Health economic analyses based on register data. Psoriasis and Psoriatic Arthritis as examples

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1 Health economic analyses based on register data Psoriasis and Psoriatic Arthritis as examples Sofia Löfvendahl Epi-center Skåne, Skåne University Hospital, Lund Lund University, Clinical Sciences Lund, Orthopedics, Lund

Skåne, Skåne University Hospital, Lund Lund University,

2 Outline Health economics (HE) Registers Psoriasis and psoriatic arthritis Register-based data and patient population definitions Register-based data and cost analysis HE-evaluations - contribution of register-based data

population definitions Register-based data and cost

3 Health economics (HE) Health Health Economics Economics

4 Register-based data National administrative registers Routinely collected Health-care resource use Drugs Sick-leave and disability pension Socio-economic information Cost information Census information Regional administrative registers Routinely collected Health-care resource use Costs National quality register Disease-specific Treatments Clinical results/status Health-related quality of life Linkage between registers by personal identification number

Routinely collected Health-care resource use Costs National quality register Disease-specific Treatments Clinical

5 Psoriasis and psoriatic arthritis (PsA) Chronic inflammatory diseases Psoriasis - affecting skin and nails A number of those with psoriasis also develop PsA PsA - inflammatory arthritis and enthesitis Affecting people of working age New efficient, but not harmless and expensive drugs Two interrelated non fatal but chronic conditions

inflammatory arthritis and enthesitis Affecting people of working age New

Conclusions: SHR is a valid healthcare register for studies on psoriasis and PsA Validity varied with frequency of diagnostic codes and level of care sensitivity analysis using different kind of case

6 Conclusions: SHR is a valid healthcare register for studies on psoriasis and PsA Validity varied with frequency of diagnostic codes and level of care sensitivity analysis using different kind of case ascertainment criteria Case ascertainment criteria: ICD-10 codes associated with psoriasis and PsA at least one time given by any physician Registers used: Skåne Healthcare Register Swedish National Population Register

ascertainment criteria Case ascertainment criteria: ICD-10 codes associated with psoriasis and PsA at

7 Incremental societal costs of psoriasis and psoriatic arthritis compared to costs due to morbidity in the general population in southern Sweden a population-based register study over four years Ongoing study

8 Costs Identify Quantify Value

9 Costs information from registers Cost categories Cost elements Information on quantity Information about unit cost Direct medical costs Direct non-medical costs Health care utilization Drugs Private transportation Home aid, devices, community care, social services National Patient Register (PAR) Regional registers Prescribed drug register (PDR) National quality registers Administrative databases Hospitals price lists Regional price lists PDR Dental and Pharmaceutical Benefits Agency Statistics Sweden mileage allowance National Quality Registers Administrative databases from the municipalities Indirect costs Sick-leave Sweden Social Insurance Agency (SSIA) Disability pension Swedish Social Insurance Agency (SSIA) Statistics Sweden Salary including social fees Productivity Informal care

Hospitals price lists Regional price lists PDR Dental and Pharmaceutical Benefits Agency ----- Statistics Sweden mileage allowance National Quality Registers Administrative databases from the

10 Costs perspectives Inclusion of costs by perspective Cost categories Direct medical costs Direct-non medical costs Cost elements Societal Perspective Hospital/County councils Private Health care utilization X X X Drugs X X X Transportation X X Home aid, devices X X Indirect costs Sick-leave X Disability pension Productivity Informal care X X X

councils Private Health care utilization X X X Drugs X X X Transportation X X Home

11 Development of HRQoL in PsA-patients switching to biological treatment compared to those staying on conventional therapy value of treatment in routine clinical practice Study under design

12 HE-evaluations of new health technologies Technology A Costs A Effects A Patient population Technology B Costs B Effects B Decision about what technology gives best value for money

13 HE-evaluation of new health technologies - approaches Most common (ex-ante) Health-economic data (resource use) is collected within a RCT Modeling studies data from a number of sources (both experimental and observational) are synthesized Increasing demand for Studies based on observations in routine clinical practice (ex-post) Not alternative but complementary

number of sources (both experimental and observational) are synthesized Increasing demand

14 Statement from the Dental and Pharmaceutical Benefits Agency Need for extended evaluation of actual use and effect of pharmaceuticals in Swedish health care How did it end up in real clinical practice What is the true value for money

effect of pharmaceuticals in Swedish health care How did

15 RCT versus observational studies RCT Randomisation Strict inclusion criteria Single intervention Short duration Intermediate effects Efficacy Protocol-driven costs Ex-ante reimbursement and access Low external validity Observational studies No randomisation Usual care Multiple interventions Long-term benefits and harms Hard effects Effectiveness Cost so far unknown Ex-post reimbursement High external validity

external validity Observational studies No randomisation Usual care Multiple interventions Long-term

16 Register used: South Swedish Arthritis Treatment Group (SSATG)

17 In conclusion Swedish registers- valuable information for health economic analyses Prevalence and incidens Case ascertainment criteria by ICD-10 codes/other systems. Populations-based and disease specific (many types of outcome measures) Good coverage of resource utilization but certain areas not covered in a systematic way (home aid, social services) More transparency in cost data would be desirable Contribution to HE-evaluation of technologies Treatment value in routine clinical practice over time/patient subgroups Cost in the long term Valuable information for pricing, reimbursement and access decisions

Populations-based and disease specific (many types of outcome measures) Good coverage of resource utilization but certain areas not covered in a

18 Thank you!

Internationale Standards des HTA? Jos Kleijnen Kleijnen Systematic Reviews Ltd

Internationale Standards des HTA? Jos Kleijnen Kleijnen Systematic Reviews Ltd Conflicts of Interest A Gutachten was commissioned by VFA we had full editorial freedom Kleijnen Systematic Reviews Ltd has