Publications by authors named "Arnaud Pages"

12 Publications

  • Page 1 of 1

Impact of a Pharmacist-included Mobile Geriatrics team intervention on potentially inappropriate drug prescribing: protocol for a prospective feasibility study (PharMoG study).

BMJ Open 2020 12 2;10(12):e040917. Epub 2020 Dec 2.

Department of Pharmacy, Toulouse University Hospital, Toulouse, France.

Introduction: Research has shown that potentially inappropriate drug prescription (PIDP) is highly prevalent in older people. The presence of PIDPs is associated with adverse health outcomes. This study aims to evaluate the impact of a PHARmacist-included MObile Geriatrics (PharMoG) team intervention on PIDPs in older patients hospitalised in the medical, surgical and emergency departments of a university hospital.

Methods And Analysis: The PharMoG study is a prospective, interventional, single-centre feasibility study describing the impact of a PharMoG team on PIDPs in older hospitalised patients. Pharmacist intervention will be a treatment optimisation (clinical medication review) based on a combination of explicit and implicit criteria to detect PIDPs. The primary outcome is the acceptance rate of the mobile team's proposed treatment optimisations related to PIDPs, measured at the patient's discharge from the department. This pharmacist will work in cooperation with the physician of the mobile geriatric team. After the intervention of the mobile geriatric team, the proposals for improving therapy will be sent to the hospital medical team caring for the patient and to the patient's attending physician. The patient will be followed for 3 months after discharge from the hospital.

Ethics And Dissemination: This study was approved by the South-West and Overseas Territories II Ethics Committee. Oral consent must be obtained prior to participation, either from the patient or from the patient's representative (trusted person and/or a family member). The results will be presented at national and international conferences and published in peer-reviewed journals.

Trial Registration Number: NCT04151797.
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http://dx.doi.org/10.1136/bmjopen-2020-040917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713213PMC
December 2020

Potentially Inappropriate Drug Prescribing in French Nursing Home Residents: An Observational Study.

Pharmacy (Basel) 2020 Jul 30;8(3). Epub 2020 Jul 30.

Department of Pharmacy, Toulouse University Hospital, 31000 Toulouse, France.

To identify the prevalence of potentially inappropriate drug prescription in a sample of nursing home residents in France, combining explicit criteria and implicit approach and to involve pharmacists in the multi-professional process of therapeutic optimization. A cross-sectional, observational, multicenter study was conducted during a five-month period in a sample of French nursing homes. Information on drug prescription, diseases, and socio-demographic characteristics of nursing home residents was collected. For each prescription, identification of potentially inappropriate drug prescription was done, based on explicit and implicit criteria. Nursing home residents were administered an average of 8.1 (SD 3.2, range 0-20) drugs per day. Nearly 87% ( = 237) of the residents had polypharmacy with five or more drugs prescribed per day. Among the 274 nursing home residents recruited from five nursing homes, 212 (77.4%) had at least one potentially inappropriate drug prescription. According to the Laroche list, 84 residents (30.7%) had at least one drug with an unfavorable benefit-harm balance. An overdosing was found for 20.1% ( = 55) of the residents. Nearly 30% ( = 82) of the residents had a drug prescribed without valid medical indication. This study shows that potentially inappropriate drug prescriptions are highly prevalent among nursing home residents, nevertheless pharmacists can take part in drug utilization review in collaboration with the nursing home staff.
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http://dx.doi.org/10.3390/pharmacy8030133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559159PMC
July 2020

Factors Associated With the Choice of Oral Anticoagulant Class in the Older Patients: An Observational Study.

J Cardiovasc Pharmacol Ther 2020 07 8;25(4):332-337. Epub 2020 Apr 8.

Department of Pharmacy, Toulouse University Hospital, Toulouse, France.

Aim: Oral anticoagulants are the first-line drugs for treating thrombotic disorders related to nonvalvular atrial fibrillation and for treating deep vein thrombosis, diseases that increase in prevalence with age. Older patients have a greater risk of thrombotic and hemorrhagic events and are more prone to drug interactions. Given this backdrop, we wanted to determine the factors associated with the prescription of direct oral anticoagulants and vitamin K antagonists in older patients.

