Costs In France Research Articles

Clinical and Economic Burden of Antibiotic Use Among Pediatric Patients With Varicella Infection in the Outpatient Setting: A Retrospective Cohort Analysis of Real-world Data in France.

Varicella infects 90% of children before age 9. Though varicella is self-limiting, its complications may require antibiotics, though how antibiotics are utilized for varicella in France is not well known. This study assessed antibiotic use and costs associated with varicella and its complications in pediatric patients managed in the outpatient setting in France. A retrospective cohort study using the Cegedim Strategic Data-Longitudinal Patient Database, an electronic medical record database from general practitioners and office-based specialists in France, was conducted. Children <18 years old diagnosed with varicella between January 2014 and December 2018 with 3-month follow-up available were included. We used descriptive analysis to assess varicella-related complications, medication use, healthcare resource utilization and costs. Overall, 48,027 patients were diagnosed with varicella; 15.3% (n = 7369) had ≥1 varicella-related complication. Antibiotics were prescribed in up to 25.1% (n = 12,045/48,027) of cases with greater use in patients with complications (68.1%, n = 5018/7369) compared with those without (17.3%, n = 7027/40,658). Mean medication and outpatient varicella-related costs were €32.82 per patient with medications costing a mean of €5.84 per patient; antibiotics contributed ~23% to total costs annually. This study showed high antibiotic use for the management of varicella and its complications. A universal varicella vaccination program could be considered to alleviate complications and associated costs in France.

P912 A Real-World Evidence Study of Dose Escalation and associated costs of advanced therapies for Ulcerative Colitis in France and United Kingdom

Abstract Background Dose escalation to optimize advanced therapies is common practice in ulcerative colitis (UC) to avoid intra-class or inter-class drug switching and maintain clinical response. Dose escalation also has impact on healthcare resource utilization (HRU) and costs. However, there are limited data available on real-life dose-escalation. Study aim was to understand real-world dose escalation/de-escalation UC advanced therapy drugs patterns in two European countries (France, United Kingdom [UK]). Methods This retrospective study analysed data from the THIN®/CEGEDIM database to identify adult patients with moderate-to-severe UC who were naïve to advanced UC therapies or had not received any of the UC advanced therapy drugs of interest (adalimumab [ADA], golimumab [GOL], infliximab [INF], tofacitinib [TOF], ustekinumab [UST], or vedolizumab [VED]) for at least 12 months prior first prescription (and/or dispensation for France) between January 2017 and February 2022. A dose increase of ≥20% during the maintenance period compared to lowest Summary of Product Characteristics recommended dose was considered dose escalation. Proportions of patients with dose escalation after maintenance date were estimated using Kaplan-Meier (KM) survival analyses. Clinical response (defined as absence of: UC-related hospitalization or colectomy, treatment switch or addition of another UC advanced drug, systemic/rectal corticosteroids exposure), and direct (consultations, hospitalisations, diagnostic tests, UC drugs, complementary therapy) and indirect costs related to UC by treatment cohort were also analysed. Results 1663 patients fulfilled the selection criteria, of whom 619 had information on dose patterns. Overall, 89% of patients (range 33% [INF] to 100% [GOL, TOF, and UST]) had dose escalation within the first 24 months after start of maintenance, with a median % dose increase ranging from +15% [VED] to +198% [GOL] (Table). Median (95% CI) time to first dose escalation was 2.1 (1.8-2.4) months (range 0.7 [UST] to 4.6 [VED]). Clinical response ranged from 56.3% (ADA) to 77.0% (INF). Direct annual HRU costs related to UC ranged from 3,085 (INF) to 16,527 (UST) EUR in France and from 1,857 (INF) to 4,104 (VED) GBP in the UK. Mean direct HRU costs in France were 25% higher in escalated patients compared to de-escalated patients (range: +4.2% GOL to +61.9% UST). Conclusion Dose escalation of advanced therapies for UC is a common strategy to avoid treatment-switching. Despite dose escalations and their cost to the system, a proportion of patients fail to achieve clinical response, highlighting the need for more efficacious and durable treatments for patients with moderate-to-severe UC.

