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To estimate the incremental phase-specific and lifetime economic burden among newly diagnosed cervical and endometrial cancer patientsCervical and endometrial cancer patients newly diagnosed between January 2015 and June 2018 were identified in the Optum Clinformatics DataMart database. 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. Patients were followed until death/loss of enrollment/end of data availability. Per patient per month (PPPM) costs attributable to cancer were calculated for four phases: pre-diagnosis (3 months before diagnosis), initial (6 months post-diagnosis), terminal (6 months pre-death), and continuation (remaining time between initial and terminal phases). Survival data were obtained to determine the monthly proportion of patients in each phase. Total survival adjusted monthly costs were obtained by multiplying the proportion of patients in each phase by the total cost incurred during that month. Phase-specific and lifetime incremental costs of cervical and endometrial cancer were obtained using generalized linear models.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. Mean adjusted incremental PPPM lifetime costs (95% CI) for cervical cancer and endometrial cancer cases were $5,910 ($5,373-$6,446) and $3,475 ($3,259-$3,691), respectively. Incremental total PPPM phase-specific costs attributable to cervical and endometrial cancer were pre-diagnosis (cervical: $1,057; endometrial: $3,315), initial ($12,084; $8,618), continuation ($2,732; $1,147), and terminal ($2,702; $5,442). Incremental costs were significantly higher for cancer patientsThis study highlights the cost burden associated with cervical/endometrial cancer and cost variation by phases of care.

Objective: To measure the economic and humanistic burden of cervical cancer in the United States. Materials and Methods: This was a retrospective analysis of Medical Expenditure Panel Survey data (2006–2015). Cervical cancer cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification code “180” or clinical classification software code “26”. The control group included women without any cancer diagnosis. Study outcomes included health care resource use (institutional inpatient and outpatient, emergency room, and physician office visits), costs, limitations in activities of daily living, and quality of life (general health status, 12-Item Short Form Health Survey [SF-12] physical and mental component summary [MCS], EuroQol-5D and Short-Form Six-Dimension health utility, and Patient Health Questionnaire-2 depression severity). Generalized linear models, controlling for sociodemographic and clinical covariates, were conducted to compare outcomes between cases and controls. Results: The analytic cohort included 275,246 cervical cancer cases and 146,061,609 noncancer controls. Cases were significantly older (mean age [years]: 42.03 vs. 36.98) and had a higher Charlson comorbidity burden (mean score: 1.06 vs. 0.46) versus controls. Multivariate analyses suggested that compared to controls, cancer cases had significantly higher costs: institutional outpatient ($1,610 vs. $502), physician visit ($2,422 vs. $1,321), and total health care ($10,031 vs. $4,913). Cases were 1.99 (odds ratio [OR]: 1.991; 95% confidence interval [CI]: 1.23–3.22) and 2.56 (OR: 2.562; 95% CI: 1.78–3.68) times as likely to report activity limitations and poor general health versus controls. Cervical cancer patients had significantly lower SF-12 physical and MCS score, health utility, and higher depression severity. Conclusions: Cervical cancer is associated with significant economic burden, activity limitations, and quality of life impairment among ambulatory women in the United States.

Aim: This study evaluated treatment patterns, healthcare resource use and healthcare costs among newly diagnosed US patients with cervical or endometrial cancer. Materials & methods: The authors identified patients diagnosed between 2015 and 2018, described them by line of therapy (LOT), then summarized all-cause per patient per month healthcare resource use and healthcare costs per LOT. Results: Among 1004 patients with cervical cancer and 2006 patients with endometrial cancer, 65.2 and 71.4%, respectively, received at least LOT1. Common treatment modalities in LOT1 were surgery (cervical, 58.0%; endometrial, 92.6%), radiation therapy (cervical, 49.8%; 24.7%) and systemic therapy (cervical, 53.3%; endometrial, 26.1%). Mean per patient per month costs per LOT were pre-treatment (cervical, US$17,210; endometrial, US$14,601), LOT1 (cervical, US$10,929; endometrial, US$6859), LOT2 (cervical, US$15,183; endometrial, US$10,649) and LOT3+ (cervical, US$19,681; endometrial, US$9206). Conclusion: Overall, newly diagnosed patients with cervical or endometrial cancer received guideline-recommended treatment. Outpatient visits mainly drove healthcare costs across LOTs.

Aim: To evaluate treatment patterns, healthcare resource use (HCRU) and all-cause healthcare costs among patients with cervical or endometrial cancer newly initiating systemic therapy. Methods: We identified patients with cervical or endometrial cancer newly initiating systemic therapy – a claims-based proxy for advanced disease – between 2014 and 2019, described them by line of therapy (LOT), and summarized the per patient per month (PPPM) HCRU and healthcare costs per LOT. Results: Among 1229 patients with cervical cancer and 2659 patients with endometrial cancer, LOT1 therapies included systemic only (cervical, 50.1%; endometrial, 83.2%) and systemic with radiation therapy (cervical, 49.9%; endometrial, 16.8%). Mean PPPM total costs were: LOT1 (cervical, US$15,892; endometrial, US$11,363), LOT2 (US$20,193; US$14,019) and LOT3+ (US$16,576; US$14,645). Conclusions: Overall, patients received guideline-concordant care and experienced significant economic burden, which increased with LOT.

Background: An estimated 11,350 uterine cancer deaths are projected to occur in the United States in 2018. We constructed an economic model to estimate the annual productivity costs associ...

