Apports de l'évaluation économique et de l'analyse d'impact budgétaire pour la décision publique en santé : l'exemple du cancer du sein

The aim of this paper is to draw the reader's attention to the problem of dissemination of costly innovations, particularly in the field of oncology, in a context of scarce resources.Comparison of five economic aggregates related to health and the gross domestic product captures the weight of this sector in the national economy but also its cost to the community. A focus on oncology shows that during the year 2004, the cost of cancer in France, all sites being taken into account, amounted to 10.9 billion euros and the societal cost to 32 billion euros (2% of gross domestic product). The cost of breast cancer (36% of all female cancers) reached 1.5 billion euros for treatment and 3.5 billion euros for societal expenses (0.2% of gross domestic product). Due to the significant, rapid expansion of these costs (+19.2% in 2006 and 18.5% in 2007 for diagnosis-related group outliers) but also to the scarcity of resources, the development of costly innovations remains problematic. This article, based on concrete examples of breast cancer treatment, provides information on the contribution of health technology assessment (particularly cost-utility and budget impact analyses) to public decision. Economic evaluation, in particular, cost-utility assessment, allows comparison of costs and consequences (generic result usually expressed in quality-adjusted life years) in order to prioritize diagnostic and/or therapeutic strategies and to make choices based on social acceptability. Budget impact analysis, without consideration of efficacy, makes it possible to balance the financing needs arising from the adoption of a costly innovation with the paying capabilities of a given institution.