["Poster Presentation Number: PP125 Abstract Title: Economic Evaluation Of Molecular Diagnostics \u2013 A Review And Future Directions Author Names: Janet Bouttell ([email protected]), Robert Heggie, Karin Oien, Amy Romaniuk, Harper VanSteenhouse, Stephan von Delft Introduction It has been suggested that health economists need to adapt their methods in order to meet the challenges of evaluating molecular diagnostics. The aim of this review is to categorize and critically examine the challenges and methodological developments identified from the literature and to suggest how such challenges may be addressed. Methods We identified challenges and suggested methodological improvements using a systematic rapid review of the literature. We categorized challenges into those common to all economic evaluations, those common to all diagnostic technologies and those relevant to molecular diagnostics. We assessed whether development in the methods of economic evaluation or alternative action was required Results We found forty-one papers which identified twelve challenges. Choice of perspective and time-horizon were challenges common to all economic evaluations. Five challenges were relevant for all diagnostic technologies: complexity of analysis; range of costs; under-developed evidence base; behavioral aspects; and choice of outcome metrics. The final five challenges were specific to molecular diagnostics: heterogeneity of tests and platforms; increasing stratification; capturing personal utility; incidental findings and spill-over effects. The final five challenges may require methodological development. For example, although methods exist to capture the value of a diagnostic test over and above any health gain captured in a quality adjusted life year (\u2018personal utility\u2019), there is currently no agreed method of incorporating this into a cost-utility analysis. For the other challenges development of evaluation processes is key. In particular, the weak evidence base for diagnostic technologies may require processes to evolve. Conclusions Current methods of economic evaluation are generally able to cope with molecular diagnostics although a renewed focus on specific decision-makers\u2019 needs and a willingness to move away from cost-utility analysis may be required. A key issue is the under-developed evidence-base and it may be necessary to rethink translation processes to ensure sufficient, relevant evidence is available to support economic evaluation and adoption of molecular diagnostics.","Poster Presentation Number: PP126 Abstract Title: Direct Patient Involvement In HTA In Canada And Brazil: The Patients\u2019 Perspectives Author Names: Aline Silveira Silva ([email protected]), Paula Orecklin, Silvia Ferrite Introduction Since 2019, Canada\u2019s Drug and Health Technology Agency (CADTH) has worked directly with patients through its Patient and Community Advisory Committee (PCAC). In Brazil, Conitec has worked directly with patients since 2021 through testimonials in its committee meetings for all assessed technologies. In this study we explored patients' perspectives about their participation in these processes. Methods Two patients directly involved with both CADTH and Conitec were invited to share their perspectives about the strengths and weaknesses of the patient engagement processes. Results For CADTH, the strengths were as follows: PCAC focuses on the whole organization, including the patient engagement strategy and strategic plan, and is on the same level as other professional committees; PCAC members are compensated; the \u2018Learning Sessions\u2019 show CADTH staff the ramifications of their work in people\u2019s lives; and there is increased patient engagement on other committees throughout CADTH. The weaknesses identified with the CADTH process were that PCAC is an advisory body with no decision-making authority and that the diversity of people on the PCAC could be increased. In addition, while CADTH informs and consults patients, the PCAC is not involved in individual HTAs. The strengths of Conitec\u2019s process were that the volunteer is selected by patients; there are opportunities to consolidate direct patient involvement and promote it in other instances; and the technical support is excellent. On the downside, there was a lack of information about this opportunity; the testimonials last only ten minutes and patients are frequently not questioned; only one patient can participate; there is a lack of transparency about testimonial analysis and its role; and being the only representative during a discussion that culminates in a decision can cause anxiety about performance. Conclusions Patients felt heard in the engagement processes and stated that the PCAC embeds patient perspectives throughout CADTH, not just in particular HTAs. One patient felt that her participation was essential for the committees to understand patients' lived experiences.","Poster Presentation Number: PP127 Abstract Title: Impact Of Brazilian Patient Testimonials On Medical Devices And Public Confidence In The Healthcare Decision-Making Author Names: Sra Fotini Toscas ([email protected]), Vivian Cardoso de Morais Oliveira, Aline Silveira Silva Introduction Since October 2020, Conitec has made public calls (PCs) to invite patients and family members to express perspectives during committee meetings. This study seeks to reflect about the impact of the newest patient and public involvement (PPI) Conitec strategy and how it can contribute to increase patient direct involvement and public confidence regarding Brazilian health decisions in medical devices. Methods We conducted a document analysis after searching for PCs addressed to medical devices in the section \u201cPatient Perspectives\u201d on Conitec\u00b4s website until Aug 31, 2021. Results From 64 PCs, five were related to medical devices. Rotational thromboelastometry for transfusion controls: Ended upon applicant request. Transcatheter aortic valve implantation (TAVI): One patient gave his testimonial, explaining how it impacted his quality of life and daily activities, besides answering questions from the committee. The testimonial was not included in the recommendation report. After the public consultation, the initial recommendation changed from non-reimbursement to reimbursement. Botton\u2122 probe for gastrotomy: Eleven people volunteered and a family member was selected. She expressed the importance of the device in her son's quality of life, making ordinary activities more accessible, helping in the physiotherapy sessions, reducing hospitalizations, and supporting her son's socialization. The initial recommendation was to reimburse it. iStent Inject Trabecular Micro-Bypass System\u2122 (glaucoma treatment): No patients volunteered. The final recommendation report informed that Conitec received 55 comments through public consultation, including experiences and opinions about the technology. After the public consultation, there was a change from the initial to the final recommendation, from non-incorporation to incorporation. Non-invasive ventilation (cystic fibrosis treatment): There were five volunteers and a mother of twins, both with cystic fibrosis, gave her testimonial. She expressed the importance of this device in her kids\u2019 quality of life, allowing them to sleep better, eat and study, control the symptoms, and reduce hospitalizations and antibiotic usage. Conclusions Aspects such as documenting this participation, communicating and offering support to the public and patients, analysis and transparency are essential for evaluating and improving this strategy.","Poster Presentation Number: PP128 Abstract Title: Development And Piloting Of An Online Training Course On Health Technology Assessment For Patients Author Names: Mar\u00eda Jos\u00e9 Vicente-Edo ([email protected]), Yolanda Tri\u00f1anes, Ana Toledo-Ch\u00e1varri, Mar\u00eda Bono-Vega, Patricia Gav\u00edn-Benavent, Luc\u00eda Prieto-Rem\u00f3n, Bego\u00f1a Su\u00f1e, Margarita Segovia, Blanca Novella- Arribas, Loeches-Belinch\u00f3n Pilar, Paula Cantero-Mu\u00f1oz, Lilisbeth Perestelo-P\u00e9rez, Nerea Arias Jayo, Eva Reviriego-Rodrigo Introduction Patients have knowledge, perspectives and experiences that are unique and can make an essential contribution to Health Technology Assessment (HTA). However, in order for their participation to be effective, they need to be able to understand how HTA reports are generated and the decision-making processes that they inform. The aim is to describe the development and virtualization of training materials for patients, as well as to their implementation in a pilot study. Methods A working group from Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS) agencies was created to develop educational materials in collaboration with patients. The content was based on international initiatives and feedback from the working group. The project was initiated in November 2020. The team consisted of HTA researchers, technicians with experience in training and virtualization and patients. The final version was obtained after an iterative process and refinement of the content and design. Results The materials were published in complete and summary versions, and they were translated into Catalan, Basque and Galician. The online course was designed in an e-learning platform (Moodle) with the aim of being implemented by each of the agencies. The materials include relevant and summarized information on HTA processes, current framework at national and European level, and the role of patients in HTA. Health research and the importance of qualitative and quantitative methods are also addressed. The course also includes a module of practical aspects of patient and citizen participation for achieving an effective contribution to HTA. The course is being piloted with patients in different regions in Spain. The objective of the pilot is to evaluate the usefulness and satisfaction with the course, and it has been designed with the purpose of incorporating the pertinent modifications in the course. Conclusions The online training course is intended to facilitate the acquisition of knowledge related to the processes and tools of HTA for patients, as well as to inform them in what phases and in what way they can participate. The pilot will provide relevant information on its use in practice. It is expected that the course will favor capacity building and patient involvement.","Poster Presentation Number: PP129 Abstract Title: Usefulness, Acceptability And Satisfaction Of A Decision Making Tool For Clinical Meso- Management In Type 2 Diabetes Mellitus Author Names: Yolanda Ramallo-Fari\u00f1a, Himar Gonz\u00e1lez-Pacheco ([email protected]), Anal\u00eda Abt Sacks, Laura Garc\u00eda-Hern\u00e1ndez, Ignacio Llorente-Gomez de Segura, Ana W\u00e4gner, Ana Toledo-Ch\u00e1varri, Pedro Serrano-Aguilar Introduction GesPeDia is a web-based application that provides aggregate clinical information, using outcome and process indicators, and disaggregated patient information. Information is obtained from the electronic medical records. GesPeDia aims to promote people-centered care, improve monitoring of patients' health outcomes and quality of professional performance. This study aims to evaluate usability, acceptability and satisfaction of GesPeDia. Methods Nineteen evaluators were included (2 management technicians, 9 health center directors and 8 endocrine consultants). They had access to GesPeDia for two months. Perception of their usefulness for decision-making, acceptability and design satisfaction were measured with an online questionnaire. In addition, suggestions for improvements in the app\u2019s functionalities were collected. Finally, a sample of the evaluators were included in a semi-structured interview to deepen the analysis of dimensions. A descriptive analysis of the data was performed. Results The questionnaire was completed by 10 professionals, with mean age of 51.1 years and professional experience 16.5 years. Among the evaluators, 60 percent considered the app quite useful and only 10 percent found it inappropriate for their daily activities. Each of the indicator blocks was rated quite useful. Eight percent considered GesPeDia moderately fast, although for 20 percent navigation within the app was not very intuitive. Appearance was positively valued by 80 percent, despite the fact that 30 percent considered that design does not favor the understanding of contents. Seventy percent considered degree of reliability, relevance and clarity of the contents to be high. Most indicated that information provided by GesPedia is complete for decision- making. Conclusions GesPeDia is valued positively by evaluators as a decision-making tool.","Poster Presentation Number: PP131 Abstract Title: European Market Access Landscape Analysis Of Reimbursement Drivers In Pompe Disease: Results From 26 Payer Interviews Author Names: Alasdair MacCulloch ([email protected]), Syed Raza, Simon Shohet, Nico Schammel, Pierre Net Introduction Pompe disease (PD) is a rare, progressive neuromuscular disease that severely affects motor and respiratory functions. Late onset PD (LOPD) is the most common phenotype. Current treatment involves enzyme replacement therapy (ERT) with alglucosidase alfa, which was first approved in 2006. In Europe, the treatment landscape is changing as two new ERTs have been filed for regulatory approval: avalglucosidase alfa and cipaglucosidase alfa plus miglustat. We analyzed how health technology assessment (HTA) and reimbursement criteria may be applied to ERTs in key countries for patients with PD. Methods Eighteen different factors were identified from the pivotal trials (LOTS, COMET, and PROPEL) for the three recombinant enzymes. These covered the categories of trial design, endpoints, quality of life, and other product characteristics. Twenty-six HTA experts and health economists from Denmark, England, France, Germany, Italy, the Netherlands, Spain, and Sweden with rare disease experience were interviewed during the period from July to September 2021. In structured discussions, each participant was asked to rate (from one to seven) the factors in terms of their importance and impact on the HTA evaluation and reimbursement of treatments for adults with PD. Results The following factors were highly rated: a well-defined PD trial population; use of an active trial comparator; efficacy in both treatment na\u00efve and experienced subpopulations; a superiority study design; and payer-relevant endpoints and quality of life improvements. The five lowest rated factors were open-label data, biomarkers, innovation, ease of administration, and mode of action. While the results were mostly consistent across countries, the HTA expert viewpoints varied depending on the country. For example, HTA experts in Italy, the Netherlands, and Sweden rated innovation and biomarkers more highly than German experts. Conclusions As new ERTs become licensed, achieving reimbursement and successful HTA of them will require a clear exposition of payer-relevant evidence for the LOPD population in the target country, including comparative randomized controlled trial data, benefits for experienced and treatment na\u00efve subgroups, and payer-relevant endpoints and quality of life gains.","Poster Presentation Number: PP132 Abstract Title: Disinvestment