Access to Innovative Drugs in Patients with Metastatic Lung Cancer in French Public Hospitals (the Territoire Study)

Abstract

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.

In-Hospital Economic Burden of Metastatic Renal Cell Carcinoma in France in the Era of Targeted Therapies: Analysis of the French National Hospital Database from 2008 to 2013

“…Indeed, the model did not take into consideration certain potential confounding variables such as comorbidities and time since diagnosis. With this respect, our results differ from the results of the TERRITOIRE study, which has evaluated access of patients with lung cancer to expensive drugs in France as a function of geographical and socio-demographic factors, and which demonstrated some lack of social equity in access to expensive drugs [ 13 ]. The differences between our results and those of the TERRITOIRE study may be explained by the fact that we used a different version of the deprivation index; that the impact of social equity in using expensive drugs might vary according to the type of disease and other confounding variables such as comorbidities.…”