Impact budgétaire de l’élimination de l’hépatite C en France : comparaison de 3 stratégies de dépistage et d’accès au traitement

Since the arrival of DAAs disrupted the management of hepatitis C, the eradication of this disease has seemed achievable. In 2016, France set the goal of eliminating this disease by 2025 using these new treatments. However, eliminating a disease requires significant financial investments. We sought to assess the effectiveness and budgetary impact of 3 elimination strategies on a French scale using a budget impact model: a reference strategy, based on the situation in 2016-2018; a strategy in which screening is increased by 10%, and a strategy in which screening is sufficient to achieve elimination by 2025. With a time horizon in 2030, budget impact of the reference strategy is €4.8 billion, and that of strategy #2 is €5 billion; none of these strategies allow the achievement of elimination by 2025. Strategy #3 achieves elimination and its budgetary impact is €5.9bn. These results should be discussed as a model is a representation of reality for which there is some uncertainty, moreover, the prices of treatments and tests are likely to vary. A public health program is necessary to achieve elimination and the cost of that program is not included in our analysis.Depuis le bouleversement dans la prise en charge de l’hépatite C introduit par l’arrivée des AAD, l’éradication de cette maladie semble atteignable. En 2016, la France s’est fixée comme objectif d’éliminer cette maladie à l’horizon 2025 grâce à ces nouveaux traitements. L’élimination d’une maladie exige cependant des investissements financiers importants. Nous avons cherché à évaluer grâce à un modèle d’impact budgétaire l’efficacité et l’impact budgétaire de 3 stratégies d’élimination à l’échelle française : une stratégie de référence, basée sur la situation de 2016-2018 ; une stratégie dans laquelle le dépistage est augmenté de 10%, et une stratégie dans laquelle le dépistage est suffisant pour atteindre l’élimination en 2025. Avec un horizon temporel en 2030, l’impact budgétaire de la stratégie de référence est de 4,8 Mds€ et celui de la stratégie n°2 est de 5 Mds€ ; aucune de ces stratégies ne permet d’atteindre l’élimination en 2025. La stratégie n°3 permet d’atteindre l’élimination et son impact budgétaire est de 5,9 Mds€. Ces résultats sont à nuancer : la modélisation est une représentation simplifiée de la réalité pour laquelle il existe une certaine incertitude, les prix des traitements et des tests sont susceptibles de varier. Un programme de santé publique doit être mis en place pour atteindre l’élimination et le coût de ce programme n’est pas pris en compte dans notre analyse

Nouvelle formule de détermination de l'âge d'un foetus

International audienceThe methods utilised in anthropology for foetal age assessment are generally rather old, based on small samples and have never been tested on other samples than the one they were established on. In this study, we establish a formula on 344 foetuses of known age, and compare it with other age determination methods found in the scientific literature. Except our formula, the tested other methods do not give the limits of the prediction's confidence interval, and therefore do not take into account the total variability. Therefore, we demonstrate the necessity to establish formulas based on large samples and on a validated methodology.Les méthodes de détermination de l'âge foetal utilisées en anthropologie sont anciennes, établies sur de petits effectifs et n'ont pas été testées sur un échantillon différent de celui qui a servi à les établir. Dans cette étude, nous établissons une formule sur 344 foetus d'âges connus et la comparons avec d'autres déteminations proposées dans la littérature. Contrairement à notre formule, ces dernières ne proposent pas d'intervalles de confiance de leur prédiction et ne prennent donc pas correctement en compte la variabilité. Nous démontrons ainsi la nécessité d'établir de nouvelles équations sur la base d'un effectif aussi large que possible et reposant sur une méthodologie validée

Postmortem assessment of fetal diaphyseal femoral length: validation of a radiographic methodology

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11305420International audienceDepending on the general condition of fetal remains, forensic specialists might face difficulties concerning age estimation. Reference tables and regression equations are helpful devices in this task, although they are generally applied for complete fetuses or fetal remains including soft tissues. However, the problem of age estimation stays for osseous remains, both for entire bones and ossified parts, since most of the reference tables come from ultrasonographic measurements, which are not easily reproducible on fetal osseous remains. Furthermore, the ultrasonographic measurements contain slight errors in comparison to the real anatomical ones. This study describes a radiographic protocol and a measurement technique that facilitate and improve bone measurements, and therefore, facilitate age estimation, too. A qualitative criterion, namely a clear-cut bony endplate, was defined and tested. Its reliability (repeatability and reproducibility) turned out to be good, showing nonsignificative differences to the threshold of 0.05, with average errors of 0.26 and 0.44 mm respectively. Moreover, concerning the test of eventual size differences between the right and left femurs showed a P value < 0.0001. The test of the qualitative criterion was based on the comparison of the radiographic in situ femur measurements and the radiographic measurements of the same bones after dissection. The results were satisfactory, since an average error of 0.58 mm was obtained, which did not give any significant differences to the threshold of 0.05. It was concluded that this methodology provides an easy and precise new measurement tool for forensic practice, and can allow us to establish some nonultrasonographic tables, which fit our population

