Background: Administrative data are used in the field of Alzheimer’s Disease and Related Syndromes (ADRS), however their performance to identify ADRS is unknown. Objective: i) To develop and validate a model to identify ADRS prevalent cases in French administrative data (SNDS), ii) to identify factors associated with false negatives. Methods: Retrospective cohort of subjects ≥ 65 years, living in South-Western France, who attended a memory clinic between April and December 2013. Gold standard for ADRS diagnosis was the memory clinic specialized diagnosis. Memory clinics’ data were matched to administrative data (drug reimbursements, diagnoses during hospitalizations, registration with costly chronic conditions). Prediction models were developed for 1-year and 3-year periods of administrative data using multivariable logistic regression models. Overall model performance, discrimination, and calibration were estimated and corrected for optimism by resampling. Youden index was used to define ADRS positivity and to estimate sensitivity, specificity, positive predictive and negative probabilities. Factors associated with false negatives were identified using multivariable logistic regressions. Results: 3360 subjects were studied, 52% diagnosed with ADRS by memory clinics. Prediction model based on age, all-cause hospitalization, registration with ADRS as a chronic condition, number of anti-dementia drugs, mention of ADRS during hospitalizations had good discriminative performance (c-statistic: 0.814, sensitivity: 76.0%, specificity: 74.2% for 2013 data). 419 false negatives (24.0%) were younger, had more often ADRS types other than Alzheimer’s disease, moderate forms of ADRS, recent diagnosis, and suffered from other comorbidities than true positives. Conclusion: Administrative data presented acceptable performance for detecting ADRS. External validation studies should be encouraged.

Patients suffering from B‐cell non‐Hodgkin lymphomas (B‐NHL) have an increased likelihood of being exposed to proton pump inhibitors (PPIs), related to several factors which have been reported in the literature. PPIs are among the drugs most likely to be prescribed inappropriately. Consequently, B‐NHL patients could be particularly at risk of inappropriate PPI prescription, with potential adverse drug reactions. We aimed to evaluate the incidence of PPIs use and to identify factors associated with PPIs initiation during the active treatment phase of B‐NHL. We conducted a new‐user cohort study using regional data from the French national health insurance database in the Midi‐Pyrénées region (southwestern France). Incident B‐NHL patients were selected according to an algorithm of selection, validated with data from a cancer registry. Our study revealed that 48.9% (95% confidence interval [CI]: 45.2–52.6) of patients initiated PPIs during chemotherapy after B‐NHL diagnosis. According to information available in the SNDS, recommended indications for PPI prescriptions were identified in 21.1% of cases. Median duration of treatment was 65.3 days (CI: 35–112). Determinants of PPIs initiation were peptic ulcer disease, gastroprotection (appropriate or not) for medications considered at risk (NSAIDs, glucocorticoids and anticoagulants), age, nonfollicular lymphoma, polypharmacy, gastroenterologists’ consultations and being hospitalized in a university hospital. Around 50% of patients initiated PPI treatment during the chemotherapy phase with only one‐fifth identified as appropriate prescriptions and with long durations of treatment in most cases. Given this background, appropriate PPI prescription should be promoted in B‐NHL to avoid potential inappropriate chronic use and related adverse events.

The aim of our study was to study the pattern of prescription of direct-acting oral anticoagulants (DOACs) according to the French recommendations.

ObjectiveTo assess and compare direct costs between giant cell arteritis (GCA) patients and matched controls and to identify incremental cost drivers.MethodsWe carried out a population‐based, retrospective cohort study using the French National Health Insurance System database. Cost analysis was performed from the French health insurance perspective and took into account direct medical and nonmedical costs (2014, €). Costs were evaluated according to different cost components and divided into periods of 6 months for the accurate assessment of care consumption. Longitudinal multivariate regression analyses using generalized estimating equations were used to adjust the effect of GCA on the mean cost over time.ResultsAnalyses were performed on 96 incident GCA patients and 563 matched controls. The cumulative incremental cost due to GCA was €6,406 and €7,236 for 3 and 5 years, respectively. Total incremental costs were significant for the first 18 months, amounting to €1,342 for the first 6 months, €1,498 between 6 and 12 months, and €1,165 between 12 and 18 months (P = 0.012, P = 0.065, and P = 0.029, respectively). The most important cost drivers were paramedical procedures, inpatient stays, medication, and medical procedures. Multivariate analysis shows the significant effect of GCA on mean cost during the first 3 years of followup (relative risk [RR] 1.72 [95% confidence interval (95% CI) 1.31–2.27], P < 0.001) with significant cost reductions (RR 0.70 [95% CI 0.49–0.99], P = 0.05) at the end of followup.ConclusionThis study provides an accurate assessment of GCA costs during a 5‐year period and gives useful information for future cost‐effectiveness studies based on new expensive biotherapies.

