[The European countries confronting cancer: a set of indicators assessing public health status]. / Les pays européens face au cancer : étude d'un ensemble restreint d'indicateurs de santé publique.

CONTEXT: We now know that efficient public policies for cancer control need to be global and take into account each and all the factors involved: economics and level of development, style of life and risk factors, access to screening, effectiveness of the care-providing system. A very simple scorecard is proposed, based on publicized public health indicators, which allows a comparison between European countries. METHODOLOGY: We extracted 49 indicators from public databases and literature concerning 22 European countries. We made correlation calculations in order to identify relevant indicators from which a global score was extracted. Using a hierarchical clustering method we were then able to identify subsets of homogeneous countries. RESULTS: A 7 indicator scorecard was drawn up: national gross product, scientific production, smoking rate, breast screening participating rate, all cancer mortality rate (male population), 5 years relative survival for colorectal cancer and life expectancy at birth. A global score shows: 1) the better positioned countries: Switzerland, Sweden, Finland and France; 2) the countries where cancer control is less effective: Estonia, Hungary, Poland and Slovakia. Three subsets of countries with a fairly similar profile were identified: a high level of means and results group; a high level of means but a medium level of results group; and a low level of means and results group. CONCLUSION: This work emphasizes dramatically heterogeneous situations between countries. A follow-up, using a reduced but regularly updated set of public health indicators, would help induce an active European policy for cancer control.

[Refining the French system of cost assessment for oncology patients following chemotherapy]. / Peut-on améliorer la description des séjours de chimiothérapie dans le cadre du PMSI ? Etude des facteurs prédictifs des coûts de la chimiothérapie.

The aim of this study was to check the clinical predictive variables of the variance of the total cost by GHM for patients undergoing chemotherapy. 10 different hospitals registered 537 hospital stays and 1,535 day care sessions. The initial disease, metastases, other pathologies, participation to randomised trial were recorded. Each day health status, pain, stage of the protocol and the drugs, use of catheter, pump or chamber implant were noted. Work was measured separately for physicians and nurses per 24 hours using a visual analogy scale. Lab tests and drugs were recorded for each patient. The cost of the drugs explain 98% of the variance of the total cost for the day care and 50% for the hospitalisations. For the latter, beside the cost of drugs, the length of stay, labor, initial disease, age, pain and associated pathology are predictive variables. According to this results, we conclude that the drugs for chemotherapy should be paid separately. No other change should be made for day care. DRG for hospitalized patients should take into account initial disease, age and pain.

[The cost of cancer in France: macroeconomic and microeconomic approaches, evolution towards a prospective payment system]. / Le coût du cancer en France: approches macro et micro-économiques, évolution vers la tarification à l'activité.

In this article we have reviewed the cost of cancer in France, based on a literature review. The cost of the treatment of cancer is estimated to be 10 thousand million euros for 75,000 lives saved annually. The increasing number of economic evaluations of cancer use both a macro economic approach, based on DRG data, and a micro economic approach, based on cost result analysis. These cost studies provide the elements for a decision aid in the context of social demands, budget constraints and the evolution towards a DRG's prospective payment system which characterises present organisation of health care in France.

[A study based on national DRG data to evaluate work load, practice and cost relating to paediatric oncology in French hospitals]. / Un essai d'exploitation de la base nationale du PMSI pour évaluer la spécificité et le coût de la prise en charge hospitaliére des cancers pédiatriques en France.

OBJECTIVES: To assess if our methodology previously used for all cancers remains valid when only 1% of cancers are analysed, we used childhood cancer in French hospitals based on national DRG data. MATERIALS AND METHODS: With a specific algorithm we extracted from the 1999 national DRG data (16,539,352 hospitalisations) the cancer data (2,947,471 hospitalisations) and the reduced cancer data (2,711,025 hospitalisations). We used this reduced cancer data to identify the 77 350 hospitalisations for childhood cancers. RESULTS: The majority of hospitalisations (83%) and the Activity Synthetic Index (ISA) for childhood cancers are concentrated on University hospitals and regional cancer centres. The cost of childhood cancers was estimated to be 136 million euros, with haematology costing 60 million euros. Chemotherapy, which accounted for almost 50% of the ISA is the predominant therapy. DISCUSSION AND CONCLUSION: Our results appear to be consistent with the incidence and the clinical practices described by the population registries and the registry of the French Society for Paediatric Oncology. They correspond also with the organisation of the care of those patients which converges towards the global care of the patient in which the concept of health networks and patient's trajectories are pivotal. However, an investigation inside the hospitals is required to see if our results correspond with the reality. This is the objective of our next study.

[Volume and costs of the hospital management of cancer in France in 1999]. / Volume et coût de la prise en charge hospitalière du cancer en France en 1999.

The volume of hospitalization care for cancer is hardly measured; this, in particular, because there are various structures assuming those responsibilities and heterogeneous information systems. The objective of this study is to present a model of precise algorithm of selection of hospital stays for cancers from French National databases of hospital discharges, and its results for 1999. Cancer stays are selected firstly, according to the presence of a tumor diagnosis code. Then, a refine in/out sort is done, based on a precise criteria grid issued from an expert group. A financial valorisation of hospital activity is realised from national cost weight scale. On the whole, the 1999 cancer database contains 5,428,518 inpatients and outpatients stays. Cancer weight 15.8 % of the whole hospitalization care activity, and costs around 6.04 billion. Surgery is the first expense with 2,100 millions, then chemotherapy with 1 135 millions and radiotherapy with 670 millions. Digestive tumors represent about 26 % of total cost, tumors of the respiratory system and breast tumor 11 % each. A work of validation of this algorithm is being realized on a sample of care providers.

[Public health: a true concern in the French political scene]. / La santé publique doit devenir un enjeu du débat politique français.

A recent report of the Senate revealed the difficulties of elaborating an effective cancer policy in France. Senators particularly pointed to the necessity of establishing cancer care priorities and to the tremendous need for medical coordination. This paper will develop the annual state debate on social security funding. The authors will show that health policy is entirely dependent on health economics. We believe that health priorities and health outcomes should be defined before any financial decision is made, this preliminary debate being an essential contribution to evidence-based policy-making in public health.

[The Livre Blanc on cancer surgery]. / Le Livre blanc de la chirurgie cancérologique.

CONTEXT: Among the several therapeutic weapons against cancer, surgical oncology has always been a major, and remains, up today. But in that field, outcomes are heavily dependent on the way the surgery is conducted. OBJECTIVES: The National Federation of Cancer Centers, in accordance with all French cancer specialists, tried to define the adequate conditions allowing the best practices for surgical oncology. This work called Livre blanc, includes several proposals to public authorities. METHOD: Both a specific survey within the French cancer centers and an analysis of public databases have been conducted first. Several experts groups of surgeons and oncologists have been organized, in order to discuss and improve the proposals. RESULTS: Different specificities of surgical oncology are described in the Livre Blanc: The state of medical capacities and it's organization, the impact of the good clinical practice on the outcomes, and the lack of recognition of this speciality. Two main proposals are highlighted: the need of setting up a university diploma better adapted to the main speciality, and the coordination of surgical oncology activity within cancer care networks.