Post-index Year Research Articles

Buprenorphine Receipt and Retention for Opioid Use Disorder Following an Initiative to Increase Access in Primary Care.

Buprenorphine, a medication for opioid use disorder (OUD), is underutilized in general medical settings. Further, it is inequitably received by racialized groups and persons with comorbidities. The Veterans Health Administration launched an initiative to increase buprenorphine receipt in primary care. The project's objective was to identify patient-related factors associated with buprenorphine receipt and retention in primary care clinics (n = 18) participating in the initiative. Retrospective cohort quality improvement evaluation of patients 18 years or older with 2 or more primary care visits in a 1-year period and an OUD diagnosis in the year before the first primary care visit (index date). Buprenorphine receipt was the proportion of patients with OUD who received 1 or more buprenorphine prescriptions from primary care providers during the post-index year and retention the proportion who received buprenorphine for 180 days or longer. Of 2880 patients with OUD seen in primary care, 11.7% (95% confidence interval [CI], 10.6%-12.9%) received buprenorphine in primary care, 58.2% (95% CI, 52.8%-63.3%) of whom were retained on buprenorphine for 180 days or longer. Patients with alcohol use disorder (adjusted odds ratio [AOR], 0.39; 95% CI, 0.27-0.57), nonopioid drug use disorder (AOR, 0.64; 95% CI, 0.45-0.93), and serious mental illness (AOR, 0.60; 95% CI, 0.37-0.97) had lower buprenorphine receipt. Those with an anxiety disorder had higher buprenorphine receipt (AOR, 1.42; 95% CI, 1.04-1.95). Buprenorphine receipt (AOR, 0.55; 95% CI, 0.35-0.87) and 180-day retention (AOR, 0.40; 95% CI, 0.19-0.84) were less likely among non-Hispanic Black patients. Further integration of addiction services in primary care may be needed to enhance buprenorphine receipt for patients with comorbid substance use disorders, and interventions are needed to address disparities in receipt and retention among non-Hispanic Black patients.

Return To Play Rate and Performance Following Surgical Repair of Athletic Pubalgia in Major League Soccer Players: A Retrospective Case-Control Study.

Introduction Athletic pubalgia (AP) injuries requiring surgical repair in elite-level soccer players are significant injuries with the potential of impacting a player's playing time and performance. Currently, no data exists explicitly analyzing Major League Soccer (MLS) players' return to play (RTP) rates and performance following these surgeries. Methods A retrospective review of publicly available data of all MLS players who underwent surgery to repair an isolated AP injury from the league inception year of 1993 through 2021 was performed. Demographic data at the time of injury was collected. Athletes who successfully returned to play for at least two seasons in the MLS were matched to healthy controls in a 1:2 ratio by demographics and position. The index year was defined as the season, including pre- and post-season, that the surgery occurred. RTP date and performance metrics one and two years pre- and post-index year were collected. Statistical analysis was performed. Results Eighty-eight players underwent surgical repair for AP from 1993 through 2021. Eighty-five athletes were able to successfully RTP (96.5%). Twenty-five players met the inclusion criteria and were included in the final analysis. The average RTP time was 1.08±4.92 months. During the combined seasons following surgery, athletes in the AP group displayed a significant reduction in minutes played compared to the two combined seasons prior to surgery (4153±912.77 vs. 3405.36±1342.35 minutes; p=0.03). There was no significant reduction in performance metrics when compared to both prior season statistics and the matched cohort (p>0.05). Conclusion There is a high RTP rate among MLS players who undergo isolated surgical repair of AP. Although there was a significant reduction in combined minutes played in the two ensuing seasons following surgery, athletes who RTP demonstrated equivalent performance metrics comparable to their pre-injury seasons as well as to a matched cohort.

Secondary Prevention Using Cholesterol-Lowering Medications in Patients with Prior Atherosclerotic Cardiovascular Disease Events: A Retrospective Cohort Analysis.

