ISOLATION, IDENTIFICATION, AND ANTIMICROBIAL SUSCEPTIBILITY TESTING OF SALMONELLA FROM SELECTED POULTRY FARMS IN DEBRE ZEIT

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Objectives: To evaluate real-world SVR12 in treatment failure patients with HCV genotype 1 and cirrhosis treated with 12 or 24 weeks of LDV/SOF or 12 weeks of LDV/SOF + RBV.  Methods: Data were obtained through Trio Health’s Innervation Platform, a cloud-based disease management platform, and directly from specialty pharmacies for 476 treatment-experienced, genotype 1 patients with cirrhosis that initiated LDV/SOF ± RBV between Oct 2014 and Mar 2015. 45% (216/476) of the patients were treated in community practices with the remainder from academic centers.  Results: Of the 476 patients in the sample, intended treatments were: 25% (121/476 patients) 12 week LDV/SOF, 69% (329/476) 24 week LDV/SOF and 6% (26/476) 12 week LDV/SOF + RBV. SVR12 rates by regimen were 84% (102/121) for 12 weeks LDV/SOF, 96% (25/26) for 12 weeks LDV/SOF+RBV, and 92% (303/329) for 24 weeks LDV-SOF. Of the 46 patients that did not achieve SVR, 5 discontinued treatment, 18 were lost to follow-up, 3 died, and 20 completed therapy and were virological failures. In the overall sample, age, ethnicity, addition of ribavirin, genotype, baseline viral load, prior treatment response, and prior treatment regimen did not have a significant impact on treatment outcome. Females (p= 0.006), treatment in an academic site (p= 0.014), and 24 weeks of treatment (p= 0.006) had a significantly positive impact on SVR12 rates.  Conclusions: From a data collection of 476 treatment-experienced patients with cirrhosis, genotype 1 Hepatitis C, SVR 12 for 12 week LDV-SOF, 12 week LDV-SOF+RBV, and 24 week LDV-SOF regimens were 84%, 96%, and 92% respectively. In real world, 12 week LDV-SOF+RBV (96%) was similar to 24 week LDV-SOF (92%). Treatment with 12 weeks of LDV-SOF without the addition of ribavirin is not recommended for treatment-experienced cirrhotic patients, and saw a lower SVR12 rate (84%) in this real-world sample. PGI5 EFFECTIVENESS OF 8 OR 12 WEEK LDV/SOF IN TREATMENT-NAÏVE PATIENTS WITH NON-CIRRHOTIC, GENOTYPE 1 HEPATITIS C: REAL-WORLD EXPERIENCE FROM THE TRIO NETWORK Curry M 1, Bacon B 2, Dieterich D 3, Flamm S 4, Guest L 5, Kowdley K 6, Lee Y 5, Tsai N 7, Younossi Z 8 1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Saint Louis University School of Medicine, St. Louis, MA, USA, 3Icahn School of Medicine at Mount Sinai, New York, NY, USA, 4Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 5Trio Health Analytics, La Jolla, CA, USA, 6Liver Care Network, Swedish Medical Center, Seattle, WA, USA, 7Queens Medical Center, University of Hawaii, Honolulu, HI, USA, 8Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA .

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Objectives: To determine SVR12 rates for 8 or 12 weeks of LDV/SOF for GT1, non-cirrhotic, treatment-naïve patients and to assess compliance with guidelines and patient adherence to treatment.  Methods: Data was obtained through Trio Health’s Innervation Platform and directly from specialty pharmacies for 895 treatment-naïve patients with non-cirrhotic GT1 Hepatitis C who initiated 8 or 12 week LDV/SOF between Oct 2014 and Mar 2015. 62% (553/895) of patients were treated in community practices with the remainder from academic centers.  Results: Intended treatments were: 29% (263/895 patients) 8 week LDV/SOF, and 71% (632/895) 12 week LDV/SOF±RBV (2% (21/895) of patients were treated with 12 weeks of LDV-SOF+RBV). 8 week therapy was initiated for 36% (254/710) of patients with baseline HCV RNA < 6MM IU and 4% (8/178) of patients with > 6MM IU HCV RNA. 12 week therapy was selected for 456 patients with HCV RNA <  6MM IU indicating physician preference for longer therapy and was independent of baseline demographics including Metavir fibrosis stage > 2. SVR12 rates by regimen were: 95% (251/263) for 8 weeks of LDV-SOF and 96% (604/632) for 12 weeks of LDVSOF±RBV. Of the 58 patients that did not achieve SVR, 7 discontinued treatment, 22 were lost to follow-up, 2 died, and 9 completed therapy and were virological failures. Among the patients’ baseline characteristics, there were no significant predictors of response.  Conclusions: In real world the 8 week regimen (SVR 95%) were comparable to the 12 week regimen of LDV-SOF (96%). Response rates were similar regardless of degree of fibrosis and baseline viral load. 456 patients (51%) with a viral load <  6MM received 12 weeks of therapy rather than 8 weeks. Overall discontinuation rate was < 1% (7/895). PGI6 ISOLATION, IDENTIFICATION, AND ANTIMICROBIAL SUSCEPTIBILITY TESTING OF SALMONELLA FROM SELECTED POULTRY FARMS IN DEBRE ZEIT Yizengaw H A Dilla University, Dilla, Ethiopia .

