Assessing the return on investments (cost-benefits) in prevention in Switzerland : a feasibility study

This study was commissioned by the Federal Office of Public Health, contract no. 06.003951

Core outcome set measurement for future clinical trials in acute myeloid leukemia: the HARMONY study protocol using a multi-stakeholder consensus-based Delphi process and a final consensus meeting

Abstract: Background: Acute myeloid leukemia (AML) is the most common acute leukemia in adults and has an unacceptably low cure rate. In recent years, a number of new treatment strategies and compounds were developed for the treatment of AML. There were several randomized controlled clinical trials with the objective to improve patients’ management and patients’ outcome in AML. Unfortunately, these trials are not always directly comparable since they do not measure the same outcomes, and currently there are no core outcome sets that can be used to guide outcome selection and harmonization in this disease area. The HARMONY (Healthcare Alliance for Resourceful Medicine Offensive against Neoplasms in Hematology) Alliance is a public-private European network established in 2017 and currently includes 53 partners and 32 associated members from 22 countries. Amongst many other goals of the HARMONY Alliance, Work Package 2 focuses on defining outcomes that are relevant to each hematological malignancy. Accordingly, this pilot study will be performed to define a core outcome set in AML. Methods: The pilot study will use a three-round Delphi survey and a final consensus meeting to define a core outcome set. Participants will be recruited from different stakeholder groups, including patients, clinicians, regulators and members of the European Federation of Pharmaceutical Industries and Associations. At the pre-Delphi stage, a literature research was conducted followed by several semi-structured interviews of clinical public and private key opinion leaders. Subsequently, the preliminary outcome list was discussed in several multi-stakeholder face-to-face meetings. The Delphi survey will reduce the preliminary outcome list to essential core outcomes. After completion of the last Delphi round, a final face-to-face meeting is planned to achieve consensus about the core outcome set in AML. Discussion: As part of the HARMONY Alliance, the pilot Delphi aims to define a core outcome set in AML on the basis of a multi-stakeholder consensus. Such a core outcome set will help to allow consistent comparison of future clinical trials and real-world evidence research and ensures that appropriate outcomes valued by a range of stakeholders are measured within future trials

Convergence monétaire européenne, PPA et PINC

European Monetary Convergence, PPP and UIRP. Building on the work of Frankel (1979) and Froot & Rogoff (1995), this article proposes a more general model to determine long-term national inflation. It combines the assumptions underlying "weak" relative purchasing power parity (PPP) with those underlying the uncovered interest rate parity (UIRP). Using this model, we endeavour to determine, first, whether monetary convergence -within the meaning of the Maastricht Treaty -linking these variables has occurred and, secondly, whether achievement of such convergence bears out the PPP and UIRP assumptions. Since Maastricht-based convergence and PPP both appear to be long-term economic relations, we are using the fractional cointegration to test these relations. Fractional cointegration allows us to determine, first, whether convergence towards a long-term equilibrium has occurred and, secondly, at which speed the economic system returns to this equilibrium after an exogenous shock. After defining fractional cointegration and giving an economic interpretation of this method, we apply it to three pairs of "in" countries. We show that the Netherlands and France have achieved monetary convergence with Germany within the meaning of the Maastricht Treaty. Weconclude that the weak form of PPP and UIRP is working between the Netherlands and Germany. The speed of Maastricht-based convergence with Germany is fast for the Netherlands and slower for France. Italy does not appear to have converged with Germany.Dans la lignée des travaux de Frankel (1979) et de Froot et Rogoff (1995), nous proposons un modèle plus général de détermination de l'inflation nationale de long terme qui lie les hypothèses de parité des pouvoirs d''achat (PPA) relative '' faible'' et de parité de taux d'intérêt non couverte (PINC). À partir de ce modèle, nous cherchons à déterminer si, d'une part, la convergence monétaire au sens de Maastricht qui lie ces variables entre elles a eu lieu et, d''autre part, si la réalisation de cette convergence entraîne la vérification des hypothèses de PPA et de PINC. Étant donné qu'aussi bien la convergence maastrichtienne que la PPA semblent être des relations économiques de long terme, nous utilisons la cointégration fractionnaire pour tester ces relations. La cointégration fractionnaire nous permet de déterminer, d'une part, si la convergence vers un équilibre de long terme a eu lieu et, d''autre part, à quelle vitesse le système économique revient vers cet équilibre à la suite d'un choc exogène. Après avoir précisé la définition de la cointégration fractionnaire et donné une interprétation économique de cette méthode, nous l''appliquons à trois couples de pays participants à l'Union Monétaire Européenne. Nous montrons que la convergence monétaire ''maastrichtienne'' a eu lieu pour les Pays-Bas et la France vis-à-vis de l'Allemagne. Nous concluons en faveur de la PPA relative et de la PINC dans leur forme faible entre les Pays-Bas et l'Allemagne. La vitesse de convergence au sens de Maastricht avec l'Allemagne est rapide pour les Pays-Bas et plus lente pour la France. Dans le cas de l'Italie vis-à-vis de l'Allemagne, il semble qu'il n'y ait pas eu de convergence.Chevrou-Séverac Hélène. Convergence monétaire européenne, PPA et PINC. In: Économie & prévision, n°155, 2002-4. pp. 79-94

Out-of-pocket payments and financial burden of elderly with depressive symptoms across Europe [Abstract]

