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Acrylamide was detected in considerable amounts in black table olives. In this study, besides black, also green and naturally black table olives were investigated for their acrylamide, free asparagine, and 3-aminopropionamide contents before and after heat treatment. Acrylamide amount was 208–773 μg/kg in black table olives and did not change due to heat treatment. In green and naturally black table olives acrylamide was ≤24 μg/kg before heat treatment and rose to 1200 μg/kg afterward. Asparagine content was 0.35–35 mg/kg in all samples before heat treatment and after heat treatment with no considerable change in the range. 3-Aminopropionamide showed amounts of ≤56 μg/kg in the unheated samples and increased up to 131 μg/kg due to heat impact. However, quantified asparagine and 3-aminopropionamide amounts were insufficient in almost all samples to explain the acrylamide quantities formed due to heat treatment based on the formation via the Maillard reaction.

Previous work on psych predicates has so far mostly focused on verbs and their non-canonical argument structures within and across languages. In this study, we propose a usage-based account using parallel subtitles in seven European languages in order to examine the intralinguistic and crosslinguistic variation of psychological expressions. We start out from 12 semantically defined psychological concepts rather than concrete constructions; this allows us to include verbal and non-verbal expressions and thus to assess the variation and distribution of construction types of psychological expressions found in language use. We show that while there is a high degree of variation in terms of constructions used within languages, psychological expressions are relatively stable across languages. On the other hand, we find systematic, crosslinguistic concept-specific preferences for psychological expressions.

AbstractObjectives:To examine treatment patterns, treatment effectiveness, and treatment costs for 1 year after patients with rheumatoid arthritis switched from a tumor necrosis factor inhibitor (TNFi) (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab), either cycling to another TNFi (“TNFi cyclers”) or switching to a new mechanism of action (abatacept, tocilizumab, or tofacitinib) (“new MOA switchers”).Methods:This retrospective cohort study used administrative claims data for a national insurer. Treatment persistence (without switching again, restarting, or discontinuing), treatment effectiveness (defined below), and costs were assessed for the 12-month post-switch period. Patients were “effectively treated” if they satisfied all six criteria for a treatment effectiveness algorithm (high adherence, no dose increase, no new conventional synthetic disease-modifying anti-rheumatic drug, no subsequent switch in therapy, no new/increased oral glucocorticoids, and <2 glucocorticoid injections). Multivariable logistic models were used to adjust for baseline factors.Results:The database included 581 new MOA switchers and 935 TNFi cyclers. New MOA switchers were 39% more likely than TNFi cyclers to persist after the switch (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.12–1.74; p = .003) and 36% less likely to switch therapy again (OR = 0.64; 95% CI = 0.51–0.81; p < .001). New MOA switchers were 43% more likely than TNFi cyclers to be effectively treated (OR = 1.43; 95% CI = 1.11–1.85; p = .006). New MOA switchers had 16% lower drug costs than TNFi cyclers (cost ratio = 0.84; 95% CI = 0.79–0.88; p < .001) and 11% lower total costs of rheumatoid arthritis-related medical care (cost ratio = 0.89; 95% CI = 0.84–0.94; p < .001).Limitations:Claims payments may not reflect rebates or other cost offsets. Medical and pharmacy claims do not include clinical end-points or reasons that lead to new MOA switching vs TNFi cycling.Conclusions:These results support switching to a new MOA after a patient fails treatment with a TNFi, which is consistent with recent guidelines for the pharmacologic management of established rheumatoid arthritis.

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This article focuses on the history of one particular institution: the National Museum of Rwanda in Butare. Built between 1987 and 1989 by the Belgian architect Lode Van Pee, funded by the Belgian government, and gifted by King Baudouin of Belgium to then–Rwandan President Juvénal Habyarimana, this museum was designed to house the ever-expanding collection of the Institut National de Recherche Scientifique, in itself a research body rooted in the colonial past. This article traces the origins of the museum and discusses the transitions that its displays and objects have undergone in a postcolonial and post-genocidal Rwandan context.

