Background: Heterozygous familial hypercholesterolemia (HeFH) predisposes to premature cardiovascular diseases. Since 2015, the European Atherosclerosis Society has advocated initiation of statins at 8 -10 years of age and a low -density lipoprotein cholesterol (LDL-C) target of <135 mg/dL. Longitudinal data from large databases on pharmacological management of pediatric HeFH are lacking. Objective: Here, we describe treatment patterns and LDL-C goal attainment in pediatric HeFH using longitudinal real -world data. Methods: This was a retrospective and prospective multicenter cohort study (2015 -2021) of children with HeFH, diagnosed genetically or clinically, aged <18 years, and followed up in the National French Registry of FH (REFERCHOL). Data on the study population as well as treatment patterns and outcomes are summarized as mean +/- SD. Results: We analyzed the data of 674 HeFH children (age at last visit: 13.1 +/- 3.6 years; 82.0 % >= 10 years; 52.5 % females) who were followed up for a mean of 2.8 +/- 3.5 years. Initiation of lipid -lowering therapy was on average at 11.8 +/- 3.0 years of age for a duration of 2.5 +/- 2.8 years. At the last visit, among patients eligible for treatment (573), 36 % were not treated, 57.1 % received statins alone, 6.4 % statins with ezetimibe, and 0.2 % ezetimibe alone. LDL-C was 266 +/- 51 mg/dL before treatment and 147 +/- 54 mg/dL at the last visit (-44.7 %) in treated patients. Regarding statins, 3.3 %, 65.1 %, and 31.6 % of patients received high-, moderate-, and low -intensity statins, respectively. Overall, 59 % of children on statin therapy alone and 35.1 % on bitherapy did not achieve the LDL-C goal; fewer patients in the older age group did not reach the treatment goal. Conclusion: Pediatric patients with FH followed up in specialist lipid clinics in France receive late treatment, undertreatment, or suboptimal treatment and half of them do not reach the therapeutic LDL-C goal. Finding a more efficient framework for linking scientific evidence to clinical practice is needed. (c) 2024 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

AbstractBackgroundPrevalence of Treatment-Resistant Depression (TRD) varied widely across studies due to heterogeneous definitions. Several treatment strategies exist to manage patients with TRD but evidence from real-world data is scarce. Investigating their use in real-life settings is important to understand national prescribing practices and to refine prevalence estimation.MethodAll adult patients (≥ 18 years) with a TRD episode for the year 2019 were identified in a sample of four French regions accounting for 27% of national individuals. After exclusion of patients with psychotic or bipolar disorders, Parkinson’s disease, and dementia, TRD was defined by i/ 3 successive sequences of different antidepressants (AD), or ii/ the dispensing of several different AD together, or iii/ an AD with a potentiator (lithium, antiepileptic drugs, or antipsychotic drugs) over the same treatment period. The prevalence rate was estimated for the year 2019 and treatment patterns were described by treatment class and molecule.ResultsFor the year 2019, 66,810 patients were identified with TRD, accounting for 23.9% of all patients treated for depression. The mean age was 56 years (±15.9) with 63.7% of women. Standardized prevalence of TRD was estimated at 35.1 per 10 000 patients, and 25.8 per 10,000 patients when excluding patients probably treated for another primary diagnosis than depression. Association of an AD with an antipsychotic was the most frequently used strategy, with SSRIs and second-generation antipsychotics being the most often prescribed.ConclusionThis study provides robust population-based estimates of the prevalence of TRD in the French population. Description of treatment patterns highlight the widespread use of second-generation antipsychotics as potentiator of antidepressants.

