French Setting Research Articles

The use of Gallicisms in English Diplomatic Terminology

English is оne оf the vаriоus lаnguаges the diplоmаtic terminоlоgy оf which wаs prоfоundly influenced by French. Mаny diplоmаtic terms аnd phrаses hаve been bоrrоwed directly frоm French due tо its histоricаl prоminence аnd the culturаl prestige аssоciаted with the lаnguаge. French Gаllicisms аre terms which mаke up the bulk оf English diplоmаtic lаnguаge, becoming pаrt оf а diplоmаtic trаditiоn, fаcilitаting the expressiоn оf the ideа оf rituаlity аnd cоnservаtism оf English diplоmаtic lаnguаge. French set expressiоns help tо creаte the speciаl style оf diplоmаtic lаnguаge, where pоliteness is clоsely interwоven with rituаlity. They аre оften used tо аdd а tоuch оf fоrmаlity, sоphisticаtiоn, оr precisiоn tо diplоmаtic discоurse The use оf Gаllicisms, оr French lоаnwоrds аnd expressiоns in the English diplоmаtic lаnguаge, hаs lоng been аn intriguing аnd cоmplex phenоmenоn thаt hаs nоt received the аttentiоn it truly deserves. This аrticle aims at explоring the multifаceted аspects оf Gаllicisms in English diplоmаtic discоurse, fоcusing оn their phоnetic, lexicаl, аnd semаntic peculiаrities, аs well аs their prаcticаl аpplicаtiоn within diplоmаtic cоntexts. Thus French Gаllicisms аnd their English equivаlents hаve а shаred meаning оr clоsely relаted meаnings in diplоmаtic cоntexts, bоth French Gаllicisms аnd their English equivаlents cаrry specific diplоmаtic nuаnces but a number оf Gаllicisms hаve undergоne phоnetic chаnges while being utilized in the English diplоmаtic lаnguаge.

Perceived health status after mid-urethral sling revision in 287 women from the VIGI-MESH registry: A cross-sectional study.

To evaluate the health status and recovery of women after mid-urethral sling (MUS) revision in response to complications. Cross-sectional study using a questionnaire sent to women from a registry. Twenty-two French surgical centres. A total of 287 women from the VIGI-MESH registry responded, having undergone MUS revision for complications. Our sample of women were compared against a representative set of French women taken from the Eurostat database. Multivariate analysis was performed to identify clinical predictors for successful MUS revision. A qualitative analysis was carried out on free-text comments. Health status, defined by the Minimum European Health Module, and recovery, assessed by Patient Global Impression of Improvement. The response rate was 76% (287/378), with 49% of the women (141/287, 95% CI 43%-55%) reporting good health status, which was 8 points lower than that expected from the comparator French set (57%, 95% CI 55%-58%). Overall, 53% (147/275, 95% CI 47%-59%) of the women reported feeling much better after MUS revision. Just over one-third (35%, 95/275, 95% CI 29%-40%) of respondents reported poor health with little or no improvement. Multivariate analysis showed that being operated on for pain at revision was associated with worse self-perceived health than being operated on for exposure (OR 0.36, 95% CI 0.14-0.95); women with pre-existing comorbidity reported a poorer health status following MUS revision (OR 0.22, 95% CI 0.13-0.38). Our results suggest that half of the women recovered good health status after MUS revision, whereas a proportion appeared to be seriously affected by an MUS complication despite the revision.

On cost-effectiveness analysis, quality-adjusted life years, and cost-effectiveness threshold values of gemcitabine plus nab-paclitaxel versus gemcitabine alone in metastatic pancreatic cancer in the French setting.

On cost-effectiveness analysis, quality-adjusted life years, and cost-effectiveness threshold values of gemcitabine plus nab-paclitaxel versus gemcitabine alone in metastatic pancreatic cancer in the French setting.

