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Hoarau D, Ramos I, Termoz A, Fernandez V, Rambure M, Allemann SS, Derex L, Haesebaert J, Schott AM, Viprey M. Determinants of adherence to post-stroke/transient ischemic attack secondary prevention medications: A cohort study. Eur J Neurol 2024:e16395. [PMID: 38953278 DOI: 10.1111/ene.16395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/26/2024] [Accepted: 06/10/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Adherence to post-stroke secondary prevention medications mitigates recurrence risk. This study aimed to measure adherence to secondary prevention medications during 3 years post-ischemic stroke/transient ischemic attack, using prescription and dispensing data, and identify factors associated with suboptimal adherence. METHODS This multicenter, prospective, cohort study involved patients from the STROKE 69 cohort, which included all consecutive patients with suspected acute stroke admitted between November 2015 and December 2016 to any emergency department or stroke center in the Rhône area in France. Prescription data for antihypertensive agents, antidiabetic agents, lipid-lowering drugs, and antithrombotics were collected. Dispensing data were provided by the French regional reimbursement database. Adherence was calculated using the continuous medication acquisition index. Associations between suboptimal adherence and potential influencing factors across the World Health Organization's five dimensions were explored through univariate and multivariate analyses. RESULTS From 1512 eligible patients, 365 were included. Optimal adherence to overall treatment (≥90%) was observed in 61%, 62%, and 65% of patients in the first, second, and third years, respectively. Education level (high school diploma or higher: OR = 3.24, 95% CI [1.49; 7.36]) and depression (Hospital Anxiety and Depression Scale-Depression scores 8-10: OR = 1.90, 95% CI [1.05; 3.44]) were significantly associated with suboptimal adherence. CONCLUSIONS Overall adherence to secondary prevention medications was fairly good. Having an initial diagnosis of transient ischemic attack, a high level of education, or depression was associated with increased odds of suboptimal adherence, while having a history of heart rhythm disorder was associated with lower odds.
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Affiliation(s)
- Damien Hoarau
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Inès Ramos
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Termoz
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | | | - Marie Rambure
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Samuel S Allemann
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Laurent Derex
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Comprehensive Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Anne-Marie Schott
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Marie Viprey
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
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Maillard O, Bun R, Laanani M, Verga-Gérard A, Leroy T, Gault N, Estellat C, Noize P, Kaguelidou F, Sommet A, Lapeyre-Mestre M, Fourrier-Réglat A, Weill A, Quantin C, Tubach F. Use of the French National Health Data System (SNDS) in pharmacoepidemiology: A systematic review in its maturation phase. Therapie 2024:S0040-5957(24)00065-9. [PMID: 38834394 DOI: 10.1016/j.therap.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/14/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
AIM OF THE STUDY The French National Health Data System (SNDS) comprises healthcare data that cover 99% of the population (over 67 million individuals) in France. The aim of this study was to present an overview of published pharmacoepidemiological studies using the SNDS in its maturation phase. METHODS We conducted a systematic literature review of original research articles in the Pubmed and EMBASE databases from January 2012 until August 2018. RESULTS A total of 316 full-text articles were included, with an annual increase over the study period. Only 16 records were excluded after screening because they did not involve the SNDS but other French healthcare databases. The study design was clearly reported in only 66% of studies of which 57% were retrospective cohorts and 22% cross-sectional studies. The reported study objectives were drug utilization (65%), safety (22%) and effectiveness (9%). Almost all ATC groups were studied but the most frequent ones concerned the nervous system in 149 studies (49%), cardiovascular system drugs in 104 studies (34%) and anti-infectives for systemic use in 50 studies (16%). CONCLUSION The SNDS is of growing interest for studies on drug use and safety, which could be conducted more in specific populations, including children, pregnant women and the elderly, as these populations are often not included in clinical trials.
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Affiliation(s)
- Olivier Maillard
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Department of Public Health and Research, CHU de La Réunion, 97400 Saint-Pierre, Ile de La Reunion, France; Clinical Investigation Center, INSERM CIC 1410, CHU de La Réunion, 97400 Saint-Pierre, Ile de La Reunion, France.
| | - René Bun
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Department of Public Health and Research, CHU de La Réunion, 97400 Saint-Pierre, Ile de La Reunion, France; Clinical Investigation Center, INSERM CIC 1410, CHU de La Réunion, 97400 Saint-Pierre, Ile de La Reunion, France
| | - Moussa Laanani
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; French National Health Insurance, 75000 Paris, France
| | - Amandine Verga-Gérard
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; INSERM, CIC-EC 1433, 54100 Nancy, France
| | - Taylor Leroy
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; INSERM, CIC-EC 1433, 54100 Nancy, France
| | - Nathalie Gault
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; INSERM, CIC-EC 1425, hôpital Bichat, 75018 Paris, France
| | - Candice Estellat
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Sorbonne Université, INSERM, institut Pierre-Louis d'épidémiologie et de Santé publique, AP-HP, hôpital Pitié-Salpêtrière, département de Santé publique, centre de pharmacoépidémiologie (Cephepi), CIC-1901, 75000 Paris, France
| | - Pernelle Noize
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Université de Bordeaux, INSERM, BPH, U1219, Team AHeaD, CHU de Bordeaux, pôle de santé publique, service de pharmacologie médicale, 33000 Bordeaux, France
| | - Florentia Kaguelidou
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; INSERM, CIC-EC 1426, Department of Pediatric Pharmacology and Pharmacogenetics, Clinical Investigations Center, hôpital Robert-Debré, 75019 Paris, France; UMR-1123, ECEVE, université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France
| | - Agnès Sommet
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Service de pharmacologie médicale et clinique, faculté de médecine, CIC 1436, CHU, université de Toulouse, 31000 Toulouse, France
| | - Maryse Lapeyre-Mestre
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Service de pharmacologie médicale et clinique, faculté de médecine, CIC 1436, CHU, université de Toulouse, 31000 Toulouse, France
| | - Annie Fourrier-Réglat
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Université de Bordeaux, INSERM, BPH, U1219, Team AHeaD, CHU de Bordeaux, pôle de santé publique, service de pharmacologie médicale, 33000 Bordeaux, France
| | - Alain Weill
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), 93200 Saint-Denis, France
| | - Catherine Quantin
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Service de biostatistiques et d'information médicale (DIM), CHU Dijon Bourgogne, INSERM, université de Bourgogne, CIC 1432, module épidémiologie clinique, 21000 Dijon, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France
| | - Florence Tubach
- Réseau de recherche en épidémiologie clinique et en santé publique/French Clinical Research Infrastructure Network (RECaP F-CRIN) Inserm network, 54500 Vandoeuvre-lès-Nancy, France; Sorbonne Université, INSERM, institut Pierre-Louis d'épidémiologie et de Santé publique, AP-HP, hôpital Pitié-Salpêtrière, département de Santé publique, centre de pharmacoépidémiologie (Cephepi), CIC-1901, 75000 Paris, France
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Keovilayhong S, Mulliez A, Feral L, Chenaf C, Clavelou P, Moisset X, Taithe F, Poncet Megemont L. Epidemiology of myasthenia gravis in France: Incidence, prevalence, and comorbidities based on national healthcare insurance claims data. Rev Neurol (Paris) 2024; 180:451-458. [PMID: 38582663 DOI: 10.1016/j.neurol.2024.02.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/13/2023] [Accepted: 02/09/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The European literature has reported high variability in the incidence and prevalence rates of myasthenia gravis (MG), but no specific epidemiological data for France have been published. This study aimed to assess the incidence and prevalence rates of myasthenia gravis in France based on data extracted from the French National Health Insurance Claims Database (the SNIIRAM database). METHODS We conducted a retrospective repeated cross-sectional population study from 2008 to 2018 using a representative sample of the French population (Échantillon généraliste des bénéficiaires) covered by health insurance. We calculated the incidence, prevalence, and sex ratio of MG and screened for comorbidities associated with MG (standardized to the general population). RESULTS In total, 331 MG patients were identified between 2008 and 2018. The average incidence of MG in France was 50 per million person-years, while the mean prevalence was 465 per million people. The female-to-male ratio was 1.33. The Incidence of MG gradually increased from 40years of age for women and 60 for men. Thymoma was present for 5.1% of MG patients and a thymectomy was performed for 4.7%. Thyroid disease was the most prevalent autoimmune comorbidity, affecting approximately 8.5% of cases. MG patients had an increased cancer risk, with a standardized rate ratio of 2.38 (95% CI: 1.64-3.46). CONCLUSION The incidence and prevalence rates of MG are significantly higher than those previously reported in the literature and the incidence increases with age. The excess risk of cancer raises concerns for MG patients, in particular, concerning the management of immunosuppressive drugs.
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Affiliation(s)
- S Keovilayhong
- Mittaphab Hospital, Vientiane, Lao Democratic People's Republic
| | - A Mulliez
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - L Feral
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Chenaf
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - P Clavelou
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Neuro-Dol, Inserm, Clermont-Ferrand, France
| | - X Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Neuro-Dol, Inserm, Clermont-Ferrand, France
| | - F Taithe
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - L Poncet Megemont
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
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Laporte C, Fortin F, Dupouy J, Darmon D, Pereira B, Authier N, Delorme J, Chenaf C, Maisonneuve H, Schuers M. The French ecology of medical care. A nationwide population-based cross sectional study. Fam Pract 2024; 41:92-98. [PMID: 37934751 DOI: 10.1093/fampra/cmad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
PURPOSE Studies in the United States, Canada, Belgium, and Switzerland showed that the majority of health problems are managed within primary health care; however, the ecology of French medical care has not yet been described. METHODS Nationwide, population-based, cross sectional study. In 2018, we included data from 576,125 beneficiaries from the General Sample of Beneficiaries database. We analysed the reimbursement of consultations with (i) a general practitioner (GP), (ii) an outpatient doctor other than a GP, (iii) a doctor from a university or non-university hospital; and the reimbursement of (iv) hospitalization in a private establishment, (v) general hospital, and (vi) university hospital. For each criterion, we calculated the average monthly number of reimbursements reported on 1,000 beneficiaries. For categorical variables, we used the χ2 test, and to compare means we used the z test. All tests were 2-tailed with a P-value < 5% considered significant. RESULTS Each month, on average, 454 (out of 1,000) beneficiaries received at least 1 reimbursement, 235 consulted a GP, 74 consulted other outpatient doctors in ambulatory care and 24 in a hospital, 13 were hospitalized in a public non-university hospital and 10 in the private sector, and 5 were admitted to a university hospital. Independently of age, people consulted GPs twice as much as other specialists. The 13-25-year-old group consulted the least. Women consulted more than men. Individuals covered by complementary universal health insurance had more care. CONCLUSIONS Our study on reimbursement data confirmed that, like in other countries, in France the majority of health problems are managed within primary health care.
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Affiliation(s)
- Catherine Laporte
- Département de Médecine Générale, Université Clermont Auvergne, UFR de Médecine et Profession paramédicales de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Frédéric Fortin
- Département de Médecine Générale, Université Clermont Auvergne, UFR de Médecine et Profession paramédicales de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Julie Dupouy
- Maison de Santé Pluriprofessionnelle Universitaire de Pins Justaret, Pins Justaret, France
- Département universitaire de médecine générale, UFR Santé, Université Toulouse III Paul Sabatier, Toulouse, France
- UMR 1295 Inserm CERPOP, Université Toulouse III, F-31000 Toulouse, France
| | - David Darmon
- Département d'Enseignement et de Recherche de Médecine Générale, Université Côte d'Azur, RETINES, UFR médecine 28, Avenue de Valombrose, Nice, 06107, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Biostatistics Unit, the Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Nicolas Authier
- CHU Clermont-Ferrand, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm 1107, Neuro-Dol, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Jessica Delorme
- CHU Clermont-Ferrand, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm 1107, Neuro-Dol, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Chouki Chenaf
- CHU Clermont-Ferrand, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm 1107, Neuro-Dol, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Hubert Maisonneuve
- Faculty of Medicine, University Institute for Primary Care, University of Geneva, Geneva, Switzerland
| | - Matthieu Schuers
- Département de Médecine Générale, Normandie Université, UFR Santé Rouen, F-7600 Rouen, France
- Department of Biomedical Informatics, CHU Rouen, F-76000 Rouen, France
- INSERM, U1142, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé, LIMICS, Sorbonne Université, F-75006 Paris, France
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Istvan M, Duval M, Hodel K, Aquizerate A, Chaslerie A, Artarit P, Laforgue EJ, Victorri-Vigneau C. Evolution of the profiles of new psychotropic drug users before and during the COVID-19 crisis: an original longitudinal approach through multichannel sequence analysis using the French health-care database. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01774-3. [PMID: 38499795 DOI: 10.1007/s00406-024-01774-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 02/02/2024] [Indexed: 03/20/2024]
Abstract
The COVID-19 pandemic has had a substantial impact on mental health. An increase in the use of anxiolytic, hypnotic, and antidepressant drugs has been highlighted in France, but with no information at the individual level (trajectories) or concerning patient characteristics. The objective of this study was to describe the profile of new psychotropic drug users since the beginning of the pandemic. We formed two historical cohorts using the Pays-de-la-Loire regional component of the National Health Data System (SNDS): a "COVID-19 crisis cohort" (2020-2021) and a "control cohort" (2018-2019). We analyzed reimbursements for psychotropic medications (anxiolytics, antidepressants, hypnotics, mood stabilizers, and antipsychotics) using a multichannel sequence analysis and performed clustering analysis of sequences. The proportion of new consumers of psychotropic drugs was higher in the COVID-19 crisis cohort (18.0%) than that in the control cohort (16.0%). In the COVID-19 cohort, three clusters of psychotropic drug users were identified, whereas four clusters were identified in the control cohort. A time lag in treatment initiation was observed in the COVID-19 crisis cohort (September) compared with the control cohort (July). This study is one of the first to analyze the profile of psychotropic treatment users during the COVID-19 crisis. Our analysis sheds light on changes in patterns of psychotropic drug use during the COVID-19 pandemic, possibly associated with changes in prescribing conditions and mental health conditions during the crisis. This study also provides an example of the application of an innovative longitudinal analysis methodology in the field of pharmacoepidemiology.