Initiatives In Health Care: A Scoping Review Of Systematic Reviews Author Names: Hanin Kamaruzaman ([email protected]), Eleanor Grieve, Olivia Wu Introduction Disinvestment of ineffective, low value technologies is growing as a priority for international health policy in order to improve quality and maximize value in health care. Different strategies have been implemented at the international and national level using various methods of evidence gathering and technical assessment. However, the success of these initiatives is mixed, with fewer than half of the empirical studies reporting reductions in the use of low value services. This review explored the role of stakeholders in the disinvestment process by describing the initiatives and analyzing the methods used for reassessment. We also identified the facilitators and barriers related to disinvestment implementation. Methods This scoping review was guided by the JBI Manual for Evidence Synthesis and the PRISMA statement for scoping reviews. Strategic literature searches were performed to identify published reviews on disinvestment in health care using the MEDLINE, Web of Science, and Scopus databases. Data were extracted using a predesigned form and then synthesized narratively to identify similarities and differences across the approaches according to prespecified domains. Results Sixteen reviews were included. We identified various disinvestment initiatives across 16 countries, with a minimum of 34 initiatives at different levels of implementation and with various agencies responsible for the activities. Two of the most used methods for facilitating disinvestment decisions were program budgeting and marginal analysis (PBMA) and health technology assessment (HTA). Stakeholder involvement was the most important aspect to be addressed since it acts as both a facilitator and a barrier in implementing disinvestment initiatives. Meaningful engagement may be strengthened with continuous stakeholder participation, transparency in methods and processes, and ongoing knowledge transfer. Conclusions This scoping review highlights the role of stakeholder involvement in disinvestment, which is a double-edged sword because it both facilitates and hinders disinvestment implementation. The most common methods for assessing candidates for disinvestment are PBMA and HTA, but there is a lack of clarity on which HTA dimension is suitable for a disinvestment process.","Poster Presentation Number: PP134 Abstract Title: Health Technology Assessment Life Cycle Approach In Asthma Care Author Names: Pieter ten Have, Geert-Jan Van Kemenade ([email protected]) Introduction Within Dutch health care, Zorginstituut Nederland regularly selects topics for reassessment of diagnostic and therapeutic interventions. Until now, about 15 topics have been investigated, such as hip\/knee arthrosis, stable angina, low back pain, urinary incontinence, palliative care, retinopathy and asthma. Methods For each topic, stakeholders were asked to report what could be improved. Also a working group was created to analyze: what do guidelines recommend, what does actual care look like seen from administrative data, is there a gap between guidelines and delivered care, what can be improved? A report with recommendations was written with a calculation of the impact. Agreements were made on implementation. This report focused on findings relating to asthma. Results We identified the multiple issues in the management of asthma: (i) Only 11 percent of patients had their diagnosis confirmed (with spirometry and reversibility or visit to pulmonologist). (ii) 60.000 patients had intensive short acting broncho-adrenegic agents (SABA) without inhaled corticosteroids (ICS) representing overuse of SABA. (iii) 200.000 patients use inhalers that can be empty, without the patient knowing this, as there is no indicator showing the number of actuation\/puffs left, which leads to under treatment. (iv) 60.000 patients have aerosol and powder inhalers together, each requiring a different technique, leading to mistakes. (v) 67 percent of asthma adults get a chest x-ray on referral to hospital, which is a high proportion. (vi) 49 percent of patients use inhalers with propellant, which is needlessly high, given their undesirable impact on climate change. This causes 36 million kg co2 equivalent, the same as 36000 extra gasoline cars. (vii) Only 37 percent of patients receive yearly monitoring. We calculated that EUR 14 million annually can be saved as a result of better diagnosis leading to less overdiagnosis and overtreatment and less spacers. Conclusions Despite that \u2018HTA (Health Technology Assessment) at the doorstep\u2019 has been applied for asthma interventions, we noticed considerable room for improvement. We consider this method important for real HTA life cycle approach.","Poster Presentation Number: PP140 Abstract Title: Economic Evaluation Of Several Vaccination Strategies Against Rotavirus In Spain Author Names: Inaki Imaz-Iglesia ([email protected]), Montserrat Carmona, Esther E. Garc\u00eda-Carpintero, Alejandro Mart\u00ednez-Portillo, Enrique Alcalde-Cabero, Lidia Garc\u00eda-P\u00e9rez, Renata Linertov\u00e1 Introduction The Spanish Ministry of Health asked us about the efficiency of extending the current rotavirus vaccination strategy to all newborns. The current strategy is to vaccinate only to high-risk newborns (premature and those qualified as high-risk by a pediatrician). The objective of this research was to compare three strategies: no- vaccination, vaccination of high-risk newborns and universal vaccination, considering the two vaccines available in Spain: RotaTeq\u00ae and Rotarix\u00ae. Methods A cost-utility analysis, based on a de novo Markov model, was carried out both from a societal and a healthcare system perspective. The model follows a cohort of newborns during their life-course. The cycle length is annual and a half-cycle correction was applied. A discount rate of 3 percent was applied in the base case both to costs and utilities. Most of the incidence, probabilities and costs data were Spanish. The Quality Adjusted Life Year (QALY) data were taken from international literature. We assumed a willingness to pay threshold of EUR 25,000 per QALY gained. We performed deterministic one-way sensitivity analysis. Results Compared to no-vaccination, the high-risk vaccination strategy is cost-effective assuming the above- mentioned threshold only with Rotarix\u00ae from a societal perspective (RotaTeq\u00ae EUR 32,008 per QALY; Rotarix\u00ae EUR 23,368 per QALY). Universal vaccination is not cost-effective either compared to no-vaccination or compared to the high- risk vaccination strategy and with both perspectives. Vaccine prices and efficacy data are highly sensitive variables. We find that universal vaccination would be cost-effective with a discount of 44.6 and 36.9 percent of the current price of RotaTeq\u00ae and Rotarix\u00ae, respectively. Conclusions Universal vaccination would not be a cost-effective strategy for Spain with either of the two vaccines at current prices. Vaccination of high-risk newborns would be cost-effective at current prices and from a societal perspective only with Rotarix\u00ae. Substantial vaccines price reductions could make the universal vaccination a cost- effective option in Spain.","Poster Presentation Number: PP142 Abstract Title: Time-Driven Activity-Based Costing (TDABC) Of Brazilian Public Healthcare System (SUS): Preliminary Results For Osteogenesis Imperfecta (OI) Author Names: Camila Azevedo, Juliana Souza, Ludmila Gargano ([email protected]), Bianca Salvador, Luiz Carlos Santana-da-Silva, Gabriel Ogata, Marcelo Nita, T\u00eamis F\u00e9lix Introduction Improving the value of healthcare delivered requires accurate cost information, which can be challenging for rare diseases. We report direct costs of patients with OI using the TDABC methodology. Methods This research is part of a nationwide observational study to assess the \u201cValue of Healthcare Journey for Patients With Rare Diseases\u201d in SUS. Patient journey and economic data was collected for the actual clinical practice in each medical center enrolled in the project. We set the starting point of disease and map a patient's path in the healthcare journey, including treatment, exams, procedures and appointments needed. Unit cost, time and amount of resources to perform each activity, such as human resources, materials and medicines, was assessed, disregarding indirect costs. Here we present preliminary results for OI. We considered medical centers from different regions of Brazil. The results are presented in terms of percentage and\/or mean and its standard deviation (SD). Results Three medical centers completed the data collection. The average [SD] cost of a one year journey of a patient diagnosed with OI is BRL 16,308.07 [11,005.21] (USD 2,886.91 [1,948.36]) per center. Activities with greater cost are medicines, with an average cost of BRL 11,919.47 [12,629.45] (USD 2,109.76 [2,235.52]), followed by materials and human resources, with an average cost of BRL 2,881.91 [3,311.57] (USD 509.92 [585.84]) and BRL 1,506.70 [1,300.46] (USD 266.54 [230.24]), respectively. When assessing the moment of a patient's journey, the percentage of appointments, diagnosis, treatments and follow-up were 11.2, 25.8, 32.5 and 30.5, respectively. Only 3.3 percent of consumed resources were external to the center (out-of-pocket or private insurance). Conclusions The TDABC can efficiently draw the processes and costs associated with it. Medicines are the main driver of annual costs for OI patients in the SUS. This study was funded by the National Council for Scientific and Technological Development \u2013 CNPq and the Ministry of Health of Brazil \u2013 MoH.","Poster Presentation Number: PP143 Abstract Title: International Assessment of the Health Care System in Kazakhstan. A performance analysis. Author Names: Mar\u00eda del Carmen Vilari\u00f1o-L\u00f3pez ([email protected]), Lyazzat Kosherbayeva, Olzhas Zhorayev, Madi Zhaksylyk Introduction Measuring the performance of the health systems is an important challenge at international level. The main objective of this work is to analyze the outcomes of the Kazakhstan Health Care System in order to establish the main causes of avoidable mortality in the country. Also, to identify benchmarking possibilities that may support public policy decisions to improve the results. Methods To calculate the avoidable mortality indicators due to preventable and treatable causes, the methodology agreed by the OECD and Eurostat based on the International Classification of Diseases, ICD-10 was applied. Starting from the mortality database of the World Health Organization, the standardized indicators of avoidable mortality was calculated for those countries that had available data based on this classification. Based on the outcomes obtained, a \u201cTwo-Step\u201d Cluster Analysis was used to identify and characterize the different clusters of countries that present similar results to identify possible affinities and detect benchmarking possibilities. Results The main causes of mortality from treatable diseases in Kazakhstan are those related to the circulatory system, followed by different types of cancer and respiratory diseases. Applying the cluster analysis in the international context, we find important differences between the different clusters, both in the standardized ratios of avoidable mortality and in its causes. Notable differences have also been identified between Kazakhstan and the countries that make up its cluster. Overall, Kazakhstan presents better avoidable mortality results, both from preventable and treatable causes, than the average of the cluster to which it belongs. However, in some causes of death, it presents worse results and high mortality rates, as in the case of those related to the circulatory and respiratory systems or different types of injuries. Conclusions The cluster analysis based on the avoidable mortality indicators reveals different conglomerates of countries that show important similarities between them and also some significant differences. Groups of avoidable diseases that characterize each cluster and subcluster, provide key information for the benchmarking and the design of future actions.","Poster Presentation Number: PP145 Abstract Title: Improving Patient Expert Involvement In The Lifecycle Of Health Technology Assessments To Build Public Confidence In Decision-Making Author Names: Mandy Tonkinson, Heidi Livingstone ([email protected]), Laura Marsden Introduction Involving patients in the health technology assessment (HTA) lifecycle is a core principle at the National Institute for Health and Care Excellence (NICE). We include both patient organizations and patient experts, which helps build public confidence in healthcare decision-making. We continually work with patient experts to improve their experience and ability to participate by seeking patient expert feedback after every committee meeting. Methods We sent patient experts an anonymous experience survey containing a five-point Likert scale and open text boxes to capture qualitative data. The survey covered their overall experience, interaction with the committee Chair, and the support they received from both NICE and the Public Involvement Programme (PIP). In the 2019 to 2020 period we sent out 59 questionnaires and received 29 responses (47%), all of which were from medicines HTA committee participants. In the 2020 to 2021 period we sent out 120 questionnaires and received 65 responses (54%), of which 64 were from patient experts who attended medicines HTAs and one was from a medical devices HTA committee participant. Results Good or excellent experiences were reported by 90 percent of patient experts. The four main success factors noted were: good support before meetings; being welcomed and respected; well organized meetings; and patient expert input being valued. Areas for further improvement included: providing better briefing before meetings; allowing more time to review documents; providing more technical support; and giving more consideration to the opinions of patient experts. Conclusions As a result of the feedback received, the PIP now holds monthly group briefing meetings for patient experts. We also publish the anonymized feedback from the patient experts quarterly in a newsletter for committee members and share the data with internal NICE teams. Additionally, NICE aims to: send committee papers out earlier; have the option of holding a technical engagement call before committee meetings; and develop a feedback mechanism to ascertain the impact of patient input.","Poster Presentation Number: PP146 Abstract Title: The Use Of Indirect Comparisons For Reimbursement Decision Making In The Netherlands And England Author Names: Rachel Kalf ([email protected]), Dalia Dawoud, Caroline Bregman, Emily Leckenby, Marijke J.S. de Vries, Diana M.J. Delnoij, Marcel L. Bouvy, Wim G. Goettsch Introduction Reimbursement decision making is based on a relative effectiveness assessment (REA), which may be combined with a cost-effectiveness assessment, by national Health Technology Assessment (HTA) agencies. These assessments are based on clinical data where new interventions are compared to the current standard of care, which may differ between