401
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Droitcourt C, Poizeau F, Kerbrat S, Balusson F, Drezen E, Happe A, Travers D, Oger E, Dupuy A. Isotretinoin and risk factors for suicide attempt: a population-based comprehensive case series and nested case-control study using 2010-2014 French Health Insurance Data. J Eur Acad Dermatol Venereol 2019; 34:1293-1301. [PMID: 31587374 DOI: 10.1111/jdv.16005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the causal role of isotretinoin in suicidal behaviour is controversial, suicide attempts (SA) do occur among patients taking isotretinoin. OBJECTIVES To describe patient profiles and the management of isotretinoin among patients who committed or attempted suicide under treatment. To assess the risk factors for SA under isotretinoin. METHODS We performed a comprehensive case series of suicides and SAs under isotretinoin, and a case-control study, using Nationwide French Health Insurance database. The main analysis compared cases (subjects with a SA during a course of isotretinoin) to controls, individually matched for age, gender and rank of the current course; controls were to be exposed to isotretinoin at the index date (date of SA for the corresponding cases). The patients' psychiatric history at isotretinoin initiation was studied. In a secondary analysis, patients who continued their isotretinoin treatment after their SA were compared to patients who discontinued it. RESULTS In all, 328 018 subjects started a course of isotretinoin between 1 January 2010 and 31 December 2014 and 184 patients were hospitalized for a SA; half of them had a psychiatric history at initiation. In the multivariate analysis, psychiatric history and history of anxiety alone were risk factors for SA [Odds ratio (OR), 18.21; 95% confidence interval (CI), 9.96-33.30 and 4.78; 95% CI, 2.44-9.33, respectively]. Among 176 cases of SA with sufficient follow-up, 103 (58.5%) carried on with their treatment after their SA. Treatment initiation by a dermatologist was inversely associated with the continuation of the treatment after a SA (OR, 0.38; 95% CI, 0.18-0.80). CONCLUSIONS Suicide attempts under isotretinoin are rare events, and our results suggest that most of the patients concerned have a risk-prone profile detectable at the time of treatment initiation. The risk-benefit ratio of continuing isotretinoin after a SA warrants further careful evaluation.
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Affiliation(s)
- C Droitcourt
- Department of Dermatology, CHU Rennes, Rennes, France.,INSERM CIC 1414, Université de Rennes, Rennes, France.,EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Université de Rennes, Rennes, France.,Pharmacovigilance, Pharmacoepidemiology and Drug Information Departments, PEPS Research Consortium, Rennes, France
| | - F Poizeau
- Department of Dermatology, CHU Rennes, Rennes, France.,EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Université de Rennes, Rennes, France.,Pharmacovigilance, Pharmacoepidemiology and Drug Information Departments, PEPS Research Consortium, Rennes, France
| | - S Kerbrat
- EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Université de Rennes, Rennes, France.,Pharmacovigilance, Pharmacoepidemiology and Drug Information Departments, PEPS Research Consortium, Rennes, France
| | - F Balusson
- EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Université de Rennes, Rennes, France
| | - E Drezen
- EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Université de Rennes, Rennes, France
| | - A Happe
- EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Université de Rennes, Rennes, France.,Pharmacovigilance, Pharmacoepidemiology and Drug Information Departments, PEPS Research Consortium, Rennes, France
| | - D Travers
- Department of Psychiatry, CHU Rennes, Rennes, France
| | - E Oger
- EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Université de Rennes, Rennes, France.,Pharmacovigilance, Pharmacoepidemiology and Drug Information Departments, PEPS Research Consortium, Rennes, France
| | - A Dupuy
- Department of Dermatology, CHU Rennes, Rennes, France.,EA 7449 REPERES 'Pharmacoepidemiology and Health Services Research', Université de Rennes, Rennes, France.,Pharmacovigilance, Pharmacoepidemiology and Drug Information Departments, PEPS Research Consortium, Rennes, France
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402
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Giral P, Neumann A, Weill A, Coste J. Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France. Eur Heart J 2019; 40:3516-3525. [PMID: 31362307 PMCID: PMC6855142 DOI: 10.1093/eurheartj/ehz458] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/08/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS The role of statin therapy in primary prevention of cardiovascular disease in persons older than 75 years remains a subject of debate with little evidence to support or exclude the benefit of this treatment. We assessed the effect of statin discontinuation on cardiovascular outcomes in previously adherent 75-year-olds treated for primary prevention. METHODS AND RESULTS A population-based cohort study using French national healthcare databases was performed, studying all subjects who turned 75 in 2012-14, with no history of cardiovascular disease and with a statin medication possession ratio ≥80% in each of the previous 2 years. Statin discontinuation was defined as three consecutive months without exposure. The outcome was hospital admission for cardiovascular event. The hazard ratio comparing statin discontinuation with continuation was estimated using a marginal structural model adjusting for both baseline and time-varying covariates (cardiovascular drug use, comorbidities, and frailty indicators). A total of 120 173 subjects were followed for an average of 2.4 years, of whom 17 204 (14.3%) discontinued statins and 5396 (4.5%) were admitted for a cardiovascular event. The adjusted hazard ratios for statin discontinuation were 1.33 [95% confidence interval (CI) 1.18-1.50] (any cardiovascular event), 1.46 (95% CI 1.21-1.75) (coronary event), 1.26 (95% CI 1.05-1.51) (cerebrovascular event), and 1.02 (95% CI 0.74-1.40) (other vascular event). CONCLUSION Statin discontinuation was associated with a 33% increased risk of admission for cardiovascular event in 75-year-old primary prevention patients. Future studies, including randomized studies, are needed to confirm these findings and support updating and clarification of guidelines on the use of statins for primary prevention in the elderly.
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Affiliation(s)
- Philippe Giral
- Department of Endocrinology, Metabolism and Prevention of Cardiovascular Diseases, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anke Neumann
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale d’assurance maladie, Cnam), Paris, France
| | - Alain Weill
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale d’assurance maladie, Cnam), Paris, France
| | - Joël Coste
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale d’assurance maladie, Cnam), Paris, France
- Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, 27 rue du faubourg Saint-Jacques, Paris, France
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403
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Tuppin P, Tanguy-Melac A, Lesuffleur T, Janah A, Gastaldi-Ménager C, Fagot-Campagna A. Intensity of care for cancer patients treated mainly at home during the month before their death: An observational study. Presse Med 2019; 48:e293-e306. [PMID: 31734050 DOI: 10.1016/j.lpm.2019.09.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/12/2019] [Accepted: 09/25/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Little is known regarding healthcare for cancer patients treated mainly at home during the month before they die. The aim of this study was to provide information on how they were treated and what were their causes of death. METHODS This population-based observational study analysing information obtained from the French national healthcare data system (SNDS) included adult health insurance beneficiaries treated for cancer who died in 2015 after having spent at least 25 of their last 30 days at home. RESULTS Among the cancer patients who died in 2015, 25,463 (20%) were included [mean age (±SD) 74±13.2 years, men 62%]; 54% of them died at home. They were slightly older (75 vs. 73 years) than those who died in hospital, had less frequently received hospital palliative care during the year preceding their deaths (19% vs. 41%) and had less often used medical transport (41% vs. 73%) to an emergency department (8% vs. 62%), to hospital-based (11% vs. 17%) or community-based (16% vs. 12%) chemotherapy, to a general practitioner (73% vs. 78%) or to a community-based nursing service (63% vs. 73%). However, when they consulted a general practitioner (median 3 visits vs. 2) or a nurse (median 22 nursing procedures vs. 10) during their last month of life, visits were more frequent. The leading cause of death was tumour, which represented 69% of deaths at home vs. 74% of deaths in hospital. CONCLUSIONS In France, home management during the last month of life is uncommon and even when it is occurs, in one out of two cases patients pass away in a hospital setting. This study is an interrogation on medical choices, given the wish of many of the French to die at home and placing their choices in an international perspective.
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Affiliation(s)
| | | | | | - Asmaa Janah
- Aix Marseille University, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Inserm, Marseille, France
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404
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Health care utilization by men with prostate cancer during the year before their death: A 2015 population-based study. Prog Urol 2019; 29:995-1006. [PMID: 31708329 DOI: 10.1016/j.purol.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To study the characteristics and health care utilization of men with prostate cancer (PCa) during their last year and last month of life, as these data have been rarely reported to date. SUBJECTS AND METHOD Men covered by the national health Insurance general scheme (77% of the French population) treated for PCa (2014-2015), who died in 2015 were identified in the national health data system, including reimbursed hospital and outpatient care, and their causes of death. RESULTS A total of 11,193 men (mean age: 81 years, SD: 9.6) were included. Almost 58% of these men died in a short-stay hospital (SSH), 4% died in hospital-at-home, 9% died in Rehab, 9% died in skilled nursing homes and 21% died at home. During the last year of life, almost all men were hospitalised at least once in SSH and 47% received hospital palliative care (HPC), immediately prior to death in 8% of cases. During the last month of life, 76% of men were hospitalised at least once in SSH, 43% attended an emergency department and 14% were admitted to intensive care, 7% received a chemotherapy session, and 24% received an antineoplastic agent dispensed by a retail pharmacy. Cancer was the main cause of death for 63% of men, corresponding to PCa in 40% of cases, and cardiovascular disease was the main cause of death for 13% of men with marked variations according to age, place of death, and use of HPC. The mean cost reimbursed per man during the last year of life was €38,750 (€48,601 including HPC). CONCLUSIONS In France, end-of-life management of men with PCa, regardless of the cause of death, is centered on SSH and HPC, essentially at the time of death. Certain indicators of end-of-life management were particular high. LEVEL OF EVIDENCE 4.
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405
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Gabet A, Grimaud O, de Peretti C, Béjot Y, Olié V. Determinants of Case Fatality After Hospitalization for Stroke in France 2010 to 2015. Stroke 2019; 50:305-312. [PMID: 30621528 DOI: 10.1161/strokeaha.118.023495] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The aims of this study were to (1) describe early and late case fatality rates after stroke in France, (2) evaluate whether their determinants differed, and (3) analyze time trends between 2010 and 2015. Methods- Data were extracted from the Système National des données de santé database. Patients hospitalized for stroke each year from 2010 to 2015, aged ≥18 years, and affiliated to the general insurance scheme were selected. Cox regressions were used to separately analyze determinants of 30-day and 31- to 365-day case fatality rates for each stroke type (ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage). Results- In 2015, of the 73 124 persons hospitalized for stroke, 26.8% died in the following year, with the majority of deaths occurring within the first 30 days (56.9%). Nonadmission to a stroke unit, older age, and having comorbidities were all associated with a poorer 30-day and 31- to 365-day prognosis. Female sex was associated with a lower 31- to 365-day case fatality rate for all patients with stroke. Living in an area with a high deprivation index was associated with both higher 30-day and 31- to 365-day case fatality rates for all stroke types. Between 2010 and 2015, significant decreases in both 30-day and 31- to 365-day case fatality rates for ischemic patients were observed. Conclusions- Case fatality rates after stroke remained high in 2015 in France, despite major improvements in stroke care and organization. Improvement in stroke awareness and preparedness, particularly in the most deprived areas, together with better follow-up after the acute phase are urgently needed.
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Affiliation(s)
- Amélie Gabet
- From Santé publique France, the French Public Health Agency, Saint-Maurice, France (A.G., V.O.)
| | - Olivier Grimaud
- French School of Public Health (EHESP), Rennes, France (O.G.)
| | - Christine de Peretti
- Directorate for Research, Studies, Assessment and Statistics, Ministry of Social Affairs and Health, Paris, France (C.d.P.)
| | - Yannick Béjot
- Dijon Stroke Registry, EA 7460 Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital and Medical School of Dijon, University of Burgundy, France (Y.B.)
| | - Valérie Olié
- From Santé publique France, the French Public Health Agency, Saint-Maurice, France (A.G., V.O.)
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406
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Thereaux J, Lesuffleur T, Czernichow S, Basdevant A, Msika S, Nocca D, Millat B, Fagot-Campagna A. Long-term adverse events after sleeve gastrectomy or gastric bypass: a 7-year nationwide, observational, population-based, cohort study. Lancet Diabetes Endocrinol 2019; 7:786-795. [PMID: 31383618 DOI: 10.1016/s2213-8587(19)30191-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Concerns are rising about the late adverse events following gastric bypass and sleeve gastrectomy. We aimed to assess, over a 7-year period, the late adverse events after gastric bypass and sleeve gastrectomy compared with matched control groups. METHODS In this nationwide, observational, population-based, cohort study, we used data extracted from the French National Health Insurance (Système National des Données de Santé) database. All patients undergoing gastric bypass or sleeve gastrectomy in France in 2009, except those who had undergone bariatric surgery in the previous 4 years before inclusion, were matched with control patients with obesity in terms of age, sex, BMI category, baseline antidiabetic therapy, and baseline insulin therapy. Exclusion criteria for the control group included cancer, pregnancy, chronic infectious disease, serious acute or chronic disease in 2008-09, or previous (2005-09) or forthcoming (2010-11) bariatric surgery. The incidence rate was calculated for each type of adverse event leading to inpatient hospital admission over a 7-year period; incidence rate ratios (with 95% CIs) were computed to compare the rate of complications among the bariatric surgery and control groups. Risks of complications during follow-up were compared using Cox proportional-hazards regression analyses. Data were analysed according to the intention-to-treat methodology. FINDINGS From Jan 1, 2009, to Dec 31, 2009, 8966 patients who underwent bariatric surgery (7359 [82%] women; mean age 40·4 years [SD 11·3]) and 8966 matched controls (7359 [82%] women; mean age 40·9 years [11·4]) were included in analyses 4955 (55%) off 8966 patients in the bariatric surgery group had a primary gastric bypass and 4011 (45%) patients had sleeve gastrectomy. With a mean follow-up of 6·8 years (SD 0·2), mortality was lower in the gastric bypass group than in its control group (hazard ratio 0·64 [95% CI 0·52-0·78]; p<0·0001) and in the sleeve gastrectomy group than in its control group (0·38 [0·29-0·50]; p<0·0001). The gastric bypass and sleeve gastrectomy groups had higher risk than did their control groups for invasive gastrointestinal surgery or endoscopy (incidence rate ratio 2·4 [95% CI 2·1-2·7], p<0·0001, for gastric bypass vs control and 1·5 [1·3-1·7], p<0·0001, for sleeve gastrectomy vs control); for gastrointestinal disorders not leading to invasive procedures (1·9 [1·7-2·1]), p<0·0001, for gastric bypass vs control and 1·2 [1·1-1·4], p<0·0001, for sleeve gastrectomy vs control); and for nutritional disorders (4·9 [3·8-6·4], p<0·0001, for gastric bypass vs control and 1·8 [1·3-2·5], p<0·0001, for sleeve gastrectomy vs control). For psychiatric disorders, there was no significant association (1·1 [0·9-1·4], p=0·190, for gastric bypass vs control and 1·1 [0·8-1·3], p=0·645, for sleeve gastrectomy vs control), except for gastric bypass and alcohol dependence (1·8 [1·1-2·8], p=0·0124). INTERPRETATION Despite lower 7-year mortality, patients undergoing gastric bypass or sleeve gastrectomy had higher risk of hospital admission at least once for late adverse events, except for psychiatric disorders, than did control patients, with a higher risk observed after gastric bypass than with sleeve gastrectomy. FUNDING None.
