699Are we treating our older generations appropriately?

Background This study aims to understand the disease burden of Atrial Fibrillation (AF) and how it is treated among older Australian women. Methods Data from the oldest cohort (born 1921-26) of the Australian Longitudinal Study of Women’s Health were linked to state based hospital data to identify AF and to Pharmaceutical Benefit Scheme data for medication details. Yearly prevalence and incidence of AF was calculated, followed by calculation of proportions for different medications received. Results A total of 6671 women were eligible for the analysis. About 1827 women from were identified as having AF between 2000-2015. Despite steady incidence, prevalence of AF increased from 2.7% (95%CI=1.6%-3.8%) when women were aged 74-79 years to 24.8% (95%CI=23.2%-26.4%) in 2015 when women were 89-94 years. About 10% of women with AF did not receive any treatment for AF and another 60% did not receive any prophylaxis for thromboembolism within 3 years of AF onset. More than three quarters of women with AF received a combination of medications. Rate control with Vitamin K Inhibitors and Rate control with Platelet Aggregation Inhibitors were the most common combinations. Conclusions Older women have high prevalence of AF. These women are undertreated for the prevention of the most common and disabling complication of AF, stroke. Key messages Prevalence of AF is increasing and women receive inadequate treatment rendering them at risk of serious complications like stroke. This results in reduced quality of life for patients as well as burdens the health care system.

Antiepileptic Drugs, Polypharmacy, and Quality of Life in People Living with Epilepsy Managed in General Practice

Objective Recently, instances of general practitioners (GPs) prescribing antiepileptic drugs (AEDs) have increased. We aimed to investigate the use of AEDs in a community sample of people with epilepsy and the effect on quality of life (QoL). Methods Responses from the Australian Epilepsy Longitudinal Study (AELS), Pharmaceutical Benefit Scheme (PBS), and Medicare Benefit Scheme (MBS) data were used. Linear regression was used to investigate the relationship between the numbers of AEDs and QoL. Results Fifty people with epilepsy were prescribed an average of two AEDs. The most common were lamotrigine, sodium valproate, and levetiracetam. Eighty-two percent were prescribed medications from two or more categories of medications. A lower QoL at wave 2 of the AELS was significantly associated with a higher number of AEDs. Conclusion Given the high number of people with epilepsy being cared for in general practice, GPs must understand the risks and benefits of epilepsy monotherapy, polytherapy, and polypharmacy.

VP07 Cost-Effectiveness Of HTA Fees

IntroductionHealth technology assessment (HTA) bodies evaluate the clinical and/or economic impact of new therapies to inform public reimbursement decision-making. This research evaluates the value for money of current or proposed fees for HTA in countries with mandatory cost-effectiveness HTA bodies relative to their respective public drug expenditure.MethodsHTA appraisal fees were identified from publicly-available websites: National Institute for Health and Care Excellence (NICE), Canadian Agency for Drugs and Technologies in Health (CADTH), Institut National d'Excellence en Santé et Services Sociaux (INESSS), and Pharmaceutical Benefits Advisory Committee (PBAC). Annual national public drug expenditure (ANPDE) were sourced from the National Health Service England, Canadian Institute for Health Information, and the Pharmaceutical Benefit Scheme.ResultsNICE is proposing to charge GBP 126,000 (EUR 142,582) for a single technology or highly specialized technology appraisal, CADTH charges CAD 72,480 (EUR 48,576) for a Schedule A submission, INESSS charges CAD 38,921 (EUR 26,089) for the first evaluation of a new drug or new indication, and PBAC charges AUD 136,716 (EUR 87,576) for a Major Lodgment. The ANPDE in England: GBP 16 billion (EUR 18.1 billion), Canada: CAD 14.5 billion (EUR 9.7 billion), Quebec: CAD 4 billion (EUR 2.7 billion) and Australia: AUD 8.7 billion (EUR 5.6 billion). The appraisal cost to drug expenditure ratio for these countries/regions were: 126,984, 200,055, 102,772, and 63,636, respectively.ConclusionsHTA submissions in the United Kingdom, Canada and Australia require financial contributions from manufacturers. These contributions bear little relation to the market size and cumulatively exceed EUR 300,000 (assuming no resubmissions). By adopting charging/cost recovery models, HTA bodies are aiming to reinvest the proceeds to increase the efficiency and capacity of appraisals, expediting patient access. However, these fees may be burdensome, especially for SMEs with promising therapies for orphan/rare diseases, and they may thus have the potential to deter/delay their submissions.