Background and Objectives: Implementing a ferritin testing policy for whole blood (WB) donors may prevent iron deficiency (ID, ferritin < 26 ng/mL) and anaemia, but may induce donation losses. As part of a national prevention plan in France, we aimed to estimate its impact on ID, anaemias and WB donations among donors at high risk of ID. Materials and Methods: A micro-simulation model was developed to evaluate different scenarios compared to the current situation without ferritin testing as a reference scenario. The following scenarios were simulated: a minimum scenario with a 6-month deferral for donors with absent iron store (AIS, ferritinemia < 15 ng/ml), a main scenario with additional delayed invitations for donors with ferritinemia 15-25 ng/ml and a supplementation scenario with additional iron supplementation for 50% of the donors with AIS. Results: In the main scenario, 52,699 WB donations per year were estimated to be lost after 1 year (-8%), falling to 27,687 (-4.7%) after 5 years. IDs and anaemias were reduced by 13.6% and 29.3%, respectively, after 1 year. The supplementation scenario increased the number of prevented IDs and anaemias to 24.1% and 35.4%, respectively, after 1 year, and halved the number of anaemias at 5 years. The latter scenario also had the least impact on the number of donations (-3.2% after 5 years). Conclusion: A ferritin testing policy resulting in delayed donations for ID donors is effective in reducing IDs and anaemias, but significantly impacts the number of donations, thereby posing a self-sufficiency challenge.

Objective Prognostic models in patients living with diabetes allow physicians to estimate individual risk based on medical records and biological results. Clinical risk factors are not always all available to evaluate these models so that they may be complemented with models from claims databases. The objective of this study was to develop, validate and compare models predicting the annual risk of severe complications and mortality in patients living with type 2 diabetes (T2D) from a national claims data. Research design and methods Adult patients with T2D were identified in a national medical claims database through their history of treatments or hospitalizations. Prognostic models were developed using logistic regression (LR), random forest (RF) and neural network (NN) to predict annual risk of outcome: severe cardiovascular (CV) complications, other severe T2D-related complications, and all-cause mortality. Risk factors included demographics, comorbidities, the adjusted Diabetes Severity and Comorbidity Index (aDSCI) and diabetes medications. Model performance was assessed using discrimination (C-statistics), balanced accuracy, sensibility and specificity. Results A total of 22,708 patients with T2D were identified, with mean age of 68 years and average duration of T2D of 9.7 years. Age, aDSCI, disease duration, diabetes medications and chronic cardiovascular disease were the most important predictors for all outcomes. Discrimination with C-statistic ranged from 0.715 to 0.786 for severe CV complications, from 0.670 to 0.847 for other severe complications and from 0.814 to 0.860 for all-cause mortality, with RF having consistently the highest discrimination. Conclusion The proposed models reliably predict severe complications and mortality in patients with T2D, without requiring medical records or biological measures. These predictions could be used by payers to alert primary care providers and high-risk patients living with T2D.

Objective To identify childhood and parental factors associated with initiation of statin therapy in children with heterozygous familial hypercholesterolemia (HeFH), including underlying genetic diagnosis or parental premature atherosclerotic cardiovascular disease (ASCVD). Study design This multicenter cohort study included 245 HeFH child- parent pairs from the REFERCHOL national register (2014-2020). Demographic and clinical characteristics at the last visit were collected. Vascular disease in parents was defined as a history of ASCVD, and/or a coronary artery calcium score >100, and/or stenosis of >50% in at least carotid artery. Statistical analyses included descriptive analysis, logistic regression for univariate and multivariate effects of statins, and a sensitivity analysis combining the characteristics of children and parents. Results Among the 245 children in the study cohort, 135 (58%), with a mean age of 14 +/- 3 years, were treated with a statin. In multivariable analysis, the predictive childhood factors associated with statin treatment were genetic diagnosis (OR, 2.5; 95% CI, 1.3 to 4.9; P = .01), older age (OR, 4.4; 95% CI, 1.8-10.6; P = .01), more than 2 visits (OR, 2.36; 95% CI, 1.18-4.73; P = .015), and longer duration of follow-up (OR, 1.3; 95% CI, 1.1-1.6; P < .001). The predictive parental factor associated with childhood treatment was the presence of vascular disease (OR, 2.4; 95% CI, 1.0-5.7; P = .04). Conclusions HeFH confirmed by DNA testing during childhood and a history of vascular disease in parents were independently associated with statin treatment in children with HeFH. Genetic diagnosis may be useful for cardiovascular prevention in children. (J Pediatr 2023;253:18-24).

