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Experiences Of Cervical Cancer Screening Performed By Health Visitors In Hungary
A306
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
leading tertiary hospitals in China. One- and two way sensitivity analyses explored the impact of input variables such as diagnostic cost, HCC prevalence and cost of therapy. Results: The base case HCC prevalence rate was 47.0%. Confirmatory additional imaging was necessary for 34.0% of patients after initial CT imaging, 22.5% after initial ECCM-MRI and 0% after initial PV-MRI. False positive (patients having unnecessary surgery) rate was 2.7% for PV-MRI, 4.6% for MDCT and 9.6% for ECCM-MRI. The false negative (missed HCC diagnosis) rate was 3.9% for PV-MRI, 12.5% for MDCT and 9.6% for ECCM-MRI. Total cost per patient after initial PV-MRI (CNY 30,357) was slightly lower than MDCT (CNY 30,653) and ECCM-MRI (CNY 31,892). The sensitivity analyses revealed that HCC prevalence in the at-risk-population had the highest impact on the cost comparison of the 3 diagnostic procedures. Conclusions: Due to higher diagnostic precision, the total cost of making a therapeutic decision with Gd-EOB-DTPA-MRI as primary diagnostic imaging method in China is unlikely to be higher than with ECCM-MRI and MDCT. PMD52 ECONOMIC EVALUATION OF PROCALCITONIN-GUIDED ANTIBIOTIC THERAPY IN ACUTE RESPIRATORY INFECTIONS: A CHILE HEALTH SYSTEM PERSPECTIVE Schneider J E 1, Stojanovic I 1, Vargas C 2, Schuetz P 3, Giglio A 2 Health Economics, Morristown, NJ, USA, 2ETESA-UC, Pontificia Universidad Católica de Chile, Santiago, Chile, 3University of Basel, Basel, Switzerland .
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1Avalon
Objectives: Mathematical models have indicated that, in the United States, the use of antibiotic stewardship protocols based on procalcitonin levels for patients with suspected acute respiratory tract infection (ARI) results in cost savings. Herein, our objective was to assess the economic impact of adopting procalcitonin (PCT) testing among patients with suspected (ARI) from the perspective of the public health system in Chile. Methods: To conduct an economic evaluation of PCT testing versus usual care, we built a cost-impact model based on patient-level meta-analysis data from randomized trials. The meta-analytic data was adapted to the Chilean setting by applying Chilean data to lengths of stay, costs, and practice patterns relevant to the treatment of ARI in Chile. We estimated the annual ARI visit rate for the public system healthcare members (about 13 million people), by clinical setting (inpatient, ICU, outpatient) and ARI diagnosis. Results: In the inpatient setting, the costs of procalcitonin-guided compared to usual care for the Chilean public health system was $1.3 billion Chilean pesos (CLP), compared to $2 billion CLP, resulting in net savings of nearly $712 million CLP to the health system for 2015. In the ICU and outpatient settings, savings were $117 million CLP and $298 million CLP, respectively. Across all three settings, the overall net savings of PCT-guided care was $1.1 billion CLP (or approximately $1.6 million USD) for the Chilean population utilizing the public health system. Results were robust for all ARI diagnoses. Conclusions: Our results show substantial savings associated with PCT protocols for ARI across common Chile treatment settings mainly by direct reduction in unnecessary antibiotic utilization. These results are robust to changes in key parameters, and savings can be achieved without any negative impact on treatment outcomes.
