Epidemiology, Comorbidities, and Treatment of Cyclic Vomiting Syndrome in the United States

INTRODUCTION

Cyclic vomiting syndrome (CVS) imposes a substantial burden, but epidemiological data are scarce. This study aimed to estimate the incidence and prevalence of CVS, comorbid conditions, and treatment patterns, using administrative databases in the United States.

METHODS

This cross-sectional study used claims data from Merative MarketScan Commercial/Medicare Supplemental and Medicaid databases in all health care settings. Incidence and prevalence rates for 2019 were calculated and stratified by age, sex, region, and race/ethnicity. Patient characteristics were reported among newly diagnosed patients with CVS (i.e., no documented claims for CVS before 2019). CVS was defined as having 1+ inpatient and/or 2+ outpatient CVS claims that were 7+ days apart.

RESULTS

The estimated prevalence of CVS was 16.7 (Commercial/Medicare) and 42.9 (Medicaid) per 100,000 individuals. The incidence of CVS was estimated to be 10.6 (Commercial/Medicare) and 26.6 (Medicaid) per 100,000 individuals. Both prevalence and incidence rates were higher among female individuals (for both Commercial/Medicare and Medicaid). Comorbid conditions were common and included abdominal pain (56%-64%), anxiety (32%-39%), depression (26%-34%), cardiac conditions (39%-42%), and gastroesophageal reflux disease (30%-40%). Despite a diagnosis of CVS, only 32%-35% had prescriptions for prophylactic treatment and 47%-55% for acute treatment within the first 30-day period following diagnosis.

DISCUSSION

This study provides the first population-level estimates of CVS incidence and prevalence in the United States. Comorbid conditions are common, and most patients with CVS do not receive adequate treatment. These findings underscore the need for improving disease awareness and developing better screening strategies and effective treatments.

Comparative Effectiveness of Bivalent (Original/Omicron BA.4/BA.5) COVID-19 Vaccines in Adults

The emergence of Omicron variants coincided with declining vaccine-induced protection against SARS-CoV-2. Two bivalent mRNA vaccines, mRNA-1273.222 (Moderna) and BNT162b2 Bivalent (Pfizer-BioNTech), were developed to provide greater protection against the predominate circulating variants by including mRNA that encodes both the ancestral (original) strain and BA.4/BA.5. We estimated their relative vaccine effectiveness (rVE) in preventing COVID-19-related outcomes in the US using a nationwide dataset linking primary care electronic health records and pharmacy/medical claims data. The study population (aged ≥18 years) received either vaccine between 31 August 2022 and 28 February 2023. We used propensity score weighting to adjust for baseline differences between groups. We estimated the rVE against COVID-19-related hospitalizations (primary outcome) and outpatient visits (secondary) for 1,034,538 mRNA-1273.222 and 1,670,666 BNT162b2 Bivalent vaccine recipients, with an adjusted rVE of 9.8% (95% confidence interval: 2.6-16.4%) and 5.1% (95% CI: 3.2-6.9%), respectively, for mRNA-1273.222 versus BNT162b2 Bivalent. The incremental relative effectiveness was greater among adults ≥ 65; the rVE against COVID-19-related hospitalizations and outpatient visits in these patients was 13.5% (95% CI: 5.5-20.8%) and 10.7% (8.2-13.1%), respectively. Overall, we found greater effectiveness of mRNA-1273.222 compared with the BNT162b2 Bivalent vaccine in preventing COVID-19-related hospitalizations and outpatient visits, with increased benefits in older adults.

Abstract 942: Real-world demographics, baseline characteristics, healthcare resource utilization and costs amongst non-small cell lung cancer (NSCLC) patients tested with a Host Immune Classifier (HIC)

Background: The Host Immune Classifier is a proteomic test that identifies a chronic inflammatory disease state for patients diagnosed with NSCLC. The test stratifies patients into two groups, HIC-H and HIC-C and helps evaluate patient prognosis and response to treatment. While much work has been done to evaluate the clinical validity of the HIC test, to date, no recent real-world studies have described healthcare resource utilization (HCRU) and costs amongst patients utilizing the test. This subset analysis of HIC claims examined demographic and baseline clinical characteristics among patients with lung cancer using the HIC proteomic test as well as HCRU and costs prior to test use.