countries. Since most pivotal trials only include a limited number of interventions, indirect treatment comparisons (ITCs) can be used to compare multiple interventions. The aim of this study was to evaluate the use of ITCs in HTA decision making in the Netherlands and England. Methods All pharmaceutical assessments published between 2015 and 2019 by the National Health Care Institute (ZIN) and the National Institute for Health and Care Excellence (NICE) were reviewed to determine whether an ITC had been used. For detailed analysis we included all assessments of ZIN using an ITC, and a random sample of assessments of NICE using an ITC (10 assessments per publication year). Results Between 2015 and 2019 a total of 106 and 265 assessments were conducted by ZIN and NICE, respectively. Of these assessments 48 from ZIN and 150 from NICE included an ITC. The detailed analysis showed that pharmaceutical assessments including indirect comparative evidence led to the REA conclusion of similar therapeutic evidence in 57 percent of 48 assessments by ZIN and in 52 percent of 50 assessments by NICE. Reimbursement recommendations including indirect comparative evidence most often resulted in positive recommendations by ZIN (57% assessments), and in restricted recommendations by NICE (50% assessments). Different methods were employed to incorporate indirect comparative evidence, such as na\u00efve ITCs and network meta-analysis. Conclusions Our results showed a significant variability in the use of ITCs between NICE and ZIN, which may contribute to differences in their recommendations. Further analysis will provide deeper insight in these differences and may provide suggestions for a clearer international guidance on the use of ITCs for HTA.","Poster Presentation Number: PP147 Abstract Title: Conditional Reimbursement Of Medicinal Products, A Procedure For Orphan Drugs, Conditionals and Exceptionals Author Names: Floor van Heesch, Marijke De Vries ([email protected]) Introduction In 2018 the Dutch Ministry of Health (MoH) introduced a new policy regarding the conditional reimbursement (CR) of drugs in the basic health insurance package. This new policy offers patients with a serious, often rare disease for which no effective treatment is yet available, the possibility of obtaining controlled access to new promising drugs. In the meantime, additional data on (cost-) effectiveness is being collected. The aim was to assess whether this new policy allowed improved inclusion of drugs in the basic health insurance package. Methods Marketing authorization holders (MAH) were able to apply for the CR. The drug had to be registered by the European Medicines Agency (EMA) as an orphan drug, conditional or exceptional and address an unmet medical need. The MAH had to submit a dossier which includes a study protocol together with the professionals\u2019 associations, patients\u2019 associations and a research institute. It was possible to engage an ongoing (international) study in the CR application. Based on the proposed study, the National Health Care Institute (ZIN) assessed whether it is possible to determine if the drug should be reimbursed at the end of the CR period. A reduced price was a condition for CR. Results Four drugs are currently reimbursed as part of the CR, being: parathyroid hormone, ataluren, larotrectinib and entrectinib. The proposed studies are ongoing and will generate data to support the final reimbursement decision. Progress will be monitored by the researchers and discussed with ZIN. Conclusions Four drugs were successfully conditionally reimbursed, concluding the new CR procedure is feasible. Additional data is being collected to aid in the decision on the definitive reimbursement of these drugs. The upcoming period, the focus will be on the quality of the collected data and whether the inclusion of patients is proceeding as planned. The MoH will be informed by ZIN on the study progress annually. The final reimbursement decision is taken at the end of the CR period.","Poster Presentation Number: PP148 Abstract Title: The Impact Of Health Technology Wales Guidance For Autologous Haematopoietic Stem Cell Transplantation: Two Years Post-Publication Author Names: Lauren Elston ([email protected]), Sophie Hughes, Eleni Glarou, Susan Myles Introduction Evaluating the impact of health technology assessment (HTA) is vital to measure its contribution to health and social care decision-making and improving citizen outcomes. Health Technology Wales (HTW) is a HTA body committed to evaluating the impact of our work. Here we present HTW\u2019s impact evaluation approach with a case study for autologous hematopoietic stem cell transplantation (AHSCT) for highly active relapsing remitting multiple sclerosis (RRMS). Methods Using an outcomes-focused approach based on contribution analysis, HTW has worked with an external evaluation organization to develop a framework to measure the impact of our work. Data on impact was collected from both qualitative and quantitative sources, including social media metrics, surveys, and informal feedback from stakeholders. We engaged with various stakeholders, including clinicians, academics, patient organizations and other HTA bodies. Results The technology appraisal and guidance were published in July 2020, recommending AHSCT for routine adoption to treat highly active RRMS. Patient groups welcomed the appraisal findings as an important step forward in recognising the needs of people with RRMS and felt that \u201cpeople living with MS were listened to throughout the process\u201d. Following publication online, the guidance has had approximately 500 views, and featured on the MS Trust website and in several news articles. The Welsh Health Specialist Services Committee, a commissioning body in Wales, recommended AHSCT for RRMS as a \u2018high priority\u2019 for funding in the WHSSC Integrated Commissioning Plan 2021-22. Conclusions Since its publication, we have been able to prospectively capture the impact of this guidance through various stakeholders groups and sources. Overall, responses have been positive and the guidance has supported decision makers in Wales. Ongoing evidence capture, including through HTW\u2019s adoption audit processes, will add further understanding to the potential impact of our work.","Poster Presentation Number: PP149 Abstract Title: A Multidimensional And Multistakeholder Approach: Assessing Ethical, Legal, Organizational, Social or Patient-centred (ELSI+) for Telemedicine In Neurological Diseases Author Names: Ana Toledo-Ch\u00e1varri ([email protected]), Alezandra Torres Casta\u00f1o, Janet Delgado Rodr\u00edguez, Anal\u00eda Abt Sacks, Pedro Serrano-Aguilar Introduction Telemedicine strategies have been broadly introducing in health services during the COVID-19 pandemic, including in care of neurological diseases. Methods A rapid realist review was conducted using EUnetHTAs Core Model 3.0 and GRADE evidence to decision frameworks were used as frameworks to describe the ethical, legal, organizational, social and patient aspects (ELSI+) related to the use of teleneurology (TN) A scoping multistakeholder meeting helped defined the scope and research questions of the assessment. Patient representatives, clinicians, scientific society representatives with relevant experience in TN were invited and participated. Industry representatives were also present. Systematic searches for ethical, legal, organizational, social and patients related aspects were conducted. Additional manual searches contributed to contextualize these dimensions in the Spanish context. A narrative synthesis was undertaken. Results Main results of the assessment of the ELSI+ aspects of TN were described. TN applications are diverse depending on the condition, objective of care and technology used. The implementation of TN lacks specific legal frameworks which implies legal uncertainty. TN may increase geographical accessibility to neurological care in remote areas and by reducing difficult commuting to specialized care centers. Nevertheless, accessibility is challenged by reduced access to technology, the digital divide, lack of health literacy or technologies not adapted to functional diversity. Therefore, equity is not guaranteed if it is offered as a non-voluntary basis or with no support. TN tends to be accepted by patients and carers if it has enough quality, saves travelling time and costs and does not dehumanize care as it is perceived as more flexible and convenient. Quality of TN needs an interdisciplinary team with skills to coordinate organizational aspects of the implementation which include among others, the planification of the support to patients and carers before, during and after the consultation. Health professionals may also need to learn adapted communicational and technological skills. Conclusions The implementation of TN poses many ethical, legal, organizational, social or patient-centred challenges.","Poster Presentation Number: PP150 Abstract Title: The Role Of Expert Consensus In UK Guidance: Patient Selection For Hydrogel Spacer Use During Prostate Cancer Radiotherapy Author Names: Rhodri Saunders, Heather Ann Payne, Suneil Jain, Clive Peedell, Albert Edwards, Andrew Thomas, Prantik Das, Amanda Hansson Hedblom ([email protected]), Emily Woodward, Amit Bahl Introduction In UK males, prostate cancer is the most common cancer, with over 47,500 diagnosed annually. Radiotherapy is a highly effective curative treatment but can be limited by dose to surrounding normal-tissues such as the rectum. Radiation to the rectum can be reduced by increasing the distance between prostate and rectum with a hydrogel spacer. Despite National Institute of Health and Care Excellence guidance, spacers are not widely funded in the UK. Limited funding has necessitated patient prioritization, without any existing consensus on method. Studies have shown generally homogenous results in reduction of rectal toxicity across assessed subgroups, but the requirement to prioritize remains. One way of addressing the appropriate use of beneficial health technologies is the inclusion of end-user experts in decision-making. The study aim was to identify consensus among radiation oncologists on patient prioritization for rectal hydrogel spacers. Methods We conducted a Delphi study where six leading clinical oncologists and one urologist from across the UK experienced in using rectal hydrogel spacers participated in two rounds of online questionnaires and two virtual advisory board meetings. Results The experts estimated that 83 percent of patients who could potentially benefit from a spacer were denied access. Overall, ten points of consensus were reached. Key ones concerning patient-access were: \u2022 Spacer use in eligible patients significantly reduces radiation dose to the rectum and toxicity-related adverse events. \u2022 Increased benefit is expected in patients on anticoagulation, with diabetes and with inflammatory bowel disease. \u2022 Increased benefit can be expected with ultra-hypofractionated radiotherapy, but radiotherapy modality is not a key consideration for patient selection. \u2022 Patients should have the opportunity to actively participate in the discussion regarding the use of a spacer. Conclusions Currently, not all patients who would benefit can access funding for hydrogel spacers. Consensus in this study indicates that appropriate health policy and funding mechanisms are warranted for patients, to provide equitable access to technologies improving quality of life.","Poster Presentation Number: PP151 Abstract Title: VALIDATE Methodology On A Medication-Related Clinical Decision Support System: Holistic Assessment For Optimal Technology Adoption Author Names: Carla Fernandez Barcelo ([email protected]), Elena Calvo-Cidoncha, Laura Sampietro-colom Introduction In the past decade, health technology assessment (HTA) has narrowed its scope to analyses of mainly clinical and economic benefits. Technology challenges in the 21st century emphasize the need for holistic assessments to obtain accurate recommendations for decision-making, as in HTA\u2019s foundations. Using the VALues In Doing Assessments of health TEchnologies (VALIDATE) methodology for complex technologies provides a deeper understanding of problems through analysis of stakeholders\u2019 views, allowing for more comprehensive HTAs. This study aimed to assess a pharmaceutical clinical decision support system (CDSS) using VALIDATE. Methods Semi-structured interviews with different stakeholders were conducted in the following domains: problem definition (medication error [ME] occurrence and prevention); judgement of solution (existing preventive methods and previous experiences of the CDSS); background theories (future impact and personal beliefs); and barriers to and facilitators of implementation. The following individuals were interviewed: medical informatic specialists (n=3), pharmacists (n=2), nurses (n=2), physicians (n=2), CDSS company representatives (n=1), electronic health record developer (n=1), and health consultancy firm representatives (n=1). Content analysis was used to integrate and analyze the data. Results The multistakeholder interviews identified various barriers to the acceptance and implementation of a pharmaceutical CDSS that were different from those reported in the literature. These included: (i) occurrence of ME (no traceability of medication taken or poor patient medication empowerment); (ii) perception of current level of MEs (huge improvement from ten years ago); (iii) perception of technology as a tool to prevent ME (not enough if only implemented at one point of care); (iv) previous experiences with a CDSS (low rates of development of CDSSs are due to medication prescriptions being digitalized last in hospitals); (v) CDSS metrics (input data should be measured to control CDSS performance); and (vi) other barriers. Conclusions Including facts and stakeholders\u2019 values in problem definition and the scoping of health technologies is essential for the proper conduct of HTAs. Incorporating views from multiple stakeholders when scoping the assessment of health technologies brings additional values to literature findings, resulting in a more holistic evaluation. The lack of multistakeholder scoping can lead to inaccurate information and result in wrong decisions about if, when, and how to adopt a CDSS","Poster Presentation Number: PP152 Abstract Title: The Assessment Of The Price Of A Medicine: The Possible Application Of Cost-Based Pricing Methods Author Names: Sibren Van Den Berg ([email protected]), Marcel Canoy, Lonneke Timmers, Carla Hollak Introduction Before admission to the insured package, the price of a medicine is usually assessed on the basis of the value of the medicine for the patient: the effect size on health and survival must be in line with the costs. That seems like a fair starting point, but the use of such \u2018value-driven\u2019 models sometimes results in unrealistic prices. These prices in turn lead to discussions about limitations within the healthcare budget and may result in delays in the accessibility of medicines. The aim of this study was to review several alternative pricing models and propose possible applications of the models. Methods Six pricing models were selected that encompassed cost-based or cost- and value-based