A French Value Set for the EQ-5D-5L

OBJECTIVE

The objective of this study was to develop a French value set for the EQ-5D-5L, for academic and clinical research, and for regulatory requirements for price-setting of drugs and medical devices.

METHOD

This study used the standardized valuation protocol developed by EuroQol, using computer-assisted personal interview software. A representative sample of 1048 French residents were interviewed by a market research company, under the supervision of the research team. Health states were valued using composite time trade-off and a discrete choice experiment. Modeling was used to create values for the 3125 possible health states. The composite time trade-off data were modeled using a Tobit model with censored observations at -1 and correcting for heteroscedasticity. A conditional logit model was used for the discrete choice results, and both models were combined using a hybrid model. An adjusted hybrid model was tested to correct for imbalance in the sample on age and sex compared with the general population. A comparison with the 3-level (3L) value set was performed.

RESULTS

The adjusted model was preferred to comply with the representativeness of the general population. It provided a value set for which all coefficients were logically consistent. Values ranged from - 0.525 to 1. The distribution of values presented a shift towards higher values versus the 3L value set. Ranking of dimensions changed. Pain and discomfort and mobility were the dimensions with the highest potential for disutility compared with mobility and self-care for the 3L instrument.

CONCLUSIONS

This study provides a value set based on societal preferences of the French population, using an improved descriptive instrument of health-related quality-of-life health states. It will contribute to improve the quality of cost-effectiveness analysis in the French context and help stimulate disease-specific quality-of-life references for academic-, institutional-, and industry-promoted studies.

Quality of diabetes follow-up care and hospital admissions

Diabetes may lead to severe complications. For this reason, disease prevention and improvement of medical follow-up represent major public health issues. The aim of this study was to measure the impact of adherence to French follow-up guidelines on hospitalization of people with diabetes. We used insurance claims data from the years 2010 to 2013 collected for 52,027 people aged over 18, affiliated to a French social security provider and treated for diabetes. We estimated panel data models to explore the association between adherence to guidelines and different measures of hospitalization, controlling for socioeconomic characteristics, diabetes treatment and density of medical supply. The results show that adherence to four guidelines was associated with a significant decrease in hospital admissions, up to approximatively 30% for patients monitored for a complete lipid profile or microalbuminuria during the year. In addition, our analyses confirmed the strong protective effect of income and a significant positive correlation with good supply of hospital care. In conclusion, good adherence to French diabetes guidelines seems to be in line with the prevention of health events, notably complications, that could necessitate hospitalization.

Costs associated with community acquired pneumonia in France

OBJECTIVES

Pneumocost is a prospective study that aimed at documenting the costs of the management of patients hospitalized with a pneumococcal pneumonia and the post-discharge costs during a 6-month period in the French context.

METHODS

Billing data were used to document hospital costs. Resource use during the follow-up period was collected through phone interviews at month 1, 3 and 6. Descriptive statistics and multivariate analyses were performed. We used generalized linear models with log-link functions to estimate parameters associated with hospital and follow-up costs of patients.

RESULTS

Five hundred twenty-four patients were enrolled in 40 public centers from October 2011 to April 2014. Average age was 63 (SD 17); 55.0% of them were male. Average length of stay was 15 days (SD 23). Average cost of stay for the French Sickness Fund was €7293 (SD €7363). Average cost of follow-up was €1242 (SD €3000) and decreased steadily through time. When controlling for patient's socioeconomic characteristics, severity of disease and hospital stay, results showed a concave relationship between hospital costs and age. Obesity, the severity of the disease and comorbidities were associated with constantly increasing inpatient costs. Concerning follow-up costs, we found the same concave relationship with age, while gender, a history of pneumonia and severity of the disease were the most important predictors of high costs after discharge.

CONCLUSION

Pneumocost is the first French study providing a robust estimation of the cost of managing invasive pneumococcal pneumonia in the French context.

Health related quality of life in patients with community-acquired pneumococcal pneumonia in France

Background

Community Acquired Pneumococcal Pneumonia is a lung infection that causes serious health problems and can lead to complications and death. The aim of this study was to observe and analyze health related quality of life after a hospital episode for patients with community acquired pneumococcal pneumonia in France.

