Market access of cancer drugs in European countries: improving resource allocation

Public health systems need to make well-founded choices in order to distribute their scarce resources in the most efficient way. Given the number of cancer patients, public/private investments in oncology research, the growing number of new anti-cancer agents and consequent budget impact of cancer care, market access of cancer drugs has become delicate over the last decade. Furthermore, decision makers are challenged by ethical objections and endeavour to provide fair and equal access to treatments for cancer patients. The aim of this study is to generate an overview of market access procedures for cancer drugs in eight European countries and formulate advice for improvement of resource allocation. Results are obtained through a literature review and a qualitative questionnaire and validated by experts with proven knowledge about procedures for price setting and reimbursement of drugs. Diverse measures are applied in the studied countries to optimize reimbursement of cancer drugs such as adjusted cost-effectiveness threshold, regulations for off-label use and new market access agreements. Additionally, innovative cancer drugs are excluded from explicit cost control measures such as payback of budget excess by pharmaceutical companies and lump-sum payments per diagnostic related groups (DRG) in the hospital. The results suggest that cancer is prioritized above other disease areas. Further research is necessary to address the question if society attaches higher value to cancer drugs than to treatments for other diseases.     

From the Cover: The age-specific force of natural selection and biodemographic walls of death

W. D. Hamilton’s celebrated formula for the age-specific force of natural selection furnishes predictions for senescent mortality due to mutation accumulation, at the price of reliance on a linear approximation. Applying to Hamilton’s setting the full nonlinear demographic model for mutation accumulation recently developed by Evans, Steinsaltz, and Wachter, we find surprising differences. Nonlinear interactions cause the collapse of Hamilton-style predictions in the most commonly studied case, refine predictions in other cases, and allow walls of death at ages before the end of reproduction. Haldane’s principle for genetic load has an exact but unfamiliar generalization.     

Is There a True Concern Regarding the Use of Hair Dye and Malignancy Development?: A Review of the Epidemiological Evidence Relating Personal Hair Dye Use to the Risk of Malignancy

Many advances in the cosmetic industry have increased our ability to enhance youth and beauty. Hair-coloring products are one such innovation. Over the past several decades, a significant amount of work has been dedicated to understanding the possible long-term side effects associated with hair-dye use, specifically looking at cancer risk. This paper describes the hair-coloring process, highlights the potentially carcinogenic ingredients in various hair-dying products, and reviews the epidemiological evidence relating personal hair-dye use to the risk of developing several types of malignancies.     

Severe retinal degeneration in a patient with Canavan disease

ABSTRACT

Background: Canavan disease is an autosomal recessive, neurodegenerative disorder caused by mutations in ASPA, a gene encoding the enzyme aspartoacylase. Patients present with macrocephaly, developmental delay, hypotonia, vision impairment and accumulation of N-acetylaspartic acid. Progressive white matter changes occur in the central nervous system. The disorder is often fatal in early childhood, but milder forms exist.

Materials and methods: Case report.

Results: We present the case of a 31-year-old male with mild/juvenile Canavan disease who had severe vision loss due to a retinal degeneration resembling retinitis pigmentosa. Prior to this case, vision loss in Canavan disease had been attributed to optic atrophy based on fundoscopic evidence of optic nerve pallor. Investigations for an alternative cause for our patient’s retinal degeneration were non-revealing.

Conclusion: We wonder if retinal degeneration may not have been previously recognized as a feature of Canavan disease. We highlight findings from animal models of Canavan disease to further support the association between Canavan disease and retinal degeneration.     

Timing and nature of reconstructive surgery for disorders of sex development – Introduction

The ideal timing and nature of surgical reconstruction in individuals with Disorders of Sex Development (DSD) is highly controversial. Despite the increasing number of publications on this topic, evidence-based recommendations still cannot be made. However it is generally accepted that optimal care for DSD requires an experienced multidisciplinary team. This means that surgical decisions are now made within the context of a multidisciplinary team and all members of the team – and not just specialist surgeons – may be called upon to discuss choices for surgery with patients and parents. To do this well, every clinician in the team should have an understanding of the range of techniques available for genital surgery, the risks and benefits of procedures and the controversies surrounding timing of surgery.The aim of this paper is to give an overview of the variety of surgical procedures in current use and in what situation a particular technique would be indicated. The short-term risks and benefits are described and where available long-term outcome data is discussed. To date, discussions surrounding genital surgery have been led primarily by surgeons. Some non-surgical clinicians have expressed unease about decision making in genital surgery but have felt ill equipped to comment on an area with which they are unfamiliar. This review gives a detailed explanation of current surgical practice offered in a specialized center for DSD and such information should facilitate a more balanced discussion.     

Fate of abstracts presented at the annual meetings of the American association of clinical anatomists

A recent study examined the rate of full‐length research paper publication following abstract presentation at the British association of clinical anatomists (BACA) annual meetings. The accepted standard for research dissemination is peer‐reviewed publication following presentation at a national or international meeting. The study objectives were quantitative assessment of the abstracts presented at the American Association of Clinical Anatomists' (AACA) annual meetings with regards to the rate of subsequent full‐length publication and comparison to BACA publication rates. All abstracts presented at the AACA annual meetings between 2003 and 2010 were analysed. MEDLINE was searched to identify peer‐reviewed publications arising from each presented abstract. In total, 1,120 abstracts were presented with 22.9% (n = 257) subsequently published as full‐length research papers. The mean number of abstracts presented each year was 140.0 ± 35.9. The median time to publication was 16 months. Chi‐squared analysis showed the publication rate of abstracts presented at AACA (22.9%) was not statistically significantly different to BACA (20.4%) (P = 0.09). A total of 11.3% (n = 29) of the articles were published as full‐length research articles before presentation as an abstract at an AACA meeting compared to 5.4% of abstracts presented at a BACA meeting. These rates are lower but comparable to those of surgical specialty meetings. Further work should try to identify any concerning reasons for the reduced rate of abstract publication in anatomical research. Clin. Anat. 30:140–144, 2017. © 2017 Wiley Periodicals, Inc.