The politics of valuation and payment for regenerative medicine products in the UK

The field of regenerative medicine (RM) faces many challenges, including funding. Framing the analysis in terms of institutional politics, valuation studies and ‘technologies of knowledge’, the paper highlights growing debates about payment for RM in the UK, setting this alongside escalating policy debates about ‘value’. We draw on interviews and publicly available material to identify the interacting and conflicting positions of institutional stakeholders. It is concluded that while there is some common ground between institutional stakeholders such as industry and health system gatekeepers, there is significant conflict about reward systems, technology assessment methodologies and payment scenarios; a range of mostly conditional payment schemes and non-mainstream routes are being experimented with. We argue that current developments highlight a fundamental conflict between a concern for the societal value of medical technologies in a resource-limited system and a concern for engineering new reward and payment models to accommodate RM innovations

De l'inefficacité du réseau social : des liens sociaux non mobilisés chez les patients atteints de cancer

International audienceDe nombreuses études sur les réseaux sociaux portent sur la question des ressources auxquelles un individu peut avoir accès à travers ses relations sociales. En s'intéressant aux réseaux qui ont « fonctionné », elles tentent alors de spécifier les facteurs ayant permis l'accès aux ressources. Mais peu de travaux se sont penchés sur les réseaux ayant échoué à fournir à l'individu le bien ou le service qu'il recherchait. Cet article se propose de discuter de ces réseaux « inefficaces » à travers le cas de patients atteints de cancer recherchant des informations relatives à leur pathologie. Les résultats indiquent que les causes de l'inefficacité du réseau sont à rechercher dans la non mobilisation des liens de la part des malades rencontrés. Un certain nombre de contraintes pèsent sur ces liens empêchant ainsi leur mobilisation

Rationale and design of the CANARI study: a case-control study investigating the association between prostate cancer and 5-alpha-reductase inhibitors for symptomatic benign prostate hypertrophy by linking SNIIRAM and pathology laboratories in a specific region in France

International audienceBenign prostate hypertrophy (BPH) could be associated with low urinary symptoms requiring medical treatment: 5-alpha-reductase inhibitors (5-ARI) or alpha-blockers. Two clinical trials investigating 5-ARI use in prostate cancer (PCa) primary prevention highlighted a potential safety signal with an increased risk of high-grade PCa. Later observational studies failed to show similar results but have some limits. This paper focuses on describing the protocol of the CANARI study and its feasibility, as regards the matching process of two pseudo-anonymous databases. The study concerned patients living in the Brittany region (France) between 2010 and 2013. We designed a case-control study nested within a cohort of men treated by medical drugs licensed for symptomatic BPH between 2010 and 2011. Cases were patients with incident PCa diagnosed between 2012 and 2013 identified through French Health database (SNIIRAM). Gleason score was searched through Brittany pathology laboratories. Controls were patients without PCa diagnosis. Local pathology laboratories database was constituted in Brittany, gathering Gleason scores. No unique identification number is available in France; linkage of SNIIRAM and Brittany pathology laboratories database was made by deterministic matching. We matched 859 cases to Gleason grading (119 had Gleason score = 8 and 740 had Gleason < 8); around 22% of cases received 5-ARI and 78% alpha-blockers or phytotherapy. The CANARI study investigated in a population of men treated for BPH the risk of PCa with 5-ARI, according to Gleason grade thanks to SNIIRAM database enriched by local pathological results