Healthcare Resource Use And Economic Burden Attributable To Respiratory Syncytial Virus In The United States

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PIN97 Determinants Of Herpes Zoster Vaccine Acceptability Among Older People In The UK Lu IX1, Bricout H2, Lecomte C3, Sevdalis N4, Torcel-Pagnon L2, Wheelock A5 1MSD, Lyon, France, 2Sanofi Pasteur, Lyon, France, 3QuintilesIMS, Paris, France, 4King’s College London, London, UK, 5Imperial College London, London, UK

Objectives: Barriers to adult immunisation persist as rates for Herpes Zoster (HZ) vaccine among eligible individuals in the UK have decreased. The aim was to identify factors associated with the uptake of HZ vaccination and to gauge their importance to vaccination uptake.  Methods: In this non-interventional multicentre, primary healthcare-based study, cases and controls were individuals who were the last cohort (79 years old) eligible for the HZ vaccination campaign in 2014-2015 to eradicate the risk of influencing future HZ vaccination decisions. Data were collected using an anonymised self-administered questionnaire completed by responders. The Health Belief Model (HBM) provided the theoretical framework for the development of the questionnaire, which included demographic and socio-economic characteristics, health status, knowledge, influences, experiences and attitudes to HZ and the HZ vaccination. Multivariable logistic regression was used to identify factors associated with participants’ decision to receive the HZ vaccine.  Results: Among the 2,530 eligible individuals contacted, 536 (21.2%) responded to the questionnaire. HZ vaccination uptake was 64.2%. Overall, 44% of variance in behaviour was accounted for by the model including all factors, 32% by the model using HBM constructs by scale, and only 14% was accounted for by demographics and socio-economics. Perceived barrier (OR= 0.7, p-value= 0.034), perceived control of disease (OR= 0.7, p-value= 0.004), and HZ history (OR= 0.2, p-value< .0001) significantly decreased likelihood of vaccination.  Conclusions: Longitudinally, HZ vaccination acceptability would be improved by efficient vaccination campaigns and communication interventions with in-depth understanding of psychosocial factors that drive or hinder vaccination. PIN98 Pattern Of Anti-Infective Drugs Use In A Tertiary Healthcare Facility In Nigeria Ogbonna BO1, Epundu UU2, Onyeyili A2 1Nnamdi Azikiwe University Awka, Awka, Nigeria, 2Nnamdi Azikiwe University Teaching Hospital Nnewi, Awka, Nigeria

Objectives: Given the increasing need to promote rational use of drugs, the World Health Organization (WHO) encourages regular drug utilization evaluation (DUE) in healthcare facilities to provide insight into patterns, quality, and determinants of drug use. This study profiled anti-infectives to understand their extent of use.  Methods: The study was a cross sectional retrospective analysis of patients prescription records from June to December 2016, based on WHO’s recommended drug use indicators. Data were analyzed using descriptive statistics.  Results: Of the 624.0 patients prescription records studied, 329.0 (55.0%) were females. The mean age was 42.0±4.6 years while the mean number of drugs per prescription was 2.94±0.6 against the reference value of 1.6 - 1.8. Out of 1833.0 drugs prescribed, 646.0 (32.2%) were anti-infectives. The number of drugs prescribed by generic was 975.0 (53.2%) against the 100.0% benchmark recommended by WHO. This comprised of antibacterial drugs 475.0 (73.5%) against a standard reference of 20.0 – 26.8, antivirals 4.0 (0.6%), antifungal drugs 16 (2.5%), antiprotozoal 120.0 (18.6%), and anthelmintics 31.0 (4.8%). Of the anti-infectives prescribed, quinolones were the most prescribed 213.0 (44.8%) followed by amoxicillin+Clavulanic acid 52.0 (11.0%). The most prescribed quinolone was ciprofloxacin 146.0 (30.7%) followed by ofloxacin 65.0 (13.7%). The most prescribed antiprotozoal agent was metronidazole 91.0 (75.8%). The anti-infectives prescribed as injectables were 188.0 (29.1%).  Conclusions: The high use of anti-infectives was an indication of high prevalence of infections and irrational use of drugs. Other indications for irrationality in drug use include poor generic prescribing, higher number of drugs per prescription, and high proportion of injectables. They predispose patients to high cost of medicines and non-adherence considering catastrophic spending in developing countries driven by rise in pharmaceutical expenditures. This baseline study has provided fundamental data for further studies in promoting the rational use of anti-infectives in Nigeria. PIN99 A Retrospective Study On The Antiretroviral Drug Dispensing And Adherence Of The Hungarian HIV Infected Population Takács P1, Halász V1, Tronczynski K2, Duchesne I2, Merth G3, Merész G3, Kasza K3, Rózsa P3, Szlávik J4 1Janssen-Cilag, Budapest, Hungary, 2Janssen EMEA, Beerse, Belgium, 3MediConcept, Budapest, Hungary, 4St. István and St. László United Hospital, Budapest, Hungary

