France's Strategy Research Articles

Elites, bureaucrats, and entrepreneurship in policy processes

Elites, bureaucrats, and entrepreneurship in policy processes

European gasoline markets: price transmission asymmetries in mean and variance

ABSTRACT The main objective of this article is to analyse the different sources of asymmetric price transmissions in the fuel market for France, Germany and Spain. During the last decades, the EU has carried out several common energy policies to achieve more efficient and competitive markets. However, given the specific characteristics of each country, the question we want to address is if fuel prices across EU members behave differently in response to different market structures. Oil operators have been targeted by competition authorities for conducting non-competitive practices. To figure out whether the common complaint that gasoline prices adjust differently to positive or negative input price changes, dynamic asymmetric models for the mean and variance are developed for each country. Several asymmetric specifications for the mean and variance are considered. The best specification combines double threshold error correction models (DT-ECM) for the mean with asymmetric EGARCH plus an asymmetric dummy variable for the conditional variance. We show that French gasoline prices behave more competitively, adjusting quicker to the long-run equilibrium and with more price volatility. This outcome is consistent with the strong presence of hypermarkets following low-cost pricing strategies in France.

The Turbulent World of Middle East Soccer

The Turbulent World of Middle East Soccer

Lower smoking rates and increased perceived harm of cigarettes among French adults one year after comprehensive tobacco control measures

ContextFrance has high smoking rates, and recently intensified tobacco control policies spearheaded by the introduction of plain tobacco packaging (PP), and an increase in graphic health warnings (GHW). We examine smoking and e-cigarettes use rates, as well as smoking-related perceptions before (2016) and one year after (2017) comprehensive tobacco control measures. MethodsDePICT is a two waves cross-sectional national telephone survey of French adults aged 18–64 years (2016: 4456 – 2017: 4114). Data were weighted to be representative of the French adult population. Adjusted prevalence ratios (PR, 95% CI) estimating changes between the two study waves were calculated using multivariate Log-Binomial regression models. Main FindingsIn 2017, as compared with 2016, smoking rates (PR = 0.93 (0.88-0.99) and current e-cigarette use (PR = 0.76 (0.61-0.96)) decreased in France. Further, French adults were more likely to report fear of the consequences of smoking (PR = 1.10 (1.06–1.14)) and that smoking is dangerous (PR = 1.08 (1.06–1.11)). Smokers were also more likely to report that health messages on tobacco products are efficient (PR = 1.18 (1.05–1.32)). ConclusionsOur study provides early and encouraging results on potential effects of the comprehensive tobacco control strategies in France introduced in 2017, including PP and larger GHW. Our findings also suggest that e-cigarettes did not replace traditional smoking.

Modeling the Outcome of Systematic TPMT Genotyping or Phenotyping Before Azathioprine Prescription: A Cost-Effectiveness Analysis.

Thiopurine S-methyltransferase (TPMT) testing, either by genotyping or phenotyping, can reduce the incidence of adverse severe myelotoxicity episodes induced by azathioprine. The comparative cost-effectiveness of TPMT genotyping and phenotyping are not known. Our aim was to assess the cost-effectiveness of phenotyping-based dosing of TPMT activity, genotyping-based screening and no screening (reference) for patients treated with azathioprine. A decision tree was built to compare the conventional weight-based dosing strategy with phenotyping and with genotyping using a micro-simulation model of patients with inflammatory bowel disease from the perspective of the French health care system. The time horizon was set up as 1year. Only direct medical costs were used. Data used were obtained from previous reports, except for screening test and admission costs, which were from real cases. The main outcome was the cost-effectiveness ratios, with an effectiveness criterion of one averted severe myelotoxicity episode. The total expected cost of the no screening strategy was €409/patient, the total expected cost of the phenotyping strategy was €427/patient, and the total expected cost of the genotyping strategy was €476/patient. The incremental cost-effectiveness ratio was €2602/severe myelotoxicity averted in using the phenotyping strategy, and €11,244/severe myelotoxicity averted in the genotyping strategy compared to the no screening strategy. At prevalence rates of severe myelotoxicity > 1%, phenotyping dominated genotyping and conventional strategies. The phenotype-based strategy to screen for TPMT deficiency dominates (cheaper and more effective) the genotype-based screening strategy in France. Phenotype-based screening dominates no screening in populations with a prevalence of severe myelosuppression due to azathioprine of > 1%.

