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.

BackgroundAntipsychotics 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.MethodsUsing 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.ResultsIn 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.ConclusionAn 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.

Background:Appropriate use of effective treatments is required for satisfactory control of allergic symptoms. Coherent medical care -regular prescribing by the same Health Care Professionals- is a preliminary need. Objective:We investigated the numbers of distinct prescribers, the regularity of medical visits, and the agreement between prescriptions and associated dispensations in individual patients with perennial allergic rhinitis (PAR) and asthma. Methods:In primary care electronic health records (EHRs), a cohort of patients with PAR and asthma was identified. Individual EHRs were linked to corresponding claims recording all dispensations. Prescribing patterns were analyzed for the major treatment classes, and the dispensations linked to individual prescriptions were retrieved to compute the proportions of days covered (PDCs) for asthma and PAR therapy. Results:A total of 3654 patients were included, with 62% being female (mean age, 46.1 years). At inclusion, asthma control was not optimal in 51% of the patients and 48% had received oral corticosteroids. The mean interval between successive prescriptions varied between 93 (leukotriene receptor antagonists, LTRAs) and 103 (inhaled corticosteroids, ICS) days, and 97 (antihistamines, AHs) and 103 days (nasal corticosteroids, NCS). On average, individual prescriptions lead to 1.2, 1.5, 1.7 and 1.8 dispensations of ICS, ICS/Long-Acting Beta-Agonist (LABA) fixed-dose combinations, LABAs, and LTRAs, respectively, and to 1.3 and 1.6 dispensations of NCS and AHs, respectively. PDCs then varied between 37.8% for ICS and 58.6% for LTRAs, and between 39.7% for NCS and 50.4% for AHs. Care was nonetheless coherent, with >90% of all dispensations related to prescriptions issued by single General Practitioners (GPs). Conclusion:Despite regular healthcare visits and medication prescriptions, allergic patients only partly and selectively refilled their treatments, preferring the less effective therapy, in a context of poor control of asthma symptoms.