MEDICAL DEVICE/DIAGNOSTICS – Patient-Reported Outcomes & Patient Preference Studies PMD53 Improvement In Antihypertensive And Cholesterol-Lowering Medication Persistence Using A Mobile Technology Application Wade RL1, Clancey B1, Michaeli J2 Health, Plymouth Meeting, PA, USA, 2Medisafe, Boston, MA, USA
1IMS
Objectives: The high cost of poor medication adherence is well established. This study evaluated persistence in patients using the Medisafe mobile application (app) to support adherence using scheduled reminders, a motivation and social support system and other personalized tools compared to a matched control group in two therapy areas. Methods: Patients loading an antihypertensive (AH) or cholesterol-lowering (CL) therapy between 10/1/2014-12/31/2014 on their mobile device (users) using Medisafe were matched 1:1 to non-app users (controls) with patient anonymous prescription claims for AH or CL identified in the IMS de-identified prescription database. Patients were matched on therapy class, age, gender, pay type, geography, and if new to therapy. Prescription activity was followed for 6 months to determine persistence, using a 10-day refill gap. Differences in persistence were tested using chi-square. Results: There were a total of 406 AH and 150 CL users matched to controls. The mean (SD) age of the patients was 52.5 (12.0) and 54.6 (10.7) years for AH and CL, respectively. The study groups were approximately equal in male-female ratio. Of AH patients, 7.9% were new to therapy, while 7.3% CL patients were new to therapy. Comparing all users to all controls at 6 months, a 5.4% higher persistence for AH (69.7% vs. 64.3%, p= 0.05), and a 10.7% higher persistence for CL (65.3% vs. 54.7%, p= 0.03) was observed for app users. Similar results were observed among patients that were not new to therapy, with AH app users having a 4.5% higher persistence (71.1% vs. 67.1%, p= 0.09) and CL app users having a 15.1% higher persistence (68.4% vs. 53.2%, p< .01) compared to controls. Conclusions: This pilot study found that CL patients using the Medisafe app were significantly more persistent, while AH patients trended toward higher persistence. Broad use of this technology could lead to better control of chronic diseases and their costs to the health care system. PMD54 Experiences Of Cervical Cancer Screening Performed By Health Visitors In Hungary György B1, Tóth L2, Boncz I3, Vajda R3, Pakai A4, Horváthné Kívés Z5 County Government Office, Nagykanizsa, Hungary, 2Zala County Government Office, Zalaegrszeg, Hungary, 3University of Pécs, Pécs, Hungary, 4University of Pécs, Zalaegerszeg, Hungary, 5University of Pécs, Pécs, Hungary 1Zala
Objectives: The aim of our study was to explore the knowledge and attitudes connected to cervical screening, Pap-smear test performed by health visitors, and to learn the participation data of screening by health visitors. Methods: Quantitative, cross-sectional studies were conducted using self-edited questionnaire (sociodemoraphic data, knowledge, screening attitude) among women aged 25-65 with the domicile of Nagykanizsa (n= 232). The other study was carried out among women in other five villages in Zala County who took part in cervical screening performed by district nurses (n= 58). The retrospective analysis was carried out in the settlements participating in the Health Visitors’ Cervical Cancer Screening Program within the National Screening System from September 2013 to September 2015 based on fixed data. Descriptive statistics, χ 2-test, ANOVA, and Kruskal-Wallis test, Mann-Whitney test, regression and factor analyses were used with 95% probability level (p< 0.05). We used SPSS version 22.0 program. Results: Health awareness means a significantly higher level of motivation for single people (p= 0.013) and those preferring healthy lifestyle (p= 0.003). Screening that is carried out by health visitors is supported by people aged 45-65 (p= 0.016) and persons with primary education (p= 0.030). Women who were screened in the past three years believe the circumstances inappropriate (p= 0.001). The knowledge level of only 43 persons was appropriate.43 regional health visitors carried out cervical cancer screening for public health purposes in 130 settlements, Zala County. 