Multi-center Medical Chart-review Study Research Articles

Economic burden of varicella in Bangkok, Thailand: A multicenter medical chart review study.

Our multicenter, medical chart review, cost-of-illness study used a micro-costing approach to evaluate the economic burden associated with varicella in Bangkok, Thailand, from a societal perspective. We reviewed medical charts of adults and children with a primary diagnosis of varicella (2014-2018) from 4 hospitals in Bangkok. Reported healthcare resource utilization and missed school or workdays were extracted from medical charts. Mean direct, indirect, and total costs per patient were estimated for overall, adult, and pediatric patients (2020 USD). Of the 200 children and 60 adults, 99.6%, 5.4%, and 5.4% had a varicella-related outpatient visit, emergency department visit, and hospitalization, respectively. The mean direct medical cost was 33 USD for pediatric and adult patients. The mean cost of outpatient visits (8 vs 13 USD, P<0.001) and medications (7 vs 9 USD, P<0.001) was significantly lower among pediatric patients. Forty-eight children reported a mean of 5.8 school days lost, and 32 adult patients reported a mean of 7.4 workdays lost. The mean total cost per varicella patient was 89 USD, with the mean total cost higher for adult than pediatric patients (145 vs 72 USD, P<0.001). Indirect cost accounted for 63% of the total cost per patient (54% for pediatric patients and 77% for adult patients). There is a substantial economic burden associated with patients seeking varicella-related healthcare in Thailand, including considerable indirect costs.

Differences in prescribing and patient demographics of cki agents among United States patients &lt; 65 and 65+ years old.

e14097 Background: Since FDA approval, immune checkpoint inhibitors (CKIs) have become increasingly important in treating NSCLC, particularly among mutation-negative patients who did not benefit from biomarker testing. Because clinical trials typically recruit healthy patients, little information is available to understand the role of CKIs in treating older patients, who also face immunosenescence. This study explores differences in prescribing behavior of CKIs for mutation-negative NSCLC patients &lt; 65 y/o and 65+ y/o in the US and satisfaction with results. Methods: The Ipsos Global Oncology Monitor: an online multi-center medical chart review study of stage IIIb-IV NSCLC patients currently receiving drug treatments seen in consultation from June – November 2018. 170 US physicians provided de-identified data on 1484 patients negative or untested for EGFR, ALK, ROS1 and BRAF. Results: Compared to patients &lt; 65 y/o (n = 539), those 65+ y/o (n = 945) were prescribed a CKI significantly more often, 63% vs 70% (p &lt; 0.01), driven by CKI monotherapy (CKIm) use, 47% vs 55% (p &lt; 0.01). This trend was seen among patients on 1L therapy (n = 1015), with 42% of patients &lt; 65 y/o and 50% of patients 65+ y/o on CKIm (p &lt; 0.05), and on 2L therapy (n = 337), with 62% of patients &lt; 65 y/o and 76% of patients 65+ y/o on CKIm (p &lt; 0.01). In both lines, this was due to more use of nivolumab among 65+ y/o patients (p &lt; 0.01), while among 2L patients &lt; 65 y/o there was also greater use of pembrolizumab (p &lt; 0.05). Physicians’ stated satisfaction with 1L CKI results was similar in both cohorts but, at 2L, greater among patients 65+ y/o (μ = 8.45; σx̅= 1.26) vs patients &lt; 65 y/o (μ = 8.01; σx̅= 1.38) (p &lt; 0.05). Older 2L CKIm patients were more likely to be ECOG 2+ (18% vs 5%; p &lt; 0.01) and to have 2+ concomitant conditions (60% vs 36%p &lt; 0.01). Conclusions: Satisfaction with 2L CKIs is higher in older vs younger patients, despite the former’s association with poorer outcomes. Potentially, lower expectations at treatment initiation caused higher satisfaction for similar treatment success, but this may also be due to immunosenescence, one study suggesting CKIs are more effective in older melanoma patients ( https://dx.doi.org/10.2147%2FOTT.S165368 ). The role of age in CKIs’ efficacy in NSCLC merits further investigation.

