Comparing Cost-Effectiveness of Strategies for Antenatal Hiv Testing: VCT and Routine Testing in Urban Nigeria

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provide additional rotational control for these unstable fractures, will demonstrate a lower rate of construct failure and better outcomes overall.  Methods: A comprehensive systematic literature review and a pairwise meta-analysis of randomised controlled trials (RCTs) and comparative observational studies comparing an Integrated 2 screw de-rotation cepahlo-medulary device * (IDRC) versus a traditional single screw cepahlo-medulary nail** (TSS) was performed. We assessed the following outcomes, revisions, non-unions, post- operative device related complications (shaft fracture, varus collapse and cutouts), hip and thigh pain and health related quality of life (HRQoL). We report odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes.  Results: Four studies met the inclusion criteria, 2 RCTs and 2 observational studies (N= 533, mean age 75 and 66% women) published between 2013 and 2016. There was no significant difference for revisions [OR 0.53 (95% CI, 0.2 to 1.40) p = 0.2] and non-union [OR 0.13 (95% CI, 0.01 to 2.63) p= 0.19]. There was a significant difference in implant related failures [OR 0.12 (95% CI, 0.05 to 0.30) p= 0.0001) and 60% less people complained of pain OR 0.40 (95% CI, 0.22 to 0.73) p= 0.0003 respectively in favour of the integrated 2-screw nail compared to the single screw nail. There was no evidence that study design substantially influenced the estimate of effects.  Conclusions: Our metaanalysis suggests that there is no difference between the two nails on revision and non-union outcomes. The integrated 2-screw de-rotation/compression, cepahlomedullary device reduces post-operative implant related complications and pain in patients with intertrochanteric fractures compared to the single screw device. *InterTAN ** Proximal Femoral Nail Antirotation PMD11 Comparing Cost-Effectiveness of Strategies for Antenatal Hiv Testing: VCT and Routine Testing in Urban Nigeria Ibekwe E1, Haigh C1, Prof Francis Fatoye F2 1Manchester Metropolitan University, UK, Manchester, UK, 2Manchester Metropolitan University, Manchester, UK

Objectives: Globally, in 2015, 90% of 2.6 million children living with humanimmune-deficiency virus (HIV) became infected through mother-to-child-transmission (MTCT). Nigeria has the largest number of new infections with 41,000 and bears one-third of global burden of MTCT. Almost 60% of pregnant women in Nigeria receive antenatal care (ANC) and deliver in hospital; however, uptake of ANC HIV testing with standard voluntary counselling and testing (VCT) is 29%, leaving more than half of sero-positive mothers undiagnosed. Low testing rate weakens the link between prevention of MTCT program. A switch to innovative routine HIV testing warrant settings specific understanding of the cost-effectiveness. This study compares cost effectiveness of two strategies for offering HIV test.  Methods: A pre-post study was conducted. The pre-test involved administering HIV testing to pregnant women on self-referral voluntary counselling and testing (VCT). In the post-test, the mid-wife offered women group HIV counselling and testing during ANC. HIV testing data involving testing and staff costs were collected, and cost-effectiveness analysis (incremental cost-effectiveness ratio (ICER), cost per new diagnosis and cost of averted cases) were calculated.  Results: In comparison, routine testing identified more women living with HIV 44 (15%) against VCT, which identified 15 (10.5%). Routine testing averted 6.60 new HIV infection per year compared to VCT at 3.75. The cost per new diagnosis of HIV in pregnant women was lower for routine testing ($290.86 versus $396.30 per new diagnosis) and similarly, the cost for averted transmission ($1264 versus $1698). The incremental cost-effectiveness ratio (ICER) is $236.31.  Conclusions: Evidently, routine HIV testing is economically dominant over VCT; identified more women living with HIV and averted more infections in children. The ICER is below acceptable threshold. A nation-wide adoption of routine testing is recommended for timely identification of sero-positive mothers and reduction of MTCT and associated resources in management of infected children. PMD12 Effectiveness of Telemonitoring Interventions for Chronic Obstructive Pulmonary Disease Sul AR, Lyu D, Park D NECA, Seoul, Korea, Republic of (South)

