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Couret A, Gardette V, Renoux A, Lapeyre-Mestre M. Impact of modifications to antidementia drug reimbursement in France: Analysis of the FRA-DEM cohort. Br J Clin Pharmacol 2024. [PMID: 38925159 DOI: 10.1111/bcp.16143] [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: 01/11/2024] [Revised: 05/03/2024] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS Alzheimer's disease and related diseases (ADRD) is a progressive and inexorable disease. In France, acetylcholinesterase inhibitors and memantine were reimbursed for subjects with ADRD, until 2 modifications of their reimbursement rate (2012, 2018). We aimed to study the consequences of these measures on ADRD subjects' healthcare use. METHODS We analysed data from the FRA-DEM cohort, including subjects with presumed incident ADRD identified since 2011 in the French health insurance system. We studied the healthcare use of subjects identified with incident ADRD in 2011, 2013, 2015, 2017 and 2019, notably the annual number of defined daily doses of various psychotropic groups. We performed 2 multivariate multinomial logistic regressions with the subcohort year as the dependent variable. RESULTS In total, 165 120 subjects were included. A progressive decrease in exposure to antidementia drugs was observed between 2011 and 2019. Consultations with private neurologists or psychiatrists, and exposure to risperidone, antidepressants and benzodiazepines increased in the 2019 subcohort, following the 2018 reimbursement withdrawal. Meanwhile, the use of nursing/allied healthcare and emergency care increased over the subcohort years, whereas we observed a decrease in general practitioner consultations. CONCLUSION These results suggest increases in private neurologist or psychiatrist consultations and exposure to recommended drugs after the reimbursement withdrawal, contrary to the fears expressed. However, antidementia drug exposure decreased long before the reimbursement modifications, probably due to the growing evidence of the modest effect of these drugs, and exposure to benzodiazepines increased after the reimbursement withdrawal.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France
- Maintain Aging Research team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Department of Epidemiology and Public Health, Toulouse, France
| | - Axel Renoux
- Centre d'Investigation Clinique 1436, Team MéDatAS "Méthodologie, Data management et Analyses Statistiques", Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Centre d'Investigation Clinique 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Department of Pharmacology, Toulouse, France
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Couret A, Lapeyre-Mestre M, Gombault-Datzenko E, Renoux A, Villars H, Gardette V. Which factors preceding dementia identification impact future healthcare use trajectories: multilevel analyses in administrative data. BMC Geriatr 2024; 24:89. [PMID: 38263052 PMCID: PMC10807194 DOI: 10.1186/s12877-023-04643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Healthcare use patterns preceding a diagnosis of Alzheimer's Disease and Related Diseases (ADRD) may be associated with the quality of healthcare use trajectories (HUTs) after diagnosis. We aimed to identify determinants of future favorable HUTs, notably healthcare use preceding ADRD identification. METHODS This nationwide retrospective observational study was conducted on subjects with incident ADRD identified in 2012 in the French health insurance database. We studied the 12-month healthcare use ranging between 18 and 6 months preceding ADRD identification. The five-year HUTs after ADRD identification were qualified by experts as favorable or not. In order to take into account geographical differences in healthcare supply, we performed mixed random effects multilevel multivariable logistic regression model to identify determinants of future favorable HUTs. Analyses were stratified by age group (65-74, 75-84, ≥ 85). RESULTS Being a woman, and preventive and specialist care preceding ADRD identification increased the probability of future favorable HUT, whereas institutionalization, comorbidities, medical transportation and no reimbursed drug during [-18;-6] months decreased it. Besides, some specificities appeared according to age groups. Among the 65-74 years subjects, anxiolytic dispensing preceding ADRD identification decreased the probability of future favorable HUT. In the 75-84 years group, unplanned hospitalization and emergency room visit preceding ADRD identification decreased this probability. Among subjects aged 85 and older, short hospitalization preceding ADRD identification increased the probability of future favorable HUTs. CONCLUSION Regular healthcare use with preventive and specialist care preceding ADRD identification increased the probability of future favorable HUTs whereas dependency decreased it.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France.