Background: Secondary prevention with lipid-lowering medications in patients with atherosclerotic cardiovascular disease (ASCVD) is known to reduce the risk of clinical events and death. Current guidelines codify recommendations for implementing secondary prevention in appropriate patients. However, in real-world practice, secondary prevention is frequently initiated only after the patient experiences a cardiovascular-related hospitalization. The impact of these delays is not well known.Objectives: To estimate the effects of delaying treatment on the risk of cardiovascular-related hospitalization and on costs for patients who meet the criteria for secondary prevention as specified in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.Methods: This is a retrospective cohort analysis using Humana data. Eligible patients were categorized by treatment group: (1) patients who initiated treatment before an ASCVD-related hospitalization and (2) patients who either did not initiate treatment until after an ASCVD hospitalization or never initiated treatment. The associations between the timely initiation of cholesterol-lowering medications for secondary prevention and (1) the risk for an ASCVD hospitalization and (2) health-care costs over one year, were estimated using multivariate regressions.Results: A total of 272 899 secondary prevention patients were identified who met study selection criteria. Early treatment was associated with significant reductions in the risk of an ASCVD hospitalization at any time following the identification of the patient’s eligibility for secondary prevention (by 33% compared to those treated late or never, P<.0001), but was significantly associated with higher total cost over the first post-index year (by US $509, P<.001). Patients whose low-density lipoprotein cholesterol (LDL-C) levels were >130 mg/dL experienced higher ASCVD hospitalization risks, and also larger risk reductions if treated before an ASCVD hospitalization compared to patients with lower LDL-C levels who were treated late or never treated.Conclusions: More widespread implementation of the treatment policies specified in the 2013 ACC/AHA Guidelines for secondary prevention should significantly reduce cardiovascular disease hospitalizations and reduce costs.

Secondary Prevention Using Cholesterol-Lowering Medications in Patients with Prior Atherosclerotic Cardiovascular Disease Events: A Retrospective Cohort Analysis

Background: Secondary prevention with lipid-lowering medications in patients with atherosclerotic cardiovascular disease (ASCVD) is known to reduce the risk of clinical events and death. Current guidelines codify recommendations for implementing secondary prevention in appropriate patients. However, in real-world practice, secondary prevention is frequently initiated only after the patient experiences a cardiovascular-related hospitalization. The impact of these delays is not well known. Objectives: To estimate the effects of delaying treatment on the risk of cardiovascular-related hospitalization and on costs for patients who meet the criteria for secondary prevention as specified in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Methods: This is a retrospective cohort analysis using Humana data. Eligible patients were categorized by treatment group: (1) patients who initiated treatment before an ASCVD-related hospitalization and (2) patients who either did not initiate treatment until after an ASCVD hospitalization or never initiated treatment. The associations between the timely initiation of cholesterol-lowering medications for secondary prevention and (1) the risk for an ASCVD hospitalization and (2) healthcare costs over one year, were estimated using multivariate regressions. Results: A total of 272 899 secondary prevention patients were identified who met study selection criteria. Early treatment was associated with significant reductions in the risk of an ASCVD hospitalization at any time following the identification of the patient’s eligibility for secondary prevention (by 33% compared to those treated late or never, P&lt;.0001), but was significantly associated with higher total cost over the first post-index year (by US $509, P&lt;.001). Patients whose low-density lipoprotein cholesterol (LDL-C) levels were &gt;130 mg/dL experienced higher ASCVD hospitalization risks, and also larger risk reductions if treated before an ASCVD hospitalization compared to patients with lower LDL-C levels who were treated late or never treated. Conclusions: More widespread implementation of the treatment policies specified in the 2013 ACC/AHA Guidelines for secondary prevention should significantly reduce cardiovascular disease hospitalizations and reduce costs.

Secondary Prevention Using Cholesterol-Lowering Medications in Patients with Prior Atherosclerotic Cardiovascular Disease Events: A Retrospective Cohort Analysis

