Richard Perry

Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England.

BackgroundDupuytrens disease is a fibro-proliferative disorder affecting ~3-5% of the UK population. Current surgical treatments for Dupuytrens contracture (DC) include fasciectomy and fasciotomy. We assessed the clinical management of DC in England over a 5-year period; associated NHS costs were assessed for a 1-year period.MethodsHospital Episode Statistics were extracted from April 2003 to March 2008 for patients with Palmar Fascial Fibromatosis (ICD10 = M720) and DC-related procedures. Variables included demographics, OPCS, patient status and physician specialty. To estimate 2010-2011 costs, HRG4 codes and the National Schedule of Tariff 2010-11-NHS Trusts were applied to the 2007-2008 period.ResultsOver 5 years, 75,157 DC admissions were recorded; 64,506 were analyzed. Mean admissions per year were 12,901 and stable. Day cases increased from 42% (2003-2004) to 62% (2007-2008). The percent of patients having two or more admissions per year increased from 5.5% in 2003-2004 to 26.1% in 2007-2008. Between 2003 and 2007, 91% of procedures were Fasciectomy. Revision of Fasciectomy and Fasciotomy each accounted for ~4%; Amputation for 1%. In 2007, classification was extended to identify Digital Fasciectomy, its Revision and Dermofasciectomy. In 2007-2008, admissions were: 70% Palmar Fasciectomy, 16% Digital Fasciectomy, 1.3% Other Fasciectomy, 4.4% Revision of Palmar Fasciectomy, 1.3% Revision of Digital Fasciectomy, 3.8% Division of Palmar Fascia, 2.6% Dermofasciectomy and 1.1% Amputation. 79% of cases were overseen by trauma and orthopaedic surgeons, 19% by plastic surgeons. Mean (±SD) inpatient hospital length of stay was 1.5 (±1.4) days in 2003-2004 and 1.0 (±1.3) days in 2007-2008. Total estimated costs for 1 year (2010-2011) were £41,576,141. Per-patient costs were £2,885 (day case) and £3,534 (inpatient). Costs ranged from £2,736 (day-case Fasciectomy) to £9,210 (day-case Revision Digital).ConclusionsBetween 2003 and 2008, fasciectomy was the most common surgical procedure for DC in England. While procedure rates and physician specialties varied little, there was a reversal in surgical venue: inpatient operations decreased as day-case procedures increased. The change is likely due to economic trends and changes to the healthcare system. Estimated costs for 2010-2011 varied by procedure type and patient status. These findings can be used to understand clinical management of DC and guide healthcare policy.

Real-World Use of Permixon® in Benign Prostatic Hyperplasia — Determining Appropriate Monotherapy and Combination Treatment

IntroductionBenign prostatic hyperplasia (BPH) is a major health concern for aging men. The resulting lower urinary tract symptoms may have a profound effect on a patient’s quality of life and it is recognized that patient acceptability of treatment is key to decreasing the human and economic burden of the condition. Alphaadrenergic antagonists (alpha-blockers), 5-alphareductase inhibitors (5-ARIs), and phytotherapy as monotherapy or in combination, form the mainstay of medical treatment.MethodsThe Adelphi Permixon Study, a cross-sectional study of representative consulting patients with BPH in two European countries, was undertaken to examine the reasons for choice of medication. Physicians completed patient record forms, and data were analyzed for clinical outcomes and their relationship with the choice of appropriate therapy.ResultsPatients receiving combination therapies for BPH are likely to be older and are more likely to be retired than those on monotherapy. Combination therapy is adopted in the real-world setting as first-line therapy on a not-infrequent basis. The analyses demonstrated an association between choice of Permixon® (Pierre Fabre Medicament, Castres, France) as appropriate monotherapy or in combination with alpha-blockers, and the following: BPH severity; treatment of general urinary symptoms, including storage and voiding symptoms; improvement of urinary flow rate; lack of a risk of sexual problems; and reduction of inflammation. Permixon combination with an alpha-blocker is associated with benefits in terms of speed of onset of action, reduction of inflammation, and a positive benefit regarding sexual problems when compared with use of alpha-blocker monotherapy.ConclusionIn the real clinical world, Permixon is considered an appropriate treatment for BPH as both monotherapy and in combination with alpha-blockers. Prescribing Permixon in combination with alpha-blockers can be demonstrated to provide benefits beyond use of either therapy alone.

