Hospital Utilization in Patients Diagnosed with Peripheral Arterial Hypertension

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prescription were included.  Results: Non-pharmacy PAH-related medical costs for patients meeting study criteria (n= 172) increased significantly from $1,740 in the pre-SCTI period to $2,929 in the post-SCTI period (p= 0.038). Total PAH-related costs, including pharmacy, were significantly different (pre $5,052 vs. post $15,791, p< 0.001). Total all-cause costs, including pharmacy, also increased post-SCTI (pre $9,044 vs. post $20,012, p< 0.001). Non-pharmacy all-cause medical costs were not significantly different (pre $5,294 vs. post $6,676, p= 0.337). All-cause and PAH-related inpatient admissions and emergency room visits were rare.  Conclusions: Rising PAH-related costs when adding the second medication class suggests that physicians may be responding to disease progression with treatment escalation. PCV60 Estimating the Cost Per Percent Point Reduction in Ldl-C for Patients Treated with Pcsk9 Inhibitors in a Large National Health Plan Gitlin M1, Patel J2, Burton T3, Seare J4, Whang J5, Harrison DJ2 Solutions, Santa Monica, CA, USA, 2Amgen Inc., Thousand Oaks, CA, USA, 3Optum, Waltham, MN, USA, 4Optum, St. George, UT, USA, 5Amgen, Thousand Oaks, CA, USA

1BluePath

Objectives: The primary aim of this study is to model the cost per 1md/dL reduction in LDL-C with evolocumab 140mg and alirocumab 75/150mg in a large national health plan.  Methods: Patients with clinical atherosclerotic cardiovascular disease (ASCVD) and LDL-C > 100 mg/dl (mean = 125.2 mg/dl; SD = 25.1 mg/dl) were obtained from Optum Research Database from Jan 1, 2012 to Jan 1, 2014. An economic model using Monte Carlo simulations was developed and validated to estimate cost per 1mg/dL reduction in LDL-C. Inputs include efficacy based on published Navarese meta-analysis (evolocumab 140mg =  63.46%; alirocumab 75mg =  52.63% and alirocumab 150mg =  56.15%) while drug acquisition costs were based on wholesale acquisition cost (evolocumab $1,085 per 4 week period; alirocumab =  $1,120 per 4 week period). The model applies the percentage reduction in LDL-C to a lognormal distribution of baseline LDL-C values to simulate the absolute LDL-C reduction achieved in these patients. The ratio of absolute LDL-C reduction to WAC price yielded the cost per 1mg/dL reduction.  Results: A total of 15,944 patients with ASCVD were identified (females =  58.4% and mean age =  64.5 years). When the LDL-C reduction from Navarese meta-analysis was applied, the cost per 1mg/dL with evolocumab 140mg was $178, with alirocumab 75mg was $222 and alirocumab 150mg was $208. The cost per 1mg/dL reduction for alirocumab is nearly 15-20% higher than evolocumab based on an mean absolute LDL-C reduction of 79.4 mg/ dL with evolocumab, 65.9 mg/dL with alirocumab 75mg and 70.3 mg/dL with alirocumab 150mg from a starting baseline LDL-C of 125.2 mg/dL.  Conclusions: The Monte Carlo simulation suggests that evolocumab 140mg has costs lower per 1mg/ dL LDL-C reduction versus alirocumab 75mg and alirocumab 150mg. Real world comparative effectiveness evaluations are needed to validate the findings from this modelling exercise. PCV61 Hospital Utilization in Patients Diagnosed with Peripheral Arterial Hypertension Belk K1, Craver CW2, Voorhees C3, Chang D4 1MedAssets, Mooresville, NC, USA, 2MedAssets, Inc., Huntersville, NC, USA, 3MedAssets, Nashville, TN, USA, 4MedAssets, Plano, TX, USA

Objectives: Peripheral arterial hypertension (PAH) is a rare progressive disease characterized by increased blood pressure in the arteries in the lungs and right side of the heart. The objective of this study is to examine drivers of hospital utilization in patients with PAH.  Methods: A retrospective descriptive study was conducted on a cross-section of PAH discharges in the MedAssets health system data for inpatient (N= 3,080) and outpatient (N= 32,133) visits from October 2013 through September 2015. Multivariable logistic regression was used to identify significant drivers of inpatient admission.  Results: The sample included 19,832 unique patients from 376 hospitals. More than half of the discharges (70.2%) were female with an average age of 62.2 and average Charlson comorbidity score of 2.6. The most common comorbid conditions were congestive heart failure (41.2%), chronic obstructive pulmonary disease (34.3%), diabetes (31.5%), renal disease (20.3%), hypertension (17.3%), and cardiac dysrhythmias (14.9%). While nearly 75% of patients had a single hospital visit during this two year timeframe approximately 6% of the population had five or more visits. Only 13% of patients were admitted as an inpatient, however the average length of inpatient stay was 9.1 days and the average cost of inpatient admissions was $23,145. In the inpatient population 5.4% expired during the hospital stay. Hypertensive chronic kidney disease (OR= 5.8, p< .0001), anemia (OR= 5.4, p< .0001), depression (OR= 3.8, p< .0001), history of smoking (OR= 3.4, p< .0001), and cardiac dysrhythmias (OR= 3.1, p< .0001) were the largest predictors of inpatient admission.  Conclusions: Patients diagnosed with PAH have a large number of comorbidities. Better management of the disease may lead to better patient outcomes and a reduction in hospital utilization and healthcare costs.

