M. Hopps

Healthcare utilization and costs in diabetes relative to the clinical spectrum of painful diabetic peripheral neuropathy.

AIMS Diabetic peripheral neuropathy (DPN) accompanied by painful symptoms is known as painful DPN (pDPN). This study characterized healthcare resource utilization and costs in patients with DPN, pDPN, and severe pDPN relative to diabetes only. METHODS Four adult cohorts were identified from the Humedica database: type 2 diabetes without DPN (n=288,328); DPN (n=35,050); pDPN (DPN subjects with a pain score ≥1 on a 0-10 numeric rating scale; n=3449); and severe pDPN (pain scores 7-10; n=1824). Resource utilization and costs for 12-months post-diagnosis were compared for diabetes relative to the other cohorts. RESULTS Demographic characteristics were different across cohorts. Relative to diabetes alone, DPN, pDPN, and severe pDPN were characterized by significantly higher proportions of patients with resource utilization for all resource categories (all P<0.0001); the highest resource use generally observed for severe pDPN. Total annual direct medical costs were

Using Random Forest Models to Identify Correlates of a Diabetic Peripheral Neuropathy Diagnosis from Electronic Health Record Data

6632 for diabetes only, with costs for DPN (

THU0321 Multisite Prospective Observational Study of Fibromyalgia Patients in the Us

12,492), pDPN (

The prevalence of probable neuropathic pain in the US: results from a multimodal general-population health survey

27,931), and severe pDPN (

Estimating the global prevalence of transthyretin familial amyloid polyneuropathy: ATTR-FAP Global Prevalence

30,755) significantly higher (all P<0.0001); outpatient costs were consistently the primary driver of total costs. CONCLUSIONS Patients with DPN, pDPN, and severe pDPN had significantly greater healthcare resource utilization and costs than patients with diabetes only, with the highest burden associated with severe pDPN.

Epidemiological and clinical characteristics of persons with transthyretin hereditary amyloid polyneuropathy: a global synthesis of 532 cases

Objective. To identify variables correlated with a diagnosis of diabetic peripheral neuropathy (DPN) using random forest modeling applied to electronic health records. Design. Retrospective analysis. Setting. Humedica de-identified electronic health records database. Subjects. Subjects ≥ 18 years old with type 2 diabetes from January 1, 2008–September 30, 2013 having continuous data for 1 year pre- and postindex with DPN (n = 35,050) and without DPN (n = 288,328) were identified. Methods. Demographic, clinical, and health care resource utilization variables (e.g., inpatient and outpatient encounters, medications, and procedures) were input into a random forest model to identify the most important correlates of a DPN diagnosis. Random forest modeling is a computationally extensive, robust data mining technique that accommodates large sets of variables to identify associated factors using an ensemble of classifications trees. Accuracy of the model was evaluated using receiver operating characteristic curves (ROC). Results. The final random forest model consisted of the following variables (importance) associated with a DPN diagnosis: Charlson Comorbidity Index score (100%), age (37.1%), number of pre-index procedures and services (29.7%), number of pre-index outpatient prescriptions (24.2%), number of pre-index outpatient visits (18.3%), number of pre-index laboratory visits (16.9%), number of pre-index outpatient office visits (12.1%), number of inpatient prescriptions (5.9%), and number of pain-related medication prescriptions (4.4%). ROC analysis confirmed model performance, with an area under the curve of 0.824 and accuracy of 89.6% (95% confidence interval 89.4%, 89.8%). Conclusions. Random forest modeling can determine likelihood of a DPN diagnosis. Further validation of the random forest model may help facilitate earlier diagnosis and enhance management strategies.

The burden of selected cancers in the US: health behaviors and health care resource utilization

Background Published findings on natural history of fibromyalgia (FM) are limited. Objectives The multisite US prospective observational cohort study followed FM subjects to assess disease burden and natural history. Methods At enrollment, consented subjects completed an online questionnaire to screen for chronic widespread pain (CWP, pain on both sides and above and below waist for ≥1 week); a physician site visit to determine FM diagnosis; and another online questionnaire to capture demographics, clinical characteristics, medications, healthcare resource use (HRU), pain (Brief Pain Inventory-Short Form [BPI-SF]), FM (modified [self-report] American College of Rheumatology [ACR] 2010 criteria, Revised Fibromyalgia Impact Questionnaire [FIQ-R]), sleep (Medical Outcomes Study-Sleep Scale [MOS-SS]), and health status (Short Form 12-item Health Survey [SF-12]). At follow-up, approximately 2 years later, subjects and physicians completed the same assessments. Statistical significance of changes was tested (p<0.05) using analysis of covariance and generalized McNemars test. Results A total of 76 FM subjects participated at both time points (at enrollment: 89.5% female, mean age 50.9 years, mean duration of FM 4.1 years, 86.8% white). Mean number of tender points at each physician visit was 14.1 and 13.5, respectively. Distribution of FM severity based on physician evaluation at enrollment was 19.7% mild/very mild, 48.7% moderate, 31.6% severe/very severe, and at follow-up was 15.6% mild/very mild, 43.8% moderate, 40.6% severe/very severe. At follow-up, 20.3% of subjects reported their overall health status had improved since enrollment, while 47.5% reported a decline. Comorbidities reported by ≥20% of subjects at follow-up: arthritis, lower back pain, depression, high cholesterol, hypertension, headache/migraine, anxiety, and sleep apnea. Medication use for pain was reported by 59.2% and 62.0% of subjects at each time point, respectively. Most common medication classes were opioids (32.4%), SSRIs (16.9%), and tramadol (14.1%) at follow-up. Mean number of healthcare provider visits for pain over the past 3 months (among those with ≥1) was 5.4 and 4.9 at each time point, respectively. There were no statistically significant changes in pain-related HRU. Significant mean changes (p-value <0.05) over time were observed for mean modified ACR 2010 criteria score (18.4 to 16.9, p=0.004), BPI-SF pain interference index (5.9 to 5.3, p=0.013), and MOS-SS overall sleep problems index (58.3 to 52.7, p=0.004). No statistically significant differences were observed for BPI-SF pain severity index (5.2 to 5.1), FIQ-R overall score (53.2 to 53.2), SF-12 physical (32.8 to 34.1) and mental (41.9 to 42.4) component summary scores. Conclusions FM patients continued to report high levels of disease burden at follow-up. There was variability among patients in outcomes, with few significant differences over time. Data suggest improvement in symptoms, sleep and pain interference with function due potentially to active management (pharmacologic, nonpharmacologic) of the condition. Disclosure of Interest C. Schaefer Consultant for: Pfizer Inc (paid consulting services provided by Covance Market Access Services), E. Adams Consultant for: Pfizer Inc (paid consulting services provided by Covance Market Access Services), M. Udall Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., E. Masters Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., R. Mann Consultant for: Pfizer Inc (paid consulting services provided by Covance Market Access Services), S. Daniel Consultant for: Pfizer Inc (paid consulting services provided by Covance Market Access Services), H. McElroy Consultant for: Pfizer Inc (paid consulting services provided by Covance Market Access Services), J. Cappelleri Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., A. Clair Shareholder of: Pfizer Inc., Employee of: Pfizer Inc., M. Hopps Employee of: Pfizer Inc., R. Staud Grant/research support from: Investigator initiated grant from Pfizer Inc., P. Mease Grant/research support from: Pfizer Inc., Consultant for: Pfizer Inc., Speakers bureau: Pfizer Inc., S. Silverman Grant/research support from: Pfizer Inc., Consultant for: Pfizer Inc. and Lilly, Speakers bureau: Pfizer Inc. and Lilly

Global epidemiology of transthyretin hereditary amyloid polyneuropathy: a systematic review

Background The prevalence of neuropathic pain (NeP) has been estimated within specific health conditions; however, there are no published data on its broad prevalence in the US. The current exploratory study addresses this gap using the validated PainDetect questionnaire as a screener for probable NeP in a general-population health survey conducted with a multimodal recruitment strategy to maximize demographic representativeness. Materials and methods Adult respondents were recruited from a combination of Internet panels, telephone lists, address lists, mall-based interviews, and store-receipt invitations using a random stratified-sampling framework, with strata defined by age, sex, and race/ethnicity. Older persons and minorities were oversampled to improve prevalence estimates. Results were weighted to match the total adult US population using US Census data. Demographic information was collected, and respondents who experienced physical pain in the past 12 months completed the PainDetect and provided additional pain history. A cutoff score of 19 or greater on the PainDetect was used to define probable NeP. Results A total of 24,925 respondents (average response rate 2.5%) provided demographic data (52.2% female, mean age 51.5 years); 15,751 respondents reported pain (63.7%), of which 2,548 (15.7%, 95% confidence interval 14.9%–16.5%) had probable NeP based on the PainDetect, which was 10% (95% confidence interval 9.5%–10.5%) of all respondents. Among those reporting pain, the prevalence of probable NeP among Blacks and Hispanics was consistently higher than Whites in each age- and sex group. The highest prevalence among those with pain was among male Hispanics 35–44 years (32.4%) and 45–54 years (24.2%) old. The most commonly used medications reported by those with probable NeP were nonsteroidal anti-inflammatory drugs (44.2%), followed by weak opioids (31.7%), antiepileptics (10.9%), and strong opioids (10.9%). Conclusion This is the first study to provide an estimate of the prevalence of probable NeP in the US, showing significant variation by age and ethnicity.

FRI0324 Does High Serum URIC Acid Increase the Risk of Renal Disease in Patients with Gout? Results from a Retrospective Analysis of Electronic Health Record Data

Introduction: This study sought to estimate the global prevalence of transthyretin familial amyloid polyneuropathy (ATTR‐FAP). Methods: Prevalence estimates and information supporting prevalence calculations was extracted from records yielded by reference‐database searches (2005–2016), conference proceedings, and nonpeer reviewed sources. Prevalence was calculated as prevalence rate multiplied by general population size, then extrapolated to countries without prevalence estimates but with reported cases. Results: Searches returned 3,006 records; 1,001 were fully assessed and 10 retained, yielding prevalence for 10 “core” countries, then extrapolated to 32 additional countries. ATTR‐FAP prevalence in core countries, extrapolated countries, and globally was 3,762 (range 3639–3884), 6424 (range, 1,887–34,584), and 10,186 (range, 5,526–38,468) persons, respectively. Discussion: The mid global prevalence estimate (10,186) approximates the maximum commonly accepted estimate (5,000–10,000). The upper limit (38,468) implies potentially higher prevalence. These estimates should be interpreted carefully because contributing evidence was heterogeneous and carried an overall moderate risk of bias. This highlights the requirement for increasing rare‐disease epidemiological assessment and clinician awareness. Muscle Nerve 57: 829–837, 2018

SAT0327 Relationship of Serum Uric Acid Levels with Cardiovascular Disease in Patients with Gout: A Retrospective Analysis of Electronic Health Record Data

Transthyretin hereditary (familial) amyloid polyneuropathy (TTR-FAP) was first identified in Portugal in 1952 [1]. In 1984, the first report of a causative mutation – substitution of methionine for...