0.05 p-value.Results: A total of 442, 56.3% female and 64.3% stage one hypertension patients were included. The total cost of hypertension was ETB 2510.32 ($91.72) ± 2152.80 (78.65) per patient per year; The direct medical and non-medical cost constituted 60.81% and 12.17% of the total cost of hypertension, respectively. Hospitalized (exp(b)=1.87, p< 0.001), using multidrug (exp(b)=1.32, p< 0.000), high socioeconomic status (exp(b)=1.41,p< 0.000), college and above education(exp(b)= 1.35, p< 0.016), government employment (exp(b)= 1.30, p< 0.012), retirement (exp(b)= 0.71, p< 0.001) and co-morbidity (exp(b)= 1.20, p< 0.004) were factors significantly associated with the cost of hypertension.Conclusion: The total cost of illness of hypertension is high, and direct medical cost has the highest component of the total cost of illness. Hospitalization, using multidrug, co-morbidity, attending college and above education, highest socioeconomic status and government employment were factors significantly associated with the high cost of hypertension. Therefore, prevention and early detection of complications and co-morbidity are essential to reduce hospitalization and the number of drugs to reduce the direct medical and indirect costs.Keywords: burden of disease, hypertension, Ethiopia

Trung Quang Vo,1,2 Usa Chaikledkaew,1,3 Minh Van Hoang,4 Arthorn Riewpaiboon1 1Department of Pharmacy, Division of Social and Administrative Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; 2Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; 3Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand; 4Hanoi School of Public Health, Hanoi, Vietnam Abstract: Influenza is a malady related to the human respiratory system, and its influenza-like illness (ILI) can cause an economic and social burden, especially among children and the elderly. This study was conducted to estimate the cost of illness based on a social perspective of ILI cases. A prospective study was conducted between February and March of 2016 in pharmacies, private clinics at Khanh Hoa, Lam Dong, Tay Ninh, Dong Nai Province, and Ho Chi Minh City, and Hospital of Tropical Diseases. Demographic and clinical information were collected by face-to-face interview. Direct costs (e.g., diagnosis and therapeutics) and indirect costs (e.g., cost of day loss) are included as treatment costs. The average cost of treatment associated with ILI was US$ 88.09 per case for all age groups; direct non-medical cost was higher compared to direct medical cost: 39.5% in pharmacies, 71.1% in clinics, and 64.2% in hospital. The indirect cost was US$27.49 per episode. The average total cost for children below 14 years old was much higher than that for the other age groups. The cost of illness of ILI was, therefore, the reason for the economic burden of influenza patients and their families. This study provides a database for future research and programs, and policies that can be adopted for influenza or ILI in Vietnam. Keywords: influenza, influenza-like illness, economic burden, cost of illness, pharmacy, clinic, hospital, Vietnam

Christos Chouaid,1 Delphine Loirat,2 Emilie Clay,3 Aurélie Millier,3 Chloé Godard,4 Amira Fannan,4 Laurie Lévy-Bachelot,4 Eric Angevin5 1Chest Department, Centre Hospitalier Intercommunal Créteil, Créteil, France; 2Institut Curie, Paris, France; 3Creativ-Ceutical, Paris, France; 4MSD France, Courbevoie, France; 5Institut Gustave Roussy, Villejuif, France Background: Adverse events (AEs) related to medical treatments in non-small cell lung cancer (NSCLC) are frequent and need an appropriate costing in health economic models. Nevertheless, data on costs associated with AEs in NSCLC are scarce, particularly since the development of immunotherapy with specific immune-related AEs.Objective: To estimate the costs of grades 3 and 4 AEs related to NSCLC treatments including immunotherapy in France.Methods: Grades 3 and 4 AEs related to treatment and reported in at least 1% of patients in Phase III clinical trials for erlotinib, ramucirumab plus docetaxel, docetaxel, pemetrexed plus carboplatin plus bevacizumab, platinum-based chemotherapies, nivolumab and pembrolizumab were identified. When no cost evaluation was reported in literature, estimates on standard treatments and medical resource use for each AE were obtained thanks to an expert panel. Total cost per AE was calculated from a French national health insurance perspective and updated in 2017 Euros. Hospital stay costs were estimated based on public and private weighted tariffs and data from the French Medical Information System (Programme de Médicalisation des Systèmes d’Information). Costs of tests, consultations and treatments were calculated based on national reimbursement tariffs.Results: Overall, costs of grades 3 and 4 AEs related to treatment ranged from €46 per event to €7,742 per year. Fourteen out of 24 AEs identified had a mean estimated cost over €2,000. The highest mean costs were related to type 1 diabetes (€7,742 per year) followed by pneumonitis (€5,786 per event), anemia (€5,752 per event), dehydration (€5,207 per event) and anorexia (€4,349 per event). Costs were mostly driven by hospitalization costs.Conclusion: Among the AEs identified, a majority appeared to have an important economic impact, with a management cost of at least €2,000 per event mainly driven by hospitalization costs. This study may be of interest for economic evaluations of new interventions in NSCLC. Keywords: non-small cell lung cancer, adverse events, cost analysis, chemotherapy, immunotherapy

