Costs of dengue in three French territories of the Americas: an analysis of the hospital medical information system (PMSI) database

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.

Estimating the cost-effectiveness profile of a universal vaccination programme with a nine-valent HPV vaccine in Austria

BACKGROUND

HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papillomatis. In the context of the arrival of a nonavalent HPV vaccine (6/11/16/18/31/33/45/52/58), this analysis aims to estimate the public health impact and the incremental cost-effectiveness of a universal (girls and boys) vaccination program with a nonavalent HPV vaccine as compared to the current universal vaccination program with a quadrivalent HPV vaccine (6/11/16/18), in Austria.

METHOD

A dynamic transmission model including a wide range of health and cost outcomes related to cervical, anal, vulvar, vaginal diseases and genital warts was calibrated to Austrian epidemiological data. The clinical impact due to the 5 new types was included for cervical and anal diseases outcomes only. In the base case, a two-dose schedule, lifelong vaccine type-specific protection and a vaccination coverage rate of 60% and 40% for girls and boys respectively for the 9-year old cohorts were assumed. A cost-effectiveness threshold of €30,000/QALY-gained was considered.

RESULTS

Universal vaccination with the nonavalent vaccine was shown to reduce the incidence of HPV16/18/31/33/45/52/58 -related cervical cancer by 92%, the related CIN2/3 cases by 96% and anal cancer by 83% and 76% respectively in females and males after 100 years, relative to 75%, 76%, 80% and 74% with the quadrivalent vaccine, respectively. Furthermore, the nonavalent vaccine was projected to prevent an additional 14,893 cases of CIN2/3 and 2544 cases of cervical cancer, over 100 years. Depending on the vaccine price, the strategy was shown to be from cost-saving to cost-effective.

CONCLUSION

The present evaluation showed that vaccinating 60% of girls and 40% of boys aged 9 in Austria with a 9-valent vaccine will substantially reduce the incidence of cervical cancer, CIN and anal cancer compared to the existing strategy. The vaccination strategies performed with the 9-valent vaccine in the current study were all found to be cost-effective compared to the current quadrivalent vaccination strategy by considering a cost-effectiveness threshold of 30,000€/QALY gained.

[Inter-individual and intra-individual pharmacokinetic variability during teicoplanin therapy in geriatric patients]

OBJECTIVES

The authors had for aim to assess the inter- and intra-individual variability of teicoplanin pharmacokinetic parameters in geriatric patients.

METHODS

A cohort of 90 geriatric patients, treated with teicoplanin, was used to build two models describing the pharmacokinetics of teicoplanin, at the beginning and at the end of treatment respectively.

RESULTS

The inter- and intra-individual variability of parameters were important as shown respectively by the coefficients of variation of pharmacokinetic parameters ranging from 125 to 694% and the half-life change during the treatment (by a factor of three to more than 30) for 60% of patients.

CONCLUSIONS

The results revealed that elderly patients presented significant variability, which was only partly explained by the renal function. Therapeutic monitoring of teicoplanin in geriatric patients should be undertaken at the end of the loading dose and repeatedly during the maintenance phase to prevent over- or underexposure.

Guidelines for aminoglycoside use and applicability to geriatric patients

OBJECTIVES

The authors had for objective to evaluate the applicability of AFSSAPS guidelines for aminoglycoside use to geriatric patients.

METHODS

Theoretical doses and dosing regimens allowing reaching target concentrations in this population were calculated by applying a pharmacokinetic model to 30 geriatric patients treated by amikacin.

RESULTS

The dose allowing reaching a maximum concentration of 60 mg/L was 1.217 mg on average. The time required to reach a blood concentration lower than or equal to 2.5mg/L was 62.5±70.4 hours. Forty-six percent of patients had a trough concentration greater than 2.5 mg/L, 48 hours after administration. For these patients, the time between critical minimum inhibitory concentration (MIC) and toxicity threshold concentration was 21.9±14.9 hours.

CONCLUSION

Reaching a target concentration can be problematic in geriatric patients. It is frequently necessary to use dosing intervals greater than 48 hours. The effectiveness and safety of these regimens remain uncertain.

[Practical application of the charter of pharmaceutical sales visit]

BACKGROUND

Visits from pharmaceutical representatives are controlled in France by regulations, but also by a Charter of good practice. The goal of this study was to measure compliance to the conditions of this charter by participating pharmaceutical companies.

MATERIAL AND METHODS

An assessment grid was drafted to determine compliance to interdictions and obligations concerning the information provided during visits from pharmaceutical representatives.

RESULTS

We studied 20 visits from pharmaceutical representatives. All of the documents and obligatory information were only provided in 5% of cases. During 80% of these meetings, the pharmaceutical representatives made a comparison with competitor's drugs, which was associated with negative remarks in 44% of cases. The pharmaceutical representatives promoted cases of use outside those, which had received marketing approval in 35%. Gifts or samples were offered at the end of these meetings in 20% of cases. Prohibited practices were observed in a total of 85% of cases.

DISCUSSION

This study shows that meetings are respected by pharmaceutical representatives in terms of regulations related to donations. In opposite, there is a very low compliance concerning the proper use of the drug, whether to provide official documentation, to give information respectful of other pharmaceutical companies or to promote the proper use.

CONCLUSION

Our results suggest that, at present hospital visits by pharmaceutical representatives do not respect the commitments made by the pharmaceutical industry, and do not make it possible to ensure that honest information is provided to favor the proper use of drugs.

