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Abstract: Organosilane pre-treatments have been studied intensively during the last years in order to replace hexavalent chromium conversion treatments. The aim of this study is to follow in-situ the formation of this organosilane layer in solution. Two in-situ techniques, spectroscopic ellipsometry and electrochemical quartz crystal microbalance, were used to investigate the mechanism and the kinetics of this protective film formation. In-situ measurements highlight that the organosilane film observed after the drying process is not formed into the solution, but during the emersion and drying step. Hence, it has been possible to characterise the presence of a very thin organosilane layer in the order of a few monolayers using the in-situ techniques. This layer is responsible for the adhesion and growth of the overall organosilane layer observed ex-situ after drying. [Copyright &y& Elsevier]

The goal of this study is to determine the effect of the molecular structure of silane monomers on the corrosion protection properties of the formed silane layers. During the curing process, the silane monomers crosslink to form a molecular network, which acts as a barrier and retards the ingress of corrosive species. Non-cured and “fully” cured silane films with a comparable thickness were applied on cold rolled steel surfaces. The layer thickness and the chemical state of the films were measured with Spectroscopic Ellipsometry (SE). Electrochemical impedance spectroscopy (EIS) measurements and linear voltammetry clearly show that the number of silanol groups of the fully hydrolyzed silanes and the presence of an organo-functional group have a big influence on the barrier properties of silane layers and hence on their corrosion protection properties. [Copyright &y& Elsevier]

The corrosion resistance of aluminium alloys can be improved by different surface treatments such as painting. A pre-treatment based on chromate is the current method used to increase the corrosion resistance and the adhesion of the organic layer. Silane films seem to be an interesting alternative system to replace the toxic chromates. In this paper, the characterisation of bis-1,2-(triethoxysilyl)ethane (BTSE) thin layers has been evaluated by coupling optical techniques like spectroscopic ellipsometry (SE) and infra-red spectroscopic ellipsometry (IRSE) along with electrochemical methods (electrochemical impedance spectroscopy (EIS)). This approach has been chosen to have a better understanding of the protection provided by these organosilane thin films. It will be demonstrated that the BTSE bath concentration modifies the thickness of the layers and that the curing of this thin film can also improve the barrier properties by forming a denser layer. [Copyright &y& Elsevier]

Objective: To describe the economic impact of age-related macular degeneration (AMD) and to assess its medical and non-medical costs.Design and Settings: An observational study was carried out in 105 patients in two French centres in a sample of 105 French patients. All consecutive patients, consulting during a 3-week period, were included provided they were 60 years of age or older and they presented an exudative form of AMD with a distant visual acuity in the best eye < or = 20/40. Data collected included clinical items, treatment modalities, medical follow-up, transport costs, impact of AMD on living conditions and welfare payments related to visual impairment. Costs were presented in 2000 values.Perspective: General payer perspective (Social Security, private health insurance and patient).Results: Mean age was 79.3 years and ranged from 62.8-95 years. Average length of disease evolution was 3.5 years. During a 3-month period, patients had a mean of 2.6 visits to the ophthalmologist. Thirty percent of the patients used vascular medications and 72.4% had been previously treated by laser photocoagulation. Only 10% had benefited from visual rehabilitation. Annual AMD cost per patient was 3660.29 euros (EUR) [95% CI: 2881.92-4438.62]. Half of these annual costs were medical costs. Other major cost components were home help costs EUR904.91 [95% CI: 478.88-1330.94] and transport costs for care EUR542.73 [95% CI: 146.31-939.14]. Non-medical costs were significantly higher for patients with more severe disease.Conclusions: The economic argument that costs are higher in patients with the lowest visual acuity emphasises the necessity of early detection and treatment of patients with AMD. [ABSTRACT FROM AUTHOR]

Clinical trials designed to evaluate the efficacy of new treatments in seasonal allergic conjunctivitis typically use symptom scores as primary or secondary efficacy measurements. Recorded symptoms are usually ‘itching’, ‘slit lamp redness’, ‘chemosis’, ‘eyelid swelling’, etc. Each symptom is generally assessed using a Lickert scale, with scores ranging from 0 (no symptoms) to a specific value (maximum intensity), which depends on the scale.In a comparative analysis, the multidimensional aspect of the efficacy criterion makes it difficult to reach a definite judgement on the alleged superiority of an analysed drug: the latter may be better than the comparator (or the placebo) for some symptoms and no better or even worse for others. Symptom scores are frequently supplemented with Clinical Global Impression (CGI) scores, which supposedly provide a synthetic and meaningful measure of efficacy. This ‘impression’, however, is highly subjective, investigator dependent, and often unclear in the manner in which it relates to the symptom score. Nevertheless, it remains important to derive a one-dimensional efficacy measurement, based on objective data, especially in economic analysis, where treatment efficacy is compared with the single-dimensional measure of resource use measured in terms of cost.Data from a clinical study comparing a new drug (olopatadine ophthalmic solution) with a reference treatment (levocabastine ophthalmic solution) in patients with seasonal allergic conjunctivitis, were used to derive an ‘aggregated symptom score’, which synthesised all the recorded information. This score was then compared with the CGI scale in order to investigate to what extent the subjective clinical impression was a good predictor of symptom status. [ABSTRACT FROM AUTHOR]