The burden of hospitalisations for COVID-19 in France: a study of all cases in the national insurance claims database in 2020

ABSTRACT Background The economic consequences of the recent COVID-19 pandemic were substantial. However, direct medical costs in France have not been determined. Objective To describe patient characteristics, intensity of care, mortality, and direct medical costs in patients hospitalised for COVID-19 infections in France. Study design A retrospective study of the French national hospital claims database for 2020. Setting Hospital care. Patients or other participants All patients hospitalised for COVID-19 in 2020 were included and classified by hospitalisation duration into acute phase and prolonged COVID-19. Intervention Stratification by intensity of care (Level 1: no or low-flow oxygen support; Level 2: non-invasive ventilation; Level 3: mechanical ventilation). Main outcome measure Cost of hospital care in 2020 Euros from a payer perspective. Results 199,455 patients were hospitalised for COVID-19 in France in 2020. 17,824 patients (8.9%) received mechanical ventilation and 32,602 patients (16.3%) died. Mean per patient cost was €5,510 ± 7,142. This cost was highest in patients receiving Level 3 care, patients aged >80 years and in those with prolonged COVID. Conclusion The economic burden of hospitalisations for COVID-19 infections in France during 2020 was substantial. The study provides robust baseline data to benchmark advances in the standard of care and to nurture epidemiological models.

Application of machine learning methods to predict drought cost in France

This paper addresses the prediction of the total damage costs brought on by a drought episode under the French “Régime de Catastrophes Naturelles”. Due to the specificity of this natural disaster compensation scheme, an early prediction of the cost of a disaster is needed to improve strategic decisions. Taking advantage of the access, thanks to a partnership with the Mission Risques Naturels, to a database of natural disaster claims fed by the major French insurance companies, we combine the information of drought event claims contained in this database with meteorological and socioeconomic data to achieve a more comprehensive knowledge of the exposure. Our prediction approach relies on the comparison of different statistical models and machine learning algorithms. To improve the prediction performance, we propose an aggregation of the different models. Since the main difficulty encountered is imbalanced data as a large majority of cities are not affected by a drought event, the predictions are assessed by F1-scores and Precision and Recall curves.

Growth of home respiratory equipment from 2006 to 2019 and cost control by health policies

BackgroundHome respiratory equipment (HRE) designed for the management of chronic respiratory failure includes oxygen therapy (O2), noninvasive ventilation (NIV) and mechanical insufflation-exsufflation (MI-E). The growth of the number of patients treated by HRE, the prevalence and the associated costs in France have not been determined. MethodsThe French open access national health insurance aggregated data was used to estimate the evolution of theses parameters from 2006 to 2019. ResultsThe number of patients treated by HRE increased by 117% between 2006 and 2019, reaching a total of 245,896 patients (367/100,000). Prescriptions for O2, NIV, and MI-E increased by 88%, 189% and 162%, respectively. In 2019, 139,323 patients received long-term home O2 alone (208/100,000) with a 13% decrease for liquid O2 compared to a 44% increase for O2 concentrator. The number of patients treated by portable oxygen concentrator increased by 509% over the last 5 years. In 2019, 96,126 patients received NIV (144/100,000) and 97% of these patients were treated by NIV for less than 12 h/day. A total of 9,158 patients were treated by MI-E in 2019 (13.6/100,000). Despite the global increase in the number of patients, health costs decreased from 9% to 8% of total medical device spending in 2019 due to adjustment of health policies, such as a reduction of reimbursement rates. ConclusionOur results highlighted the high rate of HRE prescription, but with cost control as a result of adapted health policies.

