cn017 enjeux médico-économiques de loncogériatrie pr isabelle durand-zaleski unité de recherche...
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CN017
Enjeux meacutedico-eacuteconomiques de lrsquooncogeacuteriatrie
Pr Isabelle Durand-ZaleskiUniteacute de recherche clinique
en eacuteconomie de la santeacuteDrsquoIle-de-France
Printemps de lrsquooncogeacuteriatrie 2013CN017
Enjeux meacutedico-eacuteconomiques de lrsquooncogeacuteriatrie
Pr Isabelle Durand-Zaleski
Printemps de lrsquooncogeacuteriatrie 2013CN017
Plan
Les ideacutees reccediluesLes donneacuteesLes travaux agrave mener
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les ideacutees reccedilues
Trop ou trop peu de soins pour les personnes acircgeacuteesHyperspeacutecialisation qui nuit agrave une prise en charge globaleTraitement moins invasifs Peu drsquoessais pour valider les modaliteacutes theacuterapeutiques diffeacuterentes
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees
Les coucircts de santeacute selon lrsquoacircge Et la maladieEt les recours aux soins en France et agrave lrsquoeacutetranger
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses de santeacute acircge deacutecegraves
HCAAM 2010 ndash Source BDormont
36 32 28 24 20 16 12 8 4 0Deacutelai avant la mort (en mois)
8 000
6 000
4 000
2 000
65-7475-8485+
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses et fin de vie
Les remboursements de la derniegravere anneacutee de vie srsquoeacutelegravevent agrave 22 000euro en moyenne en 2008 dont 12 500euro pour lrsquohocircpital public Ils diffegraverent selon les causes meacutedicales de deacutecegraves environ 40 000euro pour les tumeurs malignes Un effet neacutegatif de lrsquoacircge sur les deacutepenses de fin de vie est observeacute Les deacutepenses de santeacute augmentent agrave lrsquoapproche de la mort le dernier mois de vie correspondant agrave 28 des remboursements de la derniegravere anneacutee Parmi lrsquoensemble des remboursements de lrsquoassurance maladie en 2008 105 sont associeacutes agrave la derniegravere anneacutee de vie
Revue dEpideacutemiologie et de Santeacute Publique Volume 61 numeacutero 1pages 29-36 (feacutevrier 2013)
Printemps de lrsquooncogeacuteriatrie 2013CN017
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses en fonction de lrsquoacircge
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucircts de la derniegravere anneacutee de vie
Yabroff KR Lamont EB Mariotto A Warren JL Topor M Meekins A Brown ML Cost of care for elderly cancer patients in the United States J Natl Cancer Inst 2008 May 7100(9)630-41
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Enjeux meacutedico-eacuteconomiques de lrsquooncogeacuteriatrie
Pr Isabelle Durand-Zaleski
Printemps de lrsquooncogeacuteriatrie 2013CN017
Plan
Les ideacutees reccediluesLes donneacuteesLes travaux agrave mener
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les ideacutees reccedilues
Trop ou trop peu de soins pour les personnes acircgeacuteesHyperspeacutecialisation qui nuit agrave une prise en charge globaleTraitement moins invasifs Peu drsquoessais pour valider les modaliteacutes theacuterapeutiques diffeacuterentes
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees
Les coucircts de santeacute selon lrsquoacircge Et la maladieEt les recours aux soins en France et agrave lrsquoeacutetranger
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses de santeacute acircge deacutecegraves
HCAAM 2010 ndash Source BDormont
36 32 28 24 20 16 12 8 4 0Deacutelai avant la mort (en mois)
8 000
6 000
4 000
2 000
65-7475-8485+
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses et fin de vie
Les remboursements de la derniegravere anneacutee de vie srsquoeacutelegravevent agrave 22 000euro en moyenne en 2008 dont 12 500euro pour lrsquohocircpital public Ils diffegraverent selon les causes meacutedicales de deacutecegraves environ 40 000euro pour les tumeurs malignes Un effet neacutegatif de lrsquoacircge sur les deacutepenses de fin de vie est observeacute Les deacutepenses de santeacute augmentent agrave lrsquoapproche de la mort le dernier mois de vie correspondant agrave 28 des remboursements de la derniegravere anneacutee Parmi lrsquoensemble des remboursements de lrsquoassurance maladie en 2008 105 sont associeacutes agrave la derniegravere anneacutee de vie
Revue dEpideacutemiologie et de Santeacute Publique Volume 61 numeacutero 1pages 29-36 (feacutevrier 2013)
Printemps de lrsquooncogeacuteriatrie 2013CN017
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses en fonction de lrsquoacircge
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucircts de la derniegravere anneacutee de vie
