Economic Burden of Medical Transports In France over The Year 2014

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third-party payer perspective.  Methods: A retrospective cohort design using a 10% random sample of the 2006 to 2015 IMS LifeLinkPlus claims dataset was employed to identify patients with MLC who received chemotherapy. The date of first MLC diagnosis was defined as the “metastatic cancer date.” An “index date” was defined as the date of first chemotherapy administration beginning anytime 45 days prior to the metastatic cancer date. Utilization and cost of healthcare services among MLC patients was analyzed over the enrollment period beginning with the index date, and ending with the date of disenrollment or end of study. The Kaplan-Meier Sample Average Method was use to estimate lifetime costs.  Results: N= 2021 MLC patients met our inclusion/exclusion criteria. Majority were 55 years and older, and males (52%). The median follow-up was 273 days (approx. 8.9 MO). On average, patients experienced two inpatient hospitalizations with a mean length of stay of 7.5 days, 34.6 physician visits, 23.6 outpatient hospital visits and 45 prescriptions. The mean cumulative total healthcare cost was $144,795 (2015USD) per patient, with inpatient services and outpatient chemotherapy accounting for 25% and 32% of the total costs, respectively.  Conclusions: Economic burden among MLC patients receiving chemotherapy still remains high with chemotherapy and outpatient care being the major cost drivers. PHS120 Cancer Concerns From US Medical And Pharmacy Directors 2016 Brook RA1, McManama SH2, Sax MJ2, Smeeding JE3 1The JeSTARx Group & NPRT, Newfoundland, NJ, USA, 2The Pharmacy Group, Glastonbury, CT, USA, 3The TPG-NPRT & JeSTARx, Glastonbury, CT, USA

Objectives: Cancer is costly, managed by a variety of treatments that include traditional and robotic surgery, radiation, chemotherapy, and immunotherapy. Pharmaceutical treatments are shifting from chemotherapy with limited effectiveness and multiple side-effects, to effective, targeted immunotherapies with fewer side-effects, multiple treatment pathways with indications alone and in combination, and receiving fast-track approvals. To determine the types of cancers most concerning to US managed care plans, a survey invitation was sent to Medical and Pharmacy Directors (MDs+PDs) of US health plans, insurers, and pharmacy benefit managers.  Methods: Managed care (MC) MDs+PDs completed an online interactive survey. Topics included: advisor+plan information; ranking (highest= 12-to1= lowest) of cancer-types; copays; benefit-design; and top concerns today and in 5 years from budgetary and medical points of view.  Results: Fifty-four percent of respondents were MDs. Most worked for a health plan (83.6%) and 39.6% of the plans were local; 35.4% national; and 25.0% regional. Plans could cover multiple types of members and 91.3% covered commercial lives, 89.1% Medicaid; 91.3% Medicare MA-PDP and 76.1% Medicare PDP-only lives. Average ranking (out of 12): Breast-Cancer= 10.6; Lung-Cancer= 10.0; Colon+Rectal-Cancer= 9.1; ProstateCancer= 7.9; Melanoma= 7.5; Leukemia=  7.2; Non-Hodgkin’s Lymphoma= 6.5; Pancreatic-Cancer= 5.2; Kidney-Cancer= 4.7; Endometrial-Cancer= 3.8; BladderCancer= 3.6; Thyroid-Cancer= 2.7. Cancer/oncology was consistently reported the top concern from medical (38.9% today, 51% in 5 years) and budgetary (52% today, 71.1% in 5 years) points of view. Oncology was the 2nd highest ranked SpecialtyPharmacy (SP) condition with 64.3% of plans always managing under the medicalbenefit, 5.4% always under the pharmacy-benefit. SP copays are decreasing in fixed (2015= 15.8%; 2017= 13.0%) and percentage-bases (2015= 42.1%; 2017= 37.0%) with the rest varied by group and benefit-design.  Conclusions: The environment for cancer treatment is undergoing a series of changes. The shift from traditional chemotherapies toward targeted immunotherapies and the potential cost implications requires payor Medical and Pharmacy Directors to adapt and evaluate these newer agents and pathways along the same rapid timelines as they become available. PHS121 Cost Implications of Adapting The Investigation And Diagnosis Pathway of Infertilty Patients In A Uk Nhs Setting Davies S1, Umranikar A1, Huggins T2, Gauthier A3, Harty GT2 1Salisbury NHS Foundation Trust, Salisbury, UK, 2Merck Serono, London, UK, 3Amaris, London, UK

Objectives: Current organisation of fertility treatment is suboptimal and unnecessary costs are being accumulated by the NHS. Improving the patient pathway through appropriate referral could improve efficiency, utilisation of services and may improve the patient experience. This analysis aims to estimate impact on costs and outcomes associated with reorganisation of the fertility service pathway.  Methods: A retrospective audit was undertaken in Salisbury NHS Foundation Trust to assess the current patient pathway. Target population were patients with fertility problems seeking treatment within the NHS system. A budget impact model was developed to estimate the impact on cost of reorganisation of the fertility service pathway from the perspective of an NHS Clinical Commissioning Group (CCG). The “after” scenario is based on assumptions from clinical experts from Salisbury Fertility Centre. The model accounts for health care visits (at primary and secondary care levels), time between visits, discharge rate, and the number of tests, investigations and treatment sessions. Costs were obtained from NHS reference, BNF and PSSRU. Proportion of patients referred to an urologist, or gynaecologist were obtained from “Choose and Book”.  Results: Mean number of weeks spent in current diagnosis pathway for Wilshire CCG is 40.3 weeks and total number of tests, investigations and treatment sessions related to fertility per annum is 3,660. Total annual pathway costs is modelled at £1,434,772 per annum. Efficiencies could decrease patient time in the pathway by 12.9 weeks and provide savings of £540,793.  Conclusions: This tool helps assess the existing cost drivers within a UK fertility treatment pathway. Results of initial audit from Salisbury identified the main cost drivers as the number of tests and secondary care referrals. Improving the fertility diagnosis pathway by decreasing duplication of tests and unnecessary referrals could reduce costs and provide much needed savings to the NHS. A prospective audit of fertility patients undertaking a new pathway is currently in progress.

