Pharmaceutical Benefits Schedule Research Articles

Levodopa-based device-aided therapies for the treatment of advanced Parkinson's disease: a social return on investment analysis.

Parkinson's disease (PD) is an incurable, progressive, neurodegenerative disorder. As PD advances and symptoms progress, patients become increasingly dependent on family and carers. Traditional cost-effectiveness analyses (CEA) only consider patient and payer-related outcomes, failing to acknowledge impacts on families, carers, and broader society. This novel Social Return on Investment (SROI) analysis aimed to evaluate the broader impact created by improving access to levodopa (LD) device-aided therapies (DATs) for people living with advanced PD (aPD) in Australia. A forecast SROI analysis over a three-year time horizon was conducted. People living with aPD and their families were recruited for qualitative interviews or a quantitative survey. Secondary research and clinical trial data was used to supplement the primary research. Outcomes were valued and assessed in a SROI value map in Microsoft Excel™. Financial proxies were assigned to each final outcome based on willingness-to-pay, economic valuation, and replacement value. Treatment cost inputs were sourced from Pharmaceutical Benefits Schedule (PBS) and Medicare Benefits Scheme (MBS) published prices. Twenty-four interviews were conducted, and 55 survey responses were received. For every $1 invested in access to LD-based DATs in Australia, an estimated $1.79 of social value is created. Over 3 years, it was estimated $277.16 million will be invested and $406.77 million of social return will be created. This value is shared between people living with aPD (27%), their partners (22%), children (36%), and the Australian Government (15%). Most of the value created is social and emotional in nature, including reduced worry, increased connection to family and friends, and increased hope for the future. Investment in LD-based DATs is expected to generate a positive social return. Over 50% of the value is created for the partners and children of people living with aPD. This value would not be captured in traditional CEA. The SROI methodology highlights the importance of investing in aPD treatment, capturing the social value created by improved access to LD-based DATs.

OP176 Integrating Real-world Compliance In The Assessment Of Left Atrial Appendage Closure Versus Anticoagulation Therapy In Non-valvular Atrial Fibrillation

IntroductionIn patients with non-valvular atrial fibrillation (NVAF), left atrial appendage closure (LAAC) has demonstrated non-inferior efficacy and safety relative to life-long oral anticoagulation therapy (OAT) in a four-year randomized controlled trial (RCT) (PRAGUE-17). Sub-optimal compliance to OAT in the real-world setting (Simmons 2016) has been associated with increased risk of stroke (Ozaki 2020) and may alter efficacy estimates derived from RCTs in which compliance is generally higher. The study aims to model disease outcomes in NVAF patients treated with LAAC versus lifelong OAT when applying trial versus real world compliance to OAT.MethodsReal-world compliance to OAT in the Australian setting was investigated in a 10 percent Pharmaceutical Benefits Schedule (PBS) sample scripts analysis which measured treatment adherence and persistence to new oral anticoagulants (NOACs) and warfarin. Design of the 10 percent PBS analysis was informed by the compliance to medicine working group report and included the longest follow-up of any OAT compliance study identified in the literature. A Markov cohort model was developed to estimate the expected numbers of strokes and major bleeding events in NVAF patients.ResultsRates of NOAC discontinuation in PRAGUE-17 was higher at 20 months median follow-up (6.5%) versus compliance in the Australian setting (35.4% and 30.0% according to 3 and 6 month ceasing rules at 20 months follow-up). Applying sub-optimal compliance to lifelong OAT demonstrated in the Australian setting resulted in higher numbers of strokes over a life time modelled time horizon compared with LAAC.ConclusionsReal world compliance to medicines should be a consideration in economic analysis comparing lifelong medications to one-off surgical interventions.

Preliminary results from the Australian Genetics of Bipolar Disorder Study: A nation-wide cohort.