Background: Secondary prevention with lipid-lowering medications in patients with atherosclerotic cardiovascular disease (ASCVD) is known to reduce the risk of clinical events and death. Current guidelines codify recommendations for implementing secondary prevention in appropriate patients. However, in real-world practice, secondary prevention is frequently initiated only after the patient experiences a cardiovascular-related hospitalization. The impact of these delays is not well known. Objectives: To estimate the effects of delaying treatment on the risk of cardiovascular-related hospitalization and on costs for patients who meet the criteria for secondary prevention as specified in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Methods: This is a retrospective cohort analysis using Humana data. Eligible patients were categorized by treatment group: (1) patients who initiated treatment before an ASCVD-related hospitalization and (2) patients who either did not initiate treatment until after an ASCVD hospitalization or never initiated treatment. The associations between the timely initiation of cholesterol-lowering medications for secondary prevention and (1) the risk for an ASCVD hospitalization and (2) health-care costs over one year, were estimated using multivariate regressions. Results: A total of 272 899 secondary prevention patients were identified who met study selection criteria. Early treatment was associated with significant reductions in the risk of an ASCVD hospitalization at any time following the identification of the patient’s eligibility for secondary prevention (by 33% compared to those treated late or never, P&lt;.0001), but was significantly associated with higher total cost over the first post-index year (by US $509, P&lt;.001). Patients whose low-density lipoprotein cholesterol (LDL-C) levels were &gt;130 mg/dL experienced higher ASCVD hospitalization risks, and also larger risk reductions if treated before an ASCVD hospitalization compared to patients with lower LDL-C levels who were treated late or never treated. Conclusions: More widespread implementation of the treatment policies specified in the 2013 ACC/AHA Guidelines for secondary prevention should significantly reduce cardiovascular disease hospitalizations and reduce costs.

Real-World Treatment Patterns and Clinical, Economic, and Humanistic Burden in Triple-Class Refractory Multiple Myeloma: Analysis of the Connect ® Multiple Myeloma (MM) Disease Registry

Real-World Treatment Patterns and Clinical, Economic, and Humanistic Burden in Triple-Class Refractory Multiple Myeloma: Analysis of the Connect ® Multiple Myeloma (MM) Disease Registry

Economic burden of central nervous system metastases in human epidermal growth factor receptor 2-positive breast cancer.

Aim: Compare healthcare resource utilization and costs among patients with HER2+ metastatic breast cancer (MBC) with and without central nervous system (CNS) metastases. Methods: Retrospective matched cohort study using IQVIA's PharMetrics® Plus claims database. Results: Patients with CNS metastases (n=753) experienced more outpatient, emergency room and inpatient visits versus controls (n=753; all p<0.05). In the post-index year, median total all-cause healthcare costs were significantly higher among patients with CNS metastases versus controls ($112,402 vs $50,835; p<0.0001); outpatient costs primarily drove the cost differential. Conclusion: More effective therapies are needed that improve clinical outcomes and reduce economic burden associated with CNS metastases in patients with HER2+ MBC.

The Short- and Long-Term Burden of Acute Pancreatitis in the United States: A Retrospective Cohort Study.

This retrospective cohort study assessed short- and long-term economic, clinical burden, and productivity impacts of acute pancreatitis (AP) in the United States. United States claims data from patients hospitalized for AP (January 1, 2011-September-30, 2016) were sourced from MarketScan databases. Patients were categorized by index AP severity: severe intensive care unit (ICU), severe non-ICU, and other hospitalized patients. During index, 41,946 patients were hospitalized or visited an emergency department for AP. For inpatients, median (interquartile range) AP-related total cost was $13,187 ($12,822) and increased with AP severity (P < 0.0001). During the postindex year, median AP-related costs were higher (P < 0.0001) for severe ICU versus severe non-ICU and other hospitalized patients. Hours lost and costs due to absence and short-term disability were similar between categories. Long-term disability costs were higher (P = 0.005) for severe ICU versus other hospitalized patients. Factors associated with higher total all-cause costs in the year after discharge included AP severity, length of hospitalization, readmission, AP reoccurrence, progression to chronic pancreatitis, or new-onset diabetes (P < 0.0001). An AP event exerts substantial burden during hospitalization and involves long-term clinical and economic consequences, including loss of productivity, which increase with index AP event severity.

S0762 Nonbiologic Drug Use One Year Before and Two Years After Initiation of Ustekinumab or Adalimumab for Crohn's Disease Patients

