Utilisation of Antiretrovirals in the Slovak Republic - A 10-Year Retrospective Study

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

life (QoL) in a cohort of Colombia.  Methods: In a cohort study among 111 cases diagnosed in Colombia, demographic and clinical characteristics were collected at baseline, and QoL status by 36-item short-form health survey (SF-36). pCHIK cases were identified according to validated criteria by WHO (2015) via telephone. Those with other arbovirosis during follow-up were excluded.  Results: Of the total CHIK-infected subjects, 78 (45.6%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 43.9% morning stiffness, 38.6% joint edema, and 19.9% joint redness. All dimensions of SF36 as well as physical and mental component summaries were impaired in pCHIK-CIR+ compared to pCHIK-CIR- subjects. Differences in median scores between both groups, pCHIK-CIR- with 81.62% and pCHIK-CIR+ with 54.16%, were statistically significant (p< 0.0001). In addition, there in five dimensions (p< 0.05) (physical functioning [85.53%/53.89%], role physical [85.53%/41.20%], bodily pain [81.62%/51.62%], vitality [76.25%/56.42%] and role emotional [85.96%/54.94%]). Conclusions: Despite possible cohort attrition bias, the comparability of pCHIK-CIR+/- subjects allows the assumption of a longterm impact of CHIK infection with less chance of returning to a previous health status. We observed sharp reductions in QoL not only during active pCHIK-CIR+ associated illness but also for several months after clinical recovery compared to healthy normals. This has implications for developing intervention programmes in countries with high risk of CHIK outbreaks.

INFECTION – Health Care Use & Policy Studies PIN79 Impact of Dosing Schedule on the Success of A Vaccination Programme in an Elderly Population Matthews IR1, Dawson H1, Préaud E2, Lu X2, Harrison J3, Lee A3 Pasteur MSD, Maidenhead, UK, 2Sanofi Pasteur MSD, Lyon, France, 3WG Access Ltd, High Wycombe, UK

1Sanofi

Objectives: Whereas compliance rates for the full course of a multi-dose vaccine schedule in infants are generally very high, the situation in an elderly population is much less clear and there is a paucity of literature to back up the outcomes. The aim of this study was to understand the challenges of completing a multi-dose schedule in an elderly population in the UK.  Methods: A literature review on compliance rates with multi-dose vaccination programmes in an elderly population was carried out, but revealed a scarcity of relevant studies. Hence a series of telephone interviews was conducted with 49 UK health care professionals (HCP) involved in vaccination programmes to understand the potential impact of multi-dose vaccines, when compared with single dose products.  Results: 84% of HCP thought that more than 1 dose would likely result in a reduction in the number of patients completing the vaccination course. 73% of practices felt that they would struggle to schedule the extra appointments needed for a multi-dose product and 94% thought that a multi-dose product would create an additional burden on already stretched nurse resources within the practice. Additionally 67% felt that any increases in payments received from central government would not cover the costs they incurred from a multi-dose product.  Conclusions: The interviewees were clear that multi-dose vaccine products in the elderly are highly likely to lead to a significant reduction in the percentage of elderly patients completing the vaccine course as well as creating extra cost and resource burdens on surgeries already under a substantial work load pressure. The success of a vaccination programme should not just be compared directly with clinical trial results as the ability of HCP to deliver all of the doses of a vaccine to the target population can have a significant impact on the overall effectiveness actually achieved.