Methods: This retrospective claims analysis utilized MarketScan® Commercial and Medicare Supplemental Databases using data from January 1, 2016 to June 30, 2021 linked to Biodesix data files of HIC test results. Patients were age 18 or older on index date (date of HIC testing), underwent a HIC proteomic test, were continuously enrolled in the MarketScan database for the 6-months before index (pre-index period), and had at least one non-diagnostic medical claim of lung cancer during the pre-index period. Clinical characteristics and HCRU and costs were measured per patient per month (PPPM) during the pre-index period and compared between HIC-H and HIC-C cohorts.

Results: Of the 328 included patients, 260 patients were HIC-H and 68 were HIC-C. On index, 178 patients had non-metastatic lung cancer and 150 patients had metastatic lung cancer. When assessing lung cancer related comorbid conditions, significantly more HIC-C patients had empyema (3% vs 0%, P<0.05) and pneumonia (34% vs 19%, P<0.05). When examining HCRU in patients prior to the HIC test, significantly more HIC-C patients had an outpatient visit with an oncologist (40% vs 27%, P<0.05) or a primary care physician (71% vs 56%, P<0.05). Total costs and inpatient costs were higher amongst HIC-C patients ($10,299 vs $9,689 and $4,032 vs $3,218, respectively) although not significant. While fewer HIC-C patients underwent lung biopsy (41% vs 53%), HIC-C patients had significantly higher biopsy costs than HIC-H patients ($1,285 vs $400, P<0.05). Although not statistically significant, more HIC-C patients had an inpatient admission (47% vs 38%) and longer average length of stay (5.3 vs 4.2 days).

Conclusion: Patients with NSCLC who are identified as HIC-C have higher HCRU and costs, including lung cancer workup costs, prior to HIC testing. Further analyses are planned to determine long-term clinical outcomes, HCRU, and costs amongst patients post-testing.

Citation Format: Wade Iams, Kimberly Le, Nicole Princic, Isabelle Winer, Taylor Marlin. Real-world demographics, baseline characteristics, healthcare resource utilization and costs amongst non-small cell lung cancer (NSCLC) patients tested with a Host Immune Classifier (HIC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 942.

2163. RSV-related hospitalization and outpatient palivizumab use in very preterm (born at < 29 wGA) infants: 2003-2020

Background

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and pneumonia in children under one year and the leading cause of infant hospitalization. Palivizumab was approved by the FDA in 1998 as RSV immunoprophylaxis (RSV-IP) to prevent severe RSV disease in children with specific health conditions and those born at < 35 weeks gestational age (wGA). Though RSV-IP recommendations have changed over time, RSV-IP has been consistently recommended in very preterm infants (< 29 wGA) since palivizumab approval. This study's objective is to compare RSV-related hospitalization (RSVH) and RSVH characteristics in very preterm and term ( > 37 wGA) infants.

Methods

Using the MarketScan Commercial and Multi-State Medicaid administrative claims databases, very preterm and term infants born between 7/1/2003 and 6/30/2020 were identified and classified as very preterm or term using diagnosis codes. Infants with evidence of health conditions such as congenital heart disease and cystic fibrosis were excluded. During 2003-2020 RSV seasons (November to March), claims incurred by infants while they were < 12 months old were evaluated for outpatient administration of palivizumab and RSVH. RSVH was identified in infants with an inpatient claim with an RSV diagnosis. Rate of RSVH during the first 12 months of life was calculated and compared in very preterm and term infants; the proportion of very preterm infants with an outpatient administration of palivizumab was also calculated.

Results

The study included 40,123 very preterm infants and 4,421,942 term infants. Rate of RSVH in very preterm infants ranged 1.5-3.8 per 100 infant seasons in Commercially insured infants and 3.5-8.4 in Medicaid insured infants. Relative risk of RSVH in very preterm was 3-4 times higher than term infants and was inversely related to wGA at birth (Figure 1). ICU admissions and mechanical ventilation were more common during RSVH in very preterm infants (Table 1); these outcomes were less common in very preterm infants with outpatient palivizumab administration (Table 2). Figure 1.Relative risk of RSVH in very preterm vs. term infantsTable 1.RSVH characteristics of term and very preterm infants by payerTable 2.RSVH characteristics of very preterm infants by palivizumab use and payer

Conclusion

Rates of RSVH are significantly higher and RSVH is more severe in very preterm infants than in term infants. Among very preterm infants, RSVH was less severe in infants with outpatient palivizumab administration.