Methods: We performed a cross-sectional observational study using a hospital prescription database. The study population consists of 405 older patients who were given oral anticoagulants. The 2 variables of interest were the prescription of 1 of the 2 classes of oral anticoagulants (direct oral anticoagulants vs vitamin K antagonists) and appropriateness of oral anticoagulant prescribing according to Summary of Product Characteristics (potentially inappropriate vs appropriate).

Results: The factors associated with direct oral anticoagulant prescribing were the female gender (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.88) and initiation during hospital stay (OR: 2.56, 95% CI: [1.52-4.32]). Stage 4 and 5 chronic kidney diseases (OR: 0.39, 95% CI: [0.19-0.79] and OR: 0.07, 95% CI: [0.01-0.53]) were factors favoring vitamin K antagonist prescription. Being 90 years of age or more (OR: 2.05, 95% CI: [1.06-3.98]) was a factor for potentially inappropriate anticoagulant prescribing. The gastroenterology department (OR: 2.91, 95% CI: [1.05-8.11]) was associated with potentially inappropriate anticoagulant prescribing.

Conclusions: Direct oral anticoagulants are the drugs of choice for anticoagulant treatment, including in older adults. The female gender and the initiation during hospital stay increased the chances of being prescribed a direct oral anticoagulant in older adults. Stage 4 and 5 chronic kidney disease increased the likelihood of having a vitamin K antagonist prescribed. Our study also revealed a persistence of potentially inappropriate oral anticoagulant prescriptions in older patients.
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http://dx.doi.org/10.1177/1074248420917811DOI Listing
July 2020

Cost analysis of potentially inappropriate medication in older hospitalized patients.

Expert Rev Pharmacoecon Outcomes Res 2020 Dec 15;20(6):623-627. Epub 2019 Oct 15.

Department of Pharmacy, CHU de Toulouse , Toulouse, France.

: Pubmed literature search show that the prescription of potentially inappropriate medications is a major concern in older hospitalized patients, both from a clinical and financial perspective. This study aims to identify factors associated with exposure and potentially inappropriate medication costs in older hospitalized patients and to assess the financial impact of substituting these medications with safer alternatives. : We performed an observational cross-sectional study of all patients aged 75 years or older hospitalized in a university hospital (except geriatric wards) on a given day. Potentially inappropriate medications were identified using European and French guidelines. : A total of 365 patients were included. At least one potentially inappropriate medication was prescribed in 50.4% of these patients. This contributed 19.7% [16.1; 23.6] to the average cost of medication per patient. Substitution of these medications with recommended alternatives was cost saving: average incremental cost per patient: -3.97 € [-7.21; -1.58]. Both polypharmacy and type of ward providing care were associated with increased costs of potentially inappropriate medications. : This study assessed the prevalence of potentially inappropriate medications in older hospitalized patients and established that their substitution by alternative medications provided a cost saving.
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http://dx.doi.org/10.1080/14737167.2020.1678384DOI Listing
December 2020

What is the cost burden of surgical implant waste? An analysis of surgical implant waste in an orthopedics and trauma surgery department of a French university hospital in 2016.

Orthop Traumatol Surg Res 2019 10 28;105(6):1205-1209. Epub 2019 Aug 28.

Chirurgie orthopédique et traumatologique, Hôpitaux de Toulouse, Hôpital Pierre-Paul Riquet, place du Dr Baylac, 31059 Toulouse cedex 9, France.

Background: During an orthopedic or trauma surgery procedure, when an implantable medical device is unpackaged, not implanted and cannot be resterilized, it is considered "waste". The cost burden falls on the hospital. The French Social Security Code provides for add-on reimbursement for certain expensive or very specialized devices (supplementary list of costly implants). To allow its restocking without linking it to a patient or reimbursement request, the wasted implant is tracked in a computerized database. The economic impact of these wasted implants is not known in France. This led us to conduct a retrospective study: 1) to determine the percentage and number of wasted implants, 2) to identify elements related to the surgery that impact implant waste.

Hypothesis: Various elements of the surgical environment (type of procedure, specialty, surgeon experience, time of year) can independently contribute to the non-implantation of a medical device.

