Comparison of Latanoprost, Travoprost, and Bimatoprost on Adherence, Persistence, and Pattern of Initial Therapy in Glaucoma and Ocular Hypertension: An Administrative Claims Database Analysis

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8

1RTI

Health Solutions, Manchester, UK, 2Novartis Pharma AG, Basel, Switzerland, 3Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates, 4Claude Bernard University Lyon, Lyon, France, 5University of Genoa, Genoa, Italy, 6Hospital del Mar. Parc de Salut Mar, Barcelona, Spain, 7Norfolk and Norwich University Hospital, Norwich, UK, 8University Medical Center Utrecht, Utrecht, The Netherlands, 9RTI Health Solutions, Research Triangle Park, NC, USA, 10Université Nice Sophia Antipolis, Nice Cedex 2, France, 11Lynderm Research Inc., Toronto, ON, Canada, 12Salford Royal Hospital, Salford, UK, 13Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK, 14Hospital 12 Octubre, Madrid, Spain, 15University of Groningen, Groningen, The Netherlands, 16St Michael’s Hospital, University of Toronto, Toronto, ON, Canada, 17Charite Universitätsmedizin Berlin, Berlin, Germany

Objectives: Chronic spontaneous/idiopathic urticaria (CSU), defined as the spontaneous appearance of itchy hives, angioedema, or both for ≥ 6 weeks, has a significant yet underestimated impact on patients’ work productivity. The ASSURE-CSU study aimed to identify and quantify the humanistic and economic burden of CSU. We present here data on work productivity and activity impairment.  Methods: Patients with CSU for ≥ 12 months, aged ≥ 18 years, symptomatic despite treatment were recruited in 7 countries (Canada, France, Germany, Italy, Netherlands, Spain, UK). Data were collected on absenteeism, presenteeism and activity impairment over the previous 7 days via the Work Productivity and Activity Impairment–Specific Health problem (WPAI-SHP) questionnaire. Descriptive statistics were provided and stratified by disease activity, measured by the Urticaria Activity Score (UAS) daily diary, which has a range from 0-42 for the weekly score (UAS7).  Results: 673 patients (72.7% women) were enrolled with a mean age of 48.8 years and 4.8 years mean disease duration since diagnosis. The WPAI was returned by 614 patients, with 341 employed. The mean (SD) proportion of overall activity impairment due to CSU was 32.8% (28.96%). Employed patients reported a mean (SD) proportion of absenteeism, presenteeism and overall work productivity loss of 6.1% (17.83%), 25.2% (25.78%) and 26.9% (27.53%) respectively, with 12.5% of patients reporting over a half-day of work missed in the previous week. Overall, impairment increased with increasing disease activity during the same time period. Specifically, the highest percentages of absenteeism, presenteeism, overall work impairment, and activity impairment were reported by patients with the greatest disease activity (UAS7= 28-42) (9.5%, 40.4%, 43.6%, and 52.3%, respectively).  Conclusions: This analysis from ASSURE-CSU suggests that CSU patients experience substantial activity impairment. Employed patients are affected at work by their disease, through absenteeism and reduced productivity. This overall work impairment results in significant impact for patients, employers and society. PSS18 Resource Utilization and Quality of Life of Patients with Hidradenitis Suppurativa in Canada: Results from a PopulationBased Survey Lachaine J1, Miron A1, Shear N2, Alhusayen R3 of Montreal, Montreal, QC, Canada, 2University of Toronto, Toronto, ON, Canada, 3Sunnybrook Health Sciences Centre, Toronto, ON, Canada

