1
|
Gourdy P, Darmon P, Borget I, Emery C, Bureau I, Detournay B, Bahloul A, Allali N, Mahieu A, Penfornis A. Basal Insulinotherapy in Patients Living with Diabetes in France: The EF-BI Study. Diabetes Ther 2024:10.1007/s13300-024-01577-8. [PMID: 38642261 DOI: 10.1007/s13300-024-01577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Second-generation basal insulins like glargine 300 U/mL (Gla-300) have a longer duration of action and less daily fluctuation and interday variability than first-generation ones, such as glargine 100 U/mL (Gla-100). The EF-BI study, a nationwide observational, retrospective study, was designed to compare persistence, acute care complications, and healthcare costs associated with the initiation of such basal insulins (BI) in a real-life setting in France. METHODS This study was conducted using the French healthcare claims database (SNDS). Adult patients living with type 1 or type 2 diabetes mellitus (T1DM or T2DM) initiating Gla-300 or Gla-100 ± other hypoglycemic medications between January 1, 2016 and December 31, 2020, and without any insulin therapy over the previous 6 months were included. Persistence was defined as remaining on the same insulin therapy until discontinuation defined by a 6 month period without insulin reimbursement. Hospitalized acute complications were identified using ICD-10 codes. Total collective costs were established for patients treated continuously with each basal insulin over 1-3 years. All comparisons were adjusted using a propensity score based on initial patient/treatment characteristics. RESULTS A total of 235,894 patients with T2DM and 6672 patients with T1DM were included. Patients treated with Gla-300 were 83% (T1DM) and 44% (T2DM) less likely to discontinue their treatment than those treated with Gla-100 after 24 months (p < 0.0001). The annual incidence of acute hospitalized events in patients with T2DM treated with Gla-300 was 12% lower than with Gla-100 (p < 0.0001) but similar in patients with T1DM. Comparison of overall costs showed moderate but statistically significant differences in favor of Gla-300 versus Gla-100 for all patients over the first year, and in T2DM only over a 3-year follow-up. CONCLUSION Use of Gla-300 resulted in a better persistence, less acute hospitalized events at least in T2DM, and reduced healthcare expenditure. These real-life results confirmed the potential interest of using Gla-300 rather than Gla-100.
Collapse
Affiliation(s)
- Pierre Gourdy
- Endocrinology, Diabetology and Nutrition Department, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
| | - Patrice Darmon
- Endocrinology, Metabolic Diseases and Nutrition Department, AP-HM (Assistance-Publique Hôpitaux de Marseille), Marseille, France
- INSERM, INRA, C2VN, Aix Marseille University, Marseille, France
| | - Isabelle Borget
- Department of Epidemiology and Biostatistics, Gustave Roussy and University Paris Saclay, Villejuif, France
| | - Corinne Emery
- CEMKA, 43, Boulevard Maréchal Joffre, 92340, Bourg-la-Reine, France
| | - Isabelle Bureau
- CEMKA, 43, Boulevard Maréchal Joffre, 92340, Bourg-la-Reine, France
| | - Bruno Detournay
- CEMKA, 43, Boulevard Maréchal Joffre, 92340, Bourg-la-Reine, France.
| | | | | | | | - Alfred Penfornis
- Sud-Francilien Hospital and Université Paris-Saclay, 40, Avenue Serge DASSAULT, 91106, Corbeil-Essonnes Cedex, France
| |
Collapse
|
2
|
Fabron C, Laville M, Aron-Wisnewsky J, Disse E, Gatta-Cherifi B, Jacobi D, Montastier E, Oppert JM, Gaillard L, Detournay B, Czernichow S. Out-of-Pocket Expenses in Households of People Living with Obesity in France. Obes Facts 2023; 16:606-613. [PMID: 37879296 PMCID: PMC10870127 DOI: 10.1159/000533342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/28/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND/OBJECTIVES Overweight and obesity result in a substantial economic burden in both low- and high-income countries. Moreover, this burden is often underestimated because it only partially accounts for unreimbursed out-of-pocket expenses (OOPE) related to obesity. The objective of our study was not only to evaluate OOPE incurred by people with obesity in relation to their disease with respect to direct medical expenditures and direct non-medical expenditures but also the proportion of people living with obesity who have forgone obesity-related healthcare due to the costs of such care. METHODS An observational descriptive survey was conducted among people with class II/III obesity attending six obesity treatment centers in France. Volunteer adult participants completed a written/phone questionnaire on their related expenditures over the last 6 months for current expenditures and over the last 5 years for occasional ones. The costs were expressed in 2022 EUR. RESULTS 299 people participated (age: 46 years [SD: 13.9], women: 72%, BMI ≥40 kg/m2: 62% and 48% with comorbidities). 65% had a professional activity. 83% declared that they had OOPE related to obesity representing annually EUR 2027/individual on average (5% of the household revenue), including weight loss and nutritional products, vitamins, meal programs, gym memberships, psychologists, but mainly adapted clothing, additional travel costs, and others. 15% of the respondents had to modify their professional activity due to obesity and 15% forwent some medical care in the last 12 months. CONCLUSIONS OOPE is a significant part of the economic burden of obesity. Despite some limitations due to the specificities of the participants and because some costs may be more related to social activities affected by obesity than to healthcare, it seems important to consider these expenditures in cost estimates for obesity.
Collapse
Affiliation(s)
| | - Martine Laville
- Endocrinology-Diabetology-Nutrition Department, F-CRIN-FORCE network, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon University, Pierre-Bénite, France
| | - Judith Aron-Wisnewsky
- Nutrition Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, France and INSERM UMRS 1269 NutriOmics, Sorbonne University, Paris, France
| | - Emmanuel Disse
- Endocrinology-Diabetology-Nutrition Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon University, Pierre-Bénite, France
| | - Blandine Gatta-Cherifi
- Endocrinology-Diabetology-Nutrition Department, Haut-Lévêque Hospital, Bordeaux University Hospital, France and Neurocentre Magendie, INSERMU1215, Bordeaux University, Bordeaux, France
| | - David Jacobi
- Nantes Université, CHU Nantes, CNRS, INSERM, L’institut du Thorax, Nantes, France
| | - Emilie Montastier
- Nantes University Hospital, CNRS, INSERM, L’institut du Thorax, Nantes University, Nantes, France
| | - Jean-Michel Oppert
- Nutrition Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, France and INSERM UMRS 1269 NutriOmics, Sorbonne University, Paris, France
| | | | | | - Sébastien Czernichow
- Nutrition Department, Georges-Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, France and Paris Cité University, Paris, France
| |
Collapse
|
3
|
Dardari D, Franc S, Charpentier G, Orlando L, Bobony E, Bouly M, Xhaard I, Amrous Z, Sall KL, Detournay B, Penfornis A. Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study. Lancet Reg Health Eur 2023; 32:100686. [PMID: 37520145 PMCID: PMC10384180 DOI: 10.1016/j.lanepe.2023.100686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Background Two randomised controlled trials (RCTs) have previously shown that telemedical monitoring of diabetic foot ulcer (DFU) reduces the number of visits to the outpatient clinic, without losing treatment efficacy or increasing costs. Here we present the results of an open-label, randomised controlled trial designed to investigate whether telemonitoring, provided by an expert nurse (with extensive experience in DFU and trained in remote monitoring), reduces the hospital stay and the associated costs for a patient with DFU (TELEPIED trial). Methods Eligible patients (n = 180) were randomly allocated to: (i) a control group, in which they received standard care, and (ii) an intervention group, in which they received asynchronous telemedicine follow-up by the expert nurse. The primary outcome was the cumulative hospital days over 12 months. The main secondary outcomes were (i) direct healthcare costs (estimated in a collective perspective), (ii) wound healing and (iii) amputation rates. ITT (intention-to-treat) population was analysed. Findings In the ITT population, cumulative hospital days were significantly higher in the control group (13.4 days [95% CI 9.0-17.8]) than in the intervention group (7.1 days [2.8-11.5]) (p = 0.0458, ANCOVA model). Cumulative direct costs over 12 months were 7185 € (95% CI 5144-9226) in the control group and 3471 € (95% CI 1430-5512) in the intervention group (p = 0.0120). The percentage of wounds healed and amputation rate were not significantly different between groups. Similar results were found with the PP population. Interpretation The implementation of a telemedical intervention with an expert nurse could lead to a length of hospitalization and direct costs that were two times lower compared to conventional follow-up. This lower medical and economic burden was obtained without losing effectiveness on the rate of healing, nor increasing the amputation rate. Additional studies are required to confirm these findings. Funding This study was designed, funded and conducted by CERITD (Study and Research Centre for Intensification of Diabetes Treatment, Evry, France), Genopole GIP, 20 rue Henri Desbruères, 91030 EVRY Cedex and Laboratoires URGO, 15 Avenue d'Iéna, 75116 Paris Cedex, France. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the sponsor. The corresponding author (DD) certify that authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication.
Collapse
Affiliation(s)
- Dured Dardari
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- LBEPS, Université d’Evry, IRBA, Université de Paris-Saclay, Evry, France
| | - Sylvia Franc
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Guillaume Charpentier
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Laurent Orlando
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Elise Bobony
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Marie Bouly
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
| | - Ilham Xhaard
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Zohra Amrous
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Khadijatou Ly Sall
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Bruno Detournay
- CEMKA, 43, Boulevard du Maréchal Joffre, Bourg-La-Reine 92340, France
| | - Alfred Penfornis
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Saint-Aubin, France
| |
Collapse
|
4
|
Marchadier A, Bezannier L, Barré-Pierrel S, Manceau A, A Abadie A, Detournay B. Overview of organisational methods of primary cervical lesion screening programmes that use human papillomavirus testing. J Med Screen 2023; 30:113-119. [PMID: 36974487 PMCID: PMC10399092 DOI: 10.1177/09691413231158932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 03/29/2023]
Abstract
Many factors need to be considered when planning and managing a screening programme for the early detection of cervical cancer (CC). A non-systematic international review of the organisation of CC screening using high-risk human papillomavirus (HPV-HR) testing, aimed at identifying the organisational methods of these programmes, was conducted with a view to supporting the future of the French system in the context of the transition to HPV-HR testing. In countries where HPV testing has been implemented or planned, the initial reflection process has provided an opportunity to rethink the previous (cytological) screening organisation. Despite considerable differences between countries, a nationally or regionally centralised organisational model appears to be the preferred option in most countries. This model is based on a national/regional structure tasked with all invitations, reminders, follow-up and coordination, centralised laboratories integrating both biology and pathology laboratories, and a unified information system integrated with routine health management tools used by health practitioners and nurses. Besides quality considerations, grouped purchasing makes it possible to implement a public procurement policy that includes price negotiations with suppliers. Discussions around the introduction of HPV testing have resulted in most countries reviewing or creating information systems and quality assurance processes. While the WHO seems to recommend the systematic use of vaginal self-sampling, very few countries have considered this option. More and more countries are planning to implement vaginal self-sampling, but no clear organisational model has emerged from the countries where it has been implemented to date.
