Background Venous thromboembolism (VTE) and cancer are strongly associated. In France, evidence on patients with pancreatic, upper GI [gastrointestinal], lower GI, lung, or breast cancer-associated VTE and their hospital management is limited. The aims of this study were to provide data on the number of hospitalized VTE events among cancer patients, the patients’ characteristics, and their hospital management to estimate the burden of disease and the hospital burden of cancer-related VTE and to provide guidance on research. Methods This longitudinal, observational, and retrospective study was based on the comprehensive hospital discharge database (PMSI). Adult patients (≥ 18 years old) hospitalized with a cancer of interest in 2016 and hospitalized (within 2 years with VTE (captured a as a principal, related, or significant associated diagnosis) were included in the study. Results We identified 340,946 cancer patients, of which 7.2% (24,433 patients) were hospitalized with VTE. The proportions of hospitalized VTE were 14.6% (3,237) for patients with pancreatic cancer, 11.2% (8,339) for lung cancer, 9.9% (2,232) for upper GI cancer, 6.7% (7,011) for lower GI cancer, and 3.1% (3,614) for breast cancer. Around two thirds of cancer patients with a hospitalized VTE had active cancer (with metastases and/or receiving chemotherapy during the six months prior to the index date): from 62% of patients with pancreatic cancer to 72% with breast cancer. Around a third of patients were admitted to the hospital through the emergency room, up to 3% of patients stayed in an intensive care unit. The average length of stay ranged from 10 (breast cancer) to 15 days (upper GI cancer). Nine (lower GI cancer) to 18% (pancreatic cancer) of patients died during the VTE hospital stay. Conclusions The burden of cancer-associated VTE is substantial, both in terms of the number of patients affected and in the hospital use. These findings offer guidance on future research on VTE prophylaxis in a very high-risk population, particularly in patients with active cancer.

Purpose Incisional hernias are common after laparotomies. The aims of this study were to assess the rate of incisional hernia repair after abdominal surgery, recurrence rate, hospital costs, and risk factors, in France. Methods This national, retrospective, longitudinal, observational study was based on the exhaustive hospital discharge database (PMSI). All adult patients (≥ 18 years old) hospitalised for an abdominal surgical procedure between 01-01-2013 and 31-12-2014 and hospitalised for incisional hernia repair within five years were included. Descriptive analyses and cost analyses from the National Health Insurance (NHI) viewpoint (hospital care for the hernia repair) were performed. To identify risk factors for hernia repair a multivariable Cox model and a machine learning analysis were performed. Results In 2013–2014, 710074 patients underwent abdominal surgery, of which 32633 (4.6%) and 5117 (0.7%) had ≥ 1 and ≥ 2 incisional hernia repair(s) within five years, respectively. Mean hospital costs amounted to €4153/hernia repair, representing nearly €67.7 million/year. Some surgical sites exposed patients at high risk of incisional hernia repair: colon and rectum (hazard ratio [HR] 1.2), and other sites on the small bowel and the peritoneum (HR 1.4). Laparotomy procedure and being ≥ 40 years old put patients at high risk of incisional hernia repair even when operated on low-risk sites such as stomach, duodenum, and hepatobiliary. Conclusion The burden of incisional hernia repair is high and most patients are at risk either due to age ≥ 40 or the surgery site. New approaches to prevent the onset of incisional hernia are warranted.

To identify patients with unresectable/locally advanced or metastatic esophageal cancer in France. An observational retrospective study was conducted using the French exhaustive National hospital discharge database (PMSI). As there is no specific ICD-10 code for this specific stage, the study considered a stepwise approach algorithm based on expert inputs and combining criteria as ICD-10, surgery codes, treatment duration and stays in palliative care. Adults hospitalized with an ICD-10 code of esophageal cancer (C15 excluding C152) in 2015 and 2016 were included. Patients with a surgery were excluded, except those having a metastasis (C77-C79). Patients considered too weak to receive another treatment were excluded if they had a treatment discontinuation in the 2-month period after the first chemotherapy and/or at least one stay through palliative care. Treatment was defined as chemotherapy (Z511) and treatment lines were defined as (i) First line for the 0-6 months period after patient identification, (ii) Second line for the 6-10 months period and (iii) Third line for the 10 months and over period, in accordance with literature. Overall, 19,582 patients with unresectable/locally advanced or metastatic esophageal cancer were identified: a prevalent number of 11,878 patients (6,791 new cases) in 2015 and 13,713 in 2016 (6,520 new cases). Among these patients, 9,799 were considered eligible to receive a treatment, and 4,032 received at least one chemotherapy session during the study period (1st line: 3,962, 2nd line: 1,225 and 3rd line: 351). Patients were aged 65.2±9.6, 64.0±9.3 and 63.7±9.4 respectively for each treatment line and proportion of men was 81.8%, 82.3% and 87.2% respectively. Stepwise algorithm was defined from French hospital discharge database to identify patients with unresectable/locally advanced or metastatic esophageal cancer. Results were aligned with published literature. This will lead to future studies to assess burden of this disease in France.

