The Relationship Between Severity of Chronic Kidney Disease and Health Related Quality of Life Among a Nationally Representative Sample of Community Dwelling Adults in England

VA L U E I N H E A LT H

patients aged≥ 40 years with moderate to severe BPH and repeated over 1 year cycles for 35 years. The model, comprised four mutually exclusive health states comparing tamsulosin (0.4 mg/day) and dutasteride (0.5 mg/day)/tamsulosin (0.4 mg/day). A meta-analysis was conducted to estimate ADRs and After Surgery Events (ASEs) probabilities. Utilities were estimated by fulfilling a meta-analysis of studies which had used EQ5D method. Total Cost contained direct costs of medications, inpatient and outpatient services. All utilities and costs were discounted by the rate of 3% and 5% respectively.  Results: The annual probabilities of AUR syndrome and TURP surgery incidence were calculated 0.0169 and 0.0193 in monotherapy as well as 0.0055 and 0.0060 in combination therapy respectively. The utilities were accounted 0.86 in mild, 0.79 in moderate, 0.72 in severe states and 0 in death. Regarding metaanalysis results, the ASE probabilities were estimated as follows: TUR syndrome (0-0.0109), Urinary incontinence (0.0198-0.1894), urethral stricture (0.0392-0.0769), UTI (0.0169-0.0787), Urinary retention (0.0296), Erectile dysfunctions (0.1895), clot retention (0.0198-0.0488). Eventually, the ICER for combination therapy was $5159, and Probabilistic sensitivity analysis showed that cost-effectiveness probability, was between 89% and 94% given the threshold range ($3700–$11000 per QALY) applied in Iran. Performing one-way sensitivity analysis, the model was most sensitive to dutasteride unit price and surgery incidence with monotherapy.  Conclusions: Dutasteride/tamsulosin therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in Iran.

URINARY/KIDNEY DISORDERS – Patient-Reported Outcomes & Patient Preference Studies PUK17 The Relationship Between Severity of Chronic Kidney Disease and Health Related Quality of Life Among a Nationally Representative Sample of Community Dwelling Adults in England Nguyen TQ1, Cockwell P2, Griffin M3, Maxwell P1, O’Brien T3, O’Neill C1 1Queen’s University Belfast, Belfast, UK, 2University Hospitals Birmingham, Birmingham, UK, 3National University of Ireland Galway, Galway, Ireland

Objectives: Several studies have examined the relationship between healthrelated quality-of-life (HRQoL) and the severity of chronic kidney disease (CKD) experienced by the individual. While contributing to the literature these studies exhibit limitations related to sample selection and failure to control for the censored nature of the outcome. In this study we examined the relationship between HRQoL and kidney function among a representative sample of community dwelling individuals living in England.  Methods: Data on 2796 individuals from the 2010 Health Survey for England with respect to HRQoL, kidney function and a range of socio-demographic characteristics were obtained. EuroQol 5D-3L data were converted to a utility score using the English national tariff. Severity of CKD was based on estimated glomerular filtration rate (eGFR) and albuminuria status with respondents categorised into one of six levels of kidney disease. A multivariate tobit model was used to examine the relationship between utility scores and severity of kidney disease controlling for age, gender, socio-economic status, marital status and ethnicity.  Results: Those with more advanced CKD were found to have lower HRQoL than those with better kidney function. Compared to those with normal/low normal eGFR and Stage 1 CKD, those with Stage 2 CKD experienced a decrement of approximately 0.09 in their utility index while those with Stage 3a/3b CKD and micro- or macro-albuminuria and those with Stage 4/5 CKD experienced decrements of 0.17 and 0.29 respectively, controlling for other variables.  Conclusions: Among individuals with and without CKD we find that kidney function is related to quality of life in a manner consistent with intuition. The utility (uncontrolled) weights generated in our analyses have the potential to be of value in the evaluation of new technologies being developed for the treatment of kidney disease. PUK18 Sentiment Analysis of Social Media Posts from Renal Cell Carcinoma (RCC) Patients Merinopoulou E1, Ramagopalan S2, Malcolm B2, Lees M3, Cox A1 1Evidera, London, UK, 2Bristol-Myers Squibb, Uxbridge, UK, 3Bristol-Myers Squibb, Rueil Malmaison, France

Objectives: Social media are increasingly used by patients and the content of these postings uniquely reflects the views and perspectives of patients. Historical discussions span several years, are updated in real time and are available for large numbers of patients. We examined the valence or sentiment of the language patients use over their treatment history utilising natural language processing (NLP) and sentiment analysis.  Methods: We analysed a corpus of 8,433 postings from 483 Stage 4 RCC patients. Mean sentiment scores over time were computed for all patients for two distinct cases; Over follow-up from time since diagnosis and longitudinally over the 6-year period prior to 2016, regardless of time of diagnosis. The analysis of overall sentiment is presented with reference to a time-line representing regulatory approval of key targeted therapies.  Results: Language used over time since diagnosis showed a positive sentiment with a mean value of +1.2 at time of diagnosis (range -5 for negative to +5 for postive), with a gradual decline toward neutral over time. Longitudinal mean sentiment change over time showed a distinct increase in positive sentiment (+0.8 to +1.4 over two years) occurring directly following the approval of 3 targeted therapies in 2010.  Conclusions: Sentiment is much used in other industries, although its use in medical fields is less well explored. The results showing an increase in mean sentiment following the approval of three targeted therapies in 2010 indicate that sentiment scoring can provide information regarding changes in the valence of language used over time, and potentially thereby quantifying a reaction to important events in a patient population. Patient mean sentiment remained positive over time since diagnosis, an overall positive sentiment may be a slightly counter intuitive finding (to non-patients) and is reflective of a predominance of positive wording being used by RCC patients.

