Tel : 01 44 05 47 46
Bureau : P 104
Druais S., Doutriaux A., Cognet M., Godet A., Lançon C., Lévy P., Samalin L., Guillon P. (2016), Cost Effectiveness of Paliperidone Long-Acting Injectable Versus Other Antipsychotics for the Maintenance Treatment of Schizophrenia in France, PharmacoEconomics, 34, 4, p. 363-391
Mennini F., Marcellusi A., Graf von der Schulenburg J., Gray A., Lévy P., Sciattella ., Soro M., Staffiero G., Zeidler J., Maggioni A., Schmieder R. (2015), Cost of poor adherence to anti-hypertensive therapy in five European countries, The European Journal of Health Economics, 16, 1, p. 65-72
The financial burden for EU health systems associated with cardiovascular disease (CV) has been estimated to be nearly EUR110 billion in 2006, corresponding to 10 % of total healthcare expenditure across EU or a mean EUR223 annual cost per capita. The main purpose of this study is to estimate the costs related to hypertension and the economic impact of increasing adherence to anti-hypertensive therapy in five European countries (Italy, Germany, France, Spain and England). A probabilistic prevalence-based decision tree model was developed to estimate the direct costs of CV related to hypertension (CV defined as: stroke, heart attack, heart failure) in five European countries. Our model considered adherence to hypertension treatment as a main driver of blood pressure (BP) control (BP < 140/90 mmHg). Relative risk of CV, based on controlled or uncontrolled BP group, was estimated from the Framingham Heart Study and national review data. Prevalence and cost data were estimated from national literature reviews. A national payer (NP) perspective for 10 years was considered. Probabilistic sensitivity analysis was performed in order to evaluate uncertainty around the results (given as 95 % confidence intervals). The model estimated a total of 8.6 million (1.4 in Italy, 3.3 in Germany, 1.2 in Spain, 1.8 in France and 0.9 in England) CV events related to hypertension over the 10-year time horizon. Increasing the adherence rate to anti-hypertensive therapy to 70 % (baseline value is different for each country) would lead to 82,235 fewer CV events (24,058 in Italy, 7,870 in Germany, 18,870 in Spain, 24,855 in France and 6,553 in England). From the NP perspective, the direct cost associated with hypertension was estimated to be EUR51.3 billion (8.1 in Italy, 17.1 in Germany, 12.2 in Spain, 8.8 in France and 5.0 in England). Increasing adherence to anti-hypertensive therapy to 70 % would save a total of EUR332 million (CI 95 %: EUR319-346 million) from the NPs perspective. This study is the first attempt to estimate the economic impact of non-adherence amongst patients with diagnosed hypertension in Europe, using data from five European countries (Italy, France, Germany, Spain and England).
Kaucley L., Lévy P. (2015), Cost-effectiveness analysis of routine immunization and supplementary immunization activity for measles in a health district of Benin, Cost Effectiveness and Resource Allocation, 13, p. 12
BackgroundThis study was carried out at district level to describe the cost structure and measure the effectiveness of delivering supplementary immunization activity (SIA) and routine immunization (RI) for measles in Benin, a country heavily affected by this disease.MethodsThis cost-effectiveness study was cross sectional and considered 1-year time horizon. RI consists to vaccinate an annual cohort of children aged 0-1 year old and SIA consists to provide a second dose of measles vaccine to children aged 0-5 years old in order to reach both those who did not seroconvert and who were not vaccinated through RI. Ingredients approach to costing was used. Effectiveness indicators included measles vaccine doses used, vaccinated children, measles cases averted and disability adjusted life years averted. Data were collected from all the 18 health care centers of the health district of Natitingou for the year 2011. In the analysis, the coverage was 89 % for RI and 104 % for SIA.ResultsSIA total cost was higher than RI total cost (15,796,560 FCFA versus 9,851,938 FCFA). Personnel and vaccines were the most important cost components for the two strategies. Fuel for cold chain took a non-negligible part of RI total cost (4.03 %) because 83 % of refrigerators were working with kerosene. Cost structures were disproportionate as social mobilization and trainings were not financed during RI contrarily to SIA. In comparison with no intervention, the two strategies combined permitted to avoid 12,671 measles cases or 19,023 DALYs. The benefit of SIA was 5601 measles cases averted and 6955 additional DALYs averted. Cost per vaccinated child for SIA (442 FCFA) was lower than for RI (1242 FCFA), in line with previous data from the literature. Cost per DALY averted was 2271 FCFA (4.73 USD) for SIA and 769 FCFA (1.60 USD) for RI. Analysis showed that low vaccine efficacy decreased the cost-effectiveness ratios for the two strategies. SIA was more cost-effective when the proportion of previously unvaccinated children was higher. For the two strategies, costs per DALY were more likely to vary with measles case fatality ratio.ConclusionsSIA is costlier than RI. Both SIA and RI for measles are cost-effective interventions to improve health in Benin compared to no vaccination. Policy makers could make RI more efficient if sufficient funds were allocated to communications activities and to staff motivation (trainings, salaries).
