B Dervaux

Université du Droit et de la Santé Lille 2, Lille, Nord-Pas-de-Calais, France

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Publications (45)81.98 Total impact

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    ABSTRACT: Economic costs related to treatment of multiple sclerosis (MS) must be justified by health state, quality of life (QOL) and social participation improvement. This study aims to describe correlations between social participation, economic costs, utility and MS-specific QOL in a sample of patients with MS (pwMS).
    BMC Neurology 05/2014; 14(1):115. · 2.49 Impact Factor
  • Laurent Carnis, Nicolas Vaillant, Benoît Dervaux
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    ABSTRACT: This article analyses the heterogeneous character of compensation amounts awarded by insurance companies and the courts. The information source – the Association for Insurance Risk Information (AGIRA) database – covers all surviving victims of injuries resulting from road accidents in France over the period 2002 to 2008. Three results emerge: first, compensation amounts awarded under different headings – Partial Permanent Incapacity (PPI), solatium (emotional harm), disfigurement and loss of amenity – are not determined independently of each other; second, victim characteristics, notably age and sex, play a major part; and third, inequalities of treatment across the country are strikingly low.
    Applied Economics Letters 01/2013; 20(1):28-33. · 0.23 Impact Factor
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    ABSTRACT: INTRODUCTION: As for other vaccines that only target a subset of circulating pathogen types, human papillomavirus (HPV) immunization raises the concern of a potential risk of genotype replacement. Potential interactions between HPV types may affect infection acquisition and clearance. However, the existence and the nature of these interactions are still largely unknown. Here, we assess how such interactions might affect the impact of HPV vaccination on genotype distribution in the long term. METHODS: We develop two mathematical models of the transmission of oncogenic HPV infections that include interactions between vaccine and nonvaccine genotypes to examine the influence of different coinfection dynamics (simultaneous vs. sequential clearance of coinfections) on the evolution of nonvaccine prevalences postimmunization. RESULTS: After introducing vaccination, the two models give contrasting genotype-replacement outcomes. When hypothesizing that coinfections clear sequentially, genotype replacement depends on whether vaccine and nonvaccine genotypes reduce or favor the acquisition by one or the other. Interestingly, the hypothesis that coinfections clear simultaneously always leads to genotype replacement, even when infections with vaccine types favor the acquisition of infections with nonvaccine types. CONCLUSION: Our results suggest that predictions regarding HPV genotype replacement strongly depend on the assumptions describing the dynamics (acquisition and clearance) of coinfections. In particular, HPV genotype replacement could be compatible with synergistic interactions between types affecting infections acquisition, contrary to previous suggestions. Understanding better how concurrent infections with multiple types change the acquisition and time to clearance of type-specific infections is essential to be able to predict the impact of vaccination on genotype distributions. Longitudinal data collection in populations, particularly examining infection and coinfection acquisition and clearance, is needed to better predict HPV-vaccine impact.
    Vaccine 12/2012; · 3.49 Impact Factor
  • Revue d Épidémiologie et de Santé Publique 06/2011; 59. · 0.66 Impact Factor
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    ABSTRACT: Sacral nerve modulation (SNM) is an established treatment for urinary and fecal incontinence in patients for whom conservative management has failed. This study assessed the outcome and cost analysis of SNM compared to alternative medical and surgical treatments. Clinical outcome and cost-effectiveness analyses were performed in parallel with a prospective, multicenter cohort study that included 369 consecutive patients with urge urinary and/or fecal incontinence. The duration of follow-up was 24 months, and costs were estimated from the national health perspective. Cost-effectiveness outcomes were expressed as incremental costs per 50% of improved severity scores (incremental cost-effectiveness ratio). The SNM significantly improved the continence status (P < 0.005) and quality of life (P < 0.05) of patients with urge urinary and/or fecal incontinence compared to alternative treatments. The average cost of SNM for urge urinary incontinence was ∈8525 (95% confidence interval, ∈6686-∈10,364; P = 0.001) more for the first 2 years compared to alternative treatments. The corresponding increase in cost for subjects with fecal incontinence was ∈6581 (95% confidence interval, ∈2077-∈11,084; P = 0.006). When an improvement of more than 50% in the continence severity score was used as the unit of effectiveness, the incremental cost-effectiveness ratio for SNM was ∈94,204 and ∈185,160 at 24 months of follow-up for urinary and fecal incontinence, respectively. The SNM is a cost-effective treatment for urge urinary and/or fecal incontinence.