[Relationship between benzodiazepines use and falls in the elderly: a multicenter study in three geriatric centers of a university hospital]

INTRODUCTION

Benzodiazepines are widely used in the elderly, but may induce potentially severe iatrogenic events like falls. The analysis of their use is difficult because of the numerous molecules and dosages available. The aim of the present study is to build a tool to monitor their consumption and to evaluate the relation between this consumption and patient's falls reported in three geriatric institutions.

METHODS

Conversion coefficients found in the literature allowed the expression of benzodiazepine action with a unique comparator: diazepam. Benzodiazepine consumption observed during 20 consecutive months was collected and weighted by hospital activity. A correlation between benzodiazepine consumption and the number of falls reported during the same period was researched.

RESULTS

Benzodiazepine consumption expressed in milligrams of diazepam-equivalent per hospitalization day is significantly linked to the number of falls expressed during the same period (R=0.63; p<0.01). However, no statistical bound was found between monthly falls variations and monthly benzodiazepine consumption variations. These results corroborate others published studies: benzodiazepine consumptions are statistically linked to falls, but the reduction of this consumption is of poor predictive value, maybe because of the multifactorial nature of falls.

DISCUSSION AND CONCLUSION

The expression of benzodiazepine consumption in diazepam-equivalent enables one to estimate the general exposition of patients and to compare the use of each molecule. The statistical link between this indicator and a major iatrogenic event like falls makes it a tool worth interest for both clinicians and pharmacists.

Evaluation of the health of free-ranging greater rheas (Rhea americana ) in Argentina

The health of 22 free-ranging adult rheas (Rhea americana) examined and sampled during a translocation/reintroduction project and six juvenile rheas kept in semicaptivity was investigated, and details of their haematology and plasma biochemistry are presented. Serological testing for antibodies to infectious agents was negative for infectious laryngotracheitis, avian adenovirus, avian influenza, avian reovirus, infectious bursal disease, infectious bronchitis virus, paramyxovirus types 1, 2, and 3, fowlpox and Salmonella Pullorum. Antibodies to Chlamydophila species were found in 25 of 27 of the birds, and 22 of 25 had antibodies to Aspergillus species. Ova of gastrointestinal nematodes of the genus Capillaria were identified, and the anoplocephalid cestode Monoecocestus cf rheiphilus was identified in R americana for the first time.

GABRA6 gene polymorphism and an attenuated stress response

The glucocorticoid component of the stress response has been the subject of intense scientific scrutiny because of the wide ranging pathological consequences resulting from excess glucocorticoid exposure, including mood and anxiety disorders, and cognitive impairment. Exposure to stress activates the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic adrenomedullary system, which are regulated by neuronal pathways, including the inhibitory GABAergic (gamma-aminobutyric acid) system. Approximately 60% of the variance in glucocorticod levels may be attributable to genetic individual differences. In the present study, 56 healthy subjects underwent genotyping to determine the influence of the T1521C single nucleotide polymorphism (SNP) in the GABA(A)alpha6 receptor subunit gene (GABRA6) on the hormonal and autonomic responses to psychological stress induced by the Trier Social Stress Test (TSST). Adrenocorticotropin (ACTH), cortisol, diastolic blood pressure, and mean blood pressure responses to the TSST were significantly greater in subjects homozygous for the T allele or heterozygous compared to subjects homozygous for the C allele. Behavioral data was collected employing the Revised NEO Personality Inventory (NEO PI-R); subjects homozygous for the C allele scored significantly lower on the Extraversion factor compared to subjects homozygous for the T allele or heterozygous. These results suggest that the T1521C polymorphism in the GABRA6 gene is associated with specific personality characteristics as well as a marked attenuation in hormonal and blood pressure responses to psychological stress.

Internal parasites of free-ranging guanacos from Patagonia

In the winter of 2000, a greater than 80% reduction in the guanaco population located in Cabo Dos Bahi;as Wildlife Reserve, Chubut, Argentina, was evident due to massive mortality attributed to starvation. Twelve guanacos were necropsied and samples were analyzed at the Parasitology Laboratory of Facultad de Ciencias Veterinarias, Universidad Nacional del Litoral. Fecal analysis revealed developmental stages of Nematodirus sp., Marshallagia sp., Trichuris sp. and Eimeria spp. Histopathological analysis showed the presence of Sarcocystis sp. in muscle and fascia cysts. Other parasites recovered included Dictyocaulus filaria, Trichuris tenuis and Moniezia expansa. Of these, D. filaria and M. expansa possibly reflect interactions with domestic sheep. This is the first time that T. tenuis has been reported in guanacos.

[Effect of cocultivating fungal species on the degradation of lignocellulose residues]

The degradation potential of Phanerochaete sordida, Trametes trogii, Coprinus truncorum and Paecilomyces sp. upon yard wastes was evaluated. The species had been inoculated individually or in pairs formed by P. sordida and Paecilomyces sp., T. trogii and Paecilomyces sp., and C. truncorum and Paecilomyces sp. The highest level of endoxilanase activity was produced by P. sordida growing alone, during day 21 (1.09 U/g of dry material), but in P. sordida and Paecilomyces sp. cultures, the detected activity did not overcome 0.27 U/g of dry material during the whole experiment. T. trogii showed maximum activity on day 14 (0.78 U/g of dry material), but in T. trogii and Paecilomyces sp. cultures, the values increased until day 21 (1.07 U/g of dry material). P. sordida endocellulase activity reached its maximum on day 28 (0.08 U/g of dry material), but in P. sordida and Paecilomyces sp. cultures, this activity increased during the whole experiment (0.04 U/g of dry material). The major weight loss was found in P. sordida (27.6%). The possible beneficial effect of co-culture in yard wastes biodegradation is discussed.