Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus living in Puerto Rico

This is a descriptive study using healthcare claims data from patients with T2DM from public and private healthcare insurance companies providing services in Puerto Rico in 2013, aimed to estimate the prevalence of comorbidities in this population. Descriptive analyses were performed by sociodemographic, and type of service variables using frequency and percent for categorical data or means (+/-SD) or median (IQR) for continuous variables. Chi-square, Fisher exact or two-sample t-tests were used for comparisons. A total of 3,100,636 claims were identified from 485,866 adult patients with T2DM. Patients older than 65 years represented 48% of the study population. Most patients were women (57%) and had private health insurance (77%). The regions of Metro Area (17%) and Caguas (16%) had the higher number of persons living with T2DM. The overall estimated prevalence of T2DM was 17.4%. The number of claims per patient ranged from 1 to 339. A mean of 6.3 claims (SD±9.99) and a median of 3 claims (Q1 1- Q3 8) per subject were identified. Of the 3,100,636 claims most (74%) were related to the diagnosis of diabetes (59%) and associated to outpatient services (88%). The most prevalent comorbidities were hypertension (48%), hyperlipidemia (41%), neuropathy (21%); renal disease (15%), and retinopathy (13%). A high prevalence and co-prevalence of comorbidities and use of healthcare services were identified in patients with T2DM, especially in older adults. Since most comorbidities were due to diabetes-related conditions, this analysis highlights the importance of early diagnosis and adequate management of T2DM patients to avoid preventable burden to the patient and to the healthcare system.

1240. Hepatitis A in Latin America and the Caribbean: a Systematic Literature Review on Endemicity Patterns and Immunization Programs

Background

In 2019, hepatitis A virus (HAV) infections caused around 39,600 deaths worldwide. Age-specific seroprevalence is used as a marker to classify endemicity. In countries with intermediate endemicity, WHO recommends universal HAV vaccination for children ≥1 year considering local disease burden and cost-effectiveness analyses. This review aimed to describe the endemicity patterns and HAV immunization programs in Latin America and the Caribbean (LAC).

Methods

We conducted a systematic literature review using MEDLINE, Embase, CENTRAL, CDRS, Lilacs, and Scopus from January 2005 to December 2021. Additionally, we searched grey literature, including Pan American Health Organization/WHO country profiles and official government websites in January 2022. The main outcomes were HAV seroprevalence and characteristics of HAV immunization programs.

Results

We identified 30 studies containing data on HAV seroprevalence in LAC and 13 records from grey literature on HAV vaccination program. As of January 2022, among 33 countries, 8 had public universal childhood HAV vaccination program and 12 had programs for at least one population at-risk (Figure 1 and Table 1). Only 7 countries had seroprevalence data available (Figure 2). Using WHO criteria, 5 countries were classified as intermediate endemicity; 2 have already introduced HAV vaccination in the NIP (Brazil and Colombia) and 3 have not introduced yet (Bolivia, Mexico, and Peru). In Argentina and Brazil, studies conducted in certain populations at risk, such as men who have sex with men and healthcare workers aged between 20-40 years, showed higher susceptibility to infection (seroprevalence: 40%-60%). Figure 1.Hepatitis A routine immunization schedule in national immunization programs in Latin America and the Caribbean, 2022

a Available for Guatemalan Social Security Institute (employed people in formal sector), which represents 17% of total population. b Countries that included in national immunization program for at least one population at risk Table 1.Characteristics of hepatitis A immunization programs in Latin America and the Caribbeana Populations at risk: 2-dose schedule; b Partial introduction in 2014 in endemic areas; c only available for Guatemalan Social Security Institute (formally employed population), which represents 17% of total populationFigure 2.Hepatitis A endemicity level in studies conducted in Latin America and the Caribbean based on WHO classification criteriaa general population; b premarital exam; c health care workers; d children school; e liver cirrhosis; f national survey; g samples from labs, h beauticians; i population-based survey; j chronic HCV infection; k rural settlement; l low socioeconomic groups; m chronic HCV infection; n men who have sex with men/ transgender women. Mantovani 2015 and Pereira 2016 are included in the review and not showed here (description of prevalence < 5 y)

Conclusion

Eight countries had universal HAV vaccination program and 12 offered for at least one population at-risk. LAC countries where HAV seroprevalence was available showed predominance of intermediate endemicity. Bolivia, Mexico, and Peru would benefit from universal childhood vaccination, and Argentina and Brazil should evaluate increasing susceptibility among adults at-risk to expand access to vaccination. In countries without recent data, surveillance of acute cases/outbreaks and seroprevalence studies are needed to guide the HAV vaccination implementation.

