Cost-Effectiveness of Web-Based Patient-Reported Outcome Surveillance in Patients With Lung Cancer

INTRODUCTION: A multicenter randomized clinical trial in France found an overall survival benefit of web-based patient-reported outcome (PRO)-based surveillance after initial treatment for lung cancer compared with conventional surveillance. The aim of this study was to assess the cost-effectiveness of this PRO-based surveillance in lung cancer patients. METHODS: This medico-economic analysis used data from the clinical trial, augmented by abstracted chart data and costs of consultations, imaging, transportations, information technology, and treatments. Costs were calculated based on actual reimbursement rates in France, and health utilities were estimated based on scientific literature review. Willingness-to-pay thresholds of €30,000 per quality-adjusted life year (QALY) and €90,000 per QALY were used to define a very cost-effective and cost-effective strategy, respectively. Average annual costs of experimental and control surveillance approaches were calculated. The incremental cost-effectiveness ratio was expressed as cost per life-year gained and QALY gained, from the health insurance payer perspective. One-way and multivariate probabilistic sensitivity analyses were performed. RESULTS: Average annual cost of surveillance follow-up was €362 lower per patient in the PRO arm (€941/year/patient) compared to control (€1,304/year/patient). The PRO approach presented an incremental cost-effectiveness ratio of €12,127 per life-year gained and €20,912 per QALY gained. The probabilities that the experimental strategy is very cost-effective and cost-effective were 97% and 100%, respectively. CONCLUSIONS: Surveillance of lung cancer patients using web-based PRO reduced the follow-up costs. Compared to conventional monitoring, this surveillance modality represents a cost-effective strategy and should be considered in cancer care delivery

Restauration morpho-dynamique et redynamisation de la section court-circuitée du Rhin en aval du barrage de Kembs (projet INTERREG / EDF)

National audienceThe Upper Rhine River has been heavily impacted by channelization for flood protection and navigation, and then by damming for hydropower generation. In normal non flooding conditions, most of the flows are diverted in a canalized section whereas the regulated “old Rhine” bypassed reach runs a minimum flow. Between Huningue and Neuf-Brisach, engineering works induced simplification and stabilization of the channel pattern from a formerly braiding sector to a single incised channel, hydrological modifications, bottom armouring due to bedload decrease, and thus ecological alterations. Two complementary and interdisciplinary projects have been initiated to restore alluvial morphodynamics: i) the international “INTERREG IV - Redynamisation of the old Rhine” project (2009-2012) coordinated by the Alsace region, France; ii) the left bank “controlled erosion” project launched by Electricité de France (EDF) within Kembs hydroelectric station relicensing process since 2003-2004. The purpose of these projects is to evaluate the feasibility of an important hydro-morphological and ecological restoration plan on a 45 km long reach, through both field testing of bank erosion techniques at favourable locations, and artificial sediments input from right bank excavations. This will help define possible long term prospective scenarios, in order to restore sustainable sediment transport, morphodynamics variability and associated ecological functions. The study will involve historical analysis, hydro-morphological / hydraulic physical and numerical modelling, physical and ecological monitoring, and sociological aspectsLe Rhin alsacien-allemand a enregistré de profondes modifications morphologiques et hydrologiques à la suite de sa correction et de sa régularisation pour la protection contre les crues et la navigation, puis après la construction de barrages hydro-électriques. Les aménagements réalisés entre Huningue et Neuf-Brisach ont engendré une simplification et une stabilisation du style fluvial. Un fleuve en tresses a cédé la place à un chenal unique incisé. Le fond de chenal est devenu pavé à cause d’une diminution des apports de charge de fond et des altérations écologiques ont été observées (simplification des habitats aquatiques et riverains). Deux projets complémentaires et interdisciplinaires ont été engagés afin de restaurer une dynamique des formes alluviales : i) le projet international INTERREG IV – Redynamisation du Vieux Rhin (2009-2012) sous l’impulsion de la région Alsace ; ii) le projet d’érosion maitrisée des berges de la rive gauche conduit par Electricité de France (EDF) dans le cadre du renouvellement de la concession de l’aménagement de Kembs. L’objectif des deux projets est de définir un plan de restauration hydro-morphologique et écologique conduisant à la redynamisation d’un tronçon de 45 km. L’étude repose sur une analyse historique, l’exploitation de modèles à la fois physiques et numériques, et les suivis morphologiques in situ d’une recharge artificielle en sédiments et d’érosions de berge contrôlées. Ces études de faisabilité sont complétées par des analyses écologique et sociologique pour apprécier l’impact socio-environnemental de ces projets

Quelques aspects des interactions entre litières forestières et écosystèmes aquatiques ou terrestres

We have examined the processes responsible for the disturbing effects of dead leaves in freshwater environments. The first is a biochemical deoxygenation caused by the polyphenoloxidase-polyphenol system, which remains active in dead leaves. The intensity of this effect considerably varies from species to species. It depends on the quantity and nature of the phenolic substrates, as well as of the phenoloxidase activities, the presence of variable amounts of phenoloxidase inhibitors such as tanins, and the aqueous extractibility of these agents. The deoxygenating effect of dead leaves macerates is immediate and intense for some species, for example Poplar and Ash, but weak for others, such as Oak and Birch. This first process is followed by two others : 1) microbiological deoxygenation and 2) spontaneous precipitation of phytomelanins resulting from their oxidative polycondensation. These phytomelanins have ion exchange and sequestration properties. Nevertheless their disturbing effects on the aquatic environment are poorly understood at the present time. A fourth process is the toxicity of leaf macerates. This toxicity is probably due to their phenolic compounds, their oxidation products, or other compounds such as saponosides. Thus the Birch, in spite of a very weak deoxygenating effects is very toxic for juvenile roaches. We studied these four different processes in ten different species, and we established their respective role in the pollution of freshwater by dead leaves. These roles are discussed in terms of the phylogeny of the tree species studied, as well as of the functionning of temperate forest ecosystems.Trémolières M., Carbiener Roland. Quelques aspects des interactions entre litières forestières et écosystèmes aquatiques ou terrestres. In: Revue d'Écologie (La Terre et La Vie), tome 40, n°4, 1985. pp. 435-449

Some aspects of the interactions between forest litters and aquatic or terrestrial ecosystems

We have examined the processes responsible for the disturbing effects of dead leaves in freshwater environments. The first is a biochemical deoxygenation caused by the polyphenoloxidase-polyphenol system, which remains active in dead leaves. The intensity of this effect considerably varies from species to species. It depends on the quantity and nature of the phenolic substrates, as well as of the phenoloxidase activities, the presence of variable amounts of phenoloxidase inhibitors such as tanins, and the aqueous extractibility of these agents. The deoxygenating effect of dead leaves macerates is immediate and intense for some species, for example Poplar and Ash, but weak for others, such as Oak and Birch. This first process is followed by two others : 1 ) microbiological deoxygenation and 2) spontaneous precipitation of phytomelanins resulting from their oxidative polycondensation. These phytomelanins have ion exchange and sequestration properties. Nevertheless their disturbing effects o n the aquatic environment are poorly understood at the present time. A fourth process is the toxicity of leaf macerates. This toxicity is probably due to their phenolic compounds, their oxidation products, or other compounds such as saponosides. Thus the Birch, in spite of a very weak deoxygenating effects is very toxic for juvenile roaches. We studied these four different processes in ten different species, and we established their respective role in the pollution of freshwater by dead leaves. These roles are discussed in terms of the phylogeny of the tree species studied, as well as of the functionning of temperate forest ecosystems