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PHS122 The Patient Journey After A Diagnosis of Early/Locally Advanced Breast CA In Greece And Choice of Provider Karampli E1, Tsiantou V1, Skroumpelos A2, Mylona K2, Athanasakis K1, Zavras D1, Pavi E1, Kyriopoulos J1 1National School of Public Health, Athens, Greece, 2Roche (Hellas) S.A., Athens, Greece

Objectives: To describe the healthcare services included in the patient journey, after a woman has been diagnosed with breast Ca in Greece and to identify criteria of choice between private and public healthcare providers.  Methods: A telephone survey was conducted between May – June 2015 in a sample of 252 women diagnosed with early or locally advanced breast Ca from 1/1/2011 to 31/8/2014. Participants were recruited through a patients’ organization and had to have completed their therapy regimen (chemotherapy and/or radiation therapy) in order to participate. The survey questionnaire was developed based on the model of pathways to treatment and the results of a previously conducted qualitative study in 19 women.  Results: All women underwent surgery, however, 7.4% of them received therapy prior to their surgery. 51.0% had total mastectomy and 49.0% had breast conserving surgery. 73.4% of participants had chemotherapy, 19.2% received treatment with biologic agents and 68% had radiation therapy. Patients were treated in a private sector provider in 57.4%, 59.0% , 38% and 47% of cases for surgery, chemotherapy, treatments with biologic agents and radiation therapy respectively. 76.5% haven’t had plastic surgery while 23.5% had undergone breast reconstruction or were in the process of doing so. 49.8% sought psychological support primarily from patients’ organizations and from private practitioners. The main criteria for choice of provider related to the quality of services provided: the treating physician (surgeon, oncologist and radiologist), specialized breast Ca units, equipment. Cost constituted a barrier to seeking psychological care.  Conclusions: Breast Ca patients choose to a large extent private sector providers in all steps of the patient journey. Given also that out-of-pocket costs are higher in the private sector, concerns can be raised about the affordability of private healthcare services and the accessibility and responsiveness of the public breast cancer healthcare services. PHS123 Economic Burden of Medical Transports In France over The Year 2014 Feyt C, Blein C, Vainchtock A HEVA, Lyon, France

Objectives: This study aimed at describing the annual economic burden of medical transports based on the French health insurance perspective, detailed per type of transport and patient characteristics.  Methods: The French healthcare insurance agency (CNAM-TS) released in 2015 an open national health insurance reimbursement database (OpenDAMIR). The 2014 reimbursement data were used to assess the cost of each 8 types of medical transport and their evolution. Costs were detailed in accordance with the patient characteristics, such as age, sex, long-term disease status that allow a 100% reimbursement rate, and by physician prescribing practices.  Results: In 2014, medical transports reimbursements represented 3.61% of the total health expenditure with more than 4 billion euros, and increased by 2.82% since 2013. Among them, taxis accounted for 37% of costs (1.52 billion euros) with 5.65% of evolution. Taxis reimbursement accounted for 74% of the total evolution of medical transports. Ambulances came second, with up to 1.46 billion euros reimbursed (36%) and a 2.16% increase. Transport reimbursements associated with patients with long-term disease represented 67% of all transport costs, compared to 36% when considering long-term disease patients for all health insurance costs. Patients over the age of 50 accounted for 76% of all patients’ reimbursement, and reimbursements between men and women were evenly apportioned. Most of medical transport were prescribed by GPs (70%, 2.85 billion € ), then by nephrologists (6%, 226 M€ ), radiologists (3%, 137M€ ) and surgeons (3%, 110M€ ).  Conclusions: Medical transports costs have constantly increased for the past ten years, remaining the 6th expenditure item of the French healthcare insurance. Taxis are the first reimbursement cost of medical transports (1.52 billion € , 37%) and have been dramatically increasing, both in amount reimbursed and in the size of the vehicle fleet, thus remaining a major challenge to reduce social security costs. PHS124 Second Medical Opinion: Utilization Rates And Characteristics of Seekers In A General Population Shmueli L1, Shmueli E2, Pliskin JS1, Balicer RD3, Davidovitch N1, Hekselman I4, Greenfield G5 1Ben-Gurion University of the Negev, Beer-Sheva, Israel, 2Tel-Aviv University, Tel-Aviv, Israel, 3Clalit Research Institute, Tel Aviv, Israel, 4Clalit Mushlam Health Insurance, Bnei Brak, Israel, 5Imperial College London, London, UK

Objectives: Second opinion is common in medical practice and can reduce unnecessary risks and costs. To date, there is no population-based estimation of how many people seek second opinions and what the characteristics of secondopinion seekers are. This research aims to estimate how many people seek second opinions, and what the characteristics of second-opinion seekers are.  Methods: We conducted both a medical records analysis (n= 1,392,907) and a cross-sectional national telephone survey with a representative sample of the general Israeli population (n= 848, response rate= 62%). In the medical records analysis we linked consultations with specialists at community secondary care and private consultations using claims data. We developed a time-sensitive algorithm that identified potential second opinion instances. In both methods, we predicted the characteristics of second-opinion seekers using multivariate logistic regressions.  Results: The medical records analysis and the survey findings were highly consistent, and showed that about sixth (14.9% in the medical records vs. 17.2% in the survey) of a general population sought a second opinion, mostly from orthopedic surgeons.