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Biomedical subjects

F Fagnani

Publications and source records attributed to F Fagnani.

At least 55 records · Page 3Linked to original sources
PubMed1998

Cost effectiveness of a low-molecular-weight heparin in prolonged prophylaxis against deep vein thrombosis after total hip replacement.

The risk of late-occurring deep vein thrombosis and pulmonary embolism after total hip replacement persists for at least 3 weeks after hospital discharge. Recent clinical trials have demonstrated that prolonged prophylaxis with enoxaparin, a low-molecular-weight heparin (LMWH), significantly reduces this risk. We used a decision-analysis model to determine the incremental outcomes associated with the routine use of such prophylaxis, administered during hospitalisation for total hip replacement and for 3 weeks after discharge, instead of short term prophylaxis administered only during hospitalisation. For a hypothetical cohort of 100,000 patients undergoing hip surgery, prolonged LMWH prophylaxis saved between 601 and 783 additional lives compared with prophylaxis stopped at discharge. This was obtained at a net direct marginal cost ranging from 1118 to 1300 French francs (F) per patient. The cost-effectiveness ratio ranged from F11,158 to F34,591 per life-year saved and from F23,532 to F35,268 per venous thromboembolic event (routinely diagnosed and treated) avoided. Prolonged LMWH anticoagulant prophylaxis with enoxaparin is more effective in routine practice after elective hip surgery than conventional short term perioperative prophylaxis in terms of the number of deaths or thromboembolic events avoided. Such prophylaxis also appears to be clearly cost effective, using French cost data.

Anticoagulants↗
PubMed1998

Medico-economic analysis of diacerein with or without standard therapy in the treatment of osteoarthritis.

This 9-month pragmatic study compared 2 therapeutic regimens in the management of osteoarthritis of the hip and knee. Patients received either diacerein 100 mg/day plus standard osteoarthritic therapy for 6 months, followed by a 3-month monitoring period without diacerein, or standard therapy alone for the entire 9-month period. A total of 207 patients with osteoarthritis of the knee and hip were enrolled. Improvements in Lequense's functional index and quality-of-life scores (revised Arthritis Impact Measurement Scales Health Status Questionnaire and Nottingham Health Profile), and decreases in nonsteroidal anti-inflammatory drug and analgesic consumption were significantly greater with diacerein plus standard therapy than with standard therapy alone. The overall assessment of therapy by patients was good or excellent for 60% of those who received diacerein plus standard therapy, compared with 26% who received standard therapy alone. Medical and paramedical procedures carried out in addition to those stipulated in the protocol (medical consultations, physiotherapy, nursing, etc.), osteoarthritis-related, were fewer and less costly in the diacerein plus standard therapy group than in the standard therapy group. The average outpatient cost (in 1995 French francs) of osteoarthritis treatment in the standard therapy group was FF2272 compared with FF2360 in the diacerein plus standard therapy group. The cost-effectiveness ratios per point scored on Lequesne's index were FF1893 for the standard therapy group and FF1072 for the diacerein plus standard therapy group, leading to a saving of 43% with diacerein plus standard therapy. The marginal cost (additional cost corresponding to the clinical benefit obtained by adding diacerein to standard treatment) was FF88 per point scored on Lequesne's index.

Aged↗
PubMed1998

Cost effectiveness of immunoprophylaxis in the prevention of recurrent infectious rhinitis in adults.

