RESUMEN
Depression was already a public health issue before the Covid-19 pandemic. Use of service and treatment adequacy in medical students was poorly known. A 2021 French national study found the prevalence of 12-month major depressive disorder (MDD) was 25 % in medical school students and residents (MSSR). The main objective of our study was to measure the prevalence of service use and adequate treatment (therapy and/or recommended pharmacotherapy) and their associated factors. A national online survey was conducted in 2021. The Composite International Diagnostic Interview Short-Form questionnaire was used to assess MDD; 12-months service use and pharmacotherapy were assessed. Univariate and multivariate logistic regressions were performed between students' demographic characteristics, use of services, and treatment adequacy. Among included MSSR who experienced MDD in the last 12 months, only 32 % received adequate treatment, including 20 % with recommended pharmacotherapy. Being more advanced in medical studies and being treated both by a general practitioner and a psychiatrist were associated with receiving recommended pharmacotherapy. To our knowledge, our study is the largest to assess use of service and treatment adequacy in MSSR. Given the low percentage of depressed students receiving recommended treatment, it seems important to develop new interventions to better detect and treat MDD in MSSR.
RESUMEN
Real-world data (RWD) and real-world evidence (RWE) appear now as complementary to traditional randomized controlled trials (RCT), that remain the gold standard of the evidence. This review aims to illustrate how health authorities in France, United States (USA) and United Kingdom (UK) can integrate RWD and RWE in market authorization discussions and in new pathways of price and reimbursement negotiations. We conducted a review from the literature, online investigations and interviews. RWD and RWE can be valuable in the context of market access, reimbursement decisions, price negotiation, pharmacovigilance and positive patient outcomes. While RWD could open new areas of innovative approaches and improve the efficiency of health systems, they have methodological limitations requiring further analysis to reach a sufficient level of proof. Moreover, misleading use of "RWD" and "RWE" terms is very frequent and even the definitions used by stakeholders (when they have one) are heterogenous. Because of the intrinsic characteristics of each product, the value given to these RWD may differ a lot, making them a useful tool more than an indispensable one. In sum, RWD and, more precisely, RWE have the potential to bring value to the health system at every step of the drug development process, from the discovery to the pharmacovigilance phase.