psoriasis were as follows: 13% were currently taking a biologic, 42% would consider taking a biologic, 17% had previously taken a biologic, and 24% would not consider taking a biologic. Hierarchical and non-hierarchical cluster analyses were applied to the moment-to-moment affect traces that identified four unique patient clusters (# 1-4). MDA was used to identify the five most impactful time periods within the focus group audio segments. Cluster composition profiles were identified based upon demographic information and patient responses to behavioral and attitudinal questions. CONCLUSIONS: Understanding complex patient perspectives on coping with disease is essential for delivering appropriate treatments over the lifelong course of psoriasis. This novel methodology begins to bridge this knowledge gap in understanding the patient-centered view of psoriasis. Furthermore, it improves the likelihood of recommending treatments in alignment with the patient's needs to improve health-related quality-of-life, productivity, and well-being. OBJECTIVES:Currently in Brazil's public healthcare, patients with psoriasis who fail the available treatment options (phototherapy, methotrexate, acitretin and cyclosporin) due to any cause, are experiencing a medical unmet need. This study is aimed to assess comorbidity, quality of life (QoL), work/productivity loss (WPL), and medical resource utilization in patients diagnosed with psoriasis (PdwP) in Brazil. METHODS: A total of 12,000 individuals' (age 18ϩ) self-reported data were collected from 2011 National Health and Wellness Survey (NHWS) in Brazil, a crosssectional representative sample of the adult population. QoL was measured by the physical component score (PCS) and mental component score (MCS) of the Short Form-12 (SF-12). WPL was measured by the validated Work Productivity and Activity Impairment instrument. Medical resource utilization was measured by health care provider utilization, emergency room visits and hospitalization in the past 6 months. RESULTS: Of the 12,000 respondents, 205 (1.3%) were patients diagnosed with psoriasis (PdwP) (53.0% women). Mean age was 40.2. Higher percentage of co-morbidities was found among PdwP compared to patients not diagnosed with psoriasis (PndP): headache (71% vs. 54%), sleep difficulties (50% vs.24%), anxiety (50% vs.33%), insomnia (46% vs.22%), pain (42% vs.23%), skin allergies (40% vs.17%), migraine (40%vs.20%), Heartburn (38% vs.23%) hay fever (37% vs.15%), nasal allergies (33% vs.21%), depression (33% vs.16%), rhinitis (32%vs.11%), high blood pressure (29% vs.16%), gingivitis (22%vs.6%), nail fungus (20%vs.7% ), dry eye (20% vs.5%), anemia (19% vs.6%), diabetes type 1 or 2 (19% vs.4%). PdwP had a lower mean PCS (45.8 vs. 49.7) and MCS (42.3 vs.47.0), more visiting health practitioners (87.0% vs.76.0%), emergency room visits (36.0%vs.22.0%), and hospitalizations for a medical condition (21.0% vs.10.0%) over the past 6 months compared to the PndP group. Furthermore, PdwP reported higher presenteeism (30.4% vs.14.8%), work producti...

diseases are a public health priority in Colombia. The aim of this study was to estimate the difference of cases and costs from serotype coverage of pneumococcal conjugated vaccines of 10 and 13 serotypes (PCV10 and PCV13, respectively) in population under 5 years old in Colombia. Methods: A deterministic model was built for a cohort of children born in 2011. The probabilities of incidence, mortality and sequelae of pneumonia, meningitis, sepsis, and acute otitis media and clinical effectiveness of PCV10 and PCV13 for this population, were determined through a systematic literature review. Vaccination scheme 2+1 was included, herd effect of 42% and population coverage of 84.09% was assumed for both vaccines. The differences between the evaluated vaccines were estimated in terms of opportunity costs and net profit. The study was conducted from the perspective of third-party payers and a time horizon of 5 years. Costs were expressed in 2012 USD (exchange rate US$1 = $1798.23 COP). Results: A cohort of 652,611 children was assumed. Model showed a higher protection with PCV13 in comparison to PCV10. With PCV13 a difference of 98 prevented deaths for meningitis, pneumonia and sepsis was observed.