An implantable drug delivery system (IDDS) provides an alternate route of opioid administration for patients with chronic pain. We collected data on systemic opioid use before and after IDDSimplantation; patients who successfully discontinued systemic opioids; and physician support of discontinuation. This was a single‐center, retrospective chart review of 99 consecutive patients who used IDDSsfor at least six months. Data collection included pre/postimplant systemic opioid use and pain scores, and patient demographic and clinical characteristics. The study population averaged 67 years of age, was 68% women, and 77% were Medicare beneficiaries. Ninety‐five percent of patients had low back pain, and 86% had limb pain. The majority (81%) had pain for >5 years. Failed treatments included epidural injections (74%), lumbar spine surgery (46%), spinal cord stimulation (14%), and facet joint injections (11%), with 84% also reporting significant systemic opioid side‐effects. All patients taking long‐acting opioids discontinued these within one month of implant. Total systemic opioid elimination was accomplished by 68% of patients at one month postimplant, 84% at one year, and 92% at five years. At one month postimplant, 60% of patients reported decreased pain (mean change: −4.07), and at one year, 64% did (mean change: −3.42). IDDScan provide significant and lasting pain relief and an alternate route of delivery compared with systemic opioids with their associated side‐effects. We demonstrated that systemic opioid elimination could be accomplished after IDDSimplantation in the majority of cases through appropriate patient selection, monitoring, and participation.

Aim:To examine cost and mortality differences in postmenopausal women with HR+/HER2-advanced breast cancer. Methods:Using claims data (2007–2013), women with newly diagnosed (de novo) stage IV, or early- or late-recurring metastatic breast cancer were identified. Results:Compared with de novo(n 121) and late-recurrent (n 106), early-recurrent (n 172) patients had significantly higher costs in total and for anticancer systemic agents. Adjusted per patient per month costs for early-recurrent patients were US$13,404, versus US$9955 (de novo) and US$9721 (late-recurrent; p 0.02). Early-recurrent patients’ risk of death was twice that of de novopatients (p 0.02). Conclusion:Compared with new diagnosis or late recurrence, early recurrence of HR+/HER2- metastatic breast cancer was associated with higher mortality and healthcare costs.

Aims:To examine the impact of research design on results in two published comparative effectiveness studies. Methods:Guidelines for comparative effectiveness research have recommended incorporating disease process in study design. Based on the recommendations, we develop a checklist of considerations and apply the checklist in review of two published studies on comparative effectiveness of colony-stimulating factors. Both studies used similar administrative claims data, but different methods, which resulted in directionally different estimates. Results:Major design differences between the two studies include: whether the timing of intervention in disease process was identified and whether study cohort and outcome assessment period were defined based on this temporal relationship. Conclusion:Disease process and timing of intervention should be incorporated into the design of comparative effectiveness studies.

Mobile devices are used to initiate shopping or enhance traditional shopping experiences. The integration of m-commerce with social networking sites enables marketers to provide really personalized offers to customers. The basis for that is an in-depth understanding of customers’ needs and expectations which can be analyzed on social networking sites due to their explicit and implicit presentation of the customers’ context and needs as well as due to their rising popularity. This study investigates the reasons for customers to use online social networks, using the example of Facebook. For that purpose, a structural equation model with formative constructs is developed and tested against data from young Facebook users. The authors’ results show that subjective norm might show no direct effect but, however, it has a large influence which occurs indirectly via perceived usefulness and perceived enjoyment. Additionally, the authors reveal that drivers for the usage intention of social networks show major differences between men and women.

Objective.To determine the risk factors for Clostridium difficile–associated disease (CDAD) in a 25-bed rural hospital and to compare antimicrobial use ratios at the study hospital with those at a large academic medical center.Design.Case-control study.Setting.A 25-bed rural hospital in Iowa during the period from August 2002 through January 2005.Patients.A total of 17 case patients with CDAD and 34 control patients matched for age (ie, within 10 years of the case patient's age), sex, and admission date (ie, within 2 weeks of the case patient's admission date).Methods.Retrospective medical record review was performed to obtain data on antimicrobial exposures during the 6 weeks before hospital admission for both case and control patients. Exact conditional logistic regression was used for univariable and multivariable analyses. Antimicrobial use ratios were calculated to compare the rates of antimicrobial use for case and control patients at the study hospital with the rates for patients evaluated in a study of CDAD at a nearly 700-bed teaching hospital.Results.Case patients had a larger cumulative number of days of antimicrobial use (P= .004), and they received a larger total number of antimicrobial agents during hospitalization (P= .001). Antimicrobial use ratios were higher for both case and control patients at the smaller hospital, compared with the larger hospital.Conclusions.CDAD at a small rural hospital was not associated with exposure to the antimicrobial classes that are typically associated with CDAD, but was instead related to the total number of antimicrobials used to treat patients. The rate of antimicrobial use for case and control patients was about 40% higher at the small rural hospital, compared with the corresponding rates at a large academic medical center.

