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REAL-WORLD EVIDENCE OF TREATMENT PATTERN AND ASSOCIATED COSTS OF FIBROMYALGIA IN THE UNITED STATES
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consumptions were prevalent in 18.8% and 15.6% of patients, respectively. Regarding prescription patterns of osteoporosis medication, BPPs were the most widely prescribed (59.9%) and were followed by HRTs (46.9%) and SERMs (12.6%). Among the patients prescribed with BPPs, HRTs, and SERMs, those having GI RFs were 59.8%, 27.8%, and 13.4%, respectively. Conclusions: The study showed the high prevalence of GI RFs in postmenopausal women. More attentions to GI RFs should be paid when preventing and treating osteoporosis in postmenopausal women. PMS76 IDENTIFYING FACTORS WHICH INFLUENCE THE SELECTION OF ANTI-TNF TREATMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS IN ENGLAND Gavan S 1, Harrison M 2, Barton A 1, Hyrich K 1, Isaacs J 3, Morgan A 4, Wilson AG 5, Payne K 1 University of Manchester, Manchester, UK, 2The University of British Columbia, Vancouver, BC, Canada, 3Newcastle University, Newcastle upon Tyne, UK, 4University of Leeds, Leeds, UK, 5University College Dublin, Dublin, Ireland .
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Objectives: National Institute for Health and Care Excellence guidance recommends that patients with rheumatoid arthritis in England receive the anti-TNF with the lowest acquisition cost. In practice other non-cost factors may influence treatment selection, such as patient characteristics, hospital characteristics, and changes in regional rheumatology clinical guidelines. This study aimed to identify and quantify the non-cost factors which influence the probability of anti-TNF choice for patients with rheumatoid arthritis in England. Methods: Data from 1,066 patients receiving anti-TNF therapies (between 2009-2014) across 34 hospitals in England were taken from a national register held by the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate. Multivariate multinomial logistic regression identified which factors influenced the probability of receiving one of five recommended anti-TNFs. Missing data were handled by multiple imputation. Sensitivity analyses assessed if results were robust to using the imputed data and to pre-defined independent variables. Results: Greater disease severity increased the probability of choosing etanercept by 5% (p= 0.06) and reduced the probability of choosing an older monoclonal anti-TNF (infliximab and adalimumab) by 5% (p= 0.06). A 10-year increase in age increased the probability of receiving etanercept by 6% (p= 0.00) and lowered probability of receiving infliximab and adalimumab by 6% (p=0.00). Socioeconomic factors had a large influence on treatment selection, with retired patients and patients in a couple being less likely to receive etanercept by 16% (p= 0.04) and 18% (p= 0.01) respectively. Substantial heterogeneity was observed between hospitals’ probability of choosing certolizumab pegol and golimumab. Conclusions: Non-cost factors were found to affect the probability of anti-TNF choice, suggesting that practice may deviate from recommended national guidance. There was some evidence of inequity in treatment selection from the observed influence of factors reflecting socioeconomic status. Strategies to improve prescribing may be needed when deviations from guidance lead to a more expensive (and not cost-effective) anti-TNF being chosen. PMS77 REAL-WORLD EVIDENCE OF TREATMENT PATTERN AND ASSOCIATED COSTS OF FIBROMYALGIA IN THE UNITED STATES Kaushik P 1, Sehgal M 2, Sharma S 1, Pal Kaur V 1, Vadlamudi N K 3 1PAREXEL, Chandigarh, India, 2PAREXEL International, Chandigarh, India, 3PAREXEL International, Hyderabad, India .