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France.
- Faculté de médecine, 37 allées Jules Guesde, Toulouse, 31000, France.
| | - Maryse Lapeyre-Mestre
- Department of Pharmacology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
| | - Eugénie Gombault-Datzenko
- Department of Medical Information (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Axel Renoux
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hélène Villars
- Geriatric Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
- Department of Epidemiology and Public Health, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Couret A, Lapeyre-Mestre M, Gombault-Datzenko E, Renoux A, Villars H, Gardette V. Healthcare use patterns before Alzheimer's disease and related diseases identification and future healthcare trajectory. Int J Geriatr Psychiatry 2023; 38:e5849. [PMID: 36457190 DOI: 10.1002/gps.5849] [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: 05/10/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES A frequent late Alzheimer's Disease and Related Diseases (ADRD) identification is described and may induce erratic health resource use. We aimed to describe healthcare use patterns preceding ADRD identification. METHODS We studied persons aged 65 or older, identified with incident ADRD in 2012 in the French health insurance database. Healthcare use covering a wide range of care in ambulatory and hospital settings during the period ranging from 18 to six months before ADRD identification was studied. The main dimensions of healthcare use patterns before ADRD identification were investigated in three age groups (65-74, 75-84, ≥85) through a multiple correspondence analysis. These dimensions were secondarily interpreted according to the 5-year healthcare trajectory following ADRD identification, qualified as favorable (or not) by experts in the field. RESULTS This research studied 36,990 subjects. Four dimensions raised in each age group. Two dimensions' interpretations were retrieved in all age groups: intensity of healthcare use, functional dependency. However, their rank differed along with the qualification of the future healthcare trajectory. Some specificities appeared in some age group. In the 65-74 and 75-84 years groups, there were dimensions reflecting healthcare use related to psychiatric or psycho-behavioral disorders. In the ≥85 group, two dimensions reflected dependency related to other comorbidities, and organised medical follow-up. CONCLUSION Several dimensions emerged in line with erratic trajectories before ADRD identification. They underlined the need for actions towards ADRD identification.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France.,Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Department of Pharmacology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Centre D'Investigation Clinique 1436, Team PEPSS "Pharmacologie En Population CohorteS et BiobanqueS", Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Eugénie Gombault-Datzenko
- Department of Medical Information (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Axel Renoux
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hélène Villars
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France.,Geriatric Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France.,Department of Epidemiology and Public Health, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Elyn A, Gardette V, Renoux A, Sourdet S, Nourhashemi F, Sanou B, Dutech M, Muller P, Gallini A. Potential determinants of unfavourable healthcare utilisation trajectories during the last year of life of people with incident Alzheimer Disease or Related Syndromes: a nationwide cohort study using administrative data. Age Ageing 2022; 51:6554096. [PMID: 35348586 DOI: 10.1093/ageing/afac053] [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] [Received: 07/02/2021] [Revised: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND people approaching the end-of-life frequently face inappropriate care. With Alzheimer Disease or Related Syndromes (ADRS), end-of-life is characterised by progressive decline, but this period remains difficult to identify. This leads to a lack of anticipation and sometimes with unfavourable healthcare utilisation trajectories (HUTs). OBJECTIVE to quantify unfavourable HUTs during the last year of life and identify their potential determinants in both community and nursing-home settings. DESIGN nationwide cohort study using administrative database. SETTING French community and nursing-home residents. SUBJECTS incident ADRS people identified in 2012, who died up to 31 December 2017. METHODS we used multidimensional clustering to identify 15 clusters of HUTs, using 11 longitudinal healthcare dimensions during the last year of life. Clusters were qualitatively assessed by pluri-disciplinary experts as favourable or unfavourable HUTs. Individual and contextual potential determinants of unfavourable HUTs were studied by setting using logistic random-effect regression models. RESULTS 62,243 individuals died before 31 December 2017; 46.8% faced unfavourable end-of-life HUTs: 55.2% in the community and 31.8% in nursing-homes. Individual potential determinants were identified: younger age, male gender, ADRS identification through hospitalisation, shorter survival, life-limiting comorbidities, psychiatric disorders, acute hospitalisations and polypharmacy. In the community, deprivation and autonomy were identified as potential determinants. Contextual potential determinants raised mostly in the community, such as low nurse or physiotherapist accessibilities. CONCLUSIONS Nearly half of people with ADRS faced unfavourable HUTs during their last year of life. Individual potential determinants should help anticipate advance care planning and palliative care needs assessment. Contextual potential determinants suggest geographical disparities and health inequalities.