aspects. The models were reviewed within the context of the published group of medicines, followed by a discussion on their potential to aid in creating benchmarks for pricing negotiations. Results Five cost-based pricing models and one value-based model with a cost-based aspect were found with potential applications. (i) The AIM-model for innovative medicines. (ii) The adjusted AIM-model for repurposed medicines. (iii) The Cancer drug pricing model for innovative oncolytics with information about health benefit. (iv) The discounted cash flow model for orphan medicines with information about health benefit. (v) The value-based rate of return pricing for innovative orphan medicines with information about health benefit. (vi) The P-quad model for drugs with a high budget impact for which there is no generic competition after intellectual property an regulatory exclusivity end. Conclusions We argue that it would be more logical for different categories of medicines to base prices on average costs, possibly combined with a bonus for innovation: the cost-based pricing method. The next step is to discuss the possible application of cost-plus methods with stakeholders including patients, industry, payers, and healthcare professionals.","Poster Presentation Number: PP153 Abstract Title: The Economic And Fiscal Impact Of Public Health Programs For Diabetic Patients In Italy Author Names: Eugenio Di Brino ([email protected]), Michele Basile, Filippo Rumi, Giovanna Elisa Calabr\u00f2, Americo Cicchetti Introduction Technological innovations in the health sector have economic implications that go beyond their effects on health expenditure, expanding into other areas of the state budget (e.g., the social security system). Furthermore, innovation can affect the production of wealth by workers and companies, which in turn affects tax revenues. In addition, the presence of chronic diseases tends to reduce the propensity to consume and changes the allocation of consumption between the different sectors. Allocative decisions in the health system are rarely supported by an analysis that combines the health effects of innovations and their consequences in the economic system. Methods The objective of this study was to estimate the value of management programs for patients suffering from type 2 diabetes mellitus that involved different levels of use of innovative technologies and drugs. A tax impact assessment methodology was adopted in the context of chronic conditions to analyze the effect of adopting alternative management models for patients with diabetes on the broader economic system. Results Assuming a policy that reduces annual complications by 0.42 percent, there was an increase in tax revenue (cumulative value) of approximately EUR 28,175 and a reduction in productivity losses (cumulative value) of EUR 4,049,890. Projecting the impact on the age trend of the population up to 65 years of age with these estimates, it is possible to have an increase in tax revenue (cumulative value) equal to approximately EUR 7,050,598 and a reduction in productivity losses (cumulative value) equal to EUR 140,235,923. Conclusions In light of this work, providing remote patient support (telemedicine) and expanding the provision of innovative oral antidiabetic drugs to family physicians could improve care for patients with type 2 diabetes mellitus. This study provides decision makers with an immediately usable model to broaden the information base for planning and regulatory choices. In addition, it supports the use of economic evaluations that calculate the entire value of a technological innovation or health program.","Poster Display Number: PD01 Abstract Title: Using ELISA Tests For Monitoring Response To Anti-TNFs In Rheumatoid Arthritis: Findings From A NICE Health Technology Assessment Author Name: Huiqin Yang ([email protected]) Introduction Patients with severe rheumatoid arthritis (RA) disease may be treated with tumor necrosis factor (TNF)-\u03b1 inhibitors. However, their efficacy is reduced by the presence of anti-drug antibodies. The objective of this HTA was to conduct a systematic review to investigate the effectiveness of using enzyme-linked immunosorbent assay (ELISA) tests (Promonitor, IDKmonitor, LISA-TRACKER, RIDASCREEN, MabTrack, and Sanquin Diagnostic Services) to measure levels of the drug and anti-drug antibodies for monitoring response to TNF-\u03b1 inhibitors in patients with RA. Methods A range of bibliographic databases including MEDLINE, EMBASE and CENTRAL were searched from inception to November 2018. Studies were eligible for inclusion if they investigated ELISA tests in RA patients receiving treatment with a TNF-\u03b1 inhibitor who had achieved the treatment target (remission or low disease activity [LDA]) or experienced a primary or a secondary non-response. The tests must compare with standard care where treatment decisions are based on clinical judgements and monitoring using a composite score such as the disease activity score 28 joints (DAS28). Risk of bias was assessed using the Cochrane (ROBINS-1) tool for non- randomized studies. Results Two studies were included. One non-randomized controlled trial (non-RCT) compared standard care with therapeutic drug monitoring using Promonitor test kits in RA patients in remission\/LDA receiving adalimumab, and a historically controlled study investigated Sanquin ELISA kits. The non-RCT study showed that there was a non-significant reduction in the risk of flare in the intervention group compared with the control group. Patients\u2019 health-related quality of life outcomes were higher in the intervention group at all visits compared with the control group. However, this study had serious limitations because analyses were not performed using an intention-to-treat approach. The historically controlled study did not provide valid evidence on whether ELISA- based monitoring is clinically effective. Conclusions There is only limited, poor evidence available. There are considerable uncertainties on the effectiveness of using ELISA tests for monitoring response to TNF-\u03b1 inhibitors in RA. Further controlled trials are required.","Poster Display Number: PD02 Abstract Title: A Literature Review Of Treatment Schemes And Effects For Beta Thalassemia In China Author Names: Jiaqi Yuan, Jingyi Qiao, Junling Weng, Bingxing Luo, Juntao Yan, Jian Ming, Yingyao Chen ([email protected]) Introduction The incidence of beta thalassemia varies greatly in different regions of China. Blood transfusion combined with iron chelation and hematopoietic stem cell transplantation (HSCT) is the main treatment for beta thalassemia in China. This study aimed to reveal the specific treatment schemes used for patients with beta thalassemia and to evaluate their effects. Methods A search strategy was developed to identify articles published between 1 January 2010 and 30 August 2021 in the following literature databases: PubMed, Embase, the China National Knowledge Infrastructure, Wanfang Data, and the Chinese BioMedical Literature Database. Results The most used iron chelation schemes in China for patients with beta thalassemia included deferoxamine (DFO) monotherapy, deferiprone (DFP) monotherapy, deferasirox (DFX) monotherapy, and combinations of DFP and DFO. Most studies reported that combinations of DFP, DFO, and DFX monotherapy performed better than DFO or DFP monotherapy alone in reducing the blood, heart, and liver iron load. However, the adverse effects of iron chelation affected patient compliance with treatment to a certain extent. Stem cells for patients receiving HSCT in China were mainly donated by human leukocyte antigen (HLA)-matched siblings or unrelated individuals. The five-year overall survival rate after HSCT ranged from 83 to 90 percent, while the five-year beta thalassemia-free survival rate ranged from 65 to 87 percent. Graft-versus-host disease and infection were the most common serious complications experienced by transplant recipients. Conclusions For patients in China with beta thalassemia, the most effective iron chelation treatment schemes were combinations of DFP, DFO, and DFX monotherapy. HSCT from HLA-matched siblings or unrelated donors resulted in a significant improvement in the cure rate for beta thalassemia. However, patients still need safer and more effective innovative treatments, and further evidence on existing treatments needs to be generated from larger scale studies in the Chinese population.","Poster Display Number: PD03 Abstract Title: Uptake Of Health Technology Assessment In Hospitals: A Scoping Review Author Names: Johnathan Portela da Silva Galdino ([email protected]), Erika Barbosa Camargo, Fl\u00e1via Tavares Silva Elias Introduction The use of Health Technology Assessment (HTA) in hospitals contributes to decision-making, professional training, greater interaction with technical to scientific knowledge, resource-saving, and partnerships. Hospitals are strategic for the field of clinical management and quality of care and are open to partnerships with national and international agencies and groups. Despite the hospital-based (HB)-HTA movement, the incipient application of HTA to the hospital decision-making process is related to incipient planning, and there is still much room for progress worldwide. The aim of this study was to analyze the uptake level of HB-HTA in diverse contexts. Methods A scoping review was conducted according to the methodology of the Joanna Briggs Institute, whose data analysis model consisted of the combination of Donabedian\u2019s structure, process, and outcome categories and the dimensions of the project Adopting Hospital Based Health Technology Assessment in European Union (AdHopHTA). Results We identified 270 studies, and after removing duplicates and reading full texts, 36 references met the eligibility criteria. Thirty-six hospitals were identified, of which there were 24 largescale hospitals with extra bed capacity. Twenty-three hospitals were affiliated with universities. Canada stood out with five university hospitals, four of which with public funding. Half of the identified hospitals had HB-HTA units (18\/36). Hospitals with full uptake level of HTA corresponded to 75 percent of the sample (27\/36), and the remainder had partially uptake level of HTA, or 25 percent of the hospitals in the review (9\/36). There were no hospitals with incipient uptake level of HTA. Conclusions Measuring the uptake level of HTA in hospitals contributed to understanding how their participation has occurred in the field of HB-HTA. This study revealed the importance of identifying factors such as sustainability, growth, and evolution of HB-HTA in countries with and without a tradition in this field.","Poster Display Number: PD05 Abstract Title: Novel Non-Thermal Ablation Technology For The Treatment Of Atrial Fibrillation Author Names: Ana Isabel Hijas-G\u00f3mez ([email protected]), Setefilla Luengo-Matos, Bego\u00f1a Rodriguez-Ortiz-de- Salazar, Amparo Arias-Pacheco, Luis Maria S\u00e1nchez-G\u00f3mez, Maria del Mar Polo-de-Santos Introduction Pulsed-field ablation (PFA) is a new non-thermal ablative approach for treating paroxysmal and persistent atrial fibrillation (AF). It provides an alternative to the conventional thermal techniques of radiofrequency ablation and cryoablation. PFA is currently performed with the Farapulse PFA system (Boston Scientific, USA), which recently received CE marking in Europe. In this study, we describe the current evidence on the efficacy, safety, and cost- effectiveness of this new technology. Methods The Early Awareness and Alert System of the Agencia de Evaluaci\u00f3n de Tecnolog\u00edas Sanitarias-at the Instituto de Salud Carlos III- identified this new ablation approach in June 2021. An early technology assessment was conducted by reviewing relevant literature published to November 2021. The literature was identified by searching PubMed, Embase, the International Clinical Trials Registry Platform, ClinicalTrials.gov, and the Cochrane Library. Results Seven relevant publications were identified, including three open-label trials for paroxysmal AF and one for persistent AF. Three studies comparing PFA with conventional thermal ablation techniques were also included. The safety results showed a lower incidence of complications (esophageal injury, pulmonary venous stenosis, pericardial effusion, and aortic injury) after PFA relative to conventional techniques. In terms of efficacy, PFA resulted in lower rates of AF recurrence in the medium and long term, compared with conventional techniques, and there were no differences in the lengths or success rates of the procedures. No cost-effectiveness studies were identified. Seven ongoing trials were identified, but no results have been published. Conclusions The current evidence for PFA in the treatment of AF showed good safety and promising efficacy. However, there is a lack of information on its effect on quality of life and the risk of death, disabling stroke, or cardiac arrest. Early evaluation of new and emerging technologies makes it possible to gather the minimum information necessary to support decisions on their inclusion in the healthcare system. In this case, based on current evidence, the widespread use of PFA is not recommended, except under a rigorous research protocol.","Poster Display Number: PD07 Abstract Title: Cost-Effectiveness Of Direct Oral Anticoagulants In Chinese Patients With Non-Valvular Atrial Fibrillation Author Names: Kuan Peng ([email protected]), Yihua Li, Xue Li Introduction The emergence of direct oral anticoagulants (DOACs) has revolutionized the prevention of stroke-related non- valvular atrial fibrillation (NVAF). Although several DOACs are available, studies comparing the cost effectiveness of DOACs with vitamin K antagonists for NVAF are scarce. The objective of this study was to assess the cost effectiveness of DOACs and warfarin from the Hong Kong public institutional perspective to inform formulary listing decisions. Methods A previously developed Markov model was adapted to simulate the lifetime disease progression of a hypothetical cohort of 1,000 patients. Net monetary costs, quality-adjusted life-years (QALYs), and incremental cost- effectiveness ratios (ICERs) were computed for the following competing alternatives: warfarin, apixaban (5 mg twice daily), dabigatran 110mg or 150mg (twice daily), and rivaroxaban (20mg once daily). Model inputs were sourced from local real-world evidence, landmark trials, and comprehensive literature reviews. Probabilistic sensitivity analyses and deterministic sensitivity analyses were conducted to address study uncertainties. The willingness-to-pay threshold was set at one times the gross domestic product (GDP) per capita (USD 46,091) per QALY gained. Results In base case results, all DOACs provided greater improvements in QALYs at a lower cost than warfarin. Using apixaban as the reference for comparisons among the DOACs, dabigatran 110 mg resulted in greater costs and lower QALY gains and was dominated by apixaban, whereas dabigatran 150 mg provided an incremental QALY of 0.005 at an incremental cost of USD 326, leading to an ICER of USD 67,633 per QALY. The lifetime cost associated with rivaroxaban was lower than for apixaban (-USD 151), but with lower QALY gains (-0.147), resulting in an ICER of USD 1,029 per QALY. In probabilistic