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Affiliation(s)
- Jérémie Thereaux
- Department of Statistics, Caisse Nationale d'Assurance Maladie, Paris, France; Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Brest, France; Department of Thrombosis Study, University of Bretagne Occidentale, Brest, France.
| | - Thomas Lesuffleur
- Department of Statistics, Caisse Nationale d'Assurance Maladie, Paris, France
| | - Sébastien Czernichow
- Department of Nutrition (Centre Spécialisé Obésité), Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Nutrition, University Paris Descartes, Paris, France; Team METHODS, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité-CRESS INSERM UMR1153, Paris, France
| | - Arnaud Basdevant
- Institute of Cardiometabolism and Nutrition, Heart and Nutrition Department, Assistance-Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, France Sorbonne Universities, University Pierre et Marie Curie-Paris Paris, France
| | - Simon Msika
- Department of General, Digestive and Metabolic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Nocca
- Department of Surgery, Montpellier Faculty of Medicine, CHU Montpellier, Montpellier, France
| | - Bertrand Millat
- Department of Statistics, Caisse Nationale d'Assurance Maladie, Paris, France
| | - Anne Fagot-Campagna
- Department of Statistics, Caisse Nationale d'Assurance Maladie, Paris, France; Cabinet du Médecin Conseil National, Caisse Nationale d'Assurance Maladie, Paris, France
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407
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Bège T, Pauly V, Orleans V, Boyer L, Leone M. Epidemiology of trauma in France: mortality and risk factors based on a national medico-administrative database. Anaesth Crit Care Pain Med 2019; 38:461-468. [DOI: 10.1016/j.accpm.2019.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/18/2019] [Accepted: 02/02/2019] [Indexed: 12/01/2022]
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408
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Tanguy-Melac A, Aguade AS, Fagot-Campagna A, Gastaldi-Ménager C, Sabaté JM, Tuppin P. Management and intensity of medical end-of-life care in people with colorectal cancer during the year before their death in 2015: A French national observational study. Cancer Med 2019; 8:6671-6683. [PMID: 31553130 PMCID: PMC6825985 DOI: 10.1002/cam4.2527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 12/17/2022] Open
Abstract
The care pathway of patients with colorectal cancer (CRC) 1 year prior to death, their causes of death and the healthcare use, and associated expenditure remain poorly described together. People managed for CRC (2014‐2015), covered by the national health insurance general scheme and who died in 2015 were selected from the national health data system. A total of 15 361 individuals (mean age: 75 years, SD: 12.5 years) were included, almost 66% of whom died in short‐stay hospital (SSH), 9% in hospital at home (HaH), 4% in rehabilitation units (Rehab), 6% in skilled nursing homes (SNH), and 15% at home. At least one other cancer was identified for one‐third of these people. Almost one‐half of people presented cardiovascular comorbidity, 21% had chronic respiratory disease, and 13% had a neurological or degenerative disease. During the last month of life, 83% were admitted at least once to SSH, 39% had at least one emergency department admission, 17% were admitted to an intensive care unit, 15% received at least one chemotherapy session (<60 years: 27%), and 5% received oral chemotherapy. Eighty‐eight percent of the 60% of individuals who received hospital palliative care (HPC) vs 75% of those without HPC were admitted to SSH at least once during the last month. Cancer was the main cause of death for 84% (SSH: 85%, home: 77%) and corresponded to CRC for 64% of them. The mean annual expenditure per person during the last year of life was €43 398 (SSH: €48 804). This study suggests a relatively high level of HPC use during the year before death for people with CRC in France. High rates of emergency department, intensive care, and chemotherapy use were observed during the last month of life. However, management is very largely SSH‐based with a small proportion of deaths at home.
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Affiliation(s)
- Audrey Tanguy-Melac
- Caisse Nationale d'Assurance Maladie (Cnam) - Direction de la stratégie des études et des statistiques, Paris, France
| | - Anne-Sophie Aguade
- Caisse Nationale d'Assurance Maladie (Cnam) - Direction de la stratégie des études et des statistiques, Paris, France
| | - Anne Fagot-Campagna
- Caisse Nationale d'Assurance Maladie (Cnam) - Direction de la stratégie des études et des statistiques, Paris, France
| | - Christelle Gastaldi-Ménager
- Caisse Nationale d'Assurance Maladie (Cnam) - Direction de la stratégie des études et des statistiques, Paris, France
| | - Jean-Marc Sabaté
- Service de Gastroentérologie, Hôpital Avicenne AP-HP, Bobigny, France.,INSERM U-987, Physiopathologie et Pharmacologie Clinique de la Douleur, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Philippe Tuppin
- Caisse Nationale d'Assurance Maladie (Cnam) - Direction de la stratégie des études et des statistiques, Paris, France
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409
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Looten V. [Are studies of claims databases reproducible? The hypothesis of an instituted ethical misconduct in public health]. Med Sci (Paris) 2019; 35:689-692. [PMID: 31532382 DOI: 10.1051/medsci/2019134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Methodological reproducibility refers to the ability to reproduce exactly the same results by reproducing the same study protocol on the same data. The aim of this study was to assess the methodological reproducibility of studies published in the Revue d'Epidémiologie et de Santé Publique between 2008 and 2017 and using data from the national health data system. Our results suggest that only 49% of the studies could be replicated without the help of the authors. The results may reveal a lack of concern about the purpose of public health research. It is difficult to attribute responsibility for this default of reproducibility solely to researchers, so we hypothesize an instituted ethical misconduct.
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Affiliation(s)
- Vincent Looten
- Inserm, Centre de Recherche des Cordeliers, UMRS 1138, équipe « Sciences de l'information au service de la médecine personnalisée », Université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École de Médecine, 75006 Paris, France
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410
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Coste J, Karras A, Rudnichi A, Dray-Spira R, Pouchot J, Giral P, Zureik M. Statins for primary prevention of cardiovascular disease and the risk of acute kidney injury. Pharmacoepidemiol Drug Saf 2019; 28:1583-1590. [PMID: 31517431 PMCID: PMC6916201 DOI: 10.1002/pds.4898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/02/2019] [Accepted: 08/24/2019] [Indexed: 12/20/2022]
Abstract
Purpose To investigate the risk of acute kidney injury (AKI) in subjects initiating statin therapy for primary prevention of cardiovascular disease (CVD). Methods A nationwide cohort study using French hospital discharge and claims databases was performed, studying subjects from the general population aged 40 to 75 years in 2009, with no history of CVD and no lipid‐lowering drugs during the preceding 3‐year period, followed for up to 7 years. Exposure to statins (type, dose, and time since first use) and to other drugs for CVD risk was assessed. The primary outcome was hospital admission for AKI. Results The cohort included 8 236 279 subjects, 818 432 of whom initiated a statin for primary prevention. During 598 487 785 person‐months exposed to statins, 700 events were observed, corresponding to an incidence of AKI of 4.59 per 10 000 person‐years (7.01 in men, 3.01 in women). AKI mainly occurred in the context of organ failure, sepsis, and genitourinary disease. A 19% increased rate of AKI (hazard ratio = 1.19, 95%CI: 1.08‐1.31) was observed in men exposed to statins, whereas no increase in the overall risk of AKI was observed in women. However, exposure to high‐potency statins was associated with a 72% to 116% increased risk in both genders and a dose‐effect relationship observed for rosuvastatin and atorvastatin. No temporal pattern of occurrence nor interaction with drugs for CVD risk was observed. Conclusions Although the overall risk of AKI appears moderately increased, more attention should be paid to renal function in subjects taking statins for primary prevention both in clinical practice and from a research viewpoint.
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Affiliation(s)
- Joël Coste
- Department of Public Health Studies, French National Health Insurance Fund (CNAM), Paris, France.,Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France.,Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Paris, France
| | - Alexandre Karras
- Nephrology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Annie Rudnichi
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Rosemary Dray-Spira
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Jacques Pouchot
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Philippe Giral
- Department of Endocrinology-Metabolism, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié, Paris, France
| | - Mahmoud Zureik
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France.,Versailles Saint-Quentin-en-Yvelines University, Versailles, France
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411
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Dalon F, Roche N, Belhassen M, Nolin M, Pegliasco H, Deslée G, Housset B, Devillier P, Van Ganse E. Dual versus triple therapy in patients hospitalized for COPD in France: a claims data study. Int J Chron Obstruct Pulmon Dis 2019; 14:1839-1854. [PMID: 31692478 PMCID: PMC6708389 DOI: 10.2147/copd.s214061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022] Open
Abstract
Purposes Following a hospitalization for COPD, dual and triple therapies were compared in terms of persistence and relations with outcomes (exacerbations, health care resource use and costs). Methods This was a historical observational database study. All patients aged ≥45 hospitalized for COPD between 2007 and 2015 were identified in a 1/97th random sample of French claims data. Patients receiving dual therapy within 60 days after hospitalization were compared to patients receiving triple therapy, after propensity score matching on disease severity. Results Of the 3,089 patients hospitalized for COPD, 1,538 (49.8%) received either dual or triple therapy in the 2 months following inclusion, and 1,500 (48.6%) had at least 30 days of follow-up available; 846 (27.4%) received dual therapy, and 654 (21.2%) received triple therapy. After matching, the number of exacerbations was 2.4 per year in the dual vs 2.3 in the triple group (p=0.45). Among newly treated patients (n=206), persistence at 12 months was similar in the dual and triple groups (48% vs 41%, respectively, p=0.37). As compared to patients on dual therapy, more patients on triple therapy received oral corticosteroids (49.1 vs 40.4%, p=0.003) or were hospitalized for any reason (67% vs 55.8%, p=0.0001) or for COPD (35.3 vs 25.1%, p=0.0002) during follow-up. Cost of care was higher for patients on triple than for those on dual therapy (€11,877.1 vs €9,825.1, p=0.01). Conclusion Following hospitalizations for COPD, patients on dual and triple therapy experienced recurrent exacerbations, limited adherence to therapies and high cost of care. Patients on triple therapy appeared more severe than those on dual therapy, as reflected by exacerbations and health care resource use.
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Affiliation(s)
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, AP-HP and Paris Descartes University (EA2511), Sorbonne Paris Cité, Paris, France
| | | | - Maëva Nolin
- Pharmacoepidemiology Department, PELyon, Lyon, France
| | | | - Gaëtan Deslée
- Pulmonary Department, INSERM U1250, Maison Blanche University Hospital, Reims, France
| | - Bruno Housset
- Pulmonary Department, CHI de Créteil, University Paris Est Créteil, Créteil, France
| | - Philippe Devillier
- Department of Airway Diseases, UPRES EA 220, Foch Hospital, Paris-Saclay University, Suresnes, France
| | - Eric Van Ganse
- Pharmacoepidemiology Department, PELyon, Lyon, France.,EA 7425 Hesper Health Services and Performance Research, Claude-Bernard University, Lyon, France.,Respiratory Medicine, Croix-rousse Hospital, Lyon, France
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412
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Alari A, Cheysson F, Le Fouler L, Lanotte P, Varon E, Opatowski L, Guillemot D, Watier L. Association of Pneumococcal Conjugate Vaccine Coverage With Pneumococcal Meningitis: An Analysis of French Administrative Areas, 2001-2016. Am J Epidemiol 2019; 188:1466-1474. [PMID: 31197305 PMCID: PMC6670069 DOI: 10.1093/aje/kwz071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/13/2022] Open
Abstract
Geographic variations of invasive pneumococcal disease incidence and serotype distributions were observed after pneumococcal conjugate vaccine introduction at regional levels and among French administrative areas. The variations could be related to regional vaccine coverage (VC) variations that might have direct consequences for vaccination-policy impact on invasive pneumococcal disease, particularly pneumococcal meningitis (PM) incidence. We assessed vaccine impact from 2001 to 2016 in France by estimating the contribution of regional VC differences to variations of annual local PM incidence. Using a mixed-effect Poisson model, we showed that, despite some variations of VC among administrative areas, vaccine impact on vaccine-serotype PM was homogeneously confirmed among administrative areas. Compared with the prevaccine era, the cumulative VC impact on vaccine serotypes led, in 2016, to PM reductions ranging among regions from 87% (25th percentile) to 91% (75th percentile) for 7-valent pneumococcal conjugate vaccine serotypes and from 58% to 63% for the 6 additional 13-valent pneumococcal conjugate vaccine serotypes. Nonvaccine-serotype PM increases from the prevaccine era ranged among areas from 98% to 127%. By taking into account the cumulative impact of growing VC and VC differences, our analyses confirmed high vaccine impact on vaccine-serotype PM case rates and suggest that VC variations cannot explain PM administrative area differences.
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Affiliation(s)
- Anna Alari
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1181, Université Versailles St-Quentin-en-Yvelines, Institut Pasteur, Paris, France
- Université Versailles St-Quentin-en-Yvelines, Université Paris-Saclay, Versailles, France
| | - Félix Cheysson
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1181, Université Versailles St-Quentin-en-Yvelines, Institut Pasteur, Paris, France
- Université Paris Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | | | - Philippe Lanotte
- Observatoires Régionaux du Pneumocoque, Service de Bactériologie-Virologie-Hygiène Hospitalière Hôpital Bretonneau, Tours, France
| | | | - Emmanuelle Varon
- Centre National de Référence des Pneumocoques, Centre Hospitalier Intercommunal, Créteil, France
| | - Lulla Opatowski
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1181, Université Versailles St-Quentin-en-Yvelines, Institut Pasteur, Paris, France
| | - Didier Guillemot
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1181, Université Versailles St-Quentin-en-Yvelines, Institut Pasteur, Paris, France
- Assistance Publique, Hôpitaux de Paris, Hôpital Raymond-Poincaré, Unité Fonctionnelle de Santé Publique, Garches, France
| | - Laurence Watier
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1181, Université Versailles St-Quentin-en-Yvelines, Institut Pasteur, Paris, France
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413
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Meyer A, Rudant J, Drouin J, Coste J, Carbonnel F, Weill A. The effectiveness and safety of infliximab compared with biosimilar CT-P13, in 3112 patients with ulcerative colitis. Aliment Pharmacol Ther 2019; 50:269-277. [PMID: 31115919 PMCID: PMC6767082 DOI: 10.1111/apt.15323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/20/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND CT-P13, a biosimilar of the reference product infliximab, has been approved for the treatment of ulcerative colitis on the basis of the results of trials conducted in patients with spondyloarthritis and rheumatoid arthritis. AIM To compare the effectiveness and safety of CT-P13 and the reference product in infliximab-naive patients with ulcerative colitis METHODS: A comparative real-life equivalence cohort study was conducted using the French nationwide health administrative database. Infliximab-naive patients with ulcerative colitis over 15 years of age who started infliximab with no other indications for infliximab were included. The primary outcome was a composite endpoint (death, ulcerative colitis-related surgery, all-cause hospitalisation and reimbursement for other biologics). Equivalence was defined as a 95% CI of the hazard ratio (HR) of CT-P13 vs the reference product, in a multivariable marginal Cox model situated within prespecified margins of (0.80-1.25). RESULTS A total of 3112 patients were included between 1 January 2015 and 30 June 2017: 1434 received the reference product, 1678 received CT-P13. Overall, 710 patients in the reference product group and 743 patients in the CT-P13 group met the composite endpoint. In multivariable analysis of the primary outcome, CT-P13 was equivalent to the reference product (HR 1.04; 95% CI: 0.94-1.15). The number of serious infections was lower in the CT-P13 group (HR 0.65; 95% CI: 0.48-0.88). There was no difference in the incidence of solid or haematologic malignancy (HR 0.81; 95% CI: 0.41-1.60). CONCLUSIONS The effectiveness of CT-P13 is equivalent and the risk of serious infections could be lower than that of the reference product for infliximab-naive patients with ulcerative colitis.
