Bernatsky, S.

Bessette, L.

Lachaine, J.

Légaré, J.

Rahme, E.

Roussy, J.P.

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PMS74 Use of Disease-Modifying Anti-Rheumatic Drugs for Rheumatoid Arthritis in Quebec, Canada 

months prior to duloxetine initiation (defined as no duloxetine pill coverage in the
previous 90 days) were identified via administrative claims. The use of pain related
medications was assessed during the 6 and 12 months prior to duloxetine
initiation.RESULTS:The study identified 1682, 308, 1044, 1363, 4255, and 5189 in the
MDD, GAD, DPNP, FM, OA, and low back pain (LBP) cohorts in 2009-2010. Antide-
pressant use during the 12 months prior to initiation was common, and was high-
est among MDD (87.2%) and GAD patients (83.4%). The use of anticonvulsants was
comparable between cohorts, but highest among patients with DPNP (60.0%) and
FM (54.7%), and between 47.0-52.4% among other cohorts. There was varied use of
opioids across cohorts, ranging from 63.3% (GAD) to 84.7% (LBP). Non-steroidal
anti-inflammatory drugs utilization varied with the lowest use among GAD pa-
tients (30.2%) and the highest among OA patients (45.8%). Utilization of muscle
relaxants widely ranged from 22.0% (DPNP) to 40.4% (FM). Use of pain medication
during the 6 months prior was similar, but was generally 10-15% lower. Use pat-
terns in 2007 and 2008 were similar.CONCLUSIONS:Across disease states, patients
used a variety of medications prior to the initiation of duloxetine. Patterns of use
have largely stayed the same from 2007 through 2010.
PMS73
EPIDEMIOLOGY, THERAPY PATTERNS AND FUNCTIONAL STATUS OF PATIENTS
WITH JUVENILE IDIOPATIC ARTHRITIS (JIA) IN RUSSIA
Vorobyev PA1, Alexeeva EI2, Bezmelnitsyna L1, Borisenko O1, Kirdakov FI3, Hájek P4
1Russian Society for Pharmacoeconomics and Outcomes Research, Moscow, Russia, 2National
center for Child Health of Russian Academy of Medical Science, Moscow, Russia, 3University
Child Hospital of First Moscow Medical University named I.M.Sechenov, Moscow, Russia, 4Pfizer,
Praha, Czech Republic
OBJECTIVES: For distribution biologic agents in patients with JIA in Russia, data
about epidemiology, used drugs and their impact on functional status are
necessary. METHODS: Records were examined for 6 months retrospectively. Data
were collected via medical chart review by rheumatologists from 11 regions of
Russia. Functional status was assessed with CHAQ questionnaire. Inclusion crite-
ria: age (younger than 18 years), minimum 6 months since diagnosis of JIA and
availability of 6 months retrospective data. Recruitment: no more than 30% pa-
tients received biologic therapy. Disease-specific criteria: about 50% had oligoar-
thritis, 30-40% - polyarthritis and 10-20% - systemic form. Analysis was performed
with methods of descriptive statistic, parametric and non-parametric criteria.
RESULTS: Data on 405 patients were obtained. Ratio (male:female) was 1:1.6. Av-
erage duration of disease was 5 years. 72% had a disability status caused by JIA. 43%
had mild functional disorders; 32% - moderate; 23% - severe disorders, and only 2%
had no functional disorders. Seventy-two percent patients in subgroup without
functional disorders got biologic therapy, 30% and 28% got biologic agents in sub-
groups with mild and moderate disorders respectively. In subgroup with severe
disorders 41% received biologic therapy; 18% patients with oligoarthritis got bio-
logical agents; 40% - with polyartritis, 54% - with systemic form. CONCLUSIONS:
Prescription of biologic therapy increases in case of more severe form of JIA. Direct
relationship between biologic therapy prescription and functional status was not
revealed.
PMS74
USE OF DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS FOR RHEUMATOID
ARTHRITIS IN QUEBEC, CANADA
Roussy JP1, Bessette L2, Bernatsky S3, Rahme E3, Légaré J4, Lachaine J1
1University of Montreal, Montreal, QC, Canada, 2CHUL, Quebec, QC, Canada, 3McGill UHC/RVH,
Montreal, QC, Canada, 4Arthritis Alliance of Canada, Neuville, QC, Canada
OBJECTIVES: Disease-modifying anti-rheumatic drugs (DMARDs) are the corner-
stone of rheumatoid arthritis (RA) pharmacotherapy and should be initiated
promptly after RA diagnosis. We examined trends in DMARD use among RA pa-