Asthma mortality rates in Chicago are among the highest in the United States, with substantially greater rates in poor and minority populations. How much of the differential can be attributed to differences in prevalence versus severity or access to care has not been determined.

THIS study tested the hypothesis that halothane anesthesia would cause decreased acetylcholine (ACh) release within the medial pontine reticular formation (mPRF). ACh was collected by microdialysis and measured by high pressure liquid chromatography during wakefulness and during halothane-induced anesthesia. The electroen-cephalogram (EEG) showed that spindles were a reliable indicator of anesthetic depth. There was a statistically significant disease in ACh release during halothane anesthesia compared with ACh release during wakefulness. Spindles always disappeared during noxious stimulation and during emergence from anesthesia when pontine ACh levels began to increase. These results are consistent with previous data concerning brain stem cholinergic influences on thalamocortical spindle generation, and suggest that similar mechanisms generate cortical spindles during natural sleep and halothane anesthesia.

Introduction:

Lyman: G1 Therapeutics, Halozyme Therapeutics, Partners Healthcare, Hexal, Bristol-Myers Squibb, Helsinn Therapeutics, Amgen Inc., Pfizer, Agendia, Genomic Health, Inc.: Consultancy; Generex Biotechnology: Membership on an entity's Board of Directors or advisory committees; Janssen Scientific Affairs, LLC: Research Funding; Amgen Inc.: Other: Research support, Research Funding.

Lyman: Generex Biotechnology: Membership on an entity's Board of Directors or advisory committees; Amgen: Other: Research support; Halozyme; G1 Therapeutics; Coherus Biosciences: Consultancy.

Background:Young adults (22-39y) with ALL treated at an NCI-designated Comprehensive Cancer Center (CCC) have a superior survival when compared with those treated at a non-CCC site. (Wolfson et al, CEBP,2017) Despite superior outcomes, specialized cancer centers (such as CCC) have been generally criticized for a higher cost of cancer care (Nardi et al, JNCCN, 2016). However, the magnitude of difference in cost of care for ALL patients by treatment site has not been explored. Here we examine cost of cancer care at CCC and non-CCC sites in YA with ALL.

Background:This study examined post-discharge costs among individuals hospitalized with heart failure (HF) by stage of chronic kidney disease (CKD).

Several letters to the editor are presented in response to articles in the December 2013 issue including "Girl-On-Girl Power," which discusses same-sex relationships among women, "Brave Heart," which focuses on American actress Lea Michele, and "Eyes Wide Open," which features a conversation with artist Carrie Mae Weems.