Methods: We carried out a retrospective observational study of data collected prospectively in the database of our teaching hospital in 2016. The primary outcome was the percentage of wasted implants. The secondary outcome was the mean cost of these wasted implants. These parameters were determined for all the implants used in orthopedics and trauma surgery and tracked in this department, then for each variable hypothesized to led to non-implantation. Our analysis was descriptive, then comparative.

Results: In our database, 29,073 devices were tracked (€3,761,180), of which 1995 devices were wasted (6.9%). The total cost of the wasted implants was €179,193 (4.8% of the overall cost). The breakdown of the wasted implants was 430 (4.4%) from the add-on list (average cost of €293.10) versus 1565 implants associated with the hospital's diagnosis-related group payment system (average cost of €33.90). Trauma surgery procedures had significantly more wasted implants than orthopedic surgery (1135 vs. 860 (p<0.01)), although the individual cost was less (€59.20 vs. €130.10 (p<0.01)). Fracture fixation implants were more likely to be wasted than ligament reconstruction or arthroplasty implants, with a lower mean cost. More implants were wasted during hip arthroplasty than during other arthroplasty procedures. Less experienced surgeons wasted more implants than more experienced surgeons (1087 vs. 905 (p<0.01)) but these implants cost less (€69.20 vs. €114.80 (p<0.05)). The percentage of implants wasted was higher during the resident changeover period relative to the other months of the year (772 vs. 1223 (p<0.01)).

Discussion: This study is the first attempt at quantifying the number and cost of wasted implants in the context of orthopedics and trauma surgery at a teaching hospital in France. While trauma surgery is associated with more wasted implants, the cost burden is higher in orthopedics. Surgeons, by virtue of their experience and teaching mandate, have a decisive role managing this cost burden.

Type Of Study: IV, Retrospective study.
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http://dx.doi.org/10.1016/j.otsr.2019.06.010DOI Listing
October 2019

Cost-minimization analysis between intravenous iron sucrose and iron sucrose similar in hemodialysis patients.

Expert Rev Pharmacoecon Outcomes Res 2020 Jun 1;20(3):281-287. Epub 2019 Jul 1.

Department of Pharmacy, CHU de Toulouse , Toulouse, France.

Objectives: Intravenous iron and erythropoiesis-stimulating agents are used to manage anemia in chronic hemodialysis patients. The interchangeability between intravenous iron sucrose preparations is still debated. We evaluated how cost and effectiveness were impacted when chronic hemodialysis patients were switched from an original iron sucrose product to an iron sucrose similar preparation.

Methods: A single center sequential observational retrospective study was conducted at a French hospital. The same patients were followed during two 24-week periods (iron sucrose in period P1; and iron sucrose similar in period P2). Anemia-related treatment costs were assessed in P1 and P2 from a hospital perspective. Sensitivity analyses were performed to assess the robustness of the results.

Results: Our study included 109 patients (105 analyzed patients and 4 patients with missing data). The mean hemoglobin level was not different between P1 and P2 (p = 0.92). The mean differential cost per patient was + €13.90 (P2 - P1). The factors with the biggest impact on this result were the prices of epoetin alfa and iron sucrose.

Conclusion: This cost minimization analysis suggests that for chronic hemodialysis patients, iron sucrose and iron sucrose similar have the same efficacy and that using iron sucrose similar was more expensive in 66.7% of iterations.
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http://dx.doi.org/10.1080/14737167.2019.1632193DOI Listing
June 2020

Cost Effectiveness of Candida Polymerase Chain Reaction Detection and Empirical Antifungal Treatment among Patients with Suspected Fungal Peritonitis in the Intensive Care Unit.

Value Health 2017 12 7;20(10):1319-1328. Epub 2017 Aug 7.

CHU de Toulouse, Pharmacie, Toulouse, France; Inserm, UMR1027, UPS Université de Toulouse III, Toulouse, France.

Background: Mortality from intra-abdominal candidiasis in intensive care units (ICUs) is high. It takes many days for peritoneal-fluid fungal culture to become positive, and the recommended empirical antifungal therapy involves excessive costs. Polymerase chain reaction (PCR) should produce results more rapidly than fungal culture.

Objectives: To perform a cost-effectiveness analysis of the combination of several diagnostic and therapeutic strategies to manage Candida peritonitis in non-neutropenic adult patients in ICUs.

