Comptes Rendus de l Académie des Sciences - Series III - Sciences de la Vie
A retrospective case-control study was conducted over three years in a Gastroenterology Departmen... more A retrospective case-control study was conducted over three years in a Gastroenterology Department. Alcohol consumption and dietary habits of 152 male patients with liver cirrhosis and 304 hospital controls selected in the same age range, were assessed from a standardized questionnaire by a highly trained dietician. The variations of the relative risk of liver cirrhosis as a function of the estimated mean daily intakes of alcohol, fats, carbohydrates and proteins were studied using stratified conditional logistic regression models. Thus the relative risk of liver cirrhosis was found to be positively correlated with alcohol and fat consumption. Whereas in the control group, the calorie percentage from fats was 33.8, it was 39.6 in the cirrhotic group (87.11 g/d vs. 102.1 g/d). In contrast, the relative risk of liver cirrhosis was found to be negatively correlated with the mean daily carbohydrate and protein intakes. These findings indicate that in addition to alcohol consumption, dietary habits and in particular daily fat intake, should be considered for studying liver cirrhosis and for monitoring these patients.
Comptes Rendus de l Académie des Sciences - Series III - Sciences de la Vie
Vitamins A and E, transthyretin (TT) and retinol binding protein (RBP) plasma levels were assayed... more Vitamins A and E, transthyretin (TT) and retinol binding protein (RBP) plasma levels were assayed in 70 patients having a recently diagnosed digestive cancer and in 116 controls. After adjustment for sex and age, vitamin A or RBP and TT were found lowered in digestive cancer but vitamin E was lowered only in esophagus cancer. The relationship of vitamin levels to the relative risk of digestive cancer was calculated by multiple logistic conditional regression. TT level remained the only significant parameter. Since TT levels are strongly influenced by the nutritional status of patients, our results suggest that the decreased blood levels of vitamin A and its carriers observed in digestive cancer are the consequence of nutritional alterations evoked by the disease.
To identify potential factors of change in alcohol consumption and regional differences which cou... more To identify potential factors of change in alcohol consumption and regional differences which could explain why and how habits are evolving. Four hundred and thirty three subjects aged 20 to 34 years, were recruited by random sampling in Marseilles, Montpellier and Toulouse. A quantitative food frequency questionnaire was used to collect data on alcohol consumption. A stepwise logistic regression was applied to the total sample, to the sub-sample of drinkers, and to the sub-samples of drinkers of each type of alcoholic beverage. Factors associated with each type of alcoholic consumption were analyzed by city. Montpellier and Toulouse samples were pooled because of the similarity in alcoholic consumption, which was different from that in Marseilles. There are significantly more drinkers in Montpellier/Toulouse than in Marseilles (74.4% versus 53.8%; p=0.001) and also more binge drinking subjects (31.1% versus 10.3%; p=0.001). Age, tobacco, leisure physical activity are independently ...
A resume, with key European results, is given of Willing Anonymous Salivary HIV/Hepatitis C (WASH... more A resume, with key European results, is given of Willing Anonymous Salivary HIV/Hepatitis C (WASH-C) surveillance studies for estimating HIV and Hepatitis C prevalence among prisoners, and associated risk behaviours. The WASH methodology was acceptable to prisoners, with participation rates of 75% to 88% in EC Network, UK and Irish prison studies; one-third of nearly 9,000 male participant adult prisoners had a history of injection drug use, half of whom reported having injected inside prison. Half of the injectorinmates were Hepatitis C antibody positive in saliva (1,157/2,246). We then set out four other methodologies for future international application inside prisons. All four have been designed to safeguard prisoner and medical confidentiality and to avoid deductive disclosure about participant prisoners. They are: database linkage, for example to enable follow-up of drugsrelated deaths soon after release from prison; randomised controlled trials in criminal justice, for example to determine whether drug treatment and testing orders are preferable (in terms of recidivism, morbidity and mortality) to incarceration for drug-dependent offenders; a new WASH methodology for quantifying Hepatitis C and injector incidence among young offenders; and audit, for example to monitor prisoners' uptake of short-course Hepatitis B immunisation.
