ESTRO 36 Abstract Book

S151 ESTRO 36 2017 _______________________________________________________________________________________________

prognosis significantly superior than HPV negative tumor.Although their survival is excellent, standard RT-CT regimens produce substantial toxicity.In that scenario strategies for de-intensification have been developed.De- intensification is to modify the standard treatment in order to reduce the long-termtoxicities associated with radiation / chemotherapy while maintaining the high cure rates.Prognostic factors allow us to select patients with excellent outcomes that can benefits from de- intensification strategies. This factors are: Oropharyngeal cancer, P16 +, minimalsmoking history, non bulky primary and non-extensive nodal spread (not N2c-N3).Strategies for de-intensification are: Select chemo responders and reduce RT dose or thevolume, reduce RT dose and cisplatin, replace cisplatin with cetuximab, use TORSresection and reduce adjuvant RT dosePublished de- escalation clinical trial will be presented and discussed as well as the mostimportant ongoing trials.As conclusions: radiation de-escalation is experimental and should be conducted in clinicaltrials, appropriate candidates for de- escalation are well defined, there are differentstrategies for de-intensification, preliminary data show efficacy but the effect on long-termtoxicity reduction need to be proved. SP-0294 Health Technology Assessment: what’s in a word? A. Aggarwal 1 1 London School of Hygiene and Tropical Medicine, Health Services Research and Policy, London, United Kingdom Health Technology Assessments (HTA) aim to ensure rational and fair decisions are made on resource allocation for new health interventions. The advantage of HTAs are their universality when making decisions regarding which treatments across all medical specialities represent the best value to society. However, few if any countries internationally use HTA in the evaluation of radiation technologies. Instead these processes have largely focussed on new cancer drugs, informing reimbursement policy for public health systems. In the absence of HTA processes, low regulatory barriers have resulted in the relentless diffusion of increasingly expensive radiotherapy innovations which offer ever- marginal gains in the therapeutic ratio. Without a rational and evidence based approach to evaluation the costs of delivering cancer care will continue to rise exponentially. I will discuss how a commitment to HTA processes is imperative in order to avoid many of the entrenched interests and inefficient practices that have manifest in high income countries due to differences in cancer care delivery, and health system financing. I will also highlight the challenges in establishing HTA for radiotherapy interventions, given the diversity in innovation, and limitations within the evidence base to enable comparative effectiveness research. In addition I will offer insights into the challenges of implementing HTA decisions in practice, using the experiences of the UK National Institute for Health and Clinical Excellence (NICE) as an example. Specifically, the impact of political, public and media pressure on HTA assessments of cancer therapies as well as the negative consequences of bypassing these value driven approaches to reimbursement policy. SP-0295 Radiotherapy costs: the good, the bad and the ugly L.Perrier 5 Cancer Centre Léon Bérard, Clinical Research and Innovation Direction, Lyon, France Symposium with Proffered Papers: Costs and value of radiotherapy innovations: how to assess

Abstract not received

OC-0296 A critical quality appraisal of studies estimating the cost of radiotherapy N. Defourny 1 , P. Dunscombe 2 , C. Grau 3 , Y. Lievens 4 , L. Perrier 5 1 ESTRO A.I.S.B.L., HERO, Brussels, Belgium 2 University of Calgary, Department of Oncology, Calgary, Canada 3 Aarhus University, Department of Clinical Medicine, Aarhus, Denmark 4 University Hospital Ghent, Radiation Oncologist, Ghent, Belgium 5 Cancer Centre Léon Bérard, Clinical Research and Innovation Direction, Lyon, France Purpose or Objective In the context of growing healthcare expenses combined with reduced economic growth, health economics (HE) studies are becoming paramount. Considerable interest in the domain is apparent when looking at the number of articles indexed with HE keywords. Nevertheless, a recent literature review has revealed very few articles calculating the cost of radiotherapy, and a large heterogeneity in the methodologies used. The aim of this complementary review is to report on existing guidance in HE and to critically assess guideline compliance in the A systematic literature review of cost computation studies in external photon beam radiation therapy (EBRT) from 1981-2015 was recently conducted by us. Building on this earlier work, existing HE guidelines have been reviewed and a list of relevant items for cost estimations has been compiled. The guidelines searched were ISPOR’s Good Practices For Outcome Research guidelines, HE evaluation quality appraisal instruments and National guidelines (EUnetHTA). A standardised framework focusing on recommendations on cost assessment was designed with the help of these guidelines. Fifty-two HE studies meeting criteria established in our earlier literature review were studied in-depth: cost assessment methods, descriptions of methodologies (e.g. sample size, time horizon, or discounting clearly mentioned), and relevant statistical analyses performed (e.g. selection bias treated, sensitivity analyses done) were all critically appraised within the framework. Results Guidance on HE analyses is often provided in the form of a checklist of items to be addressed. Direction on the cost type to estimate, the analysis to conduct, and methods for tackling uncertainty of data are outlined, e.g. ‘’identify relevant cost for each alternative and value the cost appropriately’’. Evaluation of the 52 studies against published HE recommendations revealed shortcomings in the cost assessment methodologies, the implications of that choice, and the calculation methods used. Among selected studies, heterogeneity was observed in the quantity and quality of the information disclosed. While documentation of cost items and sample size was found in 67% of the 52 articles, and the reference year of cost data was present in 85%, only 37% of the articles specified data sources used by the authors, 35% stated their discounting methods and just 8% mentioned the study’s time horizon. Descriptive statistics analyses were present in 35% of the studies and uncertainty treatment in 48%. Conclusion Existing guidance on formulating the cost part of HE evaluation studies establishes an outline framework while giving researchers a high degree of freedom. The limited number of studies investigating the cost of EBRT do not systematically follow these published HE guidance leaving radiotherapy literature. Material and Methods