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Belhassen M, Nolin M, Jacoud F, Marant Micallef C, Van Ganse E. Trajectories of Controller Therapy Use Before and After Asthma-Related Hospitalization in Children and Adults: Population-Based Retrospective Cohort Study. JMIR Public Health Surveill 2023; 9:e50085. [PMID: 37751244 PMCID: PMC10565628 DOI: 10.2196/50085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/19/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Inappropriate use of inhaled corticosteroids (ICSs) for asthma impairs control and may cause exacerbation, including asthma-related hospitalization (ARH). In prospective studies, ICS use peaked around ARH, but information on routine care use is limited. Since ARH is a major outcome, controller therapy use in routine care before and after ARH should be documented. OBJECTIVE This study aimed to distinguish ICS use typologies (trajectories) before and after ARH, and assess their relationships with sociodemographic, disease, and health care characteristics. METHODS A retrospective cohort study was performed using a 1% random sample of the French claims database. All patients hospitalized for asthma between January 01, 2013, and December 31, 2015, were classified as either children (aged 1-10 years) or teens/adults (aged ≥11 years). Health care resource use was assessed between 24 and 12 months before ARH. ICS use was computed with the Continuous Measures of Medication Acquisition-7 (CMA7) for the 4 quarters before and after ARH. Initially, the overall impact of hospitalization on the CMA7 value was studied using a segmented regression analysis in both children and teens/adults. Then, group-based trajectory modeling differentiated the groups with similar ICS use. We tested different models having 2 to 5 distinct trajectory groups before selecting the most appropriate trajectory form. We finally selected the model with the lowest Bayesian Information Criterion, the highest proportion of patients in each group, and the maximum estimated probability of assignment to a specific group. RESULTS Overall, 863 patients were included in the final study cohort, of which 447 (51.8%) were children and 416 (48.2%) were teens/adults. In children, the average CMA7 value was 12.6% at the start of the observation period, and there was no significant quarter-to-quarter change in the value (P=.14) before hospitalization. Immediately after hospitalization, the average CMA7 value rose by 34.9% (P=.001), before a significant decrease (P=.01) of 7.0% per quarter. In teens/adults, the average CMA7 value was 31.0% at the start, and there was no significant quarter-to-quarter change in the value (P=.08) before hospitalization. Immediately after hospitalization, the average CMA7 value rose by 26.9% (P=.002), before a significant decrease (P=.01) of 7.0% per quarter. We identified 3 and 5 trajectories before ARH in children and adults, respectively, and 5 after ARH for both groups. Trajectories were related to sociodemographic characteristics (particularly, markers of social deprivation) and to potentially inappropriate health care, such as medical management and choice of therapy. CONCLUSIONS Although ARH had an overall positive impact on ICS use trajectories, the effect was often transient, and patient behaviors were heterogeneous. Along with overall trends, distinct trajectories were identified, which were related to specific patients and health care characteristics. Our data reinforce the evidence that inappropriate use of ICS paves the way for ARH.
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Affiliation(s)
| | | | | | | | - Eric Van Ganse
- PELyon, Lyon, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Respiratory Medicine, Croix Rousse University Hospital, Lyon, France
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Rousset-Jablonski C, Dalon F, Reynaud Q, Lemonnier L, Dehillotte C, Jacoud F, Berard M, Viprey M, Van Ganse E, Durieu I, Belhassen M. Cancer incidence and prevalence in cystic fibrosis patients with and without a lung transplant in France. Front Public Health 2022; 10:1043691. [PMID: 36483264 PMCID: PMC9723348 DOI: 10.3389/fpubh.2022.1043691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cystic fibrosis (CF) care and the life expectancy of affected patients have substantially improved in recent decades, leading to an increased number of patients being diagnosed with comorbidities, including cancers. Our objective was to characterize the epidemiology of cancers between 2006 and 2017 in CF patients with and without a lung transplant. Methods Medical records of CF patients from 2006 to 2016 in the French CF Registry were linked to their corresponding claims data (SNDS). The annual prevalence and incidence rates of cancers were estimated from 2006 to 2017 in CF patients without lung transplant and in those with lung transplant after transplantation. Results Of the 7,671 patients included in the French CF Registry, 6,187 patients (80.7%) were linked to the SNDS; among them, 1,006 (16.3%) received a lung transplant. The prevalence of any cancer increased between 2006 and 2017, from 0.3 to 1.0% and from 1.3 to 6.3% in non-transplanted and transplanted patients, respectively. When compared to the general population, the incidence of cancer was significantly higher in both non-transplanted [Standardized Incidence Ratio (SIR) = 2.57, 95%CI 2.05 to 3.17] and transplanted (SIR = 19.76, 95%CI 16.45 to 23.55) patients. The median time between transplant and the first cancer was 3.9 years. Among the 211 incident cancer cases, the most frequent malignant neoplasms were skin neoplasm (48 cases), lung cancers (31 cases), gastro-intestinal (24 cases), and hematologic cancers (17 cases). Conclusion The overall burden of cancer in CF patients is high, particularly following lung transplantation. Therefore, specific follow-up, screening and cancer prevention for CF patients with transplants are necessary.
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Affiliation(s)
- Christine Rousset-Jablonski
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Department of Internal Medicine, Cystic Fibrosis Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Lyon, France,Département de chirurgie, Centre Léon Bérard, Lyon, France,*Correspondence: Christine Rousset-Jablonski
| | | | - Quitterie Reynaud
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Department of Internal Medicine, Cystic Fibrosis Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Lyon, France
| | | | | | - Flore Jacoud
- PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | | | - Marie Viprey
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Eric Van Ganse
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,PELyon, PharmacoEpidemiologie Lyon, Lyon, France,Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France
| | - Isabelle Durieu
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Department of Internal Medicine, Cystic Fibrosis Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Lyon, France
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Rousset-Jablonski C, Durieu I, Dalon F, Reynaud Q, Lemonnier L, Dehillotte C, Berard M, Jacoud F, Viprey M, Van Ganse E, Belhassen M. Incidence et prévalence des cancers chez les patients atteints de mucoviscidose : données issues du chainage entre le Système national des données de santé (SNDS) et le registre français de la mucoviscidose. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Belhassen M, Bérard M, Devouassoux G, Dalon F, Bousquet J, Van Ganse E. Treatment of Allergic Rhinitis and Asthma in Primary Care: Dispensations Do Not Align with Prescriptions. J Asthma Allergy 2022; 15:1721-1729. [DOI: 10.2147/jaa.s376786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022] Open
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Danchin N, Gabriel Steg P, Mahé I, Hanon O, Jacoud F, Nolin M, Dalon F, Cotte FE, Gollety S, Ganse EV, Belhassen M. Comparison of non-persistence in the first year of treatment with oral anticoagulants in patients with atrial fibrillation: A French comprehensive nationwide study. Arch Cardiovasc Dis 2022; 115:571-577. [DOI: 10.1016/j.acvd.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
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Belhassen M, Hanon O, Steg PG, Mahé I, Née M, Jacoud F, Dalon F, Cotté FE, Guitard-Dehoux D, Marant-Micallef C, Van Ganse E, Danchin N. Apixaban versus other anticoagulants in patients with nonvalvular fibrillation: a comparison of all-cause and event-related costs in real-life setting in France. Eur J Health Econ 2022:10.1007/s10198-022-01513-2. [PMID: 36030485 DOI: 10.1007/s10198-022-01513-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Compare costs associated with all-cause healthcare resource use (HCRU), stroke/systemic thromboembolism (STE) and major bleedings (MB) between patients with non-valvular atrial fibrillation (NVAF) initiating apixaban or other oral anticoagulants (OACs). METHODS We performed a retrospective cohort study using the French healthcare claims database, including NVAF patients between 2014/01/01 and 2016/12/31, followed until 2016/12/31. We used 4 sub-cohorts of OAC-naive patients, respectively initiating apixaban, dabigatran, rivaroxaban or VKAs. We matched patients initiating apixaban with patients initiating each other OACs using 1:n propensity score matching. All-cause HCRU and event-related costs by OAC treatment were estimated and compared between matched patients using generalised-linear models with gamma-distribution and two-part models. RESULTS There were 175,766 patients in the apixaban-VKA, 181,809 in the apixaban-rivaroxaban, and 42,490 in the apixaban-dabigatran matched cohorts. Patients initiating apixaban had significantly lower HCRU costs than patients initiating VKA (€1,105 vs. €1,578, p < 0.0001), dabigatran (€993 vs. €1,140, p < 0.0001) and rivaroxaban (€1,013 vs. €1,088 p < 0.0001). They have had significantly lower costs related to stroke/STE and MB than patients initiating VKA (respectively, €183 vs. €449 and €147 vs. €413; p < 0.0001), rivaroxaban (respectively, €145 vs. €197 and €129 vs. €193; p < 0.0001), and lower costs related to stroke/STE than patients initiating dabigatran (€135 vs. €192, p < 0.02). Costs related to MB were not significantly different in patients initiating apixaban and those initiating dabigatran (€119 vs. €149, p = 0.07). CONCLUSIONS HCRU and most event-related costs were lower in patients initiating apixaban compared to other OACs. Apixaban may be cost-saving compared to VKAs, and significantly cheaper than other DOACs, although cost differences are limited.
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Affiliation(s)
- Manon Belhassen
- PELyon, Lyon, France.
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France.
| | - Olivier Hanon
- Service de Gériatrie, Université de Paris, APHP Centre, Hôpital Broca, 4468, Paris, EA, France
| | - Philippe Gabriel Steg
- FACT, Université de Paris, INSERM U-1148/LVTS, F ; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, 75018, ParisParis, France
| | - Isabelle Mahé
- APHP, Service de Médecine Interne, INNOVTE-FCRIN, Hôpital Louis Mourier, Université de Paris, Innovative Therapies in Haemostasis, INSERM, ColombesParisSaint Etienne, France
| | | | | | | | | | | | | | | | - Nicolas Danchin
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
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Whittaker H, Van Ganse E, Dalon F, Nolin M, Marrant-Micallef C, Pison C, Ryan DP, Deslee G, Quint JK, Belhassen M. Differences in severe exacerbations rates and healthcare utilisation in COPD populations in the UK and France. BMJ Open Respir Res 2022; 9:9/1/e001150. [PMID: 35944943 PMCID: PMC9367183 DOI: 10.1136/bmjresp-2021-001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/31/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality in Europe; however, it is important to understand how clinical practice patterns differ between countries and how this might relate to disease outcomes, to identify ways of improving local disease management. We aimed to describe and compare the management of patients with COPD in the UK and France between 2008 and 2017. Methods We used data from the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics in the UK and the Echantillon Généraliste des Bénéficiaire in France to identify patients with COPD each year between 2008 and 2017. We compared patient characteristics, all-cause mortality and COPD exacerbations each year between 2008 and 2017 for patients in the UK and France separately. Health care utilisation and COPD exacerbations in 2017 were compared between France and the UK using t-tests and χ2 tests. Results Patients with COPD were similar in gender and comorbidities in both countries. Incidence of COPD exacerbations remained stable in the UK and France between 2007 and 2017. In 2017, the proportion of all-cause and COPD-related hospitalisations was greater in the UK than in France (43.9% vs 32.8% and 8.3% vs 4.9%, respectively; p<0.001) as was the proportion of patients visiting accident and emergency (A&E) (39.8% vs 16.2%, respectively; p<0.001). In addition, the mean length of stay in hospital for COPD-related causes was shorter in the UK than in France (6.2 days (SD 8.4) vs 10.5 days (SD 9.1), respectively; p<0.001). Discussion Overall, UK patients were more likely to go to A&E, be hospitalised for COPD-related causes and stay in hospital for fewer days after being admitted for COPD-related reasons compared with patients in France, illustrating a difference in health-seeking behaviours and access to healthcare.
