Caregiver Burden In The United States Workforce: Health Care Resource Utilization And Quality of Life

Caregiver Burden In The United States Workforce: Health Care Resource Utilization And Quality of Life

A288 VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8 Objectives: Multiple-criteria decision analysis (MCDA), which explicitly considers a ra...

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A288

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8

Objectives: Multiple-criteria decision analysis (MCDA), which explicitly considers a range of criteria in outcomes analyses, remains relatively novel in health technology assessments (HTA). This study sought to review the use of MCDA in real world health policy decision making.  Methods: We searched the literature which reported use of MCDA in HTA within hospital or payer settings.  Results: A total of 55 citations published from 2005 to 2015 were found. The most widely used MCDA model was analytical hierarchy process (AHP), using pair-wise comparison method for weighting. The criterion that was most often included in the weighting was the intervention outcome, which includes efficacy/effectiveness, and safety. Studies that actually included patients in the final weighting (or ranking) process were 13 out of a total 55 studies. Out of 40 studies which provided specific evaluation of using MCDA, 33 (80%) were optimistic about MCDA application in their decision-making process and stated it was useful.  Conclusions: MCDA has been used for practical reasons in different countries for diverse reasons, but it has not been fully developed as a unanimous tool to make decisions for some reasons. Via extensive literature review, not only did we observe current trends in MCDA appliations in HTA, but also analyzed current unmet needs in applying the MCDA in the real-world healthcare decision-making process. However, with the need for an explicit, transparent methodology in HTA process, we consider there is still full good potential to try MCDA in Korea for the future as a decision tool. PHP176 European HTA, Pricing And Reimbursement Roadmaps: Revisited 2016 Mason N 1, Schurer M 2 1BresMed, United Kingdom, UK, 2BresMed, Utrecht, TheNetherlands .

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Objectives: ISPOR Global Health Care Systems Road Maps (ISPOR roadmaps) provide useful information on country-specific decision-making processes for regulatory approval, pricing and reimbursement for pharmaceuticals, medical devices and diagnostics. Some have not been updated since 2008. Our objective is to provide material to update the roadmaps for specific countries’ processes for pharmaceutical products to reflect recent literature.  Methods: Belgium, England, France, Germany, Italy, Poland, Sweden and the Netherlands were selected based on countries with the fewest contributors to the ISPOR roadmaps and that not have updated their roadmaps since 2010. Targeted literature reviews of published and grey literature, including country-specific HTA websites, were conducted.  Results: Detailed flow diagrams were developed for all studied countries. Significant changes were observed for the most countries, of which changes in HTA processes were most common. For example, Belgium has a HTA process. England has modified their HTA processes. France introduced a new agency (CEESP) while Germany introduced new legislation (AMNOG law) to conduct HTA assessments. In the Netherlands, the HTA agency has been renamed and Poland’s HTA became a legal entity in its own right. Sweden and Italy’s HTA agencies appear to have implemented no new changes in this study period.  Conclusions: ISPOR HTA roadmaps are a valuable source of information for researchers and manufacturers. Considering the rapidly evolving pathways, we recommend ISPOR publish annual updates via Value in Health. This study could be one of the first to help update the roadmaps.

HEALTH CARE USE & POLICY STUDIES – Population Health PHP177 Caregiver Burden In The United States Workforce: Health Care Resource Utilization And Quality of Life Reimers Iadeluca L 1, Hopps M 1, Raghunath R 2, McDonald M 1, Makinson G 1 1Pfizer Inc, New York, NY, USA, 2Atrium Staffing, New York, NY, USA .

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Objectives: To understand caregiver burden in the workplace as well as caregiver healthcare resource utilization and quality of life.  Methods: We included employed adults aged 18 years or older from the 2013 US National Health and Wellness Survey (NHWS) in this study. Employed adults were classified as a caregiver if they reported currently caring for at least one adult relative. We used chi-square tests and one-way analyses of variance to assess whether employed caregivers differed from employed non-caregivers on behavioral characteristics, workplace productivity, and healthcare resource utilization.  Results: Eight million workers (7%) are caregivers for one or more adults in the US. Nearly 18% of these caregivers are caring for two or more adults. Caregivers are more often female than male (51% vs. 49%, p< 0.05) and 53% are between 40 and 64 years of age. Eighteen percent of caregivers are Hispanic compared with 15% of non-caregivers (p< 0.05). Behavioral characteristics, specifically daily alcohol consumption (6% vs. 5%) and lack of vigorous exercise, (25% vs. 29%) were similar in caregivers as compared to non-caregivers. Whereas compared with non-caregivers, caregivers have a higher prevalence of smoking (26% vs. 19%, p< 0.05). Caregivers report a higher mean percentage of work time missed (8% vs. 4%, p< 0.05) as well as greater productivity impairment (24% vs. 14%, p< 0.05). 53% of caregivers report some form of depression compared to 32% of non-caregivers that report some form of depression (p< 0.05). Caregivers have higher self-reported insomnia as compared to non-caregivers (46% vs. 37%, p< 0.05). Caregivers report more diagnosed co-morbidities compared with non-caregivers (5 vs. 3, p< 0.05). In the previous 6 months, caregivers have a greater mean number of outpatient visits compared with non-caregivers (4 vs. 3, p< 0.05).  Conclusions: Caregivers are an important component of patient care that clinicians and employers should be cognizant of and help to mitigate caregiver burden. PHP178 Understanding Gender Disparities In Disability Prevalence: A NonLinear Decomposition Approach Goyat R , Sambamoorthi U West Virginia University, School of Pharmacy, Morgantown, WV, USA .