Hepatitis C antiviral therapies have significant psychiatric side effects. It is therefore believ... more Hepatitis C antiviral therapies have significant psychiatric side effects. It is therefore believed that they might exacerbate mental illness in patients with pre-existing psychiatric disorders, resulting in poor adherence and response to antiviral treatment. We aimed to assess adherence to treatment, virological outcomes and mental safety in psychiatric patients, compared with non-psychiatric patients, treated for hepatitis C. A cohort study involved unselected hepatitis C patients on scheduled therapy with pegylated interferon-alpha2b and ribavirin, between 2002 and 2005 in France, and followed-up until 6 months after the end of treatment. Virological response was reported by the physician according to standard definitions and adverse events were monitored. Adherence to treatment was assessed by patient report. Among 1,860 patients, 403 (22%) had pre-existing psychiatric disorders, mostly depressive and anxiety disorders. Strict adherence was similar in psychiatric and non-psychiatric patients (35% versus 39%; P=0.20) as was the rate of sustained virological response (52% versus 51%; P=0.75). Conversely the rate of mental adverse events was higher in psychiatric patients (78% versus 57%; P<0.001). Baseline characteristics independently associated with the risk of later mental adverse events were history of depression, initial pegylated interferon-alpha2b dose and female gender. Antiviral therapy in hepatitis C patients with associated psychiatric disease appears as effective as in other patients but results in a higher rate of mental adverse events, emphasizing the need for close monitoring of these psychiatric patients.
A resume, with key European results, is given of Willing Anonymous Salivary HIV/Hepatitis C (WASH... more A resume, with key European results, is given of Willing Anonymous Salivary HIV/Hepatitis C (WASH-C) surveillance studies for estimating HIV and Hepatitis C prevalence among prisoners, and associated risk behaviours. The WASH methodology was acceptable to prisoners, with participation rates of 75% to 88% in EC Network, UK and Irish prison studies; one-third of nearly 9,000 male participant adult prisoners had a history of injection drug use, half of whom reported having injected inside prison. Half of the injectorinmates were Hepatitis C antibody positive in saliva (1,157/2,246). We then set out four other methodologies for future international application inside prisons. All four have been designed to safeguard prisoner and medical confidentiality and to avoid deductive disclosure about participant prisoners. They are: database linkage, for example to enable follow-up of drugsrelated deaths soon after release from prison; randomised controlled trials in criminal justice, for example to determine whether drug treatment and testing orders are preferable (in terms of recidivism, morbidity and mortality) to incarceration for drug-dependent offenders; a new WASH methodology for quantifying Hepatitis C and injector incidence among young offenders; and audit, for example to monitor prisoners' uptake of short-course Hepatitis B immunisation.
To evaluate knowledge, opinions and attitudes of physicians towards prevention of health conseque... more To evaluate knowledge, opinions and attitudes of physicians towards prevention of health consequences from air pollution, especially photo-chemical pollution. A questionnaire was prepared by a multidisciplinary group from published literature on Health impact of air pollution and from local context. It was administered on line among a random sample of physicians practising in the County of the Bouches du Rhône (Marseille, South-eastern France). The sample consisted in pediatricians (1/2), general practitioners (GP; 1/14) and pneumologists. The answer rate was 79% (112/169 GP, 94/107 pediatricians, 82/91 pneumologists). Among the 288 physicians who answered the questionnaire, 44% declared they felt very concerned by air pollution, especially pediatricians. While 87% were knowledgeable about SO2 regulations, only 59% (48% among pediatricians) were knowledgeable about ozone regulations. While about all physicians knew the health effects of air pollution episodes on respiratory tract, o...