59.77% of women with call-in letter were connected with the health visitor 16.74% (1101 persons) attended screening. It accounts for 10% with respect on the total patients to be screened. Conclusions: Strengthening the motivating factors, increasing the awareness level of cervical cancer and its screening play a significant role in the attainment of appropriate screening. It can be concluded that health visitors can address the rarely screened women, and the Health Visitors’ Screening Program was successful. PMD55 Factors Influencing The Participation Rate On Organized Breast Bancer Screening Programme In Hungary Kisalföldi B1, Boncz I2, Vajda R2, Elmer D2, Ágoston I2, Horváthné Kívés Z3 County Government Office, Tatabánya, Hungary, 2University of Pécs, Pécs, Hungary, 3University of Pécs, Pécs, Hungary
1Komárom-Esztergom
Objectives: The aim of this study is to analize the factors motivating women to take part in breast screening, to gain a better insight into participants’ habits of seeing a doctor, their knowledge about breast screening and mammary cancer, including sources of information they use to gain more knowledge. Methods: A quantitative, cross-sectional survey was carried out in 2015, by using non-random sample selection method and by selecting women aged 45-65 participated in breast cancer screening, living in Komárom-Esztergom County (n= 174). The questionnaire included the following groups of questions: socio-demographic profile, questions about attitudes towards health, habits of seeing a doctor, motivation to take part in screening programmes, knowledge and sources of information regarding breast cancer and the screening process. Data were processed by SPSS 20.0 programme, using descriptive statistical analysis, χ 2-test, t-test, ANOVA, Kruskal-Wallis test (p< 0.05). Results: Average age of participants was 54 years, most of them completed their studies at secondary school and 77.6% of them participated in screening after they had been invited by a personal letter. The most important motivating factors are: “I consider breast screening examination important”. Participants seemed to be well-informed about the breast screening process but they had insufficient knowledge about breast cancer. Women aged 45-54 (p= 0.004), living in a family (p= 0.024), having a degree (p< 0.001) and being employed (p< 0.001) proved to have more information about risk factors. Women who frequently visit s doctor, often are involved in other screening programs also. (p= 0.001). The possibility of an award and the screening bus proved to be the least motivating factor (p< 0.001). Conclusions: Low participation in screening programmes is mainly related to individual attitude, which is due to insufficient knowledge. In their case health-related knowledge could be improved and widened by spreading information leaflets and by providing more intense medical advice. PMD56 Factors Affecting Participation In Breast Cancer Screening Pakai A1, Oláh A2, Gyuró M2, Farkasné Buzánczky G2, Horváthné Kívés Z3, Boncz I2, Brantmüller É4, Vajda R2 1University of Pécs, Zalaegerszeg, Hungary, 2University of Pécs, Pécs, Hungary, 3University of Pécs, Pécs, Hungary, 4University of Pécs, Kaposvár, Hungary
Objectives: Breast cancer is the most commonly diagnosed type of cancer and a leading cause of mortality among women both in developed and developing countries all over the world. Our study aimed to answer two questions: What is the proportion of women participating in mammography screening? What factors influence the attendance of screening? Methods: A quantitative, cross-sectional, and descriptive study (2013) examined women aged 35-65 without a history of breast cancer from Kecskemét City and its region. Convenience sampling method was applied in the study. The self-administered questionnaire included the following groups of questions: socio-demographic data, attitude examination related to screening, reasons for absence. Besides SPSS Statistic 20.00 test, x2 test, t-test, and ANOVA were used (p< 0.05). During the Principal Component Analysis, 23 variables of the motivational scale were grouped into six theoretical subgroups, and the Cronbach-alpha value was 0.758. Results: The mean age of the participants was 49.96±8.91 years. 