Background and Objectives: Carpal tunnel syndrome is a frequent cause of neuropathic pain of the upper limb. Surgery is often proposed in second-line treatment, leading to an expected decrease in analgesic drug consumption. The main objective of this study was to investigate the variations in analgesic drug prescriptions, with a special focus on constant or increasing prescription patterns, before and after surgery for carpal tunnel syndrome. Methods: We designed a retrospective cohort study of French beneficiaries from the health insurance system in Midi-Pyrenees area. All patients undergoing carpel tunnel surgery during a specified period were identified and included. Definition of increased or constant prescription of analgesics was based on the comparison of the accumulated defined daily doses received by months and a difference between early preoperative (2 months before) and late postoperative period (2-12 months after surgery) superior to a -3.5 margin. We performed 4 multivariate logistic regression models to identify factors associated with increased or constant analgesic drug prescription patterns (for all analgesics, opioid, antineuropathic, nonopioid drugs). Results: Among the 3665 patients included, 3255 (89%) received at least 1 analgesic drug during the late postoperative period (39% [n = 1426] for opioids and 15% [n = 563] for antineuropathic drugs). Prescription of analgesic, opioid, or antineuropathic drugs was maintained or increased in the late postoperative period in 11%, 5%, and 3% of the population, respectively. High levels of preoperative pain and female sex were associated with an increase in opioid use, whereas inpatient surgery (vs ambulatory surgery), high levels of preoperative pain, and psychiatric disorders were found to be associated with an increase in antineuropathic drug use. Conclusions: This study revealed that approximately 3% to 5% of patients undergoing carpal tunnel surgery had persistent and even increased use of opioid or antineuropathic drugs more than 2 months after surgery, in relation with possible chronic postoperative pain. Considering the incidence of carpal tunnel syndrome, the risks associated with persistent opioid use in this population should be further monitored.

The aim of this study was to compare the infectious risk between a group of psoriasis patients treated by biological drugs ( BD ) and a group treated by traditional systemic treatments ( TST ). We built a retrospective observational cohort study from the French health insurance database in the Midi‐Pyrénées area (2.9 million inhabitants, southwest of France) using data from 01/01/2010 to 12/31/2013. We compared the infectious risk between ‘exposed’ patients treated with BD (adalimumab, etanercept, infliximab, or ustekinumab) and ‘unexposed’ patients treated by TST (phototherapy, acitretin, methotrexate, or cyclosporine). We realized a survival analysis on the first infectious event, defined as an anti‐infective drug delivery or a hospital diagnosis of infection. We selected 101 ‘exposed’ and 788 ‘unexposed’ patients. In our multivariate Cox model, ‘exposure’ did not seem to decrease the time frame of the first infectious event compared with ‘nonexposure’ ( HR = 0.94, P = 0.62). Among all treatment, the safest seemed to be ustekinumab while the least safe was etanercept. We found factors statistically associated with the risk of infection: gender (female vs. male), economic deprivation, chronic hepatitis B or C, history of cancer, at least one infectious event, and the number of different drugs during the 6‐month period before the study. We did not find any difference of infective risk between the BD and the TST . This result enhances the recent PSONET registries conclusions.