Best Practice & Research Clinical Gastroenterology, 2013
As national budgets for health care will remain under stress for the foreseeable future, health t... more As national budgets for health care will remain under stress for the foreseeable future, health technology assessment (HTA) aimed at offering guidance to policy-making will have an increasing role to play in optimizing resources. The emergence of new treatment paradigms and health technologies, and the prevalence studies which determine when a disease is a current or future burden for patients and the community are in the roots of the HTA process. Analysing studies on screening test strategies and health care policy, this paper revisits two key concepts in epidemiology, prevalence and incidence, in order to show their major impact upon HTA. Utilization of the predictive values of screening tests that include prevalence in their calculations, and analysing all options for screening strategies are necessary in HTA. Cost-effectiveness analyses and statistical models should include potential externalities, especially the impact of prevention and treatment on infectious disease prevalence. Beyond estimates of cost-effectiveness ratios, decision makers also need to know by how much their annual health care budget is likely to increase or decrease in the years following the emergence of new technologies: hence the importance of incidence- or prevalence-based economic evaluations. As new paradigms are occurring, especially in the field of oncology, with treatments targeted to 'small' groups of patients identified through genetic testing, prevalence data are strongly needed. Precise estimates of disease prevalence, in general populations as well as in risk or targeted groups, will therefore be necessary to improve HTA process.
Estimer l'efficacité, les coûts et les bénéfices de plusieurs stratégies de dépistage de l'hépati... more Estimer l'efficacité, les coûts et les bénéfices de plusieurs stratégies de dépistage de l'hépatite chronique C en fonction de la prévalence de l'infection.Une analyse de décision a permis de comparer le coût et l'efficacité de stratégies de dépistage avec la stratégie statu quo qui consiste à ne pas dépister. Le nombre de pathologies évitées a été retenu comme critère d'efficacité. Les bénéfices retirés d'un dépistage et d'une prise en charge précoce ont été évalués par les coûts évités et pris en compte dans le calcul du coût net total. Deux hypothèses de prise en charge ont été évaluées (mono- et bithérapie). Une modélisation de l'histoire naturelle de la maladie a permis d'intégrer dans l'analyse les conséquences à long terme (10 ans) d'un programme de dépistage.L'option statu quo est dominée quelle que soit la stratégie de dépistage considérée. La stratégie consistant en un seul test ELISA, suivi d'un ELISA de confirmation en cas de positivité est la plus coût-efficace. Dépister et traiter d'emblée par interféron et ribavirine les sujets naïfs dépistés s'avère aujourd'hui plus coût-efficace que le traitement par bithérapie des seuls rechuteurs.Cette évaluation économique privilégie la stratégie du dépistage et du traitement des patients porteurs chroniques du virus C par rapport à une stratégie de statu quo.To evaluate the effectiveness, the costs and savings of hepatitis C screening strategies according to seroprevalence.A decision analysis was performed to compare the cost and effectiveness between various screening strategies and the current strategy that implies no screening. Effectiveness was defined as the number of avoided pathologies as a result of screening. Benefits due to early screening and treatment were evaluated as avoided costs and were taking into account in the net costs. Two hypotheses were proposed for the treatment. A disease history model was developed in order to evaluate the long term consequences of a screening programme (over a 10 year period).Status quo was dominated whatever screening strategies considered. The strategy consisting of an ELISA test confirmed by another ELISA was the best strategy in term of cost-effectiveness. To screen and to treat with interferon and ribavirine was a better option than adding ribavirine only for relapse patients.To screen and treat infected HCV patients would be cost-savings if we compare with status quo.
Clinics and Research in Hepatology and Gastroenterology, 2015
This retrospective hospital database analysis aimed to determine the burden and cost of hospitali... more 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 postliver transplantation. Costing was performed using French national tariffs and expressed in 2013 Euros. We documented 22,056 hospital stays involving 12,040 patients which were considered to be directly related to CHC. Of these stays, 11,779 hospital (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.
