Should oral anticancer drugs be classified in a separated list when used in hospital at home?

Abstract

The model of hospital at home (HAH) is in constant development. As a result of the increasing demand of the population to be treated at home, thisfield needsthe commitment of the government to promote better patient care. In France, an important challenge to develop home health care as an alternative to standard hospitalization is the revision of its financing mode by 2018. Since the high costs of oral anticancer drugs (OACD) are a concern in this field we designed an economic analysis to evaluate their costs. We determined the ratio of OACD costs to the total costs of stays in the Hospital at Home of Assistance Publique-Hôpitaux de Paris (AP-HP) in 2014. This ratio is used to establish whether a drug can be classified in a specific list of reimbursement
to obtain funding by the health insurance system. Data of all patients treated at home with OACD in 2014 were extracted from a database from the department of medical information. Our results showed that only 17% (42 out of 241) of all stays analyzed had a ratio of 30% or over (the criteria for reimbursement). However, we found that the ratio can exceed 100% for few HAH stays (6). These results illustrate the difficulties to finance oral cancer medicines in the HAH model. The proposal of creating a specific list for some of the drugs analyzed here could represent an alternative to achieve the goal of doubling HAH activity set by the French
Ministry of Health.