Collapse
Affiliation(s)
| | | | | | - Antoine Manceau
- PwC Advisory - Healthcare & Pharmaceuticals Life-Sciences, Neuilly-sur-Seine, France
| | - Audrey A Abadie
- PwC Advisory - Healthcare & Pharmaceuticals Life-Sciences, Neuilly-sur-Seine, France
| | | |
Collapse
|
5
|
Guerci B, Levrat-Guillen F, Vicaut E, de Pouvourville G, Detournay B, Emery C, Riveline JP. Reduced acute diabetes events after FreeStyle Libre® system initiation in people 65 years or older with type 2 diabetes on intensive insulin therapy in France. Diabetes Technol Ther 2023. [PMID: 36944104 DOI: 10.1089/dia.2023.0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background and aims Older people with type 2 diabetes (T2DM) on insulin are at increased risk of hypoglycemia and associated morbidity. Management of T2DM in older people must optimize glycemic control while minimizing risks for hypoglycemia and diabetic ketoacidosis (DKA). In France, the FreeStyle Libre® system (FSL) has been reimbursed since June 2017 for T2DM on intensive insulin therapy. We assessed the impact of starting FSL on hospitalizations for acute diabetes events (ADEs) in people ≥65 years old, with T2DM on intensive insulin therapy. Materials and methods A retrospective study on the French SNDS claims database was conducted on people ≥65 years old with T2DM, treated with MDI or insulin pump and starting FSL between 01/08/2017 to 31/12/2018. The analysis covered claims data for 12 months before, and up to 24 months after FSL initiation. Hospitalizations for severe hypoglycemia (SH), DKA, comas and hyperglycemia were identified using ICD-10 codes. Results We identified 38,312 people with T2DM ≥65 years old on intensive insulin therapy initiating FSL during the selection period. Hospitalizations for ADEs were observed in 1.6% of subjects in the 12 months before FSL initiation, compared to 1.05% after 12 months and 0.96% after 24 months, a 34% and 40% reduction, driven by fewer DKA admissions after 12 months and by fewer SH admissions at 24 months. Conclusions These results indicate that FSL can reduce hospitalization for ADEs in this vulnerable older population of adults aged 65 years and older with T2DM on intensive insulin therapy, in whom optimal glycemic control must be achieved while minimizing risk of hypoglycemia and other ADEs.
Collapse
Affiliation(s)
- Bruno Guerci
- diabetology, metabolic diseases and nutrition, morvan street, vandoeuvre les nancy, France, 54500;
| | - Fleur Levrat-Guillen
- Abbott Laboratories, Maidenhead, Berkshire, United Kingdom of Great Britain and Northern Ireland;
| | - Eric Vicaut
- Fernand Vidal Hospital, Clinical Research Unit, 200 rue du Faubourg Saint-Denis, Paris, France, 75010;
| | - Gérard de Pouvourville
- ESSEC Business School, 52819, Department of Economics, Cergy-Pontoise, Île-de-France, France;
| | - Bruno Detournay
- CEMKA-EVAL, 55352, 43 Bd Maréchal Joffre, Bourg-La-Reine, France, 92340;
| | - Corrine Emery
- CEMKA, 55352, Bourg-La-Reine, Île-de-France, France;
| | - Jean-Pierre Riveline
- Centre de Recherche des Cordeliers, 89163, IMmunity and MEtabolism in DIAbetes: IMMEDIAT Lab, 15 Rue de l'École de Médecine, 75006 Paris, Paris, France, 75006
- Hôpital Lariboisière, 378772, Centre universitaire du diabète et de ses complications, Paris, Île-de-France, France, 75010;
| |
Collapse
|
6
|
Nevoret C, Gervaise N, Delemer B, Bekka S, Detournay B, Benkhelil A, Bahloul A, d'Orsay G, Penfornis A. The Effectiveness of an App (Insulia) in Recommending Basal Insulin Doses for French Patients With Type 2 Diabetes Mellitus: Longitudinal Observational Study. JMIR Diabetes 2023; 8:e44277. [PMID: 36749650 PMCID: PMC10018375 DOI: 10.2196/44277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND For patients with type 2 diabetes (T2D), calculating the daily dose of basal insulin may be challenging. Insulia is a digital remote monitoring solution that uses clinical algorithms to recommend basal insulin doses. A predecessor device was evaluated in the TeleDiab-2 randomized controlled trial, showing that a higher percentage of patients using the app achieved their target fasting blood glucose (FBG) level compared to the control group, and insulin doses were adjusted to higher levels without hypoglycemia. OBJECTIVE This study aims to analyze how the glycemic control of Insulia users has evolved when using the app in a real-life setting in France. METHODS A retrospective observational analysis of data collected through the device in adult French patients with T2D treated with basal insulin and oral antihyperglycemic agents using the system for ≥6 months was conducted. Analyses were descriptive and distinguished the results in a subpopulation of regular and compliant users of the app. Glycemic outcomes were estimated considering the percentage of patients who achieved their individualized FBG target between 5.5 and 6 months following the initiation of device use, the frequency of hypoglycemia resulting in a treatment change over the 6-month period of exposure, and the evolution of the average hemoglobin A1c (HbA1c) level over the same period. RESULTS Of the 484 users, 373 (77.1%) performed at least one dose calculation. A total of 221 (59.2%) users were men. When app use started, the mean age, BMI, HbA1c, and basal insulin dose were 55.8 (SD 11.9) years, 30.6 (SD 5.9) kg/m2, 10.1% (SD 2.0%), and 25.5 (SD 15.8) IU/day, respectively. Over a median use duration of 5.0 (95% CI 3.8-5.7) months, patients used the system 5.8 (SD 1.6) times per week on average, and 73.4% of their injected doses were consistent with the app's suggested doses. Among regular and compliant user patients (n=91, ≥5 measurements/week and ≥80% adherence to calculated doses), 60% (55/91) achieved the FBG target (±5%) at 6 months (5.5-6 months) versus 51.5% (145/282) of the other patients (P=.15). There was an increase in the proportion of patients achieving their target FBG for regular and compliant users (+1.86% every 2 weeks) without clear improvement in other patients. A logistic model did not identify the variables that were significantly associated with this outcome among regular and compliant users. In the overall population, the incidence of reported hypoglycemia decreased simultaneously (-0.16%/month). Among 82 patients, the mean HbA1c decreased from 9.9% to 7.2% at 6 months. CONCLUSIONS An improvement in glycemic control as measured by the percentage of patients reaching their FBG individualized target range without increasing hypoglycemic risk was observed in patients using the Insulia app, especially among regular users following the dose recommendations of the algorithm.
Collapse
Affiliation(s)
| | | | - Brigitte Delemer
- Endocrinology, Diabetology and Nutrition Department, Robert Debre University Hospital, Reims, France
| | - Said Bekka
- Institut de Diabétologie et Nutrition du Centre, Mainvilliers, France
| | | | | | - Amar Bahloul
- Diabetes Department, Sanofi France, Gentilly, France
| | | | - Alfred Penfornis
- Endocrinology, Diabetology and Metabolic Diseases Department, Sud-Francilien Hospital, Université Paris-Saclay, Corbeil-Essonnes, France
| |
Collapse
|
7
|
Henry P, Cariou B, Farnier M, Lakhdari SL, Detournay B. Lipid-lowering efficacy and safety of alirocumab in a real-life setting in France: Insights from the ODYSSEY APPRISE study. Arch Cardiovasc Dis 2023; 116:3-8. [PMID: 36535853 DOI: 10.1016/j.acvd.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recently, a multicentre, prospective, single-arm, phase 3b, open-label trial was conducted to determine the safety and efficacy of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, in a real-life setting. This study enrolled patients at high cardiovascular risk, with heterozygous familial hypercholesterolaemia (HeFH) or non-familial hypercholesterolaemia (non-FH). Results showed that alirocumab was well tolerated and resulted in a clinically significant reduction in low-density lipoprotein cholesterol (LDL-C). AIM This ancillary analysis aimed to describe the characteristics of the French patients enrolled in the study, the main results observed in this population according to their familial hypercholesterolaemia status, and adherence to treatment. METHODS French data were analysed separately from the original dataset of the study. RESULTS Among 215 French patients in the ODYSSEY APPRISE trial, 63.7% had non-FH, with a mean LDL-C concentration of 5.0±1.8mmol/L at baseline. The mean duration of alirocumab exposure was 72.4±42.5 weeks, with only 48.4% of patients receiving statins concomitantly. At week 12, a mean reduction in LDL-C of 56.5±17.8% was observed: 51.2±22.8% in HeFH; 59.5±13.2% in non-FH. This improvement in LDL-C started from week 4 and remained stable and sustained until week 120 in both populations. The overall incidence of severe treatment-emergent adverse events (TEAEs) was 33.5%. The most frequent TEAEs were myalgia (15.8%) and asthenia (15.3%). No tolerance or efficacy differences were observed between patients with or without established coronary artery disease or other cardiovascular disease, whatever the age of these events or considering the concomitant use of other lipid-lowering therapies. CONCLUSIONS In the French setting, alirocumab was well tolerated, safe and highly effective at reducing LDL-C. These findings support the use of alirocumab to manage hypercholesterolaemia in patients at high cardiovascular risk.
Collapse
Affiliation(s)
- Patrick Henry
- Cardiologie et maladies vasculaires, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - Bertrand Cariou
- Inserm, CNRS, Nantes université, CHU de Nantes, institut du thorax, 44000 Nantes, France
| | - Michel Farnier
- Équipe PEC2, EA 7460, UFR sciences de santé, université de Bourgogne Franche Comté, BP 87900, 21079 Dijon, France
| | - Sarah L Lakhdari
- Medical Head, Cardiology & Transplant, General Medicines, Sanofi, 94250 Gentilly, France
| | | |
Collapse
|
8
|
Guerci B, Roussel R, Levrat-Guillen F, Detournay B, Vicaut E, De Pouvourville G, Emery C, Riveline JP. Important Decrease in Hospitalizations for Acute Diabetes Events Following FreeStyle Libre System Initiation in People with Type 2 Diabetes on Basal Insulin Therapy in France. Diabetes Technol Ther 2023; 25:20-30. [PMID: 36094418 DOI: 10.1089/dia.2022.0271] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aims/Hypothesis: Initiation of insulin therapy in people with type 2 diabetes (T2DM) may be necessary to achieve glycemic targets but is associated with acute diabetes events (ADEs), including severe hypoglycemia (SH) or diabetic ketoacidosis (DKA). We assessed the impact of initiating FreeStyle Libre® system (FSL) on hospitalizations for ADEs in people with T2DM on basal insulin only regimen±noninsulin antidiabetic drugs. Materials and Methods: A retrospective study of the French national Système National des Données de Santé reimbursement claims database (≈66 million French people) identified people with T2DM on basal insulin therapy receiving a first reimbursement of FSL between August 1, 2017 and December 31, 2018. Claims data for the 12 months before, and up to 24 months after FSL initiation, were analyzed. Hospitalizations for ADEs were identified, using ICD-10 codes as main or related diagnosis, for: SH events; DKA events; comas; and hyperglycemia-related admissions. Results: A total of 5933 people with T2DM on basal insulin therapy initiated FSL during the selection period. Of the patients, 78.9% were on basal insulin and other hypoglycemic agents. Among the 5933 patients identified, 2.01% had at least one hospitalization for any ADE in the year before FSL initiation, compared to 0.75% (1 year) and 0.60% (2 years). Reductions in ADEs were driven by 75% fewer DKA admissions, with a 44% reduction in SH admissions. These patterns of reduced ADEs persisted after 2 years, with a further 43% reduction in DKA rates. Conclusions/Interpretation: This study emphasizes the value of the FSL system in reducing ADEs in people with T2DM in France not on intensive insulin therapy and initially treated with basal-only insulin therapy.