71% of the interviewees never attended breast cancer screening. The items of the first (“background psychologicalfactors affecting participation in screening”) and second factors (“attends breast cancer screening to prevent the disease”) showed no significant correlation with the socio-demographic factors (p> 0.05). According to the one-way variation analysis, a significant correlation was found between the third factor (“absence due to time”) and qualification (p< 0.05). A weak correlation was found between the fourth factor (“attends breast cancer screening, because she cares about her health”) and age (r= -0.227, p< 0.05). Conclusions: Prevention programs play an essential role in the improvement of the health status of the Hungarian population. Mortality and morbidity
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
leading tertiary hospitals in China. One- and two way sensitivity analyses explored the impact of input variables such as diagnostic cost, HCC prevalence and cost of therapy. Results: The base case HCC prevalence rate was 47.0%. Confirmatory additional imaging was necessary for 34.0% of patients after initial CT imaging, 22.5% after initial ECCM-MRI and 0% after initial PV-MRI. False positive (patients having unnecessary surgery) rate was 2.7% for PV-MRI, 4.6% for MDCT and 9.6% for ECCM-MRI. The false negative (missed HCC diagnosis) rate was 3.9% for PV-MRI, 12.5% for MDCT and 9.6% for ECCM-MRI. Total cost per patient after initial PV-MRI (CNY 30,357) was slightly lower than MDCT (CNY 30,653) and ECCM-MRI (CNY 31,892). The sensitivity analyses revealed that HCC prevalence in the at-risk-population had the highest impact on the cost comparison of the 3 diagnostic procedures. Conclusions: Due to higher diagnostic precision, the total cost of making a therapeutic decision with Gd-EOB-DTPA-MRI as primary diagnostic imaging method in China is unlikely to be higher than with ECCM-MRI and MDCT. PMD52 ECONOMIC EVALUATION OF PROCALCITONIN-GUIDED ANTIBIOTIC THERAPY IN ACUTE RESPIRATORY INFECTIONS: A CHILE HEALTH SYSTEM PERSPECTIVE Schneider J E 1, Stojanovic I 1, Vargas C 2, Schuetz P 3, Giglio A 2 Health Economics, Morristown, NJ, USA, 2ETESA-UC, Pontificia Universidad Católica de Chile, Santiago, Chile, 3University of Basel, Basel, Switzerland .
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.
.
.
.
1Avalon
Objectives: Mathematical models have indicated that, in the United States, the use of antibiotic stewardship protocols based on procalcitonin levels for patients with suspected acute respiratory tract infection (ARI) results in cost savings. Herein, our objective was to assess the economic impact of adopting procalcitonin (PCT) testing among patients with suspected (ARI) from the perspective of the public health system in Chile. Methods: To conduct an economic evaluation of PCT testing versus usual care, we built a cost-impact model based on patient-level meta-analysis data from randomized trials. The meta-analytic data was adapted to the Chilean setting by applying Chilean data to lengths of stay, costs, and practice patterns relevant to the treatment of ARI in Chile. We estimated the annual ARI visit rate for the public system healthcare members (about 13 million people), by clinical setting (inpatient, ICU, outpatient) and ARI diagnosis. Results: In the inpatient setting, the costs of procalcitonin-guided compared to usual care for the Chilean public health system was $1.3 billion Chilean pesos (CLP), compared to $2 billion CLP, resulting in net savings of nearly $712 million CLP to the health system for 2015. In the ICU and outpatient settings, savings were $117 million CLP and $298 million CLP, respectively. Across all three settings, the overall net savings of PCT-guided care was $1.1 billion CLP (or approximately $1.6 million USD) for the Chilean population utilizing the public health system. Results were robust for all ARI diagnoses. Conclusions: Our results show substantial savings associated with PCT protocols for ARI across common Chile treatment settings mainly by direct reduction in unnecessary antibiotic utilization. These results are robust to changes in key parameters, and savings can be achieved without any negative impact on treatment outcomes.
