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International audience; Background: Discrepancies exist between guidelines and real-life practice in severe asthma. Objectives: To establish profiles for severe asthma patients according to their maintenance therapies and identify unmet needs.Methods: 2432 French lung specialists and allergists were invited to participate in a severe asthma survey between March and April 2018. Retrospective data were collected using an electronic case report form developed by IQVIA.Results: 71 respiratory physicians and/or allergists participated in the study, providing data for 736 severe asthma patients. The annual mean rates of hospitalization and exacerbation in the previous year were 0.65 (SD = 0.5) and 2.25 (SD = 1.0), respectively. One hundred one (13.7%) patients were treated with oral steroids; the mean dosage regimen was 16.1 mg per day (SD = 11.2). ICS-LABA-LAMA triple inhaled therapy was reported for 288 patients (39%); 231 patients (31.4%) had one biologic in their maintenance treatment. Among patients hospitalized at least once in the previous year (n = 311), 89 (28.5%) were currently treated with biologics, and 61 (19.6%) with oral steroids. One hundred sixty-six patients with uncontrolled asthma and no current biologic therapy had data for "T2 status"; 78 (47%), 89 (53.6%) and 137 (82.5%) of them had treatment criteria respectively for an anti-IgE, anti-IL5-pathway or anti-IL-4/IL-13 pathway therapy; 22 (13.2%) were ineligible for any current biologic according to biomarkers.Conclusion: Our study updated "real-life" therapeutic management data for severe asthma in France in 2018. We highlighted a need for improved patient-phenotyping. This work also gives a striking insight of the position of current and forthcoming biologics.

Introduction Plusieurs societes savantes, dont la SFR et l’EULAR, ont emis des recommandations sur le renouvellement et l’initiation des biotherapies (B) et des traitements synthetiques cibles (TSC) pour les patients souffrant d’une maladie inflammatoire chronique (MIC) au pic de l’epidemie. Nous avons etudie le profil de delivrances de ces traitements durant la periode de confinement en France. Materiels et methodes Nous avons utilise la source de donnees d’IQVIA, LTD, Longitudinal Treatment Dynamics, qui comprend les donnees de delivrances d’un echantillon representatif de 45 % des officines francaises. Toutes les B/TSC prescrites par les specialites habilitees a le faire et delivrees en ville ont ete prises en consideration. L’impact national des renouvellements et des initiations de ces traitements a ete etudie pendant la periode de confinement (Semaine S12 a S19) et compare a la meme periode en 2019 a partir des donnees de delivrance des pharmacies ayant transmis leur donnee regulierement pendant la periode d’interet (36 % des pharmacies francaises). Les resultats sont presentes a partir des donnees brutes et exprimes en pourcentage de patients ayant eu une delivrance des classes therapeutiques d’interet en 2020 compare a 2019 utilisee comme annee de reference ( Fig. 1 ). Les classes prises en consideration ont ete les biotherapies (anti-TNF, anti-IL6, anti-IL17, anti-IL23), les traitements synthetiques cibles (aprelimast, inhibiteurs de JAK), ainsi que des traitements susceptibles d’etre utilises dans les MIC, a savoir les aminosalicyles, l’hydroxychloroquine et le methotrexate. Resultats Pendant la periode S12 a S19, 48341 et 53944 patients ont eu au moins une delivrance d’un B/TSC respectivement en 2019 et 2020. La periode de confinement n’a pas eu d’impact sur les renouvellements de B/TSC compares a 2019 quelque soit le type de prescripteur ou la molecule prescrite. En revanche pour les initiations, elles ont diminue pour la majorite des classes suivantes dont les anti-TNF (−31 %), les anti-IL17 (− 50 %), les anti-IL23 (−12 %) et les TSC (−42 %) sauf pour les ant-IL6 (+ 152 %, augmentation concernant exclusivement le tocilizumab). Concernant les autres traitements, les initiations ont diminue pour les aminosalicyles (−7 %) et le methotrexate (−30 %) et fortement augmente pour l’hydroxychloroquine (+ 173 %). Conclusion Au pic de l’epidemie, les initiations par aminosalicyles, methotrexate, biotherapie (sauf tocilizumab) et TSC ont fortement diminue sans impact sur les renouvellements de ces traitements. Deux molecules ont ete fortement prescrites en initiation, le tocilizumab probablement lie au switch vers la voie sous cutanee et l’hydroxychloroquine dans l’hypothese d’un effet sur la COVID-19. Les recommmandations preconisees par les differentes societes savantes semblent avoir ete respectees pour ce qui concerne les B/TSC. Des analyses par MIC devraient etre realisees pour completer ces donnees.

