Cost Of Pneumonia In Older Peolple Living In Nursing Home

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episodes. The average length of stay was 7 days for pneumonia and meningitis, and 14 days for bacteremia. The average hospitalization cost in the age groups of 0-6 years, 7-49 years and >  50 years was BRL 4,554, BRL 7,110 and BRL 20,079 for meningitis, BRL 1,479, BRL 1,569 and BRL 18,800 for pneumonia and BRL 17,456, BRL 11,868 and BRL 53,524 for bacteremia, respectively. The average cost due to EAP absenteeism was BRL 1,778 for meningitis and pneumonia, and BRL 3,556 for bacteremia.  Conclusions: Hospitalizations for PD were associated with a high economic impact on PHS. EAP absenteeism for pneumonia may impact 25% on monthly work. Therefore, developing and promoting PD preventive strategies could reduce the costs associated with these diseases.

ated with the initial hospital stay and the interventions. Once DRG codes and LOS are controlled for, a cohort analysis produces intuitive results for most cohorts, but still suffers from some inaccuracies due to remaining differences between the groups. A propensity scoring based approach also produces sensible results with smaller differences between the test and control groups, but reduces the available sample size for statistical testing.  Conclusions: Evaluating the effectiveness of interventions under the BCPI bundled care initiative requires care in order to control for selection biases. Once differences between patient groups are controlled for, both follow-up care within the first month and the use of Nebulizers help lower the rate of re-hospitalization rates and total cost of care.

PRS19 Economic Impact Of The Chronic Obstructive Pulmonary Disease In Colombia

PRS22 The Costs Of Cessation Medications Among Private Health Plans: An Environmental Scan Before The Enactment Of The Affordable Care Act

Tamayo C, Simbaqueba E, Palomino RA Health-e International, Bogota, Colombia

objectives: In Colombia the chronic obstructive pulmonary disease represented the fifth disease with most DALYs for both genders, especially in patients older than 30 years. According to this result we decided to determine the economic cost of the chronic obstructive pulmonary disease in Colombia from the third-payer and patient perspectives for year 2011.  Methods: To calculate the monetary costs, we assumed that a treatment was provided to every patient reported on the system according to CIE-10: J440, J441, J448 y J449, and the study of Perez et al. (2008) and from the SOAT fare manual 2011 reported by the government. We used the official SISPRO data to get information regarding the number of visits per patient who had a diagnosis of chronic obstructive pulmonary disease. To obtain the third-payer cost we multiplied the treatment cost for each patient by the total number of registers. We calculated from the patient´s perspective the lost output as a result of a reduction of productivity due to chronic obstructive pulmonary disease, using the DALYs adjusted by life expectancy, multiplied by the 2011 current GDP divided by the working-age population.  Results: The total Economic impact for 2011 was USD 1.543.655.654. This is the result of adding the third-payer cost of USD 1.533.564.250 plus the patient cost of USD 10.091.403.  Conclusions: The cost of chronic obstructive pulmonary disease represents 0.46% of 2011 current GDP, this means that on average there is an expenditure of USD 33.53 for each Colombian citizen to prevent the disease. Those numbers shows the importance to generate permanent public policies to improve the Colombians´ health. PRS20 Budget Impact Analysis Of Budesonide In The Treatment Of Asthma In Adult Population In Russian Federation Kulikov A, Makarova E I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Objectives: To conduct the budget impact analysis of Budesonide via Easyhaler and Turbuhaler devices, which could allows determining the net economic effect of the budget impact regarding in replacement the equal medication in one medical device to another.  Methods: Information search was conducted in the public domain. Pharmacoeconomic analysis method – budget impact and direct cost analysis were performed. For reference, we accepted the exchange rate was 1 EUR =  83,44 RUB.  Results: In this study, the pharmacoeconomic evaluation was given for drugs Budesonide via Easyhaler and Turbuhaler. The study had a time horizon of one year. The daily dose of Budesonide was 800 mcg. Cost structure included following: the cost of basic pharmacotherapy, compensation costs for treatment of exacerbations, compensation costs for side effects and adverse events. The total direct cost per patient with asthma amounted to 70 098 RUB (840 EUR) to the Easyhaler group, 95 817 RUB (1 148 EUR) to the Turbuhaler group. The selection of budget impact method of pharmacoeconomic analysis was determined by the advantages of Budesonide Easyhaler in terms of its efficiency and lower value of total direct costs. In the present study, based on the results of the “cost analysis” it was revealed that the replacement Budesonide via Turbuhaler on Budesonide via Easyhaler saved per patient respectively 25 719 RUB (308 EUR) for the health care system budget.  Conclusions: The budget impact analysis of Budesonide via Easyhaler device versus Budesonide via Turbuhaler device demonstrated that asthma treatment with Budesonide via Easyhaler can significantly save the budget. PRS21 Evaluating Interventions Under The Bundled Payments For Care Initiative (Bcpi): A Case Study For The Copd Market Nygren K1, Suponcic G2 1Navigant Consulting, Lawrenceville, NJ, USA, 2Navigant Life Sciences, Lawrenceville, NJ, USA

