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Uptake of Hepatitis B HIV Co-Infection Screening And Management In A Resource Limited Setting
A604
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
Objectives: Zoster is a frequent disease which incidence, severity and impact increase with age. A study was designed to investigate the risk of Herpes Zoster (HZ) in Chronic Obstructive Pulmonary Disease (COPD) patients and its related health care resources consumption. Methods: From the population based registries of Valencia Region, Spain, a cohort of all HZ patients aged over 49 years was followed up from 2009-2014. HZ and COPD were defined using ICD-9 codes and severe cases considered when there was inhaled corticosteroids prescription (COPD-ICS). We compared incidence of HZ among groups [non-COPD, COPD and COPD-ICS populations] and health care resource consumption due to HZ in the 6 months following HZ diagnosis through different statistical generalized linear models. Results: The cohort consisted of 2,289,485 subjects ≥ 50 years old, including 161,317 COPD patients of which 28,565 were COPD-ICS. HZ incidence rates were 1105 cases/100,000//year in COPD population and 1300 cases/100,000/year in severe COPD patients. As in general population, incidence increases with age in all subgroups. The risk of HZ increased by 39% among COPD patients and by 61% among COPDICS with respect to non-COPD. COPD patients had increased severity of disease as demonstrated through more healthcare resource used: 5% more outpatient visits due to HZ than non-COPD (RR 1.053, 95% CI: 1.031-1.076), higher medication rates (RR 1.227, 95% CI: 1.168-1.289), especially for severe COPD patients (RR 1.461, 95% CI: 1.334-1.599), both zoster severity and healthcare resources used increase with age (from 8% outpatients visits for aged 60-69 to 19% for 70-79 with respect to 50-59 and 26% medication rates for aged 60-69 to 58% for 70-79). Conclusions: Beyond age, having underlying conditions and especially COPD, increase the risk, severity and impact of zoster episodes in senior population. It confirms the significant public health interest of enlarging access to vaccination in Spain.
PHS2 Uptake of Hepatitis B HIV Co-Infection Screening And Management In A Resource Limited Setting Musomba R1, Castelnuovo B1, Murphy C2, Komujuni C1, Nyakato P1, Ocama P1, Larmode M3, Ratanshi RP3 1Infectious Diseases Institute, College of Health Sciences Makerere University, Kampala, Uganda, 2Queen Elizabeth University Hospital, Scotland, UK, 3Infectious Diseases Institute, College of Health Sciences Makerere University.re, Kampala, Uganda
Objectives: WHO hepatitis B (HbsAg) guidelines recommend testing all new HIV patients, treating them accordingly or providing immunization. At the Infectious Diseases Institute (IDI) following an audit done in 2012, only 46% patients had been screened for HbsAg with variable management plans therefore new internal guidelines were implemented. This study describes the uptake of HbsAg screening and management of patients with HbsAg and HIV con-infection after the implementation. Methods: Data included for all HIV positive patients in care at IDI by October 2015. Data are expressed as median with interquartile range (IQR) and percentages were compared using the chi square test.Statistical analysis was performed using STATA version 13.The IDI laboratory upper limit of normal for alanine aminotransferase (ALT) and aspartate aminotransferase (ASTs) was 40 IU/ml. Results: Number of HbsAg tests done increased from 800 in 2012 to 1400 in 2015 with a total of, 8042/8604(93.5%) patients screened . Overall HbsAg positive were; 359 (4.6%), male 189 (52.6%), median age 38 (32, 45), on ART337 (93.9%) with a median time on ART 74 (27, 399) days.166 (81.4%) HbsAg positives were switched to a Tenofovir containing regimen. Of those not switched, 8(36.4%) died, 4(18.2%) discontinued care, 7(31.8%) had been transferred out. Overall 23 (6.5%) HbsAg positives died. Patients with ASTs done were 86(24%), 7(1.9%) had HbsAg viral loads and 250(69.6%) patients with an ultra sound scan done. Conclusions: Our study confirms the importance of screening for HbsAg and of using ART regimens containing Tenofovir in HbsAg co-infected patients. Whilst our program has made improvements in care still 18.6% of patients with HbsAg were not on Tenofovir regimens, 98.1% had no HbsAg viral loads done. Clinicians should recognize the potential for HbsAg in HIV positive patients and the importance of early diagnosis and treatment to ensure optimal management of cases and follow up. PHS3 An Indirect Comparison Between Adalimumab, Baricitinib And Tofacitinib For The Treatment of Rheumatoid Arthritis Migliore A s.Pietro Hospital, Rome, Italy
