Costs of hospitalization for severe acute asthma of patients not treated according to guidelines and recommendations. French prospective study of 169 cases.

This prospective study of 169 adult patients hospitalized for severe acute asthma in four pneumology wards compared the incidence and costs of patients who were managed (group A) or not managed (group P) before hospitalization, according to the guidelines and international recommendations (11 criteria judged by experts). Ambulatory costs were calculated by questioning patients. Valuation of hospital costs was based DRGs weighted by length of stay. The incidence in group P patients was estimated at 70%; A patients were 14 years younger than those in group P and had less severe asthma. Their annual ambulatory care prior to hospitalization was less costly irrespective of age category or degree of severity (euro 685 vs. euro 1,145 in group A); their length of hospital stay was shorter (6.03 vs. 10.78 days), resulting in a lower cost of hospitalization (euro 2,820 vs. euro 4,843). In group P a specific education program based on increased understanding, compliance, self-management, and smoking cessation, particularly in young patients should lead to reductions in hospitalizations.

Lifetime cost of HIV care in France during the era of highly active antiretroviral therapy.

OBJECTIVE: To estimate the treatment and health care costs of HIV infection or AIDS in France during the era of highly active antiretroviral therapy (HAART). DESIGN: We used a clinical database of HIV-infected patients to calculate the resource use and cost of care for different stages of HIV infection. Costs were incorporated into a computer-based, probabilistic simulation model of the natural history and treatment of HIV infection to estimate the lifetime cost of treating patients with HIV disease. SETTING: A northern France HIV clinical cohort. PARTICIPANTS: 1232 HIV-infected patients followed from January 1994 through July 1998. RESULTS: In the absence of an AIDS-defining event, the average total cost of care ranged from 670 euros (1 euro=US $1.19) per person-month in the highest CD4 stratum (>500/microl) to 1060 euros per person-month in the lowest CD4 stratum (< or = 50/microl). The mean cost of care was estimated at 3370 euros per person-month during the initial months around the occurrence of an AIDS-defining event; at 1750 euros per person-month during the period spanning from 2 months after the diagnosis of specific AIDS-defining event to 1 month prior to death; and at 13010 euros per person-month in the final month prior to death. If clinical management of HIV infection began at a CD4 cell count of 378/microl, as in this cohort, the discounted lifetime cost of treating an HIV-infected French patient was estimated at 214000 euros. The undiscounted costs were 309000 euros over a projected life expectancy of 16.4 years. CONCLUSION: The cost of HIV disease varies widely depending upon the stage of illness. These estimates of stage-specific and lifetime costs of HIV care will assist health policy planners in assessing the burden of disease in the era of HAART and projecting future resource requirements.

[Economic assessment of adjuvant and palliative chemotherapy in colorectal cancer: a review]. / Evaluation économique des chimiothérapies adjuvante et palliative dans le traitement du cancer colorectal: enseignements de la littérature.

The aim of this study is to perform a review of the literature on economic (or medico-economic) studies in the area of chemotherapy for colorectal cancer. French and international literature has been reviewed on this topic. Colorectal cancer represents a major public health problem due to high mortality, prevalence and costs. Up to now chemotherapy can be used at the adjuvant stage or at the palliative one. This work provides a synthesis of the main results of economic publications devoted to adjuvant and palliative chemotherapies, as well as a reflection on the limits frequently associated with such studies.

[Cost of colorectal cancer in France in 1999]. / Coût du cancer colorectal en France en 1999.

AIM: Due to high incidence and disease severity, colorectal cancer is a major public health concern in western countries. Few studies have been devoted to estimating its cost in France. The aim of this study was to analyze the direct (medical) and indirect (short-term disability, long-term disability, premature death) costs of colorectal cancer in France. METHODS: This cost-of-illness study was based on data available for 1999. Two evaluation perspectives were considered: French social security system (medical care + daily allowances + disability allowances) and the society (medical care + production losses). Sources of data used in this analysis were: PMSI (hospital care), EPPM-IMS study (ambulatory care) and the GAZEL cohort (short-term disability). RESULTS: Direct costs of colorectal cancer in France amounted in 1999 to more than 469.7 million euros, of which 98% were induced by hospitalisation (on an outpatient or an inpatient basis). Indirect costs represented in 1999 for the French social security system an amount of 85.9 million, of which 71% were due to disability allowances. Taking into account the society's point of view, indirect costs corresponded to production losses of 528.1 million. Total costs of colorectal cancer amounted 555.5 million for the social security system and 997 million for the society. CONCLUSION: These results confirm the high economic burden of colorectal cancer for the French social security system and for the society in general.

National survey of endodontics in general dental practice in France.

The purpose of this paper was to gather both qualitative and quantitative information on endodontic treatments performed by French dental practitioners, and to identify the factors influencing the duration of endodontic procedures. A questionnaire was addressed in a two-rounds distribution to 2000 dentists selected by the quotas method in the whole country. A total of 790 (39.5%) questionnaires containing useful information were returned. The duration of endodontic treatment increases according to the number of roots to treat. The pulpal preoperative status has an influence on the duration of treatment, which is longer for a tooth with a necrotic pulp. Three variables strongly influence the duration of endodontic treatment: the number of patients attended per day, the number of appointments required for this treatment and the presence of a wage earner in the office. Continuing education also seems to be a variable having some influence on the duration of treatment. Financial considerations are also taken into account and there was general agreement that the current remuneration system of the French Health National Insurance is inadequate. Further, when one compares the total cost of an endodontic treatment with the fees fixed by the Health Insurance, it is clear that such procedures afford no positive financial return for a majority of practitioners. Moreover, the return becomes even more negative for teeth with a necrotic pulp. The findings presented in this study constitute the first stage of the medico-economic analysis concerning the endodontic practices in France. Prospective studies to gather precise information on the duration of endodontic treatments and a cost-analysis of endodontic practices could assist in the decision making process for practitioners or for the policy makers in the formulation of policies regarding application and reimbursement of endodontic treatment.