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Affiliation(s)
- Marion Istvan
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France.
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France.
| | - Mélanie Duval
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
| | - Karl Hodel
- Direction Régionale du Service Médical des Pays de la Loire, F-44034, Nantes, France
| | - Aurélie Aquizerate
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
| | - Anicet Chaslerie
- Direction Régionale du Service Médical des Pays de la Loire, F-44034, Nantes, France
| | - Pascal Artarit
- Direction Régionale du Service Médical des Pays de la Loire, F-44034, Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France
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Sato S, Yasunaga H. A Review of Studies Using Japanese Nationwide Administrative Claims Databases. ANNALS OF CLINICAL EPIDEMIOLOGY 2023; 5:58-64. [PMID: 38505730 PMCID: PMC10944998 DOI: 10.37737/ace.23008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/16/2022] [Indexed: 03/21/2024]
Abstract
BACKGROUND Administrative claims databases are increasingly being used worldwide for research purposes. We reviewed original published articles that used one of the four nationwide administrative claims databases in Japan: the National Database of Health Insurance Claims and Specific Health Checkups (NDB), NDB Open Data, the JMDC Claims Database, and the Diagnosis Procedure Combination (DPC) database. METHODS Studies published from January 2010 to July 2022 using the JMDC and DPC databases, and from January 2013 to July 2022 using the NDB and NDB Open Data were identified using PubMed. The number of original articles was divided into 19 fields. The annual growth rate of the number of studies was calculated using the four databases. RESULTS Overall, 1047 studies were included (95 for the NDB, 31 for the NDB Open Data, 222 for the JMDC database, and 699 for the DPC databases). Studies using one of these four databases increased from around 2010, and the average annual growth rate was approximately 41% from 2010 to 2021. DPC database studies had a higher proportion of articles on surgery (19.2%), urology (3.0%), neurosurgery (6.2%), anesthesiology (1.9%), and emergency medicine (14.0%), whereas the NDB and JMDC data had higher proportions of those regarding internal medicine. CONCLUSIONS Since 2010, these four databases have increasingly attracted attention, and the number of studies using them has grown rapidly. Our review suggests that each has unique features, and researchers should understand the database characteristics to operate their studies.
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Affiliation(s)
- So Sato
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo
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Corbeau M, Mulliez A, Chenaf C, Eschalier B, Lesens O, Vorilhon P. Trends of influenza vaccination coverage in pregnant women: a ten-year analysis from a French healthcare database. Sci Rep 2022; 12:7153. [PMID: 35505069 PMCID: PMC9062868 DOI: 10.1038/s41598-022-11308-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/11/2022] [Indexed: 11/09/2022] Open
Abstract
Pregnant women have a high risk of severe influenza, associated with obstetrical complications. The World Health Organization (WHO) has recommended influenza vaccination for all pregnant women since 2012. The vaccination coverage remains low worldwide, and in Europe, due to a lack of proposition from the health care providers, and a high refusal rate from the women. The primary aim of this study was to estimate the influenza vaccination coverage (IVC) in a population of pregnant women in France, and to analyse its evolution from 2009 to 2018. The secondary objective was to describe the vaccinated population and to find determinants associated with the vaccination. This retrospective cohort study is based on the EGB French health care database, a representative sample of the French population containing data from the health insurance system. All pregnant women who delivered medically or spontaneously over the 2009–2018 period were included. In the 2009–2018 period, only 1.2% pregnant women were vaccinated against influenza (n = 875/72,207; 95% CI 1.14–1.30). The IVC slightly increased after the 2012 WHO recommendation, from 0.33 to 1.79% (p < 0.001) but remained extremely low (4.1% in 2018). Women younger than 25 years old had a low coverage (0.6%) whereas women over 35 years old were more likely to get the influenza vaccine (1.7%; OR: 2.82, 95% CI 2.14–3.71). The vaccination behavior was not influenced by multifetal pregnancy or parity, but socio-economically deprived women were less likely to be vaccinated (OR: 0.81, 95% CI: 0.67–0.98). Women with pre-existing medical conditions had an overall higher vaccination rate (2.5%; OR: 2.32, 95% CI: 1.94–2.77). The vaccine was mainly prescribed by family physicians (58%). Influenza vaccination in pregnant women in France remains very low, particularly in younger, healthy women, and measures such as information campaigns towards pregnant women and studies of the knowledge, attitudes, and practices of the health care professionals need to be undertaken to improve the coverage.
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Affiliation(s)
- Mélodie Corbeau
- Department of General Practice, Faculty of Medicine, University Clermont Auvergne, 28 Place Henri Dunant, 63001, Clermont-Ferrand, France
| | - Aurélien Mulliez
- Biostatistics Unit (Clinical Research and Innovation Department), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Chouki Chenaf
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Université Clermont Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, U1107 "Neuro-Dol", Clermont-Ferrand, France
| | - Bénédicte Eschalier
- Department of General Practice, Faculty of Medicine, University Clermont Auvergne, 28 Place Henri Dunant, 63001, Clermont-Ferrand, France
| | - Olivier Lesens
- Infectious and Tropical Diseases Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Vorilhon
- Department of General Practice, Faculty of Medicine, University Clermont Auvergne, 28 Place Henri Dunant, 63001, Clermont-Ferrand, France. .,Biostatistics Unit (Clinical Research and Innovation Department), University Hospital Clermont-Ferrand, Clermont-Ferrand, France. .,Université Clermont Auvergne, ACCePPT, Clermont-Ferrand, France.
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8
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Trends in disease-modifying therapy use in patients with multiple sclerosis using a 10-year population-based cohort study in France. Expert Rev Neurother 2022; 22:411-418. [PMID: 35363999 DOI: 10.1080/14737175.2022.2061950] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The availability of new disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) provides an opportunity for improving outcomes but makes disease management more complex. Our study aimed to describe changes in therapeutic practices over the period 2009-2018 and measure the impact of the arrival of oral DMTs on the use of injectable DMTs. METHODS Data were extracted from a representative 1/97 sample of the French population covered by the healthcare insurance system. Study period was set from 1 January 2009 to 31 December 2018. Four periods of MS identification were defined (before 2009, 2009-2011, 2012-2015 and 2016-2018). RESULTS Overall, 1,508 patients with MS were included, of whom 876 (58.1%) were treated at least once over the study period. Untreated patients were older and had more comorbidities than treated ones. First-line DMTs were the most frequent initial DMT (78.5%) and a shift has operated from injectable to oral drugs over time. The proportion of patients receiving several DMTs increased with the number of available drugs. End 2018, beta interferon, glatiramer acetate, teriflunomide, dimethylfumarate, fingolimod and natalizumab shared nearly equal parts. CONCLUSIONS This study provides valuable insights into the real-world use of DMTs and changes that have operated over time.
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9
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National reimbursement databases: use and limitations for rheumatologic studies. Joint Bone Spine 2022; 89:105369. [DOI: 10.1016/j.jbspin.2022.105369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
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10
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Martin-Latry K, Latry P, Moysan V, Berges C, Coste P, Douard H, Pucheu Y, Agosti N, Couffinhal T. One-year care pathway after acute myocardial infarction in 2018: Prescription, medical care and medication adherence, using a French health insurance reimbursement database. Arch Cardiovasc Dis 2022; 115:78-86. [PMID: 35115266 DOI: 10.1016/j.acvd.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/17/2021] [Accepted: 12/23/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Myocardial infarction is a major cause of morbidity and mortality. Guidelines have been published to optimize medical care and involve optimization of the care pathway and hospital-city coordination. AIMS To describe the myocardial infarction care pathway during the year following hospital discharge, and the use of and adherence to secondary prevention drugs. METHODS A cohort study was conducted using data from the main French health insurance reimbursement database of the ex-Aquitaine region. Information about the medical and pharmaceutical care of hospitalized patients in 2018 was collected for 12 months. Medication adherence was assessed by using the proportion of days covered by the treatment and persistence. RESULTS A total of 3015 patients were included, and the mean age was 66 years. Almost 76% of the patients had a reimbursement for BAS (combined prescription of beta-blocker/antiplatelet/lipid-lowering drug), BASI (combined prescription of beta-blocker/antiplatelet/lipid-lowering drug/angiotensin-converting enzyme inhibitor) or AS (combined prescription of antiplatelet/lipid-lowering drug) treatment. Medication adherence was around 83% for aspirin and 75% for lipid-lowering drugs for the 1-year persistence. During the same time, the proportion of days covered was suboptimal. Almost 4% of patients died after leaving hospital, 45% went to a cardiac rehabilitation centre and 23% had at least one hospital readmission, whatever the reason. Patients had a mean number of 11 general practitioner consultations during the year. Almost 41% of patients did not have a consultation with a cardiologist, and 38.4% had at least two consultations. Rehabilitation and general practitioner consultations were associated with adherence. CONCLUSIONS These new results provide clear information on the medical care environment of patients, and help us to improve care transition. Close collaboration between healthcare practitioners is very important in the early stages of outpatient follow-up.
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Affiliation(s)
- Karin Martin-Latry
- Inserm UMR 1034, Biology of Cardiovascular Diseases, Université de Bordeaux, 1, avenue de Magellan, 33600 Pessac, France; Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France.
| | - Philippe Latry
- Direction Régionale du Service Médical de l'Assurance Maladie de Nouvelle-Aquitaine, CNAM-TS, 33000 Bordeaux, France
| | - Véronique Moysan
- Direction Régionale du Service Médical de l'Assurance Maladie de Nouvelle-Aquitaine, CNAM-TS, 33000 Bordeaux, France
| | - Camille Berges
- Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France
| | - Pierre Coste
- Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France
| | - Hervé Douard
- Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France
| | - Yann Pucheu
- Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France
| | - Nadine Agosti
- Direction Régionale du Service Médical de l'Assurance Maladie de Nouvelle-Aquitaine, CNAM-TS, 33000 Bordeaux, France
| | - Thierry Couffinhal
- Inserm UMR 1034, Biology of Cardiovascular Diseases, Université de Bordeaux, 1, avenue de Magellan, 33600 Pessac, France; Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France
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11
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Marchal C, Belhassen M, Guiso N, Jacoud F, Cohen R, Le Pannerer M, Verdier R. Cocooning strategy: Pertussis vaccination coverage rate of parents with a new-born in 2016 and 2017 in France. Front Pediatr 2022; 10:988674. [PMID: 36330369 PMCID: PMC9624187 DOI: 10.3389/fped.2022.988674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The "cocooning" strategy was introduced in 2004 to protect infants too young to be vaccinated against pertussis, by immunizing their parents and close relatives. The study objective was to assess its implementation 12 years after its introduction by estimating the pertussis vaccination coverage rates (VCR) among parents of newborns. MATERIALS AND METHODS Pertussis VCR were estimated among all women who gave birth and men who took paternity leave, in 2016 or 2017, from a 1/97th random sample of French claims data. Two distinct study periods were defined based on current recommendations for the cocooning strategy: the "common practice" and the "parental project" periods. RESULTS In 2016, the pertussis VCR of women having given birth and men having taken paternity leave was 47.2 and 47.1%, respectively (46.1 and 45.6% in 2017, respectively). About one quarter of vaccinations were performed during the "parental project" period, with the vaccine most frequently reimbursed during the month of childbirth for women (57.1% in 2016 and 49.4% in 2017) and before or during the month the paternity leave began for men (about 78% in both 2016 and 2017). General practitioners were the main prescribers in private practice, even during the "parental project" period. CONCLUSION To optimize the protection for infants, the main objective of the cocooning strategy, pertussis immunization coverage of adults and seniors needs to be improved. Moreover, cocooning vaccination linked to a parental project needs to be performed earlier, during pregnancy (for those around the mother) or in immediate post-partum (e.g., during the maternity stay).