GASTROINTESTINAL DISORDERS – Cost Studies PGI7 COMPARISON OF HEALTH CARE UTILIZATION AND COSTS BETWEEN PATIENTS WITH AND WITHOUT CONSTIPATION AMONG MEDICAID ENROLLEES INITIATING OPIOIDS FOR NON-CANCER PAIN Olufade T 1, Farr A M 2, Princic N 3, Juneau P 4, Zhang K 2, Datto C 1 1AstraZeneca, Wilmington, DE, USA, 2Truven Health Analytics, Bethesda, MD, USA, 3Truven Health Analytics, Cambridge, MA, USA, 4Truven Health Analytics, Ann Arbor, MI, USA .

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Objectives: Analyses of commercially insured patients have found that opioidinduced constipation (OIC) is associated with increased healthcare costs. These analyses have defined constipation based on diagnosis alone, rather than diagnosis or medication use. The objective of this study was to compare healthcare utilization and costs between non-cancer patients with and without constipation among Medicaid enrollees with opioid use.  Methods: Patients aged ≥ 18 years old initiating opioids from 1/1/2009-6/30/2013 (index date) were identified in the MarketScan Multi-State Medicaid claims database. Patients were required to have continuous enrollment in the 6 months prior to index date and 12 months following index date (post-period) with no evidence of addiction, cancer, or functional or inflammatory bowel diseases. The presence of constipation in the post-period was defined as a medical claim with a diagnosis or procedure indicative of constipation or a pharmacy claim for an over-the-counter or prescription constipation medication. Healthcare utilization and costs during the post-period were compared between propensity-score-matched cohorts.  Results: There were 2,716 patients in each cohort after matching (mean age 47 years; 26%-28% men). The most common pain conditions diagnosed were arthritis, musculoskeletal pain, and low back pain. Total costs were significantly higher for patients with constipation than those without constipation (mean $28,234 [SD $104,362] vs. mean $13,709 [SD $29,008], p< 0.001). The proportions of patients with an inpatient admission (IP) or an emergency room visit (ER) were significantly higher for patients with constipation than those without (IP: 29% vs. 14%, p< 0.001; ER: 59% vs. 47%, p< 0.001), resulting in higher mean costs (IP: $13,532 [SD $100,706] vs. $4,591 [SD $24,085], p< 0.001; ER: $703 [SD $1,345] vs. $429 [SD $929], p< 0.001).  Conclusions: Among Medicaid enrollees, OIC was associated with an increase in healthcare utilization and costs in the 12 months following opioid initiation for non-cancer pain. PGI8 COMPARISON OF CHARACTERISTICS AND HOSPITAL COSTS IN PATIENTS UNDERGOING OPEN, LAPAROSCOPIC, AND ROBOTIC-ASSISTED COLECTOMY Fu R 1, Brown H 1, Francis D M 2 1Premier Inc, Charlotte, NC, USA, 2ETHICON US, LLC., Somerville, NY, USA .

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Objectives: The cost of colectomy may vary widely; however, an understanding of factors contributing to this variation is still limited. In this study total hospital costs were compared between open (OC), laparoscopic (LC), and robotic-assisted colectomies (RC). Factors associated with differences in hospital costs across different surgical approaches were explored.  Methods: All adults undergoing colectomy and discharged between January 1, 2010 and December 31, 2014 were identified in the Premier Healthcare Database (PHD). PHD contains approximately 20% of all US hospital discharges. Patients were grouped by the surgical approach used: OC, LC, or RC. OC and LC patients with ICD-9 codes indicating robotic assist on the same hospital day were categorized into the RC group. Patient and hospital characteristics were compared between surgical approaches and a multivariable regression model was used to assess association between surgical approach and total hospital cost.  Results: A total of 125,077 discharges with colectomy were identified (68.2% OC, 29.1% LC, and 2.7% RC). LC patients were older and more likely to have malignant cancer and less likely to have prior surgical site infection than OC or RC patients (all p< .0001). OC patients had greater severity of illness and risk of mortality as determined by APR-DRG, higher Charlson Comorbidity Index, and longer LOS than LC or RC patients (all p< .0001). Adjusted mean total hospital cost for LC patients ($16,982 ± 6,746) was significantly lower than OC ($25,775 ± 13,168) or RC patients ($20,673 ± 7,203) (p< .0001). Large variations in hospital cost within an approach were also observed.  Conclusions: After adjustment, total hospital costs were lower for patients with LC versus the other approaches and may support a greater role for the laparoscopic approach if clinical outcomes are also improved. Further evaluation is needed to identify factors contributing to the variation in hospital cost for each approach.

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Objectives: A cross sectional study was conducted from December 2013 to May 2014 with the objectives to isolate, identify and determine the antimicrobial resistance pattern of salmonella species from selected poultry farms in Debre zeit, Ethiopia.  Methods: From a total of 196 cloacal swabs collected 50 (25.5%) were found to be positive for Salmonella organisms using culture method, and 15 (7.6%) Salmonella isolates were confirmed using biochemical tests. All culture and biochemical positive samples were further confirmed by Polymerase Chain Reaction (PCR) through amplification of histidine transport operon as a target gene for the presence of salmonella isolates.  Results: From culture and biochemical positive samples, gel electrophoresis of the PCR product revealed the presence of 496bp segments in 13 (6.7%) Salmonella isolates. The statistical analysis has revealed a significantly association between different age groups of chickens (X2 =  10.56; P =  0.005) and farms (X2 = 10.74; P= 0.013) with the percentage of Salmonella isolates. Most of the Salmonella isolates were found to be resistant against commonly used antimicrobials such as Sulfisoxazole, Chloramphenicol and Ampicillin followed by Tetracycline, Amoxicillin/Clavulanic acid and Cephalotin and more than half(69.3%) of the isolates were found to be multi-drug resistant.  Conclusions: The high prevalence of resistance to antimicrobial agents found in this study might be attributed to uncontrolled use of antimicrobial agents as growth promoters in poultry farms. Therefore, proper treatment of chickens using appropriate antibiotics is then quite essential.

PGI9 LITERATURE REVIEW ON HOSPITAL COSTS FOR PATIENTS UNDERGOING COLECTOMY Chen B P 1, Cheng H 2, Romney M 3, Hsiao C 4 1Ethicon Inc., Somerville, NJ, USA, 2Global Health Economics and Market Access, Ethicon Inc., Cincinnati, OH, USA, 3Jefferson School of Population Health, Philadelphia, PA, USA, 4Ethicon Inc., Cincinnati, OH, USA .

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Objectives: This study aims to identify the range of direct hospital costs associated with a minimally invasive or open colectomy procedure across different countries.  Methods: A PubMed search was performed using the keywords: colectomy [MeSH] and cost/economic/comparison with results limited to publications of human subject studies in English from 2006 to November 2015. Studies comparing minimally invasive surgical techniques (laparoscopic or laparoscopic-assisted) to open surgical techniques were selected and studies of comparisons other than minimally invasive versus open procedures (e.g. robotic) were excluded. All abstracts were filtered, including meta-analysis, RCTs and observational studies excluding case studies.  Results: Twenty-two of 99 articles were included in the analysis. Eight (36%) studies were conducted in North America with the remaining based in European and Asian-Pacific countries. The findings from 2 meta-analysis studies reporting total direct costs indicated higher costs for laparoscopies ranging from $105 to $824. Direct hospital costs varied dramatically across countries. In North America, the cost of operating rooms (minute) ranged from $11-$20 for open