OBJECTIVE: Recurrent infectious rhinitis (RIR) is a frequent disease among adults and constitutes an economic burden for National Sickness Funds (NSF) that might be prevented by immunostimulant therapy. Cost effectiveness of preventive methods should be documented. The aim of this study was to determine whether the cost of treating patients with ribosomal vaccine (Ribomunyl), an immunostimulant therapy, could be offset by the savings associated with avoided RIR episodes. DESIGN AND SETTING: Using a 'piggy-back' approach, an economic analysis was conducted based on a placebo-controlled clinical trial of 327 patients with at least 3 episodes of RIR in the past year. Patients were recruited during September and October 1994 through 50 French and 2 Belgian specialists (ear, nose and throat; ENT) and were randomised to receive ribosomal vaccine or placebo for a 6-month period covering the entire winter season. Two economic perspectives were analysed: (i) the French NSF; and (ii) the patient (i.e., considering copayments which are not reimbursed by the NSF). MAIN OUTCOME MEASURES AND RESULTS: The placebo-controlled clinical trial demonstrated a significant decrease (p < 0.001) of more than 30% in the cumulative number of RIR episodes with ribosomal vaccine during the 6-month study period. In general, patients receiving the active treatment tolerated it well. Data were collected on the use of medical services (e.g. number of physician visits), antibacterial and other drug courses, as well as the number of sick-leave days for the study participant. Patients treated with ribosomal vaccine visited their general practitioner (GP) less frequently (mean reduction of 33%), had fewer days of antibacterial use (mean reduction of 3.5 days) and took fewer sick-leave days (mean reduction of 6.3%). CONCLUSIONS: Overall, the cost of prevention with ribosomal vaccine was offset by the savings to both the French NSF and to patients (in terms of out-of-pocket expense). Indeed, ribosomal vaccine was deemed to be a cost-saving agent in the prevention of RIR in the French healthcare setting, provided that it is prescribed only for patients who are expected to develop at least 2 episodes of RIR in the coming year.

Adjuvants, Immunologic↗
PubMed1998

Management and cost of care for low back pain in primary care settings in France.

We conducted a prospective observational study during the winter of 1994-1995 in a representative national sample of 2,406 patients aged 18 to 65 years seen in primary care settings for acute low back pain of less than 48 hours' duration. The following data were collected: demographic, social and clinical characteristics at inclusion; treatments prescribed throughout the episode, functional impairment and restriction of usual activities. These data were used to evaluate direct costs (health costs) and indirect costs (sickness payments). The sex ratio was predominantly male (60.4%), 80% of patients were economically active, mean age was 43 +/- 11.7 years, and most patients (76%) had a history of low back pain. Management consisted primarily of rest (bedrest, 32%; rest at home, 61%) and pharmacotherapy (mainly analgesics, nonsteroidal antiinflammatory drugs and muscle relaxants; mean number of drugs per patient, 3.2). Imaging studies were obtained in 34% of cases and physical therapy was prescribed in 30%. Referral and hospitalization rates were 5.4% and 0.8%, respectively. Among economically active patients, 82% were put on sick leave, for a mean duration of 8.4 +/- 4 days and 18.6% were reported as having work-related low back pain. The mean cost of outpatient care for the episode of low back pain was 1,021 French francs (FF), most of which was contributed by physical therapy (41.6%), physicians' fees (23.9%) and investigations (16%). Mean sickness payments were 821 FF per patient in the economically active subgroup and 523 FF per patient in the overall study population.

Activities of Daily Living↗
PubMed1997

An economic evaluation of tiludronic acid treatment in Paget's disease of bone.

The objective of this study was to evaluate the long term comparative outcome of intermittent courses of therapy with low-dosage tiludronic acid (400 mg/day) versus etidronic acid in patients with Paget's disease of bone. The long term outcome was evaluated by means of a model, as the number of complications avoided during a 5-year period. Only major complications were considered (fractures of long bones, spinal cord dysfunction, osteoarthritis of the hip), which can be cured by adequate medical intervention, and may thus be valued in terms of direct costs. Deafness was not considered and was not valued. The various additional direct costs incurred (treatment and follow-up) and avoided (complications avoided) were assessed using an extrapolation model, based on the results of a clinical study. A standard costing methodology was used, according to the patterns of care currently in use in France. Costs were calculated from a societal perspective, including social security and private insurance fund reimbursements, and out-of-pocket expenses. These were estimated in French francs (F: 1994 values). The estimated mean treatment cost per patient for the treatment of Paget's disease and its complications over a 5-year period was F34,198 with etidronic acid, and F30,754 to F36,422 with tiludronic acid, depending on whether an optimistic or a conservative view of the efficacy of tiludronic acid was assumed. Despite its higher acquisition cost, the use of tiludronic acid was less expensive in the treatment of Paget's disease and its complications, compared with the use of etidronic acid, when an optimistic view of the efficacy of tiludronic acid was assumed.

Adult↗
PubMed1997

A pragmatic cost-effectiveness study of routine epidural corticosteroid injections for lumbosciatic syndrome requiring inhospital management.

