Niels Serup-Hansen - Academia.edu (original) (raw)

Papers by Niels Serup-Hansen

Research paper thumbnail of POB2 Cost-Effectiveness of Treating Cardiometabolic Patients with Rimonabant (Acomplia®) in a Danish Setting

Value in Health, 2006

The Centre for Epidemiologic Studies Depression Scale (CES-D) is one of the most widely used depr... more The Centre for Epidemiologic Studies Depression Scale (CES-D) is one of the most widely used depression questionnaires; it has been translated into many languages and is frequently used in multinational studies. This research sought to examine whether different language versions of the CES-D were affected by country (cultural)-related differential item functioning (DIF). METHODS: CES-D data were available from depressed patients in the UK (n = 177), US (n = 100), Germany (n = 78) and France (n = 124). The data were pooled and applied to the one-parameter Rasch item-response model for analysis and to identify cross-cultural DIF. RESULTS: The UK and German CES-D did not fit the Rasch model (Chi 2 p < 0.001) suggesting that summation of item scores in these countries is not justified. Four items in the UK (including 2 of the 4 positively worded items) and 2 items in Germany misfitted. The US CES-D exhibited borderline overall misfit to the Rasch model (Chi 2 p < 0.01) with no item misfit and the French data fitted the Rasch model (with 1 item misfitting). The pooled data from the 4 countries did not fit the Rasch model (Chi 2 p < 0.001) and DIF was observed in 7 items (including all of the positively worded items). DIF between the US and UK (5 items), the US and Germany (5 items) and US and France (4 items) was greater than that between UK and Germany (1 item), the UK and France (2 items) and Germany and France (3 items). CONCLUSIONS: CES-D data from these countries cannot be pooled justifiably without first accounting for DIF by culture. DIF appeared to be greater between the US and Europe than within European countries. In addition, the use of both positively and negatively worded items in a questionnaire may introduce bias.

Research paper thumbnail of Burden of allergic respiratory disease: a systematic review

Clinical and Molecular Allergy, 2016

This meta-analysis compared the health-related quality of life (HRQL) of patients with allergic r... more This meta-analysis compared the health-related quality of life (HRQL) of patients with allergic rhinitis (AR) and/or allergic asthma (AA) caused by perennial house dust mite (HDM) versus AR and/or AA caused by seasonal pollen allergy. Following a systematic search, the identified studies used the disease-specific rhinitis quality of life questionnaire or generic instruments (SF-36 and SF-12). Summary estimates obtained by meta-analysis showed that HRQL in patients with perennial HDM allergy was significantly worse than that of patients with seasonal pollen allergy, when measured by both disease-specific and generic HRQL instruments, and was reflected by an impact on both physical and mental health. A systematic review of cost data on AR and AA in selected European countries demonstrated that the majority of the economic burden was indirectly caused by high levels of absenteeism and presenteeism; there was little or no evidence of increasing or decreasing cost trends. Increased awareness of the detrimental effects of AR and/or AA on patients' HRQL and its considerable cost burden might encourage early diagnosis and treatment, in order to minimize the disease burden and ensure beneficial and cost-effective outcomes.

Research paper thumbnail of Systematic Literature Review Assessing Data on the Burden of Allergic Rhinitis from a Cost and Quality of Life Perspective

Value in Health, 2014

patients recruited through an agency, Twitter and Asthma UK's website. Participants had experienc... more patients recruited through an agency, Twitter and Asthma UK's website. Participants had experienced a NCS and a SS < 3 years previously. Medication history and Asthma Control Test (ACT) scores were collected. Interviews were audio-recorded, and thematically analysed. Results: The sample was 69% Caucasian, with six males and seven females, and a mean age= 47. Most were working full time or retired, and had many years since asthma diagnosis (mean= 22 years). NCS were related to reliever (n= 7), preventer (n= 4) or both (n= 2) medications with the most common NCS from one brand to another (n= 4). Participants reported negative feelings, difficulty using the medication and ineffective symptom control. Most participants used the NCS medication < 6 months (range < 24 hours-2 years). The SS for most was a return to their original pre-NCS medication (n= 11). Although most found getting their SS straightforward, this required at least two HCP visits for half the sample, and took up to two months to obtain. Most expected symptoms to improve following the SS but nine participants still had sub-optimal ACT scores. Lasting impacts included damaged relationships with HCPs, strong views about NCS and concern about NCS reoccurrence. ConClusions: Failure to inform and involve patients in medication changes can have lasting impacts. It is important to note that NCS can incur costs associated with rejection of medicines and additional consultations, thus negating any attempt at cost saving.