Background: Hepatitis C virus (HCV) infection is an important cause of morbidity and mortality in patients with chronic kidney disease (CKD). The objective of this study was to predict the impact of EBR/GZR on the incidence of liver and kidney related complications compared with no treatment (NoTx) and pegylated interferon plus ribavirin (pegIFN/RBV) in patients with CKD stage 4/5 in Vietnam. Methods: We developed a mathematical model of the natural history of chronic HCV, CKD, and liver disease. Efficacy of EBR/GZR and pegIFN/RBV were derived from the C-SURFER trial and a meta-analysis, respectively. We calculated lifetime cumulative morbidity and mortality rates, including incidence of decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and life expectancy. Results: Estimated lifetime incidence of DC was significantly reduced in patients receiving EBR/GZR (3.47%) compared to NoTx (18.14%) and pegIFN/RBV (9.01%). Estimated incidence of HCC was 1.02%, 21.64%, and 8.90%, and 1.02% in patients receiving EBR/GZR, NoTx, and pegIFN/RBV. EBR/GZR was estimated to extend life expectancy by 4.2 and 2.0 years compared with NoTx and pegIFN/RBV. Conclusions: Our model predicted that EBR/GZR will significantly reduce the incidence of liver-related complications and prolong life in patients with chronic HCV GT1 infection and CKD compared with NoTx or pegIFN/RBV. Keywords: Hepatitis C, Chronic kidney disease, Economics, Elbasvir/grazoprevir

Background: An estimated 12,820 women in the United States will be diagnosed with CxCa in 2018, with 4,210 deaths from the disease. The economic burden of CxCa, both in terms of healthcare costs and lost productivity, has not been adequately studied. Methods: This was a mixed-methods study that evaluated the direct and indirect costs of CxCa using data from the Medical Expenditure Panel Survey (MEPS) for prevalent CxCa cases and the National Center for Health Statistics (NCHS) for deaths due to CxCa. Total healthcare costs and number of work days missed were compared between CxCa cases and controls in MEPS, using propensity scores calculated from baseline demographics and comorbidities. Missed work was converted to costs using the average hourly wage for women in 2015. Per-patient incremental healthcare and lost work productivity costs were then multiplied by the number of prevalent cases of CxCa in 2015 obtained from the Surveillance, Epidemiology, and End Results Program (SEER). NCHS data on the age-stratified number of CxCa deaths per year (1935–2015) and life expectancy data from the Social Security Administration were then used to calcluate the number of women who would be alive in 2015 if they had not died from CxCa and the lost earnings resulting from early mortality. The primary study outcome was the total direct and indirect cost of CxCa in 2015, calculated as the sum of the incremental direct healthcare costs, incremental lost productivity costs due to missed work, and lost productivity costs resulting from early death due to CxCa. Results: An estimated 257,524 women were alive with CxCa in 2015. Total healthcare costs were $4,221 higher, and an additional 0.37 work days were missed in women with CxCa compared to propensity-matched controls. Of the 488,475 women who died of CxCa prior to 2015, 108,832 would be alive in 2015 and 38,540 would be part of the workforce. Lost earnings in 2015 attributable to these deaths totaled $2.19 billion. The total economic burden of CxCa in the United States in 2015 was thus estimated at $3.3 billion (Table 1). Conclusions: CxCa was responsible for nearly $3.3 billion in direct and indirect costs in 2015. Early death among women with CxCa was the biggest driver of total economic burden.

Background: Globally, CC is the fourth most common cancer in women, with 569,847 new cases and 311,365 deaths from CC reported in 2018. Little is known about the burden of living with CC, especially related to mental health. This study examined patient-reported outcomes, including symptoms of depression and anxiety, amongst women with and without a diagnosis of CC. Methods: Data were aggregated from the 2016–2018 U.S. National Health and Wellness Surveys, a nationally representative, self-administered, internet-based survey of adults (N=247,484). Women who reported a physician-diagnosis of CC were matched 1:1 by propensity scores to a sample of women who did not report any cancer diagnoses. Propensity score matching was conducted using the following sociodemographic characteristics: age, race, possession of health insurance, smoking status, comorbidity status, body mass index, income, and year of survey completion. Bivariate analyses (ie, chi-square and t-tests) assessed differences in mental health outcomes between these 2 matched groups of female respondents. Outcomes included the following: (1) depressive severity via the Patient Health Questionnaire (PHQ-9), (2) suicidal ideation via the PHQ-9 (ie, thoughts of being better off dead on several days or more during the past 2 weeks), (3) anxiety severity via the Generalized Anxiety Disorder 7-Item Scale (GAD-7), and (4) healthcare resource use for mental health services (ie, visits to psychologists and psychiatrists during past 6 months). Results: Analyses of the propensity score matched sample of 1,044 women with a CC diagnosis versus 1,044 without a CC diagnosis showed that CC respondents reported significantly more severe scores of both depression (7.3 vs 6.0; PPP=.158). Respondents with CC were marginally more likely to visit a psychologist (8.6% vs 6.4%; P=.056) and were significantly more likely to visit a psychiatrist (8.6% vs 6.2%; P=.037) at least once during the prior 6 months than respondents without CC. Conclusions: CC is associated with mental health burden, including more severe symptoms of depression and anxiety as well as greater use of mental health services. This study highlights the likely impact of CC for both patients as well as the healthcare system

This study evaluated competency related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT).C-SCOPE is a study consisting of a self-administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and USA between April-May 2017. A 7-point scale was used to measure average competence (score4 of 7) related to HCV testing, management and treatment.Among 203 physicians (40% USA, 45% Europe, 14% Australia/Canada) 21% were addiction medicine specialists, 29% psychiatrists, and 70% were metro/urban [mean PWID managed, 51; years of experience, 11]. The majority perceived HCV testing (82%) and treatment (85%) among PWID as important. The minority reported average competence with respect to regular screening (12%) and interpretation of HCV test results (14%), while greater proportions reported average competence in advising patients about new HCV therapies (28%), knowledge of new treatments (37%), and treatment/management of HCV (40%). In adjusted analysis, factors independently associated with average self-reported competency related to the ability to treat HCV and manage side effects included fewer years in medical practice, fewer numbers of patients treated for HCV infection in the past six months, not having obtained information on screening, diagnosing or treatment of HCV, not having attended any training on HCV in the past year, and not having read or consulted AASLD/IDSA, EASL or other guidelines for HCV.Physicians treating HCV infection among PWID attending OAT clinics recognized the importance of HCV testing and treatment. However, self-perceived competency related to HCV management and treatment was low, highlighting the importance of improved HCV education and training among physicians practicing in clinics offering OAT.

