WP-7 on Cancer costs and outcomes

WP-7 is run by Dr. Andrea Micheli, EUROCHIP-3 project leader and is conducted at INT, Milan.

Given the progressive cost increase of cancer care, increasing best practice diffusion and cost-effectiveness in cancer care is to become the most strategic approach to global cancer control in the framework of the fight against inequalities in health care. We rated this approach with high priority following the results of the previous EUROCARE and EUROCHIP projects.

The 3rd International Cancer Control Congress (ICCC-3) held in Cernobbio, Italy, on 8-11 November 2009 focussed on the topic of international cooperation on cancer control and confirmed the necessity for further research to be given to this area in global cancer control (read the monograph). With ICCC-3, ideas for future cancer control international collaborations were shared, and others were newly created. In particular, seeds for European Union (EU) – African Union (AU) future cancer control collaborations were organised and can be also be taken in consideration at global level to contribute to the discussion on international collaboration in middle and low income countries with the involvement of international research, practice and policies on primary prevention, treatment, early detection and in improving health monitoring.

WP7 EUROCHIP aims to contribute to the EU debate on the need and the ways for guaranteeing cancer care to all, promoting steps towards the radical rethink of the way cancer research that is needed to invert the trend of increasing cancer control costs that are disproportional to the economy of our society.

WP-7 activities

WP7 mandate is to reporting to the EU on the possibility that the EU governments have now to improve performance in cancer care without increasing costs or even reducing costs, and propose a set of cancer managing actions to cut costs while maintaining outcomes reductions.

The focus of the study was on early and advanced breast cancer (BC) and non-HR/ non-B mature childhood acute lymphoblastic leukaemia (ALL) limited to the care tools referable for direct in-patient voices of cost, for the two cancers considered, excluding staff cost. WP7 was activated for experimenting a model to discuss the effect of cost on cancer care performance, assuming that one or few elements included in best practice guidelines for care may be looked as reason for explaining disparities in cancer outcome, at least for relatively-low-income countries or regions.

BC and ALL cancer tools on the areas of screening, diagnosis, pathology, surgery, medical oncology radiotherapy and rehabilitation are discussed by a group of experts with possible alternatives at same outcome and lower costs. See here the discussion method presented in the first year of activity.

A Health Technology Assessment (HTA) literature research protocol was developed for the revision of the available data on the different economic impact of the cancer tools considered. The WP7 group is connected with the EU Joint Action EPAAC European Partnership Action Against Cancer and with the EU parliamentary organizations MAC and FACE for discussion at EU political level.

For the majority of the tools that were considered in WP-7 discussion, both for BC and ALL, the experts evidenced the lack of lower cost alternatives able to guarantee best or at least equivalent outcomes or lack of cost effectiveness data in support of that alternatives were tentatively identified as able to guaranteeing best/equivalent outcomes. For this reason, no issues could be recognised as modifiable as originally postulated by the initial intention of the project.

For the Breast Cancer Domain, however, WP-7 conclusion is that prompt action is urged to resolve the problem of two high-cost essential care elements which should always be available to all eligible patient groups: the prices for drugs such as trastuzumab and biphosphonates should be regulated and solved. In particular, the EC should help countries to develop regulations over TRASTUZUMAB biosimilars (i.e. the officially approved new version of the product, following patent expiry).

Enrolment in clinical trials, development of international collaboration, access to effective protocols and development of health infrastructures/ allocation of resources have contributed to the improved survival in Eastern Europe and constitute the minimum requirements for care in ALL on which EUROCHIP calls for political attention.

Final material

WP-7 Final report
WP-7 Tool list

Meetings

	Date	Place	Material	Report
WP-7 breast cancer	22-09-11	Stockolm (S)		-
WP-7 childhood ALL	21-06-11	Milan (I)	-
WP-7 breast cancer	20-06-11	Milan (I)	-
WP-7 childhood ALL	15-02-11	Milan (I)
WP-7 breast cancer	14-02-11	Milan (I)
WP-7 activity meeting	07-10-10	Milan (I)
WP-7 activity meeting	31-05-10	Rome (I)
WP-7 activity discussion	16-03-10	Rome (I)	-	-