Expanding vaccination competencies to community pharmacists: modelling the organizational and economic impacts of new human papilloma virus (HPV) vaccine pathways in France.

BACKGROUND: The vaccine coverage rate (VCR) for human papillomavirus (HPV) in France is one of the lowest in Europe, well below the target of 80% announced in the French Cancer Plan 2021-2030. The extension of vaccination competencies (prescription and administration) to new health care providers, such as community pharmacists (CPs), was a decisive step by the French Health Authority (HAS) in 2022 to simplify access to vaccination and improve the VCR. This research assessed the economic and organizational impacts (OIs) of the extension of vaccination competencies in France. METHODS: A model was developed in Excel® to compare the current HPV vaccination pathway focused on general practitioners (GPs) to a mix of pathways (new and current) that extends pharmacists' competencies (prescription and/or injection). The simulated population corresponded to girls and boys targeted by the French recommendations. The model was run from 2023 to 2030. HAS guidelines were used to identify OIs related to these new pathways. Model inputs were collected from national data sources and an acceptability study. The results focused on three OIs (HPV vaccination ability [defined as the number of adolescents who could be vaccinated in each pathway], the VCR projection, and flows of activity between health care professionals]). The economic impact was evaluated from the National Health Insurance (NHI) perspective in 2022. RESULTS: With a mix of vaccination pathways, including an increasing role of pharmacists, the target of an 80% VCR could be reached in 2030 (versus 2032 with the current pathway) with lower investment than the current situation, resulting in cost savings for the NHI of €212 million. Expanding vaccination competencies will provide pharmacists with additional revenue (an average of €755,000/month for all vaccinating pharmacies) and will free up medical time for GPs (average of 603,000 consultations/year for all GPs). CONCLUSIONS: Expanding vaccination competencies to pharmacists has a positive impact on the entire ecosystem. From a public health perspective, the national VCR target can be achieved and better access to care can be provided, freeing up medical time. From an economic perspective, this approach can provide savings for the NHI and additional revenue for pharmacists.

Facilitating human papillomavirus vaccination pathways by extending vaccination competencies to community pharmacists: A cross-sectional survey on the acceptability and expectations among healthcare professionals and parents.

Background: Human papillomavirus (HPV) vaccination coverage rate (VCR) remains low in France (37.4% in girls in 2021). The French health authority recommended in 2022 to extend vaccination competencies to additional healthcare providers (HCPs), including community pharmacists (CPs). Objectives: To understand the acceptability by general practitioners (GPs), CPs and parents of adolescents of extending vaccination competencies and to identify benefits and barriers of new vaccination pathways. Methods: This cross-sectional research used a qualitative and quantitative approach. For the quantitative survey, GPs, CPs and parents of adolescents eligible to HPV vaccination completed an online questionnaire. Participants were asked to imagine themselves in different pathways and evaluate them. Results: A total of 200 GPs, 201 CPs and 800 parents were included. The level of acceptability of extending vaccination competencies to other HCPs was high in CPs (86% rated ≥7/10), but low in GPs (35%) and intermediate in parents (61%). Parents ranked first (44%) a pathway where GPs prescribed while CPs vaccinated because GPs inspire confidence as vaccine prescribers (80%) and parents prefer to be informed on vaccination by them (80%). CPs ranked first (42%) a scenario where they vaccinated after invitation of adolescents from the French National Health Insurance Fund (NHIS). They emphasized the simplicity of this scenario (94%) and the potential increase of VCR (91%), but asked to be more informed on HPV vaccination (77%) and favored television (83%) for communication campaigns. Conclusions: GPs and parents, in contrast with community pharmacists, were only moderately supportive of the extension the vaccination competencies. Confidence in the HCP remains the primary factor for adherence to a vaccination pathway beyond the simplicity of the pathway. Training of CPs, traceability tool, support from authorities and communication campaigns are levers that will support CPs in their new role and contribute to increase parents' acceptability toward CPs.

Real-world effectiveness of pembrolizumab in advanced melanoma: analysis of a French national clinicobiological database.

Aim: To describe real-world pembrolizumab administration and outcomes for advanced melanoma in France. Materials & methods: Using the MelBase longitudinal database, this multicenter historical-prospective study examined treatment and outcomes of patients with nonuveal, unresectable stage III/IV melanoma initiating pembrolizumab from April 2016 to September 2017, with follow-up to September 2019. Kaplan-Meier time-to-event analyses were conducted. Results: Of 223 patients (median age 67; 51% men), 134 (60%), 36 (16%) and 53 (24%) initiated pembrolizumab in first-, second- and third-line, respectively. Median overall survival (months) was 32.6 (95% CI: 20.3-not reached [NR]), 14.4 (8.6-NR) and 9.3 (6.4-NR), respectively. Best real-world tumor response of complete or partial response was recorded for 49, 39 and 26% of patients, respectively. Conclusion: Study results support benefits of pembrolizumab therapy for advanced melanoma.