Does employee ownership reduce agency costs? Evidence from French listed companies

Employee stock ownership (ESO) is often associated with reductions in agency costs because it increases employee satisfaction and attachment to their company and aligns the interests of employees with those of their firm. Another stream of research argues that ESO may have the opposite effect on agency costs because it serves as a management entrenchment tool and leads to divergence between stakeholders. This paper examines the relationship between ESO and agency costs in France, which is a leading European country for ESO. Using a panel database of 125 firms over the period 2002–2016, we find an inverted U-shaped relationship between ESO and agency costs. That evidence highlights that low levels of ESO increase agency costs, which is consistent with managerial entrenchment mechanisms. The findings also suggest that beyond a certain point, ESO reduces agency problems because it links employee wealth to their firm’s success.

POSA211 Are Orphan Drugs in France Priced According to International Prices and Which Factors Could Influence the Negotiated Prices?

The orphan drug status in the European Union aims to promote investment by creating incentives. The primary objective of this analysis is to compare the prices of orphan drugs in France to that of four other European countries: Germany (post-amnog), Italy, Spain and the United Kingdom. 17 orphan drugs priced in France between January 2016 and May 2021 were selected. Only products reimbursed first in an orphan indication and with public prices available were included. Daily treatment costs, first price publication date and price evolution in each country were collected. A one-to-one analysis was conducted to account for drugs not available in a country. Out of the 17 products, 11 (65%) had their lowest price in France. The mean daily treatment cost in France was significantly lower than in the UK (-20,73%; P-value = 0.0123), Italy (-18,57%; P-value = 0.0109) and Spain (-15,98%; P-value = 0.0288). The difference with Germany (+4,5%) was not statistically significant (P-value = 0.579). A trend appeared when observing the launch sequence of countries: the UK usually obtained a price first followed by other countries with a lower published price. The drop in price compared to the UK was substantial for Germany and France. In a linear regression model, the two best factors that explained the treatment cost were the population size and level of Added Medical Value (adjusted R2 = 0,7305; P-value < 0.001). These findings suggest that France grants a lower listed price than its reference countries for orphan drugs. Pricing decisions seem primarily based on the number of people to treat. The new 2021 framework agreement with the CEPS could change this. Indeed, orphan drugs will access European prices with an AMV level of IV. This status should guarantee a price at least equal to the lowest price in the four countries considered.

Breast Cancer Risk in Association with Atmospheric Pollution Exposure: A Meta-Analysis of Effect Estimates Followed by a Health Impact Assessment.

Background:The epidemiological literature of associations between atmospheric pollutant exposure and breast cancer incidence has recently strongly evolved.Objectives:We aimed to perform a) a meta-analysis of studies considering this relationship, correcting for publication bias and taking menopausal status and cancer hormone responsiveness into account; and b) for the pollutants most likely to affect breast cancer, an assessment of the corresponding number of attributable cases in France and of the related economic costs.Methods:We conducted a literature review and random-effects meta-analyses of epidemiological studies examining the association of fine particulate matter with aerodynamic diameter less than or equal to (), particulate matter with aerodynamic diameter less than or equal to 10 μm (), and long-term exposure with breast cancer incidence; additional analyses were stratified on menopausal status and on tumor hormone responsiveness status. The resulting dose–response functions were combined with modeled atmospheric pollutant exposures in 2013 for France, cancer treatments costs, lost productivity, and years of life lost, to estimate the number of breast cancers attributable to atmospheric pollution and related economic costs in France.Results:The review identified 32, 27, and 36 effect estimates for , , and , respectively. The meta-analytical relative risk estimates of breast cancer corrected for publication bias were 1.006 [95% confidence interval (CI): 0.941, 1.076], 1.047 (95% CI: 0.984, 1.113), and 1.023 (95% CI: 1.005, 1.041), respectively. estimated effects appeared higher in premenopausal than in postmenopausal women and higher for hormone responsive positive () than negative () breast cancers. Assuming a causal effect of , we estimated that 1,677 (95% CI: 374, 2,914) new breast cancer cases were attributable to annually in France, or 3.15% (95% CI: 0.70, 5.48) of the incident cases. The corresponding tangible and intangible costs were estimated to be € (low, high: 570, 1,080) per year.Conclusion:These findings suggest that decreasing long-term exposure or correlated air pollutant exposures could lower breast cancer risk. https://doi.org/10.1289/EHP8419

