Discrepancies in cancer incidence and mortality and its relationship to health expenditure in the 27 European Union member states

Ades, Felipe; Senterre, Christelle; Azambuja, Evandro de; Sullivan, Richard; Popescu, Răzvan; Parent, Florence; Piccart, Martine

doi:10.1093/annonc/mdt352

Cited by 57 publications

(46 citation statements)

References 18 publications

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“…An East-West differentiation was evident between countries along the diagonal that denotes low incidence-high mortality and high incidence-low mortality [23]. In our analysis, the main differentiation appeared along the incidence axis, indicating the evolution of disease occurrence primarily from low incidence to high incidence in countries and regions in various stages of cancer control activities.…”

Section: Discussionmentioning

confidence: 54%

Recent changes in breast cancer incidence and mortality in Estonia: Transition to the west

et al. 2016

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Background The aim of this study was to examine breast cancer (BC) incidence and mortality trends in Estonia during recent decades and to compare the pattern of these trends with other selected European countries and regions. We attempt to explain the findings in relation to changes in Estonian society and healthcare system. Methods BC incidence (1985-2012) and mortality (1985-2013) data for Estonia were obtained from the Estonian Cancer Registry and Statistics Estonia. Data for selected European countries were obtained from the EUREG database. Joinpoint regression was used to analyze age-standardized rates in Estonia by age. For international comparison of incidence and mortality rates, we used scatterplot with 95% confidence ellipses and the mortality to incidence ratio. Results The overall BC incidence continues to increase in Estonia, while mortality has been in decline since 2000. Both incidence and mortality trends varied considerably across age groups. Among women aged 60 years and older, BC incidence increased at a rate of nearly 3% per year. Significant decrease in mortality was seen only among women aged 50-59 years. Comparison of scatterplots between countries and regions revealed two clusters in Europe separated along the incidence axis. The correlation between incidence and mortality in Estonia changed its direction in the mid-1990s. Conclusion In recent years, the dynamics of BC burden in Estonia has transitioned towards the high incidence-low mortality type model, which is characteristic to Western, Northern and Southern Europe. Although overall BC incidence is much lower in Estonia than in more affluent European countries, mortality from BC is still relatively high, particularly among elderly women.

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Section: Discussionmentioning

confidence: 54%

Recent changes in breast cancer incidence and mortality in Estonia: Transition to the west

et al. 2016

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“…The causes of the consistent increased cancer survival in Europe are likely to be multifactorial; Augmented health expenditure and better access to screening, specialized diagnostics and treatment [6,41–43]. Nevertheless controversy exists about the role of delayed diagnosis and access to new expensive cancer drugs in improving survival [44].…”

Section: Discussionmentioning

confidence: 99%

“…Western European countries allocate more resources to health care than Eastern European countries [5], and this is associated with better survival after a cancer diagnosis [6]. This association is more marked in breast cancer, possibly because of the availability of effective screening methods, treatments, and multidisciplinary management [6]. In the USA, reductions in breast cancer mortality are also heterogeneous, being observed more in white women than in black, Hispanic and Native American women [3].…”

Section: Introductionmentioning

confidence: 99%

Are life-saving anticancer drugs reaching all patients? Patterns and discrepancies of trastuzumab use in the European Union and the USA

et al. 2017

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BackgroundThe development of trastuzumab is considered to be one of the greatest improvements in breast cancer treatment in recent years. This study aims to evaluate changes in the uptake of trastuzumab over the last 12 years and to determine whether its use is proportional to patient needs in the European Union and the USA.MethodsUsing national registry data, the number of new cases of HER2-positive breast cancer patients per year was estimated. The number of likely trastuzumab treatments per year was estimated using trastuzumab procurement data for each country.ResultsWestern Europe and the USA show increasing procurement level of trastuzumab over the years studied, reaching proportional of use of trastuzumab few years after its marketing authorization in the early 2000’s. After the approval in the adjuvant setting, in the year 2006, it was observed underuse of trastuzumab given the increase of the number of patients in need of treatment. Proportional use was shortly met after a couple of years. Few countries in Eastern Europe acquired the needed quantity of trastuzumab, with procurement levels starting to increase only after approval in the adjuvant setting in 2006.ConclusionSignificant differences in trastuzumab procurement are observed between Western Europe, the USA and Eastern Europe, with the latter geographic region acquiring insufficient amounts of the drug required to treat all patients in need.

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“…Notably, an increase in breast cancer mortality has been observed in some Eastern European countries [14]. Not surprisingly, the reduction in breast cancer mortality is greater in countries that allocate more budget to health care [13].…”

Section: Discussionmentioning

confidence: 99%

“…A clear division is noticeable between Western and Eastern European countries, with the former allocating higher budgets to health than the latter [12]. This translates into better survival after a cancer diagnosis in Western Europe, which is particularly marked in breast cancer [13]. The reduction in breast cancer mortality observed in recent decades for Europe as a whole is also not homogeneous, being more significant in Western European countries [14].…”

Section: Introductionmentioning

confidence: 99%

An exploratory analysis of the factors leading to delays in cancer drug reimbursement in the European Union: The trastuzumab case

Ades¹,

Senterre²,

Zardavas³

et al. 2014

European Journal of Cancer

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Discrepancies in cancer incidence and mortality and its relationship to health expenditure in the 27 European Union member states

Abstract: Despite the initiatives to standardize public health policies of the EU-27, health expenditure continues to be higher in Western European countries and this is associated with better cancer outcome in these countries.

Cited by 57 publications

References 18 publications

Recent changes in breast cancer incidence and mortality in Estonia: Transition to the west

Recent changes in breast cancer incidence and mortality in Estonia: Transition to the west

Are life-saving anticancer drugs reaching all patients? Patterns and discrepancies of trastuzumab use in the European Union and the USA

An exploratory analysis of the factors leading to delays in cancer drug reimbursement in the European Union: The trastuzumab case

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