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0.907-0.913 and 0.957; CI95% 0.951-0.962) than in Brazil and Chile (0.892, CI95% 0.8880.897 and 0.80, CI95% 0.79-0.81). In all countries, both VAS and EQ-5D index values decreased with increasing age, and were lower in females. Out of the 243 possible EQ-5D-3L health states only eight were present in at least 90% of the population in Argentina, nine in Brazil, and 19 in Chile. In Uruguay, only 33 out of the possible 3125 EQ-5D-5L health states were referred at least by 90% of the participants. In general, the prevalent states were the ones with mild limitations in pain-discomfort, anxiety-depression or mobility.  Conclusions: This is the first collaborative work between Latin-American EQ-5D researchers from four countries. This study summarizes population norms for the region that can be used in decision-making as well as in research. PHP148 IMPORTANT ASPECTS OF (FULL) HEALTH NOT CAPTURED BY EQ-5D Shah K 1, Mulhern B 2, Longworth L 3, Janssen B 4 of Health Economics, London, UK, 2University of Technology Sydney, Sydney, Australia, 3Brunel University London, Middlesex, UK, 4EuroQol Research Foundation, Rotterdam, The Netherlands .

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Objectives: Studies to produce value sets for preference-based measures of health require a full health upper anchor to be defined if the values are to be used to calculate quality-adjusted life years. In EQ-5D value set studies, this upper anchor could either be ‘full health’ or EQ-5D health state 11111. The objectives of this study were to answer the following questions: What (if anything) makes full health and 11111 different from each other? What important aspects of (full) health are not captured by the five EQ-5D dimensions?  Methods: Data were collected from a broadly representative sample of the UK general public via face-to-face interviews. After completing a computer-assisted valuation questionnaire, respondents completed a pen-and-paper follow-up questionnaire. The follow-up tasks were developed by the study team to elicit additional information about the comparability between full health and 11111 and respondents’ interpretations of those concepts; and to inform the ongoing research agenda around the measurement of health beyond the existing EQ-5D descriptive system. A combination of descriptive and thematic techniques were used to analyse the data.  Results: Data are available for 436 respondents. A sizeable minority (30%) of respondents did not agree when asked whether they considered full health and 11111 to be the same as each other. Many respondents suggested that the five EQ-5D dimensions are not exhaustive of all conditions and health problems. Sensory deprivation (particularly vision and hearing) and mental health were the aspects of health most commonly suggested by respondents as being important but not captured by EQ-5D.  Conclusions: The findings of this study support the choice of areas in which developmental bolt-on work has been conducted to date. Further research is required to establish whether and what people would be willing to trade for improvements in the aspects of health not currently included in the EQ-5D. PHP149 PHARMACIST-PERCEIVED BARRIERS TO PROVIDING PATIENT CARE SERVICES: A SYSTEMATIC REVIEW Simon A , Pinto S , Osundina F University of Toledo, Toledo, OH, USA .

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Objectives: Health care has recently witnessed many changes aimed at improving health outcomes with pharmacists taking a bigger role in patient care. In order to provide the best improvement strategy, the barriers that affect pharmacists must be identified. The purpose of this study was to systematically review and evaluate the literature regarding the perceived barriers of pharmacists when providing care.  Methods: The electronic databases, PubMed and the International Pharmaceutical Abstracts, were searched for articles published in English between 1995 and 2015. The electronic database, Embase, is currently being reviewed using the same specifications. Titles and abstracts were screened according to the inclusion criteria by one researcher. Keywords included pharmacist, barrier, limitation, impediment, inhibit, challenge, providing, provision, delivery, care, service, survey, questionnaire, attitude, perception, opinion and view. The articles that met the inclusion criteria were then audited by a second researcher.  Results: From 530 articles, 31 articles were included once duplicates were removed. Patient care services included, but were not limited to, immunizations, medication management therapy services, hospital discharge counseling, and chronic disease education. 23 articles addressed services and barriers in the community setting. Eight articles were from the hospital setting. The primary barrier identified was lack of time (65%). This was consistent with both the community and hospital settings. Secondary barriers included lack of reimbursement (55%), lack of training/knowledge (32%), lack of staff (26%), lack of space (26%), and inability to obtain complete medical information on patients (13%).  Conclusions: This review has identified several key barriers that affect the delivery of care from pharmacists. Further research that identifies barriers with specifically paired interventions may ultimately improve pharmacist provided patient care and improve health outcomes. PHP150 DO SPECIALTY DRUGS OFFER LARGER POPULATION HEALTH BENEFITS THAN NON-SPECIALTY DRUGS? Thorat T 1, Wilkinson C 1, Chambers J 2, Neumann P J 1 for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies,Tufts Medical Center, Boston, MA, USA, 2Tufts Medical Center, Boston, MA, USA .

