Prise en charge et coûts de la bronchopneumopathie chronique obstructive en France en 2011

RésuméIntroductionCette étude vise à estimer une prévalence de la bronchopneumopathie chronique obstructive (BPCO) traitée et les coûts associés par degré de sévérité.MéthodeElle a été conduite sur les données 2011 de l’échantillon généraliste de bénéficiaires (EGB). Cet échantillon représente 1/97e des bénéficiaires des principaux régimes d’assurance maladie obligatoire. Les cas et leur sévérité ont été identifiés à partir d’algorithmes originaux. Les coûts ont été établis dans une perspective collective.RésultatsLe taux de prévalence minimale de la BPCO traitée a été estimé à 3,8 % dans la population âgée de 40ans et plus, et 1,9 % tous âges confondus. La population (58,2 % d’hommes) avait 68,8±12,7ans d’âge moyen. Au total, 6,2 % des patients ont eu des consommations de soins évocatrices d’un stade très sévère, 8,1 %, 13,8 % et 71,9 % d’un stade sévère, modéré ou peu sévère. Sur une année, 28,8 % ont consulté un pneumologue, 5,0 % ont été hospitalisés (≥24h) pour BPCO et 6,7 % sont décédés. En moyenne, les patients ont eu 1,7±1,5 exacerbations/an et seulement 61,4 % ont reçu un traitement médicamenteux spécifique. La consommation annuelle moyenne de soins d’un patient a été estimée à 9382€ dont 5516€ attribuable à la BPCO.ConclusionCette étude utilisant des bases de données médico-administratives confirme l’importance du fardeau épidémiologique et économique de la BPCO en France.SummaryObjectivesTo estimate the prevalence of treated chronic obstructive pulmonary disease (COPD) and its associated costs by stage of severity.MethodsThe study was conducted on the 2011 data of the french general beneficiary sample database (EGB). EGB is a 1/97th sample of the whole population of the beneficiaries of the main compulsory national health insurances. COPD cases and the level of severity of the disease have been identified using new algorithms established from the available parameters in EGB. Costs were estimated using a collective perspective.ResultsThe minimal prevalence of treated COPD was estimated at 3.8% in patients of 40 years and older and 1.9% regardless of the age of individuals. This population was predominantly male (58.2%) with a mean age of 68.8 years (±12.7). A total of 6.2% of patients had a health-care utilization suggestive of a very severe stage of COPD and 8.1%, 13.8% and 71.9% suggestive of severe, moderate and mild stages respectively. Over one year, 28.8% of patients visited a specialist respiratory physician, 5.0% were hospitalized (≥24h) for COPD and 6.7% died. Patients experienced an average of 1.7 (±1.5) exacerbations per year and only 61.4% received specific pharmacological treatment for COPD during the year. The average yearly health-care cost of a patient with COPD was estimated at €9382, with €5342 directly related to COPD.ConclusionThis study based on medico-administrative databases confirms the high epidemiological and economic burden of COPD in France

Euclidean N=2 Supergravity

Euclidean special geometry has recently been investigated in the context of Euclidean supersymmetric theories with vector multiplets. In the rigid case, the scalar manifold is described by affine special para-Kahler geometry while the target geometries of Euclidean vector multiplets coupled to supergravity are given by projective special para-Kahler manifolds. In this letter, we derive the Killing spinor equations of Euclidean N=2 supergravity theories coupled to vector multiplets. These equations provide the starting point for finding general supersymmetric instanton solutions.Comment: 12 pages, latex. Minor sign corrections in section

Analysis of pore-fluid pressure gradient and effective vertical-stress gradient distribution in layered hydrodynamic systems