Cash Accumulation by Non Financial Corporations: New Evidence of the Role of Hedging Needs and Lower Financing Costs in France

Cet article examine les sources de l’accumulation de liquidites par les societes non financieres en France. Nous explorons notamment des explications par les couts, en proposant une mesure du cout de detention de liquidites specifique a l’entreprise, qui depend a la fois des couts de financement a court terme des entreprises et de la part des actifs financiers liquides qui generent des interets. L’analyse suggere qu’au moins un quart de la hausse de la tresorerie a l’actif des entreprises entre 2011 et 2016 decoule d’une tendance a la baisse du cout de detention de ces liquidites. En integrant l’impact supplementaire des evolutions macroeconomiques, l’explication par les couts rend compte de pres de 40 % de la hausse de la tresorerie. On identifie egalement que les entreprises conservent des liquidites afin de pouvoir exploiter de futures opportunites d’investissement, quelles que soient les conditions financieres lorsqu’elles se presenteront. Nos resultats suggerent que l’accumulation de liquidites par les entreprises dans le but de se premunir contre le risque de manquer des opportunites d’investissement en periode de ralentissement est un stabilisateur economique.

PCN105 Comparison of Healthcare Costs in France of Combination Nivolumab and Ipilimumab Treatment Versus Nivolumab Monotherapy and Ipilimumab Monotherapy in Advanced Melanoma

CheckMate 067 randomized clinical trial data has shown that a combination of immunology drugs, nivolumab (NIVO) and ipilimumab (IPI), results in longer progression-free and overall survival in advanced melanoma patients, compared with either monotherapy. We assessed the implications of these clinical benefits on costs associated with these treatments. The objective of this study was to evaluate and compare direct healthcare costs in France over 60 months for patients initiating treatment with NIVO+IPI against those initiating (i) NIVO monotherapy and (ii) IPI monotherapy from a societal costs perspective. Individual patient-level data for European patients in the CheckMate 067 trial were used to derive the resources utilized by patients. All melanoma-specific resources, both drug and non-drug, were considered in this evaluation. Unit costs for these resources were obtained from external sources. The mean cost per surviving patient in the respective regimen cohort each month was computed and aggregated. Total melanoma-specific healthcare costs incurred by the NIVO+IPI treated cohort (€230k) were 16% lower compared to the NIVO cohort (€272k) and 10% lower compared to IPI cohort (€255k). The cost advantage by the NIVO+IPI cohort is observed from month 22 (vs. NIVO cohort) and month 38 (vs. IPI cohort) and widens each month thereafter. The costs associated with subsequent melanoma therapies were greatest for the IPI cohort (€179k, 70% of total costs) and lowest for the NIVO+IPI regimen cohort (€64k, 28%). Despite the acquisition cost of two index drugs, costs incurred by the NIVO+IPI cohort over 60 months are lower than costs incurred by patients initiating treatment with either IPI or NIVO alone. The higher upfront costs of the NIVO+IPI regimen are offset by lower post-progression costs, as patients receiving NIVO+IPI enjoy a longer duration of response, delayed progression and consequently, reduced usage of subsequent melanoma therapies.

PSU2 Perioperative Complications of Scoliosis Surgery : Management Strategies and Associated Costs in France

Scoliosis is a spinal deformity that can be treated by complex spine surgery. The objective of this systematic literature review was to assess the perioperative complications associated with scoliosis surgery, their associated costs, and their management in France. A search was performed in Embase and Medline from 2014 to 2018. Adult and pediatric patients with a scoliosis pathology and/or a Scheuermann’s kyphosis that were undergoing ≥4 level spine surgery in France were included. Variables extracted from the studies and analyzed included: age, underlying indication for surgery, number of spine levels operated, operative time and length of stay, peri-operative blood loss and transfusions, complications, costs and management strategies. Out of 733 articles identified, 8 full-text articles were included for evaluation: 2 prospective studies and 6 retrospective studies. The number of patients included was comprised between 40 and 524. Seven studies included pediatric patients. Five studies included patients suffering from adolescent idiopathic scoliosis. The number of spine levels operated was between 4.3 and 13. The follow-up period was between 1 month and 7 years. The complications reported were postoperative infections (N=7), complications associated with spinal implants (N=3), proximal junction kyphosis (N=2), adding-on (N=1), blood transfusions (N=1), neurological complications (N=1), reoperation (N=1). The length of stay was reported in one study (3.5 days) and the operative time was reported in three studies (mean: 212 minutes). Postoperative pain was assessed in three studies using a visual analogical scale (VAS) or the Scoliosis Research Society SRS-22 questionnaires. Quality of life and functional outcomes were reported in two studies using the SRS-22. Management strategies and associated costs of complications associated with scoliosis surgery were not or little reported in the selected studies. A board of experts should be conducted to identify the management strategies and their costs in France.