Research paper thumbnail of Alder, død og sundhedsomkostninger: En analyse af omkostninger ved forbrug af sygehusydelser som funktion af alder, køn og afstand til død samt prediktion af de fremtidige sundhedsomkostninger

Research paper thumbnail of The moderating role of allergy immunotherapy in asthma progression. Results of a population‐based cohort study

Allergy, 2019

Allergic asthma causes substantial morbidity and constitutes a public health burden, which increa... more Allergic asthma causes substantial morbidity and constitutes a public health burden, which increases with asthma severity. There is evidence that allergy immunotherapy (AIT) prevents the progression of allergic rhinitis (AR) to asthma. However, evidence is missing on the potential of AIT to prevent progression from milder to more severe asthma.

Research paper thumbnail of Les coûts de la rhinite et de l’asthme augmentent avec le niveau de sévérité et de contrôle

Revue d'Épidémiologie et de Santé Publique, 2016

Objectif Notre etude avait pour objectif de decrire la consommation de soins et les couts associe... more Objectif Notre etude avait pour objectif de decrire la consommation de soins et les couts associes a la prise en charge de la rhinite allergique perannuelle (RAP) en France, qu’elle soit ou non associee a un asthme allergique concomitant. Methodes En utilisant les donnees issues des dossiers medicaux electroniques de medecins generalistes (« base disease analyzer », IMS Health), nous avons pu identifier deux cohortes de patients en 2010. Une premiere cohorte etait composee de patients atteints de RAP, sans avoir d’asthme associe, alors que la seconde cohorte incluait des patients atteints de RAP et d’asthme. Pour chaque patient, nous avons realise un chainage avec la base de donnees de l’Assurance maladie (le Sniiram), qui contient l’exhaustivite de la consommation de soins des patients, que ce soit en ville ou a l’hopital. Cette base de donnees contient egalement tous les couts de prise en charge rembourses par l’assurance maladie. La consommation de soins et les couts des patients inclus ont ete decrits entre 2011 et 2013. Dans chacune des cohortes, des analyses en sous-groupes ont ete realisees, selon la severite de la rhinite et le niveau de controle de l’asthme. Resultats Le cout annuel moyen d’un patient atteint de RAP sans asthme associe etait de 247€ en 2013. Ce montant variait avec la severite de la rhinite. En effet, le cout moyen des patients atteints de RAP legere (32,1 % de la cohorte) etait de 219€, alors que le cout moyen des patients atteints de RAP moderee (51,2 % de cohorte) etait de 272€ et celui des patients atteints de RAP severe (16,8 % de la cohorte) etait de 311€. Concernant les patients atteints de RAP et d’asthme, le cout annuel moyen variait de 420€ a 572€, selon le niveau de controle de l’asthme. Les traitements de l’asthme representaient 20 % des couts et les consultations medicales 35 %. Conclusion Cette etude innovante chainant les donnees de dossiers medicaux electroniques avec les donnees du Sniiram est une des premieres a avoir ete conduite en France et certainement en allergie. Cette etude a permis de recueillir des donnees valides sur la prise en charge de la RAP, associee ou non a de l’asthme, et les couts associes. Nous avons pu montrer une relation claire entre couts de prise en charge, severite de la rhinite et controle de l’asthme. L’amelioration du controle de l’asthme pour les patients atteints de RAP et d’asthme permettrait de diminuer le fardeau economique de la maladie.