Depuis plusieurs années en France, les autorités sanitaires ont lancé de nombreux travaux visant à tester une série d’indicateurs pour évaluer l’impact des mesures d’amélioration de la qualité menées au sein des établissements hospitaliers. Une fois validée, la diffusion publique de ces indicateurs de qualité est nécessaire pour une transparence envers les patients et pour contribuer à l’amélioration de la qualité des soins. L’objectif de cette étude est d’élaborer et de qualifier un modèle d’évaluation de la qualité de la prise en charge hospitalière, au travers d’un score composite fondé sur un ensemble d’indicateurs validés scientifiquement et reconnus par les autorités sanitaires. Le score composite, qui est constitué de trois sous-scores (réhospitalisation, sécurité des patients, recours aux soins), a été construit à partir de la base de données nationale de l’Échantillon Généraliste des Bénéficiaires (EGB) et a été évalué dans différentes catégories majeures de diagnostic (CMD). Il permet de classer les établissements selon des niveaux de prise en charge, tout en utilisant des critères conservateurs. Les analyses de robustesse montrent que le score composite minimise le risque d’attribuer à tort un niveau discutable de qualité. Les indicateurs de qualité inclus dans cette étude sont complémentaires des indicateurs déjà existants dans la plateforme ScopeSanté qui ne couvrent pas aujourd’hui le parcours de soins entre l’hôpital et la ville, en particulier sur le recours aux soins de ville après hospitalisation. La diffusion d’un score composite évaluant la qualité de prise en charge devrait diminuer l’asymétrie de l’information qui caractérise le marché des soins et ainsi amener à une concurrence par la qualité des offreurs de soins.

Prostate cancer (PCa) is the most frequently diagnosed cancer in men in Europe. The impact of PCa natural history and therapeutic management on the outcomes of castration-resistant prostate cancer patients with metastasis (mCRPC) remains unclear. The objective of this study was to describe retrospectively patterns of clinical progression through diagnosis sequences before the mCRPC stage and to assess how these sequences impacted patients' disease progression and overall survival at mCRPC stage. Patients with mCRPC were identified from the Prostate Cancer Registry (PCR), an observational study in a real-world setting in 16 countries between 2013 and 2016. Patients were grouped in diagnosis sequences before mCRPC and defined by date of PCa diagnosis, first metastasis, and castration resistance. Distribution of time-to-event variables were estimated using Kaplan-Meier product-limit survival curves for overall survival (OS) and progression-free survival (PFS). Non-adjusted Cox models were conducted for efficacy endpoints (OS, PFS) to estimate hazard ratios between diagnosis sequences. At the end of study, 2859 mCRPC patients were included in this analysis. Among mCRPC four diagnosis sequences were identified: 35% developed metastases (mHSPC) before becoming castration resistant (sequence 1, metachronous mHSPC), 10% developed castration resistance (nmCRPC) before metastases (sequence 2), 27% developed metastases and castration resistance within 4 months (sequence 3) and 28% of patients were de novo mHSPC (sequence 4). Median OS was 17.7 months (interquartile range (IQR): 8.8–29.9) and PFS was 6.4 months (IQR: 3.2–12.0). The univariate analyses showed no correlation between mCRPC patients' OS or PFS and the diagnosis sequence. This large European study describe four different patterns of prostate cancer progression to mCRPC stage. Our results indicate that patient survival becomes comparable after progression to mCRPC, regardless of the diagnosis sequence. ClinicalTrials.gov identifier NCT02236637; registered September 2014.

Background and aims: Heterozygous familial hypercholesterolemia (HeFH) is increasingly better diagnosed and treatments can improve the cardiovascular prognosis. We evaluated the long-term cardiovascular risk of HeFH using the French REgistry of Familial hypERCHOLesterolemia (REFERCHOL). Methods: We studied HeFH patients diagnosed genetically and clinically by the Dutch Lipid Clinic Network (DLCN) criteria in all lipid clinics across the country and their 5-year risk of cardiovascular events (all fatal and non-fatal acute coronary, cerebral and peripheral arterial disease events, aortic valve replacement surgery) using the French national health data system. Results: The database comprised 3202 individuals, 2010 (62.8%) with genetically verified HeFH and 1192 (37.2%) a DLCN score ≥6. Of these individuals, 2485 (77.6%) were in primary prevention and 717 (22.4%) in secondary prevention. The incidence of cardiovascular events was 24.58 per 1000 person-years for the overall sample, 19.15 in primary prevention and 43.40 in secondary prevention. The incidence of myocardial infarction, cerebral infarction and death was 16.32 per 1000 person-years for the overall sample, 12.93 in primary prevention and 28.08 in secondary prevention. The incidence of aortic valve replacement was 1.78 per 1000 person-years. In the overall sample, at inclusion, 41% were not treated for LDL cholesterol, 48% of these in primary prevention and 20% in secondary prevention and high-dose statins were used by only 24% of individuals, 15% of these in primary prevention and 45% in secondary prevention. Conclusions: The incidence of cardiovascular events in HeFH is high and lipid-lowering treatment is far from optimal. The cardiovascular risk of HeFH is underestimated and patients are inadequately treated.

