POS0050 ARE PATIENTS WITH IMMUNE MEDIATED INFLAMMATORY DISEASES (IMID) MORE LIKELY TO RECEIVE COVID-19 TESTS AND TEST POSITIVE FOR SARS-COV-2? A MATCHED POPULATION-BASED STUDY

Background:

Population-based data about the COVID-19 risk in patients with IMID remain scarce.

Objectives:

To investigate the cumulative incidence and risk factors for laboratory-confirmed COVID-19 infection and SARS-CoV2 testing in patients with IMID compared with matched non-IMID patients from the general population.

Methods:

A population-based, matched cohort study was conducted using health administrative data from adults living in Ontario, Canada from January to December 2020. Cohorts for each of the following IMID were assembled: rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis, systemic autoimmune rheumatic diseases (including lupus, systemic sclerosis, Sjogren’s, inflammatory myositis), multiple sclerosis (MS), iritis, inflammatory bowel disease (IBD), polymyalgia rheumatica (PMR) and vasculitis. Each patient was matched with 5 non-IMID comparators based on age, sex, area of residence and living in long term care (LTC). Standardized cumulative rates of testing for SARS-CoV2, and for receiving a positive test between IMID and non-IMID were compared between IMID and non-IMID patients. Multivariable logistic regression analyses assessed sociodemographic factors associated with COVID-19 testing and positivity.

Results:

A total of 493,499 IMID patients and 2,466,946 non-IMID comparators were assessed. Significantly more IMID patients versus non-IMID were tested for SARS-CoV2 (27.4% vs. 22.7%), while the proportions of those positive for COVID-19 were identical (0.9% of all patients in both groups). Overall, IMID patients were more likely to undergo SARS-CoV2 testing (odds ratio (OR) 1.28, 95% CI 1.27, 1.29), but their overall risk of laboratory-confirmed COVID-19 was not elevated (OR 0.97 (95% CI 0.93, 1)). However, the risk of laboratory-confirmed COVID-19 infection was lower in IBD (OR 0.75), MS (OR 0.77) and psoriasis (OR 0.94) and marginally higher in RA (OR 1.07) and iritis (OR 1.13) compared with non-IMID comparators (Figure 1A). The highest standardized rates of COVID-19 infection were found in vasculitis (115 per 10,000 patients) and iritis (109 per 10,000 patients) (Figure 1B). Risk factors for COVID-19 infection included younger age, living in LTC, multimorbidity, urban living and lower income (Table 1).

Conclusion:

Patients across all IMID were more likely to be tested for COVID-19 versus non-IMID patients. IMID patients were not at higher risk for testing positive for COVID-19 as an overall group, yet risk varied across disease subgroups.

Table 1.

Factors associated with COVID-19 infection in IMID vs. Non-IMID – Multivariable Logistic Regression

VariableORCI 95%IMID vs. Non-IMID0.970.93, 1.00Age (10-year increase)0.890.89, 0.90Sex: Female vs. Males0.950.93, 0.97LTC18.6417.9, 19.42ADG score:•5-9 vs. 0-41.401.35, 1.45•10-14 vs. 0-41.731.67, 1.80•15+ vs. 0-41.181.13, 1.23Urban vs. Rural3.493.26, 3.72Income quintile•Quintile 2 vs. 10.920.89, 0.96•Quintile 3 vs. 10.900.86, 0.93•Quintile 4 vs. 10.730.70, 0.76•Quintile 5 vs. 10.600.58, 0.63

ADG - Aggregated Diagnosis Groups; IMIDs – Immune medicated inflammatory disease; LTC – long term care

Acknowledgements:

The study is supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and information compiled and provided by MOHLTC and the Canadian Institute for Health Information. The opinions, results and conclusions reported in this paper are those of the authors and are independent of the funding or data sources; no endorsement is intended or should be inferred.

Disclosure of Interests:

None declared.

OP0285 COVID-19 HOSPITALIZATIONS, ICU ADMISSION, AND DEATH AMONG PATIENTS WITH IMMUNE MEDIATED INFLAMMATORY DISEASES (IMID) – A POPULATION-BASED STUDY

Background:

It remains unclear whether patients with IMID are at greater risk for severe COVID-19.

Objectives:

To investigate the risk of COVID-19 hospitalizations and their outcomes in patients with IMID compared with matched non-IMID patents from the general population.

