Short-Term cost impact of compliance with clinical practice guidelines for initial sarcoma treatment

Background: The impact of compliance to clinical practice guidelines (CPG) on outcomes and/or costs of care has not been completely clarified.Objective: To estimate relationships between medical expenditures and compliance to CPG for initial sarcoma treatment.Research design: Selected cohorts of patients diagnosed with sarcoma in 2005 and 2006, and treated at the University hospital and/or the cancer centre of the Rhône-Alpes region, France (n=90). Main outcome measurements were: patient characteristics, compliance with CPG, health outcomes, and costs. Data were mainly extracted from patient records. The logarithm of treatment costs was modelled using linear and Tobit regressions.Results: Rates of compliance with CPG were 86%, 66%, 88%, 89%, and 95% for initial diagnosis, primary surgical excision, wide surgical excision, chemotherapy, and radiotherapy, respectively. Total average costs reached €24,439, with €1,784, €11,225, €10,360, and €1,016 for diagnosis, surgery (primary and wide surgical excisions), chemotherapy, and radiotherapy, respectively. Compliance of diagnosis with CPG decreased the cost of diagnosis, whereas compliance of primary surgical excision increased the cost of chemotherapy. Compliance of chemotherapy with CPG decreased the cost of radiotherapy.Conclusion: Since chemotherapy is one of the major cost drivers, these results support that compliance with guidelines increases medical care expenditures in short term.Oncology; Sarcoma; Cost; Clinical guidelines; Efficacy; Medical Practices; Government Policy; Regulation; Public Health

Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions

International audienceABSTRACT: BACKGROUND: Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs) remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET) comparing costs and outcomes when clinicians adhered to CPGs and when they did not. METHODS: Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhone-Alpes region of France (in 2005/2006) or in the Veneto region of Italy (in 2007). Data collected retrospectively for the three years after diagnosis were used to determine relapse free survival and health costs (adopting the hospital's perspective and a microcosting approach). All costs were expressed in euros at their 2009 value. A 4% annual discount rate was applied to both costs and effects. The incremental cost-effectiveness ratio (ICER) was expressed as cost per relapse-free year gained when management was compliant with CPGs compared with when it was not. To capture uncertainty surrounding ICER, a probabilistic sensitivity analysis was performed based on a non-parametric bootstrap method. RESULTS: A total of 219 patients were included in the study. Compliance with CPGs was observed for 118 patients (54%). Average total costs reached 23,571 euros when treatment was in accordance with CPGs and 27,313 euros when it was not. In relation to relapse-free survival, compliance with CPGs strictly dominates non compliance, i.e. it is both less costly and more effective. Taking uncertainty into account, the probability that compliance with CPGs still strictly dominates was 75%. CONCLUSIONS: Our findings should encourage physicians to increase their compliance with CPGs and healthcare administrators to invest in the implementation of CPGs in the management of sarcoma

Energy Resolution Performance of the CMS Electromagnetic Calorimeter

The energy resolution performance of the CMS lead tungstate crystal electromagnetic calorimeter is presented. Measurements were made with an electron beam using a fully equipped supermodule of the calorimeter barrel. Results are given both for electrons incident on the centre of crystals and for electrons distributed uniformly over the calorimeter surface. The electron energy is reconstructed in matrices of 3 times 3 or 5 times 5 crystals centred on the crystal containing the maximum energy. Corrections for variations in the shower containment are applied in the case of uniform incidence. The resolution measured is consistent with the design goals

Présentation : Les groupes industriels et financiers - Mode d'organisation et déploiement stratégique

Gilly Jean-Pierre. Présentation : Les groupes industriels et financiers - Mode d'organisation et déploiement stratégique. In: Revue d'économie industrielle, vol. 47, 1er trimestre 1989. Les groupes industriels et financiers. pp. 1-5

Technopoles et développement : mythes et réalités

Gilly Jean-Pierre. Technopoles et développement : mythes et réalités. In: Revue géographique des Pyrénées et du Sud-Ouest, tome 60, fascicule 1, 1989. Bordeaux. pp. 115-124

Présentation : Les groupes industriels et financiers - Mode d'organisation et déploiement stratégique

