Healthcare Resource Use In Patients Research Articles

POSC139 Treatment Patterns, Survival, and Healthcare Resource Use of Patients With Advanced Merkel Cell Carcinoma in England from 2013-2018: Results of a Longitudinal Observational Cohort Study

POSC139 Treatment Patterns, Survival, and Healthcare Resource Use of Patients With Advanced Merkel Cell Carcinoma in England from 2013-2018: Results of a Longitudinal Observational Cohort Study

Healthcare Resource Use in Patients with Immune-Mediated Conditions Treated with Targeted Immunomodulators During COVID-19 Pandemic: A Retrospective Claims Analysis.

IntroductionThe impact of the COVID-19 pandemic on routine medical care may result in altered healthcare resource use in patients with immune-mediated conditions. The aim of this study was to determine the impact of treatment interruptions in patients with and without COVID-19 infections who were treated with targeted immunomodulators (TIMs) in the USA.MethodsData from the IBM® MarketScan® Research Databases were analyzed in patients with immune-mediated conditions from January 1, 2018, through December 31, 2020. Healthcare resource use (HCRU) including hospitalizations, emergency department (ED) visits, in-person outpatient visits, and respiratory outcomes was assessed in a cohort of patients without COVID-19 who had uninterrupted versus interrupted TIM use. The impact of treatment interruption on HCRU and respiratory outcomes was also evaluated in a cohort of patients with COVID-19. Results from adjusted logistic regression were reported as adjusted odds ratios (aORs) with 95% confidence intervals.ResultsApproximately 25% of patients in both the COVID-19 (N = 787) and non-COVID-19 cohorts (N = 77,178) experienced interruptions in TIM therapy. In the non-COVID-19 cohort, the likelihood of being hospitalized was 20% less in patients with uninterrupted versus interrupted TIM use (aOR = 0.80, 95% CI 0.71–0.90). Patients with uninterrupted TIM use had a similar likelihood of an ED visit (aOR = 0.99, 95% CI 0.91–1.08) and respiratory outcome (aOR = 0.97, 95% CI 0.71–1.31) versus patients with interrupted TIM use. The likelihood of having an in-person outpatient visit was 87% greater in patients with uninterrupted versus interrupted TIM use (aOR = 1.87, 95% CI 1.81–1.94). Similar findings were observed in the COVID-19 cohort.ConclusionThis analysis of real-world claims data showed that uninterrupted TIM use was not associated with an increased likelihood of hospitalizations, ED visits, or negative respiratory outcomes compared to interrupted TIM use among patients with immune-mediated conditions, regardless of COVID-19 diagnosis.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01906-4.

Impact of Chorea on Self-care Activity, Employment, and Health-care Resource Use in Patients with Huntington's Disease.

Background: Chorea is recognized as a prototypic motor feature of Huntington’s disease (HD), but its effect on health-related quality of life (HRQoL) has not been fully explored. This study describes the impact of chorea on HRQoL in patients with HD.Objective: To determine the impact of HD-related chorea on employment, self-care activities, activities of daily living, and health-care resource utilization (HCRU).Methods: Data were drawn from the Adelphi HD Disease Specific Programme, a real-world point-in-time survey of 144 neurologists and 427 patients in the United States between July and October 2017. HD patients with and without chorea were identified and examined for differences in employment status, reasons for employment changes, self-care activities, and modifications to cope with involuntary movements. Bivariate tests and inverse probability weighted regression adjustment methods were used to determine differences in outcomes between patients with and without chorea.Results: HD patients with (n=287) and without (n=140) chorea were identified. Patients with chorea were less likely to be employed full-time (16.7% vs 25.7%; P<0.04) and more likely to be on long-term sick leave (17.4% vs 5.0%; P<0.01). The onset of motor symptoms in HD-related chorea patients coincided with a change in employment status (42.7% vs 20.8%; P<0.01). Among those still working (n=145), more than two-fifths of patients with chorea required changes to their workplace and required these changes more frequently (45% vs 17%; P<0.001). HD patients with chorea required aid to help them get around significantly more frequently than those without chorea (55% vs 34%; P<0.001).Discussion: These results demonstrate that HD patients with chorea experienced greater negative impact to employment, self-care activities, and HCRU than patients without chorea experienced. These patients were more likely to stop working due to motor, cognitive, and behavioral symptoms; require modifications in the home and workplace; and need more assistance from caregivers than patients without chorea.Conclusions: Patients with HD-related chorea have greater detriments to emotional, interpersonal, and professional functioning that could be improved by reducing chorea.

