Deshaires, L.

Durupty, D.

Lafuma, A.

Mammar, N.

Zakin, L.

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Pso diagnoses (ICD-9 codes: 696.1). One Pso-free patient (i.e., without Pso or psori-
atic arthritis diagnosis) was randomly selected to match each Pso patient by age
and gender. Patient demographic characteristics and comorbidity profile informa-
tion, including the Charlson comorbidity index (CCI) score, the prevalence of auto-
immune diseases, and an exhaustive list of other comorbidities were compared
between Pso and Pso-free patients using Wilcoxon signed rank tests or McNemar
tests. RESULTS: Among the 106,128 selected matched pairs, 52% were female and
the mean age was 52 years (SD15 years). In the Pso population, 77% had mild Pso
(i.e., patients who did not use any systemic therapies) and 23% had moderate-to-
severe Pso (i.e., patients receiving phototherapy, conventional systemic therapies,
or biologics). Pso patients had a higher mean CCI score compared to Pso-free pa-
tients (1.06 vs. 0.74; p.01). Compared to Pso-free patients, Pso patients had a
significantly higher prevalence of autoimmune diseases, including psoriatic arthri-
tis (10.2% vs. 0.0%), rheumatoid arthritis (5.4% vs.1.4%), ankylosing spondylitis
(1.5% vs. 0.8%), ulcerative colitis (1.0 vs. 0.5%), and Crohn’s disease (0.8% vs. 0.4%)
(all p.01). As shown in other studies, Pso patients also had higher prevalence of
other comorbidities, including hypertension (41.8% vs. 34.5%), chronic pulmonary
diseases (17.7% vs. 12.6%), diabetes (16.4% vs. 12.6%), hypothyroidism (12.0% vs.
9.0%), deficiency anemias (9.3% vs. 6.7%), valvular diseases (7.8% vs. 5.6%), solid
tumorwithoutmetastases (7.2% vs. 5.8%), psychoses (6.5% vs. 4.2%), and peripheral
vascular disease (6.4% vs. 4.3%) when compared to Pso-free patients (all p.01).
CONCLUSIONS: Psoriasis was associated with a substantial comorbidity burden,
including a significantly higher prevalence of autoimmune diseases and other
physical and mental comorbidities.
PSY5
COMPARISON OF USTEKINUMAB WITH OTHER BIOLOGIC AGENTS FOR
TREATMENT OF MODERATE-TO-SEVERE PSORIASIS: A BAYESIAN MIXED
TREATMENT COMPARISON APPROACH
Lin V1, Ringold S2, Devine B1
1University of Washington, Seattle, WA, USA, 2Seattle Children’s Hospital, Seattle, WA, USA
OBJECTIVES: To compare efficacy of ustekinumab with other biologics using the
Psoriasis Area and Severity Index (PASI) in adult patients with moderate-to-severe
psoriasis in the induction phase. METHODS: A systematic literature review was
conducted for randomized controlled trials (RCTs) of biologics for moderate-to-
severe psoriasis. PASI 75 was used as the primary outcome. Bayesian mixed treat-
ment comparison (MTC) was employed by fitting three models-a fixed effect, a
random-effects, and a random-effects with meta-regression model. Sensitivity
analyses were conducted by including supra- and sub-therapeutic doses, by ex-
cluding studies with only biologic naïve patients, and by changing initial values for
Markov Chain Monte Carlo (MCMC) simulation. RESULTS: Seventeen studies were
selected. The random-effects model was the best fit for the data. For PASI 75, all
biologics were significantly more efficacious than placebo, with rank order: inflix-
imab (odds ratio (OR)155.70), ustekinumab (OR56.53), adalimumab (OR30.85),
etanercept (OR27.11), and alefacept (OR5.48). In the therapeutic class compari-
son, the IL-12/23 inhibitor (ustekinumab) had the highest odds of PASI 75 compared
to placebo (OR69.48), followed by TNF-Is (adalimumab, etanercept, and inflix-
imab) (OR42.22), and the T- cell inhibitor (alefacept) (OR5.63). In the pair-wise
comparison, ustekinumab appeared to have statistically significantly higher odds
of achieving the PASI 75 than adalimumab (OR1.84), alefacept (OR10.38), and
etanercept (OR 2.07), but a lower odds compared to infliximab (OR0.36).
CONCLUSIONS: Ustekinumab appeared to be more efficacious than adalimumab,
etanercept, and alefacept, but not infliximab. In the therapeutic class comparison,
the decreasing rank orders were anti-IL 12/23 agents, anti-TNF- agents and T-cell
targeted agents.
PSY6
