Does the availability of positron emission tomography modify diagnostic strategies for solitary pulmonary nodules? An observational study in France

International audienceBACKGROUND: Previous studies showed that at the individual level, positron emission tomography (PET) has some benefits for patients and physicians in terms of cancer management and staging. We aimed to describe the benefits of (PET) in the management of solitary pulmonary nodules (SPNs) in a population level, in terms of the number of diagnostic and invasive tests performed, time to diagnosis and factors determining PET utilization. METHODS: In an observational study, we examined reports of computed tomography (CT) performed and mentioning "spherical lesion", "nodule" or synonymous terms. We found 11,515 reports in a before-PET period, 2002-2003, and 20,075 in an after-PET period, 2004-2005. Patients were followed through their physician, who was responsible for diagnostic management. RESULTS: We had complete data for 112 patients (73.7%) with new cases of SPN in the before-PET period and 250 (81.4%) in the after-PET period. Patients did not differ in mean age (64.9 vs. 64.8 years). The before-PET patients underwent a mean of 4 tests as compared with 3 tests for the after-PET patients (p = 0.08). Patients in the before-PET period had to wait 41.4 days, on average, before receiving a diagnosis as compared with 24.0 days, on average, for patients in the after-PET period who did not undergo PET (p < 0.001). In the after-PET period, 11% of patients underwent PET during the diagnostic process. A spiculated nodule was more likely to determine prescription for PET (p < 0.001). Multivariate analysis revealed that patients in both periods underwent fewer tests when PET was prescribed by general practitioners (p < 0.001) and if the nodule was not spiculated (p < 0.001). The proportion of unnecessary invasive approaches prescribed (47% vs. 49%) did not differ between the groups. CONCLUSION: In our study, 1 year after the availability of PET, the technology was not the first choice for diagnostic management of SPN. Even though we observed a tendency for reduced number of tests and mean time to diagnosis with PET, these phenomena did not fully relate to PET availability in health communities. In addition, the availability of PET in the management of SPN diagnosis did not reduce the overall rate of unnecessary invasive approaches

Une représentation de l'économie française : le modèle DMS

Modelling French economy : DMS INSEE. Service des Programmes Macro-economic forecasts used during the preparation of the VIIIth (1981-1985) french Plan were built with the help of a dynamic macro-econometric model. This model, called DMS (Dynamique Multi Sectoriel), has been developed from 1974 to 1976 at thé INSEE (Service des Programmes). The most direct approach to DMS consists in a survey of its main equations. Three important features appears then : the role of time-lags for dynamic properties of the projections ; a complete description for eleven sectors, including price determination ; in each of the three manufacturing industries a clay-clay vintage model implies a sort of memory for thé economy on médium term outlook. However a model cannot be summarized by the list of its equations. It involves many kinds of relationships between institutional sectors and simulates regulation procedures like in the real economy. According to DMS, most of these relationships relies on the twin-aspects of capital, both physical and financial matter of économie behaviour. Key desequilibrium-indicators are bound to these aspects : the degree of utilization of capacity and the profit rate; they order regulation processes, especially the moves of prices and investment from year to year. How sophisticated the model maybe, it remains a very rough figure compared with economic reality. Econometric methods are based on statistical data analyses, refering to years ago ; are they really able to underly projections in the future ? Business fixed investment funitions of DMS model depends on profit rates, especially in the non-industrial sectors, how far can it be expected that accelarator effects have nowadays a greater influence ? DMS includes no monetary and financial sector ; what sort of discrepanciesmay result from external hypothesis on irïterest rates and external exchange rates ? The DMS-team of economist had to answer those basic questions1 in each working parties designed to prépare the VIIIth Plan. Part of the answer s are given in the paper, waiting for new improvement in statistical and economic research or analysis.de L'INSEE Service des Programmes. Une représentation de l'économie française : le modèle DMS. In: Revue économique, volume 31, n°5, 1980. pp. 930-981