Objectives: To estimate years of potential life lost (YPLL) and present value of future lost productivity (PVFLP) associated with premature mortality due to HPV-attributable cancers, specifically those targeted by nonavalent HPV (9vHPV) vaccination, in the United States (US) before vaccine use.Methods: YPLL was estimated from the reported number of deaths in 2017 due to HPV-related cancers, the proportion attributable to 9vHPV-targeted types, and age- and sex-specific US life expectancy. PVFLP was estimated as the product of YPLL by age- and sex-specific probability of labor force participation, annual wage, value of non-market labor, and fringe benefits markup factor.Results: An estimated 7,085 HPV-attributable cancer deaths occurred in 2017 accounting for 154,954 YPLL, with 6,482 deaths (91%) and 141,019 YPLL (91%) attributable to 9vHPV-targeted types. The estimated PVFLP was $3.8 billion for cancer deaths attributable to 9vHPV-targeted types (84% from women). The highest productivity burden was associated with cervical cancer in women and anal and oropharyngeal cancers in men.Conclusions: HPV-attributable cancer deaths are associated with a substantial economic burden in the US, much of which could be vaccine preventable.

There is limited published evidence for the cost-effectiveness of treatments for unresectable or metastatic endometrial cancer (mEC). The objective of this analysis was to assess the cost-effectiveness of pembrolizumab versus chemotherapy for previously treated unresectable or mEC, in women whose tumors have deficient mismatch repair (dMMR) or high microsatellite instability (MSI-H). The analysis was carried out from a US healthcare payer perspective. A lifetime partitioned survival model comprising three health states (progression-free, progressed disease and death) was constructed. Chemotherapy was represented by single-agent paclitaxel or doxorubicin. Overall survival, progression-free survival and time on treatment data for pembrolizumab were obtained from a Phase II clinical study that included women with previously treated dMMR/MSI-H unresectable or mEC (KEYNOTE-158, NCT02628067). Survival data for chemotherapy were obtained from a published Phase III study for previously treated advanced endometrial cancer. Costs included were drug acquisition and administration, health-state, end-of-life, and adverse event management. Costs were presented in 2019 US$. Outcomes were calculated as quality-adjusted life-years (QALYs), using EQ-5D data from KEYNOTE-158. Model results were tested extensively in deterministic and probabilistic sensitivity analyses. Results demonstrated that pembrolizumab is a highly cost-effective treatment option when compared with chemotherapy, with estimated deterministic and probabilistic incremental cost-effectiveness ratios (ICERs) of $58,165 and $57,668 per QALY gained, respectively. Pembrolizumab was associated with a large QALY and life-year gain per person versus chemotherapy over the model time horizon (deterministic 4.68 life year gain, 3.80 QALYs), with the majority of QALYs accrued in the progression-free health state. The key limitation of the analysis was the lack of comparative effectiveness data for pembrolizumab versus chemotherapy. Pembrolizumab is a highly cost-effective treatment option when compared with chemotherapy for women with previously treated dMMR/MSI-H unresectable or mEC. Results were robust to the changes in parameters and assumptions explored.

Introduction/Background There are little data describing the economic burden among newly diagnosed and advanced cervical cancer patients, by line of therapy (L). NCCN recommends the use of systemic treatment for advanced cervical cancer patients. Therefore, this study aimed to assess healthcare costs among newly diagnosed cervical cancer patients and those newly initiating systemic treatments. Methodology This was a retrospective observational study conducted using the Optum Clinformatics DataMart database. The first cohort consisted of cervical cancer patients newly diagnosed between January 2015 – June 2018, and continuous enrollment for 12 months prior and 6 months post diagnosis. The start of 1L was the date of the first treatment. Treatments initiated within 90 days of a surgery or the end of radiotherapy, and systemic treatment started within 28 days of any previous treatment were part of the same treatment line. The second cohort consisted of cervical cancer patients with ≥2 claims for systemic therapy (i.e., chemo- or immunotherapy) within a 4-week period between June 2014 – October 2018, and continuously enrolled for 6 months prior and 3 months post therapy initiation. All claims for the same systemic therapy without a >90-day gap, or initiation of a new systemic therapy within 28 days of a previous treatment were attributed to the same treatment line. Claims for adjuvant systemic therapy (i.e., within ±90-days of a cervical cancer-related surgery) were excluded. The per patient per month (PPPM) components of healthcare costs attributable to 1L and 2L were summarized for both cohorts (figures 1 and 2). Analyses for the second cohort were stratified by the presence of comorbid non-cervical cancers prior to systemic therapy initiation. Results The first cohort included 655 patients who received at least 1L of which 162 received 2L. The mean PPPM healthcare cost from diagnosis to end of follow-up was $10,121. The mean PPPM healthcare costs (figure 1) attributable to 2L ($15,183) exceeded that of 1L ($10,929). The second cohort included 1,229 patients who newly initiated 1L of which 357 received 2L. The mean PPPM healthcare cost from initiation of systemic therapy to end of follow-up was $15,463. The PPPM healthcare costs (figure 2) was higher during 2L versus 1L (without prior cancers: $22,973 vs $13,044; with prior cancers: $19,822 vs $16,387). Outpatient costs accounted for >70% of total PPPM healthcare costs attributable to 1L and 2L for both cohorts. Conclusion Moving from 1L to 2L 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., 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.

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.

