title: Ethical Hurdles in the Prioritization of Oncology Care.
abstract: With finite resources, healthcare payers must make difficult choices regarding spending and the ethical distribution of funds. Here, we describe some of the ethical issues surrounding inequity in healthcare in nine major European countries, using cancer care as an example. To identify relevant studies, we conducted a systematic literature search. The results of the literature review suggest that although prevention, access to early diagnosis, and radiotherapy are key factors associated with good outcomes in oncology, public and political attention often focusses on the availability of pharmacological treatments. In some countries this focus may divert funding towards cancer drugs, for example through specific cancer drugs funds, leading to reduced expenditure on other areas of cancer care, including prevention, and potentially on other diseases. In addition, as highly effective, expensive agents are developed, the use of value-based approaches may lead to unacceptable impacts on health budgets, leading to a potential need to re-evaluate current cost-effectiveness thresholds. We anticipate that the question of how to fund new therapies equitably will become even more challenging in the future, with the advent of expensive, innovative, breakthrough treatments in other therapeutic areas.
authors.affiliation: ToendersdeGroot B.V, Boomstede 281, 3608 AN, Maarssen, The Netherlands. fgroot@toendersdegroot.nl.
authors.forename: Folkert
authors.initials: F
authors.lastname: de Groot
authors.affiliation: School of Economics and Management, LIUC University, Castellanza, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Capri
authors.affiliation: Independent Consultant, Bandol, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Castanier
authors.affiliation: South East Commissioning Support Unit, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: University of Namur, Namur, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Flamion
authors.affiliation: Kassenärztliche Vereinigung Westfalen Lippe, Dortmund, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Flume
authors.affiliation: Kassenärztliche Vereinigung Hessen, Frankfurt, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Herholz
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Levin
authors.affiliation: Health Institute for Technology Transfer (HITT), Barcelona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Solà-Morales
authors.affiliation: AOK Rheinland/Hamburg, Düsseldorf, Germany.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Rupprecht
authors.affiliation: NAS Healthcare Solutions Ltd., Surbiton, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Shalet
authors.affiliation: University of Glasgow, Glasgow, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Walker
authors.affiliation: Mediqualité Omega, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Wong
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D005060:Europe; D006292:Health Priorities / Q000941:ethics*; D061889:Healthcare Financing / Q000941:ethics; D006801:Humans; D008495:Medical Oncology / Q000191:economics / Q000941:ethics*; D009369:Neoplasms / Q000188:drug therapy / Q000191:economics / Q000628:therapy; D012051:Reimbursement Mechanisms; D040841:Resource Allocation / Q000941:ethics
chemical_list: D000970:Antineoplastic Agents