Investment deviation from the optimal path: does the examination of audit quality services matter? A French study

Purpose The study of the relationship between external auditing services and investment deviation in a French setting has received relatively little research attention thus far. There are insufficient indicators to measure audit quality and then have a measurable link to investment efficiency. This study is motivated by such a research gap as well as the important role of auditing services in assuring investment efficiency. The purpose of this study is to test whether a good audit quality service improves corporate investment awareness in French-listed companies and contributes to establishing a comprehensive analysis framework for inefficient investment and how audit services have become an important tool to reduce the investment deviation of listed companies in France. Design/methodology/approach Based on a sample of 89 non-financial French firms listed on the Stoxx 600 Index from 2015 to 2021, this study uses feasible generalised least squares (FGLS) regressions to study the relationship between investment deviation and auditing service quality. Findings After running an FGLS regression model for two firm groups (overinvestment and overinvestment groups) and testing for a set of control variables, especially COVID-19, the findings show a non-linear correlation between audit service and corporate investment deviation. Both underinvestment and overinvestment decisions are negatively and statistically significantly impacted by audit indicators. Furthermore, involving a high-quality specialised auditor may enhance overall monitoring and lead to a lower investment deviation level. Overall, the empirical results show that a high-quality audit service enhances the investment efficiency of French-indexed companies. Practical implications This study offers crucial information that audit regulators can use to better appreciate the advantages of high audit quality and to take seriously the policy issues that affect it. Board members are urged to provide excellent audit quality that improves investment efficiency with careful consideration. Originality/value This study contributes to the existing audit literature by illuminating the effect of audit quality services on investment deviation to show a deeper understanding of the factors that contribute to the differences in prior studies’ findings in the field of audit quality impacts.

Insights on the carbon footprint of radiotherapy in France

The French healthcare system is responsible for 8% of the national footprint. Achieving a net zero emissions scenario will require a 4–5 fold decrease of carbon emissions in the coming years. The carbon footprint of radiation therapy has not been specifically studied to date. In this review we summarize the content of the carbon footprint dedicated session at the annual meeting of the French society of radiation oncology (SFRO). We discuss the French healthcare system carbon footprint and its major drivers and our work on the estimation of the carbon footprint of external beam radiation therapy in the French setting. We developed a dedicated methodology to estimate the carbon footprint related to radiation therapies, and describe the main drivers of emissions based on a single centre as an example, namely patient's rides, accelerators acquisition and maintenance and data storage. Based on the carbon footprint calculated in our centres, we propose mitigation strategies and an estimation of their respective potential. Our results may be extrapolated to other occidental settings by adapting emission factors (kilograms of carbon per item or euro) to other national settings. External beam radiation therapy has a major carbon footprint that may be mitigated in many ways that may impact how radiation therapy treatments are delivered, as well as the national organization of the radiotherapy sector. This needs to be taken into account when thinking about the future of radiotherapy.

Семантический анализ соматизма «голова» во фразеологии французско-канадского, французского и английского языков

The aim of the research is to identify universal patterns and specific features in the semantic fields of phraseological units with the somatism “head” in the Canadian French, French and English languages. The scientific novelty of the research is accounted for by the fact that the relationship between culture and language and the issues associated with the reflection of the national-cultural distinctness of the functional and semantic features that are peculiar to phraseological units with the somatism “head” in Canadian French, French and English has been little studied. The paper carries out a comparative analysis of phraseological units with the somatism “head” in Canadian French, French and English, identifies and systematises the semantic values of these phraseological units, determines equivalents and lacunae in the semantic fields of these phraseological units in the languages compared. As a result, it has been proved that the somatism “head” is a part of a large number of phraseological units in the languages compared, however, there are more similarities in the semantics of these phraseological units in French and English, while Canadian French, due to the use of French set expressions and idioms, shows greater lacunarity.