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Objectives: To review the real world evidence in fibromyalgia from last five years identifying prevalent pharmacological treatment options across US and costs associated for management of the disease. Methods: Embase® and Medline databases were searched between January 2011 and December 2015. Registries and observational studies in fibromyalgia population published as full text journal articles in English were included by two independent reviewers with discrepancies reconciled by a third independent reviewer. Pharmacological treatment pattern was captured along with costs of disease management if reported across the included evidence. Results: Out of 477 studies retrieved from biomedical databases, only 11 met the inclusion criteria. Average patient population was 80% women with mean age of 50 years. In a general US wide study, 68.7% used opioid, 43.3% used non-opioid painkillers, whereas only 11.3% used pregabalin for treating FM symptoms. Duloxetine (8 Studies) and Pregabalin (9 Studies) were found to be commonly prescribed for managing FM symptoms in the US, with direct total treatment costs per patient ranging between $1275-$25192 and $1231-$20809.9, respectively, for the 12 month treatment and follow-up period. Dosing and polypharmacy (four studies) largely affected the adherence and cost of the treatment among FM patients. More severe disease as per Fibromyalgia Impact Questionnaire (FIQ) score was associated with higher costs of symptom management. Milnacipran for FM was approved by US FDA in 2009. However, only conference abstracts of a pregnancy registry evaluating its safety profile were retrieved and excluded due to limited information as per inclusion criteria. Conclusions: FM specific approved pharmacological treatments and costs were identified from US real world setting. Cost data for Milnacipran was lacking. More observational studies are needed for better understanding the clinical fibromyalgia management and associated costs. PMS78 CHARACTERIZATION OF INITIAL TREATMENT STRATEGIES USED TO MANAGE INCIDENT KNEE OSTEOARTHRITIS Shewale A R 1, Barnes L 1, Fischbach L A 1, Ounpraseuth S T 1, Painter J T 1, Martin B C 2 1University of Arkansas for Medical Sciences, Little Rock, AR, USA, 2University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA .
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Objectives: Interventions for management of knee osteoarthritis (OA) are broadly classified into four classes: conservative, pharmacological, procedural and surgical. Our study describes the initial treatment strategy used for management of incident knee OA patients. Given the weak evidence on efficacy of hyaluronic acid (HA) and the potential for negative consequences with opioid use, we also compared the characteristics of HA users (with HA non-users) and opioid users (with opioid nonusers). Methods: A cohort study design using IMS Lifelink Plus (2006-2013) claims
data was used to compare the characteristics of incident knee OA patients receiving: 1) conservative, 2) pharmacological, 3) procedural, 4) procedural plus pharmacological, 5) surgical with or without other interventions 6) all other combinations and 7) no intervention. Chi-square tests were used to compare the characteristics these 7 groups, and HA users (vs. non-users) and opioid users (vs. non-users). Results: A cohort of 75,211 incident knee OA patients met our inclusion-exclusion criteria which includes 4,273 (5.68%) patients receiving conservative therapies, 5,699 (7.58%) pharmacological, 20,471 (27.22%) procedural, 9,409 (12.51%) surgical with or without other interventions, 5,855 (7.78%) procedural plus pharmacological, 6,813 (9.06%) treated with other combinations of interventions and 22,691 (30.17%) who did not receive any intervention. Opioids (16.93%) were the most commonly used pharmacological agent, followed by NSAIDs (15.80%). 78% of opioid users were also recipients of surgical or procedural intervention, which is not a first line strategy to manage incident knee OA. Almost 10.5% of incident knee OA patients used HA injections within first 90 days after incident knee OA diagnosis. Both HA users and opioid users (compared to non-users) also had a higher proportion of patients with other pain conditions. Conclusions: Although the existing literature and guideline recommendations do not support the use of opioids, HA and other procedural and surgical interventions for the initial management of incident knee OA, these interventions are frequently used. PMS79 AGE AND GENDER DISTRIBUTION OF OUTPATIENT CARE PHYSIOTHERAPY SERVICES FOR SHOULDER AND UPPER ARM INJURIES IN HUNGARY Molics B 1, Endrei D 2, Zemplényi A 2, Ács P 2, Elmer D 2, Sebestyén A 3, Pónusz R 2, Boncz I 2 1University of Pécs, Pécs, Hungary, 2University of Pécs, Pécs, Hungary, 3National Health Insurance Fund Administration, Pécs, Hungary .