Methods:

A population-based, matched cohort study was conducted in adults living in Ontario, Canada using health administrative data. Ten cohorts of the following IMID were assembled: rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, systemic autoimmune rheumatic diseases (SARDs, including systemic lupus, systemic sclerosis, Sjogren’s, myositis), multiple sclerosis (MS), iritis, inflammatory bowel disease, polymyalgia rheumatica (PMR), and vasculitis (including giant cell arteritis and other types of vasculitidies). Each patient was matched with 5 non-IMID comparators based on age, sex, area of residence and living in long-term care (LTC). Patients who were admitted to hospital from January 1st to July 31th, 2020 and had ICD-10 COVID-19 diagnosis codes (U07.2 or U07.1) were identified. Among those with COVID-19 hospitalizations, we determined those with admissions to intensive care unit or required mechanical ventilation or died in hospital (‘complicated hospitalization’). Age-sex-standardized rates were compared between IMID and non-IMID patients and risk factors for hospitalizations were identified by multivariable logistic regression analysis.

Results:

In total, 493,499 IMID (417 hospitalized) and 2,466,946 non-IMID patients (1,519 hospitalized) were assessed. The age-sex-standardized rate of COVID-19 hospitalization was higher in IMID (6.4 per 10,000, 95% confidence interval (CI) 5.8, 7.2) versus non-IMID patients (4.8 per 100,000, 95% CI 4.5, 5). The highest rates of hospitalizations were found in vasculitis (18/10,000), MS (16.7/10,000) and PMR (10.1/10,000). IMID diagnosis was associated with 37% higher risk of being hospitalized for COVID-19 (Odds Ratio (OR) 1.37, 95% CI 1.23, 1.53) (Figure 1). This risk was slightly attenuated after adjusting for sociodemographic factors and comorbidities but remained elevated by 23% compared to non-IMID (OR 1.23, 95% CI 1.10, 1.37). The risk for hospitalizations was increased in RA, vasculitis, SARDs, PsA, MS and iritis (Figure 1). Risk factors for COVID-19 hospitalizations included older age, male sex, lower income, multimorbidity and living in long-term care (Table 1). The risk for complicated COVID-19 hospitalizations was higher by 21% in IMID patients (OR 1.21, 95% CI 1.02, 1.43), however, this association was attenuated after adjustment for demographics and comorbidities (OR 1.08).

Table 1.

Risk Factors for COVID-19 Hospitalizations in IMIDs vs. non-IMIDs

VariableOR95% CIIMIDs vs. Non-IMID1.231.10, 1.37Age (10 yrs)1.491.44, 1.54Sex: Female0.680.62, 0.75Long term care resident8.287.32, 9.37ADG: 5-9 vs. 0-41.451.22, 1.7110-14 vs. 0-42.261.92, 2.6715+ vs. 0-43.232.73, 3.82Income (quintile) Quintile 2 vs. 10.820.73, 0.93 Quintile 3 vs. 10.760.67, 0.86 Quintile 4 vs. 10.560.48, 0.64 Quintile 5 vs. 10.460.40, 0.54Urban vs. rural4.333.32, 5.67

ADG - Aggregated Diagnosis Groups

Conclusion:

Patients with IMID were at higher risk of being hospitalized with COVID-19 and for having complicated hospitalizations. Hospitalization risk was partially independent of their comorbid conditions.

Acknowledgements:

The study is supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and information compiled and provided by MOHLTC and the Canadian Institute for Health Information. The opinions, results and conclusions reported in this paper are those of the authors and are independent of the funding or data sources; no endorsement is intended or should be inferred.

Disclosure of Interests:

None declared

Incidence of febrile neutropenia during adjuvant chemotherapy for breast cancer: a prospective study

We read with great interest the recent article by Madernas et al [...]

The cost burden of trastuzumab and bevacizumab therapy for solid tumours in Canada

OBJECTIVE

Monoclonal antibodies (MAbs) such as trastuzumab and bevacizumab have become important yet expensive components of systemic cancer therapy across a variety of disease sites. We assessed the potential cost implications of adopting trastuzumab and bevacizumab therapy in the context of their potential utilization in breast, lung, and colorectal cancers.

DESIGN

We first estimated MAb costs per patient and treatment indication and then included the MAb acquisition cost and the costs of medical resource utilizations required for therapy delivery. Drug costs were based on 2005 average Canadian wholesale prices, assuming full drug delivery and uncomplicated cycles. A direct-payer perspective was undertaken, and results are reported in Canadian dollars. Potential lifetime costs were then derived according to constructed schema, which account for absolute numbers of target patients and systemic therapy utilization. We subsequently estimated costs of MAb therapy relative to total costs of conventional management without MAb therapy.