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Affiliation(s)
- Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Eric Van Ganse
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France.,Respiratory Medicine, Hospital Croix-Rousse, Lyon, France
| | | | - Maeva Nolin
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France
| | | | - Christophe Pison
- Clinique de Pneumologie, Centre Hospitalier Universitaire de Grenoble, Service de Pneumologie, Grenoble, France
| | - Dermot P Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences: GP Section, University of Edinburgh, Edinburgh, UK
| | - Gaetan Deslee
- Department of Respiratory Medicine, INSERM UMRS 903, University Hospital of Reims, Reims, France
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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Lizano-Barrantes C, Garin O, Dima AL, van Ganse E, de Bruin M, Belhassen M, Mayoral K, Pont À, Ferrer M. The Inhaler Technique Questionnaire (InTeQ): Development and Validation of a Brief Patient-Reported Measure. Int J Environ Res Public Health 2022; 19:ijerph19052591. [PMID: 35270283 PMCID: PMC8909835 DOI: 10.3390/ijerph19052591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023]
Abstract
There is a need for instruments designed for patients with asthma to self-report their performance of inhaling steps. We aimed to develop an accessible and easy-to-use patient-reported tool for inhaler technique assessment, which could also serve as a training and monitoring resource for any type of inhaler device, and to evaluate its feasibility, validity, and reliability in adults with asthma. The development was based on literature review and pilot testing with clinicians and patients. The Inhaler Technique Questionnaire (InTeQ) asks about the frequency of performing five steps when using inhalers (on a five-point Likert scale). We analyzed data from adults with persistent asthma (n = 361). We examined the measurement model using Mokken scaling analysis, construct validity by assessing hypotheses on expected discrimination among known groups, and reliability based on internal consistency and reproducibility. Means of the InTeQ items were in the range of 0.23–1.61, and coefficients of homogeneity were above the cutoff point, demonstrating the unidimensionality of the scale. Known groups’ global score differences were statistically significant between patients reporting having “Discussed in detail” or having “Not discussed/Only in general” the inhaler technique with their healthcare providers (p = 0.023). The Cronbach’s alpha coefficient was 0.716, and the intraclass correlation coefficient was 0.775. The InTeQ is a feasible, valid, and reliable instrument for self-reporting inhaler technique on any type of device.
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Affiliation(s)
- Catalina Lizano-Barrantes
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Department of Pharmaceutical Care and Clinical Pharmacy, Faculty of Pharmacy, Universidad de Costa Rica, San Jose 2060, Costa Rica
| | - Olatz Garin
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
| | - Alexandra L. Dima
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Spain
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69003 Lyon, France;
- Correspondence:
| | - Eric van Ganse
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69003 Lyon, France;
- Respiratory Medicine, Croix-Rousse University Hospital, 69004 Lyon, France
- PELyon, Pharmacoepidemiology, 69007 Lyon, France;
| | - Marijn de Bruin
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | | | - Karina Mayoral
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
- Department of Pediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Àngels Pont
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
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Cottin V, Spagnolo P, Bonniaud P, Nolin M, Dalon F, Kirchgässler KU, Kamath TV, Van Ganse E, Belhassen M. Mortality and Respiratory-Related Hospitalizations in Idiopathic Pulmonary Fibrosis Not Treated With Antifibrotics. Front Med (Lausanne) 2022; 8:802989. [PMID: 35004781 PMCID: PMC8739228 DOI: 10.3389/fmed.2021.802989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Real-world data regarding outcomes of idiopathic pulmonary fibrosis (IPF) are scarce, outside of registries. The claims data from the French National Health System (SNDS) were used to describe outcomes in patients diagnosed with IPF in 2015–2016 but who did not receive antifibrotic therapies. Method: Patients aged <50 years were excluded, as were patients with pulmonary fibrosis other than IPF, patients who had previously received a lung transplant, and those who had received antifibrotic therapies at any time between 2010 and 2016. Patients were followed-up until their last health record, lung transplantation, initiation of antifibrotic therapies, death, or the end of the study period (31 December 2017), whichever occurred first. Results: A total of 5,360 patients (43.2%) not treated with antifibrotic therapies were included. The mean age was 75.5 years, and 57.9% were males. In the year before inclusion, 47.3% of patients had a Charlson score ≥5. During follow-up, 41.2% of patients died. The unadjusted incidence rate was 29.9 per 100 person-years (95%CI = [28.7–31.2]), and the cumulative incidence of death at 3 years was 50.2% (95% CI = [48.3–52.1%]). In the study population, 35.3% of patients experienced an acute respiratory-related hospitalization. The unadjusted incidence rate was 32.1 per 100 person-years (95%CI = [30.6–33.5]) and the cumulative incidence of the event at 3 years was 41.5% (95% CI = [39.7–43.2%]). Interpretation: This observational study showed that, if untreated with antifibrotics, IPF is associated with a 50% all-cause mortality at 3 years. These figures can serve as a historical control of the natural course of the disease.
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Affiliation(s)
- Vincent Cottin
- National French Reference Coordinating Center for Rare Pulmonary Diseases, Louis Pradel Hospital and Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, INRAE, IVPC, ERN-LUNG, Lyon, France
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Philippe Bonniaud
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence Constitutif des Maladies Pulmonaires Rares de l'Adulte, Centre Hospitalo-Universitaire de Bourgogne and Faculté de Médecine et Pharmacie, Université de Bourgogne-Franche Comté, Dijon, France.,INSERM U123-1, Dijon, France
| | - Maëva Nolin
- PharmacoEpidemiology Lyon (PELyon), Lyon, France
| | | | | | | | - Eric Van Ganse
- PharmacoEpidemiology Lyon (PELyon), Lyon, France.,Respiratory Medicine, Croix Rousse University Hospital and Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
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Marchal C, Belhassen M, Guiso N, Jacoud F, Cohen R, Le Pannerer M, Verdier R. Cocooning strategy: Pertussis vaccination coverage rate of parents with a new-born in 2016 and 2017 in France. Front Pediatr 2022; 10:988674. [PMID: 36330369 PMCID: PMC9624187 DOI: 10.3389/fped.2022.988674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The "cocooning" strategy was introduced in 2004 to protect infants too young to be vaccinated against pertussis, by immunizing their parents and close relatives. The study objective was to assess its implementation 12 years after its introduction by estimating the pertussis vaccination coverage rates (VCR) among parents of newborns. MATERIALS AND METHODS Pertussis VCR were estimated among all women who gave birth and men who took paternity leave, in 2016 or 2017, from a 1/97th random sample of French claims data. Two distinct study periods were defined based on current recommendations for the cocooning strategy: the "common practice" and the "parental project" periods. RESULTS In 2016, the pertussis VCR of women having given birth and men having taken paternity leave was 47.2 and 47.1%, respectively (46.1 and 45.6% in 2017, respectively). About one quarter of vaccinations were performed during the "parental project" period, with the vaccine most frequently reimbursed during the month of childbirth for women (57.1% in 2016 and 49.4% in 2017) and before or during the month the paternity leave began for men (about 78% in both 2016 and 2017). General practitioners were the main prescribers in private practice, even during the "parental project" period. CONCLUSION To optimize the protection for infants, the main objective of the cocooning strategy, pertussis immunization coverage of adults and seniors needs to be improved. Moreover, cocooning vaccination linked to a parental project needs to be performed earlier, during pregnancy (for those around the mother) or in immediate post-partum (e.g., during the maternity stay).
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Affiliation(s)
| | | | | | - Flore Jacoud
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France
| | - Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,GPIP, Pediatric Infectious Disease Group, Créteil, France.,ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur-des-Fossés, France.,Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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Rolland B, Dalon F, Gauthier N, Nourredine M, Bérard M, Carton L, Brousse G, Llorca PM, Jacoud F, Van Ganse E, Belhassen M. Antipsychotic prescribing practices in real-life (APPREAL study): Findings from the French National Healthcare System Database (2007-2017). Front Psychiatry 2022; 13:1021780. [PMID: 36387010 PMCID: PMC9659890 DOI: 10.3389/fpsyt.2022.1021780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Antipsychotics are used in a large variety of psychiatric and neurological disorders; investigating their use in real life is important to understand national prescribing practices, as well as to determine the levels of patient adherence. METHODS Using a 1/97e random sample (General Sample of Beneficiaries, EGB) of the French health insurance reimbursement database, we conducted a historical cohort study on the 2007-2017 period. The aim was to describe the sociodemographic characteristics of patients, the types of antipsychotics dispensed, the types of prescribers, the mean doses and average durations of treatment, the co-dispensed medications, and the levels of adherence to treatment. To exclude punctual uses of antipsychotics, we selected only patients with a continuous dispensing of the same antipsychotic over at least 3 months. RESULTS In total, 13,799 subjects (1.66% of the EGB sample) were included (56.0% females; mean age 55.8 ± 19.4 years). Risperidone (19.3%), cyamemazine (18.7%), olanzapine (11.9%), tiapride (8.8%), and haloperidol (7.5%) were the five most prescribed antipsychotics. 44.9% of prescriptions were written by general practitioners, 34.1% by hospital practitioners, and 18.4% by private-practice psychiatrists. On average, the mean dispensed doses were relatively low, but the variation range was large. Long-acting forms were used in 5.4% of the sample, and clozapine in 1.3%. 34.2% of patients received more than one antipsychotic, and almost 15% were prescribed at least three concomitant antipsychotics. Paliperidone and clozapine were associated with the highest levels of adherence, and risperidone and haloperidol with the lowest ones. CONCLUSION An important heterogeneity of antipsychotic prescribing practices was observed in France. The rate of use of long-acting antipsychotics was low, whereas multiple antipsychotic prescriptions were frequent.
