Access to High-Quality Oncology Care Across Europe
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ACCESS TO HIGH-QUALITY ONCOLOGY CARE ACROSS EUROPE Thomas Hofmarcher, IHE Bengt Jönsson, Stockholm School of Economics IHE REPORT Nils Wilking, Karolinska Institutet and Skåne University Hospital 2014:2 Access to high-quality oncology care across Europe Thomas Hofmarcher IHE – The Swedish Institute for Health Economics, Lund, Sweden Bengt Jönsson Stockholm School of Economics, Stockholm, Sweden Nils Wilking Karolinska Institutet, Stockholm, Sweden and Skåne University Hospital, Lund/Malmö, Sweden IHE Report 2014:2 Print-ISSN 1651-7628 e-ISSN 1651-8187 The report can be downloaded from IHE’s website. Please cite this report as: Hofmarcher, T., Jönsson, B., Wilking, N., Access to high-quality oncology care across Europe. IHE Report. 2014:2, IHE: Lund. Box 2127 | Visit: Råbygatan 2 SE-220 02 Lund | Sweden Phone: +46 46-32 91 00 This report was commissioned and funded by Janssen Fax: +46 46-12 16 04 pharmaceutica NV and based on independent research delivered by IHE. Janssen has had no E-mail: [email protected] influence or editorial control over the content of this www.ihe.se report, and the views and opinions of the authors are Org nr 556186-3498 not necessarily those of Janssen. Vat no SE556186349801 Access to high-quality oncology care across Europe 2 Table of contents Executive Summary 4 6. Access to quality care in oncology – Treatment 57 1. Introduction 5 6.1. Review and summary of published studies 58 1.1. Purpose and scope of the report 5 6.1.1. Availability of new cancer drugs 58 1.2. The EU’s role in the fight against cancer 5 6.1.2. Market access 59 2. The burden of cancer in Europe 7 6.1.3. Market uptake 60 2.1. Incidence and mortality 8 6.2. Access to sunitinib – an example 63 2.2. Prevalence 13 6.3. Market uptake of new cancer drugs 65 2.3. Health burden 15 6.3.1. Sales of new cancer drugs 66 2.4. Economic burden 18 6.3.2. Uptake of selected cancer drugs 67 3. Defining access to high-quality oncology care 24 6.4. The “high” cost of new cancer drugs 72 3.1. Defining access to oncology care 24 6.5. Patient access schemes 74 3.1.1. Access to health care 25 7. Conclusions and policy recommendations 77 3.1.2. Access to oncology care 27 References 82 3.2. Defining and measuring quality of care in oncology 29 Appendix 92 3.2.1. Quality of structure 30 3.2.2. Process quality 33 3.2.3. Quality of outcome 35 3.2.4. Conclusion 39 4. Organization of oncology care 40 4.1. France 41 4.2. Germany 42 4.3. Poland 44 4.4. Sweden 45 5. Access to quality in oncology care – Screening 49 5.1. Principles for high-quality screening 49 5.1.1. Determining factors 50 5.1.2. The impact of screening on survival 51 5.1.3. The EU’s stance on cancer screening 51 5.1.4. Colorectal cancer screening 51 5.1.5. Lung cancer screening 52 5.1.6. Prostate cancer screening 52 5.2. Review of country-specific screening programs and screening rates 53 5.3. How to improve access to and quality of screening 56 Executive Summary Cancer is one of the major diseases in Europe. It is the second Thirdly, to continue to incentivize innovative research, most common cause of death in the European Union, after the value of innovation in cancer care has to be rewarded. cardiovascular diseases, and 2.7 million new cancer cases Inadequately designed reimbursement systems hinder are diagnosed every year. Cancer also presents an economic patients from benefiting from innovation and threaten the challenge for health care systems. The ageing of the development of new treatments with better outcomes. population in conjunction with continuous technological The development of new mechanisms of payment for new improvements renders it difficult for health care systems to innovative cancer treatments should be a priority policy. constantly provide high-quality oncology care. Additionally, Fourthly, oncology care is an integrated process and its the economic crisis and resulting austerity measures have internal organization is critical for the timely management further highlighted the cost of cancer and threaten the of cancer patients. Resource inputs, e.g. medical technology sustainability and continuous improvement of quality in and health care professionals, have to be well-balanced, oncology care. Solutions are needed to optimize oncology otherwise bottlenecks emerge that result in long waiting care and to establish a high and sustainable standard of times. Clinical guidelines and multidisciplinary teams support care across Europe. the provision of effective cancer care. This report aims at providing a framework for the development Fifthly, complete and up-to-date data on resource use and of policies to ensure access to high-quality oncology care. A outcomes of the current care system is fundamental to comprehensive approach has been chosen that encompasses sustainability and improvement. A comprehensive system the whole patient