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A Vergnenègre

Publications and source records attributed to A Vergnenègre.

At least 19 recordsLinked to original sources
PubMed2006

[Economic analysis of home based versus hospital outpatient chemotherapy in stage IV non small cell lung cancer].

BACKGROUND: French law and government decisions have induced new development for home base treatments. The objective was to compare cost of home base chemotherapy (HBC) versus outpatient infusions, for non small cell lung cancer (NSCLC). METHODS: 10 patients were selected in each category. D8 of their cycles was performed at home compared to outpatient infusion. Costs were based on national fees with cytostatic drugs as supplement. The real cost was also assessed through a specific questionnaire. RESULTS: 30 D8 infusions were carried out at hospital and 24 D8 infusions at home. Average cost by cycle was 2,829.51 euros [2 560.74-3 147.02] for hospital infusion, 2,372.50 euros [1 962.75-2 792.88] for HBC (-16.15%). Difference was -457.01 euros by cycle [-919.74; 26.82]. Real costs by injection for BHC was 484.42 euros [424.18; 540.32] versus a fee of 699.89 euros [643.64; 750.23]. There were no difference in terms of adverse events. CONCLUSION: HBC for NSCLC is feasible. Average costs by cycle is lower of 16% versus hospital infusion. The results of this non randomized study had to be confirm by further clinical trials.

Ambulatory Care↗
PubMed2006

[Tools for assessing healthcare delivery].

INTRODUCTION: Assessing the quality of care has become an essential part of the medical process. In France, the Professional Practice Evaluation requires a sound knowledge of these techniques. BACKGROUND: The different tools that can be used to carry out quality assessment are presented, with their specific applications. Two main categories can be used. The first are information synthesis techniques such as consensus conferences, practice guidelines, and panellist's appropriateness rating. The second category is based on comparison to a reference: clinical audit, targeted clinical audit, or appropriateness evaluation protocols. Other, less commonly employed approaches include a problem solving approach, which is often included in total quality management, clinical care pathway, risk management, mortality morbidity conference, adverse event monitoring, and statistical process control charts. VIEWPOINT: These tools will be widely used in the next few years, because the recent changes in French law could increase their use. CONCLUSION: A good knowledge of these techniques is needed in order to improve quality assessment.

Consensus Statements as Topic↗
PubMed2005

Docetaxel and concurrent radiotherapy after two cycles of induction chemotherapy with cisplatin and vinorelbine in patients with locally advanced non-small-cell lung cancer. A phase II trial conducted by the Groupe Francais de Pneumo-Cancerologie (GFPC).

CONTEXT: The most satisfactory treatment for patients with locally advanced non-small-cell lung cancer (NSCLC) is combination chemotherapy-radiotherapy (CT-RT). The optimal treatment modalities remain to be determined. OBJECTIVE: We conducted a multicenter phase II trial of the docetaxel-radiotherapy combination after induction chemotherapy with cisplatin-vinorelbine. The main endpoint was the objective response rate. PATIENTS AND METHODS: Patient with inoperable stage locally advanced NSCLC received induction chemotherapy consisting of two cycles of cisplatin 100 mg/m2 on D1 and vinorelbine 25 mg/m2 on D1, D8, D15 and D22. Patients with responses or stable disease then received concurrent RT-CT consisting of 25 mg/m2/week docetaxel and single-fraction radiotherapy (66 grays (Gy) in 33 fractions) over 6.5 weeks. RESULTS: Fifty-six patients were enrolled from 1 July 2000 to 31 December 2001. Sixteen patients left the trial after induction chemotherapy, eight for progression, five for toxicity, and two for intercurrent events. One patient underwent surgery after induction chemotherapy. In total, 40 of the 56 patients received RT-CT. Twelve (30%) of these 40 patients experienced grade III or IV pulmonary or esophageal toxicity. In the intention-to-treat analysis, the objective response rate was 46.4% (95% CI 33.0-60.2). The median time to progression was 6.2 months [1.1-26.0]. The median survival time was 13 months [0.3-44.9 months]. Nine patients progressed during RT-CT, six with brain metastases. CONCLUSION: Weekly docetaxel with concurrent radiotherapy, following chemotherapy is acceptable. The tumor response rate is moderate. Further trials are required to determine the risk-benefit relationship of this treatment schedule, and the possible benefit of adding other cytotoxic drugs.

