J.J. Guo

Antithrombotic Therapy and Direct Medical Costs in Patients with Acute Coronary Syndrome in Shanghai, China

BACKGROUNDnAcute coronary syndrome (ACS) is a leading cause of morbidity and mortality worldwide.nnnOBJECTIVESnTo describe patient profile, treatment patterns, and disease burden for patients with ACS.nnnMETHODSnA retrospective descriptive cohort study was conducted. Data were obtained from electronic medical records from seven Shanghai medical centers. Patients with at least one primary diagnosis of ACS from 2006 to 2012 were included. Patient ACS-related antithrombotic medication use, laboratory tests, key comorbidities, health care utilization, and direct medical costs were examined. Log-linear regression was conducted to explore factors associated with total direct medical costs.nnnRESULTSnThe mean age for the 6601 patients included was 69.7 ± 12.5 years, and most of the patients (73%) were men. Comorbidities included diabetes (18.2%), hypertension (21.2%), and hyperlipidemia (8.6%). Out of these, 6466 (98%) patients had been hospitalized for ACS with an average length of stay of 14.0 ± 16.4 days per hospitalization. A total of 914 (13.8%) patients had emergency room visits. Of these, 93.5% received any antithrombotic therapy, including antiplatelet agents (92.7%) and anticoagulants (20.8%). ACS-related direct medical costs (in yuan renminbi [¥]) were ¥18,421 ± ¥24,741 per hospitalization, including costs for medications (¥6,776) and laboratory tests (¥1,355), and ¥2,894 ± ¥7,060 per outpatient visit, including costs for medications (¥620) and laboratory tests (¥464). The higher direct medical cost was associated significantly (P < 0.05) with age, being male, antiplatelet and anticoagulant use, and several comorbid disease states (diabetes, hyperlipidemia, hypertension, and chronic kidney disease).nnnCONCLUSIONSnAntithrombotic therapeutic treatments were commonly used among patients with ACS in Shanghai, China. Higher treatment costs for patients with ACS in Shanghai, China, involved their antithrombotic medication use and key comorbidities.

PHP16 a COMPREHENSIVE STUDY OF GENERIC DRUG ENTRY IN THE UNITED STATES: 1991–2008

PHP13 FACTORS ASSOCIATED WITH THE PROVISION OF LAPAROSCOPIC SURGERY IN THAILAND: RESULTS FROM THE NATIONWIDE INPATIENT DATABASE Vongkom W, Tosanguan K, Chaikledkaew U, Teerawattananon Y Division of Social and Administrative Pharmacy, Bangkok, Thailand, Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand OBJECTIVES: Laparoscopic surgery (LS) requires advanced and expensive surgical instruments but offers better quality of life and shorten hospitalization compared to conventional surgery. This study aimed to evaluate the utilization of LS between patients under Civil Servant Medical Benefi t scheme (CSMBS) and those under Universal Coverage scheme (UC) and to determine the factors associated with the provision of LS in most common diseases. METHODS: A hospital data of patients undergoing LS were obtained from the Central Offi ce for Healthcare Information. The database contained 686,553 admissions with principle diagnoses related to LS from January 2005 to December 2007. Descriptive analyses and binary logistic regression models were used to analyze the data. RESULTS: The total of 24,175 hospitalizations (3.52%) was operated with LS. The proportion of CSMBS patients undergoing LS (7.8%) was higher than that of UC patients (2.68%). It was found that diseases of gallbladder and cholecystitis, diseases of gynecology and acute appendicitis were the most diseases performing LS in Thailand. The provision of LS was signifi cantly associated with age, sex, principal diagnosis, admission year, type of hospitals and type of health insurance coverage. Patients with CSMBS were about two or three times more likely to undergo LS compared to UC. Type of health insurance was the most signifi cant factor associated with the use of LS. CONCLUSIONS: There is an unequal access to LS among patients owing to both medical and nonmedical indications. Health insurance coverage plays a signifi cant role in LS provision in Thailand.

PGI1 A SYSTEMATIC REVIEW ON KUSHENIN VERSUS WESTERN MEDICINES FOR PATIENTS WITH CHRONIC HEPATITIS B

s A57 for each calendar year from January 1, 2000 to December 31, 2005 was performed. Breast cancer prevalence was determined based on the number of females (21–64 years) having at least one medical services claim with a primary diagnosis of breast cancer (ICD-9-CM codes 174, 233.0x, 238.3x, or 239.3x) at any time during the calendar year. Corresponding medical services use and patterns of treatment were also reported among females with breast cancer for each year. State Medicaid perspective was used to calculate costs (2005 US dollars). RESULTS: From 2000 to 2005, the number of female recipients with breast cancer increased from 789 to 1205, respectively. Female recipients in the age group 45–64 years represented the highest proportion in all the study years, increasing from 78.6% in 2000 to 83.9% in 2005. Consistent with state population demographics, a majority ( 90%) of recipients in each year were white. Offi ce visits represented a large majority of medical services encounters ( 98%) and costs ( 90%) in each year. The average amount per recipient paid by Medicaid for breast cancer-related medical services use increased from