Objectives: Rheumatoid arthritis (RA) is a chronic disease characterized by inflammation of the synovial tissue leading to joint destruction. The introduction of biologic agents dramatically changed the prognosis of RA. At now there is a new class of agents, kinase inhibitors, that are approved for the therapy of RA. The aim of this Bayesian metanalysis is to compare adalimumab that is market leader in the treatment of RA with 2 kinase inhibitors, rispectively Baricitinib and Tofacitinib. Methods: A literature search was performed to identify articles reporting data from RCTs on the efficacy of Adalimumab, Baricitinib and Tofacitinib in RA. Indirect comparison results are reported as the relative risk of response (RR), intended as the capacity of inducing DAS28 ESR < 3,2 and DAS28 ESR < 2,6 response for each intervention associated compared with placebo. Results: A total of 7 scientific papers were identified. All agents, associated to MTX, proved to be more efficacious in inducing response response respect to placebo. When comparing results obtained by different drugs, Baricitinib proved to be the agent that represents the best choice for obtaining DAS28 ESR < 3,2 response with a probability of 84,26%, while Adalimumab represents the best choice for inducing DAS28 ESR < 2,6 response with a probability of 77%. Tofacitinib shows a probability lower than 1% to induce both DAS28 ESR results Conclusions: In this Indirect comparison on RCTs on the efficacy of Adalimumab compared to 2 kinase inhibitors in RA, we identified Baricitinib and Adalimumab the more probably best choices in obtaining the result respectively of DAS28 ESR < 3,2 and DAS28 ESR < 2,6 response. Baricitinib seems to be a new promising intervention for the treatment of RA. Even if Toafacitinib and
Baricitinib belong to the same class of kinase inhibitors, they don’t shows similar efficacy. PHS4 A Network Metanalysis To Compare Biologic Agents In The Treatment of Non-Radiographic Axial Spondyloarthritis Migliore A S.Pietro Fatebenefratelli Hospital, rome, Italy
Objectives: The non-radiographic axial spondyloarthritis (nrAxSpA) is referred to patients who have a clinical picture of ankylosing spondylitis (AS) without exhibiting radiographic sacroiliitis. The clinical diagnosis should be based on clinical symptoms, HLA B27 status, and magnetic resonance imaging (MRI) of sacroiliac joints.. The prevalence of nrAxSpA is similar to that of AS. The rate of progression of nrAxSpA to the radiographic stage of disease (AS) ranges from 10% to 20% over 2 years. Current treatment strategies for nrAxSpA are the same as for AS including inhibitors of tumor necrosis factor-alpha Methods: This MTC looks to compare Certolizumab (CZP), etanercept (ETA), adalimumab (ADA) and Golimumab (GDL) in clinical efficacy on nrAxSpA to achieve ASAS 20. A systematic research for RCT involving Certolizumab, etanercept, adalimumab and Golimumab was conducted using databases (CENTRAL, CINAHL,Embase, HMIC, MEDLINE and PsycINFO). MTC results are reported as the relative risk of response (RR), intended as the capacity of achieving ASAS 20 for each Anti-TNF agent compared with placebo. Results: Five RCTs were identified. Two trials compared ADA versus placebo and one trial for each one of Certolizumab,etanercept,andGolimumab. GDL had the highest probability (64,19%) of being the most effective treatmentin achieving ASAS 20 towards placebo, followed by ADA (22,87% probability), CZP (10,22% probability) and then ETA (2,72%). Comparisons among any anti-TNF agent against each other don’t give evidence for a statistically significant difference. Conclusions: The results of this MTC can suggest that GDL, compared to placebo, is expected to provide the highest rate of ASAS 20 in patients affected by nrAxSpA. PHS5 Comparison of Mortality Reduction From Gastric Cancer Among Different Screening Programs Hamashima C1, Narisawa R2, Ogoshi K2 Cancer Center, Tokyo, Japan, 2Niigata Cancer Center Hospital, Niigata, Japan