    Annals of surgery 04/2011; 253(4):720-32. · 7.19 Impact Factor
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    Nicolas Vaillant, Benoît Dervaux
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    ABSTRACT: Ehrlich?s seminal work led to several econometric analyses on the deterrent effect of punishment. Our paper extends this literature by using original cross-section time-series covering the 30 French appeal court areas from 1988 to 1993. Because of a restricted access to the crime data, we focus our attention on murders. Estimation results validate the hypothesis of the deterrent effect of both the risk of imprisonment and the length of prison sentences. Classification JEL : K14 ; K42.
    Revue économique 01/2011; 62(2):237-254.
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    ABSTRACT: Capitalizing on available data, we used a decision model to estimate the clinical and economic outcomes associated with early initiation of treatment with neuraminidase inhibitors in all patients with influenza-like illnesses ( ILI ) (systematic strategy) vs. only those at high risk of complications (targeted strategy). Systematic treatment of ILI during an A(H1N1)v influenza epidemic wave is both effective and cost-effective. Patients who present to care with ILI during an A(H1N1)v influenza epidemic wave should initiate treatment with neuraminidase inhibitors, regardless of risk status. Administering neuraminidase inhibitors between epidemic waves, when the probability of influenza is low, is less effective and cost-effective.
    PLoS currents. 10/2009; 1:RRN1121.
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    ABSTRACT: By using a novel adaptation of the free-disposable hull analysis of productivity, we assess the medical and technical efficiency of patient care in 25 Parisian intensive care units (ICUs) during 2000. The robust free disposable hull (RFDH) as defined by [Cazals et al., 2002. Nonparametric frontier estimation: a robust approach. Journal of Econometrics 106, 1-25] reduces the impact outliers may have on findings by employing Monte-Carlo techniques and repeated sample selection. Among our key findings, there was no overall significant correlation between medical and technical efficiencies for all the ICUs, therefore performing well in one does not guarantee good performance in the other. We also found that over 80% of inefficiency is concentrated in less than 20% of the sampled patients.
    International Journal of Production Economics 08/2009; 120(2):585-594. · 2.08 Impact Factor
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    ABSTRACT: The percentage of compliant continuous positive airway pressure (CPAP)-treated apnoeic patients that continue to experience residual excessive sleepiness (RES) is unknown. RES was defined by an Epworth Sleepiness Scale (ESS) score of >or=11. In total, 502 patients from 37 French sleep centres using CPAP >3 h night(-1) attending their 1-yr follow-up visit were eligible. ESS and polysomnographic data as well as symptoms, quality of life, depression scores and objective CPAP compliance at 1 yr were collected. Overall, 60 patients remained sleepy on CPAP (ESS 14.3+/-2.5) leading to a prevalence rate of RES of 12.0% (95% confidence interval (CI) 9.1-14.8). After having excluded associated restless leg syndrome, major depressive disorder and narcolepsy as confounding causes, the final prevalence rate of RES was 6.0% (95% CI 3.9-8.01). Patients with RES were younger and more sleepy at diagnosis. The relative risk of having RES was 5.3 (95% CI 1.6-22.1), when ESS before treatment was >or=11. Scores of emotional and energy Nottingham Health Profile domains were two times worse in patients with RES. As 230,000 obstructive sleep apnoea patients are currently treated in France by continuous positive airway pressure, more than 13,800 of them might suffer from residual excessive sleepiness.
    European Respiratory Journal 05/2009; 33(5):1062-7. · 7.13 Impact Factor
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    ABSTRACT: The objective was to assess the medicoeconomic impact of initial and subsequent treatments based on oral fludarabine, intravenous chemotherapy (mini-CHOP) and chlorambucil in chronic lymphocytic leukaemia. A Markov model has been defined to encompass the 18 strategies over a 3-year period after starting the first treatment. Costs of treatments, side effects and follow-up have been calculated by crossing data from published prospective trials, specific hospital databases and French resource-based relative value scales. When treatments were based on mini-CHOP, different possibilities offered for hospital care were taken into account. Probalistic sensitivity analysis was performed. Whatever the modality of hospital care for mini-CHOP, the strategies based on oral fludarabine as first-line treatment are not only more effective but are also cost effective and dominate other types of scenarios. Fludarabine given orally should be preferred to mini-CHOP or chlorambucil as a first-line treatment for patients with chronic lymphocytic leukaemia.
