Association Française de Chirurgie

There are few data on healthcare resource use and related costs of French haemophilia A (HA) and B (HB) patients. This study aimed to describe the profile of HA and HB patients, current disease management, clinical burden and costs. Data related to haemophilia patients of all ages alive on 1/1/2022 were extracted from the nationwide French claims database (SNDS). Patients were divided into four treatment groups: on-demand or prophylaxis with or without inhibitors. Haemophilia patients were compared with a control group (ratio 1:3) matched for age, gender and region using risk ratios (RR [95% confidence interval]). The annual direct health care costs per person were estimated. A total of 5,577 (HA) and 1,332 (HB) patients were included (mean age: 36.4 years). Most patients were treated on-demand (HA: 72.8%; HB: 76.6%) and a few had inhibitors (HA: 3.6%; HB: 1.1%). Overall, haemophilia clinical burden was significantly higher than among controls, in particular, mortality (RR:1.42 [1.04-1.92]), work disability (RR: 2.71 [2.22-3.30]), hospitalisation for major bleeding (RR:12.06 [8.67-16.80]), orthopaedic surgery (RR: 2.97 [2.65-3.32]) and hospitalisation all causes (RR: 2.44 [2.31-2.58]). This burden was more important in patients with inhibitors or treated in prophylaxis and was close for HA and HB patients. The annual per-person costs were €282,560 and €181,566 for HA and HB in prophylaxis without inhibitors, respectively. The population with inhibitors, although limited, had even much higher costs. The clinical burden and costs of haemophilia treatments may be very high especially in patients in prophylaxis and/or with inhibitors.

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Since June 2021 in France, patients with haemophilia A with anti-factor VIII inhibitors and patients with severe haemophilia A without anti-factor VIII inhibitors, and treated with emicizumab (Hemlibra), have to choose the dispensing circuit community or hospital pharmacy. To evaluate satisfaction of patients whether they choose dispensation from a community pharmacy or retained dispensation from the hospital pharmacy, to understand the main motivation for choosing the community or the hospital pharmacy. All patients living in France, regardless of age, were eligible to participate. Between September 13, 2022, and January 9, 2023, 175 respondents answered the satisfaction survey, including 123 in community pharmacy and 52 in hospital pharmacy. Eighteen months after availability in community pharmacies, treatment accessibility is improved for the benefit of the patient. The door-to-door travel times are significantly reduced to the community pharmacy with an average gain of 16.5min saved from the place of residence. Patients are mostly satisfied with the new dispensing circuit especially concerning the overall satisfaction (p<.0001), the travel time (p<.0001) and the strong relationship with the pharmacist (p=.0022) compared to hospital pharmacy. Innovation in care pathways is showing its full potential in improving access to medication, made possible by the implementation of a rigorous organization accompanied by training to enable healthcare professionals involved in primary care to provide appropriate management.

Le projet CLIMASSOL a pour objectif de proposer et d'évaluer des scénarios d'assolement vis-à-vis de leur résilience face au changement climatique, de l'efficience de l'eau d'irrigation et de leur rentabilité économique. Sur sept secteurs de Nouvelle-Aquitaine, des scénarios d'assolement d'adaptation ont été co-construits lors d'ateliers participatifs. Sur la base de projections climatiques passées et futures, ces scénarios ont été évalués avec l'outil de comparaison d'assolements ASALEE. Sous l'effet du changement climatique, les assolements proposés ainsi que les assolements actuellement pratiqués subissent tous des baisses de rentabilité à moyen terme. L'irrigation permet de les limiter en compensant une partie des pertes de rendement dues au stress hydrique. Les résultats obtenus permettent d'apporter aux agriculteurs de premiers éléments de réponse quant à la résilience de scénarios d'assolement qu'ils imaginent face au changement climatique.