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AWO: ASSESSMENT HOSPITALIZATION COST SAVINGS BY USING VHC+MDI COMPARED TO MDI OR SVN
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 121 (2018) S22−S62
difficult-to-treat asthma more than 10 years after enrollment in the TENOR I study. Multivariable logistic regression assessed predictors of an ATS severe exacerbation at TENOR II using TENOR II variables, with the exception of a severe exacerbation from TENOR I, defined as 1 or more corticosteroid bursts within the 3 months before enrollment. Results: A total of 288 patients were included. Mean age was 58.4 (16.0) years, 66.7% were female. Nearly half (46.9%) were obese and a quarter (25.0%) had ever smoked. Geometric mean of total IgE level was 68.9 IU/mL and mean eosinophil level was 197.6 (144.9) mL. Mean % predicted pre- and post-bronchodilator FEV1 was 72.9% and 78.3%, respectively. 71.2% of patients used combined ICS/LABA medication. Statistically significant predictors of a severe exacerbation were combined ICS/LABA use (odds ratio (OR) 3.5, 95% CI: 1.5, 8.0; p=0.004), a severe exacerbation at TENOR I (OR 2.5, 95% CI: 1.3, 4.8; p=0.007), and % predicted post-bronchodilator FEV1 (OR 1.2, 95% CI: 1.0, 1.4; p=0.046). Conclusions: A prior severe exacerbation remains a predictor of a future exacerbation in patients with severe/difficult-to-treat asthma after more than a decade. Combined ICS/LABA use, and low postbronchodilator lung function also increased the odds of a future exacerbation.
P222 AWO: ASSESSMENT HOSPITALIZATION COST SAVINGS BY USING VHC+MDI COMPARED TO MDI OR SVN M. NEWHOUSE*, Hamilton Canada, ON, Canada Introduction: A health economics study was conducted on a large patient dataset to analyze the cost of care during hospitalization in patients on long term ICS therapy delivered by MDI alone, MDI+VHC or SVN. Methods: Hospitalization rate and cost of care during hospitalization over a twelve-month period were evaluated in 835,346 patients, age 0-64 years during June 2007- Dec 2016 (data source; Humana Inc. and Pearl Diver Inc.). The cost of care during hospitalization for patients who received long term ICS therapy by MDI alone, MDI+VHC or SVN was compared. Results: Of the total, MDI: 81.5% (680,379), MDI+VHC: 3.5% (29,109), SVN:15% (126,157) prior to hospitalization. Hospitalization rates were 5.54%, 10.29% and 19.78% in patients using MDI+VHC, MDI alone and SVN respectively. Per patient cost of hospitalization was MDI +VHC: ($39,128), MDI alone ($39,768), and $47,331 using SVN to provide ICS. Conclusions: 1. Current Global Respiratory guidelines not followed with only 3.5% of patients receiving VHC with MDI. 2. Compared to MDI+VHC for ICS therapy, MDI alone had »twice as many hospitalizations and SVN»four times that rate. 3. Per-patient hospitalization cost was slightly greater if patients used MDI alone vs MDI+VHC 4. Hospitalization cost was »20% greater in patients on SVN 5. Payer Data supports Studies and Respiratory Guidelines to reflect lower hospitalization/relapse rates amounting to a significant overall category savings in patients that receive MDI+VHC.