PIN80 Utilisation and Dosage Patterns of Intravenous Echinocandins for Treatment of Invasive Fungal Infections Within Hospitals in England Ahir

HB1, McCann

1MSD

E2, Robertson

S1, Patel

S1, Yu

E3, Tham

R3

Ltd, Hoddesdon, UK, 2Merck & Co., Kenilworth, NJ, USA, 3IMS Health, London, UK

Objectives: To describe real-world utilisation of three echinocandins available in England for the treatment of invasive fungal infections: anidulafungin, caspofungin, and micafungin.  Methods: A longitudinal, retrospective cohort study was conducted using the Hospital Treatment Insights database, which links pseudonymised patient data with hospital pharmacy dispensing in England. The Jan 2011 to Apr 2013 analysis period contained 2.7m unique patients. Included patients were adults with ≥ 2 dispenses of the same echinocandin. Reporting is obscured where < 6 hospitalisations observed a particular dose dispensed.  Results: Of the anidulafungin hospitalisations (n= 53), slightly more exceeded the licensed Day 1 dose than matched it (200mg, 34.0%; > 200mg, 39.6%); 75.5% of Day ≥ 2 doses were 100mg as per licence; 15.1% were 200mg. For caspofungin (n= 1079) the most frequently dispensed dose was 70mg as per licence (Day 1: 42.5% [< 70mg, 24.7%; > 70mg, 32.6%]; Day ≥ 2: 62.8%). When including permitted adjustments for weight/hepatic impairment, 84.5% doses were as per licence on Day ≥ 2; 15.5% were not. For micafungin (n= 177) Day 1 doses were: 100mg, 35.0% (as per licence); 100mg-200mg, 48.5% (permitted only for inadequate response), > 200mg, 16.4% (not permitted). Most Day ≥ 2 doses were as per licence (100mg, 68.4%; > 100mg 21.5%; > 200mg, 10.2%). A subsequent antifungal was required in a greater proportion of micafungin hospitalisations (30.5%), compared to caspofungin (22.9%) and anidulafungin (20.8%).  Conclusions: While observed usage of anidulafungin and caspofungin was largely consistent with product licences, most Day 1 micafungin doses exceeded 100mg, suggesting inadequate treatment response or clinical cautiousness. Exceeding licensed doses may lead to higher drug costs than might be assumed based on acquisition cost and product licence. The greater requirement for subsequent antifungal treatment following micafungin may also suggest increased costs.

A421

PIN81 Seasonal Variations of Outpatient Antibiotic use in Austria Hinteregger M1, Janzek-Hawlat S1, Reichardt B2 of Austrian Social Security Institutions (HVB), Vienna, Austria, 2Sickness Fund Burgenland (BGKK), Eisenstadt, Austria

1Main Association

Objectives: Large seasonal variations concerning the prescription of antibiotics for systemic use (ATC group J01) in the outpatient sector may be a sign of overuse regarding virus infections. The aim of this study is to analyse those seasonal variations in Austria.  Methods: The data comprise all filled prescriptions at the expense of the 19 statutory health insurance funds in Austria, covering more than 97% of the national population. Observation period lasts from 2013 to 2015, on a quarterly basis. The main measure of antibiotic use is the number of persons to whom at least one antibiotic drug has been prescribed. Additionally, analyses were conducted regarding patient age as well as antibiotic subgroups.  Results: The highest number of patients was observed in the first quarter of every year, followed by the fourth and the second quarter. Thus, 10.0% of the population received an antibiotic in 2013/ Q3, while in 2013/Q1 the share amounted to 15.3% - this represents a fluctuation of 53%. In 2014 and 2015 the respective fluctuations were 34% and 63%. Variations were especially high among the youngest cohorts (age 0 to 9 years) – with up to 99%. Looking at the number of prescribed medication packages of the subgroups, fluctuations were highest for macrolides, lincosamides and streptogramins (J01F), with 58% more packages being prescribed in winter 2014/15 (2014/Q4, 2015/Q1) than in the previous summer (2014/Q2, 2014/Q3). The respective increase for cephalosporins (J01DB/DC/DD/DE) was 34%, and for penicillins (J01C) 32%.  Conclusions: Compared to other European countries, Austria has a relatively low overall antibiotic use. Nonetheless, the seasonal variations are high. This might be an indicator for suboptimal use of antibiotics. As this is a growing public health concern, the use of antibiotics in the Austrian health system should be considered carefully by doctors as well as patients. PIN82 Utilisation of Antiretrovirals in the Slovak Republic - A 10-Year Retrospective Study Olearova A, Navratil M, Lehocka L, Masarykova L Comenius University in Bratislava, Faculty of Pharmacy, Bratislava, Slovakia