Französisch im Saarland

In 2014, the German federal state of Saarland introduced its ‘France Strategy’, which comprises the objective to make French a second vehicular language next to German. This article investigates linguistic practices in Saarland’s population and attitudes towards French and the region’s language policy. An online survey carried out in spring 2017 with roughly 1,200 participants reveals a generally positive stance towards the objectives of the strategy and the French language, especially in the education system. The quantitative findings of the survey, including opinions about specific measures of the ‘France Strategy’, are complemented by qualitative data from comments given at the end of the survey, which reveal the reasoning behind the arguments made both for and against the aims of the strategy. Saarland’s society turns out to be surprisingly multilingual already and therefore offers a promising setting to further enhance the region’s multilingualism.

Delayed and reduced nitrogen fertilization strategies decrease nitrogen losses while still achieving high yields and high grain quality in malting barley

Abstract Nitrogen fertilizer applications are essential to achieve high yield and malting specifications in barley, but may also have a deleterious effect on the environment. Most strategies currently being implemented aim to optimize quantitative and qualitative production without taking environmental concerns into account. We used a barley crop model to pinpoint new nitrogen management plans maximizing the calibrated yields (yield of grains larger than 2.5 mm) and the grain quality whilst reducing N gaseous emission and N leaching. We compared the currently recommended N fertilization strategy in France and 44 new ones defined based on expertise knowledge, and differing in the amount of N applied, splitting patterns and time of application. The strategies providing the best compromise between the three criteria were identified by considering Pareto optimal solutions over 25 years in 35 French departements (equivalent to a county). We also identified Pareto optimal strategies for the seven years with the lowest yields and for years in which climatic conditions were unfavorable for efficient use of the early N supplies. The current recommended N fertilization strategy resulted in a high proportion of situations satisfying malting grain protein content requirements, but also to high N losses. We pinpointed new N strategies resulting in better compromise between the three outputs studied. Some Pareto optimal strategies were particularly efficient to reduce N losses in all tested environments regardless of the climatic conditions. They, however, also slightly reduced calibrated yield compared to the reference strategy. Others interesting strategies performed better than the reference simultaneously for all three studied outputs, but depended on the region considered. A common feature of these strategies was later application of smaller doses of N. Our results, thus demonstrated that low-N strategies are possible for malting barley.

From the Editor’s Desk…: October 2018

From the Editor’s Desk…: October 2018

Assessing the cost-effectiveness of hepatitis C screening strategies in France

In Europe, hepatitis C virus (HCV) screening still targets people at high risk of infection. We aim to determine the cost-effectiveness of expanded HCV screening in France. A Markov model simulated chronic hepatitis C (CHC) prevalence, incidence of events, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER) in the French general population, aged 18 to 80 years, undiagnosed for CHC for different strategies: S1 = current strategy targeting the at risk population; S2 = S1 and all men between 18 and 59 years; S3 = S1 and all individuals between 40 and 59 years; S4 = S1 and all individuals between 40 and 80 years; S5 = all individuals between 18 and 80 years (universal screening). Once CHC was diagnosed, treatment was initiated either to patients with fibrosis stage ≥F2 or regardless of fibrosis. Data were extracted from published literature, a national prevalence survey, and a previously published mathematical model. ICER were interpreted based on one or three times French GDP per capita (€32,800). Universal screening led to the lowest prevalence of CHC and incidence of events, regardless of treatment initiation. When considering treatment initiation to patients with fibrosis ≥F2, targeting all people aged 40-80 was the only cost-effective strategy at both thresholds (€26,100/QALY). When we considered treatment for all, although universal screening of all individuals aged 18-80 is associated with the highest costs, it is more effective than targeting all people aged 40-80, and cost-effective at both thresholds (€31,100/QALY). In France, universal screening is the most effective screening strategy for HCV. Universal screening is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of HCV eradication, this strategy should be implemented. In the context of highly effective and well tolerated therapies for hepatitis C virus that are now recommended for all patients, a reassessment of hepatitis C screening strategies is needed. An effectiveness and cost-effectiveness study of different strategies targeting either the at-risk population, specific ages or all individuals was performed. In France, universal screening is the most effective strategy and is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of hepatitis C virus eradication, this strategy should be implemented.