Cost of exome analysis in patients with intellectual disability: a micro-costing study in a French setting

BackgroundWith the development of next generation sequencing technologies in France, exome sequencing (ES) has recently emerged as an opportunity to improve the diagnosis rate of patients presenting an intellectual disability (ID). To help French policy makers determine an adequate tariff for ES, we aimed to assess the unit cost per ES diagnostic test for ID from the preparation of the pre-analytical step until the report writing step and to identify its main cost drivers.MethodsA micro-costing bottom-up approach was conducted for the year 2018 in a French setting as part of the DISSEQ study, a cost-effectiveness study funded by the Ministry of Health and performed in collaboration with the GAD (Génétique des Anomalies du Développement), a genetic team from the Dijon University Hospital, and a public sequencing platform, the Centre National de Recherche en Génomique Humaine (CNRGH). The analysis was conducted from the point of view of these two ES stakeholders. All of the resources (labor, equipment, disposables and reagents, reusable material) required to analyze blood samples were identified, collected and valued. Several sensitivity analyses were performed.ResultsThe unit nominal cost per ES diagnostic test for ID was estimated to be €2,019.39. Labor represented 50.7% of the total cost. The analytical step (from the preparation of libraries to the analysis of sequences) represented 88% of the total cost. Sensitivity analyses suggested that a simultaneous price decrease of 20% for the capture kit and 50% for the sequencing support kit led to an estimation of €1,769 per ES diagnostic test for ID.ConclusionThis is the first estimation of ES cost to be done in the French setting of ID diagnosis. The estimation is especially influenced by the price of equipment kits, but more generally by the organization of the centers involved in the different steps of the analysis and the time period in which the study was conducted. This information can now be used to define an adequate tariff and assess the efficiency of ES.Trial registrationClinicalTrials.gov identifier NCT03287206 on September 19, 2017.

Cost-effectiveness analysis alongside the inter-B-NHL ritux 2010 trial: rituximab in children and adolescents with B cell non-Hodgkin’s lymphoma

ObjectivesThe randomized controlled trial Inter-B-NHL ritux 2010 showed overall survival (OS) benefit and event-free survival (EFS) benefit with the addition of rituximab to standard Lymphomes Malins B (LMB) chemotherapy in children and adolescents with high-risk, mature B cell non-Hodgkin’s lymphoma. Our aim was to assess the cost-effectiveness of rituximab-chemotherapy versus chemotherapy alone in the French setting.MethodsWe used a decision-analytic semi-Markov model with four health states and 1-month cycles. Resource use was prospectively collected in the Inter-B-NHL ritux 2010 trial (NCT01516580). Transition probabilities were assessed from patient-level data from the trial (n = 328). In the base case analysis, direct medical costs from the French National Insurance Scheme and life-years (LYs) were computed in both arms over a 3-year time horizon. Incremental net monetary benefit and cost-effectiveness acceptability curve were computed through a probabilistic sensitivity analysis. Deterministic sensitivity analysis and several sensitivity analyses on key assumptions were also conducted, including one exploratory analysis with quality-adjusted life years as the health outcome.ResultsOS and EFS benefits shown in the Inter-B-NHL ritux 2010 trial translated into the model by rituximab-chemotherapy being the most effective and also the least expensive strategy over the chemotherapy strategy. The mean difference in LYs between arms was 0.13 [95% CI 0.02; 0.25], and the mean cost difference € − 3 710 [95% CI € − 17,877; € 10,525] in favor of rituximab-chemotherapy group. For a € 50,000 per LY willingness-to-pay threshold, the probability of the rituximab-chemotherapy strategy being cost-effective was 91.1%. All sensitivity analyses confirmed these findings.ConclusionAdding rituximab to LMB chemotherapy in children and adolescents with high-risk mature B-cell non-Hodgkin's lymphoma is highly cost-effective in France.Trial registrationClinicalTrials.gov identifier: NCT01516580.