The availability of the Diagnosis Related Group (DRG) system for determining hospital costs in some European countries has encouraged its use in pharmacoeconomic evaluations. The DRG system was developed in the US to provide data for prospective payments for hospitals. However, the financing of hospitals in some European countries is still based on the so-called 'global budget' approach. Therefore, results of pharmacoeconomic studies involving hospitals financed by the 'global-budget' approach in which DRG costs have been used require careful consideration. The main points to consider are: (i) that most of the cost components constituting the DRGs are in fact charges fixed by the government. This cost-charge ratio varies significantly across different DRGs, altering economic consequences when cost-shifting between DRGs; (ii) that there is rarely a perfect concordance between attributable cost (as proposed by the DRGs) and the definition of variable cost (as defined in economic evaluations); (iii) from the Sickness Fund's point of view, the way DRGs could be interpreted is rather unclear: financing or bench-marking?; and (iv) the perspective of DRG cost is a mixed patient-hospital perspective which is neither the societal nor the health insurance perspective generally used in pharmacoeconomic evaluations. In conclusion, the use of DRG costs is a major improvement for pharmacoeconomic evaluation. However, many hypotheses still need to be made in these studies, depending on the economic perspective of the study. Therefore, the results of pharmacoeconomic studies should be considered and discussed in line with the national financing system of the hospitals involved. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between severity and progression of illness in Parkinson's disease and the use of healthcare resources. Design and setting: This was a prospective cost-of-illness study conducted in France based on clinical observation over a 6-month period of patients with Parkinson's disease treated in the hospital or community setting. Regression analyses were performed to construct the model that offered the best explanation for health expenditures using clinical and sociodemographic indicators. Patients and participants: All patients included in the study had well-defined idiopathic Parkinson's disease, were aged >35 years, were receiving treatment with levodopa or other antiparkinsonian agents, and were capable of completing questionnaires, alone or with the help of a household member. The final study population consisted of 294 patients, of whom 54 were enrolled by general practitioners and 240 by neurologists. Interventions: Investigators completed a clinical questionnaire at the beginning and end of the 6-month observation period. Patients completed a questionnaire on their daily living conditions at the beginning and end of the study, and also completed monthly reports of healthcare use and loss of productivity. Patients with motor fluctuations also filled in fluctuation diaries on 4 consecutive days at the beginning and end of the 6-month period. Resource data collected included hospital stays, ancillary care, drug therapy, medical visits and transportation. Social costs were evaluated in nonmonetary terms, with the exception of costs of adapting the home environment. Transfer payments were analysed using reports from patients. Main outcome measures and results: Hospital stays were the most expensive component of care (39% of costs), followed by ancillary care (30%) and drug therapy (22%). The mean medical cost was 308 euros (EUR) [$US357] for patients followed by a general practitioner and EUR2580 ($US2993) for patients followed by a neurologist. Costs also varied with age and motor fluctuations. Medical costs were strongly correlated with most clinical indicators and the cost generally progressed in line with the severity of the disease. The strongest correlation was between clinical indicators and ancillary care costs. Conclusions: These results confirm the importance of the social burden of Parkinson's disease. The regression results could be used to evaluate the benefit of novel treatments that reduce the intensity of motor fluctuations. [ABSTRACT FROM AUTHOR]

NASH is a chronic disease that can progress to end-stage liver disease. This progression is particularly rapid in NASH patients with advanced liver fibrosis (stages F3-F4). Total wellbeing costs ranged from €41,536 to €90,379 million, primarily driven by the high mortality rate of NASH patients. [Extracted from the article]

Abstract: A low frequency plasma process is used to deposit thin films on steel through simultaneous sputtering and plasma enhanced chemical vapour deposition (PECVD). The deposited material consists in composite copper–organosilicon thin layers where copper is obtained by magnetron sputtering whereas the organosilicon plasma polymer is grown by PECVD from HMDSO (hexamethyldisiloxane). This paper focuses on the important process parameters required to control the quantity of incorporated copper in the layer, particularly the metalorganic concentration and the sputtering current. The dispersion of copper vs. the thin film thickness is found to be homogeneous. The deposited layers show antimicrobial activity for copper contents higher than X =38%, where X =[Cu]/([Cu]+[Si]). [Copyright &y& Elsevier]

