scholarly journals Cost-Effectiveness of Digital Breast Tomosynthesis vs. Abbreviated Breast MRI for Screening Women with Intermediate Risk of Breast Cancer—How Low-Cost Must MRI Be?

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1241
Author(s):  
Fabian Tollens ◽  
Pascal A.T. Baltzer ◽  
Matthias Dietzel ◽  
Johannes Rübenthaler ◽  
Matthias F. Froelich ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Digital Breast Tomosynthesis ◽  
Breast Mri ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Intermediate Risk ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Abbreviated Breast Mri

Background: Digital breast tomosynthesis (DBT) and abbreviated breast MRI (AB-MRI) offer superior diagnostic performance compared to conventional mammography in screening women with intermediate risk of breast cancer due to dense breast tissue. The aim of this model-based economic evaluation was to analyze whether AB-MRI is cost-effective in this cohort compared to DBT. Methods: Decision analysis and Markov simulations were used to model the cumulative costs and quality-adjusted life-years (QALYs) over a time horizon of 30 years. Model input parameters were adopted from recent literature. Deterministic and probabilistic sensitivity analyses were applied to test the stability of the model. Results: In the base-case scenario, the costs of an AB-MRI examination were defined to equal the costs of a full protocol acquisition. Two-yearly screening of women with dense breasts resulted in cumulative discounted costs of $8798 and $9505 for DBT and AB-MRI, and cumulative discounted effects of 19.23 and 19.27 QALYs, respectively, with an incremental cost-effectiveness ratio of $20,807 per QALY gained in the base-case scenario. By reducing the cost of an AB-MRI examination below a threshold of $241 in sensitivity analyses, AB-MRI would become cost-saving compared to DBT. Conclusion: In comparison to DBT, AB-MRI can be considered cost-effective up to a price per examination of $593 in screening patients at intermediate risk of breast cancer.

scholarly journals Cost-utility analysis of esketamine and electroconvulsive therapy in adults with treatment-resistant depression

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kinza Degerlund Maldi ◽  
Peter Asellus ◽  
Anna Myléus ◽  
Fredrik Norström
Keyword(s):  
Cost Effectiveness ◽  
Electroconvulsive Therapy ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Resistant Depression

Abstract Background Electroconvulsive therapy (ECT) has long been used for treating individuals with treatment-resistant depression (TRD). Esketamine has recently emerged as a new treatment for TRD due to its rapid antidepressant effects. To further inform the decision regarding choice of treatment, this paper aims to evaluate whether ECT or esketamine is the more cost-effective option. Methods The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model from a societal and life-time perspective. The incremental cost-effectiveness ratio (ICER) was calculated. Health states included different depression and remission states and death. Data to populate the model was derived from randomised controlled trials and other research. Various sensitivity analyses were carried out to test the robustness of the model. Results The base case scenario shows that ECT is cost-effective compared to esketamine and yields more QALYs at a lower cost. The sensitivity analysis shows that ECT is cost-effective in all scenarios and ECT dominates esketamine in 12 scenarios. Conclusions This study found that, from a cost-effectiveness point of view, ECT should be the first-hand option for individuals with TRD, when other first line treatments have failed. Considering the lack of economic evaluation of ECT and esketamine, this study is of great value to decision makers.

scholarly journals Cost-effectiveness of a Contact Intervention and a Psychotherapeutic Program for Post-discharge Suicide Prevention: Rentabilité D’une Intervention de Contact et d’un Programme de Psychothérapie Pour la Prévention du Suicide Après le Congé de L’hôpital

2020 ◽  
pp. 070674372098013
Author(s):  
Gonzalo Martínez-Alés ◽  
José B. Cruz Rodríguez ◽  
Pablo Lázaro ◽  
Arce Domingo-Relloso ◽  
María Luisa Barrigón ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Suicide Prevention ◽  
Cost Effective ◽  
Cost Data ◽  
Base Case ◽  
Case Scenario ◽  
Post Discharge ◽  
Base Case Scenario ◽  
Augmentation Strategies