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Affiliation(s)
- Antoine Meyer
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance,Service de gastroentérologie, BicêtreAssistance Publique-Hôpitaux de ParisLe Kremlin BicêtreFrance,Université Paris SudLe Kremlin BicêtreFrance
| | - Jérémie Rudant
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance
| | - Jérôme Drouin
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance
| | - Joël Coste
- Biostatistique et EpidémiologieHôtel-Dieu, Assistance Publique-Hôpitaux de ParisParisFrance
| | - Franck Carbonnel
- Service de gastroentérologie, BicêtreAssistance Publique-Hôpitaux de ParisLe Kremlin BicêtreFrance,Université Paris SudLe Kremlin BicêtreFrance
| | - Alain Weill
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance
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414
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Cuggia M, Combes S. The French Health Data Hub and the German Medical Informatics Initiatives: Two National Projects to Promote Data Sharing in Healthcare. Yearb Med Inform 2019; 28:195-202. [PMID: 31419832 PMCID: PMC6697511 DOI: 10.1055/s-0039-1677917] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The diversity and volume of health data have been rapidly increasing in recent years. While such big data hold significant promise for accelerating discovery, data use entails many challenges including the need for adequate computational infrastructure and secure processes for data sharing and access. In Europe, two nationwide projects have been launched recently to support these objectives. This paper compares the French Health Data Hub initiative (HDH) to the German Medical Informatics Initiatives (MII). METHOD We analysed the projects according to the following criteria: (i) Global approach and ambitions, (ii) Use cases, (iii) Governance and organization, (iv) Technical aspects and interoperability, and (v) Data privacy access/data governance. RESULTS The French and German projects share the same objectives but are different in terms of methodologies. The HDH project is based on a top-down approach and focuses on a shared computational infrastructure, providing tools and services to speed projects between data producers and data users. The MII project is based on a bottom-up approach and relies on four consortia including academic hospitals, universities, and private partners. CONCLUSION Both projects could benefit from each other. A Franco-German cooperation, extended to other countries of the European Union with similar initiatives, should allow sharing and strengthening efforts in a strategic area where competition from other countries has increased.
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Affiliation(s)
- Marc Cuggia
- INSERM, UMR 1099, Rennes, France and Université de Rennes 1, LTSI, Rennes, France
| | - Stéphanie Combes
- Lab Santé, Sous-direction de l’observation de la santé et l’assurance maladie, DREES, France
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415
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Ajrouche A, De Rycke Y, Dalichampt M, Messika Zeitoun D, Hulot J, Estellat C, Tubach F. Reduced risk of cancer among low‐dose aspirin users: Data from French health care databases. Pharmacoepidemiol Drug Saf 2019; 28:1258-1266. [DOI: 10.1002/pds.4870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/16/2019] [Accepted: 07/05/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Aya Ajrouche
- Faculté de médecine Sorbonne Université, AP‐HP, Hôpital Pitié‐Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne Université INSERM, UMR 1123, ECEVE, CIC‐P 1421 Paris France
| | - Yann De Rycke
- Faculté de médecine Sorbonne Université, AP‐HP, Hôpital Pitié‐Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne Université INSERM, UMR 1123, ECEVE, CIC‐P 1421 Paris France
| | - Marie Dalichampt
- Caisse nationale d'assurance maladie des travailleurs salariés cnamts Paris France
| | | | - Jean‐Sebastien Hulot
- Faculté de médecine Sorbonne UniversitéSorbonne Université, INSERM, CIC‐1421 Paris France
| | - Candice Estellat
- Faculté de médecine Sorbonne Université, AP‐HP, Hôpital Pitié‐Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne Université INSERM, UMR 1123, ECEVE, CIC‐P 1421 Paris France
| | - Florence Tubach
- Faculté de médecine Sorbonne Université, AP‐HP, Hôpital Pitié‐Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne Université INSERM, UMR 1123, ECEVE, CIC‐P 1421 Paris France
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416
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Sbidian E, Billionnet C, Weill A, Maura G, Mezzarobba M. Persistence of apremilast in moderate-to-severe psoriasis: a real-world analysis of 14 147 apremilast- and methotrexate-naive patients in the French National Health Insurance database. Br J Dermatol 2019; 182:690-697. [PMID: 31021438 DOI: 10.1111/bjd.18047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Real-world data on the persistence of apremilast vs. methotrexate are inconclusive. OBJECTIVES To assess and compare the long-term persistence of apremilast and methotrexate in a large cohort of patients with psoriasis. METHODS All adult patients with psoriasis registered in the French national health insurance database ('Système National des Données de Santé') between 2009 and 2017 were eligible for inclusion. The study population comprised apremilast- and methotrexate-naive patients, defined as those with a first prescription of apremilast or methotrexate. Levels of persistence were compared using a Cox model with propensity-score matching that included potential confounders (notably age, sex, psoriatic arthritis, comorbidities and previous exposure to topical and systemic treatments). RESULTS In this nationwide population-based cohort, 14 147 adult patients with psoriasis (mean age 52·3 years, 55·2% male) were found to be naive to both apremilast and methotrexate. After propensity-score matching, two subgroups of 4805 patients with similar baseline characteristics were included, of whom 3207 apremilast-treated patients and 2736 methotrexate-treated patients discontinued their treatment. Kaplan-Meier survival propensity-score analyses revealed a discontinuation rate of 69% for apremilast and 59% for methotrexate in the first year of treatment. Apremilast-treated patients had a higher risk of discontinuation than methotrexate-treated patients when considering the study population as a whole (hazard ratio 1·28, 95% confidence interval 1·23-1·34) or in a propensity-score-matched analysis (hazard ratio 1·34, 95% confidence interval 1·27-1·41; P < 0·001). CONCLUSIONS Our real-world data suggest that in the first year of treatment, the discontinuation rate was significantly higher for apremilast-treated patients than for methotrexate-treated patients, regardless of the previous therapeutic lines received. What's already known about this topic? Psoriasis is a common chronic, relapse-remitting, inflammatory skin disease associated with severe psychosocial impact. Apremilast, a phosphodiesterase 4 inhibitor, is one of the most recently commercialized psoriasis drugs. Little is known about the long-term clinical effectiveness of apremilast. What does this study add? The discontinuation rate at 1 year for apremilast was 69%, compared with 58% for methotrexate, in a nationwide population-based cohort including 14 147 nonselected adult patients with psoriasis. Patients in the apremilast cohort had a higher risk of discontinuation than patients in the methotrexate cohort using propensity-score matching, including potentially relevant individual risk factors such as age, sex, comorbidities and psoriatic arthritis, and regardless of the previous therapeutic lines received. In daily practice, physicians should take these results into account when choosing between methotrexate and apremilast as a first-line systemic therapy.
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Affiliation(s)
- E Sbidian
- Département d'Etudes en Santé Publique, Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France.,AP-HP, Hôpitaux Universitaires Henri Mondor, Département de Dermatologie, Université Paris-Est Créteil, Créteil, F-94010, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, F-94010, France.,EA 7379 EpidermE, Université Paris-Est Créteil, Créteil, F-94010, France
| | - C Billionnet
- Département d'Etudes en Santé Publique, Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
| | - A Weill
- Département d'Etudes en Santé Publique, Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
| | - G Maura
- Département d'Etudes en Santé Publique, Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
| | - M Mezzarobba
- Département d'Etudes en Santé Publique, Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
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417
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Picard F, Van Ganse E, Ducrocq G, Danchin N, Falissard B, Hanon O, Belhassen M, Ginoux M, Lefevre C, Cotte FE, Mahé I, Steg PG. EvaluatioN of ApiXaban in strOke and systemic embolism prevention in patients with non-valvular atrial fibrillation in clinical practice Setting in France, rationale and design of the NAXOS: SNIIRAM study. Clin Cardiol 2019; 42:851-859. [PMID: 31313832 PMCID: PMC6788467 DOI: 10.1002/clc.23231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 01/22/2023] Open
Abstract
Non-vitamin K antagonists oral anticoagulants (NOACs) have recently challenged vitamin-K antagonists (VKAs) for stroke and systemic embolism prophylaxis in patients with non-valvular atrial fibrillation (NVAF). Nevertheless, little information is available in routine clinical practice for France. The aim of this study is to describe the effectiveness and safety of apixaban, rivaroxaban, dabigatran or VKAs in routine clinical practice in adult NVAF patients for the prevention of stroke and systemic embolism in France. The NAXOS study is a nationwide observational retrospective cohort generated from the French national healthcare insurance database (SNIIRAM-a comprehensive in- and outpatient healthcare consumption database), consisting of eight distinct sub-cohorts of anticoagulant-naive or anticoagulant-experienced patients diagnosed with NVAF, newly initiated with either NOACs (dabigatran, rivaroxaban or apixaban) or VKAs. Patients will be included if initiating a new anticoagulant treatment for AF during the study period from 1 January 2014 to 31 December 2016. Primary effectiveness outcome will be the incidence of stroke or systemic thromboembolic events; primary safety outcome will be the incidence of major bleeding during the exposure period. The NAXOS study will provide routine clinical practice data on the effectiveness and safety profiles of apixaban vs other NOACs and VKAs in the prevention of stroke and systemic embolism in adult patients with NVAF in clinical practice conditions in France.
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Affiliation(s)
- Fabien Picard
- Department of Cardiology, Cochin Hospital, AP-HP, Paris, France.,Université Paris Descartes, Paris, France.,FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Eric Van Ganse
- PharmacoEpidemiology Lyon (PELyon), EA 7425 HESPER Health Services and Performance Research, Claude-Bernard University, Lyon, France.,Respiratory Medicine, Croix-Rousse Hospital, Lyon, France
| | - Gregory Ducrocq
- FACT (French Alliance for Cardiovascular Trials), Paris, France.,Département de cardiologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, DHU FIRE, INSERM 1148, Université de Paris, Paris, France
| | - Nicolas Danchin
- Université Paris Descartes, Paris, France.,FACT (French Alliance for Cardiovascular Trials), Paris, France.,Department of Cardiology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Bruno Falissard
- Université Paris Descartes, Paris, France.,U669 - Hôpital Cochin, Maison des adolescents, AP-HP, Paris, France
| | - Olivier Hanon
- Hôpital Broca 54-56 Pascal, 75013, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Equipe d'Accueil 4468, Paris, France
| | | | | | - Cinira Lefevre
- Bristol-Myers Squibb, Market Access, Rueil-Malmaison, France
| | - François-Emery Cotte
- Bristol-Myers Squibb, Health Economics & Outcomes Research, Rueil-Malmaison, France
| | - Isabelle Mahé
- Department of Internal Medicine, Louis-Mourier Hospital, Universite Paris 7, Inserm UMR_S1140, AP-HP, Colombes, France
| | - Philippe G Steg
- FACT (French Alliance for Cardiovascular Trials), Paris, France.,Département de cardiologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, DHU FIRE, INSERM 1148, Université de Paris, Paris, France.,National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, UK
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418
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Tuppin P, Rivière S, Deutsch D, Gastaldi-Menager C, Sabaté JM. Burden of drug use for gastrointestinal symptoms and functional gastrointestinal disorders in France: a national study using reimbursement data for 57 million inhabitants. Therap Adv Gastroenterol 2019; 12:1756284819853790. [PMID: 31320929 PMCID: PMC6628544 DOI: 10.1177/1756284819853790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Gastrointestinal therapeutic drugs (GTDs) are extensively prescribed. The aim of this study was to investigate the characteristics of GTD use in a large population: the French general health scheme beneficiaries (87% of the 66 million inhabitants) in 2016. METHODS The national health data system was used to identify individual characteristics, diseases and GTD classes reimbursed, together with the costs, using anatomical therapeutic chemical class. RESULTS Among the 57.5 million individuals included, 45% received at least one reimbursement among the 130 million prescriptions reimbursed (90% prescribed by a general practitioner): proton-pump inhibitors (PPI; A02BC: 24%), drugs for functional gastrointestinal disorders (A03: 20%), drugs for constipation (A06: 10%), antidiarrheals, intestinal anti-inflammatory/anti-infective agents (A07: 10%), antiemetics and antinauseants (A04: 7%), other drugs for acid-related disorders (A02X: 6%), other drugs for peptic ulcer and gastro-oesophageal reflux disease (A02BX: 4.5%), antacids (A02A: 1.5%). The overall cost of reimbursed GTDs was €707 million and the mean cost per user was €28. Marked variations were observed according to age, sex, and disease. The rates of at least one reimbursement among infants were A07: 28%, A03: 17%, A02BX: 9%, A02X: 7%, A02BC: 6% and A06: 5%. Women more frequently received a reimbursement than men for each GTD class. Reimbursement rates also varied according to health status (end-stage renal disease A02BC: 66%, pregnancy A03: 53%, A04: 11%), treatments (people with at least six reimbursements for nonsteroidal anti-inflammatory drugs in 2016 A02BC: 62%). Chronic GTD use (>10 reimbursements/year) was observed in 19% of people with at least one A02BC reimbursement, A02BX: 11%, A03: 7%, A04: 2%, A06: 17% and A07: 3%. CONCLUSIONS This study demonstrates extensive and chronic use of GTD in France, raising the question of their relevance according to current guidelines. They must be disseminated to general practitioners, who are the main prescribers of these drugs.