IntroductionSur la période de 2015 à 2017, près de 80 000 hospitalisations ont bénéficié du volet chirurgie orthopédique du Programme d’Accompagnement au retour à Domicile (PRADO) de l’Assurance maladie.HypothèseLe programme PRADO déployé en chirurgie orthopédique raccourcit les durées de séjour et réduit le taux de réhospitalisations à 30 jours.Matériel et méthodesL’évaluation du Programme PRADO Chirurgie Orthopédique comprenait une étude quantitative et une étude qualitative. L’étude quantitative était une étude de cohorte rétrospective multicentrique, réalisée par appariement à des données du Système national des données de santé (SNDS). Elle incluait tous les séjours ayant bénéficié de PRADO Chirurgie Orthopédique entre janvier 2015 et décembre 2017, pour un suivi de 6 mois après la sortie d’hospitalisation. Le critère principal de jugement était le taux de réhospitalisation à 30 jours. Les critères secondaires comportaient les recours aux urgences et aux soins de suite et de réadaptation (SSR), la durée moyenne de séjour (DMS), les recours aux professionnels de santé recommandés, les consommations médicamenteuses et les dépenses de santé totales à 6 mois. L’analyse statistique était en perprotocole. L’étude qualitative, réalisée par des entretiens individuels et collectifs semi-directifs, explorait l’adhésion des professionnels, leur perception de la mise en œuvre, du financement et des coûts du programme.RésultatsSur 82 202 séjours PRADO, 71 761 (87 %) ont été appariés et analysés. Les caractéristiques des séjours PRADO et contrôles étaient comparables. Les séjours PRADO présentaient une réduction significative du nombre de réhospitalisations toutes causes avec ou sans ambulatoire (respectivement 4,5 % vs 4,9 %, p<0,0001 et 3,9 % vs 4,2 %, p=0,0009). Les recours aux urgences et au SSR à 30 jours étaient significativement inférieurs chez les séjours PRADO (respectivement moyenne=2,1 % vs 2,3 %, p=0,01 et 3,4 % vs 8,4 %, p≤0,0001). Il n’y avait pas de différence de DMS. Les dépenses totales à 6 mois étaient en moyenne inférieures chez les séjours PRADO (2248€ vs 2485€). Le succès du programme dépendait de son portage médical dans l’établissement et de l’accompagnement de sa mise en œuvre. Les critères d’éligibilité des séjours au programme PRADO n’étaient pas systématiquement partagés ou connus des équipes médicosoignantes.DiscussionLe programme PRADO répond à son objectif d’amélioration des prises en charge en orthopédie et questionne la pertinence de certains séjours SSR en orthopédie.Niveau de preuveIII ; étude comparative rétrospective.

CONTEXT:The need for patient navigator is growing, and there is a lack of cost evaluation, especially during survivorship.OBJECTIVE:The objective of this study is to evaluate the cost-effectiveness of an Ambulatory Medical Assistance (AMA) programme in patients with haematological malignancies (HM).DESIGN:A cost-effectiveness analysis of the AMA programme was performed compared to a simulated control arm.SETTING:An interventional, single-arm and prospective study was conducted in a French reference haematology-oncology centre between 2016 and 2020.PARTICIPANTS:Adult patients were enrolled with histologically documented malignant haematology, during their active therapy phase, and treated either by intravenous chemotherapy or oral therapy.METHODS:An extrapolation of the effectiveness was derived from a similar nurse monitoring programme (CAPRI study). Cost effectiveness of the programme was evaluated through adverse events of Grade 3 or 4 avoided in different populations.RESULTS:Included patient (n = 797) from the AMA programme were followed during 125 days (IQR: 0-181), and adverse events (Grade 3/4) were observed in 10.1% of patients versus 13.4% in the simulated control arm. The overall cost of AE avoided was estimated to €81,113, leading to an ICER of €864.CONCLUSION:The AMA programme was shown to be cost-effective compared to a simulated control arm with no intervention.