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of Non-Hodgkin's Lymphoma (NHL) accounting for approximately 30% of newly diagnosed casesi. DLBCL is an aggressive form of NHL and without treatment, median survival estimates are <1 year.ii Rituximab in combination with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) is recommended first-line therapy for DLBCL patients and has been shown to improve overall survival compared with CHOP alone (previous standard therapy).iii In addition, published evidence suggests that receipt of granulocyte-colony stimulating factor (G-CSF) may improve outcomes among patients who initiate CHOP-based therapy.ivIt is unclear whether differences in treatment and outcomes exist among cancer patients by site where care is delivered. This study examines differences in treatment patterns, health care resource use and costs among DLBCL patients receiving rituximab (R) or R+ chemotherapy in the office/clinic (OC) setting vs. the hospital outpatient (HOSP) setting.This retrospective study used medical and pharmacy claims (1/2007 - 7/2012) from a national US commercial health plan to identify patients at least18 years old with ≥2claims for R. Patients were required to have evidence of DLBCL (≥1 claim with ICD-9-CM 200.78 or ≥2 claims with unique diagnosis codes from ICD-9-CM 200.70 to 200.77) and be enrolled in the health plan for ≥6 months before and after the index date (date of the first R claim). The follow-up period, that is, the episode of care (EOC), was the date of the first R infusion through 30 days after the last infusion prior to a gap in R administration of at least 7 months; those with less than 6 months of follow-up due to death were included. Patients with multiple cancers or receipt of R at both the OC and HOSP setting during the EOC were excluded. Differences in number of infusions, receipt G-CSF, healthcare utilization and per-patient per-month (PPPM) health care costs by cohort were examined.A total of 491 patients were identified, 65% OC (n=320) and 35% HOSP (n=171): by insurance type, 140 Medicare Advantage patients, 39% HOSP and 351 commercially insured patients, 33% HOSP. From 2007 to 2011/2012, the percentage of patients in HOSP increased from 32% to 43%.Descriptive results are shown in the Table. The cohorts had similar mean age, baseline Charlson comorbidity index scores and similar EOC lengths. However, compared to the OC cohort, the HOSP cohort had fewer infusions during the EOC and fewer infusions per month. In addition, fewer HOSP patients had evidence of combination therapy and receipt of any G-CSF during the EOC. HOSP patients also had significantly higher rates of emergency room visits, but not hospitalizations compared to OC patients. Total PPPM costs during the EOC as well as average costs of anti-cancer systemic therapy drugs plus administration costs incurred on days of rituximab infusions were significantly higher among the HOSP cohort compared to the OC cohort.Increasing proportions of DLBCL patients receive infusions in the HOSP setting. HOSP patients had fewer infusions per month and incurred greater costs on the day of infusion compared to the OC cohort. There were fewer patients in HOSP with evidence of G-CSF during the EOC compared to OC patients. Overall, total PPPM costs were higher among the HOSP cohort compared to the OC cohort. Future research is warranted to assess the impact of these differences on clinical outcomes by site of care.[i] Armitage et al. JCO 1998;16(8):2780-95[ii] Mey et al. Swiss Med Wkly 2012;140:w13511[iii] NCCN Guidelines Version 1.2013 Diffuse Large B-cell Lymphoma[iv] Donnelly, et al, Leuk Lymphoma. 2000;39(1-2):67-75Reyes: Genentech, inc: Employment, Equity Ownership. Dacosta Byfield:Genentech, Inc: Genentech contracted with OptumInsight to conducting the work described in the abstract. Stacey is employed at Optum but did not receive funds directly from Genentech and employment is not contingent on work with Genentech., Genentech contracted with OptumInsight to conducting the work described in the abstract. Stacey is employed at Optum but did not receive funds directly from Genentech and employment is not contingent on work with Genentech. Other; OptumInsight: Employment. Becker:Genentech, Inc: Genentech contracted with OptumInsight to conducting the work described in the abstract. Laura is employed at Optum but did not receive funds directly from Genentech and employment is not contingent on work with Genentech., Genentech contracted with OptumInsight to conducting the work described in the abstract. Laura is employed at Optum but did not receive funds directly from Genentech and employment is not contingent on work with Genentech. Other; OptumInsight: Employment. Small:Genentech, Inc: Employment, Equity Ownership.

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of Non-Hodgkin's Lymphoma (NHL) accounting for approximately 30% of newly diagnosed casesi. DLBCL is an aggressive form of NHL and without treatment, median survival estimates are <1 year.iiRituximab in combination with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) is recommended first-line therapy for DLBCL patients and has been shown to improve overall survival compared with CHOP alone (previous standard therapy).iiiIn addition, published evidence suggests that receipt of granulocyte-colony stimulating factor (G-CSF) may improve outcomes among patients who initiate CHOP-based therapy.iv