Objectives: We investigate analytical approaches for assessing the impact of post hospital interventions on total bundle payments and re-hospitalization rates associated with COPD bundled care episodes under CMS’s bundled payments for care initiative. Attention is paid to approaches that help control for selection bias that may be associated with different interventions and therefore could have implications for the estimated impact of interventions on anticipated bundled payments.  Methods: Health plan data covering inpatient admissions, outpatient services, and outpatient RXs is leveraged to create an episode level dataset containing information related to initial hospitalization, post-hospitalization services/ outcomes and specific types of interventions (e.g., follow-up visits and RX therapy consistent with guidelines) anticipated to drive enhanced outcomes. We evaluate approaches to the examination of the effectiveness of the interventions. This includes a naïve approach comparing patients receiving different intervention (without controlling for DRG codes or LOS), an approach grouping patients based on DRG codes and initial LOS, and an approach leveraging propensity scoring to create test and control groups.  Results: Our analysis suggests that naïve approaches produces counterintuitive results due to correlations between complications associ-

Xu X1, Asman K2, Babb SD1, Malarcher AM1, Naavaal S1, Schauer G1, King BA1 1Centers for Disease Control and Prevention, Atlanta, GA, USA, 2RTI International, Atlanta, GA, USA

Objectives: Tobacco smoking is the leading cause of preventable disease and death in the U.S., and smoking cessation has major and immediate health benefits. The Patient Protection and Affordable Care Act of 2010 (ACA) requires nongrandfathered private health plans (i.e., new plans or those changed substantially since March 2010) to cover certain recommended evidence-based clinical services, including tobacco cessation. A guidance document issued in May 2014 defined these interventions to include cessation counseling and seven Food and Drug Administration (FDA) approved medications without cost-sharing. We evaluated cessation medication costs among private health plans before ACA enactment.  Methods: Data from the 2010 Truven MarketScan®databases were used to assess average daily reimbursements and copayments of seven FDA-approved medications: five formulations of nicotine replacement therapy (patch, gum, lozenge, nasal spray, and inhaler), varenicline, and bupropion. Average daily reimbursements were defined as the net plan reimbursement divided by the number of days covered by the prescription claim. The sample was limited to pharmaceutical claims from persons aged 35-64 years old (n= 438,000). Bupropion claims were restricted to the 150mg 12-hour extended release formulation, the primary formulation recommended for cessation.  Results: For non-generic brands, including nasal spray, inhaler, and varenicline, average copayments and daily reimbursements ranged from $27$38 and $3-$14, respectively. For generic brands, averages ranged from approximately $4-$13 and $1-$4, respectively. Almost all plans (except high deductible plans) required cost-sharing for cessation medications, while both copayments and average daily reimbursements varied widely by insurance plan type. Average daily reimbursements and copayments of cessation medications were generally higher among identifiable plans (109 in total), except for copayments of non-generic brands.  Conclusions: Copayments could be a barrier to patient access of cessation medications, particularly for non-generic brands, among private health plans before ACA enactment. Removing cost-sharing, coupled with promotion of service coverage, might increase the utilization of cessation medications. PRS23 Economic Burden Of Air Leak Complications In Thoracic Surgery: Estimates From A National Hospital Billing Dataset Yoo A1, Ghosh SK2, Danker W3, Kassis E4, Kalsekar I1 1Epidemiology & Health Informatics, Medical Devices, Johnson & Johnson Co., New Brunswick, NJ, USA, 2Global Health Economics and Market Access, Ethicon, Inc., Cincinnati, OH, USA, 3Global Health Economics and Market Access, Ethicon, Inc., Somerville, NJ, USA, 4Medical Affairs, Ethicon, Inc., Cincinnati, OH, USA

