Epidemiology of atrial fibrillation in France: extrapolation of international epidemiological data to France and analysis of French hospitalization data.

The prevalence of atrial fibrillation is steadily increasing throughout the world because of ageing populations and better management of coronary heart disease. An international literature review was conducted to estimate the prevalence and incidence of atrial fibrillation in France. A review of the literature on comorbidities was also performed. Finally, French mortality and hospitalization data were analysed using the PMSI database. The prevalence of atrial fibrillation is estimated to be between 600,000 and 1 million people; of these, two-thirds are aged >75 years. The incidence is estimated at between 110,000 and 230,000 new cases per year. In 2008, 412,000 hospitalized patients had a diagnosis of atrial fibrillation; this figure increased by 26% in the 3-year period between 2005 and 2008. These findings highlight the importance of targeting therapy, of upstream therapy, and of therapy that provides clear clinical and economic advantages over the well-established reductions already achieved in atrial fibrillation morbidity, mortality and cost. In addition, new prevention strategies should be developed, particularly secondary prevention strategies in patients with cardiovascular diseases.

Screening to detect permanent childhood hearing impairment in neonates transferred from the newborn nursery.

OBJECTIVES: The focus of this report is hearing screening of newborns transferred from the regular nursery to a specialized area. The purpose of the study undertaken was: (1) to determine whether screening coverage in this population was achieved; (2) to establish whether the linkage between neonatal screening and the diagnostic follow-up was carried out correctly; (3) to better determine the incidence of permanent childhood hearing impairment (PCHI) in this at-risk population. METHODS: Six population centres averaging 12,000 births annually participated (Bordeaux, Lille, Paris, Marseille, Toulouse and Lyon). Automated auditory brainstem response (AABR) (Natus ALGO 3i) screening was performed in two stages: i.e. infants with initial "positive" results were screened a second time using the same technique. Of the 117,103 babies born during the study period, 4972 neonates were "transferred" and comprised the population for this report (4.2% of the total births). RESULTS AND DISCUSSION: Screening results for 4972 "transferred" neonates were compared with those of non-transferred neonates (N=112,131). Screening coverage of eligible infants was significantly lower (75.4%) in "transferred" neonates (3750 infants screened) compared to 97.5% coverage of non-transferred neonates (109,349 infants screened). The rate of positive results after the first stage AABR was higher in the "transferred" population (11.1%) than in the non-transferred population (6.5%). Of the 415 "transferred" newborns with initial positive screens, 91.3% were rechecked as stipulated in the project protocol. The second pre-discharge AABR ascertained that in half of the cases auditory function had normalized in the day. Of the 183 "transferred" infants whose result remained suspect at the conclusion of both stages of the neonatal screen (4.9% of the tested population), only 70.5% returned to the audiology centre for diagnostic follow-up. The incidence of bilateral PCHI was markedly higher (4/1000) in "transferred" infants than in the non-transferred population (1.08/1000). CONCLUSIONS: The difficulty of obtaining universal screening coverage in "transferred" infants was, unfortunately, verified in this prospective, multicentre study. Further, the diversity of our "transferred" population was not much greater than that revealed by careful analysis of published hearing screening studies in neonatal intensive care unit (NICU) infants. The influence of risk factors and their more or less complex combinations is apparent.

Therapeutic management of uncomplicated gastroesophageal reflux disease in france in 2005: Potential cost savings of omeprazole substitution.