Xinyi Ng,1 Chizoba Nwankwo,2 Jean Marie Arduino,2 Shelby Corman,1 Kathryn Eilene Lasch,1 Jacqueline Mary Lustrino,1 Sushma Patel,2 Heather Loryn Platt,2 Jingjun Qiu,2 Jan Sperl3 1Pharmerit International, LP, Bethesda, MD, USA; 2Merck & Co. Inc., Kenilworth, NJ, USA; 3Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic Purpose: People chronically infected with hepatitis C virus (HCV) have diminished patient-reported outcomes (PROs). This study aimed to compare the impact of elbasvir/grazoprevir (EBR/GZR) treatment versus sofosbuvir with pegylated interferon and ribavirin (SOF/PR) on changes in PROs: 1) during the treatment period and 2) at posttreatment follow-up. Patients and methods: PRO data collected during the Phase III C-EDGE Head-2-Head (H2H) open-label study was analyzed. In this trial, patients infected with HCV were randomized 1:1 to receive either EBR/GZR or SOF/PR for 12 weeks. Patients self-administered the Short Form-36 version 2 (SF-36v2®) Health Survey Acute (1-week recall) Form and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Scale at baseline, during treatment, and posttreatment. Between-group differences in mean change of PRO scores from baseline were estimated during the treatment period and also at the posttreatment follow-up. Effect sizes were calculated to evaluate if the detected change in mean PRO scores is clinically meaningful between groups. Results: There were 255 patients (99.2% White, 54.1% female, 74.9% treatment naïve) included in the analysis. During the treatment period, significant declines in SF-36v2 scores were observed across all domains for the SOF/PR group. Compared to the SOF/PR group, the EBR/GZR group reported more improvement in scores across all SF-36v2 domain scores at the end of the treatment period. At treatment week 12, the between-group differences for 6 out of the 8 domain scores for these patients reflected at least moderate effects (effect sizes >0.5). No significant between-group differences in change in SF-36v2 scores from baseline were detected posttreatment. The decline in SF-36v2 scores observed during the treatment period for the SOF/PR group returned to near baseline scores or above posttreatment. Treatment with EBR/GZR did not impact fatigue scores, but treatment with SOF/PR led to increased fatigue scores during treatment which resolved by posttreatment follow-up week 12. Conclusion: This study demonstrated that HCV treatment with EBR/GZR resulted in a significantly better PRO profile as compared to SOF/PR. PROs are an important consideration as worsening PROs experienced during treatment may negatively influence adherence and ultimately contribute to an unfavorable clinical outcome. Clinical trials.gov Identifier: NCT02358044 Keywords: hepatitis, direct-acting antivirals, health-related quality of life, fatigue, patient-reported outcomes

To evaluate the cost-utility of treatment with elbasvir/grazoprevir (EBR/GZR) regimens compared with ledipasvir/sofosbuvir (LDV/SOF), ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin (3D ± RBV), and sofosbuvir/velpatasvir (SOF/VEL) in patients with chronic hepatitis C genotype (GT) 1 infection.A Markov cohort state-transition model was constructed to evaluate the cost-utility of EBR/GZR ± RBV over a lifetime time horizon from the payer perspective. The target population was patients infected with chronic hepatitis C GT1 subtypes a or b (GT1a or GT1b), stratified by treatment history (treatment-naive [TN] or treatment-experienced), presence of cirrhosis, baseline hepatitis C virus RNA (or ≥6 million IU/mL), and presence of NS5A resistance-associated variants. The primary outcome was incremental cost-utility ratio for EBR/GZR ± RBV versus available oral direct-acting antiviral agents. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model.EBR/GZR ± RBV was economically dominant versus LDV/SOF in all patient populations. EBR/GZR ± RBV was also less costly than SOF/VEL and 3D ± RBV, but produced fewer quality-adjusted life-years in select populations. In the remaining populations, EBR/GZR ± RBV was economically dominant. One-way sensitivity analyses showed varying sustained virologic response rates across EBR/GZR ± RBV regimens, commonly impacted model conclusions when lower bound values were inserted, and at the upper bound resulted in dominance over SOF/VEL in GT1a cirrhotic and GT1b TN noncirrhotic patients. Results of the probabilistic sensitivity analysis showed that EBR/GZR ± RBV was cost-effective in more than 99% of iterations in GT1a and GT1b noncirrhotic patients and more than 69% of iterations in GT1b cirrhotic patients.Compared with other oral direct-acting antiviral agents, EBR/GZR ± RBV was the economically dominant regimen for treating GT1a noncirrhotic and GT1b TN cirrhotic patients, and was cost saving in all other populations.

Summary Among patients with chronic kidney disease (CKD) in the United States, HCV infection causes significant morbidity and mortality and results in substantial healthcare costs. A once-daily oral regimen of elbasvir/grazoprevir (EBR/GZR) for 12 weeks was found to be a safe and efficacious treatment for HCV in patients with CKD. We evaluated the cost-effectiveness of EBR/GZR in treatment-naive and treatment-experienced CKD patients compared with no treatment (NoTx) and pegylated interferon plus ribavirin (peg-IFN/RBV) using a computer-based model of the natural history of chronic HCV genotype 1 infection, CKD and liver disease. Data on baseline characteristics of the simulated patients were obtained from NHANES, 2000–2010. Model inputs were estimated from published studies. Cost of treatment with EBR/GZR and peg-INF/RBV were based on wholesale acquisition cost. All costs were from a third-party payer perspective and were expressed in 2015 U.S. dollars. We estimated lifetime incidence of liver-related complications, liver transplantation, kidney transplantation, end-stage live disease mortality and end-stage renal disease mortality; lifetime quality-adjusted life years (QALY); and incremental cost-utility ratios (ICUR). The model predicted that EBR/GZR will significantly reduce the incidence of liver-related complications and prolong life in patients with chronic HCV genotype 1 infection and CKD compared with NoTx or use of peg-IFN/RBV. EBR/GZR-based regimens resulted in higher average remaining QALYs and higher costs (11.5716, $191 242) compared with NoTx (8.9199, $156 236) or peg-INF/RBV (10.2857, $186 701). Peg-IFN/RBV is not cost-effective, and the ICUR of EBR/GZR compared with NoTx was $13 200/QALY. Treatment of a patient on haemodialysis with EBR/GZR resulted in a higher ICUR ($217 000/QALY). Assuming a threshold of $100 000 per QALY gained for cost-effectiveness, use of elbasvir/grazoprevir to treat an average patient with CKD can be considered cost-effective in the United States.

