[Evaluating the quality of care in respiratory medicine--future prospects].

International audienc

[Concordance between two variables: numerical approaches (qualitative observations - the kappa coefficient-; quantitative measures].

International audienc

[Medical-economic evaluation of lung cancers. Theoretical approaches and practical applications].

International audienceThere has been an increasing number of publications dealing with the assessment of treatments or medical strategies. Chronic diseases like lung cancer require such an analysis, in relation to their costs and their poor efficacy. In its first part, this review shows the theoretical basis of economic assessment, the available tools and the limits of these methods. The second part points out their use in lung cancer: cost evaluation of these cancers for the society, economic assessment of new chemotherapic drugs, cost-effectiveness analysis in randomized trials. These methods give to the clinicians complementary results for their final decision

Economic evaluation of first-line and maintenance treatments for advanced non-small cell lung cancer: a systematic review

Christos Chouaïd,1 Perinne Crequit,2 Isabelle Borget,3 Alain Vergnenegre4 1Service de Pneumologie et de Pathologie Professionnelle, Centre Hospitalier Intercommunal Créteil et Université de Paris Est Créteil, Paris, France; 2Service de Pneumologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; 3Service de Biostatistique et d’Epidémiologie, Institut Gustave Roussy, Villejuif, France; 4Unité d’Oncologie Thoracique et Cutanée, Centre Hospitalier Universitaire Limoges, Limoges, France Abstract: During these last years, there have been an increased number of new drugs for non-small cell lung cancer (NSCLC), with a growing financial effect on patients and society. The purpose of this article was to review the economics of first-line and maintenance NSCLC treatments. We reviewed economic analyses of NSCLC therapies published between 2004 and 2014. In first-line settings, in unselected patients with advanced NSCLC, the cisplatin gemcitabine doublet appears to be cost-saving compared with other platinum doublets. In patients with nonsquamous NSCLC, the incremental cost-effectiveness ratios (ICERs) per life-year gained (LYG) were $83,537,$178,613, and more than $300,000 for cisplatin-pemetrexed compared with, respectively, cisplatin-gemcitabine, cisplatin-carboplatin-paclitaxel, and carboplatin-paclitaxel-bevacizumab. For all primary chemotherapy agents, use of carboplatin is associated with slightly higher costs than cisplatin. In all the analysis, bevacizumab had an ICER greater than$150,000 per quality-adjusted life-year (QALY). In epidermal growth factor receptor mutated advanced NSCLC, compared with carboplatin-paclitaxel doublet, targeted therapy based on testing available tissue yielded an ICER of $110,644 per QALY, and the rebiopsy strategy yielded an ICER of$122,219 per QALY. Compared with the triplet carboplatin-paclitaxel-bevacizumab, testing and rebiopsy strategies had ICERs of $25,547 and$44,036 per QALY, respectively. In an indirect comparison, ICERs per LYG and QALY of erlotinib versus gefitinib were $39,431 and$62,419, respectively. In anaplastic lymphoma kinase-positive nonsquamous advanced NSCLC, the ICER of first-line crizotinib compared with that of chemotherapy was $255,970 per QALY. For maintenance therapy, gefitinib had an ICER of$19,214 per QALY, erlotinib had an ICER of $127,343 per LYG, and pemetrexed had an ICER varying between$183,589 and $205,597 per LYG. Most recent NSCLC strategies are based on apparently no cost-effective strategies if we consider an ICER below$50,000 per QALY an acceptable threshold. We need, probably on a countrywide level, to have a debate involving public health organizations and pharmaceutical companies, as well as clinicians and patients, to challenge the rising costs of managing lung cancer. Keywords: lung cancer, costs, economics, cost-effectiveness, evaluatio

[Analysis of mode of failure, their effects and criticality: improving of the hospital drug prescribing process].

International audienceFailure Mode, Effects, and Criticality Analysis (FMECA) is used in industry to prevent process or product failures. We studied the feasibility of this method in hospital organizations. FMECA was used to improve drug prescription in two medical wards. Failure modes were identified and classified hierarchically. Corrective actions were taken. Involvement of all the professionals concerned in this process was obtained, and has resulted in real acceptance of the proposed changes and in their effective realization

[Stage IV NSCLC. Economic analysis in lung cancers].

International audienceOBJECTIVE: To explain the help of economic analyses in the understanding of lung cancer (LC) management with a description of the quality of selected papers. METHODS: In the first part, quality criteria of economic analyses are depicted with the key words for the literature selection. RESULTS: The global costs of LC through literature review are depicted; then, in a second part, the costs of each stage of the disease. Finally, costs of chemotherapeutic drugs and target molecules are also discussed. CONCLUSION: Economic analyses are unavoidable to assess the burden of the disease but also the cost of each management strategy for LC

[Inhaled corticosteroids in asthma: a medico-economic analysis of clinical trials].

International audienceBACKGROUND: Asthma is a chronic disease with a heavy economic burden in terms of public health on account of its clinical impact and consequences on quality of life and costs. Its management is based on pharmacological measures with inhaled corticosteroids playing a large role. The objective of this study was to undertake an analysis of the published literature of medico-economic trials of the use of inhaled corticosteroids. METHODS: A review of the literature from 1990 to 2007 was undertaken with separate analyses of studies of inhaled steroids alone and those looking at combined preparations. RESULTS: The costs of asthma vary greatly depending on the clinical management. Analysis of the published clinical trials showed that the addition of inhaled steroids increased the total cost. When efficacy is taken into account the economic results are acceptable for developed societies. The use of inhaled steroids as maintenance therapy, or maintenance and symptomatic therapy, was always cost effective. CONCLUSION: These results are based on data from clinical trials. They need to be confirmed by large scale observational studies using validated criteria of effectiveness

New PDL1 inhibitors for non-small cell lung cancer: focus on pembrolizumab

Olivier Bylicki,1 Nicolas Paleiron,2 Gaëlle Rousseau-Bussac,3 Christos Chouaïd3 1Pneumology Department, Hôpital d’Instruction des Armées Percy, Paris, 2Respiratory Department, Hôpital d’Instruction des Armées Saint-Anne, Toulon, 3Pneumology Department, CHI Créteil, Paris, France Abstract: The advent of immune-checkpoint inhibitors during the past decade represents a major advancement in the treatment of non-small cell lung cancer (NSCLC) with personalized treatment. Platinum-based chemotherapy has reached its efficacy threshold, with its use remaining limited by its toxicity. For NSCLC, inhibitors of the PD1 protein and its ligand PDL1 show promising clinical activity and induce durable responses in patients with advanced disease. The US Food and Drug Administration has approved pembrolizumab for treatment-naïve metastatic NSCLC with ≥50% of tumor cells expressing PDL1 and for metastatic NSCLC with ≥1% PDL1 expression after progression following first-line platinum-based doublet chemotherapy. In 2017, it also authorized the first-line combination of pembrolizumab and carboplatin–pemetrexed chemotherapy without selection based on PDL1 expression, but European health authorities are still waiting for the results of a Phase III trial. In this review, the clinical results of published and ongoing studies evaluating pembrolizumab for advanced NSCLC are analyzed and the potential role of PDL1 as a factor predictive of overall responses addressed. Keywords: pembrolizumab, immune-checkpoint inhibitor, NSCLC, PDL