Andrews, R.

Birnbaum, H.

Cheng, W.

Duh, M.S.

Joshi, A.V.

Korves, C.

Mardekian, J.

Michna, E.

Schaaf, D.

Zhou, Z.

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 V A L U E  I N  H E A L T H  1 6  ( 2 0 1 3 )  A 1 - A 2 9 8  A111 
 
 
PSY4  
THE POTENTIAL COST SAVINGS ASSOCIATED WITH PREVENTING THE 
DEVELOPMENT OF HYPERTENSION, DIABETES AND DYSLIPIDEMIA IN AN 
OVERWEIGHT AND OBESE POPULATION  
Carlton R1, Bramley T1, Zagadailov E1, Karnawat S2 
1Xcenda, LLC, Palm Harbor, FL, USA, 2VIVUS, Inc., Mountain View, CA, USA  
OBJECTIVES: The prevalence of obesity (BMI ≥30) remains above 35% and when 
combined with the overweight population (BMI ≥25), the age-adjusted prevalence 
is 68.8%. The objective was to develop a model demonstrating the cost savings 
associated with the prevention of hypertension (HTN), diabetes (DM), and 
dyslipidemia (DLP) in an overweight and obese population by treating patients 
with phentermine/topiramate extended-release (ER) in conjunction with lifestyle 
modification. METHODS: A 1-year model was developed using data from the 
National Health and Nutrition Examination Survey (NHANES), clinical trial data, 
and published literature. The model estimates the cost of incident cases of HTN, 
DM and DLP in an overweight and obese population. Rates of progression to 
comorbidities are based on patients who progressed from no medication use for 
comorbidities at baseline to at least one medication at endpoint in the CONQUER 
study in obese and overweight subjects with ≥2 comorbidities. The risk of 
progression to HTN, DM, and DLP is applied to literature-based cost estimates  
to calculate the per-patient annual cost savings associated with 
phentermine/topiramate ER compared with lifestyle modification alone. 
RESULTS: The average cost savings per patient associated with the prevention  
of comorbidities with phentermine/topiramate ER compared with lifestyle 
modification alone is $179.06, $177.44, and no savings in grade 1 (BMI ≥30), grade 
2 (BMI ≥35), and grade 3 (BMI ≥40) obese populations, respectively. HTN-specific 
cost savings ranged from $40.20 for grade 2 obesity to $10.42 for grade 3 obesity. 
DM-specific cost savings ranged from $109.23 for grade 2 obesity to no savings 
for grade 3 obesity. DLP-specific cost savings ranged from $56.02 for grade  
1 obesity to $28.01 for grade 2 obesity. CONCLUSIONS: This analysis suggests 
that treatment with phentermine/topiramate ER may be associated with cost 
savings by preventing the development of comorbidities in overweight or obese 
patients.  
 
PSY5  
MEDICAL AND PHARMACY CLAIMS-BASED ALGORITHIMS FOR IDENTIFYING 
PATIENTS WITH MULTIPLE SCLEROSIS  
Song X1, Capkun-Niggli G2, Johnson BH3, Kahler K4 
1Truven Health, Cambridge, MA, USA, 2Novartis Pharma AG, Basel, Switzerland, 3Truven Health 
Analytics, Washington, DC, USA, 4Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA  
OBJECTIVES: This study compared different algorithms to identify patients with 
multiple sclerosis (MS) in claims data and recommended the most appropriate 
algorithm. METHODS: Our literature review on MS studies in claims data 
identified ten different algorithms to identify MS patients. Some algorithms 
require either MS diagnosis or MS treatment, or both; some require two or more 
diagnoses or treatment claims; some require evidence of other neurological 
conditions in addition to an MS diagnosis. These algorithms were used to 
identify MS patients in Truven Health MarketScan®Commercial and Medicare 
Supplemental Databases in 2004-2011. For each algorithm, MS prevalence rate, 
patients’ age and gender, proportion of patients with magnetic resonance 
imaging (MRI) and MS treatment were examined and compared with those in 
published studies wherever possible. RESULTS: Two algorithms identified about 
the same number of MS patients: one algorithm required ≥2 MS diagnoses ≥30 
days apart (123,064 patients were identified) and the other required ≥1 principal 
inpatient MS diagnosis or ≥2 MS diagnoses ≥30 days apart (123,160 patients were 
identified). Both populations had a mean age of 47 and 76% female, consistent 
with that reported in the literature (mean age: 40.9-50.3, female: 66-80%); a total 
of 69% of them had MS treatment. The proportion of patients with MRI increased 
from 41% in January 1, 2004 - February 28, 2005 to 66% in March 1, 2005 – 
September 30, 2011, consistent with when McDonald’s criteria and update were 
published. These two algorithms also produced a prevalence rate of 135 per 
100,000 people, same as the rate reported by Atlas of MS Database and the 
National MS Society. Prevalence rates based on other algorithms were either too 
high or too low. Thus these two algorithms were the most appropriate to identify 
MS patients in claims data. CONCLUSIONS: Comparison of available patient and 
epidemiological characteristics with published literature suggests that MS 
patients can be accurately identified in claims data.  
 
