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Biomedical subjects

T Lebrun

Publications and source records attributed to T Lebrun.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Cost-effective approach to the screening of HIV, HBV, HCV, HTLV in blood donors in France].

In order to provide greater safety in blood transfusions, public health authorities have imposed the use of screening tests. The purpose of this paper is to estimate the cost-effectiveness ratios of the screening test used in France. Four risks were studied: HIV, HBV, HCV and HTLV. Two efficiency measures were used: cost per positive blood donation detected and cost per case of prevented infection transmission. Moreover, for HTLV alone, the efficiency was estimated by the cost per prevented pathology. Data concerning the costs were provided by the French Blood Agency; those concerning the results of the screening campaigns were provided by the official health authorities, the other data used in the calculations were drawn either from the French Blood Agency data or from a review of international literature. Results gave information about the expenditure devoted to the screening of virologic risks associated with blood transfusion in France (250 million francs per year for the four viruses studied). They stressed the differences in screening efficiency according to the test studied (the cost by prevented seroconversion varied from 31,795 francs for HBV, 72,180 francs for HCV, 676,596 francs for HIV to 6,137,346 francs for HTLV screening test in the base case) and especially the very low efficiency of the systematic screening of the HTLV virus (from 34 to 307 million francs per prevented leukemia).

Blood↗
PubMed1997

[Medico-economical assessment in cancerology].

In recent studies, the economic criteria has begun to be integrated to the appraisal in cancerology. The question asked by the economist can be framed as follows: what incremental cost should the collectivity or the health insurance system consent, in order to improve the care of cancer patients? This involves first that the cost of the strategies, foreseen or already implemented, can be appraised, then, that indicators can be defined to capture health improvement, and finally, that this health improvement can be quantified. In this article, we present the process of integrated appraisal (cost/result approach). We specifically analyze costs in cancerology, their source and their evolution. We demonstrate the meaning of the integration of economic costs and medical results. We emphasize on the fact that part of the costs, especially those supported by the patient and his close relations, are most of the time excluded from the analysis. Two main points should be carefully analyzed, when proceeding to an appraisal in cancerology: the measurement of the patient's QoL, which represents an expression of the results of the strategy of care; the financing modalities, for the same type of care, if we consider the specificity of the structures involved and the organization of the care. We conclude by mentioning how difficult this task is and under which conditions it should be developed.

Cost of Illness↗
PubMed1997

[Socio-economic consequences and quality of life in hypertension and its management: a review of the literature].

A macro-economic approach to the cost of hypertension showed that, due to its high prevalence in industrialised countries and the increase in the costs of its treatment, the management of this condition is a preoccupation for the community. The micro-economic approach revealed an inequality between individuals concerning its management, especially with respect to social class. Ambulatory blood pressure recording provides a method of reliable assessment of the blood pressure of an individual. Its cost could be compensated on the macro-economic scale by the economies of treatment, especially as erroneous diagnosis of normal subjects as hypertensive may lead to both psychosocial and economic complications (increased professional absenteeism), the so-called "labelling effect" in Anglo-Saxon countries.

Adult↗
PubMed1997

Attempt to establish a classification of patients suffering from coma and admitted to a hospital structure for short or medium term treatment: medical aspects and costs of hospital care.

We dispose of a database, constituted between 1987 and 1993, containing medical and cost information concerning 515 patients suffering from coma and admitted, after a period of resuscitation, to a French hospital establishment--Etablissement Hélio-Marin of Berck-sur-Mer (EHMB)--for short and medium term treatment, between 1974 and 1986. From this base, which contains demographic and clinical data (age, sex, condition upon admission, duration of consciousness disorders, Glasgow Outcome Scale (GOS) upon discharge) we devised a hierarchical classification analysis following a factorial analysis of multiple correspondences, on 2 sets: a sample of 515 patients (all causes of coma being merged) and a sample of 266 patients suffering from brain injuries. Four groups were determined for each typology. These groups were first described on the basis of the variables used for their construction, and later by considering other available variables: origin of coma, duration of stay at EHMB, future evolution of patients and cost of treatment (cost of specific care, average daily cost, total cost of hospitalization). Thus, typical clinical situations were identified in each classification, depending on age of patient, origin of coma and condition upon admission. These situations led to extremely different treatment costs (ratio from 1 to 5 in the general typology and 1 to 2.85 in the classification of brain injuries.

Adult↗
PubMed1997

[Measuring the economic impact of ambulatory dialysis: the case of continuous ambulatory peritoneal dialysis].

BACKGROUND: As concerns the treatment of terminal renal failure (TRF), France is characterized by a minimal use of peritoneal dialysis, even though this technique is as effective and less expensive than others and that authorities precognize to switch patients to out-of-centre techniques, like peritoneal dialysis. The purpose of the article is to estimate benefits for the Social Security induced by an incitative program leading the current structure of TRF treatment to the existing government standards defined in 1984. METHODS: We computed treatment cost differences, on the basis of an incident case of TRF followed during 7 years, between three different situations: the current French structure of TRF treatment (29.5% of patients treated by out-of-center techniques); two reference situations A and B (respectively 45% and 37% of patients treated by out-of-center techniques). We performed a sensitivity analysis on the rate of use of continuous ambulatory peritoneal dialysis (CAPD). We made assumptions on the cost of techniques, the cost of complications and the rate of CAPD treatment failure. RESULTS: Results stress the existence of benefits induced by increased use of out-of-centre techniques on the basis of a 7-year follow-up of an incident TRF patient: around 65,000 FF in situation A with a 20% rate of use of CAPD; around 5,000 FF in situation B with a 15% rate of use of CAPD. Assumptions concerning CAPD treatment lead to an underestimation of the true benefits. CONCLUSION: The study highlights the therapeutic and economic interest to transfer some patients from hemodialysis to peritoneal dialysis.