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Affiliation(s)
| | | | | | - Flore Jacoud
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France
| | - Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,GPIP, Pediatric Infectious Disease Group, Créteil, France.,ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur-des-Fossés, France.,Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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12
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Revet A, Moulis G, Raynaud JP, Bui E, Lapeyre-Mestre M. Use of the French national health insurance information system for research in the field of mental health: Systematic review and perspectives. Fundam Clin Pharmacol 2021; 36:16-34. [PMID: 33998708 DOI: 10.1111/fcp.12696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE This systematic review registered in PROSPERO (CRD42021225296) aimed to describe the use of the French national health insurance information system, which covers the entire French population (67 million inhabitants), for research in the field of mental health. METHODS Three electronic databases and a journal hand-search identified 15 265 articles from January 1, 2003 (year of creation of the database) to October 31, 2020. Studies of any design were eligible for inclusion provided that they (i) made use of at least one component of the French health insurance database and (ii) focused on a topic in near and far connection with the field of mental health in France. Database used, design and methods, study period, population, key findings, and type of use for medical research were described. RESULTS A total of 152 studies were included in the review analysis. There was an increase in the number of published articles over time throughout the studied period. Studies focusing on adults (n = 139) largely outnumbered those focusing on children and adolescents (n = 11). Pharmacoepidemiological studies were by far the most frequent (n = 123), followed by methodological studies (n = 23), epidemiological studies (n = 17), and health economics studies (n = 3). The most studied psychotropic drugs were antidepressants (n = 27), anxiolytics (n = 27), and opioids (n = 25) while fewer studies focused on methylphenidate (n = 6) and on mood stabilizers (n = 5). Few studies specifically focused on psychiatric disorders, mainly depression (n = 4), suicide (n = 4), and psychotic disorders (n = 3). CONCLUSION This systematic review highlighted a relatively poor exploitation of the Système national des données de santé database in the field of psychiatric research with regard to the great possibilities it offers, with a clear lag in certain fields such as epidemiological or health economics studies and in specific populations, in particular children and adolescents.
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Affiliation(s)
- Alexis Revet
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France.,CERPOP, Inserm, UPS, Université de Toulouse, Toulouse, France.,CIC 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Toulouse University Hospital, Toulouse, France
| | - Guillaume Moulis
- CIC 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Toulouse University Hospital, Toulouse, France.,Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Philippe Raynaud
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France.,CERPOP, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Caen University Hospital, University of Caen Normandy, Caen, France
| | - Maryse Lapeyre-Mestre
- CIC 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Toulouse University Hospital, Toulouse, France
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13
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Cattelain-Lopez E, Chu Miow Lin D, Happe A, Goupille P, Oger E, Mulleman D. Poor assessment of bone mineral density after a forearm fracture in women aged 50 years or older: Data from a French health insurance database. Joint Bone Spine 2021; 88:105121. [PMID: 33485155 DOI: 10.1016/j.jbspin.2020.105121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Elsa Cattelain-Lopez
- Université de Tours, 37000 Tours, France; Service de rhumatologie, CHRU de Tours, 37044 Tours cedex 9, France
| | - Delphine Chu Miow Lin
- Université de Tours, 37000 Tours, France; Service de rhumatologie, CHRU de Tours, 37044 Tours cedex 9, France
| | - André Happe
- UPRES-EA 7449 REPERES, CHRU de Brest, 29200 Brest, France
| | - Philippe Goupille
- Université de Tours, 37000 Tours, France; Service de rhumatologie, CHRU de Tours, 37044 Tours cedex 9, France
| | - Emmanuel Oger
- Centre régional de pharmacovigilance, pharmaco-épidémiologie et information sur le médicament, CHRU de Rennes, 35000 Rennes, France; UPRES-EA 7449 REPERES, Université de Rennes 1, 35000 Rennes, France
| | - Denis Mulleman
- Université de Tours, 37000 Tours, France; Service de rhumatologie, CHRU de Tours, 37044 Tours cedex 9, France.
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Soeiro T, Lacroix C, Pradel V, Lapeyre-Mestre M, Micallef J. Early Detection of Prescription Drug Abuse Using Doctor Shopping Monitoring From Claims Databases: Illustration From the Experience of the French Addictovigilance Network. Front Psychiatry 2021; 12:640120. [PMID: 34079478 PMCID: PMC8165176 DOI: 10.3389/fpsyt.2021.640120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
Opioid analgesics and maintenance treatments, benzodiazepines and z-drugs, and other sedatives and stimulants are increasingly being abused to induce psychoactive effects or alter the effects of other drugs, eventually leading to dependence. Awareness of prescription drug abuse has been increasing in the last two decades, and organizations such as the International Narcotics Control Board has predicted that, worldwide, prescription drug abuse may exceed the use of illicit drugs. Assessment of prescription drug abuse tackles an issue that is hidden by nature, which therefore requires a specific monitoring. The current best practice is to use multiple detection systems to assess prescription drug abuse by various populations in a timely, sensitive, and specific manner. In the early 2000's, we designed a method to detect and quantify doctor shopping for prescription drugs from the French National Health Data System, which is one of the world's largest claims database, and a first-class data source for pharmacoepidemiological studies. Doctor shopping is a well-known behavior that involves overlapping prescriptions from multiple prescribers for the same drug, to obtain higher doses than those prescribed by each prescriber on an individual basis. In addition, doctor shopping may play an important role in supplying the black market. The paper aims to review how doctor shopping monitoring can improve the early detection of prescription drug abuse within a multidimensional monitoring. The paper provides an in-depth overview of two decades of development and validation of the method as a complementary component of the multidimensional monitoring conducted by the French Addictovigilance Network. The process accounted for the relevant determinants of prescription drug abuse, such as pharmacological data (e.g., formulations and doses), chronological and geographical data (e.g., impact of measures and comparison between regions), and epidemiological and outcome data (e.g., profiles of patients and trajectories of care) for several pharmacological classes (e.g., opioids, benzodiazepines, antidepressants, and methylphenidate).
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Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Clémence Lacroix
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Vincent Pradel
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Maryse Lapeyre-Mestre
- Université Paul Sabatier, Inserm, CIC 1436, Centre Hospitalier Universitaire de Toulouse, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Toulouse, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
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15
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Vaccination coverage rates for Diphtheria, Tetanus, Poliomyelitis and Pertussis booster vaccination in France between 2013 and 2017: Learnings from an analysis of National Health System Real-World Data. Vaccine 2020; 39:505-511. [PMID: 33357956 DOI: 10.1016/j.vaccine.2020.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Maintaining a high vaccination coverage rate (VCR) throughout the lifetime and complying with the National Immunization Program are essential to optimize the protection of the population. The study objectives were to evaluate the evolution of the VCRs and the compliance with the vaccination visits for the diphtheria, tetanus, poliomyelitis and pertussis boosters in France since the changes implemented in the 2013 National Immunization Program. METHODS Cumulative booster VCRs were estimated at all vaccination visits, from 2013 to 2017, among persons eligible for a booster vaccination from a 1/97th random sample of French claims data. Broader age groups around the recommended ages by the vaccination schedule (6, 11-13, 25, 45, 65, 75, 85, 95y) were used: all persons aged 5 to 8, 10 to 15, 21 to 29, 41 to 49, 61 to 69, 71 to 79, 81 to 89 and 91 to 99. RESULTS Over the study period, the diphtheria-tetanus-poliomyelitis booster VCRs increased, reaching in 2017: 73.3% at 8 years old, 75.6% at 15 years old, 46.6% at 29 years old, 38.4% at 49 years old, 36.3% at 69 years old, 30.8% at 79 years old, 22.1% at 89 years old and 11.0% at 99 years old. The pertussis VCRs were also increasing at all vaccination visits, in particular at the vaccination visits at 6 and 11-13 years old (from 16.4% to 63.8% and from 50.3% to 61.2%, respectively). Delayed vaccinations were observed at all vaccination visits. CONCLUSION VCRs for Diphtheria, Tetanus, Poliomyelitis and Pertussis booster vaccination increased from 2013 to 2017 while remaining suboptimal across all ages and lower in the adult populations. The analysis also shows that the introduction in 2013 of a pertussis vaccination at 6 years of age was relatively well-established in 2017 while other changes in recommendations were slowly or partially implemented.
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Cabaillot A, Bourset A, Mulliez A, Delorme J, Orri M, Vicard-Olagne M, Zenut MC, Tournier M, Gallot D, Authier N, Chenaf C, Laporte C. Trajectories of antidepressant drugs during pregnancy: A cohort study from a community-based sample. Br J Clin Pharmacol 2020; 87:965-987. [PMID: 32755022 DOI: 10.1111/bcp.14449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/30/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS The aim of this study was to monitor the trajectories of antidepressant use during pregnancy and the postpartum period among women chronically treated with antidepressants before their pregnancy, and to assess characteristics associated with each trajectory. METHODS This cohort study included all pregnant women whose data were included in the General Sample of Beneficiaries (EGB) database affiliated with the French Health Insurance System, from 2009 to 2014. Women were followed up until 6 months after childbirth. Chronic treatment was defined as exposure over the 6-month period preceding pregnancy. A group-based trajectory model (GBMT) was estimated to identify distinctive longitudinal profiles of antidepressant use. RESULTS Among 760 women chronically treated with antidepressants before their pregnancy, 55.8% stopped their treatment permanently in the first trimester, 20.4% discontinued it for a minimum of 3 months and resumed it postpartum, and 23.8% maintained it throughout pregnancy and postpartum. No sociodemographic or medical characteristics were associated with any trajectory group. Women who maintained treatment presented more frequent obstetric complications and postpartum psychiatric disorders. Among women who interrupted treatment, prescription of benzodiazepines and anxiolytics decreased initially but rose postpartum to a higher level than before pregnancy. CONCLUSIONS Pregnant women treated with antidepressant require a re-evaluation of psychiatric treatment. It is necessary to pay attention to obstetric complications for severely depressed women. Additionally, as relapse was associated with increased benzodiazepine use, it is important to carefully monitor all women who stop antidepressant treatment during pregnancy.
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Affiliation(s)
- Aurélie Cabaillot
- Département de Médecine Générale, UFR de Médicine, Université Clermont Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Observatoire Français des Médicaments Antalgiques (OFMA), Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Alexandra Bourset
- Département de Médecine Générale, UFR de Médicine, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation à la recherche clinique et à l'innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jessica Delorme
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Observatoire Français des Médicaments Antalgiques (OFMA), Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, QC, Canada.,Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Mathilde Vicard-Olagne
- Département de Médecine Générale, UFR de Médicine, Université Clermont Auvergne, Clermont-Ferrand, France.,Npsysydo, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marie Christine Zenut
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Observatoire Français des Médicaments Antalgiques (OFMA), Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marie Tournier
- Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Université de Bordeaux, Bordeaux, France.,Hospital Charles Perrens, Bordeaux, France
| | - Denis Gallot
- CNRS 6293, INSERM 1103, GReD, QC G1V 0A6 Clermont-Ferrand; Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, Faculty of Medicine, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Nicolas Authier
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Observatoire Français des Médicaments Antalgiques (OFMA), Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Chouki Chenaf
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Observatoire Français des Médicaments Antalgiques (OFMA), Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Catherine Laporte
- Département de Médecine Générale, UFR de Médicine, Université Clermont Auvergne, Clermont-Ferrand, France.,Npsysydo, Université Clermont Auvergne, Clermont-Ferrand, France
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Viprey M, Xue Y, Rousseau A, Payet C, Chapurlat R, Caillet P, Dima A, Schott AM. Adherence with brand versus generic bisphosphonates among osteoporosis patients: a new-user cohort study in the French National Healthcare Insurance database. Sci Rep 2020; 10:7446. [PMID: 32366863 PMCID: PMC7198539 DOI: 10.1038/s41598-020-64214-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/25/2020] [Indexed: 12/21/2022] Open
Abstract
Several studies documented declines in treatment adherence with generic forms of oral bisphosphonates in osteoporosis compared to branded forms, while others did not support this relation. Our aim was to compare medication adherence with brand versus generic forms of oral bisphosphonates. A new-user cohort study was conducted using routinely collected administrative and healthcare data linked at the individual level extracted from a nationwide representative sample of the French National Healthcare Insurance database. We included all patients aged 50 and older, new users of oral bisphosphonates for primary osteoporosis between 01/01/2009 and 31/12/2015. Two components of adherence were measured: implementation (continuous multiple-interval measure of medication availability version 7; CMA7) and persistence (time to discontinuation). The sample was composed of 1,834 in the "brand bisphosphonate" group and 1,495 patients in the "generic bisphosphonate" group. Initiating oral bisphosphonate treatment with brand was associated with a higher risk of discontinuation within 12 months (Hazard Ratio = 1.08; 95%CI = [1.02;1.14]). The risk of good implementation (CMA7 ≥ 0.90) was significantly lower in "brand bisphosphonate" group (Risk Ratio = 0.90; 95%CI = [0.85; 0.95]). We did not find any evidence to support the hypothesis of a lower adherence to generic bisphosphonates. In fact, prescribing of generic bisphosphonates led to a higher persistence rate and to better implementation at 1 year.
