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Cyrille Colin

Publications and source records attributed to Cyrille Colin.

At least 19 recordsLinked to original sources
PubMed2006

French claims data as a source of information to describe cancer incidence: predictive values of two identification methods of incident prostate cancers.

Claims data from the "Programme de Médicalisation du Système d'Information" (PMSI) have been commonly used for several years to complement cancer registries and describe cancer incidence in France. It is less clear whether or not it is possible to use these data as an independent source of information to assess cancer incidence, in the absence of a regional cancer registry. Following a similar study on breast cancer, we present a study which aimed to evaluate two methods of identifying incident prostate cancer using claims data. These methods were developed using claims data from the Hospices Civils de Lyon (HCL) and their validity was tested against medical records. The first method (M1) identified incident patients as those who had at least one stay with a principal diagnosis of prostate cancer. The second method (M2) had a prostate cancer treatment code in addition to the criteria for the first method. Both methods of identification had similar results, indicating a low rate of false negatives (negative predictive values: M1 = 100 [CI95: 93.8-100], M2 = 98.6 [CI95: 90.1-99.6]) and a high rate of false positives (positive predictive values: M1 = 33.3 [CI95: 23.2-42.1], M2 = 33.7 [CI95: 24.2-43.2]). The sample size did not allow us to produce consistent estimates of sensitivity and specificity. Our results showed that an estimation of the number of incident cases of prostate cancer using both methods of identification would be biased because of the high rate of false positives. Statistical methods that correct identification errors should be used.

France↗
PubMed2006

Cost of home and hospital care for patients with cystic fibrosis followed up in two reference medical centers in France.

OBJECTIVES: In France, new guidelines for clinical practices concerning cystic fibrosis came out in 2002, underscoring the need for early and intensive management of this disease. Because no recent health economic studies on cystic fibrosis in France were available, we conducted a cost-analysis study before the new guidelines were put into practice, with a view to a later study on the medical and economic impact of these guidelines. METHODS: A cost-analysis study was performed of the inpatient and outpatient costs of patients with cystic fibrosis for the 2000-2001 period. The various direct costs were estimated on a sample of sixty-five adult and pediatric patients managed for cystic fibrosis in two reference medical centers. Data were obtained from medical records, and questionnaires were filled out by the patients. Analysis was made from the perspective of the French healthcare system. RESULTS: We studied sixty-five patients, 54 percent male patients and 72 percent children under 18 years of age. The total cost of cystic fibrosis care totaled 16,189 euros per year and per patient. Outpatient costs accounted for 88 percent of the total cost versus 12 percent for inpatient costs; medication costs were the highest with 21 percent of the total cost for home intravenous antibiotic treatments and 49 percent of the total cost for chronic medications. CONCLUSIONS: The results show that outpatient costs were higher than inpatient costs, which could be related to the importance granted to home health care in France, notably for intravenous antibiotic treatments given for pulmonary complications.

Adolescent↗
PubMed2006

[Exchanges of medical information during the follow up of breast cancer patients: perceptions and expectations of the community- and the hospital based practitioners].

The multidisciplinary dimension which imposes the follow up of patients suffering from breast cancer raises difficulties of communication between community and hospital practitioners. The aim of this study was to assess information needs and expectations when the general practitioners and private gynecologists on one hand, and the hospital practitioners on the other hand, exchange medical information in the follow up of patients suffering from breast cancer. This descriptive study included a sample of 225 general practitioners and 216 gynecologists in private practice, and 233 hospital practitioners in the Rhone-Alps French region. Response rate was respectively 68 % (153), 64 % (139) and 42 % (99). This study showed different perceptions on the frequency of shared documents (reports, letters) or phone calls according to the speciality. In spite of a strongly felt partnership, an expectation of change was found with notably the wish of a stronger implication in the follow up and the wish to receive numerous information concerning the patients. The community practitioners expected to be more aware of the stage of the cancer, the prognosis and the level of information given to the patients. The hospital specialists expected to be informed about psychological problems or comorbidity. Pending the generalization of an electronic shared medical records, the experiment of a patient-held records may help to fulfil these expectations.