Objectives: To estimate economic burden of Air Leak Complications (ALC) in patients undergoing thoracic surgery. Methods: The Premier Perspective® Database containing billing data from over 600 hospitals in the U.S was used to meet the study objectives. All elective primary lobectomy, segmentectomy, and wedge resections from 2012-2014 were identified. During the hospitalization, ALC were identified as a composite of air leak and pneumothorax ICD-9 diagnosis codes. Generalized Estimating Equations (GEE) models were used to estimate impact of ALC on Length of Stay (LOS), Operating Room Time (ORT) and hospital costs after controlling for patient, procedure, and hospital factors. The multivariable models were run on the overall sample and by resection types. GEE accounted for the clustering of patients within hospitals; p values of < 0.05 were considered to be statistically significant.  Results: A total of 21,150 patients undergoing thoracic surgery were included in the analysis: lobectomy (n= 10,946), segmentectomy (n= 1,788), and wedge (n= 8,416). The overall incidence of ALC was 24.26% and varied with resection type (lobectomy= 29.20%; segmentectomy= 22.04%; and wedge 18.30%). The mean LOS for thoracic surgeries in the sample was 5.7 days (SD= 5.4), with an average ORT of 211 mins (SD= 190) and overall hospital costs of $22,163 (SD= $83,619). Results of the GEE models indicated that patients with ALC during their thoracic surgery had a significantly higher economic burden [Adjusted Means, Standard Error of Mean (SE): LOS= 7.24 (SE= 0.12) days; ORT= 214.9 (SE= 6.4) mins; and hospital costs= $26070 (SE= 1404)] compared to those without ALC [Adjusted Means, SE: LOS= 4.75 (SE= 0.07) days; ORT= 201.7 (SE= 3.9) mins; and hospital costs= $19,558 (SE= 399)]. The incremental economic burden of ALC was consistently significant across all resection types.  Conclusions: This analysis shows that Air Leak Complications in patients undergoing thoracic surgery are not only frequent but also associated with significantly higher resource utilization in terms of LOS, ORT and hospital costs. PRS24 Cost Of Pneumonia In Older Peolple Living In Nursing Home Costa N1, Hoogendijk E2, Demougeot L2, Rolland Y2, Bourrel R3, Duboué M2, Vellas B2, Molinier L2, Cesari M2 1INSERM, Toulouse, France, 2University Hospital of Toulouse, Toulouse, France, 3Regional Health Insurance, Toulouse, France

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Objectives: Respiratory infections are common and frequent diseases in nursing homes (NH). The occurrence of pneumonia in a frail elderly person is associated with a decrease in the overall health status of the individual and may increase costs of care. The objective of this study is to estimate the economic burden of the occurrence of pneumonia in (NH), and to identify the main cost drivers constituting the net cost of pneumonia.  Methods: The economic analysis was performed from the French National Health Insurance (NHI) perspective. Direct medical (i.e. inpatient stays, outpatients, medications) and non-medical (i.e. transportation) were included. Data related to resources consumption were collected from the French NHI database. Costs valuation was based on tariffs reimbursed by the French NHI. Net cost of pneumonia was calculated and a log link Generalized Linear Model (GLM) was built to estimate the most important cost drivers.  Results: The economic analysis was performed on 345 patients living in NH. During the one year follow-up period 32 patients had pneumonia (9%). Mean annual cost amounted to € 7,157±13,734 in patients who have not experienced a pneumonia compared to € 11,624±10,510€  in patients who had pneumonia (p< 0.05). Net cost of pneumonia in NH was € 4,467. This cost was mainly due to inpatients stays (€ 3,044) and outpatients (€ 1,423). Costs driver of pneumonia were inpatient stays (68%), respiratory assistance equipment (10%) and physiotherapist visits (6%). According to the results of the GLM, pneumonia increases the cost of care of 1.9 (p< 0.05). Smoking and type of NH may also affect the total cost of the care.  Conclusions: Pneumonia constitutes a significant economic burden in the care of institutionalized patient. Improvement strategies of care for these patients should be identified. PRS25 Estimating Economic Loss From Lung Cancer Undram L1, Uuganbayar G2 1Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia, 2Private hospital, Ulaanbaatar, Mongolia