RESULTS

Trastuzumab costs $49,915 and $28,350 per patient treated in the adjuvant and metastatic breast cancer settings, respectively; bevacizumab costs $48,490 and $39,614 per patient treated in the metastatic lung and colorectal cancer settings, respectively. Potential lifetime absolute costs to Canada's health care system were approximately $127 million and $299 million for trastuzumab and bevacizumab respectively, corresponding to an average increase in health care expenditure of approximately 19% for breast cancer and 21% for lung and colorectal cancer over conventional management without MAbs.

CONCLUSIONS

Novel Mab-based therapies such as trastuzumab and bevacizumab will likely add a significant cost burden to Canada's publicly funded health care system.

Comparison of production systems and selection criteria of Ankole cattle by breeders in Burundi, Rwanda, Tanzania and Uganda

A survey in Burundi, Rwanda, Tanzania and Uganda was conducted in order to determine the different production systems under which Ankole cattle are currently kept. Additionally, selection criteria of livestock keepers were documented. In Burundi, Rwanda and parts of Uganda, livestock keepers are sedentary and herds are small, whereas in the other areas Ankole cattle are kept in large herds, some of them still under a (semi-)nomadic system. Milk is the main product in all areas, and is partly for home consumption and partly for sale. Although the production systems vary in many aspects, the selection criteria for cows are similar. Productive traits such as milk yield, fertility and body size were ranked highly. For bulls, the trait 'growth' was ranked highly in all study areas. Phenotypic features (coat colour, horn shape and size) and ancestral information are more important in bulls than in cows. The only adaptive trait mentioned by livestock keepers was disease resistance. In areas of land scarcity (Burundi, Rwanda, western Uganda), a clear trend from pure Ankole cattle towards cross-bred animals can be observed.

The cost burden of trastuzumab and bevacizumab monoclonal antibody therapy in solid tumors: Can we afford it?

6044

Background: Monoclonal antibodies (MAb), such as trastuzumab (TZ) and bevacizumab (BZ), have become an important yet expensive component of cancer treatment. The potential cost impact on health care budgets needs to be assessed in the context of its potential utilization. An estimate of the additional costs incurred by adopting TZ and BZ therapy in breast (BRC), lung (LUC) and colorectal (CRC) cancers was undertaken. Methods: The MAb costs per patient were estimated based on treatment indications, length of treatment, standard doses / schedules and local pharmacy data. Supportive medications, diagnostics and health resources utilization only required for the MAb therapy were also examined. This analysis was performed in Canadian dollars ($), and assumes complete drug delivery and uncomplicated cycles. Drug costs were based on average 2005 wholesale prices in Canada. The analysis took a direct payer perspective. We subsequently estimated the cost of MAb therapy per patient relative to the total costs of conventional cancer management without MAb therapy. Budget impact estimates on Canada’s health care system were then derived according to constructed schema, which accounts for absolute numbers of target patients and systemic therapy utilization. Results: The average costs of TZ per treated patient were $47,278 and $26,648 for adjuvant and metastatic BRC, respectively. For BZ, these were $47,250 and $38,500 for metastatic LUC and CRC, respectively. Other costs associated with MAb therapy were in the range of 3–6%. The predicted TZ drug costs in metastatic breast cancer were within 10% of the actual costs derived from pharmacy data. The potential life-time absolute costs to Canada’s health care system were approximately $118 million for TZ, and $262 million for BZ. This corresponds to an average of approximately 21% increase in the health care expenditure for BRC, LUC, and CRC. Conclusions: MAb therapy, such as TZ and BZ, may add a significant cost burden to Canada’s publicly funded health care system. The developed schema in this analysis may be of potential use to health care providers and policy makers in assessing the impact of MAb therapy on health care budgets.

No significant financial relationships to disclose.

View from a cancer center

As part of Healthplan's genomics series, we have sought opinion and perspective from various sectors of health care. Articles in past issues have reflected both the enthusiasm and optimism of the genomics industry as well as the caution and concerns of health plan medical directors confronted with the question of who will pay for the new genetic services and treatments and--more importantly--how they will truly benefit patients. In this issue, we publish the perspective and goals of doctors and researchers at a renowned cancer center. As our series unfolds, it is becoming increasingly clear that a national dialogue is needed on the important questions raised by the authors in our genomic series. Readers are encouraged to send their views on this topic to Healthplan.

Parental opinions about attending parent support groups

Parent support groups are often a routine part of the services provided to families who have children with special health care needs. Often times, however, the groups are poorly attended, despite expressions of interest from parents. A survey of 45 families was conducted to examine who participates, why, and what factors encourage attendance. This article describes the survey responses and offers suggestions regarding utilization of the results for those planning parent support groups.