Background: The HEARTS (HIV  Epidemiology and  AntiRetroviral  Treatment  Study) is a non-interventional retrospective claims database study of patients receiving healthcare services for their HIV infection between 2005 and 2015 in Hungary (n= 1772), who were identified from the National Health Insurance Fund Administration databases based on multiple criteria including International Classification of Diseases and International Classification of Procedures in Medicine codes, and medication purchase data. The first results about the epidemiology of HIV patients was published earlier. During the entire period, a total of 1,496 (84.4%) of the prevalent patients received antiretroviral (ARV) treatment.  Objectives: In this part of the study, our aim was to investigate the changes of ARV drug dispensing over time at active substance and drug class level, to determine the therapeutic adherence of patients and to examine the persistence of active substances as third agents of combination therapies, especially darunavir (DRV).  Methods: The method of the ARV drug utilization analysis is based on days of treatment estimation  Results: Between 2005 and 2015 the most commonly dispended protease inhibitors (PI) were ritonavir (alone or as pharmacokinetic booster) (35%) and DRV (28%), whilst the patients most often used lamivudine (62%), tenofovir (56%) and zidovidin+lamivudine (41%) as their dual nucleoside reverse transcriptase inhibitor (NRTI) backbone. The adherence of the treated prevalent population was fair (≥ 80%)

as defined by the PDC (proportion of days covered) ratio. Considering the third agent consumption of the adherent patient population, amongst PI’s persistence of DRV was the highest. Assuming 60-day gaps, the 1-year and 5-year persistence was 87% and 51%, respectively, and the median was 1851 days.  Conclusions: Due to the development of ARV therapies and understanding their mechanism of action and keeping in mind the perspective of patients, we conclude that the tolerability and simplification of treatment administration could be major aspects of treatment success in real-world settings. PIN100 Prescribing Pattern Of Antibiotics For Acinetobacter Infection In A Tertiary Care Hospital Varghese KE, Sudhapalli V, Kanad D, Vilakkathala R Manipal College of Pharmaceutical Sciences, Manipal University, Udupi, India

Objectives: The objective of this study was to assess the resistance pattern and drug utilization pattern of a patient undergoing treatment for acinetobacter infection.  Methods: A cross sectional, observational, retrospective study, done over a period of 6 months. The data collected was analysed to understand the pattern with respect to patient demographics, prescription patterns, comorbidities as risk factors to infection, and resistance patterns.  Results: The study showed that male patients were at a greater risk of A.baumannii infections within age distribution of 41-60 years and 61-80 years. Bacteria was found to be resistant to almost all categories of drugs. The length of stay of a patient with A.baumanni infection was 23.51±27.97 days. Empirical antibiotic therapy was prescribed to most patients and drugs tigecycline and cefixime were used in 47(97.9%) patients. The least prescribed antibiotic was Piperacillin – Tazobactam in 25 (42.9%) patients. Cefoperazonesulbactam was also found to be active against the bacterium.  Conclusions: This study concluded that male patients were at a greater risk of A.baumannii infections. Tigecycline and Cefixime were the most prominently used antibiotics. The strain in this study was resistant to almost all cephalosporins except CefoperazoneSulbactam which had activity in 57.14% of the samples tested. PIN101 Economic Burden Of Vaccine Preventable Infectious Diseases Among Elderly Patients In Dutch Hospitals Dvortsin E1, Connolly M2, Standaert B3, Postma MJ2 of Groningen / Asc Academics, Groningen, The Netherlands, 2University of Groningen, Groningen, The Netherlands, 3GSK, Wavre, Belgium