Yabroff KR Lamont EB Mariotto A Warren JL Topor M Meekins A Brown ML Cost of care for elderly cancer patients in the United States J Natl Cancer Inst 2008 May 7100(9)630-41
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Plan
Les ideacutees reccediluesLes donneacuteesLes travaux agrave mener
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les ideacutees reccedilues
Trop ou trop peu de soins pour les personnes acircgeacuteesHyperspeacutecialisation qui nuit agrave une prise en charge globaleTraitement moins invasifs Peu drsquoessais pour valider les modaliteacutes theacuterapeutiques diffeacuterentes
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees
Les coucircts de santeacute selon lrsquoacircge Et la maladieEt les recours aux soins en France et agrave lrsquoeacutetranger
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses de santeacute acircge deacutecegraves
HCAAM 2010 ndash Source BDormont
36 32 28 24 20 16 12 8 4 0Deacutelai avant la mort (en mois)
8 000
6 000
4 000
2 000
65-7475-8485+
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses et fin de vie
Les remboursements de la derniegravere anneacutee de vie srsquoeacutelegravevent agrave 22 000euro en moyenne en 2008 dont 12 500euro pour lrsquohocircpital public Ils diffegraverent selon les causes meacutedicales de deacutecegraves environ 40 000euro pour les tumeurs malignes Un effet neacutegatif de lrsquoacircge sur les deacutepenses de fin de vie est observeacute Les deacutepenses de santeacute augmentent agrave lrsquoapproche de la mort le dernier mois de vie correspondant agrave 28 des remboursements de la derniegravere anneacutee Parmi lrsquoensemble des remboursements de lrsquoassurance maladie en 2008 105 sont associeacutes agrave la derniegravere anneacutee de vie
Revue dEpideacutemiologie et de Santeacute Publique Volume 61 numeacutero 1pages 29-36 (feacutevrier 2013)
Printemps de lrsquooncogeacuteriatrie 2013CN017
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses en fonction de lrsquoacircge
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucircts de la derniegravere anneacutee de vie
Yabroff KR Lamont EB Mariotto A Warren JL Topor M Meekins A Brown ML Cost of care for elderly cancer patients in the United States J Natl Cancer Inst 2008 May 7100(9)630-41
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les ideacutees reccedilues
Trop ou trop peu de soins pour les personnes acircgeacuteesHyperspeacutecialisation qui nuit agrave une prise en charge globaleTraitement moins invasifs Peu drsquoessais pour valider les modaliteacutes theacuterapeutiques diffeacuterentes
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees
Les coucircts de santeacute selon lrsquoacircge Et la maladieEt les recours aux soins en France et agrave lrsquoeacutetranger
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses de santeacute acircge deacutecegraves
HCAAM 2010 ndash Source BDormont
36 32 28 24 20 16 12 8 4 0Deacutelai avant la mort (en mois)
8 000
6 000
4 000
2 000
65-7475-8485+
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses et fin de vie
Les remboursements de la derniegravere anneacutee de vie srsquoeacutelegravevent agrave 22 000euro en moyenne en 2008 dont 12 500euro pour lrsquohocircpital public Ils diffegraverent selon les causes meacutedicales de deacutecegraves environ 40 000euro pour les tumeurs malignes Un effet neacutegatif de lrsquoacircge sur les deacutepenses de fin de vie est observeacute Les deacutepenses de santeacute augmentent agrave lrsquoapproche de la mort le dernier mois de vie correspondant agrave 28 des remboursements de la derniegravere anneacutee Parmi lrsquoensemble des remboursements de lrsquoassurance maladie en 2008 105 sont associeacutes agrave la derniegravere anneacutee de vie
Revue dEpideacutemiologie et de Santeacute Publique Volume 61 numeacutero 1pages 29-36 (feacutevrier 2013)
Printemps de lrsquooncogeacuteriatrie 2013CN017
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses en fonction de lrsquoacircge
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucircts de la derniegravere anneacutee de vie
Yabroff KR Lamont EB Mariotto A Warren JL Topor M Meekins A Brown ML Cost of care for elderly cancer patients in the United States J Natl Cancer Inst 2008 May 7100(9)630-41
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees
Les coucircts de santeacute selon lrsquoacircge Et la maladieEt les recours aux soins en France et agrave lrsquoeacutetranger
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses de santeacute acircge deacutecegraves