Collapse
Affiliation(s)
- Bruno Guerci
- Department of Endocrinology, Diabetology, and Nutrition, Brabois Adult Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Ronan Roussel
- Institut Necker Enfants Malades (INEM), Unité INSERM U1151 INEM, IMMEDIAB Laboratory, Paris, France
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Paris, France
| | | | | | - Eric Vicaut
- Clinical Research Unit, Fernand Vidal Hospital, Paris, France
| | | | | | - Jean-Pierre Riveline
- Department of Endocrinology and Diabetology, Lariboisière Hospital, Paris, France
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMR 8253, IMMEDIAB Laboratory, Paris, France
| |
Collapse
|
9
|
Dardari D, Potier L, Sultan A, Francois M, M’Bemba J, Bouillet B, Chaillous L, Kessler L, Carlier A, Jalek A, Sbaa A, Orlando L, Bobony E, Detournay B, Kjartansson H, Bjorg Arsaelsdottir R, Baldursson BT, Charpentier G. Intact Fish Skin Graft vs. Standard of Care in Patients with Neuroischaemic Diabetic Foot Ulcers (KereFish Study): An International, Multicentre, Double-Blind, Randomised, Controlled Trial Study Design and Rationale. Medicina (B Aires) 2022; 58:medicina58121775. [PMID: 36556977 PMCID: PMC9786154 DOI: 10.3390/medicina58121775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cell and/or tissue-based wound care products have slowly advanced in the treatment of non-healing ulcers, however, few studies have evaluated the effectiveness of these devices in the management of severe diabetic foot ulcers. METHOD This study (KereFish) is part of a multi-national, multi-centre, randomised, controlled clinical investigation (Odin) with patients suffering from deep diabetic wounds, allowing peripheral artery disease as evaluated by an ankle brachial index equal or higher than 0.6. The study has parallel treatment groups: Group 1 treatment with Kerecis® Omega3 Wound™ versus Group 2 treatment with standard of care. The primary objective is to test the hypothesis that a larger number of severe diabetic ulcers and amputation wounds, including those with moderate arterial disease, will heal in 16 weeks when treated with Kerecis® Omega3 Wound™ than with standard of care. CONCLUSION This study has received the ethics committee approval of each participating country. Inclusion of participants began in March 2020 and ended in July 2022. The first results will be presented in March 2023. The study is registered in ClinicalTrials.gov as Identifier: NCT04537520.
Collapse
Affiliation(s)
- Dured Dardari
- Diabetic Foot Unit, Centre Hospitalier sud Francilien Corbeil Essonnes, 91100 Corbeil-Essonnes, France
- LBEPS, IRBA, Université Evry Paris Saclay, 91025 Evry, France
- Correspondence: ; Tel.: +33-6-61-54-28-09
| | - Louis Potier
- Diabetology Department, CHU Bichat—Claude Bernard, 75018 Paris, France
- Institut Necker-Enfants Malades, Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, 75006 Paris, France
| | - Ariane Sultan
- Diabetology Nutrition Department, CHU Montpelier, Université de Montpellier, 34090 Montpellier, France
- Inserm, CNRS, Phymedexp, CHU de Montpellier, 34090 Montpellier, France
| | | | | | - Benjamin Bouillet
- Department of Endocrinology-Diabetology, Dijon University Hospital, 21000 Dijon, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, 21078 Dijon, France
| | - Lucy Chaillous
- Department of Endocrinology, Metabolic Diseases and Nutrition, University Hospital of Nante, 44000 Nantes, France
| | - Laurence Kessler
- Department of Diabetology, CHU Strasbourg, 67000 Strasbourg, France
| | - Aurelie Carlier
- Diabetology Department, CHU Bichat—Claude Bernard, 75018 Paris, France
| | - Abdulkader Jalek
- Diabetology Nutrition Department, CHU Montpelier, Université de Montpellier, 34090 Montpellier, France
| | - Ayoub Sbaa
- Department of Diabetology, CHU Strasbourg, 67000 Strasbourg, France
| | - Laurent Orlando
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, 91042 Evry, France
| | - Elise Bobony
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, 91042 Evry, France
| | - Bruno Detournay
- CEMKA, 43 boulevard du Maréchal Joffre, 92340 Bourg-la-Reine, France
| | | | | | | | - Guillaume Charpentier
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, 91042 Evry, France
| |
Collapse
|
10
|
Riveline JP, Roussel R, Vicaut E, de Pouvourville G, Detournay B, Emery C, Levrat-Guillen F, Guerci B. Reduced Rate of Acute Diabetes Events with Flash Glucose Monitoring Is Sustained for 2 Years After Initiation: Extended Outcomes from the RELIEF Study. Diabetes Technol Ther 2022; 24:611-618. [PMID: 35604792 DOI: 10.1089/dia.2022.0085] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: The RELIEF study has previously shown a fall in the rate of acute diabetes events (ADEs) in people living with type 1 diabetes (PwDT1) or people living with type 2 diabetes (PwDT2) in the 12 months after initiation of flash glucose monitoring (FLASH) in France. The 2-year follow-up has provided new insights on the frequency of ADEs, including severe hypoglycemia and diabetic ketoacidosis (DKA), during use of FLASH. Methods: The RELIEF study included 31,446 PwDT1 and 41,027 PwDT2 with a first delivery of FreeStyle Libre (FSL) between August 1 and December 31, 2017. Hospitalizations for DKA, severe hypoglycemia, diabetes-related coma, and hyperglycemia were recorded for the 12 months before and 24 months after FSL initiation. Persistence of the FSL system use was estimated through a Kaplan-Meier survival curve. Change in usual blood glucose monitoring was estimated through acquisition of blood glucose test strips. Results: In the 2 years after FSL initiation, hospitalizations for ADEs were reduced by 49% and by 48% in PwDT1 or PwDT2, respectively, driven by reductions in DKA. After 2 years, 88% of patients persisted with the system and estimated mean consumption of blood glucose test strips had fallen after 2 years by -82% and by -84% in type 1 diabetes mellitus and type 2 diabetes mellitus, respectively. Conclusion: Use of FSL consistently reduces the rates of hospitalization for ADEs, mainly DKA, 2 years after initiation, confirming this is not a transitory effect. Use of FSL also results in a clear and progressive drop in use of blood glucose test strips over the 2-year period.
Collapse
Affiliation(s)
- Jean-Pierre Riveline
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université de Paris Cité, IMMEDIAB Laboratory, Paris, France
- Service of Diabetology, Endocrinology and Nutrition, Lariboisière Hospital, Féderation de Diabétologie, Assistance Publique - Hôpitaux de Paris, Paris, France
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Paris, France
| | - Ronan Roussel
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université de Paris Cité, IMMEDIAB Laboratory, Paris, France
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Paris, France
- Department of Diabetology, Endocrinology, and Nutrition, Bichat-Claude Bernard Hospital, Paris, France
| | - Eric Vicaut
- Clinical Research Unit, Fernand Vidal Hospital, Paris, France
| | | | | | | | | | - Bruno Guerci
- Department of Endocrinology, Diabetology, and Nutrition, Brabois Adult Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
11
|
Vermersch P, Suchet L, Colamarino R, Laurendeau C, Detournay B. Stratégie thérapeutique après une première ligne de traitement de fond chez des patients avec une sclérose en plaques récurrente rémittente en France : une analyse des données du SNDS. Rev Neurol (Paris) 2022. [DOI: 10.1016/j.neurol.2022.02.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Laurendeau C, Goudemand J, Trossaert M, Polack B, Varin R, Godard C, Hadim F, Detournay B. Costs and management of patients with hemophilia A in France: the Hemraude study. Eur J Health Econ 2022; 23:23-32. [PMID: 34236542 DOI: 10.1007/s10198-021-01339-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The Hemraude study was conducted to describe the profile of patients with HA, disease management, and economic burden in a collective perspective. METHODS This retrospective study was conducted using the French administrative healthcare claims database SNIIRAM/SNDS. Male patients treated for hemophilia A with a long-term illness (ALD) status or invalidity were included in the study between January 1, 2016 and December 31, 2017. Patients were classified in six treatment groups: no treatment, on-demand FVIII, prophylactic FVIII, FVIII in immune tolerance induction (ITI) protocol, on-demand bypassing agents, and prophylactic bypassing agents. Patients treated with FVIII in ITI protocol and those treated with bypassing agents are deemed to have developed inhibitors. HA patients were compared to a control population without coagulation disorder and matched (ratio 1:3) on age and sex. RESULTS A total of 4172 patients were included in the analysis, aged on average 35.2 years, 5.3% had HIV infection, and 8.8% had hepatitis B or C. In 2017, half of the patients received no treatment for HA, 46.7% were treated with FVIII (25% on demand, 20.6% with prophylaxis, and 1.1% ITI), 1.5% with bypassing agents. Patients treated with prophylactic treatments, either inhibitor or non-inhibitor, were less likely to be hospitalized for severe bleeding compared to patients receiving on-demand treatments. The average annual costs for HA management per patient were 72,209.60 €. The highest costs were observed in patients treated with FVIII in ITI protocol and those receiving prophylactic bypassing agents. CONCLUSION Direct costs of HA treatments for HA may be very high especially in the small percentage of patients developing inhibitors or treated with ITI protocol.
Collapse
Affiliation(s)
- C Laurendeau
- Cemka, 43, Boulevard Maréchal Joffre, 92340, Bourg-la-Reine, France
| | - J Goudemand
- Department of Hemostasis and Transfusion, Lille University Hospital, Lille, France
| | - M Trossaert
- Hematology Department, University Hospital, Nantes, France
| | - B Polack
- Laboratory TIMC-IMAG, UMRS 5525, Hematology Department, University Hospital, CNRS University Grenoble-Alpes, Grenoble, France
| | - R Varin
- Clinical Pharmacy Department, University Hospital, Rouen, France
| | | | | | - B Detournay
- Cemka, 43, Boulevard Maréchal Joffre, 92340, Bourg-la-Reine, France.
| |
Collapse
|
13
|
Riveline JP, Vergés B, Detournay B, Picard S, Benhamou PY, Bismuth E, Bordier L, Jeandidier N, Joubert M, Roussel R, Sola-Gazagnes A, Bonnefond A, Clavel S, Velayoudom FL, Beltrand J, Hanaire H, Fontaine P, Thivolet C, Servy H, Tubiana S, Lion S, Gautier JF, Larger E, Vicaut E, Sablone L, Fagherazzi G, Cosson E. Design of a prospective, longitudinal cohort of people living with type 1 diabetes exploring factors associated with the residual cardiovascular risk and other diabetes-related complications: The SFDT1 study. Diabetes Metab 2021; 48:101306. [PMID: 34813929 DOI: 10.1016/j.diabet.2021.101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is associated with a high risk of cardiovascular (CV) complications, even after controlling for traditional CV risk factors. Therefore, determinants of the residual increased CV morbidity and mortality remain to be discovered. This prospective cohort of people living with T1DM in France (SFDT1) will include adults and children aged over six years living with T1DM, recruited throughout metropolitan France and overseas French departments and territories. The primary objective is to better understand the parameters associated with CV complications in T1DM. Clinical data and biobank samples will be collected during routine visits every three years. Data from connected tools, including continuous glucose monitoring, will be available during the 10-year active follow-up. Patient-reported outcomes, psychological and socioeconomic information will also be collected either at visits or through web questionnaires accessible via the internet. Additionally, access to the national health data system (Health Data Hub) will provide information on healthcare and a passive 20-year medico-administrative follow-up. Using Health Data Hub, SFDT1 participants will be compared to non-diabetic individuals matched on age, gender, and residency area. The cohort is sponsored by the French-speaking Foundation for Diabetes Research (FFRD) and aims to include 15,000 participants.