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Affiliation(s)
- Marie Viprey
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France
| | - Yufeng Xue
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France
| | - Aurélie Rousseau
- Centre Hospitalier de Bourg en Bresse, Service pharmaceutique, Bourg en Bresse, France
| | - Cécile Payet
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France
| | - Roland Chapurlat
- Université de Lyon, INSERM UMR 1033, Lyon, France
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Rhumatologie, Lyon, France
| | - Pascal Caillet
- CHU de Nantes, Service de Pharmacologie Clinique, Nantes, France
| | - Alexandra Dima
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France
| | - Anne-Marie Schott
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France.
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, Lyon, France.
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18
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Hirose N, Ishimaru M, Morita K, Yasunaga H. A review of studies using the Japanese National Database of Health Insurance Claims and Specific Health Checkups. ACTA ACUST UNITED AC 2020. [DOI: 10.37737/ace.2.1_13] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Naoki Hirose
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
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19
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Dalon F, Devouassoux G, Belhassen M, Nachbaur G, Correia Da Silva C, Sail L, Jacoud F, Chouaid C, Van Ganse E. Impact of Therapy Persistence on Exacerbations and Resource Use in Patients Who Initiated COPD Therapy. Int J Chron Obstruct Pulmon Dis 2019; 14:2905-2915. [PMID: 31908439 PMCID: PMC6927267 DOI: 10.2147/copd.s222762] [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] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/02/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose This study assessed therapy persistence in patients with chronic obstructive pulmonary disease (COPD) in France, and the impact of non-persistence on exacerbations and described COPD-related healthcare resource use (HRU). Methods Patients aged ≥45 years who received ≥1 dispensed bronchodilator per quarter over three consecutive quarters between 2007 and 2014 and initiated specific COPD therapy were selected from the Echantillon Généraliste des Bénéficiaires (EGB) database. Persistence, defined as the absence of dispensing gaps of >90 days, was measured at 12 months. Exacerbations were compared between persistent and non-persistent patients during follow-up after patient matching and adjustment for confounding factors. COPD-related HRU during follow-up was described. Results Among 4020 patients with COPD, 2164 initiated a specific therapy. Of these, 54.4% stopped treatment within 12 months. Persistence with all COPD therapy regimens was low, particularly for inhaled corticosteroid (ICS; 25.6%) and ICS/twice-daily long-acting beta-agonist (39.4%) regimens. Among 721 persistent patients who were matched with 721 non-persistent patients, there was no difference in the number of moderate or severe exacerbations at 12 months. However, medical procedures (for instance, pulmonary function testing and chest X-rays) were more frequently observed among persistent patients than among non-persistent patients, suggesting worse disease severity. Conclusion Patients receiving specific treatment(s) for COPD demonstrated low persistence for all examined therapy regimens, with no clear impact of persistence status on the frequency of exacerbations at 12 months.
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Affiliation(s)
| | - Gilles Devouassoux
- Pulmonary Department, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.,EA 7426, PI3, Inflammation & Immunité de L'épithélium Respiratoire, Université Claude-Bernard-Lyon1, Lyon, France
| | - Manon Belhassen
- PELyon, PharmacoEpidemiology, Lyon, France.,EA 7425 HESPER Health Services and Performance Research, Université Claude-Bernard-Lyon1, Lyon, France
| | - Gaëlle Nachbaur
- GlaxoSmithKline France, Pharmaco Epidemiology and Health Economics and Outcomes Research, Rueil-Malmaison, France
| | - Camille Correia Da Silva
- GlaxoSmithKline France, Pharmaco Epidemiology and Health Economics and Outcomes Research, Rueil-Malmaison, France
| | - Lynda Sail
- GlaxoSmithKline France, Pharmaco Epidemiology and Health Economics and Outcomes Research, Rueil-Malmaison, France
| | | | | | - Eric Van Ganse
- PELyon, PharmacoEpidemiology, Lyon, France.,Pulmonary Department, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER Health Services and Performance Research, Université Claude-Bernard-Lyon1, Lyon, France
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20
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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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21
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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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22
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Prada-Ramallal G, Takkouche B, Figueiras A. Bias in pharmacoepidemiologic studies using secondary health care databases: a scoping review. BMC Med Res Methodol 2019; 19:53. [PMID: 30871502 PMCID: PMC6419460 DOI: 10.1186/s12874-019-0695-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 02/26/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The availability of clinical and therapeutic data drawn from medical records and administrative databases has entailed new opportunities for clinical and epidemiologic research. However, these databases present inherent limitations which may render them prone to new biases. We aimed to conduct a structured review of biases specific to observational clinical studies based on secondary databases, and to propose strategies for the mitigation of those biases. METHODS Scoping review of the scientific literature published during the period 2000-2018 through an automated search of MEDLINE, EMBASE and Web of Science, supplemented with manually cross-checking of reference lists. We included opinion essays, methodological reviews, analyses or simulation studies, as well as letters to the editor or retractions, the principal objective of which was to highlight the existence of some type of bias in pharmacoepidemiologic studies using secondary databases. RESULTS A total of 117 articles were included. An increasing trend in the number of publications concerning the potential limitations of secondary databases was observed over time and across medical research disciplines. Confounding was the most reported category of bias (63.2% of articles), followed by selection and measurement biases (47.0% and 46.2% respectively). Confounding by indication (32.5%), unmeasured/residual confounding (28.2%), outcome misclassification (28.2%) and "immortal time" bias (25.6%) were the subcategories most frequently mentioned. CONCLUSIONS Suboptimal use of secondary databases in pharmacoepidemiologic studies has introduced biases in the studies, which may have led to erroneous conclusions. Methods to mitigate biases are available and must be considered in the design, analysis and interpretation phases of studies using these data sources.
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Affiliation(s)
- Guillermo Prada-Ramallal
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, c/ San Francisco s/n, 15786 Santiago de Compostela, A Coruña Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Clinical University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Bahi Takkouche
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, c/ San Francisco s/n, 15786 Santiago de Compostela, A Coruña Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Clinical University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública – CIBERESP), Santiago de Compostela, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, c/ San Francisco s/n, 15786 Santiago de Compostela, A Coruña Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Clinical University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública – CIBERESP), Santiago de Compostela, Spain
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23
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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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24
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Desai RJ, Lin KJ, Patorno E, Barberio J, Lee M, Levin R, Evers T, Wang SV, Schneeweiss S. Development and Preliminary Validation of a Medicare Claims-Based Model to Predict Left Ventricular Ejection Fraction Class in Patients With Heart Failure. Circ Cardiovasc Qual Outcomes 2018; 11:e004700. [PMID: 30562067 DOI: 10.1161/circoutcomes.118.004700] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ejection fraction (EF) class is an important predictor of treatment response in heart failure (HF); however, administrative claims databases lack information on EF, limiting their usefulness in clinical and health services research of HF. METHODS AND RESULTS We linked Medicare claims data to electronic medical records containing EF measurements for a cohort of 11 073 patients with HF from 2 academic medical centers. A a claims-based model predicting EF class was constructed using data from center 1 ("training sample") and validated using data from center 2 ("testing sample). Linear and logistic regression models with least absolute square shrinkage operator and Bayesian information criteria were developed to select the relevant predictor variables out of the total 57 candidate variables in the training sample. Higher accuracy was noted in the testing sample with models classifying patients into 2 EF classes (reduced EF <0.45) versus preserved EF (≥0.45) when compared with classifying patients into 3 EF classes (reduced, <0.40, moderately reduced, 0.40-0.49, or preserved, ≥0.50). In the testing sample, the most efficient model had 35 predictors and resulted in 83% of patients being correctly classified (95% CI, 82%-84%). The model had positive predictive value of 0.73 (95% CI, 0.68-0.78) and 0.84 (95% CI, 0.83-0.86) and sensitivity of 0.29 (95% CI, 0.25-0.32) and 0.97 (95% CI, 0.97-0.98) for reduced and preserved EF, respectively. In addition to HF-specific diagnosis codes, other factors including age, sex, medication use, and comorbidities, such as myocardial infarction and valve disorders, were important discriminators between EF classes. CONCLUSIONS The claims-based model developed in this study may be used to identify patient subgroups with specific EF class in studies evaluating the health outcomes, utilization patterns, and cost, of HF patients in routine care when EF measurements are not available.
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Affiliation(s)
- Rishi J Desai
- Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.J.D., K.J.L., E.P., J.B., M.L., R.L., S.V.W., S.S.)
| | - Kueiyu Joshua Lin
- Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.J.D., K.J.L., E.P., J.B., M.L., R.L., S.V.W., S.S.)
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (K.J.L.)
| | - Elisabetta Patorno
- Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.J.D., K.J.L., E.P., J.B., M.L., R.L., S.V.W., S.S.)
| | - Julie Barberio
- Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.J.D., K.J.L., E.P., J.B., M.L., R.L., S.V.W., S.S.)
| | - Moa Lee
- Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.J.D., K.J.L., E.P., J.B., M.L., R.L., S.V.W., S.S.)
| | - Raisa Levin
- Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.J.D., K.J.L., E.P., J.B., M.L., R.L., S.V.W., S.S.)
| | - Thomas Evers
- Market Access, Bayer AG, Wuppertal, Germany (T.E.)
| | - Shirley V Wang
- Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.J.D., K.J.L., E.P., J.B., M.L., R.L., S.V.W., S.S.)
| | - Sebastian Schneeweiss
- Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.J.D., K.J.L., E.P., J.B., M.L., R.L., S.V.W., S.S.)
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25
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What is pharmacoepidemiology? Definition, methods, interest and clinical applications. Therapie 2018; 74:169-174. [PMID: 30389102 DOI: 10.1016/j.therap.2018.08.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/24/2018] [Indexed: 01/13/2023]
Abstract
Clinical evaluation of drugs before approval is based on the experimental design of clinical trial with randomization of drug exposure. Unfortunately, conclusions of clinical trials are necessarily limited to patients included into the trials. It is thus necessary to compare these experimental data coming from clinical trials with the real use of drugs in clinical practice. Pharmacoepidemiology is the study of interactions between drugs and human populations, investigating, in real conditions of life, benefits, risks and use of drugs. Pharmacoepidemiology applies to drugs the methods and/or reasoning of both pharmacology and epidemiology. The development of pharmacoepidemiology should improve the "rational drug use".
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26
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Chenaf C, Kaboré JL, Delorme J, Pereira B, Mulliez A, Zenut M, Delage N, Ardid D, Eschalier A, Authier N. Prescription opioid analgesic use in France: Trends and impact on morbidity-mortality. Eur J Pain 2018; 23:124-134. [PMID: 30051548 DOI: 10.1002/ejp.1291] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND While data from USA and Canada demonstrate an opioid overdose epidemic, very little nation-wide European studies have been published on this topical subject. METHODS Using a nationally representative sample of the French Claims database (>700,000 patients), the exhaustive nationwide hospital discharge database, and national mortality registry, all patients dispensed at least one prescription opioid (PO) in 2004-2017 were identified, to describe trends in PO analgesic use, shopping behaviour, opioid-related hospitalizations and deaths. Annual prevalence of PO use and shopping behaviour (≥1 day of overlapping prescriptions from ≥2 prescribers, dispensed by ≥3 pharmacies) was estimated. RESULTS In 2004-2017, the annual prevalence of weak opioid use codeine, tramadol and opium rose by 150%, 123%, and 244%, respectively (p < 0.05). Strong opioid use increased from 0.54% to 1.1% (+104%, p < 0.05), significantly for oxycodone (+1950%). Strong opioid use in chronic noncancer pain rose by 88% (p < 0.05) and 1180% for oxycodone. Opioid shopping increased from 0.50% to 0.67% (+34%, p < 0.05), associated with higher mortality risk HR = 2.8 [95% confidence interval (CI): 1.2-6.4]. Opioid-related hospitalizations increased from 15 to 40 per 1,000,000 population (+167%, 2000-2017), and opioid-related deaths from 1.3 to 3.2 per 1,000,000 population (+146%, 2000-2015). CONCLUSIONS This study provided a first European approach to a nationwide estimation with complete access to several national registries. In 2004-2017 in France, PO use excluding dextropropoxyphene more than doubled. The increase in oxycodone and fentanyl use, and nontrivial increasing trend in opioid-related morbidity-mortality should prompt authorities to closely monitor PO consumption in order to prevent alarming increases in opioid-related morbidity-mortality. SIGNIFICANCE In 2004-2017, prescription opioid use in France at least doubled and oxycodone use increased particularly, associated with a nontrivial increase in opioid-related morbidity-mortality. Although giving no indication for an 'opioid epidemic,' these findings call for proper monitoring of opioid use.
