Complications And Health Care Costs Of Influenza In Germany: A Retrospective Claims Data Analysis

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more than patients without comorbidities (p< 0.05). Focusing on the population with two or more comorbidities, HIV/HCV patients required higher management costs than HIV (+7.58%, p< 0.05).  Conclusions: Healthcare providers managing HIV+ patients must be knowledgeable about the management of other comorbidities in the context of HIV. Treatment strategies that are able to decrease the burden of comorbidities in the long term should be preferred, freeing up economic resources to be reinvested in the clinical area. PIN24 Complications And Health Care Costs Of Influenza In Germany: A Retrospective Claims Data Analysis Scholz S1, Damm O1, Ultsch B2, Schneider U3, Remschmidt C2, Weidemann F2, Wichmann O2, Greiner W1 1School of Public Health, Bielefeld University, Bielefeld, Germany, 2Immunisation Unit, Robert Koch Institute, Berlin, Germany, 3WINEG - Scientific Institute of TK for Benefit and Efficiency in Health Care, Hamburg, Germany

Objectives: The aim of this study was to estimate complication rates and health care costs associated with influenza in Germany using routine health insurance claims data. Complications considered in the analysis were otitis media and community-acquired pneumonia (CAP).  Methods: Our analysis was based on data from a German statutory sickness fund (> 9 million insurants) over a 3-year period (2012-2014). A representative sample of 100,000 persons was drawn from all insurants diagnosed with influenza (ICD-10 codes J09-J11), and controls were matched one-to-one without replacement by age group, sex, insurance status (e.g. unemployed, student), and pharmaceutical costs of the previous year (proxy for morbidity), leading to 95,089 matched pairs. Complications were defined using the ICD-codes H65 to H67 for otitis media and J10.0, J11.0, and J12 to J18 for CAP. All complication rates and costs were calculated as the mean difference between the age-stratified influenza and control groups. Only inpatient costs were calculated directly using diagnosis-related groups.  Results: The overall excess complication rate ranged from 5.4% (2013) to 7.7% (2014) for otitis media and from 8.2% (2013) to 9.4% (2014) for CAP. Otitis media was more likely to occur in younger age groups with a decline after the age of 5 years, whereas CAP showed a higher occurrence in younger (< 14 years) and older (≥ 60 years) age groups. Excess costs for physician consultations per year and person in the influenza group varied from € 2.56 (2013) to € 6.60 (2014), and excess pharmaceutical costs ranged from € 43.74 (2014) to € 96.33 (2012). Average inpatient costs per hospitalised patient were € 2,805 (without complications).  Conclusions: Complication rates of otitis and CAP for influenza patients were relatively stable in the study period but differed between age groups. Differences in costs between the influenza group and the control group were small but could be detected in the claims data. PIN25 Health Resources Use In Patients With Human Immunodeficiency Virus (Hiv) Infection. Real world evidence from italian administrative databases Perrone V, Sangiorgi D, Crovato E, Buda S, Degli Esposti L CliCon S.r.l., Ravenna, Italy

Objectives: The study was designed to evaluate the prevalence of comorbidities in patients infected with HIV and to concomitantly estimate the associated healthcare costs.  Methods: An observational retrospective cohort analysis, using administrative and laboratory tests databases from 7 Local Health Units (LHUs) in Italy, was designed. Data from 1 LHU are currently available. Patients diagnosed with HIV (through hospitalisations, specific treatments or blood test results) between January 1st 2013 and December 31st 2015 were included. The date of the first HIV-related healthcare service/prescription was used as the index date. Clinical characteristics of patients enrolled in the study were investigated in the year before the index-date. All patients were followed for 1 year after the index-date.  Results: A preliminary analysis included a total of 298 HIV+ patients. Mean age was 53.5 years, 67% were male and 6% had AIDS. Twenty-five percent of patients had one comorbidity, 12% had two and 5% had three or more comorbidities. Twenty-seven percent of patients were prescribed with antihypertensive drugs, 17% with statins, 8% with anti-diabetics and 2% with osteoporosis drugs. Three percent were hospitalised for cardiovascular disease (Heart Failure, Myocardial Infarction, Cerebrovascular event). On average, the healthcare cost of a patient without comorbidities was 7’800€ , the cost of a patient with one comorbidity was 9’100€  and the cost of a patient with two comorbidities and with three or more was 9’700€  and 10’000€ , respectively.  Conclusions: A significant proportion of HIV+ patients were reported to have at least one comorbidity. This study has demonstrated that healthcare costs increase according to the number of comorbidities: patients with 3 or more comorbidities costed 30% more than patients without comorbidities. As a result, it is important that the management of each HIV+ patient is made through a multidisciplinary approach, taking comorbidities into account in addition to suppressing viral load. PIN26 Determination Of The Vaccine-Preventable Diseases Burden In Turkey In Terms Of Various Vaccination Policies Ceyhan M1, Bayhan C2, Ozsurekci Y3, Malhan S4, Numanoglu Tekin R4, Mcintosh D5 1Hacettepe University Pediatric Infectious Disease, Ankara, Turkey, 2Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey, 3Hacettepe University, Ankara, Turkey, 4Baskent University, Health Care Management, Ankara, Turkey, 5Imperial College,Faculty Education Office, London, UK

Objectives: Vaccination plays an important role in protection from frightening consequences of infectious diseases. Turkey has an advanced system of universal routine vaccination in the national schedule and there have been recent improvements in the Turkish childhood national immunization program since 2006. There were diphtheria, hepatitis B, measles, pertussis, polio, tetanus and tuberculosis vaccines in 2006 national schedule. Since 2006, Haemophilus influenza type B, rubella,

