[Aging population, dematerialization, a new deal for the pharmacy]. / Vieillissement de la population, dématérialisation, une nouvelle donne pour la pharmacie.

Home delivery has expanded across all retail sectors. During the first waves of the Covid-19 pandemic, pharmacists were approached by many of their patients who wanted to receive their medications at home. The question is whether this development is sustainable or merely cyclical.

[Cost of dialysis in France]. / Coût de la dialyse.

According to latest data published by the French health authority (HAS), nearly 74,000 French patients in end-stage chronic renal disease are following a replacement therapy. They were 61,000 in 2007, amounting to a cost of 4 billions euros for public health insurance. The cost varies depending on the age and comorbidities. Continuous ambulatory peritoneal dialysis is the cheapest mode of treatment, while the heavy haemodialysis centres costs are close to twice as expensive. But these two different treatments are - a priori - not applied for the same patients in terms of level of severity of disease. Moreover, associated costs, medical treatment, transportation, etc. are to be taken into account, as well as losses of income for patients facing major job difficulties. As recommended by HAS experts, it will be important to regularly conduct surveys allowing a regular economic assessment of the various modes of financial healthcare for end-stage chronic renal disease.

[Costs of cancer care]. / Le coût des traitements du cancer.

Costs Of Cancer Care. In France, healthcare for nearly 2.5 million of patients with cancer is 100 % funded through the "long duration disease" plan offered by the national insurance system. The increase in the cost of the therapeutic means and in the number of patients becoming chronically ill thanks to progress in the global care lead to having to take the economic elements into account. All items of expenditure, all costs must be considered. In 2012, the cancer has mobilized 10% of health insurance expenditure, or 14.5 billion euros. Regarding drugs, their price is based on expert assessment of their therapeutic and medico-economic contribution, followed by a demanding negotiation between representatives of the administration and the industry. The French system intends to defend both solidarity and equity in access to care, on the basis of rigorous analysis. It remains up to the doctors then to make fair use of the means thus available at their disposal.

Le coût des traitements du cancer. En France, l'assurance maladie finance à 100 % grâce au dispositif « affection de longue durée ¼ les soins de près de 2,5 millions de personnes atteintes d'un cancer. Le renchérissement des moyens thérapeutiques et l'augmentation du nombre de patients devenus des malades chroniques grâce aux progrès dans les prises en charge amènent à devoir prendre en compte les éléments économiques qui s'y rattachent. Tous les postes de dépenses, tous les coûts doivent être considérés. En 2012, le cancer a mobilisé 10 % des dépenses de l'assurance maladie, soit 14,5 milliards d'euros. S'agissant des médicaments, leur prix repose sur une évaluation experte de leur apport thérapeutique et médico-économique, suivie d'une négociation exigeante entre industriels et représentants de la tutelle. Le système français entend défendre à la fois la solidarité et l'équité dans l'accès aux soins, sur le fondement d'analyses rigoureuses. Reste ensuite aux médecins à faire un juste usage des moyens ainsi mis à leur disposition.

Iron deficiency: an emerging therapeutic target in heart failure.

In patients with heart failure, iron deficiency is frequent but overlooked, with a prevalence of 30%-50%. Since it contributes to cardiac and peripheral muscle dysfunction, iron deficiency is associated with poorer clinical outcomes and a greater risk of death, independent of haemoglobin level. Therefore, iron deficiency emerges as a new comorbidity and a therapeutic target of chronic heart failure in addition to chronic renal insufficiency, anaemia and diabetes. In a series of placebo-controlled, randomised studies in patients with heart failure and iron deficiency, intravenous iron had a favourable effect on exercise capacity, functional class, LVEF, renal function and quality of life. These clinical studies were performed in the context of a renewed interest in iron metabolism. During the past 10 years, knowledge about the transport, storage and homeostasis of iron has improved dramatically, and new molecules involved in iron metabolism have been described (eg, hepcidin, ferroportin, divalent metal transporter 1). Recent European guidelines recommend the monitoring of iron parameters (ie, serum ferritin, transferrin saturation) for all patients with heart failure. Ongoing clinical trials will explore the benefits of iron deficiency correction on various heart failure parameters.

[Cost of cancer in France: pharmaceutical expenditure as part of global patients' care]. / Le coût du cancer en France : place des dépenses pharmaceutiques dans la prise en charge des malades en oncologie.

The INCa, as well as the French National Health Insurance recently published, and for the first time, important reports making it possible to take stock of the cost of care for the patients treated for a cancer or a malignant hemopathy, and in particular on the pharmaceutical expenditure related to cancer. The number of people with full medical coverage ("ALD") for cancer increased by 62% in 10 years, and exceeds 1.25 million people today. The corresponding expenditure is close to 14 billions euros for public health insurance systems, appreciably lower than that related to the cardiovascular diseases. The annual expenditure by patient treated for cancer is much lower than that related on the chronic renal failure, transplantations or the VIH-AIDS. The share of the expenditure related to the medical drugs and other goods (devices) is estimated by the INCa at 13% of the total expenditure related to the care. The anti-cancer drugs count for 20% of the pharmaceutical expenditure of the hospitals, of which the half related to specialities reimbursed in addition to the "T2A" fixed rates. Due primarily to the new anti-cancer drugs, the expenditure for this class increased by more than 6 fold in 10 years, responsible for 37% of the total increase in hospital health care expenditure. However, the share of the expenditure related to the drugs is lower for the patients treated in "ALD" for cancer than that of the whole of the ALD (19.5 vs 20%). For the Health insurance, the cost for anticancer drugs, all classes and indications included, accounts for 2.1% of the expenses, i.e. 1.5% of the national current health expenditure. The innovating anti-cancer drugs count for less than 4% of the expenditure related to cancer, i.e. less than 0.45% of the total expenditure. It is necessary to consider these data, correlatively to the clinical and social benefit gained, in the strategies of care.

[Management of anaemia in patient with cancer: results of the F-ACT study (French Anaemia Cancer Treatment)]. / Prise en charge de l'anémie chez les patients présentant une pathologie maligne: résultats de l'étude F-ACT (French Anaemia Cancer Treatment).

Anaemia is one of the most dreaded complications among patients with malignant pathologies. Its causes can be varied and whatever its severity, the impact on the quality of life of the patient remains essential. However, the epidemiologic data concerning anaemia are very few in the literature. This is why we carried out a large national survey about the prevalence and the management of anaemia among patients with malignant diseases. The F-ACT (French Anaemia Cancer Treatment) study is a retrospective observational multicentric study conducted with 178 experts practicing in 112 centers or units treating patients with solid tumours and/or malignant haematological diseases. Control over one day standard of consultation for each questioned expert, 2 782 patients were enrolled, including 1 892 (68%) patient with solid tumour and 890 (27%) patient with malignant haematological disease. The median age was 61 years (range : 18-93 years) including 1 335 women (48%) and 1 447 men (52%). A the date of enrollment, the median level of haemoglobin (Hb) was 11,6 g/dl (range: 5,2-18,5 g/dl) and 44% of patient had a level of Hb < 11 g/dl. An anaemia was found in all the cancer localizations and whatever the stage or the therapeutic status of the disease. Approximately 2/3 of the anaemic patients received treatment by erythropoiesis stimulating agent (ESA) and approximately 17% of them did not receive any specific treatment for this anaemia. The median level of Hb at the introduction of the ESA was 10 g/dl. These results, compared with those reported in study ECAS (European Cancer Anaemia Survey) in 2001, seem to show an improvement in the management of anaemia and the use of the ESA, in particular an earlier introduction of this type of treatment since the appearance of anaemia.

Erythropoietic therapy for the treatment of anemia in patients with cancer: a valuable clinical and economic option.

BACKGROUND: Healthcare organizations must evaluate the cost effectiveness of the alternative therapies that are available to treat anemia and improve quality of life (QoL) of patients with cancer, that is, erythropoietic protein therapy and blood transfusion. METHODS: Pharmacoeconomic studies that evaluated the cost of not treating anemia or treating with transfusion or erythropoietic protein therapy were reviewed and compared. Studies of individual erythropoietic proteins (epoetin alfa, epoetin beta or darbepoetin alfa) were also assessed. As no prospective trials have compared the erythropoietic proteins, retrospective studies and the results of separate trials were analyzed. The database searched for this review was PubMed (open date to August 2006). Recent conference abstracts were also searched (2003-July 2006). RESULTS: There is a high cost associated with anemia in cancer patients. Treatment of anemia is likely to lead to increased hemoglobin (Hb) levels and improved QoL as principal outcomes. Therefore, in assessing erythropoietic protein versus transfusion, it is more appropriate to use Hb or QoL as endpoint rather than quality adjusted life year. Studies with the former approach showed that erythropoietic protein therapy is more cost effective than transfusion. Also, its cost effectiveness should be improved with the use of evidence-based guidelines for patient selection and more tailored utilization. Increasing evidence suggests there might be differences among the erythropoietic proteins in terms of response rate, speed of response, and need for dose escalation. CONCLUSION: Significant costs are incurred when anemia in cancer is not treated. Erythropoietic protein therapy is more cost effective than blood transfusion for the treatment of cancer-related anemia. Transfusion should be reserved for patients with poor responses to erythropoietic protein or for the emergency setting, when rapid improvement in Hb is required.