Modèles d'apprentissage automatique de la persistance aux médicaments : application au cancer du sein

International audienceL'adhésion aux traitements médicamenteux, c'est-a-dire le fait de prendre ses médicaments conformémentà la posologie, aété au centre des attentions ces dernières années. L'Organisation Mondiale de la Santé souligne dans ses rapports 1 que le fait de ne pas respecter le plan de traitement est en réalité un problème majeur, car cela compromet gravement l'efficacité de thérapieà long terme et augmente le coût des services de santé. En effet, dans les pays développés, environ 50% seulement des patients atteints de maladies chroniques suivent correctement leurs traitements. Dans cet article, nous présentons nos travaux sur la modélisation de la consommation de médicaments par les patientes dans les traitements du cancer du sein. Nous nous concentrons sur la persistance au traitement qui indique si le patient a arrêté son parcours de soins avant la fin prévue. Nous détaillons les différentesétapes de notre approche. A partir des données de remboursement du système de santé français, nous reconstruisons les parcours de soins des patients. Ensuite, des méthodes statistiques sont utilisées pour prédire la non-persistance des hormonothérapies et es-timer les variables explicatives des décisions de nos modèles. Nous montrons ainsi que les variables explicatives de notré etude sont conforme auxétudes médicales antérieures sur les facteurs de non persistance. Nous détaillons ensuite la com-paraison de plusieurs méthodes d'apprentissage automatique pour prédire un arrêt de traitement illégitime et discutons leurs limites, en particulier sur l'interprétabilité de leurs résultats.

CPAP resumption after a first termination and impact on all-cause mortality in France

BackgroundContinuation of continuous positive airway pressure (CPAP) therapy after initial prescription has been shown to reduce all-cause mortality versus therapy termination. However, there is a lack of data on the rates and impact of resuming CPAP in patients with obstructive sleep apnoea (OSA). This analysis determined the prevalence of CPAP resumption in the year after termination, characterised determinants of CPAP resumption, and examined the impact of CPAP resumption on all-cause mortality.MethodsFrench national health insurance reimbursement system data for adults aged ≥18 years were used. CPAP prescription was identified by specific treatment codes. Patients who resumed CPAP after first therapy termination and continued to use CPAP for 1 year were matched with those who resumed CPAP then terminated therapy for a second time.ResultsOut of 103 091 individuals with a first CPAP termination, 26% resumed CPAP over the next 12 months, and 65% of these were still using CPAP 1 year later. Significant predictors of CPAP continuation after resumption included male sex, hypertension and CPAP prescription by a pulmonologist. In the matched population, the risk of all-cause death was 38% lower in individuals who continued using CPAP after therapy resumption versus those who had a second therapy discontinuation (hazard ratio 0.62, 95% CI 0.48-0.79; p=0.0001).ConclusionThese data suggest that individuals with OSA who fail initial therapy with CPAP should be offered a second trial with the device to ensure that effective therapy is not withheld from those who might benefit

CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis

International audienceThe nationwide claims data lake for sleep apnoea (ALASKA)—real-life data for understanding and increasing obstructive sleep apnea (OSA) quality of care study—investigated long-term continuous positive airway pressure (CPAP) termination rates, focusing on the contribution of comorbidities. The French national health insurance reimbursement system data for new CPAP users aged ≥18 years were analyzed. Innovative algorithms were used to determine the presence of specific comorbidities (hypertension, diabetes and chronic obstructive pulmonary disease (COPD)). Therapy termination was defined as cessation of CPAP reimbursements. A total of 480,000 patients were included (mean age 59.3 ± 13.6 years, 65.4% male). An amount of 50.7, 24.4 and 4.3% of patients, respectively, had hypertension, diabetes and COPD. Overall CPAP termination rates after 1, 2 and 3 years were 23.1, 37.1 and 47.7%, respectively. On multivariable analysis, age categories, female sex (1.09 (1.08–1.10) and COPD (1.12 (1.10–1.13)) and diabetes (1.18 (1.16–1.19)) were significantly associated with higher CPAP termination risk; patients with hypertension were more likely to continue using CPAP (hazard ratio 0.96 (95% confidence interval 0.95–0.97)). Therapy termination rates were highest in younger or older patients with ≥1 comorbidity. Comorbidities have an important influence on long-term CPAP continuation in patients with OSA