PCN92 Cost Effectiveness of Obinutuzumab PLUS Chemotherapy Followed By Obinutuzumab Maintenance for Patient with Previously Untreated Advanced-STAGE Follicular Lymphoma in French Setting

Obinutuzumab with chemotherapy plus obinutuzumab maintenance ( G-chemo+G) is reimbursed in France for the treatment of patient with previously untreated advanced-stage follicular lymphoma. Here, we evaluate the cost effectiveness of G-chemo+G over rituximab with chemotherapy plus R maintenance (R-chemo+R). A Markov model was developed over a 30 years time horizon including four health state: ‘PFS (on/off treatment)’, ‘Early progression within 24 months, ‘Late progressive disease in subsequent months’ and ‘Death’. Patient characteristics and clinical data were retrieved from GALLIUM study, except for death probabilities in late progressive diseases state which was based on PRIMA study. We adopted a payer perspective for costs. Frequency of resources used were based on expert opinion. We estimated the benefit in quality-adjusted life years (QALYs) according to age-adjusted EQ-5D-3L utility scores from GALLIUM and to disutilities for grade 3-4 AEs. Costs and outcomes were discounted at 2,5%. Sensitivity analysis were performed. Compared R-chemo+R, G-chemo+G was associated with a gain of 0.622 (11.999 versus 11.377) (QALYs) and an incremental cost of €28,367 mostly driven by treatment costs. The incremental cost-utility ratio (ICUR) was €45,610/QALY. Progression cost (including follow-up cost and 2nd line treatment cost) were lower in the G-chemo plus G arm with a difference of - 7,350€ (€39,175 versus €46,525) due the reduced number of patients progressing within 24 months. We demonstrate that G-chemo plus G maintenance is a cost effective option compared to R-chemo plus R maintenance. The PFS gain with G-chemo+G in patient with previously untreated advanced-stage follicular lymphoma bring a substantial health benefit to the patients at an acceptable additional cost in France.

Cervical cancer screening coverage, management of squamous intraepithelial lesions and related costs in France.

Until 2018, cervical cancer screening in France was an unorganized individual screening, with the exception of some pilot programs in some territories. We aimed to assess, before the implementation of organized cervical cancer screening and human papillomavirus (HPV) nonavalent vaccine introduction in the vaccination schedule in 2018, (i) the individual cervical cancer screening coverage, (ii) the management of squamous intraepithelial lesions (SIL) and (iii) the related costs. We used the Système National des Données de Santé (SNDS) (Echantillon Généraliste de Bénéficiaires [EGB] and Programme de Médicalisation des systèmes d’information [PMSI]) to assess the cervical screening coverage rate in France between January 1st, 2012 and December 31st, 2014, and to describe diagnostic investigations and therapeutic management of SIL in 2013. After extrapolation to the general population, a total of 10,847,814 women underwent at least one smear test over the 3-year study period, corresponding to a coverage rate of 52.4% of the women aged 25 to 64 included. In 2013, 126,095 women underwent HPV test, 327,444 women underwent colposcopy, and 9,653 underwent endocervical curettage; 31,863 had conization and 12,162 had laser ablation. Besides, 34,067 women experienced hospital stays related to management of SIL; 25,368 (74.5%) had high-grade lesions (HSIL) and 7,388 (21.7%) low-grade lesions (LSIL). Conization was the most frequent in-hospital therapeutic procedure: 89.5% (22,704) of women with an in-hospital procedure for HSIL and 64.7% (4,781) for LSIL. Mean cost of smear test, colposcopy and HPV tests were around 50€. Total cost for hospital stays in 2013 was estimated at M41€, or a mean cost of 1,211€ per woman; 76% were due to stays with HSIL. This study highlights the low coverage rate of individual cervical cancer screening and a high burden related to SIL management.

