Poster Presentations
PP44 Optimal Use Of Warfarin: Self-Monitoring From A Quebec Perspective
- Sylvie Bouchard, Frederic St-Pierre, Ann Levesque, Melanie Turgeon, Helene Guay, Adriana Freitas, Eric Plante, Gabriel Carpentier, Mélanie Tardif
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- Published online by Cambridge University Press:
- 31 December 2019, pp. 45-46
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Introduction
Frequent standard International Normalized Ratio (INR) monitoring by health professionals is one of the major inconveniences reported by warfarin users. However, portable coagulometers are now available to reduce this burden by allowing patients to self-monitor their INR in the comfort of their home, thereby reducing their visiting frequency to a medical clinic. The aim of this work was thus to elaborate recommendations on the use of self-monitoring in the management of warfarin-treated patients in the province of Quebec.
MethodsSystematic literature reviews were conducted to retrieve the most up-to-date scientific data from primary studies and pharmacoeconomic evaluations as well as recommendations from published clinical practice guidelines. This information was then triangulated with the experiential knowledge of Quebec experts and clinicians collaborating on the project.
ResultsThe scientific, contextual and experiential evidence gathered during this work provided convincing support for the use of self-monitoring for long-term warfarin-treated patients, leading to a more effective treatment than standard monitoring while being safe, cost-effective and potentially improving patients’ quality of life. However, physical and mental limitations can hinder the use of portable coagulometers, outlining the need for caution in the selection and support of self-monitoring patients.
ConclusionsThis work led to the development of specific recommendations on the use of self-monitoring along with a clinical tool to help discussion between patients and health professionals leading to a shared decision-making. This work will be part of two optimal usage guides on oral anticoagulant therapy to be published by the Institut national d'excellence en santé et en services sociaux.
PP48 Risk Of Bias Of Systematic Reviews Connected To Journal Impact Factor?
- Vanesa Huertas Carrera, Gill Worthy, Joseph Kleijnen
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- Published online by Cambridge University Press:
- 31 December 2019, p. 46
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Introduction
Systematic reviews (SRs) are today's cornerstone of evidence-based medicine. However, their risk of bias (ROB) may critically impact their findings. Hence, an impartial assessment of their ROB is paramount to their interpretation. The objective of this study is to evaluate the potential association between the results of the ROB assessment for a series of SRs and their corresponding journal's impact factor as determined by the citation reports.
MethodsA sample of over 500 SRs and their corresponding ROB will be employed in this study. The source for these data will be the database KSR Evidence. The corresponding impact factor (IF) for the publishing journal as reported by the Science Citation Index will also be retrieved. The total of ROBIS signaling questions answered as ‘yes’ or ‘probably yes’ will be used to approximate the awarded quality (Quality) for each systematic review. An analysis of the potential correlation between Quality and the IF will be performed with a simple linear regression.
ResultsResults will be presented in tables and figures. Preliminary results confirm that a statistically significant association between the suggested variables exists, though this is of low magnitude.
ConclusionsFindings confirm that the ROB of an SR and the IF of the publishing journal are correlated.
PP50 How Do Target Population Sizes In Health Technology Assessments Impact Drug Price Changes?
- Daniel Liden, Rachel Jao, Cameron Lockwood, Floriane Reinaud
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- Published online by Cambridge University Press:
- 31 December 2019, p. 46
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Introduction
The relationship between heath technology assessment (HTA) recommendations and drug prices has received little attention in the published literature. We consider whether target population sizes estimated as part of positive HTA decisions impact future price changes. We hypothesize that larger target populations may result in larger drug price reductions, as overall budget impact is an important component of price negotiations.
MethodsHTA and pricing data were obtained from the Context Matters Market Access Platform (MAP) and IHS Markit's PharmOnline International (POLI) pricing database, respectively. We analyzed 55 HTA decisions from the Gemeinsame Bundesausschuss (G-BA; Germany) and the Haute Autorité de Santé (HAS; France) for oncology products receiving European Medicines Agency approval between 2011 and the end of 2014. Pricing and HTA histories were tracked from the beginning of 2012 until October 2018. Using multiple regression to control for HTA agency, country-specific scores (Improvement in Actual Benefit and Additional Benefit scores), pack size, and initial price, we examined the relationship between a drug's price change in the year following an HTA review and the increase in target population resulting from the HTA decision.
ResultsWe found that larger increases in target population were related to larger reductions in drug prices (p = 0.014). The magnitude of the effect size was low.
ConclusionsFor the sample evaluated, we found a small but statistically significant association between target population size increases (as estimated by HTA bodies) and price reductions, supporting our hypothesis that target population plays a role in price negotiations. Confidential discounts and managed-access agreements likely account, in part, for the low magnitude of the observed association. Future work on this topic will involve larger samples covering a greater number of HTA agencies to improve the power and generalizability of the analysis.
