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INFLAMMATORY BOWEL DISEASE: COST-DRIVING FACTORS AND THE IMPACT OF COST-SHARING ON OUTPATIENT UTILIZATION
A318
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
PGI31 INFLAMMATORY BOWEL DISEASE: COST-DRIVING FACTORS AND THE IMPACT OF COST-SHARING ON OUTPATIENT UTILIZATION
PGI33 HARVONI ACCESS AND UTILIZATION TRENDS IN FIFTY MEDICAID PROGRAMS IN THE UNITED STATES
Le d V 1, Vaidya V 2, Goodman M 3, Khuder S 3 of toledo, toledo, OH, USA, 2The University of Toledo, Toledo, OH, USA, 3University of Toledo, Toledo, OH, USA
Aggarwal S 1, Kumar S 2, Topaloglu H 1 Health Strategies, Chevy Chase, MD, USA, 2Institute for Global Policy Research, Washington, DC, USA
Objectives: Inflammatory bowel disease (IBD) is chronic gastro-intestinal diseases with high annual cost per person. Appropriate outpatient care is crucial in reducing cost and improving patient outcomes in IBD. However, high cost sharing can force patients to forgo necessary outpatient treatments. This research aims to (1) identify the cost-driving factors of health expenditure in IBD, (2) determine the effect of different cost-sharing levels on outpatient visits, and (3) determine the effect of different cost-sharing levels on medication adherence among patients with IBD. Methods: This is a retrospective, longitudinal study in which data was collected from 1999 to 2013 using the Medical Expenditure Panel Survey (MEPS). The study sample included all patients who were identified with IBD in MEPS using International Classification of Diseases (ICD) 9 code of 555 and 556, were at least 18 years old, and had some type of insurance (public or private). To identify the cost-driving factors, a logistic regression will be built to determine which multiple baseline factors (age, gender, race, body mass index, education, insurance type, income, smoking, perceived quality of life, and comorbidity) are significantly associated with higher expenditure in IBD. Appropriate regression models will be used to determine whether cost sharing are associated with the number of outpatient visits and medication adherence (measured in term of Medication Possession Ratio). Statistical significance will be evaluated at P < 0.05. Results: About 553 insured adults with IBD have been identified from the MEPS database. The preliminary results showed that the annual, inflation-adjusted health expenditure for IBD is about $ 9,000, which is close to the published figures. The final result will include the significant cost-driving factors of the IBD’s health expenditure and will conclude whether cost sharing has a significant impact on outpatient care. Conclusions: Research in progress. Results and conclusion will be presented at the conference.
Objectives: Harvoni is one of the breakthrough drugs for approved for HCV. Medicaid programs have expressed concerns regarding high budget impact of HCV medications. The objectives of this study were to analyze Harvoni’s launch year utilization trends in 50 fifty Medicaid programs and assess spending correlations to local HCV prevalence. Methods: The data for Harvoni’s sales were obtained from individual Medicaid programs. The HCV state level epidemiology was obtained from latest published peer-reviewed studies. Correlations were assessed for prescription units and total sales with HCV prevalence. Results: In the first full year of Harvoni’s launch the total sales in Medicaid programs was $870 million. Harvoni ranked number 1 in 2015 as the highest budget impact drug for Medicaid (the second and third highest selling drugs were Methlyphen and Lantus with sales of $410 million and $360 million, respectively). The per prescription average price of Harvoni for Medicaid was $29,308, which is ~70% discounted compared to the national list price. At the State level, the highest utilization of Harvoni was in New York ($236 million) followed by Connecticut ($76 million) and Massachusetts ($54 million). The average per state spending was $17.6 million, with standard deviation of $35million, suggesting high variation in spending patterns across regions in the US. Similarly, wide variations were observed when States were compared for percentage of total drug spending for Harvoni. There was no correlation to state level spending with local incidence (R= -0.07) or total population (R= -0.08). However, there was a relatively strong correlation (R= 0.47) to State spending level with number of reported diagnosed patients (using CDC state level data). Conclusions: Harvoni set a record by reaching Medicaid sales of ~$870 million within first full year of launch. State level trends show a high variation in spending patterns, potentially leading to disparity in access to Harvoni in some States.
