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Gombault-Datzenko E, Costa N, Mounié M, Tavassoli N, Mathieu C, Roussel H, Lagarrigue JM, Berard E, Rolland Y, Molinier L. Cost of care pathways before and after appropriate and inappropriate transfers to the emergency department among nursing home residents: results from the FINE study. BMC Geriatr 2024; 24:353. [PMID: 38641801 PMCID: PMC11027376 DOI: 10.1186/s12877-024-04946-x] [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: 07/04/2023] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Transfers of nursing home (NH) residents to the emergency department (ED) is frequent. Our main objective was to assess the cost of care pathways 6 months before and after the transfer to the emergency department among NH residents, according to the type of transfer (i.e. appropriate or inappropriate). METHODS This was a part of an observational, multicenter, case-control study: the Factors associated with INappropriate transfer to the Emergency department among nursing home residents (FINE) study. Sixteen public hospitals of the former Midi-Pyrénées region participated in recruitment, in 2016. During the inclusion period, all NH residents arriving at the ED were included. A pluri-disciplinary team categorized each transfer to the ED into 2 groups: appropriate or inappropriate. Direct medical and nonmedical costs were assessed from the French Health Insurance (FHI) perspective. Healthcare resources were retrospectively gathered from the FHI database and valued using the tariffs reimbursed by the FHI. Costs were recorded over a 6-month period before and after transfer to the ED. Other variables were used for analysis: sex, age, Charlson score, season, death and presence inside the NH of a coordinating physician or a geriatric nursing assistant. RESULTS Among the 1037 patients initially included in the FINE study, 616 who were listed in the FHI database were included in this economic study. Among them, 132 (21.4%) had an inappropriate transfer to the ED. In the 6 months before ED transfer, total direct costs on average amounted to 8,145€ vs. 6,493€ in the inappropriate and appropriate transfer groups, respectively. In the 6 months after ED transfer, they amounted on average to 9,050€ vs. 12,094€. CONCLUSIONS Total costs on average are higher after transfer to the ED, but there is no significant increase in healthcare expenditure with inappropriate ED transfer. Support for NH staff and better pathways of care could be necessary to reduce healthcare expenditures in NH residents. TRIAL REGISTRATION clinicaltrials.gov, NCT02677272.
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Affiliation(s)
- E Gombault-Datzenko
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France.
| | - N Costa
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
| | - M Mounié
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
| | - N Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - C Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France
- CREAI-ORS Occitanie, Toulouse, France
| | - H Roussel
- CNAM, DRSM Occitanie, 2 rue Georges Vivent, Toulouse, 31082, France
| | - J M Lagarrigue
- MSA Midi-Pyrénées Nord, 180 Avenue Marcel Unal, Montauban, 82000, France
| | - E Berard
- INSERM, UMR 1295, Toulouse, France
- Department of Epidemiology, University Hospital of Toulouse, 37 Allées Jules Guesde, Toulouse, 31000, France
| | - Y Rolland
- INSERM, UMR 1295, Toulouse, France
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - L Molinier
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
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Guilleminault L, Mounié M, Sommet A, Camus C, Didier A, Reber LL, Conte C, Costa N. The economic burden of asthma prior to death: a nationwide descriptive study. Front Public Health 2024; 12:1191788. [PMID: 38439749 PMCID: PMC10909909 DOI: 10.3389/fpubh.2024.1191788] [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: 03/22/2023] [Accepted: 01/30/2024] [Indexed: 03/06/2024] Open
Abstract
Background In addition to the clinical burden, asthma is responsible for a high economic burden. However, little is known about the economic burden of asthma prior to death. Objective We performed an economic analysis to describe the costs during 12 and 24 months prior to asthma death between 2013 and 2017 in France. Methods An observational cohort study was established using the French national health insurance database. Direct medical and non-medical costs, as well as costs related to absence from the workplace, were included in the analysis. Results In total, 3,829 patients were included in the final analysis. Over 24 and 12 months prior to death, total medical costs per patient were €27,542 [26,545-28,641] and €16,815 [16,164-17,545], respectively. Total medical costs clearly increased over 24 months prior to death. Over 12 months prior to death, costs increased significantly according to age categories, with mean total costs of €8,592, €15,038, and €17,845, respectively, for the categories <18 years old, 18-75 years old, and 75+ years old (p < 0.0001). Over 12 months prior to death, costs were statistically higher in patients with a dispensation of six or more SABA canisters compared to those with a dispensation of five or less canisters (p < 0.0001). In multivariate analysis, comorbidities, hospital as location of death, and dispensation of 12 or more canisters of SABA per year are independent factors of the highest costs. Conclusion To conclude, the economic burden of asthma death is high and increases with time, age, and SABA dispensation.