G-CSF spending: Cost Impact of an intervention conducted in a French area: Pays-de-la-Loire

Abstract Issue Granulocyte colony-stimulating factors (G-CSF), recommended by international oncology guidelines as a prophylaxis of febrile neutropenia are expensive drugs. Despite biosimilars marketing since 2008, G-CSF spending represents a major and growing expense for health insurance. Description of the problem Between 2010 and 2013 an unsustainable increase of G-CSF spending by 20% occurred in a French area: Pays-la-Loire. An intervention based on guidelines was carried out to the oncologists involved in ambulatory cancer care to reduce G-CSF spending by improving prescription and promoting biosimilars. Hospital oncologists have been the main target. A partnership between physicians and pharmacists of the Brittany - Pays-de-la-Loire Cancer Dedicated Observatory network and the Pays de la Loire Medical Department of Health insurance composed the operational team involved in the work. Interrupted time series analysis based on the French national health data system database were chosen to assess the impact of the intervention on G-CSF spending, their prescription and biosimilars use. Results Twelve professional meetings were performed to cancer medical teams from 7 community hospitals and 5 private hospitals of the Pays-de-la-Loire region. This intervention reduced G-CSF spending by 11% and improves G-CSF local use. Lessons This type of multi-stakeholder intervention carrying common to various health actor’s messages represents a promising tool to improve the quality of care and the control of health expenditure. These results and the possible cost saving showed have encouraged the heads of French health insurance to promote this action in 2019 in the whole France. Key messages In the current context of unsustainable increases in cancer cares related costs in France the rational use of G-CSF’s seemed to be one available resources. biosimilar promotion for ensure broad access to innovative cancer therapeutic for patients and finance cancer prevention campaigns.

Migraine burden and costs in France: a nationwide claims database analysis of triptan users

Objectives: To estimate the burden of migraine in the population of French patients identified as specific migraine acute treatment users compared to a control group.Methods: A cross-sectional retrospective analysis was performed on the Echantillon Généraliste des Bénéficiaires claims database, a 1/97 random sample of the French public insurance database. A representative sample of all adults with at least one delivery of triptans, ergot derivatives or acetylsalicylic acid/metoclopramide (all drugs with a specific label in migraine acute treatment – SMAT) in 2014 was selected with a control group matched on age, gender and geographic region. Among triptan users, a sub-group of over-users was defined according to their level of triptan uptake expressed in defined daily doses (DDD – a standard daily dose of treatment of acute migraine) per month over 3 months and more, was also compared with controls. The cost analysis was performed in a societal perspective for direct costs. Sick leave indirect costs were estimated using the human capital approach.Results: In total 8639 SMAT users (mean age: 44.6 years; 78.7% women) were selected representing a crude prevalence rate of 1.7%. The annual per capita total healthcare expenditures were higher by €280 in this group compared to controls (€2463 vs. €2183). Triptans contributed 47.8% to this extra cost. They used significantly (p < .0001) more frequently than controls antidepressants (20.8% vs. 11.0%), anxiolytics (29.4% vs. 18.8%) and analgesics (53.8% vs. 35.8%). The per capita annual productivity loss associated with sick leave was higher by €295 (€1712 vs. €1417). Among triptan users, there were 2.9% over-users. This last group was characterized by substantially higher per capita annual extra direct (+ €1805) and indirect costs (productivity loss +€706) compared to controls.Conclusions: Due to its high prevalence, migraine costs generate a significant societal burden. The group of over-users concentrates high per capita direct and indirect costs.

