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Summary:Allogeneic stem cell transplantation (SCT) is one of the most expensive medical procedures. However, only a few studies to date have addressed the costs of HLAidentical sibling transplantation and only one study has reported costs of unrelated transplantation. No recent cost analysis with a proper follow-up period and donor identification expenses is available on related or voluntary matched unrelated donor (MUD) SCT for adult AML or ALL. Therefore, we calculated direct medical (hospital) costs based on 97 adults who underwent HLA-identical sibling bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT), and patients who received a graft from a MUD between 1994 and 1999. The average costs per transplanted patient were 98 334 (BMT), 151 754 (MUD), and 98 977 (PBSCT), including donor identification expenses, 2 years follow-up and costs of patients who were not transplanted after they had been planned to receive an allograft. The majority of these costs was generated during the hospitalisation for graft infusion. For MUD transplants, nearly one-third of these costs was spent on the search for a suitable donor. For patients who were alive after 2 years, cumulative expenses were calculated to be 103 509 (BMT), 173 587 (MUD), and 105 906 (PBSCT).

Objectives: Docetaxel and Cabazitaxel are taxane chemotherapy approved in men with mCRPC after they demonstrated improved survival in first and second line respectively. If recent data suggested similar efficacy, these two taxanes have different safety profile and unit price, raising the question of their administration sequence. A cost-utility analysis comparing two sequences of treatment (Cabazitaxel followed by Docetaxel versus Docetaxel followed by Cabazitaxel) for first-line chemotherapy in metastatic prostate cancer was performed in the French context, using data from the CABADOC randomized trial. MethOds: The CABADOC study is a randomized trial with a cross-over design. Patients were randomized to receive either Docetaxel 75mg/m²/q3w x 4 followed by Cabazitaxel 25mg/m²/q3w x 4, or the reverse sequence. The economic analysis included a prospective collection of resources consumed (chemotherapy, hospitalizations, transportation, nurses and consultations) and utility data (using the EQ-5D questionnaire administered before cycle 1, cycle 5 and at the end of chemotherapy) alongside the trial. Costs were evaluated from the French collective perspective and horizon time was limited from the randomization date to the end of 2nd sequence chemotherapy. The ICER was calculated and sensitivity analyses were conducted. Results: From June 2014 to October 2016, 195 patients (median age of 70 years) were randomized in 17 centers. Patients received 3.8 ± 0.7 and 3.2 ± 1.5 cycles of chemotherapy during the first and the second period, respectively. The sequence Docetaxel-Cabazitaxel appears to be more effective (mean QALY per patient of 0.353 ± 0.025 versus 0.328 ± 0.063) and less expensive (mean cost per patient of 17 350 € ± 2955 versus 17 862 € ± 2320) as compared to the sequence Cabazitaxel-Docetaxel. cOnclusiOns: The sequence of treatment with Docetaxel followed by Cabazitaxel appears the optimal one for first line chemotherapy in metastatic prostate cancer from a cost-utility standpoint. NCT: NCT02044354.

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2972 Thalidomide (T) with melphalan/prednisone (MPT) was defined as a standard treatment in elderly patients with multiple myeloma (MM) based on 5 randomized trials. Treatment with MPT not only showed improved response rate, significantly better time to response as well as quality of response but also a significant improvement of event free survival (EFS), progression free survival (PFS) and overall survival (OS). In one of these trials, HOVON 49, a prospective Health related – Quality of life (HRQoL) was initiated in order to asses the impact of T on QoL. (Wijermans et al, J Clin Oncol 28:3160-6). Patients aged >65 years with newly diagnosed symptomatic MM were randomized to receive 8 cycles of MP or MPT, followed by T maintenance in MPT arm. 284 patients were included in this HRQoL side study (MP: n=149, MPT: n=135). HRQoL was assessed with the EORTC core QoL Questionnaire (QLQ-C30) and the myeloma-specific module (QLQ-MY24) at baseline and at pre-determined intervals during treatment. Treatment-related toxicity WHO grade 2–4 occurred in 60% of MP and 87% of MP-T treated patients. Most frequently found were neutropenia-related infections, neurotoxicity (mostly T induced peripheral neuropathy) and myelotoxicity. The QLQ-C30 subscales Physical Function (p=0.044) and Constipation (p<.001) showed a treatment related improvement during induction in favour of the MP arm. During T maintenance, the scores for the QLQ-MY24- Paraesthesia became significantly higher in the MPT arm (p<.001). The QLQ-C30 subscales Pain (p=0.12), Insomnia (p=0.068), Appetite loss (p=0.074) and the QLQ-MY24- item Sick (p=0.086) scored marginally better during T maintenance. The overall QoL scale QLQ-C30-HR-QOL showed a significant time trend towards more favourable mean values during protocol treatment but did not reveal differences between MP and MPT. For the QLQ-C30 subscales Emotional function and Future perspectives, difference in favour of the MPT arm from the start of treatment was observed (p=0.018and p=0.045 respectively) with no significant ‘time × arm' interaction, indicating a persistent better patient perspective with MPT treatment. Since the first questionnaire was filled out prior to treatment but after randomization we hypothesise that the awareness of being treated with a medication that holds out a prospect of better treatment outcome may in itself be associated with improved feeling of well-being and hope for the future. This prospective study shows that the higher frequency of adverse effects associated with MPT does not translate into a negative effect on HRQoL and that MPT holds a better patient perspective. Disclosures: No relevant conflicts of interest to declare.

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Many cost analyses of stem-cell transplantations are available, which is in sharp contrast to the level of cost analyses on first-line chemotherapy for aggressive non-Hodgkin's lymphoma (NHL). Given the scarcity of cost analyses of first-line chemotherapy for NHL, it is difficult to assess the economic impact of upcoming new treatment modalities. Therefore we performed an analysis on costs of diagnosis and treatment of patients with newly diagnosed NHL who were treated with standard CHOP (-like) chemotherapy. As many NHL patients are treated in trials and the economic effects of the trial participation are unknown, our analysis included both patients treated according to trial protocols and patients treated according to standard local practice (SLP). The cost analysis was based on the total medical consumption of the patients. It was found that costs of the trial and SLP groups are within comparable ranges, although costs of diagnostic tests were somewhat higher within the trials. In elderly patients, SLP chemotherapy was discontinued more frequently in case of leucocytopenia or thrombocytopenia. This analysis provides basic information about the costs of first-line standard chemotherapy for patients with newly diagnosed aggressive NHL and the plausible ranges in which these costs may vary. Given the results, we will initiate larger studies to investigate whether trial treatments (showing more or less similar costs as SLP treatments) are more cost-effective for patients with aggressive NHL.

Objectives: Leading medical professional societies (eg, ASCO, ESMO, NCCN) have recently released frameworks to facilitate discussions on the value of cancer therapies. This literature review summarizes recent trends on the concept of evaluating value in cancer care, using mCRC as an example. MethOds: Relevant publications were identified using predetermined search criteria in Medline (01/01/2005-12/31/2015) and abstracts presented at key conferences (01/01/2015-12/31/2015). Publications were reviewed if they addressed the following topics: providers/prescriber oncology value frameworks, factors influential for payer/reimbursement decision making in oncology, and components of "value assessment" in oncology. Results: From 13,914 unique results, 322 described mCRC-related pharmacotherapies; 90 met the inclusion criteria (46 in Europe and 39 in US; some covered > 1 country). Value evaluations published as journal articles increased more steadily across the review timeframe in Europe: