0000000000131526
AUTHOR
Catherine Lejeune
Télémédecine et accident vasculaire cérébral : étude de coût sur la téléfibrinolyse
Resume Introduction L’accident vasculaire cerebral ischemique (AVCi) est une urgence therapeutique qui necessite une prise en charge rapide par fibrinolyse au sein d’unites neurovasculaires (UNV) sous la surveillance d’un medecin specialise en neurologie. Il n’existe que deux UNV en Bourgogne (France). Afin de diminuer les inegalites territoriales et favoriser l’equite d’acces a cette technique efficace si realisee precocement, la fibrinolyse assistee par telemedecine a ete developpees en Bourgogne dans le cadre du projet TeleAVC. A ce jour, aucune etude n’a evalue avec precision le cout des actes de fibrinolyse ou fibrinolyse par telemedecine dans ce dispositif. L’objectif de cette etude e…
Incidental findings in a series of 2500 gene panel tests for a genetic predisposition to cancer: Results and impact on patients.
Abstract With next generation sequencing, physicians are faced with more complex and uncertain data, particularly incidental findings (IF). Guidelines for the return of IF have been published by learned societies. However, little is known about how patients are affected by these results in a context of oncogenetic testing. Over 4 years, 2500 patients with an indication for genetic testing underwent a gene cancer panel. If an IF was detected, patients were contacted by a physician/genetic counsellor and invited to take part in a semi-structured interview to assess their understanding of the result, the change in medical care, the psychological impact, and the transmission of results to the f…
Valuing genetic and genomic testing:current challenges and latest evidence. Resource Allocation in Personalised Medicine
International audience
Diagnostic yield of a one sample immunochemical test at different cut-off values in an organised screening programme for colorectal cancer
Abstract Background Quantitative immunochemical faecal occult blood tests have become the recommended tests for colorectal cancer screening. The aim of this study was to complete our knowledge on the performance of one of the quantitative immunochemical tests available, FOB-Gold, and to propose a possible strategy for an organised screening programme. Patients and methods Within the French organised screening programme, 23,231 average-risk individuals, aged 50–74 performed both a 3-day Hemoccult test and a 1-day FOB-Gold test. Performances of the immunochemical test were evaluated at different cut-off levels. Results The positivity rate for the Hemoccult was 2.1% and for the FOB-Gold varied…
Evaluation of efficacy and efficiency of a pragmatic intervention by a social worker to support informal caregivers of elderly patients (The ICE Study): study protocol for a randomized controlled trial
Medical progress and the lifestyle modification have prolonged life expectancy, despite the development of chronic diseases. Support and care for older subjects are often provided by a network of informal caregivers composed of family, friends and neighbors, who are essential in helping older persons to continue living at home. It has been shown that the extent and diversity of informal tasks may jeopardize the physical, mental and social wellbeing of caregivers. The aim of the Informal Carers of Elderly cohort is to define, through a longitudinal study, profiles of caregivers of older patients with a diagnosis of one of the following diseases: cancer (breast, prostate, colorectal), neurode…
Cost-effectiveness of screening for colorectal cancer in France using a guaiac test versus an immunochemical test
Objectives: The aim of this study was to compare the cost and the effectiveness of two biennial fecal occult blood screening tests for colorectal cancer: a guaiac nonrehydrated test (G-FOBT) and an immunochemical test (I-FOBT) with the absence of screening.Methods: A Markov model was developed to compare these strategies in a general population of subjects aged 50 to 74 over a 20-year period.Results: Compared with the absence of screening, G-FOBT and I-FOBT were associated with a decrease in colorectal cancer mortality of 17.4 percent and 25.2 percent, respectively. With regard to cost-effectiveness, expressed as cost per life-year gained, I-FOBT was the most effective and most costly alter…
Complémentarité des approches en sciences humaines et sociales en génétique : Présentation des études DISSEQ et DEFIDIAG dans le champ de la déficience intellectuelle
National audience
Efficiency of telemedicine for acute stroke: a cost-effectiveness analysis from a French pilot study
AbstractObjectivesTelestroke is an effective way to improve care and health outcomes for stroke patients. This study evaluates the cost-effectiveness of a French telestroke network.MethodsA decision analysis model was built using population-based data. We compared short-term clinical outcomes and costs for the management of acute ischemic stroke patients before and after the implementation of a telestroke network from the point of view of the national health insurance system. Three effectiveness endpoints were used: hospital death, death at 3 months, and severe disability 3 months after stroke (assessed with the modified Rankin scale). Most clinical and economic parameters were estimated fr…
Identification of resources and skills developed by partners of patients with advanced colon cancer: a qualitative study
National audience; Les aidants familiaux jouent un rôle central auprès des patients présentant un cancer de stade avancé. Parmi les proches susceptibles d’apporter une aide aux personnes malades, les conjoints, en raison des liens qui les unissent et parce qu’ils partagent leur vie quotidienne, sont sans doute les plus confrontés à la maladie. Ils sont également majoritairement désignés comme étant l’aidant principal. L’irruption de la maladie et le besoin d’accompagnement qu’elle nécessite, viennent bouleverser en profondeur les différents équilibres structurant leur quotidien et leur organisation. Ils viennent aussi questionner la nature des relations qu’ils entretiennent, dans une divers…
The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis
BackgroundCongenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments.MethodTo identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge …
Cancérologie, la douleur en question : Représentations sociales, Regards croisés des Médecins oncologues et des Patients
Conférence inaugurale présentée à la 15ème Journée d’étude de l’ACNRD; International audience
Care management in a French cohort with Down syndrome from the AnDDI-Rares/CNSA study.
