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Clinical and Economic Burden of Hospitalizations with Registry of Penicillin Allergy
187
Health Care Resource Utilization and Work Impairment for Asthma Patients Adherent to Medium- or High-Dosage ICS/LABA Fixed Combination Treatment: Findings From a US Real World Survey
Jill R. Davis, MS1, Mark Small2, Frank J. Trudo, MD, MBA1, James Siddall2, and James Pike2; 1AstraZeneca, Wilmington, DE, 2Adelphi Real World, Bollington, United Kingdom. RATIONALE: Uncontrolled asthma can impact healthcare resource utilization and work productivity. Asthma control may not be achieved for all patients adherent to treatment. This study describes the health care and work productivity burden of patients adherent to medium- or highdosage inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) treatment. METHODS: Cross-sectional data from 3 US Adelphi asthma surveys, conducted during 2013- 2016, were analysed in diagnosed asthma patients, prescribed medium- or high-dose ICS/LABA, and self-reported medium to high treatment adherence (Morisky Medication Adherence Scale). 629 physicians completed patient record forms for 5 asthma patients each, recording health care resource utilization (HCRU) and treatment information. These patients were invited to complete a questionnaire, including the Work Productivity and Activity Impairment (WPAI) questionnaire. Descriptive statistics were reported. RESULTS: 428 patients (mean age 44 years; 62% female; 70% employed) met inclusion criteria. Mean numbers of primary care and specialist visits for asthma in the last 12 months were 1.9 and 3.4, respectively. Mean numbers of asthma exacerbations in the past 12 months was 1.28, of which 15.1% were treated in the ER or through hospitalization. 153/422 patients _2 asthma exacerbations during the last 12 months. Mean per(36.3%) had > centage overall work impairment due to asthma was 19.6% (n5263). CONCLUSIONS: Despite adherence to medium- or high-dosage ICS/ LABA therapy, patients had considerable health care resource utilization and work impairment due to asthma which suggests an unmet need in asthma management.
188
Clinical and Economic Burden of Hospitalizations with Registry of Penicillin Allergy
Bernardo Sousa-Pinto1,2, Antonio Fernandes2,3, Luıs Araujo1,3, Jo~ao Almeida Fonseca2,3, Alberto Freitas2,3, and Luis Delgado, MD, PhD, FAAAAI1,3; 1Immunology Laboratory, Basic and Clinical Immunology, Faculty of Medicine, University of Porto, Portugal, Porto, Portugal, 2 Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Portugal, Porto, Portugal, 3Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal, Porto, Portugal. RATIONALE: Overdiagnosis of penicillin allergy appears to be a public health concern, as previous studies have shown that this diagnosis is associated with an increased risk of infection by multi-resistant agents. Therefore, we aimed to compare hospitalizations with and without registry of penicillin allergy concerning their clinical and economic burden. METHODS: We analyzed a database containing all hospitalizations occurred in Portuguese public hospitals from 2000 to 2014. We identified all episodes with reported penicillin allergy and compared them with an equal number of hospitalizations without such registry regarding patients’ demographic characteristics and comorbidities (assessed by the Charlson comorbidity index), length of stay, estimated hospitalizations costs, and frequency of drug-resistant and Clostridium difficile infections. RESULTS: There were 104,165 hospitalizations with registry of penicillin allergy. Patients’ mean age was similar among episodes with and without reported penicillin allergy. Compared to non-allergy cases, episodes with registry of penicillin allergy were associated with increased mean hospitalizations costs (3,450.09 versus 3,225.48 US Dollars; p<0.001) and with a higher average Charlson comorbidity index (0.90 versus 0.79; p<0.001). The median length of stay was similar (4 days) among both
groups. Hospitalizations with registry of penicillin allergy were associated with a higher frequency of infections by penicillin-resistant agents (0.03% versus 0.01%; p50.043), methicillin-resistant Staphylococcus aureus (0.32% versus 0.16%; p<0.001) and Clostridium difficile (0.12% versus 0.08%; p50.010). CONCLUSIONS: A registry of penicillin allergy is associated with higher hospitalizations costs, increased comorbidities and higher frequency of drug-resistant agents. Therefore, performing a correct diagnosis of penicillin allergy is of the highest importance.
