Inter-State Variability Of Adult Vaccination Coverage In The United States: Can We Explain It?

VA L U E I N H E A LT H

born 1997 and later. In 2015, more than 95% of 6 year olds are vaccinated once. However, 2-5 years olds only have a coverage of 92%. The coverage for two doses was 85% and 82% respectively. Additionally, it turns out that a third of young adults born before 1997 are missing a second dose.  Conclusions: The model is able to give insights into the situation on measles coverage in Austria and to inform decision makers about the most important issues. Coverage for small children can be presented in a high quality while coverage for teenagers and young adults underlie a greater uncertainty due to immigrants with unknown vaccination status and vaccinations of persons with an undocumented age. PIN114 Inter-State Variability Of Adult Vaccination Coverage In The United States: Can We Explain It? Kurosky S1, Trantham L1, La EM1, Aris E2, Hogea CS3 1RTI Health Solutions, Research Triangle Park, NC, USA, 2GlaxoSmithKline, Wavre, Belgium, 3GSK, Philadelphia, PA, USA

Objectives: Despite routine recommendations, adult uptake of influenza, pneumococcal, pertussis, and zoster vaccines in the United States is low. To inform development of evidence-based vaccination interventions, this study sought to evaluate inter-state variability and better understand local factors influencing adult vaccination coverage.  Methods: Logistic regression models were employed to estimate state-level adult vaccination coverage adjusted for individual-level characteristics using Behavioral Risk Factor Surveillance System data. States were ranked according to the sum of each state’s calculated z-score for each vaccine’s model-adjusted coverage, providing a composite metric across all four vaccines. Further considering the states ranked at the extremes, we then conducted a targeted review of state immunization websites and published literature to describe facilitators/barriers and interventions targeting adult vaccination, using the Social Ecological Model as a guiding theoretical framework to categorize interventions by level of influence on vaccination.  Results: Based on calculated z-scores, New Jersey, Florida, Illinois, Mississippi, and New York were ranked as low coverage states, while Minnesota, Washington, Colorado, Vermont, and New Mexico were ranked as high coverage states. All interventions reported on state immunization websites were implemented at the institutional or policy level, with immunization information systems most frequently reported (n= 10 states). Only a subset of states reported quality improvement programs (n= 6) and standing order interventions (n= 4). Other common interventions were school immunization laws and state-purchased vaccines. All interventions from the literature (n= 12 interventions) targeted improving vaccination at the institutional, interpersonal, or intrapersonal level. Data on state-specific vaccination facilitators/barriers were not identified.  Conclusions: There is substantial inter-state variability in adult vaccination coverage in the United States. Existing data provide very limited insight on local facilitators/barriers or interventions impacting adult vaccination. Further efforts to bridge this information gap are critical towards developing targeted interventions to increase coverage. Collection of qualitative data from local stakeholders may provide further insights. PIN115 A Survey On The Society’s Awareness Level On Aids In Turkey Malhan S1, Oksuz E1, Numanoglu Tekin R2 1Baskent University, Ankara, Turkey, 2Baskent University, Health Care Management, Ankara, Turkey

Objectives: The survey aims to measure the society’s awareness level on AIDS in Turkey.  Methods: Data were collected through a questionnaire on AIDS carried out with face-to-face interview method. A short and clear questionnaire was prepared and it was aimed to reach more people in the society. A total of 21,377 people were reached and information on the society’s awareness level on AIDS was collected.  Results: The mean age was 32.9 and 51.8% of the participators were female and 47.4% were male. 63.3% of respondents stated that they have a lot of information; 22.7% stated that they have little information and 14.1% stated that they have no information about HIV. 74.3% of respondents stated that HIV is transmitted through blood; 10,2% stated that it is transmitted through handshake; 33,8% stated that it is transmitted through kissing; 77,5% stated that it is transmitted through unprotected sex. 25% said that AIDS patients can continue their normal lives after taking the necessary treatment; 32.6% said that they cannot continue their normal life and 42.4% said that they do not know much about it. 53.4% of respondents stated that HIV testing can only be done in hospitals; 39.9% stated that it can be done in primary health care institutions and 6.7% stated that it can be done in all health care institutions. 49.7% of the respondents stated that their identity should be kept secret and that it is not right to submit their identity to the hospital when they have an HIV test.  Conclusions: Although the prevalence of AIDS in Turkey is low compared to other countries, it shows an increasing trend according to the estimations made. However, since the disease is not accepted by the society in terms of culture and religion, the transfer of information on the disease has always been limited. PIN116 Mapping Of Skin And Soft Tissue Infections Worldwide: An Approach From Literature Review Lizano-Díez I, Garrido E, Zsolt I, Espinosa C Ferrer, Barcelona, Spain

Objectives: The aim of this study was to conduct a global mapping of skin and soft tissue infections (SSTIs), to describe its clinical classification (bacterial, viral, parasitic, dermatomycoses and other infestations), as well as the geographical area of occurrence and climate (tropical, subtropical, desert, cold, temperate and others).  Methods: A systematic literature search was conducted (18/05/2017) through the PubMed database to identify the available evidence on SSTIs related to climate and humidity conditions. Five search strategies were designed taking into consideration terms located by MeSH vocabulary. Two additional filters were applied to search results (1. abstract availability; 2. title + abstract screening, in order to identify