sensitivity analysis, the probability of warfarin, rivaroxaban 20 mg, dabigatran 110 mg, dabigatran 150 mg, and apixaban 5 mg being cost effective out of 2,000 iterations was 0 percent, 0 percent, 29.4 percent, 33.2 percent, and 37.4 percent, respectively. Conclusions The results indicated that apixaban was the most cost-effective treatment in the management of NVAF, compared with other DOACs and warfarin. This conclusion was consistent under all the uncertainty test scenarios.","Poster Display Number: PD08 Abstract Title: A Systematic Review Of Reporting Quality Of Economic Evaluations In TCM In NRDL Of China Based On CHEERS Author Names: Juntao Yan, Shiyi Bao, Liu Liu, Yan Wei, Jian Ming, Yingyao Chen ([email protected]) Introduction Traditional Chinese Medicine (TCM) has become a common kind of health care in several countries, with increasing demands. This review aimed to appraise the reporting quality of economic evaluations of TCM in the National Reimbursement Drug List (NRDL) of China (2020 version), based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Methods The reporting quality of included economic evaluations was assessed by two independent reviewers using the CHEERS statement. Results A total of 360 articles were retrieved, but only 38 economic evaluations met the inclusion criteria. No articles were compliant with all items of the CHEERS checklist. On average, the included economic evaluations satisfactorily met 10.93 of the CHEERS items (51.31%). The least reported CHEERS checklist items included: \u201cCharacterizing heterogeneity\u201d, \u201cConflicts of interest\u201d, \u201cDiscount rate\u201d, and \u201cStudy perspective\u201d, with an average score of 0.00, 0.05, 0.08, and 0.16, respectively. Conclusions The economic evaluation of TCM is still at an early stage, with an urgent need for improving the reporting quality. To promote the reporting quality of economic evaluations and further development of TCM, multiple measures focusing on reporting formula, policy, training, and new methodology are required.","Poster Display Number: PD09 Abstract Title: Comparing Long-term Costs Associated With Intraocular Lens Selection And Nd:YAG Laser Capsulotomy In The UK: A Cost-Consequence Analysis Author Names: Derek O'Boyle ([email protected]), James North, Emily Payton Introduction Cataract surgery is the most frequently performed surgical procedure in the UK and posterior capsule opacification (PCO) is the most common complication post-surgery. Nd:YAG capsulotomy is the standard of care for treating PCO, although it bears a cost and is also associated with complications. The objective of this research was to estimate costs from a budget holders perspective associated with PCO related, post-cataract surgery resource use, comparing different single-piece intraocular lenses (IOLs) and utilizing results from a recently published audit of PCO incidence in the UK (n=601,084). Methods This research adapts the findings of the aforementioned audit to develop a cost-consequence analysis. The model is underpinned by the Nd:YAG rates of the included single-piece acrylic IOLs at 5 years. Nd:YAG related additional consultations and reported complications of the procedure were also included as variables of efficiency in the model. Estimates are presented from the perspective of a hospital setting in the UK, performing 3,000 cataract surgeries annually and extrapolated out to the broader cataract population (n=472,000). Costs were sourced from NHS Tariff documentation. Results AcrySof IQ was associated with lower Nd:YAG procedures and additional consultations at 5 years post-cataract surgery compared to all other single-piece monofocal acrylic lenses included in UK Audit Report. Assuming 3,000 cataract surgeries carried out annually, this translated into potential cost savings for the AcrySof IQ lens ranging from GBP 7,993 (EUR 9,379) (versus Eyecee One) to GBP 194,502 (EUR 228,243) (versus Akreos Adapt). Extrapolating to the broader population cataract patients in the UK would provide for a cost-saving estimates in the region of GBP 1.25 to GBP 30.6 million (EUR 1.47 to EUR 35.91 million). Conclusions This economic analysis highlights that the appropriate choice of IOL for cataract surgery, as a direct consequence of lower ND:YAG capsulotomy rates may translate into significant savings both for UK hospitals and the national healthcare system.","Poster Display Number: PD10 Abstract Title: Quality Of Economic Evaluation Of Coronary Stents Based On CHEERS: A Scoping Review Author Names: Yan Feng Ren, Fu Ming Li, Yingyao Chen ([email protected]) Introduction The study aims to systematically review all articles on the economic evaluation (EE) of coronary stenting, to critically assess the reporting quality, and to summarize the results. Methods A systematic search was undertaken through seven databases (PubMed, Web of Science, Embase, CNKI, Wanfang data, Vip data and SinoMed.) from inception until March 2021, to identify economic evaluation articles comparing coronary stenting with other therapies, or among different stenting procedures. After screening articles and extracting data independently, we summarized methods, contents, and outcomes of the included articles and appraised their methodological quality using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklists. Then, the literature scores were standardized as a proportion of the total score, and stepwise multiple regression was constructed to verify the factors that might influence the quality of literature. Results Of the 3,622 publications identified, 59 articles were included in this review. There were 33 cost-effectiveness studies and 26 were cost-utility studies. The quality of the reports varied between studies, with a standardized mean score of 0.76 (0.40-0.98). According to the Cheers checklist, \u201cIntroduction\u201d had the lowest overall score (0.53), with many articles deficient in the description of the study's perspective; \u201cDiscussion\u201d had the highest overall score (0.86), with nearly three-quarters of the articles reporting the full content; \u201cTitle and abstract\u201d, \u201cMethods\u201d, \u201cResults\u201d, and \u201cOther\u201d scored 0.71, 0.78, 0.74 and 0.66, respectively. According to the results of the stepwise multiple regression model, \u201cPublished year\u201d, \u201cNational type\u201d, and \u201cType of economic analysis\u201d research were significantly associated with the quality of literature. Conclusion The quality of current research reports on the economics of coronary stenting is generally satisfactory, but there is potential for improvement and high quality reports can provide evidence to support decision making for policy makers.","Poster Display Number: PD12 Abstract Title: Quality Assessment Of Health Economic Evaluation On Screening Programs From China Author Names: Yu Xia, Dai Lian, Yingyao Chen ([email protected]) Introduction With the increasing use of health economic evaluation (HEE) in decision-making and health resource allocation and management policy design has seen an increase in HEE studies on screening programs in China l. In addition to the quantity of HEE, the quality may be of particular concern as it influences the reliability of HEE evidence adopted in policy formulation. This study sought to assess the reporting quality of HEE on screening programs over the last 20 years in China and identify potential predictors and relevant recommendations to improve the quality of study reporting. Methods A search of HEE studies published in PubMed, Embase, CNKI and WANFANG from 2000 to 2021 was performed. Two reviewers independently extracted data and assessed the quality if reporting using the 24 item Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The CHEERS score for each study was converted into standardized 0-1 point scale. General liner regression was used to identify predictors associated with the reporting quality. Results One hundred and thirty-three studies met the inclusion criteria. The mean standardized score for the included studies was 0.56 (title), 0.64 (abstract), 0.74 (introduction), 0.58 (methods), 0.40 (results), 0.70 (discussion), and 0.54 (other section). The number and reporting quality of articles published each year showed an overall upward trend. A greater proportion of studies were published in Chinese journal (69.2%), modelling-based (54.9%), conducted by universities\/research institutions (45.9%), focused on non-infectious disease (84.2%), using cost- effectiveness analysis method (50.4%), published in non-specialty journal (60.2%), and declaring the funding support (76.7%). Items related to study perspective, discount rate, measurement of effectiveness, currency and price, analytical methods, uncertainty, heterogeneity and conflicts were under-reported. Published year, journal type, first author affiliation and economic evaluation type predicted higher score in regression analyses (p<0.05). Conclusions Overall, the quantity and quality of HEE on screening programs in China is improving, although there is a need to improve the use of on specific reporting items in the CHEERS criteria. The use of suitable evaluation guidelines will make the decision-making process more scientific.","Poster Display Number: PD13 Abstract Title: Methodologies In Economic Evaluations Of Biomarkers \u2013 A Systematic Review Author Names: Kurt Neeser ([email protected]), Linnea Koller, Elvira Mueller Introduction Diagnostic testing and patient monitoring are important to diagnose potential diseases and to evaluate treatment regimens. Since diagnosis and treatment monitoring have no intrinsic effects, an economic evaluation of biomarkers is inevitably linked to the resulting therapeutic interventions, which depend on both physicians\u2019 decisions and diagnostic accuracy of the test (i.e., sensitivity, specificity). In this review we analyzed the methodology of economic studies evaluating the management of the five most relevant non-communicable diseases, that is, obesity, cancer, diabetes, cardiovascular and chronic respiratory diseases. Methods A systematic search in Medline and the National Health Service Economic Evaluation Database (NHS EED) covering the last ten years served to identify health economic analyses of biomarkers used in diagnosing \/ monitoring. Findings were reviewed with respect to analytical method, reported outcomes and comparability. Results The search yielded 680 abstracts in total out of which 280 full texts were reviewed and 77 sources included following predefined criteria. Most economic analyses (94%) evaluated the clinical outcome and costs of testing \/ monitoring in correlation to a corresponding intervention, 6 percent of the sources focused on the accuracy of the test or monitoring methods only. There were 61 studies that included an economic model; overall, 15 sources presented the outcome as cost per life year gained (CEA), 37 sources as cost per QALY gained (CUA), and 12 provided the outcome as both a CEA and CUA. In 16 analyses the outcome was presented in other economic terms as, for example, cost per additional case detected. Conclusions Determining the value of biomarkers requires consideration of the clinical consequences of a test result (incorrect treatment decisions, impact on morbidity, mortality, or quality of life) as well as the corresponding economic outcomes. Most of the identified studies considered at least one of these aspects. Results are presented in manifold ways but do not necessarily address decision makers\u2019 needs. Thus, clear guidelines on economic evaluations of biomarkers are needed and should include broader health system views like affordability or the number of unnecessary interventions avoided.","Poster Display Number: PD14 Abstract Title: A New Equitable Biomedical Research And Development Model: Preliminary Findings From A Pilot Study Applying VALIDATE Value Methods Author Names: Marina Espriu ([email protected]), Joan Bigorra, Pedro Gallo, Laura Sampietro-Colom Introduction The public health areas without commercial value continue to be underserved, while those of high profit for industry will not be sustainable for much longer. We hypothesize that the lack of equity and efficiency in the biomedical research and development system is mainly due to a pharma-led short-term profit orientation that ignores the values of other relevant stakeholders. This pilot study reached some consensus on the principles of a co-created biomedical research and development process based on the preferred supplier (PS) model, which proposes a public health procurement system prioritizing business with companies fulfilling the \u201c4 Share\u201d criteria of priorities, risks and rewards, results, and outcomes to ensure that health needs are met. Methods A constructive health technology assessment, which included VALues In Doing Assessments of health TEchnologies (VALIDATE) methodology, was used to analyze the values and dissent of a pilot sample of ten global key informants. The methodology comprised qualitative techniques such as an online preliminary survey, in- depth semi-structured interviews, and a Delphi survey to reach a joint construction by reconstructing the stakeholders\u2019 interpretive frames and applying an adaptation of the Richardson model to contested values. Results There was consensus on combining efficiency and social justice norms by incentivizing diseases affected by market failure due to small subpopulations (e.g., rare diseases), low availability to pay, restricted use (e.g., antibiotics), and difficulty demonstrating results (e.g., Alzheimer\u2019s disease). Stakeholders mainly agreed on the PS 4 Share principles, highlighting the need for price to be linked to impact modulated by tracked research and development costs and investments, as proposed by the PS model. More market incentives such as push, and especially pull incentives (market access), should be included. The PS model should be cause-solution oriented, promote open-disruptive innovation, and guarantee fast patient access. Conclusions The PS model achieved multistakeholder consensus for desirability (values) and plausibility (shifting incentives). Stakeholders pointed out the need to apply health technology assessment to further develop the model and pilot it in the European Union with the NextGenerationEU","Poster Display Number: PD15 Abstract Title: Horizon Scanning To Nominate Subsidy Evaluation Topics For Medical Technologies: Early Experience From Singapore Author Names: Hong Ju ([email protected]), Zhen Long Ng, Jeffrey Ling, Rachel See-Toh, Kwong Ng Introduction Horizon scanning (HS) is an early health technology assessment (HTA) method for raising early awareness among policymakers of promising new and emerging health technologies. The Agency for Care Effectiveness (ACE) in Singapore established a HS system in 2019 to complement its HTA process. While the HS system initially focused on cell and gene therapies, this was expanded in 2020 to include medical technologies (MTs). This abstract focuses on the role of HS in nominating MTs for early evaluation to guide subsidy decisions, with the intention of avoiding challenges in altering deeply entrenched practices. Methods The ACE methodology for HS aligns with the core principles and methods of international best practice. Generally, MTs