S111and 67.0% in daily injectables. ConCluSionS: The results demonstrate how medication non-adherence rates and reasons vary across different conditions, modes, and frequencies. This underscores the potential importance and utility of using a self-reported scale to develop interventions.
S115Even in ideal cases for PBMs, the switch to a biosimilar may lead to 25% lower rebate dollars unless an increase in utilization can compensate for the lower rebate amount. ConCluSionS: In the US, biosimilars need to navigate a complex marketplace of payers including insurance companies, pharmacy benefit managers and government payers as well as providers, prescribers and patients. One key success driver will be to overcome the financial hurdles put up by well-established originator products. Given the revenue dollars at stake, an originator is unlikely to eliminate rebates, but rather to increase rebates to attempt to maintain market share vs. a biosimilar entrant.
Aims: To explore health technology assessment (HTA) outcomes of matched drug pairs by national agencies in Germany (Gemeinsamer Bundesausschuss, GBA), France (Haute Autorité de Santé, HAS) and England and Wales (NICE). Methods: We considered published GBA decisions, HAS reports and NICE guidance from January 2011 to June 2018. HTAs of matched pairs were compared overall, and for non-cancer and cancer drugs separately. We further analyzed the role of additional attributes related to cancer therapies. Results: Matched pairs show higher concordance for GBA/HAS than for GBA/NICE and HAS/NICE. Overall, NICE evaluated technologies more favorably than GBA and HAS. GBA appraisals of cancer drugs, however, tended to be more positive than cancer-related recommendations by NICE and HAS. Conclusion: The findings indicate substantial variations in HTAs, although cancer-related outcomes seem to diverge less than non-cancer results.
RATIONALE The National Early Warning Score (NEWS) is an early warning scoring that has been modified and scaled to detect early clinical deterioration in different clinical settings outside the intensive care unit (ICU). Previous epidemiological studies of NEWS were in non-Veterans Affairs (VA) populations. Little data exist on NEWS deployment in a VA-setting. Our study aims to evaluate how the NEWS performed in a VA 1b facility emergency department (ED). These results are important to evaluate if the NEWS scoring system is reliable in a VA population with shorter time frames inherent to ED settings. METHODS This was a quality improvement initiative to standardize recognition of clinically deteriorating patients in a VA 1b ED. The project team was multidisciplinary in nature: ED medical director, ED clinical nurse leader, pharmacists, informatics specialists, clinical nurse educators, and administrative leadership. A review of the literature was done, followed by weekly meetings in which the project design took place. The time frame for project development and deployment was September 2018 to March 2019. Informatics technology was built that incorporated the NEWS into electronic health record workflows. This was then integrated into nursing and physician workflows and tied to ED disposition decisions. Patient outcomes were then tracked via the construction of an analytics solution. RESULTS 5561 NEWS scores were obtained for 2399 patients from 2878 ED visits between December 2018 to October 2019. The median age of the patients 67 (60-74) years [male: 69 (61-74)]; [female: 60 (50-67)]. In each ED visit, patients had an average of 1.93 scores recorded. There was a total of 338 (6%) ICU admissions within 24hrs of score; of 141 patients with NEWS over 7, 52 (36.9%) were admitted to ICU within 24 hours. Only 286 (5.3%) of patients with NEWS <7 were admitted to the ICU within 24 hours (p < 0.001). A total of 4 deaths (0.07%) and 1 cardiac arrest within 24 hours of a NEWS were noted; no association with NEWS was noted. CONCLUSION In this quality improvement project at a VA 1b facility, NEWS was evaluated as a potential early warning system in the emergency department. NEWS is a promising early warning score that could have an application in VA ED settings, but more research is needed.
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