Therapeutic management of uncomplicated gastroesophageal reflux disease in france in 2005: Potential cost savings of omeprazole substitution

AbstractBackground: Proton pump inhibitors (PPIs) cost the French health care system >€1 billion in 2005, and ~50% of PPI prescriptions were for the treatment of gastroesophageal reflux disease (GERD).Objectives: This study aimed to describe the current use of PPIs for GERD, to estimate the total annual costs of treatment, and to evaluate the economic impact of the various possible substitutions among PPIs available for this indication in France.Methods: Data from a sample of patients aged ≥20 years who visited their general practitioner (GP) at least once in 2005 for uncomplicated, symptomatic GERD were retrieved from the Thales database (a group of 1200 representative GPs connected to a computerized network). Costs of the prescriptions presented for reimbursement and costs of those reimbursed by the French health care insurance system were analyzed. We then evaluated the economic consequences of replacing full-dose generic omeprazole (after substitution from brand-name omeprazole by the pharmacists) with other compounds that are indicated for mild symptoms at half dose (ie, lansoprazole 15 mg, pantoprazole 20 mg, rabeprazole 10 mg, and esomeprazole 20 mg). The results were adjusted to account for the proportions of patients who had full health care coverage and the treatment duration as reported in the database. Results are presented from the perspective of the French health care insurance system.Results: In 2005, a total of 122,571 patients (mean age, 55.7 years; 45.5% men; 13.8% with a history of at least 1 gastrointestinal disorder) met the inclusion criteria. Extrapolated to the French population, this sample corresponded to ≈5.7 million people (ie, 13% of the adult population who visited a GP during the year). PPIs were prescribed as first-line treatment for GERD in 84.1% of the consultations (14.3% in association with other antiulcer drugs). Omeprazole, as a proprietary or generic drug, was prescribed most often (78.9%) and at full dose (20 mg), while other compounds (lansoprazole, pantoprazole, rabeprazole, and esomeprazole) were prescribed at half dose in 64.3% of cases. The extrapolated annual cost of PPIs reimbursed for this indication was €465.02 million at a mean reimbursement level of 72.7%. Brand-name omeprazole still accounted for ≈11% of the total cost reimbursed. Complete replacement of brand-name omeprazole with its generic counterpart would have reduced costs by €18.35 million (a decrease of 4.3% in the total reimbursed expenditure). The switch from generic full-dose omeprazole to a half dose of other PPIs would have allowed further savings ranging from €2.59 million (with lansoprazole) to €13.19 million (with pantoprazole).Conclusion: In accordance with recent recommendations for the treatment of uncomplicated GERD and based on the 2006 PPI pricing, switching from branded full-dose omeprazole to generic omeprazole or to the use of half doses of other PPIs may allow cost savings in France

Prevalence and burden of self-reported blindness and low vision for individuals living in institutions: a nationwide survey

BACKGROUND: The prevalence of self-reported low vision (LV) and blindness, and their associated disabilities, handicaps and socio-economic consequences for individuals living in institutions are poorly documented. METHODS: 2,075 institutions were selected at random and eight individuals were picked at random from the list of residents. Three groups of individuals were defined: blind, LV, and a control group (CG). These were compared after adjustment for age and co-morbidities. Of the 15,403 individuals, 14,603 interviews (94.9%) were completed. RESULTS: The prevalence of blindness was 1.6% and the LV 13.4%. Blind individuals needed assistance more often (OR: 2.65 to 11.35) than CG members while the assistance required by LV individuals was similar to that for the CG. Blind individuals required institution adaptation (building and furniture changes) more often than the CG. Blind (57.9%) and LV individuals (35.4%) were more often registered for social allowances. Monthly social allowances were EUR 86 higher for blind than LV individuals. Monthly family incomes were found to be similar between the three groups (from EUR 782 to 797). Social and demographic data, institution description, income, handicaps, disabilities, social allowances and details of daily activities were collected interviews CONCLUSION: The results demonstrate the impact of self-reported blindness and LV on daily life for patients living in institutions

Prevalence of mental disorders in French prisons for men

BACKGROUND: Psychiatric surveys conducted in prison populations find high prevalence rates, but diagnoses may be difficult in this particular context. None of these surveys have been conducted in France. METHODS: 800 incarcerated male were sampled at random. Each prisoner was interviewed by a group of 2 clinicians, at least one of them being a senior psychiatrist. One of the clinicians used a structured clinical interview which generated DSM IV diagnosis (MINI plus); the second completed the procedure with an open clinical interview. RESULTS: Prevalence rates for a diagnosis given independently by both clinicians and for a consensual diagnosis were respectively: 3.8% (6.2%) for schizophrenia, 17.9% (24%) for major depressive disorder, 12.0% (17.7%) for generalized anxiety and 10.8% (14.6%) for drug dependence. CONCLUSION: Psychiatric diagnosis can be difficult to interpret in prison, especially using traditional standardized interviews. The approach proposed here, with good reliability and closer to a day-to-day clinical practice, yields high prevalence rates

L’investissement industriel en recherche clinique à l’hôpital : une estimation pour la France en 2010

Une estimation de l’investissement industriel en recherche clinique à l’hôpital en France pour l’année 2010 a été réalisée par une modélisation combinant différentes sources d’informations sur les volumes d’études réalisées et les coûts unitaires par patient correspondants. Les effectifs des patients inclus dans des essais cliniques ont été obtenus à partir d’une extraction de la base du National Institute of Health (NIH). Les coûts unitaires par patient ont été estimés à partir d’un échantillon de 54 études diversifiées en termes de phase et de domaine thérapeutique fournies de façon indépendante par 5 laboratoires internationaux volontaires. L’extraction de la base NIH a permis d’identifier 1 178 études ayant inclus au total 73 000 patients français. Ces études portaient pour 40,3 % d’entre elles sur l’onco-hématologie et pour 12,8 % sur les maladies rares. L’investissement industriel total en France pour 2010 en recherche clinique à l’hôpital a été estimé à 488 million d’euros se décomposant en 83,6 M€ d’honoraires médicaux (17 %), 73 M€ de surcoûts hospitaliers (15 %), 99 M€ de fournitures de médicaments (20 %) et 232 M€ de coûts internes aux laboratoires français (48 %)