The Australian Genetics of Bipolar Disorder Study is a nation-wide cohort of adults living with bipolar disorder. The study aims to detect the relationships between genetic risk, symptom severity, and the lifetime prevalence of bipolar disorder, treatment response and medication side effects, and patterns and costs of health care usage. A total of 6682 participants (68.3% female; aged 44.8 ± 13.6 years [range = 18-90]) were recruited in three waves: a nation-wide media campaign, a mail-out based on prescriptions for lithium carbonate and through the Australian Genetics of Depression Study. Participants completed a self-report questionnaire. A total of 4706 (70%) participants provided a saliva sample and were genotyped and 5506 (82%) consented to record linkage of their Pharmaceutical and Medicare Benefits Schedule data. Most participants were living with bipolar I disorder (n = 4068) while 1622 participants were living with bipolar II disorder and 992 with sub-threshold bipolar disorder. The mean age of bipolar disorder diagnosis was 32.7 ± 11.6 years but was younger in bipolar I (p = 2.0E-26) and females (p = 5.7E-23). Excluding depression with onset prior to bipolar disorder diagnosis, 64.5% of participants reported one or more co-occurring psychiatric disorders: most commonly generalised anxiety disorder (43.5%) and posttraumatic stress disorder (20.7%). Adverse drug reactions were common and resulted in discontinuation rates ranging from 33.4% for lithium to 63.0% for carbamazepine. Our findings highlight the high rate of comorbidities and adverse drug reactions among adults living with bipolar disorder in the general Australian population. Future genomic analyses focus on identifying genetic variants influencing pharmacotherapy treatment response and side effects.

The health care and societal costs of inherited retinal diseases in Australia: a microsimulation modelling study.

To estimate the health care and societal costs of inherited retinal diseases (IRDs) in Australia. Microsimulation modelling study based on primary data - collected in interviews of people with IRDs who had ophthalmic or genetic consultations at the Children's Hospital at Westmead or the Save Sight Institute (both Sydney) during 1 January 2019 - 31 December 2020, and of their carers and spouses - and linked Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Schedule (PBS) data. Annual and lifetime costs for people with IRDs and for their carers and spouses, grouped by payer (Australian government, state governments, individuals, private health insurance) and type (health care costs; societal costs: social support, National Disability Insurance Scheme (NDIS), income and taxation, costs associated with caring for family members with IRDs); estimated annual national cost of IRDs. Ninety-four people (74 adults, 20 people under 18 years; 55 girls and women [59%]) and 30 carers completed study surveys (participation rate: adults, 66%; children, 66%; carers, 63%). Total estimated lifetime cost was $5.2 million per person with an IRD, of which 87% were societal and 13% health care costs. The three highest cost items were lost income for people with IRDs ($1.4 million), lost income for their carers and spouses ($1.1 million), and social spending by the Australian government (excluding NDIS expenses: $1.0 million). Annual costs were twice as high for people who were legally blind as for those with less impaired vision ($83 910 v $41 357 per person). The estimated total annual cost of IRDs in Australia was $781 million to $1.56 billion. As the societal costs associated with IRDs are much larger than the health care costs, both contributors should be considered when assessing the cost-effectiveness of interventions for people with IRDs. The increasing loss of income across life reflects the impact of IRDs on employment and career opportunities.

A nationwide analysis of hormonal contraception, sterilisation surgeries and reversal practices amongst Australian men and women from 2001 to 2021

Family planning falls within the spectrum of care within our medical society. We sought to illustrate changes in contraceptive methods over time and evaluate tubal ligation and vasectomy reversal practices in Australia. Yearly data from 2000 to 2021 was extracted from 3 databases: Pharmaceutical Benefits Schedule, Medicare Benefit schedule and Australian Institute of Health and Welfare databases. Population adjusted rates of procedures and medical therapies were calculated using data from Australian Bureau of statistics. Use of Long acting reversible contraception (LARC) has increased by 34.1% from 2001 to 2021, with Mirena being the preferred contraception. The peak age group for tubal ligation during caesarean section was those >35-year-old (64.7%) whereas vasectomy more commonly performed in men aged 35–44. There was a 21.6% decrease in the number of vasectomies over time from 2000–2020. Female surgical sterilisation:vasectomy ratio shows tubal ligation was twice more common than vasectomy. Both macro/microsurgical anastomosis of the vas deferences were conducted: vasovasostomy (VV) and vasoepididymostomy (VE). There was a preponderance in the use of microsurgical approach for VV. Reversal mostly common occurred in those aged 40–44 at 29%. Overall, the rate of vasectomy is continuously falling over time whilst there is a steady incline in the use of LARC from 2020–2021. Both vasovasostomy and vasoepididymostomy reconstruction are practised. Although definitive conclusion from the literature lags, “real-world” trend indicate that micro-surgically conducted vasovasostomy might be the better surgical technique for desired patient outcomes.

