PINI6 COST-UTILITY OF CHRONIC HEPATITIS “C� TREATMENT WITH THYMOSIN ALPHA I IN MEXICO


309Abstracts

from eight managed care organizations. Index claims were out-
patient or emergency department visits in 1999–2001 by indi-
viduals aged 25–64 with a primary diagnosis of pneumonia,
antibiotic prescription within three-days, chest x-ray on index
date, continuous enrollment for 12-months prior, 30-days after
index visit. Exclusion criteria: antibiotic prescription, pneumo-
nia diagnosis, or hospitalization in prior 30-days; initial therapy
with multiple antibiotics; in prior 12-months residence in a 
long-term care facility or diagnosis of lung cancer, secondary
malignancy, HIV/AIDS, cystic fibrosis, immunodeficiency. 
We considered the following comorbid illnesses: chronic liver, 
renal or lung disease; cerebrovascular disease; cardiac disease;
diabetes mellitus; malignancy. Follow-up claims were considered
CAP-related if the primary diagnosis, using the Clinical 
Classifications Software, was pneumonia; septicemia; pleurisy,
pneumothorax or pulmonary collapse; respiratory failure, insuf-
ficiency or arrest; other lower respiratory infection. RESULTS:
In total, 5748 cases met criteria; 79.7% had no comorbidities,
16.8% had one comorbidity, and 3.5% had two or more comor-
bidities. Mean total charges were $955.97: 48.2% inpatient,
25.2% outpatient, 13.4% outpatient testing and diagnostics,
7.5% antibiotic prescriptions, 5.8% emergency department,
13.9% presenting to the emergency department had initial mean
charges of $360.48 compared with mean initial charges for out-
patients of $167.89. In total, 50.0% utilized follow-up services
with 3.0% requiring hospitalization. Mean total charges for
those eventually hospitalized were $16,436.23 compared with
$673.71 for the 13.1% of patients who failed initial treatment
but were not hospitalized, and $431.91 for the 78.0% of patients
requiring no additional antibiotics. Number of comorbidities
was strongly associated (p < 0.0001) with charges: $888.19 for
those without comorbidities vs. $1734.37 for those with multi-
ple comorbidities. CONCLUSION: Cost of outpatient CAP for
non-elderly adults is large even for those without comorbid
illness.

PIN15
IMPACT OF COMPLICATED SKIN AND SOFT TISSUE
INFECTIONS ON INPATIENT COSTS FOR AN ACADEMIC
MEDICAL CENTER
Patel N1, Goldfarb N1, Hartmann CW1, Maio V1, Horn DL2, Pizzi L1
1Jefferson Medical College, Philadelphia, PA, USA; 2Thomas Jefferson
University, Philadelphia, PA, USA
OBJECTIVES: To determine the additional costs and lengths of
stay (LOS) attributable to complicated skin and soft tissue infec-
tions (cSSI) for patients admitted to Thomas Jefferson University
Hospital, an urban academic tertiary care hospital. METHODS:
All patients admitted between January 1, 2003 and December
31, 2003 were identified using the hospital billing system.
Patients with a potential cSSI were identified using the specific
ICD-9 diagnosis codes. Costs of care and lengths of stay, based
on the hospital’s true cost accounting system, were compared by
Diagnosis Related Group (DRG) between the cSSI population
and the non-cSSI population. RESULTS: Of the 33,764 patient
discharges in 2003, 1,883 (5.5%) included one of the cSSI diag-
nosis codes; these encompassed 225 DRGs. The mean cost for
cSSI cases was $20,965 higher than for non-cSSI cases, and mean
LOS was ten days higher for cSSI cases. For surgical and medical
DRGs, mean cost of cSSI added $42,563 onto the cost for cases
in surgical DRGs compared to an average increase of $10,048
added to cost of medical DRGs. Differences in costs and LOS
were observed in analyses by Major Disease Categories (MDCs)
and individual DRGs as well. For MDCs, myeloproliferative dis-
orders, multiple trauma, and diseases of the nervous system,
costs were $68,027, $48,286, and $27,496, higher for the cSSI

cases, respectively. This difference was also reflected in additional
days of stay of 22, 11, and 14 days, respectively. For patients
with cSSI, the three specific DRGs responsible for the maximum
total health care dollars expended were bone marrow trans-
plants, rehabilitation, and small and large bowel procedures.
CONCLUSIONS: cSSIs significantly increase hospital resource
consumption and costs. The difference in costs is especially pro-
nounced for patients undergoing surgical procedures. Results
suggest that measures taken to avoid or more effectively treat
cSSIs could yield significant savings to hospitals.

PIN16
COST-UTILITY OF CHRONIC HEPATITIS “C” TREATMENT
WITH THYMOSIN ALPHA 1 IN MEXICO
Nevárez-Sida A, García-Contreras F, Constantino-Casas P,
Castro-Rios A, Mould J, Garduño-Espinosa J
Mexican Institute of Social Security, Mexico City, Mexico
OBJECTIVE: To estimate cost-utility of the following alterna-
tives in the treatment of chronic hepatitis C (CHC) in the
Mexican Institute of Social Security (IMSS): peginterferon,
peginterferon plus ribavirin, peginterferon plus ribavirin plus
thymosin alpha-1 and finally, not using any drug. METHODS:
In Mexico, more that one million persons are infected with CHC
virus and 80% of them develop chronic infection that might lead
to hepatic cirrhosis and other complications that affect quality
of life and costs of health care institutions. Cost-utility analysis
was carried out using institutional perspective and time horizon
of 45 years, discount rate of 3% for both, costs and effective-
ness. The base case was a 30-year-old man with CHC without
hepatic cirrhosis or cancer and cost and effectiveness data were
taken from literature, a Mexican expert panel and an on-going
clinical trial, not yet reported. Effectiveness data are reported in
QALYs and costs in 2004 USD. A decision tree using a Bayesian
approach and a Markov model were developed. Sensitivity
analysis was univariate, bivariate, threshold and probabilistic.
Acceptability curves and health net benefits were estimated.
RESULTS: Triple therapy (peginterferon plus ribavirin plus thy-
mosin alpha-1) was dominant over the rest of alternatives costing
$1802 per QALY, while peginterferon plus ribavirin $2275 per
QALY and peginterferon only $2927 per QALY. Not using any
drug was the most costly alternative with $4201 per QALY. Sen-
sitivity analysis confirmed the strength of the base study. Triple
therapy was not dominated in any comparative case. CON-
CLUSIONS: Triple therapy had the best cost-utility ratio and not
using any drug was the opposite, most expensive and with less
utility than all the compared alternatives. Although triple
therapy is initially very expensive, it provides the highest gains
in the long run, both in the improvement of quality of life and
in saving costs.

PIN17
A COMPARISON OF METHODS TO ASSESS QUALITY OF LIFE
IN ECONOMIC ANALYSES OF HEPATITIS C TREATMENTS
Yeh WS, Skrepnek GH, Armstrong EP, Malone DC
University of Arizona College of Pharmacy, Tucson, AZ, USA
OBJECTIVES: This study investigated the effect of using differ-
ent utilities for a cost-utility analysis comparing peginterferon
alpha-2b plus ribavirin, interferon alpha-2b plus ribavirin, and
no treatment for chronic hepatitis C from a U.S. payer’s per-
spective. METHODS: A Markov model was developed to sim-
ulate the lifetime disease progression of hepatitis C virus (HCV)
for a 45-year-old male. The analysis was conducted by stratify-
ing HCV genotypes. Health-state utilities were obtained from
previously published literature. Standard gamble patient-elicited
utilities were used as the base case. Five other expert-estimated