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Christina Ciaccio,1 Jessica Dunne,2 Andrea Bever,2 Karissa Johnston,2 Stacey Kowal,3 Arpamas Seetasith,3 Andrew Lloyd,4 Alexis Mickle2 1The University of Chicago, Chicago, IL, USA; 2Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada; 3Genentech, Inc., South San Francisco, CA, USA; 4Acaster Lloyd Consulting Ltd, London, UKCorrespondence: Christina Ciaccio, Department of Pediatrics and Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA, Tel +1-773-834-4010, Email cciaccio@bsd.uchicago.eduPurpose: The quality of life (QoL) impact of food allergies extends beyond severe allergic reactions, as food avoidance can permeate the daily lives of individuals with food allergies and their caregivers. People with multiple food allergies may experience a greater impact on QoL than people with a single food allergy, but there is limited evidence available. The aim of the study was to provide insight into the lived experiences of adults, teenagers, children, and caregivers of children with multiple food allergies.Methods: Semi-structured interviews were conducted of people with multiple food allergies and their caregivers (n = 20) in the United States, including 10 adults, 5 teenagers, and 5 caregivers of children. Patterns in responses were explored using reflexive thematic analysis.Results: Four themes were developed by the researchers to convey the experiences of people with food allergies and QoL impact: preparedness and allergen avoidance results in a loss of spontaneity; emotional impact varies by person and for each person; participating in society involves speaking up and trusting others; and food is more than nutrition. In addition, 3 themes were identified that convey the experiences of caregivers: looking out for your child’s safety is an emotional balancing act; limitations on what you can do on your own and as a family; and creating a safe and fulfilling environment can be time-consuming and costly.Conclusion: These findings highlight that people with multiple food allergies experience social limitations, stress about food safety and allergen avoidance, and restrictions on freedom. Caregiver QoL is impacted by the need to navigate social, emotional, and practical implications of caring for a child with multiple food allergies.Plain Language Summary: People with food allergies must constantly make an effort to avoid the foods they are allergic to. Having an allergy to more than 1 type of food (for example, peanuts, eggs, or milk) can be even more difficult. In this study, we interviewed adults and teenagers with food allergies, as well as parents of children with food allergies, about how having an allergy to more than 1 type of food affects their daily lives. We found that people with more than 1 food allergy often had stress and anxiety. They also had to change the way they traveled or socialized. Parents caring for a child with food allergies were also impacted. Parents had to look out for their child’s safety and made changes to family plans and activities. The lives of people with food allergies and their families may be improved by treatments or interventions that can lower the risk of allergic reactions.Keywords: food hypersensitivity, quality of life, patients, caregivers, multiple food allergies

Christine L Baker,1 Yao Ding,2 Cheryl P Ferrufino,2 Stacey Kowal,2 Jenen Tan,3 Prasun Subedi1 1Patient & Health Impact, Pfizer, Inc, New York, NY, USA; 2Health Economics & Outcomes Research, Real World Evidence Solutions, IQVIA, Fairfax, VA, USA; 3IQVIA, San Francisco, CA, USA Introduction: Smoking drives substantial direct health care spending, comprising 8.7% ($168 billion) of annual United States aggregated spending. Smoking cessation (SC) prescription use is an effective strategy to improve health outcomes, increase quit rates, and reduce economic burden. However, patient out-of-pocket costs may limit the use. Health care payers play a vital role in driving use through formulary decisions and copayment policies but must consider both the near-term financial investment as well as downstream effects of increased coverage on health care budgets. This study estimates the return on investment (ROI) of providing Affordable Care Act (ACA)-recommended prescription SC coverage. Methods: A cost–benefit analysis (CBA) estimates the ROI of providing prescription SC ­coverage, based on pharmacy costs and savings from smoking-attributable medical expenditures among Medicare, Medicaid, and commercial plan enrollees over 10 years. The CBA incorporated national-level population demographics, smoking prevalence estimates, proportion of smokers attempting to quit, and the utilization of SC products. A five-state Markov chain model simulated patterns of quit attempts, relapse, and cessation assuming two quit attempts per year, no patient cost-sharing, and 25.4% utilization of prescription SC aids. Results include number of quitters, annual pharmacy and smoking-attributable medical costs, and ROI. Results: After initial investment in SC treatment, smoking-attributable medical benefits accrue over time, generating a positive ROI by year 4 for commercial (11.3%) and Medicaid (78.4%) plans and by year 3 for Medicare (30.6%). Over 10 years, an average return of $1.18, $2.50, and $3.22 savings per dollar spent on SC prescriptions for commercial, Medicaid, and Medicare plans, respectively, may be realized. Discussion: Given the proven efficacy of SC pharmacotherapy, near-term investments in supporting ACA-recommended SC coverage translate into a positive ROI. As smoking is a leading cause of morbidity and mortality, increased access to prescription SC medications may improve health outcomes and reduce smoking-attributable costs to payers over time. Keywords: cost–benefit analysis, smoking cessation prescription coverage, smoking-attributable medical cost, return on investment

Shoghag Khoudigian-Sinani,1,2 Stacey Kowal,3 Jason A Suggett,4 Dominic P Coppolo5 1Faculty of Health Sciences, Department of Health Research, Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; 2QuintilesIMS, Toronto, ON, Canada; 3QuintilesIMS, Seattle, WA, USA; 4Trudell Medical International, London, ON, Canada; 5Monaghan Medical Corporation, Syracuse, NY, USA Introduction: COPD places a huge clinical and economic burden on the US health care system, with acute exacerbations representing a key driver of direct medical costs. Current treatments, although effective in reducing symptoms and limiting exacerbations, do not adequately target the underlying disease processes that drive exacerbation development. The Aerobika* oscillating positive expiratory pressure (OPEP) device has been shown in a real-world effectiveness study to lower the frequency of moderate-to-severe exacerbations during a 30-day post-exacerbation period. This study sought to determine the impact on exacerbations and costs and to determine the cost-effectiveness of the Aerobika* device. Methods: Data from published literature and national fee schedules were used to model the cost-effectiveness of the Aerobika* device in patients who had experienced an exacerbation in the previous month, or a post-exacerbation care population. Exacerbation trends and the impact of the Aerobika* device on reducing exacerbation frequency were modeled using a one-year Markov model with monthly cycles and three health states: (i) no exacerbation, (ii) exacerbation, and (iii) death. Scenario analysis and one-way sensitivity analysis (OWSA) were also performed. Results: When the effect of Aerobika* device was assumed to last 30 days, use of the device resulted in cost-savings ($553 per patient) and improved outcomes (ie, six fewer exacerbations per 100 patients per year) compared to no OPEP/positive expiratory pressure therapy. When the effect of the Aerobika* device was assumed to extend beyond the conservative 30-day time frame, the Aerobika* device remained the dominant strategy (21 fewer exacerbations per 100 patients per year; cost savings of $1,952 per patient). Consistency in findings after performing OWSAs indicates the robustness of results. Conclusion: The Aerobika* device is a cost-effective treatment option that provides clinical benefit and results in direct medical cost savings in a post-exacerbation care COPD population. Keywords: COPD, exacerbations, cost-effectiveness, Aerobika* device