PP52 Interim Decision-Making To Address Uncertainty At Early Assessment
- Noreen Downes, Jan Jones, Anne Lee, Pauline McGuire
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- Published online by Cambridge University Press:
- 31 December 2019, pp. 46-47
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Introduction
Medicines regulation has become increasingly adaptive to support earlier patient access but the immature clinical data is often challenging for health technology assessment decision-makers due to high levels of uncertainty on long term risks and benefits. Scottish Medicines Consortium (SMC) is therefore exploring new, more adaptive approaches to help manage this challenge.
MethodsSMC consulted with key stakeholders including clinicians, the pharmaceutical industry and patient groups on a number of options that would allow the committee to make an interim decision that would be revisited based on later evidence. The ability to collect robust patient level data given data capabilities in National Health Service Scotland (NHSScotland) was an important consideration.
ResultsTo ensure that additional evidence would be available to inform a re-assessment, the new approach applies to medicines with a Conditional Marketing Authorisation (MA) from the European Medicines Agency (EMA). This obligates the company to provide specified clinical data to the regulator within a pre-set timeframe. For these medicines, the SMC decision-making committee can accept or not recommend the medicine as at present but can also accept the medicine on an interim basis, if the regulator's mandated Specific Obligations are likely to address the uncertainties in the clinical evidence. When the regulator converts the MA from conditional to standard, the company is required to make a further SMC submission to allow a reassessment and a final decision. The company can also provide additional supplementary post-licensing patient level evidence at reassessment.
ConclusionsThis new decision option allows SMC to test an approach to managing uncertainty targeted at a small number of promising new medicines where there is unmet patient need, with the reassurance that a final decision will be supported by additional clinical data.
PP54 A Cohort Case Study On Implantable Cardioverter Defibrillators
- Augusto Cesar Soares dos Santos, Junior, Maria da Glória Cruvinel Horta, Mariana Fernandes, Luíza Rodrigues, Lélia Maria de Almeida Carvalho, Sandra de Oliveira Sapori Avelar, Elen Cristina Pinto, Luciano Rios Scherrer, Fernando Martin Biscione, Silvana Marcia Kelles
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- Published online by Cambridge University Press:
- 31 December 2019, p. 47
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Introduction
Many patients presenting with arrhythmias are treated with antiarrhythmic drug therapy. However, for some patients, usually survivors of previous serious ventricular arrhythmias, treatment implies the use of implantable cardioverter defibrillators (ICDs) and/or Cardiac Resynchronization Therapy (CRT) devices.
MethodsThis retrospective study evaluated a cohort of patients with arrhythmia requiring the use of ICDs, CRT or ICDs + CRT from January 2004 to March 2018. Data from a private healthcare organization in Belo Horizonte, Brazil were used to assess all-cause mortality and the need for replacement of the device. Continuous variables were expressed as mean and standard deviation. Cox proportional regression model and Log-Rank test were used to adjust the survival curve.
ResultsFive hundred and ninety-three patients were included in the study (median age 67.6 years, range 23 to 89 years; male 62 percent). According to the type of device used to treat these patients, the distribution was 338 (57.0 percent), 169 (28.5 percent), 86 (14.5 percent), for ICDs, ICDs + CRT, CRT, respectively. After a mean follow-up time of 3.12 years (range 0 to 13.6 years), 283 devices were replaced (ICDs n = 140; ICDs + CRT n = 90; CRT n = 53) and 284 deaths occurred (median survival of 6.9 years). The median survival was 7.3, 5.8, 4.8, 5.5 years for ICDs single-chamber, ICDs dual-chamber, ICDs + CRT, CRT, respectively.
ConclusionsRandomized trials are often criticized for their enrollment of highly selected patients. Studies on real-word data can provide reliable information regarding the use of ICDs and/or CRT devices in the treatment of patients with serious ventricular arrhythmias.
PP55 The Effectiveness Of Viabahn In Peripheral Artery Aneurysms
- Augusto Cesar Soares dos Santos, Junior, Maria da Glória Cruvinel Horta, Lélia Maria de Almeida Carvalho, Mariana Fernandes, Luíza Rodrigues, Sandra de Oliveira Sapori Avelar, Luciano Rios Scherrer, Fernando Martin Biscione, Silvana Marcia Kelles
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- Published online by Cambridge University Press:
- 31 December 2019, p. 47
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Introduction
Open repair was considered for several years the gold standard therapy for the treatment of peripheral artery aneurysms (PAAs). However, with advancements in endovascular technology increasing attention has been directed toward repairing PAAs using an endovascular stent graft.
MethodsThis retrospective study evaluated a cohort of patients after the correction of PAAs with Viabahn. Patients treated from January 2011 to January 2018 were assessed for all-cause mortality, amputation and the need for re-intervention. Data were extracted from an administrative database from a healthcare organization in Belo Horizonte, Brazil.