Disclosures

Cintia I. Parellada, MD, PhD, MSD Brazil: Employee of MSD Brazil, a subsidiary of Merck & Co., Inc.,|MSD Brazil: Stocks/Bonds Emilia Prieto, MD, MSc, MSD Colombia: Employee of MSD Colombia, a subsidiary of Merck & Co., Inc.,|MSD Colombia: Stocks/Bonds Cristina Carias, PhD, Merck & Co., Inc.: Employee|Merck & Co., Inc.: Stocks/Bonds Martha Carolina Valderrama, MD, Msc, IQVIA: Advisor/Consultant|IQVIA: Employee of IQVIA who received funding to execute this study Daniel Samacá-Samacá, Msc, IQVIA: Advisor/Consultant|IQVIA: Employee of IQVIA who received funding to execute this study Fabian Hernandez, BSPharm, Msc, IQVIA: Employee of IQVIA who received funding to execute this study Homero Monsanto, PhD, Merck & Co., Inc.: Employee.

Value Assessment Frameworks in Latin America: "Il buono, il brutto e il cattivo"

OBJECTIVES

Using a taxonomy previously developed, we assessed the strengths and limitations of available value assessment frameworks (VAF) in Latin America.

METHODS

Systematic review of peer-reviewed journals, gray literature review, and surveys to ISPOR Latin America Industry Committee members were done to identify and select current VAF. Once selected, independent reviewers, organized by pairs, assessed each framework's input, methodology, and outputs.

RESULTS

We assessed 7 of 9 VAF in the region, excluding 2 that were not currently in use. The review included 1 framework developed by a regional entity, and 6 country frameworks for either price assessment or to inform reimbursement. Most of these frameworks had a clear definition of the purpose (6 of 7) but could provide more details on the conceptual approach, including perspectives, methods for obtaining preferences, and the ability to incorporate multiple value dimensions (2 of 7). Most lacked information about inclusions/exclusions of elements included in the framework, and whether it assumes a base case comparator and how it is selected. The description of the evaluation of data sources and their scientific validity was inconsistently reported (3 of 7). Few included an assessment of the intervention's effect on total costs of treating a defined population (2 of 7), or a description of how uncertainty could be incorporated (3 of 7). Finally, potential conflicts of interest among those creating the framework are not sufficiently addressed (0 of 7).

CONCLUSIONS

In the 7 frameworks assessed in Latin America, there are opportunities to improve dimensions, methods, and scope. Addressing these issues will strengthen these VAF for policy and clinical decision making.

Budget impact analysis of multiple varicella vaccination strategies: a Mexico perspective

A number of live-attenuated varicella vaccines are produced globally that provide protection against the varicella zoster virus. In Mexico, varicella vaccination is not included in the national immunization program and is recommended for use only in high-risk subgroups. We developed a budget impact model to estimate the impact of universal childhood immunization against varicella on the national payer system in Mexico. A scenario of no varicella vaccination was compared to scenarios with vaccination with a single dose at 13 months of age, in alignment with the existing program of immunization with the measles-mumps-rubella vaccine. Nine different vaccination scenarios were envisioned, differing by vaccine type and by coverage. Varicella cases and treatment costs of each scenario were computed in a dynamic transmission model of varicella epidemiology, calibrated to the population of Mexico. Unit costs were based on Mexico sources or were from the literature. The results indicated that each of the three vaccine types increased vaccine acquisition and administration expenditures but produced overall cost savings in each of the first 10 years of the program, due to fewer cases and reduced varicella treatment costs. A highly effective vaccine at 95% coverage produced the greatest cost savings.

Comorbidities in a sample of adults with HIV in Puerto Rico: an exploratory study

Background

Puerto Rico is among the areas with the highest estimated rates of people living with HIV in the United States. Despite the epidemiologic data available, there is limited real-world information that can help understand the comorbidities of people with HIV. In this study, we describe common comorbidities among adults with HIV attending treatment clinics in Puerto Rico.