Impact of Chorea on Self-care Activity, Employment, and Health-care Resource Use in Patients with Huntington’s Disease

Background: Chorea is recognized as a prototypic motor feature of Huntington’s disease (HD), but its effect on health-related quality of life (HRQoL) has not been fully explored. This study describes the impact of chorea on HRQoL in patients with HD. Objective: To determine the impact of HD-related chorea on employment, self-care activities, activities of daily living, and health-care resource utilization (HCRU). Methods: Data were drawn from the Adelphi HD Disease Specific Programme, a real-world point-in-time survey of 144 neurologists and 427 patients in the United States between July and October 2017. HD patients with and without chorea were identified and examined for differences in employment status, reasons for employment changes, self-care activities, and modifications to cope with involuntary movements. Bivariate tests and inverse probability weighted regression adjustment methods were used to determine differences in outcomes between patients with and without chorea. Results: HD patients with (n=287) and without (n=140) chorea were identified. Patients with chorea were less likely to be employed full-time (16.7% vs 25.7%; P&lt;0.04) and more likely to be on long-term sick leave (17.4% vs 5.0%; P&lt;0.01). The onset of motor symptoms in HD-related chorea patients coincided with a change in employment status (42.7% vs 20.8%; P&lt;0.01). Among those still working (n=145), more than two-fifths of patients with chorea required changes to their workplace and required these changes more frequently (45% vs 17%; P&lt;0.001). HD patients with chorea required aid to help them get around significantly more frequently than those without chorea (55% vs 34%; P&lt;0.001). Discussion: These results demonstrate that HD patients with chorea experienced greater negative impact to employment, self-care activities, and HCRU than patients without chorea experienced. These patients were more likely to stop working due to motor, cognitive, and behavioral symptoms; require modifications in the home and workplace; and need more assistance from caregivers than patients without chorea. Conclusions: Patients with HD-related chorea have greater detriments to emotional, interpersonal, and professional functioning that could be improved by reducing chorea.

PMU10 A Descriptive Analysis of Costs and Healthcare Resource Use in Patients with Bronchiolitis Obliterans Syndrome (BOS) Following LUNG Transplantation

Bronchiolitis Obliterans Syndrome (BOS), a common complication after lung transplantation, is a rapidly progressive obstructive airway disease characterized by T-cell mediated inflammation and fibrosis, leading to respiratory failure and death. BOS typically manifests at least 1 year post transplantation and affects an estimated 48% of patients within 5 years of transplant. The economic burden of BOS following lung transplantation is not well understood. The data source for this retrospective longitudinal study was IQVIA PharMetricsPlus commercial claims database; the study timeframe was 01/01/2006-09/30/2018. Study patients were lung transplant recipients age 18-64y with evidence of BOS 1+ years after transplantation. There is no BOS-specific diagnosis code; consequently, patients were identified as those with 2+ claims with a diagnosis for serious lung disease at least 2 months apart and 1+ years after transplant. Hospitalizations were attributed to the admission month. Outcome measures were mean per-patient monthly costs paid by insurers and healthcare resource utilization (HRU) starting 1 year post-transplant. Monthly costs and HRU were summed to estimate per-patient costs and HRU in each year. Among 130 patients who met study criteria, 65% were male; mean age was 52.1y (±0.76); all were observable at least 28 months after transplantation, including 46 observable for 60 months. Mean per-patient monthly costs ranged from $3,951 (±6,758.11) to $403,270 (±330,175.24), with the highest rates of hospitalizations with ICU stays (1.09 ±0.47) in the most expensive month. When annualized, per-patient costs ranged from $103,635 (year 4) to $633,375 (year 1). Inpatient admissions represented 77%, 47% and 52%, and 39% of costs in the second, third and fourth post-transplant years, respectively. Lung transplantation patients who develop BOS incur healthcare costs that remain high over time. While lung transplantation is intended as curative, the economic burden of this common complication is substantial and in addition to the costs of transplant.

Real-world treatment patterns and healthcare resource use in patients with acute myeloid leukemia in Western Europe.

Aim: Assess treatment patterns and healthcare resource utilization (HRU) in patients with treatment-naive (TN) or relapsed/refractory (R/R) acute myeloid leukemia (AML) in Europe. Patients & methods: Cross-sectional, retrospective, web-based survey of AML-treating healthcare professionals (HCPs) in 12 European countries. Results: 320 HCPs provided information on 1280 TN or R/R patients. Patients ineligible versus eligible for intensive induction therapy required more general practitioner visits (4.1 vs 2.4), more uses of healthcare-related transport (6.9 vs 4.5), but less hospitalization (11.4 vs 27.5days). Differences were observed in HRU and treatment patterns across countries. Conclusions: This analysis of 'real-world' patients with TN or R/R AML in Europe demonstrates substantial healthcare use, including higher use of resources in patients ineligible for intensive induction therapy.