1National
Objectives: Despite recent declines in the incidence and mortality of gastric cancer worldwide, gastric cancer remains to be the third leading cause of cancer mortality worldwide. Several studies have reported the possibility of reducing mortality from gastric cancer by endoscopic screening. However, definitive evidence to support this contention has not yet been obtained. We investigated mortality reduction from gastric cancer on the basis of results of endoscopic screening. Methods: The study population comprised participants in gastric cancer screening by endoscopy, regular radiography, and photofluorography in Niigata City in 2005. Observed numbers of cumulative deaths from gastric cancers and other cancers were accumulated by linkage with the Niigata Prefectural Cancer Registry. Standardized mortality ratios (SMRs) for gastric cancer and other cancer deaths in each screening group were calculated by applying the mortality rate of the reference population based on the results of 5 years of follow-up. Results: Numbers of subjects in each screening group were 16,373 for endoscopic screening, 18,221 for regular radiographic screening, and 15,927 for photofluorography screening. Based on the results calculated from the mortality rate in the population of Niigata City, SMRs for gastric cancer death were 0.43 (95%CI: 0.30-0.57) for the endoscopic screening group, 0.68 (95%CI: 0.55-0.79) for the regular radiographic screening group, and 0.85 (95%CI: 0.71-0.94) for the photofluorography screening group. The mortality reduction from gastric cancer was higher in the endoscopic screening group than in the regular radiographic screening group, despite the nearly equal mortality rates of all cancers except gastric cancer. The same results were obtained even if the reference population was changed to the population of Niigata Prefecture or Japan. Conclusions: The 57% mortality reduction from gastric cancer obtained by endoscopic screening suggests the effectiveness of endoscopic screening for gastric cancer. Further confirmatory studies and prudent interpretation of results are needed. PHS6 Effectiveness And Cost-Effectiveness of The Salut Programme – A Universal Health Promotion Intervention For Parents And Children Sampaio F1, Feldman I1, Eurenius E2, Häggström J2, Lindkvist M2, Pulkki-Brännström A2, Ivarsson A2 1Uppsala University, Uppsala, Sweden, 2Umeå University, Umeå, Sweden
Objectives: To investigate the effectiveness and cost-effectiveness of the Salut Programme, a universal health promotion intervention in a Swedish County, compared to care-as-usual, during pregnancy, delivery and the child’s first two years of life, from a limited societal perspective. Methods: A register-based retrospective observational study design is used with respect to both exposures and outcomes. We analysed outcomes during pregnancy, delivery and the child’s first two years of life including birth weight and Apgar scores, information on child’s and mother’s inpatient and outpatient visits, and number of paid days for care of sick child. We simulated an experiment by retrospectively identifying geographical areas within the County where the Salut Programme was implemented in 2006-2007 (intervention group) and areas where Salut was not implemented (non-intervention group). We compared outcomes for parents and children during pre- (children born 20022004) and post- (children born 2006-2008) measure periods for the intervention (n= 1891 children, n= 1599 mothers), and non-intervention groups (n= 12,723 children, n= 10,544 mothers). Our analysis combined difference-in-difference estimation with matching, and a complementary analysis on the longitudinal subsample of women who gave birth at both the pre- and post- measure periods. A cost-effectiveness analysis compared costs and outcomes of the Salut programme to care-asusual. Results: No significant changes were found in the difference-in-difference