A theoretical analysis is carried out to investigate the pore-fluid pressure gradient and effective vertical-stress gradient distribution in fluid saturated porous rock masses in layered hydrodynamic systems. Three important concepts, namely the critical porosity of a porous medium, the intrinsic Fore-fluid pressure and the intrinsic effective vertical stress of the solid matrix, are presented and discussed. Using some basic scientific principles, we derive analytical solutions and explore the conditions under which either the intrinsic pore-fluid pressure gradient or the intrinsic effective vertical-stress gradient can be maintained at the value of the lithostatic pressure gradient. Even though the intrinsic pore-fluid pressure gradient can be maintained at the value of the lithostatic pressure gradient in a single layer, it is impossible to maintain it at this value in all layers in a layered hydrodynamic system, unless all layers have the same permeability and porosity simultaneously. However, the intrinsic effective vertical-stress gradient of the solid matrix can be maintained at a value close to the lithostatic pressure gradient in all layers in any layered hydrodynamic system within the scope of this study

The classical origin of quantum affine algebra in squashed sigma models

We consider a quantum affine algebra realized in two-dimensional non-linear sigma models with target space three-dimensional squashed sphere. Its affine generators are explicitly constructed and the Poisson brackets are computed. The defining relations of quantum affine algebra in the sense of the Drinfeld first realization are satisfied at classical level. The relation to the Drinfeld second realization is also discussed including higher conserved charges. Finally we comment on a semiclassical limit of quantum affine algebra at quantum level.Comment: 25 pages, 2 figure

Cost-Effectiveness of Web-Based Patient-Reported Outcome Surveillance in Patients With Lung Cancer

INTRODUCTION: A multicenter randomized clinical trial in France found an overall survival benefit of web-based patient-reported outcome (PRO)-based surveillance after initial treatment for lung cancer compared with conventional surveillance. The aim of this study was to assess the cost-effectiveness of this PRO-based surveillance in lung cancer patients. METHODS: This medico-economic analysis used data from the clinical trial, augmented by abstracted chart data and costs of consultations, imaging, transportations, information technology, and treatments. Costs were calculated based on actual reimbursement rates in France, and health utilities were estimated based on scientific literature review. Willingness-to-pay thresholds of €30,000 per quality-adjusted life year (QALY) and €90,000 per QALY were used to define a very cost-effective and cost-effective strategy, respectively. Average annual costs of experimental and control surveillance approaches were calculated. The incremental cost-effectiveness ratio was expressed as cost per life-year gained and QALY gained, from the health insurance payer perspective. One-way and multivariate probabilistic sensitivity analyses were performed. RESULTS: Average annual cost of surveillance follow-up was €362 lower per patient in the PRO arm (€941/year/patient) compared to control (€1,304/year/patient). The PRO approach presented an incremental cost-effectiveness ratio of €12,127 per life-year gained and €20,912 per QALY gained. The probabilities that the experimental strategy is very cost-effective and cost-effective were 97% and 100%, respectively. CONCLUSIONS: Surveillance of lung cancer patients using web-based PRO reduced the follow-up costs. Compared to conventional monitoring, this surveillance modality represents a cost-effective strategy and should be considered in cancer care delivery

Microscopic Realization of the Kerr/CFT Correspondence

Supersymmetric M/string compactifications to five dimensions contain BPS black string solutions with magnetic graviphoton charge P and near-horizon geometries which are quotients of AdS_3 x S^2. The holographic duals are typically known 2D CFTs with central charges c_L=c_R=6P^3 for large P. These same 5D compactifications also contain non-BPS but extreme Kerr-Newman black hole solutions with SU(2)_L spin J_L and electric graviphoton charge Q obeying Q^3 \leq J_L^2. It is shown that in the maximally charged limit Q^3 -> J_L^2, the near-horizon geometry coincides precisely with the right-moving temperature T_R=0 limit of the black string with magnetic charge P=J_L^{1/3}. The known dual of the latter is identified as the c_L=c_R=6J_L CFT predicted by the Kerr/CFT correspondence. Moreover, at linear order away from maximality, one finds a T_R \neq 0 quotient of the AdS_3 factor of the black string solution and the associated thermal CFT entropy reproduces the linearly sub-maximal Kerr-Newman entropy. Beyond linear order, for general Q^3<J_L^2, one has a finite-temperature quotient of a warped deformation of the magnetic string geometry. The corresponding dual deformation of the magnetic string CFT potentially supplies, for the general case, the c_L=c_R=6J_L CFT predicted by Kerr/CFT.Comment: 18 pages, no figure