Cristina Lucidi,1 Vincenza Di Gregorio,1 Giancarlo Ceccarelli,2 Mario Venditti,2 Oliviero Riggio,1 Manuela Merli1 1Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy; 2Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome,Italy Background: Early diagnosis and appropriate treatment of infections in cirrhosis are crucial. As new guidelines in this context, particularly for health care-associated (HCA) infections, would be needed, we performed a trial documenting whether an empirical broad-spectrum antibiotic therapy is more effective than the standard one for these infections. Because of the higher daily cost of broad-spectrum than standard antibiotics, we performed a cost analysis to compare: 1) total drug costs, 2) profitability of hospital admissions. Methods: This retrospective observational analysis was performed on patients enrolled in the trial NCT01820026, in which consecutive cirrhotic patients with HCA infections were randomly assigned to a standard vs a broad-spectrum treatment. Antibiotic daily doses, days of treatment, length of hospital stay, and DRG (diagnosis-related group) were recorded from the clinical trial medical records. The profitability of hospitalizations was calculated considering DRG tariffs divided by length of hospital stay.Results: We considered 84 patients (42 for each group). The standard therapy allowed to obtain a first-line treatment cost lower than in the broad-spectrum therapy. Anyway, the latter, being related to a lower failure rate (19% vs 57.1%), resulted in cost saving in terms of cumulative antibiotic costs (first- and second-line treatments). The mean cost saving per patient for the broad-spectrum arm was €44.18 (–37.6%), with a total cost saving of about €2,000. Compared to standard group, we observed a statistically significant reduction in hospital stay from 17.8 to 11.8 days (p

Luyen Dinh Pham,Nhat Huy Tran Phung,Nguyen Tu Dang Le,Trung Quang Vo Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam Background: Dengue is a mosquito-borne viral illness with the world’s fastest rate of infection. In 2014, Vietnam had recorded 43,000 cases in 53 provinces, with 28 deaths. Materials and methods: A 6-month cross-sectional study was conducted from September 2015 to March 2016 at Cu Chi General Hospital. Cost of illness in this study was estimated under the incidence-based approach from the societal perspective. Results: The average cost per case was US$139.3±$61.7. The average cost per child was higher than per adult, but not significant ($151.0±$63.5 and $132.7±$59.9, respectively; P=0.068). Meanwhile, 50.2% of the total cost was contributed by the cost of hospital bed. According to the sensitivity analysis, if both the costs of the hospital bed and ultrasound were reduced by 10%, the total treatment cost of dengue fever would fall by 5% and 1.6%, respectively. Conclusion: This study is expected to be the basis for investment-plan formulation and fund allocation for the treatment and prevention of dengue. In an attempt to examine the entire socioeconomic encumbrance caused by the dengue virus, a larger scale study targeting both dengue and dengue hemorrhagic fever needs to be conducted in several hospitals. Keywords: cost of illness, dengue, dengue fever, hospital, Vietnam&nbsp