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
Objectives: Zoster is a frequent disease which incidence, severity and impact increase with age. A study was designed to investigate the risk of Herpes Zoster (HZ) in Chronic Obstructive Pulmonary Disease (COPD) patients and its related health care resources consumption. Methods: From the population based registries of Valencia Region, Spain, a cohort of all HZ patients aged over 49 years was followed up from 2009-2014. HZ and COPD were defined using ICD-9 codes and severe cases considered when there was inhaled corticosteroids prescription (COPD-ICS). We compared incidence of HZ among groups [non-COPD, COPD and COPD-ICS populations] and health care resource consumption due to HZ in the 6 months following HZ diagnosis through different statistical generalized linear models. Results: The cohort consisted of 2,289,485 subjects ≥ 50 years old, including 161,317 COPD patients of which 28,565 were COPD-ICS. HZ incidence rates were 1105 cases/100,000//year in COPD population and 1300 cases/100,000/year in severe COPD patients. As in general population, incidence increases with age in all subgroups. The risk of HZ increased by 39% among COPD patients and by 61% among COPDICS with respect to non-COPD. COPD patients had increased severity of disease as demonstrated through more healthcare resource used: 5% more outpatient visits due to HZ than non-COPD (RR 1.053, 95% CI: 1.031-1.076), higher medication rates (RR 1.227, 95% CI: 1.168-1.289), especially for severe COPD patients (RR 1.461, 95% CI: 1.334-1.599), both zoster severity and healthcare resources used increase with age (from 8% outpatients visits for aged 60-69 to 19% for 70-79 with respect to 50-59 and 26% medication rates for aged 60-69 to 58% for 70-79). Conclusions: Beyond age, having underlying conditions and especially COPD, increase the risk, severity and impact of zoster episodes in senior population. It confirms the significant public health interest of enlarging access to vaccination in Spain.
PHS2 Uptake of Hepatitis B HIV Co-Infection Screening And Management In A Resource Limited Setting Musomba R1, Castelnuovo B1, Murphy C2, Komujuni C1, Nyakato P1, Ocama P1, Larmode M3, Ratanshi RP3 1Infectious Diseases Institute, College of Health Sciences Makerere University, Kampala, Uganda, 2Queen Elizabeth University Hospital, Scotland, UK, 3Infectious Diseases Institute, College of Health Sciences Makerere University.re, Kampala, Uganda
Objectives: WHO hepatitis B (HbsAg) guidelines recommend testing all new HIV patients, treating them accordingly or providing immunization. At the Infectious Diseases Institute (IDI) following an audit done in 2012, only 46% patients had been screened for HbsAg with variable management plans therefore new internal guidelines were implemented. This study describes the uptake of HbsAg screening and management of patients with HbsAg and HIV con-infection after the implementation. Methods: Data included for all HIV positive patients in care at IDI by October 2015. Data are expressed as median with interquartile range (IQR) and percentages were compared using the chi square test.Statistical analysis was performed using STATA version 13.The IDI laboratory upper limit of normal for alanine aminotransferase (ALT) and aspartate aminotransferase (ASTs) was 40 IU/ml. Results: Number of HbsAg tests done increased from 800 in 2012 to 1400 in 2015 with a total of, 8042/8604(93.5%) patients screened . Overall HbsAg positive were; 359 (4.6%), male 189 (52.6%), median age 38 (32, 45), on ART337 (93.9%) with a median time on ART 74 (27, 399) days.166 (81.4%) HbsAg positives were switched to a Tenofovir containing regimen. Of those not switched, 8(36.4%) died, 4(18.2%) discontinued care, 7(31.8%) had been transferred out. Overall 23 (6.5%) HbsAg positives died. Patients with ASTs done were 86(24%), 7(1.9%) had HbsAg viral loads and 250(69.6%) patients with an ultra sound scan done. Conclusions: Our study confirms the importance of screening for HbsAg and of using ART regimens containing Tenofovir in HbsAg co-infected patients. Whilst our program has made improvements in care still 18.6% of patients with HbsAg were not on Tenofovir regimens, 98.1% had no HbsAg viral loads done. Clinicians should recognize the potential for HbsAg in HIV positive patients and the importance of early diagnosis and treatment to ensure optimal management of cases and follow up. PHS3 An Indirect Comparison Between Adalimumab, Baricitinib And Tofacitinib For The Treatment of Rheumatoid Arthritis Migliore A s.Pietro Hospital, Rome, Italy