BACKGROUND: Proton pump inhibitors (PPIs) cost the French health care system >€1 billion in 2005, and ~50% of PPI prescriptions were for the treatment of gastroesophageal reflux disease (GERD). OBJECTIVES: This study aimed to describe the current use of PPIs for GERD, to estimate the total annual costs of treatment, and to evaluate the economic impact of the various possible substitutions among PPIs available for this indication in France. METHODS: Data from a sample of patients aged ≥20 years who visited their general practitioner (GP) at least once in 2005 for uncomplicated, symptomatic GERD were retrieved from the Thales database (a group of 1200 representative GPs connected to a computerized network). Costs of the prescriptions presented for reimbursement and costs of those reimbursed by the French health care insurance system were analyzed. We then evaluated the economic consequences of replacing full-dose generic omeprazole (after substitution from brand-name omeprazole by the pharmacists) with other compounds that are indicated for mild symptoms at half dose (ie, lansoprazole 15 mg, pantoprazole 20 mg, rabeprazole 10 mg, and esomeprazole 20 mg). The results were adjusted to account for the proportions of patients who had full health care coverage and the treatment duration as reported in the database. RESULTS are presented from the perspective of the French health care insurance system. RESULTS: In 2005, a total of 122,571 patients (mean age, 55.7 years; 45.5% men; 13.8% with a history of at least 1 gastrointestinal disorder) met the inclusion criteria. Extrapolated to the French population, this sample corresponded to ≈5.7 million people (ie, 13% of the adult population who visited a GP during the year). PPIs were prescribed as first-line treatment for GERD in 84.1% of the consultations (14.3% in association with other antiulcer drugs). Omeprazole, as a proprietary or generic drug, was prescribed most often (78.9%) and at full dose (20 mg), while other compounds (lansoprazole, pantoprazole, rabeprazole, and esomeprazole) were prescribed at half dose in 64.3% of cases. The extrapolated annual cost of PPIs reimbursed for this indication was €465.02 million at a mean reimbursement level of 72.7%. Brand-name omeprazole still accounted for ≈11% of the total cost reimbursed. Complete replacement of brand-name omeprazole with its generic counterpart would have reduced costs by €18.35 million (a decrease of 4.3% in the total reimbursed expenditure). The switch from generic full-dose omeprazole to a half dose of other PPIs would have allowed further savings ranging from €2.59 million (with lansoprazole) to €13.19 million (with pantoprazole). CONCLUSION: In accordance with recent recommendations for the treatment of uncomplicated GERD and based on the 2006 PPI pricing, switching from branded full-dose omeprazole to generic omeprazole or to the use of half doses of other PPIs may allow cost savings in France.

[General practitioners' management of gastroesophageal reflux in France in 2005: a pharmacoeconomic study]. / Etude pharmaco-économique sur la prise en charge du reflux gastro-oesophagien en France en 2005 en médecine générale.

AIMS: Proton pump inhibitors (PPIs) rank third among drug classes in the amount they cost the French health care system annually (more than a billion euros, i.e., 5.7% of community pharmaceutical expenditures, 50% prescribed for gastroesophageal reflux disease (GERD)). METHODS: Data for a representative sample of patients aged 20 years and older, who visited their GP at least once in 2005 for uncomplicated symptomatic GERD came from the Thales database (1200 representative general practitioners (GP) connected to a computerized network) a. RESULTS: In 2005, 122 571 patients (mean age, 56 years, 45% male, 2.6 consultations for GERD) met the inclusion criteria. Extrapolated to the French population, this sample corresponds to 5.7 million people, i.e., 13% of the adult population who visited a GP during the year. PPIs were prescribed as first-line treatment for GERD in 84% of the consultations. Omeprazole, as a proprietary or generic drug, was prescribed most often (79%) and at a full dose (20mg), while other compounds (lansoprazole, pantoprazole, rabeprazole and esomeprazole) were prescribed at half dose in 64% of cases. The extrapolated annual cost of PPIs reimbursed for this indication was 465 million euros (Meuro) at a mean reimbursement level of 73%. Brand-name omeprazole still accounts for 11% of the total cost reimbursed. Complete replacement of brand-name omeprazole by its generic counterpart would reduce costs by 18.35Meuro (-4.3% reimbursed expenditure). The switch from generic full-dose omeprazole to a half dose of other PPIs would allow a further saving of 2.6 (with lansoprazole) to 13.2 Meuro (with pantoprazole). CONCLUSION: A substantial saving in reimbursed pharmaceutical spending in uncomplicated GERD and full compliance with clinical practice recommendations could be achieved by the substitution of less expensive PPIs.