e18009 Background: NCCN recommends the use of systemic treatment for advanced cervical cancer patients. However, no study has assessed treatment patterns in this population. This study described real-world treatments patterns among women with cervical cancer newly initiating a systemic therapy. Methods: Cervical cancer patients with ≥2 claims for systemic therapy (i.e., chemo- or immunotherapy) within a 4-week period between June 2014 – October 2018, no claims within 6 months prior to systemic treatment initiation (baseline period), and continuously enrolled within the baseline period and 3 months post therapy initiation were identified from the Optum Clinformatics DataMart database. Patients who had a cervical cancer-related surgery within ±3 months of therapy initiation were excluded to exclude adjuvant use. All claims for the same systemic therapy without a > 90-day gap or new systemic therapy started within 28 days of a previous treatment were considered to be part of the same LOT. Descriptive analysis, stratified for presence of non-cervical cancers during the baseline period, were conducted to identify most common treatments, durations, and use of mono versus combination therapy within each LOT. Results: 1,229 women newly initiated systemic therapy, 357 (29.0%) received LOT2 and 141 (11.5%) had a LOT3. Treatments received within each LOT are described in the table below. The proportion receiving radiation reduced from LOT1 (49.9%) to LOT2 (12.0%). The mean duration of LOT1 and LOT2 were 2.9 and 3.7 months. The proportion of patients receiving monotherapy in LOT1 and LOT2 were 77.8% and 64.1% respectively. Conclusions: The treatment received by patients in this analysis suggested receipt of guideline concordant care. [Table: see text]

e18019 Background: To address the gap in US-based real-world data, this analysis described the real-world treatment patterns among newly diagnosed cervical cancer patients. Methods: Women newly diagnosed with cervical cancer between Jan 2015 – June 2018, with a confirmatory diagnosis or treatment within 2 months, and continuous enrollment for 12 months prior and 6 months post diagnosis were identified in the Optum Clinformatics DataMart database. Surgeries (hysterectomy, conization, lymphadenectomy and trachelectomy), radiation (external beam radiotherapy [EBRT]/brachytherapy) and systemic therapies (chemotherapy/immunotherapy) received after diagnosis were described by line of therapy (LOT). The start of the first LOT was the date of the first treatment. All treatments initiated within 90 days of a surgery or the end of radiotherapy, and all systemic treatment started within 28 days of any previous treatment were a part of the same LOT. Most frequently received treatments in LOT1 and 2 and time to treatment initiation were described. Results: Out of 1,004 newly diagnosed women, 655 (65.2%) received at least LOT1 and 162 (16.14%) received LOT2. Median time to first LOT was 1.5 (1.4 – 1.7) months from diagnosis. Surgery was the most common treatment in LOT1 (58.0%). Among patients receiving radiation, the majority received a combination of EBRT and brachytherapy (LOT1: 66.9%, LOT2: 58.0%). The use of chemotherapy increased with subsequent LOTs (LOT1: 53.3%, LOT2: 61.1%). Treatments received in LOT1 and LOT2 are described in the table. Conclusions: This analysis shows that newly diagnosed cervical cancer patients are primarily receiving guideline recommended treatment with surgery or chemoradiation as primary treatment. Radiation therapy includes EBRT and brachytherapy. Counts ≤ 10 are not reported (NR). [Table: see text]

The aim of this analysis was to evaluate perceived barriers related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT). C‐SCOPE was a study consisting of a self‐administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and the United States between April and May 2017. A 5‐point Likert scale (1 = not a barrier, 3 = moderate barrier, 5 = extreme barrier) was used to measure responses to perceived barriers for HCV testing, evaluation and treatment across the domains of the health system, clinic and patient. Among the 203 physicians enrolled (40% USA, 45% Europe, 14% Australia/Canada), 21% were addiction medicine specialists, 29% psychiatrists and 69% were metro/urban. OAT physicians in this study reported poor access to on‐site venepuncture (35%), point‐of‐care HCV testing (16%), and noninvasive liver disease assessment (25%). Only 30% of OAT physicians reported personally treating HCV infection. Major perceived health system barriers to HCV management included the lack of funding for noninvasive liver disease testing, long wait times to see an HCV specialist, lack of funding for new HCV therapies, and reimbursement restrictions based on drug/alcohol use. Major perceived clinic barriers included the lack of peer support programmes and/or HCV case managers to facilitate linkage to care, the need to refer people off‐site for noninvasive liver disease staging, the lack of support for on‐site phlebotomy and the lack of on‐site delivery of HCV therapy. This study highlights several important modifiable barriers to enhance HCV testing, evaluation and treatment among PWID attending OAT clinics.

OBJECTIVE: To assess the neurobehavioral effects of lifetime solvent exposure by comparing the performance of painters and demographically comparable controls. METHODS: Performance of exposed painters (N=133) was compared to unexposed tapers, glaziers, or carpenters (N=78) on the following domains: motor/perceptual speed, visual contrast, attention, working memory/planning, and visual and verbal memory. Lifetime exposure was estimated with questionnaires, field measurements, and paint composition. RESULTS: After controlling for confounders, lifetime solvent exposure did not predict reduction in performance for overall domains of function. Lifetime solvent exposures predicted subtle alterations for individual tests of verbal learning, motor coordination, and visuospatial accuracy. CONCLUSIONS: Concentrations of solvents in paints have steadily declined during the working lifetime of subjects in this study. Although reduced performance was observed on individual tests, these alterations were not consistent across tests and unlikely to be of clinical significance.