Assessing the role of a patient transfer network in the spread of carbapenemase-producing Enterobacteriaceae: The case of France between 2012 and 2015

Introduction The spread of carbapenemase-producing Enterobacteriaceae (CPE) is a major public health threat that has been associated with cross-border and local transfer of patients between healthcare facilities. However, the impact of healthcare transfer networks on CPE spread dynamics may vary in time and between countries. In this context, our study aimed to assess the contribution of the patient transfer network on CPE spread in France from 2012 to 2015. Methods Using the French healthcare network of 2.3 million patients, we extended a previously proposed statistical method and tested the ability of this network to support observed CPE incidence episodes. First, using 2237 CPE episodes that occurred from 2012 to 2015, we identified the most likely infector for the 1251 non-imported episodes using network-supported paths (NSPs). We then compared the observed NSP distances to those expected by chance, using random permutations of the CPE data. The impact of the assumed time window between infector episode and CPE episode was investigated in a sensitivity analysis. Results More than half of all CPE episodes were linked, either as infectors or incident episodes. The percentage of episodes with identified potential infectors over the network increased with time, from 57% in 2012 to 66% in 2015. NSP distances from 2013 to 2015 were significantly shorter in the observed data than expected by chance, indicating a role of the transfer network in CPE spread dynamics in France. In 2012 however, this result was not found. Over the entire study period, linked episodes tended to occur in the same administrative department or within close geographic distances. The 3-to-4 weeks baseline window between infector and episode was supported by the sensitivity analysis, where the strongest evidence for network-supported CPE transmission was observed for 2014 and 2015 episodes. Conclusions We observed a transition in 2013 from an epidemic sustained by importation to local transmission events sustaining the epidemic. As a result of a growing contribution of transfers in CPE spread over time, coordinated prevention and infection control strategies in France should focus on at-risk patient transfers to reduce regional and inter-regional transmission of CPE.

Comparison of national strategies in France, Germany and Switzerland for DRR and cross-border crisis management

Abstract The ESPREssO project (funded by the European Union’s Horizon 2020 research and innovation programme, under Grant Agreement No. 700342) prioritises the need for overcoming barriers to disaster risk reduction (DRR) in Europe, with cross-border crisis management identified as one of its three central challenges. In this paper, we present a synthesis of the different legal, policy and scientific approaches to DRR in France, Germany and Switzerland, through work carried out for the ESPREssO project on the basis of stakeholder interviews and an analysis of legal and policy references. A comparison of these three differing DRR strategies is then carried out, focusing specifically on resulting impacts for cross-border crisis management, capitalizing on lessons learned from the tri-national border region Upper Rhine Valley to complete the analysis.

"De-escalation" strategy using micafungin for the treatment of systemic Candida infections: budget impact in France and Germany.

BackgroundThe incidence of azole-resistant Candida infections is increasing. Consequently, guidelines for treating systemic Candida infection (SCI) recommend a “de-escalation” strategy: initial broad-spectrum antifungal agents (e.g., echinocandins), followed by switching to fluconazole if isolates are fluconazole sensitive, rather than “escalation” with initial fluconazole treatment and then switching to echinocandins if isolates are fluconazole resistant. However, fluconazole may continue to be used as first-line treatment in view of its low acquisition costs. The aim of this study was, therefore, to evaluate the budget impact of the de-escalation strategy using micafungin compared with the escalation strategy in France and Germany.MethodsA budget impact model was used to compare de-escalation to escalation strategies. As well as survival, clinical success (resolution/reduction of symptoms and radiographic abnormalities associated with fungal infection), was considered, as was mycological success (eradication of Candida from the bloodstream). Health economic outcomes included cost per health state according to clinical success and mycological success, and budget impact. A 42-day time horizon was used.ResultsFor all patients with SCI, the budget impact of using de-escalation rather than escalation was greater, but improved rates of survival, clinical success and mycological success were apparent with de-escalation. In patients with fluconazole-resistant isolates, clinical success rates and survival were improved by ~72% with de-escalation versus escalation, producing cost savings of €6,374 and €356 per patient in France and Germany, respectively; improvements of ~72% in mycological success rates with de-escalation versus escalation did not translate into cost savings.ConclusionModeling provides evidence that when treating SCI in individuals at risk of azole-resistant infections, de-escalation from micafungin has potential cost savings associated with improved clinical success rates.

Benjamin Fagan. The Black Newspaper and the Chosen Nation.