Breast Neoplasms↗
PubMed2005

[Physicians' opinions about the implementation of clinical practice guidelines for gastrointestinal oncology].

OBJECTIVE: To assess the physicians' use of clinical practice guidelines (CPG) for gastrointestinal oncology. METHOD: Quantitative study with semistructured individual interviews of 17 physicians treating patients with gastrointestinal cancer in the Rhone district of France. RESULTS: The interviews identified 7 major themes: issues associated with development of the CPG; their usefulness in the physician-patient relationship; their ease of application; relevance of the specific topic; the procedures used for their development; the methods for disseminating them; and monitoring of their impact. CONCLUSION: The physicians were relatively favorable to the CPG but stressed the need for greater transparency about related issues and effects, economic and legal, in particular, for dissemination through multiple and novel communication tools, and for assessment of their impact.

Adult↗
PubMed2005

Logistics and transplant coordination activity in the GRAGIL Swiss-French multicenter network of islet transplantation.

BACKGROUND: Since the Edmonton trial in 2000, increasing numbers of transplant centers have been implementing islet transplantation programs. Some institutions have elected to associate in multicenter networks, such as the Swiss-French GRAGIL (Groupe Rhin-Rhône-Alpes-Genève pour la Transplantation d'Ilots de Langerhans) consortium. METHODS: All pancreata offers to the University of Geneva Cell Isolation and Transplantation Center from within the network in 2002 and 2003 were reviewed. Islet preparations were attributed to the most suitable recipient on a centrally managed waiting list. All shipments were performed by ambulance in less than 5 hr. RESULTS: Over the period of study, 260 pancreata were offered, from a total of 1,304 cadaveric donors in the four allocation regions (20%). Fifty-two patients were on the waiting list at any time during this 2-year period. The percentage of organs offered varied in the range of 0.5% to 42%, depending on region of origin, with a correlation with number of patients on the waiting list in each region. Of these, 104 (40%) were accepted for processing. Ninety-two pancreata were actually processed, resulting in 42 islet preparations being transplanted. The number of international equivalents of transplanted preparations was 378,500+/-16,000 versus 165,400+/-15,400 (P<0.0001) for nontransplanted preparations. Total cold ischemia time was 6+/-0.3 hr for transplanted preparations versus 6.7+/-0.4 hr for nontransplanted preparations (not significant). CONCLUSIONS.: A high rate of pancreas offers, successful isolation, and islet transplantation can be achieved in multicenter networks such as GRAGIL. Such an approach can expand both the donor pool and the recipient population.

Adult↗
PubMed2005

Diagnostic management of pulmonary embolism using clinical assessment, plasma D-dimer assay, complete lower limb venous ultrasound and helical computed tomography of pulmonary arteries. A multicentre clinical outcome study.

The objective of the study was to assess the clinical validity of a non-invasive diagnostic strategy for acute pulmonary embolism using clinical assessment combined with both ELISA D-dimer and complete lower limb ultrasound (US) examination of proximal and distal veins, before single-detector helical computed tomography (CT) of pulmonary arteries. We expected the strategy to have a high diagnostic exclusion power and to safely decrease the number of CT scans. This prospective, multicenter outcome study included 274 consecutive outpatients. All underwent a priori clinical probability, D-dimer and bilateral complete lower limb US assessments. Only patients with a high clinical probability and both tests negative, or positive D-dimer and negative US assessments, underwent CT. This was deemed necessary in 114 patients (42%). At baseline, venous thromboembolism (VTE) was detected in 110 patients (40%), either by US showing proximal (n=65) or distal (n=36) thrombosis, or by CT (n=9). Anticoagulant was withheld in the remaining patients with negative results in both D-dimer and US but a non-high clinical probability (n=59), or in both US and CT (n=90), or with negative US (n=6) and inadequate CT (n=9). All patients underwent a three-month clinical follow-up. VTE occurred in one patient with inadequate CT, yielding an incidence of 0.6% [95% confidence interval: 0.1-3.4]. No patient died from VTE or had major bleeding. Using clinical probability, ELISA D-dimer and complete US before helical CT is a safe strategy resulting in a substantial reduction in CT scans.

Adolescent↗
PubMed2005

Cost-benefit analysis of vaccination against tick-borne encephalitis among French troops.