Background: Between 2015 and 2017, nearly 80,000 hospital stays in orthopaedic surgery were entered into a home discharge support programme (PRADO) offered by the statutory health insurance system. The objective of this study was to assess the impact of the PRADO programme on enrolled stays in orthopaedic surgery over the last three years. Hypothesis: The home discharge support programme used in orthopaedic surgery shortens hospital stays and decreases the rate of readmission within 30 days.Material and methods: The home discharge support programme PRADO was evaluated both quantitatively and qualitatively. The quantitative study used a multicentre retrospective cohort design with matching to controls identified in the national healthcare database. All hospital stays entered into the home discharge support programme between January 2015 and December 2017 were enrolled in the study. Follow-up was 6 months after discharge. The main outcome measure was the rate of readmission within 30 days after discharge. The secondary outcome measures were emergency department visits, admission to rehabilitation, mean stay duration, visits to recommended healthcare professionals, medication consumption, and total healthcare expenditure at 6 months. The statistical analysis used the per protocol approach. The qualitative study involved semi-structured individual and group interviews designed to investigate adhesion of the professionals and their perceptions of programme implementation, funding, and costs. Results: Of 82,202 stays in the programme, 71,761 (87%) were matched and included in the analysis. Characteristics were comparable between the programme stays and the control stays. The programme stays had a significant reduction in the number of all-cause ambulatory and non-ambulatory readmis-sions (4.5% vs. 4.9%, p < 0.0001 and 3.9% vs. 4.2%, p = 0.0009, respectively). Emergency department visits and rehabilitation admissions within 30 days were significantly less common in the programme group than in the control group (mean values, 2.1% vs. 2.3%, p = 0.01 and 3.4% vs. 8.4%, p <= 0.0001, respectively). Mean stay length was not significantly different between the two groups. Visits to recommended health-care professionals occurred significantly more often and earlier in the programme group. The delivery of analgesics and heparin was significantly higher in the programme group, whereas no difference occurred in the delivery of antibiotics. Mean total health expenditures at 6 months were lower in the programme group (2248 euro vs. 2485 euro ). The success of the PRADO programme was dependent on leadership from the medical staff within the institution and on assistance provided by the hospital throughout its imple-mentation. The criteria for patient eligibility to the programme were not routinely shared by or clear to the healthcare staff.Discussion: The PRADO programme effectively improves the care of orthopaedic surgery patients and raises the issue of whether some admissions to rehabilitation may be unnecessary. Level of evidence: III; comparative retrospective study. (c) 2021 Elsevier Masson SAS. All rights reserved.

La prévention de la carence en fer et de l'anémie est un enjeu majeur pour la sécurité des donneurs. L'étude Ferridon a identifié 4 groupes à risque de carence chez qui le dosage de la ferritine et l'espacement des dons doivent prévenir l'anémie et la perte de dons. L'objectif était d'en estimer l'impact sur les carences et anémies et sur le nombre de dons de sang total en France. Modèle dynamique de simulation à événements discrets comparant 2 scénarios : situation actuelle sans dosage et situation avec dosage de la ferritine, comptabilisant les retours, les carences et les anémies avec ajournement de 6 mois après carence (< 26 ng/ml) ou anémie, selon des hypothèses fondées sur la littérature et les données de Ferridon, pour un démarrage cadencé (toutes les 4 sem) entre groupes. Avec un ajournement de 6 mois, les carences en fer et anémies évitées chaque année étaient respectivement : 19 645 et 1945 à 1 an ; 72 695 et 12 738 à 2 ans ; 78 371 et 17 883 à 3 ans ; 83 809 et 20 414 à 4 ans ; 85502 et 22 154 à 5 ans. Avec une hypothèse de 50 % des donneurs carencés supplémentés en fer, les bénéfices passaient à 21 326 et 2012 à 1 an ; 84 301 et 12 854 à 2 ans ; 91 492 et 17 913 à 3 ans ; 95 232 et 20 969 à 4 ans ; 98 140 et 22 316 à 5 ans. La perte de dons était significative (entre 2 et 3 % par an) avec un maximum à 2 ans (70 808 ou 63 030 dons, avec ou sans supplémentation, respectivement), et sans amortissement des retours aux dons perdus sur une projection à 5 ans. L'abaissement du seuil d'intervention à 15 ng/ml atténuait la perte de dons, avec un taux d'anémie évitée similaire, mais ne prévenait que 50 à 60 % des carences comparativement à un seuil à 26 ng/ml