Adherence to antiretroviral (ARV) is crucial to achieve viral load suppression in HIV-infected patients. This study aimed to compare adherence to generic multi-tablet regimens (MTR) vs. brand MTR likely to incorporate ARV drugs without breaking fixed-dose combinations (FDC) and brand single-tablet regimens (STR) likely to incorporate generics by breaking the FDC. Patients aged of 18 years or over exposed to one of the generic or the brand of lamivudine (3TC), zidovudine/lamivudine (AZT/TC), nevirapine (NVP), or efavirenz (EFV), or the brand STR of efavirenz/emtricitabine/tenofovir (EFV/FTC/TDF). Adherence was measured by medication possession ratio (MPR) using both defined daily dose (DDD) and daily number of tablet recommended for adults (DNT). Adherence to generic MTR vs. brand MTR and brand STR was compared using Kruskal-Wallis. The overall median adherence was 0.97 (IQR 0.13) by DNT method and 0.97 (0.14) by DDD method. Adherence in patients exposed to generic MTR (n = 165) vs. brand MTR (n = 481) and brand STR (n = 470) was comparable by DNT and DDD methods. In conclusion, adherence to generic MTR was high and comparable with adherence to brand MTR and to STR. Utilization of DDD instead DNT to measure the MPR led to small but nonsignificant difference that has no clinical impact.

Objective.-This study aimed to estimate the rate of generic users among HIV-infected patients treated by antiretroviral (ARV) drugs potentially substitutable and to determine factors associated with switch from brand to generic ARV in real-life settings in a French region. Methods.-Cohort of HIV-infected patients aged of >= 18 years, exposed to at least one of the generic of lamivudine (3TC-150 mg/300 mg), zidovudine/lamivudine (AZT-200 mg/3TC-150 mg), nevirapine (NVP-200 mg), efavirenz (EFV-600 mg) and those exposed to brand 3TC, AZT/3TC, NVP, EFV, the fixed-dose combination abacavir/lamivudine (ABC/3TC) or the single-tablet regimen efavirenz/emtricitabine/tenofovir (EFV/FTC/TDF) as recorded in the French health insurance database between January 2012 and May 2015 were included. Factors associated with switch (for each generic versus its brand drug; and for situation requiring breaking the combination) were investigated through a logistic regression. Results.-Among the 1539 patients likely to switch from brand ARV drugs, only 165 (11%) were exposed to generics. For EFV users, switch from brand to generic was associated with age (aOR = 1.04 [CI: 1.00-1.08]). For ABC/3TC users, switch was significantly more frequent in patients receiving a monthly average of more than two non-ARV drugs (3.08 [1.42-6.68]) and whose regimen contained a non-nucleoside reverse transcriptase inhibitor (NNRTI) as index medication (3rd agent) (5.68 [2.68-11.39]). By contrast, switch was less frequent in AZT/3TC users exposed to drugs used in digestive disorders (0.39 [0.18-0.88]) or analgesics (0.42 [0.20-0.90]). Conclusion. Treatment-experienced HIV patients whose disease has been stabilized (less comorbidities) are more likely to switch to generic antiretroviral drugs. (C) 2017 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.

AIM:This article proposes a description of French regional consumption of antibiotics with a bacterial resistance risk (amoxicillin+clavulanic acid, third-generation cephalosporins [C3G] and fluoroquinolones). METHODS:Antibiotics reimbursements data were obtained by Open Medic website. The antibiotic consumption profile has been established using some indicators of the European Surveillance of Antimicrobial Consumption (ESAC) in daily-defined dose per 1000 inhabitants per day (DID) or in percentage. RESULTS:Provence-Alpes-Côte d'Azur-Corse (34.4 DID) and Midi-Pyrénées-Languedoc-Roussillon (33.5 DID) consume the most of both, systemic antibiotics and antibiotics with a bacterial resistance risk. Pays-de-la-Loire (26.7 DID), Bretagne (29.1 DID), Centre-Val-de-Loire (29.7 DID) et Auvergne-Rhône-Alpes (29.7 DID) consume the less of both, systemic antibiotics and antibiotics with a bacterial resistance risk. CONCLUSION:Even if some environmental and socioeconomic factors could explain variabilities between regions, a link between consumption intensity and misuse is not excluded.

