Descalonamento Da Terapia Antimicrobiana: Uma Estratégia De Racionalização E Custo-Minimização Em Cenário Privado De Saúde No Ceará

VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 8 5 3 – A 9 4 3

(1USD =  $ 19MXN). A deterministic sensitivity analysis was performed to test the robustness of the model.  Results: DRV/cobi showed annual savings per patient of 9.5%. This savings are equivalent to the annual cost of treatment with ritonavir. The annual cost of treatment with DRV/cobi is $2,096 versus the annual cost of DRV+ rtv which is $2,316. The robustness of the analysis was confirmed by a sensitivity analysis on the DRV/cobi acquisition price.  Conclusions: The fixed dose combination in one tablet per day of DRV/cobi is a cost-saving and convenient alternative in terms of supply and storage for the institutions in the public health sector in Mexico that use DRV+rtv. Additionally, DRV/cobi favors adherence in patients and decreases the probability of virological failure. PIN38 Descalonamento Da Terapia Antimicrobiana: Uma Estratégia De Racionalização E Custo-Minimização Em Cenário Privado De Saúde No Ceará Reis HP1, Rodrigues JL2, Girao ES1, Pontes L3, Ponte G3 1UFC, Fortaleza, Brazil, 2Universidade Federal do Ceará, Fortaleza, Brazil, 3UNIMED Fortaleza, Fortaleza, Brazil

Objectives: Avaliar impacto farmacoeconômico do descalonamento de antimicrobianos (ATM) nos custos com estes medicamentos, durante a implementação de um programa de Gestão Clínica de ATM no cenário privado de saúde.  Methods: Trata-se de um estudo transversal realizado em seis hospitais privados de Fortaleza/CE, através do time interdisciplinar de Auditoria de ATM do Programa Stewardship (STWDSP), entre janeiro/2015 a dezembro/2015. O descalonamento foi considerado quando infecção diagnosticada e início da terapia empírica de amplo espectro com posterior reorientação para um ATM de menor espectro direcionados pela cultura e Teste de Sensibilidade, bem como suspensão da terapia por não ser encontrada evidência infecciosa. As sugestões eram durante as visitas interdisciplinares do time de Auditoria com o médico assistente. O custo-minimizado teve como base o custo do tratamento do(s) ATM escolhido(s) inicialmente no tempo programado e valor real do custo/tratamento após a reorientação do ATM com o descalonamento. Foi utilizado o preço Brasíndice®. Aprovado pelo Comitê de Ética da Universidade de Fortaleza (N°252/2009).  Results: foram realizadas 421 visitas para Auditoria de Antimicrobianos, sendo avaliados 989 planos terapêuticos anti-infecciosos com 1712 ATM envolvidos. Destes esquemas, 64% (632/989) eram monoterapia e 357 (36%) foram utilizados mais de um ATM, para cobertura antibacteriana mista. O time STWDSP identificou 121 oportunidades para descalonar, nas quais 65,3% oportunidades (79/121) foi sugerido retirar um dos ATM por não ter sido identificada infecção mista (Gram+ e Gram-). A adesão global para esta estratégia de otimização terapêutica foi de 84% (102/121). O custo-minimizado direto foi de R$168.047,82 (dos R$207.459,09 programados), com redirecionamento terapêutico e suspensão de ATM desnecessário.  Conclusions: A adesão ao descalonamento neste estudo, utilizando o Stewardship como ferramenta de Gestão Clínica, promoveu uma reorientação específica da terapia antimicrobiana, diminuindo o espectro de ação da terapia empírica inicial, assim como evitou uso desnecessário destes medicamentos e, consequentemente, minimizou consideravelmente os custos com o tratamento. PIN39 Costo-Utilidad De La Vacunación Contra Varicela En Perú Bolaños-Díaz R1, Tejada RA1, Sanabria C2, Candela JL3 Nacional de Salud, Lima, Peru, 2Universidad Nacional Mayor de San Marcos, Lima, Peru, 3Instituto Nacional de Salud del Niño, Lima, Peru