HCAAM 2010 ndash Source BDormont
36 32 28 24 20 16 12 8 4 0Deacutelai avant la mort (en mois)
8 000
6 000
4 000
2 000
65-7475-8485+
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses et fin de vie
Les remboursements de la derniegravere anneacutee de vie srsquoeacutelegravevent agrave 22 000euro en moyenne en 2008 dont 12 500euro pour lrsquohocircpital public Ils diffegraverent selon les causes meacutedicales de deacutecegraves environ 40 000euro pour les tumeurs malignes Un effet neacutegatif de lrsquoacircge sur les deacutepenses de fin de vie est observeacute Les deacutepenses de santeacute augmentent agrave lrsquoapproche de la mort le dernier mois de vie correspondant agrave 28 des remboursements de la derniegravere anneacutee Parmi lrsquoensemble des remboursements de lrsquoassurance maladie en 2008 105 sont associeacutes agrave la derniegravere anneacutee de vie
Revue dEpideacutemiologie et de Santeacute Publique Volume 61 numeacutero 1pages 29-36 (feacutevrier 2013)
Printemps de lrsquooncogeacuteriatrie 2013CN017
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses en fonction de lrsquoacircge
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucircts de la derniegravere anneacutee de vie
Yabroff KR Lamont EB Mariotto A Warren JL Topor M Meekins A Brown ML Cost of care for elderly cancer patients in the United States J Natl Cancer Inst 2008 May 7100(9)630-41
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses de santeacute acircge deacutecegraves
HCAAM 2010 ndash Source BDormont
36 32 28 24 20 16 12 8 4 0Deacutelai avant la mort (en mois)
8 000
6 000
4 000
2 000
65-7475-8485+
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses et fin de vie
Les remboursements de la derniegravere anneacutee de vie srsquoeacutelegravevent agrave 22 000euro en moyenne en 2008 dont 12 500euro pour lrsquohocircpital public Ils diffegraverent selon les causes meacutedicales de deacutecegraves environ 40 000euro pour les tumeurs malignes Un effet neacutegatif de lrsquoacircge sur les deacutepenses de fin de vie est observeacute Les deacutepenses de santeacute augmentent agrave lrsquoapproche de la mort le dernier mois de vie correspondant agrave 28 des remboursements de la derniegravere anneacutee Parmi lrsquoensemble des remboursements de lrsquoassurance maladie en 2008 105 sont associeacutes agrave la derniegravere anneacutee de vie
Revue dEpideacutemiologie et de Santeacute Publique Volume 61 numeacutero 1pages 29-36 (feacutevrier 2013)
Printemps de lrsquooncogeacuteriatrie 2013CN017
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses en fonction de lrsquoacircge
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucircts de la derniegravere anneacutee de vie
Yabroff KR Lamont EB Mariotto A Warren JL Topor M Meekins A Brown ML Cost of care for elderly cancer patients in the United States J Natl Cancer Inst 2008 May 7100(9)630-41
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses et fin de vie
Les remboursements de la derniegravere anneacutee de vie srsquoeacutelegravevent agrave 22 000euro en moyenne en 2008 dont 12 500euro pour lrsquohocircpital public Ils diffegraverent selon les causes meacutedicales de deacutecegraves environ 40 000euro pour les tumeurs malignes Un effet neacutegatif de lrsquoacircge sur les deacutepenses de fin de vie est observeacute Les deacutepenses de santeacute augmentent agrave lrsquoapproche de la mort le dernier mois de vie correspondant agrave 28 des remboursements de la derniegravere anneacutee Parmi lrsquoensemble des remboursements de lrsquoassurance maladie en 2008 105 sont associeacutes agrave la derniegravere anneacutee de vie
Revue dEpideacutemiologie et de Santeacute Publique Volume 61 numeacutero 1pages 29-36 (feacutevrier 2013)
Printemps de lrsquooncogeacuteriatrie 2013CN017
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses en fonction de lrsquoacircge
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucircts de la derniegravere anneacutee de vie
Yabroff KR Lamont EB Mariotto A Warren JL Topor M Meekins A Brown ML Cost of care for elderly cancer patients in the United States J Natl Cancer Inst 2008 May 7100(9)630-41
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses en fonction de lrsquoacircge
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucircts de la derniegravere anneacutee de vie
Yabroff KR Lamont EB Mariotto A Warren JL Topor M Meekins A Brown ML Cost of care for elderly cancer patients in the United States J Natl Cancer Inst 2008 May 7100(9)630-41
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Deacutepenses en fonction de lrsquoacircge
