Lung cancer in Europe Alan Lovell The Economist Intelligence Unit - - PowerPoint PPT Presentation

4 December 2018

Lung cancer in Europe

Alan Lovell The Economist Intelligence Unit Healthcare

Biggest cancer killer in Europe

DALYs for top 5 cancers in Europe: trend

• ver time

Source: EIU. Original data compiled from GBD

Lung cancer in numbers

About 1 in 5 of all cancer deaths in Europe are due to lung cancer Lung cancer cost Europe €18·8 billion in 2009, 15% of overall cancer costs The 5-year survival rate in Europe is 11.2% for men, and 13.9% for women

Source: WHO; Lung Cancer Europe, 2016; Economic burden of cancer across the European Union: a population-based cost analysis, Lancet Oncol 2013

Europe vs the rest of the world

Source: GLOBOCAN 2018

Smoking: a risk factor and source of stigma

Source: Lung Cancer Europe, 2016

WHO European Region has the highest prevalence of tobacco smoking among adults (28%), including one of the highest smoking prevalence rates among women (19%) About 85% of lung cancer cases are related to tobacco use

Lung cancer incidence between countries

Estimated age- standardized lung cancer incidence rate in Europe by gender per 100,000, 2012

Source: The Cancer Atlas

The research goal and countries

The research programme

• Despite recent progress in diagnostics and treatment of lung cancer, incidence

and mortality rates across Europe are poor. These rates vary significantly between and within European countries.

• The EIU is conducting a research programme centred on the development of a

scorecard comparing 13 countries with the aim of exploring how differing policy environments may partially drive the variation in lung cancer outcomes.

• After the scorecard we shall participate in a series of country workshops to

identify country level opportunities for improvement.

• Sponsored by MSD.

Thirteen countries

• 1. Austria
• 2. Belgium
• 3. Finland
• 4. France
• 5. Germany
• 6. Greece
• 7. Netherlands
• 8. Norway
• 9. Poland
• 10. Romania
• 11. Spain
• 12. Sweden
• 13. United Kingdom

Five year survival rates

Lung cancer age- standardised 5- year net survival: adults 15-99 years

Source: CONCORD

Note that European 5 year survival rates for breast and prostate cancer hover around 90% +

Money is important, but not the whole story

ROM UK POL FIN SPA FRA NET GER BEL SWE AUS NOR

5 yr lung cancer survival rate against health expenditure as scored as % of GDP

Source: EIU. Original data compiled from CONCORD and World Bank

Outcomes vary within and between regions

Lung cancer age- standardised DALY rate: trends from 1990 to 2016, Europe

Source: EIU. Original data compiled from GBD

Outcomes vary within and between regions

Lung cancer age- standardised DALY rate: trends from 1990 to 2016, Europe

Source: EIU. Original data compiled from GBD

Methods: scorecard and country profiles

Our approach

Scorecard development Country profiles drafted Country-based workshops Final report Scorecard and country profiles completed Literature review and expert panel meeting

we are here The programme is designed to inform policymakers, public health authorities and society as a whole on the most urgent issues confronting lung cancer and suggest a platform for action. delivery spring 2019

Our approach

Scorecard development Country profiles drafted Country-based workshops Final report Scorecard and country profiles completed Literature review and expert panel meeting

we are here

Literature review to inform draft scorecard

Literature review highlighted key areas for consideration focussed on the patient journey and beyond. The review was performed by an experience healthcare information specialist and incorporated indexed healthcare databases such as Medline and Embase, as well as grey literature

• searching. Searches were pragmatic

and focussed. Major areas/themes explored included:

• Health system infrastructure
• Awareness and advocacy
• Risk factors and prevention
• Screening
• Diagnosis and prognosis
• Treatment
• Supportive care
• Palliative care
• Patient involvement

Expert panel

Themes from expert panel

Patient involvement in HTAs: e.g. Working with the European Medicines Agency may allow better understanding of how

patient preferences and patient needs can be imbedded in the analysis using an evidence-based model.

Tobacco policies, targeting at risk groups and new forms of smoking: e.g. Participants stressed that we

must not ignore new forms of smoking. Young people who start vaping move to cigarettes:

Access and reimbursement of smoking cessation programmes: e.g. In some countries, reimbursement of

smoking cessation programmes does not occur, making this type of ‘treatment’ difficult for patients to access.

Screening: e.g. Screening needs to be implemented in some areas and improved in others. Demonstration projects are

required as well as discussions addressing risks and benefits.