Ambulatory Care↗
PubMed1994

The introduction of economic criteria into the management of arterial disease: an illustration with regard to the socioeconomic consequences of peripheral occlusive arterial disease of the lower limbs.

A survey of studies was used to investigate the economic repercussions of arterial disease; these repercussions included the cost of the disease and its management, and cost/efficacy, cost/utility, and cost/benefit studies of preventive, diagnostic, and therapeutic strategies. The study presented is an evaluation of the socio-economic consequences of peripheral occlusive arterial disease of the lower limbs (POADLL). The cost of health care was measured by means of a prospective 6-month study of 85 patients recruited in 6 centers. The average cost over the 6-month period was 15,735 FF (1991 francs) ($2,760 U.S.). The 85 patients were classified by age, sex, risk factors, concomitant disease, and how the illness was managed, notably in terms of hospitalization and vascular surgery. The four-group classification was used to calculate an annual management cost for POADLL, which ranged from 9,500 FF ($1,667 U.S.) for a stage II patient (mean age, 66 years) with no major risk factors and not presenting any complication requiring admission to hospital, to 35,000 FF ($6,140 U.S.) for patients (mean age, 62 years) who presented major risk factors and who required vascular surgery during the year.

Adult↗
PubMed1994

[Prognostic factors of post-traumatic vegetative states: 522 cases].

Long-term prognosis of post-traumatic vegetative state (VS) remains poorly defined. Three kinds of data have been collected for 522 patients in VS 1 month after head injury: pre-traumatic data; early data, collected during the first two weeks after trauma; late data, collected one month or more after trauma. Statistical relationships have been searched for, between these data and outcome one year after trauma, according to the Glasgow Outcome Scale. Some late data appear as essential prognostic factors of VS: threat blink; complications; ventricular dilatation; motor score (Glasgow Coma Score); spontaneous eye movements. Pretraumatic data then take place: age; previous deficiencies. Other data (especially early data) seem to have a weaker influence or outcome.

Adolescent↗
PubMed1994

[Functional and occupational repercussions and seeking care services in chronic asthma].

This article reports on a 5-month long prospective survey carried out in 1990 on 208 patients aged 18 and over, suffering from moderate to severe asthma. The recorded data included information on the history of the illness, the respiratory problems encountered and asthma attacks, the repercussions the illness had on household and professional occupations, the perceived state of health, drug consumption and recourse to external services. The medical costs and production loss due to this pathology were also estimated.

Activities of Daily Living↗
PubMed1993

[Economic analysis of diagnostic and therapeutic methods in cases of cold thyroid nodules].

This article studies how two diagnostic tests (cytological puncture and 201thallium scanning) can be combined to obtain a more efficient approach of cold thyroid nodules. Diagnostic and therapeutic approaches are compared on the basis of four criteria: financial cost (immediate and delayed), number of labelled cancers, pre- and postoperative death rates and number of complications.

Biopsy, Needle↗
PubMed1992

[Determination of cost-effective strategies in colorectal cancer screening].

The object of the article is to implement particular methodologies in order to determine which strategies are cost-effective in the mass screening of colorectal cancer after a positive Hemoccult test. The first approach to be presented consists in proposing a method which enables all the admissible diagnostic strategies to be determined. The second approach enables a minimal cost function to be estimated using an adaptation of "Data Envelopment Analysis". This method proves to be particularly successful in cost-efficiency analysis, when the performance indicators are numerous and hard to aggregate. The results show that there are two cost-effective strategies after a positive Hemoccult test: coloscopy and sigmoidoscopy; they put into question the relevance of double contrast barium enema in the diagnosis of colo-rectal lesions.

Aged↗
PubMed1992

[Cost and efficacy of therapeutic strategies in candidates for heart transplantation as salvage therapy].

A study of the real cost, the cost-effectiveness of treatment was performed in 31 cases of cardiogenic shock referred for cardiac transplantation, treated in a flexible therapeutic protocol associating implantation of an expensive mechanical circulatory support system (mechanical bridge) or treatment by drugs alone (pharmacological bridge) depending on the efficacy of IV enoximone. The average patient cost was 238,386 French Francs, ranging from 440,353 FF in patients receiving the mechanical bridge to 199,296 FF in those receiving the pharmacological bridge. The cost-effectiveness ratio expressed either as cost per patient surviving the different stages of the disease or as cost of obtaining an additional day of survival at the same intervals was twice as favourable in the group receiving the pharmacological treatment. This study suggests that IV enoximone and strict selection procedures for candidates for the more expensive option should help bring together the interest of the individual patient and of society as a whole.

Adult↗
PubMed1991

Economic evaluation of cost-benefit ratio of neonatal screening procedure for phenylketonuria and hypothyroidism.

A comparison between the cost of identification and care of patients with phenylketonuria (PKU) and congenital hypothyroidism (CH) and the expenditure for the care of untreated retarded patients has been established on the basis of the activity of the Nord-Pas-de-Calais regional screening centre and of interviews with patients' families. The analysis yields a benefit-cost ratio of 6.6 for PKU and 13.8 for CH prophylaxis. However, cost-benefit varies depending on the economic partner, i.e. the patient's family, Social Security or Administration.

Cost-Benefit Analysis↗