Oncological Breast Cancer Care in Selected European Countries - Organisation of healthcare infrastructures and medical service provision

Duration: Mid-April 2024 – Mid-November 2024
Language: Englisch (with German summary)
Publication: HTA Project Report No. 162: https://eprints.aihta.at/1545/

Background:
In the last decade, the number of cancer cases in Austria has increased in terms of new cases (incidence) and the total number of patients (prevalence). The most common cancer types in Austria include breast, bowel, prostate, and lung cancer. Malignant neoplasms of the breast rank first in cancer prevalence in Austria, with 81,174 cases in 2018. At the same time, breast cancer is also the most common type of cancer in women incidence-wise (2020: 28%) [1, 2]. The increase in cancer incidence is primarily caused by demographic ageing. However, improved survival rates of cancer patients and increasing life expectancy also play decisive roles. Equally, the growing number of screening programmes and improved diagnostic methods impact the early detection of cancer, which has led to an increase in the number of registered new cases [2, 3].

The Austrian Federal Ministry of Labour, Social Affairs, Health and Consumer Protection (BMASGK) forecasted a further continuous increase in cancer prevalence in 2018. By the year 2030, it is expected that the number of cancer cases will increase by 39% compared to 2014. This would result in 457,700 cancer patients by 2030, accounting for 4.9% of the projected total population [4]. Consequently, an escalation of costs in the care of cancer patients can be expected. Current total costs for cancer in Austria per capita, adjusted for purchasing power parity (PPP), already exceed the EU average (AT: €440 versus EU: €326, as of 2018) [2].

In combination with the increasing cancer prevalence, there is also an expected growing demand for healthcare. Currently, Austria invests a higher percentage of its healthcare budget in inpatient care compared to the EU average. In 2021, this share was 30% of the total expenditures in Austria, while the EU average was 28% [5]. The intense focus on inpatient care in Austria is also reflected by the number of hospital beds. Thus, Austria's acute care bed density in 2014 was the third highest in the EU after Germany and Bulgaria (5.84 beds per 1,000 inhabitants versus the EU average of 3.94) [6, 7]. Despite ongoing reform efforts and a gradual increase in outpatient services, the Austrian healthcare system remains heavily hospital-centred compared to other countries. The lack of incentives and the significant fragmentation between cancer care sectors complicate the transition of cancer patient treatment to outpatient care [6].

Project aims and research questions (RQs):
In the context of hospital-centred care for cancer patients in Austria, the project seeks to identify "Good Practice" examples of cross-sectoral care for (breast) cancer patients in certain EU countries (Germany, selected Scandinavian countries, Belgium, and the Netherlands). Specifically, the project will examine the care structures for cancer patients using the example of breast cancer in different healthcare systems. Additionally, the provision of medical services and the involvement of professional groups will be of interest. Subsequently, the project will identify opportunities for potential shifts from inpatient cancer care to the outpatient sector within the Austrian healthcare system. Therefore, the following RQs will be addressed:

RQ1: How is cancer care, with a focus on breast cancer, organized across sectors in different European countries such as Germany, the Scandinavian countries, the Netherlands, and Belgium? Which professions are involved in the respective healthcare settings, and what medical services are available?

RQ2: How is (breast) cancer care organised in Austria? What medical services are provided in the different settings, and which professions are involved?

RQ3: To what extent does the care for breast cancer patients in Austria differ from Germany, selected Scandinavian countries, and other EU countries with social insurance systems regarding available healthcare structures, involved professions, and available medical services in the inpatient, outpatient, and ambulatory care settings? What opportunities for potential shifts from inpatient cancer care to the outpatient sector can be derived from the information obtained for Austria?

The project does not aim to…

• Consider patient pathways and medical service provision for specific breast cancer indications.
• Perform a systematic assessment of the (relative) effectiveness of medical treatments within the respective care structures (extramural versus intramural) regarding clinical endpoints or the care effectiveness within the healthcare system.
• Develop a care plan for Austrian breast cancer patients.

Methods:

RQ1: Country overview of care pathways and structures (medical service provision and involved professions) for breast cancer patients:

• Conduct an iterative search process and a structured manual search for intra- and inter-institutional care pathways in selected EU countries.
• Develop a generic patient pathway as a basis for information gathering and interviews.
• Identify institutions and experts informed about the available cancer care structures in their respective countries using the snowball principle. This step involves contacting experts, conducting interviews, and analysing grey literature. Translation will be provided for national languages.
• Screen documents related to cancer care pathways and service catalogues.
• In extraction tables, information on existing healthcare structures, involved professions, and medical service provision will be gathered.

RQ2: Identification of existing breast cancer care structures, involved professions, and medical services provided in Austria:

• Conduct an iterative search process and a structured manual search for intra- and interinstitutional care pathways.
• Contact breast cancer centres to describe the care processes and medical service provision.
• In extraction tables, information on existing healthcare structures, involved professions, and medical service provision will be gathered.

RQ3: Comparison of collected cancer care pathways and conclusion of obtained information:

• Conduct a country overview and comparison regarding existing healthcare structures, professions, and medical service provision.
• Perform a narrative synthesis of results and identification of potential areas of care that can be shifted to the outpatient/ambulatory sector.

PICo-Analysis:

All project steps (expert contact, interviews, material selection, information extraction, and control) will be conducted by two scientists. The results will be reviewed by an AIHTA reviewer (internal review) and at least one peer reviewer (expert in the field).

Timeline and Milestones:

References:

[1]       Statistik Austria. Krebserkrankungen in Österreich. Wien: 2022. Available from: https://www.statistik.at/fileadmin/publications/Krebserkrankungen_2022.pdf.

[2]       OECD. Länderprofile Krebs: Österreich 2023. EU Country Cancer Profiles. Paris: 2023. Available from: https://www.oecd-ilibrary.org/content/publication/0f690cb3-de.

[3]       Österreichische Krebshilfe und Österreichische Gesellschaft für Hämnatologie & medizinische Onkologie. Österreichischer Krebsreport. Wien: 2023 [cited 09.04.2024]. Available from: https://www.krebsreport.at/Krebsreport-2023.pdf.

[4]       Czypionka T., Kraus M. and Röhrling G. Perspektiven der Leistungs- und Kostenentwicklung in der Onkologie. Health System Watch. 2023.

[5]       OECD/European Observatory on Health Systems and Policies. Österreich: Länderprofil Gesundheit 2023, State of Health in the EU. Brussels: OECD Publishing, Paris/European Observatory on Health Systems and Policies, 2023.

[6]       Bachner F, Bobek J, Habimana K, Ladurner J, Lepuschutz L, Ostermann H, et al. Das österreichische Gesundheitssystem – Akteure, Daten, Analysen. 2019;20(3):1-288.

[7]       Czypionka T. and Kraus M. Verlagerungspotenziale im Gesundheitswesen. Wien: Institut für höhere Studien, 2020.