Primary hyperoxaluria type 1 (PH1) always leads to oxalate accumulation throughout the body (oxal... more Primary hyperoxaluria type 1 (PH1) always leads to oxalate accumulation throughout the body (oxalosis). Currently available epidemiological data only concern patients with end-stage kidney disease requiring renal replacement therapy (RRT). French nephrologists have been questioned about PH1 patients who were under their care between 1988 and 1992. Exhaustive answers were obtained and 90 cases of PH1 were collected. The average prevalence rate of PH1 was 1.05/10(6) and its average incidence rate was 0.12/10(6)/year. The median age at onset was 5 years (0-63) and initial symptoms involved the urinary tract in 82% of the cases. Half the patients were younger than 10 years at the time of diagnosis on the basis of urine oxalate (89%) +/- urine glycolate (43%) +/- plasma oxalate (71%) +/- hepatic alanine:glyoxylate amino-transferase activity (48%). At the time of the survey, 36% of patients were on a conservative treatment, 37% were transplanted and 27% were on maintenance haemodialysis; the crude mortality rate was 19% (median age 36 years). Patients on dialysis started RRT at a median age of 25 years. Transplanted patients received their first transplant at a median age of 29.5 years; among those patients with more than 1 year follow-up, 15 received an isolated kidney transplant (one success), one had a isolated liver transplant (one success) and 10 combined liver-kidney transplant (eight successes). These data confirm the rarity of PH1 together with its poor prognosis; as shown in the European experience, early combined liver-kidney transplantation seems to be the best therapeutic proposal.
: L'objectif de ce travail etait d'evaluer l'interet de la laparoscopie pour le diagnostic positi... more : L'objectif de ce travail etait d'evaluer l'interet de la laparoscopie pour le diagnostic positifet etiologique des granulotnatoses abdominales en medecine interne.
The diet is often unbalanced and deficient in poverty situations and deprived populations are bec... more The diet is often unbalanced and deficient in poverty situations and deprived populations are becoming larger and larger in developed countries. Negative effects on the health of poor populations are expected in the short or long term. The link between diet and health is well investigated in many epidemiological studies ; however they seldom analyse the link between infectious diseases and diet in western countries and rarely include poverty indicators that could help to provide more information about the situation among poor populations.
Comptes Rendus de l Académie des Sciences - Series III - Sciences de la Vie
A retrospective case-control study was conducted over three years in a Gastroenterology Departmen... more A retrospective case-control study was conducted over three years in a Gastroenterology Department. Alcohol consumption and dietary habits of 152 male patients with liver cirrhosis and 304 hospital controls selected in the same age range, were assessed from a standardized questionnaire by a highly trained dietician. The variations of the relative risk of liver cirrhosis as a function of the estimated mean daily intakes of alcohol, fats, carbohydrates and proteins were studied using stratified conditional logistic regression models. Thus the relative risk of liver cirrhosis was found to be positively correlated with alcohol and fat consumption. Whereas in the control group, the calorie percentage from fats was 33.8, it was 39.6 in the cirrhotic group (87.11 g/d vs. 102.1 g/d). In contrast, the relative risk of liver cirrhosis was found to be negatively correlated with the mean daily carbohydrate and protein intakes. These findings indicate that in addition to alcohol consumption, dietary habits and in particular daily fat intake, should be considered for studying liver cirrhosis and for monitoring these patients.
Comptes Rendus de l Académie des Sciences - Series III - Sciences de la Vie
Vitamins A and E, transthyretin (TT) and retinol binding protein (RBP) plasma levels were assayed... more Vitamins A and E, transthyretin (TT) and retinol binding protein (RBP) plasma levels were assayed in 70 patients having a recently diagnosed digestive cancer and in 116 controls. After adjustment for sex and age, vitamin A or RBP and TT were found lowered in digestive cancer but vitamin E was lowered only in esophagus cancer. The relationship of vitamin levels to the relative risk of digestive cancer was calculated by multiple logistic conditional regression. TT level remained the only significant parameter. Since TT levels are strongly influenced by the nutritional status of patients, our results suggest that the decreased blood levels of vitamin A and its carriers observed in digestive cancer are the consequence of nutritional alterations evoked by the disease.
