Evaluating the clinical and economic burden of healthcare-associated infections during hospitalization for surgery in France.

Over 4 million patients suffer nosocomial infections annually in the European Union. This study aimed to estimate the healthcare burden associated with healthcare-associated infections (HAIs) following surgery in France, and explore the potential impact of infection control strategies and interventions on the clinical and economic burden of disease. Data on the frequency of HAIs were gathered from the 2010 Programme de Médicalisation des Systèmes d'Information (PMSI), and cost data were taken from the 2009 Echelle Nationale de Coûts à Méthodologie Commune (ENCC). It was estimated that 3% of surgical procedures performed in 2010 in France resulted in infection, resulting in an annual cost of €57 892 715. Patients experiencing a HAI had a significantly increased mortality risk (4.15-fold) and an increased length of hospital stay (threefold). Scenario analysis in which HAI incidence following surgery was reduced by 8% (based on a study of the effectiveness of triclosan-coated sutures), suggested that, annually, 20 205 hospital days and €4 588 519 could be saved. Analyses of 20% and 30% reductions in incidence (based on an estimate of the number of preventable nosocomial infections) suggested that annual savings of €11 548 057 and €17 334 696, respectively, could be made. New infection control interventions which reduce HAI incidence during hospitalization for surgery have the potential to provide valuable cost savings to healthcare providers.

[Medicoeconomic evaluation of the treatment of morbid obesity by Swedish adjustable gastric banding (SAGB)]. / Evaluation médicoéconomique du traitement de l'obésité morbide par anneau gastrique ajustable suédois (SAGB).

INTRODUCTION: Aim of the present study was to analyze the medicoeconomic impact of each treatment for obesity in France, taking into account morbid obesity-associated comorbidities from a health insurance perspective and to calculate the cost-effectiveness ratio of SAGB compared to the non-surgical treatment for various kinds of patients, as well as the budget impact on a given cohort of patients. METHODS: The model studied surgery-eligible patients and compared the effectiveness of the SAGB treatment to the conventional treatment. The follow-up extended from 1 to 5 years. Costs analyzed were treatment-related direct medical costs, as well as potential comorbidities costs. The effectiveness is determined according to the BMI loss and its maintenance over time, together with the level of improved quality of life. RESULTS: An evaluation on a series of 1,000 patients shows that the treatment with SAGB is dominant (less expensive, more effective in terms of loss of BMI and its duration) compared to the conventional treatment for patients suffering from type II diabetes or obstructive sleep apnea. The same evaluation in terms of QALYs shows that the treatment with SAGB is dominant compared to the conventional treatment for patients with a BMI >or= 35 kg/m(2) and a type II diabetes, as well as for patients whose BMI >or= 40 kg/m(2) (with or without type II diabetes mellitus).