PSY6  
RELIABILITY AND VALIDITY OF CURRENT PERCEPTION THRESHOLD TEST IN 
MECHANICAL NECK DISORDER  
Uddin Z, MacDermid JC, Galea V, Gross AR, Pierrynowski M 
McMaster University, Hamilton, ON, Canada  
OBJECTIVES: Neck pain is a common musculoskeletal disorder, affecting a third 
of all adults each year. Neurological impairments exist in a severe subset of 
patients. These may be detected by sensory detection responses. Current 
Perception Threshold (CPT) testing may provide such testing but there is 
inadequate evidence on the clinical measurement properties of CPT testing in 
Mechanical Neck Disorder (MND). Therefore, the objective of this study is to 
evaluate the reliability and validity of CPT test in patients with MND. METHODS: 
The Study Design was a cross-sectional reliability and validity assessment. 
Patients with MND (N=106) were recruited after a standardized physical 
assessment performed by an experienced physiotherapist to establish that neck 
pain was related to mechanical dysfunction. The rapid CPT protocol was 
performed at three frequencies (5, 250, 2000 Hz) using 3 dermatomal locations on 
the hand. A subset of patients (N=34) was reassessed at a second visit to 
determine the test-retest reliability. For inter-trial reliability the fingertip of both 
hands was assessed. Internal consistencies of CPT between frequencies were 
calculated from CPT test scores in the most affected hand. Construct validity of 
CPT was evaluated by correlating the 3 composite scores derived the from the 
CPT tests with the Neck Disability Index NDI and Cervical Spine Outcomes 
Questionnaire (COSQ). RESULTS: Inter-trial reliability was good to excellent (ICC= 
0.73-0.82, p<0.001). Internal consistency was satisfactory (α = 0.84-0.90, p<0.001). 
Test-retest reliability of CPT scores was excellent (ICC = 0.76-0.84, p<0.001). The 
mean retest difference and the 95% limits of agreement were: -0.3 ± 3 (in 2000Hz 
and 250Hz), and 0.1 ± 3.9 (in 5Hz). A small to medium-size correlation was found 
between CPT and NDI or CSOQ (r = 0.21-0.37). CONCLUSIONS: CPT was consistent 
across occasions; and was associated with neck disability.  
 
PSY7  
COMPARATIVE EFFECTIVENESS OF SMOKING CESSATION MEDICATIONS 
AMONG OBESE SMOKERS  
Yang M1, Chen H1, Johnson ML1, Essien EJ1, Peters RJ2, Abughosh S1 
1University of Houston, Houston, TX, USA, 2University of Texas Health Science Center at 
Houston, Houston, TX, USA  
OBJECTIVES: To compare abstinence rates of different Food and Drug 
Administration (FDA)-approved smoking cessation medication strategies among 
obese smokers. METHODS: A population-based retrospective cohort study was 
conducted using the General Electric (GE) electronic medical record database 
(2006 – 2011). The cohort consisted of obese adult smokers newly initiating use of 
an FDA-approved smoking cessation medication (bupropion vs. varenicline). The 
outcome variable was abstinent versus not at 3, 6, or 12 months following first 
prescription. Descriptive analyses and chi-square tests were conducted to assess 
the frequency distribution of sample characteristics and their association with 
smoking cessation medication use. Multivariate logistic regression models were 
carried out to identify predictors of abstinence at 3, 6 and 12 months after 
assessing co-linearity between independent variables. Backward elimination was 
used to arrive at the final models. RESULTS: The abstinence rate of using any 
smoking cessation medications among obese smokers was 17.72% at 3 months, 
20.61% at 6 months, and 22.51% at 12 months, respectively. While previous 
literature among adults reports higher abstinence rates with varenicline 
compared to bupropion, our findings among obese smokers indicate slightly 
higher abstinence rates for those using bupropion compared to those using 
varenicline (bupropion vs. varenicline: 20.51% vs. 16.85% at 3 months (p = 0.01); 
22.87% versus 20.45% at 6 months (p = 0.09); 25.00% versus 22.84% at 12 months 
(p = 0.10)). Significant predictors of successful abstinence included: demographic 
characteristic factors (age, race, region, payment type, and specialty group), 
diseases (hypertension, lung cancer, depression, and alcohol dependent), 
utilization (weight control drug use and number of cigarettes smoke per day), 
smoking counseling, and baseline Body Mass Index (BMI) value. CONCLUSIONS: 
Abstinence rates were higher among obese smokers taking bupropion versus 
those taking varenicline. Predictors identified in this study should be considered 
when designing smoking cessation interventions among the high risk population 
of obese smokers.  
 
