[Prenatal screening of cytomegalovirus in France: an increasing frequency practices of screening from 2000 to 2003 despite no recommendation in favor]. / Dépistage prénatal du cytomégalovirus en France: une augmentation des pratiques de prescription de 2000 à 2003 malgré l'absence de recommandation favorable.

BACKGROUND: Screening cytomegalovirus infection in pregnant women is still controversial in 2004 in France. In this context, we evaluated the interest of such a screening in 2004 in France. This paper was designed to describe trends in CMV prenatal screening practices in 2000-2003 in France. METHODS: This retrospective study, describes the prescription of CMV screening in HIV-negative pregnant women giving birth in the private care sector, according to their occupational category and geographical area. Data were provided by the "Caisse d'Assurance-maladie des Travailleurs Indépendants" (independent workers health insurance fund). RESULTS: The study included 34.347 women, delivering in 2001-2004 (beginning of pregnancy in 2000-2003). The number of pregnant women screened for CMV increased significantly between 2000 (5.8%, 301/5.177), 2001 (11.1%, 1.130/10.139) and 2002 (22.1%, 2.701/12.223), (p<0.001), then was stable in 2003 (22.0%, 1.496/6.808). The percentage of women screened for CMV, at least once during pregnancy, doubled between 2001 and 2002 (p<0.001) in each occupational category and geographical area. It was significantly different between occupational categories (p<0.01), with a higher percentage of women in the self-employed and commercial agent occupational categories than in the craftsman category. There was also a significant difference between geographical areas (p<0.001), with a higher rate in Paris. CONCLUSION: This study providing baseline information on CMV practices showed: 1- a significant increase in the frequency of CMV screening among pregnant women over the period 2000-2002 with a stabilization in 2003; 2- a similar trend observed in each occupation category and geographical area but with a markedly higher frequency of screening practices in the Paris area and among self-employed women. A study measuring the effect of the 2004 ANAES recommendation suggesting not to screen for CMV during pregnancy should be conducted.

Measuring the variability of prescription use in patients with HIV infection or AIDS. The contribution of a French hospital longitudinal database.

This study is based on a sample of 937 patients with HIV infection or AIDS who were treated in 5 French hospitals. It sets out to describe the prescription of antiretroviral and prophylactic drugs used in treating such patients and, aims to interpret the various treatment strategies used. The study showed the contribution of longitudinal data in the descriptive analysis of patient follow-up, given the evolving nature of the illness. The Principal Components Analysis method allowed the temporal and quantitative aspects of the data, as well as their combination with qualitative variables, to be taken into account. The results revealed the stability over time of the choice of prescriptions, and allowed joint prescription/substitution phenomena between drugs to be evaluated. At the same time, the study provided evidence for a "site' effect, which showed that the heterogeneity of professional practice is not solely the result of differences in patients or in severity of the illness.

The cost of diabetes in France.

Within an economic framework it is possible to evaluate the direct cost of diabetes. In 1984, for 109 diabetics - 27 insulin-dependent patients (IDD) and 82 non-insulin-dependent patients (NIDD) - of the Paris area, the average cost of diabetes was 7711 francs (Fr) for the IDD and 5892 Fr for the NIDD. This cost is the sum of the medical visits, drugs and hospitalization. The medical expenditures of the NIDD is roughly the same as for the general population (6462 Fr). For the IDD, the main difference concerns the drug expenditures. Moreover, in 1984, there is more home-care than in 1978. Lastly, there is little difference between prescription use in the U.S. and in France. Such results allow us to discuss the reimbursement of the care needed for diabetics.

Hospital care for persons with AIDS in the European Union.

This study estimates the current and future hospital resources for AIDS patients in the European Union (EU), using multinational scenario analysis (EU Concerted Action BMH1-CT-941723). In collaboration with another EU-project ('Managing the Costs of HIV Infection'), six national European studies on the utilization of hospital care for AIDS have been selected to provide the data for our analysis. The selection criteria involve recentness, quality, comparability, accessibility and representativeness. Baseline hospital resource utilization is estimated for hospital inpatient days and outpatient contracts, using a standardized approach controlling for two severity stages of AIDS (chronic stage and late stage). The epidemiological part of the study is based on standard models for backcalculating HIV incidence and projecting AIDS incidence, prevalence and mortality. In the next step, baseline resource utilization is linked to epidemiological information in a mixed prevalence and mortality-based approach. Several scenarios render different future epidemiological developments and hospital resource needs. For the year 1999, hospital bed needs of 10,000-12,700 in the EU are indicated, representing an increase of 20-60% compared to the estimated current (1995) level. The projected range for 1999 corresponds to a maximum of 0.65% of all hospital beds available in the EU. The growth in the number of outpatient hospital contacts is projected to possibly exceed that of inpatient days up to 1.82 million in 1999. Our methodology illustrates that estimation of current and future hospital care for AIDS has to be controlled for severity stages, to prevent biases. Further application of the multinational approach is demonstrated through a 'what-if' analysis of the potential impact of combination triple therapy for HIV/AIDS. Estimation of the economic impact of other diseases could as well benefit from the severity-stages approach.

[Cost-effectiveness analysis of the treatment of chronic hepatitis C]. / Analyse coût-efficacité du traitement de l'hépatite chronique C.

