Economic evaluation of prematurity : a first year of life with major issues : the case of France

Cette thèse présente la première évaluation économique de la prématurité en France. La prématurité intervient avant 37 semaines d’aménorrhée. Elle est en constante augmentation dans le monde. Si les enjeux de santé publique sont bien identifiés, la prise en charge et les choix collectifs en matière de prématurité comportent des enjeux économiques importants. La première partie de cette thèse présente les enjeux de santé publique de la prématurité et les efforts restant à fournir en matière de prévention en France. Elle conduit ensuite une réflexion économique sur les moyens d’une utilisation au plus « juste » socialement des ressources dédiées à la santé périnatale, dans le contexte d’augmentation des dépenses de santé. Une mesure de la charge collective de la prise en charge de la prématurité est nécessaire et envisagée au moyen d’une étude Cost-Of-Illness. Enfin elle pose le cadre dans lequel l’éthique et l’évaluation économique sont complémentaires. La deuxième partie présente la méthodologie et les résultats de l’étude, consistant à évaluer les coûts directs hospitaliers et extrahospitaliers des naissances prématurées et à terme, dans la première année de vie, du point de vue de l’Assurance Maladie. Les données sont extraites du Système National d’Information Inter-Régime de l’Assurance Maladie. Les résultats montrent l’ampleur des coûts moyens associés à la grande prématurité et une relation inverse et significative entre les coûts moyens et l’âge gestationnel. Cette étude économique invite à la sensibilisation des décideurs publics à la nécessité d’allouer les moyens financiers et humains pour prévenir la survenue de situations critiques associées à la prématurité.This thesis focuses on a first economic assessment of prematurity in France. Prematurity is defined as occurring before 37 weeks of gestation. It is increasing in France and worldwide. If the issues of public health are already well identified, medical care and collective choices concerning prematurity matters also involve significant economic challenges. The first part of this thesis attempts to present the public health issues of prematurity and highlights the remaining efforts required to provide prevention in France. It then considers economic issues on the use of socially fairer resources dedicated to perinatal health in a context where current health expenditure is rising. Assessment of the collective burden of care for preterm infants is necessary and envisaged by a Cost-Of-Illness study. Finally it presents a framework where ethical and economic considerations are complementary. The second part addresses the methodology and results of the study. The study assesses the hospital and non-hospital direct costs for preterm and term births, in the first year of life, from health insurance point of view. It is based on an extraction of data from the National Heal Insurance Inter-Regime Information System. The results of the study highlight in particular the level of average costs associated with extreme prematurity (before 32 weeks) and demonstrate an inverse and significant relationship between average costs and the gestational age (GA) at birth. This economic study invites awareness of the policy makers about the need to provide financial and human resources to anticipate and prevent critical situations associated with prematurity

Evaluation économique de la prématurité : une première année de vie aux enjeux majeurs : le cas de la France

This thesis focuses on a first economic assessment of prematurity in France. Prematurity is defined as occurring before 37 weeks of gestation. It is increasing in France and worldwide. If the issues of public health are already well identified, medical care and collective choices concerning prematurity matters also involve significant economic challenges. The first part of this thesis attempts to present the public health issues of prematurity and highlights the remaining efforts required to provide prevention in France. It then considers economic issues on the use of socially fairer resources dedicated to perinatal health in a context where current health expenditure is rising. Assessment of the collective burden of care for preterm infants is necessary and envisaged by a Cost-Of-Illness study. Finally it presents a framework where ethical and economic considerations are complementary. The second part addresses the methodology and results of the study. The study assesses the hospital and non-hospital direct costs for preterm and term births, in the first year of life, from health insurance point of view. It is based on an extraction of data from the National Heal Insurance Inter-Regime Information System. The results of the study highlight in particular the level of average costs associated with extreme prematurity (before 32 weeks) and demonstrate an inverse and significant relationship between average costs and the gestational age (GA) at birth. This economic study invites awareness of the policy makers about the need to provide financial and human resources to anticipate and prevent critical situations associated with prematurity.Cette thèse présente la première évaluation économique de la prématurité en France. La prématurité intervient avant 37 semaines d’aménorrhée. Elle est en constante augmentation dans le monde. Si les enjeux de santé publique sont bien identifiés, la prise en charge et les choix collectifs en matière de prématurité comportent des enjeux économiques importants. La première partie de cette thèse présente les enjeux de santé publique de la prématurité et les efforts restant à fournir en matière de prévention en France. Elle conduit ensuite une réflexion économique sur les moyens d’une utilisation au plus « juste » socialement des ressources dédiées à la santé périnatale, dans le contexte d’augmentation des dépenses de santé. Une mesure de la charge collective de la prise en charge de la prématurité est nécessaire et envisagée au moyen d’une étude Cost-Of-Illness. Enfin elle pose le cadre dans lequel l’éthique et l’évaluation économique sont complémentaires. La deuxième partie présente la méthodologie et les résultats de l’étude, consistant à évaluer les coûts directs hospitaliers et extrahospitaliers des naissances prématurées et à terme, dans la première année de vie, du point de vue de l’Assurance Maladie. Les données sont extraites du Système National d’Information Inter-Régime de l’Assurance Maladie. Les résultats montrent l’ampleur des coûts moyens associés à la grande prématurité et une relation inverse et significative entre les coûts moyens et l’âge gestationnel. Cette étude économique invite à la sensibilisation des décideurs publics à la nécessité d’allouer les moyens financiers et humains pour prévenir la survenue de situations critiques associées à la prématurité

Mésusage de substances psychoactives en milieu professionnel. « II-Données socio-économiques "

National audienc

Données socio-économiques, in : Dépistage et gestion du mésusage de substances psychoactives (SPA) susceptibles de générer des troubles du comportement en milieu professionnel. Recommandations pour la pratique clinique

National audienc

Multidimensional impact of breast cancer screening: Results of the multicenter prospective optisoins01 study.

