Nathalie Havet

Economic burden of seasonal influenza B in France during winter 2010-2011

BackgroundIn France, 2–15% of the population is affected annually by influenza, which causes significant socioeconomic disruption. Nevertheless, despite its importance for policy makers, few published studies have evaluated the impact of influenza B. Therefore, we assessed the costs associated with influenza B during 2010–2011 in France.MethodsCases of lab-confirmed influenza B were analyzed as part of the Influenza B in General Practice Study. Cost calculations were based on micro-costing methods according to the French Health Insurance (FHI) perspective (in Euros, 2011). Costs were compared between age groups using the Kruskal–Wallis test, and when significant, by multiple comparisons based on rank. Moreover, uncertainties were assessed using one-way sensitivity and probabilistic analyses. Overall economic burden was estimated by multiplying cost per patient, flu attack rate, and the French population.ResultsA total of 201 patients were included in the study. We found that the mean cost associated with Influenza B was 72€ (SD: 205) per patient: 70€ (SD: 262) for younger children, 50€ (SD: 195) for older children, 126€ (SD: 180) for adults, and 42€ (SD: 18) for elderly. Thus, we observed significantly different costs between the distinct age groups (p<0.0001). Finally, the economic burden of influenza B for the FHI was estimated to be 145 million Euros (95% CI: 88–201).ConclusionsOur findings highlight the important impact of influenza B and encourage further investigation on policy regarding vaccination strategies in France.

Does Homeownership Harm Labour Market Performances? A Survey

While many countries have implemented various incentives to promote homeownership, this paper investigates the literature on the relationship between this residential status and the labour market performances. Since the rather negative original contribution by Oswald (1996), the literature has been extending the analyses to more precise measures of labor markets performances, to more subtle descriptions of residential status and to more sophisticated econometric techniques on individual data. Overall, the Oswalds hypothesis nds little support.

Cancer patients’ willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network

Home blood transfusion may be an interesting alternative to hospital transfusion, especially when given with curative or palliative intent or for terminal care in advanced-stage cancer patients. However, there is limited information about patients’ attitude toward this type of care. The purpose of this study was to measure French cancer patients’ willingness to pay (WTP) for home blood transfusion and to analyze determinants of their choice. A contingent valuation survey was administered to 139 patients receiving transfusions in the framework of a regional home care network or in the hospital outpatient department. Participation was high (90%). Most patients (65%) had received home care, including 43% blood transfusions. Just under half of the patients gave a zero WTP, among which we identified 8 protest bidders. The median WTP for home blood transfusion was 26.5 € per patient. In multivariate analysis, long home–hospital distance, poor quality of life, and previous experience of home care were identified as important factors in determining how much more patients would be willing to pay for transfusion at home. These results demonstrate the benefits of developing domiciliary services to improve patient well-being, notably for the weakest among them. The significant impact of previous home care experience on WTP is probably related to the strong involvement of physicians from the blood center and to their active contribution to a high-level homecare network. Some of our findings could be useful for policy decision-making regarding home care.

Why Do Women's Wages Increase So Slowly Throughout Their Career? A Dynamic Model of Statistical Discrimination

The aim of this paper is to explain the growing wage differentials between men and women during their working careers. We provide a dynamic model of statistical discrimination, which integrates specific human capital decisions: on-the-job training investment and wages are endogenously determined. We reveal a small wage differential at the beginning of womens career, but womens wages increase more slowly; this is partly due to a lower level of human capital investment by women and partly because firms smooth training costs between different periods.

Homeownership and Job-Match Quality in France

Our empirical study stems from previous research on the inter-relations between residential status and microeconomic labour market outcomes. It focuses on employees and assesses the a priori ambiguous effect of homeownership on job-match quality. We use the French data set of the 1995-2001 European Community Household Panel to build a subjective measure of job downgrading. We estimate a recursive trivariate probit with partial observability that simultaneously models the residential status choice, its impact on the probability of being downgraded, and the selection into employment. The comparison with simpler models indicates that taking into account the selection into employment and controlling unobservable individual heterogeneity are of prime necessity to obtain robust conclusions.

Do regulations protect workers from occupational exposures to carcinogenic, mutagenic and reprotoxic (CMR) agents in France?

Objective This article explores the impact of regulations on the implementation of collective protections in France to occupational exposure to carcinogenic, mutagenic and reprotoxic (CMR) agents. Methods Individual data from the French national cross-sectional survey of occupational hazards conducted in 2010 were analysed. We investigated whether stricter regulations and longer exposures were associated with higher level of collective protection using multivariate logistic regressions. Results General ventilation, for which effect is limited as collective protection for CMR products, was present in 19% of situations involving CMR agents while isolation chambers, the most effective form of protection, were only very rarely implemented. Multilevel logistic regressions show that exposure situations to products classified as category 1 or 2 by the European Union do not have a higher probability of benefiting from a collective protection measures. Exposures to products with a Binding Occupational Exposure Limit Value selectively benefited from a better level of protection. Exposures to agents entered on the International Agency for Research on Cancer (IARC) list of proven or probable carcinogens benefited more from effective collective protections than products suspected to be carcinogens but not yet classified by IARC. Conclusions These results suggest that the dissemination of evaluations of carcinogens by the IARC translate into improved protective measures even though the IARC classification has no mandatory impact on regulations.