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Affiliation(s)
- Laurent Guilleminault
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, Toulouse, France
- CRISALIS F-CRIN/INSERM, Toulouse, France
| | - Michael Mounié
- Unité d’Evaluation Médico-Economique, Centre Hospitalier Universitaire, Toulouse, France
- INSERM-UMR 1295 - Center for Epidemiology and Research in POPulation health (CERPOP), Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Agnès Sommet
- Unité “Méthodologie, Data management, Analyses Statistiques”, Centre d’Investigation Clinique 1436, Service de pharmacologie médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | | | - Alain Didier
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, Toulouse, France
- CRISALIS F-CRIN/INSERM, Toulouse, France
| | - Laurent Lionel Reber
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, Toulouse, France
| | - Cécile Conte
- Unité “Méthodologie, Data management, Analyses Statistiques”, Centre d’Investigation Clinique 1436, Service de pharmacologie médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Nadège Costa
- Unité d’Evaluation Médico-Economique, Centre Hospitalier Universitaire, Toulouse, France
- INSERM-UMR 1295 - Center for Epidemiology and Research in POPulation health (CERPOP), Université de Toulouse, Inserm, UPS, Toulouse, France
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Pouget AM, Costa N, Mounié M, Gombault-Datzenko E, Derumeaux H, Pagès A, Rouzaud-Laborde C, Molinier L. Mechanical Thrombectomy with Intravenous Thrombolysis versus Thrombolysis Alone for the Treatment of Stroke: A Systematic Review of Economic Evaluations. J Vasc Interv Radiol 2023; 34:1749-1759.e2. [PMID: 37331591 DOI: 10.1016/j.jvir.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023] Open
Abstract
Mechanical thrombectomy has revolutionized the management of stroke by improving the recanalization rates and reducing deleterious consequences. It is now the standard of care despite the high financial cost. A considerable number of studies have evaluated its cost effectiveness. Therefore, this study aimed to identify economic evaluations of mechanical thrombectomy with thrombolysis compared with thrombolysis alone to provide an update of existing evidence, focusing on the period after proof of effectiveness of mechanical thrombectomy. Twenty-one studies were included in the review: 18 were model-based economic evaluations to simulate long-term outcomes and costs, and 19 were conducted in high-income countries. Incremental cost-effectiveness ratios ranged from -$5,670 to $74,216 per quality-adjusted life year. Mechanical thrombectomy is cost-effective in high-income countries and in the populations selected for clinical trials. However, most of the studies used the same data. There is a lack of real-world and long-term data to analyze the cost effectiveness of mechanical thrombectomy in treating the global burden of stroke.
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Affiliation(s)
- Alix Marie Pouget
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; Department of Pharmacy, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Institute of Metabolic and Cardiac Diseases (I2MC), Toulouse III University, Toulouse, France.
| | - Nadège Costa
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Centre for Epidemiology and Population Health Research (for CERPOP), Toulouse III University, Toulouse, France
| | - Michael Mounié
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Centre for Epidemiology and Population Health Research (for CERPOP), Toulouse III University, Toulouse, France
| | - Eugénie Gombault-Datzenko
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Centre for Epidemiology and Population Health Research (for CERPOP), Toulouse III University, Toulouse, France
| | - Hélène Derumeaux
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Centre for Epidemiology and Population Health Research (for CERPOP), Toulouse III University, Toulouse, France
| | - Arnaud Pagès
- Health Economic Unit, Toulouse University Hospital, Toulouse, France
| | - Charlotte Rouzaud-Laborde
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Institute of Metabolic and Cardiac Diseases (I2MC), Toulouse III University, Toulouse, France
| | - Laurent Molinier
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Centre for Epidemiology and Population Health Research (for CERPOP), Toulouse III University, Toulouse, France
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Guilleminault L, Mounié M, Sommet A, Camus C, Didier A, Reber LL, Costa N, Conte C. Healthcare resource consumption prior to asthma-related death: a nationwide descriptive study. Ther Adv Respir Dis 2022; 16:17534666221130217. [PMID: 36239261 PMCID: PMC9577087 DOI: 10.1177/17534666221130217] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although asthma mortality declined sharply until the mid-2000s, a stagnation in mortality has been observed over the past decade in different countries. OBJECTIVE The objective of this study is to describe healthcare resource consumption for patients who died from asthma in France. METHOD This study was conducted using data from the French National Health Data System. Patients who died from asthma between 2013 and 2017 were identified by the ICD10 codes J45 and J46. Health care consumption data were collected. Patients were categorized into four categories according to age: ⩾75, (18-75), (12-18), (0-12). Daily doses of ICS were categorized according to GINA guidelines. RESULTS A total of 3829 patients were included. No ICS or an inadequate ICS dose was observed in 43.8%, 50.6%, 48.1%, and 54.0% of patients aged ⩾75, (18-74), (12-18), and (0-12) years, respectively. Dispensation of six or more SABA canisters was observed in 37.2%, 49.0%, and 70.3% of patients aged of ⩾75, (18-75), and (12-18) years, respectively. Omalizumab dispensation rate was very low [1.1% and 2.8% in patients aged ⩾75 and (18-75) years)]. The proportion of patients with a pulmonologist office visit was 13.8% and 14.6% in patients ⩾75 and (18-75) years, respectively. A lung function test was noted in only 18.6%, 28.3%, and 25.9% of patients ⩾75, (18-75) and (12-18) years, respectively. CONCLUSION Half of the patients who died from asthma received inadequate ICS doses and only a small proportion had access to biological therapies. Less than 15% were referred to a specialist.