Objectives: Chronic obstructive pulmonary disease (COPD) is characterized by irreversible or poorly reversible airflow obstruction in the lung. Self-management strategies are becoming more important in the treatment of COPD. In this study, the clinical effectiveness of telemonitoring for COPD was investigated.  Methods: To conduct systematic review, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL up to March 2016. We selected randomized controlled trials (RCT) comparing telemonitoring group and control group for COPD. We analyzed dichotomous data as relative risk (RR), and continuous data as mean difference (MD) or standardized mean differences (SMD) while using random-effects models. Critical outcomes were COPD exacerbation, quality of life or health status and all-cause mortality.  Results: Twenty four RCTs were included. As a result of meta-analysis, there were no variables showing statistically significant results between two groups. Exacerbation rate (6 studies) was not different between two groups (RR 0.67, 95% CI 0.31 ~ 1.42). Due to the moderate degree of the heterogeneity among studies (I2 =  67%), subgroup analysis was performed. Intervention period could be the one of the factors describing the heterogeneity. No difference between group was found for exacerbation period (6 studies; MD 0.12, 95% CI –1.18 ~ 1.43) and number of exacerbations (6 studies; MD -0.76, 95% CI –0.32 ~ 0.07). Also quality of life (10 studies) did not show any difference between the two groups (SMD -0.17, 95% CI –0.41 ~ 0.07). Finally, mortality (5 studies) was not different between the two groups (RR 0.80, 95% CI 0.48 ~ 1.35).  Conclusions: The use of telemonitoring for COPD was unlikely to result in statistically significant improvements in health outcomes. However, in the subgroup analysis, telemonitoring longer than 6 months reduced the exacerbation rates. To clarify the effects of telemonitoring for COPD, further researches are needed with the well-defined intervention and outcome variables.

PMD13 Toric Intraocular Lenses for the Correction of Pre-Existing Corneal Astigmatism During Cataract Surgery: A Systematic Review of the Literature Zignani M1, Caridad PV1, Ender F1, Breitkopf S2, Shaikh J3, O’Boyle D4 Management SA, Geneva, Switzerland, 2Alcon Pharma GmbH, Frieburg, Germany, 3Novartis Healthcare Pvt Ltd, Hyderabad, India, 4Novartis Ireland Ltd., Dublin, Ireland

1Alcon

Objectives: Astigmatism is a refractive error typically resulting from anterior corneal asymmetry. Preoperative astigmatism ≥ 0.5 diopters (D) is present in 77% of cataract eyes. Toric IOL implantation corrects pre-existing corneal astigmatism, alleviating risk of residual post-operative astigmatism, an important cause of suboptimal post-operative uncorrected distance visual acuity (UCDVA) and dependency for distance spectacles post-surgery. The objective of this study was to assess and compare the quality and quantity of published evidence for toric IOLs to correct pre-existing corneal astigmatism (≥  0.5 D) and improve postoperative visual acuity outcomes in patients undergoing cataract surgery compared to non-toric IOLs, with or without astigmatism reducing surgical interventions.  Methods: A systematic literature review was conducted using electronic searches on Embase®, MEDLINE®, MEDLINE®-In Process, and Cochrane (January 1974 -July 2016). Articles were selected if they included adult patients, undergoing phacoemulsification, with age-related cataracts and pre-operative regular corneal astigmatism (≥ 0.5D). Outcomes included postoperative UCDVA, CDVA, and residual astigmatism. Quality assessment of the included studies was performed using the Centre for Review and Dissemination (CRD), York checklist.  Results: 19 RCTs, 11 comparative non-RCTs and 34 single arm studies were identified. 14 of the RCTs (representing 64% of treated eyes) included the AcrySof® Toric IOL brand. The majority of studies reported significantly better postoperative outcomes (UDVA & residual astigmatism) for toric IOLs vs. non-toric IOLs. In the main, a significantly greater proportion of patients achieved postoperative UCDVA of at least 20/25 (0.1 logMAR) and spectacle independence for distance vision with toric IOLs compared with non-toric IOLs.  Conclusions: The evidence suggests that toric IOLs are superior to non-toric IOLs, with or without surgical interventions, in reducing postoperative astigmatism, increasing postoperative UCDVA and spectacle independence . However with 14 out of 19 RCTs the majority of evidence published to date, is based on studies including the AcrySof® toric IOL platform. PMD14 Single Versus Multiple Inhalers in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review King D1, Zhang S2, Rosen V3, Ismaila A4 Systematic Reviews Limited, Twickenham, UK, 2GSK, Collegeville, PA, USA, 3OPTUM Life Sciences, Eden Prairie, MN, USA, 4GSK, Research Triangle Park, NC, USA