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Objectives: Our objective was to estimate the potential population health benefits of specialty and traditional drugs relative to existing standard of care in the 12 months following their approval.  Methods: We identified new molecular entities (NME) approved by the FDA from 1999-2011. For each drug we searched for cost-effectiveness studies that compared the drug to standard of care at the time of approval and that presented disaggregated incremental quality-adjusted lifeyear (QALY) or life-year (LY) data. Next, we identified US disease prevalence estimates pertinent to each included drug’s indication. We categorized each drug as

a specialty or traditional drug depending on its inclusion in the largest pharmacy benefit managers’ specialty drug lists. We estimated the population health gain if 50% (range 10-90%) of eligible patients switched from the current standard of care to the new drug. We used Mann-Whitney U test to compare population health gains for specialty versus traditional drugs.  Results: FDA approved 279 NMEs from 1999-2011. We identified QALY gain estimates for 101 NMEs (36% of approved drugs), including 57 specialty drugs and LY gain estimates for 50 NMEs (18%), including 35 specialty drugs. The median estimated population QALY gain for specialty drugs was 27,809 (IQR= 150,713) [range 5,562 to 50,506] and for traditional drugs was 3,798 (IQR= 193,409) [range 760 to 6,838]. The median estimated population LY gain for specialty drugs was 38,559 (IQR= 195,801) [range 7,712 to 69,406], and for traditional drugs was 9,439 (IQR= 1,939,730) [range 1,888 to 16,990]. We did not find a statistically significant difference between specialty and traditional drugs in the estimated population QALY (p= 0.138) and LY gains (p= 0.721) in the 12 months following their approval.  Conclusions: Despite tending to be indicated for diseases of lower prevalence we found a trend towards specialty drugs offering larger population health benefits than traditional drugs, particularly when measured in terms of QALY (p= 0.138). PHP151 EFFECT OF AFFORDABILITY ON ACCESSIBILITY OF MEDICAL CARE POST AFFORDABLE CARE ACT Mukherjee K Chicago State University, Chicago, IL, USA .

Objectives: People in the USA could not access required healthcare in a timely manner becasue lack of affordability. The Patient Protection and Affordable Care Act (PPACA) was implemented in the year 2010 to increase access to medical care by improving affordability. The objective of this study was to evaluate the impact of affordability on accessibility of medical care in the USA after implementation of PPACA.  Methods: This cross-sectional study analyzed data from 2013-2014 National Health Interview Survey (NHIS). The study included adults who experienced affordability problems. A person was classified as having difficulty in accessing medical care if the person was unable to receive needed medical care or experienced delay in obtaining it or encountered both problems. Logistic regression model, after adjusting for socio-demographic characteristics was used to assess impact of affordability on accessibility.  Results: A total of 45,865 individuals were included in the analysis. Majority was non-Hispanic white (56.41%), females (54%), had some insurance (74.93%), married (51.69%) and attended some college (50.79%). A total of 27,242 (59.40%) had problems paying or were unable to pay any medical care, 8,196 (17.87%) could not pay medical bills over time, and 10,833 (23.62%) respondents experienced difficulties to access because of worry about cost. Odds of difficulty to access was significantly higher (OR =  3.39, 95%CI =  3.19, 3.61) for those with affordability issues compared to those without any problem. Ability to pay off bill over time decreased the difficulty to access (OR =  0.90, 95% CI =  0.85, 0.96). Being uninsured, female, unmarried, having poor health status and low income could significantly decrease the odds of access.  Conclusions: Lack of affordability adversely impacted accessibility of medical care even after implementation of PPACA. Increase in affordability through various policy measures is required to improve accessibility to medical care among vulnerable groups. PHP152 SELF-PERCEPTION OF AGING: RESULTS FROM A GLOBAL SURVEY ASSESSING THE PSYCHOSOCIAL IMPACT OF FACIAL AGING Bassel M 1, Gallagher C J 2, Kawata A K 3, Hanson K A 1 1UBC: An Express Scripts Company, Dorval, QC, Canada, 2Allergan, Inc., Irvine, CA, USA, 3Evidera, Bethesda, MD, USA .