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Affiliation(s)
| | - Michael Mounié
- Unité d’Evaluation Médico-Economique, Centre
Hospitalier Universitaire, Toulouse, France,INSERM-UMR 1295–Center for Epidemiology and
Research in POPulation health (CERPOP), Inserm, UPS, Université de Toulouse,
Toulouse, France
| | - Agnès Sommet
- Unité Méthodologie, Data Management, Analyses
Statistiques, Centre d’Investigation Clinique 1436, Service de pharmacologie
médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | | | - Alain Didier
- Pôle des Voies Respiratoires, Service de
Pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, Toulouse,
France,Toulouse Institute for Infectious and
Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, University of
Toulouse, Toulouse, France,CRISALIS F-CRIN, Toulouse, France
| | - Laurent L. Reber
- Toulouse Institute for Infectious and
Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, University of
Toulouse, Toulouse, France
| | - Nadège Costa
- Unité d’Evaluation Médico-Economique, Centre
Hospitalier Universitaire, Toulouse, France,INSERM-UMR 1295–Center for Epidemiology and
Research in POPulation health (CERPOP), Inserm, UPS, Université de Toulouse,
Toulouse, France
| | - Cécile Conte
- Unité Méthodologie, Data Management, Analyses
Statistiques, Centre d’Investigation Clinique 1436, Service de pharmacologie
médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
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Mounié M, Costa N, Gourdy P, Latorre C, Schirr-Bonnans S, Lagarrigue JM, Roussel H, Martini J, Buisson JC, Chauchard MC, Delaunay J, Taoui S, Poncet MF, Cosma V, Lablanche S, Coustols-Valat M, Chaillous L, Thivolet C, Sanz C, Penfornis A, Lepage B, Colineaux H, Hanaire H, Molinier L, Turnin MC, Benhamou PY, Rodier M, Ayon F, Puel-Olivier F, Fontaine S, Perron M, Arrivié J, Cousty-Pech F, Rouby C, Lafon F, Moura I. Correction to: Cost-Effectiveness Evaluation of a Remote Monitoring Programme Including Lifestyle Education Software in Type 2 Diabetes: Results of the Educ@dom Study. Diabetes Ther 2022; 13:1131-1132. [PMID: 35316510 PMCID: PMC9076765 DOI: 10.1007/s13300-022-01248-6] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Michael Mounié
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France.
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France.
| | - Nadège Costa
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Pierre Gourdy
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
| | - Christelle Latorre
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
| | - Solène Schirr-Bonnans
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
| | | | - Henri Roussel
- CNAM, DRSM Occitanie, 2 rue Georges Vivent, 31082, Toulouse, France
| | - Jacques Martini
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- DIAMIP Network, Toulouse, France
| | | | - Marie-Christine Chauchard
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- DIAMIP Network, Toulouse, France
| | - Jacqueline Delaunay
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
| | - Soumia Taoui
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
| | | | | | | | | | | | | | | | - Alfred Penfornis
- Sud Francilien Hospital, Corbeil-Essonnes, and Paris-Saclay University, Corbeil-Essonnes, France
| | - Benoît Lepage
- Department of Epidemiology, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Hélène Colineaux
- Department of Epidemiology, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
| | - Laurent Molinier
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Marie-Christine Turnin
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
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Mounié M, Costa N, Gourdy P, Latorre C, Schirr-Bonnans S, Lagarrigue JM, Roussel H, Martini J, Buisson JC, Chauchard MC, Delaunay J, Taoui S, Poncet MF, Cosma V, Lablanche S, Coustols-Valat M, Chaillous L, Thivolet C, Sanz C, Penfornis A, Lepage B, Colineaux H, Hanaire H, Molinier L, Turnin MC. Cost-Effectiveness Evaluation of a Remote Monitoring Programme Including Lifestyle Education Software in Type 2 Diabetes: Results of the Educ@dom Study. Diabetes Ther 2022; 13:693-708. [PMID: 35133640 PMCID: PMC8991290 DOI: 10.1007/s13300-022-01207-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/03/2021] [Accepted: 01/18/2022] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Telemedicine programs using health technological innovation to remotely monitor the lifestyles of patients with type 2 diabetes (T2D) can improve glycaemic control and thus reduce the incidence of complications as well as management costs. In this context, an assessment was made of the 1-year and 2-year cost-effectiveness of the EDUC@DOM telemonitoring and tele-education program. METHODS The EDUC@DOM study was a multicentre randomized controlled trial conducted between 2013 and 2017 that compared a telemonitoring group (TMG) to a control group (CG) merged with health insurance databases to extract economic data on resource consumption. Economic analysis was performed from the payer perspective, and direct costs and indirect costs were considered. The clinical outcome used was the intergroup change in glycated haemoglobin (HbA1c) levels from baseline. Missing