BACKGROUND: French troops are exposed to tick-borne encephalitis (TBE) during their tours of duty in the Balkans. This disease, potentially serious because of its lethality and morbidity, has an effective vaccination. The epidemiological characteristics of TBE in the Balkans are not well known. OBJECTIVE: In order to provide the French Department of Defence with arguments on the utility of vaccinating troops on missions in this area of Europe, we conducted a cost-benefit study. DESIGN AND SETTING: Through a decision analysis, we estimated the net benefit of a three-injection vaccination programme for all French military personnel in the Balkans versus no vaccination during a period from 2004 to 2014. We used a review of the literature to estimate the parameters necessary for the present study: the disease's morbidity and death incidence rate; the disease's sequelae; and the adverse effects of the vaccination. The initial hypothesis of the seroconversion rate of TBE in the Balkans was 834 per 100,000 person-years. Human life was valued in Euro (year 2004 values) by calculating the amounts paid by the French Department of Defence to military personnel in case of disabling sequelae and to their heirs in case of death. MAIN RESULTS: The net benefit was negative: -5.68 million Euro. The vaccination programme's cost was 10.05 million Euro. 121 cases of TBE could be prevented by this vaccination; however, the sensitivity analysis showed that the results are closely related to the incidence of the disease. CONCLUSION: Very high incidence rates of TBE were initially hypothesised compared with what has actually been reported. As a result, the vaccination programme against TBE for French military personnel should not be implemented unless the objective of the armed forces is to prevent all cases of TBE and they are willing to assume the cost of doing so.

Cost-Benefit Analysis↗
PubMed2005

[Analysis of the medical activity related to cancer in a network of multidisciplinary hospitals using claims databases, the reseau Concorde Oncology Network].

Recently, to answer patients, caregivers and professionals needs, the "Plan Cancer" has been presented by the French Government. This plan is intended to improve quality of care in cancer patients and finally, patients' survival and quality of life. This planned strategy stresses the importance of organized interactions between hospitals and between the various health professionals. Measuring the number of patients with cancer and the activity related to cancer in large networks of multidisciplinary hospitals has became a real challenge in France for organizational, quality of care and economic reasons. Many University Hospitals in France have chosen to face this question by using the French DRG based information system called PMSI. It allows estimating the proportion of hospital stays concerned by cancers that are identified with algorithms based on ICD 10. However, French databases of hospital discharges do not allow patients identification. We collected data on hospital stays and patients in a subset of an organized network focused on cancer care and composed of 55 public or private hospitals in the Rhone-Alpes area. We used these data to estimate the number of patients who had been hospitalized within the network in 2000. Approximately 110,000 hospital stays were related with a diagnostic of cancer, corresponding to a number of patients within a range of 30345 to 35700. In absence of communicating files between hospitals, claims databases are an interesting source of information for cancer burden. The recent implementation of a procedure allowing the linkage of data concerning each patient should permit better estimates in the future. The main limitation will remain the possibility of a hospital to participate to more than one network.

Adolescent↗
PubMed2004

Influence of islet transportation on pancreatic islet allotransplantation in type 1 diabetic patients within the Swiss-French GRAGIL network.

BACKGROUND: The influence of islet transportation on pancreatic islet allotransplantation in type 1 diabetic patients was evaluated within the GRAGIL network. PATIENTS AND METHODS: From December 2001 to April 2003, 16 human pancreatic islet transplants were performed in 9 type 1 diabetic patients with an established kidney graft (functioning for at least 6 months) in four centers of the GRAGIL network. Islet isolation was performed in a core laboratory in Geneva, and the islet preparations were shipped by ambulance to each center for transplantation. One month after transplantation, the efficiency of the graft was assessed according to islet transportation time (ITT): ITT less than 2 hours (group 1, n=5), and ITT greater than 4.5 hours (group 2, n=4, mediant 5 hours). RESULTS: Primary graft dysfunction was observed in one patient in group 1 after one month. Two patients became insulin independent in groups 1 and 2. All other patients in both groups had a plasma C-peptide level greater than 0.5 ng/ml. The HbA1c level and the exogenous insulin needs decreased in both groups. CONCLUSIONS: ITT does not seem to influence the efficiency of pancreatic islet allotransplantation in type 1 diabetic patients. These results emphasize the scope for multicenter networks such as the GRAGIL group.

