Bruno Lambert

The Chikungunya Epidemic on La Réunion Island in 2005–2006: A Cost-of-Illness Study

Background This study was conducted to assess the impact of chikungunya on health costs during the epidemic that occurred on La Réunion in 2005–2006. Methodology/Principal Findings From data collected from health agencies, the additional costs incurred by chikungunya in terms of consultations, drug consumption and absence from work were determined by a comparison with the expected costs outside the epidemic period. The cost of hospitalization was estimated from data provided by the national hospitalization database for short-term care by considering all hospital stays in which the ICD-10 code A92.0 appeared. A cost-of-illness study was conducted from the perspective of the third-party payer. Direct medical costs per outpatient and inpatient case were evaluated. The costs were estimated in Euros at 2006 values. Additional reimbursements for consultations with general practitioners and drugs were estimated as €12.4 million (range: €7.7 million–€17.1 million) and €5 million (€1.9 million–€8.1 million), respectively, while the cost of hospitalization for chikungunya was estimated to be €8.5 million (€5.8 million–€8.7 million). Productivity costs were estimated as €17.4 million (€6 million–€28.9 million). The medical cost of the chikungunya epidemic was estimated as €43.9 million, 60% due to direct medical costs and 40% to indirect costs (€26.5 million and €17.4 million, respectively). The direct medical cost was assessed as €90 for each outpatient and €2,000 for each inpatient. Conclusions/Significance The medical management of chikungunya during the epidemic on La Réunion Island was associated with an important economic burden. The estimated cost of the reported disease can be used to evaluate the cost/efficacy and cost/benefit ratios for prevention and control programmes of emerging arboviruses.

Medication Sales and Syndromic Surveillance, France

Real-time over-the-counter drug sales provide an additional tool for disease surveillance.

A method to assess seasonality of urinary tract infections based on medication sales and google trends.

Background Despite the fact that urinary tract infection (UTI) is a very frequent disease, little is known about its seasonality in the community. Methods and Findings To estimate seasonality of UTI using multiple time series constructed with available proxies of UTI. Eight time series based on two databases were used: sales of urinary antibacterial medications reported by a panel of pharmacy stores in France between 2000 and 2012, and search trends on the Google search engine for UTI-related terms between 2004 and 2012 in France, Germany, Italy, the USA, China, Australia and Brazil. Differences between summers and winters were statistically assessed with the Mann-Whitney test. We evaluated seasonality by applying the Harmonics Product Spectrum on Fast Fourier Transform. Seven time series out of eight displayed a significant increase in medication sales or web searches in the summer compared to the winter, ranging from 8% to 20%. The eight time series displayed a periodicity of one year. Annual increases were seen in the summer for UTI drug sales in France and Google searches in France, the USA, Germany, Italy, and China. Increases occurred in the austral summer for Google searches in Brazil and Australia. Conclusions An annual seasonality of UTIs was evidenced in seven different countries, with peaks during the summer.

A method for selecting and monitoring medication sales for surveillance of gastroenteritis.

Monitoring appropriate categories of medication sales can provide early warning of certain disease outbreaks. This paper presents a methodology for choosing and monitoring medication sales relevant for the surveillance of gastroenteritis and assesses the operational characteristics of the selected medications for early warning.

Estimating the excess of inappropriate prescriptions of anti-dopaminergic anti-emetics during acute gastroenteritis epidemics in France.

Anti‐dopaminergic anti‐emetics (ADA) use for the treatment of nausea associated with gastroenteritis (GE) can be considered inappropriate, as their effects are not supported by evidence of clinical efficacy and can potentially induce serious adverse events.

A syndromic surveillance system for clinical and non-clinical health data

The data used in health care and public health monitoring and surveillance are likely to be nonstationary and highly auto-correlated. These data may come from clinical and nonclinical sources, the latter being increasingly used in an attempt to supplement traditional surveillance. We propose an alternative approach applicable to multiple sets of health data that combines a method of preconditioning (ARMA filtering), a forecasting method (the method of analogues) and a monitoring method (the change-point). This procedure is applied to Influenza-Like Illness (ILI) surveillance in France using both clinical data (time series of weekly ILI incidence at the national level and in 22 regions) and nonclinical data (over-the-counter and prescribed weekly medication sales data at the national level). The outcomes show that multivariate monitoring provides an improved ability to recognize warning signals and drug sales data provide an indirect but earlier indication of influenza outbreaks. The proposed method has the advantage of being both practical and relatively simple to implement and could be easily adapted to develop adequate surveillance tools for specific diseases.