Department of Social Policy and LSE Health, London School of Economics, Houghton Street, London WC2A 2AE, UK.
Eur J Health Econ. 2010 Jan;10 Suppl 1:S115-29. doi: 10.1007/s10198-009-0201-2.
This paper discusses the current care management arrangements for colorectal cancer (CRC) in 16 OECD countries plus the Russian Federation by analysing data sources, the uptake of screening and surveillance, the available capacity in endoscopy services, the treatment pathways in medical treatment, as well as the type and availability of pharmaceutical care. The paper highlights significant variations in practice across the 17 countries. Common themes emerge from each of these practices and standards in terms of political interest in policies and awareness of CRC (both of which need to be enhanced), affordability (in terms of scarcity of resources in some countries and out-of-pocket payments for parts of the overall treatment process), access (in terms of the significant variation that has been observed within and across countries with regard to diagnostics, treatment and certain pharmaceuticals) and quality of CRC services (which may arise due to variations in treatment and pharmaceutical guidelines as well as minimal monitoring). When considering policy options for the future, it is important to, first, improve data collection both within as well as across countries through international co-operation; second, it is critical to have greater national and international support for cancer screening activities proven to be effective and cost-effective; third, endoscopy capacity in individual countries needs to be improved, also allowing more choice to ensure timely diagnosis, regardless of screening activities; fourth, public and political awareness needs to be enhanced as it is the key to improving CRC outcomes; fifth, where appropriate, to give consideration to the principles of equity, human dignity and disease severity, among others, when deciding on the uptake of new (targeted) treatments, rather than base decisions solely on cost-effectiveness criteria; and sixth, to firm up national guidelines including screening, diagnosis, treatment, pharmaceutical treatments and surveillance, with a view to enhancing their timeliness, evidence-base and free access to all.
本文通过分析数据来源、筛查和监测的采用情况、内镜服务的可用能力、医疗治疗的治疗途径以及药物治疗的类型和可及性，讨论了 16 个经合组织国家和俄罗斯联邦目前对结直肠癌（CRC）的护理管理安排。本文突出了 17 个国家在实践中的显著差异。从这些实践和标准中，每个国家都出现了一些共同的主题，涉及对政策的政治兴趣和对 CRC 的认识（这两者都需要加强）、可负担性（在一些国家资源稀缺和部分整体治疗过程需要自掏腰包的情况下）、可及性（就诊断、治疗和某些药物方面的显著差异而言）和 CRC 服务的质量（这可能是由于治疗和药物指南的差异以及最小化监测造成的）。在考虑未来的政策选择时，首先要通过国际合作来改善国家内部和国家之间的数据收集；其次，需要更多的国家和国际支持来证明有效的癌症筛查活动是有效的和具有成本效益的；第三，需要提高个别国家的内镜能力，也需要增加更多的选择，以确保及时诊断，无论是否进行筛查活动；第四，需要提高公众和政治意识，因为这是改善 CRC 结果的关键；第五，在决定采用新的（有针对性的）治疗方法时，应酌情考虑公平、人类尊严和疾病严重程度等原则，而不仅仅是根据成本效益标准做出决定；第六，要制定国家指南，包括筛查、诊断、治疗、药物治疗和监测，以提高其及时性、循证依据和所有人的免费获取。