Lipid-lowering efficacy and safety of alirocumab in a real-life setting in France: Insights from the ODYSSEY APPRISE study

BackgroundRecently, a multicentre, prospective, single-arm, phase 3b, open-label trial was conducted to determine the safety and efficacy of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, in a real-life setting. This study enrolled patients at high cardiovascular risk, with heterozygous familial hypercholesterolaemia (HeFH) or non-familial hypercholesterolaemia (non-FH). Results showed that alirocumab was well tolerated and resulted in a clinically significant reduction in low-density lipoprotein cholesterol (LDL-C). AimThis ancillary analysis aimed to describe the characteristics of the French patients enrolled in the study, the main results observed in this population according to their familial hypercholesterolaemia status, and adherence to treatment. MethodsFrench data were analysed separately from the original dataset of the study. ResultsAmong 215 French patients in the ODYSSEY APPRISE trial, 63.7% had non-FH, with a mean LDL-C concentration of 5.0±1.8mmol/L at baseline. The mean duration of alirocumab exposure was 72.4±42.5 weeks, with only 48.4% of patients receiving statins concomitantly. At week 12, a mean reduction in LDL-C of 56.5±17.8% was observed: 51.2±22.8% in HeFH; 59.5±13.2% in non-FH. This improvement in LDL-C started from week 4 and remained stable and sustained until week 120 in both populations. The overall incidence of severe treatment-emergent adverse events (TEAEs) was 33.5%. The most frequent TEAEs were myalgia (15.8%) and asthenia (15.3%). No tolerance or efficacy differences were observed between patients with or without established coronary artery disease or other cardiovascular disease, whatever the age of these events or considering the concomitant use of other lipid-lowering therapies. ConclusionsIn the French setting, alirocumab was well tolerated, safe and highly effective at reducing LDL-C. These findings support the use of alirocumab to manage hypercholesterolaemia in patients at high cardiovascular risk.

Defining a risk-adjustment formula for the introduction of population-based payments for primary care in France

Novel risk-adjusted payment models for financing primary care are currently being experimented in France. In particular, pilot schemes including shared-savings contracts or prospectively allocated capitation payments are implemented for voluntary primary care structures. Such payment mechanisms require defining a risk-adjustment formula to accurately estimate expected expenditure while maintaining appropriate efficiency incentives. We used nationwide data from the French national health data system (SNDS) to compare the performance of different prospective models for total and outpatient expenditure prediction among more than 8 million individuals aged 65 or more and their application at an aggregate level. We focused on the characterization of morbidity status and on the contextual characteristics to include in the formula. We proposed a set of practical routinely available predictors with fair performance for patient-level expenditure prediction (explaining 32% of variance) that could be used to risk-adjust prospective payments in the French setting. Morbidity information was the strongest predictor but could lead to considerable error in predicted expenditures if introduced as independent binary variables in multiplicative models, underlining the importance of summary morbidity measures and of using the appropriate metric to assess model performance. Distribution of aggregate-level allocations was greatly modified according to the method to account for contextual characteristics. Our work informs the introduction of risk-adjusted models in France and underlines efficiency and fairness issues raised.

Superabsorbent wound dressings versus foams dressings for the management of moderate-to-highly exuding venous leg ulcers in French settings: An early stage model-based economic evaluation

Venous leg ulcers (VLUs) are the most common hard-to-heal ulcers associated with the high humanistic and economic burden. Especially clinically challenging are moderate-to-highly exuding venous leg ulcers, and current management guidelines recommend several different wound dressings for this indication.The study aimed to determine the cost-effectiveness of managing moderate-to-highly exuding venous leg ulcers with superabsorbent wound dressings versus foams dressings in French settings from Haute Autorité de Santé perspective.For evidence synthesis decision-analytic model was developed in line with international and French good modelling practices recommendations. All model inputs were informed by data identified through systematic literature reviews that, in our best knowledge, represent the best available evidence at this moment.According to the prediction from this early stage health economic evaluation, using superabsorbent wound dressings versus foam dressings mix in patients with moderate-to-highly exuding leg ulcers in French settings will result in an improved healing rate of 2.58%, incremental HRQoL of 0.143 QALWs and total direct cost savings of € 435 (USD 473) per patient over six months period.The clinical outcomes results from this evaluation are in line with management guidelines that have recommended superabsorbent wound dressings as a first-line choice in the therapy of moderate-to-highly exuding venous leg ulcers. In addition, this evaluation demonstrates that using superabsorbent wound dressings will also lead to economic savings from the Haute Autorité de Santé perspective.

