Cemka-Eval (France)

Maternal mental health problems are leading causes of morbidity and mortality in high-income countries, yet follow-up after birth remains inconsistent. Systematic postnatal home visits are recommended but many women do not receive them. clinical and economic impact of a structured scheduling of visits before discharge has not been fully evaluated. To determine whether systematically arranged postpartum home visits were associated with reduced maternal rehospitalisations for mental health conditions. Secondary objectives included maternal and infant outcomes and healthcare costs within the first year. We conducted a matched cohort study using national administrative data from 1297,646 low risk mother-infant dyads. In the intervention group, a midwife home visit was scheduled before discharge. Controls were matched on demographic and obstetric variables. The main outcome was maternal rehospitalisation for mental health conditions (ICD-10 codes F30-F45, F48, including depression or anxiety) within one year postpartum, excluding psychoses (F20-F29). Secondary outcomes included all-cause rehospitalisation for mothers and/or infants, use of emergency services, mortality, and overall healthcare costs. A scheduled home visit occurred in 95 % of cases in the intervention group, compared to 52 % in controls (p < 0.0001). The intervention was associated with fewer maternal mental health-related rehospitalisations (RR=0.82, p < 0.0001) and slightly reduced overall rehospitalisation rates for mothers and infants. Mortality was unchanged. Mean healthcare costs were marginally lower in the intervention group. Systematic discharge planning may improve continuity of care and reduce psychiatric morbidity. Postpartum home visit scheduling supports better outcomes and may offer modest economic benefits.

BackgroundThis study aims to improve the understanding of the patient journey via the perspectives of patients with migraine.MethodsThe questionnaire was created by patients. It was based on the experiences of 24 patients with migraine and 4 members of the patient advocacy organization La Voix des Migraineux. Two focus groups were held to assess the various dimensions of the patient journey. This survey was accessible on the MoiPatient online platform between March 19th and May 17th, 2022.ResultsOut of the 683 participants (average age: 41.8 years; female: 92.4%; average age at first migraine attack: 16.2 years), 95.9% had received a formal migraine diagnosis from a physician. Migraine had a significant impact on most participants (96.0% had a severe HIT-6 score and 70.7% had severe disability on the MIDAS). Unmet patients’ needs highlighted in this study included diagnosis delay (mean 7.5 years), treatment delay, limited access to neurologists and/or headache specialists, long trial-and-error process of different medications (participants had tried an average of 5.6 acute treatments and 5.0 preventive treatments), numerous (7.2 side effects per participants on average) and often inadequately addressed side effects, suboptimal patient education, and the need for a therapeutic, empathic, and supportive relationship between patients and healthcare professionals. Participants had a negative perception of the care journey and experience with healthcare professionals: 36.2% described their care journey as an uphill battle (“parcours du combatant”). More than half of patients did not feel heard nor supported by healthcare professionals.ConclusionPatients with migraine have to face a multitude of complex obstacles trying to get the care they deserve. The burden of disease is amplified by the complexity of the migraine patient’s journey, both in terms of diagnosis and treatment. This study highlights specific areas in need for improvement.

IntroductionThe study aimed to describe the population of patients living with type 1 diabetes who had access to bariatric surgery (BS) in France, analyzing the changes in healthcare resource use and associated costs in the 3 years following this surgery.MethodsAn observational longitudinal study based on the French national health insurance database was conducted on all adult patients that underwent a first BS from 2015 to 2020. Cost analyses were conducted on a sub-population who underwent BS from 2016 to 2017 for sufficient observation time using a pre-post methodology.ResultsA total of 437 patients were identified as living with type 1 diabetes among the 234,077 patients who had undergone surgery over 6 years (2015–2020). The most frequently performed interventions were sleeve gastrectomy (n = 272; 62.2%) and gastric bypass (n = 154; 35.2%), with the majority of patients being women (77.8%) and an average age of 42.3 (± 12.0) years, consistent with the general population undergoing BS in France. While no significant differences were found in the overall healthcare costs when comparing the 3 years before and after BS, there was an increase in the frequency of biological measurements. Expenditures related to antidiabetic medications and insulin decreased significantly (p < 0.0001). The number of hospitalizations for severe hypoglycemia, coma, and ketoacidosis more than doubled in the 3 years following surgery compared with the period before (p = 0.04).ConclusionsThe risks of severe hypoglycemia or ketoacidosis in patients with type 1 diabetes undergoing BS remains a real concern and emphasizes the importance of involving the diabetologist in the operative decision with joint follow-up with the nutritionist.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-025-01709-8.

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.