French National Hospital Database Research Articles

Secular trends of hip fractures in France: impact of changing characteristics of the background population.

Hip fractures are a societal burden because of their high morbidity and mortality and the cost they generate. With the aging of the population, worries grow about an increase of the incidence and incidence rate of hip fracture in the future. Controversial data have been provided in relation to the referencepopulation used. The aim of this study was to assess the impact of the choice of the reference population in the incidence rate of hip fracture. Data were extracted from the French National Hospital Database related to the hospitalizations for hip fracture in France between 2002 and 2013 in patients over 59 years and were classified by gender and age (59-74, 75-84, over 84 years, over 59 years). The crude incidence rates of hip fracture were calculated by dividing the number of hospitalizations for hip fracture by the corresponding populations. To assess the impact of the choice of the reference population, we then calculated the adjusted incidence rates using direct standardization on age for the 2013 reference population. From 2002 to 2013, the incidence of hip fracture rose by 4.8% in women (from 49,287 to 51,661) and 21.8% in men (from 12,716 to 15,482) aged over 59 years. Meanwhile, French population over 59 years increased more with a rise of 21.3% in women and 28.7% in men, resulting in a decrease in the crude incidence rates of 13.6% in women and 5.4% in men. However, this decrease was larger after direct standardization on the 2013 population of reference as 25.6% in women and 19.2% in men as a result of a difference in age-structure of the population. The incidence of hip fractures continues to grow despite a reduced incidence rate throughout a 12-year-period.

Extra cost of brain metastases (BM) in patients with non-squamous non-small cell lung cancer (NSCLC): a French national hospital database analysis

PurposeTo assess the incremental cost associated with the management of patients with primary non-squamous non-small cell lung cancer (NSCLC) with brain metastases at the time of diagnosis.MethodsData were extracted from the French Hospital medical information database (Programme de Médicalisation des Systèmes d’Information (PMSI)). Patients with non-squamous NSCLC were identified through a diagnosis of lung cancer and a prescription of bevacizumab or pemetrexed. All such patients hospitalised with lung cancer for the first time in 2013 and with metastases identified at the first hospitalisation were eligible. Two cohorts were identified, one with brain metastases (group B: n=971) and one with metastases at other sites (group A: n=1529). For each patient, total in-hospital medical resource consumption associated with the initial hospitalisation in 2013 and with any follow-up stays in the following 24 months was documented. Costs were attributed from official French national tariffs and expressed in 2017 euros.ResultsThe mean number of hospitalisations per patient in the 24-moth follow-up period was 17 in group A and 21 in group B. >99% of patients in both groups received chemotherapy. 58% of patients in group B and 13% in group A were managed by radiotherapy. 37% in group B and 24% in group A received palliative care. The associated cost was €2979 per patient-month for patients in group B and €2426 for patients in group A, representing a differential cost of €553 per month. Radiotherapy (+€164/month) and palliative care (+€130/month) were the principal drivers of the incremental cost.ConclusionsThe presence of brain metastases at the time of diagnosis of non-squamous NSCLC carries a significant burden, and ways of lowering this burden are needed.

National trends in admission for cardiac rehabilitation after a myocardial infarction in France from 2010 to 2014

Follow-up care and rehabilitation services [soins de suite et réadaptation (SSR)], especially cardiac rehabilitation (CR), constitute a key stage for patients who have had an acute myocardial infarction (AMI). To study admission to SSR, especially for CR, among patients hospitalized for AMI in France in 2014, and its temporal trend between 2010 and 2014. We used the French National Hospital Database to select patients hospitalized with a main diagnosis of AMI (identified by ICD-10 codes I21 to I23) in the first semester of each year from 2010 to 2014. We then searched for rehabilitation admission in the 6 months after the index hospitalization. We calculated age-standardized rates of admission for CR and for other rehabilitation purposes. The average annual percentage change in admission rates was analysed by Poisson regression. In 2014, among the 29,424 patients hospitalized for an AMI in the first 6 months of the year, 10,873 (36.9%) were subsequently admitted to SSR units. More specifically, the age-standardized rate of patients hospitalized in CR units reached 28.4% (n=8380), and was greater among men (29.6%, n=6707) than among women (24.9%, n=1673). Between 2010 and 2014, rates of admission for CR increased by 5.0% per year in men and 6.6% per year in women. We found a great increase in ambulatory CR management, which accounted for half of the admissions for CR in 2014. Favourable trends in rates of admission for CR were reported in both sexes and at all ages, except the oldest. The increase in ambulatory management contributed to these changes. Despite these trends, rates of admission for CR after AMI remain low.

