Cost-of-illness of inflammatory bowel disease patients treated with anti-tumour necrosis factor: A French large single-centre experience

Background

No study has evaluated the direct annual costs of inflammatory bowel disease patients treated with anti-tumour necrosis factor therapy.

Objectives

The purpose of this study was to identify annual direct costs and main cost drivers of anti-tumour necrosis factor-treated inflammatory bowel disease patients.

Methods

All inflammatory bowel disease patients treated with infliximab or adalimumab at Nancy University Hospital were consecutively screened for inclusion from November 2016-February 2017. Data about hospitalisation, surgery, medication, outpatient visits, investigations and transport over the previous 12 months were retrospectively collected.

Results

A total of 108 patients (n = 83 Crohn's disease; n = 25 ulcerative colitis) were included. The mean annual cost per patient was €15,775 (standard deviation €7221), with no difference between Crohn's disease and ulcerative colitis (p = 0.2). The main cost driver was medication, which accounted for 84% of the total direct cost. Hospitalisation and surgery represented 11% and 2% of the direct costs. History of switch to another anti-tumour necrosis factor treatment was identified as the only independent predictor of greater direct costs in the multivariate analysis (p = 0.0018).

Conclusions

In a French tertiary referral centre, direct costs of anti-tumour necrosis factor therapy-treated patients were mainly driven by medication, while hospitalisation and surgery represented only a minor part of the costs. There was no difference between Crohn's disease and ulcerative colitis patients.

[Monkey-pox, a model of emergent then reemergent disease]

The recent emergence of monkey pox in the United States of America highlights the problem (known for other infectious agents) of dissemination of pathogens outside their endemic area, and of subsequent global threats of variable gravity according to agents. It is a real emergency since monkey pox had been confined to Africa for several decades, where small epidemics occurred from time to time, monkey pox is a "miniature smallpox" which, in Africa, evolves on an endemic (zoonotic) mode with, as reservoirs, several species of wild rodents (mainly squirrels) and some monkey species. It can be accidentally transmitted to man then develops as epidemics, sometimes leading to death. The virus was imported in 2003 in the United States of America, via Gambia rats and wild squirrels (all African species), and infected prairie dogs (which are now in fashion as pets), then crossed the species barrier to man. In the United States of America, screening campaigns, epidemiological investigations, and subsequent treatments led to a rapid control of the epidemic, which is a model of emergent disease for this country. Therapeutic and preventive measures directly applicable to monkey pox are discussed. They can also be applied against other pox virus infections (including smallpox). The risk of criminal introduction of pox viruses is discussed since it is, more than ever, a real worldwide threat.

[Epidemiologic surveillance of dengue fever in the French army from 1996 to 1999]

Dengue fever is a widespread disease that can occur outside tropical areas. Several thousand French military personnel are exposed to this infectious risk each year and exposure is expected to rise with the creation of a professional army and the increasing number of foreign missions. As a result, dengue fever has become a major priority for the Armed Services Health Corps (ASHC). A system of epidemiological surveillance based on the active participation of all military physicians has been designed by the ASHC to collect and analyze all data relevant to cases of dengue fever involving French military personnel stationed overseas or at home. The purpose of this study is to present data compiled for the period from 1996 to 1999. Analysis of these data demonstrated that the incidence of dengue fever peaked in 1997 due to epidemic outbreaks occurring in French Polynesia and Martinique. In response to these outbreaks control measures were adapted especially in regard to vector control. This study shows that the system of surveillance implemented by the ASHC is an effective but still perfectible tool.

[HBs Ag and antibodies to hepatitis C virus in complicated chronic liver disease in Gabon. A case control study]

BACKGROUND AND OBJECTIVE

The prevalence of HBs Ag and anti-HCV antibodies are high in the general population in Gabon. The aim of this study was to perform a case control study to determine the role of hepatitis B and C viruses in decompensated cirrhosis and hepatocellular carcinoma.

METHODS

Between October 1990 and June 1998, HBs Ag and anti-HCV antibodies were investigated in 1 204 newly hospitalized patients. Sixty-seven had decompensated cirrhosis, 38 had hepatocellular carcinoma and six an association of both diseases. Prevalences were compared with those in a group of 527 sex and age matched controls from the same cohort.

RESULTS

HBs Ag prevalence among cases was 35.1% (decompensated cirrhosis: 34.2%; hepatocellular carcinoma: 40.5%) and 12.5% among controls. Anti-HCV were detected in 32.4% of cases (decompensated cirrhosis: 34.2%; hepatocellular carcinoma: 28.6%) and in 20.1% of controls. Complicated chronic liver disease was linked to HBs Ag (OR=11.3; IC: 4.8-26.7; cirrhosis: OR=18; IC: 5.3-61.5; hepatocellular carcinoma: OR=8.3; IC: 2.5-27.8) in patients from 15 to 34 years old. Above 45 years, complicated chronic liver disease was linked to anti-HCV antibodies (OR=2.9; IC: 1.6-5.3; cirrhosis: OR=2.8; IC: 1.4-5.8; hepatocellular carcinoma: OR=3.2; IC: 1.1-9.5).

