1976-P: A Persistency-Based Decision Tree Analysis of Capsaicin 8% vs. Oral Agents Estimating the Health Care Resource Use Attributable to Discontinuation in Painful Diabetic Peripheral Neuropathy

Introduction and Objective: Painful diabetic peripheral neuropathy (PDPN) therapies are often discontinued, resulting in periods without treatment. Although annual healthcare resource use (HRU) for PDPN in the United States (US) is described, HRU proportions due to treatment discontinuation are unclear. This analysis estimated the HRU attributable to discontinuation by calculating time off treatment, comparing capsaicin 8% (HCCTS) vs oral agents. Methods: A 12-month decision tree simulated 1,000 adults initiating PDPN therapy, calculating total patient time into on-treatment and off-treatment states. Medication related discontinuation probabilities were from a targeted review of 78 randomized PDPN trials. Baseline HRU rates of resources were from published US PDPN claims studies. Per treatment annual HRU was calculated by multiplying HRU rate by on/off times. In the base case, HRU expected while on-treatment was assumed at 90% of baseline, and while off-treatment time assumed at 125% of baseline. Scenario analyses varied these assumptions. Results: Across 15,092 trial participants (mean age 59 years; 52% male), 12-month discontinuation was 4.8% for HCCTS and 19.7%-24.6% for oral agents. Under base case, HCCTS had ~10% reduction in annual PDPN HRU relative to expected HRU. In contrast, discontinuation related time off treatment from oral agents accounted for ~50% of expected HRU. In a 1,000-patient cohort, oral discontinuation was associated with ~300 more emergency visits, ~320 more inpatient visits, ~2,500 more outpatient, and ~6,600 more physician visits vs. HCCTS. Findings were consistent across HRU attribution scenarios. Conclusion: Across plausible ranges, a meaningful proportion of expected annual PDPN HRU was attributable to treatment discontinuation. Lower discontinuation with HCCTS shifted a smaller share of expected HRU into off-treatment time, suggesting improved persistence may reduce healthcare resource use due to discontinuation. Disclosure J. Fishman: Employee; Current; Averitas Pharma, Inc. L.P. Marcondes: Employee; Current; Averitas Pharma, Inc. H. Kalia: Consultant; Current; Abbott. N.M. Schuster: Consultant; Current; Averitas, Vertex Pharmaceuticals Incorporated, Eli Lilly and Company, Rapport, Lohocla, Syqe, Schedule 1. Research Support; Current; ShiraTronics.