Tandem and Translation: A bilingual telecollaboration course in social science translation

We describe here strategies inspired by translation studies and implemented in a bilingual translation class pairing two student groups of native speakers of English (from Barnard College, Columbia University) and of French (from the École Normale Supérieure, Lyon). Student etandems use CMC (computer mediated communication) to collaborate on the translation of a set of French and English source texts from the human and social sciences, giving the language learners the experience of translating both into and from their own language. Using a workshop format, our approach emphasizes horizontal language learning through linguistic sharing, with students reciprocally developing their language skills by being paired with a learner whose mother tongue is their target language. To provide continuous stimulation for the linguistic exchanges, we assign each student pair a "real-life" task: that of translating two book reviews that are then submitted for publication in academic journals. This goal provides them with strong motivation to produce a careful and better-informed translation, while sensitizing them to the broader academic usefulness of their work. Our objective is to broaden language exchange by advancing collaborative translation into the realm of knowledge-sharing in the human and social sciences.

The association between internal control quality and audit report lag in the French setting: the moderating effect of family directors

PurposeThe purpose of the paper is to examine the association between internal control quality (ICQ) and audit report lag (ARL) and to test whether family directors affect the relationship.Design/methodology/approachICQ is measured by using the framework developed by Michelon et al. (2015), while ARL is measured as the number of days from fiscal year-end to the date of the auditor's report.FindingsUsing a sample of 190 French companies over the period of 2016–2019, the authors document that ICQ is negatively associated with ARL, suggesting that ICQ represents a key determinant of audit delay. When testing for the moderating effect of family directors on this relationship, findings show that under high percentage of family directors on the board, this relationship becomes insignificant.Originality/valueThis paper extends previous research on audit delays by investigating the moderating effect of family directors on the relation between ICQ and ARL in the French setting. The empirical evidence highlights the adverse effect of the concentration of family directors on the board on timely disclosure as proxied by ARL.

Performance of Targeted Congenital Cytomegalovirus Screening in Newborns Failing Universal Hearing Screening: A Multicenter Study.

Cytomegalovirus (CMV) is the most frequent cause of congenital infection and ≈20% of all infected neonates present or will develop sensorineural hearing loss. Targeted congenital CMV (cCMV) screening in newborns who failed universal newborn hearing screening has been proposed as a strategy to identify neonates with both hearing loss and cCMV infection who could benefit from antiviral treatment implemented within the first month of life. To evaluate the feasibility and performance of cCMV targeted screening in a French setting. Neonates were recruited in 5 maternity centers in greater Paris. A saliva sample for CMV polymerase chain reaction (PCR) testing was collected in neonates who failed newborn hearing screening. Outcomes including CMV PCR result and confirmation of hearing loss by an otorhinolaryngologist specialist were documented. Two-hundred thirty-six newborns were included and a saliva sample was collected in 98% (231/236) of them. The result of CMV PCR was available at a median of 9 days (7-10 days) of life and in 96% of cases within the first month of life. Two neonates were infected with CMV. The result of the otorhinolaryngologist assessment was available in 75% (178/236) of cases at a median of 16 days (9-26 days). Hearing loss was confirmed in 2.8% (5/178). The 2 infected neonates had hearing loss confirmed at 5 and 8 days of life and were treated with valganciclovir at days 9 and 16, respectively. The result of this study confirms that targeted cCMV screening is feasible in these French settings.

Cost-Effectiveness Analysis for the Treatment of Diabetic Foot Ulcer in France: Platelet-Rich Plasma vs Standard of Care.