Bronchiolitis Obliterans Syndrome Following Lung Transplantation: Economic Burden by Chronic Lung Allograft Dysfunction (CLAD) Stage

<h3>Purpose</h3> Bronchiolitis obliterans syndrome (BOS), affects nearly 50% of lung transplant recipients within 5 years and is the leading cause of death for patients who survive at least one year post transplant. The impact of BOS on healthcare resource use (HRU) and costs is not well understood. The aim is to quantify the economic burden of BOS in the US. <h3>Methods</h3> A retrospective analysis of claims data for commercially insured patients age <65 who underwent lung transplantation between 1/1/2006 and 9/30/2018 was performed. Transplantation was identified using International Classification of Disease (ICD) and Common Procedure Terminology (CPT) codes. Patients were observable 12+ months pre- and post- transplantation. BOS patients were identified using diagnosis codes for severe lung disease 1+ years post-transplant and followed longitudinally. Mean monthly per patient HRU following BOS diagnosis was calculated by CLAD stage. Mean costs, calculated by HRU type, were multiplied by HRU rates to estimate costs by CLAD stage. Costs were those paid by commercial payers in the US. <h3>Results</h3> Among 134 patients who met criteria for BOS following lung transplantation, healthcare costs were substantially higher with CLAD progression. Patients in CLAD 4 had much higher mean per patient monthly costs ($5,042) compared with lower stages (CLAD 1: $554; CLAD 2: $1,080; CLAD 3: $1,724). Inpatient admissions were responsible for most costs for patients in CLAD 3 and 4, while outpatient services accounted for virtually all costs in CLAD 1 and 2. Drug costs were higher for patients in CLAD 2 vs. 1 ($9,917 vs. $6,145). On an annual basis, mean per patient costs increased from $6,658 in CLAD stage 1 to $60,508 in CLAD stage 4 (<b>Figure</b>). <h3>Conclusion</h3> BOS after lung transplantation imposes a large economic burden on healthcare systems and patients that increases substantially in later CLAD stages. Early diagnosis and therapies aimed at slowing disease progression may reduce economic burden associated with BOS.

Disease Burden and Treatment Patterns Associated With Eosinophilic Esophagitis in the United States: A Retrospective Claims Study.

This US-based, retrospective claims study aimed to investigate disease burden and treatment patterns in patients with eosinophilic esophagitis (EoE), and to compare health care resource use (HCRU) in patients with EoE and matched controls without EoE. Patients with a diagnosis of EoE and ≥12 months of prediagnosis data were identified from the Truven Health MarketScan Research databases (January 2008 to September 2016) and followed up from the diagnosis date until termination of eligibility for a health plan. Patient clinical characteristics and HCRU were recorded in the 12 months before diagnosis; HCRU and treatment patterns were recorded during follow-up. HCRU in patients with EoE and matched controls was compared during the 12-month postdiagnosis period. Among the 23,003 patients with EoE (mean age: 34.3 y; 64.8% male), gastroesophageal reflux disease was the most common prediagnosis condition (34.6%). After diagnosis, the most common off-label, first-line treatments were proton pump inhibitor monotherapy (52.8%) and topical corticosteroid monotherapy (21.5%). Overall, 3336 patients (14.5%) received at least 3 lines of off-label pharmacotherapy. Outpatient visits (recorded in 99.9% of patients on and postdiagnosis) were most frequently to gastroenterologists/pediatric gastroenterologists (49.5% prediagnosis, 72.6% on and postdiagnosis). Inpatient admissions and outpatient and emergency room visits were more likely in patients with EoE than in matched controls (P<0.0001). Patients with EoE in the USA experience a high disease burden both before and after diagnosis, which requires significant HCRU. Our findings highlight the unmet need for adequate control of EoE-related symptoms.

Cost and Healthcare Resource Use in Patients with Anemia in CKD Using Linked US Claims and Electronic Health Records

Cost and Healthcare Resource Use in Patients with Anemia in CKD Using Linked US Claims and Electronic Health Records

Application of clinical trial inclusion criteria to clinical practice patients to quantify the burden of CNS metastases on health-related quality of life and healthcare resource use in patients with NSCLC