Lilliu H, Brun-Strang C, Le Pen C, Büchler M, Al Najjar A, Priol G, Reigneau O, Lebranchu Y. Cost-minimization study comparing Simulect® vs. Thymoglobulin® in renal transplant induction. Clin Transplant 2004: 18: 247–253. © Blackwell Munksgaard, 2004 Based on the data of clinical trial CHI-F-02 comparing the efficacy and safety of basiliximab (Simulect®) vs. anti-thymocyte globulin (Thymoglobulin®) in renal transplant induction, we carried out an economic evaluation. This pharmacoeconomic study was a cost-minimization study, i.e. given the equivalent efficacy of the products, the strategy that minimized the cost of care was considered better. The cost of care was analyzed from the hospital perspective. This ‘piggyback’ study of 100 patients estimated the direct medical costs incurred over 6 months of use of two strategies for renal transplant induction therapy. Direct medical costs are those of utilized medical resources: medications, hospital stays, dialysis, and physician visits and investigations not scheduled in the protocol. In the Simulect® arm, significant reductions were found in the initial hospital stay duration and number of infectious episodes. Therefore, although the average cost of treatment was slightly higher with Simulect® than with Thymoglobulin® (2964 vs. 2298 Euros), the cost of the initial hospitalization was significantly lower in the Simulect® arm (10 907 vs. 11 967 Euros; p = 0.02). Furthermore the mean cost of infectious episodes was significantly lower in the Simulect® arm (1056 vs. 1790 Euros, p = 0.03). Cytomegalovirus infection accounted for a significantly smaller proportion of this cost in the Simulect® arm than in the Thymoglobulin® arm (30% vs. 53%, p = 0.001). This study showed direct medical cost savings of 1159 Euros per patient in the Simulect® arm, which more than compensated for the higher price of this immunosuppressive drug. [ABSTRACT FROM AUTHOR]

— The health costs of alcohol-related problems in France were estimated using two cost evaluation approaches: (1) estimate based on the proportion of cases attributable to alcohol abuse (the alcohol abuse factor); (2) estimate based on prevalence of alcohol abuse for in- and out-patients. For a 10% prevalence of alcohol abuse in the general population, the minimum cost in 1996 was about US$ 2300 million; for a prevalence of 15% it was US$ 2700 million. This cost concerns the health disorders that are linked directly or indirectly to alcohol abuse. It did not allow for injuries from accidents caused by alcohol intoxication and undervalued the cost of out-patient care. Based on the prevalence of alcohol-related disorders seen at hospitals, a percentage of the total in-patient and out-patient costs due to effects of alcohol could be estimated. However, this did not permit an estimate of the cost of care in which alcohol abuse was a risk factor only. Based on the available data showing that between 3% and 10% of inpatients have a directly alcohol-related condition, estimates of in-patient treatment costs varied from US$ 1300 to 2100 million. Among adult out-patients, 20% present with a disorder in which alcohol is a factor or suffer from an alcohol-related illness, which corresponds to a cost of about US$ 1600 million. Thus, these methods yield minimum year's cost estimated between US$ 2500 and 3300 million. These costs are high, compared to the low level of financing for the specialized facilities offering treatment to people in difficulty due to alcohol excess, which was US$ 23 million in that year. As regards social and total costs, estimates from four Western countries have found that about 75% of the total costs of alcohol abuse was attributable to social harm, and 25% to medical costs. Applying this ratio to the French data gives an estimated total cost to French society of about US$ 13 200 million, i.e. 1.04% of the gross national product. [ABSTRACT FROM PUBLISHER]