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Affiliation(s)
| | | | - David Deutsch
- Service de Gastroentérologie Hôpital Avicenne,
AP-HP, Bobigny, France
| | | | - Jean-Marc Sabaté
- Service de Gastroentérologie Hôpital Avicenne,
AP-HP, Bobigny, France INSERM U-987, Physiopathologie et Pharmacologie
Clinique de la Douleur, Hôpital Ambroise Paré, Boulogne-Billancourt,
France
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419
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Donnet A, Emery C, Aly S, Allaf B, Cayre F, Mahieu N, Gourmelen J, Levy P, Fagnani F. Migraine burden and costs in France: a nationwide claims database analysis of triptan users. J Med Econ 2019; 22:616-624. [PMID: 30836035 DOI: 10.1080/13696998.2019.1590841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: To estimate the burden of migraine in the population of French patients identified as specific migraine acute treatment users compared to a control group. Methods: A cross-sectional retrospective analysis was performed on the Echantillon Généraliste des Bénéficiaires claims database, a 1/97 random sample of the French public insurance database. A representative sample of all adults with at least one delivery of triptans, ergot derivatives or acetylsalicylic acid/metoclopramide (all drugs with a specific label in migraine acute treatment - SMAT) in 2014 was selected with a control group matched on age, gender and geographic region. Among triptan users, a sub-group of over-users was defined according to their level of triptan uptake expressed in defined daily doses (DDD - a standard daily dose of treatment of acute migraine) per month over 3 months and more, was also compared with controls. The cost analysis was performed in a societal perspective for direct costs. Sick leave indirect costs were estimated using the human capital approach. Results: In total 8639 SMAT users (mean age: 44.6 years; 78.7% women) were selected representing a crude prevalence rate of 1.7%. The annual per capita total healthcare expenditures were higher by €280 in this group compared to controls (€2463 vs. €2183). Triptans contributed 47.8% to this extra cost. They used significantly (p < .0001) more frequently than controls antidepressants (20.8% vs. 11.0%), anxiolytics (29.4% vs. 18.8%) and analgesics (53.8% vs. 35.8%). The per capita annual productivity loss associated with sick leave was higher by €295 (€1712 vs. €1417). Among triptan users, there were 2.9% over-users. This last group was characterized by substantially higher per capita annual extra direct (+ €1805) and indirect costs (productivity loss +€706) compared to controls. Conclusions: Due to its high prevalence, migraine costs generate a significant societal burden. The group of over-users concentrates high per capita direct and indirect costs.
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Affiliation(s)
| | | | - Samia Aly
- c Novartis Pharma , Rueil-Malmaison , France
| | | | - Fanny Cayre
- c Novartis Pharma , Rueil-Malmaison , France
| | | | | | - Pierre Levy
- e Université Paris-Dauphine, PSL Research University, LEDa [LEGOS] , Paris , France
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420
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Baudot FO, Aguadé AS, Barnay T, Gastaldi-Ménager C, Fagot-Campagna A. Impact of type 2 diabetes on health expenditure: estimation based on individual administrative data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:657-668. [PMID: 30612221 PMCID: PMC6602976 DOI: 10.1007/s10198-018-1024-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 12/11/2018] [Indexed: 05/31/2023]
Abstract
Only limited data are available in France on the incidence and health expenditure of type 2 diabetes. The objective of this study, based on national health insurance administrative database, is to describe the expenditure reimbursed to patients newly treated for type 2 diabetes and the proportion of expenditure attributable to diabetes. The study is conducted over a 6-year period from 2008, the year of incidence of treated diabetes, to 2014. Type 2 diabetic patients aged 45 years and older are identified on the basis of their drug consumption. To estimate expenditure attributable to diabetes, a matched control group is selected among more than 13 million beneficiaries over 44 years old not taking antidiabetic treatment. The expenditure attributable to diabetes is estimated by two methods: simple comparison of reimbursed health expenditure between both groups, and a difference-in-differences method including control variables. The cohort of incident type 2 diabetic patients comprises 170,013 patients in 2008. Mean global reimbursed expenditure is €4700 per patient in 2008 and €5500 in 2015. Expenditure attributable to diabetes, estimated by direct comparison with controls, is €1500 in the first year. We, thus, observe a decrease in the following year due to decreased hospitalisations, and then expenditure increase by an average of 7% per year to reach €1900 in the eighth year after the initiation of treatment.
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Affiliation(s)
- François-Olivier Baudot
- Université Paris-Est Créteil, ERUDITE, TEPP-FR CNRS 3435, IST-PE, Créteil, France
- Caisse Nationale de l’Assurance Maladie (Cnam), Paris, France
| | | | - Thomas Barnay
- Université Paris-Est Créteil, ERUDITE, TEPP-FR CNRS 3435, IST-PE, Créteil, France
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421
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Sabaté JM, Rivière S, Jouet P, Gastaldi-Menager C, Fagot-Campagna A, Tuppin P. Healthcare use by 30,000 patients with irritable bowel syndrome (IBS) in France: a 5-year retrospective and one-year prospective national observational study. BMC Gastroenterol 2019; 19:111. [PMID: 31248366 PMCID: PMC6598248 DOI: 10.1186/s12876-019-1031-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) can be responsible for alteration in quality of life and economic burden. The aim of this study was to evaluate healthcare use related to this disorder in France. METHODS The French health data system was used to select adults covered by the general health scheme (87% of population) through their first IBS hospitalization in 2015. We studied the healthcare refunded during the previous 5 years, 1 year before and after hospitalization. RESULTS Among 43.7 million adults who used refunded healthcare in 2015, 29,509 patients were identified (0.07, 33% males, 67% females, mean age 52 years, 30% admitted through emergency room). During their hospitalization, 33% had upper endoscopy and 64% colonoscopy. Over the five previous years, 3% had at least one hospitalization with an IBS diagnosis, 58% had abdominal ultrasonography, 27% CT scan, 21% upper endoscopy, 13% colonoscopy and 83% a gastroenterologist visit. The year before, these rates were respectively: 0, 36, 16, 6, 4 and 78%. Some of those rates decreased the year after the hospitalization with respectively: 1, 27, 13, 5, 4 and 19%. The year before, 65% had at least one CRP dosage (13% three or more), 58% a TSH dosage (7%) and 8% a test for coeliac diseases (1%) and the year after: 44% (8%), 43% (5%) and 3% (0.3%). At least one refund of a drug used to treat IBS was found for 85% of patients 5 years before, 65% one year before and 51% one year after. CONCLUSION This first study using French health data system for healthcare consumption assessment in IBS points out the repetition of outpatient visits, examinations and in particular radiological examinations, without a strong decrease after hospitalization for IBS and gastroenterologist visit.
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Affiliation(s)
- Jean-Marc Sabaté
- Service de Gastroentérologie, Hôpital Avicenne AP-HP, INSERM U-987, 175 rue de Stalingrad, 93000, Bobigny, France
- Physiopathologie et Pharmacologie Clinique de la Douleur, Hôpital Ambroise Paré, 9 avenue Charles-de-Gaulle, 92104, Boulogne-Billancourt, France
| | - Sébastien Rivière
- Caisse nationale de l'Assurance maladie (CNAM) - Direction de la Stratégie des Études et des Statistiques, 26-50 avenue du Professeur André Lemierre, F-75986, Paris, Cedex 20, France
| | - Pauline Jouet
- Service de Gastroentérologie, Hôpital Ambroise Paré AP-HP, 9 avenue Charles-de-Gaulle, 92104, Boulogne-Billancourt, France
| | - Christelle Gastaldi-Menager
- Caisse nationale de l'Assurance maladie (CNAM) - Direction de la Stratégie des Études et des Statistiques, 26-50 avenue du Professeur André Lemierre, F-75986, Paris, Cedex 20, France
| | - Anne Fagot-Campagna
- Caisse nationale de l'Assurance maladie (CNAM) - Direction de la Stratégie des Études et des Statistiques, 26-50 avenue du Professeur André Lemierre, F-75986, Paris, Cedex 20, France
| | - Philippe Tuppin
- Caisse nationale de l'Assurance maladie (CNAM) - Direction de la Stratégie des Études et des Statistiques, 26-50 avenue du Professeur André Lemierre, F-75986, Paris, Cedex 20, France.
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422
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Mahr A, Belhassen M, Paccalin M, Devauchelle-Pensec V, Nolin M, Gandon S, Idier I, Hachulla E. Characteristics and management of giant cell arteritis in France: a study based on national health insurance claims data. Rheumatology (Oxford) 2019; 59:120-128. [DOI: 10.1093/rheumatology/kez251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/21/2019] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objective
Few data are available on the epidemiology and management of GCA in real life. We aimed to address this situation by using health insurance claims data for France.
Methods
This retrospective study used the Echantillon Généraliste de Bénéficiaires (EGB) database, a 1% representative sample of the French national health insurance system. The EGB contains anonymous data on long-term disease status, hospitalizations and reimbursement claims for 752 717 people. Data were collected between 2007 and 2015. The index date was defined as the date of the first occurrence of a GCA code. Demographics, comorbidities, diagnostic tests and therapies were analysed. Annual incidence rates were calculated, and incident and overall GCA cases were studied.
Results
We identified 241 patients with GCA. The annual incidence was 7–10/100 000 people ⩾50 years old. Among the 117 patients with incident GCA, 74.4% were females, with mean age 77.6 years and mean follow-up 2.2 years. After the index date, 51.3% underwent temporal artery biopsy and 29.1% high-resolution Doppler ultrasonography. Among the whole cohort, 84.3% used only glucocorticoids. The most-prescribed glucocorticoid-sparing agent was methotrexate (12.0%).
Conclusion
The incidence of GCA in France is 7–10/100 000 people ⩾ 50 years old. Adjunct agents, mainly methotrexate, are given to only a few patients. The use of temporal artery biopsy in only half of the patients might reflect a shift toward the use of imaging techniques to diagnose GCA.
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Affiliation(s)
- Alfred Mahr
- Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France
| | | | - Marc Paccalin
- Internal Medicine, University Hospital Poitiers, Poitiers, France
| | | | - Maeva Nolin
- Pelyon EA 7425, University Hospital Lyon, Lyon, France
| | - Sophie Gandon
- Clinical Operations France, Roche S.A.S., Boulogne-Billancourt, France
| | - Isabelle Idier
- Rheumatology Medical, Chugai Pharma France, Paris La Défense, France
| | - Eric Hachulla
- Internal Medicine and Clinical Immunology, CHU Lille, University Lille, LIRIC, INSERM, Lille, France
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423
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Dib F, de Rycke Y, Guillo S, Lafourcade A, Raherison C, Taillé C, Tubach F. Impact of a population-based asthma management program in France (Sophia Asthme): A matched controlled before-and-after quasi-experimental study using the French health insurance database (SNDS). Pharmacoepidemiol Drug Saf 2019; 28:1097-1108. [PMID: 31237054 DOI: 10.1002/pds.4842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/28/2019] [Accepted: 05/16/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE Sophia Asthme (SA) is a chronic disease management program of the French national health insurance for adult patients with asthma. We evaluated the early impact of this intervention. METHODS We conducted a matched controlled, before-and-after quasi-experimental study within the French Health Insurance Database (Système National Des Données de Santé [SNDS]). The SA program was implemented in a set of 18 Départements in France and targeted 18- to 44-year-old subjects, with at least two reimbursement dates for asthma drug therapy during the 12-month period prior to program targeting. Change in outcomes was assessed from the "before program" period (January-December 2014) to the "after program implementation" period (March 2015-February 2016) in the program group (eligible to SA program in the 18 Départements) and in the matched controlled group. The main outcome measure was the before-after change in proportion of subjects with a controllers/(controllers+relievers) ratio greater than 50%. RESULTS Of the 99 578 subjects of the program group, 9225 (9.3%) actually participated in SA program. The program had no significant impact on the proportion of subjects with a ratio greater than 50%. However, subjects exposed to SA program were significantly more likely to be dispensed controller medications (OR = 1.04; 95% CI, 1.01-1.07) and to sustain their use of these medications (OR = 1.08; 95% CI, 1.05-1.12). CONCLUSION We did not demonstrate any significant impact of the program on the primary outcome. The modest yet encouraging findings of this early evaluation suggest the need for reformulation of the program and its evaluation.
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Affiliation(s)
- Fadia Dib
- Hôpital Bichat-Claude-Bernard, Département d'Epidémiologie, Biostatistiques et Recherche Clinique, AP-HP, Paris, France.,INSERM, CIC-EC 1425, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
| | - Yann de Rycke
- Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie, Céphépi, Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP UMR-S1136, CIC 1421, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sylvie Guillo
- Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie, Céphépi, Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP UMR-S1136, CIC 1421, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alexandre Lafourcade
- Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie, Céphépi, Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP UMR-S1136, CIC 1421, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Chantal Raherison
- INSERM U1219 team EPICENE, Bordeaux University, Bordeaux, France.,Service des Maladies Respiratoires, CHU Bordeaux, Bordeaux, France
| | - Camille Taillé
- Service de Pneumologie et Centre de Compétence des Maladies Pulmonaires Rares, Hôpital Bichat, AP-HP, Paris et Département Hospitalo-Universitaire FIRE, Université Paris Diderot, INSERM UMR 1152, LabEx Inflamex, Paris, France
| | - Florence Tubach
- Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie, Céphépi, Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP UMR-S1136, CIC 1421, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
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424
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Ha-Vinh P, Régnard P, Sebahoun-Gil S. [Medical service use for infertility in French private sector]. SANTE PUBLIQUE 2019; Vol. 31:137-152. [PMID: 31210509 DOI: 10.3917/spub.191.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study presents nationally representative estimates and trends for infertility service use among women aged 25-43 and men aged 25-49 in France in 2013-2016. METHODS Two retrospective repeated cross-sectional analyses for years 2013 to 2016 were performed on the statutory French health care insurance reimbursement database for independent workers. Use rate was calculated on the number of individuals who underwent at least one infertility service within the studied year per women and men who utilized health services the same year. RESULTS 1.69% [IC 95%: 1.65; 1.72] of women aged 25-43 who utilized health services had used infertility services during the year 2016: 1.5% used ovulation induction, 0.7% ultrasound monitoring of follicles, 0.3% embryo transfer, 0.3% in vitro fertilization.The use increased significantly from 2013 to 2016 for the following services: ultrasound monitoring of follicles (+ 10%), intracytoplasmic sperm injection (+ 12%), freezing of embryos (+ 32%), thawing of embryos (+ 29%), embryo cryopreservation (+ 88%).In a multivariate analysis, the use was higher among women aged 30-39 years, with a liberal profession, living in the North-east or the south-east, in Corsica or over-seas, receiving health care outside the French territory.0.19% [IC 95%: 0.18; 0.20] of men aged 25-49 years had used infertility services during the year.There was a significant increase from 2013 to 2016 of the proportion of users for sperm freezing (+ 19.18%) and sperm cryopreservation for fertility preservation when cytotoxic therapy is required (+ 84.92%). CONCLUSION Some increases resulted from expanded indications. Follow-up will be required in case of legislative enlargement for access to certain techniques.