Economic impact of ulipristal acetate on surgical procedures for uterine fibroids in France

ObjectiveTo assess the budget impact of using ulipristal acetate (UPA) 5 mg to treat women with uterine fibroids (UF) causing moderate to severe symptoms.DesignWe modelled trends in the number of...

Survival inequalities in patients with lung cancer in France: A nationwide cohort study (the TERRITOIRE Study).

The French healthcare system is a universal healthcare system with no financial barrier to access to health services and cancer drugs. The objective of the study is to investigate associations between, on the one hand, incidence and survival of patients diagnosed with lung cancer in France and, on the other, the socioeconomic deprivation and population density of their municipality of residence. A national, longitudinal analysis using data from the French National Hospital database crossed with the population density of the municipality and a social deprivation index based on census data aggregated at the municipality level. For lung cancer diagnosed at the metastatic stage, one-year and two-year survival was not associated with the population density of the municipality of residence. In contrast, mortality was higher for people living in very deprived, deprived and privileged areas compared to very privileged areas (hazard ratios at two years: 1.19 [1.13–1.25], 1.14 [1.08–1.20] and 1.10 [1.04–1.16] respectively). Similar associations are also observed in patients diagnosed with non-metastatic disease (hazard ratios at two years: 1.21 [1.13–1.30], 1.15 [1.08–1.23] and 1.10 [1.03–1.18] for people living in very deprived, deprived and privileged areas compared to very privileged areas). Despite a universal healthcare coverage, survival inequalities in patients with lung cancer can be observed in France with respect to certain socioeconomic indicators.

Burden of Clostridium difficile Infections in French Hospitals in 2014 From the National Health Insurance Perspective.

OBJECTIVE To describe the hospital stays of patients with Clostridium difficile infection (CDI) and to measure the hospitalization costs of CDI (as primary and secondary diagnoses) from the French national health insurance perspective DESIGN Burden of illness study SETTING All acute-care hospitals in France METHODS Data were extracted from the French national hospitalization database (PMSI) for patients covered by the national health insurance scheme in 2014. Hospitalizations were selected using the International Classification of Diseases, 10 th revision (ICD-10) code for CDI. Hospital stays with CDI as the primary diagnosis or the secondary diagnosis (comorbidity) were studied for the following parameters: patient sociodemographic characteristics, mortality, length of stay (LOS), and related costs. A retrospective case-control analysis was performed on stays with CDI as the secondary diagnosis to assess the impact of CDI on the LOS and costs. RESULTS Overall, 5,834 hospital stays with CDI as the primary diagnosis were included in this study. The total national insurance costs were €30.7 million (US $33,677,439), and the mean cost per hospital stay was €5,267±€3,645 (US $5,777±$3,998). In total, 10,265 stays were reported with CDI as the secondary diagnosis. The total national insurance additional costs attributable to CDI were estimated to be €85 million (US $93,243,725), and the mean additional cost attributable to CDI per hospital stay was €8,295±€17,163, median, €4,797 (US $9,099±$8,827; median, $5,262). CONCLUSION CDI has a high clinical and economic burden in the hospital, and it represents a major cost for national health insurance. When detected as a comorbidity, CDI was significantly associated with increased LOS and economic burden. Preventive approaches should be implemented to avoid CDIs. Infect Control Hosp Epidemiol 2017;38:906-911.