ResultsFifty-two patients were included in the study (median age 69.1 years, range 15 to 90 years; male 63.5 percent), three of whom also received Viabahn for contralateral PAAs. In total, 84 devices were used (average 1.5 per PAA); distribution: popliteal and tibial arteries (n = 30; 57 percent), femoral and iliac arteries (n = 19; 37 percent), axillary artery (n = 1; 2 percent), splenic artery (n = 1; 2 percent), abdominal aorta (n = 1; 2 percent). After a mean follow up time of 1.98 ± 1.68 years, we observed death (n = 3; 5.8 percent), amputation (n = 3; 5.8 percent) and the need for re-intervention (n = 17; 32.6 percent) in 23 patients (44.2 percent). The combined overall survival for the first, second and third year of follow up was 70.2 percent (Confidence Interval [95% CI]: 58.9 - 83.6); 63 percent (95% CI: 51.0 - 78.0) and 57.3 percent (95% CI 44.6 - 73.6).
ConclusionsThere are still several unanswered questions regarding the best approach for patients with PAAs. In the absence of well-designed clinical studies, the assessment of databanks on real-world patients may contribute to improve our understanding of treatment alternatives and provide guidance to improve current clinical results.
PP57 Outcomes On Transcatheter Aortic Valve Implantation
- Augusto Cesar Soares dos Santos, Junior, Maria da Glória Cruvinel Horta, Lélia Maria de Almeida Carvalho, Luíza Rodrigues, Sandra de Oliveira Sapori Avelar, Mariana Fernandes, Luciano Rios Scherrer, Fernando Martin Biscione, Silvana Marcia Kelles
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- Published online by Cambridge University Press:
- 31 December 2019, pp. 47-48
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Introduction
Severe aortic stenosis with symptoms or left ventricular dysfunction has commonly a poor prognosis and therefore, aortic valve replacement is usually performed for patients aiming at improving their functional class and survival rate.
MethodsThis retrospective study evaluated a convenience sample of patients at high risk for open surgery for the correction of aortic valve dysfunction treated with TAVI from 2013 to 2018. Data from a private healthcare organization in Belo Horizonte, Brazil were used to assess all-cause mortality. Continuous variables were expressed as mean and standard deviation. Cox proportional regression model and Log-Rank test were used to adjust the survival curve.
ResultsFifty-two patients were included in the study (mean 83 ± 5.7 years of age, range 67 to 93 years; female 55.8 percent). Patients were characterized by: left ventricular ejection fraction (n = 30; mean 52.9 percent, range 26 to 81 percent); aortic valve area (n = 36; mean 0.68 cm2, range 0.4 to 1.2 cm2); left atrium size (n = 14; range 30 to 61 ml/m2); pulmonary artery pressure (n = 20; mean 53 mmHg, range 31 to 70 mmHg). Death occurred in 19 patients during the follow-up period (mean 8.4 months, range 0 to 60 months). Nine deaths occurred within the first 30 days of follow-up (17.3 percent) and 14 (26.9 percent) in the first year. Stroke occurred in three patients (5.8 percent) in the post-implant period. A pacemaker device was required for nine patients (17.3 percent).
ConclusionsTranscatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement for patients at high risk for surgery. Real-world studies might result in a better understanding of the local team expertise on TAVI utilization.
PP58 The Alliance Between Health Technology Assessment And Public Health In National Screening Policies
- Leonor Varela-Lema, Janet Puñal-Riobóo, Paula Cantero-Muñoz, Maria José Faraldo-Vallés
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- Published online by Cambridge University Press:
- 31 December 2019, p. 48
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Introduction
Decision making regarding national population-based prenatal and newborn screening policies is recognized to be highly challenging. This paper aims to describe the formalized collaboration that has been established between the Spanish National Public Health Screening Advisory Committee (PHSAC) and the Spanish Network of Health Technology Assessment (HTA) agencies to support the development of evidence- and consensus-based recommendations to support this process.
MethodsIn-depth description and analysis of the strategic and methodological processes that have been implemented within the Spanish National Health System prenatal and newborn screening frameworks, with special emphasis on the role, actions, and responsibilities of HTA agencies.
ResultsThe role of HTA agencies is threefold: (i) support the PHSAC by providing evidence on safety, effectiveness and cost/effectiveness of the screening tests/strategies, as well as contextualized information regarding costs, organizational, social, legal and ethical issues; (ii) collaborate with the PHSAC in the development of formal evidence- and consensus-based recommendations for defining population screening programs, when required; (iii) analyze real-world data that is generated by piloted programs. This paper will provide real-life examples of how these processes were implemented in practice, with a special focus on the development of the non-invasive prenatal testing (NIPT) policy. Recommendations for NIPT were developed by a multidisciplinary group based on the European network for Health Technology Assessment (EUnetHTA) rapid assessment report and the predictive models that were built using national statistics and other contextualized data.
