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Soga Y, Ariyaratne TV, Secemsky E, Leboucher C, Blein C, Jaff MR, Priest V. Intravascular Ultrasound Guidance During Peripheral Vascular Interventions: Long-term Clinical Outcomes and Costs From the Japanese Perspective. J Endovasc Ther 2023:15266028231182382. [PMID: 37394832 DOI: 10.1177/15266028231182382] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
PURPOSE The value of intravascular ultrasound (IVUS) guidance during peripheral vascular revascularization procedures is incompletely understood. Moreover, data on long-term clinical outcomes and costs are limited. The objective of this study was to compare outcomes and costs between IVUS and contrast angiography alone in patients undergoing peripheral revascularization procedures in Japan. MATERIALS AND METHODS This retrospective comparative analysis was performed using the Japanese Medical Data Vision insurance claims database. All patients undergoing revascularization for peripheral artery disease (PAD) between April 2009 and July 2019 were included. Patients were followed until July 2020, death, or a subsequent revascularization procedure for PAD. Two patient groups were compared: one undergoing IVUS imaging or the other contrast angiography alone. The primary end point was major adverse cardiac and limb events, including all-cause-mortality, endovascular thrombolysis, subsequent revascularization procedures for PAD, stroke, acute myocardial infarction, and major amputations. Total health care costs were documented over the follow-up and compared between groups, using a bootstrap method. RESULTS The study included 3956 patients in the IVUS group and 5889 in the angiography alone group. Intravascular ultrasound was significantly associated with reduced risk of a subsequent revascularization procedure (adjusted hazard ratio: 0.25 [0.22-0.28]) and major adverse cardiac and limb events (0.69 [0.65-0.73]). The total costs were significantly lower in the IVUS group, with a mean cost saving over follow-up of $18 173 [$7 695-$28 595] per patient. CONCLUSION The use of IVUS during peripheral revascularization provides superior long-term clinical outcomes at lower costs compared with contrast angiography alone, warranting wider adoption and fewer barriers to IVUS reimbursement for patients with PAD undergoing routine revascularization. CLINICAL IMPACT Intravascular ultrasound (IVUS) guidance during peripheral vascular revascularization has been introduced to improve the precision of the procedure. However, questions over the benefit of IVUS in terms of long-term clinical outcome and over cost have limited its use in everyday clinical practice. This study, performed in a Japanese health insurance claims database, demonstrates that use of IVUS provides a superior clinical outcome over the long term at a lower cost compared to angiography alone. These findings should encourage clinicians to use IVUS in routine peripheral vascular revascularization procedures and encourage providers to reduce barriers to use.
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Affiliation(s)
- Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - Eric Secemsky
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Leboucher C, Blein C, Le Maout A, Machuron V, Benyounes K, Le Lay K, Millier A, Raffi P. Patients' description and resource use in COVID-19 hospitalized patients based on a French claims real-world database. Rev Epidemiol Sante Publique 2022. [PMCID: PMC9634436 DOI: 10.1016/j.respe.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Context Coronavirus disease (Covid-19) is an infectious disease caused by the SARS-CoV-2 virus. The disease can cause symptoms ranging from mild to very severe. People with risk factors as age, gender, medical conditions may be more likely to need hospitalization or intensive care if they have Covid-19, or to die of the infection. A retrospective study based on a national French hospitalized claims database (PMSI) over the year 2020 has been performed to support Covid-19 patient's description but also to describe the disease management with a dedicated focus on ventilation status and finally to describe the health care resource use and the economic impact for treatment of Covid-19 in outpatient patients with more than one risk-factor for severe Covid-19. – Objectives The main objective was to describe patient's characteristics hospitalized for Covid-19. The secondary objectives were to describe the disease management of Covid-19 according to the ventilation status, the health care resource use for and economic impact of Covid-19 disease management in hospital. Method This retrospective observational study identified people with Covid-19 in the PMSI through hospitalisation diagnosis codes in 2020. 4 ventilation status were identified: without and with oxygen support (O2), with non-invasive ventilation (NIV), with mechanical ventilation (MV) based on CCAM acts. Due to underreporting of medical procedure related to oxygen support, status “without oxygen support” was combined to O2 status. In case of several status in the same stay, the most severe was kept. Risk factors were identified through ICD10 codes, DRG and age. Rehospitalizations were calculated for 1st wave stays (from January to June). A minimum delay of 14 days between 2 stays was applied (to not consider transfer as a rehospitalisation). Cost estimation was performed based on health insurance perspective. Results About 200,00 patients for 240,00 stays. 1% of stay were in NIV status, 8% in MV. Median age was 69 years and 54% of patients were men. Men were overrepresented in NIV and MV. 10% of people over 80 had MV. 34% of patients had no risk factor (11% of MV patients, 6% of NIV and 36% of O2). The length of stay increases with the requirement of ventilation support. From a mean of 7 days for O2 to 22 days for MV. 16% of patients died (14% of O2, 25% of NIV, 36% of MV). The mortality rate increase with the age, between 1 and 5% for patients younger than 60 years, 9% for 61-65 years, 13% for 66-70 years, 17% for 71-75, 23% for 76-80 years and 33% for patients older than 80 years old. 14% of 1st wave patients were rehospitalised in 2020. The mean cost of Covid-19 hospitalisation was €5,510 (€+/- 7,142) and the median is €3,800. The mean cost of hospitalisation increased with ventilation support intensity from €3,990 (€+/- 3,021) for O2, up to €10, 600 (€+/- 5,534) for NIV and €21,100 (€+/- 15,343) for MV. Conclusion Age, sex and risk factor increased the severity of ventilation support, cost and mortality rates. Elderly people had less MV support, shorter length of stay and lower cost. In this study, requirement for low-flow oxygen support was largely under-reported, due to many reasons: lack of impact of O2 support on stay valorisation, not specified in the registry, and overload of work leading to enter only the most valuable information in the database. This under-reporting could also apply, to a much lesser extent to non-invasive ventilation, as such procedure is associated with increased stay cost. Conflict of interest VM, KB and KLL are employees of Roche. CL, CB, ALM and AM are employees of Creativ-Ceutical, a contract research organisation under contract with Roche for the implementation and exploitation of this study. Financial support This study was funded by Roche.
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Affiliation(s)
- C. Leboucher
- Creativ-Ceutical, Lyon, France,Auteur correspondant
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Millier A, Supiot R, Jovanoski N, Benyounes K, Machuron V, Le Lay K, Sivignon M, Leboucher C, Blein C, Raffi F. Impact de santé publique de la COVID-19 chez les patients français traités en ambulatoire, présentant au moins un facteur de risque de forme sévère. MÉDECINE ET MALADIES INFECTIEUSES FORMATION 2022. [PMCID: PMC9152514 DOI: 10.1016/j.mmifmc.2022.03.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction La situation sanitaire causée par la COVID-19 est très dynamique, tant au niveau mondial qu'en France, avec à la fois l'arrivée de nouveaux variants et donc des changements de positionnement des traitements, mais une protection accrue contre les formes sévères par les vaccins. Dans ce contexte, il apparaît utile, voire nécessaire d'estimer le poids du fardeau sanitaire et économique de la COVID-19, pour soutenir les choix futurs des allocations de ressources et pour permettre la comparaison avec d'autres maladies. L'objectif de cette étude est d'apporter des premiers éléments de réponse, en présentant les résultats d'un modèle de simulation, simple mais flexible, permettant d'évaluer l'impact de santé publique de la COVID-19 chez les patients français traités en ambulatoire, présentant au moins un facteur de risque de forme sévère. Matériels et méthodes La population d'intérêt est représentée par la population de la cohorte d'autorisation temporaire d'utilisation (ATU) de Ronapreve (moyenne de 63 ans). La première partie de ce modèle de simulation permet de refléter la phase aigüe de la COVID-19 (un mois), avec un arbre de décision. Les patients sont pris en charge soit en ambulatoire soit à l'hôpital, selon des probabilités dérivées de la même cohorte d'ATU. A l'issue de cette phase, les patients peuvent être « en vie sans forme longue », « en vie avec une forme longue traitée en ambulatoire », « en vie avec une forme longue ou prolongée traitée à l'hôpital », ou « décédé ». La seconde partie permet de simuler le devenir des patients sur 2 ans, à l'aide d'une chaîne de Markov. Dans chaque partie du modèle, les caractéristiques des séjours hospitaliers, que ce soit leur durée, la mortalité ou le coût associé, ont été documentées par une analyse de la base de données du PMSI. Plusieurs analyses de scénarios ont été réalisées. Résultats Sur 1 000 patients