IntroductionLa prise en charge et l'espérance de vie des patients atteints de mucoviscidose se sont considérablement améliorées au cours des dernières décennies, ce qui a conduit à un nombre croissant de diagnostics de comorbidités, notamment de cancers, chez ces patients.ObjectifsLes objectifs de l'étude étaient de caractériser l'épidémiologie des cancers entre 2006 et 2017 chez les patients atteints de mucoviscidose, et d'évaluer le délai entre la transplantation pulmonaire (pour les patients concernés) et la survenue du premier cancer.MéthodesLes dossiers médicaux des patients présents entre 2006 et 2016 dans le registre français de la mucoviscidose ont été chainées à leurs données de remboursement de l'Assurance maladie (SNDS). Les patients ayant reçu un diagnostic de cancer ont été identifiés parmi les patients avec et sans transplantation pulmonaire. Les taux de prévalence et d'incidence annuels ont été estimés de 2006 à 2017.RésultatsSur les 7671 patients inclus dans le registre français de la mucoviscidose, 6187 patients (80,7 %) ont pu être chainés au SNDS (51,9 % d'hommes, âge moyen=24,7 ans).Parmi eux, 1006 (16,3 %) patients avaient bénéficié d'une transplantation pulmonaire. La proportion de cas prévalents de tous types de cancer a augmenté entre 2006 et 2017, passant de 0,3 % à 1,0 % chez les patients non transplantés, et de 1,3 % à 6,3 % chez les patients transplantés. Par rapport à la population générale, l'incidence des cancers était significativement plus élevée chez les patients non transplantés (ratio d'incidence standardisé (SIR=2,57, 95% IC [2,05-3,17]) et chez les patients transplantés (SIR=19,76, 95% IC [16,45-23,55]). Chez les patients qui n'avaient pas de cancer avant leur transplantation pulmonaire (n=982), le délai médian entre la transplantation et l'apparition d'un cancer était de 3,9 ans. Dix ans après la transplantation, la probabilité d'avoir un cancer était de 13,7 %. Les sites les plus fréquents de néoplasmes malins étaient hématologiques, cutanés et digestifs.ConclusionLe fardeau global du cancer chez les patients atteints de mucoviscidose est élevé, en particulier après une transplantation pulmonaire. Il serait donc nécessaire de discuter la mise en place de dépistages et de préventions spécifiques du cancer pour les patients atteints de mucoviscidose, notamment pour les patients transplantés.Mots-clésEpidémiologie, Cancers, Mucoviscidose, Transplantation, Incidence, PrévalenceDéclaration de liens d'intérêtsLes auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Background: Better insights into the natural course of cystic fibrosis (CF) have led to treatment approaches that have improved pulmonary health and increased the life expectancy of affected individuals. This study evaluated how the combination of modified demographics and changes in CF management impacted resource consumption and the cost of care. Methods: Medical records of CF patients from 2006 to 2016 in the French CF Registry were linked to their corresponding claims data (SNDS). Medications, medical visits, procedures, hospitalisations, and indirect costs were annualized by calendar year from 2006 to 2017. Results: Of the 7,671 patients included in the French CF Registry, 6,187 patients (80.7%) were linked to the SNDS (51.9% male, mean age = 24.7 years). The average cost per patient was euro14,174 in 2006, euro21,920 in 2011 and euro44,585 in 2017. Costs associated with hospital stays increased from euro3,843 per patient in 2006 to euro6,741 in 2017. In 2017, the mean cost per CF patient was allocated as follows: 72% for medications (of which 51% for modulator therapies), 15% for hospital stays, 7% for medical visits, 3% for indirect costs, 2% for medical devices, 1% for outpatient medical procedures. Conclusion: There was a strong increase in the mean annual cost per CF patient between 2006 and 2017, mostly due to the cost of therapy after the introduction of cystic fibrosis transmembrane conductance regulator (CFTR) modulators. The combination of an increase in the number of CF patients - particularly adult patients - and an increase in the annual cost per patient led to a substantial increase in the total cost of CF disease care for the health systems. (c) 2021 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Background. - Direct oral anticoagulants (DOACs) were developed as an alternative to vitamin K antagonists (VKAs) and are commonly used for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Unlike VKAs, DOACs do not require Internal Normalized Ratio (INR) monitoring, but regular intake is as important for effective anticoagulation. Objectives. - This study examined treatment persistence among patients receiving oral anticoagulants (OACs) for NVAF. Methods. - Within the French healthcare claims database (SNDS), we assessed and compared the rates of non-persistence ( >= 30-day treatment gap) among patients with NVAF initiating an OAC between January 2014 and December 2016. The time-to-event of non-persistence was computed and plotted using a cumulative incidence function accounting for the competing risk of mortality. After adjusting on confounding factors, the risk for non-persistence was compared between apixaban and each other OACs using a Cox proportional hazard model, or Fine and Gray models. Results. - In a cohort of 321,501 OAC-naive patients with NVAF, the cumulative incidence of nonpersistence at 12 months considering competing risk was 44.3%, 31.0%, 41.3% and 46.8% for VKAs, apixaban, rivaroxaban and dabigatran, respectively. Median therapy duration before non-persistence ranged between 70 and 121 days. Non-persistence was lower with apixaban compared with VKAs (HR= 0.63, 95%CI = [0.62-0.64]), rivaroxaban (HR = 0.71, 95%CI = [0.70-0.73]), and dabigatran (HR= 0.60, 95%CI = [0.59-0.62]). Conclusions. - In this nationwide observational study, non-persistence rates of oral anticoagulant treatment were high in patients treated for NVAF. Apixaban-treated patients seem to experience lowest discontinuation rates 12 months after treatment initiation compared to patients treated with any other OAC. (c) 2022 Les Auteurs. Publie par Elsevier Masson SAS. Cet article est publie en Open Access sous licence CC BY (http: //creativerornmons.org/licenses/by/4.0/).

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.

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.

BACKGROUND:Real-world data regarding health-care resource use (HCRU) and costs of idiopathic pulmonary fibrosis (IPF) are scarce. In France, at the time of the study, pirfenidone and nintedanib were reimbursed for documented IPF only, with similar reimbursement criteria with regard to disease characteristics, prescription through a dedicated form, and IPF diagnosis established in a multidisciplinary setting. The objective of this study was to evaluate costs related to HCRU in patients newly treated with pirfenidone or nintedanib in 2015-2016, in France, using the exhaustive claims data of the French National Health System.METHODS:Patients aged <50 years or who had pulmonary fibrosis secondary to an identified cause were excluded. HCRU-related costs up to 31 December 2017 were compared using generalized linear models 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 visits prior to treatment initiation. As compared to pirfenidone, nintedanib was associated with higher costs for medications (1.2; 95% CI, 1.1-1.3) and medical visits (1.3; 95% CI, 1.2-1.4), as well as a higher global cost (1.1; 95% CI, 1.0-1.2). The costs of medical procedures, hospitalizations and indirect HCRU did not statistically differ between the two cohorts.CONCLUSIONS:This observational study identified potential differences in HCRU-related costs under newly prescribed antifibrotic drugs, deserving further explorations.

