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Rate and Healthcare Utilization (Los And Costs) of Adhesion Related Complications after Liver Resection Surgery
A510
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6
and UC patients discontinue or switch biologic within a year, suggesting suboptimal therapy and complex treatment pathways. PGI6 A Cohort Study to Access the Impact of Paediatric Use of Proton Pomp Inhibitor on the Risk of Community Acquired Infections € “ Utopie Luu M1, LE Ray I2, Bardou M1 Hospitalier Universitaire Le Bocage, Dijon, France, 2CHU Strasbourg, Strasbourg, France
1Centre
Objectives: Proton pump inhibitors (PPI) use have been associated with pulmonary and digestive infections in adults. This risk has not been well characterized in pediatry despite an over-prescription for physiological gastro-oesophageal reflux. Our objective was to evaluate the impact of PPI use on the risk of community acquired infections in the pediatric population. Methods: This retrospective cohort analysis included children from 0 to 11 years of age between 2009-2014 using a French national and longitudinal Patient Database (Cegedim®) containing 292017 children within the study period. The database collect diagnosis and prescription and allow for a longitudinal follow-up of children. The risk of community infections was assessed using the self-case control series (SCCS) method, followed by a multivariate analysis by a Poisson regression. Results: Among the 292017 children (41.6±38.5 months, mean + standard deviation) 12823 (4.6%) received at least one PPI medication. A total of 2 925 466 episodes of infection were observed, with 62% of pulmonary, 25% ENT, 12% digestive and less than 1% of urinary infections. Mean duration of PPI treatment was 32.4±29.3 days. Unadjusted analysis retrieved significantly less infections in PPI users (85.02% vs 90.03%, p< 0.001) than non-users; PPI users were younger than non-users (37.6 vs 41.9 months, p< 0.001). General Practitioners were more prone to prescribe PPI than paediatricians (61.7% vs 37.7%). Conclusions: Even is results from the multivariate analysis are still pending, this cohort study of a French paediatric population suggest that the use of PPI may not be associated with an increased risk of community acquired infections. PGI7 HCV: Estimation of the Number of Diagnosed Patients Eligible to New Anti-HCV Therapies in Italy Gardini I1, Bartoli M1, Conforti M1, Mennini FS2, Marcellusi A2, Lanati EP3 Onlus, Vimercate (MB), Italy, 2Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome Tor Vergata, Rome, Italy, 3MA Provider Srl, Milano, Italy
1EpaC
Objectives: The study wants to take a picture of the current epidemiological scenario regarding HCV infection in Italy. Studies used to estimate HCV burden of illness in Italy were so far local and performed a number of years ago, not mirroring the state of the art. EpaC wanted to provide a real number of diagnosed patients, eligible to new anti-HCV therapies. Methods: EpaC is the most important Italian NGO for hepatopathic patients. A number of source were cross-checked. Starting from all regional data regarding HCV-related exemptions, a correction/integration was performed with online questionnaire to associated patients (from which we derived patients cured and also other/no exemptions); survey to all prescribing centers in Italy (from which we derived the percentage of ineligible patients); prevalence of particular subpopulations was also collected (prisoners and HIV/HCV coinfected); calculations of new diagnosed, dead and cured patients in 2015. Excluded patients were illegal immigrants and active drug addicts (subpopulations currently rarely cured). Results: A total of 221.549 patients were derived from regional exemptions databases and the mean national prevalence was 0,364%. Adding patients without exemptions/other exemptions, total was 308.624. We deducted the yearly deaths, cured and not eligible patients and, last, integrated with coinfected and prisoner special groups. Prevalence was also estimated at regional level, highlighting a reduction of the typical North-to-South prevalence gradient. Applying the abovementioned corrections/integrations, total diagnosed and eligible HCV patients in Italy who can be immediately cured are supposed to range 163.148 –187.756. Conclusions: This is a study aimed at filling an informative gap able to provide useful actual information in terms of HCV patients real life management and future resource allocation. These data may in fact be considered the basis for policy- and decision-makers to plan and manage patients ready to be cured. The study do not provide information on patients not yet diagnosed.