Relationship Between CPAP Termination and All-Cause Mortality

International audienceBackground: Randomized controlled trials have failed to demonstrate an effect of CPAP therapy on mortality. However, these studies have a number of important limitations, including low CPAP adherence, patient selection, and a small number of mortality events.Research question: What are the effects of CPAP therapy termination in the first year on all-cause mortality in OSA patients from the Nationwide Claims Data Lake for Sleep Apnoea study?Study design and methods: Data from the Système National des Données de Santé (SNDS) database, the French national health insurance reimbursement system, for all new CPAP users ≥ 18 years of age were analyzed. The SNDS contains comprehensive, individualized, and anonymized data on health spending reimbursements for > 99% of all individuals living in France. OSA diagnosis was based on specific disease codes, whereas CPAP prescription was identified using specific treatment method codes. CPAP therapy termination was defined as the cessation of CPAP reimbursements triggered by the respiratory physician or sleep specialist in charge of follow-up. Patients who terminated therapy in the first year were propensity score matched with those who continued to use CPAP. The primary outcome was all-cause mortality. Three-year survival was visualized using Kaplan-Meier curves. Contributors to mortality also were determined.Results: Data from two matched groups each including 88,007 patients were included (mean age, 60 years; 64% men). Continuation of CPAP therapy was associated with a significantly lower risk of all-cause death compared with CPAP therapy termination (hazard ratio [HR], 0.61; 95% CI, 0.57-0.65; P < .01, log-rank test). Incident heart failure also was less common in patients who continued vs terminated CPAP therapy (HR, 0.77; 95% CI, 0.71-0.82; P < .01).Interpretation: These real-world data from a comprehensive, unbiased database highlight the potential for ongoing use of CPAP treatment to reduce all-cause mortality in patients with OSA

Relationship Between CPAP Termination and All-Cause Mortality: A French Nationwide Database Analysis.

BackgroundRandomized controlled trials have failed to demonstrate an effect of CPAP therapy on mortality. However, these studies have a number of important limitations, including low CPAP adherence, patient selection, and a small number of mortality events.Research questionWhat are the effects of CPAP therapy termination in the first year on all-cause mortality in patients with OSA from the Nationwide Claims Data Lake for Sleep Apnea study?Study design and methodsData from the Système National des Données de Santé (SNDS) database, the French national health insurance reimbursement system, for all new CPAP users&nbsp;≥ 18 years of age were analyzed. The SNDS contains comprehensive, individualized, and anonymized data on health spending reimbursements for &gt; 99%&nbsp;of all individuals living in France. OSA diagnosis was based on specific disease codes, whereas CPAP prescription was identified using specific treatment method codes. CPAP therapy termination was defined as the cessation of CPAP reimbursements triggered by the respiratory physician or sleep specialist in charge of follow-up. Patients who terminated therapy in the first year were propensity score matched with those who continued to use CPAP. The primary outcome was all-cause mortality. Three-year survival was visualized using Kaplan-Meier curves. Contributors to mortality also were determined.ResultsData from two matched groups each including 88,007 patients were included (mean age, 60 years; 64%&nbsp;men). Continuation of CPAP therapy was associated with a significantly lower risk of all-cause death compared with CPAP therapy termination (hazard ratio [HR], 0.61; 95%&nbsp;CI, 0.57-0.65; P&nbsp;&lt; .01, log-rank test). Incident heart failure also was less common in patients who continued vs&nbsp;terminated CPAP therapy (HR, 0.77; 95%&nbsp;CI, 0.71-0.82; P&nbsp;&lt; .01).InterpretationThese real-world data from a comprehensive, unbiased database highlight the potential for ongoing use of CPAP treatment to reduce all-cause mortality in patients with OSA

CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis.

The nationwide claims data lake for sleep apnoea (ALASKA)-real-life data for understanding and increasing obstructive sleep apnea (OSA) quality of care study-investigated long-term continuous positive airway pressure (CPAP) termination rates, focusing on the contribution of comorbidities. The French national health insurance reimbursement system data for new CPAP users aged ≥18 years were analyzed. Innovative algorithms were used to determine the presence of specific comorbidities (hypertension, diabetes and chronic obstructive pulmonary disease (COPD)). Therapy termination was defined as cessation of CPAP reimbursements. A total of 480,000 patients were included (mean age 59.3 ± 13.6 years, 65.4% male). An amount of 50.7, 24.4 and 4.3% of patients, respectively, had hypertension, diabetes and COPD. Overall CPAP termination rates after 1, 2 and 3 years were 23.1, 37.1 and 47.7%, respectively. On multivariable analysis, age categories, female sex (1.09 (1.08-1.10) and COPD (1.12 (1.10-1.13)) and diabetes (1.18 (1.16-1.19)) were significantly associated with higher CPAP termination risk; patients with hypertension were more likely to continue using CPAP (hazard ratio 0.96 (95% confidence interval 0.95-0.97)). Therapy termination rates were highest in younger or older patients with ≥1 comorbidity. Comorbidities have an important influence on long-term CPAP continuation in patients with OSA