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 over time Source: EIU. Original data compiled from GBD
Lung cancer in numbers Lung cancer cost The 5-year survival About 1 in 5 of all Europe € 18·8 rate in Europe is cancer deaths in billion in 2009, 11.2% for men, Europe are due 15% of overall and 13.9% for to lung cancer cancer costs 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 WHO European Region has the highest About 85% of lung prevalence of tobacco smoking among cancer cases are adults (28%) , including one of the related to tobacco highest smoking prevalence rates use among women (19%) Source: Lung Cancer Europe, 2016
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 Note that European 5 year survival rates for breast and prostate cancer hover around 90% + Source: CONCORD
Money is important, but not the whole story 5 yr lung cancer SWE FRA GER survival rate UK NET BEL against health AUS NOR FIN expenditure as SPA scored as % of POL GDP ROM 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 delivery spring 2019 Scorecard development Literature review Scorecard and Country-based and expert panel country profiles Final report workshops meeting completed Country profiles drafted The programme is designed to inform policymakers, public health authorities and society as a whole on the most urgent issues confronting lung cancer and we are here suggest a platform for action.
Our approach Scorecard development Literature review Scorecard and Country-based and expert panel country profiles Final report workshops meeting completed Country profiles drafted we are here
Literature review to inform draft scorecard Literature review highlighted key areas Major areas/themes explored included: ● for consideration focussed on the Health system infrastructure ● patient journey and beyond. Awareness and advocacy ● Risk factors and prevention ● The review was performed by an Screening ● experience healthcare information Diagnosis and prognosis ● specialist and incorporated indexed Treatment ● healthcare databases such as Medline Supportive care ● and Embase, as well as grey literature Palliative care ● searching. Searches were pragmatic Patient involvement and focussed.
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 Literature review Scorecard and Country-based and expert panel country profiles Final report workshops meeting completed Country profiles drafted we are here
The five domains ● cancer control plans Lung cancer is... 1) a strategic priority ● evidence-based guidelines ● tobacco-control strategies ● e-cigarette control ● 2) a public health issue radon and air quality ● screening ● involvement of patient organisations ● symptom awareness 3) a race against time ● referral pathways ● availability and access to treatment... ● inc surgery, radio, chemo and immunotherapies 4) possible to address ● psychological assessment and support ● supportive and palliative care ● registries 5) ready for innovation ● 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 of 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 opportunity 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 of 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 Literature review Scorecard and Country-based and expert panel country profiles Final report workshops meeting completed Country profiles drafted we are here
Interim results
All scores liable to change
Draft results The scorecard
Draft results Overall alignment with good practice ● “Good alignment” Country Alignment DALY % change 2000-2016 Limitation defined by how well Finland Very High - 20% countries scored for Norway Very High - 25% each indicator Sweden Very High - 14% United Kingdom Very High - 16% ● Countries can be Belgium High - 15% clustered according to France High - 13% how often they ranked Germany High - 15% near the top of bottom of Netherlands Moderate - 21% Missing data! the list for each indicator Poland Moderate - 24% ● Note that this is not a Spain Moderate - 21% ranking (no ordering Austria Low Missing data! - 11% within clusters) Greece Low Missing data! - 13% Romania Low + 1%
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
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