1Instituto

Objectives: comparar la relación costo-utilidad de la vacunación contra varicela de niños de un año de edad frente a la no vacunación, para su inclusión en el programa nacional de inmunizaciones.  Methods: desarrollamos un modelo de Markov desde la perspectiva del Ministerio de Salud del Perú. Consideramos un horizonte temporal de 40 años con ciclos de un año, una tasa de descuento del 3% y años de vida ajustados a la calidad (AVAC) como medida de utilidad. Los costos fueron calculados al 2017 en Soles (S/.). Calculamos la relación costo-efectividad incremental (ICER). Para evaluar la incertidumbre del modelo, realizamos análisis de sensibilidad bivariado y probabilístico mediante simulaciones de Monte Carlo. Consideramos un umbral de pago (UP) igual al 0,5 del producto bruto interno peruano per cápita (PIB pc) anual (S/. 10 000). Finalmente, calculamos la CU considerando un rango de UP entre 0,5 y 1,0 PIB pc. Utilizamos TreeAge 2015 para el análisis.  Results: La no vacunación fue más costo-efectiva que la vacunación con un costo por AVAC de S/. 1,42 frente a S/. 2,51, respectivamente. El ICER para la vacunación fue S/. 73 016 por AVAC, con el 71% de las simulaciones en el cuadrante I por encima del límite de UP. El costo por año de vida salvado se estimó en S/. 31 602. La tasa de mortalidad por varicela, el costo de la vacunación, la tasa de descuento y la probabilidad de complicaciones son las variables más sensibles del modelo. Una reducción del 50% en el precio de la vacuna rendiría un ICER en el rango de 0,5-1,0 PBI pc.  Conclusions: La vacunación contra varicela no es costo-efectiva en Perú como parte del esquema nacional de inmunizaciones. El costo de la vacuna y la probabilidad de muerte por varicela son las dos variables más influyentes en el modelo.

INFECTION – Patient-Reported Outcomes & Patient Preference Studies PIN40 Assessment of Hiv-Antiretroviral Adherence Using Refill Data From a National Administrative Database in Brazil dos Santos FM1, da Costa MR2 1IESC-UFRJ, Rio de Janeiro, Brazil, 2Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Objectives: Adherence to highly active antiretroviral therapy (HAART) is crucial to HIV treatment effectiveness. The use of pharmacy refill data has become an increasingly important approach to measure adherence. Thus, administrative databases that contain such data could be especially useful. This is the case of SICLOM, the national

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system for logistic control of medicines of the Brazilian National STD/Aids Program. Despite its administrative nature, this system contains specific information about antiretroviral dispensation providing a unique data source for adherence assessment. This study aimed to assess HAART adherence among patients followed up in a public outpatient facility located in Rio de Janeiro city, Brazil, using pharmacy refill data obtained from SICLOM.  Methods: All patients that initiated HAART in 2011 were included and followed up until December 2013. Data about dispensed medicines, including amounts and dates, and demographic data was obtained from SICLOM. Therapy adherence was estimated using the medication possession ratio (MPR) calculated as the ratio between the number of days covered by a refill and treatment duration in days. The number of days without medication (gaps) was also calculated.  Results: The analysis included 82 patients. The average age was 36.2 ±10.1 years old and 85.4% were male. Most of the patients (65.9%) were followed up at public facilities. The medians of the gaps and MPR were 66.5 days (28.75-130) and 94.6% (87.997.4) respectively. MPR was lower than 95% for 54.9% of the patients.  Conclusions: According to the World Health Organization, HIV patients should take more than 95% of antiretroviral prescribed doses. However, the fact that 54.9% of the patients presented a MPR lower than 95% suggests a high prevalence of HAART non-adherence. SICLOM showed to be a powerful data source for adherence studies that could provide useful information in order to improve HAART effectiveness. PIN41 Randomized Controlled Trial Evaluating the Effectiveness of Pictogram Intervention in Identification and Reporting Adverse Drug Reactions in Naïve Hiv Patients in Ethiopia Bhagavathula AS1, Gebreyohannes EA2, Abegaz TM3, Abebe TB2, Tegegn HG2, Belachew SA2 of Gondar- College of Medicine and Health Sciences, Gondar, Ethiopia, 2University of Gondar, Gondar, Ethiopia, 3University of Gondar-College of Medicine and Health Sciences, Gondar, Ethiopia

