Cost comparison of reusable and disposable air/water syringe tips in a large French teaching hospital

Air/water syringe (AWS) tips can be used in any type of dental care. They may be disposable (plastic) or reusable (stainless steel or plastic). We assessed the costs of using both sorts of tips in a French teaching hospital. A systematic use of one AWS tip per dental consultation was considered. Consultations performed with reusable AWS (stainless steel) tips give rise to costs linked to initial purchase of tips, their sterilisation, and replacement. Consultation costs of disposable AWS tips were calculated at their current purchase price. Replacing reusable tips was evaluat-ed in two different situations: annual replacement or replacement in case of visual deterioration. Results showed that the number of consultations must lie beyond a certain threshold in order to make reusable tips more economical in use than disposable counterparts. If the reusable tips are replaced every year, this threshold is higher (e.g.: 1,366consultations at the University of Bordeaux) than under a rule of tip replacement in case of visual deterioration (e.g. at the Bordeaux University: 1,267consultations in case of an annual replacement rate of 10%, or 1,289 with a re-placement rate of 30%). This is the first study regarding the costs of disposable versus reusable AWS tips. We suggest that disposable tips might be more cost-effective than reusable tips, not-ably because of their reduced risk of crosscontamination. The choice of the use of one or an-other AWS tip crucially depends on the number of consultations, as well as on their practical utilisation and on infection control issues.

How innovative are pharmaceutical innovations?: the case of medicines financed through add-on payments outside of the French DRG-based hospital payment system.

OBJECTIVE: To analyze the characteristics of inpatient medicines placed on the list of innovative high-cost medicines funded in addition to DRG-based payment, and to identify whether they really are innovative and/or high-cost. METHODOLOGY: The medicines placed on the list of innovative and high-cost medicines were analyzed on the basis of criteria describing their innovative nature and cost. They were categorized as innovative and high-cost, only high-cost, only innovative and neither innovative nor high-cost. RESULTS: Among the medicines financed in addition to DRG-based payment, 25.5% were classified as innovative and high-cost, 23.5% only high-cost, 22.9% only innovative and 28.1% neither innovative nor high-cost. CONCLUSIONS: The list of innovative and high-cost medicines contains medicines other than innovative and high-cost medicines. Stricter criteria for placing medicines on this list should be considered in order to limit the increase in expenditure.

Cutaneous adverse effects of ketoprofen for topical use: clinical patterns and costs.

BACKGROUND: Since its introduction in France, ketoprofen for topical use has been associated with a large number of cutaneous adverse effect reports. Therefore, the French Medicine Agency progressively introduced warnings and contraindications to its use. Despite this, serious adverse drug reactions (ADRs) still occur. OBJECTIVE: To describe clinical patterns and estimate costs of spontaneously reported cutaneous ADRs of topical ketoprofen. METHODS: All cases of cutaneous ADRs of topical ketoprofen reported to the Bordeaux regional pharmacovigilance center between January 1989 and December 2006 were included. Clinical patterns, in respect of adherence to recommendations, causality, seriousness, and direct costs incurred by the ADRs, were assessed. RESULTS: A total of 136 cases were reported (median age: 42 years, 55.9% women). Proper use of topical ketoprofen regarding indications, warnings, and contraindications was not respected by one-third of the patients. Almost all cases occurred during sunny months. Symptoms consisted predominantly of bullous eruptions (29.4%) or contact dermatitis (27.2%). Generalized lesions were observed in 37.5% of patients. Causality was considered at least possible for most of the cases (92.6%). These ADRs induced hospital admission in 15 cases (11.0%). The total estimated cost was euro 42,962 ($US 66,559), corresponding to euro 316 per case. This mean cost was nine times higher for serious ADRs. CONCLUSION: Topical ketoprofen is used to treat benign symptoms but can be associated with serious and costly cutaneous ADRs. Furthermore, the number of cases and the calculated costs may have been greatly under-estimated in the present study.

[Orphan drugs in France (2001-2005): access to information and characteristics]. / Les médicaments orphelins commercialisés en France (2001-2005): information officielle et spécificités.

In year 2000, two european regulations have been adopted in order to increase the availability of orphan drugs in the European Union. To describe the current orphan drug market in France, a cross sectional analysis was conducted, five years later, taking account of publicly available informations, including designation, registration, reimbursement. These informations are mostly available on the Internet. Eighteen orphan drugs were marketed in France in November 2005, with restricted prescription and dispensing conditions. Four of them were available before registration for compassional use. Eight will be reassessed soon, with complementary data requested by health authorities. Informations about orphan drugs are scattered on different French or European websites, which complicate access for health professionals. The opinions of "Commission de Transparence", which assess utility of drugs, give some precisions for each orphan drug (prevalence of the disease, therapeutic alternative, etc.).