Largeron N., Lévy P., Wasem J., Bresse X. (2015), Role of vaccination in the sustainability of healthcare systems, Journal of Market Access & Health Policy, 3, p. 8
The use of vaccines to prevent diseases in children, adults, and the elderly results in fewer medical visits, diagnostic tests, treatments, and hospitalisations, which leads to substantial savings in healthcare costs each year in Europe and elsewhere. Vaccines also contribute to reducing resource utilisation by preventing nosocomial infections, such as rotavirus gastroenteritis, which can increase hospital stays by 4-12 days. Vaccination also has an important role in the prevention of cancers with, for example, human papillomavirus or hepatitis B vaccines. Since the financial impact of cancer is high for patients, healthcare systems, and society as a whole, any cases prevented will reduce this impact. Newer vaccines, such as the herpes zoster vaccine, can provide an answer to unmet medical needs by preventing and reducing the severity of shingles and associated post-herpetic neuralgia, which are difficult conditions to treat. Thus, in the context of increasing pressure on healthcare budgets, vaccination can contribute to the sustainability of healthcare systems through reduced and more efficient use of healthcare resources.
Lévy P., Bordier L., Calvet J-H., Le Hérissé G., Bauduceau B. (2015), Potential Budgetary Impact of Large Scale Screening of Small Fiber Neuropathy in the Follow-Up of Patients with Type 2 Diabetes in France, Journal of Diabetes & Metabolism, 6, 10
Aims: The burden of diabetes-related complications is important and increasing in France. Early screening of microvascular complications could avoid the occurrence of more severe consequences. An economic model using a 5-year time horizon was developed to estimate the potential impact in France of large screening of diabetic autonomic neuropathy using Sudoscan, a quick, non-invasive and quantitative method developed for screening of small fiber neuropathy. Methods: A disease progression model was first developed to describe the long-term evolution of patients with type 2 diabetes regarding microvascular complications over successive time periods and patients were classified in 4 groups according to the severity. Complication-related costs were then calculated for a cohort of patients treated according to the current pattern of care and compared with the costs incurred by the same cohort assuming the introduction and widespread use of a large screening of small fiber neuropathy using the Sudoscan method. Comparison of treatment costs between the two situations was used to evaluate the potential budget impact of such a prevention policy in France. Results: According to this general screening of early complications more than 25,000 patients could avoid more severe complications. The gross benefit of such a new prevention strategy would be around EUR 280 million at 5th year. After 5 years of follow-up, the cumulated gross benefit would be EUR 837 million and in the worst case scenario (decrease of 20% for each uncertain parameter, namely the distribution of patients among severity groups, the death rates in each severity group, and the distribution of newly diagnosed patients in each severity group) gross benefit would remain at more than EUR 50 million for the first year and more than EUR 255 million at the 5th year (using 6% as global efficacy of screening method as basal value). Conclusion: Large screening of small fiber neuropathy could avoid more severe peripheral neuropathy and consequently decrease the burden related to such complications for a limited investment.