INTRODUCTION: The effect of biologic treatment on use of non-biologic drugs for treatment of Crohn’s disease (CD) symptoms may serve as a measure of treatment effectiveness. OBJECTIVE To describe nonbiologic outpatient pharmacy claim activity for CD patients 1-year before and 2-years after initiating ustekinumab (UST) or adalimumab (ADA). METHODS: Symphony Health data was used to identify adult patients with ≥2 CD diagnoses and ≥1 new (i.e., no claim for ≥1-year) outpatient pharmacy claim for UST or ADA (1st claim date = index) on and after 9/26/2016. Patients with facility-based drug claims, diagnoses for non-CD biologic indications, and those not meeting minimum claim activity requirements were excluded. One-year pre- and 2-year post-index outcomes were patients with ≥1 outpatient pharmacy claim for corticosteroid, immunosuppressant, GI anti-inflammatory, ciprofloxacin, metronidazole, antidiarrheal, antispasmodic, or opioid medications. Differences in pre- and post-index utilization were tested using a generalized estimating equation (GEE) model; between group pre-index differences were tested with chi-square. RESULTS: Average age for 935 UST and 2,827 ADA patients who met analysis criteria was similar (∼42 years; P = 0.6089) and 60.4% of UST patients were female vs 57.1% of ADA (P = 0.0703). The percentage of patients with ≥1 prior biologic in the outpatient claims was 52.1% for UST vs 8.3% for ADA. For UST, the percent of patients with ≥90 days exposure to corticosteroids declined from 30.7% in the pre-period to 22.2% in post-index year 1 (P < 0.0001) and to 17.3% post-index year 2 (P < 0.0001); for ≥30 days of opioids declined from 31.8% to 27.6% (P = 0.0484) to 22.5% (P < 0.0001). ADA showed similar trends; the percentage with ≥90 days exposure to corticosteroids declined from 16.9% to 14.5% (P = 0.0105) to 9.9% (P < 0.0001). The percentage with ≥30 days of opioids declined from 20.1% to 20.0% (P = 0.9470) to 16.6% (P = 0.0007). Results for additional pre to post-index medication use are included in Tables 1 and 2. CONCLUSION: While the populations of patients with claims for UST and ADA differed in prior biologic experience and likely in disease severity, both showed reductions in use of non-biologic drugs from pre to post-index periods and from year 1 to year 2 in a number of drug categories including corticosteroids and opioids. Future studies examining non-biologic drug use while controlling for baseline confounders are warranted to assess relative effectiveness of UST and ADA.Table 1Table 2

Healthcare Costs of Diabetes and Microvascular and Macrovascular Disease in Individuals with Incident Type 2 Diabetes Mellitus: A Ten-Year Longitudinal Study.

ObjectiveThe objective of this study was to estimate the incremental long-term costs associated with T2DM attributable to vascular diseases.Research Design and MethodsThis retrospective cohort study identified newly diagnosed (incident) T2DM patients in 2007 (baseline to 01/01/2006) using the HealthCore Integrated Research Database, a repository of nationally representative claims data. Incident T2DM patients were 1:1 exact matched on age, gender and other factors of interest to non-DM patients, and followed until the earlier of 8 follow-up years or death. Patients with documented vascular disease diagnosis were identified during the study period. All-cause and T2DM/vascular disease-related annual healthcare costs were examined for each follow-up year.ResultsThe study included 13,883 individuals with T2DM and matched non-DM controls. Among individuals with T2DM, 11,792 (85%) had vascular disease versus 9251 (66.6%) non-T2DM between 01/01/2006 and 12/31/2015. Among T2DM patients, mean all-cause annual costs were greater than in non-T2DM patients ($13,806 vs $7,243, baseline, $21,745 vs $8,524, post-index year 1, $12,756-$14,793 vs $8,349-$9,940 years 2–8, p< 0.001), respectively. A similar trend was observed for T2DM/vascular disease-related costs (p< 0. 001). T2DM/vascular disease-related costs were largest during post-index year 1, accounting for the majority of all-cause cost difference between T2DM patients and matched non-DM controls. Incident T2DM individuals without vascular disease at any time had significantly lower costs compared to non-DM controls (p< 0. 001) between years 2–8 of follow-up.ConclusionVascular disease increased the cost burden for individuals with T2DM. The cost impact of diabetes and vascular disease was highest in the year after diagnosis, and persisted for at least seven additional years, while the cost of T2DM patients without vascular disease trended lower than for matched non-DM patients. These data highlight potential costs that could be offset by earlier and more effective detection and management of T2DM aimed at reducing vascular disease burden.