Objective: To determine the cost-effectiveness of 2 strategies for post-discharge suicide prevention, an Enhanced Contact intervention based on repeated in-person and telephone contacts, and an individual 2-month long problem-solving Psychotherapy program, in comparison to facilitated access to outpatient care following a suicide attempt. Methods: We conducted a cost-effectiveness analysis based on a decision tree between January and December 2019. Comparative effectiveness estimates were obtained from an observational study conducted between 2013 and 2017 in Madrid, Spain. Electronic health care records documented resource use (including extra-hospital emergency care, mortality, inpatient admission, and disability leave). Direct cost data were derived from Madrid’s official list of public health care prices. Indirect cost data were derived from Spain’s National Institute of Statistics. Results: Both augmentation strategies were more cost-effective than a single priority outpatient appointment considering reasonable thresholds of willingness to pay. Under the base-case scenario, Enhanced Contact and Psychotherapy incurred, respectively, €2,340 and 6,260 per averted attempt, compared to a single priority appointment. Deterministic and probabilistic sensitivity analyses showed both augmentation strategies to remain cost-effective under several scenarios. Enhanced Contact was slightly cost minimizing in comparison to Psychotherapy (base-case scenario: €−196 per averted attempt). Conclusions: Two post-discharge suicide prevention strategies based on Enhanced Contact and Psychotherapy were cost-effective in comparison to a single priority appointment. Increasing contacts between suicide attempters and mental health-care providers was slightly cost minimizing compared to psychotherapy.

Cost-effectiveness of routine laparoscopic ultrasound for the assessment of resectability of gallbladder cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 272-272
Author(s):  
Thejus T. Jayakrishnan ◽  
Hasan Nadeem ◽  
Ryan Thomas Groeschl ◽  
Anthony J Zacharias ◽  
T. Clark Gamblin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Laparoscopy ◽  
Hepatic Metastases ◽  
Cost Effective ◽  
Laparoscopic Ultrasound ◽  
Base Case ◽  
Case Scenario ◽  
Base Case Scenario ◽  
The Cost ◽  
Quality Adjusted Life

272 Background: In addition to a diagnostic laparoscopy (DL), aroutine laparoscopic ultrasound (LUS) has been proposed to identify undetected hepatic metastases and/or anatomically advanced disease in patients with T2 or higher gall bladder cancer (GBC) planned for surgical resection. It was hypothesized that a routine LUS is not a cost-effective strategy for these patients. Methods: Decision tree modeling was undertaken to compare DL-LUS vs. DL at the time of definitive resection of GBC (with no prior cholecystectomy). Costs in US dollars (payers’ perspective), quality-adjusted-life-weeks (QALWs) and incremental-cost-effectiveness-ratios (ICER) were calculated (horizon: 6 weeks, willingness-to-pay: $1,000/QALW or $50,000/ QALY). Results: DL-LUS was cost effective at the base case scenario (costs: $30,838 for DL vs. $30,791 for DL-LUS and effectiveness 3.81 QALWs DL vs. 3.82 QALW DL-LUS, resulting in a cost reduction of $9,220 per quality adjusted life week gained (or $479,469 per QALY). DL-LUS became less cost effective as the cost of ultrasound increased (threshold: $163.18) or the probability of exclusion from resection decreased (threshold 0.29) (Table represents the results of univariate analyses). Conclusions: Routine LUS with diagnostic laparoscopy for the assessment of resectability and exclusion of metastases is cost effective for patients with GBC. Until improvements in pre-operative imaging occur to decrease the probability of exclusion, this appears to be a feasible strategy. [Table: see text]

scholarly journals The hemodialysis prescription and cost effectiveness. Renal Physicians Association Working Committee on Clinical Guidelines.

1993 ◽  
Vol 4 (4) ◽  
pp. 1021-1027
Author(s):  
J C Hornberger
Keyword(s):  
Cost Effectiveness ◽  
Clinical Outcomes ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Base Case ◽  
Uremic Toxin ◽  
Intradialytic Hypotension ◽  
Case Scenario ◽  
Base Case Scenario ◽  
The Cost

Case-mix adjusted mortality rates for patients undergoing hemodialysis for ESRD increased during the 1980s, despite the introduction of advanced dialysis technologies. Variations in dialysis practices suggest that excess mortality may be caused by inadequate uremic-toxin clearances. Cost-effectiveness analysis was used to assess whether attempts to improve uremic-toxin clearance are cost effective, assuming that these therapies are clinically effective. The medical literature was surveyed by the use of MEDLINE to assess the likelihood of clinical outcomes on the basis of the type of treatment given to the patient. Options considered in the model were delivered fractional urea clearance (Kt/V), dialysis-treatment duration, type of dialyzer membrane, dialysate, and ultrafiltration. Clinical outcomes included in the model were survival, severity of uremic symptoms, hospital days per year, and intradialytic hypotension and symptoms. Lifetime costs were calculated from data collected from a northern California dialysis center and abstracted from the literature. In the base-case scenario, it was assumed that increasing Kt/V to levels greater than 1 was effective in reducing morbidity and mortality. Under these assumptions, outpatient cost increased significantly, but the cost effectiveness of Kt/V equal to 1.5 was less than $50,000 per quality-adjusted life-year saved. These calculations indicate that, if higher levels of Kt/V prove clinically effective, they are also cost effective.

