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Introduction: The course of schizophrenia can vary widely, and patients experience remission phases alternating with relapse episodes, which generally lead to hospitalisation and have a significant impact on the burden of disease. The prevalence of schizophrenia in France is estimated to be approximately 600,000 people, with an incidence of 10,000 new patients per year. Patients with schizophrenia represent the largest group of hospitalised patients in French public institutions and specialised centres, and the French authorities recognise that the management of schizophrenia is a major public health concern. The Haute Autorité de Santé (HAS) and most of the evidence-based guidelines for the maintenance treatment of schizophrenia recommend long-acting injectable (LAI) antipsychotics to be used predominantly in the prevention of relapse for non-compliant patients; however, in clinical practice, the use of LAIs remains low., Objective: This analysis aimed to estimate and to compare the cost-effectiveness of the most common antipsychotic strategies in France in the management of schizophrenia., Methods: A Markov model was developed to simulate the progression of a cohort of patients with schizophrenia through four health states (stable treated, stable non-treated, relapse and death) and considered up to three lines of treatment to account for changes in treatment management. Antipsychotics including aripiprazole LAI (ALAI), olanzapine LAI (OLAI), paliperidone LAI (PLAI), risperidone LAI (RLAI), haloperidol decanoate (HD) and oral olanzapine (OO) were compared in terms of costs and clinical outcomes. Thus, costs, quality-adjusted life-years (QALYs) and number of relapses were assessed over five years based on three-month cycles from a French health insurance perspective with a discount rate of 4 %. Patients were considered to be stabilised after clinical decompensation and would enter the model at an initiation phase, followed by a prevention of relapse phase if successful. Data (e.g. relapse or discontinuation rates) for the initiation phase came from randomised clinical trials, whereas relapse rates in the prevention phase were derived from hospitalisation risks based on French real-life data in order to capture adherence effects. Safety and utility data were derived from international publications. Additionally costs were retrieved from French health insurance databases and publications. Robustness of results was assessed through deterministic and probabilistic sensitivity analyses., Results: First and second generations of LAIs were found to have similar costs over five years; i.e. approximately € 55,000, except for PLAI which was associated with a discounted cost of € 50,880. Oral antipsychotics were found to be less costly (i.e. OO cost € 50,379 after five years) but associated with a lower number of QALYs gained and relapse avoided. PLAI and RLAI were associated with the greatest number of QALYs gained; i.e. PLAI dominated ALAI, OLAI and HD and was associated with an incremental costs-effectiveness ratio (ICER) of € 2411 per QALY gained versus OO. Finally, PLAI and OLAI were associated with the lowest number of relapses; i.e. PLAI dominated RLAI, ALAI and HLAI and was associated with an ICER of € 1782 per avoided relapse compared to OO. OO and HD were found to have led to the highest number of relapses., Conclusion: This analysis, to the best of our knowledge, is the first of its kind to assess the cost-effectiveness of antipsychotics based on French observational data. PLAI was associated with the highest probability of being the optimal treatment from the French health insurance perspective., (Copyright © 2016. Published by Elsevier Masson SAS.)

We study the existence and uniqueness of the stochastic viscosity solutions of fully nonlinear, possibly degenerate, second order stochastic pde with quadratic Hamiltonians associated to a Riemannian geometry. The results are new and extend the class of equations studied so far by the last two authors.

We consider chains of rotors subjected to both thermal and mechanical forcings in a nonequilibrium steady state. Unusual nonlinear profiles of temperature and velocities are observed in the system. In particular, the temperature is maximal in the center, which is an indication of the nonlocal behavior of the system. Despite this uncommon behavior, local equilibrium holds for long enough chains. Our numerical results also show that when the mechanical forcing is strong enough, the energy current can be increased by an inverse temperature gradient. This counterintuitive result again reveals the complexity of nonequilibrium states.

The objective was to assess the cost-effectiveness ratio of HAART in the treatment of HIV infection. Two random samples were extracted from the database of the Rothschild Public Hospital, and patients were matched for age, sex and T4 cell counts: a first sample selected in 1996/97 of HAART treated patients (CAS group) and a second sample selected in 1994/95 of non-HAART treated patients (CONTROL group). Immune recovery and use of resources data were extracted and analyzed over two years for 196 included patients. Mean T4 cell count after two years was higher among CAS patients (344/mm3 vs. 234/mm3; p < 0.0001). CAS patients recorded a supplementary cost of antiretroviral treatments (+171%; p < 0.0001) balanced by savings in other drugs expenses (-62%; p = 0.0560) and in hospitalizations (-25%; NS). Overall, CAS patients presented a 15% (NS) lower medical cost than CONTROL patients.