sont observées 382 hospitalisations, dont 258 au cours du premier mois, 407 formes longues ou prolongées de la COVID-19 et 37 décès. De façon générale, le modèle permet d'estimer le fardeau de la COVID-19 à 0,7 jours de vie perdu le premier mois, avec un coût associé de 1 578 €, et à 27 jours de vie perdus sur l'ensemble de l'horizon temporel, avec un coût associé de 4 280 €. La charge sanitaire et financière la plus élevée est observée pour les patients âgés de plus de 80 ans et pour les patients non vaccinés. Les scénarios menés avec un variant moins sévère, ou avec l'arrivée de nouveaux traitements efficaces permettent de documenter la réduction non négligeable du poids de ce fardeau. Conclusion Cette étude permet de quantifier le fardeau considérable lié à la COVID-19 en France chez les patients infectés et traités en ambulatoire, présentant au moins un facteur de risque de forme sévère. Il semble indispensable de mettre en place des stratégies capables de réduire ce fardeau, en particulier chez les patients les plus vulnérables. Liens d'intérêts déclarés Roche SA France
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Affiliation(s)
- A. Millier
- Creativ-Ceutical - HEOR/HTA, Paris, France
| | - R. Supiot
- Creativ-Ceutical - HEOR/HTA, Paris, France
| | - N. Jovanoski
- Roche Pharma SA - Global HTA évidence, Bâle, Suisse
| | | | | | - K. Le Lay
- Roche SA France - HEOR, Paris, France
| | | | | | - C. Blein
- Creativ-Ceutical - HEOR/RWE, Paris, France
| | - F. Raffi
- CHU de Nantes - Service de Maladies Infectieuses et Tropicales / CIC UIC 1413 INSERM, Nantes, France
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Bylicki O, Tournier C, Canoui-Poitrine F, Blein C, Chouaid C. Coût du dernier mois de vie des patients décédés à hôpital d’un cancer du poumon : enquête nationale française. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.235] [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]
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Bylicki O, Tournier C, Canoui-Poitrine F, Blein C, Chouaid C. Évaluation de l’agressivité des soins en fin de vie des patients atteints d’un cancer du poumon en France à partir des données PMSI. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.063] [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: 10/27/2022]
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Bylicki O, Prodel M, Blein C, Margery J, Vainchtock A, Chouaid C. Intérêt des techniques de Marching Learning pour évaluer les filières de prise en charge des patients atteints de cancer du poumon : application à l’agressivité des soins en fin de vie. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.279] [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: 11/16/2022]
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Blein C, Chamoux C, Reynaud D, Lepage V. [Care pathway diversity of patients with multiple sclerosis between French regions]. Rev Epidemiol Sante Publique 2018; 66:385-394. [PMID: 30309672 DOI: 10.1016/j.respe.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 09/11/2017] [Revised: 06/15/2018] [Accepted: 08/31/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aim of this study is to analyze and to compare data from 2015, focusing on hospital care for patients with multiple sclerosis from three French regions with different characteristics in terms of prevalence, size and number of multiple sclerosis competencies and resource centers. METHODS All hospital admissions from the PMSI MCO 2015 database, with a principal or related diagnosis (PD-RD) of G35* ("multiple sclerosis") were extracted. We also extracted chemotherapy treatments administered in hospital, during admissions with a significant associated diagnosis (SAD) of G35*, if the PD or RD was coded Z512 ("non-tumor chemotherapy"). The analyzed regions corresponded to those of 2015, some of which have since merged. RESULTS There were 95,359 hospital admissions for multiple sclerosis in France in 2015 among a total cohort of 21,102 patients, resulting in a total cost of € 54.1m. Patients with MS were managed mainly in the ambulatory setting, which accounted for 88.5 % of all admissions. The Rhône-Alpes region represented 7.6 % of national admissions for MS, 9.6 % of patients, and 14 % of inpatient days, contributing 10.4 % of the national cost of MS care. 58.4 % of stays were managed by the two main multiple sclerosis centers. The Nord-Pas-de-Calais region represented 9.8 % of national admissions, 10 % of patients, 6.6 % of inpatient days, and 9.1 % of the national cost. 29.8 % of stays were managed by the main multiple sclerosis center. The Centre region represented 2.7 % of stays, 2.8 % of patients, 3.1 % of inpatient days, and 2.8 % of the national cost. 28.4 % of stays were managed by the main multiple sclerosis center. CONCLUSION This study highlights the diversity of multiple sclerosis hospital management and care between these three regions.