Benjamin Fagan bases The Black Newspaper and the Chosen Nation on the primary narrative thread of black chosenness. He defines and defends this premise as a connecting theme present in eighteenth- and nineteenth-century African American newspapers. Working from this standpoint, Fagan pinpoints black newspaper publishers, several of whom were ministers, as the proponents of his black chosenness argument. The author also advances a secondary theme, arguing that a black nation existed within the American nation through the auspices of black newspaper articles and editorials. According to Fagan, the black chosen nation was alternately the New Israel, Babylon, or the wilderness, depending on the timing of the Civil War years (before, during, and after) and the readership of the individual black newspapers. Fagan’s unique text, which includes comparative American literature excerpts and biblical illustrations, primarily focuses on five African American periodicals, four printed in New York and one published in Canada. The author begins his study of black newspapers and black newspapermen by looking at Freedom’s Journal, America’s original African American paper, and its co-founders, the Reverend Samuel Cornish and the abolitionist John Brown Russworm. Fagan argues that the goal of their newspaper was to bring the Lord’s word to black readers by educating them in the social proprieties of white elite society. The author interprets Cornish’s didactic editorials as tutorials on “how to act chosen” (22). Expounding on this idea, Fagan uses biblical passages to suggest that Frederick Douglass’s North Star newspaper had the same intent: promotion of the black chosen nation. The author cites Douglass’s reporting of the French Revolution of 1848 as an example of the renowned abolitionist disagreeing with American exceptionalism but still supporting black chosenness. Fagan deduces that the North Star offered proof of the chosen black prophecy of deliverance, similar to the Israelites fighting against their Egyptian oppressors. The author insists that the North Star showed an interest in successful European revolutionary strategies in France and the British West Indies because it wanted to imitate these uprisings in slave-owning oppressive America. Fagan makes transnational connections throughout the pages of the North Star, including the formatting of newspaper columns and the ancestry of Douglass’s Scottish printer. The author, clarifying his black nation theme with examples of scripture, determines that the North Star had “uncoupled the promise of black chosenness from American identity” (94). Fagan could have strengthened this engaging historical position by situating the North Star’s Rochester newspaper office inside its western New York burned-over district. Free Soil Party newspapers, such as the Seneca County Courier, a paper Douglass supported because of its antislavery, temperance, and pro–woman’s rights stance, could have offered further contemporary interpretations of black chosenness.

Abstract P5-16-23: Rapid germline BRCA screening for locally advanced breast cancer changes surgical procedure after neoadjuvant chemotherapy

Abstract Introduction Neoadjuvant chemotherapy (NAC) is proposed in case of locally advanced breast cancer (LABC) to improve breast conservative treatment (BCT). In the case of germline BRCA mutated (gBRCAm) patients, risk-reducing prophylactic surgical strategies in France are mastectomy for pre-symptomatic. On the other hand, BCT is proposed to all patients after NAC according to clinical response, regardless their gBRCAm status. Moreover, in the case of BRCA mutation, local recurrence risk at 15 years is higher in the BCT group (23%) vs mastectomy (5%) (Pierce 2010). The aim of this retrospective one-institution analysis is to evaluate if the knowledge of gBRCAm status impact surgical decision. Patients and methods All patients who underwent BRCA genetic testing during NAC for ≥ 3cm breast cancer between 2012 and 2015 were included. BRCA testing was decided with each patient based on age, familial history of breast or ovarian cancer and histological characteristics of the tumor. Rapid germline BRCA mutation screening was performed through targeted next generation sequencing with a 25-genes panel including full coding sequence of BRCA1 & 2. Deleterious mutations were detected using MiSeq reporter and confirmed by Sanger sequencing before giving the results to the clinical geneticist, and finally used for the choice of surgical strategy. At the end of NAC (6 three-weeks cycles in our center), a shared-decision making for surgical procedure was performed, based on pre and post-NAC clinical and radiological features, and results of the genetic testing. Results A total of 25 patients (including three with bilateral cancer) were tested during NAC: mean age 38 years (26-64); mean clinical size 46 mm (20-130mm); histological types: triple negative (n=14), HER-2 positive (n=7), luminal (n=7). A germline BRCA mutation was detected in 10 patients (40%) : 8 BRCA1 and 2 BRCA2, including 8 patients among the 14 patients with a Manchester score > 20 (6 BRCA1 & 2 BRCA2). Two patients were secondarily excluded (one being metastatic and one died during NAC), one of them having a gBRCAm status. All the 23 patients evaluable for the surgical procedure after NAC could be eligible for a BCT. All the 9 patients with gBRCAm status choose mastectomy in the shared-decision making procedure while a BCT was performed in 12 of the 14 remaining patients without BRCA mutation. Discussion In this highly selected subgroup of patients, gBRCAm rate is higher (40%) than the usual rate for BRCA testing (17% in our center). Regarding the rationale for BCT or mastectomy procedure in LABC or pre-symptomatic gBRCAm patients, the duration of NAC allows rapid germline BRCA screening that looks very useful considering the high incidence of mutation we observed and the impact on surgical final decision. Furthermore, in the group of high Manchester score (>20), patients without BRCA mutation harbored incidental mutation, currently under analysis, especially on other genes involved in hereditary breast cancer, that could also be used as a compelling argument for mastectomy. Citation Format: Tunon de Lara C, Bonnet F, Debled M, Lafon D, Breton-Callu C, Rarouk-Simonet E, Fournier M, Petit A, Bubien V, Quenel-Tueux N, Lagarde P, Longy M, Macgrogan G, Sevenet N. Rapid germline BRCA screening for locally advanced breast cancer changes surgical procedure after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-23.