Adult↗
PubMed2004

Management for severe Crohn's disease: a lifetime cost-utility analysis.

OBJECTIVES: Infliximab is a costly therapy for active Crohn's disease resistant to corticosteroids and immunosuppressive medication. The purpose of this study was to examine whether a treatment including infliximab (episodic re-infusions for relapse or maintenance therapy every 8 weeks) was relevant compared with conventional management (surgery and medical treatment without infliximab) for nonfistulizing resistant Crohn's disease. METHODS: We performed a life-time cost-utility analysis with an analytic Markov decision model from the perspective of the third-party payer system. Utility measurement using Standard Gamble was used to adjust the survival time for each health state of the disease. Direct costs were estimated from standard management based on expert opinion. A sensitivity analysis was conducted to gauge the effects of uncertainty in the values assigned to variables. RESULTS: The incremental effectiveness with infliximab therapy is .761 Quality-Adjusted Life Years (QALYs) for an added cost ranging from 48,478.79 euros to 596,990.35 euros, depending on treatment procedure. The incremental cost utility ratio expressed in euros per QALYs saved varied from 63,700.82 euros (episodic re-infusions) to over 762,245.09 euros (maintenance therapy). CONCLUSIONS: Infliximab therapy could be cost-effective in the case of relapse treatment only, whereas the marginal cost-utility ratio exceeds conventional benchmarks for maintenance therapy. This analysis will be supplemented by conducting further randomized controlled trials and prospective observational study, focused on the costs of illness (direct and indirect), patient preferences, the disease's clinical course, and infliximab safety.

Adult↗
PubMed2004

Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism.

A limited ultrasound (US) confined to the popliteal and femoral veins is usually performed to detect deep vein thrombosis (DVT) in patients with clinically suspected acute pulmonary embolism (PE). Our objective was to assess the diagnostic accuracy of complete lower limb US examining both the proximal and distal veins in this setting. In this prospective study, 210 consecutive patients were included. Complete US was performed by independent operators and compared blindly with a reference strategy combining clinical probability, ventilation perfusion scan and pulmonary angiography to a three-month clinical follow-up. Simultaneously, VIDAS D-dimer (DD) assay and helical computed tomography (HCT) of the lungs were assessed independently and blindly. PE was present in 74 patients (35%). Complete US detected DVT in 91 patients (43%), proximal in 51 and distal in 40. Sensitivity and specificity with a 0.95 confidence interval were respectively 0.93 [0.85 - 0.97] and 0.84 [0.77 - 0.89]. Limited US detected DVT in only 46 patients (22%). Sensitivity and specificity were respectively 0.55 [0.44 - 0.66] and 0.96 [0.92 - 0.98]. For DD they were 0.92 [0.83 - 0.96] and 0.24 [0.17 - 0.32] and for HCT 0.84 [0.73 - 0.90] and 0.87 [0.80 - 0.92]. Complete lower limb US has higher sensitivity and capacity to exclude PE than limited US, but a slightly lower specificity. Complete US results also compared favourably with those of HCT and DD. The utility of including this method in diagnostic strategies for PE needs to be assessed in cost-effectiveness analysis and in outcome studies.

Angiography↗
PubMed2004

Molecular evidence of interhuman transmission of Pneumocystis pneumonia among renal transplant recipients hospitalized with HIV-infected patients.

Ten Pneumocystis jirovecii pneumonia (PCP) cases were diagnosed in renal transplant recipients (RTRs) during a 3-year period. Nosocomial transmission from HIV-positive patients with PCP was suspected because these patients shared the same hospital building, were not isolated, and were receiving suboptimal anti-PCP prophylaxis or none. P. jirovecii organisms were typed with the multitarget polymerase chain reaction-single-strand conformation polymorphism method. Among the 45 patients with PCP hospitalized during the 3-year period, 8 RTRs and 6 HIV-infected patients may have encountered at least 1 patient with active PCP within the 3 months before the diagnosis of their own PCP episode. In six instances (five RTRs, one HIV-infected patient), the patients harbored the same P. jirovecii molecular type as that found in the encountered PCP patients. The data suggest that part of the PCP cases observed in this building, particularly those observed in RTRs, were related to nosocomial interhuman transmission.

Adult↗
PubMed2003

Economic impact of pharmacists' interventions with nonsteroidal antiinflammatory drugs.

OBJECTIVE: To estimate the economic impact of community pharmacists' interventions following the detection of problems related to nonsteroidal antiinflammatory drugs (NSAIDs), whether in a prescription or self-medication format. The evaluation focused on the gastroduodenal adverse events that could be avoided and the subsequent savings of healthcare resources spent on treating these adverse effects. METHODS: A previous study conducted during a 12-week period in 924 French community pharmacies provided the number of interventions for drug-related problems concerning NSAIDs. A simulation model was constructed to compare 2 strategies: a systematic pharmacist's intervention and the absence of intervention. The base-case patient was assumed to have been taking an NSAID for 3 months. The model's inputs were extracted from medical literature and from an institutional medical database. RESULTS: In this study, 608 interventions were the results of NSAID-related problems. All of these interventions reduced the risk of gastrointestinal adverse events and avoided a total cost of 37 300. CONCLUSIONS: This model indicates that the dispensing of NSAIDs by pharmacists and related pharmaceutical care activities have a positive impact by reducing the number of gastrointestinal complications. The model quantifies the costs thus avoided. It also underlines the necessity of effective collaboration between the prescriber and the pharmacist if optimal patient management is to be achieved.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

[Methodology of economic assessment: example in oncology].

The increasing costs of care make it important to identify those strategies of greatest value from both an effectiveness and cost perspective. Economic analysis is characterized by a simultaneous consideration of alternatives costs and outcomes, and can provide useful data for managerial decision making. In this paper, methods of economic evaluations in general and in cancer in particular is reviewed. In cancer treatment, preventive, curative or palliative strategies can be concerned. Economic evaluation have become increasingly important in oncology because of the proliferation of expensive new treatments. Furthermore, considering quality of life effects is particularly important in oncology, where many treatments obtain modest improvements in response or survival. Quality of life measurements are also reviewed.

Cost-Benefit Analysis↗
PubMed2003

[Which medico-economic approaches must be taken to evaluate the impact of costly molecules in oncology? The model of Herceptin in the breast metastatic cancer].

In an era where health care expenditure control is a necessity, weighing a new treatment's cost against its added benefits is of crucial importance. These medico-economic analyses may be planned for the evaluation of new molecules in their daily use. Different methods may be used. The medico-economic evaluation of a drug can be performed with the use of clinical studies or modelization techniques. "Clinical studies" include the following methods: randomized trials, so-called "experimental", non-randomized studies, and observational studies. This classification follows a downward evolution of both the investigator's intervention power and the level of proof. Finally, modelization is becoming a commonly used tool. Randomized trials are the "gold standard" but the other, more pragmatic study types, providing a lesser degree of proof can complete the evaluation of a new molecule. One must find the best compromise between the study's objectives and the study type.

Antibodies, Monoclonal↗
PubMed2002

Cost-effectiveness analysis of gestational diabetes mellitus screening in France.

OBJECTIVE: To compare three strategies for gestational diabetes screening (i) screening of high-risk pregnant women with the 50 g oral glucose tolerance test (OGTT); (ii) screening of all pregnant women with the 50 g OGTT; (iii) screening of all pregnant women according to the 75 g OGTT. STUDY DESIGN: Cost-effectiveness analysis. The outcome measures, i.e. macrosomia, prematurity, perinatal mortality, hypertensive disorders rates were estimated from published studies and the costs from a prospective study involving 120 pregnant women. RESULTS: Compared to the first strategy, the cost to obtain one unit of additional effectiveness with the second screening strategy, was up to 1.1 times more expensive, and with the third strategy was up to 3.7 times more expensive. CONCLUSION: The costs per case prevented reflect a favourable cost-effectiveness ratio (CER) for screening of high-risk pregnant women by 50 g oral glucose test.

Cost-Benefit Analysis↗