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Objectives: Women are more likely to have disability than men because of many factors. To eliminate gender disparities in disability, a thorough understanding of these factors is critical. Therefore, purpose of this study was to explain factors

that contribute to gender differences in disability prevalence by adopting a postregression decomposition approach.  Methods: We used a retrospective crosssectional study design with data on 8,379 individuals aged above 21 years from 2014 National Health Interview Survey (NHIS). We defined disability with a standard set of questions related to mobility, self-care, and cognition from the “Functioning and Disability” supplement of 2014 NHIS. Chi-square tests and logistic regressions were conducted to examine the association between gender and disability. To examine the individual characteristics that explained the gender disparity in disability a post-regression non-linear multivariate decomposition technique was performed.  Results: A higher percentage of women than men (15.4% vs 9%) reported severe disability. Women were more likely to have severe disability than men (AOR= 1.65, 95% CI= 1.34, 2.04) after controlling for age, race, marital status, region, body mass index, alcohol use, smoking status, poverty status, education, chronic condition status and employment status. Of the 6.5 percentage point difference in severe disability, 2.6 percentage points (40% of the difference in disability prevalence) were due to differences in characteristics between men and women. The characteristics, which accounted for most of the differences, were poverty, presence of chronic conditions and old age. In this study, men were more likely to have higher income and lower prevalence of chronic conditions as compared to women. The findings from the decomposition approach suggested that if women were to have similar income and chronic disease distributions as men, the difference in severe disability can be reduced.  Conclusions: To eliminate gender disparities in severe disability, poverty reduction programs and preventive healthcare programs need to be promoted.

HEALTH CARE USE & POLICY STUDIES – Prescribing Behavior & Treatment Guidelines PHP179 Predictors of Publication For Biomedical Research Canestaro W , Bansal A , Devine B , Sullivan S D , Carlson J J University of Washington, Seattle, WA, USA .

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Objectives: Publication bias represents a threat to the central tenet of evidencebased medicine: that systematic review of published evidence can create an accurate estimate of the known safety and efficacy for an intervention. The aim of this study was to identify and quantify the characteristics of studies associated with the likelihood of publication.  Methods: Medline, EMBASE, CENTRAL, and PROSPERO were searched for studies that tracked cohorts of clinical studies from launch to publication. We included studies that reported the following study covariates: number of patients enrolled, result favorability, result significance, funding source, design and geography. We hypothesized that result favorability, result significance, and randomized design would be positively associated with publication. We used univariate meta-analyses as well meta-regression of the studies. Univariate analysis was performed using both fixed and random effects models to account for heterogeneity across the sampled study cohorts.  Results: Literature review identified 30,753 unique records of which 84 met our inclusion criteria. The probability of publication was significantly higher for studies whose results were favorable (30% higher, 95%CI: 1.20, 1.41) or statistically significant (28% higher, 95%CI: 1.15, 1.43), had a multicenter design (13% higher, 95%CI: 1.06, 1.20), and were of later regulatory phase (3/4 vs 1/2, 36% higher, 95%CI: 1.10, 1.48). Industry funding was modestly associated with a 10% lower (95%CI: 0.82-0.99) probability of publication. Study design and geography were not associated with probability of publication.  Conclusions: As hypothesized, favorable and significant results were associated with greater probability of publication. The negative association of publication with single center, early phase and industry-funded trials suggests that these lower profile studies may not face the same pressure to publish. As these early phase industry funded trials may be especially valuable in advancing the scientific progress of earlier stage technologies, efforts should be made to encourage publication and transparency. PHP180 Prescription Factors Associated With A Do Not Substitute Prescription In Canada Fischer A A 1, Duclos M 2, Borrelli R 1 1IMS Health Brogan, Mississauga, ON, Canada, 2IMS health Brogan, Kirkland, QC, Canada .

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Objectives: In Canada, when both a branded and generic version of a molecule exists, pharmacists may dispense generic versions of a prescribed branded molecule. This is often translates to cost savings to patients and payers as generic versions tend to have lower list prices. However, prescribers can indicate ‘do not substitute’ (DNS) on a prescription requiring the pharmacist to dispense the branded form of a molecule. We investigated factors associated with a DNS prescription to help payers and pharmaceutical companies better understand when a DNS is indicated.  Methods: The IMS Health Brogan (IMS) E360 Canadian electronic medical record database was queried for all adult prescriptions for molecules with an approved generic recorded between October 2009 and September 2010. Variables including physician specialty, patient characteristics, prescription ATC3, longterm use, and number of refills were assessed from a SMOTE balanced 160 DNS and 138,383 non-DNS prescription dataset. Mean decrease in gini index calculated from a 10,000 tree random forest model was used to indicate the importance of each factor associated with a DNS prescription.  Results: The model performed with 85.2% accuracy, 82.0% PPV, and 87.6% NPV. The five ATC3 drug classes that were most highly associated with a DNS were systemic hormonal contraceptives (G03A), antiepileptics (N03A), antipsychotics (N05A), thyroid hormones (H03A), and antidepressants (N06A). Physician recorded long-term use, patient age, number of prescription refills, and physician specialty were highly associated non-ATC3 factors.  Conclusions: Patient demographics, long-term use, and some ATC3 classes are associated with DNS prescriptions. Payers may consider these relationships to better understand their exposure when generic options become available, while pharmaceutical manufacturers can better estimate the demand for their products