PP459 Healthcare Resource Utilisation Of Anti-Neutrophil Cytoplasmic Antibody Associated Vasculitis Patients: Real-World Data From English Clinical Practice Research Datalink

2020 ◽  
Vol 36 (S1) ◽  
pp. 37-37
Author(s):  
Antonio Ramirez de Arellano Serna ◽  
Matt Glover ◽  
Cormac Sammon ◽  
Tzu-Chun Kuo ◽  
Philip Spearpoint ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Resource Utilization ◽  
Real World ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Practice Research ◽  
Resource Utilisation ◽  
Clinical Practice Research Datalink ◽  
Real World Data ◽  
World Data

IntroductionAnti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a rare, serious and often life-threatening disease. The use of available treatments options (immunosuppressants and glucocorticoids (GCs)) improves the prognosis of AAV greatly; however, GC use is associated with significant toxicity related morbidities and the management of AAV is costly. However, information of the costs associated with AAV in the United Kingdom is limited. This study aimed to quantify the burden of AAV using a large England and Wales source of real-world data, the Clinical Practice Research Datalink (CPRD) Hospital Episode Statistics (HES) linked database, to identify healthcare resource utilization and generate estimates of costs.MethodsIncident patients (n = 220) were included if ≥ eighteen years, with diagnosis read codes G754.00/G75A.00; ICD codes M31.3/M31.7 from January 1997 to December 2017. Costs were taken from Unit Costs of Social and Health Care, National Health Service reference costs and electronic drug tariff. Distinction was made between type of consultations, outpatient visits and inpatient admission based on Healthcare Resource Grouping. Costs were summarised as mean per member per year (PMPY) in 2016 prices and presented before and after diagnosis.ResultsIn the year preceding AAV diagnosis, mean costs PMPY were GBP12,012 [USD15,400], (GBP5,339 [USD6,845] inpatient, GBP766 [USD982] outpatient, GBP314 [USD403] GP, GBP5,594 [USD7,172] GP prescribing). In the year of AAV diagnosis (Y0) costs PMPY were GBP28,252 [USD36,220], GBP15,436 [USD19,790] inpatient, GBP1,863 [USD2,388] outpatient, GBP2,407 [USD3,086] GBP8,545 [USD10,956] GP prescribing). Costs in the years post-diagnosis remained higher than pre-diagnosis with a low of GBP22,839 [USD29,281] in Y4. The prescribing costs (GC, methotrexate and azathioprine) were the largest contributor in Y0-Y4 (GBP15,047 [USD19,291] Y1; GBP12,325 [USD15,801] Y4).ConclusionsDiagnosis of AAV is associated with increased healthcare costs, including higher inpatients costs in the year of diagnosis and subsequently higher prescribing costs in the community. Given the incidence (17.2 cases per million) and considering only costs in the year of diagnosis, an additional GBP15.6 million [USD24.6 million] of healthcare resource utilization occurs every year from new diagnoses of AAV. However, this will likely be underestimated due to the lack of secondary care prescribing data in CPRD-HES and prescribing of immunosuppressant treatments in this setting.

scholarly journals Healthcare Resource Utilization and Cost in Patients with Relapsed/Refractory Classical Hodgkin's Lymphoma Who Received Autologous Stem Cell Transplantation in the US

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 36-37
Author(s):  
Xiaoqin Yang ◽  
Kaushal D Desai ◽  
Adrienne M Gilligan ◽  
Monika Raut ◽  
Akash Nahar
Keyword(s):  
Cancer Therapy ◽  
Supportive Care ◽  
Real World ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Real World Data ◽  
World Data ◽  
Anti Cancer ◽  
Ed Visits ◽  
Observation Period