ConclusionsThe current work represents an innovative approach for prenatal and newborn screening policymaking, which are commonly difficult to evaluate due to the low quality of evidence and the confounding public health issues. The paper raises awareness regarding the importance of joint collaborations in areas where evidence is commonly insufficient for decision making.
PP61 Advanced Therapy Medicinal Products Germany: Drugs Or Methods Review?
- Elvira Müller, Kurt Neeser, Ilse-Barbara Oelze
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- Published online by Cambridge University Press:
- 31 December 2019, pp. 48-49
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Introduction
Advanced Therapy Medicinal Products (ATMPs) comprise medicines for human use based on gene therapy, somatic cell therapy or bioprocessed tissue products. ATMPs are pharmaceutically manufactured drugs and mostly subject to central authorization requirements. In terms of social law, it is an ambiguous situation and more heterogeneously dealt with. ATMPs are assigned to method evaluation as well as to the Arzneimittelmarkt-Neuordnungsgesetz (AMNOG) procedure designated for drugs.
MethodsGuidelines from Gemeinsame Bundesausschuss (G-BA), Institute for Quality and Efficiency in Health Care (IQWiG) and respective legislation, consultation results and methods/medical devices (MDs) evaluations according to §137h and for drugs according to AMNOG were reviewed and analyzed. Decision criteria and reasoning, assessment outcomes and potential impact on price negotiations were the main aspects for comparison.
ResultsATMPs are subject to benefit assessment, with a decision at first on whether to be evaluated as a drug (e.g., Alofisel) or a method/device (e.g., Holoclar). By definition, an ATMP is classified as a treatment method, if the correct administration has at least the same significance for a successful therapy outcome as its mode of action. Depending on the respective decision, an evaluation as method follows or it must undergo the AMNOG process. According to G-BA's and IQWiG's point of view, randomized controlled trials (RCTs) are the “gold standard” for a benefit assessment of new therapies, including ATMPs. However, conduction of RCTs is not always possible for ATMPs which creates a disadvantage in the assessment right from the beginning. Otherwise no distinction is made between drugs and ATMPs in terms of reimbursement modalities. Outcomes based agreements could help overcoming inequalities and lead to quality-oriented reimbursement.
ConclusionsATMPs represent a grey zone causing difficulties in classifying them either as method or drug. For individualized therapies evidence beyond RCTs and new reimbursement possibilities should be considered. Until new regulations are in place it is advisable to enter early into respective discussions with authorities.
PP62 Cost-Effectiveness Of Cervical Cancer Screening In Estonia
- Triin Võrno, Kaja-Triin Laisaar, Terje Raud, Kai Jõers, Doris Meigas-Tohver, Raul-Allan Kiivet, Katrin Lutsar
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- Published online by Cambridge University Press:
- 31 December 2019, p. 49
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Introduction
In Estonia, organized cervical cancer screening program is targeted at women aged 30–55(59) years and Pap-tests are taken every five years. Since cervical cancer is associated with human papillomavirus (HPV), a number of countries have introduced the HPV-test as the primary method of screening. The objective of this study was to evaluate the cost-effectiveness of organized cervical cancer screening program in Estonia by comparing HPV- and Pap-test based strategies.
MethodsFor the cost-effectiveness analysis, a Markov cohort model was developed. The model was used to estimate costs and quality-adjusted life-years (QALYs) of eight screening strategies, varying the primary screening test and triage scenarios, upper age limit of screening, and testing interval. Incremental cost-effectiveness ratios (ICERs) were calculated in comparison to current screening practice as well as to the next best option. Sensitivity analysis was performed by varying one or more similar parameter(s) at a time, while holding others at their base case value. The analysis was performed from the healthcare payer perspective adopting a five percent annual discount rate for both costs and utilities.
ResultsIn the base-case scenario, ICER for HPV-test based strategies in comparison to the current screening practice was estimated at EUR 8,596–9,786 per QALY. For alternative Pap-test based strategies ICER was estimated at EUR 2,332–2,425 per QALY. In comparison to the next best option, HPV-test based strategies were dominated by Pap-test based strategies. At the cost-effectiveness threshold of EUR 10,000 per QALY Pap-testing every three years would be the cost-effective strategy for women participating in the screening program from age 30 to 63 (ICER being EUR 3,112 per QALY).
ConclusionsDecreasing Pap-test based screening interval or changing to HPV-test based screening can both improve the effectiveness of cervical cancer screening program in Estonia, but based on the current cost-effectiveness study Pap-test based screening every three years should be preferred.
PP64 Economic Evaluation For Esophageal Cancer Screening In China
- Yuanyuan Li, Lingbin Du, Xiaoqian Hu, Shuyan Gu, Xuemei Zhen, Yuxuan Gu, Hengjin Dong
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- 31 December 2019, p. 49
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Introduction
The aim of the study was to estimate the cost-effectiveness of esophageal cancer (EC) screening compared to non-screening in China.