addressing national healthcare priorities are tracked. To identify topics for subsidy evaluation, the local registration status of an MT was used as the main selection criterion because of its proximity to the technology\u2019s early diffusion into the healthcare system. MTs with regulatory approval were selected for HTA and subsidy consideration. All nominated technologies were checked against eligibility criteria for HTA and then assessed against a standard checklist for prioritizing HTA topics. Results Among the 1,025 MTs tracked by the HS system, 89 were locally registered and nominated for HTA. Following eligibility assessment, 26 topics remained. After the prioritization exercise six topics were shortlisted. To date, two evaluations have been completed to guide subsidy decisions and four topics are undergoing evaluation. Notably, 16 of the 26 eligible topics were excluded due to a lack of sufficient evidence, in terms of both quantity and quality, for evaluation. Conclusions HS can be a useful tool for identifying new MTs for evaluation and possible funding prior to further diffusion, but careful selection of the technologies is required to ensure a sufficient evidence base for evaluation. Moving forward, HS can also play a more active role in disinvestment of obsolete or low value health technologies.","Poster Display Number: PD16 Abstract Title: Reassessment And Selection Strategy Of Dipeptidyl Peptidase-4 Inhibitors For Ministry Of Health Malaysia Medicine Formulary Author Names: Nazatul Syima Idrus ([email protected]), Ee Vien Low, Faridah Aryani Md Yusof, Siti Hajar Mahamad Dom, Sarahfarina Abd Rahim Introduction The number of anti-diabetics listed in the Ministry of Health Medicine Formulary (MoHMF) and the proposal to change prescribing category for usage in primary care facilities has increased each year causing difficulty in monitoring effectiveness, safety and rational use of the treatment and budget management. This study aimed to describe the reassessment and selection strategy of Dipeptidyl Peptidase-4 Inhibitors (DPP4-i), a class of anti- diabetic medicines in the MoHMF. Methods A literature review on the comparative effectiveness and safety of all available DPP4-i in MoHMF were conducted. Comparative treatment cost and utilization of DPP4-i were analyzed. Approved MoHMF indications were listed and compared against approved Drug Control Authority (Malaysia) indications. Information on clinical guidelines recommendations and listing or reimbursement status in non-Ministry of Health Malaysia (MoHM) public institutions and other countries were obtained. All findings were presented to MoHM drug expert committee for DPP4-i selection strategy. The final recommendation based on consensus among drug expert committee and Pharmaceutical Services Program were presented to the MoHMF Panel. Results The MoHMF Panel acknowledged that the efficacy and safety profile of all DPP4-i were equivalent across therapeutic group as supported by strong evidence, hence, their selection can be made via cost-minimization strategy. The call for contract tender for single tablet was conducted based on therapeutic group (drug class) to encourage price competition and contracts were awarded to two DPP4-i which offered the lowest treatment costs. Saxagliptin and vildagliptin were awarded as contract items while sitagliptin remained as local purchase item. Prescribing category for all DPP4-i in MoHMF were streamlined accordingly. Linagliptin was disinvested due to sufficient availability of alternatives. Conclusions Selection strategy and disinvestment has successfully reduced the number of DPP4-i listed in MoHMF thus allowing more efficient clinical and cost monitoring. Cost minimization through tender by therapeutic group was the first to be done and has efficiently provided an avenue for price competition which results in saving to MoHM.","Poster Display Number: PD17 Abstract Title: Automating The Impact Reporting Of NICE Guidance Author Names: Shaun Rowark ([email protected]), Pall Jonsson, Seamus Kent Introduction The National Institute for Health and Care Excellence (NICE) intends to automate the way it monitors the uptake, impact, and value of its guidance. Traditionally this has been done by developing impact reports, long documents that, while well received, are time consuming to develop and can quickly become outdated. Methods We focused on a novel topic that would benefit from new data sources to examine its impact: a rapid guideline for managing the long-term effects of coronavirus disease 2019 (COVID-19). We shortlisted \u201cmeasurable\u201d recommendations within the guideline that were likely to be captured in data collections. We then reviewed available data sources that included relevant up-to-date data. Finally, we explored what existing methods were available to NICE for automating impact reporting. Results For long COVID-19 we accessed OpenSAFELY, a secure, transparent software platform for primary care COVID-19 data that was developed in response to the pandemic. This captured data on the management of long COVID-19 in primary care as well as onward referral to specialist clinics. In addition, we accessed data from the CVD-COVID- UK\/COVID-IMPACT Consortium, which links general practice records with primary care dispensing data. This enabled us to analyze the impact of the pandemic on the prescribing and dispensing of cardiovascular disease medications. Working with our digital team we developed an automated impact reporting dashboard using Google\u2019s data studio. This enabled different views of the data, for example by region or socioeconomic status, to be presented in an automated way. Conclusions Automating the impact reporting of NICE guidance provides up-to-date information on its value to the health system. While we were able to collect new sources of data and automate some aspects of how these were viewed, full automation requires several enablers. These include an application programming interface between the data sources and NICE, and ensuring that NICE guidance is computer readable so that its measurement is practical in healthcare systems.","Poster Display Number: PD19 Abstract Title: Machine Learning Modelling For Clinical Trial Design Using The National Institute for Health and Care Research Innovation Observatory\u2019s ScanMedicine Database Author Names: Ece Kavalci ([email protected]), Jawad Sadek, Michael Young, Christopher Marshall Introduction Clinical trials that fail prematurely due to poor design are a waste of resources and deprives us of data for evaluating potentially effective interventions. This study used machine learning modelling to predict clinical trials' success or failure and to understand feature contributions driving this result. Features to power the modelling were engineered using data collected from the National Institute for Health and Care Research Innovation Observatory\u2019s ScanMedicine database. Methods Using ScanMedicine, a large dataset containing 641,079 clinical trial records from 11 global clinical trial registries, was extracted. Sixteen features were generated from the data based on fields relating to trial design and eligibility. Trials were labeled positive if they were completed (or target recruitment was achieved) or negative if terminated\/withdrawn (or target recruitment was not achieved). To achieve optimal performance, phase-specific datasets were generated, and we focused on a subsample of Phase 2 trials (n=70,167). Ensemble models using bagging and boosting algorithms, including balanced random forest and extreme gradient boosting classifiers were used for training and evaluating predictive performance. Shapley Additive Explanations was used to explain the output of the best performing model and calculate feature contributions for individual studies. Results We achieved a weighted F1-score of 0.88, Receiver Operator Characteristic Area under the Curve score of 0.75, and balanced accuracy of 0.75 on the test set with the xgBoost model. This result shows that the model can successfully distinguish between classes to predict if a trial will succeed or fail and subsequently output the features driving this outcome. The number of primary outcomes, whether the study was randomized, target sample size and number of exclusion criteria were the most important features affecting the model\u2019s prediction. Conclusions This study is the first to use predictive modelling on a large sample of clinical trial data obtained from 11 international trial registries. The prediction outcomes achieved by our novel approach, which uses phase-specific trained models, outperforms previous modelling in this space.","Poster Display Number: PD20 Abstract Title: Real-World Evidence To Support Single Arm Trials Of Oncology Interventions: Necessity or \u2018NICE\u2019 (National Institute for Health and Care Excellence) to Have? Author Names: Edel Falla ([email protected]), Jennifer Gaultney Introduction The recent National Institute for Health and Care Excellence (NICE) consultation on methods for health technology evaluation (HTE) outlined plans to include guidance on the role of real-world evidence (RWE) in HTE. This is particularly pertinent for interventions where the evidence base consists of a single arm trial (SAT) design, which is more frequently observed in oncology. This study reviewed the influence of RWE submitted as part of the evidence base for NICE oncology appraisals. Methods A search for NICE HTEs was conducted for interventions supported by SATs from January 2017-November 2021. Evidence was stratified by submission packages with SAT evidence alone or in combination with randomized controlled trial (RCT) evidence, with or without RWE. Results Thirty-two decisions for interventions supported by SATs were made by NICE between 2017-2021, all in oncology indications. Fifty percent were supported by SAT evidence and fifty percent by RCT plus SAT evidence, both with or without RWE. A lower proportion of RCT\/ SAT HTEs submitted RWE compared to SAT HTEs (fifty vs ninety four percent). Seventy five percent and nineteen percent of SAT HTEs received a positive recommendation, with and without restrictions, irrespective of submitting RWE. One negative decision was observed for SATs supported by RWE. Sixty three percent and thirty eight percent of RCT\/ SAT HTEs received a positive recommendation, with and without restrictions. Overall, the proportion of positive recommendations were lower for HTEs submitting RWE (ninety six percent) compared to HTEs not submitting RWE (one hundred percent), which is in contrast to recent findings specific to orphan oncology HTEs (one hundred versus seventy eight percent). Conclusions RWE was more commonly submitted to support SAT HTEs, than RCT HTEs. The use of RWE seems to be established as a necessity to supplement a SAT evidence base, whereas RWE is more generally a nice to have in RCT HTEs. However, RWE appears to positively influence decision-making for orphan oncology indications with a more neutral influence for non-orphan indications.","Poster Display Number: PD21 Abstract Title: Data Sources And Real-World Data On Medical Devices In The Brazilian Scenario Author Names: Leidy Anne Teixeira ([email protected]), Fotini Toscas Introduction The Brazilian government has made efforts in systems to generate data from medical devices (MD). This work explores the main systems and data sources in the perspective of contributing as a source to generate real world data (RDW). Methods Document review of relevant national data sources for MD. In addition, a structured search was carried out in EMBASE using key descriptors for RWD applied to the regulatory context and to the management of health technologies, without date or language restrictions. Results Eighteen primary federal government data sources for MD were identified. Not all sources are publicly accessible. Of the articles, the search returned 1,185 results, of which 29 titles were selected and 8 met the protocol's objective. Included articles were from Europe, the United States and Canada. As in other countries, Brazil initially systematized DM administrative data to meet commercial and financial demands. With the evolution of health technology assessment methods, the use of RDW has become imperative to assess the value of MD to society. Common examples from these countries are implantable MD databases. Current challenges focus on data linkage and quality, in addition to standardized naming. The adoption of the Unique Device Identification (UDI) is one of the promising initiatives to facilitate traceability throughout the lifecycle proposed in the International Medical Device Regulators Forum (IMDRF) of which Brazil is a member. Among the systems, the following stand out: i) ConectSUS, which intends to provide access to health information centered on the patient, anywhere and at any time; ii) National implant registry that generates data on implanted prostheses and stents, surgical techniques used, the profile of patients and the health services involved. Conclusions This work showed the similarities between Brazil and other countries in the management of MD data throughout its life cycle, as well as mapped the national primary data sources for MD.","Poster Display Number: PD22 Abstract Title: Exploratory Analysis of a Brazilian Real-World Open Database Applied to Prostate Cancer Author Names: Lucilena Rebelo Monteiro, M\u00e9rcia Liane Oliveira, Mario Ol\u00edmpio Menezes, Lorena Pozzo ([email protected]) Introduction Prostate cancer was the second most frequent cancer and the fifth leading cause of cancer death among men in 2020. The incidence rates vary substantially in countries with different Human Development Indexes (HDI), while the mortality rates decrease with improved access to the health system, availability of therapies and earlier detection. Worldwide, population-based cancer registries are important tools for planning and managing health systems. The Funda\u00e7\u00e3o Oncocentro de S\u00e3o Paulo (FOSP) is responsible to collect, clean and publicize data from cancer treatment institutions. This study aimed to describe retrospectively the demographic and clinical profile of prostate cancer (PC) in Brazil using this database. It is not an incidence study as data is representative only from specific institutions. Methods This was a retrospective observational study of the years 2000 to 2020 from analysis of the publicly available FOSP database (http:\/\/www.fosp.saude.sp.gov.br). The records were extracted, merged, and cleaned using a fully documented and validated data process. Only patients included on the register with a primary PC diagnosis were considered. Results From January 2010 to June 2020, there were 943,660 patients diagnosed with C61 in FOSP database for the considered time period. The majority of the FOSP database records are from patients who live and\/or were born in SP (91.8 and 58.4%, respectively) or MG (2.8 and 10.5%, respectively). The mean age of PC at baseline was 69 years. Considering the stage of the disease, the mean ages are 55, 70, 67, 66 and 61, for stages 0, 1, 2, 3 and 4, respectively. This cohort was also analysed in relation to treatments received, and status at the end of treatment (51.3% are disease-free, 18.4% are alive with cancer, and 30.3% are dead). Conclusions FOSP population-based