related cost-effectiveness studies on diabetes. METHODS: A literature search using PubMed and OhioLINK websites was conducted for cost-effectiveness studies. The key terms used for literature search were “diabetes”, and “cost, cost-effectiveness, cost-benefit, economics, or treatment outcome”. Eligible studies were randomized controlled trials focusing cost-effectiveness of diabetes drug therapies, published in English between July 2005 and October 2007. Review articles were excluded. RESULTS: Initial search resulted in 911 abstracts. After applying the inclusion/exclusion criteria, 11 studies were selected from Canada, UK, USA, Austria, Germany and Asian regions. The median sample size was 638 patients; the median duration of trials was 39 weeks. Most studies demonstrated overall positive effects in economic outcomes and found that interventions improved the cost-effectiveness and health care utilization over the control groups from their individual perspectives. Four studies focused on insulin glargine, which together with other new drugs including insulin detemir, exenatide and rosiglita- zone can be more cost-effective. With regard to diabetes-related complications such as renal disease, hypertension and diabetic peripheral neuropathic pain, these studies suggest that the earlier introduction of preventive measures such as therapeutic drugs would lead to longer delays in the onset of its compli- cations and the overall savings in health care resource utiliza- tion. CONCLUSION: There is growing evidence that these drug interventions may promote diabetic health with better economic outcomes. The review complemented our previous study of cost on diabetes till July 2005. Future research should include extensive database search including databases such as Cochran and manual search for the journals’ Diabetes, and Diabetes Care. PCV37 BIATRIALVERSUS RIGHT ATRIAL APPENDAGE PACING IN BRADYCARDIATACHYCARDIA SYNDROME Rucinski P 1 , Kutarski A 1 , Latek MM 2 , Kaminski B 3 , Rubaj A 1 , Wdowiak L 1 1 Medical University of Lublin, Lublin, Poland, 2 George Mason University, Fairfax,VA, USA, 3 Warsaw School of Economics, Warszawa, Poland OBJECTIVE: Bradycardia-tachycardia syndrome (BTS) manage- ment includes bradycardia and tachyarrhythmia therapy. Right atrial appendage pacing (RAA), a typical pacing site, manages bradycardia but have poor AF preventive properties. Biatrial pacing (BiA) is a modality of pacing to prevent AF in BRT patients with interatrial conduction disturbances. It is a cost- effectiveness analysis of BiA versus RAA pacing in AF preven- tion, in BTS patients. METHODS: Follow-up study: 125 pts (51 males, mean age = 67.9) with BTS, P-wave >120 ms and parox- ysmal, recurrent AF; 50 pts had BiA and 75 RAA pacing system implanted. Observation window was one year before pacemaker implantation to three years after. Costs were calculated from the public health care payer perspective. Primary clinical endpoints: chronic AF occurrence and patient reported outcome reflecting symptomatic AF episodes frequency at four point scale. AF epi- sodes were defined very frequent in case of AF episodes >1 per week (rank 3), recurrent AF = 1 episode per week to 1 episode per month (rank 2), occasional = if occurred <1 per month (rank 1), no recurrences = rank 0. Confidence intervals for CER by bootstrap method. RESULTS: The frequency of symptomatic AF episodes decreased in BiA group as measured on the scale (2.54 vs 1.28; p < 0.001) and not in the RAA group (1.33 vs 1.55; NS). There was 71.2% reduction of annual number of hospitaliza- tions in BiA group; no change in RAA group as compared to pre-implantation period. In BiA group 12.0% of patients devel- oped chronic AF; 17.3% in the RAA group (NS). Incremental cost-effectiveness ratio for decrease of AF frequency episodes (BiA vs RAA) was 499.97 USD PPP (95%CI—272.5–1353.6) for one point on the scale. CONCLUSION: Biatrial pacing in contrast to RAA pacing decreases symptomatic AF episodes frequency and hospitalizations. BiA compared to RAA pacing is a cost-effective method of AF prevention in BTS patients with pacing indications. PCV38 BOSENTAN ISA COST-EFFECTIVETREATMENT FOR UNITED KINGDOM PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION OF WHO CLASS III Stevenson MD 1 , MacDonald FC 2 , Langley J 2 , Akehurst RL 1 1 University of Sheffield, Sheffield, UK, 2 Actelion Pharmaceuticals UK, London, UK OBJECTIVE: To assess whether bosentan is a cost-effective first-line treatment option compared with epoprostenol and with no active intervention, all added to palliative care, for patients with pulmonary arterial hypertension (PAH) of WHO functional class (FC) III in the UK. METHODS: A cost-utility model was constructed to simulate hypothetical patients with PAH. Patients were assumed either to remain in FC III until death or to deteriorate to FC IV where epoprostenol and pal- liative care would be prescribed until death. It was further assumed that the choice of first-line treatment would not affect the time to death, but instead would affect the duration patients spend in FC IV. The time to deterioration in FC was approxi- mated by time to clinical worsening (TTCW), a composite measure of death or worsening of PAH leading to a change in treatment. Data on TTCW was estimated from over three years of observational data for bosentan and from published epide- miological literature for palliative care alone. For epoprostenol, TTCW was assumed equal to that of bosentan—in accordance with published literature. The time horizon was that of patient lifetime with only direct medical costs considered. The utility associated with each FC was taken from published literature. Costs and benefits were discounted at 3.5% per annum. Proba- bilistic sensitivity analyses were undertaken. RESULTS: Bosen- tan dominated epoprostenol, as it provided the same number of QALYs at a reduced cost. Bosentan dominated no active inter- vention, as it had lower costs and greater QALYs, due to the reduced time, per patient, spent in FC IV. CONCLUSION: Bosentan is a more cost-effective first-line therapy for patients with PAH FC III in the UK than either epoprostenol or no active intervention. It can be inferred that bosentan would also domi- nate any other intervention with a TTCW not proven to be better than palliative care alone. PCV39 INDIRECT COMPARISONS OF RIVAROXABANVS ALTERNATIVE PROPHYLAXES FORTHE PREVENTION OF VENOUSTHROMBOEMBOLISM IN PATIENTS UNDERGOING TOTAL HIP OR TOTAL KNEE REPLACEMENT Diamantopoulos A 1 , LeReun C 2 , Rasul F 1 , Lees M 3 , Kubin M 4 1 IMS Health HEOR, London, UK, 2 Carrigaline, Ireland, 3 Bayer HealthCare plc, London, UK, 4 Bayer Healthcare AG, Wuppertal, Germany OBJECTIVE: To estimate differences in the efficacy and safety of rivaroxaban versus fondaparinux, warfarin and dabigatran in prevention of venous thromboembolism (VTE). Such differences may influence the cost-effectiveness of thromboprophylaxis following total hip replacement (THR) or total knee replacement (TKR). METHODS: Three large, randomized controlled trials (RCTs; RECORD1–3) demonstrated relative risk reductions Abstracts A197 brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Elsevier - Publisher Connector