Research paper thumbnail of Costs of perennial allergic rhinitis and allergic asthma increase with severity and poor disease control

Allergy, 2017

Perennial allergic rhinitis (PAR) represents a global and public health problem, due to its preva... more Perennial allergic rhinitis (PAR) represents a global and public health problem, due to its prevalence, morbidity, and impact on the quality of life. PAR is frequently associated to allergic asthma (AA). Costs of PAR with or without AA are poorly documented. Our study aimed to detail medical resource utilization (MRU) and related direct cost for PAR, with or without concomitant AA, in France. Using Electronic Health Records (EHRs), we identified in 2010 two cohorts of PAR patients, based on General Practitioners&#39; diagnoses and prescribing data, with and without concomitant AA. For each patient, the EHRs were linked to corresponding claims data with MRU and costs during years 2011 to 2013. Predefined sub-group analyses were performed according to severity of PAR and level of AA control. The median annual cost reimbursed by social security system for a patient with PAR and no AA was 159€ in 2013. This varied from 111€ to 188€ depending on PAR severity. For patients with PAR and concomitant AA, the median annual cost varied between 266€ and 375€, and drug treatment accounted for 42%-55% of the costs, depending on asthma control. This study linking diagnoses from EHRs to claims data collected valid information on PAR management, with or without concomitant AA, and on related costs. There was a clear increase of costs with severity of PAR and control of AA. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Future health care costs—do health care costs during the last year of life matter?

Health Policy, 2002

While some studies have shown a considerable effect of ageing upon future health care costs, othe... more While some studies have shown a considerable effect of ageing upon future health care costs, others indicate small or no effects. Moreover, studies have shown that age-related increases in health care costs in part can be explained by high costs in the last year of life. The aim of this study was to project future costs of hospital in-patient care and primary health care services in Denmark on the basis of demographic changes, both with and without account for the high costs in the last year of life. Costs were projected on the basis of a random 19% sample of the Danish population using the cohort-component method. The traditional projection method does not account for the high costs in the last year of life while the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;improved&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; method does. The Danish population was projected to increase by 8.2% during the period 1995-2020, and health care costs by 18.5% according to the traditional projection method and 15.1% according to the improved one. These results suggest that the high costs in the last year of life does matter in projections of future health care costs and should be taken into account. Furthermore, ageing per se seems to have considerable impact on future health care costs.

Research paper thumbnail of Patient preferences in allergy immunotherapy (AIT) in Germany - a discrete-choice-experiment

Health economics review, 2015

Allergic Rhinitis (AR) is a common disorder in Europe with Allergic Asthma (AA) as a frequent com... more Allergic Rhinitis (AR) is a common disorder in Europe with Allergic Asthma (AA) as a frequent comorbidity. Allergy immunotherapy (AIT) is the only causal therapy of AR and AA, and can be administered as subcutaneous injections at the physician or as sublingual drops or tablets at home. The usual treatment duration is 3 years. This study aimed to elicit patient preferences to identify the AIT administration mode preferred by patients. A discrete-choice-experiment (DCE) was developed to determine how people weight different treatment options using a paper-based questionnaire from June to September 2014, including 16 study centres. Main inclusion criteria: >18 years, grass, birch and/or house dust mite AR with moderate to severe symptoms, AIT-naïve and AIT-indicated. DCE-attributes were: Administration form, number and duration of physician visits, frequency of life-threatening anaphylactic shocks, local side-effects and co-payments. Two-hundred thirty-nine subjects participated, re...