To identify potential factors of change in alcohol consumption and regional differences which cou... more To identify potential factors of change in alcohol consumption and regional differences which could explain why and how habits are evolving. Four hundred and thirty three subjects aged 20 to 34 years, were recruited by random sampling in Marseilles, Montpellier and Toulouse. A quantitative food frequency questionnaire was used to collect data on alcohol consumption. A stepwise logistic regression was applied to the total sample, to the sub-sample of drinkers, and to the sub-samples of drinkers of each type of alcoholic beverage. Factors associated with each type of alcoholic consumption were analyzed by city. Montpellier and Toulouse samples were pooled because of the similarity in alcoholic consumption, which was different from that in Marseilles. There are significantly more drinkers in Montpellier/Toulouse than in Marseilles (74.4% versus 53.8%; p=0.001) and also more binge drinking subjects (31.1% versus 10.3%; p=0.001). Age, tobacco, leisure physical activity are independently ...
A resume, with key European results, is given of Willing Anonymous Salivary HIV/Hepatitis C (WASH... more A resume, with key European results, is given of Willing Anonymous Salivary HIV/Hepatitis C (WASH-C) surveillance studies for estimating HIV and Hepatitis C prevalence among prisoners, and associated risk behaviours. The WASH methodology was acceptable to prisoners, with participation rates of 75% to 88% in EC Network, UK and Irish prison studies; one-third of nearly 9,000 male participant adult prisoners had a history of injection drug use, half of whom reported having injected inside prison. Half of the injectorinmates were Hepatitis C antibody positive in saliva (1,157/2,246). We then set out four other methodologies for future international application inside prisons. All four have been designed to safeguard prisoner and medical confidentiality and to avoid deductive disclosure about participant prisoners. They are: database linkage, for example to enable follow-up of drugsrelated deaths soon after release from prison; randomised controlled trials in criminal justice, for example to determine whether drug treatment and testing orders are preferable (in terms of recidivism, morbidity and mortality) to incarceration for drug-dependent offenders; a new WASH methodology for quantifying Hepatitis C and injector incidence among young offenders; and audit, for example to monitor prisoners' uptake of short-course Hepatitis B immunisation.
Hepatitis C antiviral therapies have significant psychiatric side effects. It is therefore believ... more Hepatitis C antiviral therapies have significant psychiatric side effects. It is therefore believed that they might exacerbate mental illness in patients with pre-existing psychiatric disorders, resulting in poor adherence and response to antiviral treatment. We aimed to assess adherence to treatment, virological outcomes and mental safety in psychiatric patients, compared with non-psychiatric patients, treated for hepatitis C. A cohort study involved unselected hepatitis C patients on scheduled therapy with pegylated interferon-alpha2b and ribavirin, between 2002 and 2005 in France, and followed-up until 6 months after the end of treatment. Virological response was reported by the physician according to standard definitions and adverse events were monitored. Adherence to treatment was assessed by patient report. Among 1,860 patients, 403 (22%) had pre-existing psychiatric disorders, mostly depressive and anxiety disorders. Strict adherence was similar in psychiatric and non-psychiatric patients (35% versus 39%; P=0.20) as was the rate of sustained virological response (52% versus 51%; P=0.75). Conversely the rate of mental adverse events was higher in psychiatric patients (78% versus 57%; P<0.001). Baseline characteristics independently associated with the risk of later mental adverse events were history of depression, initial pegylated interferon-alpha2b dose and female gender. Antiviral therapy in hepatitis C patients with associated psychiatric disease appears as effective as in other patients but results in a higher rate of mental adverse events, emphasizing the need for close monitoring of these psychiatric patients.