Peter Bo Poulsen,1 Søren Paaske Johnsen,2 Morten Lock Hansen,3 Axel Brandes,4 Steen Husted,5,† Louise Harboe,6 Lars Dybro7 1Pfizer Denmark ApS, Ballerup, 2Department of Clinical Epidemiology, Aarhus University Hospital, 3Department of Cardiology, Zealand University Hospital, Roskilde, 4Department of Cardiology, Odense University Hospital, 5Department of Medicine, Regional Hospital West Jutland, Herning, 6Bristol-Myers Squibb Denmark, Virum, 7Pfizer Denmark, Ballerup, Denmark †Steen Husted passed away on December 28, 2016 Aim: Resources devoted to health care are limited, therefore setting priorities is required. It differs between countries whether decision-making concerning health care technologies focus on broad economic perspectives or whether focus is narrow on single budgets (“silo mentality”). The cost perspective as one part of the full health economic analysis is important for decision-making. With the case of oral anticoagulants in patients with nonvalvular atrial fibrillation (NVAF), the aim is to discuss the implication of the use of different cost perspectives for decision-making and priority setting. Methods: In a cost analysis, the annual average total costs of five oral anticoagulants (warfarin and non-vitamin K oral anticoagulants [NOACs; dabigatran, rivaroxaban, apixaban, and edoxaban]) used in daily clinical practice in Denmark for the prevention of stroke in NVAF patients are analyzed. This is done in pairwise comparisons between warfarin and each NOAC based on five potential cost perspectives, from a “drug cost only” perspective up to a “societal” perspective.Results: All comparisons of warfarin and NOACs show that the cost perspective based on all relevant costs, ie, total costs perspective, is essential for the choice of therapy. Focusing on the reimbursement costs of the drugs only, warfarin is the least costly option. However, with the aim of therapy to prevent strokes and limit bleedings, including the economic impact of this, all NOACs, except rivaroxaban, result in slightly lower health care costs compared with warfarin. The same picture was found applying the societal perspective.Conclusion: Many broad cost-effectiveness analyses of NOACs exist. However, in countries with budget focus in decision-making this information does not apply. The present study’s case of oral anticoagulants has shown that decision-making should be based on health care or societal cost perspectives for optimal use of limited resources. Otherwise, the risk is that suboptimal decisions will be likely. Keywords: atrial fibrillation, oral anticoagulants, priority setting, drug costs, total costs, silo thinking

Claudio Gerace,1 Francesco Montorsi,2 Rosa Tambaro,3 Giacomo Cartenì,4 Stefano De Luca,5 Marcello Tucci,6 Giuseppe Martorana,7 Umberto Basso,8 Leonardo Cardosi,1 Cristina Teruzzi1 1Temas s.r.l.-QuintilesIMS, Integrated Market Access Department, 2Department of Urology, IRCCS Ospedale San Raffaele, Milano, Italy; 3Department of Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy; 4A.O.R.N. A. Cardarelli, Unità Operativa Complessa di Oncologia Medica, Napoli, Italy; 5Department of Urology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Torino Italy; 6Department of Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Torino Italy; 7Department of Urology, Ospedale Policlinico S. Orsola-Malpighi, Bologna, Italy; 8Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IRCCS, Padova, Italy Background: Urothelial bladder cancer (UBC) is the ninth most common cancer worldwide. In Italy, the prevalence of the disease is approximately 10%, making it the fourth most prevalent cancer in the country. The increase in prevalence requires continuous surveillance and care, resulting in a significant burden on Italian National Health Service, making any improvement to the strategy for diagnosing and treating this disease important to the medical and scientific community. The aim of this study was to evaluate the UBC cost of illness in the Italian context, collecting the total costs of the disease.Methods: An economic analysis was carried out in the context of the National Health Service, using data collected from six centers, in order to evaluate direct costs in terms of outpatient, inpatient, and emergency care; pharmaceuticals and follow-up procedures; and indirect costs in terms of productivity losses. Data were collected through aggregated form reports, focusing on patients with an existing diagnosis of UBC who were treated in the last year. The Italian Association of Medical Oncology (AIOM) guidelines were used to identify diagnostic and therapeutic procedures. Statistical analysis was conducted to explore variations among centers.Results: The weighted mean total annual cost per patient was € 3,591, where the cost for superficial disease was € 3,252 and that for metastatic disease was € 606. The analysis confirmed a proportional relation between disease severity and disability grade. The UBC cost of illness, considering prevalence and incidence data coming from the 2016 AIOM/Italian Association of Cancer Registries report, was € 1,187,036,344. Indirect costs accounted to 44%, represented by estimated productivity losses.Conclusion: Our analysis represents the first economic study of UBC in the Italian context, as well as the first real-life evidence of the current therapeutic algorithm. This study opens the possibility for further analysis on the indirect cost components that represent a great burden for the society, especially for those in the severest stages of the disease with high disability grades. Keywords: cost of illness, cost analysis, economic evaluation, urothelial bladder cancer, direct costs, indirect costs

