title: Resources allocation in healthcare for cancer: a case study using generalised additive mixed models.
abstract: Our aim is to develop a method for helping resources re-allocation in healthcare linked to cancer, in order to replan the allocation of providers. Ageing of the population has a considerable impact on the use of health resources because aged people require more specialised medical care due notably to cancer. We propose a method useful to monitor changes of cancer incidence in space and time taking into account two age categories, according to healthcar general organisation. We use generalised additive mixed models with a Poisson response, according to the methodology presented in Wood, Generalised additive models: an introduction with R. Chapman and Hall/CRC, 2006. Besides one-dimensional smooth functions accounting for non-linear effects of covariates, the space-time interaction can be modelled using scale invariant smoothers. Incidence data collected by a general cancer registry between 1992 and 2007 in a specific area of France is studied. Our best model exhibits a strong increase of the incidence of cancer along time and an obvious spatial pattern for people more than 70 years with a higher incidence in the central band of the region. This is a strong argument for re-allocating resources for old people cancer care in this sub-region.
authors.affiliation: Dipartimento di Matematica ed Informatica, Università di Cagliari, Cagliari, Italy. mmusio@unica.it
authors.forename: Monica
authors.initials: M
authors.lastname: Musio
authors.forename: Erik A
authors.initials: EA
authors.lastname: Sauleau
authors.forename: Nicole H
authors.initials: NH
authors.lastname: Augustin
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000375:Aging; D005260:Female; D005602:France / Q000453:epidemiology; D015276:Health Care Rationing / Q000191:economics* / Q000592:standards; D006292:Health Priorities / Q000191:economics* / Q000592:standards; D006299:Health Services for the Aged / Q000191:economics* / Q000592:standards; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology; D016012:Poisson Distribution; D011157:Population Dynamics / Q000639:trends; D012042:Registries; D040841:Resource Allocation / Q000379:methods / Q000592:standards; D013029:Space-Time Clustering; D055815:Young Adult