Background: In 2005, the French Government implemented a new way of financing high-cost drugs for hospitals in order to promote innovation. Such drugs are gathered on a positive list, established by the Ministry of Health, with a reimbursement price cap. Hospitals still negotiate with pharmaceutical firms, who set their prices freely, and then charge the national health insurance according to their consumption, without budgetary constraints, but on the condition of good use of care. They are not allowed to charge a price higher than this ceiling price, which is called the 'responsibility tariff' (RT). This measure is included in another, larger reform, which concerns hospital financing through allotted amounts at a specific diagnosis-based level. The purpose of this add-on payment on top of the health funds is firstly to avoid heterogeneity in costs per diagnostic-related group and secondly to avoid an uncontrolled increase of prices due to a lack of interest in negotiation from hospitals, as supplementary funding could reduce hospital price sensitivity. Objectives: The aim of this work was to assess the bargaining power of hospitals with the pharmaceutical firms in the monopoly market of innovative cancer drugs since the implementation of this reimbursement price cap. Methods: This study used data from the French Technical Agency of Information on Hospitals (ATIH; Agence Technique de l'Information sur l'Hospitalisation) and included 487 hospitals, which were public and non-profit private. The analysis was conducted on the cancer drugs of the regulated list. An index representing the ratio of the purchase prices to the RT was built from 2004 to 2007 in order to make a 'before-and-after' comparison. Results: Results showed a transient price decrease in 2005 before an alignment of patented drugs with regulated prices in the context of a dynamic market with a 22.5% yearly growth rate in value between 2004 and 2007. Conclusion: Hospitals are able to impose the RT for single-brand drugs. However, they are no longer able to negotiate below the RT except for generic drugs. Negotiations take place upstream for setting the RT between the public authorities and the firms. [ABSTRACT FROM AUTHOR]

Background There are limited data available on the economical burden of psoriasis and its impact on everyday life. Objective The aim of this study was to evaluate the impact of psoriasis on personal and professional life, and to evaluate the cost of psoriasis for the patient. Methods We performed a cross-sectional study in psoriasis patients. All patients aged ≥18 years with a diagnosis of plaque-psoriasis confirmed by a physician were included. A self-administered questionnaire evaluating everyday life was constructed with members of the French association of psoriasis patients. In addition, the Dermatology Life Quality Index (DLQI), Working Productivity and Activity Impairment and individual costs were assessed. Results A total of 590 patients completed the study. Mean age of the responders was 56 years. The mean DLQI score was 8.5 for patients with severe psoriasis vs. 6.4 for mild psoriasis. Global loss of productivity was 10.7% without significant difference according to the disease severity. Daily activities alteration was most important in patients with severe psoriasis. In this study, 36.8% of patients with severe psoriasis reported a negative impact on their professional life vs. 19.6% for patients with mild psoriasis ( P = 0.002). Time devoted to phototherapy was on average 33 h/year/patient and the application of emollients took 25 h/year/patient; 47.3% of patients had a feeling to clean the house more often, in correlation with the severity of the disease. Mean out-of-pocket expenses for the disease was estimated to be 543€/year/patient. High impact of psoriasis on quality of life (DLQI >10), age <40 years and joint involvement were significantly associated with an increased risk of loss of work productivity. Conclusion Psoriasis, particularly severe psoriasis, is a true burden for patients and impacts significantly everyday life and patient’s economical resources. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Multicentric, randomized, and controlled study of clinical evaluation of medical device in subacute low back pain. OBJECTIVE: To evaluate the effects of an elastic lumbar belt on functional capacity, pain intensity in low back pain treatment, and the benefice on medical cost. SUMMARY OF BACKGROUND DATA: There is limited evidence of efficiency of lumbar supports for treatment of low back pain. There is also a lack of the methodology in the studies reported on the efficiency of this device. METHODS: This study is randomized, multicentric, and controlled with 2 groups: a patient group treated with a lumbar belt (BWG) and a control group (CG). The main criteria of clinical evaluation were the physical restoration assessed with the EIFEL scale, the pain assessed by a visual analogic scale, the main economical criteria was the overall cost of associated medical treatments. RESULTS: One hundred ninety-seven patients have participated. The results show a higher decrease in EIFEL score in BWG than CG between days 0 and 90 (7.6 +/- 4.4 vs. de 6.1 +/- 4.7;P = 0.023). Respectively significant reduction in visual analogic scale was also noticed (41.5 +/- 21.4 vs. 32.0 +/- 20; P = 0.002). Pharmacologic consumption decreased at D90 (the proportion of patients who did not take any medication in BWG is 60.8% vs. 40% in CG;P = 0.029). CONCLUSION: Lumbar belt wearing is consequent in subacute low back pain to improve significantly the functional status, the pain level, and the pharmacologic consumption. This study may be useful to underline the interest of lumbar support as a complementary and nonpharmacologic treatment beside the classic medication use in low back pain treatment. [ABSTRACT FROM AUTHOR]