Doutriaux A., Cognet M., Druais S., Lançon C., Samalin L., Lévy P., Godet A., Guillon P. (2014), PMH35 - Cost-Effectiveness of Paliperidone Palmitate Versus other Antipsychotics for the Treatment of Schizophrenia in France, Value in Health, 17, 7, p. A459âA460
To estimate the cost-effectiveness of paliperidone palmitate (PLAI), a once-monthly long-acting injectable (LAI) atypical antipsychotic, compared to the most common antipsychotic strategies in France.
Abotsi A., Inkoom E., Ribaira E., Le Mentec R., Lévy P., Lafarge H., de Sousa A. (2012), Cost Effectiveness of Intermittent Preventive Treatment of Malaria in Infants in Ghana, International Journal of Tropical Disease & Health, 2, 1, p. 1-15
Aim: In order to integrate malaria Intermittent Preventive Treatment in infants (IPTi) into the Ghana national immunization programme, there was the need to evaluate the feasibility of IPTi by assessing the intervention operational issues including its implementation costs, and its cost effectiveness. Study Design: Cross-sectional study. Place and Duration of Study: Upper East Region, Ghana, between July 2007 and July 2009 Methods: We calculated the costs of administrating IPTi during vaccination sessions; the costs of programme implementation during the first year of implementation (start-up costs) and in routine years (recurrent costs). For the purposes of cost-effectiveness analysis, all economic costs (including financial and opportunity costs) and the net cost were estimated. To estimate the cost effectiveness ratios of IPTi, the aggregate cost of providing the intervention for a reference target population of 1,000 infants was divided by its health outcome. Sensitivity analyses were carried out to understand the results robustness. Results: IPTi gross costs in start up and in routine years were estimated at 70.66 cents and 29.72 cents per dose, or $2.0 and $0.87 per infant, respectively. The gross cost per DALY saved was estimated at $3.49 and the net cost of IPTi for 1,000 infants was $-3,416.38 in the routine years rending IPTi a highly cost saving intervention. Sensitivity analyses showed that the cost per DALY saved never went up more than $4.50 maintaining the intervention still highly cost effective. Conclusion: IPTi in Ghana is a highly and robust cost effective intervention. The intervention is cost-saving and should be scaled up nationally to save children's health and economic capital.
Ebong C., Lévy P. (2011), Impact of the introduction of new vaccines and vaccine wastage rate on the cost-effectiveness of routine EPI: lessons from a descriptive study in a Cameroonian health district, Cost Effectiveness and Resource Allocation, 9, 9
The Expanded Program of Immunization (EPI) offers services to the population free of charge but these activities are costly with the greatest part being the cost of vaccines. In spite of the growing international solidarity towards funding for immunization, the growing objectives continue to outweigh the available resources. It is therefore crucial for any immunization system to seek greater efficiency so as to optimize the use of available means in a bid to ensure sustainability. It is in this light that we carried out this study which aims to assess the productive efficiency of routine EPI for children aged 0 - 11 months with respect to the fixed and outreach vaccine delivery strategies in Ngong health district. The study is descriptive and cross-sectional. Data were collected retrospectively for all 16 health centers of the district that offered EPI services during the period February - May 2009. The results show that: o Only 62% of planned outreach immunization sessions were effectively carried out mainly due to limited funds for transportation and staff availability. Consequently vaccine coverage was low (BCG: 70.1%, DPT-HB-Hib 3: 55.5%) and less resources (43%) were used for this strategy which served 52% of the target population - a major blow to equity. o The average cost per Fully Immunized Child (FIC) was 9,571 FCFA (19.22 USD) for the fixed strategy; 12,751 FCFA (25.61 USD) for the outreach and 10,718 FCFA (21.53 USD) with both strategies combined. These figures are high than those observed in many other African health districts. However, DPT-HB-Hib and yellow fever vaccines contributed to the increase as vaccines occupied 57% of the total cost. With DPT in lieu of DPT-HB-Hib the cost/FIC would be 6,046 FCFA (12.14 USD). Dropout rates too were high (28.1% for the fixed, 29.7% for outreach). o The cost of vaccines wasted in excess of the national norm at the level of health centers was 595,532 FCFA (1,196.15 USD), an amount that could cover the vaccine cost for 122 FIC (7.6% of the FIC during the period). This was accounted for as follows: BCG 1.1%, OPV 1.4%, DPT-HB-Hib 72.7%, measles 5.3%, yellow fever 19.5% o Therefore we suggest improved communication for EPI, the introduction of DPT-HB-Hib with liquid Hib and the effective implementation of planned outreach sessions.
