step of development/dissemination processes), transparency (assumptions/inputs are disclosed in an understandable, timely way), inclusiveness (perspectives drawn from broad range of stakeholders), diversity (diferences in subpopulations, trajectory of disease, and stage of a life should be accounted for), outcomes (includes those that patients have identifed as important), and data (variety of credible data sources are used allowing for timely incorporation of new information and account for the diversity of patient populations and patient-centered outcomes). The Rubric describes each domain and includes illustrative examples of how patient engagement/centeredness can be operationalized through direct and indirect pathways. CONCLUSIONS: The NHC Rubric is a frst step toward creating patient-centered value assessments that patients and their families can rely on. It is intended to assist all stakeholders, especially the patient community, in assessing the level of patient centeredness and engagement in a given framework or model. It can be a guide to support developers in conceptualizing plans for meaningfully engaging patients. ................................................................................... OP40 First Case Of Disinvestment Using Real-World Evidence In Brazil AUTHORS: Livia Pires de Lemos, Augusto Guerra (augustoguerrajr@ufmg.br), Ramon Pereira, Rosangela Gomes, Isabella Godói, Isabela Diniz, Ivan Zimmermann, Marisa Santos, Marion Bennie, Brian Godman, Vania Canuto, Clarice Petramale, Francisco Acurcio INTRODUCTION: Beta-interferons are used as frst-line therapy for relapsing-remitting multiple sclerosis in Brazil. In order to evaluate the possible inferiority of one of the beta-interferons available and support a guideline update, we conducted an eleven-year (January 2000 to December 2010) nationwide real-world performance assessment using the Unifed Health System (SUS) databases. METHODS: We assessed whether patients using subcutaneous beta-interferon switched treatment, relapsed or died (composite event) earlier than patients using intramuscular beta-interferons. Patients without a dispensing registry longer than three months were censored. We used the Kaplan-Meier method to estimate the cumulative probability of persistence on initial treatment, and compared groups with the Log-rank test. The infuence of the drug on the occurrence of event was assessed with Cox proportional hazards analysis. RESULTS: The number of patients included was 12,154, and the majority started treatment with subcutaneous beta-interferon-1a (45.7 percent), followed by subcutaneous beta-interferon-1b (27.7 percent) and by intramuscular beta-interferon (26.6 percent). Women represented 73.1 percent and the mean age was 38.93±11.34 years old. The group of patients who used intramuscular beta-interferon switched treatment, relapsed or died earlier (median 47 months; 95 percent Confdence Interval, CI 44–52) than patients using the subcutaneous beta-interferons, (69 months (95 percent CI 64–76) for beta- interferon 1a and 73 (95 percent CI 66–84) months for beta-interferon 1b) (p< .0001 for both comparisons). Accordingly, the use of intramuscular beta-interferon was associated with a higher probability of event (Hazard ratio, HR 1.38; 95 percent CI 1.29-1.48), while the use of the other beta-interferons had a protective efect (1a: HR .86; 95 percent CI .81-.92; 1b: HR .89; 95 percent CI .83-.95). CONCLUSIONS: The inferiority of intramuscular beta-interferon found in the real-world corroborates fndings from head-to-head studies and systematic reviews conducted by Cochrane and the National Commission for Technology Incorporation in SUS (CONITEC/Brazil). This result led to ................................................................................................................................................................................... 18 ORAL PRESENTATIONS https://doi.org/10.1017/S0266462317001349 Downloaded from https://www.cambridge.org/core. IP address: 207.241.231.80, on 30 Oct 2018 at 05:20:16, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms.