VA L U E I N H E A LT H 20 (2017) A399–A811
A629
(ASCVD)  Methods: A retrospective cohort study was conducted using the Korean
Health Insurance Review & Assessment (HIRA) Service database. Patients aged ≥ 18
years were included if they initiated statin and/or ezetimibe between January 1, 2012
and December 31, 2014 without previous claims for statin and/or ezetimibe within
12 months before index date. Index date was defined as the date of first prescription
for statin and/or ezetimibe. Patients were classified into following groups: patients
with ASCVD (defined as myocardial infarction, angina, coronary revasculariza-
tion, peripheral artery disease, ischemic stroke, and transient ischemic attack) and
patients with hypertension or diabetes without a history of ASCVD. Patients were
followed for 1 year after the index date to assess treatment patterns like discontinu-
ation, switching, reinitiation, and augmentation. Medication adherence was meas-
ured as medication possession ratio (MPR). Possible statin intolerance was assessed
based on a previously developed algorithm of treatment modifications.  Results:
Among 2,600,810 patients who initiated statin and/or ezetimibe, 746,421 (28.7%)
were with ASCVD, 956,356 (36.8%) were with hypertension, and 605,198 (23.3%) were
with diabetes. The average MPR was 69.0% for statin and 61.0% for ezetimibe. During
the follow-up period, 50.9% of patients with ASCVD, 51.6% of patients with hyperten-
sion, and 53.4% of patients with diabetes had ≥ 1 treatment modification including
permanent discontinuation (19.4%, 21.6%, and 21.1%, respectively), reinitiation (6.1%,
6.7%, and 7.6%, respectively), switching (12.4%, 11.5%, and 12.3%, respectively), and
augmentation (1.4%, 1.4%, and 1.7%, respectively). Possible statin intolerance was
observed in 21.6% of patients with ASCVD, 21.1% of patients with hypertension, and
22.1% of patients with diabetes.  Conclusions: High treatment modification rate
in lipid-lowering therapies and increased possible statin intolerance highlights an
unmet need in the prevention and management of ASCVD.
PCV156
Qualitative Evaluation of Healthcare Provider Trust (And
Mistrust) Among Patients with Symptomatic Peripheral Artery
Disease
Corriere MA1, Keith DR2
1University
of Michigan, Ann Arbor, MI, USA, 2Wake Forest University School of Medicine,
WInston Salem, NC, USA
Objectives: Communication between patients and providers is required for shared
decision making, and their interpersonal interaction directly impacts treatment
choices. We conducted a focus group study of patients with symptomatic periph-
eral artery disease (PAD) to identify factors relevant for treatment decisions. This
analysis specifically explores provider trust and communication as an important,
process-related theme.  Methods: Patients with symptomatic PAD were recruited
to participate in moderated focus groups. Focus groups lasted for approximately
one hour, used a structured moderator’s guide, and were audio recorded. Verbatim
transcripts were imported into a qualitative analytic software program and ana-
lyzed to identify key attributes and themes. Comments related to patient-provider
interaction, communication, and trust were extracted and analyzed using thematic
analysis, word frequency coding, and hierarchy charts.  Results: 51 participants
with symptomatic PAD were recruited. Mean participant age was 66.2 ±13.9 years,
35% were women, and 43% were white. Provider trust and interaction emerged as
unanticipated but important themes. Interpersonal interaction was discussed in
terms of provider specialty, treatment venues, and information sharing. Provider
trust was discussed in terms of need for second opinions, disclosure of treatment
alternatives and risks, and access to outpatient clinic visits and specific treat-
ments. Participants expressed positive attitudes toward involvement in shared
decisions, receipt of educational information, detailed counseling, and discus-
sion of treatment options under consideration. Negative attitudes were expressed
toward treatment in the emergency room, delay of appropriate treatment, provider
misinformation or withholding of information, inconsistent recommendations
between providers, patient abandonment, and pain medication as a treatment.
Attitudes about provider specialty, provider trust, and experienced decision roles
were mixed.  Conclusions: Provider trust is inconsistent among patients with
symptomatic PAD and may be affected by a variety of factors, some of which are
not provider-specific. Understanding barriers to patient-provider trust may identify
opportunities to improve interaction, facilitating shared decision-making.