Objectives: Early detection of lung cancer is important in terms of life of the patient and diminishing economic burden on patient and society. Health services for cancer patients are free in Mongolia. This study aims to determine the trend of lung cancer for the last ten years in Mongolia, direct cost of lung cancer inpatient treatment and economic loss to patient from admission in relation to the stages of lung cancer.  Methods: To estimate trend of lung cancer time-series analysis was used. 2004-2014 data on lung cancer morbidity and mortality was obtained from the National Cancer Centre database. Direct costs of inpatient treatment of lung cancer different stages were estimated using data related to patient admission. There were reviewed 80 patients data. Economic losses from lung cancer were estimated.  Results: There was a trend of increasing of lung cancer incidence by 1% for ten years. Mortality from lung cancer increased by 0.99% over ten year period. Direct costs of lung cancer inpatient treatment ranged from 271-1991 USD depending on stages of lung cancer. Some 77.5% of patients admitted with lung cancer had 3rd and 4th stages of the disease. Average cost of economic loss from lung cancer for a patient for treatment and disability was 607680 USD.  Conclusions: Incidence of lung cancer and mortality from it are increasing over years, which means cost for the disease treatment and consequently economic loss form disability will be raising. PRS26 Burden Of Copd In China: A Systematic Literature Review Zhang L, Zhu B, Ming J, Wang Y Fudan University, Shanghai, China

Objectives: Chronic obstructive pulmonary disease (COPD) ranked the fourth as a leading cause of death in China. This study aims to systematically review the evidence on burden of disease associated with COPD in China.  Methods: A literature search was performed using Pubmed, Embase and Cochrane and two Chinese data base CNKI and Wanfang Database from Jan 1st 1990 to Oct 9th 2015 to identify prevalence of COPD, economic evidence and quality of life for COPD.  Results: The search retrieved 6830 studies (6764 in Chinese and 56 in English) of which 49 fufilled the eligibility criteria. Reported COPD prevalence varied from 1.20% to 8.87% among different provinces. In terms of epidemic burden, the prevalence rate of COPD is higher among male (7.76%) in comparison with female (4.07%), and that the disease is more prevalent in rural area (7.62%) than in urban area (6.09%). The diagnostic rate of COPD patients in China varies from 23.61% to 30.00%. The percentage of COPD patients receiving outpatient treatment is around 50%, while the admission rate ranges between 8.78% and 35.60%. COPD is among the top 10 causes of DALYs, causing a total number of 16,723,800 DALYs in 2010. The direct cost of COPD ranged from $476 to $1947 per patient per year and the indirect cost ranged from $19 to $746 per patient per year. The most commonly used scales for quality of life include SGRQ, AQ20 and SF-36. COPD patients have lower quality of life score than non-COPD patients, and have higher risk to depression.  Conclusions: This analysis indicates that COPD is associated with considerable burden of disease in China regarding DALYs, cost of illness and quality of life. Measures should be taken to disease management, increase access to care and improve quality of life for COPD in China. PRS27 Assessing The Economic Burden And Health Care Resource Utilization Of Us Veterans With Chronic Obstructive Pulmonary Disease Ogbomo A1, Tan H1, Kariburyo MF1, Xie L1, Baser O2 1STATinMED Research, Ann Arbor, MI, USA, 2Columbia University and STATinMED Research, New York, NY, USA

Objectives: To evaluate the economic burden and health care resource utilization of chronic obstructive pulmonary disease (COPD) in the US Veterans Health Administration (VHA) population. Methods: Patients diagnosed with COPD (International Classification of Diseases 9th Revision Clinical Modification diagnosis codes 490.xx-491.xx) were identified using VHA claims from 01OCT2009 through 30SEPT2014. The first diagnosis date was designated as the index date. A

comparison cohort (patients without a COPD diagnosis) was created for patients of the same age, gender, race, index year, and baseline Charlson Comorbidity Index score as patients in the COPD cohort. To reduce selection bias, a random index date was chosen for the comparison cohort. Patients were required to have continuous medical and pharmacy benefits 1 year pre- and post-index date. One-to-one propensity score matching (PSM) was performed to compare follow-up health care costs and utilization between the cohorts, adjusting for demographic and clinical characteristics.  Results: Eligible patients (N= 925,970) were identified for the COPD and comparison cohorts. After 1:1 PSM, a total of 308,089 patients were matched from each cohort and baseline characteristics were well-balanced. COPD patients had a higher percentage of health care resource utilization, including inpatient visits (12.04% vs. 2.83%, p< 0.0001); outpatient visits (99.72% vs. 77.43%, p< 0.0001); and pharmacy visits (91.35% vs. 68.37%, p< 0.0001) than non-COPD patients. Higher health care resource utilization translated to higher costs for COPD patients, including inpatient ($3,845 vs. $812, p< 0.0001), outpatient ($5,060 vs. $2,582, p< 0.0001), pharmacy ($804 vs. $481, p< 0.0001), and total costs ($9,709 vs. $3,875, p< 0.0001) than non-COPD patients.  Conclusions: US veteran patients diagnosed with COPD have a higher economic burden compared to those who were not. PRS28 Evaluating Asthma-Related Expenses And Health Care Resource Utilization Among Children In The United States Medicaid Population Zhang Q1, Zhao Y1, Keshishian A1, Xie L1, Yuce H2, Baser O3 Research, Ann Arbor, MI, USA, 2New York City College of Technology-CUNY and STATinMED Research, New York, NY, USA, 3Columbia University and STATinMED Research, New York, NY, USA