Abstract 4259

Few studies have examined whether differences in treatment and outcomes exist among cancer patients by the setting where care is delivered. This study investigates differences in treatment patterns, health care resource use and costs among non-Hodgkin's Lymphoma (NHL) and Chronic Lymphocytic Leukemia (CLL) patients receiving rituximab (R) or R+ chemotherapy based on site of care: office/clinic (OC) vs. hospital outpatient (HOSP).Patients ≥18 years with evidence of NHL or CLL diagnoses codes at least 30 days apart and received ≥2 R claims from Jan 2007 to Mar 2011 were identified from a large US commercial insurance claims database. Patients were required to be enrolled in the health plan for at least 6 months before and after the index date (date of first R claim). The follow-up period was the date of the first infusion to 30 days after the last infusion prior to a gap of ≥7 months. Patients with evidence of multiple cancers or receipt of R at both sites of care were excluded. Cohorts were created based on site of care where R was administered and type of insurance, commercial (COM) vs. Medicare Advantage (MA). Descriptive analyses were conducted to examine differences in treatment patterns and per-patient per-month (PPPM) health care costs. Multivariate analyses adjusting for age, gender, baseline Charlson index score and receipt of monotherapy was also conducted to examine differences in PPPM health care costs.A total of 2,594 OC and 286 HOSP patients were identified. A higher percentage of Medicare Advantage patients (27% of 878 patients, n=236) received Rituxan therapy in the HOSP setting compared to commercially insured patients (2% of 2002 patients, n=50).Among the Medicare Advantage patients, age, gender, and baseline Charlson comorbidity index were not significantly different by cohort. The mean length of the episode of care was not significantly different by site of service but the number of Rituxan infusions (5.4 vs. 6.8, p<0.01) and infusions/mth (0.99 vs. 1.27, p<0.01) were significantly less in the HOSP compared to the OC. Incidence rates of ER visits (0.11 vs. 0.08, p=0.02), but not hospitalizations were higher among the HOSP cohort. Unadjusted infusion day costs were higher among the HOSP compared to the OC ($6,479 vs. $4,998, p<0.01) but total PPPM costs were not significantly different by cohort ($9,323 vs. $10,051, p>0.05). In multivariate analyses, total PPPM costs were slightly less among the HOSP cohort (cost ratio=0.92, p<0.01).Among the commercially insured population, gender and baseline Charlson comorbidity index were not significantly different by cohort though patients in the HOSP were slightly younger than those in the OC (55 years vs. 59 years). The mean length of the episode of care was not significantly different by site of service but compared to the OC the number of Rituxan infusions (5.52 vs. 7.56, p<0.01) and infusions per month (1.05 vs. 1.17, p>0.05) were less in the HOSP though the difference in infusions/month was not significant. Incidence rates of ER visits and hospitalizations were also not significantly different. Unadjusted infusion day costs were higher among the HOSP cohort compared to the OC cohort ($10,939 vs. $5,464, p<0.01) as well as total PPPM costs ($17,230 vs. $11,549, p=0.01). In multivariate analyses, total PPPM costs remained significantly higher among the HOSP cohort (cost ratio=1.40, p<0.01).A lower percentage of COM patients receive Rituxan infusions in the HOSP setting compared to MA patients. However, regardless of insurance type, patients in the HOSP cohort incurred greater costs on the day of Rituxan infusion compared to the OC cohort. Among MA patients, although costs incurred on the day of infusions were significantly higher in the HOSP cohort, patients treated in the HOSP setting had slightly lower total PPPM costs likely due to fewer administrations per month of Rituxan during an episode of care. Among COM patients, higher infusion day costs contributed to higher total overall costs among the HOSP cohort. These results warrant further investigation to assess the impact of these differences on clinical outcomes by site of care.Dacosta Byfield: OptumInsight: Employment, OptumInsight received payment from Genentech to conduct the study described in the abstract Other. Reyes:Genentech, Inc.: Employment, Roche Stock Other. Becker:OptumInsight: Employment, OptumInsight received payment from Genentech to conduct the study described in the abstract Other. Small:Genentech, Inc: Employment, Roche stock Other.