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Affiliation(s)
- C Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - J-L Kaboré
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - J Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - B Pereira
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France
| | - A Mulliez
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France
| | - M Zenut
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - N Delage
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - D Ardid
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - A Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
| | - N Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Délégation à la Recherche Clinique et à l'Innovation, F-63001, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, F-63001, Clermont-Ferrand, France
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Is There a Cardiotoxicity Associated With Metallic Head Hip Prostheses? A Cohort Study in the French National Health Insurance Databases. Clin Orthop Relat Res 2018; 476:1441-1451. [PMID: 29698302 PMCID: PMC6259674 DOI: 10.1097/01.blo.0000533617.64678.69] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are four distinguishable types of THA devices in wide use, as defined by the femoral and acetabular bearing surfaces: metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), metal-on-metal (MoM), and ceramic-on-ceramic (CoC). Metallic head THAs (MoP and MoM) can potentially induce cardiac toxicity because cobalt species, generated at the head-neck trunnion, and in the case of MoM devices, at the articular surface as well, can be absorbed systemically. However, studies have provided inconsistent results. QUESTIONS/PURPOSES The purpose of this study was to assess the risk of dilated cardiomyopathy (DCM) or heart failure (HF) associated with metallic head THAs using data from the French national health insurance databases. METHODS Between 2008 and 2011 in France, 399,968 patients ≥ 55 years had a first THA. A total of 127,481 were excluded after we applied the exclusion criteria regarding arthroplasty and 17,137 as a result of a history of DCM/HF, recorded in the French national health insurance reimbursement databases, between January 1, 2006, and the date of inclusion. The final cohort included 255,350 individuals (43% men; mean age 72 ± 9 years). Of them, 93,581 (37%) had been implanted with MoP, 58,095 (23%) with CoP, 11,298 (4%) with MoM, and 92,376 (36%) with CoC THAs. Patients were followed until December 2015. Patients with incident DCM/HF were identified by a new entitlement to the long-term disease scheme or a first hospitalization with a diagnosis of DCM or HF. MoP and CoP THAs are generally implanted in old patients, whereas MoM and CoC are mostly indicated in young, active male patients. Thus, to consider the specific indications of the bearing couples, analyses were separately performed in two distinct subcohorts, one comprising patients with MoP or CoP and one comprising patients with MoM or CoC THA. In each subcohort, the DCM/HF risk was compared between patients with metallic head versus nonmetallic head THAs (MoP versus CoP, MoM versus CoC). Hazard ratios (adjusted HRs) of incident DCM/HF were estimated using Cox models adjusted for baseline sex, age, THA characteristics (fixation technique with cement, use of a modular femoral neck), and comorbidities at baseline. Cox models were stratified by sex and age. RESULTS The crude incidence of DCM/HF per 100 person-years was 2.4 in patients with MoP, 1.8 with CoP, 1.2 with MoM, and 1.1 with CoC THAs. Overall, metallic head THAs were associated with a slight increase in DCM/HF risk (MoP versus CoP: adjusted HR, 1.08; 95% confidence interval [CI], 1.05-1.12; p < 0.001; MoM versus CoC: adjusted HR, 1.11; 95% CI, 1.03-1.19; p = 0.007). In the MoM-CoC subcohort, the risk tended to be more pronounced with MoM versus CoC THAs in women (MoM versus CoC: adjusted HR, 1.20; 95% CI, 1.07-1.35; p = 0.002) and patients aged ≥ 75 years (MoM versus CoC: adjusted HR, 1.16; 95% CI, 1.04-1.29; p = 0.009). CONCLUSIONS Metallic head THAs were associated with a slightly increased DCM/HF risk, especially with MoM in women and older patients. Some caveats should be mentioned: severity of DCM or HF was not available and residual confounding cannot be ruled out despite considering many covariates. Our findings suggest that cardiac function should be regularly monitored in patients with metallic head THAs. Further investigations should be planned on large international cohorts. LEVEL OF EVIDENCE Level III, therapeutic study.
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Mechtouff L, Haesebaert J, Viprey M, Tainturier V, Termoz A, Porthault-Chatard S, David JS, Derex L, Nighoghossian N, Schott AM. Secondary Prevention Three and Six Years after Stroke Using the French National Insurance Healthcare System Database. Eur Neurol 2018; 79:272-280. [PMID: 29758555 DOI: 10.1159/000488450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 03/14/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Secondary prevention is inadequate in the first 2 years after stroke but what happens after that is less documented. The aim of this study was to assess the use and the adherence to preventive drugs 3 and 6 years after experiencing a transient ischemic attack (TIA) or an ischemic stroke (IS). METHODS The population study was from the AVC69 cohort (IS or TIA admitted in an emergency or stroke unit in the Rhône area, France, for an IS or a TIA during a 7-month period). Medication use was defined as ≥1 purchase during the studied year and adherence as Continuous Measure of Medication Acquisition ≥0.8 using the French medical insurance health care funding database. RESULTS The study population consisted of 210 patients at 3 years and 163 patients at 6 years. Medication use at 3 and 6 years was, respectively, 80.9 and 79.8% for antithrombotics, 69.1 and 66.3% for antihypertensives, 60.5 and 55.2% for statins and 48.6 and 46.6% for optimal treatment defined as the treatment achieved by the use of the 3 drugs. Adherence to each class was good at 3 years and tends to decrease at 6 years. CONCLUSIONS More than one patient out of 2 do not use the optimal preventive treatment.
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Affiliation(s)
- Laura Mechtouff
- Stroke Unit, Hôpital Pierre Wertheimer, Hospices Civils de, Lyon, France
| | - Julie Haesebaert
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Viprey
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Valérie Tainturier
- Département de Recherche et d'Informations Médicalisées (DRIM), Direction Régionale du Service Médical de Rhône-Alpes (DRSM RA), Lyon, France
| | - Anne Termoz
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Jean-Stéphane David
- Service d'Anesthésie-Réanimation-Urgence, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Stroke Unit, Hôpital Pierre Wertheimer, Hospices Civils de, Lyon, France
| | - Norbert Nighoghossian
- Stroke Unit, Hôpital Pierre Wertheimer, Hospices Civils de, Lyon, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Anne-Marie Schott
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Létinier L, Mansiaux Y, Pariente A, Fourrier-Réglat A. Impact of cancer diagnosis on persistence of oral antidiabetic drugs. Diabetes Res Clin Pract 2018. [PMID: 29526679 DOI: 10.1016/j.diabres.2018.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS The purpose of this study was to determine the effects of cancer occurrence on persistence of oral antidiabetic drugs (OAD) in France. METHODS A retrospective cohort including incident OAD users between 2006 and 2011 was set up using a permanent sample of health insurance beneficiaries (Echantillon Généraliste de Bénéficiaires, EGB). A Cox model was used to assess the association between cancer occurrence and OAD persistence. Non-persistence was defined as a gap in OAD treatment coverage between the end of a given prescription and a new one greater than or equal to 90 days. Cancer occurrence was studied as a time-dependent variable. RESULTS The study included 13,943 OAD users. Median follow-up was 760 days. After adjustment for age, sex, first OAD used, type of prescriber and polypharmacy, non-persistence risk was higher after a diagnosis of cancer: (HR: 1.93 and IC 95% 1.69; 2.21). Subgroup analyses according to cancer localization found a higher risk of non-persistence for lung cancer (HR: 2.66 and IC 95% 1.68; 4.23) and colorectal cancer (HR: 2.02 and IC 95% 1.40; 2.91). CONCLUSIONS Our findings indicate there is an association between cancer diagnosis and OAD non-persistence. Additional studies of this type would be useful to evaluate the association between cancer diagnosis and persistence of treatment of other chronic diseases.
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Affiliation(s)
- Louis Létinier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de pharmacologie médicale, F-33000 Bordeaux, France.
| | - Yohann Mansiaux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - Antoine Pariente
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de pharmacologie médicale, F-33000 Bordeaux, France
| | - Annie Fourrier-Réglat
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de pharmacologie médicale, F-33000 Bordeaux, France
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30
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Huiart L, Ferdynus C, Renoux C, Beaugrand A, Lafarge S, Bruneau L, Suissa S, Maillard O, Ranouil X. Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases. BMJ Open 2018; 8:e018180. [PMID: 29602837 PMCID: PMC5884337 DOI: 10.1136/bmjopen-2017-018180] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Unlike several other national health agencies, French health authorities recommended that the newer direct oral anticoagulant (DOAC) agents only be prescribed as second choice for the treatment of newly diagnosed non-valvular atrial fibrillation (NVAF), with vitamin K antagonists (VKA) remaining the first choice. We investigated the patterns of use of DOACs versus VKA in the treatment of NVAF in France over the first 5 years of DOAC availability. We also identified the changes in patient characteristics of those who initiated DOAC treatment over this time period. METHODS Based on the French National Health Administrative Database, we constituted a population-based cohort of all patients who were newly treated for NVAF between January 2011 and December 2015. Trends in drug use were described as the percentage of patients initiating each drug at the time of treatment initiation. A multivariate analysis using logistic regression model was performed to identify independent sociodemographic and clinical predictors of initial anticoagulant choice. RESULTS The cohort comprised 814 446 patients who had received a new anticoagulant treatment for NVAF. The proportion of patients using DOACs as initial anticoagulant therapy reached 54% 3 months after the Health Ministry approved the reimbursement of dabigatran for NVAF, and 61% by the end of 2015, versus VKA use. In the multivariate analysis, we found that DOAC initiators were younger and healthier overall than VKA initiators, and this tendency was reinforced over the 2011-2014 period. DOACs were more frequently prescribed by cardiologists in 2012 and after (adjusted OR in 2012: 2.47; 95% CI 2.40 to 2.54). CONCLUSION Despite recommendations from health authorities, DOACs have been rapidly and massively adopted as initial therapy for NVAF in France. Observational studies should account for the fact that patients selected to initiate DOAC treatment are healthier overall, as failure to do so may bias the risk-benefit assessment of DOACs.
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Affiliation(s)
- Laetitia Huiart
- Unité de Soutien Méthodologique, CHU de la Réunion, Saint-Denis, France
- CHU de la Réunion, INSERM, CIC1410, Saint-Pierre, France
- Université de La Réunion, UFR Santé, Saint-Denis, France
- INSERM, Université d’Aix-Marseille, IRD, UMR912 "Sciences Économiques et Sociales de la Santé et Traitement de l’Information Médicale" (SESSTIM), Marseille, France
| | - Cyril Ferdynus
- Unité de Soutien Méthodologique, CHU de la Réunion, Saint-Denis, France
- CHU de la Réunion, INSERM, CIC1410, Saint-Pierre, France
| | - Christel Renoux
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montréal, Canada
| | - Amélie Beaugrand
- Unité de Soutien Méthodologique, CHU de la Réunion, Saint-Denis, France
- Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, Paris, France
| | - Sophie Lafarge
- CHU de la Réunion, INSERM, CIC1410, Saint-Pierre, France
| | - Léa Bruneau
- Unité de Soutien Méthodologique, CHU de la Réunion, Saint-Denis, France
- INSERM, Université d’Aix-Marseille, IRD, UMR912 "Sciences Économiques et Sociales de la Santé et Traitement de l’Information Médicale" (SESSTIM), Marseille, France
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montréal, Canada
| | - Olivier Maillard
- CHU de la Réunion, INSERM, CIC1410, Saint-Pierre, France
- INSERM, Université d’Aix-Marseille, IRD, UMR912 "Sciences Économiques et Sociales de la Santé et Traitement de l’Information Médicale" (SESSTIM), Marseille, France
| | - Xavier Ranouil
- CHU de la Réunion, Service de cardiologie, Saint-Denis, France
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Massoullié G, Chouki C, Mulliez A, Rossignol P, Ploux S, Pereira B, Reuillard A, Jean F, Andronache M, Eschalier A, Motreff P, Clerfond G, Bordachar P, Authier N, Eschalier R. Effect of Optimization of Medical Treatment on Long-Term Survival of Patients With Heart Failure After Implantable Cardioverter Defibrillator and Cardiac Resynchronization Device Implantation (from the French National EGB Database). Am J Cardiol 2018; 121:725-730. [PMID: 29402420 DOI: 10.1016/j.amjcard.2017.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/03/2017] [Accepted: 12/11/2017] [Indexed: 11/16/2022]
Abstract
Prognosis of heart failure with reduced ejection fraction (HFrEF) is improved by drug optimization according to guidelines; however, little is known regarding such optimization in HFrEF patients with an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT). This study aimed to describe implementation of this optimized strategy and its impact in patients implanted with an ICD/CRT. Using a 1/97th representative sample of the French national health-care insurance system claims database, a retrospective cohort study was conducted including HFrEF patients implanted with ICD or CRT between January 2009 and December 2014. HFrEF treatments were analyzed before and after ICD/CRT implantation. Heart failure (HF) hospitalization and survival were examined at 1, 3, and 5 years: 378 patients (135 CRT, 243 ICD) with a mean age of 68 ± 13 years were included. Mean follow-up was 23 months [11-42]. At baseline, 36% of patients had no or only 1 HFrEF drug among β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and mineralocorticoid receptor antagonists, whereas 26% of patients received an optimal treatment (all 3 classes). At 3 months after ICD/CRT implantation, the prescription rate of HFrEF drugs was higher than baseline but returned to preimplantation levels at the end of follow-up. HF hospitalization rate was higher in the nonoptimized patient group (28% vs 14%, p = 0.001). Optimal HFrEF treatment was associated with better survival (hazard ratio = 0.59 [0.4-0.86], p = 0.006). In conclusion, HFrEF drugs are underprescribed before and after ICD/CRT implantation despite the demonstration that HFrEF drug optimization also reduces death and HF hospitalization in this population.