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Affiliation(s)
- C Blein
- HEVA, 186, avenue Thiers, 69465 Lyon, France.
| | | | | | - V Lepage
- BIOGEN France, 75000 Paris, France
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Bylicki O, Tournier C, Canoui-Poitrine F, Blein C, Chouaid C. P2.15-04 Costs of Cares on the Month Before Death of Patients with Lung Cancer: A French National Database Survey. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1445] [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: 10/28/2022]
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Bernard Marty C, Blein C, Borg M, Alfonsi R, Priou V, Tournamille J, Forget J, Lebozec G, Perez-staub N, Jaffre A, Mouret-reynier M, El Islami Z, Attar-rabia H, Bahmad N, Pers-regouby C. A multi-center evaluation of clinical pathways cost and time using real-life data in 411 breast cancer patients treated with intravenous versus subcutaneous Trastuzumab. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30544-6] [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: 10/17/2022]
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Chouaid C, Assié JB, Andujar P, Blein C, Tournier C, Vainchtock A, Scherpereel A, Monnet I, Pairon JC. Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis. Cancer Med 2018; 7:1102-1109. [PMID: 29479845 PMCID: PMC5911629 DOI: 10.1002/cam4.1378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 01/02/2023] Open
Abstract
This study was undertaken to determine the healthcare burden of malignant pleural mesothelioma (MPM) in France and to analyze its associations with socioeconomic deprivation, population density, and management outcomes. A national hospital database was used to extract incident MPM patients in years 2011 and 2012. Cox models were used to analyze 1- and 2-year survival according to sex, age, co-morbidities, management, population-density index, and social deprivation index. The analysis included 1,890 patients (76% men; age: 73.6 ± 10.0 years; 84% with significant co-morbidities; 57% living in urban zones; 53% in highly underprivileged areas). Only 1% underwent curative surgical procedure; 65% received at least one chemotherapy cycle, 72% of them with at least one pemetrexed and/or bevacizumab administration. One- and 2-year survival rates were 64% and 48%, respectively. Median survival was 14.9 (95% CI: 13.7-15.7) months. The mean cost per patient was 27,624 ± 17,263 euros (31% representing pemetrexed and bevacizumab costs). Multivariate analyses retained men, age >70 years, chronic renal failure, chronic respiratory failure, and never receiving pemetrexed as factors of poor prognosis. After adjusting the analysis to age, sex, and co-morbidities, living in rural/semi-rural area was associated with better 2-year survival (HR: 0.83 [95% CI: 0.73-0.94]; P < 0.01); social deprivation index was not significantly associated with survival. With approximately 1,000 new cases per year in France, MPMs represents a significant national health care burden. Co-morbidities, sex, age, and living place appear to be significant factors of prognosis.
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Affiliation(s)
- Christos Chouaid
- GRC OncoThoParisEstService de Pneumologie, CHI CréteilUPECCréteilFrance
| | | | - Pascal Andujar
- Inserm U955Institut Santé Travail Paris EstService de Pneumologie et de Pathologie ProfessionnelleCHI CréteilCréteilFrance
| | | | | | | | - Arnaud Scherpereel
- Thoracic Oncology DepartmentUniversity of LilleCHU Lille, CIIL, Inserm U1019CréteilFrance
| | - Isabelle Monnet
- GRC OncoThoParisEstService de Pneumologie, CHI CréteilUPECCréteilFrance
| | - Jean Claude Pairon
- Inserm U955Institut Santé Travail Paris EstService de Pneumologie et de Pathologie ProfessionnelleCHI CréteilCréteilFrance
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Assié JB, Andujar P, Monnet I, Tournier C, Blein C, Vainchtock A, Scherpereel A, Pairon JC, Chouaid C. P3.03-061 Burden of Disease and Management of Mesothelioma in France: A National Cohort Analysis. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1960] [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]
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Uhart M, Blein C, L'Azou M, Thomas L, Durand L. Costs of dengue in three French territories of the Americas: an analysis of the hospital medical information system (PMSI) database. Eur J Health Econ 2016; 17:497-503. [PMID: 25962729 PMCID: PMC4837207 DOI: 10.1007/s10198-015-0694-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/29/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Dengue is a major emerging public health concern in tropical and subtropical countries. Severe dengue can lead to hospitalisation and death. This study was performed to assess the economic burden of hospitalisations for dengue from 2007 to 2011 in three French territories of the Americas where dengue is endemic (French Guiana, Martinique and Guadeloupe). METHODS Data on dengue-associated hospitalisations were extracted from the French national hospital administrative database, Programme de Médicalisation des Systèmes d'Information (PMSI). The numbers of stays and the corresponding number of hospitalised patients were determined using disease-specific ICD-10 codes. Associated hospital costs were estimated from the payer perspective, using French official tariffs. RESULTS Overall, 4183 patients (mean age 32 years; 51 % male) were hospitalised for dengue, corresponding to 4574 hospital stays. In nearly all hospital stays (98 %; 4471), the illness was medically managed and the mean length of stay was 4.3 days. The mean cost per stay was €2522, corresponding to a total hospital cost of €11.5 million over the 5 years assessed. The majority of hospitalisations (80 % of patients) and associated costs (75 % of total hospital costs) were incurred during two epidemics. CONCLUSION Severe dengue is associated with significant hospital costs that escalate during outbreaks.
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Affiliation(s)
- M Uhart
- Global Health Sanofi Pasteur, Lyon, 69007, France
| | - C Blein
- Health Economist, HEVA, 186 Avenue Thiers, 69465 Lyon Cedex 06, France.
| | - M L'Azou
- Global Epidemiologist, Sanofi Pasteur, Lyon 69007, France
| | - L Thomas
- Former head of the emergency department, Centre Hospitalier Universitaire, 97200 Fort-De-France, Martinique
| | - L Durand
- Global Health Economist, Sanofi Pasteur, Lyon 69007, France
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Chouaïd C, Debieuvre D, Durand-Zaleski I, Fernandes J, Scherpereel A, Westeel V, Blein C, Gaudin A, Ozan N, Leblanc S, Vainchtock A, Cotté F, Souquet P. Disparités régionales et socio-économiques dans le cancer du poumon (étude TERRITOIRE). Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Souquet P, Debieuvre D, Westeel V, Durand-Zaleski I, Fernandes J, Scherpereel A, Blein C, Gaudin A, Ozan N, Vainchtock A, Saitta B, Cotté F, Chouaïd C. Délais d’accès à la chimiothérapie adjuvante après une chirurgie curative dans le cancer du poumon (étude TERRITOIRE). Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.112] [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]
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Blein C, Gavazzi G, Paccalin M, Baptiste C, Berrut G, Vainchtock A. Burden of herpes zoster: the direct and comorbidity costs of herpes zoster events in hospitalized patients over 50 years in France. BMC Infect Dis 2015; 15:350. [PMID: 26286598 PMCID: PMC4545556 DOI: 10.1186/s12879-015-1059-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/23/2015] [Indexed: 11/21/2022] Open
Abstract
Background The objectives of this study were to describe hospital stays related to HZ and to evaluate the direct and indirect cost of hospitalizations due to HZ among patients aged over 50 years. Methods The hospitalizations of people aged over 50 years were selected from the French national hospital 2011 database (PMSI) using ICD-10 diagnosis codes for HZ. Firstly, stays with HZ as principal or related diagnostic were described through the patient characteristics, type of hospitalization and the related costs. Secondly, a retrospective case–control analysis was performed on stays with HZ as comorbidity in 5 main hospitalizations causes (circulatory, respiratory, osteo-articular, digestive systems and diabetes) to assess the impact of HZ as co-morbidity on the length of stay, mortality rate and costs. Results In the first analysis, 2,571 hospital stays were collected (60 % of women, mean age: 76.3 years and mean LOS: 9.5 days). The total health assurance costs were 10,8 M€. Mean cost per hospital stay was 4,206€. In the second analysis, a significant difference in LOS and costs was shown when HZ was associated as comorbidity in other hospitalization’s causes. Conclusions HZ directly impacts on the hospital cost. When present as comorbidity for other medical reasons, HZ significantly increases the length of hospital stay with subsequent economic burden for the French Health System.