To describe hospital resource utilization and costs for the management of patients with unresectable/locally advanced or metastatic esophageal cancer, eligible for a first-line treatment. An observational retrospective cohort study was conducted using the French exhaustive hospital discharge database (PMSI). Study population was identified through an algorithm based on expert inputs and combining criteria as ICD-10, surgery codes, treatment duration and stays in palliative care. Adults hospitalized with an ICD-10 code of esophageal cancer (C15 excluding C152) in 2015 and 2016 were included. Patients with a surgery were excluded, except those having a metastasis (C77-C79). Patient with a systemic anti-cancer therapy (SACT) less than 2 months or with at least one stay in palliative care were excluded, assuming weakness to receive SACT. Treatment was defined as chemotherapy (Z511) and first-line treatment was defined as the 0-6 months period after patient identification based on literature. Overall, 19,582 patients with unresectable/locally advanced or metastatic esophageal cancer were identified; 9,799 were considered eligible to receive a treatment. Among them, 4,032 received at least one chemotherapy session during the study period and 3,962 were treated in first line. These patients were aged 65.2±9.6 and 81.8% were men. 2-year mortality rate was 23%. 59,009 hospital stays were observed and distributed as 47% related to chemotherapy, 33% to radiotherapy and 20% for other reasons. Among chemotherapy sessions, 10% were associated with expensive drugs funded on top of DRG list. Chemotherapy and radiotherapy sessions were day hospitalization in majority and costed in average respectively 633.68±994.93€ and 270.41±351.05€ from NHI perspective and 1,038±684€ and 209±422€ from collective perspective. Transportation cost was estimated at 35.17€/session. This study showed that only 50% of patients with unresectable/locally advanced or metastatic esophageal cancer were eligible to receive a treatment and only 20% received at least one chemotherapy session.

Venous thromboembolism (VTE), a frequent and potentially life-threatening disease, represents one of the most important causes of morbidity and mortality in cancer patients. However very few real-world data are available in France on those patients and their hospital management. A retrospective cross-sectional study was performed using the French exhaustive National hospital discharge database (PMSI). Patients with a cancer of interest were included in 2016 and followed until 2018. A total of 14 cancers were selected through ICD-10 codes: Lung, Breast, Upper & Lower Gastrointestinal, Head and Neck-Nose-Throat, Prostate, Pancreas, Gynecological, Urothelial, Testicle, Myeloma, Melanoma, Glioblastoma and Lymphoma. Patients were described and relevant comorbidities were assessed using also ICD-10 codes. VTE rate per cancer of interest was calculated and hospital management and its associated costs were described. Median age of cancer patients experiencing VTE ranged from 39 (testicle) to 74 years old (urothelial). Between 4% (myeloma) and 71% (testicle) of cancer patients experiencing VTE had metastasis. The VTE rate ranged from 3.1% (breast and prostate) to 14.6% (pancreas) during the 2-year follow-up. Lung cancer was the most important in terms of absolute numbers with 8,339 patients experiencing VTE. Median length of stay for VTE ranged from 5 (testicle) to 10 days (upper GI and glioblastoma). Median cost of stay for VTE ranged from 3,057€ (testicle) to 5,484€ (glioblastoma). This study provides a recent and comprehensive description of cancer-associated VTE and their hospital management in France based on large real-world data on VTE patients and management with details for each cancer of interest.

Venous thromboembolism (VTE) is caused by the formation of a thrombus in the bloodstream. VTE includes deep vein thrombosis, which can evolve to embolism if the thrombus breaks off. VTE is a frequent pathology, with an annual incidence of 1 to 2 per 1,000 inhabitants in France and a severe pathology, with a 3-month mortality between 10 and 15%. However very few real-world data are available in France on those patients and their hospital management. A retrospective cross-sectional study was conducted using the French exhaustive National hospital discharge database (PMSI). VTE patients were included between 2014 and 2017 and followed until 2018. The study was conducted for the whole VTE population and on two distinct cohorts: (i) patients with venous thrombosis (I80*, I820 I821, I636, I676, O222, O223, O225, O870, O871 and O873) and (ii) patients with embolism (I26*, I822, I823, I828, I829 and O882). Relevant comorbidities were assessed using also ICD-10 codes. Incidence and prevalence of VTE inpatients were calculated and hospital management and its associated costs were described. In-hospital mortality was assessed using Kaplan-Meier model. The number of VTE patients increased from 133,633 to 143,873 between 2014 and 2017 with more than 90% of incident patients. The prevalence and incident rates were stable at 2 per 1,000 inhabitants. Median age was 71 and 52.7% were female. Median length of first VTE episode was 6 days and a recurrence lasted 2 days. The median delay between first and second episode was 354 days. The burden of VTE reached 238.8M€ in 2017. The 1-year hospital mortality was 5.11%. This study provides a recent and detailed description of VTE patients and their hospital management in France. VTE patients hospital management was found to be associated with a high economic burden, mainly caused by the first hospital stay.

Limited information is available on cost associated with AHSCT and in particular those detailing the cost of pre-transplant chemotherapy and post-transplant follow-up care. The aim of this study was to estimate the average hospital cost per patient for AHSCT pre- AHSCT chemotherapy cost and the 6-month transplant follow-up care cost. A retrospective study of patients with RR DLBCL (diffuse large b-cell lymphoma) at ages 18 and more was performed from French hospital database (PMSI) 2013 to 2016. Hospital stays were selected with the ICD10 code CIM C833 "Diffuse large B-cell lymphoma” in position of: Principal Diagnosis (PD) or Related Diagnosis (RD) or Associated Diagnosis between 01/01/2013 and 01/01/2014. Refractory patients could not be identified in the database. Relapsed patients were defined as patients by 2 criteria: (a) at least one complete cycle of rituximab chemotherapy (b) bone marrow biopsy followed by hospitalization. For each allograft identified with CCAM (Classification Commune des Actes Médicaux) procedure FEFFL009 "intravenous injection of a cell therapy for transplant", a cost evaluation per patient (€2017) was calculated according to the French health service perspective by detailing: the cost of pre-transplant chemotherapy, cost of transplant and the cost of follow-up. The prevalence of AHSCT refractory DLBCL was 6 patients in the PMSI. The median transplant cost per patient was € 85,038 (€79,216 - €121,199), the pre AHSCT chemotherapy median cost was € 13,940 (€ 2,521 -€33,246) and the follow-up median cost was € 11,398 (€3,157 -€51,094). The mean transplant cost per patient was € 93,233(±€14,973), the pre AHSCT chemotherapy mean cost was €14,617 (±€9,342) and the follow-up mean cost was € 16,625(±€16,378). The study showed that the economic burden of AHSCT in DLBCL patients, based on the hospital costs, is significant

Limited information is available on cost associated with AHSCT and in particular those detailing pre-transplant chemotherapy and post-transplant follow-up care. The aim of this study was to estimate the average hospital cost per patient of AHSCT, pre- AHSCT chemotherapy cost and the 6-month transplant follow-up care cost. A retrospective study of patients with RR B-cell ALL (acute lymphoblastic leukemia) at ages 3 and 25 was performed from French hospital database (PMSI) 2013 to 2016. Hospital stays were selected with the ICD10 code CIM C910 "Acute lymphoblastic leukemia” in position of: Principal Diagnosis (PD) or Related Diagnosis (RD) or Associated Diagnosis between 01/01/2013 and 01/01/2014 excluding stays with a Nelarabine administration. Refractory patients could not be identified in the database. Relapsed patients were defined as patients by 2 criteria: (a) at least one complete cycle of chemotherapy prior to transplant (b) bone marrow biopsy followed by hospitalization. For each allograft identified with CCAM (Classification Commune des Actes Médicaux) procedure FEFFL009 "intravenous injection of a cell therapy for transplant", a cost evaluation per stay and patient (€, 2017) was calculated according to the French health service perspective by detailing: the cost of pre- AHSCT chemotherapy, cost of transplant and the cost of follow-up. The prevalence of AHSCT refractory LAL was 126 patients in the PMSI. The median transplant cost per patient was €92,740 (€38,746 - €283,596), the pre-AHSCT chemotherapy median cost was €122,266 (€415 -€344,116) and the follow-up median cost was € 8,467 (€ 628 - €74,081). The mean transplant cost per patient was € 96,738(±€33,758), the pre AHSCT chemotherapy mean cost was €133,319 (±€67,659) and the follow-up mean cost was € 15,676(±€16,940). The study showed that the economic burden of AHSCT in LAL patients, based on the hospital costs, is significant.