Objectives: Rheumatoid arthritis (RA) is a chronic disease characterized by inflammation of the synovial tissue leading to joint destruction. The introduction of biologic agents dramatically changed the prognosis of RA. At now there is a new class of agents, kinase inhibitors, that are approved for the therapy of RA. The aim of this Bayesian metanalysis is to compare adalimumab that is market leader in the treatment of RA with 2 kinase inhibitors, rispectively Baricitinib and Tofacitinib. Methods: A literature search was performed to identify articles reporting data from RCTs on the efficacy of Adalimumab, Baricitinib and Tofacitinib in RA. Indirect comparison results are reported as the relative risk of response (RR), intended as the capacity of inducing DAS28 ESR < 3,2 and DAS28 ESR < 2,6 response for each intervention associated compared with placebo. Results: A total of 7 scientific papers were identified. All agents, associated to MTX, proved to be more efficacious in inducing response response respect to placebo. When comparing results obtained by different drugs, Baricitinib proved to be the agent that represents the best choice for obtaining DAS28 ESR < 3,2 response with a probability of 84,26%, while Adalimumab represents the best choice for inducing DAS28 ESR < 2,6 response with a probability of 77%. Tofacitinib shows a probability lower than 1% to induce both DAS28 ESR results Conclusions: In this Indirect comparison on RCTs on the efficacy of Adalimumab compared to 2 kinase inhibitors in RA, we identified Baricitinib and Adalimumab the more probably best choices in obtaining the result respectively of DAS28 ESR < 3,2 and DAS28 ESR < 2,6 response. Baricitinib seems to be a new promising intervention for the treatment of RA. Even if Toafacitinib and
Baricitinib belong to the same class of kinase inhibitors, they don’t shows similar efficacy. PHS4 A Network Metanalysis To Compare Biologic Agents In The Treatment of Non-Radiographic Axial Spondyloarthritis Migliore A S.Pietro Fatebenefratelli Hospital, rome, Italy
Objectives: The non-radiographic axial spondyloarthritis (nrAxSpA) is referred to patients who have a clinical picture of ankylosing spondylitis (AS) without exhibiting radiographic sacroiliitis. The clinical diagnosis should be based on clinical symptoms, HLA B27 status, and magnetic resonance imaging (MRI) of sacroiliac joints.. The prevalence of nrAxSpA is similar to that of AS. The rate of progression of nrAxSpA to the radiographic stage of disease (AS) ranges from 10% to 20% over 2 years. Current treatment strategies for nrAxSpA are the same as for AS including inhibitors of tumor necrosis factor-alpha Methods: This MTC looks to compare Certolizumab (CZP), etanercept (ETA), adalimumab (ADA) and Golimumab (GDL) in clinical efficacy on nrAxSpA to achieve ASAS 20. A systematic research for RCT involving Certolizumab, etanercept, adalimumab and Golimumab was conducted using databases (CENTRAL, CINAHL,Embase, HMIC, MEDLINE and PsycINFO). MTC results are reported as the relative risk of response (RR), intended as the capacity of achieving ASAS 20 for each Anti-TNF agent compared with placebo. Results: Five RCTs were identified. Two trials compared ADA versus placebo and one trial for each one of Certolizumab,etanercept,andGolimumab. GDL had the highest probability (64,19%) of being the most effective treatmentin achieving ASAS 20 towards placebo, followed by ADA (22,87% probability), CZP (10,22% probability) and then ETA (2,72%). Comparisons among any anti-TNF agent against each other don’t give evidence for a statistically significant difference. Conclusions: The results of this MTC can suggest that GDL, compared to placebo, is expected to provide the highest rate of ASAS 20 in patients affected by nrAxSpA. PHS5 Comparison of Mortality Reduction From Gastric Cancer Among Different Screening Programs Hamashima C1, Narisawa R2, Ogoshi K2 Cancer Center, Tokyo, Japan, 2Niigata Cancer Center Hospital, Niigata, Japan