MEDICAL DEVICE/DIAGNOSTICS – Patient-Reported Outcomes & Patient Preference Studies PMD53 Improvement In Antihypertensive And Cholesterol-Lowering Medication Persistence Using A Mobile Technology Application Wade RL1, Clancey B1, Michaeli J2 Health, Plymouth Meeting, PA, USA, 2Medisafe, Boston, MA, USA
1IMS
Objectives: The high cost of poor medication adherence is well established. This study evaluated persistence in patients using the Medisafe mobile application (app) to support adherence using scheduled reminders, a motivation and social support system and other personalized tools compared to a matched control group in two therapy areas. Methods: Patients loading an antihypertensive (AH) or cholesterol-lowering (CL) therapy between 10/1/2014-12/31/2014 on their mobile device (users) using Medisafe were matched 1:1 to non-app users (controls) with patient anonymous prescription claims for AH or CL identified in the IMS de-identified prescription database. Patients were matched on therapy class, age, gender, pay type, geography, and if new to therapy. Prescription activity was followed for 6 months to determine persistence, using a 10-day refill gap. Differences in persistence were tested using chi-square. Results: There were a total of 406 AH and 150 CL users matched to controls. The mean (SD) age of the patients was 52.5 (12.0) and 54.6 (10.7) years for AH and CL, respectively. The study groups were approximately equal in male-female ratio. Of AH patients, 7.9% were new to therapy, while 7.3% CL patients were new to therapy. Comparing all users to all controls at 6 months, a 5.4% higher persistence for AH (69.7% vs. 64.3%, p= 0.05), and a 10.7% higher persistence for CL (65.3% vs. 54.7%, p= 0.03) was observed for app users. Similar results were observed among patients that were not new to therapy, with AH app users having a 4.5% higher persistence (71.1% vs. 67.1%, p= 0.09) and CL app users having a 15.1% higher persistence (68.4% vs. 53.2%, p< .01) compared to controls. Conclusions: This pilot study found that CL patients using the Medisafe app were significantly more persistent, while AH patients trended toward higher persistence. Broad use of this technology could lead to better control of chronic diseases and their costs to the health care system. PMD54 Experiences Of Cervical Cancer Screening Performed By Health Visitors In Hungary György B1, Tóth L2, Boncz I3, Vajda R3, Pakai A4, Horváthné Kívés Z5 County Government Office, Nagykanizsa, Hungary, 2Zala County Government Office, Zalaegrszeg, Hungary, 3University of Pécs, Pécs, Hungary, 4University of Pécs, Zalaegerszeg, Hungary, 5University of Pécs, Pécs, Hungary 1Zala
Objectives: The aim of our study was to explore the knowledge and attitudes connected to cervical screening, Pap-smear test performed by health visitors, and to learn the participation data of screening by health visitors. Methods: Quantitative, cross-sectional studies were conducted using self-edited questionnaire (sociodemoraphic data, knowledge, screening attitude) among women aged 25-65 with the domicile of Nagykanizsa (n= 232). The other study was carried out among women in other five villages in Zala County who took part in cervical screening performed by district nurses (n= 58). The retrospective analysis was carried out in the settlements participating in the Health Visitors’ Cervical Cancer Screening Program within the National Screening System from September 2013 to September 2015 based on fixed data. Descriptive statistics, χ 2-test, ANOVA, and Kruskal-Wallis test, Mann-Whitney test, regression and factor analyses were used with 95% probability level (p< 0.05). We used SPSS version 22.0 program. Results: Health awareness means a significantly higher level of motivation for single people (p= 0.013) and those preferring healthy lifestyle (p= 0.003). Screening that is carried out by health visitors is supported by people aged 45-65 (p= 0.016) and persons with primary education (p= 0.030). Women who were screened in the past three years believe the circumstances inappropriate (p= 0.001). The knowledge level of only 43 persons was appropriate.43 regional health visitors carried out cervical cancer screening for public health purposes in 130 settlements, Zala County. 59.77% of women with call-in letter were connected with the health visitor 16.74% (1101 persons) attended screening. It accounts for 10% with respect on the total patients to be screened. Conclusions: Strengthening the motivating factors, increasing the awareness level of cervical cancer and its screening play a significant role in the attainment of appropriate screening. It can be concluded that health visitors can address the rarely screened women, and the Health Visitors’ Screening Program was successful. PMD55 Factors Influencing The Participation Rate On Organized Breast Bancer Screening Programme In Hungary Kisalföldi B1, Boncz I2, Vajda R2, Elmer D2, Ágoston I2, Horváthné Kívés Z3 County Government Office, Tatabánya, Hungary, 2University of Pécs, Pécs, Hungary, 3University of Pécs, Pécs, Hungary