IntroductionDiabetic chronic foot ulcers (DFU) lead to pain, reduced quality of life and represent a severe economic burden for patients and health systems. The clinical results of PRP effectiveness in the treatment of DFU are promising; on the other hand, the costs associated with treating DFUs with PRP are higher than those using standard therapy. Therefore, this study aims to determine the cost-effectiveness of platelet-rich plasma (PRP) therapy compared to standard therapy from the French healthcare system perspective.MethodsA cost-effectiveness analysis (CEA) was performed using a decision Markov model with a cohort of patients with chronic DFU (duration of >3 weeks) with high orthopaedic risk and with ulcers graded 3A according to University of Texas classification. The effectiveness outcomes are reported in terms of quality adjusted life year (QALY). The costs are reported in euro (€) currency evaluated in 2019. A micro-costing approach alongside a clinical study was used to assess resource use. Deterministic sensibility analyses are reported to evaluate the robustness of the results. The analyses were carried out in the French setting.ResultsThe incremental cost-effectiveness ratio (ICER) of PRP treatment is –€613/ QALY, which, being lower than zero, indicates the dominance of the PRP therapy. Deterministic and probabilistic sensitivity analysis underlines the main parameter affecting CE results. Lowest number of standard of care weekly medications (from 5 to 3) leads to a €622/QALY while increasing PRP weekly medication (from 1 to 4) has an ICER of €732/QALY.DiscussionPRP is a cost-effective or even a cost-saving alternative in the French setting. PRP has higher cost for the complete medication, but, in the absence of wound complications, has the potential to involve lower consumption of resources in the form of routine medication over a 1-year time horizon.

POSB49 Cost Effectiveness Model of Atezolizumab Plus Bevacizumab in Untreated Locally Advanced or Metastatic Hepatocellular Carcinoma (HCC) in French Setting

This cost effectiveness analysis was performed following atezolizumab in combination with bevacizumab (ATZ+BVA) established as a new standard of care in adult with unresectable hepatocarcinoma, non-eligible to chemo-embolization in France, with the latest cut off (Aug 2020) of IMbrave150 study.

Did the COVID-19 pandemic impact population’s mental health?

BackgroundSanitary, societal and economic effects due to the COVID-19 pandemic could lead to an impact on population's mental health. Santé publique France (SpF), the French public health agency set up a specific monitoring based on emergency department (ED) and GP's associations (GPs) SOS Médecins (SOSMed) data to early assess the impact of COVID-19 pandemic on mental health.MethodsSince 2004, SpF daily collects data from ED participating to the OSCOUR® network (93% of French emergency attendances) and from SOSMed network. For both data sources, visits for several mental health disorders were analyzed for different age groups in 2020 and 2021 (until Week 16) and compared to years 2018 and 2019 (mean) with a focus on the two lockdown periods (resp W11 to W19-2020 and W45 to W51-2020)ResultsDuring the first lockdown period, while a major decrease of all-cause activity was observed in both networks, the number of SOSMed visits for anxiety increased in adults with a peak of + 115% in W13-2020 compared to 2018-19 and remained higher than the 2 previous years until W12-2021. An increase in ED visits for mood disorders (including depression) for children (especially 11-17yo) were also observed from W36 (back to school) and reinforced at the beginning of the 2nd lockdown period to reach +111% in W12-2021 compared to 2018-19. 11-17yo children were also concerned by an increase in ED visits for suicide ideation since W36 (peak of + 170% in W12-2021) and suicide attempt from W04-2021 to W12-2021 (peaks of + 45% and +41% in W05 and W10-2021).DiscussionED and SOSMed visits are the most reactive data sources to assess the impact of COVID-19 pandemic on the mental health of French population. These results confirm that the impact concerns all age groups. For children, the condition seems to worsen in 2021 and highlight the need of a close follow-up of the situation and the reinforcement of preventive measures in order to prevent long-term impacts.Key messages Results confirm an impact of COVID-19 pandemic on populations mental health.Impact of COVID-19 on mental health: a long-term issue for children?