Objective To assess the cost-effectiveness of the elbasvir/grazoprevir (EBR/GZR) regimen in patients with genotype 1 chronic hepatitis C virus (HCV) infection with severe and end-stage renal disease compared to no treatment. Design This study uses a health economic model to estimate the cost-effectiveness of treating previously untreated and treatment experienced chronic hepatitis C patients who have severe and end stage renal disease with the elbasvir-grazoprevir regimen versus no treatment in the French context. The lifetime homogeneous markovian model comprises of forty combined health states including hepatitis C virus and chronic kidney disease. The model parameters were from a multicentre randomized controlled trial, ANRS CO22 HEPATHER French cohort and literature. 1000 Monte Carlo simulations of patient health states for each treatment strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The results were expressed in cost per quality-adjusted life year (QALY) gained. Patients The mean age of patients in the HEPATHER French cohort was 59.6 years and 56% of them were men. 22.3% of patients had a F0 fibrosis stage (no fibrosis), 24.1% a F1 stage (portal fibrosis without septa), 7.1% a F2 stage (portal fibrosis with few septa), 21.4% a F3 stage (numerous septa without fibrosis) and 25% a F4 fibrosis stage (compensated cirrhosis). Among these HCV genotype 1 patients, 30% had severe renal impairment stage 4, 33% had a severe renal insufficiency stage 5 and 37% had terminal severe renal impairment stage 5 treated by dialysis. Intervention Fixed-dose combination of direct-acting antiviral agents elbasvir and grazoprevir compared to no-treatment. Results EBR/GZR increased the number of life years (6.3 years) compared to no treatment (5.1 years) on a lifetime horizon. The total number of QALYs was higher for the new treatment because of better utility on health conditions (6.2 versus 3.7 QALYs). The incremental cost-utility ratio (ICUR) was of €15,212 per QALY gained for the base case analysis. Conclusions This cost-utility model is an innovative approach that simultaneously looks at the disease evolution of chronic hepatitis C and chronic kidney disease. EBR/GZR without interferon and ribavirin, produced the greatest benefit in terms of life expectancy and quality-adjusted life years (QALY) in treatment-naive or experienced patients with chronic hepatitis C genotype 1 and stage 4-5 chronic kidney disease including dialysis patients. Based on shape of the acceptability curve, EBR/GZR can be considered cost-effective at a willingness to pay of €20,000 /QALY for patients with renal insufficiency with severe and end-stage renal disease compared to no treatment.

ObjectiveTo assess the population-level impact and cost-effectiveness of hepatitis A vaccination programs in the United States.MethodsWe developed an age-structured population model of hepatitis A transmission dynamics to evaluate two policies of administering a two-dose hepatitis A vaccine to children aged 12 to 18 months: 1) universal routine vaccination as recommended by the Advisory Committee on Immunization Practices in 2006 and 2) Advisory Committee on Immunization Practices’s previous regional policy of routine vaccination of children living in states with high hepatitis A incidence. Inputs were obtained from the published literature, public sources, and clinical trial data. The model was fitted to hepatitis A seroprevalence (National Health and Nutrition Examination Survey II and III) and reported incidence from the National Notifiable Diseases Surveillance System (1980–1995). We used a societal perspective and projected costs (in 2013 US $), quality-adjusted life-years, incremental cost-effectiveness ratio, and other outcomes over the period 2006 to 2106.ResultsOn average, universal routine hepatitis A vaccination prevented 259,776 additional infections, 167,094 outpatient visits, 4781 hospitalizations, and 228 deaths annually. Compared with the regional vaccination policy, universal routine hepatitis A vaccination was cost saving. In scenario analysis, universal vaccination prevented 94,957 infections, 46,179 outpatient visits, 1286 hospitalizations, and 15 deaths annually and had an incremental cost-effectiveness ratio of $21,223/quality-adjusted life-year when herd protection was ignored.ConclusionsOur model predicted that universal childhood hepatitis A vaccination led to significant reductions in hepatitis A mortality and morbidity. Consequently, universal vaccination was cost saving compared with a regional vaccination policy. Herd protection effects of hepatitis A vaccination programs had a significant impact on hepatitis A mortality, morbidity, and cost-effectiveness ratios.

Background & Aims Obesity, kidney disease, and diabetes are common conditions that can affect outcomes of patients with chronic hepatitis C. The authors aimed to quantify the burden of these comorbid conditions among adults with chronic hepatitis C in the United States and to estimate the risk of death among people with chronic hepatitis C and comorbidities. Methods The authors conducted cross-sectional and prospective analyses of 13,726 participants in the third National Health and Nutrition Examination Survey (NHANES III) and 23,691 participants of NHANES 1999–2012. Serum samples were analyzed for the presence of antibodies to hepatitis C virus (anti-HCV); in samples found to be positive for anti-HCV, the authors quantified HCV RNA (viral load). Individuals with anti-HCV and detectable HCV RNA were considered to have chronic hepatitis C. Comorbidities were defined using self-reported, physical examination, and laboratory data, as available. The authors used logistic models and predictive margins to estimate the adjusted prevalence of comorbidities in patients with chronic hepatitis C. The authors used Poisson regression models to estimate adjusted mortality rates based on chronic hepatitis C status, with or without comorbidities. Cox proportional hazards regression models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause, cardiovascular, and cancer mortality according to chronic hepatitis C status, with and without comorbidities. Results Among persons with chronic hepatitis C, the demographic-adjusted prevalence estimate of diabetes was 17.9% (95% CI, 11.2%–27.5%) and of obesity was 20.9% (95% CI, 12.4%–29.5%). Overall, 69.6% of persons with chronic hepatitis C had at least 1 major cardiometabolic comorbidity (95% CI, 62.1%–76.2%). Only 38% of adults with chronic hepatitis C reported a diagnosis of liver disease. Chronic hepatitis C was associated with a substantially increased risk of death (HR, 2.45), especially in the presence of diabetes (HR, 3.24) or chronic kidney disease (HR, 4.39). Conclusion In an analysis of NHANES data, the authors found that individuals with chronic hepatitis C have a high burden of major cardiometabolic comorbidities. Diabetes and chronic kidney disease, in particular, are associated with substantial excess mortality in persons with chronic hepatitis C.