CONCLUSION

Both Hepatitis B and C viruses are linked to complicated chronic liver disease in Gabon in an age-dependent manner.

[Disease vector control strategy in the French army]

Disease vector control is a major priority for the Medical Health Corps of the French Armed Forces which maintains around 23,000 troops in tropical areas and is involved in numerous military and humanitarian missions throughout the world. Control strategy includes both general and personal control measures. Personal control measures include wearing permetherin-impregnated combat uniforms, application of repellents to the skin, and use of deltamethrin-impregnated bednets. General measures are implemented in facilities and in the environment. Measures in facilities include not only physical deterrents such as screens on openings and air-conditioning but also application of chemical insecticides to walls, curtains, and screening. Environmental measures include control of larval deposits and elimination of potential breeding areas. Low-volume wide-area spraying of imagocides is a supplemental option used in case of disease outbreak. For units stationed in tropical areas, command and surveillance of vector control operations is under the responsibility of the mosquito control committee which includes personnel from the affected field unit. Strategies are chosen in function of local climate and operational conditions. The efficacy of vector control programs is assessed annually by reviewing the incidence in armed forces personnel of the main vector-transmitted diseases: malaria, dengue fever, and leishmaniasis. Documentation and training are dispensed to all units stationed in tropical areas. To ensure that knowledge of military physicians remains current, three courses on malaria control are offered each year at the Tropical Medicine Institute of the Armed Forces Health Corps (Le Pharo) in Marseille. Field research conducted in collaboration with military or civilian organizations independent of the Armed Services Health Corps makes it possible to keep chiefs of staff informed of state-of-the art vector control measures adapted to use by personnel on assignment or mission in tropical areas.

Evidence for differences in MT2 cell tropism according to genetic subtypes of HIV-1: syncytium-inducing variants seem rare among subtype C HIV-1 viruses

Non-syncytium-inducing (NSI) variants seem to be more readily transmitted than syncytium-inducing (SI) variants, and the switch from NSI to SI during HIV-1 infection seems to be a key determinant to the evolution of AIDS. We investigated eventual differences in the SI capacity on MT-2 cells according to genetic subtypes of HIV-1 and correlated this observations with CD4 counts and duration of HIV infection. In total, 86 patients, most with known date of HIV contamination and infected with different genetic subtypes, have been studied: 11 subtype A, 46 subtype B, 22 subtype C, and 7 subtype E. Multivariate analysis used a Cox's proportional hazards regression. The number and percentage of patients infected with an SI strain were as follows: 3 of 11 (27%) for subtype A, 15 of 46 (33%) for subtype B, 0 of 22 (0%) for subtype C, and 5 of 7 (71%) for subtype E. After adjustment for time after seroconversion and CD4 counts, significantly fewer SI variants were observed in patients infected with subtype C (p < .002) and it was found that subjects infected with subtype E had a higher risk of being infected with an SI strain (rate ratio [RR] = 12.39%; 95% confidence interval [CI] 1.55-98.67; p < .001). Most of the subtype E-infected patients from our study switched from an NSI to SI phenotype early after seroconversion (<4 years). To predict the in vitro presence of SI variants, we scanned V3-loop sequences for mutations at positions 11 and/or 25. Overall, 54 of 55 (98.2%) NSI strains in vitro were predicted NSI, and only 4 of 12 (33.3%) of SI viruses were predicted SI. For patients in whom a switch from an NSI to an SI virus was observed, the SI phenotype could be detected earlier in vitro than by the corresponding V3-loop sequence. No SI strains were observed among patients infected with subtype C; however, longer follow-up is needed to see whether the appearance of SI variants in subtype E or the absence of SI variants in subtype C-infected patients is also associated respectively with a faster or slower progression to AIDS as described for subtype B.

[Malaria epidemic during a military-humanitarian mission in Africa]

A malaria epidemic broke out among French servicemen during a humanitarian military mission carried out in Central Africa in 1996. The purpose of this study was to determine compliance with drug prophylaxis for malaria by measuring blood levels of antimalarial drugs (combination treatment using chloroquine-proguanil or treatment with doxycycline) as well as to assess the conditions of vector control. The incidence density rate of malaria over a 60-day period was 3.1 cases per month per 100 men. Only reinforcement troops were affected. The risk of developing malaria was 5 times higher among new arrivals than in servicemen who had been in the zone for several months (95% CI relative risk = [2.9-7.8]). Type of prophylactic treatment had no effect on the incidence density rate. Study data showed that 40.2% of those treated for malaria were not in compliance with prophylactic treatment at the time of the malarial attack and that those who were in compliance with prophylaxis, i.e. the remaining 59.8%, presented a strain of plasmodium that was resistant to the prophylactic drugs at doses used. Findings also indicated the epidemic occurred mainly because operating conditions prevented implementation of proper vectorial control. The risk of epidemic could probably have been reduced by improving compliance with prophylactic treatment and changing standard vectorial control techniques, e.g. by using insecticide-treated uniforms.