PND42 ANNUAL INPATIENT, OUTPATIENT, AND PHARMACY COSTS ASSOCIATED WITH PATIENTS WITH MIGRAINE BY INTENSITY OF TREATMENT-SEEKING BEHAVIOR

To evaluate all-cause annual inpatient, outpatient, and pharmacy healthcare costs associated with patients with migraine by different intensities of treatment-seeking behavior. Retrospective analysis of administrative claims using IBM MarketScan® Commercial and Medicare Databases from 1/1/2016 through 12/31/2017 was conducted with the index date of 1/1/2017. Adult patients with ≥1 migraine medical claim in pre-index year (2016), with continuous enrollment throughout study period, and without malignancy were eligible. Annual all-cause post-index year (2017) costs were evaluated using multivariate regression techniques controlling for demographics and baseline clinical characteristics. Patients were stratified by intensity of treatment-seeking behavior observed in pre-index year, which were based on combinations of utilization of outpatient (OP) and inpatient (IP) services and acute (ARx) and preventive (PRx) prescription migraine medications. Outpatient services consisted of emergency room, physician, hospital, and other outpatient visits. 338,584 patients (mean age, 44 years; 82% female) met the study criteria. Most common comorbidities included non-headache pain (64%), hypertension (26%), and anxiety (23%). Adjusted mean all-cause annual costs ranged from $6,620 in OP-only cohort to $30,759 in OP+IP with/without (±) ARx cohort. Further adjusted mean all-cause inpatient costs ranged from $23,165 in OP-only to $44,182 in OP+IP±ARx cohorts. Adjusted mean outpatient costs ranged from $4,129 in OP-only to $16,086 in OP+IP±ARx cohorts. Use of OP+ARx and/or OP+PRx was associated with increased outpatient costs from $5,942 to $9,987 compared to OP-only. Adjusted mean pharmacy costs ranged from $1,596 in OP+ARx to $6,861 in OP+IP±ARx cohorts. Increases in intensity of treatment-seeking behavior, defined by use of migraine-specific medical and pharmacy services, were associated with incremental rises in annual healthcare expenditures, including inpatient, outpatient, and pharmacy costs. Effective migraine prevention therapies may have potential to reduce the treatment-seeking behavior intensity and, therefore, associated economic migraine burden.

Impact of early initiation of antihypertensive medications for patients with hypertension or elevated blood pressure.

The 2017 American College of Cardiology/American Heart Association High Blood Pressure Guidelines lowered high blood pressure (BP) threshold, recommending earlier treatment to prevent cardiovascular disease. This study estimated the impact of initiating early antihypertensive medications on the risk of acute myocardial infarction (AMI), stroke, death, and on healthcare costs in patients potentially qualifying for antihypertensive treatment under the 2017 guidelines. High-risk patients qualifying for antihypertensive medications under the 2017 guidelines were identified using Optum data. Patients with a diagnosis of elevated BP were also assumed eligible for hypertension treatment under the new guidelines. Patients were defined to have initiated early treatment if they initiated treatment before experiencing a cardiovascular event postdiagnosis. A total of 916 633 patients met eligibility requirements and all other study inclusion criteria. Of those, 66% initiated treatment during 2007-2016. Initiating early antihypertensive treatment decreased the likelihood of having AMI by 59%, stroke by 60% and death by 9%. Patients with only an 'elevated BP' diagnosis experienced reduced risk of stroke once they initiated medications. Treatment reduced the risk of AMI or stroke for patients with diabetes, chronic renal disease and obesity and also significantly lowered all-cause healthcare costs in the first postindex year. Initiating antihypertensive medications before experiencing a cardiovascular disease-related clinical event was associated with reduced risk of AMI, stroke and death for all hypertensive patients identified in the new guidelines. However, early treatment had a significantly smaller effect for patients with only 'elevated' BP, who experienced just a lower risk of stroke once treated.

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.

Primary Prevention Using Cholesterol-Lowering Medications in Patients Meeting New Treatment Guidelines: A Retrospective Cohort Analysis.