Background National vaccine adoption decisions may be better understood by linking multiple data sources. When examining countries’ decisions to adopt the hepatitis A vaccine, applying multiple research methods can facilitate assessments of gaps between evidence and policy. We conducted a literature review on hepatitis A and stakeholder interviews about decisions to adopt the vaccine in six countries (Chile, India, South Korea, Mexico, Russia, and Taiwan). Methods A systematic literature review was conducted across five literature databases. The review identified and abstracted 340 articles, supplemented by internet search. In addition, we interviewed 62 experts and opinion leaders on hepatitis A and/or vaccines. Data from the two sources were analyzed to identify gaps around epidemiologic data, economic data, and barriers/facilitators of hepatitis A vaccine adoption. Results Epidemiologic data gaps were found in Chile and Russia, where stakeholders believed data to be more solid than the literature documented. Economic data on hepatitis A was found to be weak across all countries despite stakeholders’ agreement on its importance. Barriers and facilitators of vaccine adoption such as political will, prioritization among vaccines, and global or local recommendations were discussed more by stakeholders than the literature. Stakeholders in India and Mexico were not concerned with the lack of data, despite growing recognition in the literature of the epidemiological transition and threat of outbreaks. Conclusions Triangulation of results from two methods captured a richer story behind vaccine adoption decisions for hepatitis A. The discrepancy between policymakers’ beliefs and existing data suggest a decline in priority of hepatitis A or weak investment in data collection. Filling the confirmed data gaps in seroprevalence or economic data is important to help guide policy decisions. Greater communication of the risk of hepatitis A and the benefits of the vaccine may help countries undergoing the epidemiologic transition.

e18226 Background: Limited chemotherapy data is available for elderly cervical cancer patients (pts). This study aimed to investigate real-world use of systemic therapies, survival, and costs among elderly pts in U.S. Methods: Pts who aged 65+ years and initially diagnosed with cervical cancer between 2007 and 2013 were identified using the SEER-Medicare data. Regimens were classified into 3 mutually-exclusive categories, i.e. cisplatin (Cis), carboplatin (Car), and Other based therapies. Chemotherapy within 90 days of surgery or radiation therapy were not considered as first line (1L) systemic therapy. All costs were converted to 2016 US dollars. Results: A total of 1 651 eligible pts were identified with 430 (26%) being stage IV at diagnosis. Among pts received systemic therapies, the median overall survival (OS) was 14 m from 1L initiation and 10 m from 2L initiation. Among 225 pts who received 1L, 58% pts received Cis-based therapy, and 17% pts received Car-based therapy. Car + paclitaxel was the most commonly used regimen (44%). Among 73 pts who received 2L, 34% and 15% pts received Cis- and Car-based therapy, respectively. Pts with 2L therapy received a variety of regimens with the top 3 being Car + paclitaxel (19%), gemcitabine (11%), and topotecan (9.6%). Median duration of treatment (DOT) was 4-6 m across line of therapies (LOTs), yet median time to next treatment (TTNT) ranged 10-32 m for 1L, and 9-11 m for 2L. The average per person per month (PPPM) costs were 7.1k for 1L and 8.8k for 2L with primary drivers of spending being outpatient and emergency room visits. Conclusions: Elderly pts with advanced cervical cancer requiring chemotherapy had poor prognosis and had no standard of care for 2L therapy. Per-patient economic burden is substantial for both 1L and 2L therapy, exceeding 7k dollars per month. [Table: see text]

e17020 Background: Treatment options for cervical cancer include surgery, radiation therapy, chemotherapy, and immunotherapy depending upon the disease stage. There is limited real-world evidence providing us with a clinical profile for a treated cervical cancer patient. The objective of this study was to compare cervical cancer patients who were currently receiving treatment versus those not receiving treatment. Methods: This was a retrospective, cross-sectional analysis of Medical Expenditure Panel Survey (MEPS) data (2006-2015). Cervical cancer cases were identified using ICD-9 CM code 180 or clinical classification software code 26. Patients receiving only chemotherapy, radiation therapy, undergoing surgery, or a combination of these treatments in a given year were regarded as “currently receiving treatment”. The comparator cohort included patients “not currently receiving treatment”. The two cohorts were compared in terms of patient clinical characteristics using bivariate analyses. Results: The analytic cohort consisted of 275,246 cervical cancer cases (mean age: 42 years, Caucasian: 88.0%, having private insurance: 55.3%) of which 115,639 (42.01%) were “currently receiving treatment”. The most common treatment option was undergoing surgery only (88.21%), followed by combination therapy (6.82%), chemotherapy only (3.84%), and radiation therapy only (1.12%). The “currently receiving treatment” cohort had a significantly higher proportion of patients having a history of myocardial infarction (4.21% vs 3.50%), congestive heart failure (2.73% vs 1.42%), chronic obstructive pulmonary disorder (29.5% vs 23.2%), connective tissue disease (20.5% vs 11.6%), renal disease (2.49% vs 0.48%), and diabetes (17.7% vs 11.7%) compared to those “not currently receiving treatment”. The latter cohort had a higher proportion of patients with moderate/severe liver disease (0.46% vs 5.32%). Conclusions: The observed real-world patient characteristics and treatment patterns were indicative of a cohort of largely early stage cervical cancer patients. Patients receiving treatment appeared to have a higher comorbidity burden which may subsequently result in poorer quality of life and activity limitations.

