Survival inequalities in patients with lung cancer in France: A nationwide cohort study (the TERRITOIRE Study)

Abstract

The French healthcare system is a universal healthcare system with no financial barrier to access to health services and cancer drugs. The objective of the study is to investigate associations between, on the one hand, incidence and survival of patients diagnosed with lung cancer in France and, on the other, the socioeconomic deprivation and population density of their municipality of residence. A national, longitudinal analysis using data from the French National Hospital database crossed with the population density of the municipality and a social deprivation index based on census data aggregated at the municipality level. For lung cancer diagnosed at the metastatic stage, one-year and two-year survival was not associated with the population density of the municipality of residence. In contrast, mortality was higher for people living in very deprived, deprived and privileged areas compared to very privileged areas (hazard ratios at two years: 1.19 [1.13–1.25], 1.14 [1.08–1.20] and 1.10 [1.04–1.16] respectively). Similar associations are also observed in patients diagnosed with non-metastatic disease (hazard ratios at two years: 1.21 [1.13–1.30], 1.15 [1.08–1.23] and 1.10 [1.03–1.18] for people living in very deprived, deprived and privileged areas compared to very privileged areas). Despite a universal healthcare coverage, survival inequalities in patients with lung cancer can be observed in France with respect to certain socioeconomic indicators.

Immunotherapy rechallenge after nivolumab treatment in advanced non-small cell lung cancer in the real-world setting: A national data base analysis

“…This is one of the largest cohort of patients treated with nivolumab to be reported to date. A previous study of the PMSI database reported 22,000 incident cases of metastatic lung cancer in 2011 [34]. Assuming that NSCLC accounts for around 80 % of these cases [35] and that around 50 % of patients never receive a second-line treatment [36] this would suggest that nivolumab was offered to a significant part of the patients in France for whom it was indicated.…”

“…We have previously described the characteristics of all patients with NSCLC in the PMSI database hospitalised with lung cancer for the first time in 2011 [34], using an identical selection procedure as in the present study. Compared to this reference population, patients prescribed nivolumab were somewhat younger and less frequently presented comorbidities.…”

Cost-effectiveness of atezolizumab versus docetaxel and nivolumab in the treatment of non-small cell lung cancer as a second line in France

“…Lastly, PD1/PDL1 blocking antibodies are gaining market access authorization to first line treatment in NSCLC with important changes in the therapeutic guidelines 9 . New health economic evaluations will be required to account for these changes and therefore, ensure access to the patient of efficient therapies.…”

“…A second-line treatment is initiated in about 40-50% of these patients, depending on histology and mutational status 1,7,8 . Overall survival (OS) in advanced lung cancer remains short: at 1 year, survival rate was 54.2%, with strong inequities between socioeconomics groups 9 , although French heath care insurance relied on universal coverage.…”

A microsimulation model to assess the economic impact of immunotherapy in non-small cell lung cancer

“…First, we performed a comprehensive analysis of the budget impact of the four EMA-approved indications for anti-PD-1 therapy in NSCLC, a high-volume disease. Second, we used patient-level data from a national observational study, which is representative of lung cancer patients treated in local hospitals, the main hospital care providers in France for NSCLC [18]. These datasets are recognised as reference real-world data in France.…”