From technical optimization to system-level value in oncology: Integrating quality assurance, economic evaluation and governance

Abstract

A persistent paradox characterizes health policy in oncology: Scientific and technical knowledge progresses rapidly, yet system performance and public decision-making do not always reflect these advances. Despite major improvements in radiotherapy, imaging, and the standardization of clinical trials, European health systems continue to face rising costs, inequalities in access, and variations in outcome that cannot be fully explained by epidemiological factors alone. This article advances the hypothesis that these limitations stem less from a lack of evidence than from insufficient integration among three essential dimensions of public action: technical quality assurance, health economic evaluation, and governance. The experience of quality assurance in radiotherapy demonstrates that variability can be reduced when standards are harmonized and embedded at the system level. Economic evaluations, in turn, highlight that the value of interventions depends closely on organizational and territorial constraints. However, these dimensions are often addressed sequentially rather than in a coordinated manner: technical validation, followed by economic analysis, and then policy decision-making. Such fragmentation limits the ability of health systems to translate available knowledge into coherent and sustainable policies. Beyond oncology, this analysis examines decision-making processes in high-technology health domains and advocates for an integrated policy framework articulating quality, efficiency, and governance.