MethodsA Markov model was conducted that followed the history of EC. Screening strategies targeted a population aged 40-69 years, classified into six age groups. Each age group had three cohorts: screening without follow-up, screening with yearly follow-up for low-grade intraepithelial neoplasia (LGIN), and non-screening. Life years (LYs) and quality-adjusted life years (QALYs) presented the effectiveness and utility. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluating indicators. Eighteen cohorts from 100,000 hypothetical individuals were used to run the model, until aged 79 years or death. Costs were changed into USD using the purchasing power parity of 3.506 in 2017. The willingness-to-pay was set as three times the gross domestic product per capita (USD 51,340.6) in 2017. A sensitivity analysis was introduced to assess model robustness.
ResultsScreening with follow-up compared to non-screening, ages 40-44, 45-49, and 50-54 years, showed cost-effectiveness, with one LY gained costing USD 6,875.0, USD 9,204.6, and USD 25,278.6, respectively. Ages 40-44 and 45-49 years explained cost-utility, with ICURs of USD 6,709.4/QALY and USD 13,991.4/QALY, respectively. Screening without follow-up compared to non-screening, ages 40-54 years, addressed cost-effectiveness, with one LY gained costing USD 6,934.8, USD 9,760.0, and USD 35,126.0 in ages 40-44, 45-49, and 50-54 years, respectively; the 40-44 years age group demonstrated cost-utility with an ICUR of USD 8,512.3/QALY. Screening with follow-up compared to screening without follow-up, all ages, explained cost-effectiveness and cost-utility. The probabilistic sensitivity analysis supported the outcome of the base cohort analysis.
ConclusionsCompared to non-screening, screening with follow-up targeting ages 40-54 years was highly recommended with the ICER as the evaluated indicator, whereas it targeting ages 40-49 years was suggested with the ICUR as indicator.
PP65 Methods Applied For Systematic Reviews Of Economic Evaluations In Health Technology Assessment
- Miriam Luhnen, Barbara Prediger, Edmund A.M. Neugebauer, Tim Mathes
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- Published online by Cambridge University Press:
- 31 December 2019, pp. 49-50
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Introduction
When making decisions in health care, it is essential to consider economic evidence about an intervention. The objective of this study was to analyze the methods applied for systematic reviews of economic evaluations in Health Technology Assessment (HTA) and to identify common challenges.
MethodsWe manually searched the webpages of HTA organizations and included HTA-reports published since 2015. Prerequisites for inclusion were the conduct of a systematic review of economic evaluations in at least one electronic database and the use of the English, German, French, or Spanish language. Methodological features were extracted in standardized tables. We prepared descriptive statistical (e.g., median, range) measures to describe the applied methods. Data were synthesized in a structured narrative way.
ResultsEighty-three reports were included in the analysis. We identified inexplicable heterogeneity, particularly concerning literature search strategy, data extraction, assessment of quality, and applicability. Furthermore, process steps were often missing or reported in a nontransparent way. The use of a standardized data extraction form was indicated in one-third of reports (32 percent). Fifty-four percent of authors systematically appraised included studies. In 10 percent of reports, the applicability of included studies was assessed. Involvement of two reviewers was rarely reported for the study selection (43 percent), data extraction (28 percent), and quality assessment (39 percent).
ConclusionsThe methods applied for systematic reviews of economic evaluations in HTA and their reporting quality are very heterogeneous. Efforts toward a detailed, standardized guidance for the preparation of systematic reviews of economic evaluations definitely seem necessary. A general harmonization and improvement of the applied methodology would increase their value for decision makers.
PP66 Increasing Burden Of Out-Of-Pocket Healthcare Expense On Patients
- Rhythm Arora, Nikhil Dugar, Vandit Saxena, Sunil K. Jaiswal, Chitresh Kumari, Nigel Cook, Olga Furio
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- Published online by Cambridge University Press:
- 31 December 2019, p. 50
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Introduction
We conducted an analysis of the key factors triggering cost-sharing mechanisms to understand the status of out-of-pocket (OOP) healthcare expense in the United States (US), Europe, and emerging markets and better appreciate the implications of OOP healthcare expense on patients’ health management.
MethodsA review of literature and databases including The Organisation for Economic Co-operation and Development (OECD) and World Bank was performed to understand different cost-sharing mechanisms, factors triggering OOP expenditure and the country-wise trends of OOP expenditure. Additionally, the impact of OOP expenditure on healthcare budget and on patients in terms of medication adherence, uptake of newer therapies and generic substitution was explored.