Bin Sulong Saperi,1 Roszalina Ramli,2 Zafar Ahmed,1 Amrizal Muhd Nur,1 Mohd Ismail Ibrahim,3 Muhd Fazlynizam Rashdi,2 Rifqah Nordin,2 Normastura Abd Rahman,4 Azizah Yusoff,4 Abd Jabar Nazimi,2 Roselinda Abdul Rahman,4 Noorhayati Abdul Razak,4 Norlen Mohamed 5 1International Centre for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, 2Department of Oral and Maxillofacial Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, 3Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 4School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, 5Malaysian Institute of Road Safety Research, Kuala Lumpur, Malaysia Objective: Facial injury (FI) may occur in isolation or in association with injuries to other parts of the body (facial and other injury [FOI]). The objective of this study was to determine the direct treatment costs incurred during the management of facial trauma. Materials and methods: A prospective cohort study on treatment cost for FIs and FOIs due to road-traffic crashes in two university hospitals in Malaysia was conducted from July 2010 to June 2011. The patients were recruited from emergency departments and reviewed after 6 months from the date of initial treatment. Direct cost analysis, comparison of cost and length of hospital stay, and Injury Severity Score (ISS) were performed. Results: A total of 190 patients were enrolled in the study, of whom 83 (43.7%) had FI only, and 107 (56.3%) had FOI. The mean ISS was 5.4. The mean length of stay and costs for patients with FI only were 5.8 days with a total cost of US$1,261.96, whereas patients with FOI were admitted for 7.8 days with a total cost of US$1,716.47. Costs doubled if the treatment was performed under general anesthesia compared to local anesthesia. Conclusion: Treatment of FI and FOI imposes a financial burden on the health care system in Malaysia. Keywords: facial injury, road traffic crashes, cost analysis, university hospitals, Malaysia

Claudio Mencacci,1 Eugenio Aguglia,2 Giovanni Biggio,3 Lodovico Cappellari,4 Guido Di Sciascio,5 Andrea Fagiolini,6 Giuseppe Maina,7 Alfonso Tortorella,8 Pablo Katz,9 Claudio Ripellino9 1Department of Mental Health, Fatebenefratelli Hospital, Milan, 2Department of Clinical and Molecular Biomedicine, University of Catania, Catania, 3Department of Experimental Biology and Center of Excellence for the Neurobiology of Drug Dependence, University of Cagliari, Calgiari, 4Department of Mental Health, Camposampiero Hospital, Padova, 5Department of Psychiatry, Policlinico Hospital, Bari, 6Department of Molecular Medicine, University of Siena and Department of Mental Health, University of Siena Medical Center, Siena, 7Department of Neurosciences, University of Torino, Torino, 8Department of Mental Health, University of Naples SUN, Naples, 9CSD Medical Research Srl, Milan, Italy Background: Major depression is a commonly occurring, seriously impairing, and often recurrent mental disorder. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the treatments most commonly used for major depressive disorder. The objective of this study was to assess the cost-effectiveness of SSRIs and SNRIs in the treatment of major depressive disorder in two Italian regional settings, ie, Veneto and Sardinia. Methods: A decision analytic model was adapted from the Swedish Dental and Pharmaceutical Benefits Agency to reflect current clinical practice in the treatment of major depressive disorder in the most significant Italian regions. This adaptation was possible as a result of collaboration with an expert panel of Italian psychiatrists and health economists. The population comprised patients with a first diagnosis of major depressive disorder and initiating one SSRI or SNRI drug for the first time. The time frame used was 12 months. Efficacy and utility data for the model were retrieved from the literature and validated by the expert panel. Local data were used for resource utilization and for treatment costs based on the perspective of each regional health service. Scenario analyses and probabilistic sensitivity analyses were performed to test the robustness of the model. Results: Base case analysis showed that escitalopram is associated with the largest health gain (in quality-adjusted life years) and a lower total cost at one year for Sardinia (except for sertraline, against which it was cost-effective) and for Veneto, and therefore dominates the other treatment strategies, given that more quality-adjusted life years are achieved at a lower total cost. Scenario analyses and probabilistic sensitivity analyses support the robustness of the model. Conclusion: The results indicate that escitalopram is the most cost-effective pharmacologic treatment strategy for both regional health services compared with all SSRIs and all SNRIs used in the first-line treatment of major depressive disorder. Keywords: antidepressants, major depressive disorder, cost-effectiveness quality of life, Italy

Jörg Mahlich,1,2 Masamichi Nishi,3 Yoshimichi Saito11Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan; 2Düsseldorf Institute for Competition Economics, University of Düsseldorf, Düsseldorf, Germany; 3Pricing, Janssen Pharmaceutical KK, Tokyo, JapanBackground: The cost of schizophrenia in Japan is high and new long-acting injectable (LAI) antipsychotics might be able to reduce costs by causing a reduction of hospital stays. We aim to estimate budget effects of the introduction of a new 1-month LAI, paliperidone palmitate, in Japan.Methods: A budget impact analysis was conducted from a payer perspective. The model took direct costs of illness into account (ie, costs for inpatient and outpatient services, as well as drug costs). The robustness of the model was checked using a sensitivity analysis.Results: According to our calculations, direct total costs of schizophrenia reach 710,500 million yen a year (US$6 billion). These costs decrease to 691,000 million yen (US$5.9 billion) 3 years after the introduction of paliperidone palmitate.Conclusion: From a payer point of view, the introduction of a new treatment for schizophrenia in Japan helps to save resources and is not associated with a higher financial burden.Keywords: budget impact, schizophrenia, long-acting injectables, paliperidone, Japan

