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Master Thesis

La dimension économique a-t-elle une place dans la prescription des traitements antinéoplasiques en oncologie thoracique ?

Abstract : Background: immune checkpoint inhibitors have revolutionized treatment of advanced non-small cell lung cancer (NSCLC). In France, concerns have been raised as to the financial burden of these therapies and fear that potential patients may be ruled out. The reality of budgetary restrictions implies for choices to be made considering both the quality of life these treatments procure as well as the financial burden they represent. From a physician’s point of view, due to financial constraints on public health facilities, physicians’ could restrain themselves from prescribing innovative expensive therapies.
Methods: this qualitative study questions the impact of financial considerations on prescription choices made by thoracic oncologists. Ten French oncologists and two hospital pharmacists voluntarily underwent a semi-structured interview conducted by a student in an Ethics Master Degree. Interviews consisted in two distinct parts: one clinical case where treatment choices had to be made in first-line and second-line advanced NSCLC setting and a second part consisted in open-ended questions.
Results: qualitative analysis of the interviews brings out that immunotherapy has radically changed the history of cancer treatment but that efforts are still necessary to improve its prescription in real-world setting. Financial matters are a source of discussions between fellow physicians and clinical pharmacists. Physicians are aware of this issue and consider they have a duty to strictly respect guidelines particularly in a French universal healthcare system. They consider they ought to remain at least aware of these issues in order to participate in healthcare arbitration discussions.
Conclusion: arising costs of innovative drugs in oncology is a reality that forces to reconsider healthcare and drug regulation systems in order to be able to provide access to innovation for all eligible patients in the French universal healthcare system. Addressing this issue with physicians provides important insight on physicians’ role in that matter.
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Master Thesis
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Nathalie Olympios. La dimension économique a-t-elle une place dans la prescription des traitements antinéoplasiques en oncologie thoracique ?. Ethique. 2019. ⟨dumas-02513284⟩



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