Have Budget Impact Analyses Included Clinical Outcomes?

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qualification since the program has been introduced at the undergraduate curriculum. However, the level and quality of PC services could be dependent on the level of qualification attained. Years of practice with post-basic qualification is a determinant of PC practice. A positive correlation exists between qualifications and PC practice. The study has provided evidence based data to understand the effect of postgraduate clinical pharmacy education on PC services. PHP234 Recent Trends In Different Devices, Operating Systems, And Browsers Used By Patients Taking Part In Online Medical Surveys Wade AG, Crawford GM, McLennan K Patients Direct, Glasgow, UK

Objectives: Recent advances in technology have meant changes in the way many users access the worldwide web. Here we compare changes in the devices, operating systems, and browsers used to complete online medical surveys since 2012, with a view to understanding how to optimise these surveys in the future.  Methods: Google Analytics data from patients participating in twelve online medical surveys hosted by Patients Direct Limited were collected quarterly between 2012 and 2016. Changing trends in the popularity of devices, operating systems, and browsers were evaluated for quarters recording a minimum of 500 sessions.  Results: A dramatic reduction occurred in the use of desktop computers to access surveys from Q4 2012 (> 90% of sessions) to Q1 2015 (typically < 20% of sessions). A simultaneous rise in the use of mobile phones took place with fewer than 5% of sessions accessed by mobile phone in Q4 2012 to typically more than 60% of sessions after the start of 2015. Google Chrome was used to access surveys in less than 25% of sessions in Q4 2012, but was used in approximately 50% of sessions in 2016. The use of Internet Explorer has dropped from over 40% in Q4 2012 to less than 3% in Q3 2015. On mobile phones and tablets only, the use of the iOS operating system to access surveys has declined slightly from approximately 70% in the first half of 2013 to approximately 40% during the same period in 2016. Simultaneously, the use of the Android operating system has risen from less than 30% in 2013 to over 50% from the beginning of 2015.  Conclusions: Changing trends in the use of devices, operating systems and browsers used by patients accessing medical surveys advertised and completed online suggest future surveys must be designed to accommodate mobile phones and tablets. PHP235 Clinical Trials Scenario In Brazil: Study And Sponsor Profiles Julian G1, MoreiraEd 1, de Oliveira RW1, FranciscoFd 2, Ruenis AP2 - Kantar Health, São Paulo, Brazil, 2ABRACRO, São Paulo, Brazil

1Evidências

Objectives: Brazil is the largest country in South America, with more than 200 million inhabitants with multi-ethnic profile. Despite the large clinical research potential, data on clinical research profile in Brazil are currently scarce. Therefore, the objective of this study is to describe types of clinical trials and studies as well as sponsor profile in Brazil.  Methods: We analyzed data on studies conducted in Brazil in 2014 using two databases, namely ABRACRO (Brazilian Association of Contract Research Organizations) and ClinicalTrials.gov. ABRACRO database compiled data of 17 CROs in 2014.  Results: ABRACRO database included 627 clinical studies in 2014, 160 initiated that year and 467 ongoing, with 16,651 subjects. The most common sponsors were global pharmaceutical (300; 74.6%) and foreign biotech (39; 9.7%) companies, while national pharmaceutical companies and global pharmaceutical local affiliates sponsored 8.5% and 5.5% of the studies, respectively. Regarding development phase, the large majority of studies were phase III (432; 74.7%), followed by phase II (93; 15.7%); observational studies accounted only for 3.5% of the studies. ClinicalTrials.gov has data on 1684 studies conducted in Brazil in 2014, of which only 8.8% were observational; phase III trials also prevailed, comprising 54.6% of the classified studies.  Conclusions: Global pharmaceutical and foreign biotech companies seem to be responsible for the majority of the clinical studies conducted in Brazil. The country has a great potential for recruitment, reflected by the number of phase III studies included in both databases. In spite of that, observational studies are rarely conducted, although being essential to obtain data on effectiveness, patient reported outcomes, epidemiology and pharmacoeconomy. Larger incentives from national pharma companies and local pharma affiliates may be an important way to increase and diversify local data generation in Brazil. PHP236 Comparative Analysis Of Medication Possession Ratio Measures For Adherence To Single-Medication Ágh T Syreon Research Institute, Budapest, Hungary

Objectives: Medication Possession Ratio (MPR) is the most commonly used method for calculating adherence to single-medication from pharmacy dispensing records. In general, MPR is calculated by dividing the total days’ supply of a medication by the number of days in the observation period; however, there are many variations of MPR used in the literature. This research aims to perform a comparative analysis of different MPR measures for adherence to single-medication and to demonstrate the impact of the length of the observation period and the number of minimum dispensing events on MPR.  Methods: A hypothetical database containing 1-year dispensing records of 150 subjects for one chronic medication was constructed. Four alternative measures of MPR were compared applying 365-day, and 180-day observation periods. Each analysis was repeated including only subjects with at least one, or two dispensing events during the observation period. Analysis was carried out in R 3.2.5. Statistical comparisons were performed using Mann-Whitney U test.  Results: Significant differences were found in the results of the four evaluated MPR measures (all P< 0.05). Differences were greater when applying shorter observation period or measurement strategies that required less dispensing events for inclusion. Change of the length of the observation period or the number of minimum dispensing events resulted in notable difference in the results of a given MPR measure (for most P< 0.05).  Conclusions: Differences in