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Objectives: Purpose of this study was to assess amount and frequency of the physiotherapy services in shoulder and upper arm injuries based on age and gender distribution. Methods: Data were derived from the countrywide database of Hungarian Health Insurance Administration (HHIA), based on official reports of outpatient care institutes in 2009. The total numbers of different physiotherapy services were determined by selecting the reported specific diagnoses codes and counting the number treatments provided for that specific diagnosis code. The different types of treatment codes are listed in the chapter of the Guidelines of HHIA for `Physiotherapists, massage-therapists, conductors and other physiotherapy practices`. The number of cases in physiotherapy activities related to for shoulder and upper arm injuries (BNO S40-49) were determined per 10.000 persons by age and gender in outpatient care, 2009. Population distribution was taken into account on the basis of the data of the Central Statistical Office from January 1st 2009. Results: The total number of the 151 different physiotherapy services was 697.896 cases at the sholder and upper arm injuries in the year of 2009. The average number of cases of physiotherapy activities per 10.000 persons accounted for 695,54 cases in the total population. The average number of cases per 10.000 persons for males and females were 675,69 cases for males and 712,95 cases for females. The number of cases of the shoulder and upper arm injuries were higher than the average in the 40-84 age group in males, and in the 50-84 age group in females. Conclusions: In case of the sholder and upper arm injuries was the second most common injury in outpatient care in Hungary in 2009. The number of physiotherapy services of the injuries for both gender were higher in older age groups. PMS80 AGE AND GENDER DISTRIBUTION OF OUTPATIENT CARE PHYSIOTHERAPY SERVICES FOR ELBOW AND FOREARM INJURIES IN HUNGARY Molics B 1, Rátgéber L 2, Hanzel A 3, Juhász K 4, Sebestyén A 4, Cs Horváth Z 5, Elmer D 3, Endrei D 3, Ács P 3, Boncz I 3 1University of Pécs, Pécs, Hungary, 2Ratgeber Academia, Pécs, Hungary, 3University of Pécs, Pécs, Hungary, 4National Health Insurance Fund Administration, Pécs, Hungary, 5Government Office of Baranya County, Pécs, Hungary .
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Objectives: The aim of our study was to assess amount and frequency of the physiotherapy services in elbow and forearm injuries based on age and gender distribution. Methods: The data come from the financial data base of the National Health Insurance Fund Administration (HHIA, in Hungarian: OEP) involving the year of 2009. The activity list was provided by the rulebook on the application of the activity code list in out-patient care. The different types of treatment codes are listed in the chapter of the Guidelines of HHIA for `Physiotherapists, massagetherapists, conductors and other physiotherapy practices`. The number of cases in physiotherapy activities related to for elbow and forearm injuries (BNO S5059) were determined per 10.000 persons by age and gender in outpatient care, 2009. Results: The total number of the 151 different physiotherapy services was 656.537 cases at the elbow and forearm injuries in the total population in the total population in the year of 2009. The average number of cases of physiotherapy activities per 10.000 persons accounted for 654,32 cases. The average number of cases per 10.000 persons were 482,66 cases for males and 808,98 cases for female. The number of cases of the elbow and forearm injuries were higher than the average in the 45-84 age group in the population, in the 30-64 age group in males and in 50-84 age group in females. Conclusions: In case of the elbow and forearm injuries was the third most common injury in outpatient care in Hungary in 2009. The claim indicators were significantly higher for females. The differences in young males vary with the physical activity and the type of recreation activities, and with the condition of osteoporosis in elderly females. PMS81 AGE AND GENDER DISTRIBUTION OF OUTPATIENT CARE PHYSIOTHERAPY SERVICES FOR WRIST AND HAND INJURIES IN HUNGARY Járomi M 1, Rátgéber L 2, Endrei D 1, Juhász K 3, Cs Horváth Z 4, Elmer D 1, Sebestyén A 3, Boncz I 1, Pónusz R 1, Molics B 5 1University of Pécs, Pécs, Hungary, 2Ratgeber Academia, Pécs, Hungary, 3National Health Insurance Fund Administration, Pécs, Hungary, 4Government Office of Baranya County, Pécs, Hungary, 5University of Pécs, Pécs, Hungary .