1University

Objectives: In this study, we sought to assess whether the pictorial intervention would help to identify and improve ADR reporting in an ART clinic serving HIV patients in Northwest Ethiopia.  Methods: A randomized controlled study on ART-naïve HIV-positive patients was conducted from July 15, 2015 to January 15, 2016. The patients were randomly categorized into intervention and control groups based on their identification number. Interventional group were then subjected to receive pictorial medication information and pictograms-enhanced tool to identify and report ADRs. However, control group did not receive any pictogramenhanced intervention to identify the medications and to report ADRs.  Results: Bivariate analysis showed that sociodemographic characteristics, age, sex, education, employment, and marital status were predictors of identifying and reporting ADRs. Males were twice more likely to identify ADRs than females. Univariate analysis revealed, intervention group showed a statistically significant association with the ability to identify ART medications using pictograms. Intervention group patients were more likely to identify 3TC [OR (95% CI)= 7.536 (4.042-14.021), p= 0.000], TDF [(OR (95% CI)= 6.250 (2.855-13.682), p= 0.000], NVP [(OR (95% CI)= 5.320 (1.954-14.484), p= 0.001], EFV [(OR (95% CI) = 3.929 (1.876-8.228), p= 0.000], and AZT [(OR (95% CI) = 3.570 (1.602-7.960), p= 0.002] using pictograms. Compared to control group, interventional group showed 4.3 times more likely to identify diarrhea as an ADR using pictogram.  Conclusions: We found that the use of pictogram-based intervention for ART medications resulted in increased identification of ADRs and improved ADR reporting among naïve HIV-positive patients with limited literacy in Northwest Ethiopia. This intervention provided promising innovation with the potential implications to improve ADR reporting and promote patients safety, particularly for HIV-positive patients with limited educational levels.

INFECTION – Health Care Use & Policy Studies PIN42 Antibiotic Stewardship Policy in Biella General Hospital (Italy): A Five-Year Surveillance Ussai S1, D’Aloia F2, Lanzone L2, Frassati C2, Bonelli G2 University, Milan, Italy, 2Biella General Hospital, Biella, Italy

1Bocconi

Objectives: A retrospective study was designed to investigate i) prescription trends and antibiotic economic burden ii) microorganisms sensitivity at the Biella General Hospital from the year 2011 to 2016.  Methods: Data were collected from official registry for prescriptions and economic burden. Sensitivity was obtained from the Microbiology Department of the Central Laboratory of the same hospital. Information regarding every single culture was collected, classified afterward according to bacteria strains and antibiotics sensitivity; results were used to build sensitivity charts along the studied period.  Results: Amoxicillin-Clavulanic Acic (ACA) was the most consistently prescribed antibiotic, not only at the 1stplace of the chart from 2011 to 2016 but also keeping a growthing number of prescriptions (from 51.000 to 55.000 prescriptions/year) during the studied period. Along this time, ACA prescriptions associated costs decreased thanks to the management of public tenders (29.000€ in 2011 - 14.000€  in 2014). Other antibiotics on the top 5 ranking were fluoroquinolones, ceftriaxone and piperacillin-tazobactam. Due to its relatively low cost and broad spectrum, ACA is used to treat all kind of infections, from the airway to the urinary tract, including skin infections. It has shown a stable sensitivity pattern for Escherichia coli, Haemophilus parainfluenzae, Proteus Mirabilis, and even Streptococcus pneumoniae (p< 0.05). It’s worthy of note that the organism Klebsiella pneumonie moved from a 72% of sensitivity in 2012 to 97% in 2016, statistically significative (p value 0.03); this is probably due to a specific clinical policy, ie a better isolation of the patients exposed. According to the recent literature warnings, we observed an increasing tendency on resistance of Escherichia coli and Klebsiella species with extended-spectrum beta-lactamases (sensitivity less than 40%) and Staphylococcus aureus (below 60%).  Conclusions: Antibiotic stewardship represents an important strategy to control inadequate antibiotic prescriptions and their consequences.