[Assessment of the budgetary impact of an emicizumab therapy introduction for patients with severe haemophilia A without inhibitor]. / Évaluation de l'impact budgétaire de l'introduction d'un traitement par émicizumab chez des patients atteints d'hémophilie A sévère congénitale sans inhibiteur.

Since March 2019, émicizumab is indicated for the treatment of patients with severe haemophilia A without inhibitor. This therapy's price amounts approximately to €33 600 per 4 weeks for a 70kg patient which represents about two times more than a factor VIII concentrates treatment's price. This study aims to assess the budgetary impact for the French Health Insurance of an émicizumab therapy introduction for patients with severe haemophilia A without inhibitor. It was an observational, retrospective, and monocentric study. Every severe haemophilia A without inhibitor patient over 18 years old followed at the Cochin Hospital haemophilia treatment centre who received émicizumab from June 2020 and for at least one year have been included. The budgetary impact was estimated by comparing the total costs of patient care the year before versus the year after émicizumab initiation. Total costs of patient care included prices of i) treatments consumed, ii) consultations with specialist physicians, iii) hospitalizations and iv) imaging procedures. Thirty-eight patients were included. The total cost of patient care increased significantly the year after émicizumab introduction (P < 0.0001). On average, this cost was estimated at €537 887 ± €137 139 per patient whereas it was at €151 442 ± €94 708 the year before. While costs of physician consultations increased, no significant difference has been reported about hospitalizations and imaging costs. Over a one-year period, émicizumab therapy significantly increased the total costs of patient care. It is mostly caused by the drug price itself.

[Prerequisites for the implementation of Ultra® packaging to replace containers for three surgical departments: Budget impact analysis]. / Pré-requis à la mise en place de l'emballage Ultra® en remplacement des conteneurs au sein de trois blocs opératoires : analyse d'impact budgétaire.

OBJECTIVES: Budgetary impact analysis of the replacement of three surgical departments containers with a new perforation-resistant packaging: Ultra® pouches and reels. METHODS: Comparison of projections of containers costs of use to those of Ultra® packaging over six years. For containers, the costs include washing, packaging, curative maintenance (annual costs), and preventive maintenance (every five years). For Ultra® packaging, the costs include the first year, the purchase of a suitable storage arsenal and a pulse welder, and the transformation of the transport system. Annual costs for Ultra® include packaging and welders maintenance and qualification. RESULTS: In the first year, the costs with Ultra® packaging are higher than the cost related to the container model because the initial investment for the installation is not completely offset by the cost of preventive maintenance of the containers. However, from the second year of use of the Ultra®, an annual saving of €19,356 is expected and up to €49,849 in the sixth year (new preventive maintenance of containers needed). In six years, a saving of €116,186 is expected, which represents 40.4% savings compared to the container model. CONCLUSIONS: The budget impact analysis is in favor of the implementation of Ultra® packaging. The expenses related to the purchase of the arsenal, a pulse welder and the adaptation of the transport system should be amortized from the second year. Significant savings are even expected.

[Assessment of the use by hospital pharmacists of the opinions issued by the Haute Autorité de santé and the economic analysis tools proposed to them]. / Évaluation de l'utilisation par les pharmaciens hospitaliers des avis émis par la Haute Autorité de santé et des outils économiques qui leur sont proposés.

BACKGROUND: In French hospitals, the supply and management of drugs are missions of pharmacists. The aim of this study is to assess the use of efficacy and economics opinions of the Haute Autorite de santé (HAS) in hospital referencing of drugs in France in 2017. METHODS: A questionnaire for hospital pharmacists was developed to establish their knowledge and their uses of Transparency Commission and Economic and Public Health Evaluation Committee opinions. This survey was distributed by the ADIPH association in July 2017. This questionnaire included 35 questions. RESULTS: Despite the health professional are more and more interesting by economics analysis, only 30 % of hospitals pharmacists of this panel declared to use HAS economic opinions (versus 80% for Transparency Commission opinions). Among these pharmacists, 86% used this report in the hospital referencing of drugs. CONCLUSION: Through this analysis, some prospects for improvement can be seen in the health professional formation, cost-effectiveness report publication and the use of cost-effectiveness analysis. This study is an overview of the use of opinions provided by the HAS. This thesis established a basis to reflection on the use of economics reports and models in the hospital decisions.

Rapid diagnostic test for G6PD deficiency in Plasmodium vivax-infected men: a budget impact analysis based in Brazilian Amazon.

OBJECTIVE: The aim of this study was to estimate the incremental budget impact (IBI) of a rapid diagnostic test to detect G6PDd in male patients infected with Plasmodium vivax in the Brazilian Amazon, as compared with the routine protocol recommended in Brazil which does not include G6PDd testing. METHODS: The budget impact analysis was performed from the perspective of the Brazilian health system, in the Brazilian Amazon for the years 2013, 2014 and 2015. The analysis used a decision model to compare two scenarios: the first consisting of the routine recommended in Brazil which does not include prior diagnosis of dG6PD, and the second based on the use of RDT CareStart™ G6PD (CS-G6PD) in all male subjects diagnosed with vivax malaria. The expected implementation of the diagnostic test was 30% in the first year, 70% the second year and 100% in the third year. RESULTS: The analysis identified negative IBIs which were progressively smaller in the 3 years evaluated. The sensitivity analysis showed that the uncertainties associated with the analytical model did not significantly affect the results. CONCLUSION: A strategy based on the use of CS-G6PD would result in better use of public resources in the Brazilian Amazon.