[QALYS or not QALYS: that is the question?]. / QALYS or not QALYS: that is the question?

The article discusses the proposal of some health economists to use the "cost per QALY (quality-adjusted-life year)" ratio as an universal indicator for economic assessment of medical interventions, in the so-called "cost-utility" analyses. Authors argue that QALYs are not a straightforward application of expected utility theory, which is the standard economic model of individual behaviours toward risk and uncertainty. Indeed, QALYs are compatible with economic utility theory only if individuals' preferences regarding health states satisfy certain very restrictive properties: utility independence between length of life and quality of life, constancy of the proportional trade-off between quality of life and length of life, risk neutrality towards health states, constancy through time of the utility associated with each health state. Aggregation of individual QALYs to obtain an indicator for patient groups at the societal level also raises complex equity problems. Last but not least, from the epistemological point of view, QALYs are based on the hypothesis that health interventions only affect the health of the individual and not any other aspects of his well-being. The authors conclude that the "cost per QALY" approach should be abandoned in order to avoid ambiguities that could impede the development of health economics in the medical field.

Patient condition affects the collection of peripheral blood progenitors after priming with recombinant granulocyte colony-stimulating factor.

A total of 258 aphereses were performed in 79 patients with nonmyeloid malignancies after mobilization of peripheral blood stem cells (PBSC) with recombinant human granulocyte colony-stimulating factor (rhG-CSF). Apheresis products were examined for viable mononuclear cell (VMC), CD34+ cell, and clonogenic cell contents. The number of progenitors in aphereses differs in subgroups of patients with different diagnoses. However, the number of CD34+ or clonogenic cells is dependent on age and amount of chemotherapy delivered to patients before collection rather than on the nature of the disease itself. In addition, the actual dose of rhG-CSF used to mobilize PBSC and the number of VMC in aphereses influenced the clonogenicity of CD34+ cells, although the daily dose of rhG-CSF seems to play little role on the number of clonogenic cells in each individual apheresis product. CD34+ cell and CFU-C (or CFU-GM) numbers are related parameters, and the relation can be described as linear. However, the linear relation varies in different patient groups, and most of the linearity is induced by the highest sets of values. We conclude that mobilization with low doses of rhG-CSF alone is feasible and that the probability of collecting a high number of peripheral blood progenitors is increased in young patients undergoing apheresis early in the course of the disease. Although the relationship between CD34+ cells and CFUs can be described as linear in well-defined situations, its relevance may be limited because it is not a universal finding.

[Evaluation of 80 virologically-confirmed cases of ocular herpes. Study of the correlation between the type of virus and the epidemiologic characteristics of the disease]. / Bilan de 80 cas d'herpès oculaire virologiquement confirmés. Etude des corrélations entre le typage du virus et les caractères épidémiologiques de la maladie.

80 strains were isolated from patients with herpetic ocular infection during the period May 1979 to May 1981: 17 patients with herpetic blepharitis, 40 patients with superficial keratitis and 23 with deep stromal keratitis or kerato-uveitis. Among 63 patients treated with antiviral agents, clinical resistance to the drug was observed in 17 cases. The strains were typed as HSV 1.1, 1.2 or 2.2 by seroneutralization and thermosensitivity in cellular cultures. No relationship between the viral types and the patient age, previous history of corticosteroid therapy and the response of ocular lesions to antiviral treatment were detected. It appeared that there was a relationship between the viral type and the clinical type of infection: 70% of herpetic blepharitis and 83% of superficial keratitis were due to HSV 1.1 while 71% of stromal keratitis were due to HSV 1.2. No HSV 2.2 was isolated. These results seem to support the hypothesis that genetic differences between herpetic virus strains may determine their virulence.

[Accidental localized vaccinia. A report of six recent cases (author's transl)]. / La vaccine accidentelle localisée. A propos de six observations récentes.

Vaccination against smallpox should be discontinued in all countries except for individuals with a high risk of exposure (WHO, 1980). Since this vaccination is performed less and less often, one must expect complications to occur, the etiology of which may not be recognized. This course of events leads the authors to point out the difficulties in diagnosis and therapy of localized accidental vaccinia encountered in six patients hospitalized in Brest (1971-1979). Diagnosis is considered if the patient himself, or a person he came in contact with, was recently vaccinated. Diagnosis should always be established by virology. Such accidents can be avoided by a faultless vaccination technique and by giving sufficient information to the inoculated subject or to his relatives.