Breast cancer (BC) screening has been developed to detect earlier stage tumors associated with better prognosis. The aim of study was to evaluate the impact of BC screening on therapeutic management of patients with first operable BC, and on costs, patients' needs, and working life. OPTISOINS01 was a multicenter, prospective observational study which aimed to identify the main care pathway of early BC. Among patients aged from 50 to 74 years-old, 2 groups were defined: the "Clinical signs" group and the "Screening" group (national organized screening and individual screening). We compared between these 2 groups: locoregional and systemic treatments, direct medical and non-medical costs from a National Health Insurance perspective, patients' needs assessed by the validated SCNS-BR8 "breast cancer" module of the SCNS-SF34 supportive care needs survey and the duration of sick leave. The "Clinical signs" group included 89 patients, while the"Screening" group included 290 patients. More axillary lymph node dissections and radical breast surgery were performed in the "Clinical signs". The rate of adjuvant chemotherapy was dramatically higher in the "Clinical signs" group. The median direct medical costs of the "Screening" group were €11,860 (€3,643-€41,030) per year and per patient, much lower than in the "Clinical signs" group (€14,940; €5,317-€41,070). Finally, needs specifically assessed by the SCNS-BR8 questionnaire were significantly higher for the postoperative and post-adjuvant periods in the "Clinical signs" group. This study highlighted the benefit of BC screening in terms of reduced therapies and positive impact on work and social life

Pediatric intensive care admissions for respiratory syncytial virus bronchiolitis in France: results of e retrospective survey and evaluation of the validity of a medical information system programme

International audienc

Humanities and social sciences informing the implementation of genomics

International audienc

Validité et enjeux du codage PMSI des séjours de courte durée en néonatalogie, chez les nouveau-nés de faible poids de naissance

International audienc

Efficiency and effectiveness of intensive multidisciplinary follow-up of patients with stroke/TIA or myocardial infarction compared to usual monitoring: protocol of a pragmatic randomised clinical trial. DiVa (Dijon vascular) study

Introduction The ongoing ageing population is associated with an increase in the number of patients suffering a stroke, transient ischaemic attack (TIA) or myocardial infarction (MI). In these patients, implementing secondary prevention is a critical challenge and new strategies need to be developed to close the gap between clinical practice and evidence-based recommendations. We describe the protocol of a randomised clinical trial that aims to evaluate the efficiency and effectiveness of an intensive multidisciplinary follow-up of patients compared with standard care.Methods and analysis The DiVa study is a randomised, prospective, controlled, multicentre trial including patients >18 years old with a first or recurrent stroke (ischaemic or haemorrhagic) or TIA, or a type I or II MI, managed in one of the participating hospitals of the study area, with a survival expectancy >12 months. Patients will be randomised with an allocation ratio of 1:1 in two parallel groups: one group assigned to a multidisciplinary, nurse-based and pharmacist-based 2-year follow-up in association with general practitioners, neurologists and cardiologists versus one group with usual follow-up. In each group for each disease (stroke/TIA or MI), 430 patients will be enrolled (total of 1720 patients) over 3 years. The primary outcome will be the incremental cost–utility ratio at 24 months between intensive and standard follow-up in a society perspective. Secondary outcomes will include the incremental cost–utility ratio at 6 and 12 months, the incremental cost-effectiveness ratio at 24 months, reduction at 6, 12 and 24 months of the rates of death, unscheduled rehospitalisation and iatrogenic complications, changes in quality of life, net budgetary impact at 5 years of the intensive follow-up on the national health insurance perspective and analysis of factors having positive or negative effects on the implementation of the project in the study area.Ethics and dissemination Ethical approval was obtained and all patients receive information about the study and give their consent to participate before randomisation. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal.Trial registration number ClinicalTrials.gov Identifier: NCT04188457. Registered on 6 December 2019

Direct medical and non-medical costs of a one-year care pathway for early operable breast cancer: Results of a French multicenter prospective study.

IntroductionThe organization of health care for breast cancer (BC) constitutes a public health challenge to ensure quality of care, while also controlling expenditure. Few studies have assessed the global care pathway of early BC patients, including a description of direct medical costs and their determinants. The aims of this multicenter prospective study were to describe care pathways of BC patients in a geographic territory and to calculate the global direct costs of early stage BC during the first year following diagnosis.MethodsOPTISOINS01 was a multicenter, prospective, observational study including early BC patients from diagnosis to one-year follow-up. Direct medical costs (in-hospital and out-of-hospital costs, supportive care costs) and direct non-medical costs (transportation and sick leave costs) were calculated by using a cost-of-illness analysis based on a bottom-up approach. Resources consumed were recorded in situ for each patient, using a prospective direct observation method.ResultsData from 604 patients were analyzed. Median direct medical costs of 1 year of management after diagnosis in operable BC patients were €12,250. Factors independently associated with higher direct medical costs were: diagnosis on the basis of clinical signs, invasive cancer, lymph node involvement and conventional hospitalization for surgery. Median sick leave costs were €8,841 per patient and per year. Chemotherapy was an independent determinant of sick leave costs (€3,687/patient/year without chemotherapy versus €10,706 with chemotherapy). Forty percent (n = 242) of patients declared additional personal expenditure of €614/patient/year. No drivers of these costs were identified.ConclusionInitial stage of disease and the treatments administered were the main drivers of direct medical costs. Direct non-medical costs essentially consisted of sick leave costs, accounting for one-half of direct medical costs for working patients. Out-of-pocket expenditure had a limited impact on the household