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Adrian Paul J Rabe,1,2 Wei Jie Loke,3 Khushboo Gurjar,4 Allison Brackley,5 Don Eliseo Lucero-Prisno III6,7 1BioPharmaceutical Medical, Respiratory & Immunology, AstraZeneca, Cambridge, UK; 2Imperial College, London, UK; 3East and North Hertfordshire NHS Trust, Stevenage, UK; 4RWA Health Economics, Cytel Health Canada, Toronto, Ontario, Canada; 5RWA Health Economics, Cytel, Inc, Waltham, MA, USA; 6Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK; 7University of the Philippines Open University, Los Baños City, PhilippinesCorrespondence: Allison Brackley, Cytel, Inc, 1050 Winter Street, Center Entrance 3rd Floor, Waltham, MA, 02451, USA, Tel +1 617 661 2011, Fax +1 617 661 4405, Email brackleyallison@gmail.comBackground: The complex nature of asthma has resulted in a poor understanding of its epidemiology, particularly in low-and middle-income countries (LMIC). Clinical subgroups, such as patients with severe asthma, eosinophilic asthma, allergic rhinitis, or nasal polyps, experience additional barriers to care.Methods: Prevalence estimates for asthma and key clinical subgroups were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 and from a targeted literature review conducted through PubMed in October of 2021. National estimates were calculated and the roles of potential explanatory factors were explored through qualitative analysis.Results: In total, 162 publications from 69 countries were included. Across continents, asthma prevalence values ranged from 3.44% (Asia), 3.67% (Africa), 4.90% (South America), 5.69% (Europe), 8.29% (North America), to 8.33% (Oceania). Globally, of those with asthma, 26.70% had severe asthma, 30.99% had eosinophilic asthma, 48.95% had allergic rhinitis, and 7.0% to 25.40% had nasal polyps. Countries with higher air quality, income status, and healthcare access and quality reported a higher asthma prevalence.Conclusion: Asthma prevalence values

Diana R Tamondong-Lachica,1 Neil Skolnik,2 John R Hurst,3 Nathaniel Marchetti,4 Adrian Paul J Rabe,5,6 Maria Montes de Oca,7 Bartolome R Celli8 1College of Medicine, University of the Philippines Manila, Manila, Philippines; 2Sidney Kimmel Medical College, Thomas Jefferson University, Abington, Philadelphia, PA, USA; 3UCL Respiratory, University College London, London, UK; 4Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA; 5Department of Primary Care and Public Health, Imperial College London, London, UK; 6Biopharmaceuticals Medical, AstraZeneca, Cambridge, UK; 7Pulmonary and Thoracic Surgery Department, Universidad Central de Venezuela, School of Medicine, Centro Médico de Caracas, Caracas, Venezuela; 8Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USACorrespondence: Diana R Tamondong-Lachica, College of Medicine, University of the Philippines Manila, 547 Pedro Gil Street, Ermita, Manila, 1000 Metro Manila, Philippines, Tel +63285264170, Email drtamondonglachica@up.edu.phAbstract: In 2022, over 3 million people died of chronic obstructive pulmonary disease (COPD) and the global burden of the disease is expected to increase over the coming decades. Recommendations for the treatment and management of patients with COPD are published by the Global Initiative for Chronic Obstructive Lung Disease, and updated annually with scientific evidence-based recommendations. The 2023 updates, published in November 2022, contain key changes to recommendations for diagnosis and treatment of COPD that are anticipated to have a significant impact on clinical practice for patients with COPD. Updates to how COPD is defined and diagnosed, including the expansion of contributing factors beyond tobacco use, have the potential to lead to the diagnosis of more patients and to allow for the implementation of early interventions for patients during early stages of the disease. Simplifi