ObjectivesQuantify the burden of central nervous system (CNS) metastases on health-related quality of life (HRQoL) and healthcare resource use (HRU) in patients with advanced non-small-cell lung cancer (NSCLC) from a prospective European study in clinical practice, utilising clinical trial inclusion criteria. Materials and MethodsPatients ≥18 years, with metastatic NSCLC, Eastern Oncology C0operative Group (ECOG) performance status 0–2 and life expectancy ≥12 weeks were enrolled in two cohorts by baseline CNS metastases status. Demographics, clinical characteristics, NSCLC management data, HRQoL and HRU were collected at baseline and two follow-up visits (Visits 2 and 3, 6 weeks apart). HRQoL was assessed using validated questionnaires. Results162 patients were enrolled (n = 80 CNS cohort, n = 82 non-CNS cohort). Baseline characteristics were balanced, but CNS patients were younger (mean ± standard deviation age: 62.1 ± 9.6 vs 65.6 ± 9.7 years, p = 0.021) with a lower body mass index (13.8 % underweight [<18.5kg/m2] vs 3.7 %, p = 0.049). Mean HRQoL scores were similar between cohorts at all visits. Cancer pharmacotherapy, procedures and concomitant treatment were comparable across cohorts, with some exceptions. More CNS patients were hospitalised at baseline (10.3 % vs 2.2 %) for longer (mean 7.2 vs 4.6 days; p < 0.001). By Visit 2, more CNS patients were hospitalised (50.0 % vs 29.3 %; p = 0.009) with emergency room visits (11.8 % vs 2.7 %; p = 0.032). At baseline, more CNS versus non-CNS patients had Magnetic Resonance Imaging (MRI) scans (80.0 % vs 31.7 %; p < 0.001), but fewer had fluorodeoxyglucose (FDG)-positron emission tomography (PET)-computed tomography (CT) scans (10.0 % vs 28.0 %; p = 0.004). ConclusionThese data from clinical practice show minor differences in HRQoL/HRU between patients with advanced NSCLC with/without CNS metastases when applying selected clinical trial criteria. Although follow-up was short, HRQoL scores were similar between cohorts at all visits, supporting the wider inclusion of selected patients with CNS disease into clinical trials.

Trends of Clinical Outcomes and Health Care Resource Use in Heart Failure in the United States.

BackgroundHeart failure (HF) imparts a significant clinical and economic burden on the health system in the United States.Methods and ResultsWe used the National Inpatient Sample database between September 2002 and December 2016. We examined trends of comorbidities, inpatient mortality, and healthcare resource use in patients admitted with acute HF. Outcomes were adjusted for demographic variables, comorbidities, and inflation. A total of 11 806 679 cases of acute HF hospitalization were identified. The burden of coronary artery disease, peripheral vascular disease, valvular heart disease, diabetes mellitus, hypertension, anemia, cancer, depression, and chronic kidney disease among patients admitted with acute HF increased over time. The adjusted mortality decreased from 6.8% in 2002 to 4.9% in 2016 (P‐trend<0.001; average annual decline, 1.99%), which was consistent across age, sex, and race. The adjusted mean length of stay decreased from 8.6 to 6.5 days (P<0.001), but discharge disposition to a long‐term care facility increased from 20.8% to 25.6% (P<0.001). The inflation adjusted mean cost of stay increased from $14 301 to $17 925 (P<0.001) (average annual increase, 1.52%), which was partially explained by the higher proportion of procedures (echocardiogram, right heart catheterization, use of ventricular assist devices, coronary artery bypass grafting) and the higher incidence of HF complications (cardiogenic shock, respiratory failure, ventilator, and renal failure requiring dialysis).ConclusionsThis national data set showed that despite increasing medical complexities, there was significant reduction in inpatient mortality and length of stay. However, these measures were counterbalanced by a higher proportion of discharge disposition to long‐term care facilities and expensive cost of care.

P0857BURDEN OF ANEMIA ASSOCIATED WITH CHRONIC KIDNEY DISEASE IN DIALYSIS AND NON-DIALYSIS-DEPENDENT PATIENTS IN EUROPE: A REVIEW OF PUBLISHED EVIDENCE

Abstract Background and Aims Anaemia is a frequent complication in patients with chronic kidney disease (CKD). The aim of this literature review was to understand the prevalence and burden of anaemia associated with CKD, with a further focus on Europe. Method A targeted literature review was conducted to identify publications on prevalence estimates (search: January 2015 to August 2018), and a systematic literature review was performed to identify publications on humanistic and healthcare resource use (HRU) burden (search: from database inception to July 2018) using MEDLINE®, Embase®, Cochrane Library, and conference proceedings. These were complemented by grey literature searches. Citations were screened per predefined criteria to include observational studies and reviews. Case series/reports and conceptual model studies were excluded. The study population included patients with anaemia associated with CKD, irrespective of CKD stage, dialysis status, or modality. All searches were funded by GSK. Results After applying all inclusion and exclusion criteria, 18 publications were retained that contained prevalence data, of which 9 provided European data. Based on 9 publications, the prevalence of anaemia associated with CKD in European adults was reported to range from 12.8% to 61.5% (Figure). Prevalence was higher in older individuals (aged &amp;gt;60 years) and increased with more advanced CKD stages. However, the methodology used to identify anaemia was not consistent across studies. Anaemia was identified based on varying thresholds of haemoglobin (Hgb) levels per different clinical guidelines (Kidney Disease Improving Global Outcomes [KDIGO], N=4; World Health Organization [WHO], N=2; European Best Practice Guidelines [EBPG], N=3), use of anaemia treatment, or Hgb thresholds without a reference to a specified guideline. Most studies focused on later-stage CKD patients (3 − 5), with only 2 studies reporting rates for stage 1 and 2 patients. A total of 50 publications provided data on humanistic and HRU burden, 6 of which provided European data. The literature on humanistic and HRU burden showed adults with anaemia associated with CKD had significantly poorer health-related quality of life (HRQoL) compared with those without anaemia, with significantly lower Kidney Disease Quality of Life (KDQoL) scores reflecting poorer HRQoL observed in the following domains: symptoms/problems, effect of kidney disease, and burden of kidney disease. This finding was consistent irrespective of instrument used for HRQoL assessment. However, tools used were not specific to anaemia or anaemia associated with CKD, and publications did not mention whether thresholds for clinical meaningfulness had been identified and/or met. Publications on HRU in anaemia associated with CKD in Europe were sparse (N=1): this single published study reported increased HRU in CKD patients with anaemia compared with CKD patients without anaemia. Conclusion Prevalence rates of anaemia associated with CKD reported in Europe vary, with increased prevalence in later stages of CKD. Anaemia negatively impacts patient QoL and leads to increased HRU in patients with CKD. More data are needed to characterise anaemia in earlier stages of CKD and across different populations (e.g. patients with particular comorbidities or undergoing different types of dialysis) in European countries. Due to varied definitions of anaemia, it would be of interest to evaluate the extent of underdiagnosis and its impact on prevalence rates.

