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Background and importance In order to ensure the sustainability of the French healthcare system, the government launched two incentives to increase biosimilar use in August 2018, within the framework of the social security funding law. The first redirected 20% of the price difference between the reference product and its biosimilar to the hospital, for every biosimilar prescription from the hospital, and provided it in retail pharmacies. The second (called article 51) was an experiment where 40 hospitals were selected after a call for a proposal. The clinical units of these 40 hospitals received 30% of the price difference between the reference product and its biosimilar for every biosimilar prescription from the hospital. Aim and objectives The aim of this study was to compare the efficacy of both incentives 10 months after implementation in October 2018. Material and methods IQVIA Xponent data were used to evaluate public hospital prescriptions of etanercept. These are based on 14 000 retail pharmacy panels (60% of the French retail pharmacies) and allows observation of the number of boxes delivered in retail pharmacies linked to the initial hospital prescription. Data from the 40 hospitals selected in the experiment were compared with hospitals not in the experiment. We assessed savings that could be made if the experiment was extended to every hospital after 10 months Results In July 2019, the average use of etanercept biosimilar reached 44.2% (+19.5 points compared with October 2018) in the 40 hospitals selected in the experiment whereas it increased by 10.5 points in the other hospitals. After 10 months of the experiment, there was a difference of 12.3 points between the groups. The government expected to reach a difference of 15 points to prove the efficacy of this measure after 3 years. The 40 selected hospitals represent about 46% of potential etanercept prescriptions. If all hospitals reach 44.2% biosimilar use, the savings could be doubled, from 650k€ to 1.4M€. Conclusion and relevance The first results of this experiment show that incentives to prescribe etanercept biosimilars seem to have an impact on biosimilar use in France. References and/or acknowledgements Acknowledgements to Iqvia and Biogen France. Conflict of interest Corporate sponsored research or other substantive relationships: Iqvia and Biogen France.

Resume Objectif Determiner la frequence du suivi plaquettaire et les risques hemorragiques associes a l’usage des anticoagulants injectables en vie reelle et estimer les couts associes. Methode Une analyse des donnees 2013 de l’echantillon generaliste des beneficiaires a ete realisee pour identifier les dosages plaquettaires effectues sur les periodes d’exposition aux anticoagulants injectables et les interruptions therapeutiques du fait d’une thrombopenie ou d’une transfusion. Ces evenements ont ete valorises et un differentiel de cout etabli. Resultats L’etude a porte sur 15 985 patients adultes representant 12 264 mois d’exposition aux anticoagulants injectables ; 2,8 % des sequences concernaient une heparine non fractionnee, 86,9 % une heparine de bas poids moleculaire et 13,1 % le fondaparinux. Les patients sous heparine non fractionnee etaient plus âges (77 vs 57 et 59 ans) avec des durees de traitement superieures (32,6 vs 25,1 et 21 jours). Le nombre mensuel moyen de dosages plaquettaires etait, apres ajustement, 1,36 fois inferieur chez les patients traites par fondaparinux par rapport aux heparines de bas poids moleculaire (p Conclusion Les patients sous fondaparinux effectuent significativement moins de dosages plaquettaires que les patients sous heparines de bas poids moleculaire sans risque hemorragique supplementaire. Cet aspect doit etre pris en compte dans l’evaluation des couts de ces traitements.

International audience; The development of new anticancer drugs has strongly contributed to improve patients’ outcomes. However, the question can be raised whether the sometimes minor benefits are worth the cost to both the individuals and the society. The aim of this medico-economic study was to evaluate trabectedin cost-effectiveness compared with end-stage care in the treatment of soft-tissue sarcoma. We retrospectively analyzed data from 45 patients treated with trabectedin for soft tissue sarcoma. Real-life data of clinical benefits and costs of trabectedin were compared with simulated end-stage treatment. Univariate and probabilistic sensitivity analyses identified key drivers of the incremental cost-effectiveness ratio. Trabectedin was associated with longer progression-free survival (4.0 months versus 1.6 months) and higher costs (€24,780 versus €15,490) compared with end-stage treatment. The incremental cost per year of progression-free survival gained with trabectedin was €46,104 (95% confidence interval; €45,039–€47,169). The results were relatively insensitive to changes. Trabectedin was cost-effective in the context of an orphan disease, when used to treat patients with a short life expectancy and few therapeutic options.

International audience; Over the last 20 years, melatonin, a pineal hormone synthesized from serotonin, has been implicated in various studies on the autism spectrum disorder (ASD) and altered melatonin levels were detected in subgroups of subjects with ASD. Its effect on sleep disturbances got the attention of clinicians and several investigations were carried out to determine the usefulness and safety of melatonin administration in this disorder. Hypotheses were also raised regarding the possibility that the dysfunctional synthesis and secretion of melatonin detected in subgroups of subjects with ASD may increase the risk as well the severity of ASD. The purpose of this paper is to review our pharmacokinetic knowledge on melatonin and present results from recent studies on sleep disorders in autism, their treatment with melatonin and the impact of melatonin prescription in children with ASD evaluated in a Diagnostic Center for Autism Spectrum Disorder in Paris, France.