A multicenter randomized study was conducted using a pragmatic approach to evaluate the benefits and costs of routine epidural corticosteroid injections for the treatment of lumbosciatic syndrome requiring inhospital management. The primary evaluation criterion was whether other treatments were required after one to three injections. The 108 patients were randomly allocated to treatment with or without routine epidural corticosteroids. Rest and a nonsteroidal antiinflammatory drug were used in all patients. The two groups were comparable at baseline except for a larger proportion of males in the routine epidural corticosteroid group. Patients in the routine epidural corticosteroid group were more likely to require other treatments, but the difference was only of borderline significance after adjustment for gender. Results showed that physicians based their treatment decisions primarily on whether an improvement in the clinical status of the patient was apparent at the second visit. None of the other factors studied influenced treatment decisions. Clinical efficacy criteria were identical in the two groups. Hospital costs contributed most of the total cost, and the mean cost was higher in the routine epidural corticosteroid group. These data suggest that adding an epidural injection as a first-line treatment to rest and a nonsteroidal antiinflammatory drug for the treatment of lumbosciatic syndrome requiring inhospital management results in additional costs and no gain in efficacy.

Adolescent↗
PubMed1996

[Recurrent respiratory infections in patients with chronic obstructive bronchitis: medical treatment and costs].

The objective of this study is to describe usual medical management and costs associated with recurrent respiratory infections in subjects with chronic obstructive bronchitis in France. A prospective survey was performed in Autumn 1994 on a national sample of private practice pulmonologists (N = 71). Two hundred forty-four patients, presenting at least one infection of the lower respiratory tract, were included. Bronchitis was the most frequent acute exacerbation observed (94%). Pneumonia concerned 9% of the patients. Biological tests, X-rays and pulmonary function tests were prescribed for, respectively, 59, 65 and 45% of the patients. Following the visit, 15 patients were hospitalized (6%). The direct medical cost per acute exacerbation was estimated 3,289 francs (1994 value) of which 60% were hospital-related. An average 10.4 day sick-leave was prescribed to 21% of patients in employment. For those patients, this sick-leave was associated to an extra-cost of 1,264-1,876 francs for Social Security and of 0-2,553 francs out of pocket per episode varying according to their Benefit Regimen.

Acute Disease↗
PubMed1995

Cost effectiveness of hepatitis A prevention in France.

A spreadsheet simulation model of hepatitis A disease was developed to evaluate the cost effectiveness of an inactivated [corrected] hepatitis A vaccine ('Havrix', SmithKline Beecham) in high risk groups in France. Gammaglobulin prophylaxis, systematic vaccination without screening and vaccination of nonimmune persons after systematic screening were compared with the reference situation of no prevention over a 10-year period. It was found that both vaccination strategies would prevent 98% of new cases of hepatitis A, and would generate savings of FF4.2 to FF4.7 million ($US1 = FF5, 1995) in alternative service volunteers [initial seroprevalence (IS) 26%] stationed in countries with high hepatitis A endemicity. The cost per symptomatic case avoided [i.e. the cost-effectiveness ratio (CER)] was found to vary from FF177,612 with screening to FF281,463 without screening in adult tourists (IS 77%). In hospital workers, screening before vaccination (CER = FF65,108) would be about half as costly as systematic vaccination (IS 55 to 79%). Recommendations for vaccination should take into account the specific collective or individual risk, age, seroprevalence and probability of compliance with the prevention protocol.

Adolescent↗
PubMed1994

[Venous disease in France: an unrecognized public health problem].

Different reasons explain that chronic venous insufficiency remains ill recognized as a public health problem in France: very few epidemiologic studies have been undertaken in this pathology; this disease is very heterogeneous in terms of gravity and clinical evidence: from isolated symptoms to localized clinical signs, with or without severe complications. Clinical semiology is actually not standardised. The analysis of available informations suggests that this pathology represents approximatively 2.6% of the whole health expenditures in France, that is to say an amount of 14.7 billion of Francs for the year 1991. The number of patients suffering from chronic venous insufficiency can be estimated to about 11 millions, whose 7 millions present symptomatic signs (leg heaviness, pain, moderate edema). The number of hospitalizations is around 200,000 per year, of which 63% are in surgery in private clinics. One half of these hospital stays concerned varicose veins (the 8th cause of hospitalization in France). Forty of the patients consulting for chronic venous insufficiency are at work and about 7 to 8% of them get sick leaves for this pathology: around 362,000 sick leaves per year representing 6.4 millions of day lost. On the basis of the medical consumption survey performed by INSEE/CREDES, an extrapolation was made to estimate the different components of costs of chronic venous insufficiency: 41% (drugs), 34% (hospital care) and 13% (medical fees).