Down syndrome (DS) is a genetic neurodevelopmental disorder. In individuals with DS, a multidisciplinary approach to care is required to prevent multiple medical complications. The aim of this study was to describe the rehabilitation, medical care, and educational and social support provided to school-aged French DS patients with varying neuropsychological profiles. A mixed study was conducted. Quantitative data were obtained from a French multicentre study that included patients aged 4-20 years with diverse genetic syndromes. Qualitative data were collected by semi-structured face-to-face interviews and focus groups. Ninety-five DS subjects with a mean age of 10.9 years were included. Sixt…
Screening for colorectal cancer with immunochemical faecal occult blood tests.
Population-based studies have shown that guaiac faecal occult blood testing followed by colonoscopy in case of positivity can reduce colorectal cancer mortality. However these tests have been criticised for their fairly low sensitivity. For this reason attention has been given to alternative tests. The aim of this paper is to review the evidence for screening for colorectal cancer using qualitative immunochemical faecal occult blood tests. For the complete range of tested cut-off values, immunochemical faecal occult blood tests lead to higher diagnostic yield, improved sensitivity and greater participation. The optimal number of samples and the optimal cut-off value has to suit local resour…
Immunochemical faecal occult blood tests are superior to guaiac-based tests for the detection of colorectal neoplasms
The aim of this study was to compare the performance of a guaiac-based faecal occult blood test (G-FOBT) with that of an immunochemical faecal occult blood test (I-FOBT). A total of 17,215 average risk individuals aged 50 to 74 enrolled in a population-based organised screening programme and performed a 3-day G-FOBT and a 2-day I-FOBT simultaneously. Among participants, 3.1% were found positive for the G-FOBT and 6.9% for the I-FOBT (p<10(-4)). Among the 1205 participants who tested positive and underwent a colonoscopy, the number of detected cancers and advanced adenomas was respectively 2.6 times higher and 3.5 times higher with the I-FOBT than with the G-FOBT. The positive predictive val…
Telemedicine: Economic and clinical evaluation of the management of ischemic stroke
Summary Introduction Ischemic stroke (IS) is a therapeutic emergency that requires prompt care in a stroke unit (SU). In order to reduce regional inequalities and to promote uniformity in access to this technique, which is effective when carried out quickly, telemedicine-assisted thrombolysis was developed in Burgundy within the Telestroke system. At the moment, no study compared costs (i.e. expenditures) and revenues (i.e. funding) associated with the management of patients presenting an IS in Burgundy after the implementation of the Telestroke system according to the management strategy: patients undergoing thrombolysis directly in a SU or Tele-thrombolysis in a local hospital (LH) receiv…
Logiques de choix des médecins sur la prise en charge thérapeutique des patients atteints d’un cancer : analyse qualitative du contenu des discours, résultats partiels de l’étude EOLE
National audience; Contexte : En France, la question de la poursuite, de la limitation ou de l’arrêt des traitements palliatifs en cas de cancer métastatique non résécable fait l’objet de débats nourris. Plusieurs études internationales estiment qu’entre 10 et 20% des patients atteints de cancer reçoivent une chimiothérapie dans le dernier mois de leur vie (Benson, 2001 ; Niedern Tollåli, Dalhaug et al. 2014 ; Earle, Landrum, Souza et al. 2008 ; Ho, Barbera, Saskin, et al. 2011). L’une des raisons de cette prescription est la surestimation faite par les médecins de l’espérance de vie de leurs patients (Nieder et al., 2014 ; Christakis & Lamont, 2000). Pourtant, ces traitements peuvent dimin…
Secondary findings from whole-exome/genome sequencing evaluating stakeholder perspectives. A review of the literature
IF 2.004 (2017); International audience; With the development of next generation sequencing, beyond identifying the cause of manifestations that justified prescription of the test, other information with potential interest for patients and their families, defined as secondary findings (SF), can be provided once patients have given informed consent, in particular when therapeutic and preventive options are available. The disclosure of such findings has caused much debate. The aim of this work was to summarize all opinion-based studies focusing on SF, so as to shed light on the concerns that this question generate. A review of the literature was performed, focusing on all PubMed articles repo…
Analyse coût-efficacité associée à l’utilisation des prothèses pariétales biosynthétiques résorbables comparativement aux prothèses biologiques dans la chirurgie contaminée de la cure d’éventration
Etat de la question La prothese biosynthetique Phasix® n’a jamais fait l’objet d’etude comparative avec les protheses biologiques lors de cure d’eventration en milieu contamine. Des donnees complementaires etaient necessaires pour confirmer la transition vers les protheses biosynthetiques resorbables et justifier l’homogeneisation des pratiques chirurgicales. Le but de cette etude etait de comparer, en termes de cout et de complications graves, l’utilisation des protheses parietales biosynthetiques resorbables et biologiques chez les patients beneficiant d’une cure d’eventration contaminee (grade 3 du « Modified Ventral Hernia Working Group »). Materiel et methodes Une analyse cout-efficaci…
Traitement du cancer de la prostate : comment les patients font-ils leur choix ?