tor, emergency department (ED), or "other," as well as the number of CD-related hospital admission days. Unit costs were assigned to each type of health care resource using national non-Medicare 2011 reimbursement rates. Hospitalization cost was estimated using the HCUP.net mean daily cost of inpatient stay (principal diagnosis 333.83). Cost of an ED visit was estimated by the mean paid amount for ED visit (principal diagnosis 333.83) using commercial claims data. RESULTS: Baseline data were available for 786 participants at time of analysis. The mean age was 57.7 years, and the majority (76%) were female. The mean (SD) number of visits to a primary care provider was 1.4 (2.1), 1.9 (1.9) for neurologist, 0.7 (1.8) for physiatrist, 1.8 (3.8) for physical/occupational therapy, 0.2 (0.9) for neurosurgeon, 1.3 (3.1) for alternative care provider, 1.1 (3) for chiropractor, and 3.2 (2.7) for "other." Participants reported a mean(SD) of 0.2(0.9) visits to the ED and 0.1(0.6) hospital admission days. The mean total cost of CD over 6 months was $1,255.80 (range $0-$63,320.20; median $639.80). The largest single cost driver was the number of hospital admission days. CONCLUSIONS: The economic impact of CD-related health care resource use should not be overlooked when assessing disease burden. OBJECTIVES:The economic burden of Multiple Sclerosis (MS) on society and the individuals concerned is not known. Documenting such costs is essential for several reasons: costs of illness is a key factor of optimal disease management policies, knowledge of cost is useful for allocating research and development. The aim of our study as the first pharmacoeconomic investigation in Iran was to estimate the costs of multiple sclerosis according to severity of disease. METHODS: Total, direct and indirect costs were compared in 160 patients divided into three groups categorized by disease severity: stage I Expanded Disability Status Scale (EDSS Ͻ2.5), stage II (EDSS 3-4.5) and stage III (EDSS Ͼ5).The majority of these patients (94%) developed relapsing-remitting MS.A minority of the patients (0.2-4 %) developed secondary progressive and primary progressive MS. Cost evaluation was performed from the societal perspective and covered the one-year period. The study was carried out at the Division of Neurology at Ghaem Hospital and MS association in Mashhad in northeast of Iran and was approved by the local ethics committee. RESULTS: The mean total cost/patient for one year was estimated at $27,095, $27,997and $31,662 for stage I, II and III, respectively. Both direct and indirect costs increased with MS progression. For indirect cost the main item was productivity loss. The mean extra medicine (treatments for MS symptoms and adverse effects of medications) cost/patient for one year was calculated at $19,036. CONCLUSIONS: This study confirms that MS represents a high economic burden to patients and society, with direct costs greatly exceeding indirect costs. As costs increase with disease progression, treatment efforts should focus on patients in t...

Aspergillus, Candida and Cryptococcus spp. infections who are refractory to or intolerant of conventional amphotericin B. The model was built from a hospital perspective, and included drug acquisition costs and costs for treating drugrelated adverse events (AEs) within a hospital stay. The treatment duration of L-AmB and ABLC and rates of AEs for these two treatments were mainly obtained from a retrospective study of these two drugs in the target population using Cerner's Health Facts data. Treatment costs of AEs were obtained from publicly available sources. The budget impact (2011USD) was evaluated by changing the market share of L-AmB and ABLC from 50/50% to 80/20%. One-way sensitivity analyses were conducted by varying drug cost, treatment duration, and rates and costs of AEs. RESULTS: The per-patient costs associated with L-AmB and ABLC during one hospital stay were $14,563 and $16,748, respectively. Cost of AEs attributed to 68.7% of the costs for L-AmB and 85.4% for ABLC. In a hypothetical hospital with 100 annual admissions of patients using one of these two drugs for fungal infections, changing the market shares from 50/50% for L-AmB and ABLC, respectively, to 80/20% yielded a cost saving of $65,561. Sensitivity analyses indicated that the results were robust to changes in input parameter values. CONCLUSIONS: This study suggests that hospitals can realize cost savings by substituting ABLC with L-AmB in the treatment of invasive fungal infections. The cost savings are driven by the lower rates of AEs associated with L-AmB compared to ABLC.

Aspergillus, Candida and Cryptococcus spp. infections who are refractory to or intolerant of conventional amphotericin B. The model was built from a hospital perspective, and included drug acquisition costs and costs for treating drugrelated adverse events (AEs) within a hospital stay. The treatment duration of L-AmB and ABLC and rates of AEs for these two treatments were mainly obtained from a retrospective study of these two drugs in the target population using Cerner's Health Facts data. Treatment costs of AEs were obtained from publicly available sources. The budget impact (2011USD) was evaluated by changing the market share of L-AmB and ABLC from 50/50% to 80/20%. One-way sensitivity analyses were conducted by varying drug cost, treatment duration, and rates and costs of AEs. RESULTS: The per-patient costs associated with L-AmB and ABLC during one hospital stay were $14,563 and $16,748, respectively. Cost of AEs attributed to 68.7% of the costs for L-AmB and 85.4% for ABLC. In a hypothetical hospital with 100 annual admissions of patients using one of these two drugs for fungal infections, changing the market shares from 50/50% for L-AmB and ABLC, respectively, to 80/20% yielded a cost saving of $65,561. Sensitivity analyses indicated that the results were robust to changes in input parameter values. CONCLUSIONS: This study suggests that hospitals can realize cost savings by substituting ABLC with L-AmB in the treatment of invasive fungal infections. The cost savings are driven by the lower rates of AEs associated with L-AmB compared to ABLC.

It is estimated that the prevalence of moderate-to-severe SA (apnoeahypopnoea index > 15/h) is 10%. Approximately 11% of SA patients have comorbid COPD, which worsens sleep quality and desaturations. This study investigated the effects of PAP therapy on all-cause mortality and cost of illness (COI) in patients with SA and COPD in Germany. A statutory health insurance (SHI) perspective was taken. Methods: A total of > 4 million individuals covered by the SHI database were analysed (≈5% of the German SHI population). PAP therapy was initiated in 4,068 patients with SA (PAP group). Propensity score matching was used to define a control group (CG) of 4,068 SA patients matched for age, sex, risk factors/aetiology, region and medication who received usual care (no PAP). Of these, 1,300 patients in the PAP group and 1,192 patients in the CG had comorbid COPD. This subgroup of patients was followed for 3 years after initiation of PAP therapy. Results: Total COI was higher in the PAP group versus CG in the first year of follow-up (€ 8,697 vs € 6,999, p< 0.0001). However, during the second and third year the difference in COI between the PAP and CG was smaller (year 2: € 7,340 vs € 7,316, p< 0.0048; year 3: € 6,847 vs € 6,714, p< 0.001). PAP recipients had a significantly lower 3-year mortality rate compared with CG (8.2% vs 11.7%, p< 0.001; relative risk reduction 30.1%). ConClusions: SA patients with COPD treated with PAP showed significantly reduced mortality and morbidity. Total COI was higher in PAP recipients versus CG over the first 3 years of follow-up, but the difference between groups decreased over time. A follow-up period of ≥ 5 years may be required to show beneficial economic outcomes in SA patients receiving PAP therapy.

istration of patients, the management of adverse events and the cost of medication. A 3.5% discount rate was used for the case of all outcomes. Monte Carlo simulation was employed to construct the 95% uncertainty intervals (UI) and to compute cost-effectiveness acceptability curve. RESULTS: The mean total QALYs estimate in the Len/Dex arm was 2.95 (95%UI: 2.75-3.14) and 2.20 (95%UI: 1.99-2.40) in the case of bortezomib, an incremental gain of 0.75 (95%UI: 0.47-1.02) QALYs. The mean total therapy cost was estimated at €76,782 (95%UI: 75,689-€77,927) and 46.380€ (95%UI: 45,719€-47,000€) for Len/Dex and Bortezomib, respectively. For both comparators, total therapy cost is mainly attributed to medication. The cost per life year gained was estimated at €35,081 (95%UI: €19,357-€73,180) and the cost per QALY gained at €42,012 (95%UI: 29,445-64,217). The probability for Len/Dex to be a cost-effective therapy option at a threshold three times the per capital income (€60,000 per QALY), was higher than 95%. Results remained constant under several one-way sensitivity analyses. CONCLUSIONS: Therefore therapy with combination of Len/Dex appears to be a cost-effective choice compared with Bortezomib alone for multiple myeloma patients in Greece.

MCO) due to the severity of the conditions and their minimal budet impact. However, as interest by pharmaceutical companies, competition, and spend in the orphan drug category grows, payers are likely to look for ways to reduce or contain the cost. This is particularly true among pharmacy benefit products where payers have more effective utilization management tools at their disposal when compared to medical benefit products. Methods: This research assessed the Wholesale Acquisition Cost (WAC) of all non-oncology FDA designated pharmacy benefit orphan drugs that were launched 2004-2014 and plotted these against disease prevalence. The extent of payer management for these products was determined for the most common formulary design of 6 MCOs (2 national, 2 regional, and 2 integrated). Results: Stronger payer management of pharmacy benefit orphan drugs has emerged in select conditions where multiple labeled competitors with comparable levels of efficacy and material price differences exist, regardless of disease prevalence. The most common type of management introduced was either a 'preferred product' or 'step edit'. Integrated plans introduced stronger management more frequently when compared to national and regional plans. ConClusions: Given the increased payer spend in the orphan drug category, payers have begun to manage products in areas where cost savings can be achieved without sacrificing outcomes, irrespective of rare disease prevalence. In disease areas where multiple product options do not exist, payer management tended to be minimal, and typically only required a confirmation of a disease diagnosis through a Prior Authorization. While integrated health systems tend to have the tightest control on orphan products given their close physician relationships, national and regional plans have also begun to implement a similar level of control for select products.