tients in Quebec, and factors correlated with DMARD initiation in newly diagnosed
RA. METHODS: Quebec administrative health databases were used to identify RA
subjects and their claims for medical and pharmaceutical services between Janu-
ary 1, 2002 and December 31, 2008. To describe DMARD use, cross-sectional anal-
yses were performed on November 1 of each year. For subjects newly diagnosed
with RA, multivariable logistic regressions were used to identify possible predictors
of DMARD initiation at 12 months and Kaplan-Meier curves to define the probabil-
ity of initiating a DMARD over time. RESULTS: A total of 32,533 subjects were
included (mean age: 67.5 years; 70.4% female). Over the study period, the percent-
age of subjects on a DMARD increased from 42.0% (November 2002) to 43.2% (No-
vember 2008). Being followed by a rheumatologist (vs. GP) was the strongest pre-
dictor of DMARD initiation (OR4.39; 95%CI: 3.80-5.08). The use of NSAIDs,
corticosteroids, and opioids in the year prior to cohort entry and the calendar year
of cohort entry had a positive effect on DMARD initiation, whereas age, comorbidity
score, and the use of acetaminophen had a negative effect. For biologics, calendar
year was the strongest predictor (OR 2007 vs. 200210.78; 95%CI: 2.45-47.37). Of
subjects newly diagnosed in 2002, 0.1% had a biologic initiated within one year,
while for those newly diagnosed in 2007 the percentage was 1.3%. In any newly
diagnosed subjects, averaged over 2002-2007, the probability of having initiated
any DMARDs at 12 months was 38.5% (47.8% for those followed by a
rheumatologist). CONCLUSIONS: Despite encouraging signs for earlier aggressive
RA management, DMARD use appears to be sub-optimal in Quebec. Use of DMARDs
was much higher among subjects followed by a rheumatologist.
PMS75
EXPLANATORY FACTORS FOR THE RHEUMATOID ARTHRITIS PATIENTS’
ACCESS TO BIOLOGICAL AGENTS IN 15 EUROPEAN COUNTRIES
Laires PA1, Exposto F2, Barosa P2, Hormigos B2, Martins AP1
1Merck, Sharp & Dohme, Oeiras, Portugal, 2IMS Health, Oeiras, Portugal
OBJECTIVES: In the last decade, several biological agents (biologics), including anti-
TNFs, have been approved for use in Rheumatoid Arthritis (RA), thus revolutioniz-
ing treatment. Despite the widespread availability of these drugs through Europe,
patient access differs significantly among countries. We aimed to compare the
share of RA patients being treated with biologics in each country and study the
factors that influence the different shares, with focus on the market potential for
Portugal. METHODS: A multivariable linear regression model using SPSS 10.0 was
built to identify which factors best explain a country’s share of prevalent RA pa-
tients treated with biologics. This share was calculated based on IMS Health re-
ported unit sales converted into annualized treatments by applying defined daily
doses by WHO. RESULTS: A total of 21 independent variables were collected for
each of the 15 European countries, including demographic, economic, funding-
related, disease-related and biologics-related data. Model results (Adjusted R2
0,953; SE0,0456) indicated that a country’s share of prevalent RA patients treated
with biologics is mostly explained by its GDP per capita (0.006; p0.0001), the
share of biologics treatments per dispensing channel - hospital vs. Retail
(0.046; p0.149) and the usage of methotrexate (0.26; p0.05). Based on
these variables and their expected evolution we estimated the overall market po-
tential for the Portuguese market, define 4 country clusters and understand Portu-
gal’s relative position among the 15 countries. Share of RA prevalent patients
treated with methotrexate in Portugal may be standing 5 years behind comparable
countries such as UK, France, Germany or Spain, thus impacting the share of pa-
tients treated with biologics. CONCLUSIONS: Portugal presents the lowest share of
RA prevalent patients treated with biologics of all selected countries. Lower GDP
per capita, biologics exclusively dispensed in hospital settings and a low consump-
tion of methotrexate are the best explanatory factors for this reality.
PMS76
TREATMENT PATTERNS AMONG PATIENTS WITH SHOULDER OSTEOARTHISTIS
Kozma CM1, Bhattacharyya SK2, Palazola P2
1Research Consultant/Adjunct Professor, University of South Carolina, St. Helena Island, SC,
