0053: Incidence of cardiovascular events following myocardial infarction in France: an observational analysis using a claims database

ObjectivesTo describe the characteristics and treatments of patients having a myocardial infarction (MI) and estimate the incidence of cardiovascular events following the index MI, in the French Health Insurance database.MethodA cohort of patients who had a MI in France between 2007 and 2011 was extracted from a claim database: the Echantillon Généraliste de Bénéficiaires (a 1% representative sample of subjects covered by the general health insurance (?600,000 patients). The incidence of cardiovascular events following the index MI was estimated using the Kaplan Meier method.Results1,977 subjects were identified with an index myocardial MI: 2/3 were males, mean age=67.2 y, 20.6% had diabetes, 37.6% hypercholesterolemia and 82.4% hypertension. Cumulative incidence rates for outcomes are shown in the table. All cause mortality at 3 years (including in-hospital death) was 27% (95% CI: 25.8-29.1). This incidence was high in the 3 months following the index MI stabilized thereafter.ConclusionDespite high prescription rates of post-MI treatments, rates of all-cause mortality and CV events remained high following MI. This underscores the need to improve secondary prevention.Abstratct 0053 – Table% patients treated6 months before index MI6 months after index MIStatins30.7%91.1%Ezetimibe3.6%4.9%Aspirine (Alone)59.9%11.6%Aspirine+P2Y12-I*23.9%76.0%Class III Antiarrhytmic2.4%8.4%Oral Anticoagulant5.1%10.1%Non-Thiazide Diuretics19.1%32.9%ACE Inhibitors18.6%71.0%Beta-Blockers26.5%86.0%Nitrates9.9%46.4%Other Antihypertensives**40.2%30.3%Cumulative incidence rate (95%CI)1 year2 year3 yearAll cause deaths***17.8% (16.0%;19.5%)21.6% (20.7%;23.5%)27.0% (25.8%;29.1%)Recurrent MI3.1% (2.3%;3.8%)4.1% (3.2%;5.0%)4,7% (3.7%;5.7%)Stroke orTIA1.9% (1.3%;2.5%)3.1% (2.3%;3.9%)4.1% (3.1%;5.0%)Composite of death***/ reinfarction/stroke20.7% (18.9%;22.5%)26.0% (24.0%;28.0%)32.1% (29.8%;34.3%)*mostly clopidogrel**thiazide diuretics, angiotensin II receptor blockers, CCBs***including in-hospital death

Direct Medical Costs of Type 2 Diabetes in France: An Insurance Claims Database Analysis

Objectives: Our objects was to estimate the direct healthcare costs of type 2 diabetes mellitus (T2DM) in France in 2013.Methods: Data were drawn from a random sample of ≈600,000 patients registered in the French national health insurances database, which covers 90% of the French population. An algorithm was used to select patients with T2DM. Direct healthcare costs from a collective perspective were derived from the database and compared with those from a control group to estimate the cost of diabetes and related comorbidities. Overall direct costs were also compared according to the diabetes therapies used throughout the year 2013.Results: Cost analysis was available for a sample of 25,987 patients with T2DM (mean age 67.5 ± standard deviation 12.5; 53.9% male) matched with a control group of 76,406 individuals without diabetes. Overall per patient per year medical expenditures were €6506 ± 10,106 in the T2DM group as compared with €3668 ± 6954 in the control group. The cost difference between the two groups was €2838 per patient per year, mainly due to hospitalizations, medication and nursing care costs. Total per capita annual costs were lowest for patients receiving metformin monotherapy (€4153 ± 6170) and highest for those receiving insulin (€12,890). However, apart from patients receiving insulin, costs did not differ markedly across the different oral treatment patterns.Conclusion: Extrapolating these results to the whole T2DM population in France, total direct costs of diagnosed T2DM in 2013 was estimated at over €8.5 billion. This estimate highlights the substantial economic burden of this condition on society

Impact of Persistence with Tumour Necrosis Factor Inhibitors on Healthcare Resource Utilization and Costs in Chronic Inflammatory Joint Diseases

International audienceAim: To assess persistence with subcutaneous (SC) tumour necrosis factor (TNF) inhibitors as well as the impact of persistence on healthcare resource utilization (HCRU) and costs in patients with chronic inflammatory joint diseases.Methods: In this cohort study using population-based French claims data (from 2011 to 2014), we measured persistence with SC TNF inhibitors within 12 months (M0-12) following treatment initiation in treatment-naïve and treatment-experienced users (divided into three cohorts: rheumatoid arthritis [RA], ankylosing spondylitis [AS] and psoriatic arthritis [PsA]). Persistent patients were propensity score matched to nonpersistent patients at M12. The impact of persistence status on HCRU and costs was assessed during M12-24.Results: Of treatment-naïve (n = 3,804) and treatment-experienced (n = 2,279) users, only 56.1% and 46.8% were persistent at M12, respectively. Nonpersistent patients had more outpatient visits, computerized tomography scans, spine or joint magnetic resonance imaging procedures and disease-related hospitalizations, while persistent patients had more rheumatologist visits. Nonpersistent patients had lower drug costs but higher nondrug-related healthcare and hospitalization costs than persistent patients. In AS and PsA, overall healthcare costs were similar in persistent and nonpersistent patients. In RA, overall healthcare costs were lower in persistent patients (15,753€ vs 17,590€ in treatment-naïve and 17,622€ vs 21,177€ in treatment-experienced).Conclusion: Persistence with SC TNF inhibitors within first 12 months following treatment initiation was low in both treatment-naïve and treatment-experienced patients. Differences were observed in distribution of costs between persistent and nonpersistent patients, showing that nonpersistence with SC TNF inhibitors can lead to increased HCRU and higher costs

Hospital costs of Balloon Pulmonary Angioplasty (BPA) procedure and management for CTEPH patients: An observational study based on the French national hospital discharge database (PMSI)

International audienceIntroduction Since 2014, Balloon Pulmonary Angioplasty (BPA) has become an emerging and complementary strategy for chronic thromboembolic hypertension (CTEPH) patients who are not suitable for pulmonary endarterectomy (PEA) or who have recurrent symptoms after the PEA procedure. Objective To assess the hospital cost of BPA sessions and management in CTEPH patients. Methods An observational retrospective cohort study of CTEPH-adults hospitalized for a BPA between January 1st, 2014 and June 30th, 2016 was conducted in the 2 centres performing BPA in France (Paris Sud and Grenoble) using the French national hospital discharge database (PMSI-MCO). Patients were followed until 6 months or death, whichever occurred first. Follow-up stays were classified as stays with BPA sessions, for BPA management or for CTEPH management based on a pre-defined algorithm and a medical review using type of diagnosis (ICD-10), delay from last BPA procedure stay and length of stay. Hospital costs (including medical transports) were estimated from National Health Insurance perspective using published official French tariffs from 2014 to 2016 and expressed in 2017 Euros. Results A total of 191 patients were analysed; mainly male (53%), with a mean age of 64,3 years. The first BPA session was performed 1.1 years in median (IQR 0.3–2.92) after the first PH hospitalisation. A mean of 3 stays with BPA sessions per patient were reported with a mean length of stay of 8 days for the first stay and 6 days for successive stays. The total hospital cost attributable to BPA was € 4,057,825 corresponding to €8,764±3,435 per stay and €21,245±12,843 per patient. Results were sensitive to age classes, density of commune of residence and some comorbidities. Conclusions The study generated robust real-world data to assess the hospital cost of BPA sessions and management in CTEPH patients within its first years of implementation in France

Cost-effectiveness analysis of elbasvir-grazoprevir regimen for treating hepatitis C virus genotype 1 infection in stage 4-5 chronic kidney disease patients in France

<div><p>Objective</p><p>To assess the cost-effectiveness of the elbasvir/grazoprevir (EBR/GZR) regimen in patients with genotype 1 chronic hepatitis C virus (HCV) infection with severe and end-stage renal disease compared to no treatment.</p><p>Design</p><p>This study uses a health economic model to estimate the cost-effectiveness of treating previously untreated and treatment experienced chronic hepatitis C patients who have severe and end stage renal disease with the elbasvir-grazoprevir regimen versus no treatment in the French context. The lifetime homogeneous markovian model comprises of forty combined health states including hepatitis C virus and chronic kidney disease. The model parameters were from a multicentre randomized controlled trial, ANRS CO22 HEPATHER French cohort and literature. 1000 Monte Carlo simulations of patient health states for each treatment strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The results were expressed in cost per quality-adjusted life year (QALY) gained.</p><p>Patients</p><p>The mean age of patients in the HEPATHER French cohort was 59.6 years and 56% of them were men. 22.3% of patients had a F0 fibrosis stage (no fibrosis), 24.1% a F1 stage (portal fibrosis without septa), 7.1% a F2 stage (portal fibrosis with few septa), 21.4% a F3 stage (numerous septa without fibrosis) and 25% a F4 fibrosis stage (compensated cirrhosis). Among these HCV genotype 1 patients, 30% had severe renal impairment stage 4, 33% had a severe renal insufficiency stage 5 and 37% had terminal severe renal impairment stage 5 treated by dialysis.</p><p>Intervention</p><p>Fixed-dose combination of direct-acting antiviral agents elbasvir and grazoprevir compared to no-treatment.</p><p>Results</p><p>EBR/GZR increased the number of life years (6.3 years) compared to no treatment (5.1 years) on a lifetime horizon. The total number of QALYs was higher for the new treatment because of better utility on health conditions (6.2 versus 3.7 QALYs). The incremental cost-utility ratio (ICUR) was of €15,212 per QALY gained for the base case analysis.</p><p>Conclusions</p><p>This cost-utility model is an innovative approach that simultaneously looks at the disease evolution of chronic hepatitis C and chronic kidney disease. EBR/GZR without interferon and ribavirin, produced the greatest benefit in terms of life expectancy and quality-adjusted life years (QALY) in treatment-naïve or experienced patients with chronic hepatitis C genotype 1 and stage 4–5 chronic kidney disease including dialysis patients. Based on shape of the acceptability curve, EBR/GZR can be considered cost-effective at a willingness to pay of €20,000 /QALY for patients with renal insufficiency with severe and end-stage renal disease compared to no treatment.</p></div

State-transition diagram for chronic hepatitis C and liver disease model.

<p>ESLD: End-Stage Liver Disease, F0: No fibrosis, F1: Portal fibrosis without septa, F2: Portal fibrosis with few septa, F3: Numerous septa without fibrosis, F4: Compensated cirrhosis, DC: Decompensated cirrhosis, HCC: Hepatocellular carcinoma, LT: Liver transplant, SVR, F0–F3 and SVR, F4: Patient’s baseline fibrosis stage before treatment and achievement of sustained virologic response (SVR).</p