1Forest

Objectives: Treatment for COPD may involve multiple types of inhalation devices. To understand the impact in COPD of single fixed dose combination (FDC) versus multiple inhalers delivering the same class of medication, a systematic literature review was conducted.  Methods: Embase, PubMed and the Cochrane library were searched for studies comparing single and multiple inhalers of the same therapies with regard to clinical, economic and medication burden endpoints in patients with COPD. Articles published in English between 1996 and November 2016, and congress abstracts published from 2013, were assessed for relevant endpoints.  Results: Four randomised controlled trials (RCTs; including one non-inferiority trial) and five retrospective studies were identified. Overall, findings from the four RCTs demonstrated comparable efficacy and safety between single and multiple inhalers. Retrospective studies found that the use of a single inhaler was associated with significantly lower healthcare costs in Canada (one study) and the US (two studies), and lower monthly expenditures in the Netherlands (one study). Use of a single inhaler was also associated with fewer urgent care visits (one study), and emergency department visits or hospitalisations (three studies) compared with the use of multiple inhalers. Adherence, evaluated in one RCT, was high and comparable between single and multiple inhaler users. In the US, two claims database studies found the use of single inhalers to be associated with a significantly increased likelihood of compliance, as measured by discontinuations and interruptions, whereas one study from the Netherlands found no difference in persistence between users.  Conclusions: Despite limitations associated with the identified studies, which included different study designs, these results suggest that use of a single FDC inhaler could improve outcomes for patients and healthcare providers in a real world setting. Further research is needed to better understand the impact of inhaler devices in COPD. Funding: GSK (HO-16-13836) PMD15 Estimating the Comparative Accuracy of Diagnostic Tests: AN Example using Typhoid Fever Arora P1, Thorlund K2, Brenner DR1, Andrews JR3 1Lighthouse Outcomes, Toronto, ON, Canada, 2McMaster University, Hamilton, ON, Canada, 3Stanford University, Palo Alto, CA, USA

Objectives: Typhoid fevers are infections caused by the bacteria Salmonella enterica serovar Typhi (Salmonella Typhi) and Paratyphi A, B and C (Salmonella Paratyphi). Approximately 17.8 million incident cases of typhoid fever are estimated to occur annually in low- and middle-income countries and incidence is highest in children. This research aims to assess the comparative diagnostic accuracy of diagnostic tests for typhoid fever.  Methods: We conducted a systematic literature to identify studies that compared diagnostic tests for typhoid fever in children to blood culture result. Diagnostic test network meta-analysis was performed building on models previously proposed by applying a Bayesian latent-class extension to the conventional network meta-analysis (NMA) model. We applied known diagnostic properties of bone marrow culture and the relationship between bone marrow and blood culture as informative priors to facilitate the network meta-analysis. We tested sensitivities for the proportion of negative blood samples that were false as well as bone marrow sensitivity and specificity.  Results: NMA was conducted on a subset