PCV157
Examining Health Care Utilization and Costs Among
Atherosclerosis Patients in the US Veteran Health Administration
Population
Zhang Q1, Kariburyo MF1, Xu J1, Xie L1, Baser O2
1STATinMED Research, Ann Arbor, MI, USA, 2Columbia University/MEF University/STATinMED
Research, New York, NY, USA
Objectives: To compare health care utilization (HRU) and costs between patients
with and without atherosclerosis in the US veteran population.  Methods: Patients
with ≥ 1 medical claim for atherosclerosis (International Classification of Diseases,
9th and 10th Revision, Clinical Modification [ICD-9-CM; ICD-10-CM] diagnosis codes
[ICD-9-CM code 440; ICD-10-CM code I70]) were identified from 01JAN2012 through
31DEC2016 using the Veterans Health Administration datasets. The first diagnosis
date was designated as the index date. Each control patient (without atherosclerosis)
was matched with an atherosclerosis patient of the same age, region, gender, and
index year. A random index date was chosen for the control cohort to reduce selec-
tion bias. All patients were required to have continuous health plan enrollment for
12 months pre- and post-index date. One-to-one propensity score matching (PSM)
was performed to compare follow-up HRU and costs between the cohorts, adjust-
ing for demographic characteristics and the pre-index Charlson comorbidity index
(CCI) score.  Results: In each cohort, 65,933 patients were identified. The mean
age was 72 years for controls and 71 years for cases. The mean CCI score was 3.0
for both cohorts. After applying 1:1 PSM, a total of 41,233 patients were matched
from each cohort, and baseline characteristics were well-balanced. Atherosclerosis
patients incurred higher HRU compared to controls, including inpatient (17.1% vs
3.3%), outpatient (99.6% vs 70.4%), and pharmacy (91.5% vs 70.9%) (all p< 0.001) visits.
Consistent with the trend of HRU, inpatient ($8,485 vs $1,014), outpatient ($6,156
vs $2,430), pharmacy ($998 vs $595) and total ($15,639 vs $4,040) (all p< 0.001) costs
were significantly higher among atherosclerosis patients compared to control
patients.  Conclusions: Patients diagnosed with atherosclerosis incurred sig-
nificantly higher HRU and costs compared to control patients in the US veteran
population.
PCV158
An Evaluation of the Utilisation and Expenditure on Dual
Antiplatelet Therapy (DAPT) in Ireland
Daly M1, Bennett K2, Clarke S1, Barry M3
1HSE Medicines Management Programme, Dublin, Ireland, 2Royal College of Surgeons in Ireland,
Dublin, Ireland, 3National Centre for Pharmacoeconomics, Dublin, Ireland
Objectives: To investigate utilisation of dual antiplatelet therapy (DAPT) with
regards treatment combinations, duration of use, co-prescribing with high-risk
medicines and associated expenditure from 2012-2015.  Methods: A retrospec-
tive, cross-sectional study of DAPT using pharmacy claims database for the means
tested General Medical Services (GMS) scheme from January 2012 to December
2015. The GMS scheme over-represents elderly, female and younger aged popula-
tions. DAPT combinations were identified using ATC codes and the duration was
measured in a ‘new-user’ cohort. Descriptive statistics was used to analyse data
using SPSS® and Microsoft Excel®.  Results: A total of 19,771 individuals received
DAPT over the study period, 61% male and 39% female with a median age of 74
years (IQR 66-80). Aspirin and clopidogrel was the most commonly prescribed with
15,584 (78.8%) individuals followed by aspirin and prasugrel with 1,059 (5.4%) and
aspirin and ticagrelor with 947 (4.8%) individuals. Aspirin and clopidogrel remained
the most commonly prescribed DAPT combination over the study period but aspi-
rin and ticagrelor prescribing increased 100 fold over the same period. Regarding
duration of use, 45.8% received treatment for 0-6 months, 21.7% for 6-12 months
and 32.5% for > 12 months. The mean duration was 306 days (10.2 months) [95% CI
for mean 301.5-309.9]. Co-prescribing with non-steroidal anti-inflammatory drugs
decreased from 10.9% to 7.9% and anticoagulants from 3.3% to 3.1% from 2012 to
2015 respectively. Total expenditure increased from € 1,519,142 in 2012 to € 2,022,131
in 2015. Conclusions: Despite reference pricing of clopidogrel in 2013, total
expenditure on DAPT is increased over the study period due in part to an increased
use of patent-protected medicines i.e. ticagrelor. The high proportion of short (0-6
months) and extended (> 12 months) duration of DAPT identifies a lack of adherence
to international best practice guidelines. Further analysis into the reasons for these
prescribing practices in Ireland is warranted.