P774 Comparison of disease burden of ulcerative colitis patients treated with biologics/biosimilars in remission and not in remission across the EU5

Disease remission is a key target while managing patients with ulcerative colitis (UC). A multi-center medical chart-review study of UC patients was conducted among physicians (majority: gastroenterologists) in hospitals/private practices to collect de-identified data on patients who are currently on a biologic/biosimilar or recently discontinued one within past three months. Physicians from the five EU countries (5EU) were screened for practice-duration and patient-volume and recruited from a large panel to be geographically representative in each country. Patient charts of ~4 successive patients visiting each center/practice during study period were selected. Physicians abstracted patient diagnosis, treatment patterns/dynamics and patient symptomatology/disease status (incl. assessment of “disease remission”, per physician clinical judgment). In 3Q2017, 213 physicians abstracted 792 eligible current biologic/biosimilar UC patient charts; patient mean age: 41 years, female: 42% (range: 37% (UK)–45% (Germany/Spain)). Geographic distribution of patients were—UK/France: 21% each, Germany/Italy: 20% each, Spain: 19%. Percentage patients currently on first-line biologic: 82% (range: 73% (France)–89% (Germany)), on second-line biologic: 16% (range: 9% (Germany)–24% (France), on ≥third-line biologic: 2% (range: 1% (Spain)–3% (France)). Overall, 72% of current biologic/biosimilar patients were in remission. Remission rate differed by biologic lines: first-line: 73%, second line: 68%, ≥third line: 64%. Average length of remission: 12 months varied by country (range 8 months (UK)–15 months (France/Spain)). Patient current disease-severity (mild:moderate:severe) differed significantly between those in remission vs. those who were not: EU5, 68%:30%:2% vs. 12%:54%:35%. Percent usage of tests between those in remission vs. those who were not differed: Calprotein 65% vs. 57%, ESR 53% vs. 50%, CRP 97% vs. 85%, and Mayo 58% vs. 56%. Among those with lab measures, results differed between those in remission vs. those who were not: mean Calprotein: 116.5 vs. 473.6, mean ESR (mm/h): 16.3 vs. 53.7, CRP (mg/l): 7.3 vs. 33.9 and Mayo 2.6 vs. 6.4. The cohort of UC biologic/biosimilar patients who were deemed to not be in remission were less likely to be tested for Calprotein, ESR, CRP and Mayo than those in remission. Results indicate a greater disease burden for the patients not in remission. As the line of treatment increased, proportion of individuals achieving remission decreased. These observed patterns warrant further scrutiny to determine the best practices and improve remission rates, thereby alleviating patient burden.

Belimumab use, clinical outcomes and glucocorticoid reduction in patients with systemic lupus erythematosus receiving belimumab in clinical practice settings: results from the OBSErve Canada Study

To describe the characteristics of patients receiving belimumab, overall patterns of systemic lupus erythematosus (SLE) care, clinical outcomes, and changes in glucocorticoid dose following 6 months of therapy with belimumab, and healthcare resource utilization in belimumab users in Canadian clinical practice settings. Retrospective multicenter medical chart review study of adult patients with SLE who were prescribed belimumab as part of usual care and who received ≥8 infusions or 6 months of treatment. Primary endpoints included physician-determined overall clinical improvement from baseline, glucocorticoid use, and physician-determined SLE disease severity at Month 6. In total, 52 patients were included in the study. At belimumab initiation, 5.8/76.9/17.3% of patients had mild/moderate/severe SLE, respectively. Oral glucocorticoids were discontinued in 11.4% of patients and 59.1% received a lower dose at Month 6. At Month 6, 80.8/57.7/17.3% of patients had a physician-determined clinical improvement of ≥20/≥50/≥80%, respectively. Sixteen patients had a SLE Disease Activity Index-2K score at both baseline and Month 6, with a mean improvement of 2.6 ± 5.3 from 8.1 ± 3.2 at baseline. No formal disease assessment tool was utilized for 42.3% of study patients at baseline. This study provides the first real-world insights into belimumab use in Canada. It demonstrates significant reduction or discontinuation of glucocorticoid dose in 70.5% of patients and clinically significant improvement following 6 months’ belimumab therapy. The high number of patients with no formal disease activity assessments highlights a key care gap in SLE treatment in the real-world setting.

FRI0275 Impact of Disease Severity on Duration of Use of First Biologic among Patients with Rheumatoid Arthritis in Uk, Germany, France, Italy and Spain

BackgroundUse of biologics have shown to reduce some disease burden among patients with Rheumatoid Arthritis (RA). Relationship between disease severity at initial diagnosis and duration of use of first biologic...

FRI0220 Prevalence of Comorbidites among Patients with Psoriasis with and without Psoriatic Arthritis in European Union

BackgroundPsoriasis (PsO) and Psoriatic Arthritis (PsA) imposes significant burden among patients with these disease conditions. Patients with both of these conditions may experience an even higher disease burden, warranting a...

THU0189 Patterns of Disease Remission among Patients with Rheumatoid Arthritis Treated with Biologic Therapies in the United States

BackgroundDisease remission is a key target while managing patients with Rheumatoid Arthritis (RA).ObjectivesTo assess the patterns of disease remission among Rheumatoid Arthritis (RA) patients recently treated with biologic therapies in...