The American College of Cardiology and American Heart Association (ACC/AHA) issued new cholesterol treatment guidelines in 2013. Two of the groups designated for primary prevention were analyzed: patients with a low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg per dL and diabetic patients aged 40-75 years. To estimate the effects of primary prevention as specified in the 2013 guidelines on cardiovascular event risk and cost. Primary prevention patients were identified using laboratory and diagnostic data for Humana members from 2007 to 2013. Potential study patients were classified into 3 risk groups: elevated LDL-C, diabetes, and elevated LDL-C and diabetes. Patients receiving cholesterol-lowering medications before their index date were excluded. Eligible patients were divided into 2 treatment groups: (1) primary prevention patients who initiated treatment before experiencing any cardiovascular disease (CVD)-related event, and (2) patients who either did not initiate treatment until after experiencing a CVD event or never initiated treatment. The associations between initiating cholesterol-lowering medications for primary prevention and the risk for acute myocardial infarction, stroke, coronary angioplasty, or coronary artery bypass graft surgery were estimated using Cox proportional hazards models. The effect of primary prevention on health care costs was estimated using generalized linear models. 91,066 patients met study selection criteria. Primary prevention rates were the lowest in diabetic patients (35%), who were newly designated for treatment in the 2013 guidelines. Primary prevention rates were higher for patients designated for treatment under earlier guidelines: 65% for patients with elevated LDL-C and 78% for the combined LDL-C and diabetes group. Primary prevention treatment was associated with significant reductions in cardiovascular event risk (up to 37%) and lower total all-cause costs (by $673) in the first post-index year. Initiating cholesterol-lowering medications for primary prevention, as specified in the ACC/AHA 2013 guidelines, for patients with high LDL-C and diabetes is associated with reduced CVD event risks and lower health care costs. No outside funding supported this study. Han received fellowship support from the Pharmaceutical Research and Manufacturers Association Foundation (PhRMA) during the conduct of this study. Dougherty is employed by PhRMA. The authors have nothing to disclose.

PCV64 - THE DIRECT RESOURCE USE AND MEDICAL COSTS OF HEART FAILURE IN NOVA SCOTIA, CANADA

Heart failure (HF) is among the leading causes of hospitalization in Canada, imposing a high burden on individuals and society, as well as a substantial economic burden on the healthcare system. The objective of this study was to assess resource utilization and direct medical costs incurred by HF patients in the first two years after an initial hospitalization for HF in Nova Scotia, Canada. A retrospective cohort study was conducted using population-based administrative health databases from Nova Scotia. The cohort consisted of adults with an incident hospitalization for HF between April 2009 and March 2013 and were all followed until March 2015. Resource utilization included use of inpatient, outpatient, and pharmaceutical resources. Costs are reported overall and by category of resource utilization. Pharmaceutical data were not available for individuals <65 years; as such, pharmaceutical utilization and costs were not reported for this age stratum. There were 6,851 HF patients included in this study, with 83% of cases ≥65 years. In the first year post-index hospitalization, 55% were re-hospitalized, with a median of 32 outpatient visits. Inpatient and outpatient costs were similar across age groups; the overall mean cost (2017 CAD) per-person was $38,294 (95% confidence interval [CI] $36,916-$39,672) in post-index year 1 and $15,893 (95% CI $14,648-$17,137) post-index year 2. In both years, more than 95% of these costs were related to inpatient care. In individuals ≥65 years, mean drug costs were shown to be an additional $1,953 post-index year 1 and $1,140 post-index year 2. The first year following a diagnosis of HF is associated with the highest overall direct medical costs, primarily driven by hospitalizations. Compared to the average per-capita healthcare expenditures in Nova Scotia, healthcare costs in the year following a diagnosis of HF were approximately three-fold higher than age-matched per-capita costs.

Risk factors and impact of allergic bronchopulmonary aspergillosis in Pseudomonas aeruginosa-negative CF patients.

Allergic bronchopulmonary aspergillosis (ABPA) is a major complication in cystic fibrosis (CF) patients. Risk factors for ABPA and clinical deterioration in CF patients, negative for Pseudomonas aeruginosa (Pa), were explored. We performed a retrospective case-control study in 73Pa-negative patients. Each patient was matched with 2 controls for age, gender, pancreas sufficiency, DeltaF508 mutation (homozygous or heterozygous), and Pa colonization. Median FEV1 at the year of diagnosis (index year) was significantly lower in patients with ABPA. The median of cumulative values of FEV1 and FVC before the index year was not significantly different. After the index year, the median of cumulative data for FEV1 and FVC was significantly lower; there were significantly more hospitalization days and more IV antibiotic days compared to controls. Comparing pre- and post-index year data in patients with ABPA, significantly more hospitalization days and more IV antibiotic days were observed after the index year. During the period preceding the index year, significantly more ABPA patients were treated with rhDNase and inhaled corticosteroids. Bronchial damage cannot be considered as a facilitating factor for ABPA. ABPA causes a significant increase in bronchial damage. In patients with ABPA, further bronchial damage can be controlled by an increase in hospitalization days and use of IV antibiotics. rhDNase and inhaled corticosteroids were associated with the development of ABPA.

