P246 The impact the introduction of a universal payment by results annual tariff cf centres upon the north south divide in england

BackgroundOur preliminary work demonstrated inequalities in key demographic characteristics, clinical outcomes and medication use in Cystic Fibrosis (CF) patients between the relatively economically disadvantaged North of England compared to the South. The analyses presented here aimed to assess if this North-South divide has been closed following the introduction of a new and equal CF payment policy (“banding”) in 2012.MethodsWe compared the cross-sectional data from Annual Review Encounter in 2010 and 2015 for patients registered on the UK CF Registry. The data for each year were analysed separately and the North/South Results compared. We used Wilcoxon and t-tests to compare continuous outcomes, and the chi-squared test to compare proportions.ResultsThe 2010 and 2015 cohorts included 6417 and 8007 patients, respectively (Table 1). There were no significant gender differences. Mean age of the populations increased, the significantly higher age in the South in 2010 levelled out by 2015. A new gap in overall lung function emerged in 2015: 72.24% vs 73.5% (p=0.041), the significantly higher FEV1in children in the South remained, although the gap narrowed from 3.27% to 1.7%. The better FEV1in adults in the North disappeared post banding. More patients in the North were diagnosed before turning 3 months. Prescription of key medications (DNase and Hypertonic saline) increased overall between 2010 and 2015 but higher use in the South remained (p<0.001). Rates of chronic Pseudomonas aeuginosafell but remain significantly higher in the North. Rates of MSSA and NTM remain higher in the South.Abstract P246 Table 1Patient characteristicsPre Banding (2010 Annual Review Encounter)Post Banding (2015 Annual Review Encounter)OutcomeSouth of England/North of England (n=3017/3400)South of England/North of England (n=3887/4120)Summary statisticsp-valueSummary statisticsp-valueAge: Mean±SD19.71±13.24/18.81±12.520.005220.82±14.23/20.3±13.780.0967Median18/1819/19Gender, n(%)Female1423 (47.17)/1578 (46.41)1870 (48.11)/1894 (45.97)Age at diagnosis, n(%)<3 months; n (%)1280 (42.43)/1590 (46.76)0.00521852 (47.65)/2121 (51.48)<0.001≥18 years; n (%)188 (6.23)/191 (5.62)0.2296295 (7.59)/258 (6.26)0.0216FEV1 percent predicted(Overall) Mean±SD70.98±24.66/71.23±24.230.717273.5±24.53/72.24±24.840.041Age<16 Mean±SD84.51±17.99/81.57±19.800.002287.78±17.37/86.08±17.660.0361Age≥16 Mean±SD64.69±24.81/66.73±24.610.015367.6±24.63/66.6±25.130.1754Hypertonic Saline (n(%))433 (14.35)/311 (9.15)<0.0011319 (33.93)/860 (20.87)<0.001Dornase Alfa (n(%))1394 (46.2)/1393 (40.97)<0.0012572 (66.17)/2274 (55.19)<0.001 Chronic macrolides (n(%))1284 (42.56)/1445 (42.5)0.98221498 (38.54)/1607 (39.00)0.6856Asthma (n(%))534 (17.7)/393 (11.56)<0.001685 (17.62)/538 (13.06)<0.001CFRD (n(%))528 (30.14)/623 (32.5)0.1325838 (53.51)/957 (57.34)0.0389NTM (n(%))116 (3.84)/55 (1.62)<0.001297 (7.64)/193 (4.68)0.001Pseudomonas (n(%))1058 (35.07)/1359 (39.97)<0.0011100 (28.3)/1332 (32.33)0.0269ConclusionsThere appears to be a closing of the North-South gap in some key areas such as FEV1and age, this may suggest improved outcomes although survival analysis is not possible on small cohorts such as these. The higher use in the South of the high cost drug DNase must now be down to clinician preference rather than funding problems. These markers of overall improvements (higher mean age, higher FEV1, lower Pseudomonas) may be associated with the introduction of equality of funding in England but could equally represent improved care in general with similar improvements seen in other international registries.