Background and aims: Current guidelines recommend colonoscopy every 3–5 years for colorectal cancer (CRC) screening of individuals with a familial history of CRC. The objective of this study was to compare the cost effectiveness of screening alternatives in this population. Methods: Eight screening strategies were compared with no screening: fecal immunochemical test (FIT), Stool DNA and blood-based screening every 2 years, colonoscopy, computed tomography colonography, colon capsules, and sigmoidoscopy every 5 years, and colonoscopy at 45 years followed, if negative, by FIT every 2 years. Screening test and procedures performance were obtained from the literature. A microsimulation model reproducing the natural history of CRC was used to estimate the cost (€2018) and effectiveness [quality-adjusted life-years (QALYs)] of each strategy. A lifetime horizon was used. Costs and effectiveness were discounted at 3.5% annually. Results: Compared with no screening, colonoscopy and sigmoidoscopy at a 30% uptake were the most effective strategy (46.3 and 43.9 QALY/1000). FIT at a 30 µg/g threshold with 30% uptake was only half as effective (25.7 QALY). Colonoscopy was associated with a cost of €484,000 per 1000 individuals whereas sigmoidoscopy and FIT were associated with much lower costs (€123,610 and €66,860). Incremental cost-effectiveness rate for FIT and sigmoidoscopy were €2600/QALY ( versus no screening) and €3100/QALY ( versus FIT), respectively, whereas it was €150,000/QALY for colonoscopy ( versus sigmoidoscopy). With a lower threshold (10 µg/g) and a higher uptake of 45%, FIT was more effective and less costly than colonoscopy at a 30% uptake and was associated with an incremental cost–effectiveness ratio (ICER) of €4240/QALY versus no screening. Conclusion: At 30% uptake, current screening is the most effective screening strategy for high-risk individuals but is associated with a high ICER. Sigmoidoscopy and FIT at lower thresholds (10 µg/g) and a higher uptake should be given consideration as cost-effective alternatives. Plain Language Summary Cost-effectiveness analysis of colorectal cancer screening strategies in high-risk individuals Fecal occult blood testing with an immunochemical test (FIT) is generally considered as the most cost-effective alternative in colorectal cancer screening programs for average risk individuals without family history. Current screening guidelines for high-risk individuals with familial history recommend colonoscopy every 3–5 years. Colonoscopy every 3–5 years for individuals with familial history is the most effective strategy but is associated with a high incremental cost–effectiveness ratio. Compared with colonoscopy, if screening based on FIT is associated with a higher participation rate, it can achieve a similar effectiveness at a lower cost.

