在荷兰,全基因组测序是癌症治疗的入场券:分子诊断机会的不平等是否不公平?

IF 2 Q3 HEALTH POLICY & SERVICES Journal of Cancer Policy Pub Date : 2024-06-20 DOI:10.1016/j.jcpo.2024.100492
Jilles Smids , Charlotte Bomhof , Maarten IJzerman , Eline Bunnik
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引用次数: 0

摘要

对肿瘤进行全基因组测序(WGS)有时会发现更多潜在的治疗靶点。因此,使用 WGS 的实践差异是造成靶向治疗机会不平等的一个原因,也是造成健康结果差异的一个原因。此外,如果患者只需自掏腰包支付相对有限的费用就能使用 WGS,有时还能为自己买到一张(非常)昂贵的公共资助治疗的门票,那么这种情况可能会更加严重。由此造成的 WGS 使用机会不平等是否应被视为不公平?根据荷兰医疗保健系统的现行做法(被称为平等主义),我们认为,不同医院在使用 WGS 方面的差异是医疗创新及其后续普及不可避免地需要时间的结果。因此,时间上的不平等是可以接受的,至少是可以容忍的,因为最终所有患者都会受益。然而,我们反对在公费医疗系统中允许自费进行 WGS,理由有四:允许自费对社会经济地位较高的患者有利的程度远高于医院之间的做法差异,可能导致公费医疗被取代,无助于最终使所有人受益,并可能破坏平等主义医疗系统所必需的团结精神。
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Whole genome sequencing as a ticket to cancer treatment in the Netherlands: Are inequalities in access to molecular diagnostics unfair?

Whole genome sequencing (WGS) of a tumour may sometimes reveal additional potential targets for medical treatment. Practice variation in the use of WGS is therefore a source of unequal access to targeted therapies and, as a consequence, of disparities in health outcomes. Moreover, this may even be more significant if patients seek access to WGS by paying a relatively limited amount of money out of pocket, and sometimes effectively buy themselves a ticket to (very) expensive publicly funded treatments. Should resulting unequal access to WGS be considered unfair? Drawing from current practice in the Dutch healthcare system, known as egalitarian, we argue that differences in employment of WGS between hospitals are the consequence of the fact that medical innovation and its subsequent uptake inevitably takes time. Consequently, temporal inequalities in access can be deemed acceptable, or at least tolerated, because and insofar as, ultimately, all patients benefit. However, we argue against allowing a practice of out-of-pocket payments for WGS in publicly funded healthcare systems, for four reasons: because allowing private spending favours patients with higher socio-economic status significantly more than practice variation between hospitals does, may lead to displacement of publicly funded health care, does not help to ultimately benefit all, and may undermine the solidaristic ethos essential for egalitarian healthcare systems.

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来源期刊
Journal of Cancer Policy
Journal of Cancer Policy Medicine-Health Policy
CiteScore
2.40
自引率
7.70%
发文量
47
审稿时长
65 days
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