Methods

An exploratory, retrospective, cross-sectional study was conducted at five HIV clinics in Puerto Rico. A random sample of medical records was reviewed. Descriptive statistics were used to summarize patient demographics, morbidity, and clinical characteristics. Multivariate analyses were conducted to explore comorbidities by age and sex.

Results

A total of 250 (179 men; 71 women) medical records were reviewed. Participants’ mean age was 47.9 years and on average they had been living with HIV for 9 years. Most (97.6%) had at least one comorbidity. The most common comorbidities were dyslipidemia and hypertension. Men were more likely to have been diagnosed with alcohol misuse while women were more likely to have been diagnosed with obesity, human papillomavirus (HPV), hypothyroidism, and osteoporosis. Participants younger than 50 years of age were more likely to have history of alcohol misuse while older individuals (50 years and old) were more likely to have been diagnosed with dyslipidemia, hypertension, and diabetes. Adjusting by sex and age, women were more likely to have been diagnosed with obesity and depression and those older than 50 years were more likely to have had a diagnosis of dyslipidemia, hypertension, HPV, and diabetes.

Conclusions

This is one of the few studies assessing comorbidities among adults with HIV in Puerto Rico, among Latino/Hispanics within the United States, and Latin America. Consistent with other studies, cardiovascular diseases are common among adults with HIV in Puerto Rico. Findings support the need for awareness and real-world evidence about comorbidities among people with HIV when implementing screenings and prescribing drugs.

Estudio retrospectivo que evalúa la carga de la varicela en México en menores de 1-14 años tratados en 10 sitios

OBJETIVO: Evaluar la carga clínica y económica de la varicela en pacientes mexicanos de 1-14 años.MÉTODOS: Estudio retrospectivo, multicéntrico, de expedientes clínicos de pacientes de 1-14 años con diagnóstico de varicela primaria atendidos del 2011 al 2016 en 10 sitios. Los costos directos e indirectos individuales (dólares americanos al tipo de cambio promedio de 2017) se calcularon a partir del uso de recursos de atención médica, los gastos pagados por los padres o tutores del paciente y la pérdida de trabajo de los cuidadores. Los costos sociales anuales se estimaron para un escenario base multiplicando los costos por paciente por la incidencia promedio de la varicela según el Sistema Único de Información para la Vigilancia Epidemiológica (SUIVE).RESULTADOS: Se incluyeron los expedientes clínicos de 152 pacientes con varicela: 75 ambulatorios y 77 hospitalizados. Estos últimos reportaron tasas de complicaciones más altas (84.4 vs 6.7%), requirieron más medicamentos recetados y de venta libre (94.8 vs 80.0%; 71.4 vs 80.0%, respectivamente), análisis y procedimientos (87.0 vs 5.3%). Los costos directos e indirectos se calcularon en 198.3 y 42.3 dólares por paciente ambulatorio, y en 5611 y 175.2 dólares por paciente hospitalizado, respectivamente.CONCLUSIÓN: Existe una carga clínica y económica considerable entre los menores de edad con varicela primaria en México. Estos resultados destacan la necesidad de implementar un programa de vacunación infantil contra la varicela.PALABRAS CLAVE: Niño; varicela; vacunación; México; carga económica de la enfermedad; uso de recursos de atención médica

Economic burden of varicella in children 1-12 years of age in Argentina, 2009-2014

BACKGROUND

In Argentina, varicella vaccination was included in the national schedule for mandatory immunizations in 2015. The vaccine has been shown to substantially reduce the morbidity and mortality associated with the virus. The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Argentina prior to vaccine introduction.

METHODS

This was a multi-center, retrospective chart review study among patients aged 1-12 years with a primary varicella diagnosis in 2009-2014 in Argentina. Healthcare resource utilization (HCRU) associated with varicella and its complications, unit costs, and work loss were used to estimate direct and indirect costs. All costs are presented in 2015 United States dollars (USD).