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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
consumptions were prevalent in 18.8% and 15.6% of patients, respectively. Regarding prescription patterns of osteoporosis medication, BPPs were the most widely prescribed (59.9%) and were followed by HRTs (46.9%) and SERMs (12.6%). Among the patients prescribed with BPPs, HRTs, and SERMs, those having GI RFs were 59.8%, 27.8%, and 13.4%, respectively. Conclusions: The study showed the high prevalence of GI RFs in postmenopausal women. More attentions to GI RFs should be paid when preventing and treating osteoporosis in postmenopausal women. PMS76 IDENTIFYING FACTORS WHICH INFLUENCE THE SELECTION OF ANTI-TNF TREATMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS IN ENGLAND Gavan S 1, Harrison M 2, Barton A 1, Hyrich K 1, Isaacs J 3, Morgan A 4, Wilson AG 5, Payne K 1 University of Manchester, Manchester, UK, 2The University of British Columbia, Vancouver, BC, Canada, 3Newcastle University, Newcastle upon Tyne, UK, 4University of Leeds, Leeds, UK, 5University College Dublin, Dublin, Ireland .
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1The
Objectives: National Institute for Health and Care Excellence guidance recommends that patients with rheumatoid arthritis in England receive the anti-TNF with the lowest acquisition cost. In practice other non-cost factors may influence treatment selection, such as patient characteristics, hospital characteristics, and changes in regional rheumatology clinical guidelines. This study aimed to identify and quantify the non-cost factors which influence the probability of anti-TNF choice for patients with rheumatoid arthritis in England. Methods: Data from 1,066 patients receiving anti-TNF therapies (between 2009-2014) across 34 hospitals in England were taken from a national register held by the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate. Multivariate multinomial logistic regression identified which factors influenced the probability of receiving one of five recommended anti-TNFs. Missing data were handled by multiple imputation. Sensitivity analyses assessed if results were robust to using the imputed data and to pre-defined independent variables. Results: Greater disease severity increased the probability of choosing etanercept by 5% (p= 0.06) and reduced the probability of choosing an older monoclonal anti-TNF (infliximab and adalimumab) by 5% (p= 0.06). A 10-year increase in age increased the probability of receiving etanercept by 6% (p= 0.00) and lowered probability of receiving infliximab and adalimumab by 6% (p=0.00). Socioeconomic factors had a large influence on treatment selection, with retired patients and patients in a couple being less likely to receive etanercept by 16% (p= 0.04) and 18% (p= 0.01) respectively. Substantial heterogeneity was observed between hospitals’ probability of choosing certolizumab pegol and golimumab. Conclusions: Non-cost factors were found to affect the probability of anti-TNF choice, suggesting that practice may deviate from recommended national guidance. There was some evidence of inequity in treatment selection from the observed influence of factors reflecting socioeconomic status. Strategies to improve prescribing may be needed when deviations from guidance lead to a more expensive (and not cost-effective) anti-TNF being chosen. PMS77 REAL-WORLD EVIDENCE OF TREATMENT PATTERN AND ASSOCIATED COSTS OF FIBROMYALGIA IN THE UNITED STATES Kaushik P 1, Sehgal M 2, Sharma S 1, Pal Kaur V 1, Vadlamudi N K 3 1PAREXEL, Chandigarh, India, 2PAREXEL International, Chandigarh, India, 3PAREXEL International, Hyderabad, India .