Disclosures

Elizabeth Packnett, MPH, IBM Watson Health: Employee|Sobi: Contracted IBM Watson Health to conduct the study. Isabelle Winer, MPH, IBM Watson Health: employee|Sobi: contracted IBM Watson Health to conduct study David R. Diakun, BS, Sanofi: Employed by IBM Watson Health which was contracted by Sanofi to perfom outcomes research|Sobi: Employed by IBM Watson Health which was contracted by Sobi to conduct the study Abiola Oladapo, PhD, Sobi Inc: Employee Tara L. Gonzales, MD, Sobi, NA: Employee Matthew Wojdyla, PharmD, Sobi: Employee.

Assessment of immune biomarkers and establishing a triple negative phenotype in gynecologic cancers

OBJECTIVE

Immuno-oncology (IO) has rapidly evolved, with many IO therapies either approved or under investigation for multiple malignancies. Biomarkers exist that can predict response to IO therapies including PD-L1 expression, microsatellite instability (MSI), and total mutation burden (TMB). This paper serves to analyze the presence of these biomarkers across gynecologic cancers.

METHODS

A total of 16,300 gynecologic cancer specimens submitted for molecular profiling to Caris Life Sciences were reviewed. Immunohistochemistry was performed using the SP142 anti-PD-L1 clone and assessed for intensity. Next-generation sequencing, immunohistochemistry, and fragment analysis were used to determine MSI status. TMB was measured by counting all non-synonymous missense mutations found per tumor not previously described as germline alterations. Chi-Square, Fisher Exact, and the Kruskal-Wallis test were used to compare cohorts.

RESULTS

Of 16,300 specimens, 54.1% were ovarian, 37.2% uterine, 7.2% cervical, 0.3% vulvar, 1.2% vaginal, with 0.1% unspecified. MSI-H was most frequent in uterine cancer (17.7%) and only 1% of ovarian cancers. PD-L1 expression was present in 38.3% of cervical and 62.5% of vulvar cancers, but less than 8% of ovarian and uterine cancers. TMB-H was present in 21.1% cervical, 19.7% uterine, and 5% ovarian cancers. Few specimens exhibited a "triple positive" phenotype - 0.3% ovarian, 1.5% uterine, and 1.5% cervical. Associations were seen between MSI, TMB, and PD-L1 across all cancer types.

CONCLUSIONS

The frequency of individual biomarkers pertinent to IO therapy varies by cancer type. HPV-driven genital tract cancers have higher frequencies of PD-L1 expression, MSI-H, and TMBH. Endometrial cancers are characterized by MSI-H and TMB, whereas ovarian cancers have a low frequency of MSI-H and modest PD-L1 or TMBH. The incidence of 'triple positive" cases was less than 2%.

Corticosteroid dosing and opioid use are high in patients with SLE and remain elevated after belimumab initiation: a retrospective claims database analysis

Objectives

To investigate corticosteroid and opioid use among patients with SLE and to examine the impact of belimumab initiation on the use of other SLE therapies.

Methods

We identified adult patients with SLE (International Classification of Diseases, 9th Revision/10th Revision 710.0 and M32) between 1 January 2012 and 31 May 2018 (earliest SLE diagnosis=index date) within MarketScan administrative claims data. Patients were followed from index date for a minimum of 12 months and until the earlier of disenrolment in their health plan or study end (31 May 2018). Corticosteroid utilisation, corticosteroid dose (in prednisone equivalents) and opioid utilisation (overall, by strength (weak, strong) and by duration (chronic use defined as >90 days of cumulative drug supply)) were measured during follow-up. Oral corticosteroid and opioid use were compared in the 6 months before and after initiation of belimumab.

