J Fernandes

French hospital discharge database (PMSI) and bacterial resistance: Is coding adapted to hospital epidemiology?

OBJECTIVE A preliminary analysis of data consistency on different types of bacterial resistance by infection site and causative agents was conducted using the French hospital discharge database (French acronym PMSI) to assess the use of the database in a national cartography tool. MATERIAL AND METHODS Hospital stays in medical, surgical, and obstetrical units were extracted from the 2014 PMSI database using the ICD-10 diagnosis codes. Bacterial infections, causative agents, and resistance corresponding to these stays were also identified. RESULTS Data from 1258462 patients, corresponding to a total of 1617893 stays, was extracted. Among these stays, 46% were associated with a bacteria code and 7% with a resistance code. Lower respiratory tract infections were the most frequent infections (32% of stays; pneumonia in 95% of cases), followed by genitourinary infections (26%), intra-abdominal infections and diarrhoeas (24%), and skin and soft tissue infections (15%). Inconsistencies were observed between the types of infection and associated bacteria and between bacteria and associated resistance. These inconsistencies are likely due to initial coding errors. CONCLUSION The cartography of bacterial infections cannot be developed using the data of the current PMSI coding. These results underline the need to improve the coding of PMSI data for its use as a complementary tool of epidemiological surveillance of bacterial infections.

Infections and associated costs following cardiovascular implantable electronic device implantations: a nationwide cohort study

Aims This study assessed the contemporary occurrence of cardiac device infections (CDIs) following implantation in French hospitals and estimated associated costs. Methods and Results A retrospective analysis was conducted on the French National Hospital Database (PMSI). Patients with a record of de novo cardiac implantable electronic device (CIED) implantation or replacement interventions in France in 2012 were identified and followed until the end of 2015. Cardiac device infections (CDIs) were identified based on coding using the French classification for procedures [Classification Commune des Actes Médicaux (CCAM)] and International Classification of Diseases (ICD-10). Associated costs were estimated based on direct costs from the perspective of the French social security system. In total 78 267 CIED patients (72% de novo implants) were identified (15% defibrillators; 84% pacemakers). The 36-month infection rate associated with de novo defibrillator-only implants, as well as for cardiac resynchronisation therapy - defibrillators (CRT-Ds) was 1.6%. The CDI risk was 2.9% and 3.9% for replacement ICDs and CRT-Ds. Infection rates were lower for de novo single-chamber pacemaker (SCP)/dual-chamber pacemaker (DCP) (0.5%) and cardiac resynchronisation therapy - pacemaker (CRT-P) implants (1.0%), while for replacement procedures the risk increased to 1.4% (SCP/DCP) and 1.3% (CRT-P). Mean infection-related costs over 24 months were €20 623 and €23 234 for CDIs associated with replacement and de novo procedures, and overall costs were not significantly different between pacemaker and defibrillator patients. Conclusion Cardiac device infections in France are associated with substantial costs, when considering inpatient hospitalizations. Strategies to minimize the rate of CIED infection should be a priority for health care providers and payers.

Hospitalisation costs of metastatic melanoma in France; the MELISSA study (MELanoma In hoSpital coSts Assessment)

BackgroundManagement of metastatic melanoma is changing rapidly following the introduction of innovative effective therapies, with consequences for the allocation of healthcare resources. The objective of this study was to assess hospitalisation costs of metastatic melanoma in France from 2011 to 2013 from the perspective of the government payer.MethodsThe population studied corresponded to all adults with metastatic melanoma hospitalised in France between 1st January 2011 and 31st December 2013 who required chemotherapy, immunotherapy or radiotherapy due to tumour progression and unresectable Stage III or Stage IV melanoma. Metastatic melanoma was identified by ICD-10 codes documented in the hospital patient discharge records. For each patient, hospital stays were stratified into a pre- or post- progression health state using proxy variables for the RECIST criteria. All healthcare expenditure documented in the French national hospital claims system database and incurred between the index hospitalisation (or change of progression state) and the end of follow-up were analysed. For the principal analysis, valuation of healthcare resource consumption was performed using official national hospitalisation tariffs. Any expensive therapy administered during the stay was documented from a linked database of expensive drugs (FICHCOMP).ResultsSeventy-eight thousand seven hundred fifty hospital stays by 10,337 patients with metastatic melanoma were identified over the three-year study period. Annual per capita costs of hospitalisation were € 5046 in the pre-progression stage and € 19,006 in the post-progression stage. Hospitalisations attributed to adverse drug reactions to chemotherapy or immunotherapy were observed in 27% of patients. Annual per capita costs of these hospitalisations related to adverse drug reactions were € 3762 in the pre-progression stage and € 5523 in the post-progression stage.ConclusionsHospitalisation costs related to metastatic melanoma rise substantially as the disease progresses. Treatment strategies which slow down disease progression would be expected to reduce costs of hospitalisation for metastatic melanoma, although they may also entail significant acquisition costs. This will entail organisational changes of resource allocation for the treatment of metastatic melanoma in hospitals.

An Assessment of The Hospitalization Costs of Melanoma in France in the Advanced/Metastatic Setting: the Melissa Study (Melanoma in Hospital Costs Assessment)

1 Heva, Lyon, France 2 Medical Oncology, Skin Cancers, Centre Léon Bérard, Lyon, France 3 Medical Information Department, Groupe OC Santé, Montpellier, France 4 Bristol-Myers Squibb, Health Economics & Public Health, Rueil-Malmaison, France AN ASSESSMENT OF THE HOSPITALIZATION COSTS OF MELANOMA IN FRANCE IN THE ADVANCED/METASTATIC SETTING: THE MELISSA STUDY (MELANOMA IN HOSPITAL COSTS ASSESSMENT) PCN 99