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Objectives: To review the real world evidence in fibromyalgia from last five years identifying prevalent pharmacological treatment options across US and costs associated for management of the disease. Methods: Embase® and Medline databases were searched between January 2011 and December 2015. Registries and observational studies in fibromyalgia population published as full text journal articles in English were included by two independent reviewers with discrepancies reconciled by a third independent reviewer. Pharmacological treatment pattern was captured along with costs of disease management if reported across the included evidence. Results: Out of 477 studies retrieved from biomedical databases, only 11 met the inclusion criteria. Average patient population was 80% women with mean age of 50 years. In a general US wide study, 68.7% used opioid, 43.3% used non-opioid painkillers, whereas only 11.3% used pregabalin for treating FM symptoms. Duloxetine (8 Studies) and Pregabalin (9 Studies) were found to be commonly prescribed for managing FM symptoms in the US, with direct total treatment costs per patient ranging between $1275-$25192 and $1231-$20809.9, respectively, for the 12 month treatment and follow-up period. Dosing and polypharmacy (four studies) largely affected the adherence and cost of the treatment among FM patients. More severe disease as per Fibromyalgia Impact Questionnaire (FIQ) score was associated with higher costs of symptom management. Milnacipran for FM was approved by US FDA in 2009. However, only conference abstracts of a pregnancy registry evaluating its safety profile were retrieved and excluded due to limited information as per inclusion criteria. Conclusions: FM specific approved pharmacological treatments and costs were identified from US real world setting. Cost data for Milnacipran was lacking. More observational studies are needed for better understanding the clinical fibromyalgia management and associated costs. PMS78 CHARACTERIZATION OF INITIAL TREATMENT STRATEGIES USED TO MANAGE INCIDENT KNEE OSTEOARTHRITIS Shewale A R 1, Barnes L 1, Fischbach L A 1, Ounpraseuth S T 1, Painter J T 1, Martin B C 2 1University of Arkansas for Medical Sciences, Little Rock, AR, USA, 2University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA .
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Objectives: Interventions for management of knee osteoarthritis (OA) are broadly classified into four classes: conservative, pharmacological, procedural and surgical. Our study describes the initial treatment strategy used for management of incident knee OA patients. Given the weak evidence on efficacy of hyaluronic acid (HA) and the potential for negative consequences with opioid use, we also compared the characteristics of HA users (with HA non-users) and opioid users (with opioid nonusers). Methods: A cohort study design using IMS Lifelink Plus (2006-2013) claims
data was used to compare the characteristics of incident knee OA patients receiving: 1) conservative, 2) pharmacological, 3) procedural, 4) procedural plus pharmacological, 5) surgical with or without other interventions 6) all other combinations and 7) no intervention. Chi-square tests were used to compare the characteristics these 7 groups, and HA users (vs. non-users) and opioid users (vs. non-users). Results: A cohort of 75,211 incident knee OA patients met our inclusion-exclusion criteria which includes 4,273 (5.68%) patients receiving conservative therapies, 5,699 (7.58%) pharmacological, 20,471 (27.22%) procedural, 9,409 (12.51%) surgical with or without other interventions, 5,855 (7.78%) procedural plus pharmacological, 6,813 (9.06%) treated with other combinations of interventions and 22,691 (30.17%) who did not receive any intervention. Opioids (16.93%) were the most commonly used pharmacological agent, followed by NSAIDs (15.80%). 78% of opioid users were also recipients of surgical or procedural intervention, which is not a first line strategy to manage incident knee OA. Almost 10.5% of incident knee OA patients used HA injections within first 90 days after incident knee OA diagnosis. Both HA users and opioid users (compared to non-users) also had a higher proportion of patients with other pain conditions. Conclusions: Although the existing literature and guideline recommendations do not support the use of opioids, HA and other procedural and surgical interventions for the initial management of incident knee OA, these interventions are frequently used. PMS79 AGE AND GENDER DISTRIBUTION OF OUTPATIENT CARE PHYSIOTHERAPY SERVICES FOR SHOULDER AND UPPER ARM INJURIES IN HUNGARY Molics B 1, Endrei D 2, Zemplényi A 2, Ács P 2, Elmer D 2, Sebestyén A 3, Pónusz R 2, Boncz I 2 1University of Pécs, Pécs, Hungary, 2University of Pécs, Pécs, Hungary, 3National Health Insurance Fund Administration, Pécs, Hungary .