USA, 2DePuy Mitek, Inc, Raynham, MA, USA
OBJECTIVES: To assess treatment patterns among patients with shoulder osteoar-
thritis (OA).METHODS:Data from Thomson MarketScan, a large national managed
care population, was used to identify patients with a shoulder OA diagnosis in the
first 6 months of 2005 (i.e., the index date). The 360 days post index (identification
period) was used to establish baseline treatments (i.e., conservative management
(pharmaceutical and physical therapy), steroid injections and shoulder surgery).
Patients were required to be continuously eligible for 54 months post-index and
were excluded if they had a shoulder surgery claim in the identification period.
Four cohorts were followed based on the baseline treatments: C1- conservative
treatment; C2- conservative treatment and at least one steroid injection; C3- at
least one steroid injection; C4- no treatment claims. Progression to additional treat-
ments was evaluated descriptively from day 361 to 1260 in 180 increments. Logistic
regression was used to model the odds or having a claim for a treatment. RESULTS:
A total of 3646 patients met the analysis criteria (C1, n2,815(77.2%); C2,
n171(4.7%); C3, n27(0.7%); C4, n633(17.4%)). The distribution was split evenly
between males (50.2%) and females (49.8%). Patients who received steroid injec-
tions in the identification period had the greatest likelihood of having a steroid
injection in the observation period (C1-19.2%;C2-43.9%;C3-44.4%;C4-14.1%). The
percentage with shoulder surgery was 6.4%, 15.2%, 11.1% and 6.5% for C1 to C4,
respectively. Patients with steroids in the observation period (C2 and C3) were more
likely to have surgery in the first year of observation. Logistic regression showed
that females who had steroid injections (C2 and C3 combined) had odds of surgery
that were 2.9 times greater than females with no treatments (C1). CONCLUSIONS:
The most significant predictor of surgery was presence of steroid injections. Rates
of steroid injections and surgery differed based on presence of pre-existing treat-
ments.
PMS77
IMPROVING QUALITY AND REDUCING COSTS IN WORKERS’ COMPENSATION
HEALTH CARE: A POPULATION-BASED INTERVENTION STUDY
Wickizer TM1, Franklin GM2, Fulton-Kehoe D2
1The Ohio State University, Columbus, OH, USA, 2University of Washington, Seattle, WA, USA
OBJECTIVES: To evaluate the effect of a quality improvement intervention that
provided financial incentives to physicians to encourage adoption of best practices,
coupled with organizational support to improve care management. The interven-
tion, implemented at two pilot sites in Washington State, was aimed at reducing
work disability for patients with occupational injuries or illnesses treated within
the workers’ compensation system. METHODS: At each pilot site, a Center for
Occupational Health and Education (COHE) was established to recruit physicians
for the pilot and to implement the intervention. We conducted a prospective non-
randomized intervention study, with a non-equivalent comparison group, using
difference-in-difference models. The intervention group included patients (31,520)
treated from July 2004 through June 2007 by COHE physicians (n  300). The com-
parison group included patients (40,176) treated by non-COHE physicians practic-
ing in the pilot target areas. The baseline (pre-intervention) period was specified as
July 2001 to June 2003 and included 33,910 patients treated by COHE and non-COHE
physicians. We used logistic regression and generalized linear models to analyze
four outcomes at one year following injury: off work and on disability, disability
days, and disability costs and medical costs per claim. RESULTS: COHE patients
were less likely to be off work and on disability at one year post injury (OR  .79,
P  0.003). The COHE was associated with a statistically significant (p  .01)
reduction in disability days (16.5%) and disability costs (23.7%), and with a non-
signific0ant (p  0.13) reduction of 6.7% in medical costs. Patients treated by
A316 V A L U E I N H E A L T H 1 4 ( 2 0 1 1 ) A 2 3 3 - A 5 1 0


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PMS74 Use of Disease-Modifying Anti-Rheumatic Drugs for Rheumatoid Arthritis in Quebec, Canada

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