economic data were imputed using multiple imputation, and fitted values from a generalized linear mixed model were used to calculate the incremental cost-effectiveness ratio (ICER). Bootstrapped 95% confidence ellipses were drawn in the cost-effectiveness plan. RESULTS The main analysis included data from 256 patients: 126 in the TMG and 130 in the CG. Incremental costs over 1 and 2 years were equal to €2129 and €5101, respectively, in favour of the TMG. Once imputed and adjusted for confounding factors, the TMG trends to a 21% cost decrease over 1 and 2 years of follow-up (0.79 [0.58; 1.08], p = 0.1452 and 0.79 [0.61; 1.03], p = 0.0879, respectively). The EDUC@DOM program led to a €1334 cost saving and a 0.17 decrease in HbA1c over 1 year and a €3144 cost saving and a 0.14 decrease in HbA1c over 2 years. According to the confidence ellipse, EDUC@DOM was a cost-effective strategy. CONCLUSION This study provides additional economic information on telemonitoring and tele-education programs to enhance their acceptance and promote their use. In the light of this work, the EDUC@DOM program is a cost-saving strategy in T2D management. TRIAL REGISTRATION This trial was registered in the Clinical Trials Database on 27 September 2013 under no. NCT01955031 and bears ID-RCB no. 2013-A00391-44.
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Affiliation(s)
- Michael Mounié
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France.
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France.
| | - Nadège Costa
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Pierre Gourdy
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
| | - Christelle Latorre
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
| | - Solène Schirr-Bonnans
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
| | | | - Henri Roussel
- CNAM, DRSM Occitanie, 2 rue Georges Vivent, 31082, Toulouse, France
| | - Jacques Martini
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- DIAMIP Network, Toulouse, France
| | | | - Marie-Christine Chauchard
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- DIAMIP Network, Toulouse, France
| | - Jacqueline Delaunay
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
| | - Soumia Taoui
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
| | | | | | | | | | | | | | | | - Alfred Penfornis
- Sud Francilien Hospital, Corbeil-Essonnes, and Paris-Saclay University, Corbeil-Essonnes, France
| | - Benoît Lepage
- Department of Epidemiology, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Hélène Colineaux
- Department of Epidemiology, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
| | - Laurent Molinier
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Marie-Christine Turnin
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
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Costa N, Mounié M, Pagès A, Derumeaux H, Rapp T, Guyonnet S, Coley N, Cantet C, Carrié I, Andrieu S, Molinier L. The Cost-Effectiveness of Three Prevention Strategies in Alzheimer's Disease: Results from the Multidomain Alzheimer Preventive Trial (MAPT). J Prev Alzheimers Dis 2021; 8:425-435. [PMID: 34585216 DOI: 10.14283/jpad.2021.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND To date, no curative treatment is available for Alzheimer's disease (AD). Therefore, efforts should focus on prevention strategies to improve the efficiency of healthcare systems. OBJECTIVE Our aim was to assess the cost-effectiveness of three preventive strategies for AD compared to a placebo. DESIGN The Multidomain Alzheimer Preventive Trial (MAPT) study was a multicenter, randomized, placebo-controlled superiority trial with four parallel groups, including three intervention groups (one group with Multidomain Intervention (MI) plus a placebo, one group with Polyunsaturated Fatty Acids (PFA), one group with a combination of PFA and MI) and one placebo group. SETTING Participants were recruited and included in 13 memory centers in France and Monaco. PARTICIPANTS Community-dwelling subject aged 70 years and older were followed during 3 years. INTERVENTIONS We used data from the MAPT study which aims to test the efficacy of a MI along PFA, the MI plus a placebo, PFA alone, or a placebo alone. MEASUREMENT Direct medical and non-medical costs were calculated from a payer's perspective during the 3 years of follow-up. The base case incremental Cost-Effectiveness Ratio (ICER) represents the cost per improved cognitive Z-score point. Sensitivity analyses were performed using different interpretation of the effectiveness criteria. RESULTS Analyses were conducted on 1,525 participants. The ICER at year 3 that compares the MI + PFA and the MI alone to the placebo amounted to €21,443 and €21,543 respectively, per improved Z score point. PFA alone amounted to €111,720 per improved Z score point. CONCLUSION Our study shows that ICERS of PFA combined with MI and MI alone amounted to €21,443 and €21,543 respectively per improved Z score point compared to the placebo and are below the WTP of €50,000 while the ICER of PFA alone amounted to €111,720 per improved Z score point. This information may help decision makers and serve as a basis for the implementation of a lifetime decision analytic model.
