Update of survival and cost of metastatic melanoma with new drugs: Estimations from the MelBase cohort.

PURPOSE: Since 2011, significant progress was observed in metastatic melanoma (MM), with the commercialisation of seven immunotherapies or targeted therapies, which showed significant improvement in survival. In France, in 2004, the cost of MM was estimated at €1634 per patient; this cost has not been re-estimated since. This study provided an update on survival and cost in real-life clinical practice. METHODS: Clinical and economic data (treatments, hospitalisations, radiotherapy sessions, visits, imaging and biological exams) were extracted from the prospective MelBase cohort, collecting individual data in 955 patients in 26 hospitals, from diagnosis of metastatic disease until death. Survival was estimated by the Kaplan-Meier method. Costs were calculated from the health insurance perspective using French tariffs. For live patients, survival and costs were extrapolated using a multistate model, describing the 5-year course of the disease according to patient prognostic factors and number of treatment lines. RESULTS: Since the availability of new drugs, the mean survival time of MM patients has increased to 23.6 months (95%confidence interval [CI] :21.2;26.6), with 58% of patients receiving a second line of treatment. Mean management costs increased to €269,682 (95%CI:244,196;304,916) per patient. Drugs accounted for 80% of the total cost. CONCLUSION: This study is the first that evaluated the impact of immunotherapies and targeted therapies both on survival and cost in real-life conditions. Alongside the introduction of breakthrough therapies in the first and subsequent lines, MM has been associated with a significant increase in survival but also in costs, raising the question of financial sustainability.

How French subjects describe well-being from food and eating habits? Development, item reduction and scoring definition of the Well-Being related to Food Questionnaire (Well-BFQ©).

Providing well-being and maintaining good health are main objectives subjects seek from diet. This manuscript describes the development and preliminary validation of an instrument assessing well-being associated with food and eating habits in a general healthy population. Qualitative data from 12 groups of discussion (102 subjects) conducted with healthy subjects were used to develop the core of the Well-being related to Food Questionnaire (Well-BFQ). Twelve other groups of discussion with subjects with joint (n = 34), digestive (n = 32) or repetitive infection complaints (n = 30) were performed to develop items specific to these complaints. Five main themes emerged from the discussions and formed the modular backbone of the questionnaire: "Grocery shopping", "Cooking", "Dining places", "Commensality", "Eating and drinking". Each module has a common structure: items about subject's food behavior and items about immediate and short-term benefits. An additional theme - "Eating habits and health" - assesses subjects' beliefs about expected benefits of food and eating habits on health, disease prevention and protection, and quality of ageing. A preliminary validation was conducted with 444 subjects with balanced diet; non-balanced diet; and standard diet. The structure of the questionnaire was further determined using principal component analyses exploratory factor analyses, with confirmation of the sub-sections food behaviors, immediate benefits (pleasure, security, relaxation), direct short-term benefits (digestion and satiety, energy and psychology), and deferred long-term benefits (eating habits and health). Thirty-three subscales and 14 single items were further defined. Confirmatory analyses confirmed the structure, with overall moderate to excellent convergent and divergent validity and internal consistency reliability. The Well-BFQ is a unique, modular tool that comprehensively assesses the full picture of well-being related to food and eating habits in the general population.

Noninvasive assessment of systolic pulmonary artery pressure in systemic lupus erythematosus: retrospective analysis of 93 patients.

OBJECTIVES: To describe the frequency of patients with an elevated systolic pulmonary artery pressure (sPAP) estimated by Doppler echocardiography in a population of SLE patients followed in a tertiary reference centre. METHODS: A search of our Internal Medicine Department database identified 93 SLE patients followed between 1995 and 2005. Their medical records were reviewed retrospectively. The PH threshold was defined as sPAP≥35mmHg. Characteristics of PH and non-PH SLE patients were compared using Fisher's, chi-square or Wilcoxon's exact test. RESULTS: Elevated sPAP was detected in 12/93 (13%) patients. When analysing the mechanisms of PH, it was considered as secondary to specific lung involvement in 2 cases, due to severe left ventricular dysfunction in 1 patient and probably corresponding to SLE-associated PAH in the 9 remaining subjects. Univariate analyses showed that sPAP≥35mmHg was more common in Black subjects (50 vs. 20%, p=0.03), in patients with longer disease duration (14±8 vs. 9.5±8 years, p=0.049), and in patients with a history of peripheral nervous system involvement (25 vs. 4%, p=0.02), pericarditis (58 vs. 27%, p=0.04), anti-Sm (42 vs. 11%, p=0.01), and anticardiolipin antibodies (75 vs. 31% p=0.007). CONCLUSIONS: PH is a relatively common complication of SLE patients managed in tertiary care centres. Doppler echocardiography allows non-invasive detection of elevated sPAP in this population that should then benefit from gold-standard techniques including right-heart catheterisation in order to confirm the diagnosis, as well as the cause and severity of PH.

