K. Atsou

Unité Inserm U1077, Caen, Lower Normandy, France

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Publications (10)21.62 Total impact

  • K. Atsou, G. Hejblum, C. Chouaid
    Value in Health 11/2011; 14(7). · 2.19 Impact Factor
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    ABSTRACT: The medico-economic impact of smoking cessation considering a smoking patient with chronic obstructive pulmonary disease (COPD) is poorly documented. Here, considering a COPD smoking patient, the specific burden of continuous smoking was estimated, as well as the effectiveness and the cost-effectiveness of smoking cessation. A multi-state Markov model adopting society's perspective was developed. Simulated cohorts of English COPD patients who are active smokers (all severity stages combined or patients with the same initial severity stage) were compared to identical cohorts of patients who quit smoking at cohort initialization. Life expectancy, quality adjusted life-years (QALY), disease-related costs, and incremental cost-effectiveness ratio (ICER: £/QALY) were estimated, considering smoking cessation programs with various possible scenarios of success rates and costs. Sensitivity analyses included the variation of model key parameters. At the horizon of a smoking COPD patient's remaining lifetime, smoking cessation at cohort intitialization, relapses being allowed as observed in practice, would result in gains (mean) of 1.27 life-years and 0.68 QALY, and induce savings of -1824 £/patient in the disease-related costs. The corresponding ICER was -2686 £/QALY. Smoking cessation resulted in 0.72, 0.69, 0.64 and 0.42 QALY respectively gained per mild, moderate, severe, and very severe COPD patient, but was nevertheless cost-effective for mild to severe COPD patients in most scenarios, even when hypothesizing expensive smoking cessation intervention programmes associated with low success rates. Considering a ten-year time horizon, the burden of continuous smoking in English COPD patients was estimated to cost a total of 1657 M£ while 452516 QALY would be simultaneously lost. The study results are a useful support for the setting of smoking cessation programmes specifically targeted to COPD patients.
    PLoS ONE 01/2011; 6(9):e24870. · 3.53 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is predicted to become a major cause of death worldwide. Studies on the variability in the estimates of key epidemiological parameters of COPD may contribute to better assessment of the burden of this disease and to helpful guidance for future research and public policies. In the present study, we examined differences in the main epidemiological characteristics of COPD derived from studies across countries of the European Union, focusing on prevalence, severity, frequency of exacerbations and mortality, as well as on differences between the studies' methods. This systematic review was based on a search for the relevant literature in the Science Citation Index database via the Web of Science and on COPD mortality rates issued from national statistics. Analysis was finally based on 65 articles and Eurostat COPD mortality data for 21 European countries. Epidemiological characteristics of COPD varied widely from country to country. For example, prevalence estimates ranged between 2.1% and 26.1%, depending on the country, the age group and the methods used. Likewise, COPD mortality rates ranged from 7.2 to 36.1 per 10(5) inhabitants. The methods used to estimate these epidemiological parameters were highly variable in terms of the definition of COPD, severity scales, methods of investigation and target populations. Nevertheless, to a large extent, several recent international guidelines or research initiatives, such as GOLD, BOLD or PLATINO, have boosted a substantial standardization of methodology in data collection and have resulted in the availability of more comparable epidemiological estimates across countries. On the basis of such standardization, severity estimates as well as prevalence estimates present much less variation across countries. The contribution of these recent guidelines and initiatives is outlined, as are the problems remaining in arriving at more accurate COPD epidemiological estimates across European countries. The accuracy of COPD epidemiological parameters is important for guiding decision making with regard to preventive measures, interventions and patient management in various health care systems. Therefore, the recent initiatives for standardizing data collection should be enhanced to result in COPD epidemiological estimates of improved quality. Moreover, establishing international guidelines for reporting research on COPD may also constitute a major contribution.
    BMC Medicine 01/2011; 9:7. · 7.28 Impact Factor
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    ABSTRACT: The purpose of this article is to review the economics of lung cancer treatments. After a brief overview of the economic burden of lung cancer, we review the cost-effectiveness of diagnostics patterns and treatments for the different stages of lung cancer. In patients with localized disease, adjuvant chemotherapy appears to have high costeffectiveness, even if there are few published data. In regional disease, combined modalities (chemotherapy, surgery and/or radiotherapy) are probably cost-effective but we lack high-quality economic analyses. In advanced NSCLC, third-generation chemotherapies used in the first-line setting can be administered with acceptable, incremental cost-effectiveness. In the second-line setting, new agents (docetaxel, pemetrexed and erlotinib) have reasonable cost-effectiveness. The lack of cost-utility analyses for elderly patients and patients with a poor prognosis rules out firm conclusions. This review suggests that most therapies for NSCLC are cost-effective when the patient has good performance status.