Foot, ankle, and leg problems in Australian primary care: consultation patterns, management practices, and costs.

To explore consultation patterns, management practices, and costs of foot, ankle, and leg problems in Australian primary care. We analyzed data from the Bettering the Evaluation and Care of Health program, April 2000 to March 2016. Foot, ankle, and leg problems were identified using the International Classification of Primary Care, Version 2 PLUS terminology. Data were summarized using descriptive statistics examining general practitioner (GP) and patient characteristics associated with a foot, ankle, or leg problem being managed. Cost to government was estimated by extracting fees for GP consultations, diagnostic imaging, and pathology services from the Medicare Benefits Schedule (MBS) database. Costs for prescription-only medicines were extracted from the Pharmaceutical Benefits Schedule and for nonprescribed medications, large banner discount pharmacy prices were used. GPs recorded 1,568,100 patient encounters, at which 50,877 foot, ankle, or leg problems were managed at a rate of 3.24 (95% confidence intervals [CIs] 3.21-3.28) per 100 encounters. The management rate of foot, ankle, or leg problems was higher for certain patient characteristics (older, having a health care card, socioeconomically disadvantaged, non-Indigenous, and being English speaking) and GP characteristics (male sex, older age, and Australian graduate). The most frequently used management practice was the use of medications. The average cost (Australian dollars) per encounter was A$52, with the total annual cost estimated at A$256m. Foot, ankle, and leg problems are frequently managed by GPs, and the costs associated with their management represent a substantial economic impact in Australian primary care.

ANZARD Data Linkage – Agreement Between Births Recorded by Clinics and in NSW Perinatal Data Collection

Background: Fertility clinics submit treatment data on all ART cycles to the Australian and New Zealand Assisted Reproductive Technology Database (ANZARD) as part of their accreditation. The National Perinatal Epidemiology and Statistics Unit (NPESU), who manages ANZARD, is undertaking a study involving the linkage of ANZARD to state and commonwealth datasets to investigate health outcomes of infants born from fertility treatments. Aim: To describe the creation and performance of the linked dataset and to evaluate the agreement between births recorded by clinics and those recorded in state perinatal data collections (PDC). Method: The linked dataset was created by linking the ANZARD to NSW and ACT administrative datasets (performed by NSW Centre for Health Record Linkage (CHeReL)) and to Medicare Benefits Scheme and Pharmaceutical Benefits Schedule (performed by AIHW). The CHeReL’s Master Linkage Key (MLK) was used as a bridge between ANZARD’s statistical linkage key and state administrative datasets. Linkage rates and concordance between births recorded in ANZARD and PDCs was evaluated. Results: A 96.7% linkage rate was achieved between women recorded in ANZARD and CHeReL’s MLKs. A reconciliation of ANZARD-recorded births among NSW residents found that 94.2% (95% CI: 93.9-94.4%) of births were also recorded in NSW/ACT PDCs. A proportion of the missing births could be to women who had ART treatment in NSW but birthed in a different Australian state or country. A high concordance rate (>99%) was found in plurality status and birth outcome between ANZARD and PDCs. Conclusion: High linkage rates can be achieved with partially identifiable data and population spines, such as the CHeReL’s MLK, can be successfully used to link clinical registries and administrative datasets. This linkage resource will provide invaluable information on the safety of the ART and non-ART treatment, and the role of subfertility on the fertility treatments for Australia and beyond.

How will the nursing profession remember the Hon Greg Hunt MP?

The Hon Nicola Roxon MP was celebrated as the Minister for Health and Aging who showed courage and conviction for the nursing profession by facilitating legislation, passed in 2010, that allowed nurse practitioners (NPs) and midwives limited access to the Medical Benefits Schedule (MBS) and the Pharmaceutical Benefits Schedule (PBS) 2010. How will the current Minister for Health and Aging, the Hon Greg Hunt MP, be remembered by the nursing profession?