189
A Cost-Effectiveness Analysis of Probiotic with Peanut Oral Immunotherapy (PPOIT) in Children
Marcus S. Shaker, MD, MS, FAAAAI; Dartmouth-Hitchcock Medical Center, Lebanon, NH. RATIONALE: PPOIT may decrease accidental systemic reactions and improve quality of life (QOL), but reactions from therapy itself are frequent. The study aimed to characterize the cost-effectiveness of PPOIT when compared with avoidance alone. METHODS: Markov cohort simulations of 2,000 subjects evaluated PPOIT for children with peanut allergy. Long term survival was modeled using age-adjusted mortality and the risk of food allergy fatality. Model assumptions were based on costs of peanut allergy, PPOIT, and treatments for reactions, as well as probabilities of therapeutic response, inadvertent accidental exposures, allergic reactions, fatalities, and QOL improvements. RESULTS: Cost-effectiveness in quality-adjusted life-years (QALY) was dominated by PPOIT. Mean costs were $39,623 (95% CI $39,050 $40,197) vs $41,685 (95% CI, $41,033 - $42,337) with effectiveness differences of 18.26 QALY (95% CI, 18.17-18.35) vs 17.11 (95% CI, 17.03-17.23), for PPOIT vs avoidance groups. A mean number of 12.3 (95% CI, 12.0-12.5) and 2.0 (95% CI, 1.9-2.1) allergic reactions occurred per subject in the PPOIT and avoidance groups over 20 years of simulation, with 2.3 (95% CI, 2.2-2.3) episodes of anaphylaxis per subject in the PPOIT group and 1.1 (95% CI, 1.0-1.2) episodes in the avoidance group. CONCLUSIONS: In this computer simulation subjects treated with PPOIT actually experienced a greater rate of peanut associated allergic reactions and anaphylaxis; however, associated improvements in QOL may still make this strategy favorable for some patients. This analysis illustrates possible challenges of using OIT in practice because although QOL improves, the number of total and severe reactions may actually increase.
SATURDAY
Abstracts AB59
J ALLERGY CLIN IMMUNOL VOLUME 139, NUMBER 2
Health Care Resource Utilization and Work Impairment for Asthma Patients Adherent to Medium- or High-Dosage ICS/LABA Fixed Combination Treatment: Findings From a US Real World Survey
Jill R. Davis, MS1, Mark Small2, Frank J. Trudo, MD, MBA1, James Siddall2, and James Pike2; 1AstraZeneca, Wilmington, DE, 2Adelphi Real World, Bollington, United Kingdom. RATIONALE: Uncontrolled asthma can impact healthcare resource utilization and work productivity. Asthma control may not be achieved for all patients adherent to treatment. This study describes the health care and work productivity burden of patients adherent to medium- or highdosage inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) treatment. METHODS: Cross-sectional data from 3 US Adelphi asthma surveys, conducted during 2013- 2016, were analysed in diagnosed asthma patients, prescribed medium- or high-dose ICS/LABA, and self-reported medium to high treatment adherence (Morisky Medication Adherence Scale). 629 physicians completed patient record forms for 5 asthma patients each, recording health care resource utilization (HCRU) and treatment information. These patients were invited to complete a questionnaire, including the Work Productivity and Activity Impairment (WPAI) questionnaire. Descriptive statistics were reported. RESULTS: 428 patients (mean age 44 years; 62% female; 70% employed) met inclusion criteria. Mean numbers of primary care and specialist visits for asthma in the last 12 months were 1.9 and 3.4, respectively. Mean numbers of asthma exacerbations in the past 12 months was 1.28, of which 15.1% were treated in the ER or through hospitalization. 153/422 patients _2 asthma exacerbations during the last 12 months. Mean per(36.3%) had > centage overall work impairment due to asthma was 19.6% (n5263). CONCLUSIONS: Despite adherence to medium- or high-dosage ICS/ LABA therapy, patients had considerable health care resource utilization and work impairment due to asthma which suggests an unmet need in asthma management.
