Décrire la population adulte sous polythérapie pour une épilepsie focale, en France, en appliquant la nouvelle définition internationale de la pharmacorésistance (2009).
Étude observationnelle, ...transversale, menée auprès de neurologues français.
Soixante et onze neurologues investigateurs ont inclus 405 patients épileptiques sous polythérapie, d’âge moyen 42,7ans, dont l’épilepsie avait débuté en moyenne 25ans avant l’inclusion : 60 % des patients étaient pharmacorésistants, 37 % pharmacosensibles et 3 % de statut indéfini. Après réévaluation par deux experts, 71 % des patients étaient pharmacorésistants, 22 % pharmacosensibles et 7 % de statut indéfini. En pratique, 76 % des investigateurs avaient mal classé au moins un de leurs patients selon la nouvelle définition de la pharmacorésistance. En raison de leur épilepsie, 24 % des patients (âge≤65ans) étaient inactifs et 42 % ne pouvaient pas conduire de véhicule à moteur. La moitié des patients avaient une comorbidité. Les patients pharmacorésistants prenaient plus de médicaments et avaient une consommation de soins plus élevée que les autres.
L’étude ESPERA montre que l’application des nouveaux critères de pharmacorésistance n’est pas simple et confirme le handicap socioprofessionnel des adultes sous polythérapie pour une épilepsie focale.
To describe the adult population treated with antiepileptic drugs (AEDs) in combination for focal epilepsy according to the definition of AED resistance proposed by the International League Against Epilepsy (ILAE) in 2009 and to evaluate its implementation in current practice.
ESPERA was a multicenter, observational, cross-sectional study with a clinical data collection covering the past 12 months conducted by neurologists. Classifications according to AED responsiveness established by investigators for each enrolled patient were revised by two experts.
Seventy-one neurologists enrolled 405 patients. Their mean age was 42.7 years (sex-ratioM/F 0.98). According to the investigators, 60% of epilepsies were drug-resistant, 37% drug-responsive and 3% had an undefined drug-responsiveness. After revision of experts, 71% of epilepsies were classified as drug resistant, 22% as responsive and 7% as undefined. Among the participating neurologists, 76% have made at least one error in classifying their patients according to the 2009 ILAE definition of AED resistance. Because of epilepsy, 24% of patients (age≤65) were inactive and 42% could not drive (respectively 29 and 49% of patients with AED resistant epilepsy). Half of patients had at least one other chronic condition. Number of prescribed drugs in combination and health care resource utilisation were significantly higher in patients with drug-resistant epilepsies than in patients with drug responsive epilepsies.
ESPERA study shows that the use of new definition of drug-resistance in everyday practice seems difficult without any additional training and that the social and professional disability is frequent in adults with focal epilepsies treated with polytherapy.
Abstract Purpose To estimate the direct costs associated with the current management of focal epilepsy in adults treated with a combination of antiepileptic drugs (AEDs) in France and the ...supplementary costs of drug resistant epilepsy as defined by the International League Against Epilepsy (ILAE) in 2009. Methods ESPERA was a multicentre, observational, cross-sectional study conducted in France in 2010. A random sample of neurologists, including specialists in epilepsy, prospectively enrolled adults with focal epilepsy treated with a combination of AEDs. Investigators classified their patients according to the 2009 ILAE criteria for drug resistance and this classification was then reviewed by two experts. All items of healthcare resource use associated with epilepsy over the previous year were documented retrospectively and valued from a societal perspective. Results Seventy-one neurologists enrolled 405 patients. After experts’ review, 70.6% of patients were classified with drug-resistant epilepsy, 22.4% with drug-responsive epilepsy and 7% with undefined epilepsy. The mean annual epilepsy-related direct costs per patient were €4485 ± €4313 in patients with drug-resistant epilepsy compared to €1926 ± €1795 in patients with drug-responsive epilepsy. In these two groups, costs of AEDs were estimated at €2603 and €1544, respectively. Patients with drug-resistant epilepsy were more often hospitalised (mean annual cost: €1270 vs. €97) and underwent more additional tests (mean annual cost: €194 vs. €53). Conclusion The direct cost of focal epilepsy in adults on AED combinations was estimated at €3850/patient/year. Drug resistance, as defined by the 2009 ILAE criteria, resulted in significant extra costs which varied with seizure frequency.
Abstract Background Bipolar disorder (BPD) is a disabling disease with high morbidity rates. An international (Spain, France) comparative study about hospitalizations and in-patient care costs ...associated with BPD I was performed. Centers were included if they had access to a database of computerized patient charts exhaustively covering a defined catchment area. Methods Economic evaluation was performed by multiplying the average cumulated annual length of stay (LOS) of hospitalized bipolar patients by a full cost per day of hospitalization in each center to obtain the corresponding annual costs. Results Hospitalization rates per annum and per 100,000 individuals (general population aged 15+) were similar between France (43.6) and Spain (43.1). There were only slight differences in relation to length of stay (LOS) per patient hospitalized with 18.1 days in Spain and 20.4 days in France. The overall estimated annual hospitalization costs were in the same order of magnitude after adjustment to an adult population of 100,000: €232,000 (Spain) and €226,500 (France). Mixed episodes had the longest LOS followed by depressive episodes, while manic episodes had the shortest ones. Mania was the most costly disorder representing 53.7% of annual BPD in-patient care costs. Conclusions BPD I care requires large resources and frequent hospitalizations, especially during manic episodes. Depressive and mixed episodes require longer hospital stays than manic episodes. Out-patient costs should now be evaluated.