1University

Objectives: Our immune system becomes less responsive to infections with age and therefore an increase in transmissible diseases is observed among elderly people aged 60+. These infections may trigger the manifestation of a real underlying chronic disease such as cardio-vascular or respiratory that may often lead to hospitalization of long duration with a high cost. Our study aimed to investigate the cost of primary and secondary diagnosis of vaccine preventable diseases causing hospital admissions in patients of 60 years and older in the Netherlands, to understand the magnitude of potential cost savings.  Methods: The Dutch Hospital Dataset was used to retrieve the number of diagnoses and hospitalisations over the most updated period (2009-2014). Expenditures were derived from governmental websites, and costs were based on references prices commonly used in the Netherlands.  Results: Vaccine-preventable infections account for 4% of total hospital cost for people aged 60+ years. Primary diagnosis accounts for 40%, however, 60% is through secondary diagnosis. A high increase in hospitalizations is observed over time among secondary diagnoses (+120%), coupled to an increase in number of bed days (+32%), while the average hospital stay dramatically decreases (-44%). This could argue that care is becoming either more effective, or less extensive. The number of beds available is slightly reduced as well (-4%), which is alarming as the demographic projections of the elderly population show increases of 6% in the age category of 60+ years during the coming decennia, potentially leading to a higher stress of the healthcare infrastructure, and a subsequent increase of costs.  Conclusions: The number of hospitalizations and associated costs of primary and secondary diagnosis of vaccine preventable diseases are increasing, and could potentially increase more due to the impending ‘double ageing’. Decision makers should consider using already available vaccines to prevent some of these costs. PIN102 Healthcare Resource Use And Economic Burden Attributable To Respiratory Syncytial Virus In The United States Amand C1, Tong S2, Kieffer A3, Kyaw M4 1Sanofi, Chilly Mazarin, France, 2IVIDATA, LEVALLOIS PERRET, France, 3SANOFI PASTEUR, LYON, France, 4SANOFI PASTEUR, SWIFTWATER, PA, United States Minor Outlying Islands

Objectives: Despite several studies that have estimated economic impact of Respiratory Syncytial Virus (RSV), limited data are available on healthcare costs attributable to RSV. The aim of this study was to quantity age specific RSV related costs on the US healthcare system.  Methods: This retrospective case-control study identified RSV patients in the Truven Health Marketscan® Commercial Claims and Encounters database from August 31th 2012 to August 1st 2013, using the primary diagnosis for RSV specific ICD 9 codes (0.79.6, 466.11 or 480.1). RSV patients (cases) and non-RSV patients (controls) were matched 1:1 for age, gender, region, healthcare plan and index date. Stratified analyses were conducted by age groups. RSV related costs were assessed based on incremental differences in resource use and costs between cases and controls.  Results: The unadjusted average costs attributable to RSV were higher in elderly than in adults and children: elderly: US$15,050 to $26,151 and children & adults: $1,727$ to $8,796. Among children, unadjusted costs attributable to RSV were higher in children aged 5-17 years ($8,796). RSV patients had a higher healthcare resource use (hospital stays, ER/UC visits, ambulatory visits and outpatient visits) than controls (non-RSV patients) in all age groups (all P< 0.01), particularly in the elderly age groups (0.4 to 0.5 more ER/UC visits, 0.7 to 2.7 more ambulatory visits, 12.1 to 18.6 more outpatient visits and 9.5 to 14.6 more prescriptions than elderly in the control groups).  Conclusions: Our findings showed a