scholarly journals Cost-Effectiveness Analysis of Dental Sealants versus Fluoride Varnish in a School-Based Setting

2016 ◽  
Vol 50 (Suppl. 1) ◽  
pp. 78-82 ◽  
Author(s):  
Matthew Neidell ◽  
Barbara Shearer ◽  
Ira B. Lamster
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Fluoride Varnish ◽  
Base Case ◽  
Case Scenario ◽  
Base Case Scenario ◽  
School Based ◽  
Occlusal Surfaces ◽  
Context Specific ◽  
The Cost

While sealants are more effective than fluoride varnish in reducing the development of new carious lesions on occlusal surfaces, and a course of treatment requires fewer clinical visits, they are more expensive per application. This analysis assessed which treatment is more cost-effective. We estimate the costs of sealants and fluoride varnish over a 4-year period in a school-based setting, and compare this to existing estimates of the relative benefits in terms of caries reduction to calculate the relative cost-effectiveness of these two preventive treatments. In our base case scenario, varnish is more cost-effective in preventing caries. Allowing for caries benefits to nonocclusal surfaces further improves the cost-effectiveness of varnish. Although we found that varnish is more cost-effective, the results are context specific. Sealants become equally cost-effective if a dental hygienist applies the sealants instead of a dentist, while varnish becomes increasingly cost-effective when making comparisons outside of a traditional dental clinic setting.

scholarly journals Optimizing the use of the Men-ACWY conjugated vaccine to control the developing meningococcal W disease outbreak in the Netherlands, a rapid analysis

2018 ◽  
Author(s):  
Albert Jan van Hoek ◽  
Mirjam Knol ◽  
Hester de Melker ◽  
Jacco Wallinga
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Vaccination Campaign ◽  
Cost Effective ◽  
Reproductive Number ◽  
Base Case ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Catch Up ◽  
The Impact

AbstractBackgroundThere is a developing outbreak of Neisseria meningitidis serotype W (MenW) in the Netherlands. In response, those aged 14 months and 14 years are vaccinated with the conjugated MenACWY vaccine. In the spring of 2018 we aimed to explore the impact of adding a one-off catch-up campaign targeting those aged 15-18 years on the transmission of MenW and the cost-effectiveness of such a campaign.MethodsWe estimated the growth rate of the MenW outbreak and quantified the impact of various targeted vaccination strategies on the reproductive number, and subsequently projected the future incidence with and without vaccination. Future cases were expressed in costs and QALYS and the incremental cost-effectiveness ratio was obtained.ResultsWe estimate a reproductive number of around 1.4 (95%CI 1.2-1.7) over the period February 2016-February 2018. Adding the catch-up campaign reduces the reproductive number five years earlier than without a catch-up campaign, to a level around 1.2. The vaccination campaign, including the catch-up, will prevent around 100 cases per year in our base case scenario. Given the projected impact and realistic assumptions on costs and QALYs, adding the catch-up can be considered cost-effective using a threshold of €20,000 per QALY.ConclusionAdding the catch-up campaign targeting those aged 15-18 brings the impact of vaccination on reducing transmission five years forward and directly prevents a high-incidence age group from carriage and disease. Such a campaign can be considered cost-effective. Our study did underpin the decision to introduce a catch-up campaign in spring 2019. Furthermore, our applied method can be of interest for anyone solving vaccine allocation questions in a developing outbreak.