1Komárom-Esztergom
Objectives: The aim of this study is to analize the factors motivating women to take part in breast screening, to gain a better insight into participants’ habits of seeing a doctor, their knowledge about breast screening and mammary cancer, including sources of information they use to gain more knowledge. Methods: A quantitative, cross-sectional survey was carried out in 2015, by using non-random sample selection method and by selecting women aged 45-65 participated in breast cancer screening, living in Komárom-Esztergom County (n= 174). The questionnaire included the following groups of questions: socio-demographic profile, questions about attitudes towards health, habits of seeing a doctor, motivation to take part in screening programmes, knowledge and sources of information regarding breast cancer and the screening process. Data were processed by SPSS 20.0 programme, using descriptive statistical analysis, χ 2-test, t-test, ANOVA, Kruskal-Wallis test (p< 0.05). Results: Average age of participants was 54 years, most of them completed their studies at secondary school and 77.6% of them participated in screening after they had been invited by a personal letter. The most important motivating factors are: “I consider breast screening examination important”. Participants seemed to be well-informed about the breast screening process but they had insufficient knowledge about breast cancer. Women aged 45-54 (p= 0.004), living in a family (p= 0.024), having a degree (p< 0.001) and being employed (p< 0.001) proved to have more information about risk factors. Women who frequently visit s doctor, often are involved in other screening programs also. (p= 0.001). The possibility of an award and the screening bus proved to be the least motivating factor (p< 0.001). Conclusions: Low participation in screening programmes is mainly related to individual attitude, which is due to insufficient knowledge. In their case health-related knowledge could be improved and widened by spreading information leaflets and by providing more intense medical advice. PMD56 Factors Affecting Participation In Breast Cancer Screening Pakai A1, Oláh A2, Gyuró M2, Farkasné Buzánczky G2, Horváthné Kívés Z3, Boncz I2, Brantmüller É4, Vajda R2 1University of Pécs, Zalaegerszeg, Hungary, 2University of Pécs, Pécs, Hungary, 3University of Pécs, Pécs, Hungary, 4University of Pécs, Kaposvár, Hungary
Objectives: Breast cancer is the most commonly diagnosed type of cancer and a leading cause of mortality among women both in developed and developing countries all over the world. Our study aimed to answer two questions: What is the proportion of women participating in mammography screening? What factors influence the attendance of screening? Methods: A quantitative, cross-sectional, and descriptive study (2013) examined women aged 35-65 without a history of breast cancer from Kecskemét City and its region. Convenience sampling method was applied in the study. The self-administered questionnaire included the following groups of questions: socio-demographic data, attitude examination related to screening, reasons for absence. Besides SPSS Statistic 20.00 test, x2 test, t-test, and ANOVA were used (p< 0.05). During the Principal Component Analysis, 23 variables of the motivational scale were grouped into six theoretical subgroups, and the Cronbach-alpha value was 0.758. Results: The mean age of the participants was 49.96±8.91 years. 71% of the interviewees never attended breast cancer screening. The items of the first (“background psychologicalfactors affecting participation in screening”) and second factors (“attends breast cancer screening to prevent the disease”) showed no significant correlation with the socio-demographic factors (p> 0.05). According to the one-way variation analysis, a significant correlation was found between the third factor (“absence due to time”) and qualification (p< 0.05). A weak correlation was found between the fourth factor (“attends breast cancer screening, because she cares about her health”) and age (r= -0.227, p< 0.05). Conclusions: Prevention programs play an essential role in the improvement of the health status of the Hungarian population. Mortality and morbidity