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1University
PGI32 PHARMACOEPIDEMIOLOGY OF CROHN’S DISEASE MANAGEMENT IN THE BRAZILIAN PUBLIC HEALTH SYSTEM
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1NOVEL
PGI34 PATIENT CHARACTERISTICS AND TREATMENT AMONG ELDERLY INFLAMMATORY BOWEL DISEASE PATIENTS: A RESTROSPECTIVE DATABASE ANALYSIS
1UCB
Khan N 1, Unniachan S 2, Vallarino C 2, Lasch K 2, Lissoos T 2, Luo M 2 of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA, 2Takeda Pharmaceuticals Inc, Deerfield, IL, USA
Objectives: Very little information is available about treatment protocols for Crohn’s disease (CD) in Brazil. The objective of this study was to examine pharmacoepidemiological data to identify how CD has been treated in Brazil and consider the need for additional treatment options. Methods: Patients with CD and their treatments were analyzed retrospectively from the Brazilian Unified Health System (SUS) database, the DATASUS. The study period was defined as January 2008 to December 2014, with emphasis on the last two years. CD was identified by the International Code of Diseases (ICD) 10 code K50 in the prescription claims. The analyzed variables included age, gender, geographical region and therapy. Results: In DATASUS during 2013 (n= 27,904) and 2014 (n= 31,029), approximately 71% of patients with CD were age 25 to 60 years and 56% were female. In 2014, the majority of treated patients were located in the Southeast region (n= 19,938, 64%), and the state with the highest number of treated patients was São Paulo (n= 12,803 41%). Mesalazine and azathioprine were used in 69% of patients; adalimumab and infliximab were used in 26% of patients. The number of patients who were treated for CD increased 49% from 2008 to 2014 and use of biologic therapies increased 4.5 times. Biologics with the highest growth rates between 2013 and 2014 were adalimumab (30%) and infliximab (23%), indicating an increasing demand. The prevalence of CD management (per 1000 people in the general population) varied in the different geographical regions: Southeast (23), South (18), Northeast (6), Midwest (11) and North (1). Conclusions: While the number of patients with CD who are treated with biologics is increasing overall, we observed a large discrepancy in the prevalence of therapy by geographical region. Recent increases in the use of biologics suggest a need for additional treatment options for CD in Brazil.
Objectives: There is paucity of guidelines addressing the management of inflammatory bowel disease (IBD) among elderly patients (≥ 65 years old). This study aims to assess the demographic features of elderly patients with IBD and treatment modalities employed to manage the disease in this cohort while comparing to 18-64 year-old adult patients. Methods: Retrospective study using MarketScan database in adults with ulcerative colitis(UC) or Crohn’s disease(CD) during 2010-2014. UC or CD diagnoses were confirmed with at least two diagnostic claims ≥ 30 days apart. The index date was the date of initiation of corticosteroids(CS), immunomodulators or biologic therapy after the IBD diagnosis. Descriptive summary statistics were used to compare baseline demographic and clinical factors and IBD treatment between patients 18-64 and ≥ 65 years old. Results: Among 63,770 IBD patients (28,328 CD and 35,442 UC patients) identified, 8,790 (13.8%) were ≥ 65 years old. Compared to 18-64 year olds, the elderly had more multiple comorbidities (mean Charlson score -1.00 vs. 0.29,P< 0. 0001), osteoporosis (6% vs. 1.6%,P< 0. 001), baseline cancer (16.5% vs. 4.4%,P< 0. 0001) and used ≥ 5 concomitant medications at baseline (53.8% vs. 24%,P< 0. 0001). Overall, significantly higher proportion (all P< 0. 0001) of elderly patients (92.6%) were initiated on CS compared to 18-64 year olds (83.9%), which is consistent among UC (95.4% vs. 91.0%) and CD (88.2% vs. 75.3%) subgroups. In contrast, immunomodulator (4.8% elderly, 8.4% 18-64) and biologics, mainly antiTNFs (2.5% elderly, 7.8% 18-64) were initiated less frequently among elderly than the 18- 64 year-olds. Conclusions: This study indicates that CS use is more prevalent in the elderly than younger IBD patients, despite a higher potential of exacerbating comorbid conditions in older patients. The utilization rates for CS-sparing biologic and immunomodulator drugs were lower among elderly IBD patients indicating potential gaps in the treatment of elderly IBD patients.
Valle A 1, Carlos Queiroz Marques J 2, Seraphim F 2, Nita M E 3, Carmo E 1 Biopharma SA, São Paulo, Brazil, 2Close-Up International, São Paulo, Brazil, 3FIPE Fundação Institute de Ensino e Pesquisas Econômicas, Sao Paulo, Brazil .