Quality-Adjusted Time without Symptoms of Disease and Toxicity (Q-TWiST) Analysis of CPX-351 Versus 7+3 in Older Adults with Newly Diagnosed High-Risk/Secondary Acute Myeloid Leukemia (AML)

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 55-56
Author(s):  
Jorge E. Cortes ◽  
Tara Lin ◽  
Geoffrey L Uy ◽  
Robert J. Ryan ◽  
Stefan Faderl ◽  
...  
Keyword(s):  
High Risk ◽  
Research Funding ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Newly Diagnosed ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Grade 3 ◽  
Intent To Treat

Introduction: CPX-351 (Vyxeos®; daunorubicin and cytarabine liposome for injection), a dual-drug liposomal encapsulation of daunorubicin and cytarabine in a synergistic 1:5 molar ratio, has been approved by the US FDA and the EMA for the treatment of adults with newly diagnosed, therapy-related AML or AML with myelodysplasia-related changes. The primary analysis of the pivotal phase 3 study (NCT01696084) that formed the basis for these approvals evaluated patients aged 60 to 75 years with newly diagnosed high-risk/secondary AML and found that, with a median follow-up of 20.7 months, CPX-351 significantly improved median overall survival (OS) versus conventional 7+3, with a comparable safety profile. Final 5-year follow-up results recently reported demonstrated that the OS benefit was maintained. To evaluate both quality and quantity of life, we conducted a Q-TWiST analysis of the phase 3 study to compare survival between patients receiving CPX-351 versus 7+3. Methods: Q-TWiST is used to evaluate outcomes in oncology trials by measuring how much of the survival improvement time is spent with toxicities, how much after disease progression or relapse, and how much is valuable time (ie, Time Without Symptoms of Disease and Toxicity [TWiST]). For this analysis, the OS for each patient from the 5-year follow-up analysis was partitioned into 3 health states: TOX (time before response plus any additional time with a grade 3 or 4 toxicity), TWiST (time without relapse or grade 3 or 4 toxicity), and REL (time after relapse). Q-TWiST gain was assessed as the mean time spent in each state weighted by its respective quality of life, represented by health utility (U; scale of 0.0 [indicates death] to 1.0 [indicates "perfect" health]). Q-TWiST gain was calculated as follows: Q-TWiST = (UTWiST × TWiST) + (UTOX × TOX) + (UREL × REL). The base case scenario used the intent-to-treat population, any grade 3 or 4 toxicities, TOX and REL utility weights of 0.5, and a TWiST utility weight of 1.0. Sensitivity analyses were performed for all treated patients (CPX-351: n = 153; 7+3: n = 151) and the intent-to-treat population, any and treatment-related grade 3 or 4 toxicities, and TOX and REL utility weights of 0, 0.5, and 1.0. A variation of the base case scenario was also performed for the subset of patients who achieved complete remission (CR) or CR with incomplete neutrophil or platelet recovery (CR+CRi; CPX-351: n = 73; 7+3: n = 52). When comparing across populations or studies, reporting relative Q-TWiST gains is an effective measure for evaluating clinical benefit (ie, Q-TWiST gains compared to a control; Solem CT, et al. Expert Rev Pharm Out 2018). A relative Q-TWiST gain of 15% or greater is considered a clinically important difference (CID) in oncology studies (Revicki DA, et al. Qual Life Res 2006). The relative Q-TWiST gain was calculated using the following equation: Q-TWiST difference ÷ mean OS of control arm × 100. Results: In total, 309 patients were randomized to CPX-351 (n = 153) or 7+3 (n = 156). In the base case scenario, the means difference (95% CI) for CPX-351 versus 7+3 was 183 days (60, 306) for the TWiST state, 7 days (−63, 78) for the TOX state, and 22 days (5, 38) for the REL states. The resulting means difference (95% CI) for Q-TWiST gain was 197 days (76, 319) for CPX-351 versus 7+3, and the relative Q-TWiST gain was 53.6%. Among patients who achieved CR or CRi, the means difference (95% CI) for Q-TWiST gain was 248 days (−1, 496) for CPX-351 versus 7+3, and the relative Q-TWiST gain was 39.8%. Both relative Q-TWiST gains were considerably above the standard CID of 15% for oncology. Across the various sensitivity analyses, the relative Q-TWiST gains for CPX-351 versus 7+3 varied from 48.0% to 57.6%, remaining all well above the standard CID threshold (Table). Conclusions: Results of this post hoc analysis suggest the survival benefit with CPX-351 for patients with high-risk/secondary AML are mostly from valuable time (TWiST), thus supporting the clinical benefit for patients. The relative Q-TWiST gains were well above what is considered CID (15%) in the cancer literature and were maintained across various sensitivity analyses, supporting the robustness of the benefit. In the absence of direct measures of quality of life, these results can be used together with the antileukemia effect when considering treatment options for this patient population. Disclosures Cortes: Daiichi Sankyo: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Sun Pharma: Research Funding; Pfizer: Consultancy, Research Funding; BioPath Holdings: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Telios: Research Funding; Astellas: Research Funding; Amphivena Therapeutics: Research Funding; Arog: Research Funding; BiolineRx: Consultancy, Research Funding; Bristol-Myers Squibb: Research Funding; Merus: Research Funding; Immunogen: Research Funding; Jazz Pharmaceuticals: Consultancy, Research Funding; Takeda: Consultancy, Research Funding. Lin:Aptevo: Research Funding; Abbvie: Research Funding; Gilead Sciences: Research Funding; Genetech-Roche: Research Funding; Incyte: Research Funding; Celyad: Research Funding; Celgene: Research Funding; Jazz: Research Funding; Mateon Therapeutics: Research Funding; Ono Pharmaceutical: Research Funding; Bio-Path Holdings: Research Funding; Astellas Pharma: Research Funding; Prescient Therapeutics: Research Funding; Pfizer: Research Funding; Trovagene: Research Funding; Tolero Pharmaceuticals: Research Funding; Seattle Genetics: Research Funding. Uy:Daiichi Sankyo: Consultancy; Pfizer: Consultancy; Agios: Consultancy; Genentech: Consultancy; Jazz Pharmaceuticals: Consultancy; Astellas Pharma: Honoraria. Ryan:Jazz Pharmaceuticals: Current Employment, Current equity holder in publicly-traded company. Faderl:Jazz Pharmaceuticals: Current Employment, Current equity holder in publicly-traded company. Lancet:Abbvie: Consultancy; Agios Pharmaceuticals: Consultancy, Honoraria; Astellas Pharma: Consultancy; Celgene: Consultancy, Research Funding; Daiichi Sankyo: Consultancy; ElevateBio Management: Consultancy; Jazz Pharmaceuticals: Consultancy; Pfizer: Consultancy.