Beauté J., Lévy P., Millet V., Debré M., Dudoit Y., Le Mignot L., Tajahmady A., Thomas C., Suarez F., Pellier I., Hermine O., Aladjidi N., Mahlaoui N., Fischer A. (2010), Economic evaluation of immunoglobulin replacement in patients with primary antibody deficiencies, Clinical and Experimental Immunology, 160, 2, p. 240-245
Lifelong immunoglobulin replacement is the standard, expensive therapy for severe primary antibody deficiencies. This treatment can be administrated either by intravenous immunoglobulin (IVIG) or subcutaneous infusions (SCIG) and delivered at home or in an out-patient setting. This study aims to determine whether SCIG is cost-effective compared with IVIG from a French social insurance perspective. Because both methods of administration provide similar efficacies, a cost-minimization analysis was performed. First, costs were calculated through a simulation testing different hypothesis on costs drivers. Secondly, costs were estimated on the basis of field data collected by a questionnaire completed by a population of patients suffering from agammaglobulinaemia and hyper-immunoglobulin (Ig)M syndrome. Patients' satisfaction was also documented. Results of the simulation showed that direct medical costs ranged from EUR19 484 for home-based IVIG to EUR25 583 for hospital-based IVIG, with home-based SCIG in between at EUR24 952 per year. Estimations made from field data were found to be different, with significantly higher costs for IVIG. This result was explained mainly by a higher immunoglobulin mean dose prescribed for IVIG. While the theoretical model showed very little difference between SCIG and hospital-based IVIG costs, SCIG appears to be 25% less expensive with field data because of lower doses used in SCIG patients. The reality of the dose difference between both routes of administration needs to be confirmed by further and more specific studies.
Guezo-Mevo B., Lévy P., Kora G., Khouna Mlom, Abdou Garda M., Barry A., Agossa A. (2009), Taux de perte en vaccins et efficience du Programme élargi de vaccination : où en est-on dans les districts sanitaires africains ?, Bulletin de la Société de Pathologie Exotique, 102, 1, p. 69-71
Lévy P. (2008), L'analyse d'impact budgétaire et l'évaluation économique : des approches substituables ou complémentaires?, La Lettre du Collège, 19Ã¨me annÃ©e, 4, p. 4-6
Lévy P., Fried M., Santini F., Finer N. (2007), The Comparative Effects of Bariatric Surgery on Weight and Type 2 Diabetes, Obesity Surgery, 17, 9, p. 1248-1256
Background: Epidemiological evidence confirms that risk of developing type 2 diabetes is related to weight gain. Weight reduction is beneficial as relative risk is reduced to 0.13 for weight loss >20 kg. This raises the question of effectiveness of bariatric surgery on 1) weight loss and 2) diabetes-related outcomes in morbidly obese patients.Methods: We reviewed the literature using Medline. Only 2 meta-analyses reporting on both outcomes were included, as well as 50 systematic reviews or primary studies.Results: Meta-analyses mainly based on case series data as well as controlled studies confirm that bariatric surgery is highly effective in obtaining weight reduction in morbidly obese patients up to 60% of the excess weight, along with resolution of preoperative diabetes in more than 75% of cases. Among bariatric surgery techniques, malabsorptive procedures (biliopancreatic diversion and gastric bypass) appear to be more effective on both outcomes than restrictive procedures (gastroplasty and gastric banding).Conclusion: Even if more studies are needed to confirm current evidence, bariatric surgery is effective for controlling diabetes. It appears as an efficient strategy from economic modeling due to savings from reduction in diabetes-related costs.