517Challenges in data linkage – experiences from an upper gastrointestinal cancer data linkage study

Abstract Background Linked, population-level data is valuable for mapping patterns of care and evaluating health service utilisation, particularly in difficult-to-reach populations. Upper gastrointestinal (UGI) cancers have a dismal prognosis, creating difficulties engaging patients in research. The utility of a linked dataset in this population is of high value. Methods Key objectives included identifying the operational and feasibility issues associated with linking Australian state-based administrative and registry data for understanding health service utilisation in UGI cancers. Datasets pertained to hospital admissions, radiotherapy, community health, primary care, palliative care, Medicare and Pharmaceutical Benefits Schedule’s and UGI cancers. Results From a logistical perspective, data access request approval processes varied, with some requiring consent to be sought from individual services contributing data. The availability of unique person-level identifying information varied widely. Additionally, the time period of data capture differed between and within datasets, limiting the quality of the linked data. Significant costs were associated with linking with primary care and Medicare and Pharmaceutical Benefits Schedule’s. Federal dataset linkage required at least a one-year waiting period. Conclusions Whilst in theory data linkage is a powerful mechanism for obtaining population-level data, in reality, there are many logistical and financial barriers to linking multiple datasets. Consequently, critical data, which has the potential to inform policy and improve patient outcomes, cannot be procured. Key messages Logistical and financial challenges are associated with linking administrative and registry datasets for research, limiting the potential of data linkage.

918Building the evidence base for australia’s veteran population

Abstract Background There is a wealth of existing research on Australia’s veteran population. However, much of the existing research seeks to answer questions on specific issues, veterans of specific conflicts, or of veterans who use the Department of Veterans’ Affairs services, with little to no information beyond these specific populations. Methods Several large administrative datasets including the Pharmaceutical Benefits Schedule (PBS), Causes of Death and Specialist Homelessness Services were linked with Defence information to enable analysis of veterans’ information against a range of topics, such as cause of death, health service and homelessness service use. Comparisons were made between the Australian Population as a whole and the veteran population. Results Results show some similarities and some differences between the veteran population and the whole Australian population. Results are disaggregated between those who are currently serving, in the reserves and ex-serving as well as by service type and other variables. Conclusions These results have helped to improve what is known about the broader veteran community. They provide important context for policy makers to understand how best to service the veteran community that was previously unknown, and help identify areas for more detailed research and exploration. Key messages Data linkage provides an important opportunity to understand the specific health and welfare needs of veterans who are otherwise difficult to identify in large administrative datasets. Comparison of veterans’ health and welfare service use with the broader Australian population provides important information for policy makers.

Changes in prescribing habits for the treatment of metastatic renal clear cell carcinoma (mRCC) in Australia

The availability of efficacious systemic therapies for metastatic clear cell renal cell carcinoma has heralded improved survival for Australians. The Pharmaceutical Benefits Schedule registry was interrogated to assess nation-wide prescribing patterns. Sunitinib remained the most commonly prescribed agent. Prescribing rates were significantly lower in Northern Territory than in other states, raising questions of disparities in access to care.

PNS55 The Effect of Pharmaceutical Policy on Demand for Branded Medicines: A Discrete Choice Experiment from Australia

In Australia prescription medicines on the Pharmaceutical Benefits Schedule are subsidised. Patients can access these medicines by paying a co-payment, with the government paying the difference between the listed price and the co-payment. The listed price to government for the medicines is often much higher, and can vary across different brands of the same medicine. We evaluated consumer preferences for medicines under a hypothetical policy in which there is a choice between the subsidised medicine (for $40) or a full priced (range $35 - $120). We designed a discrete choice experiment (DCE) in which consumers were asked to choose their preferred medicine (original brand or generic) for a hypothetical health condition. The attributes of the medicines included the cost to the consumer, whether it is listed for government subsidy, collection time (dispensed now or later in the day) and whether or not the pharmacist recommended the product. Respondents (N=1,248) were recruited via an on-line panel. Analysis was undertaken using mixed logit willingness to pay and latent class (LCA) models. Consumers prefer the subsidised medicine. On average, they are willing to pay $3 more per script for the pharmacists recommendation, $2 for a drug that is reimbursed by the government, but only $1 more for an original brand medicine. The LCA revealed four distinct classes of individuals: a class that prefers the branded product irrespective of any other attributes; a class that strongly attends to the pharmacist’s recommendation; and two classes that both prefer lower prices and subsidised products, one of these classes also have a preference for collection time and pharmacist recommendation. The majority of respondents prefer the subsidised medicine, irrespective of brand, with only a small proportion of respondents choosing the more expensive branded medicine. Suggesting that pricing policies that allow brand premiums may have limited impact on consumer choices.

