Priorities for health economic methodological research: Results of an expert consultation

Background: The importance of economic evaluation in decision making is growing with increasing budgetary pressures on health systems. Diverse economic evidence is available for a range of interventions across national contexts within Europe, but little attention has been given to identifying evidence gaps that, if filled, could contribute to more efficient allocation of resources. One objective of the Research Agenda for Health Economic Evaluation project is to determine the most important methodological evidence gaps for the ten highest burden conditions in the European Union (EU), and to suggest ways of filling these gaps. Methods: The highest burden conditions in the EU by Disability Adjusted Life Years were determined using the Global Burden of Disease study. Clinical interventions were identified for each condition based on published guidelines, and economic evaluations indexed in MEDLINE were mapped to each intervention. A panel of public health and health economics experts discussed the evidence during a workshop and identified evidence gaps. Results: The literature analysis contributed to identifying cross-cutting methodological and technical issues, which were considered by the expert panel to derive methodological research priorities. Conclusions: The panel suggests a research agenda for health economics which incorporates the use of real-world evidence in the assessment of new and existing interventions; increased understanding of cost-effectiveness according to patient characteristics beyond the “-omics” approach to inform both investment and disinvestment decisions; methods for assessment of complex interventions; improved cross-talk between economic evaluations from health and other sectors; early health technology assessment; and standardized, transferable approaches to economic modeling

Cost-Effectiveness of Magnetic Resonance Imaging with a New Contrast Agent for the Early Diagnosis of Alzheimer's Disease

Background: Used as contrast agents for brain magnetic resonance imaging (MRI), markers for beta-amyloid deposits might allow early diagnosis of Alzheimer’s disease (AD). We evaluated the cost-effectiveness of such a diagnostic test, MRI+CLP (contrastophore-linker-pharmacophore), should it become clinically available. Methodology/Principal Findings: We compared the cost-effectiveness of MRI+CLP to that of standard diagnosis using currently available cognition tests and of standard MRI, and investigated the impact of a hypothetical treatment efficient in early AD. The primary analysis was based on the current French context for 70-year-old patients with Mild Cognitive Impairment (MCI). In alternative ‘‘screen and treat’ ’ scenarios, we analyzed the consequences of systematic screenings of over-60 individuals (either population-wide or restricted to the ApoE4 genotype population). We used a Markov model of AD progression; model parameters, as well as incurred costs and quality-of-life weights in France were taken from the literature. We performed univariate and probabilistic multivariate sensitivity analyses. The base-case preferred strategy was the standard MRI diagnosis strategy. In the primary analysis however, MRI+CLP could become the preferred strategy under a wide array of scenarios involving lower cost and/or higher sensitivity or specificity. By contrast, in the ‘‘screen and treat’’ analyses, the probability of MRI+CLP becoming the preferred strategy remained lower than 5%. Conclusions/Significance: It is thought that anti-beta-amyloid compounds might halt the development of dementia i

Savoir, prévoir, vouloir…

La présidence de cette session est surtout pour moi l’opportunité d’exprimer l’immense estime que je ressens de longue date pour les ingénieurs des Mines. D’abord, et bien évidemment, en raison de l’excellence de votre formation, avec toute la puissance intellectuelle et scientifique qui la caractérise. Il est inutile ici d’énumérer les membres du corps des Mines qui ont joué des rôles nationaux et internationaux dans tous les domaines, et qui sont passés à la postérité. Ensuite, peut-être au..

Principe de précaution et Covid-19 : passion ou raison ?

International audienc

Pandémie de Covid-19 et santé publique. Comment se préparer à la prochaine crise ?

International audienceThe Covid-19 pandemic has sparked unprecedented scientific mobilization, particularly in epidemiology. Despite this, the health burden is such that one can speak of a public health failure. This article discusses the reasons for this hiatus. It emphasizes the importance of the role of occupational physicians in this context. It presents lessons for the future.La pandémie de Covid-19 a suscité une mobilisation scientifique sans précédent, notamment sur le plan épidémiologique. Malgré cela, le fardeau sanitaire est tel que l’on peut parler d’un échec de santé publique. Cet article discute les raisons d’hiatus. Il souligne l’importance du rôle des médecins du travail dans ce contexte. Il présente les leçons à tirer pour l’avenir

Les syndromes médicalement inexpliqués attribués à l’environnement : un révélateur de la relation entre l’environnement et la santé (Commentaire)

Dab William. Les syndromes médicalement inexpliqués attribués à l’environnement : un révélateur de la relation entre l’environnement et la santé (Commentaire). In: Sciences sociales et santé. Volume 28, n°3, 2010. pp. 35-40