Hip fracture incidence and social deprivation: results from a French ecological study.

Regional variations in hip fracture (HF) incidence exist worldwide. Reasons for these variations remain unknown. As regional variations have also been observed for socioeconomic status, we analyzed the association between socioeconomic deprivation (SED) and HF incidence in France in 2008. From the French Hospital National Database, we selected all HF encoded as primary diagnosis in persons aged 30years and over. The recently published French version of the European Deprivation Index (EDI) was used for SED analysis, and an EDI score was measured for the year 2007 in each French local municipality. The EDI score was categorized in quintiles. Poisson regression was performed to examine the association between HF incidence and EDI adjusted for age and sex. The population attributable fraction (PAF) was measured to calculate the proportion of excess cases of HF associated with social affluence. In 2008, 83,538 HF were reported in France of which 59,143 were included in this study. Among them, 44,401 fractures occurred in women (75%) and 14,742 in men (25%). In both men and women, there was a decrease in the HF incidence with increasing SED index. In Poisson regression, the interaction of age class and sex was significant (p<0.0001) and the EDI in quintiles was significantly associated with the incidence of HF (p<0.0001). A higher number of people living in affluent residential areas corresponded to a higher risk of HF. The risk of HF is 2.42 times higher for those living in the most affluent group compared to those living in the most underprivileged group. The value of the PAF was calculated at 27.1%. Social disparities in HF incidence exist in France with the most deprived municipalities having the lowest incidence. Prior knowledge demonstrates the strong relationships between body weight and HF risk as well as between body weight and the SED. The link found in our study between EDI and HF incidence as well as regional and temporal variations in HF incidence may be partly due to the protective effect of increased body weight against HF.

In-Hospital Economic Burden of Metastatic Renal Cell Carcinoma in France in the Era of Targeted Therapies: Analysis of the French National Hospital Database from 2008 to 2013.

Background & ObjectivesThe aim of this study was to assess the economic burden of hospitalisations for metastatic renal cell carcinoma (mRCC), to describe the patterns of prescribing expensive drugs and to explore the impact of geographic and socio-demographic factors on the use of these drugs.MethodsWe performed a retrospective analysis from the French national hospitals database. Hospital stays for mRCC between 2008 and 2013 were identified by combining the 10th revision of the International Classification of Diseases (ICD-10) codes for renal cell carcinoma (C64) and codes for metastases (C77 to C79). Incident cases were identified out of all hospital stays and followed till December 2013. Descriptive analyses were performed with a focus on hospital stays and patient characteristics. Costs were assessed from the perspective of the French National Health Insurance and were obtained from official diagnosis-related group tariffs for public and private hospitals.ResultsA total of 15,752 adult patients were hospitalised for mRCC, corresponding to 102,613 hospital stays. Of those patients, 68% were men and the median age at first hospitalisation was 69 years [Min-Max: 18–102]. Over the study period, the hospital mortality rate reached 37%. The annual cost of managing mRCC at hospital varied between 28M€ in 2008 and 42M€ in 2012 and was mainly driven by inpatient costs. The mean annual per capita cost of hospital management of mRCC varied across the study period from 8,993€ (SD: €8,906) in 2008 to 10,216€ (SD: €10,527) in 2012. Analysis of the determinants of prescribing expensive drugs at hospital did not show social or territorial differences in the use of these drugs.ConclusionThis study is the first to investigate the in-hospital economic burden of mRCC in France. Results showed that in-hospital costs of managing mRCC are mainly driven by expensive drugs and inpatient costs.