Economic evaluation protocol for a multicentre randomised controlled trial to compare Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) versus usual care cardiac rehabilitation among people with coronary heart disease

IntroductionIt is important to ascertain the cost-effectiveness of alternative services to traditional cardiac rehabilitation while the economic credentials of the Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) programme among people with...

Microbiology testing associated with antibiotic dispensing in older community-dwelling adults

BackgroundIt is commonly recommended that microbiological assessment should accompany the use of antibiotics prone to resistance. We sought to estimate the rate of microbiology testing and compare this to dispensing of the World Health Organization classified “watch” group antibiotics in primary care.MethodsData from a cohort of older adults (mean age 69 years) were linked to Australian national health insurance (Pharmaceutical Benefits Scheme & Medicare Benefits Schedule) records of community-based antibiotic dispensing and microbiology testing in 2015. Participant characteristics associated with greater watch group antibiotic dispensing and microbiology testing were estimated using adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) in multivariable zero-inflated negative binomial regression models.ResultsIn 2015, among 244,299 participants, there were 63,306 watch group antibiotic prescriptions dispensed and 149,182 microbiology tests conducted; the incidence rate was 0.26 per person-year for watch group antibiotic dispensing and 0.62 for microbiology testing. Of those antibiotic prescriptions, only 19% were accompanied by microbiology testing within − 14 to + 7 days. After adjusting for socio-demographic factors and co-morbidities, individuals with chronic respiratory diseases were more likely to receive watch group antibiotics than those without, e.g. asthma (aIRR:1.59, 95%CI:1.52–1.66) and chronic obstructive pulmonary disease (COPD) (aIRR:2.71, 95%CI:2.48–2.95). However, the rate of microbiology testing was not comparably higher among them (with asthma aIRR:1.03, 95%CI:1.00–1.05; with COPD aIRR:1.00, 95%CI:0.94–1.06).ConclusionsPriority antibiotics with high resistance risk are commonly dispensed among community-dwelling older adults. The discord between the rate of microbiology testing and antibiotic dispensing in adults with chronic respiratory diseases suggests the potential for excessive empirical prescribing.

570 Use of Non-Insulin Antihyperglycaemic Agents With Cardiovascular Benefit in Australia

Majority of type 2 diabetes mellitus (T2DM) patients are treated with non-insulin antihyperglycaemic agents (NIAHA). Recent diabetic guidelines recommend prescription of NIAHA with demonstrated cardiovascular benefits (NIAHA-CV), e.g. SGLT2 inhibitors and select GLP-1 agonists compared to non-insulin antihypgerclyaemic agents with no cardiovascular benefit (NIAHA-NCV). The gap between real-world practice and contemporary guidelines is unknown. We aim to describe prescribing patterns of NIAHA in Australia in 2019. In this study, we reviewed the available statistical data collected by the pharmaceutical benefits scheme (PBS) from the 1st Jan 2019 to 31st Dec 2019 for the number of scripts filled under the PBS/Repatriation schedule of pharmaceutical benefits using the item codes for non-insulin antihyperglycaemic agents. In 2019, metformin was the most commonly prescribed agent (6,282,295). The most popular second line non-insulin agent were the Dipeptidyl peptidase-4 (DPP4) inhibitors (3,425,863) followed by SGLT2 (229,498), Sulfonylureas (1,534,025), GLP1 (798,476), Pioglitazones (57,033) then Acarbose (29,574). Of the GLP1, Dulaglutide was prescribed 259,270 and Exenatide 539,206. Second line NIAHA-CV (SGLT2 inhibitors and Dulaglutide) comprised 31% (2,553,768) of total non-insulin prescriptions. If metformin is excluded as presumed first-line agent, the ratio of OHA-CV to OHA-NCV was 0.46:1 Despite contemporary guidelines, OHA-CVs comprise of a minority of anti-diabetic drug prescriptions, either as likely first-line or second-line agents. Further clinician education is needed to optimize anti-diabetic prescription patterns.