THE IMPACT ON SLEEP QUALITY OF BUTRANS® (BUPRENORPHINE)
TRANSDERMAL SYSTEM 5 MCG/HOUR (BTDS 5) AND 20 MCG/HOUR (BTDS 20)
DOSAGES IN PATIENTS WITH MODERATE-TO-SEVERE CHRONIC LOW BACK
PAIN
Yarlas AS1, Miller K1, Wen W2, Shah R2, Lynch SY2, Dain B2, Ripa SR2
1QualityMetric Incorporated, Lincoln, RI, USA, 2Purdue Pharma L.P., Stamford, CT, USA
OBJECTIVES:To compare the impact of 12weeks’ BTDS 20 andBTDS 5 treatment on
sleep among patients with moderate-to-severe chronic low back pain (CLBP), to
examine changes in the burden of CLBP on sleep with 12 weeks of BTDS use, and to
describe sleep outcomes over 12months of continued BTDS treatment.METHODS:
This post-hoc analysis used data from a double-blind (DB) randomized trial evalu-
ating BTDS 20 against BTDS 5 for treatment of opioid-experienced patients with
moderate-to-severe CLBP and its 12month open-label treatment extension. During
the course of BTDS treatment, patients completed the 12-item Medical Outcomes
Study Sleep Scale, which measures several sleep domains, including Disturbance
and overall Quality. ANCOVA models compared scores between treatment arms
during the 12-weekDBphase, and repeatedmeasuresmixed-models analysis com-
pared scores across visits during the 12-month treatment. Burden was examined
by comparing trial patients with an age- and gender-matched U.S. general popu-
lation sample (GPS) at trial baseline and DB endpoint. RESULTS: BTDS 20 patients
showed significantly less Disturbance and better overall Quality than BTDS 5 pa-
tients at week 12 DB (P0.05), an advantage that emerged by week 4. Analyses of
Disturbance and Quality scores across DB indicated statistically significant effects
for treatment (P 0.05), but not for visit or their interaction (P0.05). No reduction
from the end of DB Disturbance and Quality scores were observed following 12
months of BTDS 20 treatment. At baseline, patients’ Disturbance and Quality
scores were significantly worse than those of the GPS; by week 12 of the DB phase,
BTDS 20 patients’ average scores improved over the GPS, while BTDS 5 patients’ did
not. CONCLUSIONS: Moderate-to-severe CLBP patients receiving BTDS 20 exhib-
ited larger improvements in sleep Disturbance and Quality than those receiving
BTDS 5. Improvements in sleep were sustained during 12 months of continued
BTDS treatment.
PSY7
BLOOD TRANSFUSION MANAGEMENT IN ELECTIVE MAJOR ORTHOPAEDIC
SURGERY (MOS) IN FRANCE
Durupty D1, Deshaires L1, Mammar N2, Zakin L2, Lafuma A3
1clinique Arago, paris, paris, France, 2Vifor Pharma International, Neuilly-sur-Seine Cedex, Ile de
France, France, 3Cemka Eval, bourg la reine, hauts de seine, France
OBJECTIVES: To assess appropriateness of anemia management in order to opti-
mize BT during MO.METHODS:Hip (HA) and knee arthroplasty (KA) are frequently
associated with high volumes of blood loss. When those surgeries are elective, it is
possible, with adequate pre-operativemanagement, to decrease blood transfusion
(BT). A retrospective study was conducted in a single French centre on consecutive
cases of patients undergoing electiveMOS in 2009. Criteria to evaluate optimization
of BT were: transfusion rate, BT or no BT, according to international guidelines,
optimal BT rate according to potential adequate anemia treatment (ESA, oral or IV
iron) and administration of tranexanic acid. RESULTS: Sixty cases of MOS patients
were included with 38 females and 22males. 40 and 19 patients had undergone HA
and KA, respectively. 55 patient charts were sufficiently documented to be evalu-
able. The mean delay for pre-operative consult was 32 days with a minimum of 5
days. According to hemoglobin value recorded and potential blood loss estimated
during this visit, it was possible to predict that (in the absence of pharmacological
treatment) 18 patients over 55 would be transfused during surgery. Among the 37
patients with no predictable BT, 3 were nevertheless transfused. Among the 18
patients with predictable BT, 14 were not transfused (10 were treated with ESA and
14 with IV iron) and 4 patients (not treated with ESA or iron) transfused.
CONCLUSIONS: Anemia management before MOS could decrease BT during hos-