Several studies have identified older age as one of the risk factors for severe neutropenia, febrile neutropenia (FN), and related outcomes including hospitalization following myelosuppressive chemotherapy. Older age is also associated with the increased likelihood of comorbid conditions, greater severity of illness, decline in performance status, and other risk factors for complications following chemotherapy. No study has yet described the effect of age while controlling for these age-related risk factors for febrile neutropenia following chemotherapy. This analysis describes the effect of age, adjusted for patient and treatment characteristics and measurable comorbidities, on the incidence of hospitalization for any reason and also on neutropenia-related hospitalization in non-Hodgkin's lymphoma (NHL) patients receiving chemotherapy.Using U.S. claims data from 01 January 2006 through 31 December 2009, we examined rates of all-cause hospitalization and neutropenia-related hospitalization for patients with NHL aged 18 to 89 years, during their first course of chemotherapy (when patients are at highest risk for neutropenia-related hospitalization). Neutropenia was identified in claims as ICD-9-CM code 288.0. We fitted a cubic spline regression curve based on the regression spline model that best predicted the association between hospitalization and age, adjusting for sex of the patient, treatment characteristics (type of chemotherapy, cycle length), chronic comorbidities (using the Deyo-Charlson comorbidity index), and use of filgrastim, pegfilgrastim, or sargramostim (G/GMCSF) as primary prophylaxis (defined as use within the first 5 days of the first cycle). Results are presented numerically and graphically with simultaneous 95% confidence intervals.We identified 4,048 patients with NHL who were receiving chemotherapy. Approximately half (55%) were male; mean age was 61 years (standard deviation, 15 years) (table). The most common first cycle administration schedule was every 3 weeks (Q3W), reported for 64% of courses. Primary prophylaxis with G/GMCSF was administered in 49% of the chemotherapy courses. The risk of hospitalization for any cause was approximately 20% at age 20, rising in a nearly linear fashion to approximately 28% at age 80 (graph; R2 = 0.0421). The risk of neutropenia-related hospitalization was approximately 2% at age 20 and approximately 5% at age 80 (graph; R2 = 0.0125).After adjusting for sex, treatment characteristics, chronic comorbidities, and use of primary prophylaxis with G/GMCSF, older age is associated with a moderate, nearly linear increase in the risk of hospitalization from any cause and a more modest but similar increase in neutropenia-related hospitalization.Deeter: Amgen Inc.: Employment, Equity Ownership. Kaye:Amgen Inc.: Consultancy. Legg:Amgen Inc.: Employment, Equity Ownership. Rothman:RTI Health Solutions: Employment.

Abstract 2082

Patients receiving myelosuppressive chemotherapy are at risk for developing febrile neutropenia, a major dose-limiting toxicity associated with hospitalization, morbidity, and mortality. Prophylactic use of recombinant human granulocyte colony-stimulating factors (G-CSF), such as daily filgrastim and once-per-cycle pegfilgrastim, can decrease the incidence of febrile neutropenia. This study examined real-world effects of G-CSF on hospitalization risk.This retrospective U.S. claims analysis utilized data from 1/1/2004 to 2/28/2009 to examine hospitalization rates for filgrastim- and pegfilgrastim-treated patients receiving chemotherapy for non-Hodgkin's lymphoma (NHL), breast cancer, lung cancer, ovarian cancer, and colorectal cancer. Claims with the ICD-9 code for neutropenia (288) were categorized as neutropenia-related. Cycles were included if they were 20–60 days, as defined by chemotherapy claims. G-CSF use was designated ‘prophylactic' if initiated in the first 5 days of a chemotherapy cycle, or ‘delayed', if after day 5. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by generalized estimating equations models. ORs were adjusted for potential confounders such as patient, tumor, and treatment characteristics. Healthcare utilization and costs were calculated during each cycle, as well as for emergency room, inpatient, and ambulatory visits. Cycles were considered highly myelosuppressive if patients received one or more chemotherapy agents deemed highly myelosuppressive per NCCN guidelines.We identified 3,958 patients, representing 13,070 chemotherapy cycles during which G-CSF was administered (12,218 pegfilgrastim, 852 filgrastim). Most patients were female, with a mean age of 55. The most frequent cancers were breast cancer (57%), lung cancer (18%), and NHL (17%). Pegfilgrastim was used prophylactically (96% of cycles) more frequently than filgrastim (44% of cycles). Compared to chemotherapy cycles with filgrastim, those with pegfilgrastim had a decreased risk of neutropenia-related hospitalization (OR=0.33, 95% CI 0.19–0.58) and all-cause hospitalization (OR=0.56, 95% CI 0.43–0.72). Chemotherapy cycles with prophylactic initiation of either G-CSF had decreased risk of neutropenia-related hospitalization (OR=0.30, 95% CI 0.18–0.50) and all-cause hospitalization (OR=0.55, 95% CI 0.43–0.69) compared with delayed initiation of G-CSF. In subgroups of cycles with or without highly myelosuppressive chemotherapy, similar reductions in all-cause and neutropenia-related hospitalization risk were observed both with pegfilgrastim vs. filgrastim and prophylactic vs. delayed G-CSF. The two types of cycles were generally similar in patient characteristics, with the exception of proportion female, 84% vs. 67%, and baseline Deyo-Charlson comorbidity score, 4.2 vs. 5.3, for cycles with or without highly myelosuppressive chemotherapy, respectively. For all-cause utilization by cycle, the mean numbers of ambulatory visits (8.6 vs. 5.5, P<0.001) and inpatient stays (0.13 vs. 0.06, P<0.001) were greater with filgrastim as compared with pegfilgrastim, while the numbers of emergency room visits were the same (0.11 for both). For neutropenia-related utilization by cycle, there were also more ambulatory visits (1.5 vs. 0.36, P<0.001) and inpatient stays (0.02 vs. 0.01, P<0.01) with filgrastim as compared with pegfilgrastim, while mean emergency room visits were 0 for both groups. Mean total per-cycle costs (for all claims and pharmacy costs) due to all causes were similar for filgrastim and pegfilgrastim ($9,581 vs. $9,881) while mean total per-cycle costs due to neutropenia-related causes were numerically greater with filgrastim than pegfilgrastim ($1,615 vs. $1,190, P=0.054). Inpatient stays were more costly with filgrastim than pegfilgrastim for both all causes ($2,002 vs. $862, P<0.005) and neutropenia-related causes ($468 vs. $89, P=0.062).In this comparative effectiveness study, use of pegfilgrastim resulted in a lower risk of neutropenia-related and all-cause hospitalization compared to use of filgrastim. Inpatient stays were more frequent and more costly during cycles in which patients received filgrastim. Prophylactic use of either G-CSF was associated with a consistent reduction in hospitalization risk as compared with delayed use.Naeim: Amgen Inc.: Consultancy. Henk:i3 Innovus: Employment; Amgen Inc.: Research Funding. Becker:i3 Innovus: Employment; Amgen Inc.: Research Funding. Chia:Amgen Inc.: Employment, Equity Ownership. Badre:Amgen Inc.: Employment, Equity Ownership. Deeter:Amgen Inc.: Employment, Equity Ownership, Research Funding.