P0458ADVERSE EVENTS AND INFECTIONS, POTENTIALLY RELATED TO GLUCOCORTICOIDS, REMAIN COMMON DURING MAINTENANCE TREATMENT OF ANCA ASSOCIATED VASCULITIS AND ADD TO CLINICAL AND HEALTHCARE RESOURCE USE BURDEN IN EUROPEAN PATIENTS

Abstract Background and Aims ANCA associated vasculitis (AAV) treatment aims to quickly control vasculitis activity and then prevent relapse during the maintenance phase of this long term condition. Patients are at risk from disease and treatment related complications with high dose and/or long term glucocorticoid use being a major concern. This retrospective study examined adverse events, infections and healthcare resource use in patients managed in routine practice. Method 1478 AAV patients (France, Germany, Italy, Spain and UK) managed by 493 physicians (61% Nephrologists) who completed induction therapy for new or relapsing organ or life threatening AAV and initiated maintenance therapy between 2014-16 were studied. Data were collected at the time maintenance was determined to begin by the physician and then at 6, 12, 18 and 36 months. 51% had microscopic polyangiitis, mean age 54.2 years with 56% male. BVAS was not used routinely but 56% had moderate systemic disease and 44% severe systemic disease at the time of start of induction remission treatment. Results 78% patients had comorbidity (48% hypertension, 20% dylipidaemia, 17% type 2 diabetes mellitus, 14% depression, 13% COPD/asthma and 9% had BMI &amp;gt; 35) at induction treatment start. Maintenance was defined by physicians as starting approximately 6 months into treatment. AEs potentially linked to GCs were common (values are %, bp = hypertension, DM = diabetes mellitus) during the maintenance phase and many patients remained on long term glucocortioids. Infections were also common, in particular upper (URTI) and lower respiratory tract (LRTI) infection and urinary tract infections (UTI). Hospitilisations still occurred during maintenance period, in particular these are due to infections. Maintenance treatment varied and was changed over follow up (in 13-19% patients at each time point) and in a proportion of patients the change in treatment was precipitated by an adverse event or infection (6 months 21%, 12 months 22%, 18 months 23%, 38 months 26%). Conclusion Comorbidity is common in AAV patients and needs to be considered carefully when making treatment decisions. Patients receiving maintenance therapy frequently experience potentially GC related AEs and infections are also common. Healthcare resource use continues in the maintenance phase and this is on the background of comorbidity, less then complete remission rates and high use of long term steroids. New approaches are required to reduce clinical and healthcare system burdens during the maintenance treatment phase of AAV.

Health Resource Utilization and Costs Associated with the Use of Obinutuzumab-Based Regimens Are Similar to Rituximab-Based Regimens for the First-Line Treatment of Follicular Lymphoma

