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Background: Currently, few studies investigated the economic burden of atopic dermatitis (AD) in adult patients and specifically the estimation of out‐of‐pocket costs. Patients with skin disorders primarily use comfort care to ease dryness, itch or pain, and the costs of comfort care are not subject to any reimbursement from mandatory or complementary insurance. Objective: The purpose of this study was to measure the medical and non‐medical expenses paid by the patient. Methods: Eczema Cohort Longitudinal Adults was a non‐interventional study that aimed to assess the burden of AD in terms of quality of life and financial consequences. A self‐assessment questionnaire was distributed to adult patients who were cared in four French hospitals. Patients were asked to list the resources consumed for the treatment of AD during the last 12 months and to estimate the corresponding amount of money they had to pay out of their own pockets. The severity of AD was subjected to a stratification based on the PO‐SCORAD score. Results: A total of 1024 patients answered the questionnaire: 31.9% with severe AD, 40.4% with moderate AD and 27.6% with mild AD. The mean annual out‐of‐pocket cost was €462.1 for severe AD and €247.4 for moderate AD. Emollients were the most commonly used product: 74.4% for an average out‐of‐pocket cost of €151.4. The out‐of‐pocket costs increased significantly with the severity: 27% of patients with severe AD declared having bought specially textured clothes, while 19% of patients with moderate AD reported the same. The corresponding mean out‐of‐pocket costs were €162 and €91, respectively. Conclusion: The amount of out‐of‐pocket costs for patients with AD for essential medical and non‐medical expenses is relatively high, compared to the average out‐of‐pocket cost for French households. Integration of these essential resources into the list of reimbursed products and services appears necessary for a better coverage of AD. Linked Commentary: A. Zink. J Eur Acad Dermatol Venereol 2019; 33: 1817. https://doi.org/10.1111/jdv.15856. [ABSTRACT FROM AUTHOR]

The aim of the study is to evaluate the cost-utility ratio of microstructure networks (MSN) in patients undergoing opioid substitution therapy management. A qualitative first stage identified the criteria involved in the opioid management dependence, according to both physicians and patients for MSN or conventional follow-up. On the patient side, preferences differ little from those of doctors, although "access to an experienced doctor" is the most valued criterion and "control of consumption" is given as much importance as changing lives. [Extracted from the article]

The paradox of real world researches supposedly conducted in real life is that they did not succeeded in freeing themselves from the techniques of the randomised trials which they pretended to escape. In the successionist perspective of classical experimental or quasi-experimental methods, the cause always precedes the effect in a linear manner, and any interference that is likely to threaten the stability of this relationship must be neutralised by mobilising the appropriate statistical techniques. In complex systems where everything moves at the same time due to multiple interrelationships that make it impossible to construct a counterfactual, these elements are no longer considered as confounding factors that need to be controlled, but as decisive factors in the smooth running of the experiment. The protocol presented in this article proposes an alternative evaluative technique mobilising the teachings of critical realism, which seems to us to be the most appropriate for understanding what happens "in the black box" recording the events that occur between the implementation of the Article 51 experiments and the observed results. The role of the evaluator is to put the actors back at the heart of the change, since it is achieved (or not) according to their reactions and the contextual elements. This credible explanatory theory allows us to understand: how does it work? For whom does it work? Why do losers lose, winners win? and under what circumstances?, (Copyright © 2021 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Atopic dermatitis affects up to 20% of children and quite frequently persists in adulthood. Follow-up, treatment, and prevention of relapses have an impact on healthcare spending. The aim of this study was to assess the cost-effectiveness of different emollients prescribed for patients with atopic dermatitis in France. A 3-health state Markov model was designed, using French data for resource utilization, price and transition probabilities. The effects of the use of 5 different emollients (A, B, C, D, E) or no emollient were compared. The selected outcome was time (years) without flare-up (YWFU). The 5-year cost for emollient A is 1,575.64€, and the effectiveness is 3.89 YWFU. Strategy A is the most effective. Compared with treatment E, which was the least expensive emollient, A is more expensive (+481.84€) and more effective (0.082 YWFU). The incremental cost-effectiveness ratio is 5,877.48€/YWFU. In conclusion, treating atopic dermatitis with emollients is a cost-effective strategy.