    Journal of Medical Economics 10/2008; 10(4):339-354.
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    ABSTRACT: The objective of the study was to assess and to explain variation of organizational performance in intensive care units (ICUs). This was a prospective multicenter study. The study involved 26 ICUs located in the Paris area, France, participating in a regional database. Data were collected through answers of 1000 ICU personnel to the Culture, Organization, and Management in Intensive Care questionnaire and from the database. Organizational performance was assessed through a composite score related to 5 dimensions: coordination and adaptation to uncertainty, communication, conflict management, organizational change, and organizational learning, Skills developed in relationship with patients and their families. Statistical comparisons between ICUs were performed by analysis of variance with a Scheffé pairwise procedure. A multilevel regression model was used to analyze both individual and structural variables explaining differences of ICU's organizational performance. The organizational performance score differed among ICUs. Some cultural values were negatively correlated with a high level of organizational performance, suggesting improvement potential. Several individual and structural factors were also related to the quality of ICU organization, including absence of burnout, older staff, satisfaction to work, and high workload (P < .02 for each). A benchmarking approach can be used by ICU managers to assess the organizational performance of their ICU based on a validated questionnaire. Differences are mainly explained by cultural values and individual well-being factors, introducing new requirements for managing human resources in ICUs.
    Journal of Critical Care 07/2008; 23(2):236-44. · 2.19 Impact Factor
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    ABSTRACT: The clinical impact of surgical site infections (SSI) and postoperative pneumonia (PP) after head and neck cancer surgery has been assessed in the past, but little is known about their economic impact. The present study was designed to evaluate costs related to SSI and PP after head and neck cancer surgery with opening of mucosa. The incidence of SSI and PP was measured in a prospective cohort of 261 patients who had undergone head and neck cancer surgery. The additional direct medical costs related to these infections from the hospital perspective were determined based on postoperative length of stay. The mean direct hospital costs for patients with and without SSI or PP were compared. Of the 261 patients, 81 (31%), 21 (8%) and 13 (5%) developed SSI, PP or both, respectively. The additional lengths of stay attributable to SSI, PP or both were 16, 17 and 31 days, respectively, and additional direct medical costs related to these conditions were 17,000, 19,000 and 35,000 Euros. Nosocomial infections after head and neck cancer surgery significantly increase patients' length of stay and therefore generate additional direct medical costs. These results support the application of preventive interventions to reduce nosocomial infections in this setting.
    International Journal of Oral and Maxillofacial Surgery 03/2008; 37(2):135-9. · 1.36 Impact Factor
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    ABSTRACT: To assess the effectiveness and cost-effectiveness of routine childhood vaccination by new vaccines against rotavirus in France. We constructed a Markov decision tree to compare two alternatives: "no vaccination" and "vaccination". A hypothetical birth cohort of 750,000 children was followed until 3 years of age. First, the disease burden without vaccine was estimated using data from French databases and medical literature. Incidence rates in unvaccinated children were modelled as a function of age and seasons. Next, using data from the medical literature, the vaccine's protective effect on rotavirus diarrhoea was considered. A routine universal rotavirus immunization programme was estimated capable of annually avoiding 89,000 cases of diarrhoea, 10,500 hospitalizations, and 8 deaths. At a vaccination cost of euro 150/course, assuming 75% vaccine coverage, the programme would cost euro 95 million and involve a net loss of euro 68 million to the health care system. The vaccination programme would cost euro 298,000/year of life saved, and euro 138,000/QALY saved. Key variables affecting the results were disease incidence, mortality rates and vaccine price. In France, childhood rotavirus vaccination with new anti-rotavirus vaccines would reduce the morbidity burden of rotavirus infection, but would not be cost-effective unless the price of vaccine decreased considerably.