PMS3 - Prevalence Of Comorbidites Among Patients With Psoriasis (Pso) With And Without Psoriatic Arthritis (Psa) In European Union (Eu)

PMS3 Prevalence Of cOMOrbiditeS aMOng PatientS With PSOriaSiS (PSO) With and WithOut PSOriatic arthritiS (PSa) in eurOPean uniOn (eu) Narayanan S.1, Franceschetti A.2 1Ipsos Healthcare, Columbia, MD, USA, 2Ipsos Healthcare, London, UK Objectives: Assess the prevalence of comorbidities among PsO patients with PsA (PsO+PsA) and without PsA (PsO-alone) treated with biologics in UK/Germany/ France/Italy/Spain (5EU). MethOds: A multi-country multi-center medical chartreview study of PsO patients was conducted in 4Q2012 among physician (mainlydermatologists) in hospitals and private practices to collect de-identified data on patients who were recently treated with a biologic as part of usual care. Physicians were screened for duration of practice (3-30 yrs) and patient volume (incl. > 2 PsO biologic patients/month) and recruited from a large panel to be geographically representative in each country. Physicians abstracted charts of next five consecutive patients within each center/practice, and collected patient diagnosis/symptomatology, disease-severity (physician-judgment), comorbidities and treatment patterns/ dynamics. Prevalence of comorbidities among PsO+PsA and PsO-alone patients was evaluated. Results: 1064 eligible Psoriasis patients were included in the analysis (UK:19%, Germany:21%, France:21%, Italy:18%, SP:22%). Prevalence of PsA among PsO patients was: 13% (UK:13%, Germany:16%, France:15%, Italy:9%, SP:13%), thereby defining PsO+PsA(13%) and PsO-alone(87%) cohort size. Patient characteristics differed between patient groups (All/PsO+PsA/PsO-alone)age:48/49/47yrs; female:38%/46%.37%; in-remission:42%/48%/41%; mild-disease-severity:23%each; moderate-disease-severity:23%/18%/23%; severe-disease:13%/11%/13%; UK (20%) and Germany (30%) had disproportionately more severe patients within PsO+PsA and PsO-alone groups respectively. Comorbidities (> = 1) were observed in 55% of patients (UK:55%, Germany:52%, France:63%, Italy:44%, SP:59%); top-10 comorbidities observed were (All/PsO+PsA/PsO-alone): obesity(20%/27%/19%), dyslipidemia(19%/21%/19%), diabetes(12%/19%/11%), anxiety(8%/10%/8%), heart disease(7%/6%/7%), depression(6%-per-group), liver disease(4%/8%/3%), migraine/ headache(2%/4%/2%), asthma(2%/3%/2%), osteoarthritis(2%/2%/1%). Skin cancer, IBD, ankylosing spondylitis and other respiratory conditions were ~1% each per group. Key comorbidity outliers were (country:All/PsO+PsA/PsO-alone): dyslipidemia (Spain:28%/40%/27%), obesity (Spain:24%/43%/21%), diabetes (France:16%/21%/15%), anxiety (France:17%/24%/15%), heart disease (Germany:15%/14%/15%), liver-disease (Spain:7%/17%/5%). cOnclusiOns: Burden of comorbidities among Psoriasis patients is high, and significantly more so among subset of patients with PsA. This burden varied within 5EU. A multi-faceted approach to patient management is warranted to manage these patients optimally and alleviate disease burden.

AB0790 Clinical characteristics, treatment patterns and disease control among patients with systemic lupus erythematosus receiving steroid-containing standard care regimens in germany, france and spain.

BackgroundCorticosteroids (CCS) are a cornerstone of current treatment regimens in Systemic Lupus Erythematosus (SLE). However, increasing evidence points to their significant contribution to medium-to-long term organ damage.ObjectivesTo assess the clinical...

The Association between Concomitant Use of Serotonergic Antidepressants and Lithium-Induced Polyuria. A Multicenter Medical Chart Review Study

A previous study aimed at revealing the prevalence and determinants of lithium induced polyuria suggested an increased risk of polyuria (urine volume > or =3 L/24 h) in those using serotonergic antidepressants next to lithium. The objective of our study was to re-evaluate this secondary finding in another study population. We performed a multicenter medical chart review study in patients using lithium in whom a 24-hour urine volume had been determined. We included 116 patients, twelve (26%)of the 46 patients with polyuria used serotonergic antidepressants compared to ten (14%) of the 70 patients without polyuria. We found an increased risk of polyuria in lithium users concurrently using serotonergic antidepressants (oddsratio 2.86; 95% confidence interval 1.00-8.21), adjusted for age, gender, use of antiepileptics and thyreomimetics. Our results confirm the previous secondary finding of an increased risk of polyuria in patients using serotonergic antidepressants next to lithium. Physicians should take this into account when evaluating polyuria in patients using lithium and when choosing an antidepressant in patients using lithium.