CARDIOVASCULAR DISORDERS – Patient-Reported Outcomes & Patient Preference Studies PCV62 Patterns and Predictors of Discontinuation and Switch in Atrial Fibrillation Patients Treated with Non-Vitamin K Antagonist Oral Anticoagulants Yao X, Shah ND, Sangaralingham LR, Gersh BJ, Noseworthy PA Mayo Clinic, Rochester, MN, USA

Objectives: Recent clinical trials have established non-vitamin K antagonist oral anticoagulants (NOACs) as viable alternatives to warfarin in stroke prevention for atrial fibrillation. A major challenge in routine clinical practice is the high rate of medication discontinuation and switching. There are currently few large studies offering estimates of drug persistence with NOACs. Moreover, little is known about

what drives patients’ choice and behavior regarding patterns of long-term medication use. Using a large heterogeneous cohort of patients, we aimed to investigate the patterns and predictors of switch and discontinuation among patients initiating NOACs.  Methods: We performed a retrospective cohort analysis using a large U.S. commercial insurance database, OptumLabs Data Warehouse. We identified 10,147 privately insured and Medicare Advantage patients with nonvalvular atrial fibrillation who initiated apixaban, dabigatran and rivaroxaban in 2013 and 2014, the time period when all three NOACs had become available in the U.S. Discontinuation of anticoagulation was defined as having at least 3 months of gap in days of supply of any oral anticoagulants. Two multivariable logistic regression models were performed to assess the risk factors related switch and discontinuation, respectively.  Results: Within one year of NOACs initiation, 13% of the patients switched to another oral anticoagulant, among whom the majority (64%) switched to warfarin. Nearly 40% of patients discontinued oral anticoagulants. Patients initiating apixaban were less likely to switch or discontinue compared to those initiating dabigatran or rivaroxaban. Other risk factors for switch include high out-of-pocket costs, prior warfarin use, and a stroke during follow up. Risk factors for discontinuation include high out-of-pocket costs, no prior warfarin exposure, and a major bleeding during follow up.  Conclusions: Medication discontinuation and switching are common among patients treated with NOACs in routine clinical practice. Medication use may be affected by the choice of initial medication, out-of-pocket costs, and clinical events occurring during follow up. PCV63 Adherence, Compliance, and Persistence with Lipid-Lowering Therapies: A Systematic Review Xu Y1, Worden C2 of Southern California, Los Angeles, CA, USA, 2Amgen Inc., Thousand Oaks, CA, USA

1University

Objectives: This study reviewed and summarized US studies describing adherence, persistence, and compliance to lipid lowering therapy (LLT), and factors that influence adherence and persistence.  Methods: A systematic literature review using PubMed, MEDLINE, and EMBASE databases identified US studies that enrolled adults on LLT published since 2004. Eligible studies had primary data on adherence, persistence, and/or compliance (all definitions for these terms were included), such as medication possession ratio (MPR), proportion of days covered (PDC), time to discontinuation, percentage discontinued, etc. Results were stratified by study type and further by methods. Patients could receive any LLT for primary or secondary prevention. LLTs included statins, ezetimibe, fibrates, niacin, or resins (generic or branded, combination therapies also included). Data were summarized in evidence tables, and descriptive analysis was performed.  Results: A total of 72 full text articles and 28 conference abstracts were identified. Twenty-three studies reported general medication adherence, persistence, and/or compliance, and 77 studies also examined possible predictors of adherence, persistence, and compliance. Reported 6-month adherence ranged from 60%–83% and 1-year adherence was 43%–79% for statins. One-year statin discontinuation rates were 25%–50% depending on the definition of gap days applied (range 7–180 days). Primary non-adherence (prescriptions written but never filled) was reported at 18%. Results for other LLTs (N= 5) generally covered niacin which reported lower adherence rates compared to statins. While adherence, persistence, and compliance are multifactorial issues, most studies suggested higher adherence among subjects receiving LLT for secondary prevention as compared to primary prevention, and lower adherence and persistence with higher copayment.  Conclusions: Adherence, persistence, and compliance to LLT were suboptimal. Factors associated with poor adherence included higher copay and no prior cardiovascular events. These findings provide important implications for patients, physicians and payers, supporting development of individualized plans to improve use of LLTs. PCV64 Persistence and Compliance with Cardiovascular Drug Therapy Among Seniors Rioux J, Hunt J Canadian Institute for Health Information, Ottawa, ON, Canada

Objectives: This analysis examines persistence and compliance with the most commonly used cardiovascular drug classes among seniors to assess the degree to which these drugs are being used as prescribed.  Methods: This study uses drug claims data from the National Prescription Drug Utilization Information System (NPDUIS) database, housed at the Canadian Institute for Health Information. The database contains claims for roughly 70% of Canadian seniors. Persistence was measured by the amount of time a drug class was used before the presence of a gap in drug therapy that exceeded a pre-determined number of days. Compliance was measured by the proportion of days covered (PDC), calculated by summing the days’ supply for a senior taking a single drug class over a one-year period.  Results: 72.9% of seniors taking selected cardiovascular drugs were considered persistent with their drug therapy, while 80.6% were considered compliant with their cardiovascular drugs. The largest contributor to non-persistence and non-compliance was starting a new cardiovascular therapy. Thiazide diuretics had a higher rate of non-persistence and non-compliance than other classes, likely due to an increased number of side effects compared with other antihypertensive drugs.  Conclusions: While the majority of seniors appear to be taking their cardiovascular drugs as prescribed, some seniors may not be deriving full benefit from their prescribed medications. Improved medication management and education, shown to improve persistence and compliance and help reduce negative health outcomes, may be particularly valuable for patients starting a new cardiovascular therapy. PCV65 Effect of Patient-Reported Symptoms on Medication Adherence in Hypertensive Patients Fu M, Mehas N, Jaynes H, Hudmon K, Zillich A Department of Pharmacy Practice, Purdue University, West Lafayette, IN, USA