Adult↗
PubMed2004

Economics of the clinical management of lung cancer in France: an analysis using a Markov model.

To evaluate, according to the histologic type and initial stage, the mean cost (MC) of managing patients with lung cancer and the costs of the different management phases. A Markov approach was used to model these costs, based on the management of a representative nation-wide sample of 428 patients with newly diagnosed lung cancer. The 18-month MC ranged from US$ 20 691 (95% CI: 5777-50 380 for diffuse non-small-cell lung cancer (NSCLC) to US$ 31 833 (95% CI: 15 866-64 455) for localised small-cell lung cancer (SCLC); first-line treatment costs ranged from 33.8% of MC for medically inoperable localised NSCLC to 74.6% for diffuse SCLC; second- or third-line treatment costs ranged from 7.8% of MC for surgically treated localised NSCLC to 32% for locally advanced NSCLC; and the cost of palliative care ranged from 9.1% of MC for locally advanced NSCLC to 39.9% for medically inoperable localised NSCLC. The cost of first-line chemotherapy and the percentage of actively treated patients impacted more on MC than did the cost of second- or third-line chemotherapy regimens or the cost of palliative care. In conclusion, this model provides a robust economic analysis of the cost of lung cancer management, and will be useful for assessing the economic consequences of future changes in patient management.

Aged↗
PubMed2004

[The costs of asthma in France: an economic analysis by a Markov model].

INTRODUCTION: In France about 3.5 million people suffer from asthma, with an estimated annual cost of 1.5 billion euros. Few data on the components of the cost are available. To develop a medico-economic model to identify the mean annual cost of a patient with asthma together with the components of the cost and the consequences of different modalities of management (out-patient and in-patient). METHODS: A first degree homogeneous Markov model was constructed, based on published data, to identify the different states of health of asthmatic patients, their development and probabilities of change from one to another. RESULTS: The mean annual cost of asthma is 631 +/- 299 euros; 298 euros for stable patients, 1,052 for those who have at least one acute attack and 3,811 for those hospitalised. Actions leading to better control of the disease in the community (prevention and management of attacks) would produce a larger reduction in mean costs than actions undertaken in patients seen as an emergency or admitted to hospital. CONCLUSIONS: From the point of view of society better control of asthma in the community is the most effective strategy to reduce expenditure.

Asthma↗
PubMed2004

[The cost components of the management strategies for lung cancer in France].

INTRODUCTION: To evaluate the average cost of therapeutic strategies for the management of lung cancer in relation to histological type and diagnostic staging and of the individual components of the management strategy. METHODS: Samples were taken between 1 September 1998 and 30 June 1999 from centres with sufficient numbers of lung cancer (LC) cases. All events over an 18 Month period were collected from a retrospective analysis of the records. A Markov model was constructed based on decision branches for localised and diffuse small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Several components of management were identified: first line treatment, second line treatment, observation, terminal care and death. RESULTS: The average cost of LC was 22,006 Euro (10,631-36,296) for one year and 25,643 Euro (10,631-46,191) for two years. For SCLC the average annual costs were 22,420 Euro for diffuse disease and 27,098 for localised disease. For NSCLC the totals ranged from 19,543 Euro for inoperable stage I and II tumours to 39,424 for operable tumours. The cost for stage IV tumours was 24,383 Euro. The cost components over two Years varied according to the tumour type. The cost of diagnosis ranged from 6-14%, the cost of management and of terminal care from 33-45% of the total. Analyses of sensitivity confirmed that whatever the histological type or diagnostic staging the percentage of patients initially treated actively (that is to say not by palliative care) had the greatest effect on the total cost, greater than the costs of terminal care and of two courses of chemotherapy. CONCLUSIONS: This model has allowed for the first time the calculation of the contributions of the different therapeutic components to the total cost of the management of lung cancer in France. In the future it will allow analysis of the economic impact of new methods of treatment.