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425
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Blotière PO, Raguideau F, Weill A, Elefant E, Perthus I, Goulet V, Rouget F, Zureik M, Coste J, Dray-Spira R. Risks of 23 specific malformations associated with prenatal exposure to 10 antiepileptic drugs. Neurology 2019; 93:e167-e180. [PMID: 31189695 DOI: 10.1212/wnl.0000000000007696] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess the association between exposure to monotherapy with 10 different antiepileptic drugs (AEDs) during the first 2 months of pregnancy and the risk of 23 major congenital malformations (MCMs). METHODS This nationwide cohort study, based on the French health care databases, included all pregnancies ≥20 weeks and ending between January 2011 and March 2015. Women were considered to be exposed when an AED had been dispensed between 1 month before and 2 months after the beginning of pregnancy. The reference group included pregnant women with no reimbursement for AEDs. MCMs were detected up to 12 months after birth (24 months for microcephaly, hypospadias, and epispadias). Odds ratios (ORs) were adjusted for potential confounders for MCMs with at least 5 cases. Otherwise, we calculated crude ORs with exact confidence intervals (CIs). RESULTS The cohort included 1,886,825 pregnancies, 2,997 of which were exposed to lamotrigine, 1,671 to pregabalin, 980 to clonazepam, 913 to valproic acid, 579 to levetiracetam, 517 to topiramate, 512 to carbamazepine, 365 to gabapentin, 139 to oxcarbazepine, and 80 to phenobarbital. Exposure to valproic acid was associated with 8 specific types of MCMs (e.g., spina bifida, OR 19.4, 95% CI 8.6-43.5), and exposure to topiramate was associated with an increased risk of cleft lip (6.8, 95% CI 1.4-20.0). We identified 3 other signals. We found no significant association for lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, and gabapentin. CONCLUSIONS These results confirm the teratogenicity of valproic acid and topiramate. Because of the small numbers of cases and possible confounding, the other 3 signals should be interpreted with appropriate caution.
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Affiliation(s)
- Pierre-Olivier Blotière
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France.
| | - Fanny Raguideau
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Alain Weill
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Elisabeth Elefant
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Isabelle Perthus
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Véronique Goulet
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Florence Rouget
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Mahmoud Zureik
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Joël Coste
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Rosemary Dray-Spira
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
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Janah A, Gauthier LR, Morin L, Bousquet PJ, Le Bihan C, Tuppin P, Peretti-Watel P, Bendiane MK. Access to palliative care for cancer patients between diagnosis and death: a national cohort study. Clin Epidemiol 2019; 11:443-455. [PMID: 31239783 PMCID: PMC6559764 DOI: 10.2147/clep.s198499] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022] Open
Abstract
Background and purpose: Introducing palliative care earlier in the disease trajectory has been found to provide better management of physical and psychological suffering. In France, the proportion of cancer patients who receive palliative care is unclear. This study aimed primarily to measure the prevalence of access to inpatient palliative care and associated patient-level factors, and to identify the time between access to palliative care and death. Patients and methods: A nationwide retrospective cohort study using data from the French national health system database (SNDS). All those diagnosed with cancer in 2013 who died between 2013 and 2015 were included. Access to inpatient palliative care was the main outcome. Results: Of the 313,059 patients diagnosed with cancer in 2013 in France, 72,315 (23%) died between 2013 and 2015. Overall, 57% had access to inpatient palliative care. The following groups were the most likely to have access to palliative care: women (adjusted odds ratio, aOR: 1.15; 95% CI: 1.11-1.20), people aged 18-49 (aOR: 1.38; 95% CI: 1.26-1.51), individuals with metastatic cancer (aOR: 2.04; 95% CI: 1.96-2.13), and patients with cancer of the nervous system (aOR: 1.80; 95% CI: 1.62-2.01). The median time between palliative care and death was 29 (interquartile range: 13-67) days. Conclusion: More than half of cancer patients who died within 2 years after diagnosis had access to inpatient palliative care. Access to palliative care occurs late in the disease trajectory, often during the final month of life. Further research and guidelines are warranted to optimize access to early, standardized palliative care.
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Affiliation(s)
- Asmaa Janah
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Lynn R Gauthier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval - Centre Hospitalier Universitaire de Québec-Université Laval Research Centre, Oncology Division and Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs, Université Laval Cancer Research Centre, Québec, Canada
| | - Lucas Morin
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Philippe Jean Bousquet
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
- Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute - INCa), Boulogne Billancourt, France
| | - Christine Le Bihan
- Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute - INCa), Boulogne Billancourt, France
| | - Philippe Tuppin
- Département des études sur les pathologies et les patients (DEPP), Caisse Nationale d’Assurance Maladie, Paris, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, and ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
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427
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Touat M, Opatowski M, Brun-Buisson C, Cosker K, Guillemot D, Salomon J, Tuppin P, de Lagasnerie G, Watier L. A Payer Perspective of the Hospital Inpatient Additional Care Costs of Antimicrobial Resistance in France: A Matched Case-Control Study. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:381-389. [PMID: 30506456 PMCID: PMC6535148 DOI: 10.1007/s40258-018-0451-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Antimicrobial resistance (AMR) has become one of the biggest threats to global public health given its association with mortality, morbidity and cost of health care. However, little is known on the economic burden of hospitalization attributable to AMR from a public health insurance perspective. We assessed the excess costs to the French public health insurance system attributable to AMR infections in hospitals. METHODS Bacterial infectious disease-related hospitalizations were extracted from the National health data information system for all stays occurring in 2015. Bacterial infections, strains, and microbial resistance were identified by specific French ICD-10 codes. Information about health care expenditure, co-morbidities and demographic characteristics (i.e. gender, age) are provided. We used a matched case-control approach to determine the excess of reimbursements paid to stays with AMR compared to stays with an infection without resistance. Cases and controls were matched on gender, age, Charlson comorbidity index, category of infection, infection as principal diagnosis (two classes), microorganism and hospital status. The overall AMR cost was extrapolated to stays with AMR and excluded from the sample (multiple infections), and a second extrapolation was performed to consider stays with unknown resistance status. RESULTS The final sample included 52,921 matched-pairs (98.2% cases). Our results suggest that AMR overall cost reached EUR109.3 million in France with a mean of EUR1103 per stay; extrapolation to the entire database shows that the overall cost could potentially reach EUR287.1 million if all cases would be identified. The mean excess length of hospital stay attributable to AMR was estimated at 1.6 days. CONCLUSION AMR causes substantial cost burden in France for the public health insurance. Our study confirms the need to reinforce programs to prevent AMR infection and thereby reduce their economic burden.
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Affiliation(s)
- Mehdi Touat
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Paris-Saclay University, 2, avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Marion Opatowski
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Paris-Saclay University, 2, avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Christian Brun-Buisson
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Paris-Saclay University, 2, avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Kristel Cosker
- Department of Biostatistics, Public Health Department, Medical Information, AP-HP University Hospitals Pitié Salpêtrière-Charles Foix, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Didier Guillemot
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Paris-Saclay University, 2, avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Jerome Salomon
- Ministry of Social Affairs and Health, 14 Avenue Duquesne, 75350, Paris, France
| | - Philippe Tuppin
- Department of Studies on Patients and Diseases, CNAM (National Health Insurance), 50 Avenue du Professeur André Lemierre, 75986, Paris Cedex 20, France
| | - Gregoire de Lagasnerie
- Social Security Directorate, Ministry of Social Affairs and Health, 14 Avenue Duquesne, 75350, Paris, France
| | - Laurence Watier
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Paris-Saclay University, 2, avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France.
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428
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Vilcu AM, Blanchon T, Sabatte L, Souty C, Maravic M, Hanslik T, Steichen O. Cross-validation of an algorithm detecting acute gastroenteritis episodes from prescribed drug dispensing data in France: comparison with clinical data reported in a primary care surveillance system, winter seasons 2014/15 to 2016/17. BMC Med Res Methodol 2019; 19:110. [PMID: 31151387 PMCID: PMC6545010 DOI: 10.1186/s12874-019-0745-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/29/2019] [Indexed: 12/15/2022] Open
Abstract
Background This study compares an algorithm to detect acute gastroenteritis (AG) episodes from drug dispensing data to the validated data reported in a primary care surveillance system in France. Methods We used drug dispensing data collected in a drugstore database and data collected by primary care physicians involved in a French surveillance network, from season 2014/15 to 2016/17. We used an adapted version of an AG discrimination algorithm to identify AG episodes from the drugstore database. We used Pearson’s correlation coefficient to evaluate the agreement between weekly AG signals obtained from the two data sources during winter months, in the overall population, by specific age-groups and by regions. Results Correlations between AG signals for all ages were 0.84 [95%CI 0.69; 0.92] for season 2014/15, 0.87 [95%CI 0.75; 0.93] for season 2015/16 and 0.94 [95%CI 0.88; 0.97] for season 2016/17. The association between AG signals estimated from two data sources varied significantly across age groups in season 2016/17 (p-value < 0.01), and across regions in all three seasons studied (p-value < 0.01). Conclusions There is a strong agreement between the dynamic of AG activity estimated from drug dispensing data and from validated primary care surveillance data collected during winter months in the overall population but the agreement is poorer in several age groups and in several regions. Once automated, the reuse of drug dispensing data, already collected for reimbursement purposes, could be a cost-efficient method to monitor AG activity at the national level. Electronic supplementary material The online version of this article (10.1186/s12874-019-0745-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France.
| | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Laure Sabatte
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Cécile Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Milka Maravic
- Real World Insight, IQVIA, F-92099, La Défense Cedex, France.,Assistance Publique - Hôpitaux de Paris (APHP), hôpital Lariboisière, Service de Rhumatologie, F-75010, Paris, France
| | - Thomas Hanslik
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France.,Université de Versailles Saint-Quentin-en-Yvelines, UVSQ, UFR de Médecine, F-78000, Versailles, France.,Assistance Publique - Hôpitaux de Paris (APHP), hôpital Ambroise Paré, Service de Médecine Interne, F-92100, Boulogne Billancourt, France
| | - Olivier Steichen
- Sorbonne Université, Inserm, université Paris 13, Laboratoire d'informatique médicale et d'ingénierie des connaissances en e-santé, LIMICS, F-75006, Paris, France.,Assistance Publique - Hôpitaux de Paris (APHP), hôpital Tenon, Service de Médecine Interne, F-75020, Paris, France
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429
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Lower HCV treatment uptake in women who have received opioid agonist therapy before and during the DAA era: The ANRS FANTASIO project. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:61-68. [PMID: 31129024 DOI: 10.1016/j.drugpo.2019.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND In the era of direct-acting antivirals (DAA) for the treatment of hepatitis C virus (HCV) infection, HCV treatment uptake remains insufficiently documented in key populations such as people with opioid dependence. Access to opioid agonist therapy (OAT) is facilitated in France through delivery in primary care, and individuals with opioid dependence can be identified as those receiving OAT. Women with opioid dependence are especially vulnerable because of associated sex-related stigma, discrimination, and marginalization, all of which negatively interfere with access to HCV prevention and care. This study, based on data collected between 2012 and 2016 in France, aimed to assess whether (i) chronically HCV-infected women with opioid dependence had lower rates of HCV treatment uptake than their male counterparts during the same period (i.e., study period), and (ii) the advent of DAA resulted in increased treatment uptake rates in these women. METHODS Individuals with opioid dependence were identified as those receiving OAT at least once during the study period. Analyses were based on exhaustive anonymous care delivery data from the French national healthcare reimbursement database. We used multinomial logistic regression to estimate sex-based disparities in HCV treatment uptake (DAA or pegylated-interferon (Peg-IFN)-based treatment versus no treatment) while accounting for potential confounders. RESULTS The study sample comprised 27,127 individuals, including 5640 (20.8%) women. Median [interquartile range] age was 45 [40-49] years. Between 2012 and 2016, 70.9 (women: 77.2; men: 69.3), 17.3 (14.2; 18.2) and 11.7% (8.6%; 12.5%) of the study sample received, respectively, no HCV treatment, DAA and Peg-IFN-based treatment only. After multiple adjustment for potential confounders, women were 41% (adjusted odds-ratio (AOR) [95% confidence interval (CI]): 0.59[0.53-0.65]) and 28% (0.72[0.66-0.78]) less likely than men to have had Peg-IFN-based and DAA treatment, respectively. CONCLUSION Despite increased HCV treatment uptake in women with opioid dependence in the DAA era, rates remain lower than for men. In the coming years, access to DAA treatment will continue to increase in France thanks to a forthcoming simplified model of HCV care which includes primary care as an entry point. Nevertheless, a greater understanding of sex-specific barriers to HCV care and the implementation of appropriate sex-specific measures remain a priority.
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430
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Droitcourt C, Nowak E, Rault C, Happe A, Le Nautout B, Kerbrat S, Balusson F, Poizeau F, Travers D, Sapori JM, Lagarde E, Rey G, Guillot B, Oger E, Dupuy A. Risk of suicide attempt associated with isotretinoin: a nationwide cohort and nested case-time-control study. Int J Epidemiol 2019; 48:1623-1635. [DOI: 10.1093/ije/dyz093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Isotretinoin is the only effective treatment for severe acne. An isotretinoin-related suicide risk is still debated and under scrutiny by regulatory agencies. Our objectives were: to assess the risk of suicide attempt before, during and after isotretinoin treatment; to detect any potential triggering effect of isotretinoin initiation on suicide attempt.
Methods
We implemented a cohort and nested case-time-control study of subjects treated with oral isotretinoin (course or initiation) aged 10–50 years, using the Nationwide French Health Insurance data (2009–2016). The main outcome was hospitalized suicide attempt. Standardized incidence ratios for hospitalized suicide attempts were calculated before, during and after isotretinoin treatment. The number of isotretinoin initiations was compared in risk and control periods of 2 months using a case-time-control analysis.
Results
In all, 443 814 patients (median age 20.0 years; interquartile range 17.0–27.0 years) were exposed to isotretinoin, amounting to 244 154 person-years, with a marked seasonality for treatment initiation. Compared with the French general population, the occurrence of suicide attempts under isotretinoin treatment was markedly lower, with a standardized incidence ratio of 0.6 [95% confidence interval (CI) = 0.53–0.67]; the same applied, to a lesser extent, before and after isotretinoin treatment. In the case-time-control analysis, among cases of suicide attempt, 108 and 127 isotretinoin initiations were observed in the risk and control periods respectively (i.e. 0–2 months and 2–4 months before the date of suicide attempt). The comparison with the 1199 and 1253 initiations observed among matched controls in the same two periods yielded a case-time-control odds ratio of 0.89 (95% CI = 0.68–1.16). A sensitivity analysis using three-month periods and a complementary analysis adding completed suicides for case definition showed consistent results.
