| Titre : | Off-Label Prescribing in French Oncology Patients: A Multilevel Observational Study of Hospital Variation in Liste en sus Medications Using 2023 PMSI Data |
| Auteurs : | Éabha Manley ; Ecole des hautes études en santé publique (EHESP) (Rennes, FRA) |
| Type de document : | Mémoire |
| Année de publication : | 2025 |
| Description : | 37p. |
| Langues: | Anglais |
| Classement : | MPH/ (Mémoires MPH à partir de 2024) |
| Mots-clés : | Cancer ; Prescription ; Autorisation mise sur marché ; Médicament ; Médicament anticancéreux ; Hôpital ; Pratique professionnelle ; France |
| Résumé : |
Background Off-label prescribing is commonly seen in cancer patients. Progressive diminishing of regulations around off-label prescribing on the liste en sus in France may contribute to higher rates of off-label prescribing. Though often warranted, inappropriate off-label use of medications can result in worse patient outcomes and higher healthcare spending.
Objectives: In the context of rising costs of medications on the liste en sus, we wished to identify patient and hospital level factors predisposing to off label prescribing in cancer patients and explore variation in healthcare facilities across the country. Methods: We used 2023 PMSI hospital prescribing data to analyse off label prescribing trends in 1543716 hospital admissions across France. Using R we assessed association of patient level factors, initially with bivariate analysis with Chi square/Wilcoxon rank sum tests and subsequently using a generalised linear model. We then used a multilevel logistic model to explore patient and facility level factors and variation across hospitals. Results: Lower patient age and female sex were associated with off-label prescribing. Admissions with CNS cancers had 107 times the odds of off-label prescribing compared to those with respiratory cancers. Different probability of off-label prescribing was seen across different types of healthcare facilities, with teaching hospitals and cancer centres being more likely to have off label prescribing than general hospitals. When accounting for patient and facility level characteristics, we noted persistent variation in off-label prescribing practices between different hospitals. Conclusions: There appears to be significant variation in off-label prescribing practices in cancer across hospitals in France, which may be due to unmeasured factors such as hospital culture. Unwarranted variability in care is associated with poorer patient level, economic and environmental outcomes. These results warrant further investigation in order to guide future policy to improve prescribing practices |
| Diplôme : | Master MPH of public health |
| Plan de classement simplifié : | Master of Public Health - master international de Santé Publique (MPH) |
| En ligne : | https://documentation.ehesp.fr/memoires/2025/mph/eabha_manley.pdf |
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