e17009 Background: Limited data on the inpatient burden of cervical and uterine cancer exist. Therefore, this study assessed inpatient mortality, length of stay (LOS), and costs among hospitalized cervical and uterine cancer patients. Methods: This was a retrospective analysis of the 2006–2015 Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS). Cervical and uterine cancer cases were identified using ICD-9 codes of 180.9 and 182.0 respectively. Patient demographics, hospital characteristics, and hospital outcomes (hospitalization rates, inpatient mortality, LOS, and costs) were examined. Multivariate logistic regression models were used to determine predictors of inpatient mortality. Generalized linear models were used to determine predictors of LOS and costs. Results: The analytic cohort included 67,429 cervical cancer and 74,394 uterine cancer cases resulting in 55.92 (±1.51) and 61.69 (±1.78) annual hospitalizations (per 100,000 women), respectively. The highest proportion of hospitalizations related to cervical and uterine cancer were among patients aged 45-65 years (38.9%, 45.7%), Caucasians (70.3%, 78.1%), having public insurance (59.6%, 67.4%), and admitted at large (63.3%, 63.1%), urban teaching (54.8%, 56.5%) hospitals. The mean LOS, proportion of patients who died during hospitalization, and hospital charges per stay were 4.22 (±0.02) days, 1.02%, and $9,646 (±$63.06) for cervical cancer and 4.39 (±0.02) days, 1.43%, and $10,790 (±65.47) for uterine cancer related hospitalizations. Age > 65 years (vs 18-45 years) (OR: 3.656; 95% CI: 2.99 – 4.47), and higher Elixhauser mortality score (OR: 1.097; 95% CI: 1.09 – 1.10) were associated with higher inpatient mortality among cervical cancer patients. Predictors of inpatient mortality for uterine cancer were similar. Patient age, insurance, race, hospital size, urban (vs rural) location, region of the country, and Elixhauser mortality score emerged as significant predictors of LOS and cost per hospital discharge across both cancers. Conclusions: Cervical and uterine cancer are associated with considerable inpatient burden. There was considerable variation in inpatient mortality, LOS, and costs based on patient, hospital, and discharge level characteristics.

e17021 Background: Although much is known about the prevention, screening, and treatment of cervical cancer (CC), less is known about its economic burden. This study compared patient-reported outcomes (PROs) between women diagnosed and treated for CC, women diagnosed and untreated for CC, and women without CC. Methods: Data were aggregated from the 2013-2015 US National Health and Wellness Surveys, a nationally-representative, self-administered, internet-based survey of adults (N = 269,447). Controlling for baseline patient demographics and characteristics, three matched cohorts were compared in multivariable analysis: treated CC, untreated CC, and no CC. Treated CC and untreated CC patients with other forms of comorbid cancer were excluded from analyses. Economic outcomes included healthcare resource use (HCRU) over the past six months and annualized direct costs. Direct costs were calculated using Medical Expenditure Panel Survey data. Results: Adjusted means are reported. Treated CC (N = 192), untreated CC (N = 829), and no CC (N = 1,018) cohorts largely differed by number of healthcare provider (HCP) visits (0.95 vs. 0.89 vs. 0.84, p’s < 0.05), hospitalizations (0.18 vs. 0.09 vs. 0.10, p’s < 0.05), and ER visits (0.29 vs. 0.19 vs. 0.16, p’s < 0.05), though the difference between untreated CC and no CC cohorts was not significant for hospitalizations nor ER visits. Treated CC, untreated CC, and no CC cohorts also largely differed by HCP costs ($14,143 vs. $11,187 vs. $10,573, p’s < 0.01), hospitalization costs ($12,006 vs. $4,202 vs. $4,908, p’s < 0.01), ER costs ($2,104 vs. $995 vs. $872, p’s < 0.01), and total direct costs ($30,768 vs. $16,613 vs. $16,776, p’s < 0.01), though the difference between untreated CC and no CC cohorts was not significant for HCP costs nor total direct costs. Conclusions: These results indicate substantial economic burden in women diagnosed with CC in the US. In terms of HCRU and direct costs, treated CC patients incur the greatest burden, untreated CC patients incur the second greatest burden, and individuals without CC tend to incur the least burden.

Background: Lead (Pb) exposure has been associated with a host of pathological conditions in humans. In rodents Pb exposure has been shown to alter the hypothalamic–pituitary–adrenal (HPA) axis function. Objective: We investigated the effects of lead on responses of the HPA axis to a psychosocial laboratory stressor administered to Pb-exposed workers. Methods: Seventy male participants completed the Trier Social Stress Test (TSST). Serum cortisol (CORT) and plasma adrenocorticotropic hormone (ACTH) were assessed in response to and during recovery from the stressor. We measured Pb in blood, a biomarker of recent exposure, and in tibia bone by X-ray fluorescence (XRF), a biomarker of chronic exposure. Results: The TSST induced statistically significant increases in ACTH and CORT in the participants. At baseline, ACTH was not significantly higher (p = 0.052) in participants with higher blood Pb concentration, but CORT was significantly lower in these participants (p = 0.016). Adjusted linear regression models indicated a positive association between blood and bone Pb and the increase in ACTH in response to stress. However, Pb was not strongly associated with changes in CORT in response to stress. Pb was also associated with the ACTH:CORT ratio at baseline and throughout the course of the protocol, suggesting an adrenal hyporesponsiveness in participants with higher Pb concentrations. Conclusion: The altered HPA-axis stress response observed in participants exposed to higher levels of Pb further supports the idea that lead may contribute to a host of biological dysfunctions beyond the classical neurotoxic effects.

e17513Background: An estimated 4115 women died of cervical cancer in the United States (US) in 2014. Life years lost per cervical cancer death (mean, 26.4 years) are the third highest of any cancer...