Methods

A total of 524 individuals were enrolled prospectively in the study and were followed for 12 months after hospital discharge. Presence of streptococcus pneumoniae was confirmed by microbiological sampling. Quality of life was reported at four different points of time with the EQ-5D-3 L health states using the French reference tariff. Complete data on all four periods was available for 269 patients.

We used descriptive and econometric analysis to assess quality of life over time during follow-up, and to identify factors that impact the utility indexes and their evolution through time. We used Tobit panel data estimators to deal with the bounded nature of utility values.

Results

Average age of patients was 63 and 55% of patients were men. Negative predictors of quality of life were the severity of the initial event, history of pneumonia, smokers, age and being male. On average, quality of life improved in the first 6 months after discharge and stabilized beyond. At month 1, mean utility index was 0.53 (SD: 0.34) for men and 0.45 (SD: 0.34) for women, versus mean of 0.69 (SD: 0.33) and 0.70 (SD: 0.35) at Month 12. “Usual activities” was the dimension the most impacted by the disease episode. Utilities for men were significantly higher than for women, although male patients were more severe. Individuals over 85 years old did not improve quality of life during follow-up, and quality of life did not improve or deteriorated for 34% of patients. We found that length of hospital stay was negatively correlated with quality of life immediately after discharge.

Conclusion

This study provides with evidence that quality of life after an episode of community acquired pneumococcal pneumonia improves overall until the sixth month after hospital discharge, but older patients with previous history of pneumonia may not experience health gains after the initial episode.

Exploring the determinants of endocrinologist visits by patients with diabetes

BACKGROUND

Diabetes is today a major public health concern in terms of its financial and social burden. Previous studies have revealed that specialist care for patients with diabetes leads to more positive outcomes than care by general practitioners (GPs) alone. The aim of this study was to estimate the determinants of endocrinologist consultation by patients with diabetes.

METHODS

We used a two-part model to explore both the decision to consult and the frequency of consultations. We used claim data collected for 65,633 affiliates of a French social security provider. Patients were aged over 18 and treated for diabetes (types I and II). We controlled for patients' socioeconomic characteristics, type of diabetes treatment, medical care, and health status. We also controlled for variables, such as the cost of a visit, the distance to the nearest endocrinologist's office, the density of medical practitioners and the prevalence of diabetes in the area.

RESULTS

The results show that the parameters associated with the decision to consult an endocrinologist were considerably different from factors associated with the frequency of consultations. A marked positive effect of income on the decision to consult was found, whereas travel time to the office had a negative impact on both the decision to consult and the frequency of consultations. Increasing treatment complexity is associated with a higher probability of consulting an endocrinologist. We found evidence of a significant substitution effect between GPs and endocrinologists. Finally, consultation price is a barrier to seeing an endocrinologist.

CONCLUSION

Given that financial barriers were identified in the relatively wealthy population analysed here, it is likely that this may be even more of an obstacle in the general population.

Entry time effects and follow-on drug competition

Pharmaceutical firms have been criticized for concentrating efforts of R&D on the so-called me-too or follow-on drugs. There have been many comments for and against the dissemination of these incremental innovations but few papers have broached the subject from an econometric point of view, possibly because identification of me-too or follow-on drugs is not so obvious. This paper focuses on the impact of entry order on follow-on drug competition in the French market between the years 2001 and 2007. More precisely, this study examines the effects on market share of first entrants in the follow-on drug market and how this possible competitive advantage changes over time. First results are coherent with theoretical microeconomic issues concerning the importance of being first. We find evidence that first movers in the follow-on drug market have the ability to capture and maintain greater market share for a long period of time. The hierarchical market position of follow-on drugs does not seem to be affected by generic drug emergence. From a dynamic perspective, our analysis shows that market share is positively correlated with the ability of follow-on drugs to set prices higher than the average follow-on drug prices in a specific therapeutic class, which means that market power remains considerably important for first movers. Moreover, we found that the optimum level of innovation to maximize market share is the highest one.