188
Clinical and Economic Burden of Hospitalizations with Registry of Penicillin Allergy
Bernardo Sousa-Pinto1,2, Antonio Fernandes2,3, Luıs Araujo1,3, Jo~ao Almeida Fonseca2,3, Alberto Freitas2,3, and Luis Delgado, MD, PhD, FAAAAI1,3; 1Immunology Laboratory, Basic and Clinical Immunology, Faculty of Medicine, University of Porto, Portugal, Porto, Portugal, 2 Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Portugal, Porto, Portugal, 3Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal, Porto, Portugal. RATIONALE: Overdiagnosis of penicillin allergy appears to be a public health concern, as previous studies have shown that this diagnosis is associated with an increased risk of infection by multi-resistant agents. Therefore, we aimed to compare hospitalizations with and without registry of penicillin allergy concerning their clinical and economic burden. METHODS: We analyzed a database containing all hospitalizations occurred in Portuguese public hospitals from 2000 to 2014. We identified all episodes with reported penicillin allergy and compared them with an equal number of hospitalizations without such registry regarding patients’ demographic characteristics and comorbidities (assessed by the Charlson comorbidity index), length of stay, estimated hospitalizations costs, and frequency of drug-resistant and Clostridium difficile infections. RESULTS: There were 104,165 hospitalizations with registry of penicillin allergy. Patients’ mean age was similar among episodes with and without reported penicillin allergy. Compared to non-allergy cases, episodes with registry of penicillin allergy were associated with increased mean hospitalizations costs (3,450.09 versus 3,225.48 US Dollars; p<0.001) and with a higher average Charlson comorbidity index (0.90 versus 0.79; p<0.001). The median length of stay was similar (4 days) among both
groups. Hospitalizations with registry of penicillin allergy were associated with a higher frequency of infections by penicillin-resistant agents (0.03% versus 0.01%; p50.043), methicillin-resistant Staphylococcus aureus (0.32% versus 0.16%; p<0.001) and Clostridium difficile (0.12% versus 0.08%; p50.010). CONCLUSIONS: A registry of penicillin allergy is associated with higher hospitalizations costs, increased comorbidities and higher frequency of drug-resistant agents. Therefore, performing a correct diagnosis of penicillin allergy is of the highest importance.
189
A Cost-Effectiveness Analysis of Probiotic with Peanut Oral Immunotherapy (PPOIT) in Children
Marcus S. Shaker, MD, MS, FAAAAI; Dartmouth-Hitchcock Medical Center, Lebanon, NH. RATIONALE: PPOIT may decrease accidental systemic reactions and improve quality of life (QOL), but reactions from therapy itself are frequent. The study aimed to characterize the cost-effectiveness of PPOIT when compared with avoidance alone. METHODS: Markov cohort simulations of 2,000 subjects evaluated PPOIT for children with peanut allergy. Long term survival was modeled using age-adjusted mortality and the risk of food allergy fatality. Model assumptions were based on costs of peanut allergy, PPOIT, and treatments for reactions, as well as probabilities of therapeutic response, inadvertent accidental exposures, allergic reactions, fatalities, and QOL improvements. RESULTS: Cost-effectiveness in quality-adjusted life-years (QALY) was dominated by PPOIT. Mean costs were $39,623 (95% CI $39,050 $40,197) vs $41,685 (95% CI, $41,033 - $42,337) with effectiveness differences of 18.26 QALY (95% CI, 18.17-18.35) vs 17.11 (95% CI, 17.03-17.23), for PPOIT vs avoidance groups. A mean number of 12.3 (95% CI, 12.0-12.5) and 2.0 (95% CI, 1.9-2.1) allergic reactions occurred per subject in the PPOIT and avoidance groups over 20 years of simulation, with 2.3 (95% CI, 2.2-2.3) episodes of anaphylaxis per subject in the PPOIT group and 1.1 (95% CI, 1.0-1.2) episodes in the avoidance group. CONCLUSIONS: In this computer simulation subjects treated with PPOIT actually experienced a greater rate of peanut associated allergic reactions and anaphylaxis; however, associated improvements in QOL may still make this strategy favorable for some patients. This analysis illustrates possible challenges of using OIT in practice because although QOL improves, the number of total and severe reactions may actually increase.
SATURDAY
Abstracts AB59
J ALLERGY CLIN IMMUNOL VOLUME 139, NUMBER 2