1STATinMED

Objectives: To evaluate asthma-related expenses and health care resource utilization among children in the US Medicaid population.  Methods: Patients under age 18 years and diagnosed with asthma (International Classification of Diseases, 9th Revision, Clinical Modification diagnosis code: 493.xx) were identified using US Medicaid data from January 1, 2009 through December 31, 2009. The initial diagnosis date was designated as the index date. The control cohort (patients without asthma) was matched one-to-one with the case cohort (patients with asthma) having the same age, gender, race, and region. The index date for the control cohort was randomly assigned to minimize selection bias. Patients in both cohorts were required to have continuous health plan enrollment for 1-year pre- and post-index date. Propensity score matching (PSM) was used to compare health care costs and utilization during the follow-up period.  Results: Compared with the control cohort (n= 65,394), children with asthma were more likely to have higher Charlson comorbidity index (CCI) scores (0.67 vs. 0.14, p< 0.0001), and higher percentages of comorbidities, such as congestive heart failure (0.36% vs. 0.10%), renal disease (0.32% vs. 0.15%), and diabetes (0.92% vs. 0.45%, all p< 0.0001). After 1:1 PSM, 36,029 patients with balanced demographic characteristics and CCI scores were matched from each cohort. A higher proportion of children in the asthma cohort had inpatient stays (11.65% vs. 2.84%), long-term care (LTC) (2.75% vs. 1.27%), pharmacy (96.53% vs. 64.40%) and outpatient visits (99.99% vs. 84.72%, all p< 0.0001). Higher health care resource utilization translated to higher costs, including inpatient ($2,016 vs. $469), LTC ($1,437 vs. $672), pharmacy ($2,120 vs. $968), outpatient ($8,039 vs. $4,585), and total costs ($13,612 vs. $6,695, all p< 0.0001) for children with asthma compared to those without asthma.  Conclusions: Children with asthma had significantly higher health care utilization and expenses compared to those without asthma. PRS29 Assessing Health Care Resource Utilization And Costs Among Us Veterans Diagnosed With Asthma Ogbomo A1, Tan H1, Kariburyo MF1, Xie L1, Baser O2 1STATinMED Research, Ann Arbor, MI, USA, 2Columbia University and STATinMED Research, New York, NY, USA

Objectives: To evaluate the health care resource utilization and economic burden of asthma in the US Veterans Health Administration (VHA) population.  Methods: A retrospective data analysis was performed using VHA claims from October 1, 2009 through September 30, 2014. Asthmatic patients were identified using the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis code 493. The diagnosis date was designated as the index date. A comparison cohort of patients without an asthma diagnosis was created for patients of the same age, gender, race, index year, and baseline Charlson Comorbidity Index score. A random index date was chosen for the comparison cohort to reduce selection bias. Patients were required to have continuous medical and pharmacy benefits 1 year pre- and post-index date. One-to-one propensity score matching (PSM) was performed to compare follow-up health care costs and utilization between the cohorts, adjusting for demographic and clinical characteristics.  Results: Eligible patients (N= 253,302) were identified for patients with and without asthma. After 1:1 PSM, 75,214 patients were matched from each cohort, and the baseline characteristics were well-balanced. Asthmatic patients were more likely to utilize health care resources than non-asthmatic patients, including inpatient (8.50% vs. 3.48%, p< 0.0001); outpatient (99.73% vs. 74.76%, p< 0.0001), and pharmacy visits (90.91% vs. 65.94%, p< 0.0001). Higher health care resource utilization translated to higher costs for asthmatic patients than non-asthmatic patients, including inpatient ($2,314 vs. $999, p< 0.0001), outpatient ($4,435 vs. $2,803, p< 0.0001), pharmacy ($747 vs. $511, p< 0.0001) and total costs ($7,496 vs. $4,313, p< 0.0001).  Conclusions: The economic burden and health care resource utilization was significantly higher for patients in the US VHA population who were diagnosed with asthma compared to those without asthma. PRS30 Estimation Of Direct And Indirect Costs Associated With Asthma And Copd: A Canadian Employers Perspective Ng C1, Risebrough NA1, Jayasundara KS2, Freeman MA2