PGI8 Rate and Healthcare Utilization (Los and Costs) of Adhesion Related Complications after Colon Resection Procedures Etter K1, Sutton N2, Wei D3, Yoo A1 & Johnson Co., New Brunswick, NJ, USA, 2Johnson & Johnson Medical Devices, Somerville, NJ, USA, 3Johnson & Johnson Co., Raleigh, NC, USA
1Johnson
Objectives: Explore adhesion related complications (ARC) within one year after colon resection procedures, including occurrence, time to event, risk factors, and healthcare utilization for inpatient hospitalizations. Methods: Using Truven MarketScan® Commercial and Medicare databases, all inpatient colon resections between 2009-2013 (INDEX): RIGHT (cecectomy/hemicolectomy), LEFT (hemicolectomy/sigmoidectomy), transverse, partial, or total were identified. One year continuous enrollment was required before (PRE-INDEX) and after (POST-INDEX). ARC was defined as the first hospitalization with a diagnosis of ileus or small bowel obstruction or an adhesiolysis procedure occurring POST-INDEX. Only the patient’s first ARC readmission was evaluated descriptively for total hospitalization cost (2015-USD), length of stay (LOS), and time to ARC. Patient, provider, and procedure factors associated with ARCs were explored in a multivariable model, p-values < 0.05 were considered significant. Results: A total of 64,532 colon resections were identified: LEFT= 39.2%, RIGHT= 34.9%, partial= 20.0%, total= 3.6%, and transverse= 2.3%. Procedural approach was open (60.1%) and laparoscopic (39.9%). All cause inpatient
readmissions within 1-year was 24.4% (N= 15,755). ARC occurred in 5.7% (95%CI[5.65.9%]) of patients, accounting for 23.5%(N= 3,705) of all inpatient readmissions within 1-year of INDEX. Mean time to ARC event was 130 days (SD= 102) with mean LOS of 7.2 days (SD= 8.0) and mean total cost of $29,802 (SD= $43,037) per hospitalization. Risk factors for ARC within 1-year included: adhesiolysis at INDEX (OR 2.46,[1.42-4.26]), resection type: total vs RIGHT (OR 3.78,[3.27-4.37]), CT imaging at INDEX (OR 1.80,[1.65-1.96]), surgical indication: inflammatory bowel disease vs cancer (OR 1.97,[1.63-2.37]), or multiple abdominal procedures at INDEX (OR 1.37,[1.271.47]). Laparoscopic approach at INDEX was protective compared to open surgery (OR 0.43,[0.39-0.46]). Conclusions: Adhesion related complications occurred in 5.7% of all patients within the first year after colon resection and have a substantial economic burden. Multiple patient and procedural characteristics increase the risk of these complications. Colon resections performed laparoscopically were associated with reduced adhesion related complications compared to open surgery.