PCV84 - Primary Prevention Using Cholesterol-Lowering Medications in Patients Meeting New Treatment Guidelines: A Retrospective Cohort Analysis

The 2013 American College of Cardiology/American Heart Association (ACC /AHA) guidelines expanded primary prevention using cholesterol-lowering therapy to all diabetic patients. Our research documents the potential for expanded primary prevention eligibility to improve cardiovascular outcomes and reduce cost. Patients meeting 2013 guidelines for primary prevention were identified using laboratory and diagnostic data from Humana [2007-2013]. Patients were classified into three risk groups: LDL levels ≥ 190 mg/dL, patients with diabetes (aged 40 to 75), and patients with both elevated LDL-C and diabetes. Patients with no pre-classification cholesterol treatment were then selected and divided in two treatment groups: [1] patients who initiated treatment before experiencing any cardiovascular disease-related event and [2] patients who did not initiate treatment until after experiencing a CVD event (or who never initiated treatment). Clinical outcomes measured were the time to four separate events: AMI, stroke, coronary angioplasty, coronary artery bypass graft surgery (CABG). Costs were measured over the first year following a risk classification. Clinical outcomes were analyzed using Cox proportional hazards models. Costs were analyzed using generalized linear models [GLM]. 91,066 patients were selected according to ACC/AHA guidelines and met study selection criteria. Primary prevention treatment rates were the lowest in diabetic patients [35%], most of whom were newly designated for treatment in the 2013 guidelines. Primary prevention treatment rates were higher for patients identified in earlier guidelines: 65% for patients with elevated LDL and 78% for the combined LDL+diabetes group. Primary prevention was associated with significant reductions in cardiovascular event risk (up to 37%) and lower total all-cause costs in the first post-index year (by $673). Primary prevention using cholesterol-lowering medications, as specified in the new 2013 guidelines for patients with high-LDL or/and diabetes, is projected here to both reduce CVD event risk and lower healthcare costs.

Association of gastrointestinal events with osteoporosis treatment initiation and treatment compliance in Germany: An observational study

BackgroundGastrointestinal (GI) events are common in postmenopausal women treated for osteoporosis. The influence of GI events on treatment initiation and treatment compliance is the subject of ongoing research. ObjectiveThe objectives of this study were (i) to determine the association of GI events with receipt of treatment in patients newly diagnosed with osteoporosis, and (ii) among treated patients, to determine the association of GI events with treatment compliance. MethodsThis was a retrospective analysis of claims data carried out in Germany using the Mediplus database. Data were collected from January 1992 through December 2010. The dual-objective study design required two distinct cohorts. Cohort 1 comprised women aged ≥55 with a diagnosis of osteoporosis. GI events were recorded for the 12month periods before and after the date of diagnosis. Time-varying Cox regression and discrete choice models were used, respectively, to assess the association of post-diagnosis GI events with the initiation of pharmacologic treatment (yes versus no) and the type of treatment initiated (bisphosphonates versus non-bisphosphonates). Cohort 2 comprised women aged ≥55 who initiated an oral bisphosphonate (alendronate, ibandronate, or risedronate). GI events were recorded for the 12month periods before and after the date of bisphosphonate initiation, and a logistic regression model was employed to determine if pre-treatment or post-treatment GI events were associated with patient compliance, defined as a medication possession ratio (MPR) of ≥60%, with sensitivity analyses at MPR≥80%. ResultsIn cohort 1 (N=18,813), 13.8% of patients had GI events in the pre-diagnosis period, and 14.8% had GI events in the post-diagnosis period. Among the patients with post-diagnosis GI events, 93.2% remained untreated during the post-index year, 6.2% were treated with bisphosphonates, and 0.6% received non-bisphosphonates. The respective percentages in patients without post-diagnosis GI events were 81.3%, 16.7%, and 1.9%. A post-diagnosis GI event decreased the likelihood of receiving any osteoporosis treatment (versus no treatment) by 83% (HR 0.17, 95% CI 0.14–0.20) and also decreased the likelihood of receiving a bisphosphonate (versus a non-bisphosphonate) by 39% (OR 0.61, 95% CI 0.54–0.68). In cohort 2 (N=6040), 17.1% of patients had GI events in the year before treatment initiation, and 19.1% had GI events in the year after treatment initiation. At 12months post-treatment initiation, GI events were more frequent in patients with pre-treatment GI events (53.2%) than in those without pre-treatment GI events (12.0%). Post-treatment GI events decreased the likelihood of attaining compliance defined as an MPR≥60% (OR 0.84, 95% CI 0.73–0.97) but not an MPR≥80% (OR 0.91, 95% CI 0.79–1.06). ConclusionsIn German women newly diagnosed with osteoporosis, GI events decreased the likelihood of receiving treatment and were associated with the choice of treatment. In women initiating oral bisphosphonates, post-treatment GI events were associated with reduced patient compliance.