Introduction: Obinutuzumab (GA101; G), a fully humanized, glycoengineered, type II anti-CD20 monoclonal antibody, is approved in the US for the first-line (1L) treatment of follicular lymphoma (FL). Despite the superior efficacy of G plus chemotherapy (G-chemo) versus rituximab (R) plus chemotherapy (R-chemo) in patients with previously untreated FL demonstrated in the Phase III, randomized GALLIUM study (NCT01332968; Marcus et al. N Engl J Med 2017), information on healthcare resource use (HRU) and real-world costs with G in previously untreated FL patients is limited. The aim of this retrospective cohort study was to examine HRU and costs for G-based and R-based therapies for the 1L treatment of FL using a US claims database. Methods: The data source for this study was the PharMetrics Plus Commercial Claims database. Adult patients (≥18 years) diagnosed with FL between February 1, 2015 and September 30, 2018 and who began any treatment for FL between February 1, 2016 and September 30, 2018 were included. The first FL treatment date within this selection window was denoted the index date. Patients were required to have ≥12 months of pre-index and ≥3 months of post-index continuous study enrolment, and to have at least one FL diagnosis on or during the 12-month pre-index period. Patients with FL treatment during the 12-month pre-index period were excluded in order to select only previously untreated patients. HRU and cost data during the 1L treatment period were descriptive and categorized by HRU category. Costs are in 2018 US dollars ($) and standardized as per patient per month (PPPM) costs. FL treatment determination was based on National Comprehensive Cancer Network guidelines. Results: A total of 1584 FL patients with ≥3 months follow up were analyzed. Overall, 26 patients received G-chemo (any combination) as their 1L treatment, 208 patients received R-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), 391 patients received R-Benda (bendamustine) and 17 patients received R-CVP (cyclophosphamide, vincristine, prednisone); the remaining 942 patients received other regimens (predominantly other R combinations). Data are reported for those patients who received G-chemo, R-CHOP, R-Benda or R-CVP as 1L therapy (n=642; 281 females, 361 males). Baseline patient characteristics were similar for most variables across treatment groups. Mean (standard deviation [SD]) age was 56.9 (9.7) years and all patients had a Charlson Comorbidity Index (CCI) of ≥2 (mean [SD]: 2.9 [1.9]). Mean (SD) patient follow-up was 14.1 (8.0) months and mean (SD) duration of 1L treatment was 7.0 (5.1) months. A summary of all-cause HRU in patients receiving 1L treatment is provided by treatment category (Figure 1A). The proportion of patients with at least one hospitalization was highest with R-CHOP (23.6%). The proportion of patients with at least one emergency room (ER) visit was highest with R-Benda (29.4%). Mean (SD) total all-cause healthcare costs PPPM during 1L treatment were comparable among G-chemo, R-CHOP and R-Benda (Figure 1B) and lowest with R-CVP ($17,874 [$13,465]). Medical costs (mean [SD]) were highest for R-Benda ($27,716 [$19,610] PPPM) and lowest for R-CVP ($17,373 [$12,908] PPPM). G-chemo was associated with the lowest pharmacy costs ($76 [$107] PPPM) (Figure 1B). Mean (SD) total cost of FL drug treatment PPPM was $16,028 ($9,942) for G-chemo, $11,684 ($6,122) for R-CHOP and $12,108 ($8,794) for R-CVP. Mean (SD) total cost of FL drug treatment PPPM was highest with R-Benda ($21,263 [$15,328]). G-specific drug costs PPPM ($9,643 [$6,071]) were similar to R-specific drug costs ($9,992 [$5,234] R-CHOP; $9,083 [$5,859] R-Benda; and $10,702 [$7,717] R-CVP). Conclusions: Our results depict real-world HRU and costs associated with G and commonly used 1L regimens for FL. In this setting, HRU and costs associated with G-chemo were comparable with R-chemo, supporting the use of G-chemo as a treatment option for patients with previously untreated FL. The study findings are limited by the small sample size of the G-chemo patient cohort (n=26) and short follow-up; to address this, an updated analysis incorporating a larger number of patients is planned. Disclosures To: Genentech, Inc.: Employment, Equity Ownership. Dawson:Roche/Genentech: Equity Ownership; Genentech: Employment. Masaquel:Genentech: Employment; Roche: Equity Ownership. Seetasith:Genentech: Employment, Equity Ownership.

Direct Ophthalmic Healthcare Resource Use among Patients with Geographic Atrophy in a Large Cohort from the United Kingdom

To estimate the direct ophthalmic healthcare resource use in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Retrospective analysis of anonymized data derived from electronic medical records (EMRs) acquired at 10 clinical sites in the United Kingdom. Patients aged ≥50 years with ≥1 eye with a clinical record of GA or, for comparison, bilateral early/intermediate AMD. Four subgroups were identified: GA in both eyes (GA:GA); GA in 1 eye, choroidal neovascularization (CNV) in the fellow eye (GA:CNV); GA in 1 eye with early or intermediate AMD in the fellow eye (GA:E); and early/intermediate AMD in both eyes (E:E). The EMRs were analyzed to derive the median number of visits over the first 2 years after diagnosis of GA or early/intermediate AMD. Clinical tests recorded at visits were used to calculate estimated costs (payer perspective) of monitoring. Analyses were restricted to patients with an initial diagnosis on or after January 1, 2011, to represent present day monitoring and costs associated with AMD. Median number of visits and estimated monitoring costs per patient (in £) over the first 2 years among patients with ≥2 years of follow-up and in the individual subgroups. Intravitreal treatment costs in the GA:CNV group were excluded. For all 3 GA subgroups (n= 1080), the median number of visits over the first 2 years was 5, and monitoring costs were £460.80 per patient. The GA:CNV subgroup (n= 355) had the highest number of visits (median, 15), with a cost of £1581, compared with the GA:E subgroup (n= 283; median 4 visits; cost ∼£369) and the GA:GA subgroup (n = 442; median 3 visits; cost ∼£277). Ophthalmic tests were conducted most frequently in the GA:CNV subgroup. Visits and costs in the E:E subgroup (n= 6079) were lower. Resource use in patients with GA varies considerably and is strongly influenced by the concomitant presence of CNV and lack of monitoring strategies for GA.