Conclusion
Compared with the general population, a lower risk of suicide attempt was observed among patients exposed to isotretinoin and there was no evidence for a triggering effect of isotretinoin initiation on suicide attempt. A selection of patients at lower risk for suicidal behaviour and appropriate treatment management could explain these findings. Risk management plans should therefore be maintained.
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Affiliation(s)
- Catherine Droitcourt
- Univ Rennes, EA 7449 REPERES [Pharmacoepidemiology and Health Services Research]
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
- Department of Dermatology, CHU Rennes, Rennes, France
- INSERM, CIC 1414, Rennes, France
| | - Emmanuel Nowak
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
- University of Bretagne Loire, University of Brest, France
- INSERM CIC 1412, CHRU Brest, Brest, France
| | - Caroline Rault
- Univ Rennes, EA 7449 REPERES [Pharmacoepidemiology and Health Services Research]
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
| | - André Happe
- Univ Rennes, EA 7449 REPERES [Pharmacoepidemiology and Health Services Research]
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
| | - Béranger Le Nautout
- Univ Rennes, EA 7449 REPERES [Pharmacoepidemiology and Health Services Research]
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
| | - Sandrine Kerbrat
- Univ Rennes, EA 7449 REPERES [Pharmacoepidemiology and Health Services Research]
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
| | - Frédéric Balusson
- Univ Rennes, EA 7449 REPERES [Pharmacoepidemiology and Health Services Research]
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
| | - Florence Poizeau
- Univ Rennes, EA 7449 REPERES [Pharmacoepidemiology and Health Services Research]
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
- Department of Dermatology, CHU Rennes, Rennes, France
| | - David Travers
- Department of Psychiatry, CHU Rennes, Rennes, France
| | | | - Emmanuel Lagarde
- INSERM, ISPED, Bordeaux Population Health Research Center INSERM U219 – “Injury Epidemiology Transport Occupation” Team, Bordeaux Cedex, France
| | | | - Bernard Guillot
- Department of Dermatology, CHU Montpellier, Montpellier, France
| | - Emmanuel Oger
- Univ Rennes, EA 7449 REPERES [Pharmacoepidemiology and Health Services Research]
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
| | - Alain Dupuy
- Univ Rennes, EA 7449 REPERES [Pharmacoepidemiology and Health Services Research]
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
- Department of Dermatology, CHU Rennes, Rennes, France
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431
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Tuppin P, Paita M, Gastaldi-Menager C, Le Bihan-Benjamin C, Jean Bousquet P, Fagot Campagna A. Patient characteristics and treatments one year after diagnosis of renal cancer in 2015 according to the presence or absence of metastasis and a history of another tumour: A national observational study. Bull Cancer 2019; 106:538-549. [PMID: 31072597 DOI: 10.1016/j.bulcan.2019.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This study describes the characteristics, management and outcome of patients one year after a diagnosis of renal cancer, according to the presence of a history of another tumour and metastases at diagnosis or during the first year. METHODS Based on information from the national health data system (SNDS), 10,989 general scheme beneficiaries (>15 years) with a first hospital stay in 2015 for renal cancer were divided into groups according to the presence of a history of another tumour or metastases. RESULTS In this cohort of 10,989 people (75 years and older: 30%, men: 65%), 12% had a history of another tumour diagnosed during the two years before and 22% presented one or more metastases at the time of the index hospitalisation or during the following year. Overall, nephrectomy was performed in 56% of cases (partial nephrectomy in 29% of cases), in 63% and 36% of cases without metastases and in 68% and 40% of cases without metastases and with no history of another tumour. Overall, 2% of patients received at least one monoclonal antibody and 15% received a protein kinase inhibitor. These drugs were used in 6% and 53% of cases, respectively, in the presence of metastases and in 7% and 31% of cases, respectively, in the presence of metastases and a history of another tumour. CONCLUSION This study highlights the high rate of a history of another tumour and adaptation of treatment according to a history of cancer and the presence of metastases.
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Affiliation(s)
- Philippe Tuppin
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
| | - Michel Paita
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - Christelle Gastaldi-Menager
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | | | - Philippe Jean Bousquet
- Institut national du cancer, 52, avenue André-Morizet, 92100 Boulogne-Billancourt, France
| | - Anne Fagot Campagna
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
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432
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Atramont A, Lindecker-Cournil V, Rudant J, Tajahmady A, Drewniak N, Fouard A, Singer M, Leone M, Legrand M. Association of Age With Short-term and Long-term Mortality Among Patients Discharged From Intensive Care Units in France. JAMA Netw Open 2019; 2:e193215. [PMID: 31074809 PMCID: PMC6512465 DOI: 10.1001/jamanetworkopen.2019.3215] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE An aging population is increasing the need for intensive care unit (ICU) beds. The benefit of ICU admission for elderly patients remains a subject of debate; however, long-term outcomes across all adult age strata are unknown. OBJECTIVE To describe short-term and long-term mortality (up to 3 years after discharge) across age strata in adult patients admitted to French ICUs. DESIGN, SETTING, AND PARTICIPANTS Using data extracted from the French national health system database, this cohort study determined in-hospital mortality and mortality at 3 months and 3 years after discharge of adult patients (older than 18 years) admitted to French ICUs from January 1 to December 31, 2013, focusing on age strata. The dates of analysis were November 2017 to December 2018. EXPOSURE Intensive care unit admission. MAIN OUTCOMES AND MEASURES In-hospital mortality and mortality at 3 months and 3 years after hospital discharge. RESULTS The study included 133 966 patients (median age, 65 years [interquartile range, 53-76 years); 59.9% male). Total in-hospital mortality was 19.0%, and 3-year mortality was 39.7%. For the 108 539 patients discharged alive from the hospital, 6.8% died by 3 months, and 25.8% died by 3 years after hospital discharge. After adjustment for sex, comorbidities, reason for hospitalization, and organ support (invasive ventilation, noninvasive ventilation, vasopressors, inotropes, fluid resuscitation, blood products administration, cardiopulmonary resuscitation, renal replacement therapy, and mechanical circulatory support), risk of mortality increased progressively across all age strata but with a sharp increase in those 80 years and older. In-hospital and 3-year postdischarge mortality rates, respectively, were 30.5% and 44.9% in patients 80 years and older compared with 16.5% and 22.5% in those younger than 80 years. Total 3-year mortality was 61.4% among patients 80 years and older vs 35.1% in those younger than 80. After age and sex standardization, excess mortality was highest among young patients during their first year after hospital discharge and persisted into the second and third years. In contrast, the mortality risk was close to the general population risk among elderly patients (≥80 years). Age and reason for hospitalization were strongly associated with long-term mortality (9-, 13-, and 20-fold increase in the risk of death 3 years after ICU discharge in patients aged 80-84, 85-89, and ≥90 years, respectively, compared with patients aged <35 years), while organ support use during ICU showed a weaker association (all organ support had 1.3-fold or lower increase in the risk of death). CONCLUSIONS AND RELEVANCE Results of this study suggest that aging was associated with an increased risk of mortality in the 3 years after hospital discharge that included an ICU admission, with a sharp increase in those 80 years and older. However, compared with the general population matched by age and sex, excess long-term mortality was high in young surviving patients but not in elderly patients.
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Affiliation(s)
- Alice Atramont
- Caisse Nationale d’Assurance Maladie (CNAM), Paris, France
| | | | - Jérémie Rudant
- Caisse Nationale d’Assurance Maladie (CNAM), Paris, France
| | | | | | - Annie Fouard
- Caisse Nationale d’Assurance Maladie (CNAM), Paris, France
| | - Mervyn Singer
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Marc Leone
- Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Service d’Anesthésie et de Réanimation, Hôpital Nord, Marseille, France
- Comité Réanimation de la Société Française d’Anesthésie et de Réanimation (SFAR), Paris, France
| | - Matthieu Legrand
- Comité Réanimation de la Société Française d’Anesthésie et de Réanimation (SFAR), Paris, France
- L’Assistance Publique–Hôpitaux de Paris (AP-HP), Groupe Hospitalier St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
- University Paris Diderot, Paris, France
- Unité Mixte de Recherche Institut National de la Santé et de la Recherche Médicale (INSERM) 942, Investigation Network Initiative–Cardiovascular and Renal Clinical Trialists Network Paris, Paris, France
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433
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Olivera P, Danese S, Jay N, Natoli G, Peyrin-Biroulet L. Big data in IBD: a look into the future. Nat Rev Gastroenterol Hepatol 2019; 16:312-321. [PMID: 30659247 DOI: 10.1038/s41575-019-0102-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Big data methodologies, made possible with the increasing generation and availability of digital data and enhanced analytical capabilities, have produced new insights to improve outcomes in many disciplines. Application of big data in the health-care sector is in its early stages, although the potential for leveraging underutilized data to gain a better understanding of disease and improve quality of care is enormous. Owing to the intrinsic characteristics of inflammatory bowel disease (IBD) and the management dilemmas that it imposes, the implementation of big data research strategies not only can complement current research efforts but also could represent the only way to disentangle the complexity of the disease. In this Review, we explore important potential applications of big data in IBD research, including predictive models of disease course and response to therapy, characterization of disease heterogeneity, drug safety and development, precision medicine and cost-effectiveness of care. We also discuss the strengths and limitations of potential data sources that big data analytics could draw from in the field of IBD, including electronic health records, clinical trial data, e-health applications and genomic, transcriptomic, proteomic, metabolomic and microbiomic data.
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Affiliation(s)
- Pablo Olivera
- Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy.,Humanitas Clinical Research Hospital, Rozzano, Milan, Italy
| | - Nicolas Jay
- Orpailleur and Department of Medical Information, LORIA and Nancy University Hospital, Vandoeuvre-lès-Nancy, Nancy, France
| | | | - Laurent Peyrin-Biroulet
- INSERM U954 and Department of Hepatogastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, Nancy, France.
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434
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Foulon S, Cony-Makhoul P, Guerci-Bresler A, Delord M, Solary E, Monnereau A, Bonastre J, Tubert-Bitter P. Using healthcare claims data to analyze the prevalence of BCR-ABL-positive chronic myeloid leukemia in France: A nationwide population-based study. Cancer Med 2019; 8:3296-3304. [PMID: 31038849 PMCID: PMC6558491 DOI: 10.1002/cam4.2200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/24/2019] [Accepted: 04/08/2019] [Indexed: 01/03/2023] Open
Abstract
Background Data on Chronic Myeloid Leukemia (CML) prevalence are scarce. Here we provide an estimation of the prevalence of CML in France for the year 2014 using French national health insurance data. Methods We selected patients claiming reimbursement for tyrosine kinase inhibitors (TKI) or with hospital discharge diagnoses for CML, BCR/ABL‐positive or with full reimbursement of health care expenses for myeloid leukemia. We built an algorithm which we validated on a random sample of 100 potential CML patients by comparing the results obtained using the algorithm and the opinion of two hematologists who reviewed the patient demographics and sequence of care abstracted from claims data (internal validity). For external validity, we compared the number of incident CML patients identified using the algorithm with those recorded in French population‐based cancer registries in departments covered by such a registry. Results We identified 10 789 prevalent CML patients in 2014, corresponding to a crude prevalence rate of 16.3 per 100 000 inhabitants [95% confidence interval (CI) 16.0‐16.6]: 18.5 in men [18.0‐19.0] and 14.2 in women [13.8‐14.6]. The crude CML prevalence was less than 1.6 per 100 000 [1.2‐2.0] under age 20, increasing to a maximum of 48.2 [45.4‐51.2) at ages 75‐79. It varied from 10.2 to 23.8 per 100 000 across French departments. The algorithm showed high internal and external validity. Concordance rate between the algorithm and the hematologists was 96%, and the numbers of incident CML patients identified using the algorithm and the registries were 162 and 150, respectively. Conclusion We built and validated an algorithm to identify CML patients in administrative healthcare databases. In addition to prevalence estimation, the algorithm could be used for future economic evaluations or pharmaco‐epidemiological studies in this population.
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Affiliation(s)
- Stéphanie Foulon
- Biostatistics Unit, Gustave Roussy, Villejuif, France.,CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Sud Univ, Villejuif, France.,B2PHI Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, Inserm U1181, UVSQ, Paris Saclay Univ, Villejuif, France
| | - Pascale Cony-Makhoul
- Service d'Hématologie, CH Annecy Genevois, Pringy, France.,FiLMC Group, Institut Bergonié, Bordeaux, France
| | - Agnès Guerci-Bresler
- FiLMC Group, Institut Bergonié, Bordeaux, France.,Service d'Hématologie, CHRU Brabois, Vandoeuvre, France
| | - Marc Delord
- FiLMC Group, Institut Bergonié, Bordeaux, France.,Institut Universitaire d'Hématologie, Université Paris-Diderot Paris7, Paris, France
| | - Eric Solary
- Department of Hematology, Gustave Roussy, Villejuif, France.,INSERM U1170, Villejuif, France
| | - Alain Monnereau
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Bordeaux, France.,Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, Bordeaux, France.,French Network of Population-based Cancer Registries (FRANCIM), Toulouse, France
| | - Julia Bonastre
- Biostatistics Unit, Gustave Roussy, Villejuif, France.,CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Sud Univ, Villejuif, France
| | - Pascale Tubert-Bitter
- B2PHI Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, Inserm U1181, UVSQ, Paris Saclay Univ, Villejuif, France
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435
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Maura G, Billionnet C, Drouin J, Weill A, Neumann A, Pariente A. Oral anticoagulation therapy use in patients with atrial fibrillation after the introduction of non-vitamin K antagonist oral anticoagulants: findings from the French healthcare databases, 2011-2016. BMJ Open 2019; 9:e026645. [PMID: 31005934 PMCID: PMC6500377 DOI: 10.1136/bmjopen-2018-026645] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To describe (i) the trend in oral anticoagulant (OAC) use following the introduction of non-vitamin K antagonist oral anticoagulant (NOAC) therapy for stroke prevention in atrial fibrillation (AF) patients and (ii) the current patterns of use of NOAC therapy in new users with AF in France. DESIGN (i) Repeated cross-sectional study and (ii) population-based cohort study. SETTING French national healthcare databases (50 million beneficiaries). PARTICIPANTS (i) Patients with identified AF in 2011, 2013 and 2016 and (ii) patients with AF initiating OAC therapy in 2015-2016. PRIMARY AND SECONDARY OUTCOME MEASURES: (i) Trend in OAC therapy use in patients with AF and (ii) patterns of use of NOAC therapy in new users with AF. RESULTS Between 2011 and 2016, use of OAC therapy moderately increased (+16%), while use of antiplatelet therapy decreased (-22%) among all patients with identified AF. In 2016, among the 1.1 million AF patients, 66% used OAC therapy and were more likely to be treated by vitamin K antagonist (VKA) than NOAC therapy, including patients at higher risk of stroke (63.5%), while 33% used antiplatelet therapy. Among 192 851 new users of OAC therapy in 2015-2016 with identified AF, NOAC therapy (66.3%) was initiated more frequently than VKA therapy, including in patients at higher risk of stroke (57.8%). Reduced doses were prescribed in 40% of NOAC new users. Several situations of inappropriate use at NOAC initiation were identified, including concomitant use of drugs increasing the risk of bleeding (one in three new users) and potential NOAC underdosing. CONCLUSIONS OAC therapy use in patients with AF remains suboptimal 4 years after the introduction of NOACs for stroke prevention in France and improvement in appropriate prescribing regarding NOAC initiation is needed. However, NOAC therapy is now the preferred drug class for initiation of OAC therapy in patients with AF, including in patients at higher risk of stroke.