Cet article propose une description de la consommation régionale française d'antibiotiques fortement pourvoyeurs de résistances bactériennes (amoxicilline + acide clavulanique, céphalosporines de 3e génération et fluoroquinolones). Les données de remboursements des antibiotiques ont été obtenues via Open Medic. Le profil de consommation a été établi par certains indicateurs de l'European Surveillance of Antimicrobial Consumption (ESAC) exprimés en daily defined dose per 1000 inhabitants per day (DID) et/ou en pourcentages. Provence-Alpes-Côte d'Azur-Corse (34,4 DID) et Midi-Pyrénées-Languedoc-Roussillon (33,5 DID) consomment le plus d'antibiotiques systémiques et d'antibiotiques pourvoyeurs de résistances. Les régions Pays-de-la-Loire (26,7 DID), Bretagne (29,1 DID), Centre-Val-de-Loire (29,7 DID) et Auvergne-Rhône-Alpes (29,7 DID) consomment le moins d'antibiotiques systémiques et d'antibiotiques pourvoyeurs de résistances. Même si de nombreux facteurs environnementaux et socioéconomiques pouvaient expliquer cette variabilité de consommation entre les régions françaises, une corrélation entre volume de consommation et mésusage n'est pas à exclure. This article proposes a description of French regional consumption of antibiotics with a bacterial resistance risk (amoxicillin + clavulanic acid, third-generation cephalosporins [C3G] and fluoroquinolones). Antibiotics reimbursements data were obtained by Open Medic website. The antibiotic consumption profile has been established using some indicators of the European Surveillance of Antimicrobial Consumption (ESAC) in daily-defined dose per 1000 inhabitants per day (DID) or in percentage. Provence-Alpes-Côte d'Azur-Corse (34.4 DID) and Midi-Pyrénées-Languedoc-Roussillon (33.5 DID) consume the most of both, systemic antibiotics and antibiotics with a bacterial resistance risk. Pays-de-la-Loire (26.7 DID), Bretagne (29.1 DID), Centre-Val-de-Loire (29.7 DID) et Auvergne-Rhône-Alpes (29.7 DID) consume the less of both, systemic antibiotics and antibiotics with a bacterial resistance risk. Even if some environmental and socioeconomic factors could explain variabilities between regions, a link between consumption intensity and misuse is not excluded.

The purpose of this study was to measure the rate of substitution failure to generic antiepileptic drugs (AEDs) compared to two other pharmacotherapeutic classes (neuroleptics, beta-blockers).

OBJECTIVES:Pneumonia is a frequent condition in older people. Our aim was to examine the total healthcare cost related to pneumonia in nursing home (NH) residents over a 1-year follow-up period. DESIGN:This was a prospective, longitudinal, observational, and multicenter study that was a part of the Incidence of Pneumonia and related Consequences in Nursing Home Resident study. SETTING:Thirteen NHs located in Languedoc Roussillon and Midi-Pyrénées regions in France were included. PARTICIPANTS:Resident in NH, older than 60 years and had a group iso-resource score ranging from 2 to 5. MEASUREMENTS:Pneumonia events were characterized according to the Observatoire du Risque Infectieux en Geriatrie criteria. Direct medical and nonmedical costs were assessed from the French health insurance perspective. Healthcare resources was retrospectively gathered from the French Social Health Insurance database and valued using the tariffs reimbursed by the French health insurance. Sociodemographic variables, clinical factors, vaccinations, cognition, depression, functional status, frailty index, as well as group iso-resource score were also recorded. RESULTS:Among the 800 patients initially included in the Incidence of Pneumonia and Related Consequences in Nursing Home Resident study, 345 which were listed in the database of the French Social Health Insurance were included in this economic study. Among them, 64 (18%) experienced at least 1 episode of pneumonia during the 1-year follow-up period. Mean annual total additional cost for a patient who experienced at least 1 episode of pneumonia during the 1 year follow-up period is 2813€. On average, total annual costs increased by 60% to 93% when a patient experienced at least 1 episode of pneumonia. CONCLUSIONS:NH-acquired pneumonia has a great impact on total cost of care for NH residents. Our results suggest the potential economic savings that could be achieved if pneumonia could be prevented in NHs.