Collapse
Affiliation(s)
- J P Riveline
- Department of Diabetology and Endocrinology, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, 2 rue Ambroise Paré, Paris 75010, France; Unite INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Universite de Paris, Paris, France.
| | - B Vergés
- Department of Endocrinology-Diabetology, INSERM LNC UMR1231, University of Burgundy, Dijon, France
| | - B Detournay
- CEMKA, 43 boulevard du Maréchal Joffre, Bourg-la-Reine, France
| | - S Picard
- Endocrinology and Diabetes, Point Medical, Rond-Point de la Nation, Dijon 21000, France
| | - P Y Benhamou
- INSERM U1055, LBFA, Endocrinologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - E Bismuth
- Hôpital Universitaire Robert-Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Université de Paris, Paris F-75019, France
| | - L Bordier
- Department of Diabetology and Endocrinology, Begin Military Hospital, Saint Mandé, France
| | - N Jeandidier
- Department of Endocrinology, Diabetes, Nutrition, Hospices Civils Strasbourg, UdS, Strasbourg 67000, France
| | - M Joubert
- Diabetes Care Unit - Caen University Hospital - UNICAEN, Caen, France
| | - R Roussel
- Department of Diabetology, Endocrinology, and Nutrition, Bichat-Claude Bernard Hospital, Paris,France; Unite INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Universite de Paris, Paris, France
| | - A Sola-Gazagnes
- Department of Diabetology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - A Bonnefond
- Université de Lille, Inserm UMR1283, CNRS UMR8199, Institut Pasteur de Lille, CHU de Lille, Lille, France
| | - S Clavel
- Department of Diabetology Endocrinology Hotel Dieu Le Creusot, France
| | - F L Velayoudom
- Department of Diabetology and Endocrinology, University Hospital of Guadeloupe, Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, Lille University Hospital, Lille 59000, France
| | - J Beltrand
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, APHP Centre, Hôpital Universitaire Necker Enfants Malades, Université de Paris - Inserm U1016, Institut Cochin, Paris, France
| | - H Hanaire
- Department of Diabetology, University Hospital of Toulouse, University of Toulouse, France
| | - P Fontaine
- Department of Endocrinology, Diabetology and Nutrition University Hospital of Lille, University of Lille, France
| | - C Thivolet
- Center for Diabetes DIAB-eCARE, Hospices Civils de Lyon and Lyon 1 University, Lyon France
| | - H Servy
- e-health Services Sanoïa, 188 av 2nd DB, Gémenos 13420, France
| | - S Tubiana
- AP-HP, Hôpital Bichat, Centre de Ressources Biologiques, Paris F-75018, France
| | - S Lion
- Société Francophone du Diabète, Paris, France
| | - Jean-François Gautier
- Department of Diabetology and Endocrinology, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, 2 rue Ambroise Paré, Paris 75010, France; Unite INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Universite de Paris, Paris, France
| | - Etienne Larger
- AP-HP.Centre-Université de Paris, INSERM U1016, Institut Cochin Paris, France
| | - E Vicaut
- AP-HP, Hôpital F.Widal, Clinical Trial Unit, Paris 75010, France
| | - L Sablone
- Fondation Francophone Pour la Recherche sur le Diabète, 60 rue Saint Lazare, Paris 75009, France
| | - G Fagherazzi
- Department of Population Health, Deep Digital Phenotyping Research Unit, 1 AB rue Thomas Edison, Strassen, Luxembourg
| | - E Cosson
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Avicenne Hospital, Paris 13 University, Bobigny, France; UMR 557 INSERM/U11125 INRAE/CNAM / Université Paris 13, Unité de Recherche Epidémiologique Nutritionnelle, Paris 13 University Sorbonne Paris Cité, Bobigny, France
| |
Collapse
|
14
|
Roussel R, Riveline JP, Vicaut E, de Pouvourville G, Detournay B, Emery C, Levrat-Guillen F, Guerci B. Important Drop in Rate of Acute Diabetes Complications in People With Type 1 or Type 2 Diabetes After Initiation of Flash Glucose Monitoring in France: The RELIEF Study. Diabetes Care 2021; 44:1368-1376. [PMID: 33879536 PMCID: PMC8247513 DOI: 10.2337/dc20-1690] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/02/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The RELIEF study assessed rates of hospitalization for acute diabetes complications in France before and after initiation of the FreeStyle Libre system. RESEARCH DESIGN AND METHODS A total of 74,011 patients with type 1 diabetes or type 2 diabetes who initiated the FreeStyle Libre system were identified from the French national claims database with use of ICD-10 codes, from hospitalizations with diabetes as a contributing diagnosis, or the prescription of insulin. Patients were subclassified based on self-monitoring of blood glucose (SMBG) strip acquisition prior to starting FreeStyle Libre. Hospitalizations for diabetic ketoacidosis (DKA), severe hypoglycemia, diabetes-related coma, and hyperglycemia were recorded for the 12 months before and after initiation. RESULTS Hospitalizations for acute diabetes complications fell in type 1 diabetes (-49.0%) and in type 2 diabetes (-39.4%) following FreeStyle Libre initiation. DKA fell in type 1 diabetes (-56.2%) and in type 2 diabetes (-52.1%), as did diabetes-related comas in type 1 diabetes (-39.6%) and in type 2 diabetes (-31.9%). Hospitalizations for hypoglycemia and hyperglycemia decreased in type 2 diabetes (-10.8% and -26.5%, respectively). Before initiation, hospitalizations were most marked for people noncompliant with SMBG and for those with highest acquisition of SMBG, which fell by 54.0% and 51.2%, respectively, following FreeStyle Libre initiation. Persistence with FreeStyle Libre at 12 months was at 98.1%. CONCLUSIONS This large retrospective study on hospitalizations for acute diabetes complications shows that a significantly lower incidence of admissions for DKA and for diabetes-related coma is associated with use of flash glucose monitoring. This study has significant implications for patient-centered diabetes care and potentially for long-term health economic outcomes.
Collapse
Affiliation(s)
- Ronan Roussel
- Department of Diabetology, Endocrinology, and Nutrition, Bichat-Claude Bernard Hospital, Paris, France .,Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France.,Université de Paris, Paris, France
| | - Jean-Pierre Riveline
- Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France.,Université de Paris, Paris, France.,Department of Diabetology and Endocrinology, Lariboisière Hospital, Paris, France
| | - Eric Vicaut
- Clinical Research Unit, Fernand Vidal Hospital, Paris, France
| | | | | | | | | | - Bruno Guerci
- Department of Endocrinology, Diabetology, and Nutrition, Brabois Adult Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
15
|
Detournay B, Boultif Z, Bahloul A, Jeanbat V, Robert J. Treatment Costs of Basal Insulin Regimens for Type 2 Diabetes Mellitus in France. Pharmacoecon Open 2021; 5:211-219. [PMID: 33215332 PMCID: PMC8160062 DOI: 10.1007/s41669-020-00237-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Our objectives were to describe the basal insulin treatment regimens most widely used in a real-world setting in France and to estimate the associated treatment costs in people with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional observational study was conducted (November 2017-February 2018) among adult patients with T2DM requiring basal insulin therapy for their own use in a representative sample of pharmacies. Costs were compared between patients treated with three recently marketed insulins (glargine 300 U/ml [Gla-300], biosimilar glargine 100 U/ml [Gla-100] and a fixed-ratio combination of insulin degludec and liraglutide) and those treated with three established basal or intermediate insulins: branded glargine 100 U/ml, insulin detemir and neutral protamine Hagedorn insulin [NPH]). RESULTS Overall, 1933 patients were analysed. Gla-300 accounted for 59.9% of novel basal insulin prescriptions, and branded Gla-100 accounted for 67.9% of established insulin prescriptions. Recent insulins were more frequently associated with glucagon-like peptide-1 (GLP-1) analogues. Results confirmed a lower rate of severe hypoglycaemia with Gla-300 than with Gla-100. On average, weekly total costs of treatment with all basal insulins were not significantly different, except with detemir, where they were higher. CONCLUSION New basal insulins are expected to be integrated into clinical practice. This analysis shows that their use does not impact upon the management cost of insulin therapy in people with T2DM.
Collapse
Affiliation(s)
- Bruno Detournay
- CEMKA-EVAL, 43, boulevard Maréchal Joffre, 92340 Bourg-la-Reine, France
| | | | | | - Viviane Jeanbat
- CEMKA-EVAL, 43, boulevard Maréchal Joffre, 92340 Bourg-la-Reine, France
| | - Julien Robert
- CEMKA-EVAL, 43, boulevard Maréchal Joffre, 92340 Bourg-la-Reine, France
| |
Collapse
|
16
|
d'Andon A, Galaup A, Fabron C, Detournay B, Borel T. France's competitiveness in global pharmaceutical research: The situation is improving. Therapie 2021; 76:549-557. [PMID: 34053732 DOI: 10.1016/j.therap.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/31/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022]
Abstract
AIMS The French pharmaceutical companies' association (LEEM) biennially carries out a study on the attractiveness of France in pharmaceutical clinical research. This study aims to measure France's global competitiveness for international clinical trials (CT) and assess its strengths and areas of excellence. METHODS A descriptive and comparative analysis was conducted using the data from both the ClinicalTrials.gov registry for the 2015-2019 period and those reported in a national web-based database (OSCAR) involving the major pharmaceutical companies operating in France in 2018-2019. OSCAR allows to describe the administrative authorization and starting process for all drug trials conducted in France. RESULTS Among 8607 worldwide drug trials initiated in 2019, 34.3% (n=2.954) were funded exclusively by pharmaceutical companies (52.1% in France). On average, France was involved in 10.5% of all global industrial CTs launched over 2018-2019, still ranking in the 4th position among European countries. Early-phase trials represented 17.3% of trials conducted by the drug companies in France, versus 25% in Germany and 29% in United Kingdom. Oncology remains an area of excellence in France with 18.7% of all worldwide CTs conducted in this therapeutic area over the study period involving at least some French centres, ranking France 2nd among European countries. The median of total deadline before the first patient inclusion of 204 days in 2018-2019 with no marked improvement as compared to 2016-2017 period. However, the delay getting initial trial authorization was slightly reduced and an overall deadline of 167 days was observed for CTs entered the pilot phase initiated recently by the European regulation. CONCLUSION After ten difficult years, areas of excellence, such as oncology and rare diseases and more recently, the outstanding mobilization for the COVID-19 research, have enabled France to maintain its pharmaceutical research. Furthermore, a set of additional decisions would strengthen this position in the next years.