Une représentation de l'économie française : le modèle DMS

[fre] Modelling French economy : DMS . INSEE. Service des Programmes. Macro-economic forecasts used during the preparation of the VIIIth (1981-1985) french Plan were built with the help of a dynamic macro-econometric model. This model, called DMS (Dynamique Multi Sectoriel), has been developed from 1974 to 1976 at thé INSEE (Service des Programmes).. The most direct approach to DMS consists in a survey of its main equations. Three important features appears then : the role of time-lags for dynamic properties of the projections ; a complete description for eleven sectors, including price determination ; in each of the three manufacturing industries a clay-clay vintage model implies a sort of memory for thé economy on médium term outlook. . However a model cannot be summarized by the list of its equations. It involves many kinds of relationships between institutional sectors and simulates regulation procedures like in the real economy. According to DMS, most of these relationships relies on the twin-aspects of capital, both physical and financial matter of économie behaviour. Key desequilibrium-indicators are bound to these aspects : the degree of utilization of capacity and the profit rate; they order regulation processes, especially the moves of prices and investment from year to year. . How sophisticated the model maybe, it remains a very rough figure compared with economic reality. Econometric methods are based on statistical data analyses, refering to years ago ; are they really able to underly projections in the future ? . Business fixed investment funitions of DMS model depends on profit rates, especially in the non-industrial sectors, how far can it be expected that accelarator effects have nowadays a greater influence ? DMS includes no monetary and financial sector ; what sort of discrepanciesmay result from external hypothesis on irïterest rates and external exchange rates ? The DMS-team of economist had to answer those basic questions1 in each working parties designed to prépare the VIIIth Plan. Part of the answer s are given in the paper, waiting for new improvement in statistical and economic research or analysis.

Rentabilité et productivité. Une comparaison France-R.F.A. sur la période 1960-1974

[eng] M. Gabet - Profitability and rentability : a France-Germany comparison over the period 1960-1974. On the basis of harmonized data, the article is comparing, in 11 branches, the level and evolution of the productivity of labour and of capital, and of profitability both in France and in Germany, from 1960 to 1974. The figures show that while profitability and efficiency of fixed capital are higher in the French economy as a whole, and are not undergoing the same decreasing trend as in Germany, the situation is the opposite in industry, and in particular in the intermediate industries, where Germany is showing higher levels of capital efficiency and profitability, notwithstanding the tendency more favourable to industry, which observed in France, since 1968. [fre] M. Gabet - Rentabilité et productivité une comparaison France-RFA sur la periode 1960-1974. L'article, à partir de données statistiques harmonisées, compare, dans 11 branches, le niveau et 1' évolution de la productivité du travail et du capital, puis de la rentabilité en France et en RFA entre 1960 et 1974. On y constate que si la rentabilité et l'efficacité du capital fixe sont supérieurs en France dans l'ensemble de l'économie et ne subissent pas la nette décroissance enregistrée en RFA, il en est autrement dans l'industrie, et en particulier dans les industries intermédiaires où la RFA montre une efficacité meilleure dans la mise en œuvre du capital fixe et y enregistre une rentabilité plus élevée, malgré le tournant pris en France, à partir de 1968, en faveur de l'industrie.

Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis (nash) in five european countries in 2018: A cost-of-illness analysis.

BACKGROUND AND AIMS Non-alcoholic steatohepatitis (NASH) is a chronic disease that can progress to end-stage liver disease (ESLD). A large proportion of early-stage NASH patients remain undiagnosed compared to those with advanced fibrosis, who are more likely to receive disease management interventions. This study estimated the disease burden and economic impact of diagnosed NASH in the adult population of France, Germany, Italy, Spain and the United Kingdom (UK) in 2018. METHODS The socioeconomic burden of diagnosed NASH was estimated using cost-of-illness methodology applying a prevalence approach to estimate the number of adults with NASH and the attributable economic and wellbeing costs. Given undiagnosed patients do not incur costs in the study, the probability of diagnosis is central to cost estimation. The analysis was based on literature review, databases and consultation with clinical experts, economists and patient groups. RESULTS The proportion of adult NASH patients with a diagnosis ranged from 11.9% to 12.7% across countries, which increased to 38.8% to 39.1% for advanced fibrosis (F3 to F4 compensated cirrhosis). Total economic costs were €8,548-19,546M. Of these, health system costs were €619-1,292M. Total wellbeing costs were €41,536-90,379M. The majority of the undiagnosed population (87.3% to 88.2% of total prevalence) was found to have early stage NASH which, left untreated, may progress to more resource consuming ESLD over time. CONCLUSIONS This study found the majority of economic and wellbeing costs of NASH are experienced in late disease stages. Earlier diagnosis and care of NASH patients could reduce future healthcare costs