1University

Objectives: Hidradenitis suppurativa (HS) is a serious and recurrent skin disease that usually affects areas bearing apocrine sweat or sebaceous glands. These cysts can be very painful and may persist for years. Complete healing is usually not possible and progression varies between people, with some patients requiring multiple surgeries. Although burden to patients is significant in HS, there is limited information on patients’ resource utilization and on health-related quality of life (HRQoL). The aim of this study was to describe the resource utilization and the HRQoL of patients with HS.  Methods: A survey was conducted to identify HS cases using a web-based panel of respondents from all Canadian provinces in proportions reflecting the population distribution. HS patients completed a questionnaire, on treatment regimen, physician consultation, hospitalizations and HRQoL.  Results: Among the 10,002 people of the general population, 3.84% were considered as HS cases. Among the 384 HS patients, 16.1% required surgical opening/emptying of the boils, 33.2% visited a dermatologist and 36.6% a general practitioner. In the 12 months preceding the survey, 23.9% underwent diagnostic tests, 5.5% had emergency visits and 4.7% of patients were hospitalized. HS decreases HRQoL of patients. On average, patients had a level of pain of 5.2 on a 0 to 10 Likert scale (0 is no pain and 10 is the worst pain). Furthermore, in the last 6 months preceding data collection, HS has caused embarrassment or shame in 45.3% of cases and has restricted patient’s movement in 45.3% of cases.  Conclusions: This was the first attempt to estimate the resource utilization and the HRQoL of HS patients in Canada. Results indicate that HS is associated with significant resource utilization and it greatly affects patients’ HRQoL. PSS19 Biologics Switching Patterns and Associated Costs in Psoriasis Patients in a Large Commercially Insured Population in the United States Tian H1, Gilloteau I2, Mollon P3, McDwyer P4, Lotya J4 1Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 2Novartis Pharma AG, Basel, Switzerland, 3Novartis Pharmaceuticals AG, Basel, Switzerland, 4Novartis Ireland Ltd, Elm Park, Ireland

Objectives: Psoriasis is a chronic inflammatory skin disorder affecting nearly 2.2% of the US population, with substantial economic burden. The current study examined the treatment patterns and healthcare costs associated with first year biologic therapy use in psoriasis patients who switched or remained on initial therapy.  Methods: Adult patients with psoriasis (ICD-9-CM 696.1) who were newly treated with etanercept, adalimumab, infliximab or ustekinumab between 1-October-2009 to 30-September-2012, and had continuous medical and pharmacy enrollment in 1-year pre- and post-index treatment were analyzed using Truven Health Analytics MarketScan Commercial and Medicare Supplemental database. Switchers were defined as patients with a prescription for a biologic other than the index biologic during 1 year follow-up; non-switchers continued on initial therapy. Analyses included descriptive statistics and comparison of adjusted mean total

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costs per patient between switchers and non-switchers for all-cause, psoriasisrelated healthcare and medical costs. Adjusted costs were estimated using two part gamma regression models controlling for demographics, index drug, baseline Charlson comorbidity index, resource utilization and non-biologic medications.  Results: The final cohort of 6,243 patients comprised of 7.3% (n= 457) defined as switchers, 44.7% (n= 2,791) as non-switchers, and 48% (n= 2,995) as discontinuers, of initial biologic therapy. The mean age (SD) was 46 (13.4) years, with more females among switchers compared to non-switchers (50.8% vs 41.9%, p= 0.004). During 1 year follow-up, the adjusted mean costs were significantly higher for switchers compared to non-switchers: all-cause healthcare costs ($44,622 vs. $35,613); all-cause medical costs ($8,282 vs. $4, 597); and, psoriasis-related healthcare costs ($35,760 vs. $29,453). The mean differences (95% CI) were: $9,009($5,983- $12,035); $3,685($739$6,630): and, $6,308($4,899-$7,716) respectively.  Conclusions: Psoriasis patients who switched their initial biologic therapy within the first year of treatment incurred higher healthcare costs compared to non-switchers. This suggests that reductions in the cost of switching may be achieved through the use of more efficacious medications with enhanced sustainability.