Introduction: Limited real-world studies exist on the management of relapsed/refractory (R/R) classical Hodgkin's lymphoma (cHL) patients (pts) who failed autologous stem transplant (auto-SCT) and their subsequent healthcare resource utilization (HRU) and cost. Current treatment options include chemotherapy, a second auto-SCT, allogenic (allo-) SCT, palliative care, or newer therapies like brentuximab vedotin (BV) or programmed death-1 (PD-1) blocking antibodies. Pts eligible for treatment post auto-SCT failure may consume significant resources and using real-world data may inform the place of therapy of newly approved agents. Therefore, the objectives of this study were to compare HRU and cost among R/R cHL pts who received auto-SCT by transplant success and failure. Methods: This retrospective cohort study used electronic medical record (EMR) data of US pts from a network of oncology practices, including practices affiliated with CancerLinQ, maintained in the Definitive Oncology Dataset. Eligible adult (≥18 years) pts who had a confirmed diagnosis of cHL and ≥1 R/R event that occurred between 2000 to 2019 were included. Treatment patterns included any systemic anti-cancer therapy received post auto-SCT failure. Descriptive analyses examined differences by auto-SCT success vs failure. Auto-SCT failure was defined as having a R/R event or disease progression after receipt of auto-SCT. HRU included hospitalization rates, emergency department (ED) visits, and infused supportive care drugs. Costs (inflated for 2020$) were based on matched Health Care Utilization Project coded events. HRU and costs were reported per patient per month (PPPM) from initial cHL diagnosis (first-line [1L] therapy) through the second R/R event (third-line [3L] therapy) and for 3L among a subset of pts who failed auto-SCT in second line (2L). PPPM was calculated by dividing the total HRU or cost during the observation period by the number of months of the observation period and then averaged across all pts (regardless of being flagged for a specific service). Results: A total of 157 pts (54.9%) received auto-SCT among the R/R cHL cohort (n=286). Most pts were Caucasian (77.7%) with a median age of 31 years (range: 19-73) at the first R/R event. Median length of follow-up was 11 months from the first R/R event. Nearly all pts (91.7%) received auto-SCT after the start of 2L (68.2%, n=107) and 3L (23.6%, n=37). Approximately 9.6% (n=15) also received allo-SCT in later lines. Among auto-SCT pts, 62.4% (n=98) had a transplant success vs 37.6% (n=59) with a transplant failure. Across these 59 pts, 46 (78.0%) received treatment post auto-SCT failure. Treatment post auto-SCT failure consisted of 21 different anti-cancer regimens (monotherapy or in combination) and included BV (alone or in combination) (37.3%, n=22), chemotherapy (30.5%, n=18), PD-1 therapy (alone or in combination) (6.8%, n=4), other (5.1%, n=3), and allo-SCT (1.7%, n=1). The 59 pts with auto-SCT failure primarily failed in 2L (66.1%, n=39) and 3L (27.1%, n=16). HRU and costs for the 39 pts who failed auto-SCT in 2L were substantial in 3L. Approximately 92.3% of pts had a hospitalization, 30.8% had an ED visit, and 51.3% received infused supportive care treatment in 3L. Monthly costs in 3L were high: hospitalization $3,903, ED visit $130, infused supportive care $279, anti-cancer therapy $64,572, and $69,186 total. From the start of 1L through the end of 3L, the proportion of pts with a hospitalization was significantly higher for pts who failed auto-SCT (Table). Subsequently, costs were also higher and average length of stay longer. While HRU did not differ, infused supportive care costs were higher for auto-SCT pts. No significant differences in HRU and cost were observed across the two groups for ED visits and oncology setting outpatient visits. Anti-cancer therapy costs were significantly higher for pts who failed auto-SCT. Total monthly costs were higher for pts who failed auto-SCT. Conclusion: In the real-world setting, almost 40% of R/R cHL pts failed auto-SCT. There appears to be no clear standard of care post auto-SCT failure and using real-world data may inform the place in therapy of newer therapies. The HRU and cost of managing post auto-SCT failure was substantial and highlights the significant unmet need in this population. These findings add to the scarce real-world data on treatment patterns, utilization, and cost among R/R cHL pts who receive auto-SCT. Disclosures Yang: Merck & Co, Inc.: Current Employment. Desai:Merck & Co., Inc: Current Employment, Current equity holder in publicly-traded company. Gilligan:ConcertAI: Current Employment; Merck & Co., Inc.: Research Funding. Raut:Merck & Co., Inc.: Current Employment. Nahar:Merck Sharp & Dohme, Corp., a subsididary of Merck & Co., Inc., Kenlworth, NJ, USA: Current Employment.

Abstract 13154: Cardiovascular Risk in Users of Mirabegron Relative to Users of Antimuscarinic Treatments for Overactive Bladder: Findings From a Non-interventional, Real-world Data Safety Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Veena Hoffman ◽  
Jesper Hallas ◽  
Marie Linder ◽  
Andrea Margulis ◽  
Brandon T Suehs ◽  
...  
Keyword(s):  
Overactive Bladder ◽  
Real World ◽  
Incidence Rates ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Real World Data ◽  
Safety Study ◽  
World Data ◽  
All Cause Mortality ◽  
Study Population

Introduction: During clinical trials, mirabegron, a β3-adrenoreceptor agonist, was associated with increased heart rate and systolic/diastolic blood pressure vs placebo in patients with overactive bladder (OAB). We studied the association between mirabegron and cardiovascular (CV) outcomes in an observational post-marketing safety study using real-world data. Methods: The study population was identified within five data sources: Danish and Swedish National Registers, Clinical Practice Research Datalink (UK), Optum (US), and Humana (US). Episodes of time when patients were new users of mirabegron or antimuscarinic medications (AMs) from 2012 to 2018 were sourced from prescription/dispensing information and matched on propensity scores. Major adverse CV events (MACE), acute myocardial infarction (AMI), stroke, and CV and all-cause mortality were identified from register linkage or validated through medical record review or physician questionnaires. Incidence rates of these outcomes during person-time of current use were estimated along with hazard ratios (HRs) from Cox models. Results: In total, 152,026 mirabegron episodes were matched to an equal number of AM episodes. The study population was 63.2% female and 72.6% were ≥65 years old. Baseline CV risk factors were similar between matched groups. There were no appreciable differences in the incidence rates of MACE, AMI, and stroke among current users of mirabegron relative to AMs (Table). The incidence rates of CV mortality (HR: 0.83, 95% confidence interval [CI]: 0.73, 0.95) and all-cause mortality (HR: 0.80, CI: 0.76, 0.84) were no higher with mirabegron vs AMs. Results restricted to episodes at high risk for CV events or stratified by age (<65, ≥65 years) or prior OAB medication use were consistent with overall findings. Conclusions: This large, multinational study found no higher risk of MACE, AMI, stroke, or CV or all-cause mortality among current users of mirabegron relative to users of AMs.

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