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Objectives: Purpose of this study was to assess amount and frequency of the physiotherapy services in shoulder and upper arm injuries based on age and gender distribution. Methods: Data were derived from the countrywide database of Hungarian Health Insurance Administration (HHIA), based on official reports of outpatient care institutes in 2009. The total numbers of different physiotherapy services were determined by selecting the reported specific diagnoses codes and counting the number treatments provided for that specific diagnosis code. The different types of treatment codes are listed in the chapter of the Guidelines of HHIA for `Physiotherapists, massage-therapists, conductors and other physiotherapy practices`. The number of cases in physiotherapy activities related to for shoulder and upper arm injuries (BNO S40-49) were determined per 10.000 persons by age and gender in outpatient care, 2009. Population distribution was taken into account on the basis of the data of the Central Statistical Office from January 1st 2009. Results: The total number of the 151 different physiotherapy services was 697.896 cases at the sholder and upper arm injuries in the year of 2009. The average number of cases of physiotherapy activities per 10.000 persons accounted for 695,54 cases in the total population. The average number of cases per 10.000 persons for males and females were 675,69 cases for males and 712,95 cases for females. The number of cases of the shoulder and upper arm injuries were higher than the average in the 40-84 age group in males, and in the 50-84 age group in females. Conclusions: In case of the sholder and upper arm injuries was the second most common injury in outpatient care in Hungary in 2009. The number of physiotherapy services of the injuries for both gender were higher in older age groups. PMS80 AGE AND GENDER DISTRIBUTION OF OUTPATIENT CARE PHYSIOTHERAPY SERVICES FOR ELBOW AND FOREARM INJURIES IN HUNGARY Molics B 1, Rátgéber L 2, Hanzel A 3, Juhász K 4, Sebestyén A 4, Cs Horváth Z 5, Elmer D 3, Endrei D 3, Ács P 3, Boncz I 3 1University of Pécs, Pécs, Hungary, 2Ratgeber Academia, Pécs, Hungary, 3University of Pécs, Pécs, Hungary, 4National Health Insurance Fund Administration, Pécs, Hungary, 5Government Office of Baranya County, Pécs, Hungary .
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Objectives: The aim of our study was to assess amount and frequency of the physiotherapy services in elbow and forearm injuries based on age and gender distribution. Methods: The data come from the financial data base of the National Health Insurance Fund Administration (HHIA, in Hungarian: OEP) involving the year of 2009. The activity list was provided by the rulebook on the application of the activity code list in out-patient care. The different types of treatment codes are listed in the chapter of the Guidelines of HHIA for `Physiotherapists, massagetherapists, conductors and other physiotherapy practices`. The number of cases in physiotherapy activities related to for elbow and forearm injuries (BNO S5059) were determined per 10.000 persons by age and gender in outpatient care, 2009. Results: The total number of the 151 different physiotherapy services was 656.537 cases at the elbow and forearm injuries in the total population in the total population in the year of 2009. The average number of cases of physiotherapy activities per 10.000 persons accounted for 654,32 cases. The average number of cases per 10.000 persons were 482,66 cases for males and 808,98 cases for female. The number of cases of the elbow and forearm injuries were higher than the average in the 45-84 age group in the population, in the 30-64 age group in males and in 50-84 age group in females. Conclusions: In case of the elbow and forearm injuries was the third most common injury in outpatient care in Hungary in 2009. The claim indicators were significantly higher for females. The differences in young males vary with the physical activity and the type of recreation activities, and with the condition of osteoporosis in elderly females. PMS81 AGE AND GENDER DISTRIBUTION OF OUTPATIENT CARE PHYSIOTHERAPY SERVICES FOR WRIST AND HAND INJURIES IN HUNGARY Járomi M 1, Rátgéber L 2, Endrei D 1, Juhász K 3, Cs Horváth Z 4, Elmer D 1, Sebestyén A 3, Boncz I 1, Pónusz R 1, Molics B 5 1University of Pécs, Pécs, Hungary, 2Ratgeber Academia, Pécs, Hungary, 3National Health Insurance Fund Administration, Pécs, Hungary, 4Government Office of Baranya County, Pécs, Hungary, 5University of Pécs, Pécs, Hungary .
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