title: Access to innovation: is there a difference in the use of expensive anticancer drugs between French hospitals?
abstract: In DRG-based hospital payment systems, expensive drugs are often funded separately. In France, specific expensive drugs (including a large proportion of anticancer drugs) are fully reimbursed up to national reimbursement tariffs to ensure equity of access. Our objective was to analyse the use of expensive anticancer drugs in public and private hospitals, and between regions. We had access to sales per anticancer drug and per hospital in the year 2008. We used a multilevel model to study the variation in the mean expenditure of expensive anticancer drugs per course of chemotherapy and per hospital. The mean expenditure per course of chemotherapy was €922 [95% CI: 890-954]. At the hospital level, specialisation in chemotherapies for breast cancers was associated with a higher expenditure of anticancer drugs per course for those hospitals with the highest proportion of cancers at this site. There were no differences in the use of expensive drugs between the private and the public hospital sector after controlling for case mix. There were no differences between the mean expenditures per region. The absence of disparities in the use of expensive anticancer drugs between hospitals and regions may indicate that exempting chemotherapies from DRG-based payments and providing additional reimbursement for these drugs has been successful at ensuring equal access to care.
authors: Institut Gustave Roussy, Department of Biostatistics and Epidemiology, Health Economics Unit, 114 rue Edouard Vaillant, 94805 Villejuif Cedex, France. Electronic address: bonastre@igr.fr.
authors: Julia
authors: J
authors: Bonastre
authors: ESSEC Business School, Avenue Bernard Hirsch, BP 50 105, 95 021 Cergy-Pontoise Cedex, France. Electronic address: chevalier@essec.fr.
authors: Julie
authors: J
authors: Chevalier
authors: Groupement pour l'Elaboration et la Réalisation de Statistiques (GERS), 137 rue d'Aguesseau, 92641 Boulogne Billancourt, France. Electronic address: chantal.vanderlaan@gers-sas.fr.
authors: Chantal
authors: C
authors: Van der Laan
authors: Groupement pour l'Elaboration et la Réalisation de Statistiques (GERS), 137 rue d'Aguesseau, 92641 Boulogne Billancourt, France. Electronic address: michel.delibes@orange.fr.
authors: Michel
authors: M
authors: Delibes
authors: ESSEC Business School, Avenue Bernard Hirsch, BP 50 105, 95 021 Cergy-Pontoise Cedex, France. Electronic address: pouvourville@essec.fr.
authors: Gerard
authors: G
authors: De Pouvourville
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics; D003953:Diagnosis-Related Groups / Q000191:economics / Q000706:statistics & numerical data; D004059:Diffusion of Innovation; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D016304:Hospitals, Private / Q000191:economics / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009369:Neoplasms / Q000188:drug therapy / Q000191:economics
chemical_list: D000970:Antineoplastic Agents
keywords: Anticancer drugs; Hospitals; Innovation; Patient access