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Affiliation(s)
- Antoine Elyn
- CERPOP, UMR1295, Unité Mixte INSERM - Université Toulouse III Paul Sabatier, Axe Maintain, Aging Research Team, University Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France
- Pain Evaluation and Treatment Center, Neurosciences Department, University Hospital of Toulouse, Place du Dr Joseph Baylac, TSA 40031, 31059 Toulouse Cedex 9, France
- Forms – Occitanie’s Multiprofessional Health Care Centers Federation, 7 Clos de la Tuilerie, 31560 Nailloux, France
- University Toulouse III Paul Sabatier, 118 Route de Narbonne, F-31062 Toulouse Cedex 9, France
| | - Virginie Gardette
- CERPOP, UMR1295, Unité Mixte INSERM - Université Toulouse III Paul Sabatier, Axe Maintain, Aging Research Team, University Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France
- University Toulouse III Paul Sabatier, 118 Route de Narbonne, F-31062 Toulouse Cedex 9, France
- Department of Epidemiology, University Hospital of Toulouse, 37 Allées Jules Guesde, 31000 Toulouse, France
| | - Axel Renoux
- Department of Epidemiology, University Hospital of Toulouse, 37 Allées Jules Guesde, 31000 Toulouse, France
| | - Sandrine Sourdet
- CERPOP, UMR1295, Unité Mixte INSERM - Université Toulouse III Paul Sabatier, Axe Maintain, Aging Research Team, University Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France
- University Toulouse III Paul Sabatier, 118 Route de Narbonne, F-31062 Toulouse Cedex 9, France
- Geriatrics & Internal Medicine, University Hospital of Toulouse, Hôpital La Grave, Cité de la Santé, Place Lange, TSA 60033, 31059 Toulouse Cedex 9, France
| | - Fati Nourhashemi
- CERPOP, UMR1295, Unité Mixte INSERM - Université Toulouse III Paul Sabatier, Axe Maintain, Aging Research Team, University Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France
- University Toulouse III Paul Sabatier, 118 Route de Narbonne, F-31062 Toulouse Cedex 9, France
- Geriatrics & Internal Medicine, University Hospital of Toulouse, Hôpital La Grave, Cité de la Santé, Place Lange, TSA 60033, 31059 Toulouse Cedex 9, France
| | - Brigitte Sanou
- Réseau Relience - Territorial Network for Home-based Palliative Care, Chronic Pain and Chronic Disease, 39 Impasse de la Flambère, 31300 Toulouse, France
| | - Michel Dutech
- Forms – Occitanie’s Multiprofessional Health Care Centers Federation, 7 Clos de la Tuilerie, 31560 Nailloux, France
| | - Philippe Muller
- Department of Epidemiology, University Hospital of Toulouse, 37 Allées Jules Guesde, 31000 Toulouse, France
- CNRS UMR 5505 IRIT – Toulouse Institute for Research in Computer Science, University Toulouse III Paul Sabatier, 118 Route de Narbonne, F-31062 Toulouse Cedex 9, France
| | - Adeline Gallini
- CERPOP, UMR1295, Unité Mixte INSERM - Université Toulouse III Paul Sabatier, Axe Maintain, Aging Research Team, University Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France
- University Toulouse III Paul Sabatier, 118 Route de Narbonne, F-31062 Toulouse Cedex 9, France
- Department of Epidemiology, University Hospital of Toulouse, 37 Allées Jules Guesde, 31000 Toulouse, France
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