Predictive ability of HAS-BLED, HEMORR2HAGES, and ATRIA bleeding risk scores in patients with atrial fibrillation. A French nationwide cross-sectional study

ObjectiveThe HAS-BLED, ATRIA, and HEMORR2HAGES risk scores were created to evaluate individual bleeding risk in atrial fibrillation (AF). We sought to estimate and compare the predictive ability of these scores for major hemorrhage in AF, including elderly (≥80years) and non-elderly (<80years) patients. MethodsThis cross-sectional study is based on the French National Hospital Database (PMSI), which covers the entire French population. Data from all patients with an AF diagnosis in 2012 were extracted. Demographic and comorbidity data were used to calculate the three bleeding risk scores for each patient. Patients hospitalized with a principal diagnosis of major bleeding were identified. ResultsOf the 533,044 AF patients identified, 53.2% were ≥80years; 7013 patients (1.3%) were hospitalized for a bleeding event (1785 for intracranial hemorrhage). Bleeding occurred more frequently in patients with higher HAS-BLED, HEMORR2HAGES, and ATRIA scores. In patients ≥80years, the c-statistics did not differ (p=0.27) between HAS-BLED (0.54; 95% confidence interval [CI]: 0.53–0.54), HEMORR2HAGES (0.53; 95% CI: 0.53–0.54), and ATRIA (0.53; 95% CI: 0.52–0.54). In patients <80years, HAS-BLED (0.59; 95% CI: 0.58–0.60) had a slightly higher c-statistic than HEMORR2HAGES (0.56; 95% CI: 0.55–0.57) and ATRIA (0.55, 95% CI: 0.55–0.56) (p<0.0001). ConclusionsGiven its simplicity and similar performance, HAS-BLED may be an attractive alternative to HEMORR2HAGES for estimation of bleeding risk in AF patients <80years. However, accurate determination of bleeding risk among the elderly is difficult with existing risk-prediction scores, indicating a clear need for improvement in their clinical utility.

Positive predictive values of selected hospital discharge diagnoses to identify infections responsible for hospitalization in the French national hospital database

The identification of infections in electronic health databases is a key issue for pharmacoepidemiology research. The aim of this study was to assess the positive predictive values (PPVs) of hospitalizations for infection in the Système National d'Information Inter-régimes de l'Assurance Maladie, that is the electronic database recording in-and-out hospital data for the entire French population (66 million inhabitants). The source of data was the database of hospitalizations (Programme de Médicalisation des Systèmes d'Informations) of Toulouse University hospital, South of France (2880 beds). Among all hospital stays between September and December 2014, we randomly selected 100 stays with an International Classification of Diseases, 10th revision code of infection as primary diagnosis and 100 as related diagnosis. Medical charts were reviewed to assess the PPV of infection codes, as well as the PPV of correct coding of infection type among the true positive cases. The PPVs of codes of infection as reason for hospitalization were 0.97, 95% confidence interval (CI) [0.93-1.00] for primary diagnosis codes and 0.70, 95% CI [0.61-0.71] for related diagnosis codes. Among the true positive cases, the PPVs of correct coding of the type of infection were, respectively, 0.98, 95% CI [0.95-1.00] and 0.93, 95% CI [0.88-0.98]. Hospitalizations for infection codes have very good PPVs in the Programme de Médicalisation des Systèmes d'Informations. Copyright © 2016 John Wiley & Sons, Ltd.

Off-label use of the expensive orphan drug eculizumab in France 2009-2013 and the impact of literature: focus on the transplantation field.

The orphan drug eculizumab (Soliris ®) is one of the most expensive in the world and based on expenditures is classed among the highest in France, a scenario suggestive of off-label use. Given its pharmacological properties, it is likely to be used in organ transplantation. Our purposes were to describe the consumption trends of eculizumab for off-label indications overall and in the organ transplantation field and to assess the impact of publications on the latter use. We carried out a temporal ecological study within the French national hospitalization database (PMSI). First, the trend of eculizumab consumption (2009-2013) was compared to our estimate of the maximum on-label consumption (overall and for transplantation). Second, we evaluated the impact of the publications supporting the effectiveness of eculizumab in the transplantation field on temporal trends of eculizumab consumption. Eculizumab total consumption exceeded our estimate of the maximum on-label consumption since the end of 2011 and increased until the end of the study. The off-label consumption represented at least 50% of the total consumption. The off-label consumption in organ transplantation also increased since 2011. The amount of publications grew through the study period, but overall, the evidence level remained low. Statistically, publications were neither associated with the drug consumption for transplantation in the long term nor in the short term. Eculizumab started being notably used for off-label indications in France since the end of 2011, and this use increased until the end of the study. We found only low-level evidence concerning the off-label use of eculizumab in the transplantation field through the studied period.