To describe the characteristics and management of patients with gout in France during the year 2014.Data were obtained from a computerized observational longitudinal patient database of a representative sample of 1200 general practitioners. Patients on urate-lowering treatment and/or colchicine were described by demographics and comorbidities, quality of management indicators (serum uric acid and renal function testing) and treatment (type of urate-lowering treatment, change and dose regimen).We identified 14,400 patients (84.4% men, mean age: 67.5 years) with gout in the database. The most frequent comorbidities were hypertension (70%), dyslipidemia (51%), diabetes (24%) and obesity (23%). The proportion with uric acid and renal function testing data was 32% and 29%, respectively. In gout patients, only 39% had a serum uric acid6mg/dL. Among treated gout patients, 76% were receiving allopurinol at a mean dose lower than 200mg/d, most without any further change of dose regimen over one year.These data outlined the persistence of clinical inertia in 2014 for patients with gout.

Introduction: Discriminating asthma and COPD among pharmaceutical dispensation databases where diagnosis is not mentioned is highly challenging but necessary for medico-economic analyses on respiratory diseases using these databases. Machine learning may allow this type of identification especially when big data are available. Objectives: The objective was to develop an algorithm identifying asthma and COPD without relying on coded diagnoses, which could subsequently be applied to dispensation databases where diagnoses are not available. Methods: The dataset consisted of 976,584 visits (307,976 patients) with a diagnosis of asthma or COPD associated with a treatment prescription from 2015 to July 2018. Practitioners were 2,500 general practitioners, and 70 office-based pulmonologists participating in a permanent longitudinal observatory of prescription in ambulatory medicine. A majority of patients and visits corresponded to a diagnosis of asthma (84.1% and 77.8%, respectively). We used 75% of the dataset to train the algorithm and 25% to evaluate its accuracy. Variables used to train the algorithm were those available in dispensation databases, i.e., age, gender, type/dosing/presentation of the prescribed drug, and date of the prescription. A supervised machine learning approach was tested. Results: 87.2% and 86.4% of the asthma and COPD patients were properly classified by the algorithm, respectively. Conclusion: Our algorithm has an accuracy of 86% to identify asthma and COPD patients. Deep learning will be used in order to increase its performance and a sensibility analysis will be performed using different sources of dataset.

Background Knee osteoarthritis (KOA) is a chronic condition affecting mainly the elderly and considered as the leading cause of disability after cardiovascular disease. KOA is characterized by functional discomfort and deformities, leading to a deterioration in the quality of life (QoL) of patients. Objectives The main objective was to demonstrate that 3 intra-articular injections of aRTHRUM H 2% improves the physical QoL of patients over a 6-month period. Methods A French observational, prospective, multi-centre study was conducted between 02/2016 and 07/2017 in patients over 40 suffering from Kellgren and Lawrence (KL) grade I, II or III primary KOA and treated with 3 intra-articular injections of aRTHRUM H 2%. The variables included a questionnaire completed by a physician and the validated 12 items Short form Health Survey (SF-12), completed by patients at baseline (right before the injections), and then at 90 and 180 days. The primary endpoint was the change in physical summary score from baseline to 180 days (paired Student t-tests). Logistic regression analyses were used to identify the mains drivers of significant increase of physical summary score, adjusted for sociodemographic and health covariates. Results Of the 134 patients treated with aRTHRUM H 2% included in the study, 115 were evaluable for the primary outcome (non-exploitable data for 19 patients). The baseline characteristics of the analysable population were as follows: mean age of 66.4 years (±10.7); majority female (66.4%); mean BMI of 28.7 (±5.3) kg/m2 (43.3% overweight and 35.1% obese); KL grade KOA grade: I 13.6%, II 40.2%, III 46.2%; localization: uni-compartmental 53.0% (78.6% medial, 15.7% lateral, 5.7% patellofemoral), bi-compartmental 40.2% and tri-compartmental 6.8%. Regarding management history, respectively 6.7% and 44.8% of patients had previously received physical therapy or rehabilitation, and a visco-supplementation (2.2 treatments on average). Comorbidities observed in 73.9% of patients were metabolic-related in 54.5%, cardiovascular-related in 46.3%, gastrointestinal-related in 20.9%, and neurological-related in 8%. A clinically and statistically significant improvement in the QoL of patients was observed with an increase from 40.0 at baseline to 44.8 at 6 months (p The factors significantly associated with an improvement in QoL were: grade III KOA (OR=5.254, p=0.032), grade II KOA (OR=3.507, p=0.100), lateral femorotibial osteoarthritis (OR=3.175, p=0.029) and a single history of visco-supplementation (OR=2.936, p=0.044). Conclusion ART-QUALIVIE is a French study providing real-world data on the evolution of QoL of visco-supplemented KOA patients. It has demonstrated the positive impact of aRTHRUM H 2% on the QoL of patients over the 3 months following injections maintained until 6 months after treatment. References [1] Maheu E, Zaim M, appelboom T, et al. Comparative efficacy and safety of two different molecular weight (MW) hyaluronans F60027 and Hylan G-F 20 in the symptomatic osteoarthritis of the knee (KOA). Results of a non-inferiority, prospective, randomised, controlled trial. Clin Exp Rheumatol2011; 29:527-535. [2] Gandek B, Ware JE, aaronson NK, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: Results from the IQOLA Project. International Quality of Life assessment, J Clin Epidemiol1998;51(11):1171-1178. Disclosure of interests Milka Maravic Consultant for: Previous 2014 : MSD, Roche, Schering-Plough, Pfizer, Lilly, Employee of: aSTRAZENECA (2014-2017), Christian Pascaretti Consultant for: LCA Pharma, Paolo insalaco Consultant for: LCA Pharma, antoine Lesort Consultant for: LCA Pharma, Patrice Vincent Shareholder of: LCA Pharma, Employee of: LCA Pharma, Hakima Miotti: None declared, Isabelle Bardoulat: None declared, Cathy Maillard Employee of: Prior 2008 : BMS, Roche Janssen

