Les anti-TNFa en région Midi-Pyrénées : aspects thérapeutiques et économiques

Les médicaments anti-TNFa apparus à la fin des années 1990 ont bouleversé la prise en charge de deux maladies inflammatoires chroniques et invalidantes : la polyarthrite rhumatoïde et la maladie de Crohn. Une nouvelle option thérapeutique était ainsi disponible pour des patients qui ne répondaient plus ou qui devenaient intolérants aux traitements traditionnels. Le coût très élevé de ces traitements a entraîné une limitation de leur accès, notamment dans la région Midi-Pyrénées entre 1999 et 2003. Des solutions ont été trouvées pour que les patients aient finalement leur traitement mais ces restrictions budgétaires n'ont pas été sans soulever un débat éthique : peut-on refuser un traitement pour des raisons économiques ?TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocSudocFranceF

Estimates of effectiveness and impact of nirsevimab on hospitalisations for RSV bronchiolitis in metropolitan France, 2023-2024 : a modelling study

BackgroundRespiratory Syncytial Virus (RSV) is a major cause of hospitalisations and deaths amonginfants worldwide. France was one of the first countries to administer nirsevimab, asingle-dose long acting monoclonal antibody treatment to prevent lower respiratory tractinfection caused by RSV. Effectiveness in real-world settings and impact in terms ofhospitalisations averted are not well known.MethodsWe developed an age-structured deterministic model characterising RSV transmission aswell as plausible scenarios for the administration of nirsevimab doses based on delivery datato maternity wards and pharmacies. We estimated nirsevimab effectiveness and the numberof hospitalisations for RSV bronchiolitis following emergency room visits (HBER-RSV)averted, by calibrating the model to hospital and virological surveillance data from mid-2017to February 4, 2024, alongside serological data.FindingsWe estimated that nirsevimab administration prevented 5,800 (95% CI: 3,700-7,800)HBER-RSV, including 4,200 (2,900-5,600) among those aged 0-2 months, betweenSeptember 15, 2023 and February 4, 2024. This corresponds to a 23% (16%-30%) reductionin the total number of HBER-RSV (35%, 25%-44%, among 0-2 months) compared to thescenario without administration. In our baseline scenario with 215,000 doses administeredby January 31, 2024, the effectiveness of nirsevimab against HBER-RSV was estimated at73% (61%-84%), which corresponds to 1 HBER-RSV case prevented for every 39 (26-54)doses administered. The estimated number of HBER-RSV averted was insensitive to theassumed administration scenario; but effectiveness varied slightly.InterpretationWith 1 HBER-RSV averted for about every 40 children treated, our study highlights therelevance of nirsevimab administration to reduce RSV hospitalisation

Estimates of effectiveness and impact of nirsevimab on hospitalisations for RSV bronchiolitis in metropolitan France, 2023-2024 : a modelling study

BackgroundRespiratory Syncytial Virus (RSV) is a major cause of hospitalisations and deaths amonginfants worldwide. France was one of the first countries to administer nirsevimab, asingle-dose long acting monoclonal antibody treatment to prevent lower respiratory tractinfection caused by RSV. Effectiveness in real-world settings and impact in terms ofhospitalisations averted are not well known.MethodsWe developed an age-structured deterministic model characterising RSV transmission aswell as plausible scenarios for the administration of nirsevimab doses based on delivery datato maternity wards and pharmacies. We estimated nirsevimab effectiveness and the numberof hospitalisations for RSV bronchiolitis following emergency room visits (HBER-RSV)averted, by calibrating the model to hospital and virological surveillance data from mid-2017to February 4, 2024, alongside serological data.FindingsWe estimated that nirsevimab administration prevented 5,800 (95% CI: 3,700-7,800)HBER-RSV, including 4,200 (2,900-5,600) among those aged 0-2 months, betweenSeptember 15, 2023 and February 4, 2024. This corresponds to a 23% (16%-30%) reductionin the total number of HBER-RSV (35%, 25%-44%, among 0-2 months) compared to thescenario without administration. In our baseline scenario with 215,000 doses administeredby January 31, 2024, the effectiveness of nirsevimab against HBER-RSV was estimated at73% (61%-84%), which corresponds to 1 HBER-RSV case prevented for every 39 (26-54)doses administered. The estimated number of HBER-RSV averted was insensitive to theassumed administration scenario; but effectiveness varied slightly.InterpretationWith 1 HBER-RSV averted for about every 40 children treated, our study highlights therelevance of nirsevimab administration to reduce RSV hospitalisation

