Health professionals would prioritize spending on the young over the old

December 01, 2015

The survey found that health professionals generally prioritize spending on the young over the old and on preventive care over curative care. Yet this preference is at odds with the actual spending priorities in most countries throughout the world-most governments spend more on curative than on preventive health care services.

Glenn Salkeld (University of Sydney, Australia) and colleagues surveyed 253 health professionals from six countries, asking them to rank ten health interventions in order of priority for spending from most important (rank 1) to least important (rank 10).

The median rankings of health-care spending priorities across all countries, in order of importance, were:

Childhood immunization Anti-smoking education for children General practitioner care for everyday illness 4. Screening for breast cancer 5. Intensive care for neonates 6. Support for carers of the elderly 7. Treatment for people with schizophrenia 8. Hip replacement 9. Heart transplant 10. Cancer treatment for smokers

The values expressed by the health professionals in this study, say Salkeld and colleagues, transcended national and sectoral boundaries.

"Across the world many countries are struggling with the health and financial implications of a rapid rise in non-communicable disease," they say. "If health care professionals and policy makers believe that prevention and targeting the young is an important principle for health spending priorities, then health care funders should examine the cost effectiveness evidence for intervening early in life."

Citation: Salkeld G, Henry D, Hill S, Lang D, Freemantle N, et al. (2007) What drives healthcare spending priorities? An international survey of health-care professionals. PLoS Med 4(2): e94.

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The researchers then divided tumors into groups depending on how well they responded to therapy, and examined the baseline and post-therapy RNA profiles to find genes that were more commonly expressed in Herceptin sensitive and Herceptin resistant tumors.

They first found that some single gene markers, such as HER2 and ER (estrogen receptor), did not change in the majority of tumors. "That tells us that the cancer cells are still creating HER2 surface proteins even as Herceptin is being used, and that means HER2 loss does not appear to be a mechanism of resistance in early stage breast cancer," Harris said.

Then, using multigene chips, the researchers derived a bevy of transcribed genes that likely play a role in Herceptin resistance. Some, such as IGF-1R, were suspected, because this protein is frequently over-expressed in breast tumors, Harris says, but others were not. For example, non-responding tumors were more likely to express genes associated with basal-like breast cancer, which the researchers found to be surprising. "Most basal-like tumors are HER2-negative," Harris said.

Herceptin resistant tumors were also more likely to express a variety of growth factors, suggesting that "activation of parallel pathways may release tumors from dependence on HER2 proliferation and survival," she said.

Although the study was not designed to look at outcome, the researchers determined that 42 of 48 patients had a clinical response (16 complete responses and 26 partial responses) from the neoadjuvant treatment, and five patients experienced cardiotoxicity. After a median 2.6-year-follow-up, three of 48 patients relapsed and one died of her disease.

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