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Affiliation(s)
- Benjamin Rolland
- Centre Hospitalier Le Vinatier, Hospices Civils de Lyon, Academic Department of Addiction Medicine (SUAL), Bron, France.,Université Claude Bernard Lyon 1, Lyon, France
| | | | - Noémie Gauthier
- Saint-Cyr au Mont d'Or Hospital, Hospital Pharmacy, Saint-Cyr-au Mont-d'Or Psychiatric Hospital, Saint-Cyr-au Mont-d'Or, France
| | - Mikaïl Nourredine
- Hospices Civils de Lyon, Pharmacotoxicology Laboratory, Department of Clinical Research and Epidemiology, Lyon, France.,Faculté de Médecine Lyon Sud, Lyon 1 University, Lyon, France
| | | | - Louise Carton
- CHU Lille, Department of Pharmacology, Inserm, Lille Neuroscience and Cognition, UMR-S1172, Université de Lille, Lille, France
| | - Georges Brousse
- CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, University Clermont Auvergne, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, University Clermont Auvergne, Clermont-Ferrand, France
| | | | - Eric Van Ganse
- PELyon, Lyon, France.,Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.,Claude Bernard Lyon 1 University, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
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Dalon F, Majed L, Belhassen M, Jacoud F, Bérard M, Lévy-Bachelot L, de Pouvourville G, Rouzier R, Raude J, Baldauf JJ. Human papillomavirus (HPV) vaccine coverage rates (VCRs) in France: A French claims data study. Vaccine 2021; 39:5129-5137. [PMID: 34334252 DOI: 10.1016/j.vaccine.2021.07.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/16/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The French Cancer Plan 2014-2019 had a target of 60% HPV vaccine coverage. The PAPILLON study investigated the annual age-specific vaccination initiation rates and cumulative partial and complete vaccination rates in France from 2017 to 2022. It also identified the factors associated with vaccination in different age groups and those associated with the type of completion of the vaccination scheme (partial vs full vaccination). METHODS For this publication, all females recorded in the French National Claims database who initiated HPV vaccination between 1 July 2007 and 31 December 2018 and were aged between 11 and 19 years at initiation were included. Annual HPV vaccination initiation rates were estimated in 11- to 14-year-old (target population) and 15- to 19-year-old females (catch-up). Cumulative vaccine coverage rates (VCRs) were estimated among those who were 15, 16, 20 and 21 years old. Partial vaccination was defined by dispensing of at least one dose of HPV vaccine by the pharmacy, while full vaccination was defined by two or three doses dispensed by a pharmacy over an 18-month period, according to current French recommendations based on the age at vaccination initiation. RESULTS Among the 465,629 females who initiated HPV vaccination in 2017 or 2018, the initiation rate increased from 7.7 to 11.1% in 11- to 14-year-old girls and from 4.5 to 6.5% in 15- to 19-year-old females. In 2017 and 2018, the cumulative VCRs for partial vaccination by age 15 were 28.2% and 32.8%, respectively, while by age 20, they were 41.6% and 38.8%. The cumulative VCRs for full vaccination were 15.6% and 18.6% by age 16, while they were 25.9 and 23.6% by age 20. HPV vaccination initiation and completion were strongly associated with the use of health services. CONCLUSION Overall, the HPV VCR substantively increased between 2017 and 2018, which is positive evidence of the resumption of vaccination. Updates in 2022 should confirm these results.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jocelyn Raude
- Ecole des Hautes Etudes en Santé Publique (EHESP), Rennes, France
| | - Jean-Jacques Baldauf
- University Hospital of Strasbourg and EA3181, University of Bourgogne Franche-Comte, Besançon, France
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Belhassen M, Whittaker H, Nolin M, Dalon F, Micallef CM, Deslée G, Pison C, Ryan D, Quint J, Van Ganse E. Consommation de soins des patients BPCO en France et au Royaume-Uni entre 2008 et 2017, et coûts associés. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Belhassen M, Dalon F, Nolin M, Van Ganse E. Comparative outcomes in patients receiving pirfenidone or nintedanib for idiopathic pulmonary fibrosis. Respir Res 2021; 22:135. [PMID: 33947414 PMCID: PMC8094468 DOI: 10.1186/s12931-021-01714-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/13/2021] [Indexed: 12/21/2022] Open
Abstract
Background Real-world data regarding outcomes of idiopathic pulmonary fibrosis (IPF) are scarce, outside of registries. In France, pirfenidone and nintedanib are only reimbursed for documented IPF, with similar reimbursement criteria with respect to disease characteristics, prescription through a dedicated form, and IPF diagnosis established in multidisciplinary discussion. Research question The data of the comprehensive French National Health System were used to evaluate outcomes in patients newly treated with pirfenidone or nintedanib in 2015–2016. Study design and methods Patients aged < 50 years or who had pulmonary fibrosis secondary to an identified cause were excluded. All-cause mortality, acute respiratory-related hospitalisations and treatment discontinuations up to 31 December 2017 were compared using a Cox proportional hazards model adjusted for age, sex, year of treatment initiation, time to treatment initiation and proxies of disease severity identified during a pre-treatment period. Results During the study period, a treatment with pirfenidone or nintedanib was newly initiated in 804 and 509 patients, respectively. No difference was found between groups for age, sex, time to treatment initiation, Charlson comorbidity score, and number of hospitalisations or medical contacts prior to treatment initiation. As compared to pirfenidone, nintedanib was associated with a greater risk of all-cause mortality (hazard ratio [HR], 1.8; 95% confidence interval [CI] 1.3–2.6), a greater risk of acute respiratory-related hospitalisations (HR 1.3; 95% CI 1.0–1.7) and a lower risk of treatment discontinuation at 12 months (HR 0.7; 95% CI 0.6–0.9). Interpretation This observational study identified potential differences in outcome under newly prescribed antifibrotic drugs, deserving further explorations. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01714-y.
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Affiliation(s)
- Manon Belhassen
- PELyon, PharmacoEpidemiology Lyon, 210 avenue Jean Jaurès, 69007, Lyon, France
| | - Faustine Dalon
- PELyon, PharmacoEpidemiology Lyon, 210 avenue Jean Jaurès, 69007, Lyon, France
| | - Maëva Nolin
- PELyon, PharmacoEpidemiology Lyon, 210 avenue Jean Jaurès, 69007, Lyon, France
| | - Eric Van Ganse
- PELyon, PharmacoEpidemiology Lyon, 210 avenue Jean Jaurès, 69007, Lyon, France. .,Hospices Civils de Lyon, Croix-Rousse University Hospital, Department of Respiratory Medicine, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France. .,RESearch on HealthcAre PErformance (RESHAPE), Claude Bernard Lyon 1 University, 8 avenue Rockefeller, 69003, Lyon, France.
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Belhassen M, Van Ganse E, Nolin M, Bérard M, Bada H, Bruckert E, Krempf M, Rebours V, Valero R, Moulin P. 10-Year Comparative Follow-up of Familial versus Multifactorial Chylomicronemia Syndromes. J Clin Endocrinol Metab 2021; 106:e1332-e1342. [PMID: 33221907 DOI: 10.1210/clinem/dgaa838] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT The relative incidence of acute pancreatitis, ischemic cardiovascular disease, and diabetes in hyperchylomicronemic patients exhibiting familial chylomicronemia syndrome (FCS) or multifactorial chylomicronemia syndrome (MCS) is unknown. OBJECTIVE The objective was to study the occurrence of these events in FCS and MCS patients compared with the general population. METHODS Twenty-nine FCS and 124 MCS patients, with genetic diagnosis, in 4 lipid clinics were matched with 413 controls. Individual hospital data linked to the national claims database were collected between 2006 and 2016. The occurrence of complications was retrospectively assessed before follow-up and during a median follow-up time of 9.8 years, for 1500 patient years of follow-up. RESULTS Patients with FCS were younger than those with MCS (34.3 ± 13.6 vs 45.2 ± 12.6 years, P < 0.01). During the study period, 58.6% of the FCS patients versus 19.4% of the MCS patients had at least 1 episode of acute hypertriglyceridemic pancreatitis (AHP) (hazard ratio [HR] = 3.6; P < 0.01). Conversely, the ischemic risk was lower in FCS than in MCS (HR = 0.3; P = 0.05). The risk of venous thrombosis was similar in both groups. The incidence of diabetes was high in both groups compared with matched controls (odds ratio [OR] = 22.8; P < 0.01 in FCS and OR = 30.3; P < 0.01 in MCS). CONCLUSION The incidence of AHP was much higher in FCS than in MCS patients, whereas the incidence of ischemic cardiovascular events was found to be increased in MCS versus FCS patients and a representative matched control group. Differences in both triglyceride-rich lipoproteins metabolism and comorbidities in MCS versus FCS drive the occurrence of different patterns of complications.
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Affiliation(s)
| | - Eric Van Ganse
- PELyon, PharmacoEpidemiology Lyon, Lyon, France
- Department of Pneumology, Croix-Rousse University Hospital, Lyon, France
- HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Maeva Nolin
- PELyon, PharmacoEpidemiology Lyon, Lyon, France
| | | | - Hanane Bada
- Department of Endocrinology Louis Pradel University Hospital, Hospices Civils de Lyon, INSERM UMR 1060 Carmen, Claude Bernard Lyon 1 University, Lyon, France
| | - Eric Bruckert
- Department of Endocrinology, Pitié Salpêtrière University Hospital, APHP, Paris, France
| | - Michel Krempf
- Department of Endocrinology, Nantes University Hospital, Nantes, France
| | - Vinciane Rebours
- Department of gastroenterology pancreatology, Beaujon University Hospital, AP-HP, Clichy, France
| | - René Valero
- Department of Nutrition, Metabolic Diseases and Endocrinology, Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, University Hospital La Conception, Marseille, France
- Department of Endocrinology, APHM University Hospital, Marseille, France
| | - Philippe Moulin
- Department of Endocrinology Louis Pradel University Hospital, Hospices Civils de Lyon, INSERM UMR 1060 Carmen, Claude Bernard Lyon 1 University, Lyon, France
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Rousset-Jablonski C, Dalon F, Reynaud Q, Lemonnier L, Dehillotte C, Berard M, Jacoud F, Viprey M, Van Ganse E, Belhassen M, Durieu I. WS08.2 Cancer incidence and prevalence among patients with cystic fibrosis: data from the National French Cystic Fibrosis Registry. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Ryan D, Heatley H, Heaney LG, Jackson DJ, Pfeffer PE, Busby J, Menzies-Gow AN, Jones R, Tran TN, Al-Ahmad M, Backer V, Belhassen M, Bosnic-Anticevich S, Bourdin A, Bulathsinhala L, Carter V, Chaudhry I, Eleangovan N, FitzGerald JM, Gibson PG, Hosseini N, Kaplan A, Murray RB, Rhee CK, Van Ganse E, Price DB. Potential Severe Asthma Hidden in UK Primary Care. J Allergy Clin Immunol Pract 2020; 9:1612-1623.e9. [PMID: 33309935 DOI: 10.1016/j.jaip.2020.11.053] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe asthma may be underrecognized in primary care. OBJECTIVE Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care patients with PSA with patients with confirmed severe asthma from UK tertiary care. METHODS This was a historical cohort study including patients from the Optimum Patient Care Research Database (aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as Global INitiative for Asthma 2018 step 4 treatment and 2 or more exacerbations/y or at Global INitiative for Asthma step 5. The proportion of these patients and their referral status in the last year were quantified. Demographic and clinical characteristics of groups were compared. RESULTS Of 207,557 Optimum Patient Care Research Database patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred patients with PSA tended to have greater prevalence of inhaled corticosteroid/long-acting β2-agonist add-ons (54.1 vs 39.8%), and experienced significantly (P < .001) more exacerbations per year (median, 3 vs 2/y), worse asthma control, and worse lung function (% predicted postbronchodilator FEV1/forced vital capacity, 0.69 vs 0.72) versus nonreferred patients. Confirmed patients with severe asthma (ie, UK patients in the International Severe Asthma Registry) were younger (51 vs 65 years; P < .001), and significantly (P < .001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/y [initial assessment] vs 3/y), use inhaled corticosteroid/long-acting β2-agonist add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred patients with PSA. CONCLUSIONS Large numbers of patients with PSA in the United Kingdom are underrecognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.