Aged↗
PubMed2003

[Cost-effectiveness analysis: a reader's guide].

INTRODUCTION: This article is devoted to the critical appraisal of cost-effectiveness analysis. METHODS: The example chosen concerns the choice of first line chemotherapy for a patient with stage IV non small cell bronchial carcinoma; a common problem in thoracic oncology. It compares three chemotherapy regimes: vinorelbine alone, cisplatin-vinorelbine and cisplatin-vindesine. PERSPECTIVES: The guide used allows evaluation of the validity of the methodology and, therefore, of the results obtained. CONCLUSION: The article studies the possible application of these results to the patient whose clinical history was presented as an introduction. The limitations of cost-effectiveness analyses are also considered.

Antineoplastic Agents↗
PubMed2003

[Clinical practice guidelines: a reader's guide].

INTRODUCTION: This article is devoted to the critical appraisal of clinical guidelines. METHODS: The example chosen is the update of the guideline "Clinical management of chronic obstructive pulmonary disease: diagnosis, follow-up, and acute exacerbations". The full and abbreviated versions of the text published by the "Société de Pneumologie de la Langue Française" were analysed by a guide for the critical evaluation of clinical guidelines. BACKGROUND: The evaluation guide "AGREE" allows assessment of six areas included in the development of a guideline: scope and objectives, involvement of the groups concerned, rigour of development, clarity and presentation, applicability and editorial independence. CONCLUSION: Clinical guidelines are going to play an important part in medical practice. Evaluation of professional practice will be based on their contents. A critical appraisal of their validity and applicability in this way allows an accurate decision on their subsequent application.

Humans↗
PubMed2002

Phase II randomized multicenter study evaluating a treatment regimen alternating docetaxel and cisplatin-vinorelbine with a cisplatin-vinorelbine control group in patients with stage IV non-small-cell lung cancer: GFPC 97.01 study.

BACKGROUND: The potential absence of cross-resistance between cisplatin and docetaxel in non-small-cell lung cancer (NSCLC) suggests that alternating regimens of cisplatin-based chemotherapy and docetaxel might increase the activity of chemotherapy in stage IV NSCLC. PATIENTS AND METHODS: Randomized, multicenter, non-comparative phase II study in patients with stage IV NSCLC (Eastern Cooperative Oncology Group performance status of 0-2). Patients randomized to alternating treatment group (A) received docetaxel 100 mg/m2 on days (D) 1 and 43 alternating with cisplatin 100 mg/m2 on D22 and vinorelbine 30 mg/m2 on D22, D29 and D36. Those randomized to the control group (B) received cisplatin 80 mg/m2 on D1, D22 and D43 and vinorelbine 30 mg/m2 once a week from D1 to D57. Treatment was continued for a further 6 weeks in the event of objective response or stabilization. RESULTS: Seventy patients were enrolled (group A: 38, group B: 32). More premature treatment discontinuations due to toxicity were observed in group A (median number of cycles: 3) than in group B (median number of cycles: 5). The intention-to-treat objective response rate was 10.8% [95% confidence interval (CI) 0.8% to 20.8%] in group A compared with 25% (95% CI 10% to 40%) in group B, the median time to treatment failure being 10.2 weeks and 17.3 weeks, respectively. The median survival and 1-year survival were 29.1 weeks and 39% in group A compared with 41.6 weeks and 42% in group B. Febrile neutropenia occurred in 5.9 and 4.9% of the cycles in group A and group B, respectively. Non-hematological toxicity was moderate in the two groups. CONCLUSIONS: The addition of docetaxel alternating with cisplatin-vinorelbine did not enhance the activity of this combination. The development of sequential regimens might be a more promising way of exploiting the absence of cross-resistance between these two drugs.

Adult↗