International audience; OBJECTIVES:Temporal and geographic variations in knee osteoarthritis (OA) incidence occur worldwide. Regional variations also exist for socioeconomic status. We analyzed the association between socioeconomic deprivation (SED) and knee replacement (KR) incidence and assessed the proportion of KR associated with affluence.METHODS:Patients aged 15 years and over hospitalized for KR in 2013 were included. We linked each patient to a municipality of residence. Municipalities were matched to the 2011 European Deprivation Index score for SED analysis. Poisson regression was performed to examine the association between KR incidence and EDI adjusted for age and sex. The Population Attributable Fraction (PAF) was measured to calculate the proportion of excess of KR associated with social affluence.RESULTS:We included 77 597 KR. KR incidence decreased with increasing SED index. The EDI was significantly associated with KR incidence (P

Background:During the epidemic’s peak of COVID-19, scientific societies published recommendations on biotherapy and targeted synthetic treatment (B/TST) use in patients with chronic articular inflammatory diseases, inflammatory bowel diseases, and psoriasis.Objectives:The objective was to evaluate the impact of COVID-19 in France on initiation and renewal of B/TST.Methods:LRx contains all anonymized medication dispenses prescribed in outpatient care in a representative panel of French retails pharmacies, including data of near 40 million patients. The impact of B/TST initiation and renewal were studied using 2019 as reference and dispense deliveries data of pharmacies with regular flew in order to perform the comparison. B/TST considered were abatacept, anti-TNF, anti-IL6, anti-IL17, anti-IL12/23 or anti-IL23, JAK inhibitors (JAKi) and other classes such as aprelimast, aminosalicylates (AS), hydroxychloroquine (HCQ), and methotrexate (MTX). A treatment initiated was defined as a treatment not delivered in the past 12 months, and conversely for a treatment renewal. Results were presented as raw one and expressed in percentage of patients having at least one B/TST delivery in each therapeutic classes of interest in 2020 compared to 2019 used as reference year (period from week 12 to week 19 considered and corresponding to the lockdown period in France).Results:During the lockdown period, a decrease in initiation was observed for patients treated with: abatacept (405 in 2019 vs 227 in 2020: -44%, pConclusion:During the epidemic’s peak, initiation of AS, MTX, biotherapies (except for tocilizumab), and JAKi dramatically decreased without impacting their renewal. Two treatments were mainly initiated, tocilizumab probably due to a switch from intravenous to subcutaneous injection and HCQ in relation to its presumably effect on COVID-19. Overall, recommendations from scientific societies have been followed.Disclosure of Interests:None declared