To estimate and compare costs associated with all-cause healthcare resource use (HCRU), stroke/systemic embolism (SE) and major bleedings (MB) between patients with non-valvular atrial fibrillation (NVAF) initiating apixaban and patients initiating other oral anticoagulants (OAC). An observational retrospective cohort generated from the French National Health System healthcare claims database (SNDS). Patients were included between 2014/01/01 and 2016/12/31 and followed until 2016/12/31. We used 4 sub-cohorts of AC-naive patients with NVAF, respectively initiating apixaban, dabigatran, rivaroxaban or VKAs. We matched patients initiating apixaban with patients initiating each of the other OACs using 1:n propensity score matching. We estimated all-cause HCRU costs and events-related costs from a medical care perspective by OAC treatment (euros) per patient per month (PPPM). We compared costs between matched patients initiating apixaban and those initiating each of the OAC using generalised linear models with gamma distribution and two-part models. There were 175,766 patients in the apixaban (n=68,208)-VKA (n=107,558) matched cohort, 42,490 in the apixaban (n=21,245)-dabigatran (n=21,245) matched cohort, and 181,809 in the apixaban (n=81,759)-rivaroxaban (n=100,050) matched cohort. Patients initiating apixaban had lower all-cause 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). Patients initiating apixaban also had lower costs related to stroke/SE and MB than patients initiating VKA (respectively €183 vs.€449; p<0.0001 and €147 vs.€413; p<0.0001), rivaroxaban (respectively €145 vs.€197; p<0.0001 and €129 vs.€193; p<0.0001), and lower costs related to stroke/SE than patients initiating dabigatran (€135 vs.€192; p<0.02). Costs related to MB were not significantly different in patients initiating apixaban versus patients initiating dabigatran (€119 vs.€149; p=0.07). All-cause HCRU and most events-related costs were lower in patients initiating apixaban compared to patients initiating other OAC. These findings suggest that apixaban may be cost-saving (all-cause HCRU costs) compared to all therapeutical alternatives.

La pirfénidone et le nintédanib sont les seuls médicaments approuvés pour le traitement de la fibrose pulmonaire idiopathique (FPI). L’objectif de cette étude était de décrire l’utilisation des ressources de santé (URS) des patients (pts) atteints de FPI nouvellement traités par la pirfénidone ou le nintédanib et de comparer les coûts associés aux deux traitements. Une étude de cohorte basée sur des données du Système national des données de santé (SNDS) français a été réalisée chez des pts atteints de FPI âgés de ≥ 50 ans et traités par anti-fibrotiques entre janvier 2015 et décembre 2016. Les traitements (y compris les anti-fibrotiques), consultations et actes médicaux, hospitalisations et URS indirectes ont été évalués. Les coûts annualisés des URS associées ont été estimés et comparés entre les deux groupes de traitement pendant le suivi, après ajustement sur des variables confondantes, à l’aide de modèles linéaires généralisés utilisant une distribution gamma. Parmi les 7194 pts ayant un diagnostic de FPI au cours de la période de l’étude, 804 ont débuté un traitement par la pirfénidone (11,2 %) et 509 par le nintédanib (7,1 %). Les pts nouvellement traités par le nintédanib avaient des coûts significativement plus élevés pour les traitements médicaux (coût annuel médian : 24 311 € vs 22 006 €, p = 0,0002), les consultations (381 € vs 359 €, p ≤ 0,0001), et la totalité des URS associées (28 882 € vs 27 980 €, p = 0,02) que ceux recevant de la pirfénidone. Aucune différence statistiquement significative n’a été observée pour les actes médicaux (276 € vs 581 €, p = 0,23), les hospitalisations (1398 € vs 2181 €, p = 0,6646) et les coûts de l’URS indirecte (165 € vs 188 €, p = 0,09) entre le nintédanib et la pirfénidone, respectivement. Le coût des traitements, des consultations médicales et les coûts totaux de l’URS sont plus faibles chez les patients traités par pirfénidone que chez ceux traités par nintédanib. Bien que l’interprétation des données soit limitée par la méthodologie liée à une étude observationnelle et peut ne pas s’appliquer à d’autres pays que la France, ces résultats suggèrent des différences de coûts possibles entre les deux anti-fibrotiques disponibles.