Research paper thumbnail of Valuation of Chemical Related Health Impacts

Estimation of direct and indirect costs for asthma bronchiale, headache, contact allergy, lung ca... more Estimation of direct and indirect costs for asthma bronchiale, headache, contact allergy, lung cancer and skin cancer

Research paper thumbnail of Costs of Perennial Allergic Rhinitis And Asthma Increase with Level of Severity And Level of Disease Control

Research paper thumbnail of Comparison of allergy immunotherapy medication persistence with a sublingual immunotherapy tablet versus subcutaneous immunotherapy in Germany

Journal of Allergy and Clinical Immunology

Medication persistence and adherence in allergy immunotherapy (AIT) has been reported to be lower... more Medication persistence and adherence in allergy immunotherapy (AIT) has been reported to be lower in real life than in clinical studies, 1 with manufacturers' sales figures often indicating poorer adherence and persistence than postmarketing studies. 2,3 This might result from patients tending to be more compliant when their behavior is being recorded, which is commonly known as the Hawthorne effect. The low risk of anaphylaxis and serious adverse reactions with sublingual immunotherapy (SLIT) 4,5 has resulted in orodispersible SLIT-tablets being approved in Europe and the United States for self-administration provided that the first dose is tolerated under medical supervision. For many patients, self-administration of SLIT-tablets is an advantage over injection during subcutaneous immunotherapy (SCIT). However, dosing regimen and frequency of physician's office visits differ considerably between the 2 administration routes, and efficacy and safety profiles of individual products administered through each route vary widely. Because these factors have been reported to affect persistence and adherence, 6 we compared medication persistence and adherence with a SLIT-tablet versus SCIT products in patients with grass pollen allergy over a 3-year period from treatment initiation. This retrospective cohort study used prescription renewal rates for a 75,000 standardized quality units tablet (SQ-T), 2,800 BAU grass pollen SLIT-tablet, and 100 to 100,000 SQ-U/mL or 600 to 30,000 SQ1/mL suspension for subcutaneous injection from the German IMS Health Disease Analyzer database for the period of January 2006 to August 2014 to obtain an accurate picture of persistence and adherence in real life. More information about the products and database can be found in the Methods section in this article's

Research paper thumbnail of ChemInform Abstract: Effect of Ga Content on the Instantaneous Structure of Al (1-x) Ga x PO 4 Solid Solutions at High Temperature

ChemInform, 2009

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Research paper thumbnail of Assessment of enveloping distribution sampling to calculate relative free enthalpies of binding for eight netropsin-DNA duplex complexes in aqueous solution

Journal of Computational Chemistry, 2012

The performance of enveloping distribution sampling (EDS) simulations to estimate free enthalpy d... more The performance of enveloping distribution sampling (EDS) simulations to estimate free enthalpy differences associated with seven alchemical transformations of A-T into G-C base pairs at the netropsin binding site in the minor groove of a 13-base pair DNA duplex in aqueous solution is evaluated. It is demonstrated that sufficient sampling can be achieved with a two-state EDS Hamiltonian even for large perturbations such as the simultaneous transformation of up to three A-T into three G-C base pairs. The two parameters required to define the EDS reference state Hamiltonian are obtained automatically using a modified version of a scheme presented in earlier work. The sensitivity of the configurational sampling to a variation of these parameters is investigated in detail. Although for relatively small perturbations, that is, one base pair, the free enthalpy estimate depends only weakly on the EDS parameters, the sensitivity is stronger for the largest perturbation. Yet, EDS offers various convenient measures to evaluate the degree of sampling and thus the reliability of the free enthalpy estimate and appears to be an efficient alternative to the conventional thermodynamic integration methodology to obtain free energy differences for molecular systems.

Research paper thumbnail of Comparison of enveloping distribution sampling and thermodynamic integration to calculate binding free energies of phenylethanolamine N-methyltransferase inhibitors