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Affiliation(s)
- Géric Maura
- Department of Studies in Public Health, French National Health Insurance (Caisse Nationale de l’Assurance Maladie/Cnam), Paris, France
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology - UMR 1219, Bordeaux, France
| | - Cécile Billionnet
- Department of Studies in Public Health, French National Health Insurance (Caisse Nationale de l’Assurance Maladie/Cnam), Paris, France
| | - Jérôme Drouin
- Department of Studies in Public Health, French National Health Insurance (Caisse Nationale de l’Assurance Maladie/Cnam), Paris, France
| | - Alain Weill
- Department of Studies in Public Health, French National Health Insurance (Caisse Nationale de l’Assurance Maladie/Cnam), Paris, France
| | - Anke Neumann
- Department of Studies in Public Health, French National Health Insurance (Caisse Nationale de l’Assurance Maladie/Cnam), Paris, France
| | - Antoine Pariente
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology - UMR 1219, Bordeaux, France
- CHU Bordeaux, Bordeaux, France
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436
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Cottin V, Avot D, Lévy-Bachelot L, Baxter CA, Ramey DR, Catella L, Bénard S, Sitbon O, Teal S. Identifying chronic thromboembolic pulmonary hypertension through the French national hospital discharge database. PLoS One 2019; 14:e0214649. [PMID: 30998690 PMCID: PMC6472741 DOI: 10.1371/journal.pone.0214649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/18/2019] [Indexed: 12/30/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH), a rare pulmonary vascular disease, is often misdiagnosed due to nonspecific symptoms. The objective of the study was to develop, refine and validate a case ascertainment algorithm to identify CTEPH patients within the French exhaustive hospital discharge database (PMSI), and to use it to estimate the annual number of hospitalized patients with CTEPH in France in 2015, as a proxy for disease prevalence. As ICD-10 coding specifically for CTEPH was not available at the time of the study, a case ascertainment algorithm was developed in close collaboration with an expert committee, using a two-step process (refinement and validation), based on matched data from PMSI and hospital medical records from 2 centres. The best-performing algorithm (specificity 95%, sensitivity 70%) consisted of ≥1 pulmonary hypertension (PH) diagnosis during 2015 and any of the following criteria over 2009-2015: (i) CTEPH interventional procedure, (ii) admission for PH and pulmonary embolism (PE), (iii) PE followed by hospitalization in competence centre then in reference centre, (iv) history of PE and right heart catheterization. Patients with conditions suggestive of pulmonary arterial hypertension were excluded. A total of 3,138 patients hospitalized for CTEPH was estimated for 2015 (47 cases/million, range 43 to 50 cases/million). Assuming that patients are hospitalized at least once a year, the present study provides an estimate of the minimal prevalence of CTEPH and confirms the heavy burden of this disease.
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Affiliation(s)
- V. Cottin
- National Reference Centre for rare pulmonary diseases, Competence centre for pulmonary arterial hypertension, Louis Pradel hospital, Claude Bernard University Lyon 1, UMR 754, Lyon, France
| | - D. Avot
- MSD France, Courbevoie, France
| | | | | | - D. R. Ramey
- Merck & Co., Inc., Kenilworth, NJ, United States of America
| | | | - S. Bénard
- stève consultants, Oullins, France
- * E-mail:
| | - O. Sitbon
- Université Paris-Sud, CHU de Bicêtre, Le Kremlin-Bicêtre, France
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437
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Conte C, Vaysse C, Bosco P, Noize P, Fourrier-Reglat A, Despas F, Lapeyre-Mestre M. The value of a health insurance database to conduct pharmacoepidemiological studies in oncology. Therapie 2019; 74:279-288. [DOI: 10.1016/j.therap.2018.09.076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/29/2018] [Indexed: 01/28/2023]
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438
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Dupui M, Micallef J, Lapeyre-Mestre M. Interest of large electronic health care databases in addictovigilance: Lessons from 15 years of pharmacoepidemiological contribution. Therapie 2019; 74:307-314. [DOI: 10.1016/j.therap.2018.09.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/29/2018] [Indexed: 10/27/2022]
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439
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Belhassen M, Nolin M, Nibber A, Ginoux M, Devouassoux G, Van Ganse E. Changes in Persistent Asthma Care and Outcomes From 2006 to 2016 in France. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1858-1867. [PMID: 30836232 DOI: 10.1016/j.jaip.2019.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Changes in asthma care need to be documented at arrival of biotherapies. OBJECTIVES To characterize changes in asthma care and outcomes in patients with persistent asthma. METHODS Repeated transversal analyses were conducted on a historical cohort using the French national claims data over 10 years. Patients aged 18 to 40 years with either 1 or more (any-use population) or 4 or more (high-use population) yearly dispensings of controller therapy were selected. Clinical and demographic features were characterized, and comparisons were made between 2006 and 2016 to assess temporal changes in asthma therapy, health care resource utilization, and outcomes. RESULTS In 2016, prevalent use of controller therapy was 5.2% (any-use population) and 0.8% (high-use population) of the population aged 18 to 40 years. In the any-use population, the use of long-acting β2-agonists in monotherapy, and inhaled corticosteroids decreased (1.7% and 40.3% in 2016, respectively), whereas the use of fixed-dose combinations increased (56.4%). In both populations, visits to respiratory or hospital physicians and pulmonary function testing increased with time, in parallel to a decreasing number of general practitioner visits; in addition, oral corticosteroid use and incidence of emergency room visits increased. However, asthma hospitalizations and mortality remained low in both populations. CONCLUSIONS Changes in persistent asthma care included replacement of inhaled corticosteroids by fixed-dose combinations, decreased use of long-acting β2-agonists as a monotherapy, and increased involvement of secondary care physicians. In parallel, despite low figures for hospital admissions and mortality, overall use of oral corticosteroids and incidence of emergency room visits have increased over the last decade.
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Affiliation(s)
| | - Maëva Nolin
- PELyon, PharmacoEpidemiology Lyon, Lyon, France
| | - Anjan Nibber
- University of Oxford Medical School, Oxford, United Kingdom
| | | | - Gilles Devouassoux
- Respiratory Medicine, Croix Rousse University Hospital, and EA7426 University Claude Bernard Lyon-1, Lyon, France
| | - Eric Van Ganse
- PELyon, PharmacoEpidemiology Lyon, Lyon, France; Respiratory Medicine, Croix Rousse University Hospital, and EA7426 University Claude Bernard Lyon-1, Lyon, France; HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
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440
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Laanani M, Coste J, Blotière PO, Carbonnel F, Weill A. Patient, Procedure, and Endoscopist Risk Factors for Perforation, Bleeding, and Splenic Injury After Colonoscopies. Clin Gastroenterol Hepatol 2019; 17:719-727.e13. [PMID: 30099110 DOI: 10.1016/j.cgh.2018.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We investigated perforations, bleeding, and splenic injuries after screening or diagnostic colonoscopies to identify patient-, procedure-, endoscopist-, and facility-associated risk factors. METHODS We analyzed data from the SNIIRAM-PMSI national claims databases in France. A total of 4,088,799 patients, 30 years or older, undergoing a first screening or diagnostic colonoscopy from 2010 through 2015 were identified. Rates of severe adverse events (SAEs) were estimated using stringent and broad definitions. Risk factors associated with perforations and major bleeding were estimated using multilevel logistic regression models, adjusted for patient, colonoscopy, and endoscopist characteristics. RESULTS Perforation rates ranged from 3.5 (stringent definition) to 7.3 (broad definition) per 10,000 procedures, bleeding rates ranged from 6.5 to 23.1 per 10,000 procedures, and splenic injury rates ranged from 0.20 to 0.34 per 10,000 procedures. Rates of 30-day mortality were 13.2 per 1000 bleeds, 29.2 per 1000 perforations, and 36.1 per 1000 splenic injuries (stringent definitions). Patient characteristics associated with SAEs were increasing age (especially for perforation), cancer, and cardiovascular comorbidities. Procedure characteristics associated with SAEs included polypectomy-especially of polyps larger than 1 cm with an increased risk of perforation (odds ratio, 4.1; 95% CI, 3.4-5.0) and bleeding (odds ratio, 13.3; 95% CI, 11.7-15.1). Less-experienced endoscopists and endoscopists who performed a smaller number of colonoscopies were independently associated with a risk of SAEs. CONCLUSION In an analysis of national claims databases in France, we found SAEs related to screening and diagnostic colonoscopies to be more frequent in older patients, in patients with comorbidities, and with less-experienced endoscopists. Patients at risk of SAE should be identified and colonoscopies should be performed or supervised by experienced endoscopists.
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Affiliation(s)
- Moussa Laanani
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - Joël Coste
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | | | - Franck Carbonnel
- Gastroenterology unit, Hôpitaux Universitaires Paris Sud, Université Paris-Sud and Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Alain Weill
- Department of Public Health Studies, French National Health Insurance, Paris, France.
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441
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Konrad R, Zhang W, Bjarndóttir M, Proaño R. Key considerations when using health insurance claims data in advanced data analyses: an experience report. Health Syst (Basingstoke) 2019; 9:317-325. [PMID: 33354323 PMCID: PMC7738306 DOI: 10.1080/20476965.2019.1581433] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022] Open
Abstract
Health claims have become a popular source of data for healthcare analytics, with numerous applications ranging from disease burden estimation and policy evaluation to drug event detection and advanced predictive analytics. Independent of the application, a researcher utilising claims information will likely encounter challenges in using the data, which include dealing with several coding systems and coding irregularities. We highlight some of these challenges and approaches for successful analysis that may reduce implementation time and help in avoiding common pitfalls. We describe the experiences of a group of academic researchers in using an extensive seven-year repository of US medical and pharmaceutical claims data in a research study, and provide an overview of the challenges encountered with handling claims records for data analysis while sharing suggestions on how to address these challenges. To illustrate our experiences, we use the example of defining episodes of care for a bundled payment reimbursement system in the US context.
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Affiliation(s)
- Renata Konrad
- Fosie School of Business, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Wenchang Zhang
- Robert H. Smith School of Business, University of Maryland College Park, College Park, MD, USA
| | - Margrét Bjarndóttir
- Robert H. Smith School of Business, University of Maryland College Park, College Park, MD, USA
| | - Ruben Proaño
- Industrial Systems Engineering, Rochester Institute of Technology, USA
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442
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Binda F, Fougnot S, De Monchy P, Fagot-Campagna A, Pulcini C, Thilly N. Impact of selective reporting of antibiotic susceptibility test results in urinary tract infections in the outpatient setting: a protocol for a pragmatic, prospective quasi-experimental trial. BMJ Open 2019; 8:e025810. [PMID: 30798294 PMCID: PMC6278878 DOI: 10.1136/bmjopen-2018-025810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/03/2018] [Accepted: 09/28/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antibiotic resistance is a serious and increasing worldwide threat to global public health. One of antibiotic stewardship programmes' objectives are to reduce inappropriate broad-spectrum antibiotics' prescription. Selective reporting of antibiotic susceptibility test (AST) results, which consists of reporting to prescribers only few (n=5-6) antibiotics, preferring first-line and narrow-spectrum agents, is one possible strategy advised in recommendations. However, selective reporting of AST has never been evaluated using an experimental design. METHODS AND ANALYSIS This study is a pragmatic, prospective, multicentre, controlled (selective reporting vs usual complete reporting of AST), before-after (year 2019 vs 2017) study. Selective reporting of AST is scheduled to be implemented from September 2018 in the ATOUTBIO group of 21 laboratories for all Escherichia coli identified in urine cultures in adult outpatients, and to be compared with the usual complete AST performed in the EVOLAB group of 20 laboratories. The main objective is to assess the impact of selective reporting of AST for E. coli-positive urine cultures in the outpatient setting on the prescription of broad-spectrum antibiotics frequently used for urinary tract infections (amoxicillin-clavulanate, third-generation cephalosporins and fluoroquinolones). The primary end point is the after (2019)-before (2017) difference in prescription rates for the previously mentioned antibiotics/classes that will be compared between the two laboratory groups, using linear regression models. Secondary objectives are to evaluate the feasibility of selective reporting of AST implementation by French laboratories and their acceptability by organising focus groups and individual semi-structured interviews with general practitioners and laboratory professionals. ETHICS AND DISSEMINATION This protocol was approved by French national ethics committees (Comité d'expertise pour les recherches, les études et les évaluations dans le domaine de la santé (TPS 29064) and Commission Nationale de l'Informatique et des Libertés (Décision DR-2018-141)). Findings of this study will be widely disseminated through conference presentations, reports, factsheets and academic publications and generalisation will be further discussed. TRIAL REGISTRATION NUMBER NTC03612297.