Collapse
Affiliation(s)
- Anne d'Andon
- CEMKA, 43, boulevard Maréchal Joffre, 92340 Bourg-La-Reine, France
| | | | - Cecile Fabron
- CEMKA, 43, boulevard Maréchal Joffre, 92340 Bourg-La-Reine, France.
| | - Bruno Detournay
- CEMKA, 43, boulevard Maréchal Joffre, 92340 Bourg-La-Reine, France
| | | |
Collapse
|
17
|
Vermersch P, Suchet L, Colamarino R, Laurendeau C, Detournay B. Le parcours de soins des patients présentant une sclérose en plaques sous traitement de fond de 1re ligne en France : une analyse des données du SNDS. Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Franc S, Hanaire H, Benhamou PY, Schaepelynck P, Catargi B, Farret A, Fontaine P, Guerci B, Reznik Y, Jeandidier N, Penfornis A, Borot S, Chaillous L, Serusclat P, Kherbachi Y, d'Orsay G, Detournay B, Simon P, Charpentier G. DIABEO System Combining a Mobile App Software With and Without Telemonitoring Versus Standard Care: A Randomized Controlled Trial in Diabetes Patients Poorly Controlled with a Basal-Bolus Insulin Regimen. Diabetes Technol Ther 2020; 22:904-911. [PMID: 32407148 PMCID: PMC7757616 DOI: 10.1089/dia.2020.0021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The DIABEO® system (DS) is a telemedicine solution that combines a mobile app for patients with a web portal for health care providers. DS allows real-time monitoring of basal-bolus insulin therapy as well as therapeutic decision-making, integrating both basal and bolus dose calculation. Real-life studies have shown a very low rate of use of mobile health applications by patients. Therefore, we conducted a large randomized controlled trial study to investigate the efficacy of DS in conditions close to real life (TELESAGE study). Methods: TELESAGE was a multicenter, randomized, open study with three parallel arms: arm 1 (standard care), arm 2 (DIABEO alone), and arm 3 (DIABEO+telemonitoring by trained nurses). The primary outcome assessed the reduction in HbA1c levels after a 12-month follow-up. Results: Six hundred sixty-five patients were included in the study. Participants who used DIABEO once or more times a day (DIABEO users) showed a significant and meaningful reduction of HbA1c versus standard care after a 12-month follow-up: mean difference -0.41% for arm 2-arm 1 (P = 0.001) and -0.51% for arm 3-arm 1 (P ≤ 0.001). DIABEO users included 25.1% of participants in arm 2 and 37.6% in arm 3. In the intention-to-treat population, HbA1c changes and incidence of hypoglycemia were comparable between arms. Conclusions: A clinical and statistically significant reduction in HbA1c levels was found in those patients who used DIABEO at least once a day.
Collapse
Affiliation(s)
- Sylvia Franc
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, and Centre d'étude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD), Evry, France
- Address correspondence to: Sylvia Franc, MD, Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, Centre d'étude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD), 116 Bd Jean Jaures, Evry 91100, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, CHU Toulouse, University of Toulouse, Toulouse, France
| | | | - Pauline Schaepelynck
- Department of Nutrition-Endocrinology-Metabolic Disorders, Marseille University Hospital, Sainte Marguerite Hospital, Marseille, France
| | - Bogdan Catargi
- Department of Endocrinology and Diabetes, University Hospital, Bordeaux, France
| | - Anne Farret
- Department of Endocrinology, Diabetes and Nutrition, University Hospital, Montpellier, France
| | - Pierre Fontaine
- Department of Diabetology, University Hospital, Lille, France
| | - Bruno Guerci
- Endocrinology-Diabetes Care Unit, University of Lorraine, Vandoeuvre Lès Nancy, France
| | - Yves Reznik
- Department of Endocrinology, University of Caen Côte de Nacre Regional Hospital Center, Caen, France
| | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and Nutrition, CHU of Strasbourg, Strasbourg, France
| | - Alfred Penfornis
- Department of Diabetology, Metabolic Diseases and Nutrition, CHU Toulouse, University of Toulouse, Toulouse, France
- Professor at the University Paris-Sud, University Paris-Sud, Orsay, France
| | - Sophie Borot
- Centre Hospitalier Universitaire Jean Minjoz, Service d'Endocrinologie-Métabolisme et Diabétologie-Nutrition, Besançon, France
| | | | - Pierre Serusclat
- Endocrinology, Diabetology and Nutrition, Clinique Portes du Sud, Venissieux, France
| | | | | | | | - Pierre Simon
- National Association of Telemedicine, Evry, France
| | - Guillaume Charpentier
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, and Centre d'étude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD), Evry, France
| |
Collapse
|
19
|
Robert J, Detournay B, Levant M, Uhart M, Gourmelen J, Cohen J. Flu vaccine coverage for recommended populations in France. Med Mal Infect 2020; 50:670-675. [DOI: 10.1016/j.medmal.2019.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/14/2019] [Accepted: 12/04/2019] [Indexed: 11/15/2022]
|
20
|
Vermersch P, Suchet L, Colamarino R, Laurendeau C, Detournay B. An analysis of first-line disease-modifying therapies in patients with relapsing-remitting multiple sclerosis using the French nationwide health claims database from 2014–2017. Mult Scler Relat Disord 2020; 46:102521. [DOI: 10.1016/j.msard.2020.102521] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
|
21
|
Roussel R, Detournay B, Boultif Z, Bahloul A, Teissier C, Charbonnel B. Persistence with Basal Insulin and Frequency of Hypoglycemia Requiring Hospitalization in Patients with Type 2 Diabetes. Diabetes Ther 2020; 11:1861-1872. [PMID: 32651837 PMCID: PMC7376764 DOI: 10.1007/s13300-020-00874-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION A second-generation basal insulin analogue insulin glargine 300 U/mL (Gla-300) has been marketed in France since June 2016. This real-world study was designed to assess persistence with Gla-300 and the prevalence of related hypoglycemia requiring hospitalization as compared to first-generation basal insulins, in patients with type 2 diabetes mellitus (T2DM). METHODS A retrospective study was conducted using data in the large French comprehensive national healthcare system claims databases. Patients with T2DM newly treated with insulin in 2016 and 2017 (2-year period) were included. Three basal insulins [Gla-300, glargine 100 U/mL (Gla-100; both branded and biosimilar) and insulin detemir (IDet)] were compared for (1) persistence until treatment discontinuation using adjusted Cox models and (2) hypoglycemia requiring hospitalization over the period of insulin exposure. RESULTS During the 2-year study period, in France, 181,263 patients initiated basal insulin therapy (in a basal scheme or a more complex insulin scheme), of whom 74% initiated Gla-100, 14.2% initiated IDet and 11.8% initiated Gla-300. Patient characteristics varied according to the insulin regimen in terms of age, gender, social coverage, insulin scheme, and Charlson Comorbidity Index. Overall, 72% of patients were still treated with any basal insulin after 1 year (75% in basal scheme). In all insulin treatment regimens, patients were less likely to discontinue Gla-300 as compared to Gla-100 [adjusted odds ratio (OR) 0.39, 95% confidence interval (CI) 0.37-0.41], with similar results when only the basal scheme was considered (adjusted OR 0.38, 95% CI 0.35-0.40). Persistence with IDet was similar to that with Gla-100. Patients treated with Gla-100 had higher crude hospitalization rates for hypoglycemia than those receiving Gla-300 (1.4 for 100 patients-years; OR 0.67, 95% CI 0.55-0.81); however, this difference was not statistically significant after adjustment for patient characteristics. Emergency Room (ER) visits were less frequent in patients treated with Gla-300 versus Gla-100 with or without adjustment for patient characteristics (p < 0.0001). CONCLUSION Real-world persistence for basal insulin therapy in patients with T2DM was significantly better in those on Gla-300 compared with those on Gla-100 and IDet. A trend to a lower frequency of hospitalization for hypoglycemia and ER visits, whatever the cause, was also observed in patients on Gla-300.
Collapse
Affiliation(s)
- Ronan Roussel
- Endocrinology Department, Hôpital Bichat Claude Bernard, Centre Hospitalier Universitaire (CHU)-Paris, Paris, France
| | | | | | | | | | - Bernard Charbonnel
- Endocrinology Department, Nantes University Hospital Hotel-Dieu, Nantes, France
| |
Collapse
|
22
|
Téhard B, Detournay B, Borget I, Roze S, De Pouvourville G. Value of a QALY for France: A New Approach to Propose Acceptable Reference Values. Value Health 2020; 23:985-993. [PMID: 32828226 DOI: 10.1016/j.jval.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/20/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE France has included health economic assessment (HEA) as an official criterion for innovative drug pricing since 2013. Until now, no cost-effectiveness threshold (CET) has been officially proposed to qualify incremental cost-effectiveness ratios (ICERs). Although the French health authorities have publicly expressed the need for such reference values, previous initiatives to determine these have failed. The study aims to propose a locally adapted method for estimating a preference-based value for a quality-adjusted life-year (QALY) based on a rational approach to public policy choices in France. METHODS We used the official French value of statistical life (VSL) of €3 million (USD 3.25 million), proposed in 2013 by the French General Commission on Strategy and Prediction. We first estimated the value of life-year (VoLY) by age category according to life expectancy and official discounts recommended for HEA in France. We then estimated a value of statistical QALY (VSQ) by weighting VoLYs with demographic data and French EQ-5D-3L tariffs. RESULTS The estimated average VoLYs and VSQs were €120 185 (USD 130 000) and €147 093 (USD 159 022), respectively, assuming a discount rate of 2.5% and €166 205 (USD 179 681) and €201 398 (USD 217 728), respectively, assuming a discount rate of 4.5%. CONCLUSION Assuming that, as in other public domains, equity in access to healthcare across all disease areas and between all users is desirable, we propose an estimate of VSQ that is consistent with this goal. Our estimates of €147 093 (USD 179,681) to €201 398 (USD 217 728) should be perceived as breakeven costs for a QALY rather than a market access threshold. Such VSQs could be used as reference values for ICERs in HEA in France.
Collapse
|
23
|
Emery C, Torreton E, Dejager S, Levy-Bachelot L, Bineau S, Detournay B. Cost of Managing Type 2 Diabetes Before and After Initiating Dipeptidyl Peptidase 4 Inhibitor Treatment: A Longitudinal Study Using a French Public Health Insurance Database. Diabetes Ther 2020; 11:535-548. [PMID: 31953694 PMCID: PMC6995803 DOI: 10.1007/s13300-020-00760-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Diabetes is a growing epidemic that imposes a substantial economic burden on healthcare systems. This study aimed to evaluate the cost of managing type 2 diabetes (T2D) with dipeptidyl peptidase 4 inhibitors (DPP4Is) using real-world data. METHOD This longitudinal study used data from the French EGB (Echantillon Généraliste des Bénéficiaires) database. The annual average direct healthcare cost of treating patients with T2D was calculated 3 years prior and 3 years after initiation of DPP4I therapy. Actual total ambulatory and hospital care expenditure for the 3 years after DPP4I initiation was compared to projected costs. The distribution of costs across all care modalities was assessed over the 6-year period. RESULTS Ambulatory and hospital care expenditure data for 919 patients with T2D starting DPP4I therapy alone or in combination in 2013 were analyzed. A total of 526 patients (57.2%) were still being treated with DPP4I 3 years after DPP4I initiation. Regardless of the treatment regimen, the ambulatory and hospital care costs increased above projected costs in the first year following DPP4I initiation, and then declined during the second and third years to levels in line with or below projected values for patients using DPP4Is as an add-on therapy. The increase in total expenditure in the first year following DPP4I initiation and the subsequent decline in costs in the second and third years were both associated with general trends in consumption across all aspects of patient care. CONCLUSION Despite an initial increase in healthcare expenditure, concomitant with reevaluation of patient care, this study showed that initiation of DPP4Is as an add-on therapy in French patients with T2D was associated with care expenditure that was in line or below predicted values within the 3 years following treatment initiation. Additional studies are required to evaluate the economic impact of the long-term treatment benefits.