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1University
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
PGI31 INFLAMMATORY BOWEL DISEASE: COST-DRIVING FACTORS AND THE IMPACT OF COST-SHARING ON OUTPATIENT UTILIZATION
PGI33 HARVONI ACCESS AND UTILIZATION TRENDS IN FIFTY MEDICAID PROGRAMS IN THE UNITED STATES
Le d V 1, Vaidya V 2, Goodman M 3, Khuder S 3 of toledo, toledo, OH, USA, 2The University of Toledo, Toledo, OH, USA, 3University of Toledo, Toledo, OH, USA
Aggarwal S 1, Kumar S 2, Topaloglu H 1 Health Strategies, Chevy Chase, MD, USA, 2Institute for Global Policy Research, Washington, DC, USA
Objectives: Inflammatory bowel disease (IBD) is chronic gastro-intestinal diseases with high annual cost per person. Appropriate outpatient care is crucial in reducing cost and improving patient outcomes in IBD. However, high cost sharing can force patients to forgo necessary outpatient treatments. This research aims to (1) identify the cost-driving factors of health expenditure in IBD, (2) determine the effect of different cost-sharing levels on outpatient visits, and (3) determine the effect of different cost-sharing levels on medication adherence among patients with IBD. Methods: This is a retrospective, longitudinal study in which data was collected from 1999 to 2013 using the Medical Expenditure Panel Survey (MEPS). The study sample included all patients who were identified with IBD in MEPS using International Classification of Diseases (ICD) 9 code of 555 and 556, were at least 18 years old, and had some type of insurance (public or private). To identify the cost-driving factors, a logistic regression will be built to determine which multiple baseline factors (age, gender, race, body mass index, education, insurance type, income, smoking, perceived quality of life, and comorbidity) are significantly associated with higher expenditure in IBD. Appropriate regression models will be used to determine whether cost sharing are associated with the number of outpatient visits and medication adherence (measured in term of Medication Possession Ratio). Statistical significance will be evaluated at P < 0.05. Results: About 553 insured adults with IBD have been identified from the MEPS database. The preliminary results showed that the annual, inflation-adjusted health expenditure for IBD is about $ 9,000, which is close to the published figures. The final result will include the significant cost-driving factors of the IBD’s health expenditure and will conclude whether cost sharing has a significant impact on outpatient care. Conclusions: Research in progress. Results and conclusion will be presented at the conference.
Objectives: Harvoni is one of the breakthrough drugs for approved for HCV. Medicaid programs have expressed concerns regarding high budget impact of HCV medications. The objectives of this study were to analyze Harvoni’s launch year utilization trends in 50 fifty Medicaid programs and assess spending correlations to local HCV prevalence. Methods: The data for Harvoni’s sales were obtained from individual Medicaid programs. The HCV state level epidemiology was obtained from latest published peer-reviewed studies. Correlations were assessed for prescription units and total sales with HCV prevalence. Results: In the first full year of Harvoni’s launch the total sales in Medicaid programs was $870 million. Harvoni ranked number 1 in 2015 as the highest budget impact drug for Medicaid (the second and third highest selling drugs were Methlyphen and Lantus with sales of $410 million and $360 million, respectively). The per prescription average price of Harvoni for Medicaid was $29,308, which is ~70% discounted compared to the national list price. At the State level, the highest utilization of Harvoni was in New York ($236 million) followed by Connecticut ($76 million) and Massachusetts ($54 million). The average per state spending was $17.6 million, with standard deviation of $35million, suggesting high variation in spending patterns across regions in the US. Similarly, wide variations were observed when States were compared for percentage of total drug spending for Harvoni. There was no correlation to state level spending with local incidence (R= -0.07) or total population (R= -0.08). However, there was a relatively strong correlation (R= 0.47) to State spending level with number of reported diagnosed patients (using CDC state level data). Conclusions: Harvoni set a record by reaching Medicaid sales of ~$870 million within first full year of launch. State level trends show a high variation in spending patterns, potentially leading to disparity in access to Harvoni in some States.