The Journal of Chemical Physics, 2011

The relative binding free energy between two ligands to a specific protein can be obtained using ... more The relative binding free energy between two ligands to a specific protein can be obtained using various computational methods. The more accurate and also computationally more demanding techniques are the so-called free energy methods which use conformational sampling from molecular dynamics or Monte Carlo simulations to generate thermodynamic averages. Two such widely applied methods are the thermodynamic integration (TI) and the recently introduced enveloping distribution sampling (EDS) methods. In both cases relative binding free energies are obtained through the alchemical perturbations of one ligand into another in water and inside the binding pocket of the protein. TI requires many separate simulations and the specification of a pathway along which the system is perturbed from one ligand to another. Using the EDS approach, only a single automatically derived reference state enveloping both end states needs to be sampled. In addition, the choice of an optimal pathway in TI calculations is not trivial and a poor choice may lead to poor convergence along the pathway. Given this, EDS is expected to be a valuable and computationally efficient alternative to TI. In this study, the performances of these two methods are compared using the binding of ten tetrahydroisoquinoline derivatives to phenylethanolamine N-transferase as an example. The ligands involve a diverse set of functional groups leading to a wide range of free energy differences. In addition, two different schemes to determine automatically the EDS reference state parameters and two different topology approaches are compared.

Research paper thumbnail of Microtexture of Lamellar Structures in Al Heavily Deformed by Accumulative Roll-Bonding (ARB)

Materials Science Forum, 2002

ABSTRACT The microtexture of lamellar structures in a commercial purity Al deformed to high strai... more ABSTRACT The microtexture of lamellar structures in a commercial purity Al deformed to high strains (εvM=3.2-6.4) by accumulative roll-bonding was analyzed based on the local orientation measurements along the ND direction. Volumes between lamellar boundaries of random orientations was observed instead of volumes of rolling orientations observed in conventionally cold rolled aluminum. As a consequence, a distribution rather close to the Mackenzie distribution was obtained for the misorientation angles across the lamellar boundaries. The randomization of the crystallographic orientations in ARB was related to the introduction of a large redundant shear through the sample thickness, which may change the slip pattern from that which characterizes conventional rolling.

Research paper thumbnail of EBSD and TEM Characterization of Ultrafine Grained High Purity Aluminum Produced by Accumulative Roll-Bonding

Materials Science Forum, 2006

Research paper thumbnail of Structure and Strength of IF Steel After Large Strain Deformation

Microstructure and Texture in Steels, 2009

ABSTRACT Interstitial free (IF) steel with an ultrafine microstructure has been produced by three... more ABSTRACT Interstitial free (IF) steel with an ultrafine microstructure has been produced by three different routes: (i) cold rolling, (ii) accumulative roll-bonding (ARB) and (iii) martensitic transformation followed by cold rolling. The microstructure refines with increasing strain without saturation to a value of about 100 nm at an equivalent strain (εVM) of 8, which is the maximum strain investigated. At all strains a microscopic analysis by transmission electron microscopy (TEM) and electron backscatter diffraction (EBSD) shows that the microstructure is subdivided by dislocation boundaries and high-angle boundaries. For both cold rolled samples and ARB samples the flow stress increases as the boundary spacing decreases. For the finest structures this leads to a flow stress at room temperature in the range 900–1000 MPa. Finally structure-property relationships are discussed especially the effect of post-processing treatments by annealing and by low strain deformation.

Research paper thumbnail of Flow Stress Anisotropy - Effect of Microstructure and Texture in Aluminium and IF Steel

Materials Science Forum, 2005

Research paper thumbnail of Thermal Behavior of Nickel Deformed to Ultra-High Strain by High Pressure Torsion

Materials Science Forum

Polycrystalline Ni (99.5 %) has been deformed to an ultra-high strain of εvM=100 (εvM, von Mises ... more Polycrystalline Ni (99.5 %) has been deformed to an ultra-high strain of εvM=100 (εvM, von Mises strain) by high pressure torsion (HPT) at room temperature. The deformed sample is nanostructured with an average boundary spacing of 90 nm, a high density of dislocations of >1015m-2 and a large fraction of high angle boundaries (>15o) 68% as determined by transmission electron microscopy and 80% as determined by electron backscatter diffraction. The thermal behavior of this nanostructued sample has been investigated by isochronal annealing for 1h at temperatures from 100 to 600°C, and the evolution of the structural parameters (boundary spacing, average boundary misorientation angle and the fraction of high angle boundaries), crystallographic texture and hardness have been determined. Based on microstructural parameters the stored energy in the deformed state has been estimated to be 24 MPa. The isochronal annealing leads to a hardness drop in three stages: a relatively small dec...