Being Treated In Higher Volume Hospitals Leads To Longer Progression-Free Survival For Epithelial Ovarian Carcinoma Patients in the Rhone-Alpes region of France

BackgroundTo investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France.MethodsThis retrospective study using prospectively implemented databases was conducted on an exhaustive cohort of 267 patients undergoing first-line therapy during 2012 in the Rhone-Alpes Region of France. We compared Progression-Free Survival for Epithelial Ovarian Carcinoma patients receiving first-line therapy in high- (i.e. ≥ 12 cases/year) vs. low-volume hospitals. To control for selection bias, multivariate analysis and propensity scores were used. An adjusted Kaplan-Meier estimator and a univariate Cox model weighted by the propensity score were applied.ResultsPatients treated in the low-volume hospitals had a probability of relapse (including death) that was almost two times (i.e. 1.94) higher than for patients treated in the high-volume hospitals (p < 0.001).ConclusionTo our knowledge, this is the first study conducted in this setting in France. As reported in other countries, there was a significant positive association between greater volume of hospital care for EOC and patient survival. Other factors may also be important such as the quality of the surgical resection.

Inégalités d'exposition aux agents cancérogènes, mutagènes ou reprotoxiques (CMR) en milieu professionnel en France

Notre etude exploite l’edition 2010 de l’enquete Surveillance medicale des expositions aux risques professionnels (SUMER) pour dresser un etat des lieux des expositions des salaries francais aux agents CMR sur leur lieu de travail. Au total, 2,2 millions de personnes, soit 10,2% des salaries, ont ete exposes a un ou plusieurs produits CMR lors de la semaine precedant leur visite medicale. Parmi eux, 70000 connaissaient une multi-exposition sur leur lieu de travail, ce qui porte a 3,5 millions le nombre de situations d’expositions recensees en 2010. Les situations des expositions a l’amiante ne representent que 2,3% des expositions aux produits CMR, soit 10 fois moins que les expositions aux gaz d’echappement diesel. Nos resultats montrent qu’il existe des emplois et des profils de salaries qui cumulent les prejudices sur le marche du travail, y compris de forts risques d’exposition a des produits dangereux pour la sante. Il s’agit notamment des ouvriers, des travailleurs de nuit et des salaries a contrats precaires, qui devraient donc constituer des cibles prioritaires pour les mesures de prevention.

The effect of health care expenditures on survival in locally advanced and metastatic Non Small Cell Lung Cancer

Context: The significant survival benefit of chemotherapy over best supportive care for locally advanced and metastatic NSCLC has been amply demonstrated in the literature. However, there is no clear evidence of the impact of the type of chemotherapy or of a superiority of combination chemotherapy over single-agent chemotherapy.Objective: The present study empirically examines, in real-life practise and using multiple proxies, the impact of health care expenditures on overall survival in locally advanced and metastatic NSCLC in order to guide medical decision-making.Methods: Disease characteristics, the resources used, the costs of treatment and survival data were retrospectively collected from the records of 175 patients treated between 2000 and 2004 at Leon Berard Regional Cancer Center (Lyon, France). Survival data were modelled using multivariate Cox models and controlled for endogeneity with the instrumental variable method.Results: The median survival for the whole cohort was 289 days. The average total cost of treatment reached €35,160. Survival was significantly shorter for patients with stage IV disease, poor performance status, and past or concomitant cardiovascular disease and/or diabetes, for current smokers, and for patients with adenocarcinoma compared to large cell carcinoma. Survival duration was not significantly associated with the total cost of treatment per day of hospitalisation, the number of chemotherapy drugs administered, nor inpatient length of stay.Conclusion: Higher care expenditures do not appear to improve survival for patients with locally advanced or metastatic NSCLC. Hence, maintaining patient quality of life and tailoring therapy to stage, histology and comorbidities appears to be the less bad choice.

Does the Wage and Professional Valorization of the Training in Company Differ According to the Sex? The Canadian Example (La Valorisation Salariale Et Professionnelle De La Formation En Entreprise DiffèRe-T-Elle Selon Le Sexe ?: L'Exemple Canadien)

The paper focuses on the effects of formal and informal on-the-job training on wages and promotions for men and women. For that purpose, we use the 1999-2000 Canadian Worplace and Employee Survey (WES). Using a simulated maximum likelihood, we estimate a recursive trivariate probit that simultaneously models the both decisions to follow formal and infomal on-the-job training and their impact on promotion process. We evaluate the returns of promotions and of the two kinds of on-the-job training through a Mincer wage equation using instruments for these variables.