ResultsThe findings reveal that patients are concerned about rising healthcare OOP costs, and we observed an increase of 134 percent in the number of articles published on OOP from 2005 to 2017. The percentage of household spending that goes OOP as healthcare expense is higher in Brazil, Russia, India, and China (BRIC countries; ~11 percent) compared to France, Germany, Italy, United Kingdom, US, Japan, and Canada (G7 countries; ~2 percent). In addition, OOP expenditure increased with age (1.9 percent of take home income in 55-64 age group versus 1.2 percent in 18-25 age group) and is higher in the low-income population (2.8 percent of take home income versus 1 percent in high-income group). Whereas, increasing OOP expenditure reduces the overall healthcare expenditure due to generic substitution (28 percent reduction) and reduction in excessive consumption of supplementary medicines, it also reduces patient adherence (~20 percent decline in dispensed prescriptions) and may foster a reluctance to adopt newer therapies.
ConclusionsThe population groups most impacted by increasing OOP expense are the older population, those in the low-income bracket and in poorer countries. While OOP expense may help in the effective and judicious utilization of healthcare system resources and medicines usage, its implementation requires a cautious and considered approach.
PP68 Indicators From The Real World Data To Improve Opioid Use
- Eric Tremblay, Jean-Marc Daigle, Marie-Claude Breton, Sylvie Bouchard
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- 31 December 2019, p. 50
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Introduction
Opioids are being used increasingly to treat chronic noncancer pain despite the uncertainty regarding its long-term benefits. This study served to determine if problems are associated with opioid use in Québec for new users from 2006 to 2013 without history of cancer.
MethodsA retrospective longitudinal cohort study was conducted using administrative databases stored at the Régie de l'assurance maladie du Québec (RAMQ) to describe the annual proportion of new users to whom at least one of the five indicators of potentially inappropriate opioid use applied was estimated. These indicators are (i) overlapping opioid prescriptions, (ii) overlapping opioid and benzodiazepine prescriptions, (iii) the use of long-acting opioids at the start of treatment, (iv) a high mean daily dose, and (v) a rapid increase in the opioid dose.
ResultsThe annual proportion of new users to whom at least one of the five indicators of potentially inappropriate opioid use applied decreased from 15.4 percent in 2006 to 12.3 percent in 2013. It was mainly the following three indicators that contributed the most to these proportions in 2013: (i) overlapping opioid prescriptions (5.8 percent), (ii) overlapping opioid and benzodiazepine prescriptions (8.2 percent), and (iii) the use of long-acting opioids at the start of treatment (1.8 percent).
ConclusionsThe vast majority of new users with no history of diagnosed cancer used opioids adequately according to the five indicators of potentially inappropriate opioid use applied. Improvement could still be made to decrease mainly overlapping opioid prescriptions and overlapping opioid and benzodiazepine prescriptions.
PP69 Potential Gains In Health-Adjusted Life Expectancy From Reducing Four Non-Communicable Diseases Among Chinese Elderly
- Shuyan Gu, Xuemei Zhen, Xueshan Sun, Yuxuan Gu, Hengjin Dong, Xiaoqian Hu
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- Published online by Cambridge University Press:
- 31 December 2019, pp. 50-51
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Introduction
With the fast speed of aging, burden from non-communicable diseases (NCDs) is increasing in China, and will continue to increase to 2020 and beyond. This study aims to estimate the potential gains in health-adjusted life expectancy (HALE) after hypothetical elimination of four NCDs among Chinese elderly from 1990 to 2016, including cardiovascular diseases (CVD), cancers, chronic respiratory diseases (CRD) and diabetes mellitus (DM).
MethodsBased on data from Global Burden of Disease 2016, we generated life table by gender using Sullivan method to calculate HALE. Disease-deleted method was used to calculate cause-elimination HALE, after hypothetical elimination of specific diseases. This method could combine the impact of mortality and morbidity, which are particularly useful for estimating the impact of the disease and setting priorities for health planning to get ready for the new challenges in upcoming decade.
ResultsFrom 1990 to 2016, HALE increased for all age groups. After hypothetically eliminating the four main NCDs, potential gain in HALE by CVD, DM and cancers increased, while CRD decreased from 1990 to 2016 for both genders. Among four main NCDs, potential gain in HALE after eliminating CVD was largest and increased most for both genders. Although elimination of DM led to the smallest gain in HALE, the increasing speed of gain in HALE by DM was faster than that by CVD and cancers from 1990 to 2016.
ConclusionsThis study highlights the potential gains in HALE of NCDs among Chinese elderly from 1990 to 2016. HALE of Chinese elderly could further increase from the reduction of NCDs. Control measures and targeted prevention should be carried out to get ready for the new decade.