To describe the adult population treated with antiepileptic drugs (AEDs) in combination for focal epilepsy according to the definition of AED resistance proposed by the International League Against ...Epilepsy (ILAE) in 2009 and to evaluate its implementation in current practice.
ESPERA was a multicenter, observational, cross-sectional study with a clinical data collection covering the past 12 months conducted by neurologists. Classifications according to AED responsiveness established by investigators for each enrolled patient were revised by two experts.
Seventy-one neurologists enrolled 405 patients. Their mean age was 42.7 years (sex-ratioM/F 0.98). According to the investigators, 60% of epilepsies were drug-resistant, 37% drug-responsive and 3% had an undefined drug-responsiveness. After revision of experts, 71% of epilepsies were classified as drug resistant, 22% as responsive and 7% as undefined. Among the participating neurologists, 76% have made at least one error in classifying their patients according to the 2009 ILAE definition of AED resistance. Because of epilepsy, 24% of patients (age≤65) were inactive and 42% could not drive (respectively 29 and 49% of patients with AED resistant epilepsy). Half of patients had at least one other chronic condition. Number of prescribed drugs in combination and health care resource utilisation were significantly higher in patients with drug-resistant epilepsies than in patients with drug responsive epilepsies.
ESPERA study shows that the use of new definition of drug-resistance in everyday practice seems difficult without any additional training and that the social and professional disability is frequent in adults with focal epilepsies treated with polytherapy.
There were 21,850 cases of newly diagnosed lung cancers in France in 1995. This figure corresponds to an incidence rate (standardized to the population of Europe) of 66.5 per 100,000 men and 8.9 per ...100,000 women. The incidence is age-related and reaches a peak between 70 and 74 years of age for men and between 75 and 79 years of age for women. The incidence also varies by region and the highest rates were observed in east of France. Non-small-cell lung cancers represent 80% of all lung cancers. Between 1985 and 1995, as a result of changes in tobacco consumption, the incidence rates increased by 56% in women and by 5% in men under the age of 65. The incidence rates in France are close to the average rates observed in Europe. In 1995, lung cancers led to 23,900 deaths in France (mortality rate standardized to Europe: 36.6 per 100,000). 85% of deaths due to lung cancer occurred among men. Prognosis of lung cancer remains poor and has not improved appreciably over the last two decades. 58% of all patients died during the first year and 82% during the three years following lung cancer diagnosis. Survival rates appear to be better for patients with non small cell lung cancer than for patients with small cell lung cancer. Few studies have addressed the economics of lung cancer in France. Cost-of-illness studies of lung cancer were published mainly in Canada, the Netherlands and Australia. These analyses have included descriptive works as well as economic models based on theoretical diagnostic and treatment algorithms.
Several variations of the total cavopulmonary connection (TCPC) have been investigated for favorable fluid mechanics and flow distribution. This study presents a hemodynamically optimized TCPC ...configuration code-named "OptiFlo." Featuring bifurcated vena cava (superior venacava to inferior vena cava SVC/IVC), it was designed to lower the fluid mechanical power losses in the connection and to ensure proper hepatic blood perfusion to both lungs.
A rapid prototype model of the OptiFlo TCPC was built and in vitro control volume flow analysis was performed to evaluate the fluid mechanical power loss performance of the model. Furthermore, computational fluid dynamics simulations were used to investigate the flow patterns in the model, which were compared with those in the planar one-diameter offset TCPC with flared anastomosis sites, the best known TCPC configuration to date.
Compared with the one-diameter offset reference model, the OptiFlo showed lower power losses: -26%, -31%, and -42% for increasing cardiac outputs of 2, 4, and 6 L/minute, respectively. No statistically significant differences were found in power loss between 40:60 and 50:50 SVC/IVC flow ratios (p > 0.1) for the OptiFlo model. The power loss characteristic curve for different left and right pulmonary artery ratios was flatter for the OptiFlo than the one-diameter offset reference model. Pulmonary artery flow was much more streamlined in the OptiFlo compared with the one-diameter offset model.
The OptiFlo TCPC design exhibits lower power losses with better adaptive distribution of hepatic blood to both lungs and lower blood flow disturbances compared with the planar one-diameter offset TCPC model. Its significantly superior hemodynamic performance at higher cardiac outputs (exercise) rationalizes further design and feasibility studies toward a workable clinical model.