Background: High frequency stimulation of the subthalamic nucleus (STN) is an alternative but expensive neurosurgical treatment for parkinsonian patients with levodopa induced motor complications. Objective: To assess the safety, clinical effects, quality of life, and economic cost of STN stimulation. Methods: We conducted a prospective multicentre study in 95 consecutive Parkinson's disease (PD) patients receiving bilateral STN stimulation and assessed its effects over 12 months. A double blind randomised motor evaluation was carried out at 3 month follow up, and quality of life, self care ability, and predictive factors of outcome following surgery were assessed. The cost of PD was estimated over 6 months before and after surgery. Results: The Unified Parkinson's Disease Rating Scale (UPDRS) motor score improved by 57% (p<0.0001 ) and activities of daily living improved by 48% (p<0.0001) at 12 month follow up. Double blind motor scoring improved by 51% at 3 month follow up (p<0.0001). The total PD Quality of Life Questionnaire (PDQL-37) score improved by 28% (p<0.001). The better the preoperative motor score after a levodopa challenge, the better the outcome after STN stimulation. Five patients developed an intracerebral haematoma during electrode implantation with permanent after effects in two. The 6 month costs of PD decreased from €10 087 before surgery to €1673 after surgery (p<0.0001) mainly because of the decrease in medication. These savings allowed a return on the procedure investment, estimated at €36 904 over 2.2 years. Conclusions: STN stimulation has good outcomes with relatively low risk and little cost burden in PD patients with levodopa induced motor complications. [ABSTRACT FROM AUTHOR]

Objective: To assess and compare the incremental costs of the 15-day treatment of osteoarthritis (OA) with nimesulide vs that with diclofenac in France, Italy and Spain. Design: A cost-minimisation analysis was performed through a decision tree, assuming the National Health System perspective. A meta-analysis was performed to assess the incidence of gastrointestinal adverse events (GIAEs) in patients with OA treated with nimesulide or diclofenac. Results: Three studies were included in the meta-analysis, which included a sample size of 484 patients in total. The incidence of GIAEs is higher in patients treated with diclofenac than in those treated with nimesulide. Nimesulide is cost-saving in all three countries: treatment costs are reduced by Euro dollars (EUR) 1.5 per case in France, EUR2 in Italy and EUR3.6 in Spain. Final results are not sensitive to variation of incidence rates of gastric and intestinal events and to changes in the resource consumption: nimesulide always remains cost-saving. Conclusions: This is the first economic analysis carried out in three different countries on original epidemiological data comparing nimesulide and diclofenac directly. Projecting our results to the estimated OA prevalence in the entire population of the three countries, the expected savings to the NHS would vary from a minimum of EUR17 500 000 in France to a maximum of EUR30 000 000 in Spain. It can be stated that these findings can provide support for clinicians and policy-makers for the adoption of this cost-saving treatment strategy in patients with OA. [ABSTRACT FROM AUTHOR]

Introduction – objectifs La rage humaine peut être prévenue par la prophylaxie post-exposition (PPE) (vaccination +/- RIG). En France seules 2 RIG (commercialisées par le laboratoire Sanofi) disposent d’une AMM : une d’origine humaine (HRIG), l’autre équine. Elles ne peuvent être prescrites et administrées que dans les centres antirabiques (CAR) qui doivent tracer ces étapes pour les HRIG. En 2013 les CAR et les autorités de santé ont dû faire face à plusieurs annonces de rupture de stock de RIG. L’ampleur et la durée de la pénurie ont été demandées au laboratoire mais il fallait préciser les besoins annuels pour la France en termes de volumes, indications et coûts. Matériels et méthodes Pour estimer les besoins en RIG nous avons analysé la base de données du CNR de la rage abondée par plus de 90 % des CAR français sur la période 2001-2011 en précisant l’indication et le nombre de patients traités. La quantité de RIG par patient étant fonction du poids et non déductible de cette base, une étude rétrospective des fiches de délivrance de RIG du CAR d’Ile de France de 2009 à 2010 a été réalisée. Les RIG ont été valorisées aux coûts 2011. Résultats Sur les 93 723 consultants post exposition 49 396 ont reçu une PPE. 4 208 (9 %) des PPE incluaient des RIG (après une exposition, à l’étranger dans 1 473 cas, en France à une chauve-souris dans 666 cas, et en Guyane dans 240 cas). Le nombre de flacons d’HRIG était de 4 en moyenne par patient et 16 832 au total pour un coût de 2 945 600 €. Conclusion Dans le contexte étudié il faut prévoir environ 1 500 flacons d’HRIG par an pour un coût de 270 000 €. Pour limiter les pénuries et l’augmentation des prix (multipliés par 2 entre 2010 et 2013 pour les HRIG majoritairement prescrits car mieux tolérés) il serait préférable de remédier au monopole actuel en autorisant en France d’autres HRIG disposant d’une AMM européenne. [ABSTRACT FROM AUTHOR]