Cost-Effectiveness Evaluation of a Remote Monitoring Programme Including Lifestyle Education Software in Type 2 Diabetes: Results of the Educ@dom Study.

INTRODUCTION: Telemedicine programs using health technological innovation to remotely monitor the lifestyles of patients with type 2 diabetes (T2D) can improve glycaemic control and thus reduce the incidence of complications as well as management costs. In this context, an assessment was made of the 1-year and 2-year cost-effectiveness of the EDUC@DOM telemonitoring and tele-education program. METHODS: The EDUC@DOM study was a multicentre randomized controlled trial conducted between 2013 and 2017 that compared a telemonitoring group (TMG) to a control group (CG) merged with health insurance databases to extract economic data on resource consumption. Economic analysis was performed from the payer perspective, and direct costs and indirect costs were considered. The clinical outcome used was the intergroup change in glycated haemoglobin (HbA1c) levels from baseline. Missing economic data were imputed using multiple imputation, and fitted values from a generalized linear mixed model were used to calculate the incremental cost-effectiveness ratio (ICER). Bootstrapped 95% confidence ellipses were drawn in the cost-effectiveness plan. RESULTS: The main analysis included data from 256 patients: 126 in the TMG and 130 in the CG. Incremental costs over 1 and 2 years were equal to €2129 and €5101, respectively, in favour of the TMG. Once imputed and adjusted for confounding factors, the TMG trends to a 21% cost decrease over 1 and 2 years of follow-up (0.79 [0.58; 1.08], p = 0.1452 and 0.79 [0.61; 1.03], p = 0.0879, respectively). The EDUC@DOM program led to a €1334 cost saving and a 0.17 decrease in HbA1c over 1 year and a €3144 cost saving and a 0.14 decrease in HbA1c over 2 years. According to the confidence ellipse, EDUC@DOM was a cost-effective strategy. CONCLUSION: This study provides additional economic information on telemonitoring and tele-education programs to enhance their acceptance and promote their use. In the light of this work, the EDUC@DOM program is a cost-saving strategy in T2D management. TRIAL REGISTRATION: This trial was registered in the Clinical Trials Database on 27 September 2013 under no. NCT01955031 and bears ID-RCB no. 2013-A00391-44.

[Patterns of non steroidal anti-inflammatory drug use in ambulatory care]. / Profil des utilisateurs d'anti-inflammatoires non stéroïdiens.

The aim of this study was to discuss the patterns of non steroidal anti-inflammatory drug (NSAID) use in general population. We identified NSAID's users from the French Health Insurance System claims database covering more of the population in the Midi-Pyrenees area (southwest of France), if they have received at least one NSAID in June 2003. We discussed this population according to the NSAID used, to their demographic characteristics and to other drugs delivered in the period. Our study shows different patterns of use according to each NSAID. For example, users of ibuprofen or tiaprofenic acid were younger and less frequently exposed to "gastroprotective" drugs, users of coxibs were older and more frequently exposed to drugs increasing the risk of bleeding. This study confirms the wide use of NSAIDs and describes their target population. It underlines the interest of Health Insurance System Database for better knowledge of drug use in ambulatory care in France.

[The use of triptan in ambulatory medicine in Midi-Pyrénées Region: clinical and pharmacological contra-indications and drug abuse]. / Prescription des triptans en médecine de ville dans la ré gion Midi-Pyrénées : indications, contre indications, abus médicamenteux.

OBJECTIVE: Evaluate triptan prescriptions in ambulatory medicine. METHODS: Collection of medical data from 301 patients treated with triptans reimbursed by the French National Health Fund in the region of Midi-Pyrenees. RESULTS: Ninety-five per cent of selected patients suffered from migraine condition according to the International Headache Society diagnosis criteria [Confidence interval (CI) 95%: 93-98]. Co-morbidity factors contra-indicating triptan therapy were present in 6% of patients (CI 95%: 3-9). 2% of patients were prescribed other medicinal products contra-indicated with their triptan therapy (CI 95%: 0-4). Twenty-six per cent of patients were taking triptan medicines more than 8 times per month over a period of three months (CI 95%: 21-31) and 8% were taking this treatment more than 12 times per month (CI 95%: 5-1 I). Eleven per cent kept written information of their migraine crises (CI 95%: 7-15). Thirty-nine per cent benefited from dedicated prophylactic treatments (CI 95%: 33-45). CONCLUSION: In a context of sustained increase in prescriptions of migraine treatments, it appears necessary to remain cautious about clinical and pharmacological contra-indications. Prevention of abuse of medicines is based on a better use of crises agendas and introduction of prophylactic therapies.

[Not Available]. / Prescription des triptans en médecine de ville dans la région Midi-Pyrénées : indications, contre indications, abus médicamenteux.

OBJECTIVE: Evaluate triptan prescriptions in ambulatory medicine. METHODS: Collection of medical data from 301 patients treated with triptans reimbursed by the French National Health Fund in the region of Midi-Pyrenees. RESULTS: Ninety-five per cent of selected patients suffered from migraine condition according to the International Headache Society diagnosis criteria [Confidence interval (CI) 95%: 93-98]. Co-morbidity factors contra-indicating triptan therapy were present in 6% of patients (CI 95%: 3-9). 2% of patients were prescribed other medicinal products contra-indicated with their triptan therapy (CI 95%: 0-4). Twenty-six per cent of patients were taking triptan medicines more than 8 times per month over a period of three months (CI 95%: 21-31) and 8% were taking this treatment more than 12 times per month (CI 95%: 5-11). Eleven per cent kept written information of their migraine crises (CI 95%: 7-15). Thirty-nine per cent benefited from dedicated prophylactic treatments (CI 95%: 33-45). CONCLUSION: In a context of sustained increase in prescriptions of migraine treatments, it appears necessary to remain cautious about clinical and pharmacological contra-indications. Prevention of abuse of medicines is based on a better use of crises agendas and introduction of prophylactic therapies.

[Outpatient use of heparin: data from the Midi-Pyrenes Health Fund]. / Utilisation des héparines en médecine de ville: données de l'Assurance Maladie de Midi-Pyrénées.

The risk of haemorrhagic complications associated with heparin therapy can be reduced by good clinical practice. The aim of this study was to describe outpatient heparin therapy by using the database of the National Health Fund. The study population consisted of affiliates of the salaried employees insured by the health fund branch of the Midi-Pyrénées region, and corresponded to 62% of the residents of that region. Analysis of treatments and biological monitoring was carried out on a 1-year period. During this period, 16,462 patients started a treatment with heparin, 92% for a single treatment. The mean age of the patients was 55 years (SD = 19.8) and the majority were women (53%). Nine percent of these patients were switched to oral anticoagulant therapy. Of the other patients, 52% received heparin for less than 10 days, 36% for between 10 days and 5 weeks, and 12% for more than 5 weeks; 33% of the last group where heparin was prescribed for more than 5 weeks corresponds to a prescription of more than 3 months. Seventy-three percent of the heparin treatment durations complied with the authorities' (l'Agence française de sécurité sanitaire des produits de santé [AFSSAPS]) recommendations. Biological monitoring comprised a platelet count, an APTT (activated partial thromboplastin time) or an anti-Xa check in 41.9%, 27.8% and 3.1% of treated patients, respectively. Creatininaemia was measured in 27% of patients aged > 75 years (a group at increased risk of adverse drug reactions). Even considering some of the differences noted between the medical prescriptions and the reimbursement data of the health fund, results from this study allowed an evaluation of medical practices and suggests that monitoring of patients receiving heparin treatments remains insufficient, thus decreasing the benefit/risk ratio of such therapies.