France's Strategy Research Articles

PCN225 - Market Access Levers and Barriers for Key Oncology Agents in the EU5: Surveyed Oncologist and Interviewed Payer Insights

Health technology assessment (HTA), pricing and reimbursement (P&R) processes, and cost-containment strategies in France, Germany, Italy, Spain, and the UK, are increasingly stringent. This study explored the resulting impact on high-cost oncology brands, and carved out specific market access levers and barriers. Across the EU5,500 medical or hematological oncologists were surveyed regarding their current and expected prescribing patterns, and 30 payers who influence reimbursement at national or regional level were interviewed. Some 68-83% of surveyed oncologists in France, Italy, Spain, and the UK, and 44% in Germany report that the average time taken by their health care authority to review newly approved cancer treatments and settle reimbursement terms delays availability for prescribing by ≥6 months. Thereafter, country-specific prescribing restrictions impede uptake; e. g., 18% of German hematologists surveyed report that their indicative prescribing budget prevents use of ponatinib in >20% of their chronic myeloid leukemia patients, while 30% of Italian medical oncologists say the national oncology drugs register monitoring use of costly agents severely restricts prescribing of erlotinib and gefitinib for non-small-cell lung cancer. Interviewed payers stress, however, that well-designed pivotal trials considering increasing focus on added benefit over direct comparators will help optimize HTA and P&R terms, with those in Italy and the UK, especially, advocating cost-sharing schemes to secure market entry. Furthermore, demonstrable downstream cost savings, locally targeted marketing campaigns, and manufacturer estimates of patient population size to aid regional/local budget planning are specified as uptake levers. HTA and P&R demands and tightening budgets negatively impact prescribing of costly oncology brands in the EU5. However, clear demonstration of robust benefits over currently used agents, strategies such as cost-sharing to encourage payers to think beyond the price tag, and promoting familiarity with novel agents among regional and local payers will help optimize the market access opportunity.

Economic burden of seasonal influenza B in France during winter 2010-2011

BackgroundIn France, 2–15% of the population is affected annually by influenza, which causes significant socioeconomic disruption. Nevertheless, despite its importance for policy makers, few published studies have evaluated the impact of influenza B. Therefore, we assessed the costs associated with influenza B during 2010–2011 in France.MethodsCases of lab-confirmed influenza B were analyzed as part of the Influenza B in General Practice Study. Cost calculations were based on micro-costing methods according to the French Health Insurance (FHI) perspective (in Euros, 2011). Costs were compared between age groups using the Kruskal–Wallis test, and when significant, by multiple comparisons based on rank. Moreover, uncertainties were assessed using one-way sensitivity and probabilistic analyses. Overall economic burden was estimated by multiplying cost per patient, flu attack rate, and the French population.ResultsA total of 201 patients were included in the study. We found that the mean cost associated with Influenza B was 72€ (SD: 205) per patient: 70€ (SD: 262) for younger children, 50€ (SD: 195) for older children, 126€ (SD: 180) for adults, and 42€ (SD: 18) for elderly. Thus, we observed significantly different costs between the distinct age groups (p<0.0001). Finally, the economic burden of influenza B for the FHI was estimated to be 145 million Euros (95% CI: 88–201).ConclusionsOur findings highlight the important impact of influenza B and encourage further investigation on policy regarding vaccination strategies in France.