PSY8  
A META-ANALYSIS OF EFFICACY AND SAFETY OF PRESCRIPTION OPIOIDS, 
INCLUDING FORMULATIONS WITH TAMPER-RESISTANT TECHNOLOGIES, IN 
NON-CANCER PAIN MANAGEMENT  
Michna E1, Cheng W2, Korves C2, Schaaf D3, Andrews R4, Zhou Z4, Mardekian J3, Joshi AV5, 
Birnbaum H2, Duh MS2 
1Brigham and Women's Hospital, Chestnut Hill, MA, USA, 2Analysis Group, Inc., Boston, MA, 
USA, 3Pfizer, Inc., New York, NY, USA, 4Analysis Group, Boston, MA, USA, 5Shire 
Pharmaceuticals, Wayne, PA, USA  
OBJECTIVES: This meta-analysis was conducted to compare pain intensity  
and adverse event (AE) outcomes between opioids formulated with technologies 
designed to deter or resist tampering (tamper-resistant technologies [TRTs])  
and non-TRTs for commonly prescribed long-acting opioids (LAOs) and short-
acting opioids (SAOs) for treatment of non-cancer pain in adults. METHODS: 
Sixteen journal articles [13 non-TRT vs. placebo, 3 TRT vs. placebo] from a 
systematic literature review (9/1/2001-8/31/2011) meeting eligibility criteria were 
included in the meta-analyses. Summary estimates of standardized pain 
intensity outcomes [difference in mean change of pain intensity from baseline to 
end of study (DMCPI), difference in sum of pain intensity difference over the 
study period (DSPID)] and of odds ratios (OR) of 7 AEs were computed through 
random effects meta-analyses using DerSimonian-Laird method. Additional 
analyses included stratified analyses by treatment duration (<2 months, 2-3 
months, ≥3 months) and by LAO/SAO, and indirect comparisons to contrast TRTs 
versus non-TRTs. RESULTS: Summary estimates for standardized DMCPI and for 
standardized DSPID indicated that TRTs and non-TRTs showed significantly 
greater efficacy than placebo in reducing pain intensity [(Standardized DMCPI) 
Non-TRT versus placebo: -0.59(95% CI: -0.94,-0.24), TRF versus placebo: -0.21(-
0.35,-0.07); (Standardized DSPID) Non-TRT versus placebo: 0.73(0.26,1.20),  
TRF versus placebo: 0.51(0.30,0.72)]. TRTs and non-TRTs had similar safety 
profiles—both were associated with higher odds of AEs than placebo. ORs from 
indirect analyses comparing AEs for TRTs versus non-TRTs were not significant 
different [nausea: 0.87(0.24,3.12), vomiting: 1.54(0.40,5.97), dizziness/vertigo: 
0.61(0.21,1.76), headache: 1.42(0.57,3.53), somnolence/drowsiness: 0.47(0.09,2.58), 
constipation 0.64(0.28,1.49), pruritus 0.41(0.05,3.51)]. CONCLUSIONS: Pain 
intensity and ORs of AEs between non-TRTs/TRTs and placebo did not vary  
by treatment duration and opioid formulation (p-values>0.05). TRTs and non-
TRTs had comparable safety profiles and both were more efficacious than 
placebo in reducing pain intensity. Since TRTs are designed to reduce 
misuse/abuse due to tampering, they may be a means to reduce public health 
burden of opioid abuse.  


PSY8 A meta-analysis of efficacy and safety of prescription opioids, including formulations with tamper-resistant technologies, in non-cancer pain management 

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PSY8 A meta-analysis of efficacy and safety of prescription opioids, including formulations with tamper-resistant technologies, in non-cancer pain management

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