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1University
PGI32 PHARMACOEPIDEMIOLOGY OF CROHN’S DISEASE MANAGEMENT IN THE BRAZILIAN PUBLIC HEALTH SYSTEM
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1NOVEL
PGI34 PATIENT CHARACTERISTICS AND TREATMENT AMONG ELDERLY INFLAMMATORY BOWEL DISEASE PATIENTS: A RESTROSPECTIVE DATABASE ANALYSIS
1UCB
Khan N 1, Unniachan S 2, Vallarino C 2, Lasch K 2, Lissoos T 2, Luo M 2 of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA, 2Takeda Pharmaceuticals Inc, Deerfield, IL, USA
Objectives: Very little information is available about treatment protocols for Crohn’s disease (CD) in Brazil. The objective of this study was to examine pharmacoepidemiological data to identify how CD has been treated in Brazil and consider the need for additional treatment options. Methods: Patients with CD and their treatments were analyzed retrospectively from the Brazilian Unified Health System (SUS) database, the DATASUS. The study period was defined as January 2008 to December 2014, with emphasis on the last two years. CD was identified by the International Code of Diseases (ICD) 10 code K50 in the prescription claims. The analyzed variables included age, gender, geographical region and therapy. Results: In DATASUS during 2013 (n= 27,904) and 2014 (n= 31,029), approximately 71% of patients with CD were age 25 to 60 years and 56% were female. In 2014, the majority of treated patients were located in the Southeast region (n= 19,938, 64%), and the state with the highest number of treated patients was São Paulo (n= 12,803 41%). Mesalazine and azathioprine were used in 69% of patients; adalimumab and infliximab were used in 26% of patients. The number of patients who were treated for CD increased 49% from 2008 to 2014 and use of biologic therapies increased 4.5 times. Biologics with the highest growth rates between 2013 and 2014 were adalimumab (30%) and infliximab (23%), indicating an increasing demand. The prevalence of CD management (per 1000 people in the general population) varied in the different geographical regions: Southeast (23), South (18), Northeast (6), Midwest (11) and North (1). Conclusions: While the number of patients with CD who are treated with biologics is increasing overall, we observed a large discrepancy in the prevalence of therapy by geographical region. Recent increases in the use of biologics suggest a need for additional treatment options for CD in Brazil.
Objectives: There is paucity of guidelines addressing the management of inflammatory bowel disease (IBD) among elderly patients (≥ 65 years old). This study aims to assess the demographic features of elderly patients with IBD and treatment modalities employed to manage the disease in this cohort while comparing to 18-64 year-old adult patients. Methods: Retrospective study using MarketScan database in adults with ulcerative colitis(UC) or Crohn’s disease(CD) during 2010-2014. UC or CD diagnoses were confirmed with at least two diagnostic claims ≥ 30 days apart. The index date was the date of initiation of corticosteroids(CS), immunomodulators or biologic therapy after the IBD diagnosis. Descriptive summary statistics were used to compare baseline demographic and clinical factors and IBD treatment between patients 18-64 and ≥ 65 years old. Results: Among 63,770 IBD patients (28,328 CD and 35,442 UC patients) identified, 8,790 (13.8%) were ≥ 65 years old. Compared to 18-64 year olds, the elderly had more multiple comorbidities (mean Charlson score -1.00 vs. 0.29,P< 0. 0001), osteoporosis (6% vs. 1.6%,P< 0. 001), baseline cancer (16.5% vs. 4.4%,P< 0. 0001) and used ≥ 5 concomitant medications at baseline (53.8% vs. 24%,P< 0. 0001). Overall, significantly higher proportion (all P< 0. 0001) of elderly patients (92.6%) were initiated on CS compared to 18-64 year olds (83.9%), which is consistent among UC (95.4% vs. 91.0%) and CD (88.2% vs. 75.3%) subgroups. In contrast, immunomodulator (4.8% elderly, 8.4% 18-64) and biologics, mainly antiTNFs (2.5% elderly, 7.8% 18-64) were initiated less frequently among elderly than the 18- 64 year-olds. Conclusions: This study indicates that CS use is more prevalent in the elderly than younger IBD patients, despite a higher potential of exacerbating comorbid conditions in older patients. The utilization rates for CS-sparing biologic and immunomodulator drugs were lower among elderly IBD patients indicating potential gaps in the treatment of elderly IBD patients.
Valle A 1, Carlos Queiroz Marques J 2, Seraphim F 2, Nita M E 3, Carmo E 1 Biopharma SA, São Paulo, Brazil, 2Close-Up International, São Paulo, Brazil, 3FIPE Fundação Institute de Ensino e Pesquisas Econômicas, Sao Paulo, Brazil .
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1University