{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:52:52Z","timestamp":1791298372726,"version":"4.1.0"},"reference-count":10,"publisher":"CAIRN.INFO","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:p>En oncologie, un paradoxe persistant caract\u00e9rise les politiques de sant\u00e9\u00a0: les connaissances scientifiques et techniques progressent rapidement, mais les performances des syst\u00e8mes et les d\u00e9cisions publiques ne refl\u00e8tent pas toujours ces avanc\u00e9es. Malgr\u00e9 des progr\u00e8s majeurs en radioth\u00e9rapie, en imagerie et dans la standardisation des essais cliniques, les syst\u00e8mes europ\u00e9ens demeurent confront\u00e9s \u00e0 des co\u00fbts croissants, \u00e0 des in\u00e9galit\u00e9s d\u2019acc\u00e8s et \u00e0 des variations de r\u00e9sultats insuffisamment expliqu\u00e9es par les seuls facteurs \u00e9pid\u00e9miologiques. Cet article d\u00e9fend l\u2019hypoth\u00e8se que ces limites rel\u00e8vent moins d\u2019un d\u00e9ficit de preuves que d\u2019un d\u00e9faut d\u2019int\u00e9gration entre trois dimensions essentielles de l\u2019action publique\u00a0: l\u2019assurance qualit\u00e9 technique, l\u2019\u00e9valuation \u00e9conomique en sant\u00e9 et la gouvernance. L\u2019exp\u00e9rience de l\u2019assurance qualit\u00e9 en radioth\u00e9rapie montre que la variabilit\u00e9 peut \u00eatre r\u00e9duite lorsque les standards sont harmonis\u00e9s et int\u00e9gr\u00e9s \u00e0 l\u2019\u00e9chelle des syst\u00e8mes. Les \u00e9valuations \u00e9conomiques soulignent, quant \u00e0 elles, que la valeur des interventions d\u00e9pend \u00e9troitement des contraintes organisationnelles et territoriales. Cependant, ces dimensions sont souvent abord\u00e9es de mani\u00e8re s\u00e9quentielle plut\u00f4t que coordonn\u00e9e\u00a0: validation technique, puis analyse \u00e9conomique, puis d\u00e9cision politique. Cette fragmentation limite la capacit\u00e9 des syst\u00e8mes \u00e0 transformer les connaissances disponibles en politiques coh\u00e9rentes et soutenables. Au-del\u00e0 du champ oncologique, cette analyse interroge les modalit\u00e9s de d\u00e9cision dans les domaines de sant\u00e9 \u00e0 forte intensit\u00e9 technologique et plaide pour un cadre int\u00e9gr\u00e9 d\u2019\u00e9laboration des politiques, articulant qualit\u00e9, efficience et gouvernance.<\/jats:p>","DOI":"10.3917\/spub.263.0019","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:30:38Z","timestamp":1791297038000},"page":"19-22","source":"Crossref","is-referenced-by-count":0,"title":["De l\u2019optimisation technique \u00e0 la valeur au niveau du syst\u00e8me en oncologie\u00a0: int\u00e9grer l\u2019assurance qualit\u00e9, l\u2019\u00e9valuation \u00e9conomique et la gouvernance"],"prefix":"10.3917","volume":"vol. 38","author":[{"given":"Christos","family":"Melidi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2273","reference":[{"key":"rb1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.08.348"},{"key":"rb2","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2012.09.001"},{"key":"rb3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmir.2023.05.042"},{"key":"rb4","doi-asserted-by":"publisher","DOI":"10.1016\/j.vhri.2025.101510"},{"key":"rb5","doi-asserted-by":"publisher","DOI":"10.1002\/hec.3120"},{"key":"rb6","unstructured":"6. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford: Oxford University Press; 2015."},{"key":"rb7","unstructured":"7. Giannoula E, Exadaktylou P, Melidis C, Koutsouki G, Katsadouros I, Tsangaridi A, et al. Real-world applicability of differentiated thyroid cancer guidelines. Hell J Nucl Med. 2024;27. doi: 10.1967\/s002449912730."},{"key":"rb8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-0009.2007.00505.x"},{"key":"rb9","unstructured":"9. European Commission. Europe\u2019s Beating Cancer Plan. COM(2021) 44 final. Brussels: European Commission; 2021."},{"key":"rb10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7272.1300"}],"container-title":["Sant\u00e9 Publique"],"original-title":[],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:30:39Z","timestamp":1791297039000},"score":1,"resource":{"primary":{"URL":"https:\/\/stm.cairn.info\/revue-sante-publique-2026-3-page-19?lang=fr&ref=doi"}},"subtitle":[""],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,10,5]]}},"URL":"https:\/\/doi.org\/10.3917\/spub.263.0019","relation":{},"ISSN":["0995-3914"],"issn-type":[{"value":"0995-3914","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,5]]}}}