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Affiliation(s)
- Francesca Binda
- Université de Lorraine, APEMAC, Nancy, France
- Département des sciences cliniques et biomédicales «Luigi Sacco», Université de Milan, Milan, Italy
| | | | | | | | - Céline Pulcini
- Université de Lorraine, APEMAC, Nancy, France
- Université de Lorraine, CHRU-Nancy, Service des maladies infectieuses et tropicales, Nancy, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France
- Université de Lorraine, CHRU-Nancy, Plateforme d’Aide à la Recherche Clinique, Nancy, France
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443
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Ferrier C, Dhombres F, Khoshnood B, Randrianaivo H, Perthus I, Guilbaut L, Durand-Zaleski I, Jouannic JM. Trends in resource use and effectiveness of ultrasound detection of fetal structural anomalies in France: a multiple registry-based study. BMJ Open 2019; 9:e025482. [PMID: 30772861 PMCID: PMC6398629 DOI: 10.1136/bmjopen-2018-025482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To analyse trends in the number of ultrasound examinations in relation to the effectiveness of prenatal detection of birth defects using population-based data in France. DESIGN A multiple registry-based study of time trends in resource use (number of ultrasounds) and effectiveness (proportion of cases prenatally diagnosed). SETTING Three registries of congenital anomalies and claims data on ultrasounds for all pregnant women in France. PARTICIPANTS There were two samples of pregnant women. Effectiveness was assessed using data from three French birth defect registries. Resource use for ultrasound screening was based on the French national healthcare database. MAIN OUTCOME MEASURES The main outcome measures were prenatal diagnosis (effectiveness) and the average number of ultrasounds (resource use). Statistical analyses included linear and logistic regression models to assess trends in resource use and effectiveness of prenatal testing, respectively. RESULTS The average number of ultrasound examinations per pregnancy significantly increased over the study period, from 2.47 in 2006 to 2.98 in 2014 (p=0.005). However, there was no significant increase in the odds of prenatal diagnosis. The probability of prenatal diagnosis was substantially higher for cases associated with a chromosomal anomaly (91.2%) than those without (51.8%). However, there was no evidence of an increase in prenatal detection of either over time. CONCLUSIONS The average number of ultrasound examinations per pregnancy increased over time, whereas the probability of prenatal diagnosis of congenital anomalies did not. Hence, there is a need to implement policies such as high-quality training programmes which can improve the efficiency of ultrasound examinations for prenatal detection of congenital anomalies.
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Affiliation(s)
- Clément Ferrier
- Fetal Medicine Department, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Ferdinand Dhombres
- Fetal Medicine Department, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Babak Khoshnood
- INSERM U1142, LIMICS, Sorbonne University, Paris, France
- Paris registry of congenital anomalies, Port-Royal Hospital, Paris, France
| | - Hanitra Randrianaivo
- Reunion registry of congenital anomalies, St Pierre, Saint Pierre de la Réunion, France
| | - Isabelle Perthus
- Study center for congenital anomalies, CEMC-Auvergne, Clermont-Ferrand, France
| | - Lucie Guilbaut
- Fetal Medicine Department, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Isabelle Durand-Zaleski
- INSERM CRESS UMR 1153, Paris, France
- AP-HP, URCEco Ile de France, Hôtel-Dieu Hospital, Paris, France
| | - Jean-Marie Jouannic
- Fetal Medicine Department, Sorbonne University, AP-HP, Armand Trousseau Hospital, Paris, France
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444
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Laviolle B, Perche O, Gueyffier F, Bégué É, Bilbault P, Espérou H, Gaillard-Bigot F, Grenet G, Guérin JF, Guillot C, Longeray PH, Morere J, Perrier L, Sanlaville D, Thevenon J, Varoqueaux N. Apport de la génomique dans la médecine de demain, applications cliniques et enjeux. Therapie 2019; 74:1-8. [DOI: 10.1016/j.therap.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 11/24/2022]
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Laviolle B, Denèfle P, Gueyffier F, Bégué É, Bilbault P, Espérou H, Gaillard-Bigot F, Grenet G, Guérin JF, Guillot C, Longeray PH, Morere J, Perche O, Perrier L, Sanlaville D, Thevenon J, Varoqueaux N. The contribution of genomics in the medicine of tomorrow, clinical applications and issues. Therapie 2019; 74:9-15. [DOI: 10.1016/j.therap.2018.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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446
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Meyer A, Rudant J, Drouin J, Weill A, Carbonnel F, Coste J. Effectiveness and Safety of Reference Infliximab and Biosimilar in Crohn Disease: A French Equivalence Study. Ann Intern Med 2019; 170:99-107. [PMID: 30534946 DOI: 10.7326/m18-1512] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND CT-P13 is a biosimilar of the reference product (RP) infliximab, with demonstrated efficacy and safety for some inflammatory arthritides. It was approved for the treatment of Crohn disease (CD) on that basis, without specific studies examining its effects in CD. OBJECTIVE To compare the effectiveness and safety of CT-P13 and RP in infliximab-naive patients with CD. DESIGN Comparative equivalence cohort study. SETTING Système National des Données de Santé (SNDS), a French nationwide health administrative database (1 March 2015 to 30 June 2017). PATIENTS 5050 infliximab-naive patients with CD who were older than 15 years, had started treatment with RP (n = 2551) or CT-P13 (n = 2499), and had no other indications for infliximab. MEASUREMENTS The primary outcome was a composite end point of death, CD-related surgery, all-cause hospitalization, and reimbursement of another biologic therapy. Equivalence was defined as a 95% CI of the hazard ratio (HR) of CT-P13 versus RP in a multivariable marginal Cox model situated within prespecified margins (0.80 to 1.25). RESULTS Overall, 1147 patients in the RP group and 952 patients in the CT-P13 group met the composite end point (including 838 and 719 hospitalizations, respectively). In multivariable analysis of the primary outcome, CT-P13 was equivalent to RP (HR, 0.92 [95% CI, 0.85 to 0.99]). No differences in safety outcomes were observed between the 2 groups: serious infections (HR, 0.82 [CI, 0.61 to 1.11]), tuberculosis (HR, 1.10 [CI, 0.36 to 3.34]), and solid or hematologic cancer (HR, 0.66 [CI, 0.33 to 1.32]). LIMITATION The SNDS does not contain all relevant clinical data (for example, disease activity). CONCLUSION This analysis of real-world data indicates that the effectiveness of CT-P13 is equivalent to that of RP for infliximab-naive patients with CD. No difference was observed for safety outcomes. PRIMARY FUNDING SOURCE Caisse Nationale de l'Assurance Maladie.
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Affiliation(s)
- Antoine Meyer
- Caisse Nationale de l'Assurance Maladie, Paris, and Hôpital Bicêtre, Le Kremlin-Bicêtre, France. (A.M.)
| | - Jérémie Rudant
- Caisse Nationale de l'Assurance Maladie, Paris, France (J.R., J.D., A.W.)
| | - Jérôme Drouin
- Caisse Nationale de l'Assurance Maladie, Paris, France (J.R., J.D., A.W.)
| | - Alain Weill
- Caisse Nationale de l'Assurance Maladie, Paris, France (J.R., J.D., A.W.)
| | | | - Joël Coste
- Caisse Nationale de l'Assurance Maladie, Paris, and Hôpital Bicêtre, Le Kremlin-Bicêtre, France (J.C.)
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447
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Bouget J, Balusson F, Scailteux LM, Maignan M, Roy PM, L'her E, Pavageau L, Nowak E. Major bleeding with antithrombotic agents: a 2012-2015 study using the French nationwide Health Insurance database linked to emergency department records within five areas - rationale and design of SACHA study. Fundam Clin Pharmacol 2019; 33:443-462. [PMID: 30537335 DOI: 10.1111/fcp.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/27/2018] [Accepted: 12/06/2018] [Indexed: 12/29/2022]
Abstract
Bleeding represents the most recognized and feared complications of antithrombotic drugs including oral anticoagulants. Previous studies showed inconsistent results on the safety profile. Among explanations, bleeding definition could vary and classification bias exists related to the lack of medical evaluation. To quantify the risk of major haemorrhagic event and event-free survival associated with antithrombotic drugs (vitamin K antagonist [VKA], non-VKA anticoagulant [NOAC], antiplatelet agent, parenteral anticoagulant) in 2012-2015, we linked the French nationwide Health Insurance database (SNIIRAM) with a local 'emergency database' (clinical and biological data collected in clinical records). In the VKA-NOAC comparison, a Cox regression analysis will be used to estimate the hazard ratio of major haemorrhagic event adjusted on gender, modified HAS-BLED score and comorbidities. A distinction on the type of major haemorrhagic event (intracranial, gastrointestinal and other haemorrhagic events) was made. We present here the study protocol and the database linkage results. Using six linkage keys, among 3 837 557 hospital visits identified in SNIIRAM, 5264 have been matched with a major haemorrhagic event identified in the 'emergency database', thus clinically confirmed. The 1090 unmatched haemorrhagic events could be explained by the fact that patients were not extracted in the SNIIRAM database (patients living in accommodation establishment with internal use of pharmacy, military people with specific insurance…). We showed the value of SNIIRAM enrichment with a clinical database, a necessary step to categorize haemorrhagic events by a clinically relevant definition and medical validation; it will allow to estimate more accuracy each type of haemorrhagic event.
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Affiliation(s)
- Jacques Bouget
- Univ Rennes, REPERES [Pharmacoepidemiology and Heath Services Research] - EA 7449, Univ Rennes, Rennes, F-35000, France.,Emergency Department, University hospital, Rennes, F-35033, France
| | - Frédéric Balusson
- Univ Rennes, REPERES [Pharmacoepidemiology and Heath Services Research] - EA 7449, Univ Rennes, Rennes, F-35000, France
| | - Lucie-Marie Scailteux
- Univ Rennes, REPERES [Pharmacoepidemiology and Heath Services Research] - EA 7449, Univ Rennes, Rennes, F-35000, France.,Pharmacovigilance, Pharmacoepidemiology and drug information center, Rennes, F-35033, France
| | - Maxime Maignan
- Emergency Department, University Hospital, Grenoble, F-38043, France
| | - Pierre-Marie Roy
- Emergency Department, University hospital, Angers, F-49033, France
| | - Erwan L'her
- Emergency Department, University hospital, Brest, F-29609, France
| | - Laure Pavageau
- Emergency Department, University hospital, Nantes, F-44093, France
| | - Emmanuel Nowak
- CHU de Brest, Brest, F-29200, France.,Inserm CIC 1412, IFR 148, Université de Brest, Brest, F-29200, France
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448
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Landré B, Aegerter P, Zins M, Goldberg M, Ankri J, Herr M. Association between Hospitalization and Change of Frailty Status in the GAZEL Cohort. J Nutr Health Aging 2019; 23:466-473. [PMID: 31021364 DOI: 10.1007/s12603-019-1186-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To assess the relationship between changes of frailty status and intervening hospitalizations, using information of the GAZEL cohort, matched with the data of the French National Health Data System. DESIGN Observational cohort study. PARTICIPANTS Community-dwelling adults of the GAZEL cohort (n = 12145; aged between 58 and 73 years in 2012). MEASUREMENTS Frailty was determined with the Strawbridge questionnaire in 2012, 2013 and 2014. Data regarding hospitalizations (notably their number, length of stay, emergency department use, and main diagnosis) were collected from the French National Health Data System. The relationship between intervening hospitalizations and changes of frailty status over time was assessed with multivariate Markov models. RESULTS The prevalence of frailty was 14% in 2012 and 2013 and 17% in 2014. A total of 2715 changes in frailty status were observed from 2012 to 2014. At least one hospitalization was recorded for 1453 people (12%) between the 2012 and 2013 questionnaires, and 1472 (13%) between the 2013 and 2014 questionnaires. No association was found between intervening hospitalizations and changes of frailty status (aHR 1.14 [0.97-1.35] for robust to frail transition and aHR 0.89 [0.73-1.08] for frail to robust transition). However, repeated hospitalizations, hospitalizations after emergency department use, surgery and several diagnosis groups were significantly associated with transitions towards frailty or its recovery. CONCLUSION Hospitalizations encompass a wide range of clinical situations, some of them being associated with incident frailty. An early recognition of these situations could help to better prevent and manage frailty in the early old age.
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Affiliation(s)
- B Landré
- Marie Herr ; UMR 1168, UFR des Sciences de la Santé Simone Veil, 2 avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France ;
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449
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Identifying diabetes cases in health administrative databases: a validation study based on a large French cohort. Int J Public Health 2018; 64:441-450. [PMID: 30515552 DOI: 10.1007/s00038-018-1186-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/03/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES In the French national health insurance information system (SNDS) three diabetes case definition algorithms are applied to identify diabetic patients. The objective of this study was to validate those using data from a large cohort. METHODS The CONSTANCES cohort (Cohorte des consultants des Centres d'examens de santé) comprises a randomly selected sample of adults living in France. Between 2012 and 2014, data from 45,739 participants recorded in a self-administrated questionnaire and in a medical examination were linked to the SNDS. Two gold standards were defined: known diabetes and pharmacologically treated diabetes. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and kappa coefficients (k) were estimated. RESULTS All three algorithms had specificities and NPV over 99%. Their sensitivities ranged from 73 to 77% in algorithm A, to 86 and 97% in algorithm B and to 93 and 99% in algorithm C, when identifying known and pharmacologically treated diabetes, respectively. Algorithm C had the highest k when using known diabetes as the gold standard (0.95). Algorithm B had the highest k (0.98) when testing for pharmacologically treated diabetes. CONCLUSIONS The SNDS is an excellent source for diabetes surveillance and studies on diabetes since the case definition algorithms applied have very good test performances.
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450
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Abstract
Introduction Postmarketing pharmacovigilance reports have raised concerns about non-bleeding adverse events associated with direct oral anticoagulants (DOACs), but only limited results are available from large claims databases. Objective The aim of this study was to assess the potential association between DOAC initiation and the onset of four types of non-bleeding adverse events by sequence symmetry analysis (SSA). Methods SSA was performed using nationwide data from the French National Healthcare databases (Régime Général, 50 million beneficiaries) to assess a cohort of 386,081 DOAC new users for the first occurrence of four types of non-bleeding outcomes: renal, hepatic, skin outcomes identified by using hospitalization discharge diagnoses, and gastrointestinal outcomes by using medication reimbursement. Asymmetry in the distribution of each investigated outcome occurring before and after initiation of DOAC therapy was used to test the association between DOAC therapy and these outcomes. SSA inherently controls for time-constant confounders, and adjusted sequence ratios were computed after correcting for temporal trends. Negative (glaucoma) and positive (bleeding, depressive disorders) control outcomes were used and analyses were replicated on a cohort of 310,195 patients initiating a vitamin K antagonist (VKA). Results This study demonstrated the expected positive association between either DOAC or VKA therapy and hospitalised bleeding and initiation of antidepressant therapy, while no association was observed between either DOAC or VKA therapy and initiation of antiglaucoma medications. For DOAC therapy, signals were the associations with hepatic outcomes, including acute liver injury [for the 3-month time window, aSR3 = 2.71, 95% confidence interval (CI) 1.79–4.52]; gastrointestinal outcomes, including initiation of drugs for constipation and antiemetic drugs (aSR3 = 1.31, 95% CI 1.27–1.36; and 1.17, 95% CI 1.12–1.22, respectively); and kidney diseases (aSR3 = 1.33, 95% CI 1.29–1.37). Conclusion Results of this nationwide study suggest that DOACs are associated with rare but severe liver injury and more frequent gastrointestinal disorders. A low risk of kidney injury with DOAC therapy can also not be excluded. Electronic supplementary material The online version of this article (10.1007/s40264-018-0668-9) contains supplementary material, which is available to authorized users.
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