Abstract 3801

For MM patients with malignant bone lesions (BM), SREs including pathologic fracture, spinal cord compression, hypercalcemia of malignancy, and radiotherapy and/or surgery to bone are associated with significant morbidity and mortality and reduced quality of life. ZOL is an IV bisphosphonate (BP) proven to reduce and delay incidence of SREs in several tumor types. This study was designed to assess the benefit of long-term ZOL use in a real-life setting.Claims-based analysis of commercial and Medicare data from a large US managed care plan and a 45 health-plan database was used to evaluate SRE rates, time from BM to 1st SRE, and mortality in patients treated with ZOL or no IV BP therapy. Patients older than 18 years with MM and BM diagnosed between Jan 2001 and Dec 2006 were included. Treatment Persistency was defined as the absence of a >45 day gap between ZOL administrations. Continuous enrollment in the health plan for 6 months before and no prior evidence of BM or IV BP use were required. When assessing mortality, patients with a date of death less than 30 days following index date were excluded. Patients were followed until they disenrolled from the plan or to the end of the study's follow-up period. In this study, SREs were defined as evidence of pathologic fracture, spinal cord compression, and radiotherapy and/or surgery to bone.The study sample included 1,655 Patients with a mean age of 61.7 ± 11.9 years; approx. 64% were treated with ZOL and 36% with no IV BP. Incidences of SREs and mortality rates were both greater in the no IV BP group (incidence rate ratio [IRR] = 1.58; p-value<0.001 and mortality rate = 1.71; p-value=0.0234) vs. the ZOL groups. Longer persistency with ZOL was associated with a lower risks of first SRE compared with no IV BP (trend test p-value=0.0025) [TABLE 1].This study showed that in MM Patients with BM, ZOL use was associated with a lower risk of SREs, including fractures, and lower mortality rates. In addition, longer persistence was found to be associated with lower risk of SRE.Kaura: Novartis: Employment, Equity Ownership. Perez:Novartis: Employment, Equity Ownership.

Abstract 3881

The article offers the author's insights on several arts in the University District of Spokane, Washington. Topics include the Light Reading outdoor reading room created by Peter Reiquam at the Washington State University Health Sciences Spokane campus, the Soaring and Rooted mirror-polished stainless steel conical sculptures by Shani Marchant and Lea Anne Lake at the University District Gateway Bridge plazas, and the Myrtle Woldson Performing Arts Center at the Gonzaga University.