1National
Objectives: Despite recent declines in the incidence and mortality of gastric cancer worldwide, gastric cancer remains to be the third leading cause of cancer mortality worldwide. Several studies have reported the possibility of reducing mortality from gastric cancer by endoscopic screening. However, definitive evidence to support this contention has not yet been obtained. We investigated mortality reduction from gastric cancer on the basis of results of endoscopic screening. Methods: The study population comprised participants in gastric cancer screening by endoscopy, regular radiography, and photofluorography in Niigata City in 2005. Observed numbers of cumulative deaths from gastric cancers and other cancers were accumulated by linkage with the Niigata Prefectural Cancer Registry. Standardized mortality ratios (SMRs) for gastric cancer and other cancer deaths in each screening group were calculated by applying the mortality rate of the reference population based on the results of 5 years of follow-up. Results: Numbers of subjects in each screening group were 16,373 for endoscopic screening, 18,221 for regular radiographic screening, and 15,927 for photofluorography screening. Based on the results calculated from the mortality rate in the population of Niigata City, SMRs for gastric cancer death were 0.43 (95%CI: 0.30-0.57) for the endoscopic screening group, 0.68 (95%CI: 0.55-0.79) for the regular radiographic screening group, and 0.85 (95%CI: 0.71-0.94) for the photofluorography screening group. The mortality reduction from gastric cancer was higher in the endoscopic screening group than in the regular radiographic screening group, despite the nearly equal mortality rates of all cancers except gastric cancer. The same results were obtained even if the reference population was changed to the population of Niigata Prefecture or Japan. Conclusions: The 57% mortality reduction from gastric cancer obtained by endoscopic screening suggests the effectiveness of endoscopic screening for gastric cancer. Further confirmatory studies and prudent interpretation of results are needed. PHS6 Effectiveness And Cost-Effectiveness of The Salut Programme – A Universal Health Promotion Intervention For Parents And Children Sampaio F1, Feldman I1, Eurenius E2, Häggström J2, Lindkvist M2, Pulkki-Brännström A2, Ivarsson A2 1Uppsala University, Uppsala, Sweden, 2Umeå University, Umeå, Sweden
Objectives: To investigate the effectiveness and cost-effectiveness of the Salut Programme, a universal health promotion intervention in a Swedish County, compared to care-as-usual, during pregnancy, delivery and the child’s first two years of life, from a limited societal perspective. Methods: A register-based retrospective observational study design is used with respect to both exposures and outcomes. We analysed outcomes during pregnancy, delivery and the child’s first two years of life including birth weight and Apgar scores, information on child’s and mother’s inpatient and outpatient visits, and number of paid days for care of sick child. We simulated an experiment by retrospectively identifying geographical areas within the County where the Salut Programme was implemented in 2006-2007 (intervention group) and areas where Salut was not implemented (non-intervention group). We compared outcomes for parents and children during pre- (children born 20022004) and post- (children born 2006-2008) measure periods for the intervention (n= 1891 children, n= 1599 mothers), and non-intervention groups (n= 12,723 children, n= 10,544 mothers). Our analysis combined difference-in-difference estimation with matching, and a complementary analysis on the longitudinal subsample of women who gave birth at both the pre- and post- measure periods. A cost-effectiveness analysis compared costs and outcomes of the Salut programme to care-asusual. Results: No significant changes were found in the difference-in-difference