PP70 Identification Of Prostheses With Worse Than Expected Outcomes
- Jorge Arias de la Torre, Olga Martínez, Kayla Smith, Miquel Pons-Cabrafiga, Daniel Prieto-Alhambra, Jose Valderas, Vicente Martin, Jonathan Evans, Raul Marcos, Marta Esteban, Susana Villabrille, Mireia Espallargues
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- 31 December 2019, p. 51
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Introduction
Monitoring the effectiveness of knee and hip arthroplasties could be useful at the clinical, economic, and patient levels. In Catalonia, there is currently no systematic monitoring of the different prostheses available. The aims of this study were to propose an approach for the systematic identification of knee and hip prostheses with the highest revision rates, and to identify those with the poorest outcomes.
MethodsData recorded from January 2005 to December 2016 were considered from 53 out of the 61 public hospitals in Catalonia included in the Catalonian Arthroplasty Register (RACat). Specific prostheses were classified by joint, type, fixation, and, in total hip prostheses, the bearing surface. Prostheses with the worst outcomes were identified using a three-step approach, based on previous literature: (i) screening using Poisson models; (ii) comparison of prostheses using adjusted Cox models; and (iii) consensus-based review by a panel of orthopedic surgeons to detect possible sources of bias. After this process, selected prostheses were provisionally labeled as having the poorest outcomes. This process will be repeated periodically within the RACat to definitively classify the prostheses.
ResultsAfter first two steps, ten knee prostheses and eight hip prostheses were identified. After the panel discussion (third step), one knee and one hip prosthesis were excluded from the final list. The knee prosthesis was excluded because it was a unicompartmental implant, while the hip prosthesis was excluded because it was a monoblock implant. Finally, nine knee prostheses and seven hip prostheses were provisionally identified as having the worst results relative to other available prostheses. These results await confirmation in subsequent analyses.
ConclusionsThis study contributed to the current need to identify hip and knee prostheses whose outcomes might be worse than expected. This identification could have an impact at the patient, surgeon, industry, and stakeholder levels.
PP72 Using INTEGRATE-HTA On The Example Of Rasterstereography For Scoliosis
- Barbara Buchberger, Kaya Jastrzebski, Laura Krabbe
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- Published online by Cambridge University Press:
- 31 December 2019, pp. 51-52
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Introduction
Full health technology assessment (HTA) reports discuss not only the safety and efficacy of a technology, but also the economic, ethical, legal, socio-cultural, and organizational aspects. INTEGRATE-HTA is a completed European Union project that developed concepts and methods for a patient-centered, integrated assessment of complex technologies. Technologies can be considered complex if they are characterized by a large number of interacting components, a wide variability of outcomes, or a high degree of flexibility. In contrast to the usual linear approach of addressing individual HTA domains separately, the INTEGRATE-HTA methodology is based on the assumption that different aspects of the domains interact. From the very beginning, these interactions are captured systematically using various tools. Continuous reflection and compaction of these relations can lead to an extended perspective on a technology. As a result, complexity and mechanisms of action open up, helping to channel public discussion and implementation. We investigated whether using the INTEGRATE-HTA methodology improves the understanding of individual domains and their interactions.
MethodsAccording to the methodology, an initial logic model for rasterstereography in patients with scoliosis was developed and successively expanded. A synoptic table, showing multiple maps of individual aspects to domains, and a complexity checklist were used. In addition, harvest plots were created and the socio-cultural impact of the disease was highlighted as a semantic complex. A final logic model and an interaction figure were established to initiate discussion.
ResultsHaving been classified as slightly complex in the beginning, rasterstereography turned out to be highly complex after using a variety of tools and a final graphical representation; the multiple mapping of individual aspects to domains resulted in a high density of interactions.
ConclusionsThe INTEGRATE-HTA methodology helped to identify interactions between domains and significantly expanded the perspective on a technology. It improved patient-centered understanding and facilitated the discussion of single aspects.
PP78 Analysis Of Resource Utilization In Psoriasis Care In The Brazilian Health System
- Larissa de Araujo Costa Andrade, Ricardo Moreira, Vinicius Vitale
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- Published online by Cambridge University Press:
- 31 December 2019, p. 52
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Introduction
Psoriasis is associated with metabolic disorders and has a significant negative impact on patients’ quality of life. There is little information about treatment patterns and the resources used to treat psoriasis and its associated comorbidities. This study aimed to evaluate the frequency of metabolic syndrome (MetS) and estimate the costs associated with psoriasis care in the Brazilian health system.
MethodsA cross-sectional observational study was conducted of 293 Brazilian patients with psoriasis who attended selected dermatology outpatient centers in Brazil during a one-year period. Patients underwent detailed skin and rheumatologic assessments and a series of laboratory tests. The annual costs were estimated by multiplying the amount of each resource consumed by its unit cost.