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucircts de la derniegravere anneacutee de vie
Yabroff KR Lamont EB Mariotto A Warren JL Topor M Meekins A Brown ML Cost of care for elderly cancer patients in the United States J Natl Cancer Inst 2008 May 7100(9)630-41
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucircts de la derniegravere anneacutee de vie
Yabroff KR Lamont EB Mariotto A Warren JL Topor M Meekins A Brown ML Cost of care for elderly cancer patients in the United States J Natl Cancer Inst 2008 May 7100(9)630-41
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Taux bruts et ajusteacutes de recours aux urgences
HCAAM 2010
Part des seacutejours hospitaliers en MCO pour lesquels les patients sont arriveacutes
par les urgences 2008
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les traitements en oncogeacuteriatrie
Par maladie en fonction de lrsquoacircgePour les diffeacuterents cancers chez les personnes acircgeacuteesLes coucircts des traitements initiaux Les coucircts du suivi
Essai clinique et eacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Coucirct moyen en euro des 7 ALD en France
Source A Holly
ECOSANTEacute France 2009
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Oncongeacuteriatrie et autres maladies
Akushevich I Kravchenko J Akushevich L Ukraintseva S Arbeev K Yashin AIMedical cost trajectories and onsets of cancer and noncancer diseases in US elderly population
Comput Math Methods Med 20112011857892 Comparaison des coucircts 1) du diagnostic 2) du traitement
initial et 3) du suivi des pathologies lieacutees au vieillissement dont les cancers
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Changement drsquoeacutechelle
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les donneacutees drsquoessais cliniques
erlotinib followed after progression by weekly chemotherapy (docetaxel 30 mgmsup2 for 6 consecutive weeks and gemcitabine 900 mgm2 at weeks 1 2 4 and 5 followed by a two-week treatment-free period) (Arm A) reverse strategy (arm B) The primary endpoint was second-progression-free survival
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Reacutesultats
This analysis showed no significant difference in patient outcomes between first-line erlotinib followed by chemotherapy after progression and the reverse sequence However the erlotinib-first strategy was less costly and the ICER of the chemotherapy-first strategy relative to the erlotinib-first strategy was 395 400 euro per QALY
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Chouaid C Le Caer H Locher C Dujon C Thomas P Auliac JB Monnet I Vergnenegre A GFPC 0504 Team Cost effectivenes of erlotinib versus chemotherapy for first-line treatment of non small cell lung cancer (NSCLC) in fit elderly patients participating in a prospective phase 2 study (GFPC 0504) BMC Cancer 2012 Jul 2012301
Les donneacutees drsquoessais cliniques
27 734thinspplusmnthinsp19 801euro and 31 688thinspplusmnthinsp22693 euro
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Que signifie ce scheacutema
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Effectiveness
Too high
Acceptable range
Low
1 times per capita GDP per 1 QALY
3ndash5 times per capita GDP per 1 QALY
Le ratio cout efficaciteacute ou coucirct utiliteacute en chiffres
GDP gross domestic product ICER incremental cost-effectiveness ratio QALY quality-adjusted life year
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
More costly worse outcome
Dominated
Less costly better outcome
Dominant
Increasing costs
Improving outcome
Less costly worse outcome
More costly better outcome
Are we ready to reduce qualityin order to contain costs
How much is the better outcome worth
Adapted from Laupacis A et al Can Med Assoc J 1992146473ndash81NICE Guide to the methods of technology appraisal 2008 Available at httpwwwniceorgukmediaB52A7TAMethodsGuideUpdatedJune2008pdf
Le plan coucirct efficaciteacute
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Lrsquoeacutevaluation eacuteconomique
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2013CN017
Les axes de recherche
Agrave partir de lrsquoanalyse de parcours individuelsReacuteduire
Les prescriptions et actes inadapteacutes(20 des hospitalisations seraient iatrogegravenes)Le recours aux urgences hospitaliegraveres
Creacuteer les incitations financiegraveres pour Une organisation autour du patienteacutevitant la sur-speacutecialisation disciplinaireReacutemuneacuterer les actes coordonneacutesFaciliter les interactions entre secteurs
HCAAM 2010
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-
Printemps de lrsquooncogeacuteriatrie 2e eacutedition
- Slide 26
-