PP135 Cost-Effectiveness Of Cryoballoon Ablation In China: Real-World Results

2018 ◽  
Vol 34 (S1) ◽  
pp. 119-119
Author(s):  
Jian Ming ◽  
Hui Sun ◽  
Gongru Wang ◽  
Yan Wei ◽  
Yingyao Chen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Real World ◽  
Cost Effective ◽  
Tertiary Hospital ◽  
Base Case ◽  
Cryoballoon Ablation ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Life Years ◽  
The Cost

Introduction:Paroxysmal atrial fibrillation (PAF) represents a significant economic burden to the healthcare system. Catheter ablation is a commonly adopted treatments for PAF, and cryoballoon ablation (CBA) has been recently proven to be as effective as radiofrequency ablation (RFA). This study aims to evaluate the cost-effectiveness of CBA versus RFA in patients with drug-refractory PAF in China.Methods:A Markov model was developed to study the effects and the costs of CBA versus RFA. Cost and probability inputs data were obtained mainly from a real-world study of 85 CBA and 284 RFA patients treated in a tertiary hospital between July 2014 and July 2016. Propensity score matching was used to overcome retrospective bias, resulting in including 75 patients in each group. Input data gaps were closed with literature review and advisory board. A simulation was carried out for 14 cycles/years, and a discount rate of 3 percent was used. Then, a probabilistic sensitivity analysis was carried out with Monte Carlo approach.Results:In the base case scenario, the cumulative costs incurred by the CBA and RFA groups were CNY 132,222 (USD 20,767) and CNY 147,304 (USD 23,136), respectively. Over the 14-year period, the quality-adjusted life years (QALYs) gained by the CBA group was 7.85 versus 7.71 in the RFA group. The incremental cost-effectiveness ratio for CBA versus RFA was thus CNY 107,729 (USD 16,920)/QALY. Model results were most sensitive to the cost incurred during the first hospitalization, recurrence rate, and relative utility weights. The probability of CBA being cost-effective for willingness to pay thresholds of per capita GDP in China was estimated to be 99 percent.Conclusions:Compared with RFA, CBA is a cost-saving treatment providing increased QALYs. It represents good value for money for patients with drug-refractory PAF in China. However, further evidence needs to be generated from larger-scale studies in China.

Immunocompromised Status of Patients with Hematologic and Solid Tumor Malignancies: Construction of a Practical Algorithm.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2484-2484
Author(s):  
Trung N Tran ◽  
G. Thomas Ray ◽  
Patricia Saddier ◽  
Michael Trigg ◽  
Neil Hayes ◽  
...  
Keyword(s):  
Cancer Registry ◽  
Solid Tumor ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Using Data ◽  
Ic Treatment ◽  
Chemotherapy Agents

Abstract Abstract 2484 Poster Board II-461 Background: Hematologic (HM) and solid tumor malignancy (STM) patients may be immunocompromised (IC) due to their underlying diseases and the immunosuppressive therapies they received. Availability of a practical and robust algorithm to classify HM and STM patients into IC levels using data from healthcare databases could be valuable for a variety of epidemiologic, health service or outcome research in the field of oncology. Classification of the IC status of patients also permits accurate prediction of the types of supportive care that such patients may need to prevent infectious complications that often accompany treatments for the underlying malignancy. Methods: An expert panel mainly comprised of hematologists and oncologists developed an algorithm to classify HM and STM patients' level of IC into either none/low, medium, or high, using data available in electronic databases. The algorithm was based on the following factors: (1) the type of chemotherapy agents and/or corticosteroids, (2) time since last chemotherapy/corticosteroid treatment, and (3) specific type of HM (for HM patients). Chemotherapy agents were classified into levels of IC, irrespective of dose used. Corticosteroid therapy was classified into levels of IC based on dose and duration of treatment. IC levels were allowed to change monthly to reflect what chemotherapy agents were used, dose and duration of corticosteroid if any, and time since the last IC treatment. In the base case scenario, the patient's IC level (based on treatment) stayed at an assigned level for 6 months after the last treatment and then moved to the next lower level for an additional 6 months. In alternative scenarios, sensitivity analyses were also performed using the 1, 3, 9, and 12 month cutoffs. If the patient received multiple chemotherapy agents/corticosteroid regimens, the most immunocompromising agent determined the IC level during that time period. We applied and tested this algorithm in a study of HM and STM patients diagnosed in 2001-2005 at Kaiser Permanente Northern California (KPNC). Herpes zoster (HZ), a viral disease caused by the reactivation of varicella zoster virus, is associated with impairment of cell-mediated immunity. Therefore, we used incidence of HZ as a proxy for true IC status. The KPNC cancer registry was used to identify cancer diagnoses and the type, stage and grade of the underlying HM. Data on specific chemotherapy agents and/or dose and duration of corticosteroids as well as time since last IC treatment were obtained from KPNC pharmacy databases. Potential episodes of HZ in 2001-2006 were identified from HZ diagnosis codes and antiviral use in various KPNC databases. HZ diagnosis was confirmed by clinical review of patient's medical records. We measured HZ incidence rates in HM and STM patients and examined whether they were correlated with IC level based on our algorithm. Results: In the base case scenario, among the 4,465 patient-years (py) of follow-up in HM patients, 25.3%, 34.4%, and 40.3% of follow-up time was categorized as none/low, medium, or high IC, respectively. The corresponding rates of HZ were 13, 25, and 48/1000 py. Among the 23,072 py of follow-up in STM patients, 74.9%, 8.0%, and 17.1% of follow-up time was categorized as none/low, medium, or high IC, respectively. The corresponding rates of HZ were 10, 20, and 19/1000 py, respectively. The algorithm was not sensitive to changes from 3 to 12 months, but was sensitive to the 1 month cutoff, in the assumption of duration of IC since the last IC treatment. Conclusions: It is feasible and practical to categorize cancer patients into IC levels using electronic pharmacy and cancer registry databases. The correlation between incidence of HZ and levels of IC in both HM and STM patients suggested that the proposed algorithm may appropriately assign IC levels in these patients. Additional testing in other cancer populations may be needed to further validate this algorithm. Disclosures: Tran: Merck & Co., Inc.: Employment. Ray:Merck & Co., Inc.: Investigative. Saddier:Merck & Co., Inc.: Employment. Trigg:Merck & Co., Inc.: Employment. Hayes:Merck & Co., Inc.: Consultancy. Li:Merck & Co., Inc.: Investigative. Rizzieri:Merck & Co., Inc.: Consultancy. Stein:Merck & Co., Inc.: Consultancy. Weber:Merck & Co., Inc.: Consultancy. Serody:Merck & Co., Inc.: Consultancy. Raasch:Merck & Co., Inc.: Consultancy. Habel:Merck & Co., Inc.: Investigative.

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