Philosemitism and the mission civilisatrice in Gautier's La Juive de Constantine

Theophile Gautier's play La Juive de Constantine was not a success. Cowritten with Noel Parfait, (1) the play opened at the Porte-Saint-Martin Theater on November 12, 1846 and closed after a mere 20 performances. (2) Reviewers seemed to take a perverse pleasure in attacking one of their own, devoting uncharacteristically long articles to skewering the play after lamenting how sorry they were to do so: Certes j'aurais ete heureux de raconter le succes [...] de cette soiree, wrote the legendary critic Jules Jan in in the Journal des debats: mais en presence de ces huees, de ces cris, de cet ennui [...] en presence de cette action noire, plate, et sans genie [...] il faut bien etre vrai avec nos deux confreres, si nous voulons conserver le droit d'etre justes et sinceres avec tout le monde. (3) So awful did the critic for Le Constitutionnel find the play that he sarcastically suggests it must have been written not by Gautier at all but rather by the Algerian rebel Abd El-Kader in order to discourage the French from further colonization by boring them to tears. (4) It is tempting to follow these critics in dismissing the play as a badly constructed compendium of cultural cliches and threadbare theatrical conventions. In what follows, however, I want to suggest that despite its dramatic shortcomings, La Juive de Constantine merits closer attention for the insights it provides into the ideology of the French colonial endeavor at a key historical moment. For we find here, amid the cliches and conventions, a roadmap to what would become France's strategy in managing the indigenous population of Muslims and Jews in Algeria. Twenty-five years before the Cremieux Decree would enfranchise Algeria's Jews while continuing to consign Muslims to second-class status, the play articulates a rationale for this hierarchy based on the relative capacity of these groups to assimilate French legal norms. As Joshua Shreier has recently argued, Algeria served as a crucible for the development of France's civilizing mission, the justification of colonization on moral grounds that would come to dominate French colonial policy during the Third Republic. (5) Gautier's play provides a remarkably prescient formulation of this ideology, one that lays bare its political and social stakes, as well as its racializing logic, with instructive clarity. First, a short summary of the rather complicated action of the play. The curtain opens on the eastern Algerian city of Constantine dans les deux premieres annees de l'occupation francaise. (6) At the start of the play, Dominique, a French soldier, is keeping watch on the shop of a Jewish merchant named Nathan for his superior officer, Maurice d'Harvieres, who is in love with the Jew's beautiful daughter, Lea. Maurice and Lea plot to run off to France to get married, but their plans are foiled when a Muslim woman, Kadidja, who is in love with Maurice, betrays their intentions to Lea's father, Nathan. When Nathan confronts his daughter about her illicit love for the Frenchman, she reveals that she has already converted to Christianity. A rabbinical scholar in addition to being a merchant, Nathan knows that the Talmud commands him to treat his apostate daughter as if she has died or face the censure of the Jewish community. But the wily Jew concocts a plan: he will give Lea a sleeping draught in order to fake her death, allowing her to escape with Maurice and save his honor. (7) At the start of the third act, Maurice has been captured by Ben Aissa, the brother of Kadidjah, who is also in love with Lea. The jealous Ben Aissa wants to kill Maurice, but then hears that the belle juive they both love is dead. Kadidjah arranges for Maurice to escape. Act Four takes place at the Jewish cemetery as Nathan frees his daughter from her tomb and bids her farewell, refusing her entreaties to join her and her Christian lover in France. Both Maurice and Ben Aissa come to the cemetery to see Lea's grave for themselves, and discover she is in fact still alive. …

Field Evaluation Results of new Isolated and Coordinated Ramp Metering Strategies in France

The paper is focused on the development and the field evaluation of the isolated and new coordinated ramp metering strategies on the A6W motorway in Paris. Three strategies are implemented, tested and evaluated. Traffic, environmental and safety indices are used during the evaluation process. A simple and robust coordinated strategy are developed and tested which corresponds to the added value of this paper. The second added value of this paper is the use of the generalized risk index function as safety index for the evaluation process.

The role of irrigation in farmers' risk management strategies in France

We analyse the way French farmers manage production risks, especially the risk of drought. To this end, we assess the role of irrigation in farmers’ risk management. Based on the European Farm Accountancy Data Network data, we jointly estimate farmers' attitudes to risk and their production decisions. We correct for sample selection bias and endogeneity. Results of the probit model show that irrigation technology serves as a self-insurance. Results of the joint estimation show that irrigating farmers have higher means but lower variance of profits than non-irrigating farmers. However, for already irrigating farmers, using more water volumes increases the variance of outcome.

Cost-effectiveness modeling of colorectal cancer: Computed tomography colonography vs colonoscopy or fecal occult blood tests

To assess the cost-effectiveness of three colorectal-cancer (CRC) screening strategies in France: fecal-occult-blood tests (FOBT), computed-tomography-colonography (CTC) and optical-colonoscopy (OC). Ten-year simulation modeling was used to assess a virtual asymptomatic, average-risk population 50-74 years old. Negative OC was repeated 10 years later, and OC positive for advanced or non-advanced adenoma 3 or 5 years later, respectively. FOBT was repeated biennially. Negative CTC was repeated 5 years later. Positive CTC and FOBT led to triennial OC. Total cost and CRC rate after 10 years for each screening strategy and 0-100% adherence rates with 10% increments were computed. Transition probabilities were programmed using distribution ranges to account for uncertainty parameters. Direct medical costs were estimated using the French national health insurance prices. Probabilistic sensitivity analyses used 5000 Monte Carlo simulations generating model outcomes and standard deviations. For a given adherence rate, CTC screening was always the most effective but not the most cost-effective. FOBT was the least effective but most cost-effective strategy. OC was of intermediate efficacy and the least cost-effective strategy. Without screening, treatment of 123 CRC per 10,000 individuals would cost €3,444,000. For 60% adherence, the respective costs of preventing and treating, respectively 49 and 74 FOBT-detected, 73 and 50 CTC-detected and 63 and 60 OC-detected CRC would be €2,810,000, €6,450,000 and €9,340,000. Simulation modeling helped to identify what would be the most effective (CTC) and cost-effective screening (FOBT) strategy in the setting of mass CRC screening in France.