Research paper thumbnail of POB2 Cost-Effectiveness of Treating Cardiometabolic Patients with Rimonabant (Acomplia®) in a Danish Setting

Value in Health, 2006

The Centre for Epidemiologic Studies Depression Scale (CES-D) is one of the most widely used depr... more The Centre for Epidemiologic Studies Depression Scale (CES-D) is one of the most widely used depression questionnaires; it has been translated into many languages and is frequently used in multinational studies. This research sought to examine whether different language versions of the CES-D were affected by country (cultural)-related differential item functioning (DIF). METHODS: CES-D data were available from depressed patients in the UK (n = 177), US (n = 100), Germany (n = 78) and France (n = 124). The data were pooled and applied to the one-parameter Rasch item-response model for analysis and to identify cross-cultural DIF. RESULTS: The UK and German CES-D did not fit the Rasch model (Chi 2 p < 0.001) suggesting that summation of item scores in these countries is not justified. Four items in the UK (including 2 of the 4 positively worded items) and 2 items in Germany misfitted. The US CES-D exhibited borderline overall misfit to the Rasch model (Chi 2 p < 0.01) with no item misfit and the French data fitted the Rasch model (with 1 item misfitting). The pooled data from the 4 countries did not fit the Rasch model (Chi 2 p < 0.001) and DIF was observed in 7 items (including all of the positively worded items). DIF between the US and UK (5 items), the US and Germany (5 items) and US and France (4 items) was greater than that between UK and Germany (1 item), the UK and France (2 items) and Germany and France (3 items). CONCLUSIONS: CES-D data from these countries cannot be pooled justifiably without first accounting for DIF by culture. DIF appeared to be greater between the US and Europe than within European countries. In addition, the use of both positively and negatively worded items in a questionnaire may introduce bias.

Research paper thumbnail of Burden of allergic respiratory disease: a systematic review

Clinical and Molecular Allergy, 2016

This meta-analysis compared the health-related quality of life (HRQL) of patients with allergic r... more This meta-analysis compared the health-related quality of life (HRQL) of patients with allergic rhinitis (AR) and/or allergic asthma (AA) caused by perennial house dust mite (HDM) versus AR and/or AA caused by seasonal pollen allergy. Following a systematic search, the identified studies used the disease-specific rhinitis quality of life questionnaire or generic instruments (SF-36 and SF-12). Summary estimates obtained by meta-analysis showed that HRQL in patients with perennial HDM allergy was significantly worse than that of patients with seasonal pollen allergy, when measured by both disease-specific and generic HRQL instruments, and was reflected by an impact on both physical and mental health. A systematic review of cost data on AR and AA in selected European countries demonstrated that the majority of the economic burden was indirectly caused by high levels of absenteeism and presenteeism; there was little or no evidence of increasing or decreasing cost trends. Increased awareness of the detrimental effects of AR and/or AA on patients' HRQL and its considerable cost burden might encourage early diagnosis and treatment, in order to minimize the disease burden and ensure beneficial and cost-effective outcomes.

Research paper thumbnail of Systematic Literature Review Assessing Data on the Burden of Allergic Rhinitis from a Cost and Quality of Life Perspective

Value in Health, 2014

patients recruited through an agency, Twitter and Asthma UK's website. Participants had experienc... more patients recruited through an agency, Twitter and Asthma UK's website. Participants had experienced a NCS and a SS < 3 years previously. Medication history and Asthma Control Test (ACT) scores were collected. Interviews were audio-recorded, and thematically analysed. Results: The sample was 69% Caucasian, with six males and seven females, and a mean age= 47. Most were working full time or retired, and had many years since asthma diagnosis (mean= 22 years). NCS were related to reliever (n= 7), preventer (n= 4) or both (n= 2) medications with the most common NCS from one brand to another (n= 4). Participants reported negative feelings, difficulty using the medication and ineffective symptom control. Most participants used the NCS medication < 6 months (range < 24 hours-2 years). The SS for most was a return to their original pre-NCS medication (n= 11). Although most found getting their SS straightforward, this required at least two HCP visits for half the sample, and took up to two months to obtain. Most expected symptoms to improve following the SS but nine participants still had sub-optimal ACT scores. Lasting impacts included damaged relationships with HCPs, strong views about NCS and concern about NCS reoccurrence. ConClusions: Failure to inform and involve patients in medication changes can have lasting impacts. It is important to note that NCS can incur costs associated with rejection of medicines and additional consultations, thus negating any attempt at cost saving.