Patients with B cell non-Hodgkin’s lymphomas (B-NHLs) are known to be at risk of developing psychological disorders. The aims of this study were to measure the incidence of psychotropic drug use during the diagnosis and the active treatment phase in comparison with controls from the general population, and to identify factors associated with this use.

Background Parkinson’s disease (PD) is characterized by its impact on quality of life, constituting a substantial economic burden on society. Education programs implicating patients more in the management of their illness and complementing medical treatment may be a beneficial adjunct in PD. This study assessed the impact of an education program on quality of life and its cost-effectiveness in PD patients. Methods This single-center, prospective, randomized study assessed an education program consisting of individual and group sessions over a 12-month period. A total of 120 PD patients were assigned to either the Treated by Behavioral Intervention group (TTBI) or the no TTBI group. The primary outcome criterion was quality of life assessed using PDQ39. The Unified Parkinson’s Disease Rating Scale (UPDRS) and psychological status were collected. An economic evaluation was performed, including calculations of incremental cost-effectiveness ratios (ICERs). Results After 12 months of follow-up, changes recorded in the PDQ39 between the groups were not significantly different but better changes were observed in each dimension in the TTBI group compared to the no TTBI group. UPDRS I, II and total score were significantly improved in TTBI group compared to the no TTBI group. Mean annual costs did not differ significantly between the two groups. Conclusion This study suggested that the education program positively impacts the perceived health of PD patients without increasing medical costs.

Introduction. - Antipapillomavirus vaccination is used to prevent genital infection by papilloma virus, responsible for a high morbidity. In France, the High Council for Public Health published on September 28th 2012 a new guideline decreasing the age of vaccination from 16 to between 11 to 14 allowing a joint vaccination with mandatory tetravalent or trivalent (against diphtheria, tetanus, pertussis and poliomyelitis Tdap-IPV or Td/IPV booster) vaccination. Our study aimed to assess if this guideline changed the rate of joint vaccinations.Methods. - A descriptive before/after study was conducted on French health insurance reimbursement database at the regional level (Midi-Pyrenees area). The study period comprised 1 year before and 1 year after the publication of the new guideline. We assess the rate of co-vaccinations in these 2 periods and compared them by a Chi(2) test.Results. - On the study period, 35,647 vaccines were reimbursed corresponding to 18,230 complete vaccinations. Concerning co-vaccinations, 3287 were reimbursed: 1406 (16.4%) before the publication of the guideline and 1881 (19.4%) after (P < 0.01).Discussion. - The new guideline was accompanied by a rapid increase in the rate of co-vaccinations. It did not diminish the rate of vaccination by antipapillomavirus. (C) 2016 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.

Objective. To identify predictors and protectors for cardiovascular hospitalization in a giant cell arteritis (GCA) population-based cohort. Methods. Using the French National Health Insurance system, we included patients with incident GCA from the Midi-Pyrenees region, southern France, from January 2005 to December 2008 and randomly selected 6 controls matched by sex and age at calendar date. We used a Cox model to identify independent predictors for cardiovascular hospitalization [combining stroke, coronary artery disease (CAD), heart failure, peripheral arterial disease, or cardiac arrhythmias]. Results. Among 103 patients with GCA followed 48.9 ± 14.8 months, the incidence rates of hospitalization for cardiovascular disease, atherosclerotic disease (combining stroke, CAD, and peripheral arterial disease), heart failure, and cardiac arrhythmias were 48.6, 17.5, 14.8, and 9.8 events per 1000 person-years versus 14.9, 4.6, 6.2, and 2.5 events per 1000 person-years among controls, respectively. In patients with GCA, cardiovascular comorbidities at diagnosis (HR 6.2, 2.0–19.2), age over 77 years (HR 5.0, 1.40–17.54), as well as the cumulative defined daily dose of statins (HR 0.993, 0.986–0.999) were independent predictors for subsequent cardiovascular hospitalization. None of the 25 patients with GCA who were taking platelet aggregation inhibitors experienced a cardiovascular hospitalization during followup. Conclusion. Patients with GCA present a high risk of cardiovascular hospitalization after diagnosis. In patients with incident GCA from the Midi-Pyrenees region, southern France, statin therapy was associated with reduced cardiovascular hospitalizations.