4118 - Impact of financial considerations on French physicians’ prescription choices for advanced non-small cell lung cancer (NSCLC)

Background

Immune checkpoint inhibitors (ICI) have revolutionized treatment of advanced 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 potential impact of drug prices 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’s degree. Interviews consisted of two distinct parts: one clinical case where treatment choices had to be made in the first-line and second-line advanced NSCLC setting and a second part consisting of open-ended questions.

Results

Qualitative analysis of the interviews brings out that immunotherapy has radically changed the history of cancer treatment but that hopes in advanced NSCLC need to be tempered. Efficacy in a real-world setting is difficult to predict and efforts need to be made to identify accurate biomarkers. Financial matters are a source of discussions between fellow physicians and clinical pharmacists but not with patients. Physicians consider they have a duty to strictly respect guidelines particularly in a French universal healthcare system.

Conclusions

Rising costs of innovative drugs in oncology is a reality that forces a reconsideration of 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 how treatment choices are made, their expertise and their involvement in this matter. Physicians are concerned about access to innovation for their patients and consider they ought to remain aware of these issues in order to participate in healthcare arbitration discussions.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Laboratoire Ethique Médicale - Université Paris Descartes.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.