France↗
PubMed1992

Definition and estimation of lifetime detriment from radiation exposures: principles and methods.

Although the lifetable methodology is a standard tool in epidemiology and risk assessment, there are a number of differences in the way it has been applied by various advisory committees that have attempted to estimate radiation risks. The most fundamental of these differences concerns the choice of parameter to be estimated: the "excess lifetime risk" is the difference in lifetime risks between exposed and unexposed populations; the "risk of exposure-induced death" is the lifetime risk of dying of a disease attributable to exposure. These two quantities are not the same, even at low doses. Although both quantities have some utility in risk assessment, the "risk of exposure-induced death" comes closer to capturing the total impact of exposure. Other differences between reported risk estimates include details of the calculations, the baseline rates and age distributions of the exposed population, the forms of the models for excess rates, handling of organ-specific doses, and the groupings of cancer sites. These issues are discussed theoretically and illustrated with comparisons of the BEIR V and UNSCEAR reports. Although the risk estimates from these two reports are similar for most cancer sites, it is shown that this happens to be the result of an approximate cancellation of a number of differences that could be quite large.

Environmental Exposure↗
PubMed1991

Prevalence of HIV infection and cost of medical follow-up for asymptomatic seropositive patients followed in general practice in France.

To estimate the number of HIV patients followed by general practitioners and the average cost of their medical care, a questionnaire was mailed to 500 general practitioners of the French Communicable Diseases Network (1% sample, representative of French general practitioners). They were asked the number of HIV seropositive patients detected in 1987, the number of HIV positive asymptomatic patients regularly followed, the number of consultations and the type of biological and clinical examinations prescribed. The response rate was 78%. During the past year 29% of practitioners were caring for one or more infected patients. The mean number of HIV seropositive patients known per general practitioner was 1.37 corresponding to an estimated 69,000 +/- 3000 cases, (mean +/- S.D.) for France. The mean number of HIV seropositive patients diagnosed in 1987 was 0.60 per general practitioner (30,000 +/- 2000 cases) and the mean number of HIV seropositive patients followed regularly was 0.89 per general practitioner (45,000 +/- 2500 cases). Two-thirds of HIV seropositive patients were regular patients of general practitioners. The mean number of visits per patient was 3.6 per year. Biological examinations regularly prescribed were blood count, CD4/CD8 ratio, lymphocyte counts, thrombocyte counts, HBs antigen detection and HIV antigen detection. Average costs were 523 +/- 18 FF for the first visit and 446 +/- 36 FF for subsequent examinations. In total, the average cost of general practitioner visits per patient per year have been estimated at 2,288 +/- 251 FF (380 +/- 42 US$).

Attitude of Health Personnel↗
PubMed1989

Doses to patients from dental radiology in France.

In France, a national study was undertaken to estimate both dental radiology practices (equipment and activity) and the associated population collective dose. This study was done in two steps: A nationwide survey was conducted on the practitioner categories involved in dental radiology, and dosimetric measurements were performed on patients and on an anthropomorphic phantom by using conventional dental x-ray machines and pantomographic units. A total of 27.5 x 10(6) films were estimated to have been performed in 1984; 6% of them were pantomographic and 94% were conventional. Most of the organ doses measured for one intra-oral film were lower than 1 mGy (100 mrad); pantomogram dose values were generally higher than intra-oral ones. The collective effective dose equivalent figure was 2,000 person-Sv (2 x 10(5) person rem) leading to a per head dose equivalent of 0.037 mSv (3.7 mrem). The study allowed authors to identify ways to reduce the patient dose in France (e.g., implementing the use of long cone devices and controlling darkroom practices).

France↗
PubMed1988

Social perception of AIDS in the general public: a French study.