A population database study of outcomes associated with vitamin K antagonists in atrial fibrillation before DOAC.

This study aimed to describe the real-life incidence of bleeding, arterial thrombotic events and death during vitamin K antagonist (VKA) treatment in atrial fibrillation (AF). This was a cohort study in Echantillon Généraliste de Bénéficiaires, the 1/97 sample of the French national healthcare claims and hospitalization database, of new VKA users with definite or probable AF and no other indication, and of patients without AF, from 2007 to 2011. Prespecified outcomes were all-cause death, hospitalization for bleeding, arterial thrombotic event (ATE), or acute coronary syndrome (ACS) or any of the above (composite outcome). Of 8894 new VKA users, 3345 had probable or certain AF, 51.7% were male, mean age was 75.1years, 87.1% had a CHA2 DS2 -VASc score≥2 and 11.6% a HAS-BLED score>3. Among AF patients, during VKA exposure the incidence rate of bleeding was 2.8 [95% confidence interval (CI) 2.2, 3.4] per 100 patient-years, including 0.6 (95% CI 0.3, 0.8) cerebral, 1.0 (95% CI 0.7, 1.3) digestive and 1.4 (95% CI 1.0, 1.7) other bleeds. There were 1.6 (95% CI 1.2, 2.0) ACS, 1.5 (95% CI 1.1, 1.8) ATE and 3.8 (95% CI 3.2, 4.4) deaths per 100 patient-years. The incidence rate of the composite outcome was 9.1 per 100 patient-years (95% CI 8.2, 10.0). When patients stopped VKA, bleeding decreased (RR 0.67, 95% CI 0.43, 1.04)), but death or thrombosis increased (RR 3.06, 95% CI 2.46, 3.81 and 1.75, 95% CI 1.14, 2.70, respectively). During VKA exposure non-AF patients had similar rates of bleeding, but fewer deaths, ACS and ischaemic events. Real-life rates for bleeding, arterial thrombotic events, ACS and deaths in AF patients treated with VKA were similar to those observed in clinical trials.