PGI9 Rate and Healthcare Utilization (Los And Costs) of Adhesion Related Complications after Liver Resection Surgery Etter K1, Sutton N2, Wei D3, Yoo A1 & Johnson Co., New Brunswick, NJ, USA, 2Johnson & Johnson Medical Devices, Somerville, NJ, USA, 3Johnson & Johnson Co., Raleigh, NC, USA
1Johnson
Objectives: Explore adhesion related complications (ARC) within one year after liver surgery, including occurrence, time to event, risk factors, and healthcare utilization for inpatient hospitalizations. Methods: Using Truven MarketScan® Commercial database, all patients < 65 years undergoing inpatient liver resections between 2009-2013 (INDEX): lobectomy, wedge-biopsy, and wedge-therapeutic were identified. One year continuous enrollment was required before (PRE-INDEX) and after (POST-INDEX). ARC was defined as the first hospitalization with a diagnosis of ileus or small bowel obstruction or an adhesiolysis procedure occurring POST-INDEX. Only the patient’s first ARC readmission was evaluated descriptively for total hospitalization cost (2015-USD), length of stay (LOS), and time to ARC. Patient, provider, and procedure factors associated with ARC were explored in a multivariable model, p-values < 0.05 were considered significant. Results: A total of 4,303 liver resections were identified: wedge-biopsy= 48.6%, wedge-therapeutic = 36.0%, and lobectomy= 15.4%. Mean age was 49.6 years (SD= 10.2), 60.1% (N= 2,612) of patients were female, and 27.5% (N= 1,183) had metastatic cancer identified using Elixhauser. All cause inpatient readmissions within 1-year was 26.7% (N= 1,149). ARC occurred in 2.8% (95%CI [2.3-3.3%]) of patients, accounting for 10.4% (N= 120) of all inpatient readmissions within 1-year of INDEX. ARC occurrence by resection: wedge-biopsy (2.4%, [1.8-3.1%]), wedge-therapeutic (3.4%, [2.5-4.3%]) and lobectomy (2.6%, [1.4-3.8%]). Mean age of patients with ARC was 51.2 years (SD= 9.8), 47.5% (N= 57) were female, and 51.7% (N= 62) had metastatic cancer identified using Elixhauser. Mean time to ARC event was 142 days (SD= 120), with a mean LOS of 7.4 days (SD= 7.4), and mean total cost of $38,606 (SD= $45,862) per hospitalization. Risk factors for ARC within 1-year were increasing Charlson Comorbidity Index: with 5 vs 0 (OR 11.4, 95%CI [3.35-38.77]) and male gender (OR 1.54, [1.03-2.27]). Conclusions: Adhesion related complications occurred in 2.8% of all patients within the first year after liver surgery and have a substantial inpatient resource utilization and economic burden.
GASTROINTESTINAL DISORDERS – Cost Studies PGI10 The Impact of Rifaximin-A on Non-Elective Hospital Admission and Attendance Costs in Uk Patients with Hepatic Encephalopathy Hudson M1, Whitehouse JT2, Di Maggio P2 1Freeman Hospital, Newcastle upon Tyne, UK, 2Norgine, Uxbridge, UK
Objectives: In the UK retrospective observational study IMPRESS, rifaximin-α use in patients with hepatic encephalopathy (HE) reduced hospitalisations, bed occupancy including critical care, emergency room visits, and 30-day emergency readmissions, in the 6 months after compared to the 6 months prior to rifaximin-α initiation. The impact of rifaximin-α on the costs of hospital admissions and attendances in these patients has not been reported. This analysis assessed the impact of rifaximin-α on the costs associated with hospital admissions and attendances in patients with HE. Methods: Between July-08 and May-14, 145 patients from 11 specialist National Health Service (NHS) centres received rifaximin-α for prevention of HE. Hospital admissions and attendances were analysed for the 6 months pre- and post-rifaximin-α initiation. The costs for liver disease admissions and attendances were estimated using 2014/2015 prices from published NHS sources, inflated to 2016 costs. All costs are taken from the hospital perspective. This analysis included only patients alive at 6 months post-rifaximin-α initiation with at least 1 admission/attendance in either observed period. Results: At rifaximin-α initiation, the patients’ (61% males) mean age was 61 years and 82% were on concomitant lactulose. The mean number of non-elective hospitalisations per patient decreased from 2.06 (SD±1.92) in the 6 months pre- to 0.99 (SD±1.25 p< 0.001) in the 6 months post-rifaximin-α -initiation, translating into a reduction of hospitalisation cost/patient from £3,910 to £1,879 (n= 88). In the 6 months pre- versus the 6 months post-rifaximin-α -initiation, the estimated critical-care-bed-day cost/patient decreased from £12,208 to £3,091 (n= 19), the estimated emergency-room-visit cost/patient decreased from £256 to £135 (n= 63), and the estimated 30-day-emergency-readmission cost/ patient decreased from £3,226 to £1,708 (n= 50). Treatment costs have not been included. Conclusions: In UK clinical practice, prevention of HE episodes with rifaximin-α is associated with potential reductions in costs related to non-elective hospitalisations, critical care bed occupancy, emergency room visits and 30-day emergency re-admissions.