ResultsThe prevalence rate of MetS was high in this cohort (50%). Other metabolic disorders were more common in this group than in the general population, including hypertension (62%), diabetes (31%), dyslipidemia (75%), and obesity (53%). The disease duration was, on average, 17.2 years. There were 2,713 consultations reported by 288 patients (average of nine per patient per year). The most common specialists consulted were: dermatologists (93%); general practitioners (41%); cardiologists (27%); rheumatologists (18%); and endocrinologists (13%). There were 110 non-physician visits (average of 11 per patient per year), of which the most frequently consulted specialists were nutritionists (26%), psychologists (24%), and nurses (22%). A total of 279 patients (95%) had at least one medical test (average of 18 per patient per year). Among the treatments required for other conditions, 65% (n = 149) of prescribed medicines were for the cardiovascular system and 24% (n = 5/21) of hospitalizations were due to diseases of the circulatory system; myocardial revascularization was the costliest procedure (USD 2,298).
ConclusionsMetS is frequently associated with psoriasis and directly affects health resource utilization in the Brazilian health system by increasing consultation costs. Further research is needed to evaluate the impact of a multidisciplinary treatment approach for psoriasis patients with MetS.
PP79 Impact Of Hidradenitis Suppurativa On Healthcare Resource Utilization
- Larissa de Araujo Costa Andrade, Ricardo Moreira, Vinicius Vitale
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- Published online by Cambridge University Press:
- 31 December 2019, p. 52
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Introduction
Hidradenitis suppurativa (HS) is a debilitating, chronic inflammatory skin disease characterized by painful nodules and abscesses. HS has a strong impact on patient quality of life. In Brazil, the prevalence of HS is estimated at 0.4 percent. Medical and surgical treatments have low effectiveness and disease recurrence is common, which affects health system costs. This study aimed to assess how HS patients utilize medical care (emergency and inpatient care) in Brazil and to describe the all-cause costs.
MethodsData were retrieved from a public healthcare claims database (DATASUS), which provides access to information regarding health services and costs. Data from DATASUS were used to perform a cost-identification analysis on patients with HS who used health services over a two-year period. A retrospective bottom-up approach was used to estimate direct costs, multiplying the amount of each medical resource consumed by its unit cost.
ResultsOver the two-year period, 90 patients (16%) with HS received inpatient care (151 procedures) at a total cost of BRL 83,520 (USD 21,715). Surgeries were the most frequently performed (73% of total) and expensive procedures, costing BRL 73,122 (USD 19,011; 88% of total costs), followed by clinical treatments (BRL 8,354 [USD 2,172]; 10%), and physician consulting (BRL 1,659 [USD 431]; 2%). For the 500 patients treated in the emergency department (total cost BRL 3,027 [USD 787]), the most frequently received services were physician consulting (34%), nursing care (12%), and minor surgeries (11%). Each patient received, on average, three procedures over the two-year period.
ConclusionsHS is a high-burden disease, as demonstrated by the high healthcare resource utilization among patients. Since DATASUS is a public database, the costs presented reflect a government reference price and do not consider local costs, which is a limitation of this study. Health managers should be aware of this finding, although further research is needed to investigate the effect of healthcare utilization on patient outcomes.
PP80 A Systematic Review Of The Gugging Swallowing Screen For Assessing Dysphagia
- Seon Heui Lee
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- Published online by Cambridge University Press:
- 31 December 2019, pp. 52-53
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Introduction
Dysphagia is a clinical burden that can lead to serious complications like aspiration and pneumonia. Complications often result in longer hospital stays or an increased mortality rates. The Gugging Swallowing Screen (GUSS) assesses swallowing ability in patients by allowing separate evaluations for non-fluid and fluid textures, and is a potentially useful tool for determining the risk of aspiration and dysphagia. The purpose of this study is to analyze the validity and effectiveness of GUSS for dysphagia screening.
MethodsWe conducted a systematic review by searching the following electronic databases: Medline, EMBASE, The Cochrane Library, KoreaMed, the Research Information Sharing Service, and the Korean Studies Information Service System. We included studies related to dysphagia screening with GUSS that were published in English or Korean up to November 2018.
ResultsOf 297 unique studies identified, 219 were reviewed by two independent reviewers. Finally, eight articles were identified as being relevant for this study. With regard to validity, GUSS had a sensitivity ranging from 90 to 100 percent and a specificity of between 50 and 88 percent. In addition, GUSS results significantly correlated with the results of the videofluoroscopic swallow study and the fiberoptic endoscopic evaluation of swallowing. In terms of effectiveness, early systematic dysphagia screening with GUSS by nurses reduced the duration of screening and rate of pneumonia, compared with the control group (p = 0.004). The incidence of X-ray verified pneumonia in the GUSS group was also significantly lower than in the clinical screening group (p < 0.01), although there was no difference in the occurrence of pneumonia, compared with the 10 mL water swallowing test.
ConclusionsResults showed that GUSS is a reliable and sensitive tool for screening patients for dysphagia. This early and systematic assessment can reduce the occurrence of aspiration and pneumonia, although further research is needed to establish the effectiveness of GUSS.