Thrombosis in Cancer Patients during Hospitalization: Impact on Stays and Costs

Background: Cancer patients represent an at-risk population for Venous Thromboembolic Events (VTE). Following a previous study on two localizations, we intended to determine the incidence and recurrence rate of VTE in breast cancer (BC), colon cancer (CC), lung cancer (LC) and prostate cancer (PC), four of the most frequent cancers in France. We evaluate their impact on the number and the duration of hospitalizations and calculate the additional costs for hospitals compared to cancer patients without VTE.Methods: The French national hospital database (PMSI) was used to identify BC, CC, LC and PC patients diagnosed in 2010 who were hospitalized for a VTE during the following two years. The number of stays induced by a VTE, the number of patients hospitalized or re-hospitalized and the time before recurrent event were determined using the disease-specific ICD-10 codes, among all VTEs classified as primary or related diagnosis (PD / RD) and significant associated diagnosis (SAD).Subsequently, we evaluated the extra cost and extra duration of stay when a VTE is managed during a hospitalization. Therefore, we selected stays during witch a VTE is managed but was not the main reason of hospitalization (cancer was classified as primary/related diagnosis and VTE as significant associated diagnosis). Those stays were matched and compared to similar stays without VTE. Costs were estimated from the healthcare system perspective, using the French official tariffs.Results: Among 194,964 patients newly diagnosed in 2010 with BC, CC, LC and PC in 2010, 1,271 (2.0%) BC patients, 2,866 (6.0%) CC patients, 3,775 (9,6%) LC patients and 997 (2.2%) PC patients, were hospitalized for a VTE or experienced a VTE during a hospital stay, over two years. In total, 12,880 stays related to VTE were identified.We found that 2.053 cancer patients (23.0% of all VTE patients) were re-hospitalized at least once with a recurrent VTE, representing 3,969 admissions (30.8% of total admissions). In those patients with VTE recurrence, median time between first and recurrent event was 23 days in BC patients, 22 days in CC patients, 19 days in LC patients 25 days in PC patients.In the second part of our study, the comparison between stays for cancer during which a VTE occurred and stays for cancer without VTE showed that the duration of hospital stay was longer in patients with VTE: in public hospitals, median stay duration raised from 4 to 7 days for BC, from 8 to 16 days in CC, from 2 to 9 days in LC and from 6 to 10 days in PC.VTE consequently induced a significant extra cost related to hospitalizations over the two years of follow-up: in public hospitals, the median expenditure per stay increased by 37% in BC, (up to Û 5,518), by 61% in CC (up to Û9,878), by 202% in LC (up to Û7,308) and by 22% in PC (up to Û6,200).Conclusion: VTE appeared to make cancer management much heavier as patients faced increased hospital stays duration whereas healthcare system faced important additional costs. Better prevention and follow-up guidelines could reduce this burden, and benefit both patients and hospitals.TableMedian hospital stay duration and cost in cancer patients with and without VTE as SADBreast cancerColon cancerLung cancerProstate cancerDuration (days)CostDuration (days)CostDuration (days)CostDuration (days)CostWith VTE7Û 5,51816Û9,8789Û7,30810Û 6,200Without VTE4Û 4,0188Û6,1712Û2,4226Û 5,094 DisclosuresNo relevant conflicts of interest to declare.

Chronic hepatitis C: Burden of disease and cost associated with hospitalisations in France in 2012 (The HEPC-LONE study)

This retrospective hospital database analysis aimed to determine the burden and cost of hospitalisations related to chronic hepatitis C (CHC) infections in France in 2012. All hospital stays with CHC (ICD-10 code B18.2) coded as the principal, related or significantly associated diagnosis were extracted from the French National Hospital database 2012 (PMSI). Hospitalisations not directly related to CHC were excluded. Patients were assigned to a liver disease stage, namely non-cirrhotic liver disease, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma or post-liver transplantation. Costing was performed using French national tariffs and expressed in 2013 Euros. We documented 22,056 hospital stays involving 12,040 patients who were considered to be directly related to CHC. Of these stays, 11,779 (53.4%) were documented in patients with severe complications (decompensated cirrhosis, hepatocellular carcinoma or liver transplantation). The mean number and duration of hospital stays increased with disease severity. Overall, 1181 patients (9.8%) died during hospitalisation. The total cost of hospital stays for CHC was estimated to be €61 million, of which 26.4% were attributable to hepatocellular carcinoma, 32.5% to post-liver transplantation and 21.0% to decompensated cirrhosis. Compared with a previous analysis in 2009, the number of patients hospitalised fell by 22%, although the patients hospitalised were overall more severely ill. The total cost of hospitalisation decreased by 8%, with a notably marked reduction in the number of biopsies performed (32%). This study illustrates the persistently high burden of CHC infections in France.

Pcn260 - Burden of Metastatic Renal Cell Carcinoma in France From 2008 To 2013: Analysis of the French National Hospital Database