Dépistage combiné de la trisomie 21 au premier trimestre : à propos de cinq ans d’expérience prospective multicentrique

First trimester screening for Down syndrome is yet to become the first intention strategy in France. This screening program at 11-14 weeks of gestation using maternal age, fetal nuchal translucency, maternal serum free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A has already been validated for a long time by many international studies. It seems to improve detection rate and decrease false positive rates. We report here five years prospective experience.

Mobilités étudiantes et socialisations professionnelles en France et au Québec

Cet article decrit le processus de construction d’une comparaison menee selon l’approche societale en recourant a une recherche ayant porte sur la mobilite internationale d’etudiants francais et quebecois. Apres avoir presente les traits que prend le phenomene dans les deux contextes societaux, ce qui permet de mieux situer les choix theoriques et methodologiques qui se sont imposes au fur et a mesure que l’enquete progressait, les resultats exposes ont pour vocation d’illustrer les modalites de construction d’une typologie en tant qu’instrument d’analyse comparative. On voit alors en quoi la demarche typologique permet d’identifier les parametres qui interviennent dans la construction des pratiques de mobilite et des socialisations professionnelles dans deux societes.

The Cost of Lung Cancer Management in France from the Payor???s Perspective

We assessed the average management cost per case of lung cancer in France according to the histological type and stage at diagnosis, together with the cost of each component of different treatment strategies. The sample was drawn from public and private hospitals that were treating large numbers of patients. The study covered the period from 1 July 1998 to 30 June 1999 and was based on medical chart review. A Markov model with six decision trees (two for small cell lung cancer [SCLC] and four for non-small cell lung cancer [NSCLC]) was used for the cost analysis. Treatment was broken down into first-line and second-line strategies, surveillance, and terminal care (TC). The average management costs were €22 006 (€10 631–36 296) for 1 year and €25 643 (€10 631–41 191) for 2 years. The 2-year average costs were €22 420 for disseminated SCLC and €27 098 for localized SCLC. The costs of NSCLC ranged from €19 543 for nonsurgical stages to €30 024 for surgical stages and €24 383 for stage IV. The weight of the different components of each strategy differed markedly according to the diagnostic subgroup: the cost of diagnosis ranged from 7.4% to 14% of total management costs, and that of TC from 11.5% to 31.1%. The principal cost component was first-line chemotherapy (32–58.5%). Sensitivity analyses showed that, whatever the type of lung cancer, the percentage of actively treated patients was the main cost determinant. TC and chemotherapeutic lines also had important economic implications. The model developed here enables the component costs of different lung cancer management strategies in France to be assessed and the economic consequences of new treatment modalities to be predicted.

Study on the Urban Transport Strategy in France Oriented for the Promotion of Trips Using Public Transport Network

Study on the Urban Transport Strategy in France Oriented for the Promotion of Trips Using Public Transport Network

Un modèle épidémiologique de l’herpès génital pour l’évaluation des interventions thérapeutiques et prophylactiques: Application à la France

This study was performed to quantify the development of the number of cases of genital herpes and to assess the impact of different treatment strategies in France. A model for the natural history of herpes simplex virus genital infection is presented and applied to the French population. The model encompasses infection by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2), first episodes, recurrences, viral shedding and the effect of treatment on infected individuals. In the Year 2000, 270,000 individuals would have suffered from genital herpes in France. A total annual cumulated number of 1.5 million episodes of recurrence and 23 million days of viral shedding were estimated. Seventy percent of viral shedding occurred in sub-clinical seropositive individuals. The expected number of attributable neonatal deaths remained very low. Systematic treatment of clinical episodes might reduce the number of days with lesions (- 27 p. 100), and is also effective on viral shedding (symptomatic: - 50 p. 100). Continuous treatment of the most severe patients (>or=6 recurrences per Year) might reduce viral shedding slightly more (- 85 p. 100). Antiviral treatment might have a major impact on the quality of life of these patients but would only slightly curb the number of new infections. This model tries to integrate the various data currently available at international level on the epidemiology of genital herpes. However, many aspects are still not well documented and remain uncertain. It is therefore necessary to define various assumptions in order to simulate the natural history of the disease in a population. The lack of French data especially on the HSV-1 and HSV-2 seroprevalence profiles reinforces these uncertainties. Our results should hence be considered as exploratory. However, this modeling approach is the only possible way to integrate the multiple parameters describing the pathology and predicting of the public health impact of different interventions. This model is an open tool which may be modified when new data become available.