Productivity of French and Dutch (semi-)copular constructions and the adverse impact of high token frequency

AbstractThis paper examines the productivity of the subject complement slot in a set of French and Dutch (semi-)copular micro-constructions. The presumed counterpart of productivity, conventionalization in the form of high token frequency, will also be taken into account in the analysis of the productivity complex. On the one hand, it will be shown that prototypical copulas generally have a higher productivity than semi-copulas, although there are some semi-copulas that can rival the productivity of prototypical copulas. On the other hand, it will be demonstrated that high token frequency is in general detrimental to productivity, on the level of the entire subject complement slot and on the level of the different semantic classes. However, the shape of the frequency distribution also seems to play a role: multiple highly frequent types are in my data more detrimental to productivity than one extremely frequent type, although the semantic connectedness of the types in the distribution might also be an explanatory factor.

Cost-Utility Analysis of Continuation Versus Discontinuation of First-Line Chemotherapy in Patients With Metastatic Squamous-Cell Esophageal Cancer: Economic Evaluation Alongside the E-DIS Trial

ObjectivesContinuous chemotherapy has been used to treat patients with metastatic esophageal squamous cell carcinoma (mESCC), despite weak evidence supporting a clinical benefit, associated side effects for the patients, and unjustified medical costs. In the French setting, we conducted a cost-utility analysis alongside the randomized E-DIS trial (NCT01248299), which compared first-line fluorouracil/platinum-based chemotherapy continuation (CT-CONT) to CT discontinuation (CT-DISC) in progressive-free patients after an initial 6-week treatment phase. MethodsA partitioned survival analysis was performed using patient-level data collected during the trial for survival outcomes, quality of life (EQ-5D-3L), and medical costs. The mean quality-adjusted life-years (QALYs) and medical costs were estimated over an 18-month period to assess the incremental net monetary benefit and incremental cost-effectiveness ratio. Uncertainty was handled using the nonparametric bootstrap and univariate analysis. Sixty-seven patients with mESCC were randomized and included in the cost-utility analysis. ResultsOn average, CT-CONT slightly decreased the number of QALYs (-0.038) and increased the cost per patient (+ €1177). At a willingness-to-pay threshold of €50 000/QALY, the incremental net monetary benefit was negative (-€3077 [95% confidence interval: -6564; 4359]), and the incremental cost-effectiveness ratio was -30 958€/QALY (CT-CONT dominated). The probability of the CT-CONT treatment option being cost-effective at a willingness-to-pay threshold of €50 000/QALY, compared to CT-DISC, was 29%. ConclusionsCT-DISC may be considered as an alternative therapeutic option to CT-CONT in patients with mESCC who have stable disease after an initial chemotherapy treatment phase. A continuous chemotherapy could indeed reduce the number of QALYs because of the disutility associated with the continuous treatment.

Whole exome sequencing in molecular diagnostics of cancer decreases over time: evidence from a cost analysis in the French setting.

Although high-throughput sequencing is revolutionising medicine, data on the actual cost of whole exome sequencing (WES) applications are needed. We aimed at assessing the cost of WES at a French cancer institute in 2015 and 2018. Actual costs of WES application in oncology research were determined using both micro-costing and gross-costing for the years 2015 and 2018, before and after the acquisition of a new sequencer. The entire workflow process of a WES test was tracked, and the number and unit price of each resource were identified at the most detailed level, from library preparation to bioinformatics analyses. In addition, we conducted an ad hoc analysis of the bioinformatics storage costs of data issued from WES analyses. The cost of WES has decreased substantially, from €1921 per sample (i.e. cost of €3842 per patient) in 2015 to €804 per sample (i.e. cost of €1,608 per patient) in 2018, representing a decrease of 58%. In the meantime, the cost of bioinformatics storage has increased from €19,836 to €200,711. This study suggests that WES cost has decreased significantly in recent years. WES has become affordable, even though clinical utility and efficiency still need to be confirmed.