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tiveness analyses were compared with methods specified by NICE as the reference case in its 2004 and 2008 Methods Guides. The review focused on guidance published before June 2013 for medicines treating metastatic breast cancer, metastatic colorectal cancer, metastatic hormone-refractory prostate cancer and metastatic non-smallcell lung cancer. Nineteen technology appraisals published between March 2002 and August 2012 met the inclusion criteria. Results: Common themes or variations that exist between utility values selected by manufacturers and independent academic groups for each metastatic cancer and between the 4 metastatic cancers were analysed. The research also explored the methodological issues that were considered by the Appraisal Committee relating to the selection of utility values. ConClusions: Therefore, this research provides insight to the methodological considerations regarding incorporation of utility values that have informed health technology assessment decision-making in England for 4 metastatic cancers.

Bone metastases and associated skeletal-related events (SREs) are common in patients with advanced breast, lung, and prostate cancer. Bone-targeted agents (BTAs) are available for the treatment of bone metastases, but little is known about patients' and physicians' preferences for the various attributes of these agents. We evaluated preferences for BTAs used to prevent SREs among patients with bone metastases and physicians involved in treating such patients in Turkey. Participants completed an online discretechoice experiment survey of 10 questions, choosing between pairs of hypothetical treatment profiles, defined by five BTA attributes: time to first SRE, time to worsening of pain, annual risk of osteonecrosis of the jaw (ONJ), annual risk of renal impairment, and administration regimen. The analysis included 91 patients and 99 physicians. Both groups rated annual risk of renal impairment, time to worsening of pain, and time to first SRE as the most important BTA attributes. For patients, the preference weights for all levels of these attributes were significantly different, whereas for physicians, preference weights were significantly different for all levels except time to a 2-point increase in "Brief Pain Inventory" score by 6 months or 10 months. Annual risk of ONJ was judged by patients and physicians to be the least important of the BTA attributes. This study adds to the information available on the preferences of patients and physicians for BTAs and provides useful data to aid clinicians in decision-making by understanding the treatment goals that are important to patients in Turkey.Keywords: Bone-targeted agents, Bone metastases, Discrete-choice experiment, Patient preference, Physician preference, Skeletal-related event ÖZET Türkiye'de Kemik Metastazı Tedavisine Yaklaşımda Hasta ve Hekim TercihleriKemik metastazları ve bunlardan kaynaklanan iskeletle ilişkili olaylar (İİO) ilerlemiş meme, akciğer ve prostat kanseri olan hastalarda yaygındır. Kemik metastazlarının tedavisi için kemiği hedef alan ilaçlar (BTA'lar) bulunmakla birlikte, hastaların ve hekimlerin bu ilaçların çeşitli özellikleriyle ilgili tercihlerine ilişkin bilgiler sınırlıdır. Türkiye'de yapılan bu çalışmada, kemik metastazları olan hastalar ile bu tip hastaların tedavisini yürüten hekimlerin SRE'lerin önlenmesine yönelik BTA'larla ilgili tercihleri değerlendirilmiştir. Katılımcılar çevrimiçi yapılan ve 10 soru içeren çoktan seçmeli deney anketini tamamlayarak beş BTA özelliği ile tanımlanan hipotetik tedavi profili çiftleri arasında seçim yapmıştır: ilk SRE'ye kadar geçen süre, ağrının kötüleşmesine kadar geçen süre, yıllık çene osteonekrozu (ONJ) riski, yıllık böbrek yetmezliği riski ve uygulama rejimi. Analize 91 hasta ve 99 hekim dahil edilmiştir. Her iki grup da yıllık böbrek yetmezliği riski, ağrının kötüleşmesine kadar geçen süre ve ilk İİO'ya kadar geçen süreyi en önemli BTA özellikleri olarak değerlendirmiştir.

Objectives: To evaluate European physicians' treatment preferences for preventing skeletal-related events (SREs) in patients with bone metastases from solid tumors. MethOds: Physicians completed an online discrete-choice experiment survey consisting of 10 choices between pairs of hypothetical medication profiles for a putative patient. Each profile included five attributes within a pre-defined range (based on prescribing information for the available bone-targeted agents [BTA]): months until first SRE (10, 18 and 28 months); months until worsening of pain (3, 6 and 10 months); annual risk of osteonecrosis of the jaw (ONJ; 0, 1 and 5%); annual risk of renal impairment (0, 4 and 10%); and mode of administration (oral tablet, subcutaneous injection, 15-minute infusion and 120-minute infusion). Choice questions were based on an experimental design with known statistical properties. The survey was pretested with 8 physicians using open-ended interviews. A separate main-effects random parameters logit model was estimated for each country. Results: Physicians from France (n= 191), Germany (n= 192) and the UK (n= 197) completed the survey. Among the attributes included in the survey, months until first SRE and the risk of renal impairement were the most important attributes in France and the UK, whereas in Germany months until first SRE and a delay in worsening of pain were the most important. For all these attributes, better levels were significantly preferred to worse levels (p< 0.05). In all three countries, a 120-minute infusion every 4 weeks was the least preferred mode of administration (p< 0.05). The annual risk of ONJ was judged by physicians to be the least important attribute in all three countries. cOnclusiOns: Physicians generally make treatment decisions regarding choice of BTA for patients with bone metastases based on intent to delay the onset of SREs, managing risk of renal impairment and preventing the worsening of pain.

and retrieved from an extra boost of ONCOVIEW database. ONCOVIEW is a continuous syndicated study on cancer treatment in the hospital setting, based on the collection of patient questionnaires. Patients inclusion criteria were the presence of an mCRC diagnosis, 3rd or later actual therapy line and no participation in a phase II or III clinical study. Information collected included patient demographic characteristics, mCRC characteristics (TNM Classification, Karnofsky performance status scale and mutation analyses) and treatments (actual and previous schedules, dosages and durations). Furthermore, an evaluation of the "Rechallenge" occurrence, in other words the use in 3rd or later line of treatment of drugs previously used, has been performed. Results: 261 patients diaries have been collected: 218 out of 261 patients were in third line of treatment, while 43 patients were in 4th or later treatment line. The most administered schema among third line patients was Capecitabine alone (63 patients), while the most used schema in fourth line was a combination of Fluorouracil and Folinic Acid (7 patients). About 40% of molecules administered in 3rd line and 67% of molecules administered in 4th line were used in previous lines. ConClusions: Results from the present study underline the unmet medical need in 3rd or later line of treatment of mCRC patients and the need for additional evidence-based treatment options.