The Cost of Cochlear Implantation: A Review of Methodological Considerations

Objectives. Cost studies can provide useful guidance, so long as they adhere to accepted methodology. Cochlear implants (CIs) are electronic devices introduced surgically into the inner ear. It is a relevant example to review cost study analyses because of its costliness. The aim of this study was to review relevant published cost studies of CI to analyze the method used. Methods. First, we described the key points of cost study methodology. Cost studies relating to CI were systematically reviewed, focussing on an analysis of the different methods used. Results. The methods, data sources, and estimated cost categories in each study varied widely. The paper showed that cost studies adopted significantly different approaches to estimate costs of CI, reflecting a lack of consensus on the methodology of cost studies. Conclusion. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable

The Progeny of Arabidopsis thaliana Plants Exposed to Salt Exhibit Changes in DNA Methylation, Histone Modifications and Gene Expression

Plants are able to acclimate to new growth conditions on a relatively short time-scale. Recently, we showed that the progeny of plants exposed to various abiotic stresses exhibited changes in genome stability, methylation patterns and stress tolerance. Here, we performed a more detailed analysis of methylation patterns in the progeny of Arabidopsis thaliana (Arabidopsis) plants exposed to 25 and 75 mM sodium chloride. We found that the majority of gene promoters exhibiting changes in methylation were hypermethylated, and this group was overrepresented by regulators of the chromatin structure. The analysis of DNA methylation at gene bodies showed that hypermethylation in the progeny of stressed plants was primarily due to changes in the 5′ and 3′ ends as well as in exons rather than introns. All but one hypermethylated gene tested had lower gene expression. The analysis of histone modifications in the promoters and coding sequences showed that hypermethylation and lower gene expression correlated with the enrichment of H3K9me2 and depletion of H3K9ac histones. Thus, our work demonstrated a high degree of correlation between changes in DNA methylation, histone modifications and gene expression in the progeny of salt-stressed plants

Etude médico-économique comparant les coûts hospitaliers de la résection monopolaire et de la vaporisation bipolaire transurétrale de la prostate

Objectifs : Comparer les coûts des 2 techniques. Pré-requis : elles sont équivalentes en termes de résultats fonctionnels. Méthodes : 86 patients consécutifs présentant une HBP symptomatique résistant au traitement médical ou compliquée ont été répartis en 2 groupes homogènes de manière non randomisée prospective monocentrique, en intention de traiter (42 en VBTUP et 44 en RTUP). La présence d un adénocarcinome de prostate, d une sclérose du col vésical ou d une sténose de l urètre étaient un critère d exclusion. Les critères analysés sont médicaux (âge, volume prostatique, score ASA, antécédents urologiques, traitements anticoagulants, durée de lavage, de sondage et d hospitalisation, complications et ré-hospitalisations) et économiques (coûts directs médicaux hospitaliers avec un recul de 3 mois post-opératoires, à partir de la base de données du département d information médical du CHU. Le point de vue est celui de l établissement. Résultats : Il n y a pas de différence significative entre les 2 groupes concernant l âge, les antécédents urologiques, la prise de traitement anticoagulant, le score ASA, la durée moyenne de sondage, le taux de complications et de ré-hospitalisations. Dans le groupe VBTUP, le volume prostatique est supérieur (60 +-24ml Vs 42 +-16ml ; p<0,05) et la durée d hospitalisation inférieure (4 +-2.8j Vs 4.4 +-2.1j ; p<0,05), le prix du matériel consommable est supérieur (252 euros Vs 72 euros). Le prix de l hospitalisation initiale est 3293 +-704 euros en VBTUP et de 3304 +-708 euros en RTUP (p=0,09). Le prix total de la prise en charge avec un suivi de 3 mois est de 3 439 +-958 euros en VBTUP et de 3 667+- 1435 euros en RTUP (p=0,54). Conclusion : Il n existe pas de différence significative de coût total de la prise en charge avec un recul de 3 mois post opératoire entre la RTUP et la VBTUP.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Déterminants de la décision thérapeutique et analyse coût efficacité de la prise en charge thérapeutique initiale (étude sur une base de population)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les analyses économiques dans la prise en charge des cancers (évaluation et modélisation des coûts application au cancer bronchopulmonaire)