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mumps, pneumococcal, varicella and hepatitis A vaccines implemented in national immunization programme, and rotavirus, human papillomavirus, and meningococcal vaccines are available widely across the country. However, some groups have questioned the benefits of the vaccine and refused to vaccinate themselves and their relatives as well. We questioned what would happen if vaccination is completely terminated for any reason and compare the results regarding the existing vaccines in 2006 and 2016.  Methods: We modeled the impact on pediatric public health and the society of the cessation of routine vaccination in Turkey.  Results: In case of the cessation of seven vaccines available in 2006, we predict that there would be 6.973 deaths per year arising from the return of vaccine-preventable diseases. The direct costs of the seven vaccine preventable diseases returning would be $550.305.406 whilst the societal costs would be $1.375.651.478 making a total of $1.925.956.884. According to our calculations, the cessation of vaccination with vaccines available in 2016 would cause 14.788 deaths per year. The direct, societal and total costs of the 16 vaccine preventable diseases returning would be $5.526.515.195, $2.617.580.150, $8.144.095.345, respectively.  Conclusions: There would be serious and unrecoverable results if vaccination will be ceased in Turkey for whatever reason. PIN27 Indirect Cost Of Hiv/Aids: Results Of A Survey From A Turkish Research Center Tatar M1, Kockaya G2, Ozelgun B2, Zengin Elbir T2, Senturk A3, Tuna E3, Unal S1, Tumer A1, Inkaya C1 1Hacettepe University, Ankara, Turkey, 2Gilead Science, Istanbul, Turkey, 3Polar Health Economics and Policy Consultancy, Ankara, Turkey

Objectives: Anti-retroviral treatment (ART) alternatives in HIV/AIDS have improved in the last decade with a significant impact on both the length and quality of life of patients. As patients are now living longer, indirect costs associated with the disease are becoming increasingly important. A total of 6889 HIV+ cases were diagnosed between 2003-2014 in Turkey, and in recent years there has been increasing evidence indicating that the impact of HIV/AIDS on the general economy may be higher than expected. This study, aimed at exploring the indirect cost of HIV/AIDS in Turkey.  Methods: The study adopted the human capital approach in measuring indirect costs. A questionnaire, exploring the number of days lost at work due to the disease and the extent of productivity losses was designed. The questionnaire was completed via telephone interview by 72 HIV+ patients of a university hospital in Ankara, Turkey between August-November 2015. The indirect costs associated with lost income due to premature death were also calculated from the patient record database of the center (255 patients). The number of life years lost due to premature death and official employment statistics were used to estimate the income lost.  Results: The annual indirect cost of HIV/AIDS per patient was estimated as 3,560.40 TL. The majority of this cost was due to unpaid work (1,478.4TL) and absenteeism due to a disease related visit to the health center (1,057.92 TL). The total lost income of patients in the dataset at productive age (19-60) was estimated as 10,401,595 TL.  Conclusions: This study explored the indirect costs of HIV/AIDS from a single research center in Turkey. The results indicated that these costs have a significant impact to society and the general economy which should also be taken into account when estimating the total burden of the disease. PIN28 Burden Of Comorbidities In Hcv And Hiv/Hcv Patients. Real world evidence from italian administrative databases Perrone V, Sangiorgi D, Crovato E, Buda S, Degli Esposti L CliCon S.r.l., Ravenna, Italy

Objectives: The study was designed to assess the prevalence of comorbidities in patients with Hepatitis C Virus (HCV) and with concomitant HIV/HCV infection, and to estimate the healthcare costs associated with those comorbidities.  Methods: An observational retrospective cohort analysis, using administrative and laboratory tests databases from 7 Local Health Units (LHUs) in Italy was designed. A preliminary analysis from one LHU was completed. Patients diagnosed (through hospitalisations, specific treatments or blood test results) with HCV or HIV/HCV co-infection between January 1st 2013 and December 31st 2015 were included. The date of the first diagnosis related to HCV or HIV/HCV co-infection was used as the index date. Clinical characteristics of patients enrolled in the study were investigated in the year before the index-date. All patients were followed for 1 year after the index-date.  Results: The preliminary analysis included a total of 105 patients mono-infected with HCV and 68 patients co-infected with HIV/HCV.  Mean age was 53.8 and 54.3 years, respectively; 60% were male; 44% of HCV mono-infected patients had one comorbidity (rheumatologic/pulmonary conditions), 12% had two and 7% had three or more. Among HIV/HCV co-infected patients, 25% had one, 9% had two and 12% had three or more comorbidities. On average, the cost to the healthcare system of a co-infected patient was 45% more than mono-infected HCV patients. Pharmaceutical expenditure accounted for 51% and 87% of the total cost for mono-infected and HIV/HCV co-infected patients, respectively.  Conclusions: The preliminary findings of this study showed that a significant proportion of HCV and HIV/HCV co-infected patients also experience comorbidities. As a consequence, antiviral strategies with minimal drug-drug interactions (DDIs) and favourable safety and tolerability profiles are necessary for optimal management of these patients. HIV/HCV co-infected patients required higher overall costs than HCV mono-infected ones. This was mainly due to drugs prescribed for comorbidities.

PIN29 Direct Cost Of Hiv/Aids In Turkey Tatar M1, Kockaya G2, Ozelgun B2, Zengin Elbir T2, Senturk A3, Tuna E3, Unal S1, Tumer A1, Inkaya C1 1Hacettepe University, Ankara, Turkey, 2Gilead Science, Istanbul, Turkey, 3Polar Health Economics and Policy Consultancy, Ankara, Turkey