Donaldson K., Wiebe S., Langfitt J., Lévy P., Butler J., Chisholm D., Pachlatko C., Beghi E., Baker G., Begley C. (2007), Cross-Country Measures for Monitoring Epilepsy Care by ILAE Commission on Healthcare Policy, Epilepsia, 48, 5, p. 990-1001
Comparaison internationale des modes de prise e ncharge de l'épilepsie.
Purpose: The International League Against Epilepsy (ILAE) Commission on Healthcare Policy in consultation with the World Health Organization (WHO) examined the applicability and usefulness of various measures for monitoring epilepsy healthcare services and systems across countries. The goal is to provide planners and policymakers with tools to analyze the impact of healthcare services and systems and evaluate efforts to improve performance. Methods: Commission members conducted a systematic literature review and consulted with experts to assess the nature, strengths, and limitations of the treatment gap and resource availability measures that are currently used to assess the adequacy of epilepsy care. We also conducted a pilot study to determine the feasibility and applicability of using new measures to assess epilepsy care developed by the WHO including Disability-Adjusted Life Years (DALYs), responsiveness, and financial fairness. Results: The existing measures that are frequently used to assess the adequacy of epilepsy care focus on structural or process factors whose relationship to outcomes are indirect and may vary across regions. The WHO measures are conceptually superior because of their breadth and connection to articulated and agreed upon outcomes for health systems. However, the WHO measures require data that are not readily available in developing countries and most developed countries as well. Conclusion: The epilepsy field should consider adopting the WHO measures in country assessments of epilepsy burden and healthcare performance whenever data permit. Efforts should be made to develop the data elements to estimate the measures.
Lévy P., Lévy E. (2002), Pharmacoeconomic Considerations in Assessing and Selecting Congestive Heart Failure Therapies, PharmacoEconomics, 20, 14, p. 963-977
Over the last two decades the incidence of congestive heart failure (CHF) has increased with aging of the population and in spite of the decline in age-adjusted mortality rates due to coronary heart disease. Its management has seen substantial progress, embodied in the introduction of ACE inhibitors, initially as part of triple therapy in which they complemented diuretics and digoxin, and latterly as first-line therapy. The current consensus on treatment of CHF has been based on the multiple clinical studies performed with ACE inhibitors in which these agents have been shown to prevent a new cardiovascular accident and/or progression to more severe CHF in an increasingly wide range of patients with symptomatic CHF or post-infarction left ventricular dysfunction (ejection fraction <= 40% in some trials or <= 35% in others). Not only have the results shown a marked decrease in all-cause (and especially cardiovascular) mortality, but also a great number of cost-effectiveness analyses have shown the advantages of ACE inhibitors in terms of resource allocation: they are either cost saving or convincingly cost effective compared with standard treatment with digoxin and diuretics. Other drugs require similar cost and clinical analyses before they can earn their place in an add-on strategy. To date, cost savings have been documented only for ?-blockers; implantable devices are still undergoing assessment. Two trends are now competing: one is to downplay add-on strategies and to recommend first-line therapy with ACE inhibitors and ?-blockers at effective doses, supplemented by a raft of non-pharmaceutical measures (specialist nurses, patient education, dietary advice, exercise) in a multidisciplinary approach to CHF; the second is, on the contrary, to prescribe up to five drugs for patients with advanced CHF. The evidence that this decreases hospital admission rates and patient cost is more than anecdotal, but conclusive proof of cost effectiveness is still lacking and the approach presupposes dedicated structures. This review argues that despite technical limitations, a combined approach of CHF therapy based on clinical trials and cost-effectiveness analyses is essential. However, improvements can be made. The absence of sufficient comparative data still makes it difficult to choose between drugs within the same class; institutional purchasers need to conduct such analyses to identify the drugs best suited to their patients' profiles and budgetary constraints.