Ashraf Alzaabi,1 Mohammed Alseiari,2 Bassam Mahboub3 1Respiratory Medicine Division, Zayed Military Hospital, Abu Dhabi, United Arab Emirates; 2General Secretariat of Executive Council, Abu Dhabi, United Arab Emirates; 3University of Sharjah, Rashid Hospital, Sharjah, United Arab Emirates Abstract: This study evaluates the direct costs of treating asthma in Abu Dhabi in the United Arab Emirates. Data was compiled for 2011 from health insurance claims covering all medical interventions or treatments coded as asthma. Costs were calculated from a health care perspective. The total direct cost of treating 139,092 asthma patients was estimated to be United Arab Emirates Dirhams (AED) 105 million (US$29 million), corresponding to around AED 750 per patient per annum. The total cost is principally generated by outpatient visits (>AED 85 million; 81% of the total cost). Ten point four percent of patients had made an emergency room visit. The cost per visit seems to be higher during hospital admissions (AED 7,123) compared to outpatient visits and emergency room visits. The direct cost of asthma medications was around AED 33 million (31% of the total cost). The economic burden of asthma in Abu Dhabi is high and the number of emergency visits suggests that the disease is not optimally controlled. Keywords: asthma, cost, Abu Dhabi, UAE, Middle East

Naghmeh Foroutan,1 Hamid R Rasekh,1 Jamshid Salamzadeh,1 Hamid R Jamshidi,1 Mohsen Nafar2 1Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, 2Department of Kidney Transplantation, Urinary Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Objectives: The aim of this study was to determine budget impact of conversion from cyclosporine (CsA) to sirolimus (SRL) in renal transplant therapy (RTT) from the perspective of insurance organizations in Iran. Methods: An Excel-based model was developed to determine cost of RTT, comparing current CsA based therapy to an mTOR inhibitor-based therapy regimen. Total cost included both cost of immunosuppressive agents and relative adverse events. The inputs were derived from database of Ministry of Health and insurance organizations, hospital and pharmacy based registries, and available literature that were varied through a one-way sensitivity analysis. According to the model, there were almost 17,000 patients receiving RTT in Iran, out of which about 2,200 patients underwent the operation within the study year. The model was constructed based on the results of a local RCT, in which test and control groups received CsA, SRL, and steroids over the first 3 months posttransplantation and, from the fourth month on, CsA, mycophenolate mofetil (MMF), and steroids were used in the CsA group and SRL, MMF, and steroids were administered in the SRL group, respectively. Results: The estimated cost of RTT with CsA was US$4,850,000 versus US$4,300,000 receiving SRL. These costs corresponded to the cost saving of almost US$550,000 for the payers. Conclusion: To evaluate the financial consequence of adding mTOR inhibitors to the insurers’ formulary, in the present study, a budget impact analysis was conducted on sirolimus. Fewer cases of costly adverse events along with lower required doses of MMF related to SRL based therapies were major reasons for this saving budgetary impact. Keywords: budget impact, renal transplantation, mTOR inhibitors, health insurance, out-of-pocket

Sharrel L Pinto, Jinender Kumar, Gautam Partha, Robert A BechtolThe Pharmaceutical Care and Outcomes Research Laboratory, Department of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH, USABackground: The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees.Methods: Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman’s test was used to determine changes in outcomes due to the nonparametric nature of the data.Results: The mean number of visits to a physician’s office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed.Conclusion: Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program.Keywords: costs, patient satisfaction, adherence, pharmaceutical care, diabetes