Gilly Jean-Pierre. Présentation : Les groupes industriels et financiers - Mode d'organisation et déploiement stratégique. In: Revue d'économie industrielle, vol. 47, 1er trimestre 1989. Les groupes industriels et financiers. pp. 1-5

Crise, mutations techniques et transformations des rapports des groupes au territoire

Gilly Jean-Pierre. Crise, mutations techniques et transformations des rapports des groupes au territoire. In: Revue d'économie industrielle, vol. 47, 1er trimestre 1989. Les groupes industriels et financiers. pp. 113-124

L’économie de proximité

Le débat contemporain sur les dynamiques territoriales renvoie dos à dos les thèses qui considèrent les territoires comme déterminés par les processus de mondialisation et les approches “localistes” pour lesquelles les logiques locales sont strictement endogènes. Notre approche qui est centrée sur les phénomènes productifs, repose sur trois hypothèses fondamentales : elle s’inscrit dans le temps de l’histoire, elle est ancrée dans les interrelations entre les acteurs et, surtout, elle prend e..

Nouvelles stratégies spatiales des groupes industriels en Midi-Pyrénées : le rôle croissant de Toulouse

Summary. — Midi-Pyrénées Region. Three public industrial state supported groups were recently developed in Toulouse. They belong to the aeronautical branch (SNIAS and Dassault), the aérospatial (CNES, Thomson, Matra) and the motors (Rénix). These developments illustrate the growing weight of the industrial conglomeration in Toulouse as compared with the regional net of industrial plants and enterprises. Such an evolution which is one of the main present features of the regional balance can be partly explained by the development since 1960 of a local universitary, technical and fundamental research conglomerate and by the increasing implication of the region's productive equipments within the international division of industrial labour.A partir de trois monographies relatives à l'implantation à Toulouse de groupes industriels publics relevant de trois secteurs technologiques appartenant à la lignée des industries des constructions mécaniques, et électro-mécaniques et des composants électroniques, dans les branches de l'aéronautique (SNIAS et Dassault), de l'aérospatiale (CNES, Thomson, Matra), et de l'automobile (Renix), l'auteur souligne le poids industriel croissant de l'agglomération de Toulouse vis-à-vis de Midi-Pyrénées. Il l'explique par la mise en place, dans les années 1960, d'un complexe local de formation et de recherche particulièrement efficace et par l'insertion accrue de la région dans le système de la division internationale du travail.Las nuevas estrategias territoriales de los grupos industriales en Midi-Pyrénées : papel creciente de Toulouse, capital metropolitana. Tres monografías sobre la implantación en Toulouse de grupos industriales estatales para desarrollar tecnología de construcción mecánica, electromecánica y de componentes electrónicos en las tres ramas de la construcción aeronáutica (S.N.I.A.S. y Dassault), del espacio (C.N.E.S., Thomson y Matra) y del automóvil (Renix), evidencian el peso industrial creciente de la aglomeración urbana de Toulouse dentro de Midi-Pyrénées. Lo explicaría la creación en los años 60 de un complejo local de formación y de investigación muy eficaz y también la mayor inserción de la región en el sistema de división internacional del trabajo.Gilly Jean-Pierre. Nouvelles stratégies spatiales des groupes industriels en Midi-Pyrénées : le rôle croissant de Toulouse. In: Revue géographique des Pyrénées et du Sud-Ouest, tome 56, fascicule 1, 1985. pp. 5-16

Forms of Proximity, Local Governance and the Dynamics of Local Economic Spaces: The Case of Industrial Conversion Processes

Starting from an approach that mobilizes a plural definition of proximity - institutional, organizational and geographical - in the aim of endogenizing the space in economic analysis, this article seeks to understand the dynamics of local economic spaces through a re-reading of the concept of local governance. Thus, it stresses the importance of institutional compromise-building processes in explaining the trajectories and the diversity of spatialized forms of economic coordination, and it tackles these by giving an operational definition to the concept of local governance. More precisely, it considers the mechanisms that explain the dynamics of local governance through the distinction between endogenous and exogenous dynamics, a distinction that accounts for the linkages between local governance and macro-economic regulation. Then, in the second part, these theoretical and methodological principles are tested in an analysis of the evolution of local governance in relation to the process of industrial conversion in the aerospace-defence industrial centre located in the Bordeaux conurbation. Copyright Joint Editors and Blackwell Publishers Ltd 2001.