Objectives: To describe the care trajectories of adults aged ≥50 years with fragility fractures in France., Methods: A postal questionnaire was sent to 15,000 individuals aged ≥50 years extracted from a representative panel of the French population (METASKOPE) in April-May 2018. Respondents experiencing a single fragility fracture in the previous three years constituted the study population. Information was collected regarding diagnosis, hospitalisations, physician visits and treatment related to the fractures., Results: 13,914 participants returned a questionnaire (92.8%), of whom 436 reported a single fragility fracture. Their mean age was 68.7±10.3 years. 11.9% of this sample had undergone bone densitometry (DXA) prior to the fracture and 11.9% had received a diagnostic of osteoporosis. Following the fracture, a further 17.4% underwent DXA and 8.5% were diagnosed with osteoporosis. 74.3% of fractures were initially managed in an emergency department and 29.6% led to immediate hospitalisation. Prior to fracture, 3.4% received a specific anti-osteoporotic treatment, 10.1% vitamin D and 6.4% calcium supplementation. After the fracture, these figures rose to 10.8%, 26.8% and 19.0% respectively. 86.2% participants made at least one follow-up visit to a physician., Conclusions: The rate of DXA screening following fragility fractures in subjects over fifty is very low. Most patients with fragility fractures did not receive a diagnosis of osteoporosis. The proportion of patients treated with a specific anti-osteoporotic treatment after a fracture is low even though around half consulted their general practitioner after the fracture. Practice guidelines are thus not being adhered to in everyday clinical practice in France., (Copyright © 2020. Published by Elsevier Masson SAS.)

Between 1 and 2% of people aged 50 years and over living at home in France are likely to experience a fragility fracture each year. Three-quarters of these individuals are not diagnosed with osteoporosis and lose the opportunity for appropriate care., Purpose: To estimate the incidence of fragility fractures in France and to describe the characteristics of individuals with such fractures and of their fractures., Methods: In April-May 2018, a postal survey was performed in France targeting a representative panel of 15,000 individuals aged ≥ 50 years, who were invited to complete a questionnaire. If they reported experiencing a fracture in the previous 3 years, they were asked to provide information on demographics, fracture type, risk factors for fractures and osteoporosis diagnosis. Only fragility fractures were considered, and these were classified as major (associated with increased mortality) or minor, based on the fracture site., Results: Around 13,914 panellists returned an exploitable questionnaire (92.8%). About 425 participants reported ≥ 1 fragility fracture (453 fractures), corresponding to a 12-month incidence rate of 1.4% [95%CI: 1.2, 1.6]. Incidence was higher in women (1.99% [1.87, 2.05]) than in men (0.69% [0.38, 0.86]) and increased with age. Around 157 fractures (34.6%) were classified as major. Participants reporting major fractures were older than those reporting minor fractures (mean age: 72.6 ± 11.3 vs 67.1 ± 10.6) and more likely to report previous corticosteroid use (odds ratio: 1.90 [95%CI: 1.13, 3.18]). No other patient characteristic was associated with fracture severity. About 117 participants with fractures (27.5%) had undergone bone densitometry, and 97 (22.8%) declared having received a diagnosis of osteoporosis., Conclusions: Around 340,000 people aged ≥ 50 years living at home in France are estimated to experience osteoporotic fractures each year. However, > 75% of panellists reporting fractures were never diagnosed with osteoporosis and thus did not have the opportunity to receive appropriate care.

Background: Recombinant human activated protein C (rhAPC) has been reported to be cost-effective in severely ill septic patients in studies using data from a pivotal randomized trial. We evaluated the cost-effectiveness of rhAPC in patients with severe sepsis and multiple organ failure in real-life intensive care practice., Methods: We conducted a prospective observational study involving adult patients recruited before and after licensure of rhAPC in France. Inclusion criteria were applied according to the label approved in Europe. The expected recruitment bias was controlled by building a sample of patients matched for propensity score. Complete hospitalization costs were quantified using a regression equation involving intensive care units variables. rhAPC acquisition costs were added, assuming that all costs associated with rhAPC were already included in the equation. Cost comparisons were conducted using the nonparametric bootstrap method. Cost-effectiveness quadrants and acceptability curves were used to assess uncertainty of the cost-effectiveness ratio., Results: In the initial cohort (n = 1096), post-license patients were younger, had less co-morbid conditions and had failure of more organs than did pre-license patients (for all: P < 0.0001). In the matched sample (n = 840) the mean age was 62.4 +/- 14.9 years, Simplified Acute Physiology Score II was 56.7 +/- 18.5, and the number of organ failures was 3.20 +/- 0.83. When rhAPC was used, 28-day mortality tended to be reduced (34.1% post-license versus 37.4% pre-license, P = 0.34), bleeding events were more frequent (21.7% versus 13.6%, P = 0.002) and hospital costs were higher (47,870 euros versus 36,717 euros, P < 0.05). The incremental cost-effectiveness ratios gained were as follows: 20,278 euros per life-year gained and 33,797 euros per quality-adjusted life-year gained. There was a 74.5% probability that rhAPC would be cost-effective if there were willingness to pay 50,000 euros per life-year gained. The probability was 64.3% if there were willingness to pay 50,000 euros per quality-adjusted life-year gained., Conclusion: This study, conducted in matched patient populations, demonstrated that in real-life clinical practice the probability that rhAPC will be cost-effective if one is willing to pay 50,000 euros per life-year gained is 74.5%.