20 (2017) A399–A811

A491

PUK19 Risky Business: What Factors Influence Decision-Maker’s Willingness to Pay for New Treatments on the Hospital Formulary? Hamrosi KK1, Fifer S1, Earle K2 and Patient Preference Research (CaPPRe), Sydney, Australia, 2AstraZeneca Australia, Macquarie Park, Australia

1Community

Objectives: Hospital Drugs and Therapeutic Committee (DTC) or its equivalent are responsible for making recommendations to fund new medicines on the hospital formulary. These decisions are complex. While safety, efficacy and cost-effectiveness are key considerations, there is limited information surrounding the tradeoffs and relative importance of other factors that influence their decisions. This study aimed to understand hospital decision makers (HDMs) stated preferences and the value placed on specific attributes of new treatments for hyperkalaemia to a relevant comparator. Other factors influencing their decision-making were explored.  Methods: Six HDMs were involved in qualitative interviews to inform the design of the discrete choice experiment (DCE). HDMs (n= 60) from public and private hospitals in Australia were recruited through a specialist healthcare panel to complete the survey. HDMs were members of the DTC or equivalent and/or had made applications to the hospital formulary. Survey questions elicited treatment attitudes, decision-making criteria and the evidence considered. The DCE required HDMs to trade-off attributes including hospital resource use, frequency and mode of administration, onset of action, side effects, drug interactions and cost. The relative priority HDMs place on different attributes and estimate their willingness to pay for new treatments was assessed using latent class models.  Results: HDMs primary clinical role and hospital funding model influenced the key factors driving funding decisions. HDMS were less willing to trade off safety, efficacy and administration to competing considerations such as access and cost-effectiveness.  conclusions: HDMs preferences were consistent with clinical roles and treatment experience. Overall, HDMs were willing to trade-off between the benefits (clinical and patient), risks (safety) and cost (resource use and treatment cost) when considering the funding of new treatments in the hospital setting. PUK20 Health Valuation of Dialysis with the EQ-5D: Determinants of Discrepancy Between Patients and Society Beby AT, Voskamp PW, Zamanipoor Najafabadi AH, van Diepen M, Dekker FW Leiden University Medical Center (LUMC), Leiden, The Netherlands

Objectives: This study evaluates the discrepancy of self-reported health valuation by incident dialysis patients and the societal valuation of the health states of these patients. Subsequently, it investigates which socio-demographic and medical characteristics explain this discrepancy.  Methods: We used data from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD-2), a prospective multicenter cohort study on incident end-stage renal disease patients. Health valuation was measured with the EuroQol (EQ-5D) questionnaire. The discrepancy in valuation, Δ EQ-5D, was calculated by subtracting the health valuation by patients (EQ-5D Visual Anologue Scale; EQ-5D VAS) from the societal valuation (EQ-5D Index). Mean Δ EQ-5D scores were stratified by problem level, socio-demographic and medical characteristics. Univariable and multivariable regression analyses were performed to explain the discrepancy by socio-demographic and medical characteristics.  Results: 1,441 dialysis patients were included. Overall, the societal (EQ-5D Index) score was higher than the patients’ (EQ-5D VAS) score (mean Δ EQ-5D= 10.86, SD= 23.63). The discrepancy in valuation was largest for patients who reported no problems on the five health dimensions, were younger, male, never married, highly educated, employed and completed the form without help.  Conclusions: Our results showed that the societal valuation of the health states of dialysis patients is generally higher than patients’ own health valuation, especially for patients who are younger, male, have never been married, a better kidney function and reported no problems. This indicates that using societal valuation with the EQ-5D may underestimate the impact of dialysis on the quality of life of this patient group. PUK21 Quality of Life in Patients with Kidney Transplantation in Czech Republic Bielik J, Dingova M, Melus V, Jurdikova K Trencin University, Trencin, Slovakia

Objectives: There are about 40000 patients with chronic kidney disease (CKD) in Slovakia and about 4500 patients are treated by dialysis. More than 120 patients undergo kidney (KT) transplantation per year. The objective of this study was to find out the level of quality of life (QoL) in patients and other relevant characteristics in patients with KT.  Methods: The primary method used for the analysis of QoL was the own original combined questionnaire. Statistical methods from Excel 2010 (Student,- Dunn, - Friedman, Spearmann tests) were used in results evaluation.  Results: There were 100 patients in the examined group, 61men, 39 women, with age average 49,1 years. The average of CKD duration was- 12,17 years, symptoms before diagnosis- 5,8 months, waiting time to transplantation- 3,81 y, time after transplantation- 5,8 y, outpatients visits (nephrology, urology, GP, others)- 7,2 per year. Present level of QoL was identified as 7,22 on the scale from 0 to 10, in the time of the diagnosis - 4,57, in the time of KT- 5,86, in the time without CKD – 8,85 and in optimal state of health- 8,99. Comparative to the QoL was examined the ability to work (AW) – 5,53 vs 4,82 vs 3,87 vs 8,91 vs 9,28. The impact of KT on family QoL reached 6,11. The level of information about the disease was 4,3, physician care- 4,65, nursing care- 4,76 (0-the worst, 5- the best). Disability per month was 3,1 days vs 1,3 days from other diseases. The average income was 339,7 € and the willingness to pay for 1 month of full health was 305,4 € per month.  Conclusions: KT had a significant positive impact on patients´s QoL and AW. QoL and AW had strong correlation each other. The others parameter had no impact on QoL – gender, duration of dialysis, time before transplantation.