Improving family caregiver and patient outcomes in lung cancer surgery: Study protocol for a randomized trial of the multimedia self-management (MSM) intervention

ObjectiveTo describe the study protocol of the Multimedia Self-Management (MSM) intervention to prepare patients and family caregivers (FCGs) for lung cancer surgery. DesignThe study is a five-year, single site, randomized controlled trial of 160 lung cancer surgery FCG and patient dyads (320 total participants), comparing intervention and attention control arms. SettingOne National Cancer-Institute (NCI) designated comprehensive cancer center in Southern California. ParticipantsPatients who are scheduled to undergo lung cancer surgery and their FCGs are enrolled as dyads only. InterventionBased on the Chronic Care Self-Management Model (CCM), the intervention is a nurse-led, caregiver-based, multimedia care program for lung cancer surgery. Its primary focus is to help FCGs develop self-management skills related to their caregiving role through goal setting, proactive planning, building problem-solving skills, and accessing family support services. The intervention also supports dyads to prepare for surgery and post-operative recovery at home. It includes videos, print, web-based, and post-discharge telephone support. Main outcome measuresFCG and patient psychological distress and QOL; FCG burden and preparedness for caregiving; FCG and patient healthcare resource use (in-home nursing care, urgent care/ER visits, readmissions). AnalysisRepeated measures ANCOVA statistical design will be used, removing variances prior to examining mean squares for the group by occasion interactions, and co-varying the baseline scores. In addition, structured equation modeling (SEM) will assess whether mediating and moderating factors are associated with outcomes.ClinicalTrials.gov Identifier: NCT03686007

Abstract 274: Healthcare Resource Use and Expenditures in Younger Women and Men Newly Diagnosed with Paroxysmal Supraventricular Tachycardia (PSVT)

Objective: Characterize variations in healthcare resource use (HRU), costs, and ablation prevalence in younger women and men newly diagnosed with paroxysmal supraventricular tachycardia (PSVT). Methods: Commercially insured patients age 18-40 from the Truven Health MarketScan database with newly diagnosed PSVT (ICD-9: 427.0; ICD-10: I47.1) from October 2012 to September 2016, were included when observable one year before and after index diagnosis. The outcomes were mean annual per patient HRU and costs paid by insurers 1 year pre- and post-diagnosis. Results: Among 5,466 study patients, a majority were women (N=3,655; 66.9%). Newly diagnosed women were older (mean age: 30.4y vs. 29.4y; P&lt;0.0001), although there were no significant differences in the Charlson Comorbidity Index (CCI). Rates of hypertension (9.8% vs 15.3%), atrial fibrillation (0.8% vs 2.9%), and heart failure (1.3% vs 2.6%) were low, but significantly lower (p&lt;0.01) in women; chronic pulmonary disease (10.9% vs 8.3%) and anxiety (13.9% vs 10.9%) were significantly higher (p&lt;0.01) in women. Mean annual per patient costs increased for all patients in the post-index year relative to the pre-index year ($17,188 for women versus $25,279 for men, p&lt;0.05). Post-diagnosis costs were significantly lower for women ($26,922 vs $33,112, p&lt;0.05), reflecting lower spending for services with a PSVT diagnosis (women: $8,471 vs men: $11,405, p&lt;0.05). Fewer women were treated with cardiac ablation (12.6% vs. 15.3%; P&lt;0.01). Post-diagnosis rates of beta blocker and calcium channel blocker use were higher for women (46.1% vs. 44.2%; P&lt;0.05), with larger increases in the proportions of women newly prescribed these medications. Patients having at least 1 emergency department visit post-diagnosis (47.9%) and at least 1 hospital admission post-diagnosis (7.6%) were frequent, and these were both more prevalent in women (p&lt;0.01) [ Figure ]. Conclusion: Healthcare spending increases significantly in younger patients newly diagnosed with PSVT. Despite the fact that emergency department visits and hospital admissions are more common in women than men after a PSVT diagnosis, spending after a PSVT diagnosis is significantly lower for women, reflecting lower ablation rates and spending for services with a PSVT diagnosis.