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Affiliation(s)
- Dermot Ryan
- Usher Institute, University of Edinburgh, United Kingdom
| | - Heath Heatley
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust and Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom
| | - Paul E Pfeffer
- UK Severe Asthma Network, Barts Health NHS Trust and Queen Mary University of London, London, United Kingdom
| | - John Busby
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - Andrew N Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Rupert Jones
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | | | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | - Vibeke Backer
- Department of ENT & Centre for Physical Activity Research, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
| | - Manon Belhassen
- PELyon, HESPER 7425, Claude Bernard University, Lyon, France
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW, Australia
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Montpellier University Hospitals, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | - Isha Chaudhry
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Neva Eleangovan
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | | | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | | | - Alan Kaplan
- Family Physician Airways Group of Canada, Stouffville, ON, Canada; University of Toronto, Toronto, ON, Canada
| | | | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eric Van Ganse
- PELyon, HESPER 7425, Claude Bernard University, Lyon, France
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
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Danchin N, Steg P, Hanon O, Mahe I, Falissard B, Belhassen M, Dalon F, Gollety S, Cotte F, Van-Ganse E. Naxos study: risk of bleeding with oral anticoagulants in non-valvular atrial fibrillation patients in France. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In patients with non-valvular atrial fibrillation (NVAF), oral anticoagulants reduce the risk of stroke and systemic embolism, at the expense of an increased risk of bleeding.
Purpose
To compare the risk of bleeding and sites of bleeding according to the type of oral anticoagulant used in NVAF patients.
Methods
NAXOS is a population-based, historical cohort study including all patients aged ≥18 years with NVAF and newly initiating one of the OACs available in France between 2014 and 2016, aiming to compare safety, effectiveness, and all-cause mortality, according to the type of oral anticoagulant used. The French national health insurance reimbursement database, cross-linked with the hospitalisation database and civil status registry (SNIIRAM) was used to identify first users of oral anticoagulants and outcomes over their follow-up.
Major bleeding events were identified through main diagnoses of hospital stays, with a specific focus on bleeding site. Apixaban was used as the reference treatment.
Analyses were performed on crude data and with adjustment on propensity scores calculated separately for each of the comparators (VKAs, rivaroxaban and dabigatran).
Results
Overall, 321,501 NVAF patients were included: 87,565 (27.2%), 112,628 (35.0%), 100,063 (31.1%), and 21,245 (6.6%) initiated apixaban, VKAs, rivaroxaban, and dabigatran, respectively. The crude risks of intracranial bleeding were 0.45 [0.40–0.50], 1.23 [1.16–1.30], 0.48 [0.44–0.53], and 0.26 [0.19–0.34] per 100 patient-year, for apixaban, VKA, rivaroxaban, and dabigatran, respectively. The respective figures for gastro-intestinal bleeding were: 0.67 [0.61–0.74], 1.73 [1.64–1.81], 1.01 [0.94–1.08], 1.02 [0.89–1.17]; and those for non-intracranial and non-gastro-intestinal but other bleeding were: 0.84 [0.78–0.92], 2.22 [2.13–2.32], 1.24 [1.17–1.31] and 0.71 [0.60–0.84].
After adjustment on propensity-scores, patients initiating apixaban were at a lower risk of all major bleeding vs. VKA, rivaroxaban and dabigatran (HR=0.49 [0.46–0.52], 0.63 [0.58–0.67]) and 0.85 [0.76–0.95]). Apixaban was associated with a decreased risk of intracranial bleeding compared with VKAs (HR=0.46 [0.40–0.53]) and rivaroxaban (HR=0.80 [0.69–0.93]), and an increased risk compared with dabigatran (HR=1.53 [1.12–2.07]). The risk of gastro-intestinal bleeding was lower with apixaban than with VKAs (HR=0.57; [0.55–0.59]), rivaroxaban (HR=0.59; [0.52–0.66]), and dabigatran (HR=0.57; 0.48–0.68]). For other bleedings, apixaban was associated with a lower risk compared with VKAs (HR=0.47; [0.43–0.52]), and rivaroxaban (HR=0.59; [0.53–0.66]), and with a similar risk compared with dabigatran (HR=1.01; [0.84–1.23]).
Conclusion
In this large, real-world, population-based cohort, apixaban was associated with a lower risk of all types of bleedings requiring hospitalisation, compared with vitamin K antagonists. Differences between direct oral anticoagulants were also observed.
Results of the comparative analyses
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bristol-Myers Squibb, Pfizer
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Affiliation(s)
- N Danchin
- Hopital Europeen Georges Pompidou- University Paris Descartes, Paris, France
| | - P.G Steg
- Hospital Bichat-Claude Bernard, Paris, France
| | - O Hanon
- Hospital Broca of Paris, Paris, France
| | - I Mahe
- Hospital Louis Mourier, Colombes, France
| | | | | | | | - S Gollety
- Bristol-Myers Squibb, Rueil Malmaison, France
| | - F.E Cotte
- Bristol-Myers Squibb, Rueil Malmaison, France
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Bonniaud P, Cottin V, Spagnolo P, Nolin M, Dalon F, Kirchgässler KU, Chia J, Kamath T, Van Ganse E, Belhassen M. Healthcare resource use and related costs in patients receiving nintedanib or pirfenidone for idiopathic pulmonary fibrosis. Epidemiology 2020. [DOI: 10.1183/13993003.congress-2020.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dalon F, Van Ganse E, Walther D, Bérard M, Lemonnier L, Durieu I, Belhassen M. Appariement probabiliste des données du Registre français de la mucoviscidose aux données du Système national des données de santé. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Van Ganse E, Danchin N, Mahé I, Hanon O, Jacoud F, Nolin M, Dalon F, Lefevre C, Cotté FE, Gollety S, Falissard B, Belhassen M, Steg PG. Comparative Safety and Effectiveness of Oral Anticoagulants in Nonvalvular Atrial Fibrillation: The NAXOS Study. Stroke 2020; 51:2066-2075. [PMID: 32539675 PMCID: PMC7306262 DOI: 10.1161/strokeaha.120.028825] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: The effects of direct oral anticoagulants in nonvalvular atrial fibrillation should be assessed in actual conditions of use. France has near-universal healthcare coverage with a unified healthcare information system, allowing large population-based analyses. NAXOS (Evaluation of Apixaban in Stroke and Systemic Embolism Prevention in Patients With Nonvalvular Atrial Fibrillation) aimed to compare the safety, effectiveness, and mortality of apixaban with vitamin K antagonists (VKAs), rivaroxaban, and dabigatran, in oral anticoagulant-naive patients with nonvalvular atrial fibrillation. Methods: This was an observational study using French National Health System claims data and including all adults with nonvalvular atrial fibrillation who initiated oral anticoagulant between 2014 and 2016. Outcomes of interest were major bleeding events leading to hospitalization (safety), stroke and systemic thromboembolic events (effectiveness), and all-cause mortality. Four approaches were used for comparative analyses: matching on propensity score (PS; 1:n); as a sensitivity analysis, matching on high-dimensional PS; adjustment on PS; and adjustment on known confounders. For each outcome, cumulative incidence rates accounting for competing risks of death were estimated. Results: Overall, 321 501 patients were analyzed, of whom 35.0%, 27.2%, 31.1%, and 6.6% initiated VKAs, apixaban, rivaroxaban, and dabigatran, respectively. Apixaban was associated with a lower PS–matched risk of major bleeding compared with VKAs (hazard ratio [HR], 0.43 [95% CI, 0.40–0.46]) and rivaroxaban (HR, 0.67 [95% CI, 0.63–0.72]), but not dabigatran (HR, 0.93 [95% CI, 0.81–1.08]). Apixaban was associated with a lower risk of stroke and systemic thromboembolic event compared with VKAs (HR, 0.60 [95% CI, 0.56–0.65]), but not rivaroxaban (HR, 1.05 [95% CI, 0.97–1.15]) or dabigatran (HR, 0.93 [95% CI, 0.78–1.11]). All-cause mortality was lower with apixaban than with VKAs, but not lower than with rivaroxaban or dabigatran. Conclusions: Apixaban was associated with superior safety, effectiveness, and lower mortality than VKAs; with superior safety than rivaroxaban and similar safety to dabigatran; and with similar effectiveness when compared with rivaroxaban or dabigatran. These observational data suggest potentially important differences in outcomes between direct oral anticoagulants, which should be explored in randomized trials.
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Affiliation(s)
- Eric Van Ganse
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France (E.V.G., F.J., M.N., F.D., M.B.).,Department of Respiratory Medicine, Croix Rousse University Hospital, Lyon, France (E.V.G.).,HESPER (Health Services and Performance Research) 7425, University Claude Bernard Lyon 1, Lyon, France (E.V.G.)
| | - Nicolas Danchin
- Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, France (N.D.)
| | - Isabelle Mahé
- Hôpital Louis Mourier, AP-HP, Department of Internal Medicine, Colombes, France (I.M.).,Université de Paris, Department of Innovative Therapies in Haemostasis, INSERM, Paris, France (I.M.)
| | - Olivier Hanon
- Université Paris Descartes, Sorbonne Paris Cité, Equipe d'accueil, 4468, Paris, France (O.H.).,Hôpital Broca, Department of Geriatrics, AP-HP, Paris, France (O.H.)
| | - Flore Jacoud
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France (E.V.G., F.J., M.N., F.D., M.B.)
| | - Maëva Nolin
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France (E.V.G., F.J., M.N., F.D., M.B.)
| | - Faustine Dalon
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France (E.V.G., F.J., M.N., F.D., M.B.)
| | - Cinira Lefevre
- Bristol-Myers Squibb, Rueil-Malmaison, France (C.L., F.-E.C., S.G.)
| | | | - Sabrina Gollety
- Bristol-Myers Squibb, Rueil-Malmaison, France (C.L., F.-E.C., S.G.)
| | | | - Manon Belhassen
- PELyon (Pharmaco Epidemiology Lyon), Lyon, France (E.V.G., F.J., M.N., F.D., M.B.)
| | - Ph Gabriel Steg
- Department of Cardiology, Hôpital Bichat, AP-HP, Paris, France (P.G.S.).,Université de Paris, Paris, France (P.G.S.).,INSERM U-1148, Paris, France (P.G.S.)
