Regional variations in quinolone use in France and associated factors.

The purpose of this study was to investigate geographic variations in the use of quinolones in France and their associated factors. All reimbursement claims of antimicrobials were collected for 90 % of the French population for the year 2007. Dispensed quantities were then converted into defined daily doses (DDD) and adjusted for the age structure of the national population. Correlations between quinolone use and total antimicrobial use and some morbidity and socio-economic factors were studied using Spearman's rank correlation coefficients. On average, 2.05 DDD of quinolones per 1,000 inhabitants per day (DID) were dispensed in 2007 in France, accounting for 10.2 % of the total antimicrobial consumption in adults. A 40 % variation was observed between the regions with the lowest (1.73 DID) and the highest use (2.44 DID). This variation was more important for anti-pneumococcal quinolones than for quinolones directed against urinary tract infections (coefficients of variation: 26 vs. 6 %). Quinolone use was correlated with some regional socio-economic factors (unemployment, growth domestic product, health expenditures) and physician density, but was independent of the total antimicrobial use. After adjustment for age, large variations in quantitative and qualitative quinolone use were observed across French regions, especially for anti-pneumococcal fluoroquinolones. These results, though not controlled for potential epidemics variations, argue in favour of a possible improvement in quinolone prescribing to be achieved in some regions.

[Analysis of generic drug supply in France]. / Analyse de l'offre de médicaments génériques.

BACKGROUND: The list of generic medicines (LGM), published since 1997 by the Agence Française de Sécurité Sanitaire des Produits de Santé (AFFSSaPS), the French Medicine Agency, concerns a special part of the medicines reimbursed by the National Health Insurance (Social Security). The objectives of the present study were: i) to describe the components of this list, based on pharmaceutical, economical and therapeutic characteristics, ii) to study differences between generic and reference products (formulations, excipients, prices, etc.), iii) to analyze information on excipients provided to health care professionals. METHODS: The 21st version of the LGM (April 2001) was used. Therapeutic value was retrieved from the 2001 AFSSaPS report on the therapeutic value of 4490 reimbursed medicines. Information on excipients in the LGM and the Vidal dictionary (reference prescription book in France) was compared. RESULTS: The products included in the LGM represent 20% of all reimbursed medicines. The mean price differences between generics and their reference products vary between 30 and 50% for more than two thirds of the generic groups. The therapeutic value of the products of the LGM was judged important in 71% of cases (vs 63% for the 4409 assessed medicines) and insufficient in 13% of cases (vs 19%). Information on excipients is often missing and sometimes erroneous. CONCLUSION: Although the LGM is regularly revised and thus the generic market in perpetual change, the 2001 cross description of this pharmaceutical market provides much informations and raises some concern.

[Neurosurgical and endovascular treatment of intracranial aneurysms: a cost analysis of two different strategies at the University Hospital of Bordeaux (France)]. / Traitement neurochirurgical et endovasculaire des anévrismes intracrâniens. Approche économique de deux alternatives thérapeutiques sur le CHU de Bordeaux.

BACKGROUND: Rupture of intracranial aneurysms causes major mortality and morbidity. Moreover, treatment of this vascular malformation generates high medical costs. We compared the cost of two different strategies employed at the University of Bordeaux to prevent aneurysms from rebleeding: a classical neurosurgical technique consisting in clipping the neck of the aneurysm and a new less invasive neuroradiological technique based on embolization using platinum coils. METHOD: A micro-cost study was carried out retrospectively from May 1998 to June 2000) comparing data from 44 patients admitted for ruptured intracranial aneurysm: 22 operated patients and 22 patients treated with an endovascular approach. Each operated patient was matched with an embolized patient for clinical status at admission (World Federation of Neurological Surgeons Scale) and complications resulting from cerebral hemorrhage (hydrocephalus, vasospasm, rebleeding). RESULTS AND CONCLUSION: Our results showed the same cost for the same efficiency . Expenditures are however made differently. The endovascular technique allows a shorter hospital stay (8 days less), balancing the high cost of single use medical supplies (coils, microcatheters.). The endovascular technique has many advantages for the patients, but cannot be successful in all types of intracranial aneurysms. Both techniques remain indispensable.

[Pharmacoeconomics as a tool for the synthesis of available information on drugs]. / La pharmaco-économie comme outil de synthèse de l'information disponible sur le médicament.