Mainstreaming in response to superdiversity? The governance of migration-related diversity in France, the UK and the Netherlands

This article examines mainstreaming as a governance strategy in immigrant integration governance. Diversity mainstreaming involves a whole society approach for raising awareness about migrationrelated diversity, mobilising a network of actors to embed diversity across policy areas. Bringing together the literature on superdiversity, policy targeting and governance mainstreaming this article examines empirically whether, and if so, why, and how, mainstreaming is applied as a governance strategy in France, the Netherlands and the UK. Based on a qualitative policy analysis covering the period 2000–14, we find mainstreaming ‘incomplete’ and driven by political and economic motives rather than considerations of superdiversity.

Comparaison des bénéfices médico-économiques des antipsychotiques dans la prise en charge de la schizophrénie en France

IntroductionThe course of schizophrenia can vary widely, and patients experience remission phases alternating with relapse episodes, which generally lead to hospitalisation and have a significant impact on the burden of disease. The prevalence of schizophrenia in France is estimated to be approximately 600,000 people, with an incidence of 10,000 new patients per year. Patients with schizophrenia represent the largest group of hospitalised patients in French public institutions and specialised centres, and the French authorities recognise that the management of schizophrenia is a major public health concern. The Haute Autorité de Santé (HAS) and most of the evidence-based guidelines for the maintenance treatment of schizophrenia recommend long-acting injectable (LAI) antipsychotics to be used predominantly in the prevention of relapse for non-compliant patients; however, in clinical practice, the use of LAIs remains low. ObjectiveThis analysis aimed to estimate and to compare the cost-effectiveness of the most common antipsychotic strategies in France in the management of schizophrenia. MethodsA Markov model was developed to simulate the progression of a cohort of patients with schizophrenia through four health states (stable treated, stable non-treated, relapse and death) and considered up to three lines of treatment to account for changes in treatment management. Antipsychotics including aripiprazole LAI (ALAI), olanzapine LAI (OLAI), paliperidone LAI (PLAI), risperidone LAI (RLAI), haloperidol decanoate (HD) and oral olanzapine (OO) were compared in terms of costs and clinical outcomes. Thus, costs, quality-adjusted life-years (QALYs) and number of relapses were assessed over five years based on three-month cycles from a French health insurance perspective with a discount rate of 4 %. Patients were considered to be stabilised after clinical decompensation and would enter the model at an initiation phase, followed by a prevention of relapse phase if successful. Data (e.g. relapse or discontinuation rates) for the initiation phase came from randomised clinical trials, whereas relapse rates in the prevention phase were derived from hospitalisation risks based on French real-life data in order to capture adherence effects. Safety and utility data were derived from international publications. Additionally costs were retrieved from French health insurance databases and publications. Robustness of results was assessed through deterministic and probabilistic sensitivity analyses. ResultsFirst and second generations of LAIs were found to have similar costs over five years; i.e. approximately € 55,000, except for PLAI which was associated with a discounted cost of € 50,880. Oral antipsychotics were found to be less costly (i.e. OO cost € 50,379 after five years) but associated with a lower number of QALYs gained and relapse avoided. PLAI and RLAI were associated with the greatest number of QALYs gained; i.e. PLAI dominated ALAI, OLAI and HD and was associated with an incremental costs-effectiveness ratio (ICER) of € 2411 per QALY gained versus OO. Finally, PLAI and OLAI were associated with the lowest number of relapses; i.e. PLAI dominated RLAI, ALAI and HLAI and was associated with an ICER of € 1782 per avoided relapse compared to OO. OO and HD were found to have led to the highest number of relapses. ConclusionThis analysis, to the best of our knowledge, is the first of its kind to assess the cost-effectiveness of antipsychotics based on French observational data. PLAI was associated with the highest probability of being the optimal treatment from the French health insurance perspective.