Evaluations of healthcare delivery models in Australia: a scoping review protocol.

The aim of this review is to identify and describe the evidence base of published primary, comparative healthcare delivery model evaluations that require the employment of additional healthcare practitioners undertaken in Australia. In Australia, formal processes are utilized in assessing the value of new pharmaceuticals and medical services, which inform decisions on whether to list new items on the Pharmaceutical Benefits Schedule and Medicare Benefits Schedule, respectively. There are no formal processes to aid in decision making on the funding of new, evaluated healthcare delivery models. This imbalance undervalues the available evidence on healthcare delivery models, leading to the sub-optimal allocation of resources between new health technologies and new healthcare delivery models within the Australian health system. Eligible studies will evaluate healthcare delivery models that require the employment of additional healthcare practitioners (either to replace existing practitioners of another type or to provide new services). Studies must include a comparator to evaluate a condition of interest being treated using alternative healthcare delivery models, or no treatment, and will involve observation of outcomes over a similar period of time. Studies in any Australian setting will be included. Interventions aimed at primary preventions will be excluded. PubMed, Embase and CINAHL will be searched for articles published from 2008. One reviewer will review titles, and then two reviewers will independently review abstracts to identify eligible studies. One reviewer will extract data on study characteristics and design. The results of the data extraction will be presented in a table with examples of case studies.

PCN356 ARE CANCER DRUGS ASSOCIATED WITH A COMPANION DIAGNOSTIC TEST TAKING LONGER TO BE REIMBURSED IN AUSTRALIA?

In Australia, co-dependent technologies that require reimbursement are assessed by two committees: the Pharmaceutical Benefits Advisory Committee (PBAC) and the MSAC (Medical Services Advisory Committee). Most of co-dependent technologies evaluated by the PBAC since March 2011 have been for cancer medicines. We tested the hypothesis that cancer medicines with an associated submission to the MSAC take longer to be reimbursed than those with no co-dependency. We examined the PBAC outcomes for cancer medicines considered by the PBAC between March 2011 and December 2018 to identify those with an associated MSAC submission. Medicine registration details were obtained from the Therapeutic Goods Administration website. Serial issues of the Schedule of Pharmaceutical Benefits from March 2011 to June 2019 were examined to determine PBS listing dates. Our study metrics were the average number of PBAC submissions required to obtain a PBAC recommendation and the average time from date of registration to date of PBS listing. It took, on average, 2.27 PBAC submissions for a cancer medicine with an associated MSAC submission to obtain a PBAC recommendation; the mean for a cancer medicine with no MSAC submission is 2.03. Cancer medicines with an associated MSAC submission also took longer, on average, to be listed on the PBS after their registration (1,493 days versus 717 days). These results should be interpreted with caution given the inclusion of some medicines with a complex history. A recent report[1] estimated that co-dependent medicines take on average twice as long to be reimbursed in Australia, compared to non-co-dependent medicines. This is supported by the findings from our study. Further consideration is needed to reduce the delay in funding for co-dependent medicines, including alignment of the reimbursement processes. [1] Sansom Institute for Health Research. Cancer Biomarkers in Australia. University of South Australia, 2017.

Opioid use prior to elective surgery is strongly associated with persistent use following surgery: an analysis of 14 354 Medicare patients.

BackgroundPersistent opioid use following total joint replacement (TJR) surgery is common; however, the association between pre‐surgical opioid use and surgery type has not been established. The objective of this study was to determine the association between pre‐surgery opioid use and persistent post‐surgery opioid use in TJR patients compared to other elective surgical patients.MethodsThis is a retrospective cohort study, of univariate and multinomial logistic regression of linked, de‐identified Medicare Benefits Schedule and Pharmaceutical Benefits Schedule data, adjusted for perioperative opioid use, age and sex. Oral morphine equivalents daily doses (OMEDD) were calculated and opioid use was categorized into three mutually exclusive categories for each observation window: low (0–5 OMEDD), moderate (5–10 OMEDD), high (10+ OMEDD). Persistent opioid use was defined as opioid use between 180 and 270 days after the date of surgery.ResultsPersistent opioid use was associated with older age, female gender and pre‐surgery opioid use. There was no increased risk for persistent opioid use for TJR patients compared to other surgical patients. The intensity of pre‐surgery opioid usage is strongly associated with persistent opioid use in all observed surgical patients.ConclusionsOur results suggest that many patients who use opioids prior to surgery will persist in their opioid use following surgery. No association was found between persistent opioid use and TJR surgery, but rather a risk reduction compared to other elective surgeries when associations with opioid use are controlled for. Primary care clinicians and surgeons should monitor the duration and dosage of perioperative opioid use.