cancer registries are a powerful tool to obtain information for planning, and improving the management of healthcare services especially for S\u00e3o Paulo.","Poster Display Number: PD23 Abstract Title: Assessing The Suitability Of Real-World Data For Answering Decision Problems \u2013 NICE\u2019s Data Suitability Assessment Tool Author Names: Lynne Kincaid ([email protected]), Vandana Ayyar-Gupta, Shaun Rowark, Seamus Kent, Stephen Duffield, Pall Jonsson Introduction The National Institute for Health and Care Excellence (NICE) intends to increasingly use real-world evidence in developing guidance. To increase trust in such evidence, NICE has developed a framework for developing and assessing real-world evidence studies, including understanding the value of the selected data source for the decision problem. Methods Starting with published high-quality studies about data quality, we developed a conceptual model of the elements needed to understand the quality of a data source. Results from a literature search were then mapped to the model. We used this to design a structured reporting tool, the data Suitability Assessment Tool (dataSAT), and tested it in several cases studies. Additionally, we engaged with internal and external stakeholders to obtain feedback on the tool and revised it accordingly. Results DataSAT covers provenance of the data, assessment of data quality, and the data\u2019s relevance to the research question. For data provenance, information is requested about the data source independent of the study\u2019s interests, including the purpose, setting, dates of operation, funding, data specification, and management and quality assurance plans for the data sources. Data quality is covered by quantitively assessing the completeness and accuracy of the following key study elements to inform critical appraisal of the study: population inclusion and exclusion criteria; intervention; comparator; and outcomes and key covariates. The findings on data sources and data quality are then interpreted in terms of relevance to the decision problem. This includes relevance to the population in the United Kingdom, the treatment pathway and care setting, the availability of key study elements, time-related factors such as length of follow up, and the effects of sample size and missing data on the validity of findings. Conclusions DataSAT allows summary information on source data, including quality and relevance, to be reported in a structured manner, enabling decision makers to better understand how the data influence the robustness of analyses used in health technology assessment. This helps increase trust in the use of real-world evidence","Poster Display Number: PD24 Abstract Title: Robust Real-World Evidence Generation In Comparative Effects Studies \u2013 NICE\u2019s Methods Guidance Author Names: Stephen Duffield ([email protected]), Seamus Kent, Manuj Sharma, Lynne Kincaid, Vandana Ayyar-Gupta, Shaun Rowark, Pall Jonsson Introduction Recent reviews have shown that many real-world evidence (RWE) studies suffer from avoidable methodological flaws. Meanwhile, the National Institute for Health and Care Excellence (NICE) is seeing an increase in RWE submissions in Health Technology Appraisals and is keen to support the use of this evidence. However, limited guidance exists for the development and assessment of RWE, risking both missed opportunities for unbiased evidence generation and inconsistent decision making based on that evidence. As part of its RWE framework, NICE has developed methods guidance to provide clear expectations for the conduct and reporting of non- randomized comparative effects studies using real world data. Methods A conceptual model and draft framework were developed based on established international best practices in RWE and observational research. This was refined with focused literature searches, for example, on the use of external control arm studies. We then engaged with external stakeholders to incorporate their feedback and develop case studies. A reporting template was developed and tested on multiple use cases. Results & Conclusions The guidance stresses the central importance of a target trial approach to study design, e.g., adopting an active comparator, new user design, where possible. Target trial emulation is a useful tool to improve the quality and transparency of RWE studies, helping to overcome selection and confounding biases. Various other study design and analytical approaches are outlined for addressing confounding bias and biases due to missing data, measurement error, or misclassification, which are common challenges in RWE. Alongside traditional approaches to sensitivity analysis, the framework promotes quantitative bias analyses which includes a range of methods to assess and communicate the potential impact of remaining bias to study findings by quantifying the direction, magnitude, and uncertainty of bias. A reporting template, based on common methodological pitfalls, is provided to help evidence developers consider key areas of bias in their work and to inform reviewers of any approaches used to investigate or resolve these.","Poster Display Number: PD25 Abstract Title: Use Of Real-World Evidence In The Reimbursement Assessment Of Medical Devices Author Names: Amy Crompton, Tom Macmillan ([email protected]), Jen Ferris, Isobel Munro Introduction Randomized controlled trials (RCTs) are typically considered the gold standard source of clinical evidence for reimbursement submissions, but they can often be resource-intensive, expensive, and may not always be appropriate. For example, it may be unethical to assign patients to an untreated or undiagnosed control group, or blinding may not be feasible when assessing medical devices. Evidence for medical devices is therefore often limited to nonrandomized studies. We explored the use and value of real-world evidence (RWE) in the reimbursement of medical devices across several health technology assessment (HTA) agencies. Methods A narrative review was completed to compare the acceptability of RWE for the HTA evaluation of medical devices across a convenience sample of countries. English-language published guidance documents were reviewed, and study design preferences extracted. Results In Australia, France, Germany, Ireland, Norway, and Scotland, HTA agencies prefer RCT evidence but accept RWE as supporting data. In England, there is no preferred study design, with directly observed clinical outcomes, evidence syntheses, nonclinical, and modelling studies accepted. Notably, methods and processes for HTA programs are being reviewed and are expected to place a greater emphasis on RWE. In Australia, pseudo- randomized trials, comparative cohort studies, case series, and other study designs are permitted. In France, nonrandomized or nonblinded trials, patient preference cohorts, prospective comparative observational studies, and propensity score matched cohorts are permitted, accompanied by justification. In Scotland, lived experiences, RWE, and systematic reviews are accepted. In Germany, nonrandomized studies are deemed to provide \u201cminimum\u201d, \u201cvery low\u201d or \u201clow\u201d certainty of results. In Norway, RWE may be accepted if no RCT data are available, or to support RCTs. Conclusions In the assessment of medical devices, where RCTs are unsuitable, RWE can form a feasible alternative. Real- world evidence is increasingly being recognized as a valuable source of evidence for medical interventions and is accepted by a number of HTA agencies. No funding was received for this study.","Poster Display Number: PD26 Abstract Title: Overscreening For Older Women In Cervical And Breast Cancer Screening In Japan Author Name: Chisato Hamashima ([email protected]) Introduction Appropriate resource utilization is crucial for cancer screening programs. Overscreening is defined as screening provided beyond the upper age limit of the target age or at a shorter interval than recommended in national programs. In Japan, there are no upper age limits set for cancer screening programs, and the recommended screening interval for cervical and breast cancer screening is 2 years. To examine the efficient use of resources for cervical and breast cancer screening, we investigated how often overscreening occurred in both programs. Methods The target age for this study was defined as 20-69 years for cervical cancer screening and 40-69 years for breast cancer screening. We used the national report for cancer screening in 2017 in Japan and estimated the number of participants over 70 years old or those who participated in screening annually. The percentage of overscreening was compared between cervical cancer and breast cancer screening by chi-square test. Results The number of participants was 4,294,127 for cervical cancer screening and 3,087,781 for breast cancer screening in 2017. The percentage of overscreening in total participants was 38.0 percent for cervical cancer screening and 35.7 percent for breast cancer screening (p<0.01). The percentage of screening at overage was higher in breast cancer screening than in cervical cancer screening (21.1% vs. 13.9%, p<0.01), whereas more frequent screening was seen more often in cervical cancer screening than in breast cancer screening (29.7% vs. 19.6%, p<0.01). If the resources used in overscreening could be used for the target population, it was estimated that the participation rate could increase by 4.1% for cervical cancer screening and 4.3% for breast cancer screening. Conclusions In Japan, screening for overage participants and short intervals may have contributed to unnecessary screening for cervical cancer and breast cancer. These resources used for overscreening could be allocated to screening for the target population.","Poster Display Number: PD28 Abstract Title:Cost-Effectiveness Of Selective Internal Radiation Therapy Using Y-90 Resin Microspheres For Unresectable Hepatocellular Carcinoma In Brazil Author Names: Ion Agirrezabal, Victoria Brennan, Phuong Lien Carion ([email protected]), Suki Shergill Introduction Hepatocellular cancer (HCC) is a severe condition with poor prognosis and a significant burden. Selective internal radiation therapy (SIRT) is recommended as an alternative treatment option to overcome some limitations of current treatments. This analysis estimated the cost-effectiveness of SIRT using Y-90 resin microspheres for the treatment of unresectable HCC in Brazil. Methods This study was conducted from the Brazilian payer perspective according to local guidelines, with a lifetime horizon. The use of SIRT in patients with intermediate- or advanced-stage HCC, without extrahepatic disease and ineligible to transarterial chemoembolization, was compared with sorafenib, the commonly used HCC systemic treatment in Brazil. A sensitivity analysis included the subgroup of patients with low tumour burden and preserved liver function. A partitioned-survival model was developed, which included a tunnel state for patients downstaged to receive a treatment with a curative intent such as liver surgery, transplantation or ablation. Survival curves, utilities and adverse events incidence were extracted from published sources of pivotal randomized control trials. Effectiveness of health interventions was measured in quality-adjusted-life-years (QALYs) and life-years (LYs). Local costs from Brazil were applied. Future costs and effects were discounted at five percent. A willingness-to-pay threshold of USD 53,936 was used, based on a 2017 review of healthcare technology adoption in Brazil. Results LYs and QALYs were higher for SIRT using Y-90 resin microspheres versus sorafenib (0.27 and 0.20 incremental LYs and QALYs, respectively) and costs were slightly higher for SIRT (USD 3,056 incremental costs). The incremental cost-effectiveness ratio (ICER) was USD 14,948 per QALY in the basecase. One-way and probabilistic sensitivity analyses confirmed the robustness of the analyses. Scenario analyses tested different model assumptions and reinforced the basecase results indicating that SIRT using Y-90 resin microspheres was highly likely to be cost-effective compared with sorafenib. Also, the ICER was lower in the subgroup compared with the overall population. Conclusions SIRT using Y-90 resin microspheres represents a cost-effective option compared with sorafenib in Brazil.","Poster Display Number: PD29 Abstract Title: Systematic Review With Meta-analysis Of Pharmacokinetic Parameters Of Tyrosine Kinase Inhibitors Used In Chronic Myeloid Leukemia Author Names: Mariana Fachi, Michel de Campos, Allan Junkert, Raquel Vilhena, Beatriz B\u00f6ger, Alexandre Cobre, Eric Domingos, Leticia Leonart, Fernanda Stumpf Tonin ([email protected]), Roberto Pontarolo Introduction Therapeutic drug monitoring (TDM) is a cost-effective tool to increase treatments\u2019 efficacy and safety. Analyses of pharmacokinetics proprieties of tyrosine kinase inhibitors (TKI) used for chronic myeloid leukemia (CML) can contribute towards effective TDM, development of tailored treatments and new dosing regimens. We aimed to synthesize the available evidence on pharmacokinetic parameters of imatinib, nilotinib, bosutinib, ponatinib in healthy individuals vs. CML patients. Methods Systematic searches were conducted in PubMed, Scopus and Web of Science. We included in vivo studies addressing TKIs\u2019 pharmacokinetics, including maximum observed concentration (Cmax), time of maximum observed concentration (Tmax) and half-life (t1\/2). Meta-analyses of event rates (mixed-effect models) were performed for the parameters of interest: area under the concentration-time curve from time zero to the last measurable concentration (AUC0-t) and from time zero to infinity (AUC 0-\u221e). Results were presented as event rates with 95 percent confidence intervals. Heterogeneity was assessed using chi-square and I2 statistical tests and considered significant when p<0.05 and high when I2>75 percent (Comprehensive Meta-Analysis v.2 Biostat- Englewood, NJ). Results Overall, 50 articles were included for analyses (n=26 imatinib, n=11 nilotinib, n=8 bosutinib, n=5 ponatinib). Most studies were performed in the United States (46.0%), designed as open-label trials (70.0%). Several significant interactions between TKI with enzyme inhibitors (ketoconazole, midazolam, aprepitant, metoprolol, grapefruit juice), proton pump inhibitors (esomeprazole, lanzoprazole, omeprazole), antacids, H2 antagonists (famotidine) and enzyme inducers (St. John's, rifampicin) were found (p<0.001). Given the significant increase in AUC and Cmax in patients with hepatic\/liver impairments currently using TKI, strict therapeutic monitoring is paramount to maintain safety. The between study heterogeneity was rated as moderate to high (I2=75-90%) due the limited number of trials for some drugs, different study design, and populations. Conclusions The co-administration of TKI with hepatic enzyme inducers or inhibitors, proton pump inhibitors, antacids, H2 antagonists, as well as in patients with hepatic\/liver failures requires caution and additional monitoring. Further well-designed trials are needed to strengthen this evidence for some TKIs, namely bosutinib and ponatinib.","Poster Display Number: PD30 Abstract Title: Radioactive Seed Localization And Radio-Guided Occult Lesion Localization For Non-Palpable