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Objectives: To describe the psychosocial impact of facial aging in adult females and males.  Methods: Participants aged 18-75 were recruited from a pool of internet panelists in Australia, Canada, United Kingdom, and United States. Psychosocial impact of facial aging was evaluated using the Self-Perception of Age (SPA) measure, the Facial Line Satisfaction Questionnaire (FLSQ), and the Facial Line Outcomes (FLO11) Questionnaire. Quotas were used to ensure representation of all age, gender, and race categories of interest. Descriptive statistics were reported.  Results: A total of 4,086 respondents completed the survey. Mean age was 47.7 years (SD= 16.1) and 80.0% of respondents were female. Nearly all participants (95.6%) perceived themselves as looking their current age or younger (females: mean 9.7 [SD= 6.8]; males: mean 9.6 [SD= 6.4] years younger). Participants aged 40-49 perceived themselves as looking slightly younger than any other cohort. Black participants perceived themselves as looking greater years younger than White participants (in all age cohorts) and Asian and Hispanic participants (in select age cohorts). Over half of participants (53.8%) were ‘mostly/very satisfied’ with the appearance of their face; satisfaction was higher in younger cohorts (18-49 years) and decreased slightly in older cohorts (50-75 years). White and Black participants reported the greatest negative selfperception and most favorable self-perception, respectively, based on the FLO-11. Females reported greater negative impact of facial lines than males, with the greatest negative impact among females aged 40-59; among males, White participants and participants aged 40-49 reported the greatest negative impact.  Conclusions: This is the first multinational study to describe the psychosocial impact associated with facial lines. Participants generally reported a high overall positive outlook on their facial appearance, with Black participants reporting the highest levels of satisfaction. Data from this study can be used as a basis for future research on the impact of facial aging. PHP153 DO JOURNAL EDITORS PERCEIVE REAL-WORLD EVIDENCE AS VALUABLE? Mullins C D 1, Anyanwu C 1, Oehrlein E M 1, Graff J S 2, Perfetto E M 3, Onukwugha E 1, Heath C D 1 1University of Maryland School of Pharmacy, Baltimore, MD, USA, 2National Pharmaceutical Council, Washington, DC, USA, 3National Health Council, Washington, DC, USA .

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Objectives: Spurred by proliferation of data sources, research methods, and published guidelines supporting the conduct of rigorous real-world evidence (RWE) studies, the past decade has seen increasing submissions of RWE studies to peerreviewed journals. Historically, there has been the perception among traditional biomedical researchers, clinicians, and others that observational studies produce less credible evidence than randomized trials. This perception may impact the review and acceptance of observational RWE studies for publication and therefore dissemination. The purpose of this study is to obtain peer-reviewed journal editors’ views on the value and barriers to RWE publications.  Methods: Journals representing general medicine, specialty care, health policy, and health services research were identified based on journal impact factor and topic area covered (e.g., specialty). Editors were contacted by email and telephone and invited to participate in a telephone interview, in-person roundtable discussion, and survey. Qualitative data analysis was conducted using NVivo software.  Results: In total, 77 journals (16 health policy, 46 specialty medicine, 15 general medicine) were approached, resulting in 15 telephone interviews. Factors associated with RWE publication included: rigor of methodology, novelty and relevance of the research question, suitability of data source to the research question, and extent to which merits of real-world data sources are realized (e.g., generalizability, sample size). The process for evaluation of RWE is similar to clinical trials. Journals generally do not provide guidance, assistance, or training to reviewers about RWE studies, however standard guidelines for review of RWE studies may improve quality.  Conclusions: Widespread perceptions that RWE studies are viewed less favorably by journal editors may be incorrect, provided RWE studies are methodologically rigorous and examine important questions. Interviewed journal editors evaluate studies using the same critical approach whether the findings stem from observational or interventional evidence. These findings, however, may be biased due to editor’s willingness to participate in this study. PHP154 USING PREDICTIVE ANALYTICS TO AUDIT PHARMACY BENEFIT DECISIONS WITHIN THE VA SYSTEM Fominaya CE Ralph H. JohnsonVAMC, Charleston, SC, USA

PHP155 AGE, COHORT, AND HEALTH-RELATED QUALITY OF LIFE: AN AGE-PERIODCOHORT ANALYSIS OF THE NATIONAL HEALTH INTERVIEW SURVEY Hanmer J 1, Hess R 2, Roberts M S 3, Rothenberger S 1, Yu L 1 of Pittsburgh, Pittsburgh, PA, USA, 2University of Utah, Salt Lake City, UT, USA, 3University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA .

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Elmer D 1, Boncz I 1, Sebestyén A 2, Molics B 3, Danku N 1, Vajda R 1, Horváthné Kívés Z 3, Kovács G 4, Endrei D 1 1University of Pécs, Pécs, Hungary, 2National Health Insurance Fund Administration, Pécs, Hungary, 3University of Pécs, Pécs, Hungary, 4Széchenyi István University, GyÅ‘r, Hungary .

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Objectives: To assess the relative importance of age, cohort, and period on HRQoL in the US non-institutionalized population.  Methods: We use serial cross-sectional data from the 1982-2013 waves of the National Health Interview Survey to evaluate the outcome of self-rated health (SRH) (Would you say your health in general is excellent, very good, good, fair, or poor?) among participants age 18 and older. We employed a partial least squares regression model for an age (year of age)-period (year of data collection)-cohort (year of birth) analysis. Based on R-square and Wold’s variable importance in projection (VIP) criteria, we report a reduced model using age, age-squared, and cohort. These analyses were performed for both the overall population and sex- and race- subgroups.  Results: Using the full dataset (n= 2,293,356), SRH worsens with age as both a linear and squared term (R2 =  10.2). SRH also worsens with cohort. While the age-squared term in the model limits the ability to directly compare the parameter estimates, the effect of a oneyear increase in age is roughly equivalent to the effect of a 70- to 90-year increase in cohort. Within all sex- and race- strata, age is significant predictor of SRH with increasing age being generally associated with worse SRH. The significance and direction of cohort differs across strata. Cohort is not a significant predictor of SRH for American Indians (female or male), Asian males, and White females. As birth year increases, SRH improves for Asian females, Black females, and Black males. As birth year increases, SRH worsens for White males.  Conclusions: In an age-period-cohort analysis of SRH, age is the most important predictor both by parameter magnitude and importance criteria. Cohort has a smaller but statistically significant contribution which varies by sex- and race- strata; year of birth is also important in predicting SRH.

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Objectives: After Hungary joined to the European Union in 2004, health care professionals were allowed to enter onto the European labour market. The higher salaries in Western European countries are important motivating factors for Hungarian health care professional to go abroad. The aim of our study was to analyze the changes in the income of health care professionals in Hungary.  Methods: Data derive from the database of the Hungarian Central Statistical Office. The following health care professional – working in hospitals – were included into the analysis: physicians, dentists, pharmacists, nurses, dieticians, physiotherapists, midwifery, optometrists, health visitors, and occupational health professionals. We calculated the average increase in monthly income between 2003-2012.  Results: In 2003, we observed the highest income for pharmacists (287397 Hungarian Forint, HUF per month), specialist physicians (271220 HUF) and occupational health professionals (223836 HUF). We found the highest income in 2012 for specialist physicians (319765 HUF), pharmacists (370194 HUF) and general practitioners (319765 HUF). Between 2003-2012 the average increase of the income of all health care professionals was 39 %. We observed the highest increase in the income of optometrists (76 %) pharmacists (73 %) and specialist physicians (64 %), while we found the lowest increase in the income of health visitors (18 %), occupational health professionals (19 %) and dentists (21 %).  Conclusions: Between 2003-2012 there was a remarkable increase in the income of health care professionals in Hungary. However, this increase showed significant differences among different professions. In order to prevent well trained health care professionals leaving Hungary for working abroad, futher increase of salaries is needed. PHP157 CLINICIAN ENGAGEMENT IN THE NIH HEALTH CARE SYSTEMS RESEARCH COLLABORATORY Moloney R M , Tambor E S , Tunis S Center for Medical Technology Policy, Baltimore, MD, USA .