• A retrospective analysis was performed using the French national hospital database (PMSI), an exhaustive hospital discharge database that covers all hospital stays in public and private hospitals in France. For each hospital stay, the PMSI provides a compilation of administrative data (i.e. age, gender, residence code) and medical data (i.e. diagnosis, medical procedures performed during hospital stays). Each hospital stay is then classified in a diagnosis related group (DRG) and can be linked to a patient using the unique patient identification number. • We extracted all hospital stays from 2007 to 2013 with the ICD-10 codes for both renal cell carcinoma (C64*) and metastasis (C77*, C78*,C79*). Among hospital stays for mRCC, we extracted incident cases identified by the absence of hospitalization for mRCC and the absence of metastasis in the previous year. Hospital stays for which the patient identification number was not adequately recorded as well as hospital stays that could not be classified into a DRG were excluded. Hospital stays for non incident cases and patients aged under 18 were also excluded. • Included patients were followed until death and data were censored on December 2013 for living patients. • Descriptive analysis were performed in terms of hospital stays and patients. • The cost of hospitalizations for mRCC was calculated from the perspective of the French national health insurance. For this purpose, the DRG tariffs for both public and private settings were used. Context & Objective • Kidney cancer accounts for approximately 3% of all cancers in France(1). In 2012, there were 11,573 new cases of kidney cancer and 3,957 deaths in France(2). • Renal cell carcinoma (RCC) accounts for 85% to 92% of kidney cancer cases (1,3–4). Approximately 25% to 30% of patients with RCC have metastasis at diagnosis and up to 50% of patients who undergo curative renal resection are likely to develop metastatic renal cell carcinoma (mRCC)(4).

PCN261 - Value of Assessing the Burden of Hospitalizations for Metastatic Melanoma in the era of Targeted Therapies: Analysis of the French National Hospital Database From 2008 To 2013

PCN261 - Value of Assessing the Burden of Hospitalizations for Metastatic Melanoma in the era of Targeted Therapies: Analysis of the French National Hospital Database From 2008 To 2013

Thromboembolic events in hospitalized cancer patients: Impact on stay duration and cost for four major cancer localizations.

186 Background: Cancer patients represent an at-risk population for Venous Thromboembolic Events (VTE). Our study aimed to evaluate the impact of VTE on the length and cost of hospital stay in French patients hospitalized for breast cancer (BC), colon cancer (CC), lung cancer (LC) or prostate cancer (PC). Methods: The French national hospital database (PMSI) and the disease-specific ICD-10 codes were used to identify BC, CC, LC or PC patients diagnosed in 2010 who were hospitalized with a VTE during the following two years. We selected stays during which a VTE occurred but was not the main reason of hospitalization (cancer was classified as primary/related diagnosis and VTE as significant associated diagnosis). Those stays were matched and compared to similar stays (same cancer and same reason for hospitalization) without VTE. Costs were calculated using the French official tariffs, from the perspective of the third-party payer. Results: We identified 214 stays for breast cancer during which a VTE occurred and was classified as significant associated diagnosis, 843 stays for colon cancer, 1301 for lung cancer, and 126 for prostate cancer. The comparison between those stays and similar stays without VTE showed significant increase of hospital stay duration in patients experiencing VTE. Median duration rose from 4 to 7 days in BC patients, from 8 to 16 days in CC, from 2 to 9 days in LC and from 6 to 10 days in PC. Consequently, the median expenditure per stay increased by 37% in BC patients with VTE (up to € 5,518), by 61% in CC (up to € 9,878), by 202% in LC (up to € 7,308) and by 22% in PC (up to € 6,200). Conclusions: When occurring during hospitalization, VTE made cancer management much heavier: patients faced prolonged hospital stays whereas healthcare system faced significant additional cost. Better prevention and follow-up measures could reduce this burden, and benefit both patients and hospitals. [Table: see text]

Incidence and costs of thromboembolic events in cancer patients: A study on four major cancer localization.

