title: RELATIVE EFFECTIVENESS IN BREAST CANCER TREATMENT: A HEALTH PRODUCTION APPROACH.
abstract: BACKGROUND
  Pharmaceuticals' relative effectiveness has come to the fore in the policy arena, reflecting the need to understand how relative efficacy (what can work) translates into added benefit in routine clinical use (what does work). European payers and licensing authorities assess value for money and post-launch benefit-risk profiles, and efforts to standardize assessments of relative effectiveness across the European Union (EU) are under way. However, the ways that relative effectiveness differs across EU healthcare settings are poorly understood.
  
  
  METHODS
  To understand which factors influence differences in relative effectiveness, we developed an analytical framework that treats the healthcare system as a health production function. Using evidence on breast cancer from England, Spain, and Sweden as a case study, we investigated the reasons why the relative effectiveness of a new drug might vary across healthcare systems. Evidence was identified from a literature review and national clinical guidance.
  
  
  RESULTS
  The review included thirteen international studies and thirty country-specific studies. Cross-country differences in population age structure, deprivation, and educational attainment were consistently associated with variation in outcomes. Screening intensity appeared to drive differences in survival, although the impact on mortality was unclear.
  
  
  CONCLUSIONS
  The way efficacy translates into relative effectiveness across health systems is likely to be influenced by a range of complex and interrelated factors. These factors could inform government and payer policy decisions on ways to optimize relative effectiveness, and help increase understanding of the potential transferability of data on relative effectiveness from one health system to another.
authors.affiliation: Servei Català de la Salut (CatSalut)Ruth.puig@catsalut.cat.
authors.forename: Ruth
authors.initials: R
authors.lastname: Puig-Peiro
authors.affiliation: University of York.
authors.forename: Anne
authors.initials: A
authors.lastname: Mason
authors.affiliation: Office of Health Economics.
authors.forename: Jorge
authors.initials: J
authors.lastname: Mestre-Ferrandiz
authors.affiliation: Office of Health Economics.
authors.forename: Adrian
authors.initials: A
authors.lastname: Towse
authors.affiliation: AstraZeneca.
authors.forename: Clare
authors.initials: C
authors.lastname: McGrath
authors.affiliation: Stockholm School of Economics.
authors.forename: Bengt
authors.initials: B
authors.lastname: Jonsson
mesh_terms: D000367:Age Factors; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality; D057186:Comparative Effectiveness Research; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D011379:Prognosis; D012307:Risk Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D013673:Technology Assessment, Biomedical / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents
keywords: Breast neoplasms; Drug evaluation; European Union; Relative effectiveness