Coupling local renewable energy production with electric vehicle charging: a survey of the French case

The share of renewable energy sources (RES) production in energy mixes, especially the ones of PV panels and wind farms, has been continuously increasing during the last few years. Similarly, a strong development of battery electric vehicles (EV) is expected within the next years. However, these two new innovations could trigger local security issues on electrical grids. One way to mitigate these problems could be to combine the charging periods of the EVs with the local RES production. This paper aims at analysing the possibility to implement this kind of smart charging strategy in France by 2020, taking into account the wide diversity of local energy mixes in France and their seasonal dependencies. The results show the achievable green charging ratio for the EV fleet per season and per region, with and without a smart charging strategy.

Coupling local renewable energy production with electric vehicle charging: a survey of the French case

The share of renewable energy sources (RES)’ production in energy mixes, especially the ones of PV panels and wind farms, has been continuously increasing during the last few years. Similarly, a strong development of battery electric vehicles (EV) is expected within the next years. However, these two new innovations could trigger security issues on electrical grids, in particular local congestions and voltage deviations from the required standards. One way to mitigate these problems could be to combine the charging periods of the EVs with the local RES production. This paper aims at analysing the possibility to implement this kind of smart charging strategy in France by 2020, taking into account the wide diversity of local energy mixes in France and their seasonal dependencies. First, the authors identify four different energy mixes representative of most of the local French mixes, each one related to a region in France. Then, we model the charging load curves of the EVs at the substation level for the same regions. We deduce the “green charging ratio” (GCR) without any charging management strategy. The same ratio is then computed assuming that an Energy Management System (EMS), which goal is to maximize this ratio, controls the EV charging patterns. The results are provided for each region and seasons. They show a wide diversity of green charging ratio achievable: in very windy regions, the GCR without any EMS is already rather high; on the contrary, in sunny regions, the GCR is much improved with the implementation of the EMS. In such regions, the GCR can also be enhanced with the penetration of charging stations at working places.

Cost-Effectiveness of Routine Varicella Vaccination Using the Measles, Mumps, Rubella and Varicella Vaccine in France: An Economic Analysis Based on a Dynamic Transmission Model for Varicella and Herpes Zoster

PurposeEach year in France, varicella and zoster affect large numbers of children and adults, resulting in medical visits, hospitalizations for varicella- and zoster-related complications, and societal costs. Disease prevention by varicella vaccination is feasible, wherein a plausible option involves replacing the combined measles, mumps, and rubella (MMR) vaccine with the combined MMR and varicella (MMRV) vaccine. This study aimed to: (1) assess the cost-effectiveness of adding routine varicella vaccination through MMRV, using different vaccination strategies in France; and (2) address key uncertainties, such as the economic consequences of breakthrough varicella cases, the waning of vaccine-conferred protection, vaccination coverage, and indirect costs. MethodsBased on the outputs of a dynamic transmission model that used data on epidemiology and costs from France, a cost-effectiveness model was built. A conservative approach was taken regarding the impact of varicella vaccination on zoster incidence by assuming the validity of the hypothesis of an age-specific boosting of immunity against varicella. FindingsThe model determined that routine MMRV vaccination is expected to be a cost-effective option, considering a cost-effectiveness threshold of €20,000 per quality-adjusted life-year saved; routine vaccination was cost-saving from the societal perspective. Results were driven by a large decrease in varicella incidence despite a temporary initial increase in the number of zoster cases due to the assumption of exogenous boosting. In the scenario analyses, despite moderate changes in assumptions about incidence and costs, varicella vaccination remained a cost-effective option for France. ImplicationsRoutine vaccination with MMRV was associated with high gains in quality-adjusted life-years, substantial reduction in the occurrences of varicella- and zoster-related complications, and few deaths due to varicella. Routine MMRV vaccination is also expected to provide reductions in costs related to hospitalizations, medication use, and general-practitioner visits, as well as indirect costs, and it is expected to be a cost-effective intervention in France (GSK study identifier: HO-12-6924).

Cost-Effectiveness of Paliperidone Palmitate Versus other Antipsychotics for the Treatment of Schizophrenia in France

To estimate the cost-effectiveness of paliperidone palmitate (PLAI), a once-monthly long-acting injectable (LAI) atypical antipsychotic, compared to the most common antipsychotic strategies in France.