SENSORY SYSTEMS DISORDERS – Patient-Reported Outcomes & Patient Preference Studies PSS20 Comparison of Latanoprost, Travoprost, and Bimatoprost on Adherence, Persistence, and Pattern of Initial Therapy in Glaucoma and Ocular Hypertension: An Administrative Claims Database Analysis Heo JH, Rascati KL The University of Texas at Austin, College of Pharmacy, Austin, TX, USA

Objectives: Glaucoma causes an atrophy of the optic nerve with increased intraocular pressure (IOP), which can lead to blindness. When topical treatment fails to lower IOP adequately, the patient may add or change medications or have surgery/laser treatment. Prostaglandin therapy is recommended as initial therapy. The purpose of this study was to compare medication adherence, persistence, and post-index patterns between latanoprost, bimatoprost, and travoprost as initial therapies for glaucoma/ocular hypertension.  Methods: The study cohort consisted of Humana commercial and Medicare Advantage plan members over 40 identified between 2007 and 2010, as newly diagnosed with glaucoma, ocular hypertension, or suspected glaucoma (ICD-9 code; 365.xx, 377.14) with at least one paid prescription claim for a topical ocular hypotensive medication. At least 365 days of continuous enrollment after the date of the first latanoprost, travoprost, or bimatoprost fill was required. The medication possession ratio (MPR) was used to measure medication adherence. Persistence was defined as duration of continuous treatment with the initially prescribed glaucoma medication without a 60-day gap.  Results: Patients who had latanoprost, travoprost, and bimatoprost as initial therapy accounted for 50.3%, 30.3%, and 19.4%, of patients respectively. Latanoprost users had significantly higher average MPR than travoprost and bimatoprost users (61.4% vs. 47.4% and 58.2%, p< .0001). Latanoprost users had significantly longer persistence than travoprost and bimatoprost (199 vs. 145 and 171 days, p< .0001). About 30% in each group had changes in therapy. Of those changing therapy, most switched to another medication (47.4%, 56.8%, and 47.0%), followed by adding a medication (42.0%, 33.3%, and 40.5%), and surgery/laser treatment (11.6%, 10.0%, and 12.5%) for latanoprost, travoprost, and bimatoprost users (respectively).  Conclusions: The study suggests that latanoprost users showed higher adherence and longer persistence compared to travoprost and bimatoprost users, and switching was more common than addition of medication therapy or surgery for all cohorts. PSS21 Real-World Cost Per Persisting Patient: Comparing Psoriasis Patients Initiated on Apremilast or Biologic Therapies Feldman SR1, Kuznik A2, Clancy Z3 1Wake Forest University School of Medicine, Winston-Salem, NC, USA, 2Celgene Corp & Regeneron Pharmaceuticals, Warren, NJ, USA, 3Celgene Corporation, Warren, NJ, USA

Objectives: Compare the cost per persisting patient among psoriasis (PsO) patients initiating apremilast or biologics from the US managed care perspective.  Methods: Adults with ≥ 2 diagnosis codes for psoriasis (ICD-10:L40) were selected from the MarketScan Commercial and Medicare Supplemental Databases (2014-2015). The first prescription date was defined as the index date; patients had to be continuously enrolled for ≥ 6 months pre-index and ≥ 3 months post-index. Biologic users had to be treatment-naïve to index medication in the pre-index period; prior use of another biologic was not reason for exclusion. Treatment persistence, defined as the lack of a gap of ≥ 60 consecutive days after the end of supply of a prescription fill, was assessed at 6 months post-index. Healthcare costs (2014 US$) were defined as PsOspecific pharmacy costs incurred by payers over 6 months. The analysis assumed patients discontinue treatment if benefits received do not outweigh risks. A patient on therapy for 6 months was assumed to be benefitting from treatment and was considered a persisting patient. The cost per persisting patient was calculated by dividing cumulative cost at month 6 by persistence rate at month 6 for apremilast and biologic therapy.  Results: 839 apremilast and 1,981 biologics patients met inclusion criteria; baseline demographics were balanced between cohorts, except mean age (apremilast: 50.4y; biologics: 46.1y; P< 0.001), and mean Charlson Comorbidity Index score (apremilast: 0.6; biologics: 0.4; P< 0.001). Treatment persistence at month 6 was 67.2% with apremilast vs. 68.5% with biologics. Mean cumulative cost per patient over the 6-month follow-up period was $12,534 with apremilast and $19,944 with biologics. Cost per persisting patient was lower for apremilast vs. biologics ($18,652 vs. $29,115, respectively).  Conclusions: Real-world data shows apremilast is associated with a persistence rate similar to biologics but apremilast has substantially lower cost per persisting patient at month 6 of treatment vs. biologics.