Background and Purpose: The incidence of stroke in France is estimated at between 120 000 and 150 000 cases per year. This modeling study assessed the clinical and economic benefits of establishing specialized stroke units compared with conventional care., Methods: Data from the Dijon stroke registry were used to determine healthcare trajectories according to the degree of autonomy and organization of patient care. The relative risks of death or institutionalization or death or dependence after passage through a stroke unit were compared with conventional care. These risks were then inserted with the costing data into a Markov model to estimate the cost-effectiveness of stroke units., Results: Patients cared for in a stroke unit survive more trimesters without sequelae in the 5 years after hospitalization than those cared for conventionally (11.6 versus 8.28 trimesters). The mean cost per patient at 5 years was estimated at 30 983 for conventional care and 34 638 in a stroke unit. An incremental cost-effectiveness ratio for stroke units of 1359 per year of life gained without disability was estimated., Conclusions: The cost-effectiveness ratio for stroke units is much lower than the threshold (53 400 ) of acceptability recognized by the international scientific community. This finding justifies organizational changes in the management of stroke patients and the establishment of stroke units in France.

A health-related quality of life (HRQOL) assessment is particularly necessary for patients with chronic venous insufficiency (CVI), as is an assessment of the objective signs (edema, dilated veins, ulceration and other lesions). A comprehensive 3-year research program was undertaken in France to construct and validate the Chronic Venous Insufficiency Questionnaire (CIVIQ), a questionnaire designed specifically to evaluate the quality of life for CVI sufferers. The next step was to implement a program of cross-cultural validation in several countries. Translation into Spanish was undertaken following international guidelines. Face validity was verified with a pilot test among 12 Spanish patients. Psychometric validation was performed in Spain (n = 476 patients with CVI). The Spanish CIVIQ demonstrated very good internal consistency, high reproducibility and responsiveness, as well as longitudinal clinical validity. It appears to be a valuable instrument for assessing improvement in patient quality of life in response to both therapy in clinical practice and clinical trials.

Over the past decade, as pressure to control costs has accelerated, the term cost effective has come increasingly into common usage. The central purpose of cost-effectiveness analysis is to compare the relative value of different interventions in creating better health. This article presents the rationale for using such an approach to prioritize public and private healthcare programmes.

Unlabelled: The main objective of the study was to determine the psychometric properties (mainly, validity and reliability) of the French language version of the brief Quality of Life Interview (QoLI). That instrument evaluates both the subjective and objective aspects of quality of life., Methods: 128 patients fulfilling the DSM IV criteria for schizophrenia were included. Quality of life was evaluated using the brief QoLI. Schizophrenic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). The validity of the internal structure of the QoLI was investigated by means of item analysis, study of the correlations between the items and between the item-dimensions and principal component analysis addressing the subjective fields. The validity of the external structure was mainly investigated through the nomological validity study. The reliability of the scale was evaluated by studying the internal consistency. In addition, the acceptability of the scale was documented., Results: The results of the study of the validity of the internal structure confirmed the pertinence of the pre-defined fields, particularly the subjective fields. Only some of the subjective fields of the QoLI showed significant correlations with the PANSS sub-scales. The acceptability of the scale was satisfactory., Conclusions: The psychometric properties of the French language version of the brief QoLI appeared satisfactory. The brief QoLi was shown to be an easily used instrument for assessment of the various objective and subjective aspects of the quality of life of schizophrenic patients.

The cost of schizophrenia has been a major point of interest abroad. In the United States, two authors evaluated the direct cost of the illness. According to Gunderson and Mosher (13), it reaches US $25,625 million. In the United Kingdom, the estimations are of 390 million pounds (7) and 1,178 million pounds (16). In Australia, a direct cost calculation based on incidence leads to US $24,621 million (1), which is 6 times as much as the cost of infarction. At last, the only French study (Rouillon et al., 1997) gives a result of FF 17,911 millions. The indirect cost estimations vary from 71% (29) to 83% (13) of the total cost. The difference between the 6 publications are suprizing (especially when they concern the same country) and are probably link to the difference of methodology. This point tempers largely the interest of these studies as a tool in order to hierarchise Public Health priorities. Moreover, the elaboration of structures equivalencies between the different countries is an ambitious enterprise and make difficult comparisons of the studies. Finally, the lack of transparency of some of them limits their credibility.

Although the extent of medical care in France may be thought adequate, the same does not apply to the social medicine sector. The Assurance-maladie paid 87.7% of hospital health expenditure in 1994, whereas direct funding of home assistance amounted to only 9%. In contrast, a recent Legos study (Bungener M. et al. Le bilan économique et financier du secteur médico social, Université de Paris IX, Legos, Janvier 1994) [1] estimated that home assistance costs represent 41-50% of medical-social expenditure. When people are unable to manage because of the high costs of their invalidity, the social security system comes to their assistance, although only under Draconian conditions involving compulsory "family support commitments" and the state's claim on the inheritance of the beneficiary (total costs for hospital admission and boarding and the dual limits of 1000F liabilities and 250,000F net assets for home assistance). The elderly well appreciate the severity of this problem and are deeply distressed by the thought of dependency. Many, however, live under the illusion that the social security system or, to a lesser extent, the mutual funds will come to their assistance, although the problems involved lie partly outside their remits. We therefore need to design new systems to allow the elderly to finance their costs should they become dependant.