Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis.

Introduction: Chemotherapy (CT) is commonly used as an adjuvant treatment for women with early breast cancer (BC). However, not all patients benefit from CT, while all are exposed to its short- and long-term toxicity. The Oncotype DX® test assesses cancer-related gene expression to estimate the risk of BC recurrence and predict the benefit of chemotherapy. The aim of this study was to estimate, from the French National Health Insurance (NHI) perspective, the cost-effectiveness of the Oncotype DX® test compared to standard of care (SoC; involving clinicopathological risk assessment only) among women with early, hormone receptor-positive, human epidermal growth factor receptor 2-negative BC considered at high clinicopathological risk of recurrence. Methods: Clinical outcomes and costs were estimated over a lifetime horizon based on a two-component model that comprised a short-term decision tree representing the adjuvant treatment choice guided by the therapeutic decision support strategy (Oncotype DX® test or SoC) and a Markov model to capture long-term outcomes. Results: In the base case, the Oncotype DX® test reduced CT use by 55.2% and resulted in 0.337 incremental quality-adjusted life-years gained and cost savings of €3,412 per patient, compared with SoC. Being more effective and less costly than SoC, Oncotype DX® testing was the dominant strategy. Discussion: Widespread implementation of Oncotype DX® testing would improve patient care, provide equitable access to more personalized medicine, and bring cost savings to the health system.

Evaluation of full costs of care for patients with Alzheimer's disease in France: the predominant role of informal care.

OBJECTIVE: It is crucial that the cost of Alzheimer's disease be evaluated, from a societal perspective, since the number of patients is expected to increase dramatically in the coming decades. This assessment of the full cost of care for community-dwelling patients with Alzheimer's disease in France also addresses the factors associated with informal care, its predominant component. DATA AND METHODS: From 2009 to 2010, 57 patient/informal caregiver pairs were interviewed using the Resource Utilization in Dementia questionnaire, adapted to provide a micro-costing approach of the overall care process. Both the opportunity cost method and the proxy good method were used to value informal care. Ordinary least square regression was performed to determine factors associated with informal care. RESULTS: Average total monthly costs were €2450 with the proxy good method and €3102 with the opportunity cost method. Living with the patient, severity of dementia and hours spent on formal care were significantly associated with informal care time. POLICY IMPLICATIONS: Since French allowance cannot cover all formal and informal non-medical costs, the choice for policy makers is either to spend more on formal care or to develop family care by investing in supportive programmes for informal caregivers.

Economic analysis of the intangible impacts of informal care for people with Alzheimer's disease and other mental disorders.

OBJECTIVES: Valuation of the intangible impacts of informal care remains a great challenge for economic evaluation, especially in the framework of care recipients with cognitive impairment. Our main objective was to explore the influence of intangible impacts of caring on both informal caregivers' ability to estimate their willingness to pay (WTP) to be replaced and their WTP value. METHODS: We mapped characteristics that influence ability or inability to estimate WTP by using a multiple correspondence analysis. We ran a bivariate probit model with sample selection to further analyze the caregivers' WTP value conditional on their ability to estimate their WTP. RESULTS: A distinction exists between the opportunity costs of the caring dimension and those of the intangible costs and benefits of caring. Informal caregivers' ability to estimate WTP is negatively influenced by both intangible benefits from caring (P < 0.001) and negative intangible impacts of caring (P < 0.05). Caregivers' WTP value is negatively associated with positive intangible impacts of informal care (P < 0.01). CONCLUSIONS: Informal caregivers' WTP and their ability to estimate WTP are both influenced by intangible burden and benefit of caring. These results call into question the relevance of a hypothetical generalized financial compensation system as the optimal way to motivate caregivers to continue providing care.

Might the decrease in the suicide rates in France be due to regional prevention programmes?

Suicide mortality rates decreased in France from 1996 to 1999, and a difference was observed between the 11 regions which have implemented suicide prevention programmes (Programmes régionaux de santé (PRS)) and the 11 others which have not launched PRS of this kind. The former regions showed a sharper decrease in their suicide mortality rates than the latter. In the present study, the explanatory factors underlying these differential regional trends were examined using an ecological model. Principal component analysis (PCA) and multiple regression procedures provided consistent findings in terms of the main factors associated with the male and female mortality rates, which were found to be unemployment problems and economic inequalities, respectively. However, these factors do not explain the differential regional trends. The suicide mortality rates were negatively correlated with regional lithium prescription rates in the case of males, whereas alcohol withdrawal drug prescription rates were positively correlated in the case of females. It is still difficult to conclude whether the PRS definitely had positive effects. However, no single variable alone can account for all the trends in the suicide rates.