BackgroundParkinson’s disease (PD) is a progressive neurological disorder for which, at present, there is no cure. Current therapy is largely based on the use of dopamine agonists and dopamine replacement therapy, designed to control the signs and symptoms of the disease. The majority of current treatments are administered in tablet form and can involve multiple daily doses, which may contribute to sub-optimal compliance. Previous studies with small groups of patients suggest that non-compliance with treatment can result in poor response to therapy and may ultimately increase direct and indirect healthcare costs.ObjectiveTo determine the extent of non-compliance within the general PD population in the USA as well as the patient characteristics and healthcare costs associated with compliance and non-compliance.MethodsA retrospective analysis from a managed care perspective was conducted using data from the USA PharMetrics patient-centric claims database. PharMetrics claims data were complete from 31 December 2005 to 31 December 2009. Patients were included if they had at least two diagnoses for PD between 31 December 2005 and 31 December 2008, were older than 18 years of age, were continuously enrolled for at least 12 months after the date of the most recent PD diagnosis, and had no missing or invalid data. The follow-up period was the most recent 12-month block of continuous enrollment that occurred between 2006 and 2009. Patients were required to have at least one PD-related prescription within the follow-up period. The medication possession ratio (MPR) was used to categorise patients as compliant or non-compliant. Direct all-cause annual healthcare costs for patients with PD were estimated for each patient, and regression analyses were conducted to determine predictors for non-compliance.ResultsA total of 15,846 patients were included, of whom 46 % were considered to be non-compliant with their prescribed medication (MPR <0.8). Predictors of non-compliance included prescription of a medication administered in multiple daily doses (p < 0.0001), a period of <2 years since the initial PD diagnosis (p = 0.0002), a diagnosis of gastrointestinal disorder (p < 0.0001), and a diagnosis of depression (p < 0.0001). Non-compliance was also found to be related to age, with a lower odds of non-compliance in patients aged 41–80 years than in patients aged ≥81 years (p < 0.05). Although total drug mean costs were higher for compliant patients than non-compliant patients (driven mainly by the cost of PD-related medications), the mean costs associated with emergency room and inpatient visits were higher for patients non-compliant with their prescribed medication. Overall, the total all-cause annual healthcare mean cost was lower for compliant ($77,499) than for non-compliant patients ($84,949; p < 0.0001).ConclusionNon-compliance is prevalent within the general USA PD population and is associated with a recent PD diagnosis, certain comorbidities, and multiple daily treatment dosing. Non-compliance may increase the burden on the...

The impact of type 1 diabetes (T1D) on patient’s lives has been described in the literature, but little insight exists on the experience of newly diagnosed pediatric patients. This timeframe is unique for clinical reasons (honeymoon period) and psychosocial reasons (adapting to living with T1D). This project aimed to identify concepts core to describing the experience of pediatric patients in the first two years of T1D and organize them into a framework. Based on literature and clinician input, a semi-structured interview guide was developed. Patients (n=29) ages 7-17 recruited by an agency and childrenwithdiabetes.com participated in face-to-face (age &lt;10) or phone interviews. Interviews were recorded, transcribed, and inductively coded using ATLAS.ti software. Detailed concepts were categorized into overarching domains reflecting their conceptual underpinning to design the framework. The sample mean age was 12 years, and was 48% male and 72% white. The interviews confirmed symptoms of hyper and hypoglycemia already described in the literature, but above all, they provided in-depth information as to how symptoms and impacts are experienced within the first two years of T1D diagnosis. The proposed conceptual framework includes symptoms, impacts, and disease management. Symptoms include hyper and hypoglycemia. Impacts include peers, school, sports, emotions, diet, preoccupation with the disease, conflict with parents (adolescents only) and parental supervision (children only). Disease management focused on checking blood glucose, giving insulin, carrying supplies, the pain of treatment, and adapting to management of the disease over time. This study highlights the impact of T1D within the first two years of diagnosis in pediatric patients. It provides a conceptual foundation for the measurement of the benefit of medical or psychosocial interventions and monitoring while patients and their caregivers assimilate to the implications of the disease on their day-to-day lives. Disclosure E. Senior: Employee; Self; UCB, Inc. R. Fong: Employee; Self; UCB, Inc.. A. Christian: None. J.T. Markowitz: None. S. Strzok: None. T. Schmidt: None. K. Harris: Employee; Self; UCB, Inc.. P. Marquis: None.

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A629ment was associated with 38% fewer unplanned admissions (981 vs. 604, X 1 2 = 89.2, p< 0.001) and 58% fewer unplanned bed nights (8,817 vs. 3,681, X 1 2 = 2109.8, p< 0.001) in the year following treatment initiation compared with the year before. A 14% reduction in all outpatient appointments was also observed, due principally to a 25% reduction in neurological outpatient appointments (from 7,826 to 5,901, X 1 2 = 269.7, p< 0.001). Evidence from this study indicates that duration of treatment is a significant factor in this response; patients receiving between 12 and 14 doses (n= 1,122) experienced 70% reduction in unplanned admissions and 90% reduction in unplanned bed nights. ConClusions: Our data support the notion that natalizumab treatment significantly reduces unplanned hospital treatment and outpatient attendance.

Background This study aimed to determine patterns of nocturnal pulse oximetry indices in moderate to late preterm infants, and investigate the relationship between oxygen desaturations, the apnoea hypopnoea index, and both corrected gestational and postnatal age. Methods 21 healthy infants born at 32 + 0 - 36 + 6 weeks gestation underwent serial nocturnal pulse oximetry studies and respiratory polygraphy studies until 40 weeks corrected gestational age (CGA). The main outcome measures were number of >3% oxygen desaturations/hour (ODI3), mean oxygen saturations, and number of apnoeas and hypopnoeas/hour. Results Median ODI3 increased between weeks 1 and 3 from 49.9 to 85.4/hour (p = 0.017). Mean oxygen saturations reached a corresponding nadir of 96.0% in week 3, then increased to 96.8% in week 6 (p = 0.019). Mixed effects modelling demonstrated that ODI3 and mean saturations were influenced by postnatal age but not CGA (p < 0.05). Desaturations frequently occurred without an apnoea or hypopnoea. Conclusion ODI3 rises then falls during the first 8 weeks of life in moderate to late preterm infants, independently of CGA. These interesting preliminary results highlight the importance of further serial data collection to generate age-specific normal ranges, and develop a better understanding of respiratory control in preterm infants. Impact The frequency of >3% oxygen desaturations (ODI3) in healthy moderate to late preterm infants rises then falls after birth, peaking in postnatal week 3. There is a corresponding nadir in mean saturations. There were significant non-linear relationships between ODI3/mean saturations and postnatal age, but not corrected gestational age. The majority of brief oxygen desaturations occurred without an apnoea or hypopnoea. Normal ranges for oxygen saturation indices are not known in this population. These results demonstrate the need for further serial data collection to generate age-specific normal ranges and inform oxygen prescribing guidelines.