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Affiliation(s)
| | - Gaetan Gavazzi
- Université de Grenoble-Alpes et GREPI, clinique universitaire de médecine gériatrique, CHU de Grenoble, la tronche, France.
| | - Marc Paccalin
- Geriatrics Department University Hospital La Milétrie, Poitiers, France.
| | | | - Gilles Berrut
- Hôpital Saint Jacques, CHU de Nantes, Nantes, France.
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Fernandez H, Legendre G, Blein C, Lamarsalle L, Panel P. Tubal sterilization: pregnancy rates after hysteroscopic versus laparoscopic sterilization in France, 2006-2010. Eur J Obstet Gynecol Reprod Biol 2014; 180:133-7. [PMID: 24993770 DOI: 10.1016/j.ejogrb.2014.04.043] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 02/14/2014] [Revised: 04/28/2014] [Accepted: 04/30/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the rates of pregnancy among women who underwent Essure hysteroscopic sterilization versus tubal ligation in France between 2006 and 2010. STUDY DESIGN Retrospective cohort study. SETTING Hospital care in France (nationwide). Anonymised database of all hospital discharge summaries in France. PATIENTS Recruitment was based on procedure codes in the national database of hospital discharge summaries. The study included all women who underwent tubal sterilization by Essure microinserts or by tubal ligation and subsequently were hospitalised either for all unexpected pregnancies related diagnosis (e.g., miscarriage, legal abortion, or delivery) or for pregnancies following reversal microsurgery or invitro fertilization (IVF) treatment. MEASUREMENTS AND MAIN RESULTS During the study period, French hospitals performed 109,277 tubal sterilization procedures: 39,169 Essure sterilizations and 70,108 laparoscopic tubal ligations. The respective indication of both techniques depended on the surgeons' skill. The median age of the two populations was similar, 41 years (range 28-52) for Essure patients and 40 years (range 27-54) for those undergoing tubal ligation (p=0.42). A Cox model has been performed. Following sterilization, after adjustment on age Essure patients became pregnant at a significantly lower rate than laparoscopic ligation patients 0.36% versus 0.46%, respectively (HR=0.62 (040-096)), and their pregnancy rate of post-sterilization procedure was significantly lower (reversal microsurgeries: 0.02% versus 0.19% (p<0.001), IVF treatment: 0.08% versus 0.27%) (p<0.001). The pregnancy rates after IVF were 12.5% and 5.35%, respectively, and 0% and 11.36% after tubal repair. CONCLUSION This nationwide study of tubal sterilization demonstrates that Essure was associated with lower rates of pregnancy versus tubal ligation.
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Affiliation(s)
- H Fernandez
- AP-HP, Department of Obstetrics and Gynecology, Hôpital Bicêtre, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94270, France; CESP-INSERM U1018, 82 rue du Général Leclerc, Le Kremlin Bicêtre, 94276, France; Université Paris Sud, 63 rue Gabriel Péri, Le Kremlin Bicêtre, 94270, France.
| | - G Legendre
- AP-HP, Department of Obstetrics and Gynecology, Hôpital Bicêtre, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94270, France; Université Paris Sud, 63 rue Gabriel Péri, Le Kremlin Bicêtre, 94270, France
| | - C Blein
- Heva-Health Evaluation, 186 avenue Thiers, Lyon, France
| | - L Lamarsalle
- Heva-Health Evaluation, 186 avenue Thiers, Lyon, France
| | - P Panel
- Department of Obstetrics and Gynecology, Centre Hospitalier de Versailles, Versailles, France
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Fernandez H, Panel P, Blein C, Lamarsalle L. Efficacy of Tubal Sterilization: Reported Pregnancies after Tubal Ligation and Essure ® Hysteroscopic Sterilization – French Enquiry 2006-2010. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.066] [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: 10/27/2022]
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