[How to finance chemotherapy with new cancer drugs? / Comment financer l'utilisation de nouveaux médicaments de chimiothérapie?

Recently developed drugs are ten to one hundred fold more costly than the chemotherapies of the past while the number of eligible patients and the average duration of treatments are ever increasing. The combined effect of these trends makes budgeting a daunting task, in particular for hospitals with budgetary allocation. Balancing budgets became difficult with the arrival of taxanes, but innovative therapies based on biotechnological advances will further increase the financial slide. Hospital running costs can not be infinitely reduced. Therefore, new rules that govern the financing of innovative therapies become mandatory and budgetary allocations based on DRG evaluations will no longer be feasible.

[Prescription of diphosphonates in ambulatory oncology. A study of the health insurance medical services]. / Prescription des biphosphonates à visée cancérologique en pratique de ville. Une étude des services médicaux de l'assurance-maladie.

OBJECTIVES: As requested by the Health Ministry, the Agricultural (Mutualité Sociale Agricole) and Independant Professions (Assurance Maladie des Professions Indépendantes) Health Insurances carried out a survey to analyse the use of second generation oral biphosphonates. METHODS: The data, from 3,414 prescriptions, gathered over the twelve months from May '93, showed that clodronate is prescribed mainly for breast cancer (35%), prostate cancer (23%), multiple myeloma (19%) and carcinoma of the lung (7%). The other prescriptions (16%) were either related to various malignant diseases (18 types encountered) or non-malignant diseases (mainly osteoporosis, but also Paget's disease of bone and hyperparathyroidism). The initial prescriber was most often a cancerologist (49%) but also quite frequently (17%) a general practitioner. The treatment was prescribed for an average of 41 days. 1600 mg daily was the most frequent dose (79%). However, in non-authorised indications, especially osteoporosis, the dose was lower, generally 800 mg a day. Altogether 14% non-authorised indications were linked either to non-metastatic malignant diseases (for the prevention of metastases) or with osteo-condensing type metastases (prostate cancer: 43%) or non-malignant diseases (osteoporosis, Paget's disease of bone, hyperparathyroidism, chronic renal insufficiency, sympathetic algodystrophy, bedbound decalcification, etc.). The prescription for these cases was motivated by the expected beneficial effect on bone mineralisation. Such treatment authorised was more often initiated by a general practitioner (23%) than a specialist (12%). CONCLUSION: These data raise the problem of limiting the possibility of prescribing second generation biphosphonates as initial treatment to a specialist. They also reaffirm the need to have precise guidelines in the field of medical prescription controls.

Effect of lenograstim on the cost of autologous bone marrow transplantation. A preliminary communication.

High dose chemotherapy and autologous bone marrow transplantation (BMT) can produce prolonged remission in patients with malignant lymphoma or solid tumours. However, neutropenia is a serious complication of treatment in patients with these diseases. In this study, we investigated the costs and effects of using lenograstim, a recombinant human granulocyte colony-stimulating factor, to treat neutropenia in 16 patients with lymphoma or solid tumours. The cost of lenograstim was not included in the calculations. The duration of neutropenia and hospitalisation were both lower in patients who received lenograstim compared with no treatment. The mean cost of autologous BMT was FF142,000 in patients who received lenograstim, compared with FF166,000 in patients who did not. Savings were largely attributable to decreased expenditure on hospitalisation in the lenograstim-treated group. The cost of 14 days' treatment with lenograstim was estimated at FF10,500, based on a daily dosage of 150 micrograms/m2/day.

[Influence of the granulocyte growth factor on the cost of bone marrow autografts in oncologic hematology]. / Influence du facteur de croissance granulocytaire sur le coût des autogreffes de moelle en onco-hématologie.

OBJECTIVE: It is now possible to achieve prolonged remission of malignant lymphoma and certain cancers with high-dose chemotherapy followed by autograft with haematopoietic stem cells. We tested such a protocol, evaluating haematologic recovery, in order to determine the total cost of hospitalization. METHODS: Sixteen patients were included in the study, 7 had severe or relapsing lymphoma, 7 had breast cancer or cancer of the ovary and 2 had cancer of the testicule. Mean age was 34 years, 14 patients reached complete remission and relapse occurred in 2. Ten patients were given granulocyte growth factor and 6 were given a placebo. RESULTS: The duration of aplasia (number of days with a white cell count below 1 x 10(9)1) ranged from 10 to 32 days. In patients treated with granulocyte growth factor, it was shorter (16 vs 22 days) as was hospitalization time (27 vs 33 days). The cost of the autograft ranged from 100,000 FF to 250,000 FF and the average cost for the 16 patients was 149,500 FF including: 83,600 FF (56.4%) for hospitalization itself, 33,200 FF (22%) for drugs, mostly antibiotics, and 19,000 FF (13%) for laboratory examinations and 14,000 FF (9%) for blood transfusions. Total cost was lower in patients given granulocyte growth factor, 142,000 FF vs 166,000 FF for those given placebo. CONCLUSION: In order to shorten the duration of the aplasia period, haematopoietic growth factors are widely used in autograft protocols. Our findings give an evaluation of the cost in 16 patients and show that cost decreases in patients given granulocyte growth factor. This reduction is cost is related to a lower hospitalization cost and not a reduction in the number of drugs and transfusions required.