FEMDEM modelling which combines the multi-body particle interaction and motion modelling (i.e. Discrete Element Model, DEM) with the ability to model internal deformation of arbitrary shape (Finite Element Model, FEM) has been applied to breakwater models. There are two versions of a FEMDEM solver developed; Y3D_D is for deformable materials and is required for dynamic and static stress analysis and Y3D-R is the rigid version often used to numerically construct the armour unit packs. This paper also reports the placement protocols: POSITIT.FEMDEM modelling deals with solids interactions and is one modelling component that is to be coupled to other modelling technologies e.g. CFD, interface tracking, wave models, porous media etc. so that the key fluid-solid interactions can be modelled in a full scale virtual breakwater alongside work on scaled hydraulic laboratory models and prototype structures. The latest developments of two-way coupled interactions of waves with coastal structures are also described in this paper.

of sixteen countries from the region according to different criteria: characteristics, quality (using Drummond's checklist), use of local data, addressed inputs limitation and results transferability. Results: Economic evaluations are used in CEE countries for informing decision making, while critically considering methodology, quality and study's reliability. Experts acknowledged limited generalizability of study results both between and within geographic regions. Meanwhile, despite these constraints, facing limited health technology assessment (HTA) capacity experts were still using foreign evidence. At the same time, the usefulness of studies published in CEE and former Soviet countries to inform their decision making is limited because of insufficient transparency in reporting, unaddressed uncertainty, limited insight on inputs and transferability of results. Although local costs, baseline risk and resource use data are required, experts accept evidence originating from health care settings outside CEE and former Soviet countries regarding relative effect and utilities values. ConClusions: HTA priority setting and transferability assessment of economic evidence are important issue in health care decision making in CEE and former Soviet countries, since HTA research capacity is limited and local evidence is scarce. For this purpose, quality, transparency, and transferability should be addressed explicitly in published economic evaluations originating from CEE and former Soviet countries.

A429is overlap in the criteria to qualify for funding. Many countries consider drugs for additional funding when a drug can be used in more than one indication and cannot be grouped to a specific DRG. Other criteria identified relate to, for example, drug prices and indications. Some countries grant additional reimbursement for drugs prior to assessment by a national reimbursement process, while others only grant additional reimbursement after the drug has been available for a certain period of time and funding decisions are based on historical data. In most countries, additional reimbursement is considered annually. Hospitals and expert groups can suggest additional reimbursement for expensive drugs to the responsible authority. ConClusions: Many countries have adapted to the need for additional funding for expensive drugs, and have established systems to grant this funding to hospitals. There are differences in criteria to qualify for, and timelines for receiving, additional funding after drugs are launched.

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S91based upon their anticipated budget impact and affordability, 100% were deemed low value. ConCluSionS: ICER reports have generally concluded that assessed therapies offer important clinical benefits but generally do not justify their economic impact. These reports currently do not influence coverage/pricing decisions but there is anecdotal evidence of insurers using these in negotiations. For example they were formally cited as part of Medicare Part B payment model reform discussions, indicating ICER reports may play a greater role in future reforms to US drug reimbursement as payers struggle to manage increasing costs.