Data on refundable pharmaceutical drugs are numerous and of various kinds. The clinical approach and the economic approach could be used together. This new approach allows for not only the synthesis but also the structuring of all the available information. The new information obtained is involved in decision trees.

Quality of life and use of health care among people with genital herpes in France.

In order to assess psychological morbidity in France related to genital herpes infection, we carried out a transversal study comparing infected patients with a control group. A total of 236 patients with genital herpes were first identified by means of a postal survey, then matched against a witness group of 236 noninfected persons. Detailed questionnaires were sent out to each person in the 2 groups. A total of 150 herpes patients and 200 non-infected persons answered the questionnaire, which enabled us to measure the incidence of the disease by means of 2 indicators: a herpes-specific scale and the SF-36 quality of life questionnaire. Emotional trauma due to genital herpes was reported amongst 23% of the participants. Of the participants, 57% indicated that herpes interfered with their sexual relationships; 50% felt it difficult to live with genital herpes; and 37% felt that herpes ruins their lives. An analysis assessing health-related quality of life indicated significant differences between the scores of the 2 groups and showed that quality of life is lower amongst herpes patients. Respondents with genital herpes required more frequent consultations with GPs (81% vs. 73%), and significantly more frequent consultations with specialists (59% vs. 45%). Our study confirms that substantial psychological morbidity exists in patients with genital herpes.

[Impact of demographic changes on drug utilization related to diabetes in Aquitaine]. / L'incidence de l'évolution démographique sur la consommation pharmaceutique liée au diabète en Aquitaine.

Diabetes is a chronic disease highly correlated to age. In 1998, the Sickness Find of the Aquitaine region has reimbursed 273 million French Francs for expenditures related to diabetes pharmaceuticals. The amount would increase to 300 million French Francs in 2005, a growth of nearly 10%, whereas the Aquitaine population would increase only 4%, from 2,909,000 in 1998 to 3,024,000 seven years later. The difference comes from population aging, as the calculations are undertaken "other things being equal": the insurance coverage rate, the disease prevalence rate, the consumption of pharmaceuticals per patient are supposed unchanged during the period.

[Evaluation of drug iatrogeny by medico-economic modelling techniques]. / Evaluation de la iatrogénie médicamenteuse par les techniques de modélisation médico-économique.

Decision-making methods can be extremely useful in managing the large amount of information available on the complex effects of medication over various time spans. Event trees help to formulate data and visualise the medical strategies with the highest performance in regard to clinical benefits, adverse side effects, cost and cost-benefit ratios. However when the quantity of phenomena becomes too diversified (i.e. multiplicity of events, long observation periods, changing variables, etc.) we can use one of the more sophisticated modelling techniques available with today's more powerful computers.

[30 years in the history of drugs and drug therapy]. / Trente ans dans la vie du médicament.

The last three decades have been undoubtedly a "revolutionary time" in the life of pharmaceuticals. Progress in scientific knowledge and medical practice have fueled tremendous change in the drug universe. The "drug chain" has been totally transformed, from the early conception through evaluation by the public authorities to end up with the utilization by the patient. The article describes all these transformations in the French context.

[Rationalization of health expenditures: the Séguin's plan in 1987]. / La rationalisation des dépenses de santé: le plan Séguin en 1987.

Sickness insurance is universal and compulsory in France. It is financed mainly by contributions from employers and employees. Consequently its soaring costs may sharply reduce the competitive French products on the world market. Successive French administrations have attempted to curb the growing health costs by increasing co-payment. The program launched in 1987 was innovating since it was aimed at the group of insured people who were previously not submitted to co-payment (persons having presumably grave illness...). The program was a breakthrough in the French system which was built on a mixed concept of insurance and solidarity. The program was undoubtedly a great success. However, lack of an efficient information system, and reaction of the various actors (patients and doctors) who succeeded to adjust themselves to the new regulations, diminished its impact some years after it has been implemented.

Comparative consumption of antidiabetic drugs in Britain, France and Germany.

With the aid of IMS, a database of drug sales statistics, the quantities (expressed in Defined Daily Doses per 1000 inhabitants and per day) of antidiabetic drugs prescribed from 1978 to 1987, in Britain, France and the Federal Republic of Germany has been compared.