pathway from prevention to treatment. of nationwide cancer registries facilitates the monitoring The barriers that prevent the provision of effective oncology of the quality of care. It also helps to plan the allocation of care are identified and described in the report alongside resources, identify over- and under-consumption, detect the determinants of a high-quality standard in care. Special regional differences in access to and quality of treatment, emphasis is placed on access to effective screening programs monitor the implementation of policy measures and enables for cancer prevention as well as on access to innovative the measurement of progress in care over time. treatments in the form of new cancer drugs. The analysis is based on assessments across three common cancer Finally, health policies need to better recognize the types (colorectal, lung and prostate cancer) and four health importance of quality of life as an outcome measure in systems from the following selected European countries - cancer care, due to improvements in survival and the France, Germany, Poland and Sweden. occurrence of co-morbidities in elderly cancer patients. The potential benefits and value from high quality cancer care Six policy recommendations have been derived from the that improves patient quality of life, enables participation analysis. Firstly, a cost-effective allocation of resources is in activities of daily living, and maintains or restores work pivotal for a more accessible and sustainable oncology care performance must be recognized and supported. system. For instance, in the area of screening there is room to improve patient outcomes and cost-effectiveness. By optimizing prostate cancer screening and the development of well-designed colorectal cancer screening, improved outcomes and value for patients may be achieved. Secondly, an adequate level of resources is needed to provide effective cancer care. Lack of funding limits the availability of high-quality treatment facilities, health care professionals and medical technologies used for diagnostics and treatment. This hampers the geographic accessibility of oncology services, results in low treatment standards and patient outcomes, and might discourage patients from seeking care. Further studies on the level and direction of spending on cancer in Europe are needed for the development of a strong evidence base. Access to high-quality oncology care across Europe 4 1. Introduction 1.1. Purpose and scope of the report Rising health care expenditures and the squeeze on national Data availability also played a role in the selection of the four health budgets are putting a heavy strain on health care countries. France, Germany and Sweden are all characterized systems in Europe. These developments underline the need to by a fairly similar high level of living standards. However, reform and optimize health care systems for the longer term. resources are allocated differently and care is organized in a The challenge herein is to strike a balance between containing different way across these three health care systems. Poland health care expenditures and sustaining access to and quality is the most populous country to have joined the European of health care. Cancer presents a high health-economic burden Union during the last decade and has developed its own to society and oncology care forms a key area in response to health care system with implications for priority setting this challenge [3]. The purpose of this report is therefore (1) to in the provision of care. All countries are members of the inform policy-makers on the value and importance of ensuring European Union and even though health policy primarily access to high-quality oncology care and (2) to provide rests with member states, the European Commission plays an evidence-based policy recommendations on how to optimize increasing role in the sharing and promotion of best practice access to oncology care and how to achieve a high-quality in health care, including goals and recommendations in the standard that is both achievable and sustainable. common fight against cancer. This report is designed to look at the full cancer patient pathway encompassing primary prevention measures, screening efforts, diagnostics and treatment with curative and 1.2. palliative intent. These are the central elements determining The EU’s role in the fight against access to high-quality oncology care and are decisive in determining patient outcomes. In order to highlight areas cancer for quality improvement, the report identifies barriers that The European Commission has for a long time recognized the prevent access to effective oncology care and establishes burden of cancer and the challenge that it poses to society. In determinants of a high-quality standard in care. The report the past, several initiatives were specifically directed towards puts a special emphasis on access to effective screening cancer.