Background:Discriminating chronic inflammatory diseases under biotherapy and/or targeted synthetic treatments (B/TST) using medico-administrative databases are challenging but required for medico-economic analyses focusing on these diseases.Objectives:The objective was to evaluate the feasibility of using a medication dispense data in order to identify patients with chronic inflammatory diseases under B/TST in outpatient care setting and evaluate the impact of COVID-19 in FranceMethods:LRx contains all anonymized medication dispenses prescribed in outpatient care in a representative panel of French retails pharmacies, including data of near 40 million patients. Patients having at least one B/TST delivered in 2019 were selected. An algorithm was constructed using different steps, including a machine learning step by transfer learning applied in patient classified as having a rheumatologic condition in order to differentiate rheumatoid arthritis (RA) from spondyloarthritis (SA). We numbered 190,640 patients, of which 87.8% were classified in one of the following diseases: RA, SA, psoriatic arthritis (PA), psoriasis, inflammatory bowel diseases (IBD) (extrapolated data to France). Descriptive analysis was performed. The impact of COVID-19 on biotherapy initiation was evaluated during the lockdown period (W2-W19 2020) in these different conditions.Results:Among the 167,468 patients under B/TST, 20.7%, 18.4%, 6.5%, 37.9% and 16.5% were considered as having a psoriasis, IBD, PA, RA, and SA, respectively. Female patients were more frequent in RA and PA (> 60%); younger (< 20 years) and older patients (74 years) were found in patients with IBD (5.7%) and RA (12.6%), respectively. Contrasting with IBD, SA, and RA patients were mainly under anti-TNF treatment (> 90% for IBD and SA, 73.5% for RA), psoriasis and PA patients received a range of broadly well-balanced of B/TST. Among the immunosuppressant, methotrexate was mostly prescribed in RA (58.4%), PA (34.1%), and psoriasis (14.1%), and azathioprine in IBD (19.9%). Oral corticosteroid delivered at least 4 times in 2019 were mostly found to be associated with a RA condition (28%). A significant decrease of biotherapy initiation was observed during the lockdown in France in patients with IBD (-20%, p=0.03) and psoriasis (-54%, pConclusion:The algorithm was able to identify patients with chronic inflammatory diseases under B/TST delivered in outpatient care and will allow to follow-up its management and study the COVID-19 impact on biotherapy initiation. An external validation needs to be performedDisclosure of Interests:None declared

The incidence of hip fractures decreased in France in both genders, especially in the elderly, from 2002 to 2008, in parallel with availability of bone densitometry and effective anti-osteoporotic treatments. However prescriptions of these treatments are decreasing, since 2008, and recent studies show declining of osteoporosis management after fragility fractures. The aim of this study was to assess the incidence of hip fractures in men and women aged 60 years and over, from 2002 to 2013 in France. Data were drawn from the French Hospital National Database which includes all hospitalizations of the country. Hospital data for hip fractures between 2002 and 2013 were numbered and the incidence rates per 1,000,000 adjusted on age (60-74; 74-84, and ≥ 85 years), and gender was calculated using the data of the French population. The number of hip fractures increased in women (+5%; from 49,287 in 2002 to 50,215) and in men (+22%, from 12,716 to 15,482) aged over 60 years. Between 2002 and 2013, the French population increased by 21 and 29% in women and men of this age group; thus, incidence of hip fractures decreased by 14% in women (6929 and 5987 per million in 2002 and 2013, respectively) and a slight decrease of -1% was observed in men (2344 and 2316). The decrease in incidence is also confirmed in the very elderly (≥ 85 years), with a decrease of -29% and -24% in women and men respectively. Over the last 12 years, the incidence of hip fractures decreased in France in women and men aged over 60 years. This decrease is also observed in the subjects (≥ 85 years and older in both genders). Further studies are needed to assess potential changes in risk factors of hip fractures during the last decade.

The association between socioeconomic status (SES) and hip fracture (HF) incidence was analyzed in France in 2008. In men and women, a decrease in HF incidence was observed as the social deprivation index increased. This result may be partly due to the protective effect of increasing body weight against HF. Regional variations in hip fracture (HF) incidence exist worldwide. Reasons for these variations remain unknown. As regional variations have also been observed for socioeconomic status, we analyzed the association between socioeconomic deprivation (SED) and HF incidence in France in 2008. From the French Hospital National Database, we selected all HF encoded as primary diagnosis in persons aged 30 years and over. The recently published French version of the European Deprivation Index (EDI) was used for SED analysis, and an EDI score was measured for the year 2007 in each French local municipality. The EDI score was categorized in quintiles. Poisson regression was performed to examine the association between HF incidence and EDI adjusted for age and sex. The population attributable fraction (PAF) was measured to calculate the proportion of excess cases of HF associated with social affluence. In 2008, 83,538 HF were reported in France of which 59,143 were included in this study. Among them, 44,401 fractures occurred in women (75%) and 14,742 in men (25%). In both men and women, there was a decrease in the HF incidence with increasing SED index. In Poisson regression, the interaction of age class and sex was significant (p

Objective To assess the cost of switching surgical aponeurectomy to percutaneous needle aponeurotomy in one-ray Dupuytren's disease. Methods A model analysis was performed with a cross-sectional national survey of public and private French hospitals in 2012. All stays for one-ray aponeurectomy were “virtually” replaced with 1, 2 or 3 outpatient sessions of percutaneous needle aponeurotomy. The costs were based on the hospital cost (tariff per disease-related group) and on common classification of medical procedures performed in outpatient care for 2013. Results Dupuytren's disease represented 18,707 hospitalizations (€26 million [2013 euros]) in France in 2012, 8534 hospitalizations for one-ray aponeurectomy (€11.9 million). By replacing surgical aponeurectomy with percutaneous needle aponeurotomy for one-ray Dupuytren's disease, 91% to 97% and 56% to 59% of the treatment costs could be saved using hospitalizations for one-ray aponeurectomy or total hospital costs, respectively, as reference. Conclusions Replacing aponeurectomy with percutaneous needle aponeurotomy for one-ray Dupuytren's disease could greatly reduce the treatment costs for all Dupuytren's disease. Effective alternatives to surgery for Dupuytren's disease, such as needle aponeurotomy in an outpatient setting should be considered in the economic perspective.

Purpose Total knee arthroplasty (TKA) is currently the international standard of care for treating degenerative and rheumatologic knee joint disease, as well as certain knee joint fractures. We sought to answer the following three research questions: (1) What is the international variance in primary and revision TKA rates around the world? (2) How do patient demographics (e.g., age, gender) vary internationally? (3) How have the rates of TKA utilization changed over time? Methods The survey included 18 countries with a total population of 755 million, and an estimated 1,324,000 annual primary and revision total knee procedures. Ten national inpatient databases were queried for this study from Canada, the United States, Finland, France, Germany, Italy, the Netherlands, Portugal, Spain, and Switzerland. Inpatient data were also compared with published registry data for eight countries with operating arthroplasty registers (Denmark, England & Wales, Norway, Romania, Scotland, Sweden, Australia, and New Zealand). Results The average and median rate of primary and revision (combined) total knee replacement was 175 and 149 procedures/100,000 population, respectively, and ranged between 8.8 and 234 procedures/100,000 population. We observed that the procedure rate significantly increased over time for the countries in which historical data were available. The compound annual growth in the incidence of TKA ranged by country from 5.3% (France) to 17% (Portugal). We observed a nearly 27-fold range of TKA utilization rates between the 18 different countries included in the survey. Conclusion It is apparent from the results of this study that the demand for TKA has risen substantially over the past decade in countries around the world.

Objective Hip fracture is the most devastating osteoporotic fracture, increasing the risk of mortality. Recent data suggest a decrease in incidence of this fracture. Few data are available on potential changes in mortality. We studied the change of inpatient mortality from 2002 to 2008 in France. Methods Data were extracted from the French Hospital National Database. The absolute number of inpatient mortality for hip fracture was described as well as the case fatal rate and mortality rate adjusted on age and gender. Risk factors of inpatient mortality were assessed by multiple regressions. Results Inpatient mortality stay decreased from 3057 to 2350 in patients aged 40 years and over and in both gender. Inpatient mortality stays were more important in women and increased with age, but the case fatal rate was higher in men than in women (5.4 vs. 2.8% in 2008). During the study period, the mortality rate (per 1 000 000) varied from 132 to 88 and from 82 to 64 in women and men, respectively. In the older patients, case fatality and mortality rates decreased significantly during the study period. From 2008 data, age more or equal to 85 years, male gender, stay in intensive care and existence of some chronic or acute disease, especially cardiovascular disease, hepatic disease, renal insufficiency, and infection were significant determinants of inpatient mortality. Conclusion Inpatient mortality after hip fracture decreased in France between 2002 and 2008, although age, male gender and comorbidities were identified as determinants of inpatient mortality.

In France, few economic assessments on the cost of rheumatoid arthritis have been undertaken. Descriptive cost studies were available with different methodological approaches (prospective vs retrospective, economic and/or medical assessment, analytical economic assessment of the cost vs tariff per diagnosis-related group for calculation of hospital costs, based on inpatient and/or outpatient records, focused on diagnosis and/or treatment, and based on real vs theoretical practice) at different times, especially compared with the daily availability of biotherapy or the phase of change of the French Health System financing. Direct medical costs were primarily described. Medicoeconomic assessment should be continued when the disease prognosis is altered by the administration of a new but expensive therapy (i.e. biotherapy) and focused on direct and indirect costs. The ESPOIR and the VERA cohort studies of recent arthritis patients, recently initiated in France, will be useful database contributors. In parallel with the hospitalizations for rheumatoid arthritis extracted from the French national hospital database, a national register is required to follow the administration of biotherapy. As the French Health System is currently changing, some methodological approaches of economic assessment were proposed. Further studies need to be conducted according to guidelines for economic evaluation to allow relevant economic data at country level and for international comparison.

Resume L’objectif de notre travail est de faire un etat des lieux sur l’evaluation pragmatique dans la polyarthrite rhumatoide. Nous avons fait une analyse critique de litterature apres realisation d’une recherche documentaire sur PubMed de janvier 1990 a mai 2001, a partir de mots-cles (rheumatoid arthritis, clinical practice, physician’s practice patterns, health service research). Nous avons observe une grande variabilite dans la prise en charge de la polyarthrite rhumatoide qu’il s’agisse de la prescription des examens complementaires au debut, de la prise en charge therapeutique initiale, de l’evolution de l’etat clinique du patient en fonction du nombre de consultations, de la prescription et de la surveillance des traitements de fond, de l’utilisation des criteres de suivi, des resultats cliniques en fonction de la couverture sociale, de la pratique face a un cas simule. Il existait egalement une variabilite dans la methodologie utilisee qui reposait soit sur des enquetes, soit sur l’analyse de donnees prospectives. Cette revue de la litterature souligne la necessite d’elaborer des recommandations dans la prise en charge de la polyarthrite rhumatoide.

Objective To describe the hospital burden of microcrystal arthropathies in France. Methods Data were extracted from the 2009–2011 French hospital national databases. We selected all hospital stays for microcrystal arthropathies (gout, chondrocalcinosis, other) encoded as primary or secondary diagnoses in patients older than 18. A descriptive analysis focused on number of patients and hospital stays, age, gender, comorbidities related to metabolic syndrome, and hospital costs based on 2012 public-sector costs. Results 132,275 hospitalizations involving 109,734 patients were related to microcrystal arthropathies encoded as primary or secondary diagnosis (61% related to gout, 34% to chondrocalcinosis, and 5% to other microcrystal arthropathies). 23,362 hospitalizations involving 25,105 patients were due to microcrystal diseases, encoded as primary diagnosis, (48% related to gout, 43% to chondrocalcinosis, and 9% to other microcrystal arthropathies). In this population, patients with chondrocalcinosis were older (mean 75.6 ± 13.5 versus 71 ± 16 years for other microcrystal arthropathies and 69.7 ± 14.7 for gout). Men represented 70% of the patients with gout, 39% of those with chondrocalcinosis and 52% of the patients with other microcrystal arthropathies. Hypertension, diabetes, dyslipidemia, cardiac ischemia, and renal failure were more frequent in patients with gout than other patients. The hospital costs for microcrystal arthropathies encoded as primary diagnosis were 82.3 million Euros, 45% related to gout, 45% to chondrocalcinosis and 11% to other microcrystals. Conclusion In terms of hospital costs, gout and chondrocalcinosis represented the main part of the economic burden of crystal arthropathies and a high level of diseases belonging to the metabolic syndrome. Specific education programs favouring accurate microcrystal diagnosis and adherence to treatment could diminish this hospital economic burden.

Resume Objectifs. La prise en charge globale des malades atteints de polyarthrite rhumatoide a fait l’objet d’une evaluation medicoeconomique prospective descriptive (incluant la qualite de vie) sur une duree de six mois portant sur 20 cas incidents. Patients et methodes. Les patients ont beneficie d’une prise en charge multidisciplinaire lors d’un sejour en hospitalisation classique et ont ete revus a trois et a six mois en hospitalisation de jour. Les parametres etudies ont ete : la qualite de vie par un indice generique (indicateur de sante perceptuelle de Nottingham ou, ISPN) et deux indices specifiques (HAQ, Emir court), la douleur, l’appreciation de la maladie par le malade et le medecin, le nombre d’articulations douloureuses et gonflees, la vitesse de sedimentation et la proteine C reactive. Les couts des examens biologiques, radiologiques et autres explorations, des consultations medicales (rhumatologique et autres), du traitement de fond et de sa surveillance, de l’activite du personnel infirmier et de reeducation (kinesitherapeutes et ergotherapeutes) ont ete evalues. Resultats. L’ensemble des patients a ete significativement ameliore a trois mois par la prise en charge therapeutique et reeducative. Cet effet se maintient a six mois. Une evolution favorable a ete objectivee pour la qualite de vie sauf pour l’isolement social de l’ISPN et sur l'aspect psychologique et les activites sociales et professionnelles de l’Emir court. Le cout sur six mois de suivi a ete de 22 454 ± 5 774 FF (3 429 ± 880 euros). Le cout des examens biologiques (39 %) occupe la premiere place, suivi par le cout des consultations rhumatologiques (16 %). Les autres couts representent 7,6 a 9,2 %. Conclusion. Cette etude prospective medicoeconomique constitue une premiere approche. Des etudes comparatives sont necessaires.

We described the whole population of patients hospitalized for vertebral fractures in France in 2009. Only 6.4 % of them were operated by vertebroplasty; these patients were younger and healthier than non-operated patients. This study aims to describe the burden of vertebral fractures from the 2009 French Hospital National Database in acute care in people aged 60 years and over, with or without vertebroplasty. All stays due to nonmalignant and nontraumatic vertebral fractures as primary cause were selected. Patients’ characteristics were described and compared between patients with or without vertebroplasty. The in-patient mortality was compared to the one related to hip and upper humerus fracture in patients hospitalized during the same year. In 2009, 13,624 patients were hospitalized for vertebral fracture. Men accounted for 29.3 % of cases. Length of stay was 9.6 ± 8.2 days, higher in patients with at least one comorbidity than in patients without (11.2 ± 8.6 and 7.8 ± 7.2 days, respectively). The in-patient mortality was 0.9 %; it was 3.8 and 1.1 % for hip and upper humerus fractures, respectively. Vertebroplasty was performed in 6.4 % of them. Patients with vertebroplasty were younger (mean age of 75 ± 8 versus 79 ± 9 years), had a less duration of stay (7 ± 7.5 versus 9.8 ± 8.2 days), less comorbidities (at least one comorbidity, 45 versus 54 %), and less in-patient mortality (0.1 versus 0.9 %). Rehospitalization for vertebral fracture occurred in 9 and 6 % of the patient with and without vertebroplasty. This is the first French study assessing the national burden of vertebral fractures based on hospital data. In-hospital death rate is lower in patients with vertebroplasty, who are younger and have less comorbidities than the general population with vertebral fractures.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 3 aout 2011

Objective Determining the economic impact of rheumatoid arthritis (RA) biotherapies in France. Method The number of patients on RA biotherapy in France was estimated from the French national medical information system program (PMSI) database using the 2007 hospital data. The cost of each biotherapy was calculated on a theoretical basis (French national health authority (HAS) recommendations) and on real-life setting, using ‘real-life’ setting data. In order to calculate the economic impact of the biotherapies, the cost of management with each biotherapy was applied to the RA patient population taking into account the market share of each biotherapy. Results The number of patients with RA estimated was 15,873. Management costs ranged from 11,576 to 21,128 € for the theoretical management scenario and from 6,451 to 19,618 € for the real-life scenario. The overall cost was 222 million € (real-life setting). TNF antagonists (adalimumab, etanercept, infliximab) were prescribed for 82% of the patient population and accounted for 80% of the annual overall cost of theoretical management and 84% of the cost of the real-life setting, respectively. Other biotherapies (abatacept, rituximab) were prescribed for 18% of the patients and accounted for 20 and 16% of the annual overall cost of the theoretical setting and real-life setting. Outpatient biotherapy was prescribed for 61% of the patient population and generated 68 and 71% of the total costs. Conclusion The data constitutes an initial inventory of the economic impact of RA biotherapies in France.

Controversies exist about the change in hip fracture incidence among countries. In France, over the last 6 years, the incidence in people aged 40 years and over of hip fractures decreased in women over 39 years and increased in men; a decrease in the incidence was observed in both genders in the elderly.Controversies exist about the change in hip fracture incidence among countries. The aim of this study was to assess the incidence of hip fractures in men and women aged 40 years and over between 2002 and 2008 in France.Data were drawn from the French Hospital National Database. The absolute number of admissions was described and the incidence rates per 1,000,000 adjusted on age (40-59, 60-74; 74-84, and ≥ 85 years), and gender was calculated using the data of the French population.The number of hip fractures increased in men (+13%; from 14,736 in 2002 to 16,611 in 2008) and remained stable in women (+0.2%, 50,910 in 2008). Between 2002 and 2008, the French population increased by 9% in both genders. Incidence over 39 years decreased by 8% in women (3,356 and 3,093 per million in 2002 and 2008, respectively) and increased by 4% in men (1,131 and 1,172 per millions in 2002 and 2008, respectively). An age-specific incidence decrease was found, in particular, in the elderly in both genders (74-84 and ≥ 85 years), most importantly in women.Over the last 6 years, the incidence of hip fractures decreased in women aged over 39 years and increased in men aged over 39 years; a decrease in the incidence of these fractures was observed in both genders in the elderly. Such epidemiological data may help policy making, planning resource allocation, and setting up complementary health decisions for the management of osteoporosis.

Summary Introduction The aim of this study was to assess the burden of hospitalized wrist fractures between 2002 and 2006 in France. Methods Data were drawn from the French Hospital National Database. The number of admissions and the incidence rates were described as well as the type of entry and discharge from hospital, length of stay, and 2006 in-patients costs. Results In 2002 and 2006, 38,710 and 38,979 hospitalizations for wrist fractures were registered respectively. The incidence rate of fractures increased with age whatever the year and decreased significantly from 2002 to 2006. Length of stay and mean inpatients costs increased with age. The overall in-patients 2006 costs was 79 millions with an average individual cost of 2100 € per hospitalized wrist fractures. Conclusion The incidence of hospitalizations for wrist fractures decreased in 2006 compared to 2002. The number of hospitalizations increased, as a consequence of ageing, (except for wrist fracture in men), with a subsequent increase in cost related to these fractures. The increase with age outlines the role of underlying osteoporosis and the relevance of appropriate care of patients at risk of for such fractures. Level of evidence IV.

Objectives To evaluate the health implications and economic burden on society of osteoporotic fractures as a major source of morbidity and mortality in the ageing population. Methods We have summarised the findings of a literature review of French studies published between 1960 and 2009, characterised the epidemiology of osteoporosis and osteoporotic fractures, and predicted future trends. Results Published data for France supported the observation that osteoporosis is under-diagnosed in many countries. The incidence of fracture increased exponentially with age, alongside a concurrent decrease in bone mineral density, a risk factor for fracture. Combined with a projected rise in the French elderly population, this poses a significant burden for the future. The incidence of fracture was high in the osteopenic population; consequently, fragility fractures may be underestimated if reports focus on osteoporotic women only. As in many other countries, French data revealed that women have a higher incidence of osteoporotic fractures than men, although mortality from hip fracture was higher in men. Discussion Due to ageing of the population, an increase in the number of people suffering from fractures is predicted over the next few decades unless preventative action is taken, highlighting the need for improved diagnosis and screening in postmenopausal women.

The objective of this study was to describe the hospital incidence rate and the in-patient costs of three peripheral "osteoporotic" fractures (proximal humerus and hip, distal radius and/or ulna) in women and men aged over 45 in France during 2001. Each stay for fracture was selected from the dataset of the French national hospital database in 2001. The incidence rate (CI 95%) was standardized by age and gender according to the last census of the French population (1999). The effect of age and existence of geographical difference in incidence rates has been studied. For each fracture, we described the number of stays, rate of surgical procedure and in-patient costs according to the 2004 French list of cost per diagnosis-related group (2004 Euros); 118,839 fractures were registered during 2001 (61% hip, 28% distal radius and 11% proximal humerus; sex ratio 0.26). The incidence rate for all fracture was 7,567 (7,519-7,615) and 2,312 (2,283-2,341) for 10(6) inhabitants in women and men aged over 45 years, respectively. The incidence increased significantly whatever type of fracture and gender. There were more fracture incidents in the east of France compared to the west and in the south compared to the north, whatever type of fracture in women and only for hip fracture in men. Surgical procedures were performed in 91% of proximal hip fractures, 83% of distal radius fractures and 53% of proximal humerus fractures. The median in-patient costs were 3,786 Euros for the humerus, from 2,363 to 2,574 Euros for the radius and from 8,048 to 8,727 Euros for the hip. The evaluation of the burden of peripheral fractures is possible using national hospital data in France. The incidence of fractures increased with age and is more common in women. Hip fracture with its higher occurrence, rate of procedure and in-patient costs could be used as a marker of osteoporosis for evaluating strategies of management.

RANTES is a chemokine produced in delayed-type hypersensitivity (DTH) and allergic reactions, in which it may contribute to the recruitment of immune cells. Macrophages participate in the cellular infiltration in both conditions and they represent a potent source of RANTES. To understand the regulation of RANTES production by human monocytes, we analyzed the effect of cytokines and of corticosteroids on this production. We showed that IFN-gamma and tumor necrosis factor (TNF)-alpha cooperated to induce RANTES production by monocytes. N-acetylcysteine inhibited this effect, indicating that reactive oxygen intermediates are required for RANTES production. Both IL-10 and corticosteroids antagonized the stimulating effect of IFN-gamma and TNF-alpha on RANTES production. In contrast, IL-4 had no effect on IFN-gamma-induced RANTES production and it potentiated the positive effect of TNF-alpha on this production. Thus, the deactivating properties of IL-10 and corticosteroids on macrophage functions include RANTES production, and this may contribute to the immunosuppressive effect of both compounds in DTH and allergic reactions. In contrast, IL-4 has an opposite effect on RANTES production and this property may contribute to cell recruitment in allergic reactions. Therefore, although IL-10 and IL-4 belong to the Th2 family of cytokines, they can display distinct functions in immune reactions.

Summary Introduction The aim of this study was to assess the burden of hospitalized wrist fractures between 2002 and 2006 in France. Methods Data were drawn from the French Hospital National Database. The number of admissions and the incidence rates were described as well as the type of entry and discharge from hospital, length of stay, and 2006 in-patients costs. Results Thirty-eight thousand seven hundred and ten and 38,979 hospitalizations for wrist fractures were registered in 2002 and 2006, respectively. The incidence rate of fractures increased with age whatever the year and decreased significantly from 2002 to 2006. Lengths of stay and mean inpatients costs increased with age. The overall in-patients 2006 costs was 79 millions with an average individual cost of 2100 € per hospitalized wrist fractures. Conclusion The incidence of hospitalizations for wrist fractures decreased in 2006 compared to 2002. The number of hospitalizations increased, as a consequence of ageing, (except for wrist fracture in men) with a subsequent increase in cost related to these fractures. The increase with age outlines the role of underlying osteoporosis and the relevance of appropriate care of patients at risk of for such fractures. Level of evidence IV.