Functional menorrhagia is responsive of significant economic burden, as its initial management is based on surgical strategies and implies hospitalization in case of failure or severe complications. The objective of this study is to compare 4 surgical strategies used for the treatment of functional menorrhagia in terms of costs and failure or complication avoided. A retrospective database analysis was performed using the French exhaustive national hospital discharge database (PMSI). All hospital stays from 2009 to 2015 with 4 types of menorrhagia surgery identified by CCAM codes associated with ICD-10 codes were extracted: 2nd generation (2G), 1st generation (1G), curettage, hysterectomy. Only incident 35-55 year-old women were analyzed (no surgery since 2006). Rehospitalizations related to surgery failure or severe complication were followed during at least 18 months. Hospital costs associated with these patients were estimated using the French official tariffs expressed in 2017 Euro. A cost-effectiveness analysis was performed comparing each surgical procedure to 2G, in terms of cost and rate of failure or severe complication avoided. 7,863 patients with 2G (7%), 39,935 with 1G (36%), 38,923 with curettage (35%), 23,163 with hysterectomy (21%) were included. Mean cost per patient was respectively €4,285 for curettage, €6,064 for hysterectomy, €4,182 for 2G and €3,765 for 1G. Failure or complication occurred in respectively in 17.9%, 30.6%, 10.1% and 21.5% of patients treated by 2G, curettage, hysterectomy and 1G. As compared to 2G, curettage was dominated (less effective and more expensive), hysterectomy was more expensive and more effective (ICER = €24,128 per % of patient with failure or complication avoided) and 1G was less effective and less expensive (ICER = €11,583 per % patient with failure or complication avoided). This study shows 1G and 2G techniques are cost-effective, in line with their recommended use at first stage in France.

Few data exist on comparative costs between splenectomized and non-splenectomized ITP patients. The objective of this study was to estimate, with a 6 to 9-year time horizon, the average hospital cost of splenectomized ITP patients including the surgical procedure and their follow-up in comparison with the average hospital cost of non-splenectomized ITP patients. A PMSI data analysis was performed on 4 cohorts of incident ITP patients in lag (2007 to 2010 until 2015), with or without splenectomy. Hospital stays were selected with the ICD10 code D69.3 in position of: Principal Diagnosis (PD) or Related Diagnosis (RD) or Associated Diagnosis with selected ICD10 codes in PD/RD related to hemorrhage, thrombosis and infection. The list of codes was selected by French clinicians. An incident ITP patient was defined as any patient who had never had an ICD10 code "D69.3" on the calendar year preceding the inclusion. Hospital stays with at least one of the 2 CCAM codes for splenectomy (FFFC001 "Total splenectomy by laparoscopy", FFFA001 "Total splenectomy by laparotomy") were extracted. For each stay, a disease related group (DRG) cost (€, 2016) was calculated according to the French health service perspective. Costs of extra-DRG drugs were not accounted for. The incidence of ITP was stable over time with 3,600-3,900 patients/year. The incident number of hospital stays for ITP was also stable over time (12,000-14,000 stays). The number of splenectomized patients has decreased by 37% since 2007 (152 patients were splenectomized in 2015 vs. 241 in 2007). The average hospital cost of ITP patients varied from 13,428€ to 14,446€ per splenectomized patient and from 3,459€ to 3,599€ per non-splenectomized patient. This study suggests that hospitalization costs for hemorrhage, thrombosis and infection are higher in the group of splenectomized patients. A cost-effectiveness analysis from a broader perspective (in and out patients) should be conducted.

To assess the current hospital burden of functional menorrhagia surgically treated in France. A retrospective database analysis was performed using the French exhaustive national hospital discharge database (PMSI). All hospital stays from 2009 to 2015 with 4 types of menorrhagia surgery identified by CCAM codes associated with ICD-10 codes were extracted: 2nd generation (2G), 1st generation (1G), curettage, hysterectomy. Only incident 35-55 year-old women were analyzed (no surgery since 2006). An algorithm was completed with the medical input of experts in order to exclude any patient identified as presenting comorbidities that would introduce bias in the results (breast or colorectal cancer, myoma, endometriosis…). Patients operated on before 2014/06/30 were followed at least 18 months from their surgery. Another algorithm and a medical review identified rehospitalizations related to surgery failure or complication. Hospital costs associated with these patients were estimated using the French official tariffs expressed in 2017 Euro. 7,863 patients with 2G (7%), 39,935 with 1G (36%), 38,923 with curettage (35%), 23,163 with hysterectomy (21%) were included. Whereas the global evolution was -13% from 2009 to 2015, it was +80% for 2G and +5% for 1G, and -37% for curettage and -15% for hysterectomy. The 18-month failure rate ran from 2.8% for hysterectomy to 9.9% for 2G, 12.7% for 1G and 20.6% for curettage, whereas the 18-month complication rate was 1.4% for curettage, 1.5% for 1G, 1.9% for 2G and 5.3% for hysterectomy. The trend was similar at 24 and 60 months. The 18-month median cost per patient varied from €782 [Q1 741-Q3 2,732] for curettage to €1,059 [913-2,075] for 1G, €1,173 [1,002-2,231] for 2G, €3,090 [2,909-4,189] for hysterectomy. This study shows that mini-invasive 1G and 2G techniques low complication rates and costs are in line with their recommended use at first stage.