OBJECTIVES This study aimed at investigating the additional contribution of coronary artery calcium (CAC) score to SAFEHEART (Spanish Familial Hypercholesterolemia Cohort Study) risk equation (SAFEHEART-RE) for cardiovascular risk prediction in heterozygous familial hypercholesterolemia (HeFH). BACKGROUND Common cardiovascular risk equations are imprecise for HeFH. Because of the high phenotype variability of HeFH, CAC score could help to better stratify the risk of atherosclerotic cardiovascular disease (ASCVD). METHODS REFERCHOL (French Registry of Familial Hypercholesterolemia) and SAFEHEART are 2 ongoing national registries on HeFH. We analyzed data from primary prevention HeFH patients undergoing CAC quantification. We used probability-weighted Cox proportional hazards models to estimate HRs. Area under the receiver-operating characteristic curve (AUC) and net reclassification improvement (NRI) were used to compare the incremental contribution of CAC score when added to the SAFEHEART-RE for ASCVD prediction. ASCVD was defined as coronary heart disease, stroke or transient ischemic attack, peripheral artery disease, resuscitated sudden death, and cardiovascular death. RESULTS We included 1,624 patients (mean age: 48.5 +/- 12.8 years; men: 45.7%) from both registries. After a median follow-up of 2.7 years (interquartile range: 0.4-5.0 years), ASCVD occurred in 81 subjects. The presence of a CAC score of 100 was associated with an HR of 32.05 (95% CI: 10.08-101.94) of developing ASCVD as compared to a CAC score of 0. Receiving-operating curve analysis showed a good performance of CAC score alone in ASCVD prediction (AUC: 0.860 [95% CI: 0.853-0.869]). The addition of log(CAC + 1) to SAFEHEART-RE resulted in a significantly improved prediction of ASCVD (AUC: 0.884 [95% CI: 0.871-0.894] for SAFEHEART-RE + log(CAC + 1) vs AUC: 0.793 [95% CI: 0.779-0.818] for SAFEHEART-RE; P < 0.001). These results were confirmed also when considering only hard cardiovascular endpoints. The addition of CAC score was associated with an estimated overall net reclassification improvement of 45.4%. CONCLUSIONS CAC score proved its use in improving cardiovascular risk stratification and ASCVD prediction in statintreated HeFH. (J Am Coll Cardiol Img 2021;14:2414-2424) (c) 2021 by the American College of Cardiology Foundation.

SynopsisObjectivesThe extended half-life of dalbavancin justifies a once-a-week dosing schedule and is supposed to favour early discharge. These advantages may therefore compensate for the cost of dalbavancin. We aimed to assess the real-life budget impact of dalbavancin through its impact on the length of stay in French hospitals.MethodsA multicentre cohort based on the French registry of dalbavancin use in 2019 was compared to the French national discharge summary database. Lengths of stay and budget impact related to the infection type, the time of introduction of dalbavancin, the type of catheter and patient subgroups were assessed. An early switch was defined when dalbavancin was administered as the first or second treatment and within less than 11 days of hospitalization.ResultsOne hundred seventy-nine patients were identified in the registry, and 154 were included in our study. Dalbavancin is mostly used for bone and joint infections, infective endocarditis and acute bacterial skin and skin structure infections. When compared to the data for similar patients in the national database, the length of stay was almost always shorter for patients treated with dalbavancin. The budget impact for dalbavancin was heterogeneous but frequently generated savings. Early switching was associated with savings (or lesser costs). Patients who required a deep venous catheter and those with the most severe patients benefited the most from dalbavancin.ConclusionsOur study confirms that dalbavancin is associated with early discharge, which can offset its cost and generate savings. The greatest benefit is achieved with an early switch.

Background: A nationwide colorectal cancer (CRC) screening program was set up in France from 2009 for average-risk, asymptomatic people aged 50–74 years based on an immunochemical fecal occult blood test [faecal immunochemical test (FIT)] every 2 years, followed by colonoscopy if positive. The European standard recommends a participation rate of 45% for the program to be cost-effective, yet the latest published rate in France was 34%. The objective of this study was to compare the cost effectiveness of screening alternatives taking real-world participation rates into account. Methods: Eight screening strategies were compared, based either on a screening test (Guaiac or FIT testing, blood-based, stool DNA, computed tomography colonography, colon capsules, and sigmoidoscopy) followed by full colonoscopy if positive or direct colonoscopy. A microsimulation model was used to estimate the cost effectiveness associated with each strategy. Results: Compared with no screening, FIT was associated with a 14.0 quality-adjusted life year (QALY) increase of €50,520 per 1000 individuals, giving an incremental cost-effectiveness ratio (ICER) of €3600/QALY. Only stool DNA and blood-based testing were associated with a QALY increase compared with FIT, with stool DNA weakly dominated by blood-based testing, and the latter associated with an ICER of €154,600/QALY compared with FIT. All other strategies were dominated by FIT. Conclusion: FIT every 2 years appears to be the most cost-effective CRC screening strategy when taking into account a real-world participation rate of 34%.