MH2 ECONOMIC AND CLINICAL CONSEQUENCES ASSOCIATED WITH POTENTIAL DRUG-DRUG INTERACTIONS BETWEEN ANTIPSYCHOTICS AND CONCOMITANT MEDICATIONS IN PATIENTS WITH SCHIZOPHRENIA

2637 to

PHP34 PRINCIPAL COMPONENTS ANALYSIS OF DRUG UTILIZATION AND EXPENDITURETRENDS FOR MAJORTHERAPEUTIC CLASSES IN U.S. MEDICAID PROGRAMS

3570 between 2000 and 2005, respectively. The average cost per offi ce visit increased from

PMH15 ANALYSIS OF POTENTIAL DRUG-DRUG INTERACTION PAIRS ASSOCIATED WITH ANTIPSYCHOTICS AMONG MEDICAID PATIENTS WITH SCHIZOPHRENIA OR BIPOLAR DISORDER

255/visit to

PMH23 A COMPARISION OF HEALTH CARE UTILIZATION AND COST OF CHILDREN AND ADOLESCENTS WITH BIPOLAR DISORDER TREATED WITH ATYPICAL ANTIPSYCHOTIC MONOTHERAPYVERSUS MOOD STABILIZER MONOTHERAPY

429/visit during the same period. CONCLUSIONS: Breast cancer prevalence increased between 2000 and 2005. There has been a substantial increase in the cost impact associated with breast cancer on the State Medicaid program during the same period. PCN110 A RETROSPECTIVE CLAIMS DATABASE COMPARISON OF SORAFENIB AND SUNITINIB DOSING PATTERNS IN PATIENTS WITH RENAL CELL CARCINOMA (RCC) Keefe S, Moyneur E, Barghout V, Flaherty KT University of Pennsylvania, Philadelphia, PA, USA, StatLog Consulting Inc, L’Ange-Gardien, QC, Canada, Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ, USA OBJECTIVES: To compare dose-reduction patterns in patients with RCC treated with FDA-approved tyrosine kinase inhibitors (TKIs) sorafenib and sunitinib. METHODS: A retrospective analysis was conducted using data from a claims-based database (MarketScan MedStat) covering 18 million lives for 2002–2008 in all US census regions. Patients with 2 claims for RCC (ICD9 189.0 or 198.0), continuous health care coverage, 180 days’ coverage before RCC diagnosis, and no claim for sorafenib or sunitinib before RCC diagnosis, who received a standard RCC initial daily dosage of sorafenib 800 mg or sunitinib 50 mg and 2 consecutive dispensings, were included. Initial episode was defi ned as time from date of fi rst drug-dispensing to fi rst of switch to another TKI, health care coverage end, treatment end, or March 31, 2008. Both patient and patient-time level analyses for dose reductions between treatments were conducted. RESULTS: Baseline demographics between the groups (sorafenib, n 189; sunitinib, n 304) were similar except for a higher incidence of stroke (7.9% vs. 3.6%, P .037) and other cancer site (93.7% vs. 87.8%, P 0.036) in the sorafenib group. Signifi cantly more patients receiving sunitinib required dose reductions compared with sorafenib (fi rst 3 months: 23.0% vs 4.2%; complete initial episodes: 35.5% vs 16.9%; P 0.001 for both). For all episodes, mean time to dose reduction was signifi cantly longer for sorafenib than sunitinib (162 days vs 104 days, P 0.003). Signifi cantly more dose reductions occurred within the fi rst 3 months with sunitinib than sorafenib (65% vs. 25%, P 0.001). Controlling for different lengths of exposure time further confi rmed that more dose reductions were observed in patients treated with sunitinib than with sorafenib (from 2–6 times greater, P 0.001). CONCLUSIONS: This retrospective US claims analysis showed that signifi cantly more dose reductions, including total number of patients and days, were required in patients who initially received sunitinib than in those who received sorafenib. PCN111 INFLUENCE OF AGE ON COMORBIDITIES AND TREATMENT IN PATIENTS WITH RENAL CELL CARCINOMA (RCC): A RETROSPECTIVE CLAIMS DATABASE ANALYSIS Dorff TB, Moyneur E, Barghout V, Quinn DI Keck School of Medicine, Los Angeles, CA, USA, StatLog Consulting Inc, L’Ange-Gardien, QC, Canada, Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ, USA OBJECTIVES: To analyze baseline symptoms, comorbidities, and treatments in newly diagnosed RCC patients by age group. METHODS: Retrospective claims-based analysis was conducted using MarketScan MedStat, a database covering all US census regions, including 18 million lives for years 2002–2008. Patients with initial RCC diagnosis in 2005–2007, 2 outpatient or 1 inpatient RCC claims (ICD9 189.0 or 198.0), continuous health care coverage, and 180 days coverage before diagnosis were included. Patients were followed from diagnosis until health care coverage end or June 30, 2008. Conditions, symptoms, and individual Charlson comorbidities were assessed. Treatment was analyzed using prevalence and time to initiation in patients and 65 years old. RESULTS: Of 12,253 patients identifi ed, 61.8% were male (mean age, 63 years old) and 51.0% were 65 years old. Overall, pain (59.6%), hypertension (53.7%), anemia (23.2%), diabetes (23.6%), and chronic kidney disease (19.4%) were most common comorbidities