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Introduction/Background Guidelines recommend surgery as primary therapy for endometrial cancer patients. Subsequent treatments can include radiation with/without systemic therapy depending on patients’ prognosis. However, there is little data describing real-world treatment patterns and economic burden among newly diagnosed endometrial cancer patients. Therefore, this study aimed to assess real-world treatment patterns and healthcare costs by line of therapy (LOT) among newly diagnosed endometrial cancer patients. Methodology Endometrial cancer patients newly diagnosed between January 2015 – June 2018 with continuous medical enrollment for 12 months prior and 6 months post diagnosis were identified in the Optum Clinformatics DataMart database. Treatments associated with endometrial cancer, including surgeries (bilateral salpingo-oophorectomy, hysterectomy and lymphadenectomy), radiotherapy (external beam radiotherapy and brachytherapy) and systemic therapies (chemotherapies, immunotherapies and hormonal therapies) were identified and described by LOT. The first treatment received post diagnosis was classified as LOT1. Treatments initiated within ±90 days of surgical procedures, 30 days of the end of a radiotherapy, and 28 days of the start of a systemic therapy were considered to be a part of the same LOT. Study outcomes included time to treatment initiation, most frequently received treatments in LOT1 and LOT2, and per patient per month (PPPM) costs attributable to LOT1 and LOT2. Results Among 5,006 newly diagnosed endometrial cancer patients, 3,574 (71%) received at least LOT1 and 771 (15.4%) received LOT2. The median time from diagnosis to LOT1 initiation was 1.0 (1.0 – 2.0) month. Hysterectomy (98.9%) was the most common treatment in LOT1. Majority of patients received radiation therapy (65%) in LOT2. Treatments received in LOT1 and LOT2 are summarized in table 1. The mean total healthcare cost from diagnosis to end of follow-up was $6,088 PPPM. The PPPM costs attributable to each LOT are presented in figure 1. The total healthcare costs during LOT2 exceeded those incurred during LOT1 with outpatient costs being the biggest driver. Conclusion Newly diagnosed endometrial cancer patients received treatments consistent with guidelines with hysterectomy being the most common LOT1 treatment. Outpatient costs accounted for 70%-80% of total healthcare costs attributable to LOT1 and LOT2. Moving from LOT1 to subsequent LOTs was associated with an increase in healthcare costs which may be indicative of disease progression/recurrence. Disclosures This study was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Chizoba Nwankwo is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Anuj Shah, Ruchit Shah, Shelby Corman, and Nehemiah Kebede are employees of Pharmerit, which received consulting fees related to this study.

Introduction/Background NCCN guidelines recommend the use of systemic therapy for women with advanced endometrial cancer. However, there are no data examining real-world treatment patterns and economic burden in this population. Therefore, this analysis described treatment patterns, and costs in a real-world cohort of endometrial cancer patients initiating systemic treatment. Methodology Endometrial cancer patients with ≥2 claims for a systemic therapy (i.e., chemo-, immuno- or hormonal therapies) within a 4-week period or a claim for an intrauterine device between June 2014 – September 2018 and having continuous medical enrollment for 6 months prior and 3 months post therapy initiation were identified in the Optum Clinformatics DataMart database. Patients with endometrial cancer-related surgery performed within ±90 days of systemic therapy initiation were not included to exclude adjuvant use. All claims for the same systemic therapy without a >90-day gap or a new systemic treatment initiated within 28 days were a part of the same line of therapy (LOT). We reported the most frequently used treatments and per patient per month (PPPM) healthcare costs for LOT1 and LOT2. All analyses were stratified by the presence of non-endometrial cancers prior to systemic therapy initiation. Results 2,659 women with endometrial cancer newly initiated systemic therapy (i.e., LOT1), 877 (32.98%) received a LOT2, and 350 (13.16%) had a LOT3. Most patients had a non-endometrial cancer (88.9%) prior to initiating systemic therapy. The treatments received and associated costs in LOT1 and LOT2 are described in table 1 and figure 1, respectively. The median durations of LOT1 and LOT2 were 3.5 and 3.1 months, respectively. The proportions of patients receiving monotherapy in LOT1 and LOT2 were 55.3% and 54.4%, respectively. The mean PPPM total healthcare expenditure over the entire follow-up was $11,109 and outpatient costs ($8,073) accounted for ~75% of this burden. Healthcare expenditure increased as patients moved from LOT1 to LOT2. Conclusion Both taxanes and platinum-based therapies were used as the primary systemic treatments in this population. The use of targeted and immunotherapies was not common perhaps because the approval of these treatments was recent and not adequately captured in the data. Delaying progression to subsequent LOTs may help reduce the economic burden in this population. Disclosures This study was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Chizoba Nwankwo is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Anuj Shah, Ruchit Shah, Shelby Corman, and Nehemiah Kebede are employees of Pharmerit, which received consulting fees related to this study.

Introduction/Background There are little data describing the economic burden of cervical/endometrial cancers. Therefore, this study aimed to estimate the incremental lifetime economic burden among newly diagnosed cervical and endometrial cancer patients versus non-cancer controls using a phase-based costing approach. Methodology Cervical and endometrial cancer patients newly diagnosed between January 2015 – June 2018, with continuous enrollment for 12 months prior and 6 months post diagnosis were identified in the Optum Clinformatics DataMart database. Non-cancer controls included patients who did not have any cancer diagnosis and had at least 18 months of continuous enrollment in the data. The index date was the date of the first diagnosis for cancer cases and the first claim date after 12 months of continuous enrollment for non-cancer controls. Both cases and controls were followed until death/loss of enrollment/end of data availability. Cancer patients were matched with non-cancer controls on the propensity of receiving a cervical/endometrial cancer diagnosis, index year, and year of last follow-up. Per patient per month (PPPM) costs (outpatient, inpatient, ER, pharmacy) attributable to cervical and endometrial cancer were calculated for the following 4 phases: pre-diagnosis (3 months prior to diagnosis), initial (6 months post-diagnosis), terminal (6 months pre-death), and continuation (any remaining time between initial and terminal phases). Survival data were obtained (cases: Surveillance, Epidemiology, and End Results registry; controls: United States life tables) to determine the monthly proportion of patients in each phase of care. Total survival adjusted monthly cost were obtained by multiplying the proportion of patients in each phase by the total cost incurred during that month (figures 1 and 2). Generalized linear models were used to assess phase-specific incremental costs attributable to cervical and endometrial cancer. Results The analytic cohort included 1,002 cervical cancer patients and 4,005 matched non-cancer controls, and 5,003 endometrial cancer patients matched with 19,999 non-cancer controls. The incremental total PPPM phase-specific costs attributable to cervical and endometrial cancer were: pre-diagnosis (cervical: $1,057; endometrial: $3,315), initial (cervical: $12,084; endometrial: $8,618), continuation (cervical: $2,732; endometrial: $1,147), and terminal (cervical: $2,702; endometrial: $5,442). Incremental costs were significantly higher for cancer patients versus non-cancer controls across all phases of care (except terminal phase costs for cervical cancer). Outpatient costs were the major driver of costs across all post-diagnosis phases (figure 1 and 2). Conclusion The mean phase-specific costs followed the following order: Terminal > Initial > Continuation > Pre-diagnosis. This study highlights the substantial cost burden associated with cervical/endometrial cancer, and cost variation by phases of care. Disclosures This study was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Chizoba Nwankwo is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Anuj Shah, Ruchit Shah, Shelby Corman, and Nehemiah Kebede are employees of Pharmerit International, which received consulting fees related to this study.