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Belhassen M, Tubach F, Hudry C, Woronoff-Lemsi M, Levy-Bachelot L, Van Ganse E, Fautrel B. Impact of persistence with tumour necrosis factor inhibitors on healthcare resource utilization and costs in chronic inflammatory joint diseases. Br J Clin Pharmacol 2020; 87:163-177. [PMID: 32441383 DOI: 10.1111/bcp.14387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023] Open
Abstract
AIM To assess persistence with subcutaneous (SC) tumour necrosis factor (TNF) inhibitors as well as the impact of persistence on healthcare resource utilization (HCRU) and costs in patients with chronic inflammatory joint diseases. METHODS In this cohort study using population-based French claims data (from 2011 to 2014), we measured persistence with SC TNF inhibitors within 12 months (M0-12) following treatment initiation in treatment-naïve and treatment-experienced users (divided into three cohorts: rheumatoid arthritis [RA], ankylosing spondylitis [AS] and psoriatic arthritis [PsA]). Persistent patients were propensity score matched to nonpersistent patients at M12. The impact of persistence status on HCRU and costs was assessed during M12-24. RESULTS Of treatment-naïve (n = 3,804) and treatment-experienced (n = 2,279) users, only 56.1% and 46.8% were persistent at M12, respectively. Nonpersistent patients had more outpatient visits, computerized tomography scans, spine or joint magnetic resonance imaging procedures and disease-related hospitalizations, while persistent patients had more rheumatologist visits. Nonpersistent patients had lower drug costs but higher nondrug-related healthcare and hospitalization costs than persistent patients. In AS and PsA, overall healthcare costs were similar in persistent and nonpersistent patients. In RA, overall healthcare costs were lower in persistent patients (15,753€ vs 17,590€ in treatment-naïve and 17,622€ vs 21,177€ in treatment-experienced). CONCLUSION Persistence with SC TNF inhibitors within first 12 months following treatment initiation was low in both treatment-naïve and treatment-experienced patients. Differences were observed in distribution of costs between persistent and nonpersistent patients, showing that nonpersistence with SC TNF inhibitors can lead to increased HCRU and higher costs.
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Affiliation(s)
- Manon Belhassen
- Pharmacoepidemiologie Lyon (PELyon), Lyon, France; HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
| | - Florence Tubach
- Faculté de Médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Céphépi), Unité de Recherche Clinique, INSERM, UMR 1123, Sorbonne Université, Paris, CIC-P 1421, France
| | | | - Macha Woronoff-Lemsi
- CHU Besançon, Université Franche-Comté, COMUE UBFC, UMR INSERM, Besançon, 1098, France
| | | | - Eric Van Ganse
- Pharmacoepidemiologie Lyon (PELyon), Lyon, France; HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
| | - Bruno Fautrel
- GRC 08, Institut Pierre Louis d'Epidémiologie et Santé Publique, AP-HP, Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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Van Ganse E, Danchin N, Mahé I, Hanon O, Jacoud F, Nolin M, Dalon F, Lefevre C, Cotte FE, Gollety S, Falissard B, Belhassen M, Steg P. Comparaison de la sécurité et de l’efficacité en vraie vie des anticoagulants chez les patients présentant une fibrillation auriculaire non valvulaire : l’étude NAXOS. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Hanon O, Mahé I, Danchin N, Steg P, Falissard B, Belhassen M, Jacoud F, Nolin M, Ginoux M, Dalon F, Lefevre C, Gollety S, Cotte F, Van Ganse E. NAXOS: Healthcare resource use among patients with non-valvular atrial fibrillation newly treated with apixaban in France, and comparison with other oral anticoagulants. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Van Ganse E, Texier N, Dima AL, Belhassen M, Laforest L, Herbage S, Schuck S, Hernandez G, Garin O, Ferrer M, de Bruin M. Effects of short- and long-acting beta-agonists on asthma exacerbations: a prospective cohort. Ann Allergy Asthma Immunol 2019; 124:254-260. [PMID: 31862434 DOI: 10.1016/j.anai.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/13/2019] [Accepted: 12/08/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND In asthma, short- and long-acting β-agonists (SABAs and LABAs) should be used together with inhaled corticosteroids (ICS), and regular use is inappropriate. OBJECTIVE To assess the relationship between patterns of use of therapy and asthma exacerbations (AEx). METHODS Patients with asthma (6-40 years) were enrolled in France and the United Kingdom. Prescribing data, computer-assisted telephone interviews (CATIs), and text messages assessed medication use and AEx over a maximum period of 24 months. Generalized linear mixed models provided AEx risks associated with therapy. RESULTS Among the 908 patients (median age: 20.0 years, 46.6% women, 24.5% children) answering a total of 4248 CATIs over 486 (±235) days, regular (ie, daily) use was more frequent for single LABAs and fixed dose combinations (FDCs) than for single ICS (75.6%, 70.1%, and 65.4% of investigated periods of use, respectively). Regular (ie, daily or almost daily) SABA use was observed for 21.1% of periods of use. Altogether, 265 patients (29.2%) experienced 1 or more AEx. The ORs for AEx risk related to regular vs no use of FDCs, single ICS, and single LABAs were 0.98 (95% CI = [0.73-1.33]), 0.90 (95% CI = [0.61-1.33]), and 1.29 (95% CI = [0.76-2.17]), respectively, after adjustment for cotherapy, sociodemographic, and disease characteristics. The OR was 2.09 (95% CI = [1.36-3.21]) in regular SABA users. CONCLUSION Inhaled corticosteroids and FDCs were often used intermittently, whereas SABAs and LABAs could be used regularly, and exacerbations were frequent. Compared with non-users, the risk of exacerbation increased moderately under regular use of single LABAs, whereas it doubled, significantly, in regular SABA users, likely in relationship with poor overall asthma control.
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Affiliation(s)
- Eric Van Ganse
- Lyon Pharmaco-Epidemiology Unit, Health Services and Performance Research (HESPER), Claude Bernard Lyon 1 University, Lyon, France; Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France; PELyon, Lyon, France.
| | | | - Alexandra L Dima
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, the Netherlands
| | - Manon Belhassen
- Lyon Pharmaco-Epidemiology Unit, Health Services and Performance Research (HESPER), Claude Bernard Lyon 1 University, Lyon, France; PELyon, Lyon, France
| | - Laurent Laforest
- Lyon Pharmaco-Epidemiology Unit, Health Services and Performance Research (HESPER), Claude Bernard Lyon 1 University, Lyon, France
| | - Sandrine Herbage
- Lyon Pharmaco-Epidemiology Unit, Health Services and Performance Research (HESPER), Claude Bernard Lyon 1 University, Lyon, France
| | | | - Gimena Hernandez
- IMIM-Hospital del Mar Medical, Research Institute, Barcelona, Spain
| | - Olatz Garin
- IMIM-Hospital del Mar Medical, Research Institute, Barcelona, Spain
| | - Montse Ferrer
- IMIM-Hospital del Mar Medical, Research Institute, Barcelona, Spain
| | - Marijn de Bruin
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, the Netherlands; University of Aberdeen, Scotland
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Dalon F, Devouassoux G, Belhassen M, Nachbaur G, Correia Da Silva C, Sail L, Jacoud F, Chouaid C, Van Ganse E. Impact of Therapy Persistence on Exacerbations and Resource Use in Patients Who Initiated COPD Therapy. Int J Chron Obstruct Pulmon Dis 2019; 14:2905-2915. [PMID: 31908439 PMCID: PMC6927267 DOI: 10.2147/copd.s222762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/02/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose This study assessed therapy persistence in patients with chronic obstructive pulmonary disease (COPD) in France, and the impact of non-persistence on exacerbations and described COPD-related healthcare resource use (HRU). Methods Patients aged ≥45 years who received ≥1 dispensed bronchodilator per quarter over three consecutive quarters between 2007 and 2014 and initiated specific COPD therapy were selected from the Echantillon Généraliste des Bénéficiaires (EGB) database. Persistence, defined as the absence of dispensing gaps of >90 days, was measured at 12 months. Exacerbations were compared between persistent and non-persistent patients during follow-up after patient matching and adjustment for confounding factors. COPD-related HRU during follow-up was described. Results Among 4020 patients with COPD, 2164 initiated a specific therapy. Of these, 54.4% stopped treatment within 12 months. Persistence with all COPD therapy regimens was low, particularly for inhaled corticosteroid (ICS; 25.6%) and ICS/twice-daily long-acting beta-agonist (39.4%) regimens. Among 721 persistent patients who were matched with 721 non-persistent patients, there was no difference in the number of moderate or severe exacerbations at 12 months. However, medical procedures (for instance, pulmonary function testing and chest X-rays) were more frequently observed among persistent patients than among non-persistent patients, suggesting worse disease severity. Conclusion Patients receiving specific treatment(s) for COPD demonstrated low persistence for all examined therapy regimens, with no clear impact of persistence status on the frequency of exacerbations at 12 months.
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Affiliation(s)
| | - Gilles Devouassoux
- Pulmonary Department, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.,EA 7426, PI3, Inflammation & Immunité de L'épithélium Respiratoire, Université Claude-Bernard-Lyon1, Lyon, France
| | - Manon Belhassen
- PELyon, PharmacoEpidemiology, Lyon, France.,EA 7425 HESPER Health Services and Performance Research, Université Claude-Bernard-Lyon1, Lyon, France
| | - Gaëlle Nachbaur
- GlaxoSmithKline France, Pharmaco Epidemiology and Health Economics and Outcomes Research, Rueil-Malmaison, France
| | - Camille Correia Da Silva
- GlaxoSmithKline France, Pharmaco Epidemiology and Health Economics and Outcomes Research, Rueil-Malmaison, France
| | - Lynda Sail
- GlaxoSmithKline France, Pharmaco Epidemiology and Health Economics and Outcomes Research, Rueil-Malmaison, France
| | | | | | - Eric Van Ganse
- PELyon, PharmacoEpidemiology, Lyon, France.,Pulmonary Department, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER Health Services and Performance Research, Université Claude-Bernard-Lyon1, Lyon, France
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27
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Fautrel B, Belhassen M, Hudry C, Woronoff-Lemsi MC, Levy-Bachelot L, Van Ganse E, Tubach F. Predictive factors of tumour necrosis inhibitor treatment persistence for rheumatoid arthritis: An observational study in 8052 patients. Joint Bone Spine 2019; 87:137-139. [PMID: 31669808 DOI: 10.1016/j.jbspin.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine whether changes in ultrasonography (US) features of monosodium urate crystal deposition is associated with the number of gouty flares after stopping gout flare prophylaxis. METHODS We performed a 1-year multicentre prospective study including patients with proven gout and US features of gout. The first phase of the study was a 6-month US follow-up after starting urate-lowering therapy (ULT) with gout flare prophylaxis. After 6 months of ULT, gout flare prophylaxis was stopped, followed by a clinical follow-up (M6 to 12) and ULT was maintained. Outcomes were the proportion of relapsing patients between M6 and M12 according to changes of US features of gout and determining a threshold decrease in tophus size according to the probability of relapse. RESULTS We included 79 gouty patients (mean [±SD] age 61.8±14 years, 91% males, median disease duration 4 [IQR 1.5; 10] years). Among the 49 completers at M12, 23 (47%) experienced relapse. Decrease in tophus size≥50% at M6 was more frequent without than with relapse (54% vs. 26%, P=0.049). On ROC curve analysis, a threshold decrease of 50.8% in tophus size had the best sensitivity/specificity ratio to predict relapse. Probability of relapse was increased for patients with a decrease in tophus size <50% between M0 and M6 (OR 3.35 [95% confidence interval 0.98; 11.44]). CONCLUSION A high reduction in US tophus size is associated with low probability of relapse after stopping gout prophylaxis. US follow-up may be useful for managing ULT and gout flare prophylaxis.