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substantial annual healthcare costs and resource use due to RSV in the US. These data can be used in cost effective analyses and are useful for policy maker to guide future RSV vaccination programs and other effective interventions and therapies. PIN103 Impact Of Seasonal Infections On Overcrowding In A Paediatric Department Of A French Hospital In Marseille: A Retrospective Analysis Guelfucci F1, Aballea S1, Colin X2, Argoubi R3, Pouchoux C4, Dubus J4 1Creativ-Ceutical, Paris, France, 2GSK, Marly-le-Roi, France, 3Creativ-Ceutical, Tunis,

Tunisia, 4Hôpital-Nord, Marseille, France

Objectives: The objective of this study was to assess the impact of seasonal infections on overcrowding in one university paediatric department of a French hospital.  Methods: This study was a retrospective analysis using electronic records provided by a French hospital (Hôpital Nord, Marseille). All admissions of children aged less than 5 years in the paediatric department of the hospital occurring between 1 January 2012 and 31 December 2016 were analysed. The paediatric department was considered overcrowded in a given week if the bed occupancy rate exceeded 85%, threshold derived from the literature. Children admitted for bronchiolitis or gastroenteritis were identified using ICD-10 codes selected based on the department coding practice. Proportions of cases with bronchiolitis and gastro-enteritis admitted in the department were calculated during overcrowding periods.  Results: The paediatric department recorded 1021 to 1321 admissions per year, 30% to 50% of which were cases of gastroenteritis (8.3% [2012] to 17.2% [2016]) or bronchiolitis (22.3% [2013] to 32.7% [2016]). Over the 5 years, there were 20 weeks of overcrowding (1 to 7 weeks per year), 18 of which occurred during periods from October to April (predominantly December and January). Bronchiolitis and gastroenteritis were associated with 52.7% and 10.6% of admissions respectively during overcrowding periods. During overcrowding weeks, the proportion of bronchiolitis and gastroenteritis patients transferred to the paediatric surgery department increased from 4.8% to 16.0%.  Conclusions: During winter, the paediatric department of the studied hospital handled a large influx of patients with bronchiolitis and gastro-enteritis, leading to overcrowding situations that can cause disruption and degradation of the quality of care. PIN104 Budget Impact Analysis Of Treatments For Hepatitis C Virus: What’s New? Garagiola E1, Foglia E1, Ferrario L1, Menzaghi B2, Pizzi MG2, Rizzardini G3, Croce D1 1LIUC University, Castellanza, Italy, 2ASST Valle Olona, Busto Arsizio, Italy, 3ASST Fatebenefratelli Sacco, Milan, Italy

