Access to innovative drugs for metastatic lung cancer treatment in a French nationwide cohort: the TERRITOIRE study

• Main Authors: Arnaud Scherpereel, Isabelle Durand-Zaleski, François-Emery Cotté, Jérôme Fernandes, Didier Debieuvre, Cécile Blein, Anne-Françoise Gaudin, Charlène Tournier, Alexandre Vainchtock, Pierre Chauvin, Pierre-Jean Souquet, Virginie Westeel, Christos Chouaïd
• Format: Article
• Language: English
• Published: BMC 2018-10-01
• Series: BMC Cancer
• Subjects: Metastatic lung cancer; Innovative treatments; France; Social deprivation
• Online Access: http://link.springer.com/article/10.1186/s12885-018-4958-5

Abstract Background Territorial differences in the access to innovative anticancer drugs have been reported from many countries. The objectives of this study were to evaluate access to innovative treatments for metastatic lung cancer in France, and to assess whether socioeconomic indicators were predictors of access at the level of the municipality of residence. Methods All incident cases of metastatic lung cancer hospitalised for a chemotherapy in public hospitals in 2011 were identified from the French National Hospital discharge database. Information on prescription of innovative drugs from an associated database (FICHCOMP) was crossed with the population density of the municipality and a social deprivation index based on national census data. Results Overall, 21,974 incident cases of metastatic lung cancer were identified, all of whom were followed for 2 years. Of the 11,486 analysable patients receiving chemotherapy in the public sector, 6959 were treated with a FICHCOMP drug at least once, principally pemetrexed. In multivariate analysis, prescription of FICHCOMP drugs was less frequent in patients ≥66 years compared to those ≤55 years (odds ratio: 0.49 [0.44–0.55]), in men compared to women (0.86 [0.79–0.94]) and in patients with renal insufficiency (0.55 [0.41–0.73]) and other comorbidities. Prescription rates were also associated with social deprivation, being lowest in the most deprived municipalities compared to the most privileged municipalities (odds ratio: 0.82 [0.72–0.92]). No association was observed between the population density of the municipality and access to innovative drugs. Conclusion Although access to innovative medication in France seems to be relatively equitable, social deprivation is associated with poorer access. The reasons for this need to be investigated and addressed.