    Revue des Maladies Respiratoires Actualites 10/2009;
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    ABSTRACT: To explain the help of economic analyses in the understanding of lung cancer (LC) management with a description of the quality of selected papers. In the first part, quality criteria of economic analyses are depicted with the key words for the literature selection. The global costs of LC through literature review are depicted; then, in a second part, the costs of each stage of the disease. Finally, costs of chemotherapeutic drugs and target molecules are also discussed. Economic analyses are unavoidable to assess the burden of the disease but also the cost of each management strategy for LC.
    Revue des Maladies Respiratoires 11/2008; 25(8 Pt 2):3S127-37. · 0.50 Impact Factor
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    ABSTRACT: The literature on preoperative smoking cessation indicates that smoking patients are more likely to have postoperative complications. However, the economic implications of such complications are unclear. In particular, the balance between the cost of a preoperative intervention for smoking cessation (PISC) and the benefit resulting from the potential decrease in hospitalization costs is not known. Only one previous study, a randomized trial involving smokers scheduled for hip or knee replacement surgery, provides sufficient data to simulate the hospital course of patients subjected or not subjected to a PISC. We used a multistate Markov-type model and official French hospital costs for 2008 to simulate this situation. The cost-benefit analysis adopted the payer's perspective. The mean benefit, corresponding to the decrease in the cost of the hospital stay for a reference case patient having followed a PISC, was estimated at 313 euros, with a corresponding mean cost of the PISC estimated at 196 euros. Therefore, the PISC was associated with a cost saving of 117 euros per patient. The results were most sensitive to the cost of ICU care as a proxy for cost of smoking-related complications, and to the relative risk of complication between patients with and without a PISC. Under the conditions simulated by this cost-benefit model, potential modest cost savings may accrue with implementation of an institution-based smoking cessation program through reduced total hospitalization costs that exceed the cost of the intervention.
    Chest 09/2008; 135(2):477-83. · 7.13 Impact Factor
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    ABSTRACT: Asthma is a chronic disease with a heavy economic burden in terms of public health on account of its clinical impact and consequences on quality of life and costs. Its management is based on pharmacological measures with inhaled corticosteroids playing a large role. The objective of this study was to undertake an analysis of the published literature of medico-economic trials of the use of inhaled corticosteroids. A review of the literature from 1990 to 2007 was undertaken with separate analyses of studies of inhaled steroids alone and those looking at combined preparations. The costs of asthma vary greatly depending on the clinical management. Analysis of the published clinical trials showed that the addition of inhaled steroids increased the total cost. When efficacy is taken into account the economic results are acceptable for developed societies. The use of inhaled steroids as maintenance therapy, or maintenance and symptomatic therapy, was always cost effective. These results are based on data from clinical trials. They need to be confirmed by large scale observational studies using validated criteria of effectiveness.
    Revue des Maladies Respiratoires 05/2008; 25(4):375-89. · 0.50 Impact Factor
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    ABSTRACT: Background Asthma is a chronic disease with a heavy economic burden in terms of public health on account of its clinical impact and consequences on quality of life and costs. Its management is based on pharmacological measures with inhaled corticosteroids playing a large role. The objective of this study was to undertake an analysis of the published literature of medico-economic trials of the use of inhaled corticosteroids. Methods A review of the literature from 1990 to 2007 was undertaken with separate analyses of studies of inhaled steroids alone and those looking at combined preparations. Results The costs of asthma vary greatly depending on the clinical management. Analysis of the published clinical trials showed that the addition of inhaled steroids increased the total cost. When efficacy is taken into account the economic results are acceptable for developed societies. The use of inhaled steroids as maintenance therapy, or maintenance and symptomatic therapy, was always cost effective. Conclusion These results are based on data from clinical trials. They need to be confirmed by large scale observational studies using validated criteria of effectiveness.
    Revue des Maladies Respiratoires 04/2008; 25(4):507-507. · 0.50 Impact Factor
  • Revue Des Maladies Respiratoires - REV MAL RESPIR. 01/2007; 24:19-19.
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    ABSTRACT: A. Vergnenègre, K. Atsou, L. Molinier, C. Chouaïd Objective To explain the help of economic analyses in the understanding of lung cancer (LC) management with a description of the quality of selected papers. Methods In the first part, quality criteria of economic analyses are depicted with the key words for the literature selection. Results The global costs of LC through literature review are depicted ; then, in a second part, the costs of each stage of the disease. Finally, costs of chemotherapeutic drugs and target molecules are also discussed. Conclusion Economic analyses are unavoidable to assess the burden of the disease but also the cost of each management strategy for LC.
    Revue des Maladies Respiratoires. 25(8):3S127–3S137.