Methods: We constructed a decision tree model to evaluate the cost effectiveness. Cost and effectiveness were taken into account in a 1-year time horizon and from the French National Health Insurance perspective. Six strategies were compared: fluconazole or echinocandin as an empirical therapy, plus diagnosis by fungal culture or detection by PCR of all Candida species, or use of PCR to detect most fluconazole-resistant Candida species (i.e., Candida krusei and Candida glabrata).

Results: The use of fluconazole empirical treatment and PCR to detect all Candida species is more cost effective than using fluconazole empirical treatment without PCR (incremental cost-effectiveness ratio of €40,055/quality-adjusted life-year). Empirical treatment with echinocandin plus PCR to detect C. krusei and C. glabrata is the most effective strategy, but has an incremental cost-effectiveness ratio of €93,776/quality-adjusted life-year. If the cost of echinocandin decreases, then strategies involving PCR plus empirical echinocandin become more cost-effective.

Conclusions: Detection by PCR of all Candida species and of most fluconazole-resistant Candida species could improve the cost-effectiveness of fluconazole and echinocandin given to non-neutropenic patients with suspected peritoneal candidiasis in ICUs.
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http://dx.doi.org/10.1016/j.jval.2017.06.009DOI Listing
December 2017

The cost of molecular-guided therapy in oncology: a prospective cost study alongside the MOSCATO trial.

Genet Med 2017 06 1;19(6):683-690. Epub 2016 Dec 1.

Gustave Roussy, Service de Biostatistique et d'Epidémiologie, Villejuif, France.

Aim: There is increasing use of molecular technologies to guide cancer treatments, but few cost data are available. Our objective was to assess the costs of molecular-guided therapy for patients with advanced solid tumors alongside the Molecular Screening for Cancer Treatment and Optimization (MOSCATO) trial.

Materials And Methods: The study population consisted of 529 patients. The molecular diagnosis included seven steps from tumor biopsy to the multidisciplinary molecular tumor board. The cost of a complete molecular diagnosis was assessed by micro-costing. Direct costs incurred from enrollment until progression were assessed from the French National Health Insurance perspective.

Results: The patients' mean age was 54 years (range: 3-82) and the mean follow-up period was 145 days (range: 1-707 days). A complete molecular diagnosis cost [euro ]2,396. There were 220 patients with an actionable target (42%), among whom 105 (20%) actually received a targeted therapy. The cost of molecular-guided therapy per patient was [euro ]31,269. The main cost drivers were anticancer drugs (54%) and hospitalizations (35%).

Conclusion: This prospective cost analysis showed that molecular diagnosis accounts for only 6% of the cost of molecular-guided therapy per patient. The costs of drugs and hospitalizations are the main cost drivers.Genet Med advance online publication 01 December 2016.
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http://dx.doi.org/10.1038/gim.2016.174DOI Listing
June 2017

Undesirable effects related to oral antineoplastic drugs: comparison between patients' internet narratives and a national pharmacovigilance database.

Drug Saf 2014 Aug;37(8):629-37

Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, INSERM U1027, Faculté de Médecine, CHU de Toulouse, Université de Toulouse, 37 Allées Jules Guesde, 31000, Toulouse, France.

Background: The Internet is changing the way people learn about health and illness. Over the previous decade, the oral antineoplastic (OAN) agents have changed patient management allowing more ambulatory care. In this regard, websites could be an interesting source of data about OAN-induced adverse events (AEs).

Objective: The aim of the study was to describe the characteristics of AEs, as reported on websites by patients exposed to OAN agents, and to compare these to those recorded in the French pharmacovigilance database (FPVD).

Methods: We performed a retrospective study to collect AEs reported by patients in five of the best-known website forums in France over 1 year (2011). For each report, we recorded demographic data, cancer type, drug involved and AEs. The same analysis was done in the FPVD for OAN-induced adverse drug reactions (ADRs).

Results: A total of 202 AEs were identified in website posts and 1,448 ADRs were found in the FPVD. The most cited drugs in websites were protein kinase inhibitors (n = 88, 43.5%) and hormone antagonists (n = 61, 30.2%). More musculoskeletal disorder reports were found in the patient websites compared with the FPVD (16.34 vs. 4.70%, p < 0.001). As for skin disorders, we collected fewer reports in the patient website forums than in the FPVD (13.37 vs. 22.17%, p = 0.004). AEs reported in the patient websites were less serious (n = 10, 4.95%) than ADRs recorded in the FPVD (n = 999, 68.99%) (p < 0.001).