Results

There were 49 413 patients with SLE eligible for analysis (mean (SD) age: 50.1 (14.0) years, 90.2% female). Of these, 68.5% received corticosteroids, and the average number of prescriptions was 4.59 (4.11) over the first 12 months of follow-up. Among patients with oral corticosteroids, average daily dose was 19.4 (14.2) mg and 59.6% had an average daily dose of ≥15 mg. Half (52.6%) had at least one opioid prescription and of these, 34.6% had chronic use over the first 12 months of follow-up. Among patients initiating belimumab during follow-up (n=1710), oral corticosteroid use decreased by 9.1% (p=0.001), and average daily dose decreased from 14.5 (18.4) mg to 11.9 (18.0) mg (p<0.001) in the 6 months after initiation compared with the 6 months prior. Initiation of belimumab had no impact on prevalence of opioid use.

Conclusions

A high proportion of patients with SLE are treated with corticosteroids to control SLE and opioid therapy to manage chronic pain. While there was no change in opioid use, oral corticosteroid use and dose intensity decreased following initiation of belimumab.

Direct and indirect economic burden associated with rotator cuff tears and repairs in the US

OBJECTIVE

This retrospective study examined treatment characteristics and the economic burden associated with rotator cuff tears (RCT) and rotator cuff repairs (RCR). Additionally, this study aimed to explore the economic implications associated with delayed surgical intervention.

METHODS

Adult RCT patients meeting eligibility criteria were identified from 1/1/2013-6/30/2017 using the IBM Watson Health MarketScan Commercial database. Patients with incident RCR within 12 months post-index and 12 months continuous enrollment after the RCR date were also analyzed. Early surgery was defined as RCR within 6 months and 1 month from the partial-thickness tear and full-thickness tear diagnoses, respectively. Patient characteristics, all-cause direct costs (plan paid and patient out-of-pocket), RCT-related costs, pre-surgical costs, post-surgical costs, and healthcare resource utilization were reported by RCT type. Attributable indirect costs, absenteeism and short-term disability (STD), were also estimated.

RESULTS

102,488 RCT patients were identified (partial-thickness tears: 46,856 [45.7%]; full-thickness tears: 55,632 [54.3%]). Fifty per cent RCT patients underwent RCR within 12-months of diagnosis. Full-thickness RCT patients had an average total baseline (one year pre-diagnosis) and post-index costs of $17,096 and $32,110, respectively. Similarly, partial thickness patients had baseline costs of $16,385 and post-index costs of $27,017. Mean all-cause annual post-surgery costs were $34,086 for patients with partial-thickness tears and $34,249 for patients with full-thickness tears, of which 40% and 38% of costs were RCT-related, respectively. Productivity losses due to absenteeism and STD in the 12-month post-surgery period averaged $5843 and $4493, respectively, for partial-thickness tear patients and $5770 and $4382, respectively, for full-thickness tear patients. Average additional spending per delayed surgical patient between diagnosis and surgery was $8524 and $3213 (both p <0.001) for partial- and full-thickness tear patients, respectively.

CONCLUSIONS

This exploratory analysis indicates considerable RCT and RCR economic burden to the healthcare system. High healthcare utilization and costs highlight the importance of efficiently managing patients with RCT diagnosis. Data also suggest that early surgical intervention may be economically beneficial if surgical intervention is anticipated post-RCT.

Methodologies for Validation of Diagnoses in Real-World Data: BONES-A Case Study

SUMMARY

The accuracy of any claim-based study is dependent on the quality of real-world coding of the condition of interest. This retrospective, administrative claims analysis presents a method for using a real-world data source to evaluate the accuracy of coding for nonunion of a fifth metatarsal fracture. Patients 21-80 years old with a diagnosis of a fifth metatarsal fracture between January 1, 2016, and October 31, 2016, and a nonunion of the fifth metatarsal fracture within the next 9 months were identified in the MarketScan Databases. Patient health care claims in the 12 months after the nonunion diagnosis were examined for health care encounters and pharmaceutical treatments considered indicative of treatment for nonunion, such as claims for bone growth stimulation or a second claim with a diagnosis of nonunion. Of the 230 patients who had at least one health care encounter attributable to a nonunion of the fifth metatarsal, 95.2% had at least one subsequent health care encounter confirming nonunion diagnosis. The mean number of supporting health care claims was 5.8, and the mean time between nonunion and first confirmatory claim was 33 days. This analysis demonstrated a method for evaluating the quality of coding for a specific condition when a traditional medical chart comparison is not feasible.