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Affiliation(s)
- N Costa
- Nadège Costa, Health economist, PhD, Health Economic Unit of the University Hospital of Toulouse, Hôtel Dieu Saint-Jacques, 2, rue viguerie, 31059 Toulouse Cedex 9, France, Email : , Tel: +335 61 77 83 72
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Mounié M, Costa N, Conte C, Petiot D, Fabre D, Despas F, Lapeyre-Mestre M, Laurent G, Savy N, Molinier L. Real-world costs of illness of Hodgkin and the main B-Cell Non-Hodgkin lymphomas in France. J Med Econ 2020; 23:235-242. [PMID: 31876205 DOI: 10.1080/13696998.2019.1702990] [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] [Indexed: 10/25/2022]
Abstract
Background: Lymphomas are costly diseases that suffer from a lack of detailed economic information, notably in a real-world setting. Decision-makers are increasing the search for Real-World Evidence (RWE) to assess the impact, in real-life, of healthcare management and to support their public decisions. Thus, we aimed to assess the real-world net costs of the active treatment phases of adult Hodgkin Lymphoma (HL), Follicular Lymphoma (FL) and Diffuse Large B Cell Lymphoma (DLBCL).Methods: We performed a retrospective cohort study using population-based data from a national representative sample of the French population covered by the health insurance system. Cost analysis was performed from the French health insurance perspective and took into account direct and sick leave compensation costs (€2,018). Healthcare costs were studied over the active treatment phase. We used multivariate modeling to adjust cost differences between lymphoma subtypes.Results: Analyses were performed on 224 lymphoma patients and 896 controls. The mean additional monthly costs due to HL, FL and DLBCL patients were respectively €5,188, €3,242 and €7,659 for the active treatment phase. The main additional cost driver was principally inpatient stay (hospitalization costs and costly cancer-related drugs), followed by outpatient medication and productivity loss. When adjusted, DLBCL remains significantly the most costly lymphoma subtype.Conclusion: This study provides an accurate assessment of the main lymphoma subtypes related cost with high magnitude of details in a real-world setting. We underline where potential cost saving could be realized via the use of biosimilar medication, and where lymphoma management could be improved with the early management of adverse events.KEY POINTSThis is one of the first studies which assess the additional cost of lymphoma in Europe, according the main sub-types of lymphoma and with real-world database.The additional monthly cost due to HL, FL and DLBCL patients were respectively €5,188, €3,242 and €7,659 for the active treatment phase and the main additional cost driver was principally inpatient stay (i.e. hospitalization costs and additional inpatient medicines, notably rituximab), followed by outpatient medication and productivity loss.This study provides an accurate and detailed lymphoma subtype cost description and comparison which supply data for efficiency evaluations and will allow French health policy to improve lymphoma management.
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Affiliation(s)
- Michael Mounié
- Unité d'Evaluation Médico-Economique, Centre Hospitalier Universitaire, Toulouse, France
- Institut National de la Santé et de la Recherche Médicale - INSERM, Unité Mixte de Recherche-UMR 1027, Toulouse, France
| | - Nadège Costa
- Unité d'Evaluation Médico-Economique, Centre Hospitalier Universitaire, Toulouse, France
- Institut National de la Santé et de la Recherche Médicale - INSERM, Unité Mixte de Recherche-UMR 1027, Toulouse, France
| | - Cécile Conte
- Laboratoire de Pharmacologie Médicale, facultés de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Dominique Petiot
- Département d'Information Médicale, Centre Hospitalier Universitaire, Toulouse, France
| | - Didier Fabre
- Département d'Information Médicale, Centre Hospitalier Universitaire, Toulouse, France
| | - Fabien Despas
- Laboratoire de Pharmacologie Médicale, facultés de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France
- Service de Pharmacologie Clinique, CIC 1436, CHU Toulouse, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Laboratoire de Pharmacologie Médicale, facultés de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France
- Service de Pharmacologie Clinique, CIC 1436, CHU Toulouse, Toulouse, France
| | - Guy Laurent
- Service d'hématologie CHU Toulouse, Institut Universitaire du Cancer-Oncopôle de Toulouse, Toulouse, France
| | - Nicolas Savy
- Institut Mathématiques de Toulouse, UMR 5219, CNRS, Toulouse, France
| | - Laurent Molinier
- Unité d'Evaluation Médico-Economique, Centre Hospitalier Universitaire, Toulouse, France
- Institut National de la Santé et de la Recherche Médicale - INSERM, Unité Mixte de Recherche-UMR 1027, Toulouse, France
- Département d'Information Médicale, Centre Hospitalier Universitaire, Toulouse, France
- Faculty of Medicine of Purpan, Université Toulouse III Paul Sabatier, Toulouse, France