L’amélioration des connaissances de l’évolution naturelle de la mucoviscidose a conduit au développement de nouvelles approches thérapeutiques, qui ont amélioré la santé pulmonaire et prolongé l’espérance de vie des personnes atteintes par cette maladie. Cette étude visait à évaluer l’impact des changements démographiques et de prise en charge de la mucoviscidose sur la consommation de soins et les coûts associés de ces patients. La cohorte de patients inclus entre 2006 et 2016 dans le registre français de la mucoviscidose a été chaînée aux données des patients SNDS. Les coûts des traitements, consultations et procédures médicales, hospitalisations, et les coûts indirects ont été annualisés par année calendaire de 2006 à 2017. Sur les 7671 patients inclus dans le registre entre 2006 et 2016, 6187 patients (80,7 %) ont été chaînés (51,9 % d’hommes, âge moyen : 24,7). Le coût moyen par patient était de 14 174 € en 2006, 21 920 € en 2011, et 44 585 € en 2017. Les coûts associés aux séjours hospitaliers ont augmenté, passant de 3 843 € par patient en 2006 à 6 741 € en 2017. La répartition du coût moyen par patient en 2017 était la suivante : 72 % pour les traitements (dont 51 % pour les modulateurs CFTR), 15 % pour les hospitalisations, 7 % pour les consultations médicales, 3 % pour les coûts indirects, 2 % pour les dispositifs médicaux, 1 % pour les procédures médicales en ambulatoire. Le coût annuel moyen des patients atteints de mucoviscidose a fortement augmenté entre 2006 et 2017, notamment le coût lié aux traitements, après l’introduction des modulateurs de la CFTR. L’augmentation du coût des soins des patients atteints de mucoviscidose (avec l’arrivée des nouvelles thérapies) est associée aux améliorations de leur prise en charge et de leur durée de vie.

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.

Le Royaume-Uni (UK) présente des taux de mortalité et d'hospitalisation pour Broncho Pneumopathie Chronique Obstructive (BPCO) plus élevés que ceux de la France. Ces différences pourraient être dues à des différences de prise en charge : le but de cette étude était de décrire la consommation de soins des patients BPCO et les coûts associés dans les 2 pays. Il s'agissait d'une étude transversale répétée chaque année entre 2008 et 2017, réalisée pour la France sur l'Échantillon Généraliste de Bénéficiaires (EGB), et pour le UK sur la base du Clinical Practice Research Datalink (CPRD). Les patients, âgés de 40 ans ou plus, ont été inclus chaque année, identifiés par une hospitalisation pour BPCO ou par la prise de bronchodilatateurs (LABA, LAMA, association fixe [AF] LABA/ICS, AF LABA/LAMA) sur 3 trimestres consécutifs. Nous avons décrit, pour chaque année d'étude : – les caractéristiques socio-démographiques, le nombre d'exacerbations sévères (hospitalisations) et les comorbidités ; – a consommation de soins et les coûts associés en termes de visites médicales, hospitalisations, et types de médicaments dispensés. L'âge moyen des patients BPCO était stable dans le temps et légèrement plus élevé au UK (71 ans) qu'en France (67 ans) ; il en était de même pour la proportion d'hommes dans la population (UK : 51 %, France : 53 %). Le taux de mortalité des patients était stable au cours du temps, et légèrement plus élevé au UK (3 %) qu'en France (2 %). Dans les 2 pays, le diabète était la comorbidité la plus fréquente et sa prévalence augmentait au cours du temps en France (14 % en 2008, 17 % en 2017) alors qu'elle restait stable au UK (∼12 %). Le taux d'exacerbations sévères était plus élevé au UK qu'en France et il augmentait au cours du temps (de 4 % à 6 % en France, et de 12 % à 28 % en Angleterre de 2008 à 2017). En 2008, le taux d'hospitalisations toutes causes était plus élevé au UK (39 %) qu'en France (30 %) et il augmentait entre 2008 et 2017 au UK (59 % en 2017), alors qu'il restait stable en France. Le taux de passages aux urgences était aussi plus élevé au UK, et il augmentait plus fortement au cours du temps qu'en France (de 27 % à 45 % au UK, de 11 % à 16 % en France de 2009 à 2017). Alors que le taux de visite chez le médecin généraliste était similaire entre les 2 pays en 2008 (∼96 %), il a fortement chuté entre 2008 et 2017 au UK (78 %), alors qu'il est resté stable en France durant la même période. Les dispensations d'ICS/LABA en AF ont fortement augmenté au UK entre 2008 et 2017, mais restaient toujours plus élevées en France (70 % vs 58 % en 2017). Les dispensations de corticoïdes oraux étaient plus fréquentes en France (45 %), mais elles ont beaucoup augmenté au UK (de 25 % à 39 %) alors qu'elles sont restées stable en France entre 2008 et 2017. Les coûts associés à la prise en charge de la BPCO augmentaient dans les 2 pays entre 2008 et 2017. Les coûts les plus importants en France étaient ceux des traitements, alors qu'au UK, les coûts des visites étaient les plus élevés. Nous avons mis en évidence des différences de profils et de pratiques dans la prise en charge de la BPCO en France et au UK, qui pourraient en partie expliquer les différences observées entre les 2 pays en termes de mortalité et d'hospitalisation, malgré la difficulté à identifier des populations de sévérité comparable. Ces résultats seront statistiquement comparés ultérieurement, afin de pouvoir tirer des conclusions plus robustes.