[Therapeutic modalities and economic assessment in the treatment of superficial basal cell carcinomas and multiple actinic keratoses by French dermatologists]. / Evaluation médico-économique de la prise en charge des carcinomes basocellulaires superficiels et des kératoses actiniques multiples par les dermatologues français.

INTRODUCTION: To date, no prospective studies have been conducted in France describing the management of actinic keratoses (AK) and superficial basal cell carcinomas (sBCC). The aim of the present study was to describe the therapeutic modalities for AK and sBCC adopted by French dermatologists and to determine the direct annual medical costs. PATIENTS AND METHODS: This was a prospective, observational study conducted in France between January and June 2004 in a random selection of representative dermatologists (n=202). The first 5 adult patients seen for one or more sBCCs and the first patient with at least 4 AKs over a period of four non-consecutive weeks were included in the study. The following data were recorded using a standardized questionnaire at inclusion: date of birth, gender, habitat, professional activity, social insurance regimen, site, number and maximum size of lesions. The therapeutic modalities, the physicians involved and the laboratory examinations during the 3 months following diagnosis were recorded prospectively. Medical management costs were calculated taking into account the usual parameters (e.g. French nomenclature of medical acts). RESULTS: 512 patients with sBCC (mean age: 69 years; sex-ratio M/F: 0.92) were included in the study. sBCC was isolated in 80% of cases, measured less than 2 cm in 90%, and was located on the head/neck in 51% and on the trunk in 37%. Histological confirmation of diagnosis of BCC was obtained in 85% of cases. Treatment comprised surgical excision in 70% of cases, cryotherapy in 13%, topical therapy in 7% and curettage/electrodessication in 4%. Clinical follow-up was performed in 79% of cases. The mean cost per patient over 3 months was 139 euros (CI95%: 125-153). In addition, 226 patients with AK (mean age: 76 years; sex-ratio M/F: 2.1) were included in the study. AKs were located on the head/neck in 74% of cases and on the trunk in 6%. Treatment consisted of cryotherapy in 92% of cases. The mean cost per patient over 3 months was calculated at 85 euros (CI95%: 71-99). An on-site audit of 5% of the investigators gave a concordance rate of 98.8%. DISCUSSION: This is the first study conducted in France to evaluate both the medical approach and treatment costs of sBCC and AK. Finally, the mostly surgical treatment of sBCC observed is in accordance with the recent French ANAES guidelines. When extrapolating the results of the present study, the annual cost of treatment of sBCC by French dermatologists may be estimated at between 10.2 and 10.6m euros.

[Abstract quality assessment of articles from the Annales de Dermatologie]. / Qualité des résumés des articles publiés dans les Annales de Dermatologie.

INTRODUCTION: Article's abstracts are an important part of the publication, widely available in electronic databases. We assessed the quality of abstracts in the Annales de Dermatologie. The main objective was to compare abstract quality in 3 periods in the past decade. In this Journal, structured abstracts are required since 1993. The secondary objective was to compare structured and non structured abstract quality. MATERIAL AND METHODS: Three periods were assessed: 1991-92, 1996 and 2000. We selected the abstracts of original studies, excluding non focused descriptive case series. We used a criteria scale elaborated by Narine et al. Thirty criteria were assessed for each abstract, divided into 8 categories: purpose, research design, setting, subjects, intervention, outcome measurement, results and conclusion. If applicable to the study, a criterion was rated 1 (present) or 0 (absent). The final score for each abstract was defined as the ratio of positive answers among rated criteria. Mean scores for each period were compared using analysis of variance (mean +/- standard deviation). The temporal trend was calculated by simple linear regression. The mean scores of structured and unstructured abstracts were also evaluated and then compared. RESULTS: For each period, chronologically, 8, 17 and 18 (total 43) abstracts were evaluated. Mean scores for each period were 0.72 +/- 0.20 (1991-92); 0.69 +/- 0.12 (1996) and 0.83 +/- 0.08 (2000). These 3 scores were significantly different (P=0.006), with a trend toward increasing (Regression coefficient R(2)=0.136; P=0.015). Research setting obtained the lowest score (0.4). Structured (0.72 +/- 0.20; n=35) and non structured abstracts (0.76 +/- 0.12; n=8) were not significantly different. DISCUSSION: Abstracts of articles published in the Annales de Dermatologie contained on average 3/4 of the required informative items. The trend toward better scores may be explained by an increased attention of the editorial board as well as authors and reviewers. The quality could be improved by systematically mentioning the research setting.