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Pialat PM, Mounié M, Fleury B, Suchaud J, Racadot S, Pommier P. Curiethérapie de rattrapage pour les carcinome épidermoïdes de la cavité orale ou de l’oropharynx en territoire déjà irradiés : résultats d’une étude rétrospective sur 25 patients. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.041] [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: 11/28/2022]
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Costa N, Mounié M, Bernard G, Bieler L, Molinier L, Serrano E, de Bonnecaze G. Cost-effectiveness of trans-nasal endoscopic sphenopalatine artery ligation vs arterial embolisation for intractable epistaxis: Long-term analyses. Clin Otolaryngol 2019; 44:511-517. [PMID: 30720918 DOI: 10.1111/coa.13299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/01/2017] [Revised: 06/04/2018] [Accepted: 01/26/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Trans-nasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolisation both provide excellent success rates for intractable epistaxis. Recent economic models suggest that TESPAL could be a cost-saving strategy. Our main aim was to perform cost-effectiveness analyses on TESPAL compared with embolisation to treat patients with epistaxis. DESIGN We performed retrospective, monocentric, comparative analyses on patients referred to our centre and treated with embolisation or TESPAL. SETTING This economic evaluation was carried out from a payer's perspective (ie French National Health Insurance) within a time horizon of 12 months. PARTICIPANTS Thirty-seven TESPAL procedures and thirty-nine embolisation procedures to treat intractable epistaxis were used in the analyses. MAIN OUTCOME MEASURES The primary outcome is presented as the cost per 1% of non-recurrence. Effectiveness was defined as avoiding recurrence of epistaxis during the 1-year follow-up. Cost estimates were performed from the payer's perspective. RESULTS Hospitalisation costs were higher for embolisation compared with TESPAL (5972 vs 3769 euros). On average, hospitalisation costs decreased by 41% when a patient was treated by TESPAL compared with an embolisation strategy (P = 0.06). The presence of comorbidities increased hospitalisation costs by 79% (P = 0.04). TESPAL enabled 1867€ to be gained in intractable epistaxis. CONCLUSIONS The outcomes from our decision model confirm that TESPAL is more cost-effective for patients with intractable epistaxis.
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Affiliation(s)
- Nadège Costa
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France.,Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Toulouse, France
| | - Michael Mounié
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France.,Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Toulouse, France.,University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Toulouse Cedex 9, France
| | - Geraldine Bernard
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France
| | - Laurent Bieler
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France
| | - Laurent Molinier
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France.,Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Toulouse, France.,University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Toulouse Cedex 9, France
| | - Elie Serrano
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
| | - Guillaume de Bonnecaze
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
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Mounié M, Pugnet G, Savy N, Lapeyre-Mestre M, Molinier L, Costa N. Additional Costs of Polymyalgia Rheumatica With Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2018; 71:1127-1131. [PMID: 30156754 DOI: 10.1002/acr.23736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess and compare direct costs between patients with giant cell arteritis (GCA) that is associated or not associated with polymyalgia rheumatic (PMR), and to identify the additional cost drivers due to PMR. METHODS A population-based, retrospective cohort study using the French National Health Insurance System Database was conducted. Cost analysis was performed from the French health insurance perspective and direct medical and nonmedical costs were taken into account (based on 2014 costs [€]). Costs were analyzed according to different components and divided into 6-month periods to assess care consumption. Longitudinal multivariate analyses, using generalized estimating equations, were used to adjust the effect of PMR on the mean cost over time. RESULTS Analyses were performed on 100 incident patients with GCA, 54 of whom had PMR. The cumulative additional cost due to PMR was €8,801 for 3 years, and €10,532 for 5 years. The significant additional costs occurred especially during the second and third years of follow-up, amounting to €1,769 between 12 and 18 months (P = 0.02), €1,924 between 18 and 24 months (P = 0.17), €1,458 between 24 and 30 months (P = 0.08), and €1,307 between 30 and 36 months (P = 0.07). The most important cost drivers were inpatient stays, paramedic procedures, and medications. Multivariate analyses showed a significant effect of PMR on mean cost during the first 3 years of follow-up (relative risk 1.76 [95% confidence interval 1.03-2.99], P = 0.038). CONCLUSION To our knowledge, this study is the first to accurately assess the cost of PMR care in patients with GCA and to highlight that PMR is largely responsible for the high cost of GCA.