reported. Most comorbidities were prevalent in 65 years old than 65 years old: notably, cerebrovascular disease (8.7% vs. 3%; P 0.001), acute myocardial infarction (2% vs 0.7%; P 0.001), and chronic renal failure (9.3% vs. 6%; P 0.001). In 65 and 65 groups, most commonly used treatments were nephrectomy (53.4% vs. 40.4%; P .001), intravenous chemotherapy (11.7% vs. 13.3%; P 0.0079) and oral chemotherapy (10.5% vs. 13.3%; P 0.0001), although less than 4% of patients in either group received FDA-approved oral agents sorafenib or sunitinib. For 65 and 65 groups, respectively, mean time from RCC diagnosis to: nephrectomy, 25 and 31 days; radiotherapy, 170 and 177 days; intravenous chemotherapy, 154 and 181 days; sorafenib, 220 and 247 days; sunitinib, 221 and 205 days. CONCLUSIONS: Baseline comorbidities and symptoms were more common in RCC patients 65 years old than those 65 years old. Nephrectomy was used more frequently in patients 65, probably because of comorbidities in older patients. In contrast, systemic treatment was similar in both groups. PCN112 OFF-LABEL USE OF ONCOLOGY DRUGS IN A COMMUNITY ONCOLOGY EMR DATABASE Stephen R, Knopf K, Reynolds MW, Luo W, Fraeman K United BioSource Corporation, Lexington, MA, USA, Pacifi c Hematology/Oncology Associates, San Francsico, CA, USA, United BioSource Corporation, Bethesda, MD, USA OBJECTIVES: The objective of this study was to examine the utilization patterns of cancer medications beyond their labeled indications approved by the FDA in community oncology practices. METHODS: Drug prescription information from a community oncology data warehouse was used for two separate analyses. Patients were categorized according to whether they had an ICD-9 diagnosis code for one of four cancer types including lung, breast, bladder or gastric, and having no other malignancy. The frequency of use of various oncology drugs was examined for each of these groups, against a set of medications that were FDA-approved for these indications or were recommended by NCCN guidelines. In the second analysis, patients with a single malignancy, who received any of the fi ve oncology drugs (paclitaxel, vinorelbine, rituximab, bevacizumab) and gemcitabine, were counted. Comparisons were then made against the cancer indications for which these agents were approved by the FDA. RESULTS: Seventy-eight percent of breast and 95% of lung cancer patients received medications approved for these indications, while 68% and 75% also received drugs that were not approved by the FDA for those conditions. More than 99.7% of these patients received agents recommended on NCCN guidelines. None of the bladder cancer patients and only 5% of gastric cancer patients received drugs approved for these indications, while 97% and 95% of them received guideline-recommended drugs. Only half of the patients given paclitaxel or bevacizumab received these for an FDA-approved indication. In the case of vinorelbine and gemictabine, the proportion was lower at 30% and 40% respectively, while it was higher for rituximab at 60%. CONCLUSIONS: Oncologists’ choice of drugs is driven by evidence-based guidelines, independent of FDA approval. There is a high and varying proportion of off-label use across oncology medications and cancer types. GASTROINTESTINAL DISORDERS – Clinical Outcomes Studies PGI1 A SYSTEMATIC REVIEW ON KUSHENIN VERSUS WESTERN MEDICINES FOR PATIENTS WITH CHRONIC HEPATITIS B Bian B, Shao R, Xia Y, Guo JJ, Chen Y University of Cincinnati, Cincinnanti, OH, USA, China Pharmaceutical University, Nanjing, Jiangsu, China, University of Cincinnati, Cincinnati, OH, USA OBJECTIVES: Hepatitis B virus infected over 2 billion people worldwide, and 350 million suffering from chronic HBV infection. The prevalence of chronic HBV infection is high in Asia and most of Africa. Kushenin injection as a new traditional Chinese medicine is now widely used for chronic HBV treatment in China. The objective of this study was to compare the effectiveness between Kushenin and western medicines on patients with chronic HBV. METHODS: Based on a pilot study of patient interview at one hospital setting, we identifi ed key outcome measurements of effectiveness related to Kushenin and western medicine, including ALT recovery rate and negative conversion rate of HBeAg. Consequently, we performed a systematic literature review using computer-based search-engines such as MEDLINE (1966 to 2007), EMBASE (1966 to 2006), OVID (1965 to 2006), the Chinese Biomedical Database (CBM) (1978 to 2006) and CNKI (China National Knowledge Infrastructure) (1994 to 2007). From available data, both interferon and lamivudine were selected as western medicines to compare with Kushenin regimen. A Meta-analysis was performed usin