Non-interventional Study Describing Epidemiology, Prognosis and Patient Healthcare Costs in France, 2010-2017

Non-interventional Study Describing Epidemiology, Prognosis and Patient Healthcare Costs in France, 2010-2017

Targeted prevention could reduce RSV costs in France

Targeted prevention could reduce RSV costs in France

Do complications following pancreatic resections impact hospital costs in France: Medico-economic study on 127 patients

To define the cost of pancreatectomies and to identify factors associated with increased hospital costs after pancreatic resection. All patients undergoing pancreatic surgery in our department between January 2008 and December 2014 were included. All complications occurring during hospitalization or in the 90-day period after discharge were documented. The hospital costs were analyzed and predictive factors of increased hospital costs were determined. One hundred and twenty seven patients were identified. Most patients underwent pancreatectomy for malignant tumors (70%). Median hospital costs were 21,392 [15,998-29,667] euros. Age (P=0.011) and preoperative jaundice (P<0.001) were associated with higher hospital costs. Intraoperative surgical time and blood loss were correlated with increased costs (P=0.001 and P=0.002, respectively). Pancreatoduodenectomy was associated with statistically significantly higher costs compared to distal pancreatectomy (21,770 vs. 15,422 euros, P=0.001). Severe postoperative complications (Clavien-Dindo grade≥3) (P=0.001), septic complications (P=0.002) and hemorrhage (P=0.001) statistically significantly increased costs. In multivariate analysis, septic (P=0.003) and severe complications (P=0.01) were statistically significantly associated with increased hospital costs. Pancreatic surgery is associated with high hospital costs, essentially related to postoperative complications.

SAT-479 - NAFLD/NASH patients with compensated cirrhosis (CC) had a high prevalence of comorbidities, substantial liver disease progression, and increased annual number of hospitalizations and associated costs in France: a PMSI database analysis

SAT-479 - NAFLD/NASH patients with compensated cirrhosis (CC) had a high prevalence of comorbidities, substantial liver disease progression, and increased annual number of hospitalizations and associated costs in France: a PMSI database analysis

Outcomes and management costs of peripheral arterial disease in France

BackgroundLittle is known about the characteristics and prognosis of patients with peripheral arterial disease (PAD) and related real-life health costs in France. MethodsA cohort of patients diagnosed with PAD between 2007 and 2011 was extracted from the French Echantillon Généraliste des Bénéficiaires (EGB) claims database. The patients were followed up from the date of PAD diagnosis. Their characteristics, incidence of death and other events, treatments, and costs were analyzed by comparison with age- and gender-matched PAD-free controls. ResultsThere were 5889 patients with PAD identified. Mean age was 70.8 years, and 68.1% of patients were male. Diabetes was present in 28.9% of patients (13.2% of controls), hypercholesterolemia in 52.9% (28.7%), and hypertension in 46.6% (12.3%); 4.9% of patients had a history of unstable angina or myocardial infarction (0.5%), and 6.0% had a history of stroke or transient ischemic attack (1.4%). At inclusion, 69.3% of patients were receiving antiplatelet drugs (17.3%), 52.3% statins (21.9%), 26.7% angiotensin-converting enzyme inhibitors (13.7%), and 24.2% angiotensin receptor blockers (16.6%). Cumulative mortality rates were 13.2% at 1 year and 19.4% at 2 years (3.2% and 6.5% in controls). Cumulative incidence rates of death and major cardiovascular events (myocardial infarction and ischemic stroke) were 15.7% (95% confidence interval [CI], 14.8%-16.6%) at 1 year and 22.9% (95% CI, 21.9%-24.0%) at 2 years vs 3.9% (95% CI, 3.4%-4.4%) and 7.8% (95% CI, 7.1%-8.5%) in controls. All differences were statistically significant (P < .05). Total annual management costs were €14,949 in the PAD group and €3812 in the control group. ConclusionsMortality is elevated and cardiovascular events are frequent among French PAD patients. PAD drug treatment guidelines are not fully implemented in France.