Objectives: Patients enrolled in Veterans Affairs (VA) hospitals are eligible for cost-free medical and pharmacy benefits for conditions developed during military service as determined during compensation and pension exam(s) (Code of Federal Regulations, Chapter 38). As it relates to pharmacy benefits, practitioners point-of-care decisions which determine if first-party and third-party billing events occur. This quality improvement project aims to identify instances of discordance between pharmacy benefits decisions in point-of-care decisions and predictive analysis.  Methods: During a proof-of-concept pilot, prescription records were extracted prospectively to build a repository of probabilities that a particular disability was associated with a medication using logistic regression and automated model selection, stepwise minimization of Akaike information criterion (AIC). The subset of known probabilities were then applied to the VA-wide database for prescriptions to evaluate pharmacy benefit decisions.  Results: During the pilot run approximately 5,742 / 3 million drug-disability pairs were evaluated and the probability of being service connected or non-service connected was applied to 1,026,677 prescriptions with pharmacy benefits determinations during the month of January 2015. Due to the partial database of drug-disability predictions, 317,474 prescriptions were evaluated on 550,239 drug-disability pairs. This method found that 43,571 / 317,474 (13.7%) prescriptions had a pharmacy benefits decision that conflicted with the predicted probability, and 18,185 (5.7%) fell into a high probability that a variance occurred.  Conclusions: Each month a considerable volume of pharmacy benefit decisions may warrant further clinical and/or administrative review. If validated, statistical and machine learning techniques could be a reasonable approach to analyze benefits decisions in VA hospitals.

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PHP156 CHANGES IN THE INCOME OF HEALTH CARE PROFESSIONAL IN HUNGARY

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Objectives: Despite efforts to minimize clinician burden by relying on electronic health records as a primary means of data collection, research conducted within healthcare delivery settings requires the support and engagement of practicing clinicians. Comparative effectiveness researchers are only beginning to understand the relationship between effective clinician engagement and study success. We sought to gain a deeper understanding of the challenges to and successful strategies for clinician engagement in health systems based pragmatic clinical trials (PCTs).  Methods: We conducted semi-structured telephone interviews between June and August of 2015 with researchers conducting pragmatic trials as part of the NIH Health Care Systems Research Collaboratory. Participants were asked to describe the types of on-the-ground clinicians engaged in their trials, challenges encountered during both planning and implementation phases, what worked well, and what they might have done differently. Interviews were recorded, transcribed, and analyzed using NVivo 10 software, to identify key themes.  Results: Twelve key informants participated, representing investigators and staff from six research projects. Findings reveal challenges and potential facilitators to clinician engagement across multiple levels of healthcare delivery, including: individual clinician motivators, logistical issues associated with the unique clinic environment and IT infrastructure, clinician leadership within the delivery system, and support from health system administration.  Conclusions: Lessons learned from the initial set of NIH Collaboratory demonstration projects provide a strong foundation for developing a national agenda to improve clinician engagement in health systems based research. Next steps include development of a stakeholder-informed plan of action for expanding clinician participation in PCTs to the degree that will be necessary to build and sustain a learning healthcare system. PHP158 A LITERATURE REVIEW OF STUDY DESIGN ELEMENTS IN COST-EFFECTIVENESS ANALYSES Udeze C J 1, Goto D 1, Park Y 1, Yang K F 2, Downton K 2, Lecomte P 3, Olson M S 3, Mullins C D 1 1University of Maryland School of Pharmacy, Baltimore, MD, USA, 2University of Maryland Health Sciences and Human Services Library, Baltimore, MD, USA, 3Novartis Pharma AG, Basel, Switzerland .

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Objectives: Increased drug costs have placed an emphasis at not only looking at a drug’s efficacy, but also its cost-effectiveness. Cost-effectiveness of a drug depends on the study design elements of the cost-effectiveness analysis. These include elements that account for dynamic changes in market and clinical factors after a drug is approved. This literature review summarizes the frequency of specific study design elements that can affect a drugs cost-effectiveness.  Methods: Articles published between January 2000 and February 2015 were identified from PubMed, EMBASE, International Pharmaceutical Abstracts (IPA), and EconLit. Search terms were developed for three categories: Cost, Time Span, and Drug/Pharmaceutical. We included original cost-effectiveness analyses (CEA) from high-income OECD countries that were published in English and had at least 100 patients if they were based on clinical trials. Each article was evaluated by two reviewers using a stepwise approach.  Results: A total of 192 articles were included after full-text review from 710 screened articles. The most common type of analysis was cost-utility (n= 124), followed by cost-effectiveness analysis (n= 54) and cost minimization analysis/budget impact models (n=  12). The national health system (n= 80), thirdparty payer (n= 68), and societal perspectives (n= 43) were taken in these analyses. Markov models (n= 87) and decision tree (n= 44) were the most frequently models used in the articles reviewed. Only a few of the cost-effectiveness articles (n= 10) incorporated dynamic effects. The most common dynamic factor was drug price followed by market or clinical factors. These articles incorporated generic entry,