Helicobacter Pylori dans le biofilm oral et ses conséquences sur les infections gastriques : analyse de la littérature et proposition d'un protocole de prise en charge multidisciplinaire

H . Pylori est responsable de gastrites chroniques, ulcères peptidiques et carcinomes gastriques. La cavité buccale, et plus particulièrement les poches parodontales des patients atteints de parodontites rassembleraient les conditions idéales pour héberger la bactérie et se comporterait comme un réservoir pour la réinfection gastrique, entrainant un échec de la triple thérapie. En effet, les antibiotiques systémiques n'agiraient sur les bactéries du biofilm sous-gingival uniquement lorsque celui-ci est désorganisé. La rédaction d'un article scientifique intitulé Helicobacter Pylori et maladies parodontales : mise à jour et proposition d'un protocole clinique multidisciplinaire , reprenant les données actuelles de la littérature en lien avec ce sujet a permis d'aboutir à une proposition de procédure de soins alliant antibiotiques systémiques et traitement mécanique parodontal afin de réduire à un minimum, par le biais de soins bucco-dentaire, les récidives d'infection gastrique à H. Pylori tout en traitant la maladie parodontale.NANTES-BU Médecine pharmacie (441092101) / SudocNANTES-Bib.Odontologie (441092219) / SudocSudocFranceF

Cost-effectiveness of the adjuvanted quadrivalent influenza vaccine in the elderly Belgian population

Background Between 2015 and 2019, when 62% of Belgian adults aged ≥65 years were vaccinated with standard quadrivalent influenza vaccines, influenza caused an average of 3,905 hospitalizations and 347 premature deaths per year in older adults. The objective of the present analysis was to estimate the cost-effectiveness of the adjuvanted quadrivalent influenza vaccine (aQIV) compared to the standard (SD-QIV) and high-dose (HD-QIV) vaccines in elderly Belgians. Research Design and Methods The analysis was based on a static cost-effectiveness model that captured the evolution of patients infected with influenza and was customized with available national data. Results Vaccinating adults aged ≥65 years with aQIV instead of SD-QIV would decrease the number of hospitalizations by 530 and the number of deaths by 66 in the 2023–2024 influenza season. aQIV was cost-effective compared to SD-QIV with an incremental cost of €15,227/quality-adjusted life year (QALY). aQIV is cost-saving when compared to HD-QIV in the subgroup of institutionalized elderly adults who were granted reimbursement for this vaccine. Conclusion In a health care system striving to improve the prevention of infectious diseases, a cost-effective vaccine such as aQIV is a key asset to reduce the number of influenza-related hospitalizations and premature deaths in older adults

Cost-effectiveness of retreatment with varenicline after failure with or relapse after initial treatment for smoking cessation

AbstractObjectivesA recent trial showed the clinical benefit of retreatment with varenicline in subjects failing on the initial treatment, or relapsing after initial success. The objective of this study was to evaluate the cost-effectiveness of retreatment with varenicline compared with other smoking cessation interventions.MethodsA published Markov model was adapted to compare one quit attempt of varenicline followed by retreatment to treatment/retreatment with nicotine replacement therapy (NRT), bupropion or placebo, and with only 1 quit attempt of varenicline. Efficacy was obtained from clinical trials. Incidence of smoking-related diseases was based on published data. Cost of therapies and complications was obtained from databases and literature.ResultsFor 1000 smokers willing to quit, varenicline retreatment saves 275,000€, 118,000€, 316,000€ and 237,000€ compared to NRT, bupropion, placebo, or one single varenicline quit attempt respectively at lifetime and from the healthcare payer perspective. The number of quality adjusted life years gained is 74, 63, 193 and 111 respectively. Sensitivity analyses showed the robustness of these findings.ConclusionThis analysis suggests that in the long term, varenicline retreatment is a dominant intervention, meaning both greater health gains and greater costs saved, over other possible interventions and therefore should be considered as a standard option

Changes to the statin prescribing policy in Belgium potential impact in clinical and economic terms