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6
and UC patients discontinue or switch biologic within a year, suggesting suboptimal therapy and complex treatment pathways. PGI6 A Cohort Study to Access the Impact of Paediatric Use of Proton Pomp Inhibitor on the Risk of Community Acquired Infections € “ Utopie Luu M1, LE Ray I2, Bardou M1 Hospitalier Universitaire Le Bocage, Dijon, France, 2CHU Strasbourg, Strasbourg, France
1Centre
Objectives: Proton pump inhibitors (PPI) use have been associated with pulmonary and digestive infections in adults. This risk has not been well characterized in pediatry despite an over-prescription for physiological gastro-oesophageal reflux. Our objective was to evaluate the impact of PPI use on the risk of community acquired infections in the pediatric population. Methods: This retrospective cohort analysis included children from 0 to 11 years of age between 2009-2014 using a French national and longitudinal Patient Database (Cegedim®) containing 292017 children within the study period. The database collect diagnosis and prescription and allow for a longitudinal follow-up of children. The risk of community infections was assessed using the self-case control series (SCCS) method, followed by a multivariate analysis by a Poisson regression. Results: Among the 292017 children (41.6±38.5 months, mean + standard deviation) 12823 (4.6%) received at least one PPI medication. A total of 2 925 466 episodes of infection were observed, with 62% of pulmonary, 25% ENT, 12% digestive and less than 1% of urinary infections. Mean duration of PPI treatment was 32.4±29.3 days. Unadjusted analysis retrieved significantly less infections in PPI users (85.02% vs 90.03%, p< 0.001) than non-users; PPI users were younger than non-users (37.6 vs 41.9 months, p< 0.001). General Practitioners were more prone to prescribe PPI than paediatricians (61.7% vs 37.7%). Conclusions: Even is results from the multivariate analysis are still pending, this cohort study of a French paediatric population suggest that the use of PPI may not be associated with an increased risk of community acquired infections. PGI7 HCV: Estimation of the Number of Diagnosed Patients Eligible to New Anti-HCV Therapies in Italy Gardini I1, Bartoli M1, Conforti M1, Mennini FS2, Marcellusi A2, Lanati EP3 Onlus, Vimercate (MB), Italy, 2Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome Tor Vergata, Rome, Italy, 3MA Provider Srl, Milano, Italy
1EpaC
Objectives: The study wants to take a picture of the current epidemiological scenario regarding HCV infection in Italy. Studies used to estimate HCV burden of illness in Italy were so far local and performed a number of years ago, not mirroring the state of the art. EpaC wanted to provide a real number of diagnosed patients, eligible to new anti-HCV therapies. Methods: EpaC is the most important Italian NGO for hepatopathic patients. A number of source were cross-checked. Starting from all regional data regarding HCV-related exemptions, a correction/integration was performed with online questionnaire to associated patients (from which we derived patients cured and also other/no exemptions); survey to all prescribing centers in Italy (from which we derived the percentage of ineligible patients); prevalence of particular subpopulations was also collected (prisoners and HIV/HCV coinfected); calculations of new diagnosed, dead and cured patients in 2015. Excluded patients were illegal immigrants and active drug addicts (subpopulations currently rarely cured). Results: A total of 221.549 patients were derived from regional exemptions databases and the mean national prevalence was 0,364%. Adding patients without exemptions/other exemptions, total was 308.624. We deducted the yearly deaths, cured and not eligible patients and, last, integrated with coinfected and prisoner special groups. Prevalence was also estimated at regional level, highlighting a reduction of the typical North-to-South prevalence gradient. Applying the abovementioned corrections/integrations, total diagnosed and eligible HCV patients in Italy who can be immediately cured are supposed to range 163.148 –187.756. Conclusions: This is a study aimed at filling an informative gap able to provide useful actual information in terms of HCV patients real life management and future resource allocation. These data may in fact be considered the basis for policy- and decision-makers to plan and manage patients ready to be cured. The study do not provide information on patients not yet diagnosed.