David MG Halpin,1 Adrian Paul Rabe,2,3 Wei Jie Loke,4,5 Stacy Grieve,6 Patrick Daniele,6 Sanghee Hwang,6 Anna Forsythe6,7 1Respiratory Medicine, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK; 2Primary Care and Public Health, Imperial College London, London, UK; 3Global Medical Affairs, AstraZeneca, Cambridge, UK; 4Lister Hospital, Stevenage, East and North Hertfordshire NHS Trust, Stevenage, UK; 5Ways Group, London, UK; 6North America Real World Advanced Analytics, Cytel, Inc., Waltham, MA, USA; 7Value and Access, Cytel, Inc., Waltham, MA, USACorrespondence: Anna Forsythe, Value and Access, Cytel, Inc., 1050 Winter Street, Suite 2700, Waltham, MA, 02451, USA, Tel +1-617-661-2011, Email Anna.Forsythe@cytel.comPurpose: There has been concern that asthma and chronic obstructive pulmonary disease [COPD] increase the risk of developing and exacerbating COVID-19. The effect of medications such as inhaled corticosteroids (ICS) and biologics on COVID-19 is unclear. This systematic literature review analyzed the published evidence on epidemiology and the burden of illness of asthma and COPD, and the use of baseline medicines among COVID-19 populations.Patients and Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Embase®, MEDLINE® and Cochrane were searched (January 2019–August 2021). The prevalence of asthma or COPD among COVID-19 populations was compared to the country-specific populations. Odds ratios (ORs) were estimated to compare healthcare resource utilization (HCRU) rates, and meta-analyses of outcomes were estimated from age-adjusted ORs (aORs) or hazard ratios (aHRs). Meta-analyses of COVID-19 outcomes were conducted using random effects models for binary outcomes.Results: Given the number and heterogeneity of studies, only 183 high-quality studies were analyzed, which reported hospitalization, intensive care unit (ICU) admissions, ventilation/intubation

Aikaterini Bilitou,1 John Were,2 Archie Farrer,2 Adrian Rabe,2,3 Simon Wan Yau Ming,2 Inaam Haq,1 Kyle Dunton4 1Daiichi Sankyo Europe GmbH, Munich, Bayern, Germany; 2Health iQ Ltd, London, UK; 3Imperial College London, London, UK; 4Daiichi Sankyo UK Ltd, Uxbridge Business Park, Uxbridge, UKCorrespondence: Aikaterini Bilitou, Health Economics and Outcomes Research, Daiichi Sankyo Europe GmbH, Zielstattstrasse 48, Munich, 81379, Bayern, Germany, Tel +49 897 808802, Email aikaterini.bilitou@daiichi-sankyo.euBackground: Guidelines for the management of dyslipidemias recommend intensive low-density lipoprotein (LDL-C) control through lifestyle advice and lipid-lowering drugs to reduce the risk of cardiovascular disease (CVD).Objective: This retrospective study aimed to characterize the adult primary care population with primary hypercholesterolemia (PH)/mixed dyslipidemia (MD).Methods: Data on adults with PH/MD between 1 January 2009 and 31 December 2019 in the UK were extracted from linked primary Clinical Practice Research Datalink (CPRD) and secondary care (Hospital Episode Statistics) datasets and analyzed.Results: A total of 279,221 patients met the inclusion criteria. Mean follow-up was 8.6 years. Crude prevalence of PH/MD increased from 13.5% in 2009 to 23.5% by 2019. The incidence decreased from 176 to 49 per 100,000 population. Mean age of the cohort was 58 years, baseline LDL-C was 4.32 mmol/L, 19.6% had atherosclerotic CVD, 30.1% diabetes, and 8.5% heterozygous familial hypercholesterolemia. Estimated LDL-C reductions of 40% and 50% were achieved in 2.6% and 2.3% of patients, respectively. Most received moderate-intensity statins as monotherapy (62.4%); high-intensity statins were used less frequently (24.3% as initial treatment). Less than 10% of patients received ezetimibe plus statins of different intensities.Conclusion: The prevalence of dyslipidemia doubled between 2009 and 2019, likely due to more systematic identification of PH/MD. A large proportion of