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Affiliation(s)
- Michael Mounié
- Centre Hospitalier Universitaire de Toulouse, UMR 1027 INSERM and Université de Toulouse, Toulouse, France
| | - Grégory Pugnet
- UMR 1027 INSERM, Université de Toulouse and Service de Médecine Interne, CHU Toulouse, Toulouse, France
| | - Nicolas Savy
- Université de Toulouse and Institut Mathématiques de Toulouse, UMR 5219, CNRS, Toulouse, France
| | - Maryse Lapeyre-Mestre
- UMR 1027 INSERM, Université de Toulouse, Laboratoire de Pharmacologie Médicale et Clinique, Service de Pharmacologie Clinique, CIC 1436, CHU Toulouse, Toulouse, France
| | - Laurent Molinier
- Centre Hospitalier Universitaire de Toulouse, UMR 1027 INSERM and Université de Toulouse, Toulouse, France
| | - Nadège Costa
- Centre Hospitalier Universitaire de Toulouse, UMR 1027 INSERM, Toulouse, France
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Mouly D, Goria S, Mounié M, Beaudeau P, Galey C, Gallay A, Ducrot C, Le Strat Y. Waterborne Disease Outbreak Detection: A Simulation-Based Study. Int J Environ Res Public Health 2018; 15:ijerph15071505. [PMID: 30018195 PMCID: PMC6068474 DOI: 10.3390/ijerph15071505] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 11/16/2022]
Abstract
Waterborne disease outbreaks (WBDOs) remain a public health issue in developed countries, but to date the surveillance of WBDOs in France, mainly based on the voluntary reporting of clusters of acute gastrointestinal infections (AGIs) by general practitioners to health authorities, is characterized by low sensitivity. In this context, a detection algorithm using health insurance data and based on a space–time method was developed to improve WBDO detection. The objective of the present simulation-based study was to evaluate the performance of this algorithm for WBDO detection using health insurance data. The daily baseline counts of acute gastrointestinal infections were simulated. Two thousand simulated WBDO signals were then superimposed on the baseline data. Sensitivity (Se) and positive predictive value (PPV) were both used to evaluate the detection algorithm. Multivariate regression was also performed to identify the factors associated with WBDO detection. Almost three-quarters of the simulated WBDOs were detected (Se = 73.0%). More than 9 out of 10 detected signals corresponded to a WBDO (PPV = 90.5%). The probability of detecting a WBDO increased with the outbreak size. These results underline the value of using the detection algorithm for the implementation of a national surveillance system for WBDOs in France.
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Affiliation(s)
- Damien Mouly
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Sarah Goria
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Michael Mounié
- Unité D'évaluation Médico-Economique, Université Paul Sabatier, CHU 31059 Toulouse, France.
| | - Pascal Beaudeau
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Catherine Galey
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Anne Gallay
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
| | - Christian Ducrot
- Institut National de la Recherche Agronomique, UR346-Unité d'Épidémiologie Animale, 63 122 Saint Genès Champanelle, France.
| | - Yann Le Strat
- Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.
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13
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Mounié M, Costa N, Sailler L, Lapeyre-Mestre M, Bourrel R, Savy N, Molinier L, Pugnet G. Incremental Costs in Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2017; 70:1074-1081. [PMID: 28973818 DOI: 10.1002/acr.23429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/26/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess and compare direct costs between giant cell arteritis (GCA) patients and matched controls and to identify incremental cost drivers. METHODS We carried out a population-based, retrospective cohort study using the French National Health Insurance System database. Cost analysis was performed from the French health insurance perspective and took into account direct medical and nonmedical costs (2014, €). Costs were evaluated according to different cost components and divided into periods of 6 months for the accurate assessment of care consumption. Longitudinal multivariate regression analyses using generalized estimating equations were used to adjust the effect of GCA on the mean cost over time. RESULTS Analyses were performed on 96 incident GCA patients and 563 matched controls. The cumulative incremental cost due to GCA was €6,406 and €7,236 for 3 and 5 years, respectively. Total incremental costs were significant for the first 18 months, amounting to €1,342 for the first 6 months, €1,498 between 6 and 12 months, and €1,165 between 12 and 18 months (P = 0.012, P = 0.065, and P = 0.029, respectively). The most important cost drivers were paramedical procedures, inpatient stays, medication, and medical procedures. Multivariate analysis shows the significant effect of GCA on mean cost during the first 3 years of followup (relative risk [RR] 1.72 [95% confidence interval (95% CI) 1.31-2.27], P < 0.001) with significant cost reductions (RR 0.70 [95% CI 0.49-0.99], P = 0.05) at the end of followup. CONCLUSION This study provides an accurate assessment of GCA costs during a 5-year period and gives useful information for future cost-effectiveness studies based on new expensive biotherapies.
