title: [Brachytherapy in France: current situation and economic outlook due to the unavailability of iridium wires].
abstract: In 2013, about 6000 patients were treated with brachytherapy, the number diminishing by 2.6% per year since 2008. Prostate, breast and gynecological cancers are the most common types of cancers. Since 2008, the number of brachytherapy facilities has decreased by 18%. In medicoeconomic terms, brachytherapy faces many problems: the coding system is outdated; brachytherapy treatments cost as much as internal radiation; fees do not cover costs; since iridium wire has disappeared from the market, the technique will be transferred to more expensive high-speed or pulse dose rates. The French financing grid based on the national study of costs lags behind changes in such treatments and in the best of cases, hospitals resorting to alternatives such as in-hospital brachytherapy are funded at 46% of their additional costs. Brachytherapy is a reference technique. With intense pressure on hospital pricing, financing brachytherapy facilities will become even more problematic as a consequence of the disappearance of iridium 192 wires. The case of brachytherapy illustrates the limits of the French financing system and raises serious doubts as to its responsiveness.
authors.affiliation: Département stratégie et gestion hospitalière, Unicancer, 101, rue de Tolbiac, 75654 Paris cedex 13, France. Electronic address: b-levu@unicancer.fr.
authors.forename: B
authors.initials: B
authors.lastname: Le Vu
authors.affiliation: Département stratégie et gestion hospitalière, Unicancer, 101, rue de Tolbiac, 75654 Paris cedex 13, France.
authors.forename: S
authors.initials: S
authors.lastname: Boucher
mesh_terms: D001918:Brachytherapy / Q000191:economics / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D002173:Cancer Care Facilities / Q000191:economics; D003132:Commerce; D004867:Equipment Design; D004864:Equipment and Supplies / Q000600:supply & distribution; D005602:France; D017721:Hospital Costs; D006801:Humans; D007496:Iridium Radioisotopes / Q000008:administration & dosage*; D009369:Neoplasms / Q000191:economics / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D013675:Technology, High-Cost / Q000191:economics; D019472:Universal Health Insurance / Q000191:economics; D018875:Vocabulary, Controlled
chemical_list: D007496:Iridium Radioisotopes
keywords: Brachytherapy; Cancer; Coûts hospitaliers; Curiethérapie; Financial management; Gestion financière; Hospital costs; Hospital economics; Économie hospitalière