Risk and Mortality of Recurrent Breast Cancer in Stockholm 1985-2005

The purpose of this study was to estimate the risk and mortality of breast cancer recurrences in Swedish women, and to analyse changes over time and variations between patients in different risk groups. Such estimates are of key importance for modelling the cost-effectiveness of different strategies for adjuvant treatment of breast cancer. The study was based on all women diagnosed with breast cancer in Stockholm County between 1985 and 2005. Information about dates for locoregional recurrences, metastatic relapses, new contralateral tumours and death was collected. Cox proportional hazard and Weibull regression models were used to estimate survival functions, where year of diagnosis (dived into 5-year intervals), were included as explanatory variables in the models. The risk of recurrences has decreased during the last 20 years for all three types of recurrence; for metastatic relapse the 5-year risk was reduced from 12.9% to 6.0% from 1985-90 to 2000-2005 . Mortality has also been reduced, resulting in an increased 5-year survival from 52.6% to 64.1% after locoregional recurrence and from 10.4% to 15.5% for metastatic relapse. For contralateral tumours, with a 5-year survival rate of 74.6% in 1985-1990 and 78% 2000-2005, no significant increase was observed. Analysis of risk groups according to TNM classification showed large difference in the risk of metastatic breast cancer between the three defined groups, but small differences for the risk of locoregional recurrences and new contralateral tumours. The findings indicate that the early detection and new treatments have been successful in improving outcome for breast cancer patients and that it is important to use up-to-date information, when assessing the value of new treatment options.Breast cancer; Mortality; Survival; Recurrence; Sweden

The European Code of Cancer Practice

There are considerable disparities between the quality of cancer care and clinical outcomes for cancer patients in different European countries, regions, hospitals and communities. These have persisted despite the introduction of many European and National Cancer Plans, an extensive portfolio of clinical guidelines and the existence of evidence based guidelines for the good practice in planning cancer healthcare systems. We describe the European Code of Cancer Practice which is a citizen and patient-centred accessible widely disseminated statement of the core requirements for good clinical cancer practice. The Code sets out 10 key overarching Rights of what a patient should expect from their healthcare system each supported by a plain language explanation. The Rights highlight the importance of equal access to affordable and optimal cancer care, good quality information about an individual patient’s disease and treatment and about the quality and outcomes of the cancer service they will use. Specialised multidisciplinary cancer care teams, shared decision-making, research and innovation, a focus on quality of life, the integration of supportive and palliative care within oncology are all emphasised. There is a need for a systematic approach to supporting cancer survivors with a survivorship care plan including their rehabilitation, reintegration into society and return to work where appropriate without discrimination. The Code has been co-produced by a team of cancer patients, patient advocates and cancer professionals to bridge the gap between clinical guidelines, healthcare policies and patients’ everyday experience. It is robustly evidence-based and supported by a comprehensive review of the medical literature and evidence for good clinical practice. The Code is strongly endorsed by Europe’s professional and patient cancer organisations and the European Commission

Forecasting drug utilization and expenditure in a metropolitan health region

<p>Abstract</p> <p>Background</p> <p>New pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning), forecasting of drug utilization and expenditure, critical drug evaluation as well as structured programs for the introduction and follow-up of new drugs. The aim of this paper is to present the forecasting model and the predicted growth in all therapeutic areas in 2010 and 2011.</p> <p>Methods</p> <p>Linear regression analysis was applied to aggregate sales data on hospital sales and dispensed drugs in ambulatory care, including both reimbursed expenditure and patient co-payment. The linear regression was applied on each pharmacological group based on four observations 2006-2009, and the crude predictions estimated for the coming two years 2010-2011. The crude predictions were then adjusted for factors likely to increase or decrease future utilization and expenditure, such as patent expiries, new drugs to be launched or new guidelines from national bodies or the regional Drug and Therapeutics Committee. The assessment included a close collaboration with clinical, clinical pharmacological and pharmaceutical experts from the regional Drug and Therapeutics Committee.</p> <p>Results</p> <p>The annual increase in total expenditure for prescription and hospital drugs was predicted to be 2.0% in 2010 and 4.0% in 2011. Expenditures will increase in most therapeutic areas, but most predominantly for antineoplastic and immune modulating agents as well as drugs for the nervous system, infectious diseases, and blood and blood-forming organs.</p> <p>Conclusions</p> <p>The utilisation and expenditure of drugs is difficult to forecast due to uncertainties about the rate of adoption of new medicines and various ongoing healthcare reforms and activities to improve the quality and efficiency of prescribing. Nevertheless, we believe our model will be valuable as an early warning system to start developing guidance for new drugs including systems to monitor their effectiveness, safety and cost-effectiveness in clinical practice.</p

Drug utilization research in the area of cancer drugs

Increased biological understanding of cancer diseases has resulted in a paradigm shift in the medical treatment of cancer. Despite encouraging advances, most cancer types are still incurable and cancer is the second most common cause of death in developed countries.The high price of cancer drugs is a major challenge to equal access and puts heavy strains on public health care payers. After sharp increases in the 2000s, total expenditures on cancer drugs have levelled off due to patent expiration of many expensive and widely used drugs.Cancer drug utilization studies cover a great variety of topics. Four main research areas are patient adherence, physician adherence to guidelines, effectiveness and safety (outcomes research) and access (market uptake).Most cancer drugs are classified under Anatomical Therapeutic Chemical (ATC) group L. The use of defined daily dose (DDD) as a measurement unit is feasible for oral cancer drugs. As most cancer drugs are administered as infusions or injections at hospitals, usage is commonly measured in milligrams.Drug utilization research in the area of cancer is faced with a lack of data. Comparisons are challenging, as prices and population bases vary across regions. The linkage of registries and health care databases that include cancer drug usage will create improved opportunities in the future

The value of anticancer drugs:a regulatory view

The high prices of new anticancer drugs and the marginal added benefit perceived by some stakeholders have fuelled a debate on the value of anticancer drugs in the European Union, even though an agreed definition of what constitutes a drug's value does not exist. In this Perspective, we discuss the value of drugs from different viewpoints and objectives of decision makers: for regulators, assessment of the benefit-risk balance of a drug is a cornerstone for approval; payers rely on cost-effectiveness analyses carried out by health technology assessment agencies for reimbursement decisions; for patients, treatment choices are based on personal preferences and attitudes to risk; and clinicians can use several scales (such as the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS)) that have been developed as an attempt to measure value objectively. Although a unique definition that fully captures the concept of value is unlikely to emerge, herein we discuss the importance of understanding different perspectives, and how regulators can help to inform different decision makers

Cost of breast cancer in Sweden in 2002

Cost, Cost of illness, Breast cancer,

Comparator report on patient access to cancer medicines in Europe revisited

In a new report, the Swedish Institute for Health Economics (IHE) compares the cancer situation in EU28 plus Norway and Switzerland. The report builds on a previous comparative study conducted in 2005 and provides a comprehensive view of the development of cancer in Europe over the past two decades. The report shows that the number of people diagnosed with cancer continue to increase in Europe, up by 30 percent between 1995 and 2012 due to a growing and aging population. Despite this growth and an increased spending on cancer medicines the overall spending on cancer care has remained stable at around six percent of total health expenditure largely due to a shift towards outpatient care. The report also concludes that there is great difference in access to medicines, in particular between richer and poorer countries but also between countries with similar purchasing power. The access problem requires collaboration between policy makers, payers, regulators, HTA bodies and manufacturers. Local solutions seem most feasible to balance the risk and reward of new treatment options between payers and manufacturers and reflect the affordability levels of different countries