Collapse
Affiliation(s)
- Corinne Emery
- Cemka, 43, boulevard Maréchal Joffre, 92 340, Bourg la Reine, France
| | - Elodie Torreton
- Cemka, 43, boulevard Maréchal Joffre, 92 340, Bourg la Reine, France
| | - Sylvie Dejager
- Laboratoires MSD France, 10-12 Cours Michelet, 92800, Puteaux, France
| | | | - Sébastien Bineau
- Laboratoires MSD France, 10-12 Cours Michelet, 92800, Puteaux, France
| | - Bruno Detournay
- Cemka, 43, boulevard Maréchal Joffre, 92 340, Bourg la Reine, France.
| |
Collapse
|
24
|
le Douarin Y, Traversino Y, Graciet A, Josseran A, Bili AB, Blaise L, Chatellier G, Coulonjou H, Delval C, Detournay B, Zaleski ID, Forest J, Saidani N, Vandenbergue J. Télésurveillance et expérimentations ETAPES. Quelle pérennité après 2021 : quel modèle organisationnel et financement ? Therapie 2020; 75:29-42. [DOI: 10.1016/j.therap.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
|
25
|
Joubert M, Benhamou PY, Schaepelynck P, Hanaire H, Catargi B, Farret A, Fontaine P, Guerci B, Reznik Y, Jeandidier N, Penfornis A, Borot S, Chaillous L, Franc S, Serusclat P, Kherbachi Y, Bavière E, Detournay B, Simon P, Charpentier G. Remote Monitoring of Diabetes: A Cloud-Connected Digital System for Individuals With Diabetes and Their Health Care Providers. J Diabetes Sci Technol 2019; 13:1161-1168. [PMID: 30862245 PMCID: PMC6835183 DOI: 10.1177/1932296819834054] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Benefits of telemedicine have been proven in the field of diabetes. Among a number of technical solutions, Diabeo® has been studied in both type 1 and type 2 diabetes with intensive insulin therapy. This digital therapeutic system contains a self-monitoring glucose logbook and offers automated insulin dose recommendations thanks to a fully customizable algorithm. In addition, the cloud-based dedicated software also has features to facilitate remote monitoring, including a platform for diabetes nurses who perform coaching and treatment adjustment. A detailed description of this telemedicine system is provided, as well as results of completed clinical studies. In particular, TeleDiab 1's positive results on HbA1c in type 1 diabetes are detailed. We conclude with a discussion of the role of this telemedicine system within the landscape of mobile apps for diabetes.
Collapse
Affiliation(s)
- Michael Joubert
- Diabetes Care Unit, Caen University Hospital, Caen, France
- Michael Joubert, MD, PhD, Diabetes Care Unit, Caen University Hospital, CHU Côte de Nacre, 14033 Caen Cedex 09, France.
| | | | - Pauline Schaepelynck
- Department of Nutrition-Endocrinology-Metabolic Disorders, Marseille University Hospital, Sainte Marguerite Hospital, Marseille, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, CHU Toulouse, University of Toulouse, Toulouse, France
| | - Bogdan Catargi
- Department of Endocrinology and Diabetes, University Hospital, Bordeaux, France
| | - Anne Farret
- Department of Endocrinology, Diabetes and Nutrition, University Hospital, Montpellier, France
| | - Pierre Fontaine
- Department of Diabetology, University Hospital, Lille, France
| | - Bruno Guerci
- Endocrinology-Diabetes Care Unit, University of Lorraine, Vandoeuvre Lès Nancy, France
| | - Yves Reznik
- Diabetes Care Unit, Caen University Hospital, Caen, France
| | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and Nutrition. CHU of Strasbourg, Strasbourg, France
| | - Alfred Penfornis
- University Paris-Sud, Orsay, Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France
| | - Sophie Borot
- Centre Hospitalier Universitaire Jean Minjoz, Service d’Endocrinologie-Métabolisme et Diabétologie-Nutrition, Besançon, France
| | - Lucy Chaillous
- Department of Endocrinology, Diabetology and Nutrition, Institut du Thorax, Nantes University Hospital, France
| | - Sylvia Franc
- CERITD (Centre d’étude et de Recherche pour l’Intensification du Traitement du Diabète), Evry, Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France
| | - Pierre Serusclat
- Endocrinology, Diabetology and Nutrition, Clinique Portes du Sud, Venissieux, France
| | | | | | | | - Pierre Simon
- National Association of Telemedicine, Paris, France
| | - Guillaume Charpentier
- CERITD (Centre d’étude et de Recherche pour l’Intensification du Traitement du Diabète), Evry, Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France
| |
Collapse
|
26
|
Hoogendoorn M, Corro Ramos I, Baldwin M, Luciani L, Fabron C, Detournay B, Rutten-van Mölken MPMH. Long-term cost-effectiveness of the fixed-dose combination of tiotropium plus olodaterol based on the DYNAGITO trial results. Int J Chron Obstruct Pulmon Dis 2019; 14:447-456. [PMID: 30863045 PMCID: PMC6388779 DOI: 10.2147/copd.s191031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Combinations of long-acting bronchodilators are recommended to reduce the rate of COPD exacerbations. Evidence from the DYNAGITO trial showed that the fixed-dose combination of tiotropium + olodaterol reduced the annual rate of total exacerbations (P<0.05) compared with tiotropium monotherapy. This study aimed to estimate the cost-effectiveness of the fixed-dose combination of tiotropium + olodaterol vs tiotropium monotherapy in COPD patients in the French setting. PATIENTS AND METHODS A recently developed COPD patient-level simulation model was used to simulate the lifetime effects and costs for 15,000 patients receiving either tiotropium + olodaterol or tiotropium monotherapy by applying the reduction in annual exacerbation rate as observed in the DYNAGITO trial. The model was adapted to the French setting by including French unit costs for treatment medication, COPD maintenance treatment, COPD exacerbations (moderate or severe), and pneumonia. The main outcomes were the annual (severe) exacerbation rate, the number of quality-adjusted life-years (QALYs), and total lifetime costs. RESULTS The number of QALYs for treatment with tiotropium + olodaterol was 0.042 higher compared with tiotropium monotherapy. Using a societal perspective, tiotropium + olodaterol resulted in a cost increase of +€123 and an incremental cost-effectiveness ratio (ICER) of €2,900 per QALY compared with tiotropium monotherapy. From a French National Sickness Fund perspective, total lifetime costs were reduced by €272 with tiotropium + olodaterol, resulting in tiotropium + olodaterol being the dominant treatment option, that is, more effects with less costs. Sensitivity analyses showed that reducing the cost of exacerbations by 34% increased the ICER to €15,400, which could still be considered cost-effective in the French setting. CONCLUSION Treatment with tiotropium + olodaterol resulted in a gain in QALYs and savings in costs compared with tiotropium monotherapy using a National Sickness Fund perspective in France. From the societal perspective, tiotropium + olodaterol was found to be cost-effective with a low cost per QALY.
Collapse
Affiliation(s)
- Martine Hoogendoorn
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, the Netherlands,
| | - Isaac Corro Ramos
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, the Netherlands,
| | | | | | | | | | - Maureen P M H Rutten-van Mölken
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, the Netherlands,
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
27
|
Lizée T, Basch E, Trémolières P, Voog E, Domont J, Peyraga G, Urban T, Bennouna J, Septans AL, Balavoine M, Detournay B, Denis F. Cost-Effectiveness of Web-Based Patient-Reported Outcome Surveillance in Patients With Lung Cancer. J Thorac Oncol 2019; 14:1012-1020. [PMID: 30776447 DOI: 10.1016/j.jtho.2019.02.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/22/2019] [Accepted: 02/10/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A multicenter randomized clinical trial in France found an overall survival benefit of web-based patient-reported outcome (PRO)-based surveillance after initial treatment for lung cancer compared with conventional surveillance. The aim of this study was to assess the cost-effectiveness of this PRO-based surveillance in lung cancer patients. METHODS This medico-economic analysis used data from the clinical trial, augmented by abstracted chart data and costs of consultations, imaging, transportations, information technology, and treatments. Costs were calculated based on actual reimbursement rates in France, and health utilities were estimated based on scientific literature review. Willingness-to-pay thresholds of €30,000 per quality-adjusted life year (QALY) and €90,000 per QALY were used to define a very cost-effective and cost-effective strategy, respectively. Average annual costs of experimental and control surveillance approaches were calculated. The incremental cost-effectiveness ratio was expressed as cost per life-year gained and QALY gained, from the health insurance payer perspective. One-way and multivariate probabilistic sensitivity analyses were performed. RESULTS Average annual cost of surveillance follow-up was €362 lower per patient in the PRO arm (€941/year/patient) compared to control (€1,304/year/patient). The PRO approach presented an incremental cost-effectiveness ratio of €12,127 per life-year gained and €20,912 per QALY gained. The probabilities that the experimental strategy is very cost-effective and cost-effective were 97% and 100%, respectively. CONCLUSIONS Surveillance of lung cancer patients using web-based PRO reduced the follow-up costs. Compared to conventional monitoring, this surveillance modality represents a cost-effective strategy and should be considered in cancer care delivery.
Collapse
Affiliation(s)
- Thibaut Lizée
- Department of Radiation Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France.
| | - Ethan Basch
- Department of Radiation Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Pierre Trémolières
- Department of Radiation Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France
| | - Eric Voog
- Department of Medical Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France
| | - Julien Domont
- Department of Medical Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France
| | - Guillaume Peyraga
- Department of Radiation Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France
| | - Thierry Urban
- Department of Pneumology, University Hospital Center, Angers, France
| | - Jaafar Bennouna
- Department of Medical Oncology, University Hospital Center, Nantes, France
| | | | | | | | - Fabrice Denis
- Department of Radiation Oncology, Jean Bernard Center, Inter-Regional Institute of Oncology, Le Mans, France
| |
Collapse
|
28
|
Robert J, Detournay B, Cohen JM, Levant MC, Uhart M. Estimation des couvertures vaccinales grippe des populations cibles des recommandations officielles en vigueur en France à partir de la base de l’Échantillon généraliste des bénéficiaires (EGB). Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
29
|
Roussel R, Fontaine P, Gouet D, Serusclat P, Martinez L, Detournay B, Martin-Kristensen M. Le traitement du diabète de type 2 en France est dynamique plutôt qu’inerte : analyse des prescriptions de 847 122 patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1957-2557(18)30096-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
30
|
Charbonnel B, Simon D, Dallongeville J, Bureau I, Dejager S, Levy-Bachelot L, Gourmelen J, Detournay B. Direct Medical Costs of Type 2 Diabetes in France: An Insurance Claims Database Analysis. Pharmacoecon Open 2018; 2:209-219. [PMID: 29623622 PMCID: PMC5972121 DOI: 10.1007/s41669-017-0050-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES Our objects was to estimate the direct healthcare costs of type 2 diabetes mellitus (T2DM) in France in 2013. METHODS Data were drawn from a random sample of ≈600,000 patients registered in the French national health insurances database, which covers 90% of the French population. An algorithm was used to select patients with T2DM. Direct healthcare costs from a collective perspective were derived from the database and compared with those from a control group to estimate the cost of diabetes and related comorbidities. Overall direct costs were also compared according to the diabetes therapies used throughout the year 2013. RESULTS Cost analysis was available for a sample of 25,987 patients with T2DM (mean age 67.5 ± standard deviation 12.5; 53.9% male) matched with a control group of 76,406 individuals without diabetes. Overall per patient per year medical expenditures were €6506 ± 10,106 in the T2DM group as compared with €3668 ± 6954 in the control group. The cost difference between the two groups was €2838 per patient per year, mainly due to hospitalizations, medication and nursing care costs. Total per capita annual costs were lowest for patients receiving metformin monotherapy (€4153 ± 6170) and highest for those receiving insulin (€12,890). However, apart from patients receiving insulin, costs did not differ markedly across the different oral treatment patterns. CONCLUSION Extrapolating these results to the whole T2DM population in France, total direct costs of diagnosed T2DM in 2013 was estimated at over €8.5 billion. This estimate highlights the substantial economic burden of this condition on society.
