Local Production Policies In The Turkish Pharmaceutical Market

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VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1

PHP196 Do Changing Attitudes To Death Have Implications For National Tariffs For Health States? Results From An Examination Of Attitudes To Euthanasia In The Republic Of Ireland Barry L1, Hobbins A1, Kelleher D1, Shah K2, Devlin N2, Ramos-Goñi JM3, O’Neill C1 Galway, Galway, Ireland, 2Office of Health Economics, London, UK, 3RTI Health Solutions, Research Triangle Park, NC, USA

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Objectives: Many religions teach that life has intrinsic value regardless of the condition in which it is experienced. Those who adhere to such religions may be less likely to assign “worse than dead” values to health states or favour access to services such as euthanasia when quality of life is poor. Quantitative methods may be useful in understanding more precisely the role religious adherence and attitudes on access to euthanasia may have on the propensity to assign worse than dead values.  Methods: Using the EuroQol Valuation Technology (EQ-VT), EQ-5D-5L valuation tasks were administered to a sample of 153 residents of the Irish Republic in 2016. Individuals provided data on attitudes to physician provided euthanasia as well as how frequently they attended religious services. Each respondent provided 10 time trade-off valuations for health states drawn at random. Data were analysed using a recursive bivariate probit (RBP) in which endogeneity related to attitudes to euthanasia was identified and addressed in a model examining propensity to assign worse than dead values.  Results: 96% of respondents whose religion was identified were Roman Catholic. A Wald test revealed that attitudes to euthanasia were endogenous at p< 0.01. RBP results revealed that those who favour access to euthanasia were 30 percentage points (p< 0.01) more likely to assign worse than dead values than those who were not. Those who were older were also more likely to exhibit a higher propensity to assign worse than dead values.  Conclusions: Religious adherence and attitudes to euthanasia are examples of social norms. These may influence the values assigned to health states. Societies undergoing social change may experience shifts in social norms that impact on values and the distribution of values assigned to health states in national tariffs. This will have implications for value sets and the frequency with which they require revision. PHP197 A Systematic Review To Evaluate The Association Between Medication Adherence And Personality Traits Kohli RK TheraInsight Pvt. Ltd., Bangalore, India

Objectives: Medication adherence is a matter of concern for clinicians, healthcare systems, and payers. We empirically evaluated the association between prescription medication adherence and personality traits.  Methods: PsycINFO®, Embase®, MEDLINE®, and CINAHL were searched from database start to January 2017. Studies assessing impact of personality constructs on medication adherence in patients with chronic conditions (hypertension, heart failure, HIV, diabetes, asthma, dialysis, organ transplant, etc.) were included in the review. Screening and data extractions were conducted by two independent reviewers, and any discrepancies between reviewers were reconciled by a third independent reviewer.  Results: A total of 9980 individual references were identified through database searches. Personality was found to be associated with adherence across 47 included studies. Prospective observational cohort design was employed in 47% of the included studies. Self-report for measuring adherence was used in 63% of the studies. Neuroticism (16 studies), openness to experience (10 studies), hostility (5 studies), and extraversion (4 studies) were the most commonly investigated personality traits associated with non-adherence. Conscientiousness (17 studies), extraversion (13 studies), and agreeableness (12 studies) were most commonly reported personality traits associated with good adherence. In a random effects logistic regression analyses, neuroticism was associated with medication non-adherence (< 80% of prescribed pills), with an increase in SD by 1 in neuroticism associated with a 4.2% (95% CI: 0.3, 6.1); p< 0.05 increase in probability of non-adherence. Conscientiousness was positively related to adherence, indicating that individuals scoring high tended to be more adherent to treatment, β  (SE) =  0.049 (0.018); p= 0.012.  Conclusions: Although a correlation was observed between personality traits and medication adherence, the results of the study should be interpreted with caution due to heterogeneity across the studies including study design, population, personality inventories, and statistical techniques. PHP198 Patient Outcomes In Wales: The Proms, Prems & Effectiveness Programme (PPEP) Palmer RI, Withers KL, Carolan-Rees G Cardiff & Vale University Health Board, Cardiff, UK

Objectives: The PPEP is a national programme supported by Welsh Government, Welsh health boards and the NHS Wales Informatics Service, with the aim of providing an electronic platform for data collection across the country. The programme has been funded via the Welsh Government Efficiency through Technology Fund. Its purpose is to make patient-level data available during clinic consultations, and collated data to be analysed for clinical effectiveness assessment and benchmarking.  Methods: Patients are invited to submit PROMs at baseline and post-treatment. Tools are available for completion in English and Welsh, and are currently collected at home via a website or in-clinic via tablet computers. Collected data for all consenting patients include the EQ5D, co-morbidities, BMI, employment status and work productivity impairment, as well as lifestyle information such as smoking history, alcohol intake and exercise levels. Condition-specific tools are in use for 3 conditions, while a further 15 condition specific PROMs and a generic PREMs survey will be available imminently. The platform is currently being piloted in 4 of the 7 health boards in Wales with all consenting responses linked to clinical data.  Results: 2,263 generic PROMs have been collected by consenting patients at Cardiff & Vale University Health Board. Analysis confirmed that the 72.2% of responding patients who do not meet the national exercise guideline had worse health scores than those who do (p< 0.01). Furthermore the 25.8% of patients with high blood pressure and the 60.7% who are overweight/obese also had worse generic health scores (p< 0.01).  Conclusions:

Such data analyses will facilitate service improvements while informing patient and clinician decision making as part of the prudent healthcare agenda. The platform has allowed large dataset collection in a small space of time, with the programme continuing to capture datasets for chronic and acute conditions across Wales. PHP199 Local Production Policies In The Turkish Pharmaceutical Market Şentürk A, Tatar M Polar Health Economics & Policy Consultancy, Ankara, Turkey

Objectives: Heath care reforms in the last decade have resulted in improved access to health care services and pharmaceuticals in Turkey. As a result of this, several measures were taken to curb the increasing healthcare expenditures. In recent years, the government has focused on the burden of imported drugs on the Turkish economy and has declared increasing R&D activities and supporting local production as the main objectives of the 10th Development Plan. In this respect, the government has targeted to meet 60% of the pharmaceutical need in terms of value through local production. Pharmaceutical companies are required to invest for local production of their products. This study aimed at outlining the local production policies in Turkey.  Methods: Data for the study are obtained from the Turkish Pharmaceuticals and Medicines Agency (TITCK). Calculations are made by the TITCK with the discount rates published by the Social Security Institution (SSI).  Results: Local production policies are comprised of five stages. There are different policies for drugs with equivalent groups and without equivalent groups. For drugs with equivalent groups, there will be three stages. Local production policies are first applied to drugs with 50% or more local products in the market. Followed by drugs with more than 10% and less than 10% local products. The fourth stage will be applied to imported drugs and fifth stage will be applied to drugs without an equivalent groups.  Conclusions: The first stage of local production policies has been completed where 48 drugs will be delisted from the reimbursement list as of 8 February 2018. The government expects to save 22,3 billion TRY (5,7 billion € ) from this policy. The Ministry is meeting companies for the following stages. Additional incentives for licensing, pricing and reimbursement policies of these locally produced drugs are on the agenda of the government. PHP200 Measurement Of Multimorbidity To Predict All-Cause Mortality In A Nationwide Population, Using The French National Health Insurance Database (SNIIRAM) Constantinou P1, Tuppin P2, Pelletier-Fleury N1 1French National Institute of Health and Medical Research (INSERM), Villejuif, France, 2French National Health Insurance (CNAMTS), Paris, France

Objectives: Summary health-state measures are essential for risk-adjustment in comparative effectiveness or performance measurement studies and to inform policy-makers. The SNIIRAM database provides morbidity information for each beneficiary of the main health insurance scheme, representing over 57 million individuals, through a set of algorithms combining ICD-10 diagnoses and pharmacy data to identify specific conditions. In this study, we developed a multimorbidity measure predictive of 2-years mortality.  Methods: All beneficiaries aged 65 years or older in December 31, 2013 with complete follow-up until December 31, 2015 (n= 7,672,111) were randomly divided into a training (n= 3,836,056) and a validation population (n= 3,836,055). We used age, gender and selected indicator morbidity variables as predictors for 2-years mortality in multivariate logistic regression analyses, in the training population. Predictors were selected according to face validity of their identifying algorithm, number of events, univariate association with mortality and principal components analysis within disease categories. To derive a weighted index from the adjusted regression coefficients, we applied a scoring rule where each additional point reflected risk associated with a 5-years age increase. We assessed the predictive performance of the computed index in the validation population, using discrimination and calibration measures.  Results: Adjusted Odds Ratios [95% confidence interval] for the fifteen selected conditions ranged from 1.35 [1.31-1.38] for Depression, 1.36 [1.32-1.40] for Rheumatic or connective tissue diseases, to 3.89 [3.72-4.07] for End-Stage Renal disease, 4.06 [4.01-4.11] for Cancer. Score values were monotonically related to mortality. The weighted index had a higher discrimination (c-statistic= 0.825) than age and gender (c-statistic= 0.761) or count of all-56 available morbidity variables (c-statistic= 0.790). Within each score value, predicted probability was included in the 95% confidence interval of observed mortality proportion.  Conclusions: We computed a performant score to study multimorbidity in the French context. Such predictive measures could be externally validated in large medico-administrative databases with routinely collected morbidity information. PHP201 The Prevalence Of Chronic Health Conditions And Multimorbidity In The Portuguese Population - Results From The 2014 National Health Interview Survey Laires PA1, Rocha L2, Perelman J1 1Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa, Lisbon, Portugal, 2NA, Lisbon, Portugal

Objectives: In a context of severe population aging, knowing the prevalence of chronic diseases and multimorbidity is crucial to evaluate healthcare needs, as these are the most costly health conditions. We measured the prevalence of selfreported chronic health conditions multimorbidity in the adult Portuguese population for the year 2014.  Methods: Our sample included all people aged above 15 years old from mainland Portugal (7,944 men and 10,260 women) who participated in the fifth Portuguese National Health Interview Survey, conducted in 2014. We considered the following chronic conditions: hypertension, diabetes, coronary disease, stroke or myocardial infarction in the previous year, arthrosis, chronic back or neck pain, chronic obstructive pulmonary disease, asthma, allergy, kidney disease, urinary incontinence, liver cirrhosis, and depression. Multimorbidity was measured either by the presence of two or more of these self-reported chronic conditions.  Results: Chronic back pain was the most prevalent self-reported