Conclusions: AEs reported in the website forums are considered by patients to be relevant enough to be shared. Data from patient websites could be used as a source of data to detect AEs alongside conventional pharmacovigilance.
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http://dx.doi.org/10.1007/s40264-014-0203-6DOI Listing
August 2014

[Retroperitoneal laparoscopic pyeloplasty: retrospective study of 45 consecutive adult cases].

Prog Urol 2006 Sep;16(4):439-44

Service d'Urologie-Andrologie, CHU de Saint-Etienne, France.

Objective: To evaluate the results of retroperitoneal laparoscopic surgical repair of ureteropelvic junction (UPJ) syndrome.

Material And Methods: Retrospective study of 45 consecutive Küss-Anderson-Hynes laparoscopic pyeloplasties performed over a 4-year period (December 1998-November 2002) in adults (26 women, 19 men) with a mean age of 44.8 years (range: 16-83 years).

Results: The mean operating time was 138 minutes (range: 75-250 minutes). Open conversion was necessary in 3 cases: necrotic pyelitis, ectopic renal artery, posterior pelvic tear. The mean hospital stay was 6.1 days. With a mean follow-up of 19 months (range: 3-58 months), the clinical success rate was 97.6% and the success rate on IVU or scintigraphy was 83.3%.

Conclusion: This series confirms that laparoscopic pyeloplasty is a minimally invasive technique that gives better results than those of the various endopyelotomy techniques and equivalent results to those of open pyeloplasty with decreased morbidity.
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September 2006

[One-stage laparoscopic bilateral upper pole nephrectomy for ectopic insertion of complete ureteral duplication].

Prog Urol 2003 Apr;13(2):342-5

Service d'Urologie-Andrologie, Hôpital Nord, 42055 Saint Etienne.

Ectopic ureteric insertion of the superior renal unit in the context of complete ureteric duplication is frequently accompanied by destruction of the corresponding parenchymal territory. Surgical treatment must comprise upper pole nephrectomy with partial ureterectomy. The authors report a case of one-stage retroperitoneal laparoscopic bilateral treatment which could become the treatment of choice of this disease.
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April 2003

[Prognostic factors of invasive bladder cancer with lymph node invasion].

Prog Urol 2002 Sep;12(4):615-20

Service d'Urologie-Andrologie, Hôpital Nord, CHU, Saint-Etienne.

Objective: To identify the prognostic factors influencing survival and to assess the value of extensive lymphadenectomy in invasive bladder cancer with lymph node invasion.

Material And Methods: The medical records of 62 patients treated by cystectomy with curative lymphadenectomy for invasive bladder cancer with lymph node invasion were reviewed. Thirty four patients had lymph node dissection ascending at least as far as the common iliac vessels, 26 had pelvic lymph node dissection and 2 had simple lymph node biopsies.

Results: The 2-, 3- and 5-year actuarial survival rates were 37%, 26.6% and 23.6%, respectively, with a median survival of 18.4 months. This study appears to show the independent prognostic value of the following factors: tumour strictly confined to the bladder (< or = pT3a) (p = 0.002), < or = 2 invaded lymph nodes (p = 0.001), N1 lymph node stage (p = 0.009). Extensive lymphadenectomy would not provide any benefit in terms of survival compared to simple pelvic lymph node dissection (p = 0.8). Common iliac node invasion appears to be a factor of poor prognosis when the tumour extends beyond the bladder (> pT3a) (p = 0.018).

Conclusion: In these patients with invasive bladder cancer and lymph node invasion, a number of invaded lymph nodes < or = 2 and local stage < or = pT3a appear to be favourable prognostic factors resulting in a 23.6% remission rate (56.8% when both factors were present simultaneously) after cystectomy plus lymphadenectomy. Extensive lymphadenectomy including the common iliac vessels would not improve survival compared to pelvic lymph node dissection, but nevertheless appears us to be justified, as the presence of common iliac lymph node invasion constitutes a significant and powerful prognostic factor to recommend adjuvant therapy.
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September 2002