Objectives: While novel drugs (DAAs) for Hepatitis C Virus (HCV) care are more effective than interferon-based therapies used in the past, they represent a significant economic absorption for healthcare providers, particularly within the Italian setting, characterised by continuous spending review actions. The present study aimed at estimating the budget impact of the recently introduced treatments (Velpatasvir, a pan-genotypic regimen, and Zepatier), for a more accurate healthcare planning and decision making in the HCV setting.  Methods: A three-year budget impact analysis (BIA) was developed, taking into consideration the National Healthcare Service point of view, considering the overall HCV and HIV/HCV population. Patients’ previous medical history, degree of liver fibrosis, genotypes, achievement of sustained virological response (SVR) and direct healthcare total costs were the model input variables. Data were collected from scientific evidence, regional and national legislation, administrative information and consumption data of two Hospitals (Valle Olona and Fatebenefratelli Sacco), and expert opinions.  Results: From a national perspective (population at point of care= 393.102), on the basis of current reimbursement criteria (F3-F4), at the 36 month-horizon, the introduction of the novel therapies could lead economic savings (-7%). Enlarging the reimbursement criteria to F0-F2, at the first year, patients achieving a SVR condition increase (+25%), although an initial investment is necessary (that mean an increase of costs of 0.33%), recovered within 24 months, generating economic benefits for the NHS (-16% in second year and -20% in third year).  Conclusions: The proposed healthcare planning tool are useful in order to provide clinicians and policy makers a consistent economic forecast to allocate HCV patients. An investment in new HCV drugs would reduce the national healthcare expenditure, especially concentrating all the eligible patients (including F0-F2 individuals, with the consequent avoidance of Interferon-based combinations), within the same drug regimen could be considered a cost-effective strategy. PIN105 Adapting The United States’ Antimicrobial Stewardship Programme Guidelines To Build An Economic Evaluation Framework For Chinese Hospitals Gao X1, Chen Y2, Jiang S1, Lesher B1, Yang F3, Dong P2, Charbonneau C4 1Pharmerit International, Bethesda, MD, USA, 2Pfizer Investment Co. Ltd., Beijing, China, 3Institute of Antibiotics, Shanghai, China, 4Pfizer P.I.O., Paris, France

Objectives: Antimicrobial stewardship programmes (AmSPs) are widely reported to support appropriate antibiotic use and help control antibiotic resistance. However, the value of AmSPs has not been fully studied and there is a lack of established AmSP value evaluation framework in China. This study aimed to develop a China-specific AmSP evaluation framework by referring to the existing U.S. guidelines and supplementing with the unique characteristics of Chinese AmSPs.  Methods: Experts from geographically representative Chinese hospitals were interviewed face-to-face between August-October 2016 using the questionnaire developed based on the U.S. Center for Disease Control and Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection guidelines. An evaluation model framework adapted to the Chinese healthcare system was developed based on the US guidelines and survey responses.  Results: The interviewed experts were infectious disease specialists (n= 6) or hospital/pharmacy directors (n= 3) from 9 tertiary/Grade A hospitals with active AmSPs (average implementing time= 3 years) in Beijing, Shanghai, Guangzhou, and Chengdu. Most components from the U.S. guidelines

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were incorporated into the Chinese framework with 3 main categories: resource needs (personnel, equipment), related clinical outcomes (antimicrobial resistant rate, mortality), and health economic impact (length of stay, defined daily dose). Main differences from U.S. include: 1) limited/no pharmacist involvement in routine participation in intravenous-to-oral switch programs, antibiotic dose modifications/ discontinuations; 2) inclusion of more economic outcome endpoints of AmSPs (e.g., ICU use, reduced intravenous days due to early switch, hospital onset infection rate, and restricted antimicrobial drugs use); and 3) taking a hospital business case perspective by adding a return-on-investment calculation.  Conclusions: This study is the first step to develop a comprehensive AmSP evaluation framework for Chinese hospitals. It will help Chinese hospital decision-makers measure the costs and benefits associated with their specific AmSP and gain a better understanding of their value, thus creating an enhanced engagement in implementing AmSPs. PIN106 Influenza Vaccination Among Pregnant Women: Exploratory Analysis From The 2012-2015 National Health Interview Survey Chan H1, Chang J2, Erickson SR3, Wang C1 1School of Pharmacy, National Taiwan University, Taipei, Taiwan, 2Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, 3University of Michigan, Ann Arbor, VA, USA