    Vaccine 02/2008; 26(5):706-15. · 3.49 Impact Factor
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    ABSTRACT: Varicella is a universal childhood disease in Spain, causing approximately 400,000 cases, 1,500 hospitalizations and 15 deaths every year. The aim of this study is to determine the economic impact of childhood varicella vaccination on the burden of disease and associated costs by using a dynamic model. The analysis is based on the varicella transmission model developed by Halloran and adapted to the Spanish context. Cost data (Euro, 2004) were derived from previous studies and official tariffs. Two vaccination scenarios were analysed: (1) routine vaccination program for children aged 1-2 years, and (2) routine vaccination program for children aged 1-2 years completed by a catch-up program during the first year of vaccine marketing for children aged 2-11 years. The analysis considers that a similar coverage rate to the MMR one would be achieved (97.15%). A societal perspective, including direct and indirect costs, and a health care payor perspective were adopted. A probabilistic sensitivity analysis was performed. A routine vaccination program has a positive impact on varicella-related morbidity: the number of varicella cases is estimated to be reduced by 89%, and 1230 hospitalizations are prevented. From the societal perspective, scenario (1) is cost-saving whether or not indirect costs are considered (-51 and -4%, respectively). From the Health Care System the strategy is cost-effective, with a cost-effectiveness ratio estimated at 3,982 Euro per life-year gained, although it leads to a small increase in the costs. Considering the impact of vaccination on morbidity and costs, a routine childhood vaccination program against varicella is worth while in Spain without taking into account the potential impact on HZ.
    Vaccine 12/2006; 24(47-48):6980-9. · 3.49 Impact Factor
  • Infection Control and Hospital Epidemiology 12/2006; 27(11):1282-5. · 3.94 Impact Factor
  • J P Marissal, B Gueron, B Dervaux
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    ABSTRACT: A well-known methodology used to compute the macroeconomic cost of risk factors is the etiologic cost ratio, leading to estimates based on data on the prevalence of the risk factor in the general population, the relative risk of complications associated to it and the cost of the complications. A major problem of this method is that it is in some extent inconsistent with recent findings showing an increase in the per capita cost of some complications in presence of type II diabetes mellitus. The aim of the paper is to reconcile the approach with most recent economic studies and to overview the consequences of such an attempt in terms of methodological framework. We developed a methodological framework introducing heterogeneity in the cost of treating complications according to the presence of diabetes. We estimated the macroeconomic cost of type II diabetes mellitus based on selected complications (stroke, myocardial infarction, nephropathy and peripheral arterial obstructive disease) from French representative data in two situations: a situation in which the heterogeneity is not taken into account, another situation in which heterogeneity is introduced. Our results point out that the assumption of homogeneity in the cost of complications is associated to an underestimation of the cost of diabetes by about 30%. Our results present an attempt to reconcile the economic modeling of the cost of type II diabetes mellitus with the "real world". We conclude that the introduction of heterogeneity is necessary to capture the whole extent of the economic burden of the disease and that it places significant constraints on the data and the methodological framework to be used in such attempts.
    Revue d Épidémiologie et de Santé Publique 05/2006; 54(2):137-47. · 0.66 Impact Factor
  • J.-P. Marissal, B. Gueron, B. Dervaux
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    ABSTRACT: Background A well-known methodology used to compute the macroeconomic cost of risk factors is the etiologic cost ratio, leading to estimates based on data on the prevalence of the risk factor in the general population, the relative risk of complications associated to it and the cost of the complications. A major problem of this method is that it is in some extent inconsistent with recent findings showing an increase in the per capita cost of some complications in presence of type II diabetes mellitus. The aim of the paper is to reconcile the approach with most recent economic studies and to overview the consequences of such an attempt in terms of methodological framework. Methods We developed a methodological framework introducing heterogeneity in the cost of treating complications according to the presence of diabetes. We estimated the macroeconomic cost of type II diabetes mellitus based on selected complications (stroke, myocardial infarction, nephropathy and peripheral arterial obstructive disease) from French representative data in two situations: a situation in which the heterogeneity is not taken into account, another situation in which heterogeneity is introduced. Results Our results point out that the assumption of homogeneity in the cost of complications is associated to an underestimation of the cost of diabetes by about 30%. Conclusion Our results present an attempt to reconcile the economic modeling of the cost of type II diabetes mellitus with the “real world”. We conclude that the introduction of heterogeneity is necessary to capture the whole extent of the economic burden of the disease and that it places significant constraints on the data and the methodological framework to be used in such attempts.