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Affiliation(s)
- Grégoire Massoullié
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Chenaf Chouki
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Aurélien Mulliez
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Patrick Rossignol
- INSERM, UMR-1116, Nancy, France; Faculty of Medicine, Université de Lorraine, Nancy, France; CHRU-Nancy, Hôpitaux de BRABOIS, Service de Médecine Nucléaire, Vandœuvre, France; INI-CRCT F-CRIN, Nancy, France
| | - Sylvain Ploux
- INSERM, UMR-1116, Nancy, France; Faculty of Medicine, Université de Lorraine, Nancy, France; CHRU-Nancy, Hôpitaux de BRABOIS, Service de Médecine Nucléaire, Vandœuvre, France; Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Bruno Pereira
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Adrien Reuillard
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Fréderic Jean
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Marius Andronache
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Pascal Motreff
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Guillaume Clerfond
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France
| | - Romain Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Cardiology Department, Pharmacology Department, Biostatistics Unit (Clinical Research and Innovation Direction), CNRS, Institut Pascal, TGI, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Clermont-Ferrand, France; INI-CRCT F-CRIN, Nancy, France.
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Increase of vitamin D assays prescriptions and associated factors: a population-based cohort study. Sci Rep 2017; 7:10361. [PMID: 28871163 PMCID: PMC5583252 DOI: 10.1038/s41598-017-10263-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/17/2017] [Indexed: 02/02/2023] Open
Abstract
A worldwide increase in the frequency of testing for serum 25-hydroxyvitamin D (25OHD) levels has been observed over the last years. Our aim was to measure the evolution in the number of vitamin D assays performed in France from 2008 to 2013 and to investigate some of the drivers that may explain this increase. Patients within the representative 1/97th sample of the French health insurance system reimbursement database (EGBS database) who had at least one 25OHD or 1-25(OH)2D assay between 2008 and 2013 were included. Trends over time in number of vitamin D assays were analysed globally and per year in a multivariable Poisson regression model with GEE. Among the 639,163 patients of the EGBS database, 118,509 (18.5%) had at least one vitamin D assay over the 6-year study period. Among the individuals tested, 52.1% had only one test. The number of vitamin D assays (25OHD or 1-25(OH)2D) increased 7.5-fold from 9,620 in 2008 to 81,641 in 2013. This study confirms the rapid and dramatic increase in vitamin D assays prescriptions and shows that this is mostly due to a global increase of the proportion of patients tested rather than an increase in repetition of tests in some individual patients.
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Dallongeville J, Ansolabehere X, Karusisi N, Maurel F, Van Ganse E, Le Heuzey JY. Real-life cost of vitamin K antagonist treatment in patients with non-valvular atrial fibrillation in France in 2013. J Med Econ 2017; 20:974-981. [PMID: 28682153 DOI: 10.1080/13696998.2017.1352508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Data highlighting the cost drivers for non-valvular atrial fibrillation (NVAF) patients in terms of vitamin K antagonist (VKA) treatment and monitoring are lacking in France. This study aimed to evaluate the real-life daily cost of VKA treatment in 2013, in French patients suffering from NVAF. METHODS This longitudinal observational study was performed using the EGB (Echantillon Généraliste des Bénéficiaires) database, a random sample of the French national insurance (NHI) database, which covers 80% of the population. All adult patients whose first NVAF anticoagulant treatment in 2013 was a VKA were analyzed. Costs were calculated for the duration of follow-up and then divided by the number of days of therapy. The analysis was performed both from the French NHI perspective (amount reimbursed by the NHI) and from a collective perspective. RESULTS In this study, 3,254 NVAF patients treated with VKA in 2013 were included, and this sample comprised 52.6% males. The mean daily cost of VKA treatment was €1.13 (±1.18) according to the collective perspective (89.4% of this cost was associated to INR measurement) and €1.05 (±1.16) according to the NHI perspective. LIMITATIONS As diagnoses associated with procedures are not available in the EGB database, proxies were used, and an algorithm was created to define the AF population. CONCLUSIONS This analysis is the first to consider an exhaustive spectrum of the costs of VKA treatment in France using EGB data. VKA medication requires exhaustive follow-up, and, thus, associated costs are important. The results of the present study confirmed this close follow-up for VKA patients, making the cost of treatment by VKA nearly 10-times more expensive than the cost of medication itself.
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Affiliation(s)
| | | | - Noëlla Karusisi
- b QuintilesIMS , Real-World Insights (RWI) , La Defense , France
| | | | - Eric Van Ganse
- c PELyon (Pharmacoepidemiology Lyon); HESPER 7425 , Health Services and Performance Research UCBL , Lyon , France
| | - Jean-Yves Le Heuzey
- d Hôpital Européen George Pompidou , René Descartes University , Paris , France
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Bosco-Lévy P, de Boissieu P, Gouverneur A, Noize P, Molimard M, Fourrier-Réglat A, Bezin J. National trends in use and costs of oral anticancer drugs in France: An 8-year population-based study. Pharmacoepidemiol Drug Saf 2017; 26:1233-1241. [PMID: 28771878 DOI: 10.1002/pds.4282] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/29/2017] [Accepted: 07/04/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE During the last decade, many oral anticancer drugs (OAcDs) have been marketed, providing interesting but potentially costly pharmaceutical alternatives to intravenous treatments. This study aims to provide updated information on their use and costs. METHODS A cross-sectional yearly repeated study was conducted from 2006 to 2014 using the representative sample of the French national health care insurance system claims database (EGB). OAcD use was described for each year, among prevalent (ie, patients with at least 1 OAcD reimbursement) and incident users (ie, patients with no OAcD reimbursement within the prior year) and according to their pharmacological classes (Hormone Therapy [HT], Cytotoxic Therapy [CT], Targeted Therapy [TT], and others). Demographic characteristics were described for both users; comorbidities and direct medical costs were described for incident users only. RESULTS The yearly prevalence and incidence of OAcD use, mainly represented by HT, remained stable from 2006 to 2014 (1.2%; 0.4%). Compared with users of other OAcD classes, the proportion of TT users substantially increased over the 8-year study period (+9.3%), and TT incident users had more severe comorbidities at treatment initiation. The health expenditures were the most important in TT users with median monthly medical direct costs varying from 2995€ to 4968€ per patient between 2006 and 2014. CONCLUSION With the development of new OAcDs, the TTs use reaches a wider population of patients but is responsible for increasing health expenditures.
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Affiliation(s)
- Pauline Bosco-Lévy
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, Bordeaux, France.,CHU de Bordeaux, Pole de sante publique, Département de Pharmacologie médicale, Bordeaux, France
| | - Paul de Boissieu
- CHU de Bordeaux, Pole de sante publique, Département de Pharmacologie médicale, Bordeaux, France
| | - Amandine Gouverneur
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, Bordeaux, France.,CHU de Bordeaux, Pole de sante publique, Département de Pharmacologie médicale, Bordeaux, France
| | - Pernelle Noize
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, Bordeaux, France.,CHU de Bordeaux, Pole de sante publique, Département de Pharmacologie médicale, Bordeaux, France
| | - Mathieu Molimard
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, Bordeaux, France.,CHU de Bordeaux, Pole de sante publique, Département de Pharmacologie médicale, Bordeaux, France
| | - Annie Fourrier-Réglat
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, Bordeaux, France.,CHU de Bordeaux, Pole de sante publique, Département de Pharmacologie médicale, Bordeaux, France
| | - Julien Bezin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, Bordeaux, France.,CHU de Bordeaux, Pole de sante publique, Département de Pharmacologie médicale, Bordeaux, France
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Colas S, Allalou A, Poichotte A, Piriou P, Dray-Spira R, Zureik M. Exchangeable Femoral Neck (Dual-Modular) THA Prostheses Have Poorer Survivorship Than Other Designs: A Nationwide Cohort of 324,108 Patients. Clin Orthop Relat Res 2017; 475:2046-2059. [PMID: 28194710 PMCID: PMC5498370 DOI: 10.1007/s11999-017-5260-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/19/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Exchangeable neck stems, defined as those with a dual taper (that is, a modular junction between the femoral head and the femoral neck and an additional junction between the neck and the stem body), were introduced in THA to improve restoration of joint biomechanics (restoring anteversion, offset, and limb length) and reduce the risk of dislocation. However exchangeable necks have been reported to result in adverse effects such as stem fractures and acute local tissue reaction. Whether they result in a net improvement to or impairment of reconstructive survivorship remains controversial. QUESTIONS/PURPOSES (1) To compare the prosthetic survivorship and all-cause revision risk of exchangeable femoral neck THAs versus fixed neck THAs, taking known prosthetic revision risk factors into account; and (2) to compare the cause-specific revision risk of exchangeable femoral neck THAs versus fixed neck THAs, adjusting for known prosthetic risk factors. METHODS Using French national health-insurance databases, we identified all French patients older than 40 years who underwent primary THA from 2009 through 2012. To ensure accuracy of the data, we considered only beneficiaries of the general insurance scheme (approximately 77% of the population). Characteristics of the prosthesis and the patients receiving an exchangeable femoral neck THA were compared with those receiving a fixed femoral neck THA (defined as femoral stem with only the head being exchangeable). Revision was the event of interest. Followup started on the date the THA was performed, until the patient experienced revision, died, was lost to followup, or until the followup period ended (December 31, 2014), whichever came first. Competing risk THA survivorship was calculated and compared (purpose 1), as were cause-specific Cox regression models (purpose 2). The study cohort included 324,108 individuals with a mean age of 77 years. A total of 24% underwent THA for acute trauma, and 3% of the group received an exchangeable neck THA. During the median 45-month followup (mean, 42 months; minimum, 1 day; maximum, 6 years), 11,968 individuals underwent prosthetic revision. RESULTS The cumulative revision incidence was 6.5% (95% CI, 5.8%-7.3%) for exchangeable neck THAs versus 4.7% (95% CI, 4.6%-4.8%) for fixed neck THAs (p < 0.001). After controlling for potential confounding variables including age, sex, comorbidities, indication for THA, cementation, bearing surface, and the characteristics of the center where the implantation was performed, we found that the exchangeable femoral neck THA was associated with an increased hazard ratio (HR) of revision of 1.26 (95% CI, 1.14-1.38; p < 0.001) compared with the fixed neck THA. When dealing with cause-specific revision, exchangeable neck THAs had a higher incidence of revision for implant failure or periprosthetic fracture, and for mechanical complications; adjusted HRs were, respectively, 1.68 (95% CI, 1.24-2.27; p < 0.001) and 1.27 (95% CI, 1.13-1.43; p < 0.001), for exchangeable neck THAs compared with fixed ones. CONCLUSIONS Exchangeable neck THAs had poorer survivorship independent of other prosthetic revision risk factors. Accordingly, expected anatomic and functional benefits should be carefully assessed before choosing this design. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Sandrine Colas
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Assia Allalou
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | | | | | - Rosemary Dray-Spira
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Mahmoud Zureik
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
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Cossec CL, Colas S, Zureik M. Relative impact of hospital and surgeon procedure volumes on primary total hip arthroplasty revision: a nationwide cohort study in France. Arthroplast Today 2017; 3:176-182. [PMID: 28913403 PMCID: PMC5585819 DOI: 10.1016/j.artd.2017.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/08/2017] [Accepted: 03/25/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Both surgeon and hospital procedure volumes have been found to be associated with total hip arthroplasty (THA) outcomes. However, little research has been conducted on the relative influence. We studied the association between THA survivorship and both hospital and surgeon procedure volumes, considering their relative impact. METHODS A population-based cohort included all patients aged ≥40 years having received a unilateral primary THA from 2010 to 2011, from the French National Health Insurance Database. Patients were followed up until the end of 2014. The outcome was THA revision. Exposures of interest were procedure volumes, divided into tertiles: <1.5, 1.5-4, >4 and <7, 7-15, >15 procedures per month defined as low, medium, and high volumes for surgeon and hospital, respectively. RESULTS The cohort had 62,906 patients, with mean age 69 years and women 57%. Mean surgeon and hospital volumes were 8 and 23 procedures per month, respectively, and 5%, 72%, 22% and 7%, 28%, 65% of THAs were implanted by a low-, medium-, and high-volume surgeon or in a low-, medium-, and high-volume hospital, respectively. Median follow-up was 45 months (range, 0-57 months). In multivariate analysis, adjusted for both surgeon and hospital volumes, for patient and THA characteristics, a lower surgeon volume was associated with poorer THA survivorship (adjusted hazard ratio [aHR] = 1.19; 95% confidence interval [CI], 1.07-1.34 and aHR = 1.70; 95% CI, 1.40-2.05, for medium- and low-volume surgeon, respectively, compared with that of high volume), whereas hospital volume was not. CONCLUSIONS This study brings evidence to support the notion that THAs performed by high-volume surgeons in French private hospitals have higher survivorship in the first 4 years.