Background and Objective: New policies in Belgium encourage prescribing of generic HMG-CoA reductase inhibitors (statins), but may lead to non-equivalent switching of patients from more potent second generation statins, as has occurred elsewhere. We sought to assess the potential health economic impact of the new policies. Design: This was a cost-effectiveness analysis. Methods: A Markov model was constructed to simulate the onset of cardiovascular disease (CVD) and death among a representative cohort of 80 Belgian patients initially free of CVD and taking atorvastatin. Cardiovascular risks were estimated from calibrated Framingham equations, and utilities and costs from published data. Decision analysis assessed the potential impact of switching all 80 patients to simvastatin. Changes in lipid levels expected to arise from switching were based on a published meta-analysis. Results: If the 80 patients remained on atorvastatin, the model predicted that 23 (29%) would develop CVD over 20 years. If they were switched to simvastatin, the predicted number was 25 (31%), equating to a 'number needed to harm' of 52. Switching would lead to a net cost saving of (sic)131 (2012) per subject, but also a loss of 0.03 quality-adjusted life-years (QALYs) per subject. These equated to a decremental cost-effectiveness ratio of (sic)4777 per QALY lost. Sensitivity analyses indicated this result to be robust. Conclusion: Recently introduced statin prescribing policies in Belgium are likely, as intended, to reduce statin costs, but also increase the burden of CVD due to non-equivalent switching. It would be cost effective to maintain patients on atorvastatin for primary prevention rather than switch them to simvastatin

Cost-effectiveness of retreatment with varenicline after failure with or relapse after initial treatment for smoking cessation

A recent trial showed the clinical benefit of retreatment with varenicline in subjects failing on the initial treatment, or relapsing after initial success. The objective of this study was to evaluate the cost-effectiveness of retreatment with varenicline compared with other smoking cessation interventions.status: publishe

Cost effectiveness of apixaban versus aspirin for stroke prevention in patients with non-valvular atrial fibrillation in Belgium

Evidence indicates that vitamin K antagonists (VKAs) and oral anticoagulant therapy are under-utilised for stroke prevention in patients with non-valvular atrial fibrillation (AF), and patients who decline or cannot tolerate such treatment are often prescribed aspirin instead. Apixaban has been shown in the AVERROES trial to be superior to aspirin in preventing stroke and systemic embolism without significantly increasing the risk of major bleeding among patients with AF who are unsuitable for VKA therapy. This study estimates the economic implications and potential cost effectiveness of apixaban compared with aspirin in such individuals from the perspective of healthcare payers in Belgium. A Markov model was developed to evaluate the clinical and economic impact of apixaban compared with aspirin in patients unsuitable for VKA therapy. The clinical events modelled include ischaemic and haemorrhagic stroke, systemic embolism, intracranial haemorrhage, other major bleeding, clinically relevant non-major bleeding, myocardial infarction, cardiovascular hospitalisation and treatment discontinuations obtained from AVERROES. Outcomes included life-years and quality-adjusted life-years (QALYs) gained, costs and incremental cost-effectiveness ratios (ICERs) over a lifetime. Apixaban was projected to increase life expectancy and QALYs compared with aspirin, with an associated increase in drug acquisition costs. The estimated ICER was a,not sign7,334 per QALY gained with apixaban compared with aspirin. Apixaban is a cost-effective alternative to aspirin for patients with AF in Belgium who decline or cannot tolerate VKA treatment

Cost effectiveness of Varenicline in Belgium, compared with Bupropion, nicotine replacement therapy, brief counselling and unaided smoking cessation : a BENESCO Markov cost-effectiveness analysis

Background and Objective: Varenicline is a nicotinic acetylcholine receptor partial agonist that is approved for use as an aid to smoking cessation. Randomized clinical trials show that its efficacy is superior to that of other current smoking cessation therapies. This study set out to determine the cost effectiveness of varenicline relative to other smoking cessation interventions (bupropion and nicotine replacement therapy [NRT]) as well as brief counselling alone and unaided cessation in a cohort of Belgian adult smokers making a one-time quit attempt, from the perspective of the healthcare payer (public and private). Methods: A Markov model, the Benefits of Smoking Cessation on Outcomes (BENESCO) model, was applied to calculate the long-term health and economic benefits of smoking cessation. Cost effectiveness was expressed as cost per life-year (LY) gained and cost per quality-adjusted life-year (QALY) gained. Clinical and economic model inputs were obtained from the literature and public healthcare databases. Costs were discounted at 3% and health outcomes at 1.5%. A probabilistic sensitivity analysis and a one-way sensitivity analysis were performed to test the robustness of the results. Results: Varenicline is associated with a reduction of smoking-related morbidity and mortality as well as with a decrease in healthcare costs compared with the pharmacological agents bupropion and NRT. Varenicline also leads to additional LYs and QALYs compared with brief counselling alone and unaided cessation over a lifetime period. Varenicline is a dominant strategy compared with bupropion and NRT. Compared with brief counselling alone and unaided cessation, varenicline presents a cost/QALY of (sic)240 and (sic)1656, respectively. Conclusion: Varenicline is a cost-effective alternative to brief counselling and unaided cessation, and is a cost-saving treatment in comparison with bupropion and NRT, in a Belgian population of smokers willing to quit