Research paper thumbnail of Alder, død og sundhedsomkostninger: En analyse af omkostninger ved forbrug af sygehusydelser som funktion af alder, køn og afstand til død samt prediktion af de fremtidige sundhedsomkostninger

Research paper thumbnail of The moderating role of allergy immunotherapy in asthma progression. Results of a population‐based cohort study

Allergy, 2019

Allergic asthma causes substantial morbidity and constitutes a public health burden, which increa... more Allergic asthma causes substantial morbidity and constitutes a public health burden, which increases with asthma severity. There is evidence that allergy immunotherapy (AIT) prevents the progression of allergic rhinitis (AR) to asthma. However, evidence is missing on the potential of AIT to prevent progression from milder to more severe asthma.

Research paper thumbnail of Les coûts de la rhinite et de l’asthme augmentent avec le niveau de sévérité et de contrôle

Revue d'Épidémiologie et de Santé Publique, 2016

Objectif Notre etude avait pour objectif de decrire la consommation de soins et les couts associe... more Objectif Notre etude avait pour objectif de decrire la consommation de soins et les couts associes a la prise en charge de la rhinite allergique perannuelle (RAP) en France, qu’elle soit ou non associee a un asthme allergique concomitant. Methodes En utilisant les donnees issues des dossiers medicaux electroniques de medecins generalistes (« base disease analyzer », IMS Health), nous avons pu identifier deux cohortes de patients en 2010. Une premiere cohorte etait composee de patients atteints de RAP, sans avoir d’asthme associe, alors que la seconde cohorte incluait des patients atteints de RAP et d’asthme. Pour chaque patient, nous avons realise un chainage avec la base de donnees de l’Assurance maladie (le Sniiram), qui contient l’exhaustivite de la consommation de soins des patients, que ce soit en ville ou a l’hopital. Cette base de donnees contient egalement tous les couts de prise en charge rembourses par l’assurance maladie. La consommation de soins et les couts des patients inclus ont ete decrits entre 2011 et 2013. Dans chacune des cohortes, des analyses en sous-groupes ont ete realisees, selon la severite de la rhinite et le niveau de controle de l’asthme. Resultats Le cout annuel moyen d’un patient atteint de RAP sans asthme associe etait de 247€ en 2013. Ce montant variait avec la severite de la rhinite. En effet, le cout moyen des patients atteints de RAP legere (32,1 % de la cohorte) etait de 219€, alors que le cout moyen des patients atteints de RAP moderee (51,2 % de cohorte) etait de 272€ et celui des patients atteints de RAP severe (16,8 % de la cohorte) etait de 311€. Concernant les patients atteints de RAP et d’asthme, le cout annuel moyen variait de 420€ a 572€, selon le niveau de controle de l’asthme. Les traitements de l’asthme representaient 20 % des couts et les consultations medicales 35 %. Conclusion Cette etude innovante chainant les donnees de dossiers medicaux electroniques avec les donnees du Sniiram est une des premieres a avoir ete conduite en France et certainement en allergie. Cette etude a permis de recueillir des donnees valides sur la prise en charge de la RAP, associee ou non a de l’asthme, et les couts associes. Nous avons pu montrer une relation claire entre couts de prise en charge, severite de la rhinite et controle de l’asthme. L’amelioration du controle de l’asthme pour les patients atteints de RAP et d’asthme permettrait de diminuer le fardeau economique de la maladie.