Coifman and Donoho (1995) suggested translation-invariant wavelet shrinkage as a way to remove noise from images. Basically, their technique applies wavelet shrinkage to a two-dimensional (2-D) version of the semi-discrete wavelet representation of Mallat and Zhong (1992), Coifman and Donoho also showed how the method could be implemented in O(Nlog N) operations, where there are N pixels. In this paper, we provide a mathematical framework for iterated translation-invariant wavelet shrinkage, and show, using a theorem of Kato and Masuda (1978), that with orthogonal wavelets it is equivalent to gradient descent in L (2)(I) along the semi-norm for the Besov space B(1) (1)(L(1)(I)), which, in turn, can be interpreted as a new nonlinear wavelet-based image smoothing scale space. Unlike many other scale spaces, the characterization is not in terms of a nonlinear partial differential equation.

Congestive heart failure is a severe condition responsible for 1%-2% of total health expenditure. In France, three-quarters of the medical cost of congestive heart failure, i.e. FF7 billion, is attributed to 150000 annual hospital admissions. But new treatments, especially ACE inhibitors and beta-blockers, have demonstrated, through large controlled trials (SAVE, AIRE, US trials on carvedilol and CIBIS I) that these drugs can reduce mortality and hospitalization. These results, translated in terms of cost per life year saved, show that they are all very cost effective and could be cost saving, under some conditions.

Purpose: There is little data on the different techniques used in France to treat venous leg ulcers. Due to the lack of a well-accepted standard, it is most likely that therapeutic attitudes vary greatly. An assessment of the respective cost/benefit ratios would be most useful, but requires prior knowledge of the techniques used. We therefore conducted a survey of the main management schemes applied in France., Patients and Methods: A cross-sectional survey involved 800 investigators (85% general practitioners. 15% specialists: angiologists and dermatologists) throughout France. Each investigator was invited to include 2 patients with venous ulcerations of the leg. One patient was to have a long-standing ulceration (at least 6 weeks duration) and the other a new ulceration (less than 2 weeks duration). Patients were followed to cure or to study end-point six months after diagnosis. The clinical observations at inclusion are presented here for 247 patients with venous ulcerations., Results: The patient population showed a clear predominance and advanced age (mean 72 years). In half of the cases, the diagnosis was made at a home visit and in 20% of the cases at an office visit for a reason other than leg ulceration. History taking revealed a high frequency of varicose veins, osteoarthritis of the lower limbs and high blood pressure as well as a high rate of recurrence (60% for long-standing ulcerations). Treatments prescribed at the first visit were divided into 10 groups. The most frequently used methods were: cleansing, contention and general therapy (antibiotics, anticoagulants, antiaggregates, analgesics). General practitioners focused primary treatment on general therapies and local care while specialists used contention more often (more than 90%) and different skin treatments. These different treatment combinations were then grouped into 7 main types of therapeutic attitudes, differentiating between general practitioners and specialists. There were however three common elements found in the treatments applied by more than 50% of the physicians: cleansing (99%), combined with contention (64%) or a general therapy (56%)., Conclusion: The main observation was that contention is used at a relatively high percentage (77%). This survey must be continued with a larger number of inclusion visits and an analysis of follow-up visits in order to identify possible changes in therapeutic attitudes and the associated costs as a function of treatment duration and rate of cure within the 6 month period.

The purpose of this study was to quantify the social and financial burden imposed by osteoarthritis in France. Six million new diagnoses of osteoarthritis are reported each year in France. The number of physician visits for osteoarthritis totals 8.7 million per year, for a total cost of 950 million French francs (FF). The cost of drugs prescribed to treat osteoarthritis is 965 million FF. Total annual cost of laboratory tests, roentgenograms, and rehabilitation therapy is 330 million French francs per year. The annual number of hospital admissions for osteoarthritis is 93,000. Duration of the hospital stay ranges from 11 to 16 days according the site involved. Hospital costs (in public and private institutions) total 1.7 billion French francs per year. Total direct costs related to osteoarthritis are 4 billion French francs per year. Indirect costs are the costs related to days of work lost. Sick leave benefits total 556 million FF and the production costs for the national economy are estimated at 1.6 billion French francs per year. Direct costs (4 billion FF) and indirect costs (at least 600 million FF) related to osteoarthritis represent an enormous burden for the French economy and national health care system. Novel treatments capable of substantially decreasing these costs would be of great value.

Menopausal osteoporosis has many consequences for women over 50. Its complications incur high treatment costs both for society and the patients themselves. Collection of the epidemiological data required for a cost analysis of menopause-related osteoporosis is not easy, but we have calculated the direct (i.e. purely medical) costs as follows: hip fractures: approximate number per annum in women over 50: 55,000, minimum hospital costs (treatment and rehabilitation): 3.5 bn FF; forearm fractures: approximate number per annum: 35,000, cost of out-patient treatment: 200 m FF; vertebral fractures: common, but generally unrecorded: estimated number 40,000-65,000 cost: unevaluated. The relative benefit of hormone therapy versus nontreatment may be used to calculate the cost of osteoporosis due to non treated menopause. In France, where currently only 5% women over 50 are treated, this cost is 2.2 bn FF. If 50% of women were treated, the savings from hormone therapy (in terms of osteoporosis treatment costs) could be 1.2 bn FF, a figure which must be weighed against a cost analysis of oestrogen therapy.