The paper presents the results of the first national survey about social perception of AIDS in a representative sample of the French general public (which was carried out in June 1987). A large majority of the French public (73.1% of respondents) support mandatory screening for HIV, and a significant part (21.9% of respondents) even favours isolation of AIDS patients. Results show the relations between false beliefs on transmission of AIDS by casual contact and willingness to agree with measures that carry a great danger of stigmatization for AIDS patients and HIV carriers; but strong correlations between support of coercive measures for prevention of AIDS and similar opinions on other controversial issues suggest that, for a fraction of the public, attitudes about AIDS are rather determined by a priori ideological and ethical values than by risk perception of the disease per se. Results also suggest that any ambiguity in scientific information about AIDS may increase social pressure, even among the most educated part of the population, for unnecessary measures. Tentative conclusions for public policy on prevention and information about AIDS are drawn.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Economic analysis of an immunosuppressive strategy in renal transplantation.

Recently introduced immunosuppressants, which have been shown to be more effective but apparently more costly than conventional regimens, have renewed interest in the economic evaluation of national policies regarding the management of end-stage renal disease. The present paper addresses these questions, together with the different methods of expressing the costs involved, with reference to a sequential protocol using anti-lymphocyte serum (ALS), followed by cyclosporine from the third post-graft month onwards. The analysis is based on the results of a randomized trial carried out at the University Hospital, Nantes (France), from 1982 to 1984, in which the above protocol was compared to conventional treatment with ALS alone. Despite the considerable cost of long-term cyclosporine treatment, analysis reveals collective financial and social benefits from the reduced rate of graft failure and subsequent return to dialysis.

Antilymphocyte Serum↗
PubMed1988

Doses to patients from diagnostic radiology in France.

Reported here are results of a 1982 national survey in France to establish the collective effective dose equivalent associated with the main types of radiological examinations practiced annually in this country (except nuclear medicine, C.T. scans, dental radiology and mass chest screening). This report describes the methodology followed in achieving dose measurements either on an anthropomorphic phantom or directly on the patient, and it highlights the importance of the radiological procedures (number of x-ray films, fluoroscopy screening time, etc.) on the patient organ doses. The estimated collective effective dose equivalent associated with these radiological practices is 86,000 person-Sv, i.e., an individual effective dose equivalent of 1.58 mSv y-1; the genetically significant dose figure is 0.29 mSv and the collective red bone marrow dose due to 45 million x-ray exams practiced in France (1982) is 40,300 person-Sv, i.e. 0.74 mSv per inhabitant.

Adult↗
PubMed1988

[The financing of medico-technical activities. The example of a scanner in France (1986)].

To analyse the french methods for financing technical-medical activities as CT scanners, and to assess if they can face, or not, the management constraints of such activities a financial simulation has been executed. First, current expenditures are totalized (including depreciations and financial charges) with variations according to the number of examinations per year. Costs are classified especially according to fixed and variable charges: the weight of fixed charges, especially equipment charges, is the most significant. It's very high in yearly expenditures. Most, that involves a very fast decreasing cost with increasing number of procedures. Second, consequences of such accounts are analyzed: on private CT scanners, Payed with a charge per examination whatever would be the factor's cost; on public CT scanners, payed with an annual allowance; in this case charges equal receipts whatever would be the cost for a procedure. Third, a break point is defined; either the annual activity is higher: there would be an excedent; either it is lower: there would be a deficit. Then, those results are reported to CT-scanners activity's data in France (1986). After all, we discuss about financing systems themselves, and suggest a few hypothesis to explain those desadjustments between charges and their financing way.

Financial Management↗
PubMed1988

Contrasted diffusion and the use of CT scanner equipment in France.

During the last 4 years, there has been a rapid catching-up in the distribution level of CT-scanners in France. In a survey of CT-scanner utilization, data from all machines operating in the PACA Region in 1986, showed that the mean activity was 6,080 examinations per machine. The co-existence of both private and public medicine led to different use of materiel (5,500 to 5,800 exams per machine in the public versus 8,600 in the private sector and a higher productivity in the profit-making establishments. This difference was not explained by procedural variations in carrying out the technique, which appeared to be similar and standardized everywhere, but probably reflected patient selection (80% of ambulatory patients in the private sector, 25 to 50% in PTH).

France↗