The objectives of this study were to develop an image-based surgical planning framework that 1) allows for in-depth analysis of pre-operative hemodynamics by the use of cardiac magnetic resonance and ...2) enables surgeons to determine the optimum surgical scenarios before the operation. This framework is tailored for applications in which post-operative hemodynamics are important. In particular, it is exemplified here for a Fontan patient with severe left pulmonary arteriovenous malformations due to abnormal hepatic flow distribution to the lungs. Patients first undergo cardiac magnetic resonance for 3-dimensional anatomy and flow reconstruction. After analysis of the pre-operative flow fields, the 3-dimensional anatomy is imported into an interactive surgical planning interface for the surgeon to virtually perform multiple surgical scenarios. Associated hemodynamics are predicted by the use of a fully validated computational fluid dynamic solver. Finally, efficiency metrics (e.g., pressure decrease and hepatic flow distribution) are weighted against surgical feasibility to determine the optimal surgical option.
Few studies have assessed the actual costs associated with failure of initial empiric antibiotic therapy administered to patients with community-acquired intra-abdominal infections. The goals of this ...study were (i) to determine the frequency of unsuccessful initial empiric therapy in a real-world setting and (ii) to determine the associated impact on medical costs. Thus, a retrospective chart review was performed at four acute-care university hospitals in France. A total of 292 patients hospitalized for community-acquired intra-abdominal infection were included. The mean age of the cohort was 51 years, and 42% of the patients were female. The most commonly administered empiric regimens were intravenous amoxicillin/clavulanate alone (69 patients) or in combination with other antibiotics ( n=87) and piperacillin/tazobactam alone ( n=24) or in combination ( n=48). Other regimens included broad-spectrum penicillin, cephalosporins, and fluoroquinolones administered alone or in combination ( n=64). Empiric therapy was successful in 189 (65%) patients and unsuccessful in 103 (35%). Among the 292 patients with community-acquired infection, 15 died of the infection, 8 required reoperation and 80 required second-line antibiotic therapy. Patients with unsuccessful initial empiric therapy had significantly more parenteral antibiotic days (10.3 vs. 7.6 days) and a longer length of stay (16.2 vs. 12.8 days) compared to those with successful initial empiric therapy. A better selection of initial empiric antibiotic therapy may significantly influence the medical costs associated with patients who are hospitalized with community-acquired intra-abdominal infections.
Bipolar disorder is a chronic, highly disabling illness. However, few studies have evaluated the economic impact of this illness. The objective of this study was to estimate: 1) the annual number of ...manic episodes in patients with bipolar I disorder, and 2) the costs of hospitalisations related to manic episodes in France. We only included data on bipolar I disorder, as there is greater consensus and better documentation for this subgroup of patients with bipolar disorder. The prevalence of manic episodes was estimated using published epidemiological data. A computerised literature search was performed using the traditional scientific and medical databases. Additional epidemiological references were identified from published studies and textbooks. For hospitalisation data, we used the statistics of the Medical Information Department of a large psychiatric hospital in Paris for the year 1999. We estimated the annual number of manic episodes in France based on: 1) the lifetime prevalence of bipolar I disorder, 2) the average cycle duration, 3) the proportion of rapid cycling patients, and 4) the proportion of depressive vs. manic episodes for patients with bipolar I disorder. In order to estimate the prevalence of bipolar I disorder, we conducted a random effects meta-analysis using published international data. Results of the meta-analysis, which was based on a total of 62 736 patients, showed the lifetime prevalence of bipolar I disorder to be 0.82% 95% CI: 0.42, 1.21. Applied to the adult population in France, this prevalence implies that the number of persons who have ever experienced a bipolar I -disorder is approximately 390,000 95% CI: 200,000, 575,000. Few studies provide information on the duration of cycles in patients with bipolar I disorder. Available estimates suggest the cycle duration to be approximately 12 months. Regarding the proportion of rapid cyclers, data from the meta-analysis by Tondo et al. show that 18% of patients with bipolar disorder experience at least four episodes of mood disorder per year. Finally, based on findings provided by cohort studies, the number of depressive episodes appears to be roughly equal to the number of manic episodes during the course of bipolar disorder. A rapid cycling rate of 18% and a cycle duration of 12 months imply that, on average, among 100 bipolar patients, 18 will have a 3-month cycle duration and 82 a 14-month cycle duration. Given an equal proportion of manic and depressive episodes, the annual number of manic episodes would then be 68 for a cohort of 100 bipolar patients (0.68 episode per patient per year). Applying this figure to the estimate of the total number of patients with bipolar I disorder in France suggests that the annual number of manic episodes in France is 265,000 95% CI: 136,000, 391,000. Based on data from a psychiatric hospital in Paris, the proportion of manic episodes that require hospitalisation was estimated to be around 63% with an average length of stay of 32.4 days. Hence the annual number of hospitalisations for manic episodes in France is estimated to be 167 000 95% CI: 86 000, 246 000 and the hospitalisation-related costs 1,3 billion euros approximately. Our review of literature highlights the lack of medical and economic data at the national level on the frequency and hospitalisation-related costs of manic episodes in patients with bipolar I disorder in France. Given the lifetime prevalence of bipolar I disorder which may be as high as 3% among adults, further studies are required in order to provide representative national data and to allow economic evaluations of costs related to bipolar disorder in France.
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