A354 Abstracts OBJECTIVES: To assess the cost-effectiveness, from the UK NHS perspective, of magnetic resonance angiography (MRA), duplex ultrasound (DUS) and computed tomography (CT) com- pared with contrast angiography (CA) in assessing the extent and location of stenosis and subsequently formulating a treatment plan for patients with peripheral arterial disease (PAD). METHODS: A probabilistic decision tree was developed in order to estimate the cost per QALY (in £2004) associated with each diagnostic method for assessment of the whole leg, and the arter- ies above and below the knee. Input parameters were obtained from a systematic review, other published sources and expert opinion. Lack of data to extrapolate the results to a longer period led to consideration of a 1-year time horizon, therefore dis- counting was not performed. RESULTS: DUS was the dominant strategy for the assessment of the whole leg, with a cost per QALY of £13,646. MRA appeared to be more cost-effective for assessment of the arteries above the knee, with a cost-per-QALY equal to £8628 with 2D-TOF MRA, and an incremental cost per additional QALY equal to £37,024 when 2D-TOF MRA was compared to DUS. For below the knee comparisons, results were uncertain, with DUS being more likely to be cost-effective at commonly accepted cost-per-QALY threshold values. CON- CLUSIONS: The cost-effectiveness of the diagnostic tests was dependent on the area of the leg being assessed, with DUS being dominant for comparisons of the whole leg and cost-effective for below the knee comparisons, and MRA being cost-effective for above the knee assessments. PCV55 ECONOMIC EVALUATION OF DRUG ELUTING STENTS: COST-UTILITY ANALYSIS Bischof M , Briel M, Bucher HC, Nordmann A University Hospital Basel, Basel, BS, Switzerland OBJECTIVES: Drug eluting stents (DES) are more effective than bare metal stents (BMS) in preventing angiographic and clinical restenosis. Within this study the cost-effectiveness of sirolimus (SES) and paclitaxel eluting stents (PES) compared to BMS was estimated for a UK setting with data from a meta-analysis. METHODS: A probabilistic Markov model was constructed. The model includes events observed in clinical trials (MI, revas- cularisation, CABG) and the health states heart failure and stroke. The meta-analysis data comprised 3-year follow-up data from randomized controlled trials. Probability distributions were fitted to all transition probability, cost and quality of life (QoL) parameters. Univariate sensitivity analysis was performed on several parameters. Effects and costs were discounted at 3%, the time horizon was 3 years and the number of stents was 1.27 per patient. A health care perspective was adopted. QoL data was obtained from published studies. RESULTS: The incremental costs for SES patients are €712 (95% CI: -2431–1715) and €1101 (95% CI: 150–1493) for PES patients. DES yield less QALYs than BMS with -0.0156 incremental QALYs (95% CI: -0.2652–0.2302) per SES patient and -0.0077 incremental QALYS (95% CI: -0.0777–0.06643) per PES patient compared to BMS patients. At a threshold level of Euros 50’000 per QALY the incremental net monetary benefit per SES patient is €-1492 (95% CI: -14213–10766) and €-1484 (95% CI: -5004–2273) per PES patient. At the same threshold level SES have a 35% probability of being cost-effective, PES have a probability of 17% of being cost-effective. CONCLUSIONS: Three-year follow up data show that DES are less effective than BMS when mortality is taken into account. Given the higher costs per DES patient, DES are dominated by BMS. Althoug DES show favourable results over BMS concerning revascularisation rates, they are not cost-effective. PCV56 ESTIMATION OF THE PRESENCE OF CARDIOVASCULAR EVENTS AND DIRECT COSTS ASSOCIATED WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN AN AMBULATORY SETTING Sicras A 1 , Navarro R 1 , F Bobadilla J 2 , García M 3 , Soto J 2 1 Badalona Servicios Asistenciales, Badalona, Barcelona, Spain, 2 Pfizer Spain, Alcobendas, Madrid, Spain, 3 Euroclin Institute, Alcobendas, Madrid, Spain OBJECTIVE: To determine the presence of cardiovascular events (CVEs) and their association with the main cardiovascular risk factors (CVRFs) and resource utilization parameters (direct costs) in subjects with chronic obstructive pulmonary disease (COPD) in different Spanish primary care centers. METHODS: A retrospective-multicenter design was adopted, with inclusion of the patients seen for COPD (ICPC:R95) by four primary care teams and two hospitals during 2004. The main measures were: age-sex, cardiovascular antecedents (ischemic heart disease [IHD], cerebrovascular accident, hypertension, dyslipidemia, diabetes mellitus, smoking, obesity) and other co-morbidities, clinical parameters (FEV 1 , BMI), resources utilization (comple- mentary tests, pharmaceutical prescription, specialist referral, physician visits, hospitalizations and emergency-room visits, ambulatory care) and costs (semifixed and direct). A logistic regression analysis was made to fit the model. The costs were contrasted by covariance analysis (ANCOVA-marginal means). Data were analyzed using SPSS-v12 and p values of <0.05 were taken as the level of statistical significance. RESULTS: Nine- hundred patients were seen for COPD; mean age 70.4 ± 9.8 years and 85.3% were males. Around 19.0% (n = 171) had undergone a CVE (CI: 16.4–21.6%); 15.1% with IHD. The main CVRFs were: 44.1%-hypertension, 36.2%-obesity, 31.9%-dyslipidemia, 23.6%-diabetes and 22.7%-smoking. The mean morbidity/ patient/year was 10.1 ± 4.2 with CVEs vs. 8.3 ± 4.3 (p = 0.000); the clinical parameters studied (FEV 1 , BMI) showed no signifi- cance. The logistic model, corrected for age-sex and severity identified as associated factors: diabetes mellitus (OR = 2.1; CI = 1.3–3.4; p = 0.001) and dyslipidemia (OR = 1.7; CI = 1.1–2.7; p = 0.002). Quantification of unit cost/year/COPD was €2793.22 ± 3166.30 (70.5% pharmaceutical expenditure). The cost/year/patient-adjusted was €2847.22 (SE = 117.02) without CVEs, versus €2563.66 (SE = 244.05) with CVEs, p = NS. CON- CLUSIONS: The presence of CVEs associated with COPD is high, causing an important co-morbidity, though without increasing the global costs of the disease. Diabetes mellitus and dyslipidemia are the main CVRFs associated; their prevention could improve the disease outcomes. Further studies are needed to confirm the consistency of these results. PCV57 COSTS ASSOCIATED WITH DRUG USE IN THE NON- ADHERENCE TO CHOLESTEROL MANAGEMENT GUIDELINES FOR PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE IN AN ELDERLY POPULATION:THE ROTTERDAM STUDY Gumbs PD 1 ,Verschuren WMM 2 , Mantel-Teeuwisse AK 1 , De Wit GA 2 , Hofman A 3 ,Trienekens PH 4 , Stricker BHC 3 , De Boer A 1 , Klungel OH 1 1 Utrecht University, Utrecht, Utrecht, The Netherlands, 2 National Institute for Public Health and the Environment, Bilthoven,The Netherlands, 3 Erasmus University, Rotterdam, The Netherlands, 4 Stichting Trombosedienst en Artsenlaboratorium Rijnmond, Rotterdam, The Netherlands OBJECTIVES: In The Netherlands, costs of statin use have recently increased sharply compared to costs of other drugs. Yet, several studies have established undertreatment and overtreat- brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Elsevier - Publisher Connector