OBJECTIVES: Chronic active hepatitis C is an important public health issue because of its prevalence, evolution, and overall cost. Treatment by recombinant alpha-interferon is both expensive and exacting and its effectiveness is limited. We report the results of a cost-effectiveness analysis of alpha-interferon treatment in patients with chronic active hepatitis C. METHODS: Direct medical costs of caring for patients with chronic active hepatitis C and its complications, based on treatment or no treatment, were assessed with retrospective data collected from the files of 137 hospital patients. Seventy-seven patients were treated with alpha-interferon between 1988 and 1994. The overall costs of caring for chronic active hepatitis C patients, without treatment or with alpha-interferon treatment (3 millions units three times a week) for 6 months (strategy A), 12 months (strategy B), or 12 months but discontinuing treatment when there was no response (strategy C), was reported and compared to the respective effectiveness of each. RESULTS: With an actualization rate of 5%, the real overall cost of caring for a chronic active hepatitis C patient was 143290 FF. Considering the contraindication rate (15%), the treatment acceptance (85%), the response rate to treatment (50%), and the prolonged response rate (25 to 30%), treating patients with strategy A induced a real overall cost of caring to 140731 FF to avoid 0.11 cases of cirrhosis, to 150277 FF to avoid 0.13 cases of cirrhosis with strategy B, and to 136947 FF to avoid 0.13 cases of cirrhosis with strategy C. CONCLUSION: Alpha-interferon treatment in patients with chronic active hepatitis C provides a long-term saving compared to cases which receive no treatment. Strategy C was the most cost-effective, inducing the reduction of both the number of cases of cirrhosis and the cost of care.

[Cost-benefit analysis of vaccinal prevention of hepatitis B policy]. / Analyse coût-avantage d'une politique de prévention vaccinale de l'hépatite virale B.

Morbidity and mortality related to hepatitis B (VHB) induce heavy costs even in low endemia countries as France. Recent changes in patterns of virus transmission (increasing heterosexual contamination) lead to discuss the opportunity of re-evaluation of current VHB vaccine policies aiming primarily at most exposed populations (patients under dialysis, hospital workers, infants born to VHB+ mothers). Using cost-benefit methodology, in a context where epidemiological and economical pertinent data are quite rare, this article evaluates different strategies ("no vaccination", "universal vaccination" and "vaccination after screening") for four different populations with contrasted exposure (French general population, young men adults, homosexual men and intravenous drug users). The cost-benefit ratios indicate that thresholds are, for low-risk populations, very far from usually accepted values attributed to epidemiological and economical parameters. If vaccine is administrated to young men adults, the cost-per-hepatitis saved relative to "no vaccination" is 36,000 F. For high-risk exposure groups, vaccination may be considered cost-benefit for attack rates near (homosexual men) or greater (drug users) than that observed; optimal strategy could be obtained if drug users are screened and vaccined. This is the result of combination of relatively low incidence of VHB and variability of medical course and chronic sequalae. Consequently, if universal vaccination has to be chosen, it would mean that the implicit value attributed to the prevention of one hepatitis is very high.

[Economics of health systems in developing countries: what is the contribution of work published in french?]. / Economie des systèmes de santé des pays en développement: quelle contribution des travaux publiés en français?

Health economics is poorly developed in the francophone community. There is little published work addressing developing francophone countries, and it is largely limited to the sub-Saharan Africa. Few specialist research workers from developing countries contribute. Universities only propose global analyses, and other groups involved (expert consultants) only conduct narrow studies, targeted at immediate action or decision making. The article analyses some of the reasons from this underdevelopment, and overviews what has been produced over the last 15 years. Three areas appear to be preferred: the analysis of costs and financing of vertical programs (vaccination programs in particular), the issue of supply and the price of essential drugs, and the effects and consequences of attempts to recover costs. Research work is mainly conducted by experts and consultants working for the financing bodies or international organizations. Their ideas, methods and conclusions often reflect the interests and working methods of those sponsoring the study. In many cases, pragmatism and short-termism dominate over intellectual and ethical rigor. A major issue is that of the roles of the State and the marker in the organization and financing of health systems and policies. Francophone economist differ from others on this issue, although, since the 1993 World Bank report entitled "Investing in Health" the opposition is less direct, and the "specificities" in the health sector, including those concerning economics, are now universally recognized.

Characteristics of children and adolescents with insulin-dependent diabetes mellitus participating in a summer camp educational program.

Clinical, biological and social characteristics were assessed in 456 children and adolescents participating in a summer camp for children with diabetes mellitus. In these subjects, aged from 7 to 18 years, the mean duration of the diabetes was five and a half years. They carried out their usual treatment under parental supervision, 31% of them being of rural origin. Mean glycosylated haemoglobin was approximately twice as high as a reference population (12.2% +/- 2.3, vs. 6.6% +/- 0.7) and was similar to that observed in various specialized hospitals. Factors which correlated with glycosylated haemoglobin included gender, school performance, vacation away from home, time spent watching television and practicing sport and eating patterns. This descriptive analysis gives some insight into the health status of the studied population. It represents the initial phase of a study to assess the efficacy of a diabetes educational programme for children and adolescents.