Breast Cancer Surgery: A Meta-Analysis Author Names: Hort\u00eancia Ferreira ([email protected]), Maria Rostelato Introduction Non-palpable breast cancers require intraoperative localization to guide the surgical procedure. The radio-guided occult lesion localization (ROLL) and radioactive seed localization (RSL) techniques use radioactive material (technetium-99m labeled macroaggregated albumin and iodine-125 seeds, respectively) implanted at the lesion site. The success of conservative surgery depends on complete tumor excision with negative surgical margins. The objective of this study was to perform a meta-analysis of the surgical effectiveness of the ROLL and RSL techniques with respect to rates of positive surgical margins, reoperation, and recurrence. Methods A systematic search of the PubMed, Embase, LILACS, SciELO, and Web of Science databases was performed on 2 August 2021. A standard form was used to extract data from the studies selected in the screening process. The ROBINS-I tool was used to analyze risk of bias and RevMan 5.4 software was used to perform the meta-analysis. Results Four observational studies met the inclusion criteria. The overall evidence quality was moderate. The studies included women aged from 28 to 91 years with non-palpable breast cancer. The results demonstrated similar effectiveness between RSL and ROLL for rates of positive surgical margins (risk ratio [RR] 0.83, 95% confidence interval [CI]: 0.50, 1.39; 763 patients) and reoperation (RR 1.14, 95% CI: 0.75, 1.74; 1,550 patients). Regarding the rate of disease recurrence, RSL was superior to ROLL (RR 0.50, 95% CI: 0.29, 0.87; 939 patients). Conclusions The results demonstrate that the ROLL and RSL techniques are equivalent with respect to rates of positive surgical margins and reoperation, although patients undergoing RSL had lower rates of disease recurrence. However, there is a tendency to favor the RSL technique because of the longer interval between implantation and surgery, which is possible due to the longer half-life of iodine-125 (59.4 days). This also means that radioactive seed implantation can occur before neoadjuvant chemotherapy, so the tumor bed remains marked if further interventions are required, obviating the need for another invasive procedure before surgery.","Poster Display Number: PD32 Abstract Title: Cost-Utility Of Selective Internal Radiation Therapy Using Y-90 Resin Microspheres For Chemotherapy-Refractory Metastatic Colorectal Cancer In Brazil Author Names: Richard F Pollock ([email protected]), Suki Shergill, Victoria K Brennan, Ion Agirrezabal Introduction There were an estimated 55,102 new cases of colorectal cancer (CRC) in Brazil in 2020, comprising 9.3 percent of all newly diagnosed cancers, and making it the third most common cancer in the Brazilian population. Up to half of all patients with CRC will develop liver metastases, and the prognosis for these patients is poor. The objective of the present analysis was to evaluate the cost-utility of selective internal radiation therapy (SIRT) using Y-90 resin microspheres versus best supportive care (BSC) in patients with unresectable, liver-dominant, chemotherapy-refractory metastatic CRC (mCRC). Methods A three-state partitioned survival model was developed in Microsoft Excel to evaluate the cost-utility of SIRT using Y-90 resin microspheres versus BSC. Membership of the three model states of pre-progression, post- progression and death was governed by parametric models of Kaplan-Meier data from a retrospective, interventional study. Costs associated with SIRT using Y-90 resin microspheres, BSC, and adverse events were obtained from Brazilian sources and reported in 2021 United States dollars (USD). Future costs and effects were discounted at 5 percent. One-way and probabilistic sensitivity analyses (PSA) were performed. A willingness-to- pay threshold of USD 53,936 was used based on a 2017 review of Brazilian healthcare technology adoption. Results The base case analysis showed that Y-90 resin microspheres would result in an increase of 0.76 QALYs versus BSC, increasing quality-adjusted life expectancy from 0.67 QALYs to 1.43 QALYs. The improvement in quality- adjusted life expectancy was accompanied by an increase in costs from USD 9,884 to USD 40,399 over the model time horizon, corresponding to an increase of USD 30,515, and yielding an incremental cost-utility ratio (ICUR) of USD 40,265 per QALY gained. PSA showed there was a 90.8 percent likelihood of cost-effectiveness at USD 53,936 per QALY gained. Conclusions SIRT using Y-90 resin microspheres was cost-effective versus BSC in the treatment of unresectable, liver- dominant mCRC patients and should be considered for incorporation in the Brazilian Private Healthcare System.","Poster Display Number: PD33 Abstract Title: Development And Validation Of A Machine Learning-Based Prediction Model For COVID-19 Diagnosis Using Patients\u2019 Metabolomic Profile Data Author Names: Alexandre Cobre, Monica Surek, Dile Stremel, Karime Domingues, Fernanda Stumpf Tonin ([email protected]), Roberto Pontarolo Introduction We aimed to develop and validate machine learning (ML) -based algorithms to predict COVID-19 diagnosis as well as to identify new biomarkers associated with the disease. Methods Initially, 96 blood samples of patients diagnosed with COVID-19 (Thaizhou Hospital, China) were analyzed through liquid chromatography coupled to mass spectrometry. Samples of patients presenting other pneumonias or severe acute respiratory syndrome, but with negative RT-PCR for SARS-CoV-2, were used as positive controls. Samples from healthy volunteers were used as negative controls. The final database included around 1000 metabolites. Exploratory analyses for the development of ML-based models using principal component analysis (PCA) were performed. Leverage plot versus studentized residuals method was used to detect outliers. Three supervised ML-based models were developed: discriminant analysis by partial least squares (PLS-DA), artificial neural networks discriminant analysis (ANNDA) and k-nearest neighbors (KNN). Samples for the training (70%) and testing sets (30%) were randomly selected using the Kenrad Stone algorithm. Models\u2019 performance was evaluated considering accuracy, sensitivity and specificity. Analyzes were conducted in SOLO (Eigenvector- Research). Results The PCA model was able to distinguish the three classes of patients\u2019 samples (positive for COVID-19, negative controls, positive controls) with an overall accumulated variance of 94.27 percent. The PLS-DA model presented the best performance (accuracy, sensitivity, and specificity of 93%, 98% and 88%, respectively). Increased levels of the biomarkers uridine (linked to glucose homeostasis, lipid, and amino acid metabolisms), 4- hydroxyphenylacetoylcarnitine (metabolite from the tyrosine metabolism; probably associated with anorexia) and ribothymidine (resulting from oral and fecal microbiota alterations) were significantly associated with COVID- 19. Conclusions Three different and updated ML-based algorithms were developed to predict COVID-19 diagnosis; PLS-DA led to the most accurate results. High levels of some metabolites were found as potentially predictors of the disease. These biomarkers should be further evaluated as potential therapeutic targets in well-designed clinical trials. These ML-based models can help the early diagnosis of COVID-19 and guide the development of tailored interventions.","Poster Display Number: PD34 Abstract Title: Neuron-specific Biomarkers Associated With Neurological Manifestations In COVID-19: An Evidence Mapping Systematic Review Author Names: Karime Domingues, Alexandre Cobre, Fernanda Stumpf Tonin ([email protected]), Roberto Pontarolo Introduction We aimed to map and synthesize the available evidence on neuron-specific biomarkers related to COVID-19. Methods A systematic review and qualitative evidence mapping synthesis was performed (PROSPERO-CRD42021266995). Searches were conducted in PubMed and Scopus, and complemented by manual search (July 2021). We included observational studies of any design assessing neurological biomarkers in adult patients (>18 years; with or without neurological comorbidities) diagnosed with COVID-19. Methodological quality of nonrandomized studies (case-control, cohorts) was assessed using the Newcastle-Ottawa Scale. Results Overall, 14 studies (n=485 patients) conducted in Sweden (n=4 articles, 28.5%), Germany (n=3; 21.4%), USA (n=3; 21.4%), Canada, France, Italy and Norway (n=1 study each) were included. The most reported neurological symptoms (n=13 studies, 92.8%) were headache, confusion, general weakness, loss of smell\/taste, cognitive impairments and behavioral changes. Prevalent neurological conditions included encephalopathies, neuropathies, myopathies, and delirium; most critical cases presented cerebrovascular events (n=4 studies, 28.5%). Hypertension, diabetes, obesity, dyslipidemia, and chronic lung disease were the most reported comorbidities. Eight different neuron-specific biomarkers were found in primary studies: neurofilament-light chain \u2013 NfL (n=10 studies; 71.4%), glial fibrillary acidic-protein \u2013 GFAp (n=5; 35.7%), tau protein (n=5; 35.7%), neurofilament-heavy chain \u2013 NfH, S100B protein, ubiquitin C-terminal hydrolase L1 - UCH-L1, neuron-specific enolase and beta protein-amyloid \u2013 A\u03b2 (n=1 study each). These biomarkers were found both in cerebrospinal fluid and blood\/plasma samples even without an evident cytokine storm. In patients with COVID-19, NfL and GFAp can act as sensitive indicators of neuroaxonal and astrocytic damages, respectively. Increased levels of NfL were significantly associated with severe COVID-19, unconsciousness and longer stay in the intensive care unit (p<0.05). Studies had an overall poor to moderate methodological quality. Conclusions We identified eight neuron-specific biomarkers that should be further studied as prognostic factors of COVID-19. These findings can also guide the development of targeted therapies against SARS-CoV-2. Additional well- designed clinical trials are needed to strengthen this evidence and help understand the mechanisms of neurological symptoms and sequelae after COVID-19 infection.","Poster Display Number: PD35 Abstract Title: Mortality And Risk Factors Associated With Dialysis Patients With COVID-19 In A Brazilian Supplementary Health Service Author Names: Karina de Castro Zocrato, Maria da Gl\u00f3ria Cruvinel Horta, Ricardo Mesquita Camelo, Geraldo Jose Coelho Ribeiro ([email protected]), Nelson Ot\u00e1vio Beltr\u00e3o Campos, Douglas Ribeiro de Oliveira, Daniel Pitchon dos Reis, Mariana Ribeiro Fernandes, Patr\u00edcia Liz Terenzi Cunha, L\u00e9lia Maria de Almeida Carvalho Annemarie Dusanek, Fernando Mart\u00edn Biscione, Silvana Kelles Introduction Patients with chronic kidney disease (CKD) and COVID-19 are at high risk of adverse outcomes due to the presence of comorbidities. However, it is still unclear whether dialysis therapy is associated with a worse prognosis in patients infected with SARS-CoV-2. The objectives were to assess mortality and risk factors associated with a worse prognosis of these patients (e.g., age, sex, comorbidities, Intensive Care Admission [ICU] admission, and need for invasive mechanical ventilation [IMV]). Methods An observational, descriptive, retrospective study was conducted in the private healthcare maintenance organization (Unimed-BH) of Belo Horizonte and 33 surrounding cities in Brazil. We used data collected from the organization\u2019s database. We included adult inpatients with CKD on previous dialysis therapy who tested positive for COVID-19, from February 2020 to June 2021. Results During the period, 16182 patients were admitted to Unimed-BH with a diagnosis of COVID-19. Of these, 333 (2%) had dialysis CKD. Male patients were 180 (54%), age ranged from 22.85 to 95.75 years and the mean was 60.91 years. Of the 333 patients, 109 (32.7%) were admitted to the ICU, and 56 (16.8%) required IMV. Among the 14 comorbidities analysed, the mean number of comorbidities was 6, with 93 (27.9%) dyslipidaemia, 74 (22%) diabetic, 270 (81%) hypertensive, 25 (7.5%) asthmatic, 42 (12.6%) with chronic pulmonary disease (CPD) and 122 (36.6%) with congestive heart failure (CHF). There were 66 (19.8%) deaths, 29 (43.9%) were male, the mean age was 60.8 years, and 23 patients (34.8%) were elderly (>60 years). Among the patients who died, 55 (83.3%) were in the ICU and 46 (69.7%) on IMV. The mean number of comorbidities was 9.27 being 16 (24.2%) dyslipidaemia, 44 (66.6%) diabetic, 60 (90.9%) hypertensive, 5 (7%) asthmatic, 10 (15%) with CPD and 32 (48.5%) with CHF. Conclusions Dialysis patients appear more susceptible to unfavourable outcomes than the general population. Our findings are similar to those reported in the world literature which is still scarce. It is important to conduct more studies on this population.","Poster Display Number: PD36 Abstract Title: Outcomes Of Centenaries Hospitalized Due To COVID-19 In A Private Healthcare System Author Names: Ricardo Mesquita Camelo, Maria da Gl\u00f3ria Cruvinel Horta, Geraldo Jose Coelho Ribeiro ([email protected]), Nelson Ot\u00e1vio Beltr\u00e3o Campos, Douglas Ribeiro de Oliveira, L\u00e9lia Maria de Almeida Carvalho, Karina de Castro Zocrato, Daniel Pitchon dos Reis, Mariana Ribeiro Fernandes, Patr\u00edcia Liz Terenzi Cunha, Annemarie Dusanek, Fernando Mart\u00edn Biscione, Silvana Kelles Introduction Life expectancy is increasing worldwide. However, during the COVID-19 pandemic, people 100 years or more (centenaries) were challenged by a potentially fatal disease. We evaluated the outcome of centenaries hospitalized due to COVID-19 in a private healthcare system of Belo Horizonte\/Brazil (Unimed-BH). Methods Administrative data were collected from the hospital database. Patients were included if they had a severe adult respiratory syndrome due to coronavirus type 2 (SARS-CoV-2) ribonucleic acid identified by quantitative real-time reverse transcriptase polymerase chain reaction (RT-qPCR) or by the International Code of Disease-10th review (ICD-10) hospitalization codes U07.1, B34.2, or B97.2. Results From March 1 2020 to October 31 2021, 316.4 \u00b1 12.9 centenaries\/month were registered. Eighteen hospitalizations due to COVID-19 were identified. Median age was 101.8 years (inter quartile range [IQR]:100.7,103.0). Most patients were female (83%). There was a median of 6.0 morbidities per patient (IQR:5.3,7.8), range 2-12 morbidities, among 71 possible morbidities. The most described morbidities were systemic arterial hypertension (94%), dementia (61%), and congestive heart failure (61%). Median length of hospitalization was 6.5 days (IQR:3.3,8.0). No patient was dialyzed. Seven (39%) patients died during hospitalization, of whom 3 (17%) were admitted to the Intensive Care Unit and 2 (11%) were oxygenated by invasive mechanical ventilation. No other patients were admitted to the Intensive Care Unit or invasively mechanically ventilated. Conclusions Although the hospitalization rate was low, the mortality rate during hospitalization was high among centenaries. Further research is required to evaluate the actual risks of centenaries to be infected by SARS-CoV-2 and the subsequent outcomes."]
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