Sustainable development strategies in France: institutional settings, policy style and political discourse

AbstractThe sustainable development (SD) strategies of two successive French governments, led by Prime Ministers Jospin (1997–2002) and Raffarin (from 2002), are compared and analysed in relation to three debates: (i) the influence of institutional settings and levels of continuity between international, European and national policy frameworks; (ii) compatibility between SD policy frames, national policy style and institutional capacity and (iii) relationships between traditional political discourses and SD discourse. Difficulties in achieving a good ‘fit’ are identified in each of these areas, explanations are offered and implications for future developments outlined. Copyright © 2004 John Wiley &amp; Sons, Ltd and ERP Environment.

Consumer demand for and attitudes toward alternative beef labeling strategies in France, Germany, and the UK

AbstractFood safety scares have led to loss of consumer confidence in the quality and safety of beef products in Europe. To counteract such concerns, firms and regulators can use brands or labels to signal quality. Using data from mail surveys in France, Germany, and the United Kingdom, we analyze consumer preferences for alternative beef labeling strategies: brands, origin labels, and mandatory labeling of beef from cattle fed genetically modified feed. The analysis suggests that consumers place more importance on labels of origin as opposed to private brands. More than 90% of surveyed consumers wanted a mandatory labeling program for beef produced from cattle fed genetically modified crops. [EconLit citations: D120, L660.] © 2003 Wiley Periodicals, Inc. Agribusiness 19: 77–90, 2003.

Cultural images and different varieties of English in French television commercials

A report on the impact of English on media advertising in France.English (in all of its creative manifestations) and images associated with English are extremely popular advertising strategies in France. In order to explore the stereotypical images that French consumers commonly associate with different varieties of English and the reasons for such perceptions, this study compares television data collected in France during the summer of 2000 with data featured in an earlier study (Martin 1998).

Central demyelinating disorders and hepatitis B vaccination: a risk–benefit approach for pre-adolescent vaccination in France

The objective of the study was to provide immunization policy decision makers with a risk–benefit analysis for pre-adolescents vaccination, for various scenarios regarding the existence and the strength of an association between hepatitis B vaccination and the occurrence of first episode of central demyelinating (FECD) disease. The risks were assessed as the attributable risks of FECD for various time intervals between vaccination and onset of FECD and the benefits as the number of acute fulminant hepatitis B and cirrhosis prevented in a vaccinated annual cohort. Even in the worst-case considered, the number of complications prevented by the vaccination outweighs quantitatively the potential risks. Even if both sides of the balance are of different medical and sociological nature, this result is in favor of reinforcing the pre-adolescent vaccination strategy in France.

Naval policy and national strategy in France, 1933–1937

This article argues that French naval policy‐makers were slow to adjust to the changed strategic landscape of the 1930s. During the 1920s France did not face a serious land or air threat. Defence policy‐makers were therefore able to devote a large portion of the defence budget to rebuilding French maritime power. But when the Depression and the rise of Nazi Germany overturned the strategic situation in Europe, policy‐makers adjusted by giving priority to land and air rearmament and by placing ever greater emphasis on securing an alliance with Great Britain. The French naval establishment resisted this trend unsuccessfully. The frustration of naval planning increased the resentment and mistrust of both the Third Republic and Great Britain that characterised naval attitudes before and particularly during the Second World War.

Surveillance of blood transfusion safety: Contribution of the hemovigilance strategy in France

Surveillance of blood transfusion safety: Contribution of the hemovigilance strategy in France

Communautés expatriées, entre France et Indonésie

François Raillon To a large extent the relationship between France and Indonesia is determined by their respective expatriate communities, which in turn are affected by the state and evolution of the relationship. The French community in Indonesia (some 3000 people) is basically engaged in business activities. But the French expatriates find it difficult to expand due to a lack of continuity in France's strategy towards Indonesia despite a high priority given to the Archipelago. In France, the Indonesian community is even more limited (around 1000 people) ; its members are deeply involved in pursuing higher education and training in technological fields, within the framework of a number of doctoral programs between both countries. Data about both communities are presented and discussed, as well as developments in the French-Indonesian relationship with its major emphasis on business and training ; however a large mental cultural gap remains between both communities, as their respective cultures and motives differ widely.

Urban policies and development strategies in France

(1993). Urban policies and development strategies in France. Local Government Studies: Vol. 19, No. 2, pp. 190-207.

Local housing strategies in France

(1993). Local housing strategies in France. Planning Practice & Research: Vol. 8, No. 1, pp. 4-8.