Vassilis Fragoulakis1, Georgia Kourlaba1, Dimitris Goumenos2, Manousos Konstantoulakis3, Nikolaos Maniadakis11Department of Health Services Management, National School of Public Health, Athens, 2Department of Medicine University Hospital of Patras, Patras, 3Department of Medicine, Athens Medical School, Athens, GreecePurpose: To conduct an economic evaluation comparing Ferinject® (ferric carboxymaltose [FCM]) with Venofer® (iron sucrose [IS]) and CosmoFer® (low-molecular-weight iron dextran [LMWID]) in the management of iron deficiency anemia in Greece.Patients and methods: A cost-minimization analysis was conducted since there are no clear data indicating that one of these regimens is superior to the others in terms of efficacy. Main data inputs were based on bibliography and validated by clinicians. The economic evaluation was conducted for inpatients (ie, surgical patients or patients hospitalized due to a disease related to chronic or acute blood loss) and outpatients (eg, nondialysis chronic kidney disease patients), separately. Analysis was carried out from a National Health Service (NHS) perspective and also from a patient perspective. Total cost treatment reflects the cost of drugs, the cost of all resources expended in patient management such as the cost of disposables for each infusion, the monitoring costs during infusion (salaries of personnel), other hospital expenses, the cost for management of adverse events, the productivity loss, and the traveling cost for patients.Results: In the case of outpatients, the mean total cost per patient in the FCM arm was €198.6, in the IS arm €627.7, and in the LMWID arm, €510.5. For inpatients the mean total cost was estimated at €189.2 for FCM while it was €419.9 and €228.8 for IS and LMWID, respectively. Budget impact analysis for a typical Greek hospital with 100 patients revealed that the total cost of FCM (inpatients analysis) was 113% and 15.4% lower against their comparators. In an outpatient situation, the total cost of FCM was 201.1% and 151.8% lower compared with IS and LMWID, respectively.Conclusion: Ferric carboxymaltose may represent a cost-saving option compared with the most likely alternative existing therapies used for the management of anemia in the National Health Service of Greece.Keywords: economic evaluation, cost minimization, ferric carboxymaltose, anemia, iron therapy

Jan Norum1, Wenche Koldingsnes2, Torfinn Aanes3, Margaret Aarag Antonsen4, Jon Florholmen5, Masahide Kondo61Northern Norway Regional Health Authority, Bodø, Norway; 2Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway; 3Drug Procurement Cooperation, Oslo, Norway; 4Hospital Pharmacy of North Norway Trust, Tromsø, Norway; 5Department of Gastroenterology, University Hospital of North Norway, Tromsø, Norway; 6Department of Health Care Policy and Management, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki JapanObjective: Costly biologic therapies have improved function and quality of life for patients suffering from rheumatic and inflammatory bowel diseases. In this survey, we aimed to document and analyze the costs.Methods: In 2008, the total costs of tumor necrosis factor alpha inhibitors and other biologic agents in Norway were registered prospectively. In addition to costs, the pattern of use in the four Norwegian health regions was analyzed. The expenses were calculated in Norwegian krone and converted into Euros.Results: The pattern of use was similar in all four regions, indicating that national guidelines are followed. Whereas the cost was similar in the southeast, western, and central regions, the expenses per thousand inhabitants were 1.56 times higher in the northern region. This indicates that patients in the northern region experienced a lower threshold for access to these drugs. The gap in costs between trusts within northern Norway was about to be closed. The Departments of Rheumatology and Gastroenterology had the highest consumption rates.Conclusion: The total cost of biologic agents was significant. Northern Norway had among the highest consumption rates worldwide. This can partly be explained. Further exploration calls for a national registry for the use of these drugs.Keywords: TNFα inhibitors, biologic agents, Norway, cost

Uchenna Ekwochi,1 D Chidiebere Osuorah,3 Ikenna K Ndu,1 Osita U Ezenwosu,2 Ogechukwu F Amadi,1 Ikenna C Nwokoye,1 O Israel Odetunde2 1Department of Pediatrics, Enugu State University Teaching Hospital, Parklane, Nigeria; 2Department of Pediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria; 3Child Survival Unit, Medical Research Council (UK), The Gambia unit, Fajara, The Gambia Background: Neonatal illnesses usually require long hospital stays and specialized care and/or facilities, which usually results in huge medical bills. With more than 70% of people in Nigeria living on less than US$2 per day, these bills are not affordable to many families' livelihoods. Aim: This study aims to determine the average cost of managing neonatal illnesses in Enugu in southeast Nigeria and the proportion of family income spent on these illnesses. It further seeks to ascertain the cost of various components in the management of neonatal diseases. Methods: This is a longitudinal and descriptive study involving 106 newborns admitted to the sick baby unit of the Enugu State University Teaching Hospital and the out-of-pocket medical expenditure in the management of their illnesses. Results: A hundred and six newborns participated in the study. All (100%) medical bills were out-of-pocket payments, and 103 (97.2%) of these were catastrophic health expenditure (more than 10% of total family monthly income). The average duration of hospital stay and cost of managing a neonatal illness was 12.86±8.81 days and ₦36,382±19,389.72 (US$223±119), respectively. This expenditure amounted to 157%, 71%, and 25% of total monthly family income for the low, middle, and upper socioeconomic class families, respectively, with a mean percentage of 85%. Families with a total monthly income of less than ₦10,000 (US$61), ₦10,000–49,999 (US$61–306), and ₦50,000–100,000 (US$306–612) and more than ₦100,000 (US$612) on average spent 683%, 108%, 54%, and 20% of their monthly income on their newborn's illness. Hospital and utility bills compared with bills accruing from drug and laboratory investigations account for a significantly larger proportion of total cost incurred in neonatal sepsis (₦23,499±14,987 [US$144±92], P=0.001), low birth weight (₦39,863±24,003 [US$224±147], P=0.001), severe anemia (₦40,504±13,923 [US$248±85], P=0.001), transient tachypnea of the newborn (₦10,083±1,078 [US$62±7], P=0.001), birth asphyxia (₦24,398±14,096 [US$149±86], P=0.001), and meningitis (₦26,731±7,675 [US$164±47], P=0.001), whereas cost for laboratory investigations was significantly higher for neonatal jaundice (₦11,690±3,169 [US$72±19], P=0.001). There was a strong positive correlation between duration of hospital stay and total medical cost incurred (r=0.897, P=0.001). Conclusion: Health expenditure on neonatal illness is high and leads to catastrophic expenditure for the majority of households in the state. There is a need for effective health insurance schemes to help subsidize and cushion this disastrous and impoverishing health expenditure on families for improved neonatal survival in Nigeria. Keywords: neonatal illness, out of pocket, health expenditure, Enugu State

