Patterns in the distribution of Australasian species of freshwater aquatic plants were sought, to determine whether vicariance, distance dispersal, local speciation, or a mixture of these could best explain the distribution. The distribution was recorded from 10 regions of Australasia that include sizeable areas of wetland: Papua New Guinea, Cape York Peninsula, south-east Queensland, eastern New South Wales, Victoria, Tasmania, New Zealand, northern Northern Territory, the Kimberley, and south-west Western Australia. Matrices of 553 species by 10 regions, 139 genera by 10 regions, and 56 families by 10 regions were analysed using hierarchical fusion, nearest neighbour and ordination techniques. The results indicate that there are two distinct elements in the aquatic flora, tropical and temperate. The diffuse boundary between these two climatic zones could be interpreted as a barrier in the sense used in definitions of vicariance. There is little effective spread between tropical and temperate areas but, within each of these climatic zones, the species are mobile and many spread reasonably readily between regions, provided suitable habitats and dispersal opportunities are available. Where geographic barriers to distance dispersal have been great then these may become as important as the climatic barrier. This is demonstrated, at least in part, by the differences between some of the generic and species dendrograms. Local speciation (not shown by our PATN analyses because of the endemic species being ignored in them) has been important where some primarily aquatic genera have proliferated when conditions have been suitable. Local speciation has occurred in cosmopolitan aquatic genera that have presumably arrived in regions via long distance dispersal. The significance of bird migration and dispersal patterns are discussed. The aquatic flora of the monsoon tropics has evolved mainly from long distance dispersal but with significant local speciation in some genera such as Nymphoides, Utricularia, Nymphaea and Vallisneria. The pattern of distribution was compared with those recorded from other ecologically defined groups such as the Australian arid and alpine floras.

Objectives: To compare treatment persistence and adherence over one year in biologic naïve psoriatic arthritis (PsA) patients initiating apremilast or biologics using a U.S. administrative claims database. MethOds: This retrospective study selected adult PsA patients initiating apremilast or biologics within the January 2013-June 2016 Truven Health MarketScan claims databases. Patients were required to be apremilast/biologic naïve on the index agent in the 12-month pre-index period and have continuous enrollment in the 12-month pre-and post-index periods (index date = initial apremilast or biologic claim). Biologic users were matched 2:1 to apremilast users. Treatment persistence at 12 months was defined as continuous treatment without (1) a > 60-day gap in therapy or (2) a switch to a different PsA treatment and measured during the 12-month post-index period. Patients were adherent if their medication possession ratio (MPR) was ≥ 80% while persistent on the index agent. Results: A total of 381 patients initiating apremilast were matched to 761 patients initiating biologics. Baseline characteristics were similar in both groups (mean age 51 years, 60% female, mean Charlson score 0.6). Treatment persistence at 12 months for apremilast users was similar to biologic users (43% vs 48%; p= 0.082). Average time to non-persistence was 124 days for apremilast users compared to 132 days for biologics users (p= 0.194). Among non-persistent users, apremilast users and biologic users had similar switch rates (7% vs 9%; p= 0.389) and discontinuation rates (93% vs 91%; p= 0.389). Average persistence-based MPR was 0.870 for apremilast users compared to 0.854 for biologic users (p= 0.056), and the adherence rates were 77% and 73%, respectively (p= 0.175). cOnclusiOns: At 12 months, persistence and adherence as well as drivers of non-persistence were similar for biologic naïve patients initiating apremilast or biologics for the treatment of PsA in the U.S.

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S9 ObjectiveS: To assess the cost-effectiveness of fibrosis-based direct-acting antiviral (DAA) treatment policies for chronic Hepatitis C (HCV) patients at the Kaiser Permanente Mid-Atlantic States health system (KPMAS). MethOdS: We used a Markov model to compare the lifetime costs and effects of treating chronic HCV patients at different stages of disease severity based on a fibrosis score. The initial distribution of patients across fibrosis scores, the effectiveness of DAA therapy and follow-up and monitoring protocols used to build the model were specific to the KPMAS system. Other parameters, including direct and indirect costs, transition probabilities and health state utilities were derived from the literature. We performed both deterministic and probabilistic sensitivity analyses to assess the robustness of our results. ReSultS: The universal, or 'Treat All', treatment option was the dominant strategy from both the societal and health care sector perspectives. Varying the model parameters in a deterministic analysis did not change this conclusion. It is important to note that the range of incremental costs between the three less restrictive policies was very small-the difference between the 'Treat F1+' and the 'Treat All' option was just under $100 per person. Probabilistic sensitivity analyses showed, at both the $100,000/QALY and $150,000/QALY thresholds, there was a 70% chance that the 'Treat All' option was cost-effective and a 30% chance the 'Treat F1+' option was cost-effective. cOncluSiOnS: Our results are consistent with the current literature on the value of treating patients with the new DAA therapies-expanded treatment access is cost-effective and in many cases cost saving. While our results are primarily applicable to a unique integrated health care system, the results offer some direction to any health care setting that is faced with resource constraints in the face of these highly priced drugs.