Influence of oily vehicles on fetal testis and lipid profile of rats exposed to di-butyl phthalate

It has been hypothesized that oils containing high levels of omega-3 polyunsaturated fatty acids, such as canola and fish oil, could counteract some of the adverse effects induced by phthalates. In the present study, the influence of different oily vehicles on di-butyl phthalate (DBP)-induced testicular toxicity and lipid profile was investigated. Pregnant Wistar rats were treated by oral gavage from gestation days 13 to 20 with DBP (500 mg/kg/day) diluted in three different vehicles: corn, canola or fish oil. Male fetuses were analyzed on gestation day 20. DBP exposure lowered intratesticular testosterone levels and anogenital distance, regardless of the vehicle used. The percentage of seminiferous cords containing multinucleated gonocytes and cord diameter was increased in DBP-exposed groups, compared with vehicle controls, with no difference between the three DBP-exposed groups. Clustering of Leydig cells was seen in all DBP groups. Lipid profile indicated that administration of canola and fish oil can increase the content of omega-3 fatty acids in rat testis. However, content of omega-3 was diminished in DBP-treated groups. Overall, our results indicate that different oily vehicles did not alter fetal rat testicular toxicity induced by a high DBP dose.

The effect of cyanide compounds, fluorides, aluminum, and inorganic oxides present in spent pot liner on germination and root tip cells of Lactuca sativa

SPL (spent pot liner) is a solid waste produced by the aluminum industry. This waste has a highly variable composition, consisting of cyanides, fluorides, organics, and metals. The aim of this work was to study the effect of SPL on root tips of Lactuca sativa using current plant bioassays. We observed a decrease in the germination rate with increasing concentrations of SPL. In addition, SPL was found to reduce root growth, which is correlated with a decrease in the mitotic index. Nevertheless, we noticed a significant enhancement in the percentage of stickiness, c-metaphase, anaphase bridges, and laggard chromosomes in dividing cells and also an increase in the number of cells with condensed nuclei. Moreover, SPL was found to alter the root tip surface, resulting in a reduction in the amount of root hair. These results demonstrate that SPL is a toxic agent that leads to cell damage and disturbance.

Cytogenetic alterations induced by SPL (spent potliners) in meristematic cells of plant bioassays

Spent potliners (SPL) is solid waste generated by the aluminum industry during the manufacture of aluminum metal. Information on the cytotoxicity effect of SPL is necessary to facilitate understanding of their action on organisms and to subsidize environmentally correct solutions. Thus, the aim of the present investigation is to compare the effect of SPL on meristematic cells of Allium cepa and Zea mays and also to discuss the mechanisms of SPL cytotoxicity involved. A strong inhibition on root growth in higher SPL concentrations has been observed in both A. cepa and Z. mays. For cytogenetic analysis, the results showed a reduction of mitotic index and increase of different abnormalities as the SPL concentration increased. We observed bridges, chromosome fragments, stickiness, multipolar anaphase, later segregation and cell death. In general, it was possible to observe an increase of different abnormalities as the SPL concentration increased. It is obvious from the results of the present investigation that SPL is cytotoxic on meristematic cells of plant tests (A. cepa and Z. mays).

Vaccination of day-old broilers against infectious bronchitis: effect of vaccine strain and route of administration

Nine groups of 10 one-day-old broiler chicks were vaccinated by eye-drop, coarse spray, or intratracheal instillation with combined Newcastle disease-infectious bronchitis live vaccines containing the Massachusetts (Mass) 41, Holland 120, or Connecticut 46 strain of infectious bronchitis virus (IBV). Chickens vaccinated with Mass-41 or Holland 120 were protected against challenge with a Mass strain administered at 4 weeks of age. When immunity to the disease was evaluated by virus recovery, detection of IBV by fluorescent antibody, evaluation of ciliary activity, histopathology, and virus-neutralization titers, the group vaccinated with Connecticut 46 did not show protection. Vaccination at 1 day of age resulted in an antibody response and increased resistance to challenge with Mass-41, regardless of vaccination route.

Evaluation of ciliary movement in tracheal rings to assess immunity against infectious bronchitis virus

Chickens vaccinated at one and 14 days of age with a live vaccine containing the Massachusetts and Connecticut strains of infectious bronchitis virus were protected against challenge with a Massachusetts strain administered at 5 weeks of age. The virus recovery method in which tracheal swabs taken 4 days post-challenge were used to inoculate chicken embryos was compared with the method based on ciliary activity in tracheal explants. The results showed that evaluation of ciliary activity effectively measured immunity to infectious bronchitis virus. Serological results obtained in a microneutralization test using chicken embryo kidney cells correlated with the immune status of the birds as well as with the alpha neutralization results obtained using chicken embryos.