Introduction Spina bifida (SB) is a congenital malformation of the spinal cord, nerves, and adjacent covering structures, with different levels of severity and functional disability. The economic cost of spina bifida and its prevention using folic acid have never been estimated in Italy. This study was conducted to define the cost of illness of SB in Italy. Methods A retrospective multicenter observational study on the social cost of patients with SB was carried out in three SB centers in Italy. Cost data were collected relating to the 12 months preceding the enrollment time (T0), and subsequently 3 months after the T0 time (±20 days) through a case report form designed to collect the relevant information on the costs incurred during the period considered. The data for all patients were analyzed through multivariate analysis on the main parameters. Results We enrolled 128 patients equally divided between males and females, with a mean age of 13 years (minimum, 0; maximum, 29). Diagnosis was mostly postnatal, with 64 cases diagnosed at birth and 33 cases diagnosed subsequently. The lesion severity levels, as defined in the inclusion criteria, were walking (52 patients); walking with simple orthoses (33 patients); walking with complex orthoses (16 patients); and nonwalking, (25 patients). The anatomic type identified is open SB in most cases (84 patients), followed by closed SB (37 patients) and SB occulta (3 patients). The most significant cost per year was for assistive devices, for a total of 4307.00 €, followed by hospitalization (907.00 €), examinations (592.00 €), and drug therapy (328.00 €). Cost breakdown by age range shows that the highest costs are incurred in the 0–4 age range. The highest cost was for cases of open SB (12,103.00 €). The cost/degree of severity ratio showed that the highest cost was for nonwalking patients (14,323.00 €), followed by patients walking with complex orthoses (13,799.00 €). Conclusion The data from this study show that the mean total cost for a patient with SB was 11,351.00 € per year. Based on data provided by the Italian Institute of Health, we can estimate a total annual social cost of about 60 million Euros per year for SB in Italy. Cost of illness was correlated with age and degree of severity of SB., Video abstract

BACKGROUND: The present study aimed to estimate the cost of rheumatoid arthritis and its components in a university hospital-based health management organization in Argentina, during the prebiologic era. METHODS: A one-year (2002) observational prevalence, cost-of illness study of patients with rheumatoid arthritis from the societal perspective was performed in a hospital-based health management organization population. Direct medical costs were obtained using administrative databases. Direct nonmedical and indirect costs were obtained from a semistructured questionnaire. Indirect costs included work absenteeism, permanent work disability, and housework lost for housewives, using the human capital approach. Costs are expressed in 2002 US dollars per patient per year. RESULTS: A total of 165 patients (84% females), of mean age 61 ± 15 years and with a mean disease duration of 8.5 ± 8.3 years were included. Mean total direct medical costs were US$1862 (95% confidence interval [CI] 828-2899). Mean direct nonmedical costs were US$222 (95% CI 149-294). Mean indirect costs were US$1008 (95% CI 606-1412). The annual mean total cost was US$3093 without biologics. Hospitalizations represented 73% of total direct medical costs while drugs and outpatient procedures represented 16% and 8% of total direct medical costs, respectively. Sixty percent of the total costs were related to direct medical costs, while indirect costs represented 33% of total costs. CONCLUSION: In our population, annual mean total costs in the prebiologic therapy era were mainly driven by direct medical costs. Even without the use of biologic agents, rheumatoid arthritis represents an important burden for society in developing countries.