Collapse
Affiliation(s)
| | - Dominique Simon
- Diabetes Department and ICAN (Institute of Cardiometabolism And Nutrition), Pitié Hospital, Paris, France
| | | | - Isabelle Bureau
- Cemka-Eval, 43 Bd du Maréchal Joffre, 92 340 Bourg-la-Reine, France
| | | | | | | | - Bruno Detournay
- Cemka-Eval, 43 Bd du Maréchal Joffre, 92 340 Bourg-la-Reine, France
| |
Collapse
|
31
|
Saba G, Andrade LF, Gaillat J, Bonnin P, Chidiac C, Illes HG, Laurichesse H, Messika J, Ricard JD, Detournay B, Petitpretz P, de Pouvourville G. Costs associated with community acquired pneumonia in France. Eur J Health Econ 2018; 19:533-544. [PMID: 28547724 DOI: 10.1007/s10198-017-0900-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Pneumocost is a prospective study that aimed at documenting the costs of the management of patients hospitalized with a pneumococcal pneumonia and the post-discharge costs during a 6-month period in the French context. METHODS Billing data were used to document hospital costs. Resource use during the follow-up period was collected through phone interviews at month 1, 3 and 6. Descriptive statistics and multivariate analyses were performed. We used generalized linear models with log-link functions to estimate parameters associated with hospital and follow-up costs of patients. RESULTS Five hundred twenty-four patients were enrolled in 40 public centers from October 2011 to April 2014. Average age was 63 (SD 17); 55.0% of them were male. Average length of stay was 15 days (SD 23). Average cost of stay for the French Sickness Fund was €7293 (SD €7363). Average cost of follow-up was €1242 (SD €3000) and decreased steadily through time. When controlling for patient's socioeconomic characteristics, severity of disease and hospital stay, results showed a concave relationship between hospital costs and age. Obesity, the severity of the disease and comorbidities were associated with constantly increasing inpatient costs. Concerning follow-up costs, we found the same concave relationship with age, while gender, a history of pneumonia and severity of the disease were the most important predictors of high costs after discharge. CONCLUSION Pneumocost is the first French study providing a robust estimation of the cost of managing invasive pneumococcal pneumonia in the French context.
Collapse
Affiliation(s)
- Grèce Saba
- ESSEC Business School, Avenue Bernard Hirsch, 95021, Cergy-Pontoise Cedex, France
| | - Luiz Flavio Andrade
- ESSEC Business School, Avenue Bernard Hirsch, 95021, Cergy-Pontoise Cedex, France.
| | | | | | | | | | - Henri Laurichesse
- Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Jonathan Messika
- AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, 92700, Colombes, France
- INSERM, IAME, UMR 1137, 75018, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, 75018, Paris, France
| | - Jean-Damien Ricard
- AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, 92700, Colombes, France
- INSERM, IAME, UMR 1137, 75018, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, 75018, Paris, France
| | | | | | | |
Collapse
|
32
|
Jeandidier N, Chaillous L, Franc S, Benhamou PY, Schaepelynck P, Hanaire H, Catargi B, Farret A, Fontaine P, Guerci B, Reznik Y, Penfornis A, Borot S, Serusclat P, Kherbachi Y, D'Orsay G, Detournay B, Simon P, Charpentier G. DIABEO App Software and Telemedicine Versus Usual Follow-Up in the Treatment of Diabetic Patients: Protocol for the TELESAGE Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e66. [PMID: 29674306 PMCID: PMC5934533 DOI: 10.2196/resprot.9154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background Self-management of diabetes minimizes the risk of macrovascular and microvascular complications, but understanding and/or adherence to self-management recommendations is often suboptimal. DIABEO is a smartphone app (downloaded via the internet) used to calculate bolus insulin doses. A previous study (TELEDIAB 1) showed that the use of DIABEO was associated with a significant improvement in glycemic control in patients with poorly controlled type 1 diabetes mellitus, particularly when combined with teleconsultations with physicians. Objective Here, we present the protocol for a new study (Suivi A Grande Echelle d’une cohorte de diabétiques de type 1 et de type 2 sous schéma insulinique basal bolus par la TELEmédecine; abbreviated TELESAGE), conducted in a larger population of diabetic patients with poorly controlled basal-bolus insulin levels. Methods TELESAGE is a multicenter, double-randomized, open-label, three parallel–arms study, conducted in approximately 100 centers in France. The study will compare a control group (arm 1: usual follow-up) with two DIABEO telemedicine systems: (1) physician-assisted telemedicine (arm 2), and (2) nurse-assisted telemonitoring and teleconsultations by a diabetologist’s task delegation (arm 3). Initial randomization will allocate the study arms in 12 French regions. A second randomization will assign patients in the groups allocated to each studied region. The primary objective of TELESAGE will be to investigate the effect of the DIABEO telemedicine system versus usual follow-up, with respect to improvements in the glycated hemoglobin levels of approximately 696 diabetic patients with poorly controlled basal-bolus insulin levels. Results The TELESAGE study is sponsored by Sanofi (Gentilly, France). A primary completion date is expected in June 2018, and publication of results is expected within 6 months of work completion. Conclusions The TELESAGE study is expected to confirm the previous results of the TELEDIAB 1 study using a larger sample of diabetic patients. It is also expected to evaluate a nurse-assisted telemonitoring system. We will assess the potential of the DIABEO telemedicine service in terms of its utility and explore whether it can become an integral part of diabetes care for patients. Trial Registration ClinicalTrials.gov NCT02287532; https://clinicaltrials.gov/ct2/show/NCT02287532 (Archived by WebCite at http://www.webcitation.org/6ykajhJKd)
Collapse
Affiliation(s)
- Nathalie Jeandidier
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, Strasbourg, France
| | - Lucy Chaillous
- Hospital Laennec, University Hospital of Nantes, Saint-Herblain, France
| | - Sylvia Franc
- Centre d'Étude et de Recherche pour l'Intensification du Traitement du Diabète, Evry, Department of Diabetes, Sud-Francilien Hospital, University Paris-Sud, Orsay, Corbeil-Essonnes, France
| | | | - Pauline Schaepelynck
- Department of Nutrition-Endocrinology-Metabolic Disorders, Marseille University Hospital, Sainte Marguerite Hospital, Marseille, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, University Hospital of Toulouse, University of Toulouse, Toulouse, France
| | - Bogdan Catargi
- Department of Endocrinology and Diabetes, University Hospital, Bordeaux, France
| | - Anne Farret
- Department of Endocrinology, Diabetes and Nutrition, University Hospital, Montpellier, France
| | - Pierre Fontaine
- Department of Diabetology, University Hospital, Lille, France
| | - Bruno Guerci
- Endocrinology-Diabetes Care Unit, University of Lorraine, Vandoeuvre Lès Nancy, France
| | - Yves Reznik
- Department of Endocrinology, University of Caen Côte de Nacre Regional Hospital Center, Caen, France
| | - Alfred Penfornis
- Centre d'Étude et de Recherche pour l'Intensification du Traitement du Diabète, Evry, Department of Diabetes, Sud-Francilien Hospital, University Paris-Sud, Orsay, Corbeil-Essonnes, France
| | - Sophie Borot
- Department of Endocrinology, Metabolism, Diabetology and Nutrition, University Hospital Jean Minjoz, Besançon, France
| | - Pierre Serusclat
- Endocrinology, Diabetology and Nutrition, Clinique Portes du Sud, Venissieux, France
| | | | | | - Bruno Detournay
- CEMKA Contract Research Organization, Bourg-la-Reine, France
| | - Pierre Simon
- National Association of Telemedicine, Evry, France
| | - Guillaume Charpentier
- Centre d'Étude et de Recherche pour l'Intensification du Traitement du Diabète, Evry, Department of Diabetes, Sud-Francilien Hospital, University Paris-Sud, Orsay, Corbeil-Essonnes, France
| |
Collapse
|
33
|
Detournay B, Cousin M, Gourmelen J, Machuron V, Depoortere PH, Pau D. Les traitements des patients présentant une sclérose en plaques en France. Une analyse des données de l’EGB. Rev Neurol (Paris) 2018. [DOI: 10.1016/j.neurol.2018.01.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
Andrade LF, Saba G, Ricard JD, Messika J, Gaillat J, Bonnin P, Chidiac C, Illes HG, Laurichesse H, Detournay B, Petitpretz P, de Pouvourville G. Health related quality of life in patients with community-acquired pneumococcal pneumonia in France. Health Qual Life Outcomes 2018; 16:28. [PMID: 29394941 PMCID: PMC5797362 DOI: 10.1186/s12955-018-0854-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/25/2018] [Indexed: 12/21/2022] Open
Abstract
Background Community Acquired Pneumococcal Pneumonia is a lung infection that causes serious health problems and can lead to complications and death. The aim of this study was to observe and analyze health related quality of life after a hospital episode for patients with community acquired pneumococcal pneumonia in France. Methods A total of 524 individuals were enrolled prospectively in the study and were followed for 12 months after hospital discharge. Presence of streptococcus pneumoniae was confirmed by microbiological sampling. Quality of life was reported at four different points of time with the EQ-5D-3 L health states using the French reference tariff. Complete data on all four periods was available for 269 patients. We used descriptive and econometric analysis to assess quality of life over time during follow-up, and to identify factors that impact the utility indexes and their evolution through time. We used Tobit panel data estimators to deal with the bounded nature of utility values. Results Average age of patients was 63 and 55% of patients were men. Negative predictors of quality of life were the severity of the initial event, history of pneumonia, smokers, age and being male. On average, quality of life improved in the first 6 months after discharge and stabilized beyond. At month 1, mean utility index was 0.53 (SD: 0.34) for men and 0.45 (SD: 0.34) for women, versus mean of 0.69 (SD: 0.33) and 0.70 (SD: 0.35) at Month 12. “Usual activities” was the dimension the most impacted by the disease episode. Utilities for men were significantly higher than for women, although male patients were more severe. Individuals over 85 years old did not improve quality of life during follow-up, and quality of life did not improve or deteriorated for 34% of patients. We found that length of hospital stay was negatively correlated with quality of life immediately after discharge. Conclusion This study provides with evidence that quality of life after an episode of community acquired pneumococcal pneumonia improves overall until the sixth month after hospital discharge, but older patients with previous history of pneumonia may not experience health gains after the initial episode.
