A. Powers

Outcomes associated with switching from monotherapy to adjunctive therapy for patients with partial onset seizures

Background: Some patients with partial onset seizures are drug-resistant and may benefit from adjunctive therapy. This study evaluated monotherapy/sequential monotherapy versus adjunctive therapy on use/costs. Methods: Retrospective analysis using commercial/Medicare database (1 January 2007 to 31 December 2009). Patients with ≥2 diagnoses for partial onset seizures who received ≥2 prescriptions of the same antiepileptic drug were included. Outcomes assessed in the 12-month follow-up period were hospitalizations, ER visits, outpatient visits and prescription costs for patients who received monotherapy but switched to adjunctive. Results: 1353 patients met criteria. After patients transitioned to adjunctive therapy, the average monthly percentage of patients with a hospitalization decreased from 5.3 to 3.0% (p < 0.0001). Similar results occurred with epilepsy-related hospitalizations (4.0 vs 1.7%, p < 0.0001). Adjusted costs decreased significantly (US

Understanding the impact of settings of care and the development of chemotherapy-induced nausea and vomiting within a population of commercially insured patients.

4205 vs 2944/month, p < 0.0001). Adjusted epilepsy-related costs decreased from US

Investigating rates of CINV across settings of care in Medicare: A retrospective claims-based analysis.

1601 to 909/month (p < 0.0001). Conclusion: Adjunctive therapy in potentially drug-resistant patients with partial onset seizures can lead to reduced healthcare use and costs.

Eribulin treatment patterns in patients with and without prior anthracycline use.

298 Background: Research evaluating the impact of different clinical practice patterns according to settings of care and oncology patient outcomes is limited. This study describes chemotherapy-induced nausea and vomiting (CINV) rates in chemotherapy (CT) naïve cancer patients starting CT in a hospital outpatient (HOP) or community outpatient (COP) setting. METHODS Using the Optum Normative Health Information Database, patients with a new claim of CT and ≥1 outpatient cancer diagnosis claim between 1/1/06 - 6/30/12 were identified. Patients with previous inpatient cancer diagnoses, multi-day CT regimens or Medicare/Medicaid patients were excluded. CINV was defined using relevant claims-based ICD-9-CM diagnosis and procedure codes or a prescription claim for antiemetics within days 2-7 of 1st 8 CT cycles or 1st 6 months following the index CT claim. CINV events were evaluated descriptively and using regression models Results: Patients receiving CT in HOP vs. COP were similar in age. Patients receiving CT in COP vs. HOP setting were more likely to be female (78.7% vs. 62.8%), breast cancer patients (66.8% vs. 46.7%), live in the South region (49.7% vs. 44.1%) and have higher baseline healthcare costs (mean

Relationship between age and health care utilization in patients with myelodysplastic syndrome receiving supportive care.

24,950 vs.

Healthcare utilization and costs in children with stable and uncontrolled epilepsy

24,629) (all p<0.05). Patients in the HOP vs. COP settings had higher Charlson Comorbidity Index scores (mean 3.9 vs. 3.3, p < 0.05). More CINV events were reported for patients in COP vs. those in HOP settings (p < 0.05) (Table). After adjusting for clinical and demographic factors, number of CINV events remained higher for COP vs. HOP settings. However, we were unable to control for antiemetic prophylaxis use or CT emetogenic potential, due to coding irregularities. CONCLUSIONS Results suggest cancer patients starting CT in COP vs. HOP settings may have more CINV events. However, further analyses are needed to explore the impact of antiemetic prophylaxis use or CT emetogenic potential on CINV events between settings of care. [Table: see text].

The Impact of 5-HT3RA Use on Cost and Utilization in Patients with Chemotherapy-Induced Nausea and Vomiting: Systematic Review of the Literature.