Physician-prescribed Asthma Treatment Regimen does not differ Between Smoking and Non-smoking Patients With Asthma in Seoul and Gyunggi province of Korea

Purpose Smoking has detrimental effects on asthma symptom control and response to treatment and is prevalent among asthma patients in South Korea. The aim of this study is to determine the prevalence of smoking among asthma patients in South Korea and to compare the medication regimens of asthma patients who do and do not smoke. Methods A cross-sectional survey was conducted from August 2010 to January 2011. Participating physicians (N=25) recorded demographic and clinical data on all asthma patients presenting during the study period (N=2,032), and then recruited a subset of patients (N=500) for the survey such that half were self-reported current smokers. Recruited patients were between the ages of 18 and 60. Results Among presenting asthma patients, 17.3% were current smokers, 19.2% were former smokers, and 63.5% had never smoked. Within the analyzable study population (N=471), 212 patients reported smoking currently, 79 smoking formerly, and 180 never smoking. Among current and former smokers, 79.7% and 81.0%, respectively, were men, while women represented 80.5% of patients who had never smoked. Agreement was strong between physician-determined smoking status and patient-reported smoking status (κ=0.82; P<0.001). However, asthma medication regimens examined according to GINA treatment steps did not differ by smoking status. In addition, mean quality of life scores and level of asthma control did not differ by smoking status. Conclusions In South Korea, physicians are well aware of the smoking status of their patients. However, smoking status did not affect the prescribed medication regimens of this population of asthma patients.

PMH42 QUALITY OF LIFE IN PATIENTS WITH BIPOLAR DISORDER IN 5 EUROPEAN COUNTRIES

ment by day one in shoulder and back pain when compared to a lower dose of the same drug. Patients also reported statistically significant (p < 0.05) reduced pain while awake by day three, improved overall pain by day two, global emotional improvement by day three, and global physical improvement by day seven. This improvement data was collected electronically using a verbally administered numeric scale. RESULTS: In both cases, these data would have been difficult, if not impossible, to collect reliably at the study site or via paper. Sponsor acceptance of ePRO data is shown by a recent survey of 156 webinar registrants that found that 36% indicated that they have included, or intend to include, ePRO data in a regulatory submission as a primary (22%) or secondary (14%) endpoint. CONCLUSIONS: This session reviews the methods and associated research for verbally orienting a study subject and verbally administering analog scales in clinical trials. Additionially, regulatory acceptance of electronic patient reported outcomes in clinical trials is explored through real world case studies.

PMH32 ANALYSIS OF A MULTINATIONAL, CROSS-SECTIONAL SURVEY OF PHYSICIAN DESCRIPTIONS AND PERCEPTIONS OF PATIENTS WITH NEGATIVE SYMPTOMS OF SCHIZOPHRENIA

PMH30 DIFFUSION OF NEWLY-APPROVED GENERIC DRUG PRODUCT USE WITHIN A STATE EMPLOYEE PRESCRIPTION DRUG PROGRAM: A COMPARISON OF MAIL ORDER VERSUS RETAIL PHARMACY CLAIMS Johnsrud M The University of Texas at Austin, Austin,TX, USA OBJECTIVES: Pharmacy benefit managers (PBMs) market their ability to accelerate use of newly-approved generic drugs among enrollees based upon the use of the PBMs’ wholly-owned mail order drug facilities. Higher utilization rates of newly-approved generic drugs result in an economic benefit to enrollees and plans. This study examines the differences in the diffusion of a newly-approved generic drug product between mail order and retail pharmacy channels. METHODS: Pharmacy claims data for branded and generic versions of citalopram were collected from a large state employee prescription drug program in Texas consisting of over 400,000 enrollees beginning in November 2004 (representing the launch date of the newly-approved generic). In addition, claims data were collected from the Texas Medicaid Prescription Program during the same time period, for comparison. Claims were collected for the first six months postgeneric launch. Total outstanding “drug product in possession” was calculated for each day post-generic launch based upon a sum of the days supply for the branded and generic drug for claims dispensed previous to, and during, the post-launch period. Trends were examined in the percent of total outstanding days supply represented by the branded or generic citalopram. RESULTS: At days 30, 60, 90, and 120 post-generic drug launch, percentage of generic drug product utilization (based upon outstanding days supply) for mail order claims was 22%, 53%, 91%, and 96%. Retail claims showed generic utilization of 52%, 70%, 74%, and 78%. Medicaid program rates were 9%, 37%, 56% and 72%, respectively. Mail order generic utilization rates of citalopram were lower than retail pharmacy utilization rates until day 77 post-generic drug launch. CONCLUSIONS: While the mail order pharmacy channel realized higher utilization rates over the retail pharmacy channel of a newly-approved generic drug product at four months post-launch, rates were higher in retail setting during the first 11 weeks.