Objectives: The HIV infection rises, by number of infected people, and by worldwide spreading of infection. Increasing number of infected people and incoming of expensive and high-active antiretrovirals result in growth of costs for pharmacotherapy of public health insurance money. The aim of the study was 1. to define epidemiology of the spreading HIV infection, incidence and prevalence in Slovakia and in European Economic Area countries within 2004–2014; 2. to cover information about utilisation of antiretrovirals in Slovakia during tracking period.  Methods: Publicly available data analysis on: 1. epidemiological trends in Slovakia and in Europe from Slovak National Health Information Centre, ECDC and WHO papers; 2. the consumption of antiretrovirals ATC group J05 within the period 2004-2014 from Slovak State Institute for Drug Control database.  Results: The incidence of infection has been increased more than 4-fold during 2004 -2014 in Slovakia. The prevalence of HIV by the end of the year 2014 was 595 cases, and is increasing. 78 people are in AIDS phase of infection, it makes 13 % of infected people. The mortality has increased near to 2-fold during tracking period. The consumption of antiretrovirals in 2004 and 2014 was 827,205 DDD and 3 235,139 DDD, respectively. The J05AF subgroup of antiretrovirals with its rate 0,15 % (16 841,160 € ) had the highest rate on the consumption among all products in Slovakia. The J05AG subgroup of antiretrovirals has the lowest rate on the consumption with its 0.01 % (1 333,680 € ) rate. The costs for pharmacotherapy of one infected person in 2004 and 2014 were 15,445 €  and 21,993 €  respectively. It makes growth of public health insurance costs by 42.40 %.  Conclusions: The continuous analysis and data of incidence, prevalence and utilisation of antiretrovirals are needed for prediction of infection growth, and rational allocation of health care financing. PIN83 Dispensing Patterns of Vaccines by Pharmacies in South Africa Truter I, Lamprecht JC King Khalid University, Abha, Saudi Arabia

Objectives: Immunisation is one of the most cost-effective healthcare interventions. The aim of this study was to determine the dispensing patterns of vaccines by community pharmacies in South Africa with the focus on the cost of the different vaccines.  Methods: A retrospective drug utilisation study was conducted on a 2015 pharmacy dispensing database. All records for ATC group J07 were extracted and analysed. Each prescription contained one vaccine dispensed to a patient.  Results: A total of 140  902 vaccines were dispensed to 79  415 patients at a total cost of R27 622 656.28. The average cost per vaccine was R196.04 (SD= R192.60). Viral vaccines (J07B) accounted for most of the prescriptions (82.73% of volume and 62.25% of cost), followed by bacterial vaccines (J07A) (17.06% of volume and 37.47% of cost), and bacterial and viral vaccines combined (0.21% of volume and 0.28% of cost). There was a clear increase in the dispensing patterns of viral vaccines (J07B) during April, May and June (the period just before the winter months in South Africa). Half of all vaccines (50.40%) dispensed were for the influenza vaccine (J07BB01). This vaccine accounted for only 15.62% of the total cost of vaccines (the average cost per influenza vaccine was R60.75). The most expensive vaccines were pneumococcal polysaccharide conjugate vaccine (13-valent adsorbed, pre-filled syringe) (J07AL01) at an average cost of R621.28, followed by the human papillomavirus bivalent vaccine (J07BM02) (average cost of R613.57) and human papillomavirus quadrivalent (types 6, 11, 16, and 18) vaccine (recombinant, pre-filled syringe) (J07BM01) (average cost of R601.94).  Conclusions: Approximately half of all vaccines dispensed by community pharmacies were for the influenza vaccine, but a wide spectrum of other vaccines were also dispensed. Pharmacists have an important educational role to play in both preventative and therapeutic vaccines, including the Expanded Programme on Immunisation in South Africa.