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Affiliation(s)
- Michael Mounié
- Centre Hospitalier Universitaire de Toulouse, UMR 1027 INSERM, and Université de Toulouse, Toulouse, France
| | - Nadège Costa
- Centre Hospitalier Universitaire de Toulouse, UMR 1027 INSERM, Toulouse, France
| | - Laurent Sailler
- UMR 1027 INSERM, Université de Toulouse, and Service de Médecine Interne, CHU Toulouse, Toulouse, France
| | - Maryse Lapeyre-Mestre
- UMR 1027 INSERM, Université de Toulouse, Laboratoire de Pharmacologie Médicale et Clinique, Service de Pharmacologie Clinique, CIC 1436, CHU Toulouse, Toulouse, France
| | - Robert Bourrel
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées, Toulouse, France
| | - Nicolas Savy
- Université de Toulouse, and Institut Mathématiques de Toulouse, UMR 5219, CNRS, Toulouse, France
| | - Laurent Molinier
- Centre Hospitalier Universitaire de Toulouse, UMR 1027 INSERM, and Université de Toulouse, Toulouse, France
| | - Grégory Pugnet
- UMR 1027 INSERM, Université de Toulouse, and Service de Médecine Interne, CHU Toulouse, Toulouse, France
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Mounié M, Costa N, Savy N, Molinier L, Bourel R, Lapeyre-Mestre M, Sailler L, Pugnet G. Évaluation du coût de prise en charge de l’artérite à cellules géantes avec ou sans pseudopolyarthrite rhizomélique. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.264] [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: 11/24/2022]
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Raboisson D, Mounié M, Maigné E. Diseases, reproductive performance, and changes in milk production associated with subclinical ketosis in dairy cows: a meta-analysis and review. J Dairy Sci 2014; 97:7547-63. [PMID: 25306269 DOI: 10.3168/jds.2014-8237] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [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: 04/15/2014] [Accepted: 08/28/2014] [Indexed: 11/19/2022]
Abstract
Many studies have shown that subclinical ketosis (SCK) is associated with an increased risk of developing various diseases, reproductive disorders, and changes in milk production. The present work aims at producing an overview between this disorder and theses outcomes. A meta-analysis of the literature, including 131 different models from 23 papers, or a review when the literature was scarce was conducted. For each outcome, the odds ratio (OR), relative risk, or hazard ratio was presented for various moderators to reduce heterogeneity among the studies. The raw change in milk production associated with SCK was estimated and adjusted, taking into consideration the outcomes known to interact with milk production during the peripartum period. The results showed that 2 main categories of moderators had a significant effect on the adjusted risk. First, the adjustment made by defining SCK as (1) β-hydroxybutyrate concentration >1.4 mM, (2) nonesterified fatty acid (NEFA) concentration >0.4 mM prepartum, or (3) NEFA concentration >1.0 mM postpartum corrected the underestimated risk (despite low significance). This is because several trials reported the relevant risks using lower thresholds for the β-hydroxybutyrate or NEFA values. Using a low threshold leads to lower risk of disease compared with using a high threshold. Second, the correction produced using the polyfactorial terms corrected the overestimation of risk because many trials reported only univariable models. The relative risk or OR (95% confidence interval) related to abomasal displacement, clinical ketosis, early culling and death, metritis, placental retention, clinical mastitis, lameness, and a doubling of the SCC in cases with SCK were 3.33 (2.60-4.25), 5.38 (3.27-8.83), 1.92 (1.60-2.30), 1.75 (1.54-2.01), 1.52 (1.20-1.93), 1.61 (1.24-2.09), 2.01(1.64-2.44), and 1.42 (1.26-1.60), respectively. The precision level of the estimate depended on the outcome. The direct mean ± standard deviation of the 305-d milk losses associated with SCK were 251 ± 73 kg after adjusting for abomasal displacement, clinical ketosis, metritis, and placental retention. The OR (95% confidence interval) for first service calving risk in cases of SCK was 0.67 (0.53-0.83). The calving-to-first-service interval was 8 d longer and the calving-to-conception interval was 16 to 22 d longer in cows with SCK. The relationships among the different reproductive indicators were quantified in only 1 or 2 trials. The present work highlights the need to conduct further studies on the associations between SCK and the risks of diseases, changes in milk production, and reproductive parameters.
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Affiliation(s)
- D Raboisson
- Université de Toulouse, Institut National Polytechnique (INP), Ecole Nationale Vétérinaire de Toulouse (ENVT), UMR 1225, Interaction Hôte Agent Pathogène (IHAP), F-31076 Toulouse, France; INRA, UMR1225, IHAP, F-31076 Toulouse, France; INRA, ODR, Observatoire des Programmes Communautaires de Développement Rural, F- 31326 Auzeville, France.
| | - M Mounié
- INRA, ODR, Observatoire des Programmes Communautaires de Développement Rural, F- 31326 Auzeville, France
| | - E Maigné
- INRA, ODR, Observatoire des Programmes Communautaires de Développement Rural, F- 31326 Auzeville, France
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