A multicentre pharmacoepidemiological study of therapeutic practices in invasive fungal infections in France during 1998-1999.

OBJECTIVE: To study the pharmacoepidemiology of the prescription of systemic antifungal agents in 48 French haematology, intensive care and infectious diseases units. PATIENTS AND METHODS: Cases of invasive fungal infections (IFI) were identified retrospectively over a 1 year period. Data on underlying condition, IFI diagnosis, antifungal treatment and outcome were collected on the last five cases in each centre. Factors associated with first line therapy and with death were identified by multivariate analysis. RESULTS: Two hundred and nine cases were included (102 aspergillosis, 86 candidiasis, 15 cryptococcosis). Amphotericin B, in different formulations, was the first line therapy in 60%, azoles in 32%, combinations in 8%. Haematological malignancies and neutropenia were associated with less frequent initial prescription of azoles [OR = 0.3 (0.1-0.8) and OR = 0.3 (0.1-0.9), respectively]. In aspergillosis, younger age and neutropenia were associated with less frequent initial prescription of azoles [OR = 0.03 (0.002-0.6) and OR = 0.09 (0.03-0.3), respectively] and previous history of IFI was associated with a higher probability of azole prescription [OR = 17.2 (2.4-124.3)]. In candidiasis, haematological malignancy and co-prescription of nephrotoxic agents were associated with a less frequent initial prescription of azoles [OR = 0.1 (0.04-0.4) and OR = 0.2 (0.06-0.9), respectively]. Three factors were associated with a lower risk of death: cryptococcosis [OR = 0.16 (0.03-0.98)], hospitalization in infectious diseases units [OR = 0.40 (0.16-0.97)] and recent surgery [OR = 0.26 (0.08-0.80)]. Severe renal insufficiency was associated with a higher probability of death [OR = 8.77 (1.97-38.97)]. CONCLUSIONS: Our results emphasize factors associated with the antifungal therapeutic decision and with the outcome of IFI.

Changes in osteoarthritis management by general practitioners in the COX2-inhibitor era-concomitant gastroprotective therapy.

OBJECTIVES: Two selective COX2 inhibitors, rofecoxib and celecoxib, were introduced on the French market in 2000. We evaluated their use in the treatment of osteoarthritis by general practitioners, with special attention to concomitant prescription of gastroprotective agents. MATERIAL AND METHODS: The Thales Epidemiology Observatory is a medical database compiled by a representative sample of 1000 general practitioners in France. We examined the data collected during the year before and the year after the introduction of rofecoxib and celecoxib on the French market (November 1999-October 2001). During each of the 2 years of the study period, about 200,000 visits for 70,000 patients were entered into the database. RESULTS: COX2 inhibitors were prescribed at a rapidly increasing rate during the second year, when they accounted for 38% of the prescription volume for nonsteroidal antiinflammatory drugs (NSAIDs) and 25% of prescribed medication costs. In some patients, COX2 inhibitors were substituted for nonselective NSAIDs, and in others they were used as first-line NSAID therapy. On average over the 2-year study period, 22.1% of prescriptions for conventional NSAIDs included a prescription for a gastroprotective agent; this proportion increased from 18.6% in November 1999 to 24.8% in October 2001. Among prescriptions for COX2 inhibitors, 17.5% included a gastroprotective agent. CONCLUSION: General practitioners have been prompt to use COX2 inhibitors in the treatment of osteoarthritis. However, they have not decreased their use of concomitant gastroprotective treatment. Thus, they seem aware that proof of a lower long-term risk of gastrointestinal toxicity with COX2 inhibitors is lacking, and that elderly patients such as those with osteoarthritis are at high risk for gastrointestinal side effects of NSAIDs.