A resume, with key European results, is given of Willing Anonymous Salivary HIV/Hepatitis C (WASH... more A resume, with key European results, is given of Willing Anonymous Salivary HIV/Hepatitis C (WASH-C) surveillance studies for estimating HIV and Hepatitis C prevalence among prisoners, and associated risk behaviours. The WASH methodology was acceptable to prisoners, with participation rates of 75% to 88% in EC Network, UK and Irish prison studies; one-third of nearly 9,000 male participant adult prisoners had a history of injection drug use, half of whom reported having injected inside prison. Half of the injectorinmates were Hepatitis C antibody positive in saliva (1,157/2,246). We then set out four other methodologies for future international application inside prisons. All four have been designed to safeguard prisoner and medical confidentiality and to avoid deductive disclosure about participant prisoners. They are: database linkage, for example to enable follow-up of drugsrelated deaths soon after release from prison; randomised controlled trials in criminal justice, for example to determine whether drug treatment and testing orders are preferable (in terms of recidivism, morbidity and mortality) to incarceration for drug-dependent offenders; a new WASH methodology for quantifying Hepatitis C and injector incidence among young offenders; and audit, for example to monitor prisoners' uptake of short-course Hepatitis B immunisation.
To evaluate knowledge, opinions and attitudes of physicians towards prevention of health conseque... more To evaluate knowledge, opinions and attitudes of physicians towards prevention of health consequences from air pollution, especially photo-chemical pollution. A questionnaire was prepared by a multidisciplinary group from published literature on Health impact of air pollution and from local context. It was administered on line among a random sample of physicians practising in the County of the Bouches du Rhône (Marseille, South-eastern France). The sample consisted in pediatricians (1/2), general practitioners (GP; 1/14) and pneumologists. The answer rate was 79% (112/169 GP, 94/107 pediatricians, 82/91 pneumologists). Among the 288 physicians who answered the questionnaire, 44% declared they felt very concerned by air pollution, especially pediatricians. While 87% were knowledgeable about SO2 regulations, only 59% (48% among pediatricians) were knowledgeable about ozone regulations. While about all physicians knew the health effects of air pollution episodes on respiratory tract, o...
Best Practice & Research Clinical Gastroenterology, 2013
As national budgets for health care will remain under stress for the foreseeable future, health t... more As national budgets for health care will remain under stress for the foreseeable future, health technology assessment (HTA) aimed at offering guidance to policy-making will have an increasing role to play in optimizing resources. The emergence of new treatment paradigms and health technologies, and the prevalence studies which determine when a disease is a current or future burden for patients and the community are in the roots of the HTA process. Analysing studies on screening test strategies and health care policy, this paper revisits two key concepts in epidemiology, prevalence and incidence, in order to show their major impact upon HTA. Utilization of the predictive values of screening tests that include prevalence in their calculations, and analysing all options for screening strategies are necessary in HTA. Cost-effectiveness analyses and statistical models should include potential externalities, especially the impact of prevention and treatment on infectious disease prevalence. Beyond estimates of cost-effectiveness ratios, decision makers also need to know by how much their annual health care budget is likely to increase or decrease in the years following the emergence of new technologies: hence the importance of incidence- or prevalence-based economic evaluations. As new paradigms are occurring, especially in the field of oncology, with treatments targeted to 'small' groups of patients identified through genetic testing, prevalence data are strongly needed. Precise estimates of disease prevalence, in general populations as well as in risk or targeted groups, will therefore be necessary to improve HTA process.