Objectives: The issue of suboptimal flu vaccine coverage during pregnancy has been previously addressed by studies conducted with internet panel survey and several active surveillance systems. However, most of them suffered from insufficient statistical comparison due to lacking complex probabilistic sampling design. Our study aimed to explore the determinants and coverage of influenza vaccination among pregnant women using a national representative sample of the United States.  Methods: This study was conducted with the 2012-2015 National Health Interview Survey (NHIS). The Andersen Behavioral Model of Health Services Use was applied as the conceptual framework to explore potential factors that may influence the flu vaccination rate. A series of individual determinants, categorized into predisposing, enabling and need factors, were compared using logistic regressions between women who received flu shot before/during pregnancy and those who did not. All analyses were adjusted for complex survey designs and sample weights using SAS 9.4 (SAS Institute, Cary NC).  Results: Among an estimated 4.8 million pregnant women, an average of 35% women received influenza vaccination before/during pregnancy. The odds of receiving a flu shot before/during pregnancy was lower among non-Caucasian ethnicity groups (odds ratio (OR) [95% confidence interval (CI)], African American, 0.777 [0.550-1.098]; others, 0.636 [0.4290.942]), women without usual source of health care (OR, 0.647 [0.442-0.945]), and women with heavier alcohol consumption (OR, 0.601 [0.403-0.894]). In contrast, higher education and family income were positively correlated with influenza vaccination, with an OR of 1.763, [1.290-2.409] (> =  bachelor’s degree versus < =  high school) and 2.038 [1.368-3.035] (ratio of family income to the poverty threshold category > 4 versus < 1), respectively.  Conclusions: No usual source of health care, poverty, lower education level and alcohol drinking behavior appeared to be negatively associated with influenza vaccination during pregnancy. Policy makers may consider developing interventions to improve the vaccination rate among these subgroups. PIN107 Knowledge Of Leptospirosis Among Malaysian Wet Market Sellers Ismail NE1, Ahmad S1, Johari AN2, Ishak NA2, Husin N2 1MAHSA University, Bandar Saujana Putra, Jenjarom Kuala Langat, Selangor, Malaysia, 2Universiti Teknologi MARA, Bandar Puncak Alam, Selangor, Malaysia

Objectives: The study aimed to assess the knowledge level of leptospirosis among Malaysian wet market sellers and investigated the differences, association, and predictors of independent variables with measured knowledge.  Methods: In this cross-sectional study, post ethics approval, wet market sellers (≥  18 years old) in Klang and Shah Alam, Selangor, Malaysia, were given reliable and validated selfadministered questionnaires determined by Rasch analysis that consisted of sociodemographic, medical and source of knowledge (n =  11 items), and knowledge (n =  26 items) of leptospirosis covering causes, signs, symptoms, complications, treatment, prevention and risk factors of leptospirosis (“correct”, “incorrect” or “don’t know” answers scored “2”, “0” and “1” mark(s), respectively). The collected data from January until March 2015 were statistically analysed using SPSS version 20.  Results: A total of 140 wet market sellers were recruited in this study. The mean (SD) age of the respondents was 36.37 years old. The mean (SD) number of years working at wet market was 8.72 (6.94) years. Majority of the respondents had moderate knowledge with percentage score of 51.4 (moderate: score <  72 %). There were statistical significant differences in the mean scores of the knowledge of leptospirosis with gender, marital status, ethnicity, highest completed level of education, type of occupation, and whether they had ever heard of leptospirosis (independent samples t-test and ANOVA). There were significant associations between knowledge and highest completed level of education, occupation, and ever heard of leptospirosis (chi-square test for independence). Two predictors that made statistically significant contribution to knowledge score were the highest completed level of education, and ever heard of leptospirosis that had a negative relationship with knowledge score while the other had positive relationship (multiple linear regressions).  Conclusions: Malaysian wet market sellers possessed moderate knowledge level of leptospirosis, with significant differences and relationship with independent study variables, hence warrant leptospirosis education programme. PIN108 Maternal Screening And Treatment For Group B Streptococcus (GBS) Are Associated With Non-Adherence To Guidelines, False-Negative Results And High Management Costs In The United Kingdom, Italy, France, Spain And Germany Iadeluca L1, Farrington E2, McLean T2, Rousseau B2, Agosti Y3, Absalon J4, Anderson AS4