Estimating excess mortality and economic burden of <i>Clostridioides difficile</i> infections and recurrences during 2015–2019:The RECUR England study

Objective To generate real-world evidence on all-cause mortality and economic burden of Clostridioides difficile infections (CDIs) and recurrences (rCDIs) in England. Methods We conducted a cohort study using retrospective data from Clinical Practice Research Datalink linked to Hospital Episode Statistics. Patients diagnosed with CDI in hospital and community settings during 2015–2018 were included and followed for ≥1year. All-cause mortality was described at 6-, 12-, and 24-months. Healthcare resource usage (HCRU) and associated costs were assessed at 12-months of follow-up. A cohort of non-CDI patients, matched by demographic and clinical characteristics including Charlson Comorbidity Index score, was used to assess excess mortality and incremental costs of HCRU. Results All-cause mortality among CDI patients at 6-, 12-, and 24-months was 15.87%, 20.37%, and 27.03%, respectively. A higher proportion of rCDI patients died at any point during follow-up. Compared with matched non-CDI patients, excess mortality was highest at 6-months with 1.81 and 2.53 deaths per 100 patient-months among CDI and ≥1 rCDI patients. Hospitalisations were the main drivers of costs, with an incremental cost of £1,209.21 per CDI patient. HCRU and costs increased with rCDIs. Conclusions CDI poses a substantial mortality and economic burden, further amplified by rCDIs

Prescription Medicines and the Risk of Road Traffic Crashes: A French Registry-Based Study

Using three nationwide databases in France, Ludivine Orriols, Emmanuel Lagarde, and colleagues provide evidence that prescribed medicines contribute to the risk of experiencing a road traffic crash

Estimate of Venous Thromboembolism and Related-Deaths Attributable to the Use of Combined Oral Contraceptives in France

<div><p>Purpose</p><p>To estimate the number of venous thromboembolic events and related-premature mortality (including immediate in-hospital lethality) attributable to the use of combined oral contraceptives in women aged 15 to 49 years-old between 2000 and 2011 in France.</p><p>Methods</p><p>French data on sales of combined oral contraceptives and on contraception behaviours from two national surveys conducted in 2000 and 2010 were combined to estimate the number of exposed women according to contraceptives generation and age. Absolute risk of first time venous thromboembolism in non-users of hormonal contraception and increased risk of thromboembolism in users vs. non-users of hormonal contraception were estimated on the basis of literature data. Finally, immediate in-hospital lethality due to pulmonary embolism and premature mortality due to recurrent venous thromboembolism were estimated from the French national database of hospitalisation and literature data.</p><p>Results</p><p>In France, more than four million women are daily exposed to combined oral contraceptives. The mean annual number of venous thromboembolic events attributable to their use was 2,529 (778 associated to the use of first- and second-generation contraceptives and 1,751 to the use of third- and fourth-generation contraceptives), corresponding to 20 premature deaths (six with first- and second-generation contraceptives and fourteen with third- and fourth-generation contraceptives), of which there were eight to nine immediate in-hospital deaths. As compared to the use of first- and second-generation contraceptives, exposure to third- and fourth-generation contraceptives led to a mean annual excess of 1,167 venous thromboembolic events and nine premature deaths (including three immediate in-hospital deaths).</p><p>Conclusions</p><p>Corrective actions should be considered to limit exposure to third- and fourth-generation contraceptives, and thus optimise the benefit-risk ratio of combined oral contraception.</p></div

Exposure of combined oral contraceptives, overall and by generation, in France from 2000 to 2011.

<p>Exposure of combined oral contraceptives, overall and by generation, in France from 2000 to 2011.</p

Exposure of combined oral contraceptives, overall and by generation, in France - Results of Fecond survey, 2010.

<p>*Percentage of use within the general population.</p><p>**Percentage of use within the users of combined oral contraceptives (COC).</p

Number of cases of venous thromboembolism annually attributable to combined oral contraceptives.

<p>The figure shows the number of cases attributable to combined oral contraceptives overall and by generation in France from 2000 to 2011.</p

Number of deaths annually attributable to the use of combined oral contraceptives.

<p>The figure shows the number of deaths attributable to combined oral contraceptives overall and by generation in France from 2000 to 2011.</p

Number of cases of venous thromboembolism attributable to combined oral contraceptives in 2011.

<p>The figure shows the number of cases attributable to combined oral contraceptives broken into age group, overall and by generation.</p

Incidence rate of venous thromboembolism in non-users of oral contraceptives per 100,000 women years [10].

<p>Incidence rate of venous thromboembolism in non-users of oral contraceptives per 100,000 women years <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0093792#pone.0093792-Lidegaard3" target="_blank">[10]</a>.</p

Exposure of combined oral contraceptives, overall and by generation, in France - Results of Cocon survey, 2000.

<p>*Percentage of use within the general population.</p><p>**Percentage of use within the users of combined oral contraceptives (COC).</p