Background In the elderly community, depressive symptoms are frequent and often disabling because of its association with other comorbidities. The objectives of this study were to explore, across Europe, out-of-pocket (OOP) health spending between individuals with and without depressive symptoms. Methods We used baseline data from 10 countries participating in the Survey of Health, Aging and Retirement in Europe (SHARE). We included around 17 000 non-institutionalized individuals aged 50-79 years, with available, plausible income and OOP data. Depressive symptoms were diagnosed with the EURO-D depression symptoms scale. Previous 12 months OOPpayments, excluding health insurance premiums, were self-reported, and financial burden defined as the share of income spent in OOP. Whether individuals forwent care because of costs was considered as another outcome. Multivariate pooled and country- level regressions were performed on weighted data, adjusting for age, gender, marital status, education, and chronic diseases. Results The estimated overall prevalence of depressive symptoms is 24.6%. Preliminary results show that individuals with depressive symptoms are more likely to spend $1$5% as the share of income spent in OOP, odds ratio varied more across countries for outpatient care. In addition, individuals with depressive symptoms are at increased risk of foregoing care because of costs, in all countries except Sweden. Conclusions Our results show that across Europe, individuals with depressive symptoms bear a higher financial burden than those without them. In all countries, individuals forego care because of costs even when they face OOP higher than 5% of their income. Depression worsens the financial situation and the health of the elderly

Une Europe monétaire à plusieurs vitesses ? La demande de monnaie dans les grands pays de la zone euro (1979-1999)

The paper analyses the demand for money -measured by broad aggregates -in the four main euro-area countries (France, Germany, Italy and Spain) between 1979 and 1999. Two main questions are explored : 1) Is the demand-for-money function empirically stable in each country in the long and short term ? 2) If so, are its coefficients similar in each country or are there significant differences ? More generally the paper deals with the question of whether there has been a " return to normal" by demand for money after a period of instability due to financial innovation. The same VAR error correction model has been used for all countries. The main conclusions are : 1) There is evidence of significant differences in the demand-for-money function between the four main euro-area countries with, on the one hand, France and Germany -where the function is stable -and, on the other, Italy and Spain -where it is not ; 2) More generally there is strong evidence supporting the assumption of a return to normal (i. e. stability) by the demand for money ; however, its short-term dynamics are difficult to explain.L'article porte sur la demande de monnaie -mesurée au moyen d'agrégats larges -dans les quatre grands pays de la zone euro (Allemagne, Espagne, France et Italie) sur la période 1979-1999. Il cherche à répondre, en priorité, aux deux questions suivantes. 1/ Peut-on mettre en évidence, dans chacun de ces pays, des comportements de demande de monnaie stables à long terme et à court terme ? 2/ Si c'est le cas, ces comportements présentent-ils des similitudes ou observe-t-on, d'un pays à l'autre, des différences significatives dans les valeurs des coefficients de la demande de monnaie ? En outre, il aborde la question, beaucoup plus générale, de l'existence ou non d'un retour à la " normale" du côté de la demande de monnaie après une période troublée par les innovations financières. Une modélisation identique est retenue pour tous les pays, à savoir un Modèle Vectoriel à Correction d'Erreur (MVCE). On débouche sur deux séries de conclusions : 1° On observe des différences importantes dans les comportements de demande de monnaie entre les grands pays de la zone euro ; on peut opposer l'Allemagne et la France -où la demande de monnaie apparaît stable -à l'Espagne et l'Italie -où elle ne l''est pas. 2° Plus généralement, l'hypothèse d'un retour à la normale – c’est-à-dire à la stabilité -du côté de la demande de monnaie est confortée ; toutefois, sa dynamique de court terme reste difficile à expliquer.Bordes Christian, Chevrou-Séverac Hélène, Marimoutou Velayoudom. Une Europe monétaire à plusieurs vitesses ? La demande de monnaie dans les grands pays de la zone euro (1979-1999). In: Économie & prévision, n°147, 2001-1. Structure et comportements macro-économiques : comparaisons économiques entre nations. pp. 51-71

Immunonutrition for patients undergoing elective surgery for gastrointestinal cancer: impact on hospital costs

<p>Abstract</p> <p>Background</p> <p>Oral or enteral dietary supplementation with arginine, omega 3 fatty acids and nucleotides (known as immunonutrition) significantly improve outcomes in patients undergoing elective surgery. The objective of the study was to determine the impact on hospital costs of immunonutrition formulas used in patients undergoing elective surgery for gastrointestinal cancer.</p> <p>Methods</p> <p>US hospital costs of stay with and without surgical infectious complications, and average cost per day in the hospital for patients undergoing elective surgery for gastrointestinal cancer were estimated using data from the Healthcare Cost and Utilization Project’s 2008 Nationwide Inpatient Sample. These costs were then used to estimate the impact of perioperative immunonutrition on hospital costs using estimates of reduction in infectious complications or length of stay from a meta-analysis of clinical trials in patients undergoing elective surgery for gastrointestinal cancer. Sensitivity of the results to changes in baseline complication rates or length of stay was tested.</p> <p>Results</p> <p>From the meta-analysis estimates, use of immunonutrition resulted in savings per patient of $3,300 with costs based on reduction in infectious complication rates or$6,000 with costs based on length of hospital stay. Cost savings per patient were present for baseline complication rates above 3.5% or when baseline length of stay and infectious complication rates were reduced to reflect recent US data for those with upper and lower GI elective cancer surgery (range, $1,200 to$6,300).</p> <p>Conclusions</p> <p>Use of immunonutrition for patients undergoing elective surgery for gastrointestinal cancer is an effective and cost-saving intervention.</p