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Affiliation(s)
| | - Sandrine Colas
- Corresponding author. 143-147 Boulevard Anatole France, F-93285 Saint-Denis Cedex, France. Tel.: +3 315 587 4152.143-147 Boulevard Anatole FranceF-93285 Saint-Denis CedexFrance
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37
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Gouverneur A, Dolatkhani D, Rouyer M, Grelaud A, Francis F, Gilleron V, Fourrier-Réglat A, Noize P. Agreement between hospital discharge diagnosis codes and medical records to identify metastatic colorectal cancer and associated comorbidities in elderly patients. Rev Epidemiol Sante Publique 2017; 65:321-325. [PMID: 28576381 DOI: 10.1016/j.respe.2017.03.132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/01/2017] [Accepted: 03/15/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Quality of coding to identify cancers and comorbidities through the French hospital diagnosis database (Programme de médicalisation des systèmes d'information, PMSI) has been little investigated. Agreement between medical records and PMSI database was evaluated regarding metastatic colorectal cancer (mCRC) and comorbidities. METHODS From 01/01/2013 to 06/30/2014, 74 patients aged≥65years at mCRC diagnosis were identified in Bordeaux teaching hospital. Data on mCRC and comorbidities were collected from medical records. All diagnosis codes (main, related and associated) registered into the PMSI were extracted. Agreement between sources was evaluated using the percent agreement for mCRC and the kappa (κ) statistic for comorbidities. RESULTS Agreement for primary CRC and mCRC was higher using all types of diagnosis codes instead of the main one exclusively (respectively 95% vs. 53% for primary CRC and 91% vs. 24% for mCRC). Agreement was substantial (κ 0.65) for cardiovascular diseases, notably atrial fibrillation (κ 0.77) and hypertension (κ 0.68). It was moderate for psychiatric disorders (κ 0.49) and respiratory diseases (κ 0.48), although chronic obstructive pulmonary disease had a good agreement (κ 0.75). Within the class of endocrine, nutritional and metabolic diseases (κ 0.55), agreement was substantial for diabetes (κ 0.91), obesity (κ 0.82) and hypothyroidism (κ 0.72) and moderate for hypercholesterolemia (κ 0.51) and malnutrition (κ 0.42). CONCLUSION These results are reassuring with regard to detection through PMSI of mCRC if all types of diagnosis codes are considered and useful to better choose comorbidities in elderly mCRC patients that could be well identified through hospital diagnosis codes.
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Affiliation(s)
- A Gouverneur
- CHU de Bordeaux, 33000 Bordeaux, France; University de Bordeaux, 33076 Bordeaux cedex, France; Inserm U1219, 33076 Bordeaux cedex, France; Inserm CIC1401, 33076 Bordeaux cedex, France.
| | - D Dolatkhani
- CHU de Bordeaux, 33000 Bordeaux, France; University de Bordeaux, 33076 Bordeaux cedex, France
| | - M Rouyer
- Inserm CIC1401, 33076 Bordeaux cedex, France; ADERA, 33608 Pessac, France
| | - A Grelaud
- Inserm CIC1401, 33076 Bordeaux cedex, France; ADERA, 33608 Pessac, France
| | - F Francis
- CHU de Bordeaux, 33000 Bordeaux, France; University de Bordeaux, 33076 Bordeaux cedex, France
| | | | - A Fourrier-Réglat
- CHU de Bordeaux, 33000 Bordeaux, France; University de Bordeaux, 33076 Bordeaux cedex, France; Inserm U1219, 33076 Bordeaux cedex, France; Inserm CIC1401, 33076 Bordeaux cedex, France
| | - P Noize
- CHU de Bordeaux, 33000 Bordeaux, France; Inserm U1219, 33076 Bordeaux cedex, France; Inserm CIC1401, 33076 Bordeaux cedex, France
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38
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Belhassen M, Demoly P, Bloch-Morot E, de Pouvourville G, Ginoux M, Chartier A, Laforest L, Serup-Hansen N, Toussi M, Van Ganse E. Costs of perennial allergic rhinitis and allergic asthma increase with severity and poor disease control. Allergy 2017; 72:948-958. [PMID: 27886386 DOI: 10.1111/all.13098] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perennial allergic rhinitis (PAR) represents a global and public health problem, due to its prevalence, morbidity, and impact on the quality of life. PAR is frequently associated with allergic asthma (AA). Costs of PAR with or without AA are poorly documented. OBJECTIVE Our study aimed to detail medical resource utilization (MRU) and related direct cost for PAR, with or without concomitant AA, in France. METHODS Using Electronic Health Records (EHRs), we identified in 2010 two cohorts of PAR patients, based on General Practitioners' diagnoses and prescribing data, with and without concomitant AA. For each patient, the EHRs were linked to corresponding claims data with MRU and costs during years 2011 to 2013. Predefined subgroup analyses were performed according to severity of PAR and level of AA control. RESULTS The median annual cost reimbursed by social security system for a patient with PAR, and no AA was 159€ in 2013. This varied from 111€ to 188€ depending on PAR severity. For patients with PAR and concomitant AA, the median annual cost varied between 266€ and 375€, and drug treatment accounted for 42-55% of the costs, depending on asthma control. CONCLUSION This study linking diagnoses from EHRs to claims data collected valid information on PAR management, with or without concomitant AA, and on related costs. There was a clear increase in costs with severity of PAR and control of AA.
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Affiliation(s)
- M. Belhassen
- HESPER 7425; Health Services and Performance Research; University Claude Bernard Lyon 1; Lyon France
- PELyon; PharmacoEpidemiologie Lyon; Lyon France
| | - P. Demoly
- Department of Pulmonology; Division of Allergy; Arnaud de Villeneuve Hospital; University Hospital of Montpellier; Montpellier France
- Sorbonne University; UPMC Paris 06; UMR-S 1136 INSERM; IPLESP; EPAR; Paris France
| | - E. Bloch-Morot
- French Association for Continual Medical Education of Allergists (ANAFORCAL); Reims France
| | | | - M. Ginoux
- HESPER 7425; Health Services and Performance Research; University Claude Bernard Lyon 1; Lyon France
- PELyon; PharmacoEpidemiologie Lyon; Lyon France
| | | | - L. Laforest
- HESPER 7425; Health Services and Performance Research; University Claude Bernard Lyon 1; Lyon France
- PELyon; PharmacoEpidemiologie Lyon; Lyon France
| | | | | | - E. Van Ganse
- HESPER 7425; Health Services and Performance Research; University Claude Bernard Lyon 1; Lyon France
- PELyon; PharmacoEpidemiologie Lyon; Lyon France
- Respiratory Medicine; Croix Rousse University Hospital; Lyon France
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Bezin J, Duong M, Lassalle R, Droz C, Pariente A, Blin P, Moore N. The national healthcare system claims databases in France, SNIIRAM and EGB: Powerful tools for pharmacoepidemiology. Pharmacoepidemiol Drug Saf 2017; 26:954-962. [PMID: 28544284 DOI: 10.1002/pds.4233] [Citation(s) in RCA: 361] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/30/2017] [Accepted: 04/23/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Julien Bezin
- Department of Medical Pharmacology, CHU de Bordeaux; Université de Bordeaux; 33076 Bordeaux France
- INSERM U1219; 33076 Bordeaux France
| | - Mai Duong
- INSERM U1219; 33076 Bordeaux France
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Régis Lassalle
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Cécile Droz
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Antoine Pariente
- Department of Medical Pharmacology, CHU de Bordeaux; Université de Bordeaux; 33076 Bordeaux France
- INSERM U1219; 33076 Bordeaux France
| | - Patrick Blin
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Nicholas Moore
- Department of Medical Pharmacology, CHU de Bordeaux; Université de Bordeaux; 33076 Bordeaux France
- INSERM U1219; 33076 Bordeaux France
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
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40
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Ajrouche A, Estellat C, De Rycke Y, Tubach F. Evaluation of algorithms to identify incident cancer cases by using French health administrative databases. Pharmacoepidemiol Drug Saf 2017; 26:935-944. [PMID: 28485129 DOI: 10.1002/pds.4225] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 03/31/2017] [Accepted: 04/17/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE Administrative databases are increasingly being used in cancer observational studies. Identifying incident cancer in these databases is crucial. This study aimed to develop algorithms to estimate cancer incidence by using health administrative databases and to examine the accuracy of the algorithms in terms of national cancer incidence rates estimated from registries. METHODS We identified a cohort of 463 033 participants on 1 January 2012 in the Echantillon Généraliste des Bénéficiaires (EGB; a representative sample of the French healthcare insurance system). The EGB contains data on long-term chronic disease (LTD) status, reimbursed outpatient treatments and procedures, and hospitalizations (including discharge diagnoses, and costly medical procedures and drugs). After excluding cases of prevalent cancer, we applied 15 algorithms to estimate the cancer incidence rates separately for men and women in 2012 and compared them to the national cancer incidence rates estimated from French registries by indirect age and sex standardization. RESULTS The most accurate algorithm for men combined information from LTD status, outpatient anticancer drugs, radiotherapy sessions and primary or related discharge diagnosis of cancer, although it underestimated the cancer incidence (standardized incidence ratio (SIR) 0.85 [0.80-0.90]). For women, the best algorithm used the same definition of the algorithm for men but restricted hospital discharge to only primary or related diagnosis with an additional inpatient procedure or drug reimbursement related to cancer and gave comparable estimates to those from registries (SIR 1.00 [0.94-1.06]). CONCLUSION The algorithms proposed could be used for cancer incidence monitoring and for future etiological cancer studies involving French healthcare databases. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Aya Ajrouche
- APHP, Hôpital Pitié Salpétrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Département Biostatistique, Santé Publique et Information Médicale, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMR 1123 ECEVE, Paris, France
| | - Candice Estellat
- APHP, Hôpital Pitié Salpétrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Département Biostatistique, Santé Publique et Information Médicale, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMR 1123 ECEVE, Paris, France
| | - Yann De Rycke
- APHP, Hôpital Pitié Salpétrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Département Biostatistique, Santé Publique et Information Médicale, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMR 1123 ECEVE, Paris, France
| | - Florence Tubach
- APHP, Hôpital Pitié Salpétrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Département Biostatistique, Santé Publique et Information Médicale, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMR 1123 ECEVE, Paris, France.,Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
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[Identification of neurodegenerative diseases in administrative databases in France: A systematic review of the literature]. Rev Epidemiol Sante Publique 2017; 65 Suppl 4:S183-S197. [PMID: 28341166 DOI: 10.1016/j.respe.2017.01.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/10/2017] [Accepted: 01/20/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the health, social and economic burden of neurodegenerative diseases (ND), the development of epidemiologic studies is required. Administrative databases, such as the French national health insurance database (SNIIRAM) could represent an opportunity for researchers. ND could be presumed from drug reimbursement data, hospital stays or registration of a chronic condition. The aim of this study was to describe, in French administrative databases, algorithms used to identify Alzheimer's disease and associated disorders (ADAD), Parkinson's disease and associated disorders (PDAD), multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS). METHODS A systematic literature review was performed in Medline and gray literature through December 31th, 2015. French studies focusing on ADAD, PDAD, MS or ALS as a primary health outcome, conducted among one of the SNIIRAM data sources (outpatient reimbursements, chronic condition registration, hospital discharge) were included. RESULTS Thirty-four studies were included (ADAD, n=18, PDAD, n=9, MS, n=4, ALS, n=3), leading to 36 algorithms. For each studied ND, there was an important variability in the algorithms, concerning (i) the type of criteria used (administrative database versus multi-source systems); (ii) the number of criteria used; (iii) the definition used for each criteria. The extent and level of drug exposure highly varied. Identification through hospitalizations showed variations in terms of type of stay (short stay, long-term stay, psychiatric ward…), extent of diagnosis codes used, diagnosis type (principal, related, associated diagnosis) and period used. A validation study was conducted for 2 out of 36 algorithms (PDAD), and criteria completeness was estimated for 3 algorithms (MS, ALS). CONCLUSION Despite the increase in ND identification among French administrative databases, few algorithms have been validated. Validation studies should be encouraged.
