A simple way of evaluating surgical outcomes is to compare mortality and morbidity. Such comparisons may be misleading without a proper case mix. The POSSUM scoring system was developed to overcome this problem. The score can be used to derive predictive mortality and morbidity for surgical procedures. POSSUM and a modified version P-POSSUM have been evaluated in various groups of surgical patients for the accuracy of predicting mortality. These scoring systems have not been evaluated in neurosurgical patients. Thus, we tried to evaluate the usefulness of POSSUM and P-POSSUM scoring systems in neurosurgical patients in predicting in-hospital mortality. POSSUM physiological and operative variables were collected from all neurosurgical patients undergoing elective craniotomy, from April 2005 to Feb 2006. In-hospital mortality was obtained from the hospital mortality register. The physiological score, operative score, POSSUM predicted mortality rate and P-POSSUM predicted mortality rate were calculated using a calculator. The observed number of deaths was compared against the predicted deaths. A total of 285 patients with a mean age of 38 +/- 15 years were studied. Overall observed mortality was nine patients (3.16%). The mortality predicted by the P-POSSUM model was also nine patients (3.16%). Mortality predicted by POSSUM was poor with predicted deaths in 31 patients (11%). The difference between observed and predicted deaths at different risk levels was not significant with P-POSSUM (p = 0.424) and was significantly different with POSSUM score (p < 0.001). P-POSSUM scoring system was highly accurate in predicting the overall mortality in neurosurgical patients. In contrast, POSSUM score was not useful for prediction of mortality.

Background and Aims:Continuous audit of clinical practice is an essential part of making improvements in medicine and enhancing patient care. Validated tools are needed to gather evidence for comparisons. Recently, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores were evaluated in Indian patients undergoing elective craniotomy and it was concluded that P-POSSUM was highly accurate in predicting overall mortality. We wished to study whether this system could be used in a different country and health care system [United Kingdom, UK]. We have evaluated these scores in patients undergoing elective and emergency craniotomies in a tertiary centre in the UK.Methods:Data was collected from all neurosurgical patients who underwent craniotomy overone year. Preoperative variables were collected prior to induction of anaesthesia, and operative variables were also collected. Chi-square test was used for expected and actual mortality differences. Survivor and non-survivor demographics were compared by one-way ANOVA for continuous and Chi-square for categorical variables.Results:One hundred and forty-five patients were studied. Mean [SD] physiologic score of the patients was 18.83 [5.07], and mean [SD] operative score was 18.09 [3.75]. P-POSSUM was a better predictor for elective patients and for those undergoing immediate life-saving surgery.Conclusion:This study confirms and validates the findings of previous work that P-POSSUM is an accurate and reliable tool for estimating in-hospital mortality. It also confirms its usefulness in comparison of results across healthcare systems internationally. Larger scale evaluations may be needed to examine its usefulness in emergency procedures.

A 3 4 7 -A 7 6 6 A759 combination-oncologics. Methods: We reviewed two combination-oncologics currently available (Yervoy-Opdivo and Cotellic-Zelboraf) using a structured, value assessment framework that considers clinical performance, price and access metrics (for the US and UK). We also reviewed the combination-oncologic pipeline, and trends in Payer management to assess key indicators for access going forward. The research was conducted using evidence from peer-reviewed literature, business journals, manufacturer websites and press-releases. Results: Investment is growing, with > 400 industry sponsored trials listed for cancer immunotherapies in adults. The two cases exhibited considerable clinical benefit of combination, the Yervoy-Opdivo combination (versus Yervoy-monotherapy) resulted in tumor shrinkage in 60% (versus 11%), and PFS of 8.9 months (versus 4.7 months), while Cotellic-Zellboraf provided a median PFS of 12.3 months (versus 7.2 months for Zelboraf monotherapy). Estimated annual list price of Yervoy-Opdivo may exceed $295,000 (US annual list prices were $135,179 (Yervoy-monotherapy) and $142,300 (Opdivo-monotherapy)); while Cotellic-Zellboraf may approach $200,000 (individual US list prices were $72,741 (Cotellic-monotherapy) and $123,957 (Zellborafmonotherapy). US managed care organizations have reacted -Aetna and Anthem have implemented pilot projects incentivizing physicians for choosing preferred clinical treatment pathways. In the UK, Yervoy-Opdivo received a swift, yet positive, NICE appraisal (post 30% price mark-down to US, and additional, confidential discounts), while Cotellic-Zellboraf was not approved due to lack of cost-effectiveness data. ConClusions: A burgeoning clinical trial pipeline, considerable budget impact, and an increased need for effective disease management to alleviate morbidity and mortality, is bound to result in Payer control of access through existing (price discounts, precertification, patient cost burden), and innovative channels. Policies and market access strategies will increasingly need to account for budget impact, affordability, cost burden on patients, and increasing evidence requirements for access. PCN282GeoGraPhiC, raCial, aNd TemPoral VariaTioNs of adhereNCe To sCreeNiNG for CerViCal CaNCer aNd hPV VaCCiNaTioN iN The UNiTed sTaTes,

Health Technology Assessment (HTA) considerations for TTs and CDx in NSCLC in France, Germany, and England. Differences in access schemes were also explored. Methods: A literature search of the EMA, national HTA agency, and institutional websites was performed to identify TTs-CDx pairings, their corresponding HTA evaluations, and patient access schemes. HTAs were assessed for key clinical, economic, or other criteria taken into account by the agencies. Results: As of June 2016, seven TTs were identified for further analysis. NICE and IQWiG were more likely than HAS to issue a negative opinion or restrict the target population or treatment line. NICE guidance provided an integrated assessment including cost-effectiveness and discussion of the accuracy and availability of the CDx, whereas these aspects were assessed separately or not at all by HAS and IQWiG. Notable access schemes included the use of the Cancer Drugs Fund in England and the National Institute of Cancer's diagnostic access program in France. ConClusions: There is a heterogeneous approach to HTA and access schemes for NSCLC TTs in France, Germany, and England. HAS may be more likely than NICE or IQWiG to grant wider access for treatments which other agencies consider to have insufficient evidence. Potential future developments such as a shift towards adaptive licensing and multi-biomarker tests could lead to increasingly divergent approaches.