Validation of a Radiographic Method to Establish<br />New Fetal Growth Standards: Radio-Anatomical<br />Correlation

International audienceIn forensic medicine, specialists might face difficultieswhen estimating age at death from fetal remains. Depending on the state of preservation, this age assessment is essentially based on the diaphyseal size of long bones. In a previous work, for the measurement of fetal femoral ossified shafts, we already established a simple and reliable method using a radiographic protocol. Since we previously stated that radiographic measurement values were closer to real anatomical size than ultrasonographic ones, in the present study we decided to check the importance of the difference between radiographic and anatomical measurements. Therefore, we dissected 30 pairs of fetal femurs and compared the difference between the two kinds of measurements (in percentages). This difference seemed to be slight (4.027%), but it was large enough to entail significantdifferences (p 0.001). In order to provide a correction factor for radiographic measurements, we established a linear regression formula, which was tested on another sample of 30 pairs of dissected femurs. As a consequence of the good results, we improved the linear regression using a powerful statistical tool: the bootstrap. Finally, we obtained a simple equation that allowed us to figure out the real anatomical size with an R2 of 99% and a mean relative difference of 0.153% (with a standard error of 0.252 mm, and therefore a 95% confidence interval with limits of 0.35 and 0.657 mm). This difference did not entail any significant differences(p 0.498), and therefore, we concluded that with the proposed correction, radiographic measurements can easily be used by forensic specialists in their daily tasks or to establish new growth standardsin order to best fit their population of interest

Postmortem assessment of fetal diaphyseal femoral length: validation of a radiographic methodology

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11305420International audienceDepending on the general condition of fetal remains, forensic specialists might face difficulties concerning age estimation. Reference tables and regression equations are helpful devices in this task, although they are generally applied for complete fetuses or fetal remains including soft tissues. However, the problem of age estimation stays for osseous remains, both for entire bones and ossified parts, since most of the reference tables come from ultrasonographic measurements, which are not easily reproducible on fetal osseous remains. Furthermore, the ultrasonographic measurements contain slight errors in comparison to the real anatomical ones. This study describes a radiographic protocol and a measurement technique that facilitate and improve bone measurements, and therefore, facilitate age estimation, too. A qualitative criterion, namely a clear-cut bony endplate, was defined and tested. Its reliability (repeatability and reproducibility) turned out to be good, showing nonsignificative differences to the threshold of 0.05, with average errors of 0.26 and 0.44 mm respectively. Moreover, concerning the test of eventual size differences between the right and left femurs showed a P value < 0.0001. The test of the qualitative criterion was based on the comparison of the radiographic in situ femur measurements and the radiographic measurements of the same bones after dissection. The results were satisfactory, since an average error of 0.58 mm was obtained, which did not give any significant differences to the threshold of 0.05. It was concluded that this methodology provides an easy and precise new measurement tool for forensic practice, and can allow us to establish some nonultrasonographic tables, which fit our population

Prenatal prognosis of congenital diaphragmatic hernia using magnetic resonance imaging measurement of fetal lung volume

Objectives: To investigate the correlation between fetal lung volume (FLV), measured with magnetic resonance imaging (MRI), and postnatal mortality in newborns with prenatally diagnosed isolated congenital diaphragmatic hernia (CDH). Methods: In a 4-year prospective multicenter study, 77 fetuses with isolated CDH diagnosed between 20 and 33 weeks' gestation underwent fast spin-echo T2-weighted lung MRI. These MRI-FLV measurements were compared with a previously published normative curve obtained in 215 fetuses without thoracoabdominal malformations and with normal ultrasound biometric findings. FLV measurements were correlated with postnatal survival. The mean gestational age at MRI was 31.3 weeks. Results: The measured/expected FLV ratio was significantly lower in the newborns with CDH who died compared with those who survived (23.6 ± 12.2 vs. 36.1 ± 13.0, P < 0.001). When the ratio was below 25%, there was a significant decrease in postnatal survival (19% vs. 40.3%, P = 0.008). Survival was significantly lower for neonates when one lung could not be seen by fetal MRI compared with those fetuses with two visible lungs on MRI (17.9% vs. 62.1%, P < 0.001). Conclusion: In isolated CDH, FLV measurement by MRI is a good predictor of postnatal mortality due to pulmonary hypoplasia. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe