[Market access agreements: Definition and features. Could MAA be defined as a solution for immunotherapy funding by French health system?] / Les contrats d'accès au marché : définition et caractéristiques. Une solution pour garantir la prise en charge de l'immunothérapie par le système de santé français ?

Over the last few years, many therapeutic innovations have been approved and marketed in France, within a strained financial setting. Legal dispositions allowed manufacturers (LEEM - les enterprises du medicament) and the economic committee for health products (CEPS) to contract various confidential market access agreements to contain health product expenses. The purposes of this article are to define and describe these different existing market access agreements and to open discussion on their applicability to the problematic of immune-oncology drugs financing. Financial agreements, which led to major savings (discounts refunded to the public payer), have not responded completely to the therapeutic innovations financing problems. Performance agreements (funding based on real-life data and effectiveness of the drug) constitute a hope for health products financing, but major methodological challenges for their use in routine restrict them to rare cases only today. Even though several financial agreements could partly respond to this problematic, use of performance agreements could really constitute an interesting track to tackle this issue.

[Impact of the expiry of the patent on quality and price of medicines at hospital: Study of five anticancer drugs from 2008 to 2015 at the Assistance publique-Hôpitaux de Paris]. / Impact de la chute des brevets sur le critère « qualité ¼ et sur le prix des médicaments à l'hôpital : étude sur cinq anticancéreux entre 2008 et 2015 à l'Assistance publique­Hôpitaux de Paris.

OBJECTIVES: Anticancer drugs were in 2005 the first expenditure item of the hospital drugs. Ten years later, it is noted that the placing on the market of generic drugs has led to a strong decrease of their price. To determine whether this decrease comes at the expense of product quality, a price-quality ratio trend study of five anticancer drugs was performed at AP-HP. METHOD: This work concerns docetaxel, oxaliplatin, gemcitabine, irinotecan and paclitaxel, and focus on the transition period between monopoly conditions and competitive situation (2008 to 2015). The price is set by calculating the cost per milligram of each specialty. Quality is evaluated by the average of quality marks obtained during the analysis of the tenders received in the purchasing procedures on four assessment criteria: ready for use form, stability of the solution after dilution, safety use and labeling. RESULTS: Between 2008 and 2015, the price per milligram of these anticancer drugs decreases, following the placing on the market of generic drugs. The quality of the tenders is maintained and even improved in many cases. On average, generic rating quality, lower than that of the originators in 2008, are now the highest. CONCLUSION: This study allows an objective basis of the effects of the drop in patent originator medicines. The placing on the market of generic drugs has a double positive result for the buyer: strong price cuts, parallel to the quality improvement, through the example of five anticancer drugs studied.

[Advances in the contributions of imaging to stereotaxic localization of cerebral arteriovenous malformations for radiosurgery ]. / Evolution des données d'imagerie dans le repérage stéréotaxique pour la radiochirurgie des malformations artério-veineuses cérébrales.

Historically, angiography was one of the first diagnostic methods to allow for visualization of neurovascular structures. It has been and still is very useful for precise evaluation of vascular pathology and is one of the main elements in treatment planning for radiosurgical targets. It is the only imaging method that gives insight into the angioarchitecture of a cerebral arteriovenous malformation, possibly reducing the target volume. Construction of frames (Leksell, Fisher) that are compatible with cross-sectional imaging methods, such as CT and MRI allowed there use for planning of stereotactical treatment for brain cerebral arteriovenous malformations. The advantages of these methods are given by the fact, that they are less invasive and that they allow visualization of neurovascular structures and surrounding cerebral structures. Further evolution of the cross-sectional imaging techniques allowed reconstruction of the image data in different planes and segmentation of structures such as vessels. Use of special algorithms allow visualization of the image data, i.e. surface rendering with 3D images of vascular structures. However, such images allow no detailed insight into the angioarchitecture of a cerebral arteriovenous malformation and give rather a view of the whole volume, i.e. a "tumor" aspect of the cerebral arteriovenous malformation. Similar images are currently also obtained with digital substraction angiography using rotational image acquisitions and image postprocessing allowing 3D reconstruction of angiographical image data. The different image evaluation methods are thus complementary all giving useful information for treatment planning. Therefore it would be useful to develop the possibility to integrate the information obtained by these modalities. Image fusion require identification of fiducial marks, what can be performed with application of external marks or by using internal anatomical marks. Recent developments allow now use of vascular structures as fidiucial marks to obtain image fusion. This paper reports on the evolution of stereotactical planning, performed on 541 patients over a period of eight years.

[Hodgkin's disease in children. Stage IV. Treatment and results]. / Maladie de Hodgkin chez l'enfant. stade IV. Traitement et résultats

Without prior treatment, 13 children with stage IV Hodgkin's disease have received a multiple drug therapy (MOPP). Of these patients, 7 have experienced a complete remission; 3 a partial remission, completed in two cases by radiotherapy on the site of the residual disease, and the third by another combination chemotherapy. Out of the 10 children living as of July 1st 1975, 8 are still on first remission. Tolerance for the treatment has been good. The evolution of the disease and problems of treatment are also discussed.