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Context: Adverse drug reactions (ADRs) are responsible for 5 % of hospital admissions, but hospital re-admission induced by ADRs remains poorly documented. Objective: The aim of this study was to estimate the rate of hospital re-admission and the factors associated with re-admission in the patients over the age of 65 years. Secondary, we described the characteristics of cases of ADRs leading to re-admission for drugs other than chemotherapy agents. Methods: Data were extracted from hospital discharge summaries provided by the Department of Medical Information of Toulouse University Hospital. All patients over the age of 65 years admitted to the hospital in 2010 for an ADR, identified from ICD-10 codes, were selected. All subsequent admissions of members of this cohort within 1 year of discharge following the index admission were reviewed retrospectively. The risk factors associated with hospital re-admission for ADRs were analyzed. Medical records were used for descriptive analysis of re-admission due to drugs other than chemotherapy agents. Results: We found that 553 of the 1000 patients admitted for ADRs in 2010 were re-admitted to hospital within 1 year. Among them, 87 cases were re-admitted for ADRs (estimated rate of 87/1000 re-admission for an ADR within 1 year). A comparison of the patients re-admitted for ADRs ( n = 87) with those of patients re-admitted for other causes ( n = 410) suggested that only cancer increased the risk of re-admission for ADRs (OR = 7.69 [4.59-12.88] 95 % CI). ADRs due to the same drug combination were the suspected cause of repeat admission in half the cases (other than chemotherapy). Hospital re-admission was considered avoidable in four cases (22 %). Conclusion: This study shows an estimated rate of re-admission for an ADR around 87/1000 within 1 year, and the same drug combination were the suspected cause of repeat admission in half the cases. At least, 11 % of cases were avoidable. [ABSTRACT FROM AUTHOR]

Background: 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.Methods: 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).Results: The average management costs were [Euro sign]22 006 ([Euro sign]10 631-36 296) for 1 year and [Euro sign]25 643 ([Euro sign]10 631-41 191) for 2 years. The 2-year average costs were [Euro sign]22 420 for disseminated SCLC and [Euro sign]27 098 for localized SCLC. The costs of NSCLC ranged from [Euro sign]19 543 for nonsurgical stages to [Euro sign]30 024 for surgical stages and [Euro sign]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.Conclusion: 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. [ABSTRACT FROM AUTHOR]

To evaluate, according to the histologic type and initial stage, the mean cost (MC) of managing patients with lung cancer and the costs of the different management phases. A Markov approach was used to model these costs, based on the management of a representative nation-wide sample of 428 patients with newly diagnosed lung cancer. The 18-month MC ranged from US$ 20?691 (95% CI: 5777-50?380 for diffuse non-small-cell lung cancer (NSCLC) to US$ 31?833 (95% CI: 15?866-64?455) for localised small-cell lung cancer (SCLC); first-line treatment costs ranged from 33.8% of MC for medically inoperable localised NSCLC to 74.6% for diffuse SCLC; second- or third-line treatment costs ranged from 7.8% of MC for surgically treated localised NSCLC to 32% for locally advanced NSCLC; and the cost of palliative care ranged from 9.1% of MC for locally advanced NSCLC to 39.9% for medically inoperable localised NSCLC. The cost of first-line chemotherapy and the percentage of actively treated patients impacted more on MC than did the cost of second- or third-line chemotherapy regimens or the cost of palliative care. In conclusion, this model provides a robust economic analysis of the cost of lung cancer management, and will be useful for assessing the economic consequences of future changes in patient management.British Journal of Cancer (2004) 90, 397-402. doi:10.1038/sj.bjc.6601547 www.bjcancer.com [ABSTRACT FROM AUTHOR]

Large Registries of HLA-typed potential volunteer donors have been set up in numerous countries to find HLA-matched unrelated bone marrow donors. This study compared two strategies medicoeconomically for HLA typing in the context of a bone marrow volunteer donor Registry. It investigated the cost-effectiveness of strategies before and after the French Registry was modified in January 1999: HLA- A, B typing only at registration and secondary HLA-DR typing on part of the Registry (AB strategy) vs. typing at once for HLA- A, B, and DR (ABDR strategy). The point of view considered was that of payers, French typing tariffs with a 5% discount rate were used, effectiveness was defined as identification of at least one donor with no HLA-A, B, DR incompatibilities for a given recipient (compatible potential donor), the observation period was 9 months, and the judgement criterion was the differential cost-effectiveness ratio. The ABDR strategy identified 94.7% (142/150) of compatible potential donors. The differential cost-effectiveness ratio between the two strategies was 387,005 francs (Euro 58,995) for one supplementary compatible potential donor. Compared with a “do nothing” policy, the ratio was 3,744,087 francs (Euro 570,745) for the AB strategy vs. 576,136 francs (Euro 87,826) for the ABDR strategy. The ABDR strategy is thus more effective but also more costly than the AB strategy. Nevertheless, because of its lower effectiveness and the size of available ABDR Registries, the AB strategy will become obsolete. [ABSTRACT FROM AUTHOR]

To assess the benefits of an integrated hematology system in the day-to-day running of a specialized university hospital laboratory the authors tested the Sysmex HST-330 system. Medical and economic evaluation sought to answer two questions: Does sample automation and use of such a system risk causing information loss prejudicial to patient care? Does it result in time-saving? The HST-330 was compared with the existing laboratory system by subjecting 1030 tubes to each work mode. With no loss of quality in medical results, the HST-330 provided an excellent technical base for the development of an expert system managing environmental data. The larger the batch, the more impressive was the performance of the HST-330 (0.86 min per specimen versus 1.04 min with the reference system for a 50-tube batch), reducing operator time by 41.5%. The HST-330 saved time while maintaining medical quality. [ABSTRACT FROM AUTHOR]

In France, as in other European countries, management of prostate cancer in the population is rather variable. The objective was to analyse diagnosis and treatment modalities of prostate cancer in patients from French cancer registries.A sample of 803 patients with prostate cancer diagnosed in 1995 was drawn at random from cases recorded in four cancer registries in the geographical regions of Bas-Rhin, Calvados, Isère and Tarn. Diagnosis, clinical staging and treatment were analysed by questionnaire. Multivariate analysis by logistic regression was used to describe medical determinants (age, PSA, clinical staging) of the various treatment choices.The mean age of the patients was 71.6 y (range 46–94 y). Clinical staging showed 60% T1–2 tumours, 15% T3–4 and 17% N+or metastases. PSA rate (median 18.2 ng/ml) was assessed in 92.4% of patients. Prostate cancer was diagnosed by prostate biopsy in 63% and by transurethral resection of the prostate (TURP) in 32% of patients. The main treatments were radical prostatectomy 22%, radiotherapy 19.4%, hormonal therapy 33%, TURP alone 17.7% and expectant management 6%. The method of treatment was unknown in 5.7% of cases. Adjuvant radiotherapy or hormonal therapy had been used in 31% of cases. Logistic regression analysis showed that radical prostatectomy was most often performed in patients aged <60 y, three times more frequently for T2 tumour and for PSA between 4 and 20 ng/ml. Radiotherapy was the most frequently applied treatment for patients aged between 65 and 75 y, especially in T3 tumours.Approximately 75% of the patients in the study underwent a specific treatment for prostate cancer with a curative intention in 40%. This study provides a baseline to clinicians and public health authorities on the management of prostate cancer in France with recent data. This survey will be useful to compare future descriptive analysis and to provide data... [ABSTRACT FROM AUTHOR]