SAT0190 CORTICOSTEROID AND OPIOID USE REMAIN HIGH IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS RECEIVING BIOLOGIC THERAPY: A RETROSPECTIVE CLAIMS DATABASE ANALYSIS

Background:

SLE is managed by variable combinations of five drug classes: antimalarials, biologics, corticosteroids, non-steroidal anti-inflammatory agents, and immunosuppressants. Opioids are commonly prescribed to SLE patients despite not being effective for the management of long-term musculoskeletal pain.1

Objectives:

To describe corticosteroid and opioid use among SLE patients in the United States, and the impact of belimumab initiation on prescribing patterns.

Methods:

This retrospective study used MarketScan administrative claims databases to select insured adults, age ≥18, with a diagnosis (ICD-9/10 710.0 & M32) of SLE between 1/1/2012 and 5/31/2018 (earliest SLE diagnosis = index date). Patients were followed from index through the earliest of health plan disenrollment or 5/31/2019 (minimum of 12 months). Corticosteroid use was measured in the 12 months following SLE index date. Average daily dose of oral corticosteroids in prednisone equivalents was measured for 12 months after corticosteroid initiation. Opioid use was measured overall, and by strength and length of treatment (chronic use defined as >90 days of supply). Oral corticosteroid and opioid use were compared in the 6 months before and after initiation of belimumab.

Results:

Of 49,413 SLE patients eligible for analysis, mean [SD] age was 50.1 [14.0] years, 90.2% were female, and average follow-up was 3.6 [1.9] years. 89.8% of patients received any SLE treatment and 68.5% received corticosteroids. The average number of corticosteroid prescriptions was 4.6 [4.1] during 12 months of follow-up. 52.6% of patients had ≥1 claim for an opioid prescription in the 12 months after SLE index and 34.6% were identified as having chronic opioid treatment. Among patients with oral corticosteroid treatment and 12 months of study enrollment post-corticosteroid initiation, the average daily dose for oral corticosteroids was 19.4 [14.2] mg and 59.6% had a high average daily dose of >15mg (Figure 1). Among 1,710 patients with belimumab treatment and 6 months of study enrollment after the first prescription, use of oral corticosteroids decreased by 9.1% (p=0.001), average daily dose decreased from 14.5 [18.4] mg to 11.9 [18.0] mg (p<0.001) in the 6 months post initiation as compared to the 6 months prior. However, 48.6% of patients remained on a medium (7.5mg – <15mg) or high dose (≥15mg). Initiation of belimumab resulted in no change in opioid use (Table 1).

Table 1.Before BelimumabAfter Belimumabp-value, pre vs.(N =1,710)(N =1,710)post BelimumabPatients with an oral steroid prescription (N, %)1,24272.6%1,08663.5%0.001Number of prescriptions (Mean, SD)2.32.32.12.3<0.001Average daily dose (Mean, SD)14.518.411.918.0<0.001Low average daily dose (>0 to <7.5 mg) (N, %)21012.3%25514.9%0.037Medium average daily dose (7.5 - <15 mg) (N, %)38922.7%33419.5%0.041High average daily dose (15 mg or more) (N, %)64337.6%49729.1%<0.001Patients with an opioid prescription (N, %)90152.7%86150.4%0.341Weak opioids35620.8%31218.2%0.089Strong opioids69940.9%69540.6%0.915Acute Opioid Use53859.7%48656.4%0.165Chronic opioid use36340.3%37543.6%0.165

Conclusion:

These results suggest that a strikingly high proportion of patients with SLE are treated with corticosteroids to control the disease and opioid therapy to manage chronic pain. While there was no change in opioid use, corticosteroid use decreased following initiation of belimumab.