Collapse
Affiliation(s)
- Luiz Flavio Andrade
- ESSEC Business School, Avenue Bernard Hirsch, 95021, Cergy-Pontoise Cedex, France.
| | - Grèce Saba
- ESSEC Business School, Avenue Bernard Hirsch, 95021, Cergy-Pontoise Cedex, France
| | - Jean-Damien Ricard
- Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, Colombes, France.,INSERM, IAME, UMR 1137, University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France
| | - Jonathan Messika
- Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, Colombes, France.,INSERM, IAME, UMR 1137, University of Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France
| | | | | | | | | | - Henri Laurichesse
- Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | |
Collapse
|
35
|
Emery G, Le Fur C, Epis-de-Fleurian AA, Josseran A, Blin O, Debroucker F, Demarcq O, Detournay B, Favrel-Feuillade F, Finas R, Malbezin M, Mercier G, Mismetti P, Oget-Gendre C. Care pathway, towards the establishment of tailored funding: Reasons and criteria for success. Therapie 2018; 73:33-40. [DOI: 10.1016/j.therap.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 12/01/2022]
|
36
|
Balkau B, Charbonnel B, Penfornis A, Chraibi N, Lahouegue A, Faure C, Thomas-Delecourt F, Detournay B. The Use of Saxagliptin in People with Type 2 Diabetes in France: The Diapazon Epidemiological Study. Diabetes Ther 2017; 8:1147-1162. [PMID: 28948519 PMCID: PMC5630565 DOI: 10.1007/s13300-017-0311-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Saxagliptin is a potent, reversible inhibitor of dipeptidyl peptidase-4 that is indicated for the treatment of type 2 diabetes. The DIAPAZON study was a multicenter observational study intended to document the effectiveness, safety and patterns of saxagliptin use in France, including the saxagliptin retention rate, over 2 years of follow-up. METHODS A geographically representative sample of 304 French physicians (general practitioners and specialist endocrinologists or diabetologists) recruited 1131 adults with type 2 diabetes into an ambispective cohort; 1033 fulfilled the inclusion criteria. All had started saxagliptin during the previous 6 months or at study inclusion, and follow-up was for 24 ± 3 months after starting saxagliptin. RESULTS The mean age of the study population when starting saxagliptin was 61 years, and the mean HbA1c level was 8.0%; 79% had an HbA1c level ≥7%. Prior to starting saxagliptin treatment, most participants (91%) were receiving treatment with oral glucose-lowering drugs alone. The most commonly prescribed regimen at starting saxagliptin (53% of participants) was a combination of saxagliptin and metformin. The overall saxagliptin retention rate at 2 years was 79%, as estimated by the Kaplan-Meier method. The most common reasons for discontinuation were inadequate glycemic control (52%) and intolerance (22%). During the course of the study, the mean HbA1c level decreased to 7.0%, and the percentage of people with HbA1c <7% increased from 21% to 49%. The mean change in body weight was -1.8 kg. A total of 294 hypoglycemic episodes were reported in 70 participants (6.8%) during the follow-up period. Of these, 143 episodes in 41 participants (4.0%) occurred when saxagliptin was used in combination with agents associated with hypoglycemia, such as insulin, sulfonylureas or glinides. CONCLUSION Saxagliptin is efficacious and well tolerated in a real-world practice setting, with almost 80% of participants remaining on treatment after 2 years. FUNDING AstraZeneca, France.
Collapse
Affiliation(s)
- Beverley Balkau
- CESP, Faculty of Medicine, University Paris-South, Orsay, France.
- Faculty of Medicine, University Versailles-St Quentin, Versailles, France.
- INSERM U1018, University Paris-Saclay, Villejuif, France.
| | - Bernard Charbonnel
- Service endocrinologie-maladies métaboliques et nutrition, CHU Nantes, Nantes, France
| | - Alfred Penfornis
- CESP, Faculty of Medicine, University Paris-South, Orsay, France
- Service de diabétologie-endocrinologie, CHSF, Corbeil Essonnes, Université Paris-Sud, Orsay, France
| | | | | | | | | | | |
Collapse
|
37
|
Moutairou A, Roussel R, Charbonnel B, Leye A, Detournay B, Mohammedi K, Potier L. Predicting severe hypoglycaemia with self-monitoring of blood glucose in type 1 diabetes. Diabetes & Metabolism 2017; 43:392-394. [DOI: 10.1016/j.diabet.2016.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/06/2016] [Indexed: 11/28/2022]
|
38
|
Donio V, Auvrignon A, Pellegrino B, Courouve L, Nisenbaum N, Vialle G, Gabolde M, Detournay B. De l’intérêt/de la possibilité d’utiliser les données de la base Sniiram pour identifier le parcours de soins des enfants décédés de maladie en Île-de-France en 2012–2013. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
39
|
Detournay B, Halimi S, Levy P, Bec M, Torreton E, Dejager S. Le coût des hospitalisations pour hypoglycémie en France chez les patients diabétiques de type 2. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
40
|
Guerci B, Benhamou PY, Durain D, Bahloul A, Jeanbat V, Detournay B. [Self-monitoring of blood glucose in France: data from a national survey]. Sante Publique 2017; 29:229-240. [PMID: 28737342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objectives: To describe Self-Monitoring of Blood Glucose (SMBG) practices in France in patients with type 1 (T1DM) or type 2 (T2DM) diabetes, by estimating the proportion of patients performing SMBG at the recommended testing frequency and the proportion of patients complying with the current quality control guidelines on SMBG. Materials and methods: National cross-sectional study conducted in 238 pharmacies. A questionnaire was completed with adult diabetic patients buying SMBG devices or reagent strips for themselves, using a blood glucose meter for at least 6 months, treated with insulin or sulfonylurea/glinides ± other oral hypoglycaemic agents (HA). Results: Data from 449 patients were analysed: 85 T1DM and 121 T2DM patients treated by multiple basal-bolus injections ± HA (Group A and Group B), 123 T2DM patients treated by basal insulin ± HA (Group C), 102 patients treated by other insulin regimens ± HA (Group D) and 120 T2DM patients treated by sulfonylurea / glinides without insulin ± other HA (Group E). The recommended test frequency was observed by 29.8%, 36.4%, 61.8% and 69.2% of patients in Group A, Group B, Group C, and Group E, respectively. The quality of self-monitoring was insufficient in terms of device cleaning, storage conditions/expiry date of reagent strips, or use of control solutions. Patients displayed a limited capacity to take decisions in relation to their SMBG results (Group A: 56.5%, Group B: 70.2%, Group C: 49.2%, Group E: 36.0%) and limited knowledge about their glucose targets (Group A: 81%, Group B: 80.5%, Group C: 68.6%, Group E: 73.7%). Conclusion: SMBG use and compliance with quality guidelines must be improved, but healthcare professionals and patients must also focus their efforts on education to interpret SMBG results.
Collapse
|
41
|
Moutairou A, Roussel R, Charbonnel B, El Boustany R, Nicolas A, Leye A, Mohammedi K, Marre M, Detournay B, Potier L. Short-term effect of severe hypoglycaemia on glycaemic control in the Diabetes Control and Complications Trial. Diabetes & Metabolism 2017; 43:187-190. [DOI: 10.1016/j.diabet.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/10/2016] [Indexed: 11/25/2022]
|
42
|
Dervaux B, Le Fur C, Dubois S, Josseran A, Baseilhac É, Baumstark L, Blin O, Bresse X, Debroucker F, Delaitre O, Detournay B, Diebolt V, Durand-Zaleski I, Gaudin AF, Huot L, Jeanblanc G, Launois R, Levesque K, Levy-Bachelot L. Quel impact budgétaire pour l’arrivée d’un nouveau traitement ou d’une nouvelle technologie de santé ? Therapie 2017; 72:81-91. [DOI: 10.1016/j.therap.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 11/16/2022]
|
43
|
Dervaux B, Le Fur C, Dubois S, Josseran A, Baseilhac É, Baumstark L, Blin O, Bresse X, Debroucker F, Delaitre O, Detournay B, Diebolt V, Durand-Zaleski I, Gaudin AF, Huot L, Jeanblanc G, Launois R, Levesque K, Levy-Bachelot L. What is the budget impact of a new treatment or new health technology arriving on the market? Therapie 2017; 72:93-103. [DOI: 10.1016/j.therap.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
|
44
|
Chouaid C, Vella-Boucaud J, Pairon JC, Duburcq A, Detournay B, Boyer L, Housset B, Andujar P, Monnet I. P1.01-036 Lung Cancer Screening Program Is Cost Effective in French Setting: A Model Based Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
45
|
Vella-Boucaud J, Pairon JC, Duburcq A, Brochard P, Chamming'S S, Luc A, Detournay B, Paris C, Andujar P, Chouaid C. MA03.06 Cost Effectiveness of Chest Scan Screeing for Lung Cancer in Abestos Occupational Exposure Subjects: A Model Based Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
46
|
Hanaire H, Attali C, Lecointre B, Fraysse M, Gouet D, Babel MR, Charbonnel B, Sarkozy F, Gourmelen J, Detournay B. [Determinants of the cost of initiation of insulin therapy type 2 diabetic patients in France: possible approaches to optimization]. Sante Publique 2016; 28:781-789. [PMID: 28155773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Increased costs cannot be exclusively attributed to the consequences of insulin prescription. Any initiative designed to accelerate acquisition of patient autonomy would be likely to reduce the costs observed after switching to insulin, provided this initiative is adapted to the patient’s health profile, diabetes history and available medical resources.</ce:para>.
Collapse
|
47
|
Chidiac C, Bonnin P, Detournay B, Illes HG, Gaillat J, Laurichesse H, Messika J, Ricard JD, Saba G, Petitpretz P, Pouvourville GD. Streptococcus pneumoniae Community-Acquired Pneumonia (SP-CAP) in a French Cohort of Hospitalized Patients: Economic Burden and Impact on Quality of Life (QoL). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christian Chidiac
- ID Department, Regional Reference Center for Bji, Hospices Civils de Lyon, Lyon, France
| | | | | | | | | | | | | | | | - Grèce Saba
- Chair of Health Systems, ESSEC Business School, Cergy-Pontoise, France
| | | | | |
Collapse
|
48
|
Charbonnel B, Simon D, Dallongeville J, Bureau I, Leproust S, Levy-Bachelot L, Gourmelen J, Detournay B. Coût du diabète de type 2 en France. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
49
|
Simon D, Dallongeville J, Charbonnel B, Bureau I, Levy-Bachelot L, Leproust S, Gourmelen J, Detournay B. Prise en charge thérapeutique des patients diabétiques de type 2 en France. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
50
|
Chidiac C, Laurichesse H, Illes HG, Gaillat J, Bonnin P, Ricard JD, Messika J, Detournay B, Saba G, Petitpretz P, de Pouvourville G. Coût des pneumonies communautaires à pneumocoque hospitalisées en France. Résultats intermédiaires de l’étude prospective PNEUMOCOST. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|