Abstract
BackgroundTerritorial differences in the access to innovative anticancer drugs have been reported from many countries. The objectives of this study were to evaluate access to innovative treatments for metastatic lung cancer in France, and to assess whether socioeconomic indicators were predictors of access at the level of the municipality of residence.MethodsAll incident cases of metastatic lung cancer hospitalised for a chemotherapy in public hospitals in 2011 were identified from the French National Hospital discharge database. Information on prescription of innovative drugs from an associated database (FICHCOMP) was crossed with the population density of the municipality and a social deprivation index based on national census data.ResultsOverall, 21,974 incident cases of metastatic lung cancer were identified, all of whom were followed for 2 years. Of the 11,486 analysable patients receiving chemotherapy in the public sector, 6959 were treated with a FICHCOMP drug at least once, principally pemetrexed. In multivariate analysis, prescription of FICHCOMP drugs was less frequent in patients ≥66 years compared to those ≤55 years (odds ratio: 0.49 [0.44–0.55]), in men compared to women (0.86 [0.79–0.94]) and in patients with renal insufficiency (0.55 [0.41–0.73]) and other comorbidities. Prescription rates were also associated with social deprivation, being lowest in the most deprived municipalities compared to the most privileged municipalities (odds ratio: 0.82 [0.72–0.92]). No association was observed between the population density of the municipality and access to innovative drugs.ConclusionAlthough access to innovative medication in France seems to be relatively equitable, social deprivation is associated with poorer access. The reasons for this need to be investigated and addressed.
Highlights
Territorial differences in the access to innovative anticancer drugs have been reported from many countries
The reasons for hospitalisation are coded by International Classification of Diseases, 10th revision (ICD-10) codes [12], either as principal diagnoses (PD; the condition for which the patient was hospitalised), related diagnoses (RD; any underlying condition which may have been related to the PD) or as significantly-associated diagnoses (SAD; comorbidities which may affect the course or cost of hospitalisation)
We have previously shown using the Programme de Médicalisation des Systèmes d’Information (PMSI) database that survival is better in women with incident metastatic lung cancer than in men [14], which may indicate that their treatment or disease trajectories are different to those of men
Summary
Territorial differences in the access to innovative anticancer drugs have been reported from many countries. An untoward consequence of the expense of these drugs was to restrict access to treatment, in particular in health systems where healthcare budgets are delegated to a local or hospital level, with marked territorial differences in access to treatment This issue of ‘postcode prescribing’ became problematic in the United Kingdom before measures were taken to improve equality of access to treatment [3, 4]. The decision to use one of these drugs is taken on a patient-by-patient basis during a multidisciplinary care team (MCT) meeting in which potential risks and benefits of treatment are evaluated This system allows hospitals to be fully reimbursed retrospectively, based on maximum reimbursement prices set by the Pricing Committee of the French Health Authority (Comité Economique des Produits de Santé, CEPS). At the time of the analysis, access to the FICHCOMP database was only available for public hospitals
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
