Objectives: A Relationship between volume and outcome for complex medical procedures has been used as an argument for regionalization; however, this must be balanced against preferences to have care delivered close to home. The objective of our study was to determine how families trade-off variations in risk against the ability to have complex pediatric care delivered locally. MethOds: Twenty parents of children without serious medical problems seen in an outpatient clinic participated in a probability trade-off experiment involving two scenarios in which they were asked to imagine their child required a complex medical procedure ('lowrisk'= 5% mortality, 'high-risk'= 30% mortality) available locally or at an alternate large center 2.5 hours away by air. Numeric and graphic representations of mortality risk were reduced in a stepwise fashion for procedures performed at the alternate center. Thresholds at which participants chose to travel were identified. Participant's decisions were then challenged by increasing the costs incurred by travelling to the alternate center. Results: In the low-risk scenario, participants chose not to travel until absolute risk was reduced by 2±0.2% (relative risk reduction of 39±3%). In the high-risk scenario, a larger absolute risk reduction (5.1±0.8%, p= 0.0001) but smaller relative risk reduction (17±3%, p= 0.0001) triggered a decision to travel. In the low-risk scenario, only 2 of 8 participants with household income > $100,000/ yr changed their decision to travel when faced with additional costs; however 8 of 12 with lower income changed their decision (p= 0.07). In the high-risk scenario, 1 of 8 in the high income group changed their decision compared to 7 of 12 in the low income group (p= 0.04). cOnclusiOns: Many families would trade substantially higher risk to have complex pediatric care delivered locally. These results have implications for policy development related to delivery of complex care at smaller children's hospitals located far from large urban centers.

A227sensitivity analysis (PSA) results. METHODS: Decision analytic models were developed in Excel and R to assess the cost-effectiveness of a hypothetical therapy for a hypothetical, chronic disease. The models consisted of a decision tree (22 branches) for the first year of therapy and of a Markov model to capture long-term costs and effects. Both models comprised 24 decision nodes and 6 Markov models. All costs, effectiveness and utility parameters were hypothetical. Probabilistic sensitivity analysis was used to assess decision uncertainty by performing 10 000 Monte Carlo simulations. RESULTS: The incremental cost-effectiveness ratio (ICER) of the new therapy

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lenges and opportunities. Results: Only 22%-27% of payers and providers believe that personalized medicine is a "very important" strategic goal versus ~50% of large biopharma manufacturers. Although 47%-52% of all stakeholders have integrated staff with area expertise, fewer than 20% have developed a centralized focus on personalized medicine and only 8%-20% believe they have tools to evaluate its success. Decision maker perspectives ranged broadly on its key benefits but included improved and more predictable outcomes and cost efficiencies. Approximately 30% of all stakeholders believe that personalized medicines will continue to receive premium pricing to justify ROI for this business approach. ConClusions: Although most stakeholders see value in personalized medicines, they struggle with practical implementation and need actionable strategies to characterize the value and impact of these technologies. The survey suggests that limited emphasis on infrastructure development and methods, heterogeneous value assessment, and misalignment of incentives remain key challenges to enabling care and economic efficiencies promised by this evolving treatment paradigm.

A443shows a positive development within the region's HTA. The Regional Decrees were impactful however the HTA reports are not fully compliant to the scoping document and it is central to understand the reason behind the challenge.Objectives: Data availability and decision makers methodology requirements are two important factors influencing transferability of economic studies. Applying qualitative assessment of experts' opinion and systematic review of published economic studies, we aimed to analyze transferability of economic evaluations in Central and Eastern European (CEE) and former Soviet countries. MethOds: Firstly, eleven reimbursement experts from eight countries were interviewed on their background and current practice of using economic evaluations, opinion regarding transferability of economic evaluations and importance of individual Welte's transferability factors. Secondly, we analyzed peer-reviewed English-language economic evaluations