title: [Evolution of reimbursement of high-cost anticancer drugs: Financial impact within a university hospital].
abstract: BACKGROUND
  In the context of health expenses control, reimbursement of high-cost medicines with a 'minor' or 'nonexistent' improvement in actual health benefit evaluated by the Haute Autorité de santé is revised by the decree of March 24, 2016 related to the procedure and terms of registration of high-cost pharmaceutical drugs. This study aims to set up the economic impact of this measure.
  
  
  METHODS
  A six months retrospective study was conducted within a French university hospital from July 1, 2015 to December 31, 2015. For each injectable high-cost anticancer drug prescribed to a patient with cancer, the therapeutic indication, its status in relation to the marketing authorization and the associated improvement in actual health benefit were examined. The total costs of these treatments, the cost per type of indication and, in the case of marketing authorization indications, the cost per improvement in actual health benefit were evaluated considering that all drugs affected by the decree would be struck off.
  
  
  RESULTS
  Over six months, 4416 high-cost injectable anticancer drugs were prescribed for a total cost of 4.2 million euros. The costs of drugs with a minor or nonexistent improvement in actual benefit and which comparator is not onerous amount 557,564 euros.
  
  
  CONCLUSIONS
  The reform of modalities of inscription on the list of onerous drugs represents a significant additional cost for health institutions (1.1 million euros for our hospital) and raises the question of the accessibility to these treatments for cancer patients.
authors.affiliation: Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, unité de pharmacie clinique oncologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Baudouin
authors.affiliation: Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, unité de pharmacie clinique oncologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Fargier
authors.affiliation: Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, unité de pharmacie clinique oncologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Ariane
authors.initials: A
authors.lastname: Cerruti
authors.affiliation: Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, unité de pharmacie clinique oncologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Dubromel
authors.affiliation: Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, unité de pharmacie clinique oncologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Vantard
authors.affiliation: Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, unité de pharmacie clinique oncologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Ranchon
authors.affiliation: Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, unité de pharmacie clinique oncologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Vérane
authors.initials: V
authors.lastname: Schwiertz
authors.affiliation: Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France; Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, service d'hématologie clinique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Salles
authors.affiliation: Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France; Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, service de pneumologie, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Souquet
authors.affiliation: Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France; Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, service de dermatologie, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France; Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, Service d'immuno-allergologie, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Hospices civils de Lyon, pôle d'activité médicale de médecine, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bérard
authors.affiliation: Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France; Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, service d'hépato-gastro-entérologie, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Nancey
authors.affiliation: Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France; Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, service d'oncologie médicale, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Freyer
authors.affiliation: Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France; Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, service d'oncologie médicale, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Trillet-Lenoir
authors.affiliation: Hospices civils de Lyon, institut de cancérologie, groupement hospitalier Sud, unité de pharmacie clinique oncologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France. Electronic address: catherine.rioufol@chu-lyon.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Rioufol
mesh_terms: D000279:Administration, Cutaneous; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000191:economics; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000191:economics; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005602:France; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007275:Injections, Intravenous; D007880:Legislation, Drug / Q000191:economics*; D009369:Neoplasms / Q000188:drug therapy*; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents
keywords: Amélioration du service médical rendu; Anticancer drug; Anticancéreux; Dépenses de santé; Health expenses; High-cost medicines; Improvement in actual benefice; Médicaments onéreux