pitalisation. Currentmedical practice assessment in a single French centre showed
that in 32% of the patients anemia should be treated prior to hospitalisation.
Among these patients, one out of 5 was not adequately treated with ESA and/or
iron and was finally transfused. Approximately half of the BT could be avoided in
this centre, which has already a low blood transfusion rate (13%).
PSY8
APPLICATION OF DATA VISUALIZATION TOOL: TREATMENT PATTERNS OF
MEDICARE PATIENTS WITH ANKYLOSING SPONDYLITIS WHO INITIATED
TUMOR NECROSIS FACTOR THERAPY
Baser O1, Wang L2, Xie L1, Yuce H3
1STATinMED Research/The University of Michigan, Ann Arbor, MI, USA, 2STATinMED Research,
Dallas, TX, USA, 3New York City College of Technology-CUNY/STATinMED Research, New York,
NY, USA
OBJECTIVES: In recent years, methodologies used in outcomes research have ad-
vanced. In a field where many disciplines, such as clinicians, epidemiologists,
economists and statisticians interact frequently, a tool to communicate informa-
tion clearly and effectively through graphical means has become a necessity.To
present treatment patterns among patients diagnosed with ankylosing spondylitis
(AS) using data visualization techniques.METHODS:Using 100%nationalMedicare
data with Part D information, we selected patients over the age of 65 with at least
oneAS diagnosis.We identified patientswho initiated therapywith tumor necrosis
factor (TNF) and non-TNF agents. For 2 years after the initiation, we examined
switching to another TNF, a non-TNF, and discontinuation treatment patterns.
Using a processing language, we created a data visualization tool to demonstrate
changes in treatment patterns after the first and second switches. RESULTS:A total
of 1,159 AS patients (1,159) initiated therapy with TNF. 5.69% of these patients
switched to another TNF, 2.67% switched to a non-TNF, 55.91% discontinued ther-
apy and 35.72% continued their initial therapy. Among patients who switched to
another TNF, 53.03% remained on the switched therapy, 28.79% discontinued ther-
apy, 15.15% switched to another TNF, and 3.03% switched to a non-TNF. A total of
532 AS patients initiated therapy with a non-TNF. 1.50% of these patients switched
to a TNF, 0.94% switched to a non-TNF, 93.61% discontinued their therapy and
3.95% continued their initial therapy. CONCLUSIONS: Treatment patterns can be
difficult to present, especially when analyzing several years of data and various
drug switches. Data visualization tools can help present these complicated flows
effectively to researchers.
PSY9
PREVALENCE OF OPIOID ABUSE AND ASSOCIATED HEALTH CARE RESOURCE
UTILIZATION AND COSTS IN A MANAGED CARE POPULATION
Roland CL1, Joshi AV2, Mardekian J2, Walden SC3, Harnett J2
1Pfizer, Inc., Cary, NC, USA, 2Pfizer, Inc., New York, NY, USA, 3Pfizer, Inc., Atlanta, GA, USA
OBJECTIVES: This retrospective cohort study evaluated the prevalence, character-
istics, healthcare resource utilization (HCRU) and costs of patients with diagnosed
opioid abuse (OpA) using administrative claims from the Thomson MarketScan
Commercial and Medicare Supplemental research databases (44.9 million lives).
METHODS: Patients aged 12 years with OpA (ICD-9-CM codes: 304.0, 304.7, 305.5,
965.0 excluding 965.01) during OCT2008–SEPT2009 were identified. OpAers (cases)
were randomly matched 1:3 on demographics and geographic region to controls
(no OpA); OpA date being the index date. Unadjusted all-cause HCRU and total
costs (inpatient, outpatient, emergency department (ED), and Rx) were calculated
for the 6-month period before (pre-index) and the 12-month period after the index
date (post-index). Opioid use was also examined during the pre-index period for
OpAers and controls. RESULTS: The overall prevalence of OpA was 0.12% (average
age 41.9 years). Among OpAers, 68% had prescriptions for opioids. Among OpAers
A99V A L U E I N H E A L T H 1 5 ( 2 0 1 2 ) A 1 – A 2 5 6


PSY7 Blood Transfusion Management in Elective Major Orthopaedic Surgery (MOS) in France 

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PSY7 Blood Transfusion Management in Elective Major Orthopaedic Surgery (MOS) in France

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