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Résumé: Objectifs. La supplémentation en fer par voie parentérale est l'option préférée pour traiter efficacement la carence martiale chez les patients présentant une anémie ferriprive. Le fer saccharose et similaires (FS) et le carboxymaltose ferrique (CMF) sont les principales préparations de fer injectable pour le traitement de l'anémie ferriprive. Le risque de réaction anaphylactique associé à ces produits limite l'administration du fer injectable au milieu hospitalier. Les objectifs de l'étude étaient, d'une part, d'évaluer les pratiques d'utilisation du fer par voie parentérale par les médecins anesthésistes chez des patients présentant une carence martiale et une anémie ferriprive en chirurgie orthopédique ou gynécologique dans des établissements de santé français et, d'autre part, d'en déduire l'impact sur les coûts de prise en charge par les établissements. Méthodes. Nous avons utilisé dans cette étude la méthodologie validée des vignettes cliniques représentant quatre situations cliniques fictives pour le FS ou le CMF. Les principaux paramètres d'intérêt étaient : patients d'orthopédie ou de gynécologie, hospitalisation complète/préopératoire ou hospitalisation de jour/postopératoire et documentation de la dose de fer par perfusion, de la dose totale de fer, du nombre de perfusions et de la durée des soins infirmiers associés. Résultats et discussion. Sur 94 médecins participants actifs, 40 indiquent utiliser plus fréquemment le FS dans leur pratique courante et 54 choisissent le CMF. Au vu des simulations, les choix thérapeutiques faits par les médecins ont conduit à 134 cas d'anémie ferriprive traités par FS et 242 cas traités par CMF. Le nombre moyen de perfusions était plus faible avec le CMF (1,3 ± 0,5) qu'avec le FS (2,1 ± 0,7). La durée de soins infirmiers estimée était de 72,5 ± 170,3 minutes et 73,4 ± 186,5 minutes avec le CMF et de 86,1 ± 51,5 minutes et 94,8 ± 65,6 minutes avec le FS pour l'hospitalisation complète et l'hospitalisation de jour respectivement. Conclusion. Par rapport au FS, l'utilisation du CMF pourrait simplifier l'organisation de la prise en charge des patients en raison du nombre plus faible de perfusions, des hospitalisations plus courtes et de la moindre mobilisation des professionnels de santé. En considérant les coûts de transport et les coûts administratifs, le coût total du traitement de l'anémie ferriprive par le CMF pourrait être inférieur à celui du FS. What is known? Parenteral iron-replacement therapy (IRT) is the preferred option to treat efficiently iron deficiency (ID) in ID anemia (IDA) patients. Iron sucrose (IS/ISS) and ferric carboxy maltose (FCM) are the main available injectable iron preparations for the treatment of IDA. Due to reports of anaphylactic reactions, the prescription and the administration of injectable irons is now restricted to the hospital to ensure safety monitoring. Study objectives were, on the one hand, to assess the use of parenteral IRT by anesthesiologists in orthopedic or gynecological surgery patients with ID/IDA, and, on the other hand, to deduce the impact of the costs of management in the French hospital setting. Methods. We used the validated methodology of case-vignettes with four different fictive clinical cases built by randomization of clinical parameters. Key parameters of interest were: context of orthopedics or gynecology and patient situation, either inpatient stay/pre-surgery or outpatient stay/post-surgery. The selection of either IS/ISS or FCM was left to participant's decision and the iron administration was documented: iron dose per infusion, the total iron dose, number of infusions and nursing time required for each infusion. Results. Of 94 active participating physicians, 40 use IS/ISS more frequently in their routine practice and 54 choose FCM. In view of the simulations, the therapeutic choices made by the doctors led to 134 cases of IDA treated with IS/ISS and 242 cases treated with FCM. Mean number of infusions was lower with FCM (1.3 ± 0.5) than with IS/ISS (2.1 ± 0.7). The estimated nursing time spent by infusion: 72.5 ± 170.3 minutes for an inpatient stay and 73.4 ± 186.5 minutes for an outpatient stay with FCM and 86.1 ± 51.5 minutes and 94.8 ± 65.6 minutes with IS/ISS for inpatient and outpatient stay, respectively. Conclusion. Compared to IS/ISS, the use of FCM could result in an organizational simplification patient management due to reduced number of infusions, hospitalization duration and health professionals mobilization. Considering transportation costs and administrative costs, the total cost of treating IDA with FCM might be lower than that of IS/ISS. [ABSTRACT FROM AUTHOR]

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Objectives: To compare the hospital costs associated with two fluid resuscitation strategies for cirrhotic ascites: one with human albumin 20% (Vialebex 20%) and one with polygeline., Methods: Multicenter prospective randomized double-blinded comparative trial (that also compared efficacy and tolerance). The economic evaluation was based on direct medical costs throughout the follow-up period: days of hospitalization, hospital consultations, medical procedures, and fluid resuscitation products. This cost-minimization study had a 6-month follow-up period. Daily costs in euros were adjusted over a 30-day period. The study was interrupted prematurely because of an alert due to the bovine origin of the polygeline, and the inclusion objectives could therefore not be met., Results: The economic analysis included all patients in the efficacy population (group receiving human albumin 20%: n=30, polygeline group: n=38). It found a standardized cost per patient for 30 days of treatment that was significantly lower (p=0.004) for human albumin 20% (median: 1915 euro; range: 1330-4105) than for polygeline (median: 4612 euro; range: 2138-12234). This difference is related mainly to a reduction in the frequency and duration of hospitalization in specialized units, but also to other aspects of management: hospitalization in other departments, specific solutions for the study products, and hospital procedures., Conclusion: The economic results of this trial favor a fluid resuscitation strategy that uses human albumin 20% for cirrhotic patients. They are consistent with the clinical results and help assess the cost-benefit ratio of human albumin 20% for this indication.

Unlabelled: Ovarian cancer is the most frequent cause of death due to gynecologic malignancy in both the United States and in Europe. A phase III investigation compared second line treatment Caelyx with topotecan in patients with advanced epithelial ovarian carcinoma who failed a first-line platinum-containing regimen. A total of 474 patients were enrolled Although no significant advantage of Caelyx over topotecan with regards to overall survival and progression was found, there were fewer adverse events in the Caelyx arm and Caelyx had significantly better quality of life profile. We conducted a cost minimization analysis of both treatment arms. Costs were estimated from the viewpoint of the hospital, over the duration of the study period (12 weeks). The frequency of adverse events was derived from the trial's CRF, the treatment patterns of adverse events was estimated for each type of adverse event and each grade for a given type of adverse event. Costs included that of the drug and management of adverse events. Because of uncertainty on actual time spent in French hospitals, administration costs were not valued. Adverse events valued in the analysis were: stomatitis/ pharyngitis, PPE, nausea/vomiting diarrhea, anemia, thrombocytopenia, neutropenia, sepsis, fever. Drug costs and costs of blood products were valued using the purchase price by the hospital, costs of tests and hospital days were estimated from the hospital's accounting system. The drug cost per patient was 8,735 euros for Caelyx and 6,196 euros for topotecan, the cost of adverse events were 528 and 3,632 euros for Caelyx and topotecan respectively, due to the high rate of adverse events in patient treated with topotecan. The total costs were 9,279 and 9,938 for Caefyx and topotecan respectively., Conclusion: the least expensive management for second line advanced ovarian cancer is Caelyx. Although the initial cost of the drug is higher, the reduced number of adverse events results in a lower total cost. Because treatment with Caelyx is also associated with a better of quality of life, this treatment strategy could be considered dominant.