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Affiliation(s)
- Bruno Fautrel
- Sorbonne universités, UPMC université Paris 06, GRC 08, 75006 Paris, France; Rheumatology department, Pitié-Salpétrière university hospital, AP-HP, 75013 Paris, France
| | - Manon Belhassen
- PELyon, pharmacoépidemiologie Lyon, 69008 Lyon, France; HESPER 7425, health services and performance research, university Claude Bernard Lyon 1, 69008 Lyon, France.
| | | | | | | | - Eric Van Ganse
- PELyon, pharmacoépidemiologie Lyon, 69008 Lyon, France; HESPER 7425, health services and performance research, university Claude Bernard Lyon 1, 69008 Lyon, France
| | - Florence Tubach
- Inserm, Institut Pierre Louis d'épidémiologie et de Santé Publique, Sorbonne université, 75013 Paris, France; Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, IPLESP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, 75013 Paris, France
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Danchin N, Steg PG, Hanon O, Mahe I, Belhassen M, Jacoud F, Nolin M, Ginoux M, Dalon F, Lefevre C, Cotte FE, Gollety S, Falissard B, Van Ganse E. P1255Comparative safety and effectiveness of standard doses of apixaban versus dabigatran, rivaroxaban, and VKAs in non-valvular atrial fibrillation patients in France: the NAXOS study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Real-world data comparing all available oral anticoagulants (OAC) on a nationwide scale (i.e. in France: apixaban, rivaroxaban, dabigatran and vitamin K antagonists – VKAs) are lacking. In everyday practice, oral anticoagulants are often underdosed, which may render comparisons between agents difficult.
Purpose and methods
NAXOS is a French real-world study comparing the safety (major bleeding), effectiveness (stroke, systemic thromboembolic events (STE)) and all-cause mortality for apixaban, dabigatran, rivaroxaban, and VKAs, in adult patients with non-valvular atrial fibrillation (NVAF) initiating a given OAC between 2014 and 2016. The French national health insurance data (SNIIRAM) were used. Analyses were performed with adjustment on propensity scores. To avoid bias potentially related to underdosing, the present analysis included only patients receiving standard doses of apixaban (5mg bid), rivaroxaban (20mg od), and dabigatran (150 mg bid), or VKAs. Only OAC naïve patients were included.
Results
In the OAC-naive cohorts treated with apixaban, rivaroxaban, and dabigatran, 54,575 (62.3%), 65,208 (65.2%), and 9,000 (42.4%), respectively, had the standard dose at the index dispensation, and 112,628 patients received VKAs. After adjustment on propensity scores, apixaban 5 mg was associated with a lower risk of major bleeding, compared to VKAs (Hazard Ratio: 0.47; 95% CI: 0.43–0.51) and rivaroxaban 20mg (HR: 0.64; 0.59–0.71), but not to dabigatran 150 mg (HR: 0.97; 0.79–1.18). Apixaban was associated with a lower risk of stroke and STE, compared to VKAs (HR: 0.62; 0.56–0.69) but not to rivaroxaban (HR: 1.03; 0.92–1.16), and dabigatran (HR: 0.96; 0.76–1.21). Apixaban showed a lower risk of all-cause mortality compared to VKAs (HR: 0.44; 0.41–0.47) and rivaroxaban (HR: 0.87; 0.81–0.94) but not to dabigatran (HR: 1.10; 0.92–1.32).
Figure 1. Forest plot presenting the results of the standard dose analysis (PS adjusted).
Conclusions
The NAXOS population-based country-wide observational study shows that 42% to 65% of patients were treated with standard doses of OACs. Analyses of standard doses confirmed the superiority of apixaban compared with VKAs for the three studied outcomes and suggests better safety profile of apixaban compared to rivaroxaban but similar to dabigatran.
Acknowledgement/Funding
The Alliance Bristol-Myers Squibb/Pfizer
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Affiliation(s)
- N Danchin
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - P G Steg
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | - O Hanon
- Hospital Broca of Paris, Geriatric Medicine, Paris, France
| | - I Mahe
- Hospital Louis Mourier, Internal Medicine, Paris-Diderot University, INSERM-UMR 1140, APHP, Colombes, France
| | - M Belhassen
- Pharmaco-Epidemiologie Lyon PELyon, Lyon, France
| | - F Jacoud
- Pharmaco-Epidemiologie Lyon PELyon, Lyon, France
| | - M Nolin
- Pharmaco-Epidemiologie Lyon PELyon, Lyon, France
| | - M Ginoux
- Pharmaco-Epidemiologie Lyon PELyon, Lyon, France
| | - F Dalon
- Pharmaco-Epidemiologie Lyon PELyon, Lyon, France
| | - C Lefevre
- Bristol-Myers Squibb, Rueil-Malmaison, France
| | - F E Cotte
- Bristol-Myers Squibb, Rueil-Malmaison, France
| | - S Gollety
- Bristol-Myers Squibb, Rueil-Malmaison, France
| | - B Falissard
- CESP/INSERM U1018 (Center for Research in Epidemiology and Population Health), Paris, France
| | - E Van Ganse
- Pharmaco-Epidemiologie Lyon PELyon, Lyon, France
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Dalon F, Roche N, Belhassen M, Nolin M, Pegliasco H, Deslée G, Housset B, Devillier P, Van Ganse E. Dual versus triple therapy in patients hospitalized for COPD in France: a claims data study. Int J Chron Obstruct Pulmon Dis 2019; 14:1839-1854. [PMID: 31692478 PMCID: PMC6708389 DOI: 10.2147/copd.s214061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022] Open
Abstract
Purposes Following a hospitalization for COPD, dual and triple therapies were compared in terms of persistence and relations with outcomes (exacerbations, health care resource use and costs). Methods This was a historical observational database study. All patients aged ≥45 hospitalized for COPD between 2007 and 2015 were identified in a 1/97th random sample of French claims data. Patients receiving dual therapy within 60 days after hospitalization were compared to patients receiving triple therapy, after propensity score matching on disease severity. Results Of the 3,089 patients hospitalized for COPD, 1,538 (49.8%) received either dual or triple therapy in the 2 months following inclusion, and 1,500 (48.6%) had at least 30 days of follow-up available; 846 (27.4%) received dual therapy, and 654 (21.2%) received triple therapy. After matching, the number of exacerbations was 2.4 per year in the dual vs 2.3 in the triple group (p=0.45). Among newly treated patients (n=206), persistence at 12 months was similar in the dual and triple groups (48% vs 41%, respectively, p=0.37). As compared to patients on dual therapy, more patients on triple therapy received oral corticosteroids (49.1 vs 40.4%, p=0.003) or were hospitalized for any reason (67% vs 55.8%, p=0.0001) or for COPD (35.3 vs 25.1%, p=0.0002) during follow-up. Cost of care was higher for patients on triple than for those on dual therapy (€11,877.1 vs €9,825.1, p=0.01). Conclusion Following hospitalizations for COPD, patients on dual and triple therapy experienced recurrent exacerbations, limited adherence to therapies and high cost of care. Patients on triple therapy appeared more severe than those on dual therapy, as reflected by exacerbations and health care resource use.
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Affiliation(s)
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, AP-HP and Paris Descartes University (EA2511), Sorbonne Paris Cité, Paris, France
| | | | - Maëva Nolin
- Pharmacoepidemiology Department, PELyon, Lyon, France
| | | | - Gaëtan Deslée
- Pulmonary Department, INSERM U1250, Maison Blanche University Hospital, Reims, France
| | - Bruno Housset
- Pulmonary Department, CHI de Créteil, University Paris Est Créteil, Créteil, France
| | - Philippe Devillier
- Department of Airway Diseases, UPRES EA 220, Foch Hospital, Paris-Saclay University, Suresnes, France
| | - Eric Van Ganse
- Pharmacoepidemiology Department, PELyon, Lyon, France.,EA 7425 Hesper Health Services and Performance Research, Claude-Bernard University, Lyon, France.,Respiratory Medicine, Croix-rousse Hospital, Lyon, France
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Belhassen M, Van Ganse E, Ginoux M, Nolin M, Bada H, Bruckert E, Krempf M, Rebours V, Valero R, Moulin P. Identification Of Medical Complications And Real-Life Care Of Familial And Multifactorial Chylomicronaemia Syndromes: The Esthym Study. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Picard F, Van Ganse E, Ducrocq G, Danchin N, Falissard B, Hanon O, Belhassen M, Ginoux M, Lefevre C, Cotte FE, Mahé I, Steg PG. EvaluatioN of ApiXaban in strOke and systemic embolism prevention in patients with non-valvular atrial fibrillation in clinical practice Setting in France, rationale and design of the NAXOS: SNIIRAM study. Clin Cardiol 2019; 42:851-859. [PMID: 31313832 PMCID: PMC6788467 DOI: 10.1002/clc.23231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 01/22/2023] Open
Abstract
Non-vitamin K antagonists oral anticoagulants (NOACs) have recently challenged vitamin-K antagonists (VKAs) for stroke and systemic embolism prophylaxis in patients with non-valvular atrial fibrillation (NVAF). Nevertheless, little information is available in routine clinical practice for France. The aim of this study is to describe the effectiveness and safety of apixaban, rivaroxaban, dabigatran or VKAs in routine clinical practice in adult NVAF patients for the prevention of stroke and systemic embolism in France. The NAXOS study is a nationwide observational retrospective cohort generated from the French national healthcare insurance database (SNIIRAM-a comprehensive in- and outpatient healthcare consumption database), consisting of eight distinct sub-cohorts of anticoagulant-naive or anticoagulant-experienced patients diagnosed with NVAF, newly initiated with either NOACs (dabigatran, rivaroxaban or apixaban) or VKAs. Patients will be included if initiating a new anticoagulant treatment for AF during the study period from 1 January 2014 to 31 December 2016. Primary effectiveness outcome will be the incidence of stroke or systemic thromboembolic events; primary safety outcome will be the incidence of major bleeding during the exposure period. The NAXOS study will provide routine clinical practice data on the effectiveness and safety profiles of apixaban vs other NOACs and VKAs in the prevention of stroke and systemic embolism in adult patients with NVAF in clinical practice conditions in France.