Viviano Benedini,1 Nicola Caporaso,2 Gino Roberto Corazza,3 Zaccaria Rossi,4 Giovanni Fornaciari,5 Mario Cottone,6 Giorgio Frosini,7 Mauro Caruggi,8 Chiara Ottolini,8 Giorgio L Colombo9,10 On behalf of the COSMO Study Group1Department of Gastroenterology, AO Carlo Poma, Mantova; 2Department of Gastroenterology, University of Naples, Federico II, Naples; 3IRCCS Policlinico San Matteo, Pavia; 4Department of Gastroenterology, Ospedale Regina Apostolorum, Albano Laziale, Rome; 5Department of Gastroenterology, Arcispedale S Maria Nuova, Reggio Emilia; 6Medical Division, Azienda Ospedaliera Cervello, Palermo; 7Department of Gastroenterology, Policlinico Universitario Senese, Siena; 8Hospital S Antonio Abate, Gallarate, Varese, 9University of Pavia; School of Pharmacy, Pavia, Lombardy; 10Studi Analisi Valutazioni Economiche (SAVE), Milan, ItalyBackground: This was a prospective observational study designed to evaluate direct and indirect costs and quality of life for patients with Crohn’s disease in Italy from the perspectives of the National Health System and of society.Methods: A total of 162 male and female subjects aged 18–70 years with Crohn’s disease in the active phase and a Crohn’s Disease Activity Index score ≥150 were included in the study. Subjects were recruited from 25 Italian centers on a consecutive basis. The study consisted of four visits undertaken every 6 months with a follow-up period of 18 months. The study started on September 1, 2006 and was completed on April 12, 2010. Multivariate analyses were carried out on demographic characteristics, treatment costs based on the prescribed daily dose, resource use and other cost parameters, and changes in quality of life using the EQ5D questionnaire.Results: Cost of illness per subject with Crohn’s disease in Italy was estimated to be €15,521 per year, with direct costs representing 76% of total costs. Nonhealth care costs and loss of productivity accounted for 24% of total costs. Societal costs during the first months of enrolment were higher compared with costs in the final months of the study. Quality of life measured by the EQ-5D was 0.558 initially and then increased to 0.739, with a mean value of 0.677 during the enrolment period. The cost of illness was not correlated with age or gender.Conclusion: The cost of illness was correlated with quality of life; Crohn’s disease had a negative impact on subjects’ quality of life, and higher costs corresponded to a lower quality of life as measured with the EQ5D. Drug treatment may improve quality of life and reduce hospitalization costs. Our results appear to be in line with the results of other international cost-of-illness studies.Keywords: Crohn’s disease, quality of life, EuroQol, EQ5D, cost-of-illness, cost analysis, economic evaluation

Paolo Sacchi1, Savino FA Patruno1, Raffaele Bruno1, Serena Maria Benedetta Cima1, Pietro Previtali2, Alessia Franchini2, Luca Nicolini3, Carla Rognoni4, Lucia Sacchi5, Riccardo Bellazzi4, Gaetano Filice11Divisione di Malattie Infettive e Tropicali - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 2Università degli Studi di Pavia – Facoltà di Economia, Pavia, Italy; 3Controllo di Gestione Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy; 4Dipartimento di Informatica e Sistemistica, Universita' degli Studi di Pavia, Pavia, Italy; 5Department of Information Systems and Computing, Brunel University, London, UKBackground and aims: The total health care cost for human immunodeficiency virus (HIV) patients has constantly grown in recent years. To date, there is no information about how this trend will behave over the next few years. The aim of the present study is to define a pharmacoeconomic model for the forecast of the costs of a group of chronically treated patients followed over the period 2004–2009.Methods: A pharmacoeconomics model was built to describe the probability of transition among different health states and to modify the therapy over time. A Markov model was applied to evaluate the temporal evolution of the average cost. The health care resources exploited during hospitalization were analyzed by using an “activity-based costing” method.Results: The Markov model showed that the mean total cost, after an initial increase, tended to remain stable. A total of 20 clinical records were examined. The average daily cost for each patient was EUR 484.42, with a cost for admission of EUR 6781.88.Conclusion: The treatment of HIV infection in compliance with the guidelines is also effective from the payer perspective, as it allows a good health condition to be maintained and reduces the need and the costs of hospitalizations.Keywords: health care cost, HIV, Markov model, activity-based costing