297 Background: Clinical practice may differ according to settings of care and may impact both the quality of care delivered and, ultimately, patient outcomes. This study describes the differences in chemotherapy-induced nausea and vomiting (CINV) rates between chemotherapy (CT) naïve Medicare cancer patients starting CT in a hospital outpatient (HOP) or community outpatient (COP) setting. METHODS Using the 5% Medicare Fee-for-Service standard analytic files, patients with a new claim of CT and ≥1 outpatient cancer diagnosis claim between 1/1/10 - 6/30/11 were identified. Patients with a previous inpatient cancer diagnosis, multi-day CT cycles or who switched CT relevant to emetogenic potential were excluded. CINV was defined using relevant claims-based ICD-9-CM diagnosis and procedure codes within days 2-7 of the first 8 single-day CT cycles or the first 6 months following the index CT claim. CINV events were evaluated descriptively and using regression models. RESULTS Medicare patients receiving CT in HOP (n=1,007) vs. COP (n=1,080) were similar in demographics such as age, race, and baseline healthcare costs. However, Medicare patients receiving CT in COP compared to those in HOP settings were more likely to be female (57.0% vs. 44.7%), breast cancer patients (27.6% vs. 16.0%), live in the South region (37.7% vs. 32.3%), have higher Charlson Comorbidity Index scores (mean 5.2 vs. 4.8) and receive moderately to highly emetogenic CT (44.1% vs. 36.0%) (all p<0.05). Overall, 13.9% had any CINV in the evaluation period. More CINV events per patient were reported among those in COP compared to those in HOP settings (0.43 vs 0.27, p <0.05). However, differences between settings of care were not shown to be significantly different in adjusted regression analyses (p=0.177). CONCLUSIONS We found the population characteristics between Medicare patients treated with CT in HOP and COP to vary on a number of factors. However, after controlling for these differences, our results suggest the number of CINV events was similar across settings of care. Future research should further clarify how differences in quality of care for antiemesis between COP and HOP settings may impact the incidence of CINV events in this population.

Effects of dose modification of eribulin mesylate in patients with locally recurrent or metastatic breast cancer.

292 Background: Eribulin mesylate is indicated for patients with metastatic breast cancer after treatment with ≥2 prior chemotherapeutic regimens for metastatic disease. Prior therapy should have included an anthracycline and a taxane. Evidence examining the effects of prior exposure to anthracyclines on eribulin therapy is limited. The purpose of this study was to compare demographic characteristics and treatment patterns for anthracycline-experienced patients vs. anthracycline-naïve patients treated with eribulin. METHODS A retrospective analysis using electronic medical record (EMR) data from 1/1/08 to 3/1/14 was conducted. Chemotherapy drugs were identified by the treatment name field in the EMR. Index date was defined as the first eribulin treatment. Patients with ≥2 eribulin administrations, continuous eligibility including a 6 month pre-period prior to the index date, and no treatment gaps more than 6 months were included. Patients were stratified into an anthracycline experienced cohort (treated prior to eribulin therapy) or without anthracycline cohort (never treated with this drug class prior to eribulin therapy). Demographics (gender, age, receptor status) and treatment characteristics (number and days of eribulin therapy) were compared between the cohorts. RESULTS 190 patients received eribulin; 46 (24%) with prior anthracycline use, 144 (76%) without. The majority of patients were female (87% for prior anthracycline, 97% without), and the average age of both groups was 59 yrs. Most patients were HR+/HER2- (56% overall; 70% for prior anthracycline, 51% for without), followed by TNBC (29% overall; 24% prior anthracycline, 31% without). Some patients had been treated previously with trastuzumab (15% overall; 7% for prior anthracycline, 17% for without). The number of eribulin administrations did not differ significantly between cohorts (8.2 administrations for anthracycline vs. 9.6 without, p=0.268). Likewise the number of days of therapy did not differ significantly (88.1 days for prior anthracycline vs. 104 without, p=0.369). CONCLUSIONS There was no significant difference detected for prior anthracycline use impacting the number of eribulin administrations or days of therapy.

Hematologic complications, healthcare utilization, and costs in commercially insured patients with myelodysplastic syndrome receiving supportive care.

6560 Background: Myelodysplastic syndrome (MDS) is rare in people under 50. Little is known about the disease in this group, particularly among those patients who receive supportive care only. METHODS This was a descriptive cohort study using a large commercial claims database. The study included patients with an initial MDS claim (ICD-9-CM 238.72-238.75) between 2/1/2007 and 7/31/2008, who were continuously enrolled for 6 months prior to and 12 months following the index claim. Patients were excluded it they were treated with either hypomethylating agents (HMA) or thalidomide analogues (TA). Once identified, patients were stratified into two group, those aged <50 and those ≥50. Demographic variables and utilization and costs were calculated in the pre- and postindex period, respectively. RESULTS The study identified 1,209 patients newly diagnosed with MDS and continuously enrolled in the health plan. After excluding 76 (6.3%) who were treated with HMA/TA, the final cohort contained 1,133 patients. Of these, 221 (19.5%) were <50 and 912 (80.5%) were ≥50. In the first year after diagnosis, patients <50 had significantly fewer office visits than the older group (17.5 vs. 24.2, p<.001) but were no different in the proportion hospitalized (25.8% vs. 29.2%, respectively, p=.52) or in length of stay (7.8 vs. 9.0 days, p=.42). Mean total health care charges were

Cohort analysis assessing medical and non-medical cost associated with obesity in the Workplace

30,177 (SD