[Cost of clotting factors in hospitalization]. / Coût des facteurs antihémophiliques en hospitalisation.

OBJECTIVES: Hemophilia is a rare genetic disease, characterized by uncontrolled bleeding. Injections of clotting factor are the principal are the principal treatment. This drug is very expensive. The objectives of this study are to determine the cost of clotting factor for in patients and the factor impacting this cost. METHODS: A retrospective study was carried on hemophiliac in patients between 1 January 2014 and 31 December 2015 in Cochin hospital and having received at least an injection of clotting factor during their hospitalization. A collection of clinical data and treatments received during the hospitalization was realized for every patient. RESULTS: Fifty-one patients were included in the study with a total of 68 hospitalizations. The median cost of clotting factors by hospitalization was 16,908€. The median part of clotting factors on the total cost of the hospitalization was 68.2%. The cost of factors by stay was higher for the severe haemophiliacs (P=0.015) and for the major surgeries (P<0.0001). The daily median cost of clotting factors was 3124€. This cost was higher at the haemophiliacs B (P=0.0112), the severe haemophiliacs (P<0.0001) and the haemophiliacs with inhibitor (P=0.0053). CONCLUSIONS: Clotting factors represent the most part of the cost of hospitalization of a haemophiliac. Their cost in hospitalization varies according to many factors. It may evolve with the arrival of long-acting clotting factors.

Assessing the benefit of the 72-hour antibiotic therapy reassessment documentation.

OBJECTIVES: To assess the documentation of the 72-hour antibiotic therapy reassessment in medical records. METHODS: One-day prevalence evaluation of curative antibiotic therapies≥72hours. The documentation of the reassessment was defined according to three criteria: (1) "clear" documentation (clinical or microbiological comment associated with a comment on the need to adjust the antibiotic therapy or on the lack of need); (2) "tacit" documentation (only based on a clinical or microbiological comment); (3) no documentation. RESULTS: We assessed 114 antibiotic therapies in 26 hospital departments. A clear reassessment at 72hours was observed in only 45 (39%) records and 31 (27%) records had no reassessment. The planned duration of treatment was written in 63 (55%) records. At 72hours, among the 71 antibiotic therapies with a microbiological documentation, 69 (97%) were active and 44 (62%) had a narrow spectrum. Among the 48 antibiotic therapies with a broad spectrum on day 1, only 21 (44%) benefited from a de-escalation at 72hours. A clearly recorded reassessment at 72hours was associated with de-escalation (P=0.025) and the prescription of a planned duration of treatment was associated with antibiotic therapy compliance with local or national guidelines (P=0.018). CONCLUSION: Although reassessment was observed in 73% of records, it was correctly recorded at 72hours in only 39% of cases. The documentation of the reassessment and the prescription of a planned duration were associated with a better quality of antibiotic prescription (de-escalation, compliance with guidelines) and are relevant indicators for monitoring the proper use of antibiotics.