Estimer l'efficacité, les coûts et les bénéfices de plusieurs stratégies de dépistage de l'hépati... more Estimer l'efficacité, les coûts et les bénéfices de plusieurs stratégies de dépistage de l'hépatite chronique C en fonction de la prévalence de l'infection.Une analyse de décision a permis de comparer le coût et l'efficacité de stratégies de dépistage avec la stratégie statu quo qui consiste à ne pas dépister. Le nombre de pathologies évitées a été retenu comme critère d'efficacité. Les bénéfices retirés d'un dépistage et d'une prise en charge précoce ont été évalués par les coûts évités et pris en compte dans le calcul du coût net total. Deux hypothèses de prise en charge ont été évaluées (mono- et bithérapie). Une modélisation de l'histoire naturelle de la maladie a permis d'intégrer dans l'analyse les conséquences à long terme (10 ans) d'un programme de dépistage.L'option statu quo est dominée quelle que soit la stratégie de dépistage considérée. La stratégie consistant en un seul test ELISA, suivi d'un ELISA de confirmation en cas de positivité est la plus coût-efficace. Dépister et traiter d'emblée par interféron et ribavirine les sujets naïfs dépistés s'avère aujourd'hui plus coût-efficace que le traitement par bithérapie des seuls rechuteurs.Cette évaluation économique privilégie la stratégie du dépistage et du traitement des patients porteurs chroniques du virus C par rapport à une stratégie de statu quo.To evaluate the effectiveness, the costs and savings of hepatitis C screening strategies according to seroprevalence.A decision analysis was performed to compare the cost and effectiveness between various screening strategies and the current strategy that implies no screening. Effectiveness was defined as the number of avoided pathologies as a result of screening. Benefits due to early screening and treatment were evaluated as avoided costs and were taking into account in the net costs. Two hypotheses were proposed for the treatment. A disease history model was developed in order to evaluate the long term consequences of a screening programme (over a 10 year period).Status quo was dominated whatever screening strategies considered. The strategy consisting of an ELISA test confirmed by another ELISA was the best strategy in term of cost-effectiveness. To screen and to treat with interferon and ribavirine was a better option than adding ribavirine only for relapse patients.To screen and treat infected HCV patients would be cost-savings if we compare with status quo.
Clinics and Research in Hepatology and Gastroenterology, 2015
This retrospective hospital database analysis aimed to determine the burden and cost of hospitali... more 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 postliver transplantation. Costing was performed using French national tariffs and expressed in 2013 Euros. We documented 22,056 hospital stays involving 12,040 patients which were considered to be directly related to CHC. Of these stays, 11,779 hospital (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.
Primary hyperoxaluria type 1 (PH1) always leads to oxalate accumulation throughout the body (oxal... more Primary hyperoxaluria type 1 (PH1) always leads to oxalate accumulation throughout the body (oxalosis). Currently available epidemiological data only concern patients with end-stage kidney disease requiring renal replacement therapy (RRT). French nephrologists have been questioned about PH1 patients who were under their care between 1988 and 1992. Exhaustive answers were obtained and 90 cases of PH1 were collected. The average prevalence rate of PH1 was 1.05/10(6) and its average incidence rate was 0.12/10(6)/year. The median age at onset was 5 years (0-63) and initial symptoms involved the urinary tract in 82% of the cases. Half the patients were younger than 10 years at the time of diagnosis on the basis of urine oxalate (89%) +/- urine glycolate (43%) +/- plasma oxalate (71%) +/- hepatic alanine:glyoxylate amino-transferase activity (48%). At the time of the survey, 36% of patients were on a conservative treatment, 37% were transplanted and 27% were on maintenance haemodialysis; the crude mortality rate was 19% (median age 36 years). Patients on dialysis started RRT at a median age of 25 years. Transplanted patients received their first transplant at a median age of 29.5 years; among those patients with more than 1 year follow-up, 15 received an isolated kidney transplant (one success), one had a isolated liver transplant (one success) and 10 combined liver-kidney transplant (eight successes). These data confirm the rarity of PH1 together with its poor prognosis; as shown in the European experience, early combined liver-kidney transplantation seems to be the best therapeutic proposal.
: L'objectif de ce travail etait d'evaluer l'interet de la laparoscopie pour le diagnostic positi... more : L'objectif de ce travail etait d'evaluer l'interet de la laparoscopie pour le diagnostic positifet etiologique des granulotnatoses abdominales en medecine interne.
The diet is often unbalanced and deficient in poverty situations and deprived populations are bec... more The diet is often unbalanced and deficient in poverty situations and deprived populations are becoming larger and larger in developed countries. Negative effects on the health of poor populations are expected in the short or long term. The link between diet and health is well investigated in many epidemiological studies ; however they seldom analyse the link between infectious diseases and diet in western countries and rarely include poverty indicators that could help to provide more information about the situation among poor populations.
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Papers by Michel Rotily