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Affiliation(s)
- Fabien Picard
- Department of Cardiology, Cochin Hospital, AP-HP, Paris, France.,Université Paris Descartes, Paris, France.,FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Eric Van Ganse
- PharmacoEpidemiology Lyon (PELyon), EA 7425 HESPER Health Services and Performance Research, Claude-Bernard University, Lyon, France.,Respiratory Medicine, Croix-Rousse Hospital, Lyon, France
| | - Gregory Ducrocq
- FACT (French Alliance for Cardiovascular Trials), Paris, France.,Département de cardiologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, DHU FIRE, INSERM 1148, Université de Paris, Paris, France
| | - Nicolas Danchin
- Université Paris Descartes, Paris, France.,FACT (French Alliance for Cardiovascular Trials), Paris, France.,Department of Cardiology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Bruno Falissard
- Université Paris Descartes, Paris, France.,U669 - Hôpital Cochin, Maison des adolescents, AP-HP, Paris, France
| | - Olivier Hanon
- Hôpital Broca 54-56 Pascal, 75013, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Equipe d'Accueil 4468, Paris, France
| | | | | | - Cinira Lefevre
- Bristol-Myers Squibb, Market Access, Rueil-Malmaison, France
| | - François-Emery Cotte
- Bristol-Myers Squibb, Health Economics & Outcomes Research, Rueil-Malmaison, France
| | - Isabelle Mahé
- Department of Internal Medicine, Louis-Mourier Hospital, Universite Paris 7, Inserm UMR_S1140, AP-HP, Colombes, France
| | - Philippe G Steg
- FACT (French Alliance for Cardiovascular Trials), Paris, France.,Département de cardiologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, DHU FIRE, INSERM 1148, Université de Paris, Paris, France.,National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, UK
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Mahr A, Belhassen M, Paccalin M, Devauchelle-Pensec V, Nolin M, Gandon S, Idier I, Hachulla E. Characteristics and management of giant cell arteritis in France: a study based on national health insurance claims data. Rheumatology (Oxford) 2019; 59:120-128. [DOI: 10.1093/rheumatology/kez251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/21/2019] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objective
Few data are available on the epidemiology and management of GCA in real life. We aimed to address this situation by using health insurance claims data for France.
Methods
This retrospective study used the Echantillon Généraliste de Bénéficiaires (EGB) database, a 1% representative sample of the French national health insurance system. The EGB contains anonymous data on long-term disease status, hospitalizations and reimbursement claims for 752 717 people. Data were collected between 2007 and 2015. The index date was defined as the date of the first occurrence of a GCA code. Demographics, comorbidities, diagnostic tests and therapies were analysed. Annual incidence rates were calculated, and incident and overall GCA cases were studied.
Results
We identified 241 patients with GCA. The annual incidence was 7–10/100 000 people ⩾50 years old. Among the 117 patients with incident GCA, 74.4% were females, with mean age 77.6 years and mean follow-up 2.2 years. After the index date, 51.3% underwent temporal artery biopsy and 29.1% high-resolution Doppler ultrasonography. Among the whole cohort, 84.3% used only glucocorticoids. The most-prescribed glucocorticoid-sparing agent was methotrexate (12.0%).
Conclusion
The incidence of GCA in France is 7–10/100 000 people ⩾ 50 years old. Adjunct agents, mainly methotrexate, are given to only a few patients. The use of temporal artery biopsy in only half of the patients might reflect a shift toward the use of imaging techniques to diagnose GCA.
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Affiliation(s)
- Alfred Mahr
- Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France
| | | | - Marc Paccalin
- Internal Medicine, University Hospital Poitiers, Poitiers, France
| | | | - Maeva Nolin
- Pelyon EA 7425, University Hospital Lyon, Lyon, France
| | - Sophie Gandon
- Clinical Operations France, Roche S.A.S., Boulogne-Billancourt, France
| | - Isabelle Idier
- Rheumatology Medical, Chugai Pharma France, Paris La Défense, France
| | - Eric Hachulla
- Internal Medicine and Clinical Immunology, CHU Lille, University Lille, LIRIC, INSERM, Lille, France
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Belhassen M, Van Ganse E, Nolin M, Bruckert E, Krempf M, Rebours V, Valero R, Moulin P. Complications et prise en charge en soins courants des sujets présentant une hypertriglycéridémie majeure : appariement d’un observatoire avec la base du SNDS (étude ESTHYM). Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Marchal C, Belhassen M, Guiso N, Cohen R, Verdier R, Uhart M. Vaccins combinés de rappels : couvertures vaccinales 2013–2017 en France. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Belhassen M, Nolin M, Nibber A, Ginoux M, Devouassoux G, Van Ganse E. Changes in Persistent Asthma Care and Outcomes From 2006 to 2016 in France. J Allergy Clin Immunol Pract 2019; 7:1858-1867. [PMID: 30836232 DOI: 10.1016/j.jaip.2019.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Changes in asthma care need to be documented at arrival of biotherapies. OBJECTIVES To characterize changes in asthma care and outcomes in patients with persistent asthma. METHODS Repeated transversal analyses were conducted on a historical cohort using the French national claims data over 10 years. Patients aged 18 to 40 years with either 1 or more (any-use population) or 4 or more (high-use population) yearly dispensings of controller therapy were selected. Clinical and demographic features were characterized, and comparisons were made between 2006 and 2016 to assess temporal changes in asthma therapy, health care resource utilization, and outcomes. RESULTS In 2016, prevalent use of controller therapy was 5.2% (any-use population) and 0.8% (high-use population) of the population aged 18 to 40 years. In the any-use population, the use of long-acting β2-agonists in monotherapy, and inhaled corticosteroids decreased (1.7% and 40.3% in 2016, respectively), whereas the use of fixed-dose combinations increased (56.4%). In both populations, visits to respiratory or hospital physicians and pulmonary function testing increased with time, in parallel to a decreasing number of general practitioner visits; in addition, oral corticosteroid use and incidence of emergency room visits increased. However, asthma hospitalizations and mortality remained low in both populations. CONCLUSIONS Changes in persistent asthma care included replacement of inhaled corticosteroids by fixed-dose combinations, decreased use of long-acting β2-agonists as a monotherapy, and increased involvement of secondary care physicians. In parallel, despite low figures for hospital admissions and mortality, overall use of oral corticosteroids and incidence of emergency room visits have increased over the last decade.
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Affiliation(s)
| | - Maëva Nolin
- PELyon, PharmacoEpidemiology Lyon, Lyon, France
| | - Anjan Nibber
- University of Oxford Medical School, Oxford, United Kingdom
| | | | - Gilles Devouassoux
- Respiratory Medicine, Croix Rousse University Hospital, and EA7426 University Claude Bernard Lyon-1, Lyon, France
| | - Eric Van Ganse
- PELyon, PharmacoEpidemiology Lyon, Lyon, France; Respiratory Medicine, Croix Rousse University Hospital, and EA7426 University Claude Bernard Lyon-1, Lyon, France; HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
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Hanon O, Steg P, Falissard B, Touzé E, Mahé I, Danchin N, Belhassen M, Jacoud F, Nolin M, Ginoux M, Dalon F, Lefevre C, Cotte F, Ricci L, Gaudin A, Van Ganse E. Use of oral anticoagulants in the treatment of non-valvular atrial fibrillation in France: Patient characteristics from the NAXOS cohort study. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dima A, Van Ganse E, Stadler G, Belhassen M, De Bruin M. Adhésion aux corticostéroïdes inhalés : associations inter- et intra-individuelles avec l’évolution de l’asthme. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Belhassen M, Cortet B, Confavreux CB, Lamezec L, Ginoux M, Van Ganse E. Impact of bisphosphonate compliance on the risk of osteoporotic fracture in France. Arch Osteoporos 2018; 13:113. [PMID: 30341636 DOI: 10.1007/s11657-018-0530-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/15/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Limited information is available on the impact of bisphosphonate compliance levels on fracture risk in osteoporosis patients in France. The results of this nested case-control, retrospective study suggest that fracture risk did not significantly change with bisphosphonate compliance levels, except for highly compliant patients. PURPOSE/INTRODUCTION This was the first study conducted in France to evaluate the impact of compliance levels for bisphosphonates, the most frequently prescribed first-line anti-osteoporotic treatment, on fracture risk. METHODS This retrospective nested case-control study included patients ≥ 50 years old, who were recorded in a random sample of French claims data, did not die between 2006 and 2013, and received ≥ 1 reimbursement for anti-osteoporotic treatment between 2007 and 2013. Cases (patients hospitalised for osteoporosis-related fractures) were matched to 1-3 controls (patients hospitalised for other reasons). Patients hospitalised for fractures within 12 months preceding the first delivery of anti-osteoporotic treatment or during the first 24 months of follow-up were excluded. Bisphosphonate compliance during the 24 months preceding hospitalisation was calculated by the Continuous measure of Medication Acquisition version 7 (CMA7). We evaluated the impact of bisphosphonate compliance (CMA7 ≥ 80%) and very good compliance levels (CMA7 > 90%) on fracture risk. RESULTS In the main analysis, the mean CMA7 values during the 24 months preceding hospitalisation were 48.4% for the 434 cases and 51.3% for the 1123 age-matched controls. An adjusted conditional logistic regression showed no significant impact (odds ratio: 0.851 [95% confidence interval: 0.668, 1.084]) of bisphosphonate compliance on fracture occurrence. In the sensitivity analysis, including one randomly selected control per case and only controls with CMA7 values > 90%, occurrence of fractures was lower (odds ratio: 0.741 [95% confidence interval: 0.608, 0.903]) among the 119 controls. CONCLUSION In conclusion, this study suggested that very high levels of compliance with bisphosphonates are necessary to induce significant decreases in fracture risk.