Resume Le cancer de la prostate demeure un probleme de sante publique en France chez les hommes de 50 a 70 ans. Pour le cancer localise de la prostate de bon pronostic ou de pronostic intermediaire, il existe une pluralite de possibilites therapeutiques. Objectif. Identifier, dans le discours des patients, les mecanismes et les logiques intervenant dans la decision therapeutique. Methode. etude qualitative aupres de 15 hommes âges de 53 a 70 ans, traites pour un cancer de la prostate de stade precoce, par entretiens abordant l’itineraire diagnostique, la representation et le vecu de la maladie, les facteurs decisionnels en matiere de traitement. Resultats. Les hommes ont elabore leur choix …
Economic analysis of the costs associated with prematurity from a literature review
International audience; Abstract : Objectives : To analyse published cost-of-illness studies that had assessed the cost of prematurity according to gestational age at birth. Methods : A review of the literature was carried out in March 2011 using the following databases: Medline, ScienceDirect, The Cochrane Library, Econlit and Business Source Premier, and a French Public-Health database. Key-word sequences related to ‘prematurity’ and ‘costs’ were considered. Studies that assessed costs according to the gestational age (GA) at the premature birth (<37 weeks of gestation) in industrialized countries and during the last two decades were included. Variations in the reported costs were anal…
Analyse économique des essais cliniques internationaux en cancérologie
International audience; In oncology, as in other fields of medicine, international multicentre clinical trials came into being so as to include a sufficient number of subjects to investigate a clinical situation. The existence of tight budgetary constraints and the desire to make the best use of the resources available have resulted in the development of economic evaluations associated with these trials, which, thanks to their level of evidence and their size, provide particularly relevant material. Nonetheless, economic evaluations alongside international clinical trials raise specific questions of methodology with regard to both the design and the analysis of the results. Indeed, the cost…
Évaluation de l’impact de l’intervention d’un travailleur social auprès d’aidants informels de personnes âgées atteintes d’une pathologie chronique. Protocole de l’étude ICE : cohorte prospective multicentrique d’aidants informels en BFC
Introduction L’amelioration des conditions de vie et les progres medicaux ont permis un allongement de la duree de vie a des âges tres eleves, lequel a genere l’apparition et le developpement de maladies chroniques associees a des comorbidites. Dans ce contexte, la problematique de la dependance est devenue un enjeu majeur pour les politiques publiques. Depuis de nombreuses annees, elles traduisent leur volonte de faciliter le maintien au domicile le plus longtemps possible a des personnes âgees en perte d’autonomie. Ainsi, cette volonte de continuer a vivre a domicile, directement exprimee par les aines, repose en grande partie sur un reseau d’aides informelles (famille, amis, voisins). Le…
Associations between cognitive performance and the rehabilitation, medical care and social support provided to French children with Prader-Willi syndrome
International audience; Prader-Willi syndrome (PWS) is a rare genetic neurodevelopmental disorder with a characteristic behavioural phenotype. A multidisciplinary approach to care is required to prevent multiple medical complications in individuals affected by PWS. The aim of this study was to describe the rehabilitation, medical care, educational and social support provided to school-aged French PWS patients with varying neuropsychological profiles. Data were obtained from a French multicentre study that included patients aged 4-20 years with diverse genetic syndromes. Nineteen PWS subjects with a mean age of 9.2 years were included. The mean full-scale intellectual quotient (IQ) was 58 (W…
How do gastroenterologists follow patients with colorectal cancer after curative surgical resection? A three-year population-based study
Summary Objectives To assess the contribution of gastroenterologists (GEs) to the surveillance of colorectal cancer after curative surgery. Patients and methods This registry-based study included 407 patients residing in two French administrative areas diagnosed with newly diagnosed colorectal cancer in 1998 and free of disease six months after curative surgery. All surveillance examinations performed either in the three years after surgery or until death or recurrence were collected retrospectively. Results One hundred nine patients (27%) had a regular clinical check-up with a GE at least once a year. Factors independently associated with GE follow-up were young age (P=0.004), use of adjuv…