P223 CAREGIVER QUALITY OF LIFE AND MANAGEMENT SELF-EFFICACY IN A TECHNOLOGY-BASED ASTHMA MEDICATION MONITORING CLINICAL TRIAL J. Blumenstock*,1, K. Boon2, M. Kanaley2, J. Szkodon1, P. Newmark2, A. Bozen2, D. Vojta3, R. Gupta2, 1. CHICAGO, IL; 2. Chicago, IL; 3. Minnetonka, MN Introduction: Asthma is a problem of epidemic proportions in Chicago with childhood prevalence and mortality rates above the
S45
national average. In an effort to improve asthma outcomes, children diagnosed with moderate to severe asthma were recruited from Chicago clinics to participate in a technology-based medication monitoring platform. Caregivers were surveyed to assess asthma-related psychosocial outcomes. Methods: Intake surveys were completed by caregivers of 260 children aged 4-17 with moderate to severe asthma to assess caregiver quality of life (PACQLQ) and asthma-management self-efficacy (PAMSES). Mean scores from PACQLQ and PAMSES scales were analyzed by t-tests for differences among caregiver race, ethnicity, insurance, and clinic-setting. Results: Overall mean PACQLQ scores were significantly higher in caregivers with private insurance (Public = 5.5[5.3-5.8]; Private = 6.2 [6.0-6.3]; p < 0.001), Whites (White=6.20[6.0-6.4]; Non-White=5.6 [5.4-5.8]; p< 0.0001). Mean PAMSES scores were higher in caregivers with public insurance (Public = 57.5[56.4-58.6]; Private = 54.6[53.156.1]; p < 0.001), Hispanics/Latinos (Non-Hispanic/Latino=55.5[54.356.7]; Hispanic/Latino=57.7[56.1-59.2] p< 0.005). Conclusions: These data suggest that although asthma-related quality of life was more impaired in minority populations, those with public insurance, and those seeking care at a public clinic, asthma self-efficacy was higher in these groups. This indicates a possible disconnect between asthma-related quality of life and caregiver-perceived self-efficacy. As the study progresses, the intervention’s effect on this disconnect will be an interesting dynamic.
P224 DIFFERENCES IN ELIGIBILITY CRITERIA AND BASELINE PATIENT CHARACTERISTICS AMONGST TRIALS OF BIOLOGIC THERAPIES IN ASTHMA L. Bacharier*,1, T. Casale2, M. Holden3, Y. Rajput4, J. Dang3, Q. Li3, O. Herrera-Restrepo5, P. Bilir3, A. Karabis6, 1. St Louis, MO; 2. Tampa, FL; 3. San Francisco, CA; 4. South San Francisco, CA; 5. Fairfax, VA; 6. Amsterdam, Noord Holland, Netherlands Introduction: The understanding of asthma pathophysiology has evolved over time, impacting investigation of asthma biologics. Differences in eligibility criteria amongst trials for patients with diverse asthma severity and phenotypes have resulted in relevant differences in baseline characteristics. A systematic literature review explored these differences. Methods: PubMed, EMBASE, Cochrane, ClinicalTrials.gov, and conferences were searched from 2003 onwards. Randomized controlled trials (RCTs) were included with: ≥ 24 weeks’ duration; biologic (omalizumab [OMA]/dupilumab [DUPI]/benralizumab [BENRA]/mepolizumab [MEPO]/reslizumab [RESLI]) + daily highdose ICS + ≥ 1 controller; adults ≥ 18 years with moderate/severe uncontrolled asthma and evidence of Type 2 inflammation (eg, blood eosinophils). Results: 27 RCTs (9 OMA/3 DUPI/6 BENRA/7 MEPO/2 RESLI) were included. Overall, BENRA/MEPO/RESLI trials enrolled patients with more severe asthma than OMA/DUPI (Table 1). Per inclusion criteria, the number of prior exacerbations was higher in BENRA/MEPO versus OMA/DUPI/RESLI trials. Baseline blood eosinophil levels varied between trials, but were highest in RESLI. There was a trend towards higher baseline FEV1 in OMA/RESLI trials compared with others. Most patients received medium/high dose ICS + LABAs, with more patients in MEPO trials receiving maintenance OCS. Conclusions: Transitivity, an important assumption in network metaanalysis (NMA), requires populations and study designs be sufficiently similar or have differences that can be adjusted for by accepted methods. Substantial heterogeneity in baseline characteristics existed between trials of asthma biologics and OMA. These characteristics are potential treatment effect modifiers with limited evidence for adjustment. Therefore, comparison of OMA to other
difficult-to-treat asthma more than 10 years after enrollment in the TENOR I study. Multivariable logistic regression assessed predictors of an ATS severe exacerbation at TENOR II using TENOR II variables, with the exception of a severe exacerbation from TENOR I, defined as 1 or more corticosteroid bursts within the 3 months before enrollment. Results: A total of 288 patients were included. Mean age was 58.4 (16.0) years, 66.7% were female. Nearly half (46.9%) were obese and a quarter (25.0%) had ever smoked. Geometric mean of total IgE level was 68.9 IU/mL and mean eosinophil level was 197.6 (144.9) mL. Mean % predicted pre- and post-bronchodilator FEV1 was 72.9% and 78.3%, respectively. 71.2% of patients used combined ICS/LABA medication. Statistically significant predictors of a severe exacerbation were combined ICS/LABA use (odds ratio (OR) 3.5, 95% CI: 1.5, 8.0; p=0.004), a severe exacerbation at TENOR I (OR 2.5, 95% CI: 1.3, 4.8; p=0.007), and % predicted post-bronchodilator FEV1 (OR 1.2, 95% CI: 1.0, 1.4; p=0.046). Conclusions: A prior severe exacerbation remains a predictor of a future exacerbation in patients with severe/difficult-to-treat asthma after more than a decade. Combined ICS/LABA use, and low postbronchodilator lung function also increased the odds of a future exacerbation.
P222 AWO: ASSESSMENT HOSPITALIZATION COST SAVINGS BY USING VHC+MDI COMPARED TO MDI OR SVN M. NEWHOUSE*, Hamilton Canada, ON, Canada Introduction: A health economics study was conducted on a large patient dataset to analyze the cost of care during hospitalization in patients on long term ICS therapy delivered by MDI alone, MDI+VHC or SVN. Methods: Hospitalization rate and cost of care during hospitalization over a twelve-month period were evaluated in 835,346 patients, age 0-64 years during June 2007- Dec 2016 (data source; Humana Inc. and Pearl Diver Inc.). The cost of care during hospitalization for patients who received long term ICS therapy by MDI alone, MDI+VHC or SVN was compared. Results: Of the total, MDI: 81.5% (680,379), MDI+VHC: 3.5% (29,109), SVN:15% (126,157) prior to hospitalization. Hospitalization rates were 5.54%, 10.29% and 19.78% in patients using MDI+VHC, MDI alone and SVN respectively. Per patient cost of hospitalization was MDI +VHC: ($39,128), MDI alone ($39,768), and $47,331 using SVN to provide ICS. Conclusions: 1. Current Global Respiratory guidelines not followed with only 3.5% of patients receiving VHC with MDI. 2. Compared to MDI+VHC for ICS therapy, MDI alone had »twice as many hospitalizations and SVN»four times that rate. 3. Per-patient hospitalization cost was slightly greater if patients used MDI alone vs MDI+VHC 4. Hospitalization cost was »20% greater in patients on SVN 5. Payer Data supports Studies and Respiratory Guidelines to reflect lower hospitalization/relapse rates amounting to a significant overall category savings in patients that receive MDI+VHC.