Sacubitril-valsartan versus enalapril for acute decompensated heart failure: a cost-effectiveness analysis.

The Comparison of Sacubitril-Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilised from an Acute Heart Failure Episode (PIONEER-HF) trial demonstrated significant reductions in N-terminal pro-B-type natriuretic peptide. Our study explored the cost-effectiveness of the use of sacubitril-valsartan versus enalapril in acute decompensated heart failure from the Australian healthcare perspective. A Markov model was designed using data from the PIONEER-HF trial to model the clinical progress and costs of patients over a lifetime time horizon. The model consisted of three health states: 'alive and event-free', 'alive after non-fatal hospitalisation for acute decompensated heart failure' or 'dead'. Costs and utilities were estimated from published sources. The cost of sacubitril-valsartan (per the Australian pharmaceutical benefits schedule) was AU$7.08/day. Outcomes of interest were the incremental cost-effectiveness ratios in terms of cost per quality-adjusted life year gained and cost per year of life saved. Cost and benefits were discounted at 5.0% per annum. Compared to enalapril, sacubitril-valsartan was estimated to cost an additional AU$7464 (discounted) per person, but lead to 0.127 years of life saved (discounted) and 0.096 quality-adjusted life years gained (discounted) over a lifetime analysis. These equated to incremental cost-effectiveness ratios of AU$58,629/year of life saved (US$41,795, EU€58,629, GBP£32,001) and AU$77,889/quality-adjusted life year gained (US$55,526, EU€49,202, GBP£42,504). We have assumed a threshold of AU$50,000/quality-adjusted life year gained to suggest cost-effectiveness. At its current acquisition price, sacubitril-valsartan in comparison to enalapril is not likely to be cost-effective in the management of acute decompensated heart failure in Australia. A price reduction of more than 25% would confer cost-effectiveness.

OP86 Exploring Public Utilization Data For Primary Care Education Programs

IntroductionNPS MedicineWise delivers nationwide educational programs to improve quality use of medicines and medical tests in Australia. Targeted horizon scanning approaches are required to detect and address emerging challenges in the healthcare landscape such as overutilization and unexpectedly high expenditure on medicines and medical tests. Publicly available utilization and expenditure data from the Australian Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) may provide insights into identifying potential areas for intervention.MethodsFive financial years (2013-18) of publicly available PBS/MBS data was extracted from Australian Government websites and clustered according to medicine class, disease groups or anatomical therapeutic chemical classification (ATC). Usage and expenditure trends were explored with signals of potential inappropriate use identified as unusual spikes or changes.ResultsPBS data showed two fixed dose combination inhalers for respiratory conditions, three direct oral anticoagulants, four analgesics (including opioids) and two blood glucose lowering agents had high volume and expenditure growths in the 2016-17 financial year. Cholesterol-reducing medicines and anti-hypertensives also commonly had high utilisation growth. The highest growth classified by ATC level two codes were for urologicals. These signals were collated into themes of stroke prevention, cardiovascular, respiratory, pain management and type two diabetes. MBS data on pathology tests showed viral and bacterial testing had the highest growth, followed by vitamin B12 testing and vitamin D testing. Magnetic resonance imaging had the highest growth in expenditure and volume of services of the various imaging modalities and X-ray of the lower leg had the highest volume of services.ConclusionsSeveral medicines and medical tests were detected as possible targets for interventions based on high volume or expenditure growth. Themes identified from the data can then be further investigated and contextualized to inform topic areas for primary care education to support quality use of medicines and medical tests.