André, S

Correia, V

Van de Velde, N

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 VA L U E  I N  H E A LT H  1 8  ( 2 0 1 5 )  A 3 3 5 – A 7 6 6  A597
compared to those without ICS and statins. However, analyses using combined 
medication categories revealed that only adults with statin use in combination with 
antidepressants and ICS or ICS alone were more likely to have new-onset diabetes. 
Instrumental variable adjusted regression which controlled for selection bias in 
statin use revealed no significant association between statin use and new-onset dia-
betes. ConClusions: Our study results suggest that multiple medication use (anti-
depressants, ICS and statins) was not associated with new-onset diabetes. However, 
as individuals with COPD are at higher risk of developing new-onset diabetes due to 
shared risk factors, further research with longer follow-up and randomized design 
is require to evaluate the safety of these medications.
PDB2
The AssociATion of WAisT circumference AnD microvAsculAr 
comPlicATions in DiABeTic PATienTs in An AsiAn PoPulATion
Azmi S1, Feisul MI2, Abdat A1, Goh A1, Abdul Aziz SH1
1Azmi Burhani Consulting, Petaling Jaya, Malaysia, 2Ministry of Health, Malaysia, Putrajaya, 
Malaysia
objeCtives: The aim of the study was to explore the association of waist circum-
ference with microvascular complications in Malaysian patients with type 2 diabe-
tes. Methods: We utilised data of type 2 diabetes patients followed up in Malaysian 
public sector primary care clinics contained in the National Diabetes Registry in 
the year 2012. Variables of interest were the presence of microvascular complica-
tions, namely nephropathy and retinopathy. Multiple logistic regression was used 
to explore the association between presence of microvascular complications and 
waist circumference, which was adjusted for age, sex, duration of diabetes, systolic 
blood pressure, insulin use, total cholesterol and HbA1c. Results: A total of 114,719 
patients with type 2 diabetes were included in the study. The mean age of patients 
was 59.8 years (SD: 11.2) with mean duration of diabetes of 6.8 years (SD: 5.1). Male 
patients comprised 39.9% of the sample population and 83.5% of the patients were 
overweight with BMI ≥ 23 kg/m2. Nephropathy and retinopathy was present in 9.1% 
and 7.9% of patients respectively. The mean waist circumference was 94.1 cm (SD: 
11.8) for males and 90.8 cm (SD: 11.8) for females; while 78.4% of the patients had waist 
circumference above the cut off (≥ 90 cm for men and ≥ 80 cm for women). Larger 
waist circumference was found to be significantly associated with nephropathy (adj. 
OR 1.005; p-value< 0.001; 95% CI: 1.003–1.008) after adjusting for confounding factors. 
However, waist circumference was not significantly associated with retinopathy (adj. 
OR 0.998; p= 0.209; 95% CI: 0.996–1.001). ConClusions: Analysis showed that patients 
with higher waist circumference were more likely to have nephropathy than patients 
with lower waist circumference. The analysis also showed that waist circumference 
was not associated with retinopathy in the study population.
PDB3
relATionshiP BeTWeen GlycAemic BurDen AnD micro- AnD 
mAcrovAsculAr comPlicATions in PATienTs WiTh TyPe 2 DiABeTes 
melliTus: A reAl-WorlD sTuDy in The PhArmo DATABAse neTWork
Overbeek J1, van Wijngaarden R1, Diels J2, Schubert A3, Straatman H1, Besson H1, 
Steyerberg EW4, Hemels M5, Nijpels G6, Herings R1
1PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands, 2Janssen Research & 
Development, Beerse, Belgium, 3Janssen-Cilag Poland, Warsaw, Poland, 4Erasmus MC, Rotterdam, 
The Netherlands, 5Janssen-Cilag A/S, Birkerød, Denmark, 6EMGO Institute, VU Medical Centre, 
Amsterdam, The Netherlands
objeCtives: The relationship between glycaemic burden and micro- and macrovascu-
lar complications among patients with type 2 diabetes mellitus (T2DM) was investigated 
using real-world data. Methods: T2DM patients aged 40 to 84 years and receiving 
antihyperglycaemic agents (AHAs) during the analysis period (2004-2013) were selected 
from the PHARMO Database Network. All HbA1c measurements between the first AHA 
prescription (index date) recorded and end of follow-up (i.e., end of database regis-
tration, death, or end of study period, whichever occurred first) were used to assess 