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.

Describe and compare healthcare resource utilization (HCRU) among non-valvular atrial fibrillation (NVAF) patients newly treated with apixaban vs. VKA (vitamin K antagonist), rivaroxaban or dabigatran. All adult patients with NVAF newly initiating apixaban, VKA, rivaroxaban or dabigatran between January 2014 and December 2016 (absence of OAC use in the previous 24 months) were identified using the SNIIRAM database. Different types of HCRU were described: medical visits, nurse visits, concomitant drugs, biology dosings, medical procedures and hospital stays. HCRU were compared between groups with generalized linear model adjusted on propensity score, taking account of the follow-up time of patients as offset. Final cohorts included 87,565 apixaban, 112,628 VKA, 100,063 rivaroxaban, and 21,245 dabigatran patients. Over the follow-up period, apixaban patients had an average of 1.8 medical visits per month (SD: 1.9), mostly with general practitioners (89.9%) and cardiologists (52.2%). Mean number of nurse visits was 4.5 per month (SD: 8.5) for 66.3% of patients treated with apixaban. Mean number of concomitant drugs packages was 13.4 per month (SD: 18.0), and most frequent drug classes were antiarrhythmics, beta-blocking agents, analgesics in 68.2%, 64.1%, 60.5% respectively. Half of patients treated with apixaban had monthly dosing of creatinine, glucose and transaminases (56.5%, 55.5%, and 53.1%). Most frequent medical procedures were Doppler, thorax radiography and electrocardiography, 48.5%, 27.6%, and 26.8% and 47.7% of patients had at least one hospitalization. For all HCRU types, apixaban patients had significantly fewer HCRU than VKA patients. For drug claims, biology, and medical procedures, apixaban patients had significantly fewer HCRU than rivaroxaban and dabigatran patients. This large real-world study found lower adjusted HCRU for apixaban compared to VKA and, to a lesser extent, compared to rivaroxaban and dabigatran.

En raison de leur utilisation intensive, les effets des anticoagulants oraux directs (AOD) sur la fibrillation auriculaire non valvulaire (FANV) doivent être évalués dans les conditions réelles d'utilisation. L'objectif était de comparer en vraie vie la sécurité, l'efficacité et la mortalité chez des patients atteints de FANV et initiant apixaban versus les antagonistes de la vitamine K (AVK), rivaroxaban et dabigatran. Étude observationnelle utilisant les données du Système national des données de santé (SNDS) et incluant tous les adultes atteints de FANV ayant initié un AOD entre 2014 et 2016. Trois comparaisons ont été réalisées : apixaban versus AVK, apixaban versus rivaroxaban et apixaban versus dabigatran, sur les critères suivants : saignements majeurs (sécurité), accidents vasculaires cérébraux (AVC) et événements thromboemboliques systémiques (STE, efficacité) et mortalité toutes causes. Un appariement sur score de propension (1 : n) a été utilisé comme méthode principale et un ajustement sur facteurs de confusion comme analyse de sensibilité. Au total, 321 501 patients ont été étudiés, dont 35,0 %, 27,2 %, 31,1 % et 6,6 % ont initié respectivement AVK, apixaban, rivaroxaban et dabigatran. Après appariement sur score de propension, l'utilisation d'apixaban était associée à un risque de saignement plus faible par rapport aux AVK (HR = 0,43, CI 95 % : 0,40–0,46) et au rivaroxaban (HR = 0,67, IC 95 % : 0,63–0,72), mais pas par rapport au dabigatran (HR = 0,93, IC 95 % : 0,81–1,08). apixaban était associé à un risque plus faible d'AVC et de STE que les AVK (HR = 0,60, IC 95 % : 0,56–0,65), mais pas que le rivaroxaban (HR = 1,05, IC 95 % : 0,97–1,15) ou le dabigatran (HR = 0,93, IC95 % : 0,78–1,11). La mortalité toutes causes était plus faible avec apixaban qu'avec les AVK, mais pas comparé au rivaroxaban ou au dabigatran. Apixaban était associé à une meilleure sécurité, efficacité et mortalité comparé aux AVK. Apixaban présentait une sécurité supérieure à celle du rivaroxaban et à une sécurité similaire à celle du dabigatran, ainsi qu'une efficacité similaire à celle du rivaroxaban ou du dabigatran.