An overarching goal of healthcare reform is to improve the value of care defined as patient outcome per dollar spent. We evaluated the outcomes and cost of two arms of a phase 3, definitive chemoRT HNSCC trial to determine the arm delivering the superior healthcare value. 69 non-nasopharynx HNSCC pts were randomly assigned to concurrent RT, 72 Gy (mean) and either outpatient CDDP, 100 mg/m2, wk 1, 4, 7 (Arm A) or an inpatient regimen of CDDP, 20 mg/m2/d and 5FU, 1000 mg/m2/d by continuous intravenous infusion x 4 days, wk 1, 4 (Arm B). Local (LC), regional (RC), distant control (DC) and overall (OS) and relapse-free survival (RFS) outcomes were estimated using Kaplan-Meier method and compared using log-rank test. Revenue and cost data was collected from 388 encounters in 21 pts (Arm A: 11 pts, Arm B: 10 pts) with data within our EPSi accounting database from treatment start date to 6 months post-treatment. Revenue was modeled payor-specific and cost data was based on HCPCS/CPT codes. As presented at ASCO 2013, the two arms were well balanced in pretreatment variables including HPV+ status (84 vs 79%). At a median follow up of 29.4 months there was no difference in two year outcomes for LC (100 vs 97%), RC (100 vs 100%), DC (94 vs 91%), OS (96 vs 83%), or RFS (94 vs 85%) for Arm A vs B although patterns of toxicity differed between arms. Grade 3 mucosal and skin toxicity, ANC<1, hospitalization for neutropenic fever was significantly higher in Arm B; grade 2 hearing toxicity, creatinine >2 was significantly higher in Arm A. HPV+ pts had shorter duration of feeding tube use (7 vs 22 wks; p<0.01). Adding to treatment cost were 8 non-treatment related admissions seen in 4 pts in Arm A vs 14 admissions in 8 pts in Arm B. Net income per patient was nearly identical in Arms A and B but net revenue and total cost were significantly different. Arm B had $19,338 higher net revenue but also $18,664 higher total cost per patient from treatment start to 6 mos post-treatment. Updated analysis shows successful implementation of value-based practice change with 45%, 19%, and 0% of patients treated with the in-patient regimen in 2011, 2012, 2013, respectfully. Measurement of outcomes and cost of two definitive chemoRT regimens for HNSCC reveals equal survival and disease control outcomes but lower costs for the outpatient regimen. The higher cost of Arm B largely reflects treatment and non-treatment hospitalizations. Cost and outcome measurement for a full cycle of care enabled us to change our practice pattern by appropriately reducing cost without sacrificing tumor outcomes.