Lévy P. (2002), Economic Evaluation of Antiepileptic Drug Therapy: A Methodologic Review, Epilepsia, 43, 5, p. 550-558
Summary: Purpose: The increasing number of antiepileptic drugs (AEDs) fostered the development of economic studies in epilepsy. We reviewed this literature to identify and discuss methodologic issues. Methods: We included all studies devoted to cost-based evaluation in epilepy, published in English from 1989 to 2001, and identified via a Medline search. Results: We identified a series of methodologic problems. First, we reconsidered heterogeneity of concepts and estimating methods, often cited as the most critical problem, as they do not necessarily result from a failure to apply standard methods. One must distinguish "natural" sources of heterogeneity arising from the many unconstrained choices left open in the implementation of economic evaluation on the one hand, and imperfect information and observation-based sources of heterogeneity leading to constrained choices on the other hand. By their very nature, cost-of-illness studies are subject to this variety of choices and were used to illustrate our purpose. Second, cost-minimization studies were reviewed, as they raise additional problems related to study design and choice of an outcome measure. Finally, deficiencies were also identified in cost-effectiveness and cost-utility studies concerning attempts to incorporate patient's point of view in outcome measurement. Conclusions: We agreed with previous reviews on the difficulty of compare results from economic studies in epilepsy due to heterogeneity in methods and concepts used. This is partly due to imperfect information and limits in observation as sources for data collection, as well as to unavailability of refined outcome measures. Therefore, improvements are possible in this field
Lévy E., Lévy P. (1993), Treatment of peritonitis in France: Comparative cost-effectiveness of the association imipenem-cilastatin and other antibiotic therapy, Journal de chirurgie, 130, 4, p. 200-209
Imipeneme, a molecule chemically related to the carbapenems (beta-lactam), is a potent wide spectrum antibiotic reserved for hospital use. Effective as therapy for major infections, and for use in severely debilitated patients (immunodepressed, etc...) its efficacy in the treatment of peritonitis has been demonstrated in numerous studies abroad, confirmed by results of a French multicenter trial in 1989. Its cost-effectiveness ratio was assessed as excellent in a comparative case-controlled study of totally matched patients treated with other antibiotics. As expected, the cost of the treatment itself (imipeneme/cilastatine plus associated products and costs of their administration) was higher by about 1000 F per patient when compared with other antibiotic regimens, but its markedly superior efficacy allowed overall economies ofabout four and a half times this sum (4300 F). This cost reduction was related to different factors, some of which could not be individualized because of missing data (personnel) or protocol bias (laboratory examinations). Nevertheless, the global result was a shortening of hospital stay by more than two days due to a very pronounced decrease in failure rate of the first treatment. This result is even more remarkable in that the peritonitis treated by Tienam was significantly more severe than that treated by the other antibiotics.
Chambat P., Lévy P. (1991), Les nouveaux outils du savoir, Paris, 274 p.
Lévy P. (2005), L'évaluation économique des maladies chroniques, in Wittwer J. (dir.), Economie du vieillissement : âge et protection sociale (tome 2), L'Harmattan, p. 263-282
L'évaluation économique est pertinente pour appréhender les stratégies thérapeutiques des maladies chroniques. Celles-ci posent néanmoins des difficultés d'application qui peuvent exister dans les maladies aiguës mais sont cumulées dans les maladies chroniques (horizon de long terme, prise en compte de la qualité de vie, intégration des coûts non médicaux) comme l'illustrent plusieurs exemples.
Lévy P. (2009), Pharmaco-économie et analyse d'impact budgétaire : les recommandations du CES, 4ème Séminaire scientifique de pharmaco-épidémiologie, Paris, France
Lévy P. (2005), Viabilité financière et efficience des stratégies vaccinales dans les pays en développement : des approches substituables ou complémentaires ? Une réponse fondée sur la littérature grise, Financement de la santé dans les pays en développement, 2e colloque CERDI (Centre d'Etudes et de Recherches sur le Développement International), Clermont-Ferrand, France