ACCESS TO INNOVATIVE DRUGS IN PATIENTS WITH METASTATIC LUNG CANCER IN FRENCH PUBLIC HOSPITALS (THE TERRITOIRE STUDY)
Author(s)
Scherpereel A1, Fernandes J2, Cotté F3, Blein C4, Debieuvre D5, Durand-Zaleski I6, Gaudin A3, Ozan N3, Saitta B4, Souquet P7, Vainchtock A4, Westeel V8, Chouaïd C9
1CHU Lille, Lille, France, 2Oc Santé, Montpellier, France, 3Bristol-Myers Squibb, Rueil-Malmaison, France, 4HEVA, Lyon, France, 5Mulhouse Hospital, Mulhouse, France, 6URC Eco, Paris, France, 7Hospices Civils de Lyon, Lyon, France, 8Besançon Hospital, Besançon, France, 9CHIC, Créteil, France
OBJECTIVES: Lung cancer survival is socioeconomically patterned, and socioeconomic inequalities in receipt of treatment have been demonstrated in several countries. In the hospitals, many innovative anticancer drugs are too expensive to be funded through a Diagnosis-Related Group (DRG) of chemotherapy administration. In France, such drugs are fully reimbursed up to national reimbursement tariffs (extra-DRG funding) to ensure equity of access. Our aim was to analyze the access of patients to innovative drugs according to social deprivation index. METHODS: A retrospective cohort study was constituted with all patients having a diagnosis of metastatic lung cancer in the French National hospitals databases (PMSI) during year 2011. Patients’ data were linked to allow a two-year follow-up period. Because extra-DRG data were not available for private hospitals, our analysis was restricted to patients benefiting from chemotherapy in public hospitals only. In addition of demographic characteristics, comorbidities, and treatment, we assigned each patient to social deprivation index based on their postcode of residence. RESULTS: We identified 11,602 patients receiving chemotherapy in public hospitals. During follow-up, 7,417 patients (63.9%) received expensive drugs at least once, including mostly pemetrexed (57.5%), bevacizumab (16.9%), or topotecan (7.2%); these patients were significantly more likely women and younger than the rest of the cohort (p<0.0001). Conversely, all selected comorbidities were associated with lower rates of administration i.e. chronic renal failure, diabetes, hypertension, COPD and other respiratory diseases (p<0.0001). Taking as reference patients from affluent areas, we observed lower rates of access in intermediary affluent, intermediary deprived and deprived areas. After multivariate adjustment, odd ratios were 0.85 [95%:0.75–0.95], 0.82 [95%:0.74–0.92] and 0.80 [95%:0.71–0.89], respectively. CONCLUSIONS: Even in a health care system organized to ensure a high degree of equity in medical care, we found indications of a socioeconomic gradient in innovative anticancer drugs access in lung cancer.
Conference/Value in Health Info
2015-11, ISPOR Europe 2015, Milan, Italy
Value in Health, Vol. 18, No. 7 (November 2015)
Code
EA2
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
Oncology