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reports of SSTIs). The identified studies were evaluated by two independent reviewers to assess their inclusion in this project.  Results: All search strategies resulted in 1,122 references after duplicates removal. Subsequent filtration excluded 447 of them, resulting in 675 references for analysis. Global results showed that almost 20% of evidence was specific for Central America, Caribbean and Latin America areas (Brazil and Colombia accounted about 60%), followed by Africa (13%; highlighting Nigeria, Cameroon and Ethiopia). More than 50% of publications were focused on reporting a wide casuistry of parasitic SSTIs, followed by dermatomycoses (18%) and bacterial infections (16%). Parasitic SSTIs recorded were related to leishmaniasis in 60% of cases, dermatomycoses showed high variability of cases and bacterial SSTIs were mostly related to staphylococci and streptococci, accounting for 48% of references (i.e. abscess, furunculosis, cellulitis and impetigo/pyoderma). Studies located in tropical and subtropical climates exceeded 40% of total, followed by temperate (18%) and desert (15%). Maps with global and specific results for SSTIs and climates will be disclosed.  Conclusions: The greatest burden of disease occurrs in tropical and subtropical climates (mostly in Central America, Caribbean, Latin America and Africa areas), which are resource-limited settings with endemic populations of SSTIs. PIN117 Processes And Requirements For Health Economic Assessment Of Antibiotics For Hta Purposes: Time For A Paradigm Shift? Gaultney J1, Yesufu-Udechuku A2, Bending MW3 1Mapi Group, Houten, The Netherlands, 2Mapi Group, London, UK, 3Mapi, London, UK

Objectives: Regulatory incentives for development of antibiotics have increased the number approved by EMA allowing them to come to market based on adapted evidence requirements, challenging the generation of evidence required for health technology assessment (HTA) reimbursement decision making purposes and impeding patient access to effective treatments. We aimed to assess the potential mis-alignment between regulatory approval requirements and HTA requirements for antibiotics in Europe.  Methods: A targeted review was conducted to identify the appraisal processes and health economic assessment requirements as well as incentive schemes for antibiotics (NICE, SMC, AWMSG, TLV and HAS). To understand the relationship between EMA approvals and HTA body appraisals, a search via the EMA website was performed to identify all antibiotics that were approved since 2013 followed by a search via the HTA body website to identify those that were eventually appraised. Finally, a review of the HTA appraisal challenges with the health economic assessment was performed.  Results: All but NICE appraise innovative antibiotics. Of those, only HAS instituted adapted appraisal criteria for antibiotics. Since 2013, a total of 8 antibiotics were approved by EMA. The SMC appraised all antibiotics on this list (n= 8), followed by HAS (n= 5), AWMSG (n= 4) and TLV (n= 3). The appraisals cited the following challenges with the health economic assessment: difficulty in establishing added therapeutic effectiveness due to non-inferiority design, small sample size and uncertainty around treatment effects, short treatment duration hindering lifetime horizon, and choice of comparators. None incorporated the impact of treatment on resistance and spill-over effects.  Conclusions: HTA processes in Europe need to be adapted for innovative antibiotics to support the regulatory incentives for their development and to accelerate patient access. As a start, traditional requirements for health economic assessment methodology, which does not capture the public health value of antibiotics, should be adapted specifically for antibiotics. PIN118 Are We Prep-Ared For Differences Between Nice And SMC Decision Making? Hendrich J, Boodhna T WG Access, London, UK

Objectives: Recently, emtricitabine/tenofovir disoproxil for pre-exposure prophylaxis (PrEP) of HIV has been approved by NHS Scotland after appraisal by the SMC. However, following an evidence review by NICE it has been decided that further study is required before emtricitabine/tenofovir disoproxil can be approved for use in England. A case study was performed to evaluate this recent disparity between NHS England and NHS Scotland.  Methods: A comparative evaluation was performed to assess differences in decision making between each agency regarding emtricitabine/tenofovir disoproxil. The methods and findings of Evidence Summary ESNM78 from NICE and the SMC technology appraisal (No. 1225/17) were compared qualitatively. The NICE evidence summary did not offer formal guidance or include economic analysis.  Results: NICE evaluated data from four clinical trials of emtricitabine/tenofovir disoproxil, compared with the SMC which focused on two of the studies. Both bodies considered the drug combination to be clinically effective, with NICE reporting a reduced relative risk (of acquiring HIV infection) between 44% and 86% compared with placebo or no prophylaxis. The SMC performed an economic analysis, which estimated an annual cost of £4,316 per patient (£4.27m overall annual cost). However, the NICE evidence summary did not consider it possible to provide estimated usage based on the available data, citing prioritisation and eligibility criteria as factors influencing uptake.  Conclusions: This decision makes Scotland the first country in the UK to adopt emtricitabine/tenofovir disoproxil for PrEP of HIV, while further research is considered necessary in England. This research is necessary to ascertain variables such as: uptake, adherence, sexual behaviour, and drug resistance. Differing epidemiology may explain the difference in approach. The example of emtricitabine/tenofovir disoproxil for PrEP of HIV hints at SMC divergence from simply following NICE recommendations and evidence requirements, indicating a growing influence of the SMC as a self-contained centre for technology appraisal. PIN119 The Early Bird Catches The Worm: Measuring The Potential Value Of Mesenchymal Stem Cells Therapy For Septic Shock Using The Early Health Economic Evaluation Thavorn K1, Van Katwyk S1, Krahn M2, Coyle D3, McIntyre L1