Anna Forsythe,1 Patricia S Brandt,2 Mike Dolph,1 Sachin Patel,3 Adrian Paul J Rabe,1 Gabriel Tremblay1 1Purple Squirrel Economics, New York, NY, 2Novartis Pharmaceuticals, East Hanover, NJ, USA; 3Novartis Pharmaceuticals UK Limited, Frimley, Camberley, Surrey, UK Background: Cost-utility analyses for acute myeloid leukemia (AML) require health state utility values (HSUVs) in order to calculate quality-adjusted life-years (QALYs) for each health state. Aim: This study reviewed AML-related HSUVs that could be used in economic evaluation studies. Materials and methods: EMBASE, MEDLINE, and Cochrane databases were searched from January 2000 to November 2016 for relevant studies that reported quality of life (QoL) and HSUVs in AML. Identified relevant European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 values were mapped to HSUVs. HSUVs for each health state in the AML treatment pathway were then collated. Results: Ten relevant studies were identified. Six were cost-effectiveness analyses utilizing HSUVs for calculation of QALYs, one was an effectiveness analysis (incremental QALY), and two were QoL studies reporting AML-specific utilities. An additional study reported QoL for patients undergoing stem cell transplantation (SCT). Since no study reported HSUVs for relapse, values from a study of secondary AML patients who failed prior treatment for myelodysplastic syndrome were used. Where multiple HSUVs were available, collected values were given priority over assumed values. AML treatment (induction, consolidation, or SCT) was associated with decreased HSUV, while post-treatment complete remission led to increased HSUV. Conclusion: There are some methodologically robust HSUVs that can be directly used in economic evaluations for AML. Careful interpretation is advised considering significant differences in methodologies and patient population (inclusion, size). We need to develop HSUVs with larger-sized studies, making greater

OBJECTIVES: Preventing pregnancy in the year after childbirth provides health benefits, and an intrauterine device (IUD) placed immediately after birth is a cost-effective tool to prevent pregnancy. However, it is not known if this strategy is cost-effective in the UK context. Therefore, our study objective was to identify the cost-effectiveness of immediate compared to routine IUD placement strategies in the UK. METHODS: A decision tree cost-effectiveness model was constructed using inputs from published literature including data and costs from the National Institute for Clinical Effectiveness (NICE). The study population for this evaluation is women in the UK who desire a postpartum IUD. The perspective of the study was payer and the time horizon was one year. The outcome measure was incremental cost-effectiveness ratio (2018 Great British Pound per quality-adjusted life-year [QALY] gained), with a threshold of an ICER<20,000 considered cost effective. RESULTS: The results of the analysis yielded an ICER of -21,845, which is interpreted as a cost savings of 21,485 GBP for every QALY averted with the immediate placement strategy. Our results and probabilistic sensitivity analysis both indicate that immediate placement is a consistently dominant strategy as compared to routine placement. Results were most sensitive to changes to the health utility assigned to pregnancy. CONCLUSIONS: Immediate as compared to routine postpartum placement of an IUD is a dominant strategy and presents an opportunity for a cost saving policy. Budget impact analysis indicates that savings from the implementation of this strategy over a 5-year time horizon (2019-2023) would be over £17 million.

Policy Points: The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. While there is a large amount of literature on the economic aspects of delivering primary care services, there is a need for more comprehensive overviews of this evidence. In this article, we offer such an overview. Evidence suggests that there are several strategies involving coverage, financing, service delivery, and governance arrangements which can, if implemented, have positive economic impacts on the delivery of primary care services. These include arrangements such as worker task-shifting and telemedicine. The implementation of any such arrangements, based on positive economic evidence, should carefully account for potential impacts on overall health care access and quality. There are many opportunities for further research, with notable gaps in evidence on the impacts of increasing primary care funding or the overall supply of primary care services. Context: The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. To strengthen primary health care, policymakers need guidance on how to allocate resources in a manner that maximizes its economic benefits. Methods: We collated and synthesized published systematic reviews of evidence on the economic aspects of different models of delivering primary care services. Building on previous efforts, we adapted existing taxonomies of primary care components to classify our results according to four categories: coverage, financing, service delivery, and governance. Findings: We identified and classified 109 reviews that met our inclusion criteria according to our taxonomy of primary care components: coverage, financing, service delivery, and governance arrangements. A significant body of evidence suggests that several specific primary care arrangements, such as health workers' task shifting and tel