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Bezin J, Groenwold RH, Ali MS, Lassalle R, Robinson P, de Boer A, Moore N, Klungel OH, Pariente A. Comparative effectiveness of recommended versus less intensive drug combinations in secondary prevention of acute coronary syndrome. Pharmacoepidemiol Drug Saf 2017; 26:285-293. [DOI: 10.1002/pds.4171] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/16/2016] [Accepted: 01/07/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Julien Bezin
- University of Bordeaux, U1219; Bordeaux France
- Department of Clinical Pharmacology; University Hospital of Bordeaux; Bordeaux France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology Research Team; Bordeaux France
- Bordeaux PharmacoEpi, INSERM CIC1401; Bordeaux France
| | - Rolf H.H. Groenwold
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences, Utrecht University; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - M. Sanni Ali
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences, Utrecht University; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401; Bordeaux France
- ADERA; Pessac France
| | - Philip Robinson
- Bordeaux PharmacoEpi, INSERM CIC1401; Bordeaux France
- ADERA; Pessac France
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences, Utrecht University; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - Nicholas Moore
- University of Bordeaux, U1219; Bordeaux France
- Department of Clinical Pharmacology; University Hospital of Bordeaux; Bordeaux France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology Research Team; Bordeaux France
- Bordeaux PharmacoEpi, INSERM CIC1401; Bordeaux France
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences, Utrecht University; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - Antoine Pariente
- University of Bordeaux, U1219; Bordeaux France
- Department of Clinical Pharmacology; University Hospital of Bordeaux; Bordeaux France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology Research Team; Bordeaux France
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43
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Declarative Sequential Pattern Mining of Care Pathways. Artif Intell Med 2017. [DOI: 10.1007/978-3-319-59758-4_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Molinier A, Palmaro A, Rousseau V, Sommet A, Bourrel R, Montastruc JL, Bagheri H. Does substitution of brand name medications by generics differ between pharmacotherapeutic classes? A population-based cohort study in France. Eur J Clin Pharmacol 2016; 73:471-477. [PMID: 28035437 DOI: 10.1007/s00228-016-2185-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to measure the rate of substitution failure to generic antiepileptic drugs (AEDs) compared to two other pharmacotherapeutic classes (neuroleptics, beta-blockers). METHODS We conducted a cohort study involving beneficiaries of the French health insurance system from January 2009 to November 2012. Substitution failure to generic drugs was estimated by the rate of switchback (i.e. from generic drug back to its branded drug). We selected the patients who had a dispensation of a branded AED for 60 days or more during the 90 days preceding the generic substitution. Cox proportional hazard regression was used to model time to switchback for antiepileptics vs. other therapeutic classes in the 90 days after generic substitution, adjusting for age, gender and polytherapy. RESULTS The cohort included 6727 patients of whom 1947 were exposed to AEDs, 2398 to neuroleptics and 2382 to beta-blockers. The switchback rate was 62% for AEDs. AED users were more likely to switch back as compared to beta-blocker (crude hazard ratio 1.87; 95% CI 1.68-2.07 for patients under 75) or neuroleptic users. The same observation was made in patients above 75 years (crude hazard ratio 1.36; 95% CI 1.16-1.60). CONCLUSIONS Compared to beta-blocker users, AED users were more likely to switch back to the branded drug, whereas this difference was not observed with neuroleptics. These results could reflect a poor acceptance of switching AEDs to generic compounds in France.
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Affiliation(s)
- Alicia Molinier
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France
| | - Aurore Palmaro
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France. .,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France. .,CIC INSERM 1436 Université et Centre Hospitalier Universitaire de Toulouse, Toulouse , France.
| | - Vanessa Rousseau
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France.,CIC INSERM 1436 Université et Centre Hospitalier Universitaire de Toulouse, Toulouse , France.,Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Agnès Sommet
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France.,CIC INSERM 1436 Université et Centre Hospitalier Universitaire de Toulouse, Toulouse , France
| | - Robert Bourrel
- Direction Régionale du Service du contrôle Médical de Midi-Pyrénées, Toulouse, France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France.,Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Haleh Bagheri
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France.,Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Codeine Shopping Behavior in a Retrospective Cohort of Chronic Noncancer Pain Patients: Incidence and Risk Factors. THE JOURNAL OF PAIN 2016; 17:1291-1301. [DOI: 10.1016/j.jpain.2016.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 02/02/2023]
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Les données des certificats de décès en France : processus de production et principaux types d’analyse. Rev Med Interne 2016; 37:685-693. [DOI: 10.1016/j.revmed.2016.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/10/2015] [Accepted: 01/16/2016] [Indexed: 11/30/2022]
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Récoché I, Rousseau V, Bourrel R, Lapeyre-Mestre M, Chebane L, Despas F, Montastruc JL, Bondon-Guitton E. Drug-drug interactions with imatinib: An observational study. Medicine (Baltimore) 2016; 95:e5076. [PMID: 27749579 PMCID: PMC5059082 DOI: 10.1097/md.0000000000005076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Many patients treated with imatinib, used in cancer treatment, are using several other drugs that could interact with imatinib. Our aim was to study all the drug-drug interactions (DDIs) observed in patients treated with imatinib.We performed 2 observational studies, between the 1st January 2012 and the 31st August 2015 in the Midi-Pyrénées area (South Western France), using the French health insurance reimbursement database and then the French Pharmacovigilance Database (FPVD).A total of 544 patients received at least 1 reimbursement for imatinib. Among them, 486 (89.3%) had at least 1 drug that could potentially interact with imatinib. Paracetamol was the most frequent drug involved (77.4%). Proton pump inhibitors, dexamethasone and levothyroxine, were found in >10% of patients. In the FPVD, among a total of 25 reports of ADRs with imatinib recorded in the Midi-Pyrénées area, 10 (40%) had potential DDIs with imatinib. Imatinib was most frequently prescribed by hospital physicians and drugs interacting with imatinib, by general practitioners.Our study showed that at least 40% of the patients treated with imatinib were at risk of DDIs and that all prescribers must be cautious with DDIs in patients treated with imatinib. During imatinib treatment, we particularly recommend to limit the dose of paracetamol at 1300 mg per day, to avoid the use of dexamethasone, and to double the dose of levothyroxine.
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Affiliation(s)
- Isabelle Récoché
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de l’Université de Toulouse and Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de PharmacoEpidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire
| | - Vanessa Rousseau
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de l’Université de Toulouse and Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de PharmacoEpidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire
| | - Robert Bourrel
- Echelon Régional du Service Médical de la CNAM-TS Midi-Pyrénées
| | - Maryse Lapeyre-Mestre
- Laboratoire de Pharmacologie Médicale et Clinique, Equipe de PharmacoEpidémiologie, Faculté de Médecine de l’Université de Toulouse and Service de Pharmacologie Clinique, Centre Hospitalier Universitaire, Toulouse, France
| | - Leila Chebane
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de l’Université de Toulouse and Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de PharmacoEpidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire
| | - Fabien Despas
- Laboratoire de Pharmacologie Médicale et Clinique, Equipe de PharmacoEpidémiologie, Faculté de Médecine de l’Université de Toulouse and Service de Pharmacologie Clinique, Centre Hospitalier Universitaire, Toulouse, France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de l’Université de Toulouse and Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de PharmacoEpidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire
| | - Emmanuelle Bondon-Guitton
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de l’Université de Toulouse and Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de PharmacoEpidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire
- Correspondence: Emmanuelle Bondon-Guitton, Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine, Toulouse, France (e-mail: )
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Ferdynus C, Huiart L. [Technical improvement of cohort constitution in administrative health databases: Providing a tool for integration and standardization of data applicable in the French National Health Insurance Database (SNIIRAM)]. Rev Epidemiol Sante Publique 2016; 64:263-9. [PMID: 27592033 DOI: 10.1016/j.respe.2016.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 02/04/2016] [Indexed: 11/26/2022] Open
Abstract
AIM Administrative health databases such as the French National Heath Insurance Database - SNIIRAM - are a major tool to answer numerous public health research questions. However the use of such data requires complex and time-consuming data management. Our objective was to develop and make available a tool to optimize cohort constitution within administrative health databases. METHODS We developed a process to extract, transform and load (ETL) data from various heterogeneous sources in a standardized data warehouse. This data warehouse is architected as a star schema corresponding to an i2b2 star schema model. We then evaluated the performance of this ETL using data from a pharmacoepidemiology research project conducted in the SNIIRAM database. RESULTS The ETL we developed comprises a set of functionalities for creating SAS scripts. Data can be integrated into a standardized data warehouse. As part of the performance assessment of this ETL, we achieved integration of a dataset from the SNIIRAM comprising more than 900 million lines in less than three hours using a desktop computer. This enables patient selection from the standardized data warehouse within seconds of the request. CONCLUSION The ETL described in this paper provides a tool which is effective and compatible with all administrative health databases, without requiring complex database servers. This tool should simplify cohort constitution in health databases; the standardization of warehouse data facilitates collaborative work between research teams.
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Affiliation(s)
- C Ferdynus
- Unité de soutien méthodologique, département d'informatique médicale, CHU La-Réunion, allée des Topazes, CS11021, 97400 Saint-Denis, France; Inserm, CIC 1410, 97410 Saint-Pierre, France.
| | - L Huiart
- Unité de soutien méthodologique, département d'informatique médicale, CHU La-Réunion, allée des Topazes, CS11021, 97400 Saint-Denis, France; Inserm, CIC 1410, 97410 Saint-Pierre, France.
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Persistence to 5-year hormonal breast cancer therapy: a French national population-based study. Br J Cancer 2016; 115:912-919. [PMID: 27599040 PMCID: PMC5061907 DOI: 10.1038/bjc.2016.276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/16/2016] [Accepted: 08/09/2016] [Indexed: 12/20/2022] Open
Abstract
Background: Non-persistence to oral hormonal therapy (HT) in breast cancer (BC) is an emerging health issue, and estimations vary according to the population selected and/or the statistical method applied. This study aimed to estimate non-persistence over 5 years to HT in an unselected sample of women with BC using a French national population-based database and accounting for competing risks. Methods: A retrospective cohort of 600 women initiating a HT between 2006 and 2007 was constituted using a representative sample of the French national healthcare insurance system database. The Cumulative Incidence Function method was used to estimate the probability of first treatment discontinuation of at least 90 days accounting for competing risk of death from any cause over the theoretical 5-year period of treatment. Results: Thirty one percent of patients who initiated a HT were identified as non-persistent at the fifth year of follow-up. Patients who switched to another HT (HR 3.10, 95% CI (2.20; 4.36)) or had metastatic BC (HR 3.07, 95% CI (1.73; 5.46)) were more likely to be non-persistent. Women who initiated aromatase inhibitors as compared with tamoxifen (HR 0.62, 95% CI (0.46; 0.83)), had administrative registration for BC (HR 0.21, 95% CI (0.13; 0.32)), or had received an adjuvant chemotherapy (HR 0.65, 95% CI (0.48; 0.89)) were less likely to discontinue. Conclusions: The estimate of long-term non-persistence in an unselected sample of women treated in France by oral hormonal therapy is substantial, even accounting for competing risks.
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Verger P, Cortaredona S, Tournier M, Rey D, Bendiane MK, Peretti-Watel P, Verdoux H. Psychotropic drug dispensing in people with and without cancer in France. J Cancer Surviv 2016; 11:92-101. [DOI: 10.1007/s11764-016-0569-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/09/2016] [Indexed: 12/11/2022]
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