The impact of comorbidities and their stacking on short- and long-term prognosis of patients over 50 with community-acquired pneumonia.

BACKGROUND: The prognosis of patients hospitalized with community-acquired pneumonia (CAP) with regards to intensive care unit (ICU) admission, short- and long-term mortality is correlated with patient's comorbidities. For patients hospitalized for CAP, including P-CAP, we assessed the prognostic impact of comorbidities known as at-risk (AR) or high-risk (HR) of pneumococcal CAP (P-CAP), and of the number of combined comorbidities. METHODS: Data on hospitalizations for CAP among the French 50+ population were extracted from the 2014 French Information Systems Medicalization Program (PMSI), an exhaustive national hospital discharge database maintained by the French Technical Agency of Information on Hospitalization (ATIH). Their admission diagnosis, comorbidities (nature, risk type and number), other characteristics, and their subsequent hospital stays within the year following their hospitalization for CAP were analyzed. Logistic regression models were used to assess the associations between ICU transfer, short- and 1-year in-hospital mortality and all covariates. RESULTS: From 182,858 patients, 149,555 patients aged ≥ 50 years (nonagenarians 17.8%) were hospitalized for CAP in 2014, including 8270 with P-CAP. Overall, 33.8% and 90.5% had ≥ 1 HR and ≥ 1 AR comorbidity, respectively. Cardiac diseases were the most frequent AR comorbidity (all CAP: 77.4%). Transfer in ICU occurred for 5.4% of CAP patients and 19.4% for P-CAP. Short-term and 1-year in-hospital mortality rates were 10.9% and 23% of CAP patients, respectively, significantly lower for P-CAP patients: 9.2% and 19.8% (HR 0.88 [95% CI 0.84-0.93], p < .0001). Both terms of mortality increased mostly with age, and with the number of comorbidities and combination of AR and HR comorbidities, in addition of specific comorbidities. CONCLUSIONS: Not only specific comorbidities, but also the number of combined comorbidities and the combination of AR and HR comorbidities may impact the outcome of hospitalized CAP and P-CAP patients.

Adults at risk of pneumococcal disease in France.

BACKGROUND: Immunocompromised patients and those with certain underlying medical conditions are at risk of pneumococcal disease, but in France their vaccine coverage is largely unknown. We aimed to assess the number of adult patients eligible for pneumococcal vaccination in France. METHODS: We conducted an annual cross-sectional study based on retrospective data from the French National Health Data System. Over 2014-2018, we included all adults continuously affiliated to the General health insurance scheme (covering 76% of the population), at risk of pneumococcal disease. Patients were identified with published or newly developed algorithms using diagnoses and reimbursements for hospital stays, medical procedures, and specific treatments, laboratory tests, or medical devices. RESULTS: On January 1, 2018, we identified 4,045,021 at-risk patients (11% increase since 2014). Mean age was 66.1years (55.1% were aged≥65), 51% were men, and 18% had at least two conditions. Of these, 3,634,594 had a chronic medical condition (including 2,617,921 patients treated for diabetes, 616,003 for chronic respiratory disease, 424,223 for heart failure, and 285,214 for chronic liver disease) and 570,035 were immunocompromised (of these, 191,527 were treated with immunosuppressive drugs or biotherapy, 152,255 with chemotherapy for cancer, and 100,604 for HIV). CONCLUSION: These published or newly developed algorithms - which can be used to address other public health issues - identified more than 4 million adults eligible for pneumococcal vaccination in the main health insurance scheme (10% of the studied adult population). This is a first step towards ensuring patients get vaccinated as part of their chronic condition management.

French hospital discharge database (PMSI) and bacterial resistance: Is coding adapted to hospital epidemiology?

OBJECTIVE: A preliminary analysis of data consistency on different types of bacterial resistance by infection site and causative agents was conducted using the French hospital discharge database (French acronym PMSI) to assess the use of the database in a national cartography tool. MATERIAL AND METHODS: Hospital stays in medical, surgical, and obstetrical units were extracted from the 2014 PMSI database using the ICD-10 diagnosis codes. Bacterial infections, causative agents, and resistance corresponding to these stays were also identified. RESULTS: Data from 1258462 patients, corresponding to a total of 1617893 stays, was extracted. Among these stays, 46% were associated with a bacteria code and 7% with a resistance code. Lower respiratory tract infections were the most frequent infections (32% of stays; pneumonia in 95% of cases), followed by genitourinary infections (26%), intra-abdominal infections and diarrhoeas (24%), and skin and soft tissue infections (15%). Inconsistencies were observed between the types of infection and associated bacteria and between bacteria and associated resistance. These inconsistencies are likely due to initial coding errors. CONCLUSION: The cartography of bacterial infections cannot be developed using the data of the current PMSI coding. These results underline the need to improve the coding of PMSI data for its use as a complementary tool of epidemiological surveillance of bacterial infections.

Burden of breast cancer with brain metastasis: a French national hospital database analysis.

OBJECTIVE: Incidence of breast cancer with brain metastases (BCBM) is increasing, especially among patients over-expressing HER2. Epidemiology on this sub-type of cancer is scarce, since cancer registries carry no information on the HER2 status. A retrospective database analysis was conducted to estimate the burden of BCBM, especially among HER2-positive patients in a secondary objective. METHODS: Patients with a new diagnosis of BCBM carried out between January and December 2008 were identified from the national hospital database using the International Disease Classification. Patients receiving a targeted anti-HER2 therapy were identified from the national pharmacy database. Hospital and pharmacy claims were linked to estimate the burden of HER2-positive patients. Data on hospitalizations were extracted to describe treatment patterns and healthcare costs during a 1-year follow-up. Predictors of treatment cost were analyzed through multi-linear regression analysis. RESULTS: Two thousand and ninety-nine BCBM patients were identified (mean age (SD) = 57.8 (13.6)), of whom 12.2% received a targeted anti-HER2 therapy; 79% of patients had brain metastases associated with extracranial metastases, and the attrition rate reached 82%. Patients received mostly palliative care (47.4%), general medical care (40.6%), and chemotherapy (35.0%). The total annual hospital cost of treatment was 8,426,392€, representing a mean cost of 22,591€ (±14,726) per patient, mainly influenced by extracranial metastases, surgical acts, and HER2-overexpression (p < 0.0001). CONCLUSIONS: The database linkage of hospital and pharmacy claims is a relevant approach to identify sub-type of cancer. Chemotherapy was widely used as a systemic treatment for breast cancer rather than for local treatment of brain metastases whose morbi-mortality remains high. The variability of treatment costs suggests clinical heterogeneity and, thus, extensive individualization of protocols.

Economic burden of anal cancer management in France.

BACKGROUND: The incidence of anal cancer has increased over the last 25 years. No organized screening exists for the precursors of anal cancer (anal intraepithelial neoplasia and carcinoma in situ) and diagnosis is often delayed. Treatment for precursor lesions is of limited success, while cancer management is traumatic for the patient. Like cancers of the cervix, most cases of anal cancer are associated with infection with human papillomavirus (HPV). With increases in the incidence of anal cancer, and in light of the availability of prevention strategies such as screening and HPV vaccination, it is important, from a public health perspective, to assess the economic burden of anal cancer in France. METHODS: We performed a retrospective analysis based on data extracted from a French hospital database - the Programme de médicalisation des systèmes d'information (PMSI) - to assess the number and management of patients hospitalized for anal cancer in 2006. Data on radiotherapy sessions performed in private hospitals were obtained from the Statistiques annuelles des établissements de santé (SAE) database. Costs of hospitalization, from the healthcare-payer perspective, were obtained from official diagnosis-related group tariffs for public and private hospitals. Ambulatory and indirect costs were estimated using information obtained from the literature. RESULTS: In 2006, 3,711 patients with anal cancer were treated in hospitals in France. Of these, the majority were women (69%). The annual cost of hospital treatment for anal cancer was estimated at € 20,326,868. The overall estimated cost (including hospitalization, outpatient and daily allowances costs) to the healthcare payer was € 38,249,981. CONCLUSION: This study, the first to investigate the economic burden of anal cancer in France, shows that the management costs of anal cancer are high and comparable to cervical cancer management costs (€ 44 million). Further research is required to determine the cost of management of precursor lesions, which is mostly performed in an outpatient setting. Prophylactic HPV vaccination could significantly reduce the burden of this disease.