Introduction
In Europe about 16,000 children and adolescents are diagnosed with cancer each year . Due to progress in treatment up to 80 % survive the disease so that today about 500,000 survivors of childhood and adolescent cancer are living in Europe (Vassal et al., 2015). However, the chance to survive is distributed unequally across countries in Europe (WHO 2022). The PanCareSurPass project aims to improve person-centred survivorship care for survivors of childhood and adolescent cancer in Europe by implementing the digital tool SurPass v2.0 in clinics in Austria, Belgium, Germany, Italy, Lithuania and Spain. The SurPass v2.0 consists of a standardised Treatment Summary and a personalized Survivorship Care Plan. The project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 899999. The central issue of this presentation is to describe setting up a health economic evaluation framework for the implementation of the SurPass v2.0. The health economic framework has two main objectives. First, it compares the outcomes of the implementation of the SurPass v2.0 to its costs. Second, it provides decision makers and stake holders within various health systems on local, regional and national level with a tool that enables them to take informed decisions within the decision-making process of the implementation of the SurPass v2.0.

Methods
The health economic evaluation framework of the implementation of the SurPass v2.0 consists of three parts.
1. a cost utility analysis,
2. a multi criteria decision analysis, and
3. a prediction model.
The cost utility analysis relates costs to the health outcome Quality of Life (QoL) presented as cost per quality per adjusted life year (QALY) gained. The clarification of cost categories, which is a precondition for all further analysis, is based on literature research and results of an online workshop with experts from the PanCareSurPass consortium.
Multi-criteria decision analysis (MCDA) enlarges the outcome categories and criteria which have to be taken into consideration in order to evaluate the SurPass v2.0. Therefore, additionally to QoL-measures benefits of the intervention in terms of patient activation in one’s health, patient education and empowerment as well as perceived usefulness and acceptance of the SurPass by survivors are discussed in online workshops with relevant stakeholders.
The prediction model is based on the results of both the cost utility analysis and multi criteria decision analysis taking into account the country specific decision contexts such as degree of digitalization and the various types of health care systems.

Results
Four levels of cost categories were detected: Costs at survivors level, costs at providers level, costs at payers level and system wide costs. Furthermore, costs can be distinguished between costs on setting up the systems and providing the infrastructure to be able to deliver a SurPass v2.0 (implementation costs), operational costs and costs for patients. Three tools were developed to cover all these costs:
1. a cost reporting tool at hospital level
2. a cost reporting survey for Health Care Providers on patient level
3. a cost reporting questionnaire for caregivers and survivors
The cost reporting tool at hospital level is an MS-Excel based expert questionnaire both addressing and focusing on clinicians, researchers, managers, administration, IT-specialists and other relevant hospital staff members. Furthermore, it helps to gain insight into information about the stakeholders involved. The tool is divided into five sections. Section one covers the costs of the decision-making process. The tool further contains two different stakeholder analysis sections both for the decision-making process and implementation of the SurPass-infrastructure. The section “Implementation” covers costs related to the technical implementation of the SurPass. The section “Platform” covers costs of third parties providing standards and infrastructure needed to be able to run the algorithms to receive and operate a SurPass.
The cost reporting survey for HCPs operates at the survivor’s level. The costs of the hospital staff’s time investment including all necessary preparation before generation of a SurPass and all processes after the generation of a SurPass on individual level. In order to operate the cost reporting survey an online questionnaire using the online tool “lime survey” was designed and programmed.
For the cost reporting questionnaire for caregivers and survivors the questionnaire in use by the PanCareFollowUp Project funded by the European Union’s Horizon 2020 research and innovation programme under grant agreement No 824982 was adapted.
To be able to perform the cost utility analysis it was decided to opt for EQ-5D-5L(-Y), a validated measure that allows to compare health outcomes.
MCDA will include estimated benefits of the intervention on survivor’s level additionally to quality of life measured before and after the intervention (EQ-5D) (Kreimeier/Greiner 2019), in terms of (1) accessibility, which will be assessed by measuring the perceived usefulness and acceptance of technology measured after the intervention (TAM) (Davis 1989); (2) the patient activation in one’s health measured before and after the intervention (PAM) (Hibbard et al. 2004); (3) patient education and empowerment measured before and after the intervention (heiQ). Non-individual criteria apart from costs (e.g. ELSE-criteria, equality, drivers for digitalisation of electronic health systems) were identified in the course of a decision context and criteria identification workshop and arriving from project-internal documentation, interviews and publications. Determining the performance of the quantitative criteria will be assessed by comparing outcomes before and after the intervention. The weights of the criteria will be assessed via a stakeholder survey. The MCDA will result in an overall value score which is calculated based on performance and weights of the different outcomes and serves as base for the prediction model.