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The prenatal diagnosis of Down syndrome (amniocentesis) presents parents with a complex dilemma which requires comparing the risk of giving birth to an affected child and the risk of losing an unaffected child through amniocentesis-related miscarriage. Building on the specific features of the French Health insurance system, this paper shows that variation in the monetary costs of the diagnosis procedure may have a very significant impact on how parents solve this ethical dilemma. The French institutions make it possible to compare otherwise similar women facing very different reimbursement schemes and we find that eligibility to full reimbursement has a largely positive effect on the probability of taking an amniocentesis test. By contrast, the sole fact of being labelled 'high-risk' by the Health system seems to have, as such, only a modest effect on subsequent choices. Finally, building on available information on post-amniocentesis outcomes, we report new evidence suggesting that amniocentesis increases the risk of premature birth and low weight at birth., (Copyright © 2011 John Wiley & Sons, Ltd.)

The reimbursement databases of the French health insurance systems are greatly used for pharmaceoepidemiological research. However, the terminology used to describe them in subsequent articles and abstracts vary greatly and thus lead to a problem of identification during bibliograhic research or during the process of indexation in medline. In this article we have fixed the terminology used and proposed both a terminology and appropriate MeSH terms for indexation for the futur. Fifty-six published studies were included. At least six different root terms were found to define the French health insurance system, 64.3% of the publications mentioned the term "database", and 30.4% mentioned the term "reimbursement". We propose that abstracts of future articles contain the three terms: database, reimbursement, and health insurance. We also propose to include in the keywords of an article the MeSH terms that are most appropriate to define these three concepts: Insurance, Health, Reimbursement and Databases, Factual., (© 2010 Société Française de Pharmacologie et de Thérapeutique.)

Frequently, in data packages submitted for Marketing Approval to the CHMP, there is a lack of relevant head-to-head comparisons of medicinal products that could enable national authorities responsible for the approval of reimbursement to assess the Added Therapeutic Value (ASMR) of new clinical entities or line extensions of existing therapies.Indirect or mixed treatment comparisons (MTC) are methods stemming from the field of meta-analysis that have been designed to tackle this problem. Adjusted indirect comparisons, meta-regressions, mixed models, Bayesian network analyses pool results of randomised controlled trials (RCTs), enabling a quantitative synthesis.The REAL procedure, recently developed by the HAS (French National Authority for Health), is a mixture of an MTC and effect model based on expert opinions. It is intended to translate the efficacy observed in the trials into effectiveness expected in day-to-day clinical practice in France.