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Affiliation(s)
- Manon Belhassen
- HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France. .,PharmacoEpidemiology Lyon (PELyon), Lyon, France.
| | - Bernard Cortet
- Department of Rheumatology, Lille University Hospital, 2 Avenue Oscar Lambret, 59000, Lille, France
| | - Cyrille B Confavreux
- INSERM UMR 1033, Rheumatology Department, University of Lyon, Hospices Civils de Lyon, 69002, Lyon, France
| | | | | | - Eric Van Ganse
- HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France.,PharmacoEpidemiology Lyon (PELyon), Lyon, France
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Dalon F, Devouassoux G, Belhassen M, Nachbaur G, Correia Da Silva C, Sail L, Chouaid C, Van Ganse E. Persistence to COPD therapies and impact on exacerbations: a French claims data study. Epidemiology 2018. [DOI: 10.1183/13993003.congress-2018.pa2273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Belhassen M, Nolin M, Ginoux M, Van Ganse E. Adherence to inhaled corticosteroids before and after an asthma-related hospitalisation: distinct trajectories. Epidemiology 2018. [DOI: 10.1183/13993003.congress-2018.pa4478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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41
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Belhassen M, Nolin M, Ginoux M, Van Ganse E. Changes in asthma drug use in France between 2006 and 2015: a claims data study. Epidemiology 2018. [DOI: 10.1183/13993003.congress-2018.pa4476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bulathsinhala L, Eleangovan N, Heaney LG, Menzies-Gow A, Gibson PG, Peters M, Hew M, van Boven JFM, Lehtimäki L, van Ganse E, Belhassen M, Harvey ES, Perez de Llano L, Maitland-van der Zee AH, Papadopoulos NG, FitzGerald JM, Porsbjerg C, Canonica GW, Backer V, Rhee CK, Verhamme KMC, Buhl R, Cosio BG, Carter V, Price C, Le T, Stagno d'Alcontres M, Gopalan G, Tran TN, Price D. Development of the International Severe Asthma Registry (ISAR): A Modified Delphi Study. J Allergy Clin Immunol Pract 2018; 7:578-588.e2. [PMID: 30179741 DOI: 10.1016/j.jaip.2018.08.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/30/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND The lack of centralized data on severe asthma has resulted in a scarcity of information about the disease and its management. The development of a common data collection tool for the International Severe Asthma Registry (ISAR) will enable standardized data collection, subsequently enabling data interoperability. OBJECTIVES To create a standardized list of variables for the first international registry for severe asthma via expert consensus. METHODS A modified Delphi process was used to reach consensus on a minimum set of variables to capture in ISAR: the core variables. The Delphi panel brought together 27 international experts in the field of severe asthma research. The process consisted of 3 iterative rounds. In each round, all Delphi panel members were issued an electronic ISAR Delphi workbook to complete and return to the ISAR Delphi administrator. Workbooks and result summaries were anonymously distributed by the Delphi administrator to all panel members at subsequent rounds. Finalization of the core variable list was facilitated by 2 face-to-face meetings. RESULTS Of the initial 747 selected variables, the Delphi panel reached a consensus on 95. The chosen variables will allow severe asthma to be assessed against patient demographics and medical history, patient-reported outcomes, diagnostic information, and clinical characteristics. Physician-reported outcomes such as nonadherence and information about treatment and management strategies will also be recorded. CONCLUSIONS This is the first global attempt to generate an ISAR using a common set of core variables to ensure that data collected across all participating countries are standardized.
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Affiliation(s)
| | | | - Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Andrew Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield National Health Service (NHS) Foundation Trust, London, UK
| | - Peter G Gibson
- Australasian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Matthew Peters
- University of Sydney Medical School, Sydney, NSW, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia
| | - Job F M van Boven
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, University of Tampere, Tampere, Finland
| | | | | | - Erin S Harvey
- Australasian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | | | - Anke H Maitland-van der Zee
- Amsterdam University Medical Center, University of Amsterdam, Department of Respiratory Medicine, Amsterdam, The Netherlands
| | | | | | | | - G Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milan, Italy; SANI-Severe Asthma Network Italy, Italy
| | - Vibeke Backer
- Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
| | | | | | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | | | | | - Thao Le
- Optimum Patient Care, Cambridge, UK
| | | | | | | | - David Price
- Optimum Patient Care, Cambridge, UK; Observational and Pragmatic Research Institute, Singapore; Academic Primary Care, University of Aberdeen, Aberdeen, UK.
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Sclison S, Le Pen C, Bardoulat I, Gayon A, Kolahi C, Belhassen M, Depont F, Van Ganse E. Télémédecine et dépenses de santé – une modélisation économique évaluant l’impact d’une intervention en télémédecine dans trois pathologies chroniques : diabète de type 2, hypertension artérielle et cancer de la prostate. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.04.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Van Ganse E, Belhassen M, Ginoux M, Chrétien E, Cornu C, Ecoffey C, Aubrun F. Use of analgesics in France, following dextropropoxyphene withdrawal. BMC Health Serv Res 2018; 18:231. [PMID: 29609613 PMCID: PMC5880096 DOI: 10.1186/s12913-018-3058-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 03/23/2018] [Indexed: 12/05/2022] Open
Abstract
Background In 2009, the European Medicines Agency recommended withdrawal of dextropropoxyphene (DXP); in March 2011 it was withdrawn from the market in France. Up until that time the combination dextropropoxyphene-paracetamol (DXP/PC) was widely used for analgesia. At withdrawal, French regulators recommended that DXP/PC be replaced by other step 2 analgesics, i.e. tramadol, codeine, or opium-containing drugs, or by PC for a weak level of pain. To investigate prescribing behaviours after DXP/PC withdrawal, dispensations of analgesics before and after withdrawal were analysed. Methods Aggregated dispensation data of analgesics prescribed between January 2009 and December 2012 in the Rhône-Alpes region were obtained from the general health insurance claims data; changes in analgesic dispensation over time were analysed with the ATC/DDD methodology. Pre (Jan-June 2009) and post-withdrawal (Jan-June 2012) changes of DDDs where computed for each analgesic step. Results The dispensations of DXP/PC experienced a two-step decrease until 2011. Over the withdrawal period 2009-2012, there was a 14% decrease in the overall use of analgesic (from 109 to 94 DDDs), while the use of step 2 analgesics declined by 46% (− 22 DDDs, from 47 to 25 DDDs). This latter decline included a cessation of use of DXP/PC (29 DDDs in 2009) that were only in part (+ 7 DDDs, from 18 to 25 DDDs) compensated by increased use of codeine, tramadol and opium, in monotherapy or combined with PC. For step 1 analgesics, use increased with 9%, mostly PC (+ 8 DDDs, from 31 to 39 DDDs). Step 3 analgesics dispensations remained largely unchanged over this period (around 3 DDDs). Conclusions In the Rhône-Alpes region, DXP/PC withdrawal was accompanied in part by an increased use of same level analgesics, and in part by an increased use of PC in monotherapy. The extent of DXP/PC use before withdrawal, and the increased use of PC after DXP withdrawal, underline the complexity of pain management.
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Affiliation(s)
- E Van Ganse
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France. .,PELyon, PharmacoEpidemiologie Lyon, Lyon, France. .,Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.
| | - M Belhassen
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | - M Ginoux
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | - E Chrétien
- Department of Anesthesiology and Critical Care, Croix Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - C Cornu
- UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Claude Bernard University, CNRS, Lyon, France.,Louis Pradel Hospital, Lyon University, Lyon, France INSERM Clinical Investigation Centre (CIC1407), Lyon, France
| | - C Ecoffey
- Department of Anaesthesiology and Critical Care, Ponchaillou University Hospital, CIC Inserm, Rennes, France
| | - F Aubrun
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,Department of Anesthesiology and Critical Care, Croix Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
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Belhassen M, Dima A, Texier N, Ferrer M, de Bruin M, Van Ganse E. Les ratios thérapeutiques prédisent le contrôle de l’asthme dans la cohorte ASTROLAB. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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46
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Belhassen M, Bérard M, Dima A, Ginoux M, Van Ganse E. À quelle fréquence les patients asthmatiques vont-ils chercher leur ordonnance ? Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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47
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Belhassen M, Dima A, Nolin M, Texier N, Ferrer M, De Bruin M, Van Ganse E. Les ratios thérapeutiques prédisent le contrôle de l’asthme dans la cohorte ASTROLAB. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Van Ganse E, Aubert H, Gaillard M, Hamami N, Laforest L, Belhassen M, Devouassoux G. Éducation thérapeutique des asthmatiques à l’hôpital de la Croix Rousse (Lyon) : résultats observés sur les 30 premiers patients. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Laforest L, Belhassen M, Devouassoux G, Didier A, Ginoux M, Van Ganse E. Long-Term Inhaled Corticosteroid Adherence in Asthma Patients with Short-Term Adherence. J Allergy Clin Immunol Pract 2017; 4:890-899.e2. [PMID: 27587320 DOI: 10.1016/j.jaip.2016.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the use of inhaled corticosteroids (ICS) in asthma is known to be overall erratic, the long-term use of ICS by patients selected during an episode of regular use is poorly documented. OBJECTIVE In a cohort of patients with asthma regularly acquiring ICS therapy over several months, we verified whether these patients remained treated in the following 12 months. The correlates of regular ICS use over this period were investigated. METHODS A historical cohort of patients with asthma was identified from the Echantillon généraliste de bénéficiaires national French health care reimbursement data (2007-2012). Patients (6-40 years) were selected during a regular ICS use episode, with 3 or more ICS refills within 120 days. Continuous multiple-interval measures of medication availability (CMA) were computed for the 12 months after the third dispensation, and the factors associated with a CMA value of 80% or more (adherent patients) were identified. RESULTS Among 5096 patients (42.1% children/teenagers, 48.8% females), only 24.0% had a CMA value of 80% or more (mean CMA = 54.4%) over the 12 months following the ICS selection period. Achieving a CMA value of 80% or more was primarily associated with being a child/teenager (P = .002), having more severe or less controlled asthma (P = .007), more previous dispensing of short-acting beta agonists (P < .0001), and receiving devices with 200 unit doses (P < .0001). Adherent patients had more frequent general practitioner visits (P < .0001), more distinct prescribers of respiratory therapy (P = .0002), and more frequent switches of ICS (P < .0001). CONCLUSIONS Most patients with asthma selected during an episode of regular ICS use did not maintain therapy over the following months. Adherence should be repeatedly monitored, and the reasons for discontinuation should be investigated, at prescriber and patient levels.
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Affiliation(s)
- Laurent Laforest
- PELyon, Lyon, France; HESPER, EA 7425, Health Services and Performance Research, Université Claude Bernard, Lyon, France
| | - Manon Belhassen
- PELyon, Lyon, France; HESPER, EA 7425, Health Services and Performance Research, Université Claude Bernard, Lyon, France
| | | | - Alain Didier
- Respiratory Medicine, Larrey University Hospital, Toulouse, France
| | - Marine Ginoux
- HESPER, EA 7425, Health Services and Performance Research, Université Claude Bernard, Lyon, France
| | - Eric Van Ganse
- PELyon, Lyon, France; HESPER, EA 7425, Health Services and Performance Research, Université Claude Bernard, Lyon, France; Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.
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Caillet P, Oberlin P, Monnet E, Guillon-Grammatico L, Métral P, Belhassen M, Denier P, Banaei-Bouchareb L, Viprey M, Biau D, Schott AM. Algorithmes d’identification des séjours pour fracture du col du fémur d’origine ostéoporotique dans les bases médico-administratives européennes utilisant la CIM-10 : revue non systématique de la littérature. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.04.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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