Can we reasonably address and overcome cancer care inequalities across Europe?
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Can we reasonably address and overcome cancer care inequalities across Europe?. THE WORK OF THE EUROCHIP3 WP7 on BREAST CANCER. Olivia Pagani Clinical Director Breast Unit and Institute of Oncology of Southern Switzerland. Breast cancer survival in EU (1999-2007) by region and age .

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Olivia Pagani Clinical Director Breast Unit and Institute of Oncology of Southern Switzerland

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Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

Can we reasonably address and overcome cancer care inequalities across Europe?

THE WORK OF THE EUROCHIP3 WP7 on BREAST CANCER

Olivia Pagani

Clinical Director Breast Unit and

Institute of Oncology of Southern Switzerland


Breast cancer survival in eu 1999 2007 by region and age

Breast cancer survival in EU(1999-2007) by region and age

5 year mortality

Age-specific 5 year mortality

EUROCARE 5 Lancet Oncol. 2014;15(1):23-34


Some worrying evidence

Some «worrying» evidence

Peter F. Health equity & social justice.

J Applied Philosophy, 2001. 18 (2): 159-170

Global sales ($M) 2007-2012


Are we going this way

Are we going this way?


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

EUROCHIP-3 mission

Reducing inequalities

in cancer incidence and cancer care

across Europe

by improving cancer information


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

WP7 Rationale

Could cost constrains be a significant factor

explaining why

patients do so much worse

in some countries or regions

than in others?


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

WP7 Objectives

  • availability of cost-effectiveness data

  • possibility to consider cost effective alternatives

  • role of costs in the cancer health strategy for reducing survival disparities in the EU


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

WP7 Methods (1)

  • Early Breast cancer (Stage I and II)

  • Advanced Breast cancer (stage III and IV)


Wp7 methods 2

WP7 Methods (2)

multidisciplinary setting:

clinicians

epidemiologists

health economists


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

WP7 Methods (3)

  • Screening

  • Diagnosis

  • Pathology

  • Surgery

  • Medical Oncology

  • Radiotherapy

  • Rehabilitation & Supportive care


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

WP7 Methods (4)

  • The care components were classified in:

  • minimum requirements for acceptable care

  • additional tools for improvement of care


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

Breast Health

Global Initiative

www. portal.bhgi.org

Breast 2013;22(5):593-605


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

The WP 7 Discussion Template

For each WP7 tool, a discussion template was created covering:

Definition

Purpose

Target

Efficacy

Caveat


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

The WP 7 Red List


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

Obj1: availability of cost-effectiveness data

To reach objective 1, a HTA protocol of literature revision was developed by health economics experts

for the revision of available data

on the different economic impact

linked with the WP7 Red list


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

Obj 2: the possibility of

cost effective alternatives

To reach objective2, the WP7 discussion template was applied to the proposed alternatives

An alternative was defined as

a diagnostic or management tool

with same outcome

to that of a given tool

but bearing lower costs


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

Obj3: the role of costs

in the cancer health strategy

for reducing survival disparities in the EU

Comparable information on costs and cost effectiveness across the EU is not sufficiently available in scientific literature to answer this question


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

WP7 FOCUS - early BC


Olivia pagani clinical director breast unit and institute of oncology of southern switzerland

WP7 FOCUS – advanced BC


Conclusions 1

Conclusions (1)

The creation of a system able to include cost

in the evidence evaluation

of the different components

of cancer care

is a EU priority


Conclusions 2

Conclusions (2)

More research must be promoted to ensure

that cost information is included in the model we use for monitoring delivery of affordable quality and equitable care across the EU


Conclusions 3

Conclusions (3)

The “minimal requirement tools for acceptable treatment” constitute an innovative approach to enable public health authorities to identify those core health priorities able to change outcome disparities especially in low income settings, before investing in additional tools


Wp7 final remarks

WP7 Final Remarks

the WP7 model is EFFECTIVE

to

identify problem areas

and

expand access

especially to

minimum requirements of care


Wp7 multidisciplinary team

WP7 multidisciplinary team

The Clinical Group : Olivia Pagani, Antonella Richetti, Institute of Oncology of Southern Switzerland, Ospedale Beata Vergine, Mendrisio CH; Carlos A. Garcia-Etienne, Humanitas Cancer Center, Istituto Clinico Humanitas – IRCCS, Milan, Italy; Stefano Ciatto, retired professor, ISPO, Florence, Italy; Christine BARA, Institut National du Cancer, Boulogne Billancourt cedex, France; Valérie MAZEAU-WOYNAR, Institut National du Cancer, Boulogne-Billancourt Cedex, France; Riccardo Masetti, Policlinico Gemelli Universita' Cattolica Roma, Italy; Pietro Folino Gallo, Italian Medecines Agency (AIFA) Roma, Italy; Roberto Agresti, Fondazione IRCCS “Istituto Nazionale Tumori” Milan, Italy. The Epidemiology Group: Andrea Micheli, Milena Sant, Fondazione IRCCS “Istituto Nazionale dei Tumori” Milan, Italy; Riccardo Capocaccia, Silvia Francisci, Italian Institute of Public Health, ISS Roma, Italy; Magdalena Bielska Lasota, Dominik Maslach, National Institute of Public Health and Hygiene, Warsaw, Poland. The HTA group: Luciana Scalone, Paolo Cortesi, CHARTA Foundation, Milan, Italy; Agnese Cangini, Luisa Muscolo, Italian Medecines Agency (AIFA*) Roma, Italy; Bogusława Osińska, Agency for Health Technology Assessment in Poland, Warsaw; Anna Nachtnebel, Ludwig Boltzmann Institut Health Technology Assessment, Wien, Austria; Sabine Vogler and Nina Zimmermann, Pharma Team, Gesundheit Österreich GmbH Wien, Austria; Joan Rovira, Department of Economics, Autonomous University of Barcelona, Barcelona, Spain; Vladimir Stevanovic, Alan Diener, Franco Sassi, OECD, Paris, France; Rafal Halik National Institute of Public Health and Hygiene, Warsaw, Poland. Special thanks to the external referees from SIOP-E, EUSOMA, ESO, the EUROCHIP partners , the EPAAC Consortium and the European School of Oncology and Cancer World Magazine for support throughout.


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