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the calculation methods of MPR have a significant effect on adherence estimates. Results of studies that use different MPR measures or the same MPR formula but different measurement strategies (i.e., difference in the length of the observation period or the number of minimum dispensing events) are not comparable. These findings highlight an important methodological issue which is inter alia relevant for the data synthesis of MPR results of individual studies for systematic literature reviews and meta-analysis. PHP237 Good Enough For Policy Work? Study-Design Challenges In Implementing Stated-Preference Methods For Complex Health-Care Technologies Marshall DA1, Gonzalez JM2, MacDonald KV3, Johnson FR4 Bone and Joint Health Institute, Calgary, AB, Canada, 2RTI Health Solutions, Research Triangle Park, NC, USA, 3University of Calgary, Calgary, AB, Canada, 4Duke Clinical Research Institute, Durham, NC, USA

1Alberta

Objectives: The objectives of this study were (1) to design and implement a statedpreference study to quantify the value of whole-genome sequencing (WGS) and (2) to evaluate the limitations of current stated-preference study-design methods for evaluating such complex health-care technologies.  Methods: Following evaluations of early drafts in respondent interviews, the final study design incorporated solutions to three study-design challenges. First: multiple kinds and levels of uncertainty about the likelihood of numerous kinds of gene variants required simplifying the decision problem to evaluating a single gene variant with associated health consequences of varying severity. Second: the probability of getting WGS information about elevated health risks for which there are possible risk-reducing interventions, but have their own uncertain effects, required a simplified discretechoice experiment (DCE) for the assumed health problem using surgery, medication, and watchful-waiting labeled alternatives. Third: valuing multiple kinds of test results required constructing contingent-valuation questions for a report containing only actionable information versus a report containing both actionable and non-actionable information.  Results: The online survey was administered to a US general-population sample of 410 respondents. Differences in DCE preferences for watchful waiting versus surgery or medication for a 20% chance of mild symptoms and a 60% chance of severe symptoms were statistically significant. A majority of respondents had no interest in non-actionable genomic information (55%, 95%CI: 50- 60%). Respondents with a positive value of information were willing to pay $299 (SD: $86, p< 0.01) for actionable findings and $180 (SD: $83, p< 0.05) for non-actionable findings.  Conclusions: Our study complies with the ISPOR checklist for good stated-preference research practices and the results have reasonable face validity. However, necessary simplifications of the problem that departed substantially more than usual from the actual decision context suggest that current stated-reference methods have significant limitations for quantifying policy-relevant preferences for such complex technologies as WGS. PHP238 Have Budget Impact Analyses Included Clinical Outcomes? Wang-Silvanto J1, Taylor M2, Buckland A1, Hirst A1, Shephard C1, Vlachaki I1 1WG Access Ltd, London, UK, 2York Health Economics Consortium, York, UK

Objectives: Healthcare decision makers are increasingly using Budget Impact Analysis (BIA) to capture the financial impact of adopting a new health technology. Clinical outcomes of the health technology have economic consequences, as such the BIA should include these outcomes. The current guidance on BIA, such as that provided by ISPOR and NICE, recommend that clinical outcomes, including survival benefits and adverse events, should be incorporated; however, it is unclear how often this occurs in practice. The objective of this research was to find out how many published BIAs have included clinical outcomes.  Methods: A targeted literature review was conducted. The search strategy was developed with key words and MESH terms around ‘budget impact’, ‘clinical health outcomes’, ‘response’, ‘progression free survival’, ‘overall survival’, and ‘adverse events’. Databases searched were MEDLINE, EMBASE, Cochrane, EconLit, and NHS EED. Searches were restricted to English language articles published between 1990 and 2015. Abstracts were reviewed and relevant full papers were retrieved. A data extraction table was used to extract the information, and the final findings were summarised.  Results: Out of 515 papers identified, there were only 23 papers (4%) that included some kind of clinical outcome such as adverse events. Only 6 papers (1%) included all clinical outcomes specified in the searches such as progression free survival, overall survival, and adverse events. All of these 6 papers adopted a similar method to those used in cost-effectiveness models in that parametric models were developed in order to estimate the cost consequences of these clinical events.  Conclusions: Despite the recommendations in HTA guidelines, the practice of incorporating clinical outcomes in the BIA is limited. More research is required in this area to find out why this is the case, and how to improve the BIA to incorporate the outcomes that have substantial cost impact. PHP239 Utilization Of Physiotherapy Visits Completed In Specialized Home Care In Hungary Between 2010 And 2014 Molics B1, Simon-Ugron Á2, Mihajlovic I3, Gyuró M1, Ács P1, Varga V1, Rátgéber L4, Boncz I1 of Pécs, Pécs, Hungary, 2Babes-Bolyai University Cluj-Napoc, Cluj-Napoca, Romania, 3University of Novi Sad, Novi Sad, Serbia, 4Ratgeber Academia, Pécs, Hungary

1University

Objectives: Specialized home care was introduced in primary care in Hungary in 1996. The aim of our study was to investigate the number of rounds completed in specialized home care and their distribution between nursing and physiotherapy services.  Methods: The data come from the database of the National Health Fund, through the Central Statistics Office, being the only health financing agency in Hungary. We analyzed the number of home care visits and its distribution among specialized care and physiotherapy services.  Results: The number of specialized home care visits accounted for values between 1106396 and 1310093 in the period of