185 Background: Venous thromboembolic event (VTE) is a common complication for cancer patients, leading to hospitalizations that increase the burden of cancer management. Our study aimed to estimate the incidence and costs of hospitalizations for VTE, in French patients with breast cancer (BC), colon cancer (CC), lung cancer (LC) or prostate cancer (PC), four of the most frequent cancers in France. Methods: We used the French national hospital database (PMSI) to select new patients with BC, CC, LC or PC in 2010, who had at least one VTE-related hospitalization during the following two years. VTE-related stays and patients were identified using the disease-specific ICD-10 codes. Hospital costs were calculated over stays for which VTE was considered as primary/related diagnosis. Costs were estimated from the healthcare system perspective, using the French official tariffs. Results: Among 194,964 patients newly diagnosed in 2010 with BC, CC, LC or PC in 2010, 8,909 (4.6%) were hospitalized for a VTE or experienced VTE at hospital, representing, 12,880 hospital stays. During the two-year follow-up, 2,053 (23.0%) patients were re-hospitalized for a VTE recurrence, representing 3,969 stays (30.8% of admissions for VTE). For one patient with VTE who did not experience recurrence, the mean hospital cost over two years ranged from €3,302 to €3,674. This amount was dramatically increased for patients with recurrent VTE, as it ranged from €5,441 to €5,692 per patient. Hospitalizations for VTE associated with those 4 types of cancer only were responsible for an overall expenditure reaching €13.30 million over two years, including €1.82 million due to recurrent events. Conclusions: VTE-related cancer hospitalizations remain frequent and induce a notable cost. Prevention and management in respect to guidelines would be an efficient way to reduce the incidence of this complication and moderate its economic cost. [Table: see text]

Changes in number and incidence of hip fractures over 12 years in France

The incidence of hip fractures decreased in France in both genders, especially in the elderly, from 2002 to 2008, in parallel with availability of bone densitometry and effective anti-osteoporotic treatments. However prescriptions of these treatments are decreasing, since 2008, and recent studies show declining of osteoporosis management after fragility fractures. The aim of this study was to assess the incidence of hip fractures in men and women aged 60years and over, from 2002 to 2013 in France.Data were drawn from the French Hospital National Database which includes all hospitalizations of the country. Hospital data for hip fractures between 2002 and 2013 were numbered and the incidence rates per 1,000,000 adjusted on age (60–74; 74–84, and ≥85years), and gender was calculated using the data of the French population.The number of hip fractures increased in women (+5%; from 49,287 in 2002 to 50,215) and in men (+22%, from 12,716 to 15,482) aged over 60years. Between 2002 and 2013, the French population increased by 21 and 29% in women and men of this age group; thus, incidence of hip fractures decreased by 14% in women (6929 and 5987 per million in 2002 and 2013, respectively) and a slight decrease of −1% was observed in men (2344 and 2316). The decrease in incidence is also confirmed in the very elderly (≥85years), with a decrease of −29% and −24% in women and men respectively.Over the last 12years, the incidence of hip fractures decreased in France in women and men aged over 60years. This decrease is also observed in the subjects (≥85years and older in both genders). Further studies are needed to assess potential changes in risk factors of hip fractures during the last decade.

National trends in rate of patients hospitalized for heart failure and heart failure mortality in France, 2000-2012.

The objectives of this study were to describe annual trends in patients hospitalized for heart failure (HF) and HF-associated mortality rates in France between 2000 and 2012. Hospital discharge data were extracted from the French National Hospitalization Database (PMSI). Mortality data were obtained from the French National Mortality Database. HF events constituting the underlying or associated cause of death were selected. Rates were age standardized using the 2010 European census population as the standard population. Time trends were tested using a Poisson regression model. In 2012, the overall age-standardized rate of patients hospitalized for HF was 246.2 per 100,000 inhabitants. The age-standardized rate of HF-associated mortality was 113.8 per 100,000 inhabitants in 2010. Hospitalized patient rates remained steady between 2002 and 2012, whereas mortality decreased by 3.3% annually from 2000 to 2010. Trends in hospitalized patients and mortality differed significantly between men and women, particularly among the 45- to 55- and 65- to 74-year-old age groups, with a smaller decrease observed in women. Among men, a slight decrease in patients hospitalized for HF and a substantial reduction in mortality were observed. Among women, only a large decrease in HF mortality was observed. HF remains one of the leading causes of death and hospitalization in France, particularly in the elderly.