RESULTS

One hundred and fifty children with varicella were included (75 outpatients, 75 inpatients), with a mean age of 3.8 (SD = 2.4) and 2.9 (SD = 2.2) years, respectively. One or more complications were experienced by 28.0% of outpatients and 98.7% of inpatients, the most common being skin and soft tissue infections, pneumonia, sepsis, cerebellitis, and febrile seizure. HCRU estimates included use of over-the-counter (OTC) medications (58.7% outpatients, 94.7% inpatients), prescription medications (26.7% outpatients, 77.3% inpatients), tests/procedures (13.3% outpatients, 70.7% inpatients), and consultation with allied health professionals (1.3% outpatients, 32.0% inpatients). The average duration of hospital stay was 4.9 (95% CI = 4.2-5.7) days, and the average duration of ICU stay was 4.8 (95% CI = 1.6-14.1) days. The total combined direct and indirect cost per varicella case was 2947.7 USD (inpatients) and 322.7 USD (outpatients). The overall annual cost of varicella in Argentina for children aged ≤14 years in 2015 was estimated at 40,054,378.0 USD.

CONCLUSION

The clinical burden of varicella in Argentina was associated with utilization of significant amounts of healthcare resources, resulting in substantial economic costs. These costs should be reduced with the recent implementation of routine vaccination of children.

Association between work time loss and quality of life in patients with Herpes Zoster: a pooled analysis of the MASTER studies

Background

Herpes zoster (HZ) has a significant negative effect on the productive work life of individuals, and has been shown to be responsible for cases of absenteeism, presenteeism and decreased work effectiveness. The aim of this study was to evaluate health utility scores and associated predictors in an actively employed population of Herpes Zoster (HZ) patients with and without work time loss (WTL).

Methods

This was a pooled analysis of the prospective, observational MASTER cohort studies, conducted in 8 countries across North America, Latin America and Asia. A total of 428 HZ patients engaged in full or part time work were included. WTL, defined as missing ≥ 1 partial or full work day, and work effectiveness, reported on a scale of 0–100%, were evaluated with the Work and Productivity Questionnaire (WPQ). The Pearson product–moment correlation was used to assess the correlation between work effectiveness and HRQoL. Mixed models with repeated measures assessed the relationship between HZ-related WTL over a 6-month follow-up period, and HRQoL, as evaluated by the EQ-5D. Additional predictors of HRQoL were also identified.

Results

Overall, 57.7% of respondents reported WTL. Mean (SD) percent work effectiveness of patients in the WTL group was significantly lower compared to non-WTL (NWTL) patients at baseline [50.3 (31.6) vs. 71.4 (27.8); p < 0.001]. Patients in the WTL group also reported lower health utility scores at baseline and overall than their NWTL counterparts, with WTL identified as an independent negative predictor of both the EQ-5D summary scores and the EQ-5D VAS (p < 0.001). Decrease in work effectiveness was negatively associated with HRQoL overall (p < 0.001). Predictors of lower HRQoL were worst Zoster Brief Pain Inventory (ZBPI) pain score, the presence of HZ complications and country income (predictor of EQ-5D VAS only).

Conclusions

HZ adversely impacts the work and productive life of actively employed individuals. In turn, HZ-related reductions in work effectiveness and work time are associated with a negative effect on HRQoL.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0588-x) contains supplementary material, which is available to authorized users.

Predictors of postherpetic neuralgia in patients with herpes zoster: a pooled analysis of prospective cohort studies from North and Latin America and Asia

OBJECTIVES

The most common complication of herpes zoster (HZ) is postherpetic neuralgia (PHN), a persistent pain that can substantially affect quality of life (QoL). This analysis aimed to evaluate predictors of PHN in HZ patients.

METHODS

A pooled analysis of prospective cohort studies of HZ patients aged ≥ 50 years from North America (Canada), Latin America (Brazil, Mexico, and Argentina), and Asia (Taiwan, South Korea, and Thailand) was performed. Patients within 14 days of rash onset were included. The incidence of PHN was defined as a worst pain score of ≥ 3, persisting/appearing at >90 days after rash onset. Socio-demographics, HZ disease characteristics, treatment, pain-related interference with activities of daily living, and health-related QoL were assessed.

RESULTS

Of 702 patients with HZ, 148 (21.1%) developed PHN. Similar risks of PHN were observed across geographic regions. On multivariate analysis, older age, greater severity of pain at rash onset, employment status, walking problems at enrollment, and pain interference affecting social relationships were significantly associated with the development of PHN.

CONCLUSIONS

In addition to older age and severe acute pain, this study suggests that impaired physical and social functioning from acute zoster pain may play a role in the development of PHN in this prospective cohort study of HZ patients from North and Latin America and Asia.