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Cost-Effectiveness Analysis of Vaginal Misoprostol versus Dinoprostone Pessary: a large noninferiority RCT in France

International audienceObjective: To assess the cost-effectiveness of vaginal misoprostol (PGE1) (25μg) compared to a slow-release dinoprostone (PGE2) pessary (10μg) for labor induction due to an unfavorable cervix at term. Methods: We used data from an open-label multicenter, randomized noninferiority trial which recruited women for whom labor was induced for medical reasons, a Bishop score ≤ 5 at ≥ 36 weeks, and a cephalic-presenting singleton pregnancy with no prior cesarean delivery. The Incremental Cost Effectiveness Ratio (ICER) was assessed from the payer’s perspective, with the focus on inpatient care costs and using the Caesarean Deliveries Avoided (CDA) rate as primary analysis and the rate of Vaginal Delivery within 24h (VD24) as secondary analysis. Results: Analyses were based on 790 women in each group. Differences between treatment arms were the mean cost per patient of €4,410 and €4,399, a CDA rate of 80.1% and 77.9% and a VD24 rate of 46.1% and 59.4% for dinoprostone and misoprostol respectively. Dinoprostone is not cost-effective according to the CDA and misoprostol was either a cost-effective or a dominant strategy according to the VD24. Conclusion: Misoprostol and dinoprostone have equal cost management with mixed efficacy according to the clinical outcome used. Finally, misoprostol may be an attractive option for hospitals since the price is lower and it is easier to use

Additional costs of polymyalgia rheumatica with giant-cell arteritis

International audienc

Randomised clinical trial for the cost–utility evaluation of two strategies of perineal reconstruction after abdominoperineal resection in the context of anorectal carcinoma: biological mesh repair versus primary perineal wound closure, study protocol for the GRECCAR 9 Study

International audienceIntroduction: Abdominoperineal resections performed for anorectal tumours leave a large pelvic and perineal defect causing a high rate of morbidity of the perineal wound (40%-60%). Biological meshes offer possibilities for new standards of perineal wound reconstruction. Perineal fillings with biological mesh are expected to increase quality of life by reducing perineal morbidity.Methods and analysis: This is a multicentre, randomised and single-blinded study with a blinded endpoint evaluation, the experimental arm of which uses a biological mesh and the control arm of which is defined by the primary closure after abdominoperineal resection for cancer. Patients eligible for inclusion are patients with a proven history of rectal adenocarcinoma and anal canal epidermoid carcinoma for whom abdominoperineal resection was indicated after a multidisciplinary team discussion. All patients must have social security insurance or equivalent social protection. The main objective is to assess the incremental cost-utility ratio (ICUR) of two strategies of perineal closure after an abdominoperineal resection performed for anorectal cancer treatment: perineal filling with biological mesh versus primary perineal closure (70 patient in each arm). The secondary objectives focus on quality of life and morbidity data during a 1-year follow-up. Deterministic and probabilistic sensitivity analyses will be performed in order to estimate the uncertainty surrounding the ICUR. CIs will be constructed using the non-parametric bootstrap approach. A cost-effectiveness acceptability curve will be built so as to estimate the probability of efficiency of the biological meshes given a collective willingness-to-pay threshold.Ethics and dissemination: The study was approved by the Regional Ethical Review Board of 'Nord Ouest 1' (protocol reference number: 20.05.14.60714; national number: 2020-A01169-30).The results will be disseminated through conventional scientific channels.Trial registration number: ClinicalTrials.gov Registry (NCT02841293)