PGI8 Rate and Healthcare Utilization (Los and Costs) of Adhesion Related Complications after Colon Resection Procedures Etter K1, Sutton N2, Wei D3, Yoo A1 & Johnson Co., New Brunswick, NJ, USA, 2Johnson & Johnson Medical Devices, Somerville, NJ, USA, 3Johnson & Johnson Co., Raleigh, NC, USA
1Johnson
Objectives: Explore adhesion related complications (ARC) within one year after colon resection procedures, including occurrence, time to event, risk factors, and healthcare utilization for inpatient hospitalizations. Methods: Using Truven MarketScan® Commercial and Medicare databases, all inpatient colon resections between 2009-2013 (INDEX): RIGHT (cecectomy/hemicolectomy), LEFT (hemicolectomy/sigmoidectomy), transverse, partial, or total were identified. One year continuous enrollment was required before (PRE-INDEX) and after (POST-INDEX). ARC was defined as the first hospitalization with a diagnosis of ileus or small bowel obstruction or an adhesiolysis procedure occurring POST-INDEX. Only the patient’s first ARC readmission was evaluated descriptively for total hospitalization cost (2015-USD), length of stay (LOS), and time to ARC. Patient, provider, and procedure factors associated with ARCs were explored in a multivariable model, p-values < 0.05 were considered significant. Results: A total of 64,532 colon resections were identified: LEFT= 39.2%, RIGHT= 34.9%, partial= 20.0%, total= 3.6%, and transverse= 2.3%. Procedural approach was open (60.1%) and laparoscopic (39.9%). All cause inpatient
readmissions within 1-year was 24.4% (N= 15,755). ARC occurred in 5.7% (95%CI[5.65.9%]) of patients, accounting for 23.5%(N= 3,705) of all inpatient readmissions within 1-year of INDEX. Mean time to ARC event was 130 days (SD= 102) with mean LOS of 7.2 days (SD= 8.0) and mean total cost of $29,802 (SD= $43,037) per hospitalization. Risk factors for ARC within 1-year included: adhesiolysis at INDEX (OR 2.46,[1.42-4.26]), resection type: total vs RIGHT (OR 3.78,[3.27-4.37]), CT imaging at INDEX (OR 1.80,[1.65-1.96]), surgical indication: inflammatory bowel disease vs cancer (OR 1.97,[1.63-2.37]), or multiple abdominal procedures at INDEX (OR 1.37,[1.271.47]). Laparoscopic approach at INDEX was protective compared to open surgery (OR 0.43,[0.39-0.46]). Conclusions: Adhesion related complications occurred in 5.7% of all patients within the first year after colon resection and have a substantial economic burden. Multiple patient and procedural characteristics increase the risk of these complications. Colon resections performed laparoscopically were associated with reduced adhesion related complications compared to open surgery.