Estimates of effectiveness and impact of nirsevimab on hospitalisations for RSV bronchiolitis in metropolitan France, 2023-2024 : a modelling study

BackgroundRespiratory Syncytial Virus (RSV) is a major cause of hospitalisations and deaths amonginfants worldwide. France was one of the first countries to administer nirsevimab, asingle-dose long acting monoclonal antibody treatment to prevent lower respiratory tractinfection caused by RSV. Effectiveness in real-world settings and impact in terms ofhospitalisations averted are not well known.MethodsWe developed an age-structured deterministic model characterising RSV transmission aswell as plausible scenarios for the administration of nirsevimab doses based on delivery datato maternity wards and pharmacies. We estimated nirsevimab effectiveness and the numberof hospitalisations for RSV bronchiolitis following emergency room visits (HBER-RSV)averted, by calibrating the model to hospital and virological surveillance data from mid-2017to February 4, 2024, alongside serological data.FindingsWe estimated that nirsevimab administration prevented 5,800 (95% CI: 3,700-7,800)HBER-RSV, including 4,200 (2,900-5,600) among those aged 0-2 months, betweenSeptember 15, 2023 and February 4, 2024. This corresponds to a 23% (16%-30%) reductionin the total number of HBER-RSV (35%, 25%-44%, among 0-2 months) compared to thescenario without administration. In our baseline scenario with 215,000 doses administeredby January 31, 2024, the effectiveness of nirsevimab against HBER-RSV was estimated at73% (61%-84%), which corresponds to 1 HBER-RSV case prevented for every 39 (26-54)doses administered. The estimated number of HBER-RSV averted was insensitive to theassumed administration scenario; but effectiveness varied slightly.InterpretationWith 1 HBER-RSV averted for about every 40 children treated, our study highlights therelevance of nirsevimab administration to reduce RSV hospitalisation

Estimates of effectiveness and impact of nirsevimab on hospitalisations for RSV bronchiolitis in metropolitan France, 2023-2024 : a modelling study

BackgroundRespiratory Syncytial Virus (RSV) is a major cause of hospitalisations and deaths amonginfants worldwide. France was one of the first countries to administer nirsevimab, asingle-dose long acting monoclonal antibody treatment to prevent lower respiratory tractinfection caused by RSV. Effectiveness in real-world settings and impact in terms ofhospitalisations averted are not well known.MethodsWe developed an age-structured deterministic model characterising RSV transmission aswell as plausible scenarios for the administration of nirsevimab doses based on delivery datato maternity wards and pharmacies. We estimated nirsevimab effectiveness and the numberof hospitalisations for RSV bronchiolitis following emergency room visits (HBER-RSV)averted, by calibrating the model to hospital and virological surveillance data from mid-2017to February 4, 2024, alongside serological data.FindingsWe estimated that nirsevimab administration prevented 5,800 (95% CI: 3,700-7,800)HBER-RSV, including 4,200 (2,900-5,600) among those aged 0-2 months, betweenSeptember 15, 2023 and February 4, 2024. This corresponds to a 23% (16%-30%) reductionin the total number of HBER-RSV (35%, 25%-44%, among 0-2 months) compared to thescenario without administration. In our baseline scenario with 215,000 doses administeredby January 31, 2024, the effectiveness of nirsevimab against HBER-RSV was estimated at73% (61%-84%), which corresponds to 1 HBER-RSV case prevented for every 39 (26-54)doses administered. The estimated number of HBER-RSV averted was insensitive to theassumed administration scenario; but effectiveness varied slightly.InterpretationWith 1 HBER-RSV averted for about every 40 children treated, our study highlights therelevance of nirsevimab administration to reduce RSV hospitalisation