Background:
In the last decade, the EUROCHIP-EC projects promoted actions against cancer inequalities in the EU. The EUROCARE studies showed large differences in survival of cancer patients across countries, mostly related to variations in Gross Domestic Product (GDP): the lowest cancer survival in countries at medium-low GDP. The amount of necessary cancer management resources is increasing, many countries do not guarantee what cancer guidelines require. The EUROCHIP-3WORK-PACKAGE-7 proposed a strategy for reducing cancer inequalities investigating breast cancer (BC) management.
Aim:
To investigate the availability of cost-effectiveness data, identify effective alternatives and major obstacles for EU citizens to equal access to care.
Methods:
Early and advanced BC were considered separately. International multidisciplinary discussions involving clinicians, epidemiologists and health economists were conducted. Using an ad-hoc study template, BC management components (tools) listed by domain were described and classified according to resource investment rankings. Tools were classified in “Minimal requirements” for acceptable care (to be guaranteed to all) and “Additional” tools for improvement of care (where resources allow).
Results:
Cost-effectiveness data on cancer management components are scarce; cost effectiveness information on alternatives are not sufficiently available in scientific literature.
Table 1. Medical oncology tools for early BC
Minimal requirement tools: Endocrine treatment, Chemotherapy, Trastuzumab
Additional Tools: Consider addition of ovarian suppression/oophorectomy in premenopausal patients,
Bisphoshonates
(In italic, tools requiring maximal investment: only one as minimal-requirement)
Conclusions:
Cost should be systematically considered in the evidence-based evaluation of cancer care. Considering the minimal-requirement-tools for acceptable treatment constitutes an innovative approach that enables public health authorities to act on priorities which can reduce disparities: for example, for early BC, Trastuzumab - and biosimilars- should be made available at low price. The WP7 model is effective to identify problems and improve access to minimal requirement components of cancer care.
The EUROCHIP group: http://www.tumori.net/eurochip/material/WP7/WP7_experts.pdf