PGI9 Rate and Healthcare Utilization (Los And Costs) of Adhesion Related Complications after Liver Resection Surgery Etter K1, Sutton N2, Wei D3, Yoo A1 & Johnson Co., New Brunswick, NJ, USA, 2Johnson & Johnson Medical Devices, Somerville, NJ, USA, 3Johnson & Johnson Co., Raleigh, NC, USA
1Johnson
Objectives: Explore adhesion related complications (ARC) within one year after liver surgery, including occurrence, time to event, risk factors, and healthcare utilization for inpatient hospitalizations. Methods: Using Truven MarketScan® Commercial database, all patients < 65 years undergoing inpatient liver resections between 2009-2013 (INDEX): lobectomy, wedge-biopsy, and wedge-therapeutic were identified. One year continuous enrollment was required before (PRE-INDEX) and after (POST-INDEX). ARC was defined as the first hospitalization with a diagnosis of ileus or small bowel obstruction or an adhesiolysis procedure occurring POST-INDEX. Only the patient’s first ARC readmission was evaluated descriptively for total hospitalization cost (2015-USD), length of stay (LOS), and time to ARC. Patient, provider, and procedure factors associated with ARC were explored in a multivariable model, p-values < 0.05 were considered significant. Results: A total of 4,303 liver resections were identified: wedge-biopsy= 48.6%, wedge-therapeutic = 36.0%, and lobectomy= 15.4%. Mean age was 49.6 years (SD= 10.2), 60.1% (N= 2,612) of patients were female, and 27.5% (N= 1,183) had metastatic cancer identified using Elixhauser. All cause inpatient readmissions within 1-year was 26.7% (N= 1,149). ARC occurred in 2.8% (95%CI [2.3-3.3%]) of patients, accounting for 10.4% (N= 120) of all inpatient readmissions within 1-year of INDEX. ARC occurrence by resection: wedge-biopsy (2.4%, [1.8-3.1%]), wedge-therapeutic (3.4%, [2.5-4.3%]) and lobectomy (2.6%, [1.4-3.8%]). Mean age of patients with ARC was 51.2 years (SD= 9.8), 47.5% (N= 57) were female, and 51.7% (N= 62) had metastatic cancer identified using Elixhauser. Mean time to ARC event was 142 days (SD= 120), with a mean LOS of 7.4 days (SD= 7.4), and mean total cost of $38,606 (SD= $45,862) per hospitalization. Risk factors for ARC within 1-year were increasing Charlson Comorbidity Index: with 5 vs 0 (OR 11.4, 95%CI [3.35-38.77]) and male gender (OR 1.54, [1.03-2.27]). Conclusions: Adhesion related complications occurred in 2.8% of all patients within the first year after liver surgery and have a substantial inpatient resource utilization and economic burden.
GASTROINTESTINAL DISORDERS – Cost Studies PGI10 The Impact of Rifaximin-A on Non-Elective Hospital Admission and Attendance Costs in Uk Patients with Hepatic Encephalopathy Hudson M1, Whitehouse JT2, Di Maggio P2 1Freeman Hospital, Newcastle upon Tyne, UK, 2Norgine, Uxbridge, UK
Objectives: In the UK retrospective observational study IMPRESS, rifaximin-α use in patients with hepatic encephalopathy (HE) reduced hospitalisations, bed occupancy including critical care, emergency room visits, and 30-day emergency readmissions, in the 6 months after compared to the 6 months prior to rifaximin-α initiation. The impact of rifaximin-α on the costs of hospital admissions and attendances in these patients has not been reported. This analysis assessed the impact of rifaximin-α on the costs associated with hospital admissions and attendances in patients with HE. Methods: Between July-08 and May-14, 145 patients from 11 specialist National Health Service (NHS) centres received rifaximin-α for prevention of HE. Hospital admissions and attendances were analysed for the 6 months pre- and post-rifaximin-α initiation. The costs for liver disease admissions and attendances were estimated using 2014/2015 prices from published NHS sources, inflated to 2016 costs. All costs are taken from the hospital perspective. This analysis included only patients alive at 6 months post-rifaximin-α initiation with at least 1 admission/attendance in either observed period. Results: At rifaximin-α initiation, the patients’ (61% males) mean age was 61 years and 82% were on concomitant lactulose. The mean number of non-elective hospitalisations per patient decreased from 2.06 (SD±1.92) in the 6 months pre- to 0.99 (SD±1.25 p< 0.001) in the 6 months post-rifaximin-α -initiation, translating into a reduction of hospitalisation cost/patient from £3,910 to £1,879 (n= 88). In the 6 months pre- versus the 6 months post-rifaximin-α -initiation, the estimated critical-care-bed-day cost/patient decreased from £12,208 to £3,091 (n= 19), the estimated emergency-room-visit cost/patient decreased from £256 to £135 (n= 63), and the estimated 30-day-emergency-readmission cost/ patient decreased from £3,226 to £1,708 (n= 50). Treatment costs have not been included. Conclusions: In UK clinical practice, prevention of HE episodes with rifaximin-α is associated with potential reductions in costs related to non-elective hospitalisations, critical care bed occupancy, emergency room visits and 30-day emergency re-admissions.