References:

[1]Chen SK, Feldman CH, Brill G, et al. Use of prescription opioids among patients with rheumatic diseases compared to patients with hypertension in the USA: a retrospective cohort study. BMJ 2019;9:e027495

Disclosure of Interests: :

Julie Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jianmin Wu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kirstin Griffing Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Natalia Bello Vega Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Nicole Princic Employee of: I work for IBM Watson Health who was paid by Eli Lilly who funded this research., Isabelle Winer Employee of: I work for IBM Watson Health who was paid by Eli Lilly who funded this research., Carolyn Lew Employee of: I work for IBM Watson Health who was paid by Eli Lilly who funded this research., Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca

The economic burden of systemic lupus erythematosus in commercially- and medicaid-insured populations in the United States

OBJECTIVE

To estimate the economic burden of systematic lupus erythematous (SLE), stratified by disease severity, in commercially- and Medicaid-insured US populations.

METHODS

Adults (≥18 years) with SLE treated with antimalarials, selected biologics, immunosuppressants, and systemic glucocorticoids (2010-2014) were identified within the commercial and Medicaid insurance IBM MarketScan® databases (index date = first SLE medication claim). Both cohorts were stratified into mild (receiving antimalarial or glucocorticoid monotherapy ≤5 mg/day) versus moderate/severe SLE (receiving glucocorticoids >5 mg/day, biologic, immunosuppressant, or combination therapy) during a 6-month exposure period. All-cause healthcare utilization and costs were evaluated during the 12 months following the exposure period.

RESULTS

Among 8231 commercially-insured patients, 32.6% had mild and 67.4% had moderate/severe SLE by our definition. Among 802 Medicaid-insured patients, 25.2% had mild and 74.8% had moderate/severe SLE. Adjusted mean total healthcare costs, excluding pharmacy, for moderate/severe SLE patients were higher than for mild SLE patients in the commercially-insured ($39,021 versus $23,519; p < 0.0001) and Medicaid-insured populations ($56,050 versus $44,932; p = 0.06). In both SLE severity populations total unadjusted costs were significantly higher among Medicaid-insured than commercially-insured patients.

CONCLUSION

Commercially-insured patients with treatment suggesting moderate/severe SLE incurred significantly higher adjusted mean healthcare costs, excluding pharmacy, compared with mild SLE patients. While not reaching statistical significance, moderate/severe Medicaid-insured patients had higher costs then mild SLE patients. Total unadjusted healthcare costs were significantly higher among Medicaid-insured than commercially-insured patients. These differential costs are important to consider and monitor when implementing interventions to improve health and reduce healthcare spending for SLE.

Expression of 12-lipoxygenase as a biomarker for melanoma carcinogenesis

12-Lipoxygenase (12-LOX), through its metabolite 12( )-hydroxyeicosatetraenoic acid [12( )-HETE], has been demonstrated to play a pivotal role in experimental melanoma invasion and metastasis, and 12-LOX expression may be important in early human melanoma carcinogenesis. We have studied the differences in 12-LOX protein expression during the progression of melanoma from human melanocytic cells to benign and dysplastic naevi to malignant metastatic disease. 12-LOX expression was determined in normal human skin melanocytes and in melanocytes found in compound naevi, dysplastic naevi and melanomas using a platelet-type 12-LOX antibody with a diaminobenzidine immunoperoxidase system detection system and was quantified using the analysis software NIH Image 1.62. Mean cellular pixel densities for 12-LOX staining ( = 50 cells/histological type) were unchanged in compound naevi ( = 0.14) and were increased in dysplastic naevi and melanomas compared with normal skin melanocytes ( = 0.03 and = 0.01, respectively). Similarly, melanomas had higher levels of expression compared with dysplastic naevi ( = 0.03). 12-LOX expression was significantly different between compound naevus and dysplastic naevus melanocytes ( = 0.01). These data suggest that 12-LOX may be an important novel marker for cancer progression within the melanoma system, and therefore could be a useful biomarker and therapeutic target for melanoma chemoprevention.

Laser beam directed at the lunar retro-reflector array: observations of the first returns

On 1 August between 10:15 and 12:50 Universal Time, with the Lick Observatory 120-inch (304-cm) telescope and a laser operating at 6943 angstroms, return signals from an optical retro-reflector array placed on the moon by the Apollo 11 astronauts were successfully detected. After the return signal was first detected it continued to appear with the expected time delay for the remainder of the night. The observed range is in excellent agreement with the predicted ephemeris. Transmitting between 7 and 8 joules per pulse, we found that each return signal averaged more than one photoelectron. This is in good agreement with calculations of the expected signal strength.