glycaemic burden. Glycaemic burden was defined based on the extent and duration 
that HbA1c values exceeded a threshold of 7% (53 mmol/mol) and was expressed as gly-
caemic burden years (GBY). The relationship between GBY and microvascular (includ-
ing retinopathy, diabetic foot, nephropathy) and macrovascular (including coronary 
artery disease [CAD], cerebrovascular disease) complications were analysed using a 
time-dependent Cox proportional hazards model, with glycaemic burden entered in 
each regression as a categorical variable with four levels (no burden [reference], 0-≤ 1 
GBY, > 1-≤ 3 GBY, and > 3 GBY). Results: A total of 34,153 T2DM patients were included; 
mean (±standard deviation) age at index date was 66 (±11) years and 53% were male. 
As compared to patients with no GBY, patients with GBY (0-≤ 1 GBY, > 1-≤ 3 GBY, and 
> 3 GBY) had a significantly higher risk of developing retinopathy (hazard ratio [HR]: 
1.38, 1.76, and 2.22, respectively), diabetic foot (HR: 1.08, 1.24, and 1.55, respectively), 
nephropathy (HR: 1.11, 1.16, and 1.14, respectively), and cerebrovascular disease (HR: 
1.16, 1.28, and 1.36, respectively). For CAD, a significantly higher risk was found only for 
patients with > 1-≤ 3 GBY and > 3 GBY (HR: 1.12 and 1.32, respectively). ConClusions: 
Results of this study show that GBY is an important predictor of micro- and macrovas-
cular complications and thus may be important to consider in T2DM management.
PDB4
exenATiDe once Weekly Plus meTformin for The TreATmenT of TyPe 
2 DiABeTes melliTus: A neTWork meTA-AnAlysis of rAnDomiseD 
conTrolleD TriAls
Kayaniyil S1, Lozano-Ortega G2, Bennett H1, Johnsson K3, Shaunik A4, Grandy S5,  
Kartman B3
1ICON plc, Toronto, ON, Canada, 2ICON, Vancouver, BC, Canada, 3AstraZeneca, Mölndal, Sweden, 
4AstraZeneca, Gaithersburg, MD, USA, 5Astrazeneca Phamaceuticals, LP, Gaithersburg, MD, USA
objeCtives: A network meta-analysis (NMA) was conducted to estimate the rela-
tive efficacy and tolerability of exenatide 2mg once-weekly (EQW), a glucagon-
like peptide-1 receptor agonist (GLP-1 RA), compared to other GLP-1 RAs for the 
treatment of adult patients with type 2 diabetes mellitus (T2DM) not adequately 
controlled on metformin (MET). Methods: A systematic literature review was 
objeCtives: Before 2006 bed occupancy rates during winter periods were above 
the good management threshold (85%) in Jessa Hospital paediatric ward (Hasselt, 
Belgium), with peaks above 100%. This causes pressure on bed and people man-
agement expressed in bad QoC scores. We evaluated two methods to improve the 
scores and their investment costs. Methods: Option A is extending the number 
of paediatric beds until the unit operates under the 85% threshold during the 
whole winter season. Option B is introducing rotavirus vaccination to infants 
with high coverage in the catchment area. A hospital with 36 paediatric beds 
was selected as pilot design. Bed occupancy rates/day over a period of 6 years 
(2004-2009) were collected, including pre- and post-introduction of the vaccine 
in 2006. Estimated birth cohort was 7,000/year in the catchment area. For Option 
A total cost per year was calculated referencing to the observed pre-vaccination 
period. For Option B cost of vaccinating the birth cohort with implications on 
hospital savings was calculated applying the observed post-vaccination period. 
Total cost per year for each option was compared. Results: Option A: extend-
ing hospital ward with 4 extra beds to remain under the threshold, costs about 
€ 436,000/year and the threshold may still sometimes be exceeded. Option B: 
vaccination program in the area costs € 420,000/year, leading to a 41% reduction 
in the number of bed-days for gastro-enteritis during the winter, equivalent to 
€ 82,000/year of cost offsets. Total cost of Option B is therefore € 338,000/year with 
an overall 82% bed occupancy rate/day, being below the threshold throughout win-
ters. ConClusions: Option B with vaccination is cheaper than option A with extra 
beds. Moreover it maintains the occupancy rate below the safety threshold during 
the whole winter period, and thus guarantees better QoC scores in the pediatric 
ward.
Pin120
cosT-effecTiveness AnAlysis of PhiD-cv rouTine vAccinATion 
ProGrAmme comPAreD To Pcv-13 in PorTuGAl
