Patients place a high value on therapies that provide a chance of durable or "tail-of-the-curve" survival, whereas physicians do not. Value frameworks should incorporate measures of tail-of-the-curve survival gains into their methodologies.

This study and medical writing assistance was funded by Otsuka Pharmaceutical Development & Commercialization. Shafrin and Schwartz are employees of Precision Health Economics, which received funding from Otsuka Pharmaceutical Development & Commercialization in support of this study. Lakdawalla is Chief Scientific Officer and a founding partner of Precision Health Economics. Schwartz is a consultant for Otsuka Pharmaceutical Development & Commercialization, and Forma is an employee of Otsuka Pharmaceutical Development & Commercialization. The authors presented the abstract for this study as a poster presentation at the AMCP Managed Care & Specialty Pharmacy Annual Meeting, April 19-22, 2016, San Francisco, California. All authors contributed equally to the study design, data collection and analysis, and the writing and revision of the manuscript.

The simulation showed that increased monitoring and treatment intensification would improve A1C levels; however, the resulting average increases in reimbursement would be small.

Background The Advisory Committee on Immunization Practices recommended a 1 dose varicella immunization program in 1996, expanding this to include 2 doses in 2006. As a result, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented annually in the United States. Since varicella infections have become uncommon, the response of health care providers (HCPs) to patients presenting with varicella symptoms may result in misdiagnosis and/ mistreatment. This study investigated the diagnostic and treatment strategies used by HCPs for managing varicella infections in US children. Methods An online cross-sectional survey of licensed HCPs was conducted, after an Institution review board approval and HCP consent. 8 clinical vignettes with information on patients with varying varicella symptoms (representing uncomplicated and complicated cases) were presented. For each vignette, HCPs selected a diagnosis and appropriate intervention(s) from pre-determined lists. Descriptive analyses were performed. Results A total of 153 HCPs (50 nurses, 103 doctors) completed the survey. Mean age was 44 years, 62% were female, and 82% were licensed after 1995. Varicella infection was correctly diagnosed 79% of the time. HCPs were able to recognize uncomplicated cases of varicella 85% of the time and complicated cases 61% of the time. HCPs recommended the correct intervention 43% of the time for uncomplicated cases and 25% of the time for complicated cases. For example, HCPs recommended antibiotics 17% of the time and/or antivirals 18% of the time (Table 1), of which 25% and 69% (respectively) were not appropriate per the American Academy of Pediatrics guidelines respectively. Antibiotics were incorrectly recommended 6% of the time for uncomplicated cases of varicella. Table 1. Additional Diagnosis & Treatment Results Conclusion Given the low incidence of varicella infections in the US, complicated cases of varicella may be under-recognized or inappropriately treated by some HCPs. Additional training may help HCPs better recognize/ treat cases of varicella. Further, ensuring high rates of varicella vaccination is important to avoid vaccine preventable conditions and to minimize unnecessary exposure to antimicrobial and antiviral therapies. Disclosures Jaime Fergie, MD, AstraZeneca (Speaker’s Bureau)Sobi, Inc. (Speaker’s Bureau) Manjiri D. Pawaskar, PhD, Merck & Co., Inc (Employee, Shareholder) Phani Veerkani, MD, DrPH, Merck (Research Grant or Support) Salome Samant, MBBS, MPH, Merck & Co., Inc., Kenilworth, NJ, USA (Employee, Shareholder) Carolyn Harley, PhD, Merck (Consultant) Joanna MacEwan, PhD, PRECISIONheor (Employee) Taylor T. Schwartz, MPH, Merck (Consultant, Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Shikha Surati, MPH, Merck & Co., Inc. (Employee, Shareholder)

Background In 1995, the CDC recommended one-dose routine varicella immunization for children <12 years of age, expanding its recommendation to two doses in 2006. Today, with widespread varicella vaccination coverage, an estimated 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented annually in the United States. Since varicella infections are now uncommon, health care providers (HCPs) may not recognize varicella infections and may prescribe inappropriate treatment. Methods An online survey of HCPs was conducted to assess recognition and management of varicella infections. Responses to eight varicella vignettes describing patients with varying varicella symptoms were analyzed and descriptive analyses performed. Stratified analysis comparing responses of those licensed before and in/after 1996 was also performed. Results 153 HCPs (50 nurse practitioners, 103 doctors) completed the survey. Mean age of respondents was 44 years. 62% were female, and 82% were licensed before 1996. Varicella infection was correctly diagnosed 79% of the time. HCPs correctly recognized uncomplicated varicella vignettes 85% of the time versus 61% of the time for complicated varicella vignettes. Antibiotics were recommended 17% of the time and antivirals 18% of the time, of which 25% and 69% (respectively) were not appropriate per guidelines. HCPs licensed before 1996 were better able to recognize varicella compared to those licensed later, but prescribed more antimicrobials medications to treat varicella. Conclusions Although most HCPs recognized varicella infection, a sizable proportion could not recognize cases with complications, and some of the varicella cases were inappropriately treated with antibiotics and/or antivirals. Additional HCP training and high vaccination coverage are important strategies to avoid inaccurate diagnoses and minimize unnecessary exposure to antimicrobial/antiviral therapies.