BackgroundCurrent asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain.MethodsAn observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®.Results2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively.For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain).ConclusionsIn both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others.

Background: Short-term effects of air pollution are documented more than long-term effects. Objective: We investigated 12-year impacts of ambient air pollutants on cardiovascular and respiratory morbidity and mortality at the departmental level in metropolitan France. Methods: Daily air pollution data at 2-km resolution, including concentrations of particulate matter of 10 µm or 2.5 µm in diameter or less (PM10 and PM2.5), nitrogen dioxide (NO2), and ozone (O3), were accrued from the CHIMERE database for 1999 and 2000. Simultaneously, morbidity (hospitalizations) and mortality data were collected in 2012 using the ESPS (Enquête Santé et Protection Sociale/Health, Health Care and Insurance Survey) survey data and the CepiDc (Centre d’Épidémiologie sur les Causes Médicales de Décès/French Epidemiology Centre on Medical Causes of Death) database. Based on Poisson regression analyses, the long-term effect was estimated. A higher risk of all-cause mortality was observed using CépiDc database, with a relative risk of 1.024 (95% CI: 1.022, 1.026) and 1.029 (95% CI: 1.027, 1.031) for a 10 µg/m3 increase in PM2.5 and PM10, respectively. Mortality due to cardiovascular and respiratory diseases likewise exhibited long-term associations with both PM2.5 and PM10. Using ESPS survey data, a significant risk was observed for both PM2.5 and PM10 in all-cause mortality and all-cause morbidity. Although a risk for higher all-cause mortality and morbidity was also present for NO2, the cause-specific relative risk due to NO2 was found to be lesser, as compared to PM. Nevertheless, cardiovascular and respiratory morbidity were related to NO2, along with PM2.5 and PM10. However, the health effect of O3 was seen to be substantially lower in comparison to the other pollutants. Conclusion: Our study confirmed that PM has a long-term impact on mortality and morbidity. Exposure to NO2 and O3 could also lead to increased health risks.

Patient safety practices, targeting organisational changes for improving patient safety, are implemented worldwide but their costs are rarely evaluated. This paper provides a review of the methods used in economic evaluation of such practices. International medical and economics databases were searched for peer-reviewed publications on economic evaluations of patient safety between 2000 and 2010 in English and French. This was complemented by a manual search of the reference lists of relevant papers. Grey literature was excluded. Studies were described using a standardised template and assessed independently by two researchers according to six quality criteria. 33 articles were reviewed that were representative of different patient safety domains, data types and evaluation methods. 18 estimated the economic burden of adverse events, 3 measured the costs of patient safety practices and 12 provided complete economic evaluations. Healthcare-associated infections were the most common subject of evaluation, followed by medication-related errors and all types of adverse events. Of these, 10 were selected that had adequately fulfilled one or several key quality criteria for illustration. This review shows that full costebenefit/utility evaluations are rarely completed as they are resource intensive and often require unavailable data; some overcome these difficulties by performing stochastic modelling and by using secondary sources. Low methodological transparency can be a problem for building evidence from available economic evaluations. Investing in the economic design and reporting of studies with more emphasis on defining study perspectives, data collection and methodological choices could be helpful for strengthening our knowledge base on practices for improving patient safety.

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