PMH3 ANTIDEPRESSANT PROPHYLAXIS FOR POST-STROKE DEPRESSION:A META-ANALYSIS

were estimated. RESULTS: A total of 1179 eligible patients were identified with mean age 15.2 years (SD, 2.16) and 51% female. The distribution was: FGA’s 19% (n = 253), aripiprazole 11% (n = 129), olanzapine 15% (n = 182), quetiapine 25% (n = 297), risperidone 26% (n = 308), and ziprasidone 3% (n = 32). In the linear model, adolescents on olanzapine experienced a significant increase in BMI [0.84 kg/m (CI, 0.17–1.52)] compared to those on aripiprazole. Logistic model results indicated a significant likelihood of a 5 to 20% increase in BMI for those on olanzapine [OR: 1.54 (CI, 0.96–2.5) to 4.53 (CI, 1.79–11.48) and a 10 to 20% increase for those on risperidone [OR: 1.84 (CI, 1.15–3.0) to 2.18 (CI, 1.21–3.96)], compared to aripiprazole. In the BMI z-score analysis, adolescents on olanzapine experienced a significant increase in BMI [OR: 1.65 (CI, 1.02–2.67)]. Results for FGA’s, quetiapine, and ziprasidone were not statistically significant. CONCLUSION: Potential for weight gain varies by antipsychotics and should be taken into account while prescribing these medications to adolescents.

PCV30 TREND ANALYSIS OF PRICE AND UTILIZATION OF STATIN DRUGS IN U.S. MEDICAID PROGRAMS

PHP31 DRUG PROXIES FOR IDENTIFYING SPECIFIC DIAGNOSES IN MEDICARE PART D Livengood KB, Harada A, Gong S, Stockl K, Le L, Zhang S Prescription Solutions, United Health Group, Irvine, CA, USA OBJECTIVE: The purpose of this analysis was to develop a method for identifying Medicare Part D members with cardiovascular disease using medication proxies. METHODS: A binary matrix was created from cardiovascular medication prescription claims for Medicare Part D MAPD and commercial members from the first quarter of 2007. The binary matrix was subjected to factor/principal component analysis. The maximum valued factor loading for each of the generated components were then used to create a member/factor loading matrix. This matrix was used to derive beta coefficients, from logistic regression, to calculate a member’s probability of having hypertension, CAD, or CHF. RESULTS: One-hundred and twelve factors were produced over 696,471 members prescribed cardiovascular medications. Different probability thresholds were evaluated to determine the sensitivity and specificity for the identification method. The threshold probabilities ran from >0.30 to >0.975. As the threshold probabilities increased, sensitivity/specificity for hypertension, CAD, and CHF ran from 0.99/0.50–0.50/0.99, 0.61/0.91– 0.50/0.99, and 0.63/0.96–0.50/0.99, respectively. A similar result was produced using maximum score coefficients resulting from the principal component analysis. CONCLUSION: Although this approach to identifying members with medication proxies appears to separate members with and without certain cardiovascular conditions, it tends to exclude members at the cost of minimizing erroneously identified members.

Utilization, Spending, and Price Trends for Short- and Long-Acting Beta-Agonists and Inhaled Corticosteroids in the Medicaid Program, 1991-2010

Objectives: Patients with schizophrenia, schizoaffective disorder, or bipolar disorder often receive multiple medications as part of their treatment regimens. Since many antipsychotics are metabolized by cytochrome P450 (CYP450) isoenzymes (1A2, 2D6, and 3A4), we proposed to assess the risk of receiving potential drug-drug interaction (DDI) pairs associated with the inhibition or induction of CYP450 isoenzymes.