Individual income, mortality and healthcare resource use in patients with chronic heart failure living in a universal healthcare system: A population-based study in Catalonia, Spain

BackgroundTo evaluate the associations between individual income, all-cause mortality and use of healthcare resources in a very large population of chronic heart failure (CHF) patients living in Catalonia (Spain), where access to public healthcare is granted by law. Methods and resultsWe used 2016 data from the Catalan Health Surveillance System, a large, exhaustive, administrative healthcare database which includes information on medical diagnoses, healthcare resource use, and individual income for all Catalan residents (N = 7,638,524). Individual annual income was categorized as high (>100,000€), medium (18,000–100,000€), low (<18,000€), and very low (welfare support). Among 155,883 CHF patients, lower individual income was associated with a shorter life expectancy at age 50 (life expectancy for high income patients 22.2 years, for very low income patients 12.8), and were independently associated with higher all-cause mortality adjusting for age, sex, comorbidities, and duration of the CHF diagnosis (odds ratio very low vs. medium income 1.21 [95% CI 1.11, 1.33]). Also, in patients with lower income levels the burden of public healthcare resource use was displaced towards urgent hospitalizations and frequent emergency department visits, as opposed to regular, specialized CHF ambulatory-based care. ConclusionIn a very large population of CHF patients with access to universal healthcare, lower income was independently associated with higher mortality and with lower use of ambulatory-based healthcare resources. Our findings suggest that CHF patients may benefit from systematic assessment of their socioeconomic status, as this may aid the identification of vulnerable subgroups who may benefit from tailored health education and management.

PMH25 - Quality of Life and Healthcare Resource Use in Patients With Major Depressive Disorder In China: Results From the Proact Study

Major depressive disorder (MDD) is associated with significant disability and poor quality of life (QoL) (1). It is the second leading cause of years lived with disability in China (2). Few studies have examined QoL beyond the acute or short-term maintenance phase. This study examined short- and long-term QoL and healthcare resource use in patients initiating antidepressant treatment. The Prospective Research Observation to Assess Cognition in Treated MDD patients (PROACT) is a non-interventional, prospective, multi-site study of Chinese MDD outpatients, aged 18–65 years, initiating new antidepressant monotherapy at Baseline with follow-up at Months 1, 2 and 6. Hamilton Depression Rating Scale – 17 Items (HAM-D17), Digit Symbol Substitution Test (DSST), EuroQoL five Dimensions (EQ-5D) and healthcare resource use were collected at each visit. The analysis population included patients with DSST assessment at both Baseline and Month 2 visits. Data were summarised descriptively. Of 1008 patients enrolled, 666 (66.1%) completed the study. 598 patients were included in the analyses. At Baseline, mean (SD) age was 36.5 (±12.0) years. 42.6% patients had previous depressive episodes. Mean (SD) HAM-D17 total score was 23.3±4.4 points. 34.6% and 64.5% patients were in remission (HAM-D17 ≤ 7) at Month 2 and 6 respectively. Mean (SD) EQ-5D utility was 0.74±0.14 at Baseline, while 0.93±0.09 versus 0.82±0.13 at Month 2, and 0.95±0.08 versus 0.81±0.14 at Month 6 for patients in remission compared to patients not in remission. Lower proportions of patients in remission compared to patients not in remission had seen a psychiatrist since Baseline at Month 2 (57.1% versus 64.4%) and since last visit at Month 6 (56.5% versus 63.0%). Same pattern was seen for non-psychiatric physician visits. Less than 2% of patients were hospitalised. Patients achieving remission reported better QoL and had lower healthcare resource use compared to patients not in remission.

The impact of targeted therapy on healthcare resource use in patients with metastatic renal cell carcinoma: The University of Sherbrooke experience.

We assessed the impact of targeted therapies on healthcare resource use and compared treatment regimens used in patients diagnosed with metastatic renal cell carcinoma (mRCC). Clinicopathological and administrative data of patients with mRCC from our institution were retrospectively collected from January 2000 to August 2014. Patients were divided into two groups based on the use of targeted therapies. Healthcare resource use (HCRU) data included non-scheduled total number of hospitalizations, total days hospitalized, emergency department visits, and healthcare professional consultations. Each variable was presented with absolute and relative values (i.e., per month of survival). Statistics relied on the use of t-student and Chi-square tests. Ninety-nine patients were included in the study; 60 were treated with targeted therapy. There were no statistically significant differences between the two groups for demographic features and clinicopathological stage. HCRU analysis revealed an absolute increase in the median number of healthcare consultants (6 vs. 4; p&lt;0.01) and emergency department visits (1 vs. 0; p=0.02) for the targeted therapy group. However, analysis per month of survival showed the targeted therapy group had fewer consultants (0.33 vs. 0.40; p=0.04) and hospitalizations (0.09 vs. 0.13; p=0.03) than their counterpart. Population size, non-randomization, treatment selection bias, and heterogeneity were the main limitations of this study. Monthly use of HCRU is lower in mRCC patients treated with targeted therapies. However, because of a greater overall survival, their absolute total HCRU will be higher than those not exposed to targeted agents.