Treatment – guidelines, organisation of services and availability: e.g. The equipment and tests used in

biomarker and molecular testing are not reimbursed in some countries. Centralisation of surgery could improve outcomes.

Outcome variation within countries: e.g. National perspectives cannot explain within country variations. Central

governments do not always impact health issues, particularly if they are managed regionally with different budgetary allocations.

Our approach

Scorecard development Country profiles drafted Country-based workshops Final report Scorecard and country profiles completed Literature review and expert panel meeting

we are here

The five domains

Lung cancer is...

1) a strategic priority

• cancer control plans
• evidence-based guidelines

2) a public health issue

• tobacco-control strategies
• e-cigarette control
• radon and air quality
• screening
• involvement of patient organisations

3) a race against time

• symptom awareness
• referral pathways

4) possible to address

• availability and access to treatment...
• inc surgery, radio, chemo and immunotherapies
• psychological assessment and support
• supportive and palliative care

5) ready for innovation

• registries
• research and development

How do we score the indicators?

With a finalised framework, the EIU will initiate the data collection process to evaluate individual countries. Draft scores will come from an objective assessment

• f the evidence base, including:
• Review of national policies, plans and strategies
• Review of specialised healthcare literature
• Utilisation of quantitative and qualitative information from international

databases (such as WHO, GLOBOCAN, and European Commission) Once draft scores have been completed, we will use the national workshops as an

• pportunity to validate the scores based on the experience of the attendees.

After the scorecard: Country profiles

• A 3-4 page profile of each country, culminating in local suggestions for ways to

improve outcomes

• Will incorporate the epidemiological burden of lung cancer in the country (including

prevalence, incidence, mortality, five-year survival rates and DALYs), and

• … an analysis of 3-4 scorecard indicators where the country performed poorly through

the lens of the (e.g.) WHO’s health systems building blocks or other suitable framework analysis, and

• … a description of where there may be barriers for progress in each indicator, in terms
• f the building blocks analysis, i.e.: 1) service delivery, 2) workforce, 3) information

system, 4) access, 5) financing and 6) leadership or governance.

Country profiles

Our approach

Scorecard development Country profiles drafted Country-based workshops Final report Scorecard and country profiles completed Literature review and expert panel meeting

we are here

Interim results

All scores liable to change

The scorecard

Draft results

Overall alignment with good practice

Country Alignment DALY % change 2000-2016 Limitation Finland Very High

• 20%

Norway Very High

• 25%

Sweden Very High

• 14%

United Kingdom Very High

• 16%

Belgium High

• 15%

France High

• 13%

Germany High

• 15%

Netherlands Moderate

• 21%

Missing data! Poland Moderate

• 24%

Spain Moderate

• 21%

Austria Low

• 11%

Missing data! Greece Low

• 13%

Missing data! Romania Low + 1%

• “Good alignment”

defined by how well countries scored for each indicator

• Countries can be

clustered according to how often they ranked near the top of bottom of the list for each indicator

• Note that this is not a

ranking (no ordering within clusters)

Draft results

Best performing by domain

Lung cancer is...

1) a strategic priority 2) a public health issue 3) a race against time 4) possible to address 5) ready for innovation

Draft results

Interim results: broad themes

• While there are patches of good practice everywhere, no single country or domain

scores highly across the board.

• While every country has a NCCP, quality is variable and only four countries have

updated them in the last five years. Only Sweden and Poland have a specific lung cancer plan/section of plan.

• Guideline coverage on the whole is good, though often missing details around

supportive/palliative care, shared decision making and the need for psychological support.

• Only seven countries (Belgium, France, Germany, Netherlands, Poland, Spain, UK)

have started/are involved in a trial to investigate whether and how lung cancer screening could be introduced.

Draft results

Interim results: broad themes cont’d

• Poland, Greece and Romania could do more to include patient organisations (in e.g.

policy).

• Only Belgium, Germany, Greece, Netherlands, Romania and UK have explicit fast-track

referral schemes for suspect lung cancer patients.

• Of the four commonly used biomarkers in lung cancer, testing for all four is only

reimbursed in Norway, Spain, Sweden and UK. None are reimbursed in France or Germany.

• Some form of cancer registry exists in all countries, though only Austria, Finland and UK

tick "all the boxes."

• Austria allocates the highest proportion of GDP on research. Romania and Poland the

least.

Draft results

Next steps

Next steps

• Quality assure the scores
• Continue to develop the country profiles
• Decide on “opportunities for improvement” for each country
• Attend country workshops

○ validate scores ○ complete country profiles

• Publish and amplify final report

Questions

alanlovell@eiu.com