Treatment of primary headache in children: a multicenter hospital-based study in France

The aim of this 6-month, prospective, multicenter study of 398 children and adolescents with primary headaches was to collect data on headache treatment in neuropediatric departments. Treatments were compared before and after consultation. Prior to consultation, the acute treatments that had been prescribed most frequently were paracetamol (82.2% of children) and non-steroidal anti-inflammatory drugs treatment (53.5%); 10.3% had received a prophylactic treatment. No differences in either acute or prophylactic treatment with respect to headache diagnosis were observed. After the neuropediatric consultation, paracetamol was replaced by a non-steroidal anti-inflammatory drug in about three-quarters of cases and by triptan in about one-quarter of cases. The number of children prescribed a prophylactic treatment nearly doubled, whereas there was a 5-fold and 23-fold increase in psychotherapy and relaxation training, respectively, between pre-referral and referral. We conclude that specific treatments were underused for primary headache

Étude pharmacoépidémiologique française de l'utilisation des triptans en médecine générale

Cette étude pharmacoépidémiologique décrit l'utilisation des triptans en médecine générale, auprès de migraineux "naïfs" (n'ayant jamais utilisé un triptan) et "non naïfs" de triptans (expérience antérieure d'un traitement par cette classe thérapeutique). Elle montre que 95 % des patients inclus sont migraineux selon les critères de l'International Headache Society (IHS), ce qui confirme le bon usage des triptans en médecine générale. Les patients bénéficiant de triptans sont des migraineux ayant un profil de sévérité supérieur à celui des migraineux en population générale. Les patients "naïfs" et "non naïfs" ont un profil comparable en termes de diagnostic IHS et de sévérité de la maladie mais les patients "non naïfs" ont une histoire de la maladie plus ancienne et un impact plus marqué sur la qualité de vie. Les raisons des modifications de traitements avancées le plus fréquemment sont la recherche d'une meilleure efficacité de leur nouveau traitement, une action plus rapide, une moindre récurrence et une meilleure tolérance

Heparin-induced thrombocytopenia: an estimate of the average cost in the hospital setting in France.

International audienceHeparin-induced thrombocytopenia is a severe drug adverse effect with possible dramatic consequences. The risk is 0.1% to 5%. The costs of heparin-induced thrombocytopenia in France were estimated using the Programme Médicalisé des Systèmes d'Information (PMSI) national discharge database. Hospitalizations with heparin-induced thrombocytopenia were identified using diagnostic codes. Costs were assessed from the perspective of the French Sickness Fund or hospitals. Heparin-induced thrombocytopenia could be the reason of admission or could occur during the stay and lead to a different tariff or to additional costs associated with extra length of stay. Direct costs were also estimated from experts' opinions. A sensitivity analysis was performed from data collected in 1 center. During 2005, 445 hospitalizations with heparin-induced thrombocytopenia codes were identified. For 45 patients, the main diagnosis was heparin-induced thrombocytopenia; for the remaining 400 patients, heparin-induced thrombocytopenia occurred during the hospital stay. Tariffs and extra costs were used to estimate an overall average cost of 3230 for heparin-induced thrombocytopenia. For patients with heparin-induced thrombocytopenia as main diagnosis, the average cost was 3400; for the patients with heparin-induced thrombocytopenia that occurred during the stay, 1910 was due to an increased of the tariff and 3348 to an increased length of stay. Estimated direct costs of an episode were 3350 to 3700. Different methods were used to arrive at an estimated cost of 3500 for a heparin-induced thrombocytopenia episode for inpatients. One limitation of the study is that heparin-induced thrombocytopenia tends to be underreported by physicians during hospitalization