Psoriasis: an epidemiological evaluation of disease burden in 590 patients.

BACKGROUND: There are limited data available on the economical burden of psoriasis and its impact on everyday life. OBJECTIVE: The aim of this study was to evaluate the impact of psoriasis on personal and professional life, and to evaluate the cost of psoriasis for the patient. METHODS: We performed a cross-sectional study in psoriasis patients. All patients aged >or=18 years with a diagnosis of plaque-psoriasis confirmed by a physician were included. A self-administered questionnaire evaluating everyday life was constructed with members of the French association of psoriasis patients. In addition, the Dermatology Life Quality Index (DLQI), Working Productivity and Activity Impairment and individual costs were assessed. RESULTS: A total of 590 patients completed the study. Mean age of the responders was 56 years. The mean DLQI score was 8.5 for patients with severe psoriasis vs. 6.4 for mild psoriasis. Global loss of productivity was 10.7% without significant difference according to the disease severity. Daily activities alteration was most important in patients with severe psoriasis. In this study, 36.8% of patients with severe psoriasis reported a negative impact on their professional life vs. 19.6% for patients with mild psoriasis (P = 0.002). Time devoted to phototherapy was on average 33 h/year/patient and the application of emollients took 25 h/year/patient; 47.3% of patients had a feeling to clean the house more often, in correlation with the severity of the disease. Mean out-of-pocket expenses for the disease was estimated to be 543 euro/year/patient. High impact of psoriasis on quality of life (DLQI >10), age <40 years and joint involvement were significantly associated with an increased risk of loss of work productivity. CONCLUSION: Psoriasis, particularly severe psoriasis, is a true burden for patients and impacts significantly everyday life and patient's economical resources.

Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson's disease.

BACKGROUND: High frequency stimulation of the subthalamic nucleus (STN) is an alternative but expensive neurosurgical treatment for parkinsonian patients with levodopa induced motor complications. OBJECTIVE: To assess the safety, clinical effects, quality of life, and economic cost of STN stimulation. METHODS: We conducted a prospective multicentre study in 95 consecutive Parkinson's disease (PD) patients receiving bilateral STN stimulation and assessed its effects over 12 months. A double blind randomised motor evaluation was carried out at 3 month follow up, and quality of life, self care ability, and predictive factors of outcome following surgery were assessed. The cost of PD was estimated over 6 months before and after surgery. RESULTS: The Unified Parkinson's Disease Rating Scale (UPDRS) motor score improved by 57% (p<0.0001) and activities of daily living improved by 48% (p<0.0001) at 12 month follow up. Double blind motor scoring improved by 51% at 3 month follow up (p<0.0001). The total PD Quality of Life Questionnaire (PDQL-37) score improved by 28% (p<0.001). The better the preoperative motor score after a levodopa challenge, the better the outcome after STN stimulation. Five patients developed an intracerebral haematoma during electrode implantation with permanent after effects in two. The 6 month costs of PD decreased from 10,087 euros before surgery to 1673 euros after surgery (p<0.0001) mainly because of the decrease in medication. These savings allowed a return on the procedure investment, estimated at 36,904 euros over 2.2 years. CONCLUSIONS: STN stimulation has good outcomes with relatively low risk and little cost burden in PD patients with levodopa induced motor complications.

Erythropoietin and preoperative autologous blood donation in the prevention of hepatitis C infection: necessity or luxury?

BACKGROUND: Prevention of exposure to allogeneic blood transfusion during surgery is an important financial issue when recombinant human erythropoietin (rHuEPO) is used in addition to preoperative blood donation. STUDY DESIGN AND METHODS: The aim of this study was to carry out a cost-effectiveness analysis of the use of rHuEPO in preoperative blood donation in orthopedic surgery. The study, based on a decision tree analysis of the use of rHuEPO, was conducted from the perspective of the French health care system. The efficacy criterion was the number of hepatitis C infections prevented. The decision tree analysis was constructed as follows: the residual risk of hepatitis C infection was 8.26 per million units transfused, and the chance node was defined according to the number of units transfused. RESULTS: With the use of rHuEPO in preoperative blood donation, 0.30562 cases of hepatitis C infection per 100,000 patients were prevented. The incremental cost of one prevented hepatitis C infection amounted to $888,000,000 (US). CONCLUSION: Despite the limitations of our model, the cost-effectiveness ratio was so large that variations only slightly modified the size of the result. From the societal perspective, it was not cost-effective to add rHuEPO to preoperative blood donation.

[Medico-economic evaluation of abciximab]. / Evaluation médico-économique d'abciximab.

Abciximab (RéoPro) is a chimeric monoclonal antibody directed against platelet glycoprotein IIb-IIIa. It reduces the frequency of major cardiac ischaemic events after percutaneous transluminal coronary angioplasty (PTCA). This treatment is more expensive than the commonly used treatment (aspirin and heparin). However, a treatment can only be validly assessed in term of its cost-benefit ratio. The authors present the results of a medico-economic evaluation of abciximab in the French institutional context, based on the three-year clinical results of the EPIC study (Evaluation of abciximab for the Prevention of Ischemic Complications). The efficacy of treatment was expressed by means of two quantitative indicators: the number of patients with no major ischaemic event (MIE) and the number of years of life without myocardial infarction or revascularization. According to French good practice recommendations for economic evaluation of therapeutic strategies, major ischaemic events were assessed by using the complete cost of the corresponding homogeneous groups of diseases (GHM). Medico-economic evaluation of abciximab showed that the net excess cost per patient for national health insurance was 395 Francs, while the cost of the product is 5,300 Francs. The incremental cost per additional patient with no major ischaemic event is 6,585 Francs and the incremental cost per additional year of life without myocardial infarction or revascularization is 2,469 F. From a public health point of view, abciximab administered by bolus injection plus a 12-hour infusion, presents a good cost-effectiveness ratio in the prevention of cardiac ischaemic complications in high-risk patients after PTCA.