Correia V1, André S1, Van de Velde N2
1GSK Portugal, Alges, Portugal, 2GSK Vaccines, Wavre, Belgium
objeCtives: To estimate the incremental cost-effectiveness ratio (ICER) of the 
pneumococcal non-typeable Haemophilus influenzaeprotein D conjugate vaccine 
(PHiD-CV) compared to the 13-valent pneumococcal conjugate vaccine (PCV-13) in 
routine infant vaccination in Portugal. Methods: The cost-effectiveness analysis 
(CEA) is based on a Markov model simulating meningitis, bacteraemia, pneumonia 
and acute otitis media (AOM) in a Portuguese birth cohort until 10 years of age. 
CEA is performed from the National Health Service (NHS) perspective with 5% 
discounting on both costs and effects. The model has been parameterized using 
local serotype distribution, disease incidence and direct medical costs. Disutility 
weights come from international published literature and vaccine efficacy 
assumptions come from large randomized controlled trials. Model parameters 
have been validated by a panel of experts. Base case scenario assumes vaccina-
tion in a 2+1 schedule at 2, 4 and 12 months of age with 95% coverage. One-way 
and probabilistic sensitivity analyses were carried out to identify most influential 
parameters and estimate conjoint parameter uncertainty, respectively. Results: 
Assuming both vaccines have the same price, the model predicts that PHiD-CV 
is the dominant intervention resulting in a health gain of 7 Quality-Adjusted 
Life Years (QALYs) and a saving of 332,151€ over PCV-13 (ICER = -45,216€ /QALY). 
One-way sensitivity analysis shows ICER is very sensitive to efficacy against 
Streptococcus pneumoniae and Haemophilus influenzae, general practices visits 
and disutility, all related to AOM. The probabilistic sensitivity analysis confirms 
the robustness of our results with 93% of simulations showing that PHiD-CV ICER 
is below € 30,000/QALY compared to PCV-13. ConClusions: Using PHiD-CV in the 
routine vaccination program for children in Portugal could generate more health 
benefits and savings for NHS, even when considering parity price versus PCV-13. 
These savings could then be used to implement other public health measures such 
as a catch-up program to reduce inequalities in older cohorts.
reseArch PosTer PresenTATions – session iv
DiseAse – sPecific sTuDies
DiABeTes/enDocrine DisorDers – clinical outcomes studies
PDB1
risk of neW-onseT DiABeTes AssociATeD WiTh concomiTAnT 
AnTiDePressAnT, inhAleD corTicosTeroiDs, AnD sTATin use AmonG 
meDicAiD BeneficiAries WiTh coPD
Ajmera MR1, Sambamoorthi U2
1RTI Health Solutions, RTP, NC, USA, 2West Virginia University, Morgantown, WV, USA
objeCtives: Multiple medication use is common among individuals with Chronic 
Obstructive Pulmonary Disease (COPD). Specifically, use of antidepressants, inhaled 
corticosteroids (ICS), and statins may place individuals with COPD at high risk for 
new-onset diabetes. We examined the relationship between use of medications 
(antidepressants, ICS, and statins) and new-onset diabetes among Medicaid ben-
eficiaries with COPD. Methods: We used a retrospective longitudinal dynamic 
cohort design using multiple years (2005-2008) of Medicaid claims of beneficiaries 
with newly diagnosed COPD (n = 15,287). We identified receipt of antidepressants, 
ICS, and statins using National Drug Codes (NDC) and new-onset diabetes using 
International Classification of Diseases-9th-Clinical Modification (250.x2) codes. 
Chi-square tests of independence and multivariate logistic regressions were used 
to examine the relationship between medication use and new-onset diabetes. 
Instrumental variable approach was used to control for selection bias in statin use. 
We conducted analysis using SAS v. 9.3 and STATA v11. Results: Among Medicaid 
beneficiaries with newly-diagnosed COPD, 6.3% had new-onset diabetes. After con-
trolling for baseline characteristics, adults with ICS (AOR: 1.23; 95% CI: 1.07, 1.47) 
and statins (AOR: 1.48; 95% CI: 1.27, 1.72) had greater risk of new-onset diabetes 


PIN120 Cost-Effectiveness Analysis Of Phid-Cv Routine Vaccination Programme Compared To Pcv-13 In Portugal 

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PIN120 Cost-Effectiveness Analysis Of Phid-Cv Routine Vaccination Programme Compared To Pcv-13 In Portugal

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