PCV159
Cluster-Randomized, Crossover Trial of Head Positioning in Acute
Stroke
Kanneganti S
Aster Ramesh Hospital, Guntur, India
Background: The role of supine positioning after acute stroke in improving cerebral
blood flow and the countervailing risk of aspiration pneumonia have led to varia-
tion in head positioning in clinical practice.  Methods: In a pragmatic, cluster-ran-
domized, crossover trial conducted in nine countries, we assigned 11,093 patients with
acute stroke (85% of the strokes were ischemic) to receive care in either a lying-flat
position or a sitting-up position with the head elevated to at least 30 degrees, accord-
ing to the randomization assignment of the hospital to which they were admitted; the
designated position was initiated soon after hospital admission and was maintained
for 24 hours. The primary outcome was degree of disability at 90 days, as assessed
with the use of the modified Rankin scale (scores range from 0 to 6, with higher scores
indicating greater disability and a score of 6 indicating death).  Results: The median
interval between the onset of stroke symptoms and the initiation of the assigned
position was 14 hours (interquartile range, 5 to 35). Patients in the lying-flat group
were less likely than patients in the sitting-up group to maintain the position for 24
hours (87% vs. 95%, P< 0.001). In a proportional-odds model, there was no significant
shift in the distribution of 90-day disability outcomes on the global modified Rankin
scale between patients in the lying-flat group and patients in the sitting-up group
(unadjusted odds ratio for a difference in the distribution of scores on the modified
Rankin scale in the lying-flat group, 1.01; 95% confidence interval, 0.92 to 1.10; P = 
0.84). Mortality within 90 days was 7.3% among the patients in the lying-flat group and
7.4% among the patients in the sitting-up group (P =  0.83).  Conclusions: Disability
outcomes after acute stroke did not differ significantly between patients assigned to
a lying-flat position for 24 hours and patients assigned to a sitting-up position with
the head elevated to at least 30 degrees for 24 hours.
PCV160
Patient Care Pathway for Post-Stroke Spasticity and Bont
Management in French Hospitals Through the Prism of PMSI Data
Josseran L1, Baptiste C2, Bensmail D1, Karam P3
1HOPITAL RAYMOND POINCARE, GARCHES, France, 2IPSEN, BOULOGNE, France, 3PKCS, LE VAL
SAINT PERE, France
Objectives: Stroke is the leading cause of spasticity in adults, with a significant
impact on patients’ quality of life. This study explores the incidence of spastic-
ity post-stroke, its management with botulinum toxin (BoNT), and describes the
patient care pathway over several years.  Methods: The data were extracted from
the French national PMSI (Programme Médical de Systemes d’Information) database
MCO (Medecine-Chirurgie-Obstetrique) and SSR (Soins de Suite et de Readaptation)
chained 2009-2014. The analysis describes the care pathway for stroke between 2009
and 2011; patients who died within 6 months of stoke were excluded. The coding of
spasticity was analyzed, as were the frequency of BoNT treatments. A correlation
coefficient of treatment rates was calculated by age group.  Results: In total over
the 2009-2014 period, 271,586 stroke cases were monitored. A diagnosis of spastic-
ity was made in the hospital in 9.1% of cases, with a median time to spasticity
diagnosis of 24 days post-stroke. Among spastic patients, 18% benefited from BoNT