Relationship Between Gastrointestinal Events and Compliance With Osteoporosis Therapy: An Administrative Claims Analysis of the US Managed Care Population

PurposeA large proportion of women with osteoporosis do not comply with current osteoporosis therapies, resulting in diminished therapeutic effect. Noncompliance may be due to the occurrence of gastrointestinal (GI) events during the course of therapy. The objective of this study was to estimate the rate of GI events among women taking oral bisphosphonates and to determine the association between GI events and compliance with bisphosphonate therapy. MethodsThis was a retrospective analysis of data from a US Medicare claims database (HUMANA). The study period was from January 2007 to June 2013. The index date was the date of the first oral bisphosphonate prescription (alendronate, ibandronate, or risedronate) occurring between January 2008 and June 2012. The pre- and postindex periods were the 1-year periods before and after the index date, respectively. The analysis included women 65 years of age and older who were naïve to all osteoporosis treatments before the index date. GI events included nausea/vomiting; dysphagia; esophagitis; esophageal reflux; esophageal, gastric, duodenal, and peptic ulcer; stricture, perforation, or hemorrhage of the esophagus; acute gastritis; and GI hemorrhage. GI events were assessed during the preindex period and at 3, 6, and 12 months in the postindex period. Compliance was defined as a medication possession ratio of ≥80%. The medication possession ratio was calculated as the total days׳ supply of bisphosphonate in the postindex period divided by 365 days. The association of postindex GI events with compliance was assessed using multivariate logistic regression. FindingsThe analysis included 37,886 women initiating oral bisphosphonate therapy. In the preindex year, 37.5% of the women experienced a GI event, and in the postindex year, 38.9% had a GI event. Patients with preindex GI events had numerically higher rates of postindex GI events than patients without preindex GI events (61.8% vs 25.1% at 12 months postindex). Patients who experienced postindex GI events were less likely to be compliant with bisphosphonate therapy, with odds of compliance of 0.76 (95% CI, 0.72–0.80) after 12 months. ImplicationsAmong US women who were prescribed oral bisphosphonates, on-treatment GI events were associated with decreased compliance at 1 year.

Characteristics and use of treatment modalities of patients with binge-eating disorder in the Department of Veterans Affairs

ObjectiveIn 2013 binge-eating disorder (BED) was recognized as a formal diagnosis, but was historically included under the diagnosis code for eating disorder not otherwise specified (EDNOS). This study compared the characteristics and use of treatment modalities in BED patients to those with EDNOS without BED (EDNOS-only) and to matched-patients with no eating disorders (NED). MethodsPatients were identified for this study from electronic health records in the Department of Veterans Affairs from 2000 to 2011. Patients with BED were identified using natural language processing and patients with EDNOS-only were identified by ICD-9 code (307.50). First diagnosis defined index date for these groups. NED patients were frequency matched to BED patients up to 4:1, as available, on age, sex, BMI, depression, and index month encounter. Baseline characteristics and use of treatment modalities during the post-index year were compared using t-tests or chi-square tests. ResultsThere were 593 BED, 1354 EDNOS-only, and 1895 matched-NED patients identified. Only 68 patients with BED had an EDNOS diagnosis. BED patients were younger (48.7 vs. 49.8years, p=0.04), more were male (72.2% vs. 62.8%, p<0.001) and obese (BMI 40.2 vs. 37.0, p<0.001) than EDNOS-only patients. In the follow-up period fewer BED (68.0%) than EDNOS-only patients (87.6%, p<0.001), but more BED than NED patients (51.9%, p<0.001) used at least one treatment modality. DiscussionThe characteristics of BED patients were different from those with EDNOS-only and NED as was their use of treatment modalities. These differences highlight the need for a separate identifier of BED.