    Revue d Épidémiologie et de Santé Publique 04/2006; 54(2):137-147. · 0.66 Impact Factor
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    ABSTRACT: In this paper, data envelopment analysis (DEA) techniques are applied to the French nursing home industry in order to address two policy issues. The first involves nursing home size and returns to scale, while the second deals with the potential effects of a change in nursing home reimbursement from a flat rate to one based on the severity of case-mix. To accomplish this, our analysis expands on the existing nursing home literature to analyze technical and allocative efficiency along with budget-constrained models rather than the more common direct input-based distance function. Technical efficiency is evaluated via an indirect output distance function while allocative output efficiency is computed with a cost indirect revenue function. The findings suggest that system-wide efficiency and equity may result from coming reforms since payments would more accurately reflect resource use.
    Socio-Economic Planning Sciences 03/2006;
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    ABSTRACT: In this paper, we show that the ratio of the number of fetal anomalies detected by ultrasounds (US) to the total number of cases is not a consistent estimator of the US sensitivity. As Eddy 1 pointed out, when the disease evolves over time, the sensitivity of a test also varies over time according to the development of the disease. To assess correctly the detection capability of a test, it is therefore necessary to estimate a time continuous function (sensitivity function) instead of a single parameter. From a methodological point of view, by considering the “detectability” time of a fetal anomaly as a random variable and parametrizing its distribution function, we estimate the probability that an anomaly is detected conditional upon the precise timing of actually performed US during pregnancy. We fit this model with Eurofetus data (about 7,300 abnormal fetuses), and we compare estimations for different kinds of anomalies (classification based on the system involved and/or severity of the handicap). To allow for heterogeneity of anomalies regarding the detectability time, we generally adopt mixture models. For instance, we select a bi-gamma distribution for major malformations and estimate that 63% of such anomalies are detectable quite early in pregnancy (conditional mean: 15.2 weeks of amenorrhea (WA) ± 4.2 WA), the others becoming detectable later (30.3 WA ± 6.4 WA). Such results are then integrated in a cost-effectiveness analysis.
    Annals of the New York Academy of Sciences 02/2006; 847(1):125 - 135. · 4.38 Impact Factor
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    ABSTRACT: The objective of this study is to develop and validate a questionnaire designed to assess the culture, organization, and management of intensive care units. This is a prospective multicenter study. The study was conducted in 26 intensive care units located in Paris. All personnel were asked to complete the questionnaire. The questionnaire was developed in 2 steps: (1) development of a theoretical framework based on organizational theory and (2) testing of the reliability and validity of a comprehensive set of measures. The internal consistency of the items composing each scale was tested by using the Cronbach alpha. Convergent, and discriminant validity was assessed by factor analysis with varimax rotation. The overall completion rate was 74% with 1000 respondents (750 nurses, 26 head nurses, 168 physicians, and 56 medical secretaries). Starting with a 220-item questionnaire, we constructed a short version-conserving metrological characteristics with good reliability and validity. The short questionnaire, entitled Culture, Organization, and Management in Intensive Care, consists of 106 items distributed in 9 dimensions and 22 scales: culture (n = 3), coordination and adaptation to uncertainty (n = 3), communication (n = 3), problem solving and conflict management (n = 2), organizational learning and organizational change (n = 2), skills developed in a patient-caregiver relationship (n = 1), subjective unit performance (n = 3), burnout (n = 3), and job satisfaction and intention to quit (n = 2). All the scales showed good-to-high reliability, with Cronbach alpha scores higher than .7 (with the exception of coordination [.6]). Team satisfaction-oriented culture is positively correlated with good managerial practices and individual well-being. The Culture, Organization, and Management in Intensive Care questionnaire enables staff and managers to assess the organizational performance of their intensive care unit.
    Journal of Critical Care 07/2005; 20(2):126-38. · 2.19 Impact Factor

Publication Stats

338 Citations
81.98 Total Impact Points

Institutions

  • 2012–2013
    • Université du Droit et de la Santé Lille 2
      Lille, Nord-Pas-de-Calais, France
  • 1994–2009
    • Lille Catholic University
      Lille, Nord-Pas-de-Calais, France
  • 2008
    • Institut de recherches économiques et sociales
      Noisy, Île-de-France, France
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2005
    • Centre Oscar Lambret
      Lille, Nord-Pas-de-Calais, France