Use and representations of intrauterine device in Martinique, F.W.I.: A cross-sectional survey.

INTRODUCTION: Abortion rate is higher in Martinique than in metropolitan France. Difference in pattern of contraception may be involved, particularly regarding IUD use. IUD use is often hampered by misconceptions. The aim of the study was to evaluate IUD use in a non-selected population in Martinique and to explore knowledge and acceptance of the method. MATERIAL AND METHODS: Women were submitted a self-questionnaire about their contraceptive history, appropriate candidates for, effectiveness, side effects and perceived risks of IUD. Acceptance of the method among men and women and reasons for rejecting it were also surveyed. We included 112 men and 136 women. Descriptive statistics and comparison of answers between ever and never IUD-users were realized. RESULTS: Past or current IUD use was found in 26.5% [19.3-34.8] of women and the method was known by 90.4% of women and 85.1% of men. Pain at insertion (important for 22%), infectious risk (increased for 23.6%), and eligible candidates for the method (possible in nulliparous for only 56.9%) were the main misconceptions recorded. Knowledge was better among ever than never IUD-users. Theoretical acceptance of the method was high (87.5% among women of reproductive age, 82.5% among men). Rejection of the method was mainly motivated by doubts on efficacy and fear from pain, whereas religious barriers were seldom set forward. DISCUSSION: IUD use seems comparable in Martinique and France but misconceptions are still common. Information may help diffusion of IUD in a targeted population at higher risk of unintended pregnancy.

A global economic model to assess the cost-effectiveness of new treatments for advanced breast cancer in Canada.

Objective Considering the increasing number of treatment options for metastatic breast cancer (MBC), it is important to develop high-quality methods to assess the cost-effectiveness of new anti-cancer drugs. This study aims to develop a global economic model that could be used as a benchmark for the economic evaluation of new therapies for MBC. Methods The Global Pharmacoeconomics of Metastatic Breast Cancer (GPMBC) model is a Markov model that was constructed to estimate the incremental cost per quality-adjusted life years (QALY) of new treatments for MBC from a Canadian healthcare system perspective over a lifetime horizon. Specific parameters included in the model are cost of drug treatment, survival outcomes, and incidence of treatment-related adverse events (AEs). Global parameters are patient characteristics, health states utilities, disutilities, and costs associated with treatment-related AEs, as well as costs associated with drug administration, medical follow-up, and end-of-life care. The GPMBC model was tested and validated in a specific context, by assessing the cost-effectiveness of lapatinib plus letrozole compared with other widely used first-line therapies for post-menopausal women with hormone receptor-positive (HR+) and epidermal growth factor receptor 2-positive (HER2+) MBC. Results When tested, the GPMBC model led to incremental cost-utility ratios of CA$131 811 per QALY, CA$56 211 per QALY, and CA$102 477 per QALY for the comparison of lapatinib plus letrozole vs letrozole alone, trastuzumab plus anastrozole, and anastrozole alone, respectively. Results of the model testing were quite similar to those obtained by Delea et al., who also assessed the cost-effectiveness of lapatinib in combination with letrozole in HR+/HER2 + MBC in Canada, thus suggesting that the GPMBC model can replicate results of well-conducted economic evaluations. Conclusions The GPMBC model can be very valuable as it allows a quick and valid assessment of the cost-effectiveness of any new treatments for MBC in a Canadian context.