P223 CAREGIVER QUALITY OF LIFE AND MANAGEMENT SELF-EFFICACY IN A TECHNOLOGY-BASED ASTHMA MEDICATION MONITORING CLINICAL TRIAL J. Blumenstock*,1, K. Boon2, M. Kanaley2, J. Szkodon1, P. Newmark2, A. Bozen2, D. Vojta3, R. Gupta2, 1. CHICAGO, IL; 2. Chicago, IL; 3. Minnetonka, MN Introduction: Asthma is a problem of epidemic proportions in Chicago with childhood prevalence and mortality rates above the
S45
national average. In an effort to improve asthma outcomes, children diagnosed with moderate to severe asthma were recruited from Chicago clinics to participate in a technology-based medication monitoring platform. Caregivers were surveyed to assess asthma-related psychosocial outcomes. Methods: Intake surveys were completed by caregivers of 260 children aged 4-17 with moderate to severe asthma to assess caregiver quality of life (PACQLQ) and asthma-management self-efficacy (PAMSES). Mean scores from PACQLQ and PAMSES scales were analyzed by t-tests for differences among caregiver race, ethnicity, insurance, and clinic-setting. Results: Overall mean PACQLQ scores were significantly higher in caregivers with private insurance (Public = 5.5[5.3-5.8]; Private = 6.2 [6.0-6.3]; p < 0.001), Whites (White=6.20[6.0-6.4]; Non-White=5.6 [5.4-5.8]; p< 0.0001). Mean PAMSES scores were higher in caregivers with public insurance (Public = 57.5[56.4-58.6]; Private = 54.6[53.156.1]; p < 0.001), Hispanics/Latinos (Non-Hispanic/Latino=55.5[54.356.7]; Hispanic/Latino=57.7[56.1-59.2] p< 0.005). Conclusions: These data suggest that although asthma-related quality of life was more impaired in minority populations, those with public insurance, and those seeking care at a public clinic, asthma self-efficacy was higher in these groups. This indicates a possible disconnect between asthma-related quality of life and caregiver-perceived self-efficacy. As the study progresses, the intervention’s effect on this disconnect will be an interesting dynamic.
P224 DIFFERENCES IN ELIGIBILITY CRITERIA AND BASELINE PATIENT CHARACTERISTICS AMONGST TRIALS OF BIOLOGIC THERAPIES IN ASTHMA L. Bacharier*,1, T. Casale2, M. Holden3, Y. Rajput4, J. Dang3, Q. Li3, O. Herrera-Restrepo5, P. Bilir3, A. Karabis6, 1. St Louis, MO; 2. Tampa, FL; 3. San Francisco, CA; 4. South San Francisco, CA; 5. Fairfax, VA; 6. Amsterdam, Noord Holland, Netherlands Introduction: The understanding of asthma pathophysiology has evolved over time, impacting investigation of asthma biologics. Differences in eligibility criteria amongst trials for patients with diverse asthma severity and phenotypes have resulted in relevant differences in baseline characteristics. A systematic literature review explored these differences. Methods: PubMed, EMBASE, Cochrane, ClinicalTrials.gov, and conferences were searched from 2003 onwards. Randomized controlled trials (RCTs) were included with: ≥ 24 weeks’ duration; biologic (omalizumab [OMA]/dupilumab [DUPI]/benralizumab [BENRA]/mepolizumab [MEPO]/reslizumab [RESLI]) + daily highdose ICS + ≥ 1 controller; adults ≥ 18 years with moderate/severe uncontrolled asthma and evidence of Type 2 inflammation (eg, blood eosinophils). Results: 27 RCTs (9 OMA/3 DUPI/6 BENRA/7 MEPO/2 RESLI) were included. Overall, BENRA/MEPO/RESLI trials enrolled patients with more severe asthma than OMA/DUPI (Table 1). Per inclusion criteria, the number of prior exacerbations was higher in BENRA/MEPO versus OMA/DUPI/RESLI trials. Baseline blood eosinophil levels varied between trials, but were highest in RESLI. There was a trend towards higher baseline FEV1 in OMA/RESLI trials compared with others. Most patients received medium/high dose ICS + LABAs, with more patients in MEPO trials receiving maintenance OCS. Conclusions: Transitivity, an important assumption in network metaanalysis (NMA), requires populations and study designs be sufficiently similar or have differences that can be adjusted for by accepted methods. Substantial heterogeneity in baseline characteristics existed between trials of asthma biologics and OMA. These characteristics are potential treatment effect modifiers with limited evidence for adjustment. Therefore, comparison of OMA to other