IntroductionIn rare disease areas representative data are scarce. Routine sick fund claims data provide a meaningful and reliable base for the in- and outpatient treatment landscape. This real-world data (RWE) from Germany was used to describe treatment patterns for Diffuse Large B-cell Lymphoma (DLBCL), the most frequent and aggressive non-Hodgkin lymphoma type in adults.MethodsClaims data from several sick funds of 4.8 Million insured were analyzed. Diagnosis of non-follicular Lymphoma (C83) was confirmed in 2.178 patients, DLBCL (C83.3) in 819 patients. The analysis was age- and gender-adjusted, observational period was 2014 and 2015. Treatments were analyzed for hospitalization and medication based on ATC-Code, Pharma Central Number and coded diagnoses (per ICD).ResultsMean age of DLBCL patients was 60.3 years, with two peaks at 50-54 and 70-74 years. Total costs for patients with DLBCL averaged 25.048 EUR versus 1.259 EUR in healthy insured. Charlson comorbidity index (CCI) of 4.58 indicates clinical relevance and severity. Comorbidities included several psychiatric diagnoses such as depression in every fifth patient. Mean 3.2 hospitalizations with average 31.5 hospital days were observed in DLBCL patients. Forty-seven percent of patients during observational time-frame did not receive oncological treatment, including relapsed / refractory patients. Only few patients received stem cell transplantation (2.6 percent) or radiation (3.9 percent). Most pharmacological treatments were Rituximab (RTX) + CHOP (57 percent), followed by RTX mono therapy (25 percent) or RTX in combination with Bendamustine (8 percent).ConclusionsDespite limitations in sick fund claims analyses, these provide a reasonable database for rare diseases. They allow standard treatment pathway- and longitudinal analyses. All DLBCL patients frequently required hospitalization and generated significant costs. A high unmet medical need exists for treatments other than palliative care, especially for a tolerable and effective outpatient therapy in elderly relapsed / refractory DLBCL.

219 Background: ADT is an established part of the guideline-oriented therapy of prostate cancer (PCa). Concerns regarding increased CV risks associated with ADT were raised by the FDA in 2010. Results from a pooled data-analysis of six prospective randomised trials suggest a lower number of CVevents in patients treated with the GnRH antagonist Degarelix compared with GnRH agonist treated patients with preexisting cardiovascular disease [Albertsen P. et al: Eur Urol 2014; 65: 565-73]. Objective: Can SHI data confirm the observation that the risk for CVevents varies depending on the substance used for ADT. Methods: Retrospective data sets of 4 Mio assured people from SHI funds from the years 2009-2012 were analysed to identify PCa patients treated with ADT, GnRH agonists and GnRH antagonists, respectively. An age-adjusted reference group with 1.1 Mio non-PCa persons was identified in the data sets. Results: 44.166 patients suffering from PCa were identified. Of those 10.611 patients were treated with ADT. 10.554 with GnRH agonists and 132 with GnRH antagonists, respectively. An increased prevalence for relevant baseline CV diseases was observed in ADT treated patients compared to the Non-PCa reference group (diabetes mellitus: 28.66% vs 17.43%.; CAD: 35.77% vs 15.70%; Heart failure: 27.54% vs 9.64%). The rate of heart attack and stroke (CVevents) after treatment begin with ADT was determined: 2.37% in the reference group, 5.9% in the PCa group, 7.8% in the ADT group, 2.3% in the GnRH antagonist group. All CVevents in GnRH antagonist group occurred in high risk patients, only. The urologist examined and reported the state of CV risk for 25% of the PCa patients, only. Urologists examine and treat statistically significantly more patients with a combination of PCa and CVevents than general practitioners (30 vs. 5 per year/per physician). Conclusions: This retrospective analysis confirms the hypothesis that the risk of CVevents varies by using different ADT. The risk might be lower by using GnRH antagonists. A close collaboration of urologists, general practitioners and cardiologists is therefore recommended in the management of PCa patients.