Research paper thumbnail of Costs of perennial allergic rhinitis and allergic asthma increase with severity and poor disease control

Allergy, 2017

Perennial allergic rhinitis (PAR) represents a global and public health problem, due to its preva... more Perennial allergic rhinitis (PAR) represents a global and public health problem, due to its prevalence, morbidity, and impact on the quality of life. PAR is frequently associated to allergic asthma (AA). Costs of PAR with or without AA are poorly documented. Our study aimed to detail medical resource utilization (MRU) and related direct cost for PAR, with or without concomitant AA, in France. Using Electronic Health Records (EHRs), we identified in 2010 two cohorts of PAR patients, based on General Practitioners&#39; diagnoses and prescribing data, with and without concomitant AA. For each patient, the EHRs were linked to corresponding claims data with MRU and costs during years 2011 to 2013. Predefined sub-group analyses were performed according to severity of PAR and level of AA control. The median annual cost reimbursed by social security system for a patient with PAR and no AA was 159€ in 2013. This varied from 111€ to 188€ depending on PAR severity. For patients with PAR and concomitant AA, the median annual cost varied between 266€ and 375€, and drug treatment accounted for 42%-55% of the costs, depending on asthma control. This study linking diagnoses from EHRs to claims data collected valid information on PAR management, with or without concomitant AA, and on related costs. There was a clear increase of costs with severity of PAR and control of AA. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Future health care costs—do health care costs during the last year of life matter?

Health Policy, 2002

While some studies have shown a considerable effect of ageing upon future health care costs, othe... more While some studies have shown a considerable effect of ageing upon future health care costs, others indicate small or no effects. Moreover, studies have shown that age-related increases in health care costs in part can be explained by high costs in the last year of life. The aim of this study was to project future costs of hospital in-patient care and primary health care services in Denmark on the basis of demographic changes, both with and without account for the high costs in the last year of life. Costs were projected on the basis of a random 19% sample of the Danish population using the cohort-component method. The traditional projection method does not account for the high costs in the last year of life while the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;improved&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; method does. The Danish population was projected to increase by 8.2% during the period 1995-2020, and health care costs by 18.5% according to the traditional projection method and 15.1% according to the improved one. These results suggest that the high costs in the last year of life does matter in projections of future health care costs and should be taken into account. Furthermore, ageing per se seems to have considerable impact on future health care costs.

Research paper thumbnail of Patient preferences in allergy immunotherapy (AIT) in Germany - a discrete-choice-experiment

Health economics review, 2015

Allergic Rhinitis (AR) is a common disorder in Europe with Allergic Asthma (AA) as a frequent com... more Allergic Rhinitis (AR) is a common disorder in Europe with Allergic Asthma (AA) as a frequent comorbidity. Allergy immunotherapy (AIT) is the only causal therapy of AR and AA, and can be administered as subcutaneous injections at the physician or as sublingual drops or tablets at home. The usual treatment duration is 3 years. This study aimed to elicit patient preferences to identify the AIT administration mode preferred by patients. A discrete-choice-experiment (DCE) was developed to determine how people weight different treatment options using a paper-based questionnaire from June to September 2014, including 16 study centres. Main inclusion criteria: >18 years, grass, birch and/or house dust mite AR with moderate to severe symptoms, AIT-naïve and AIT-indicated. DCE-attributes were: Administration form, number and duration of physician visits, frequency of life-threatening anaphylactic shocks, local side-effects and co-payments. Two-hundred thirty-nine subjects participated, re...

Research paper thumbnail of Valuation of Chemical Related Health Impacts

Estimation of direct and indirect costs for asthma bronchiale, headache, contact allergy, lung ca... more Estimation of direct and indirect costs for asthma bronchiale, headache, contact allergy, lung cancer and skin cancer

Research paper thumbnail of Costs of Perennial Allergic Rhinitis And Asthma Increase with Level of Severity And Level of Disease Control

Research paper thumbnail of Comparison of allergy immunotherapy medication persistence with a sublingual immunotherapy tablet versus subcutaneous immunotherapy in Germany

Journal of Allergy and Clinical Immunology

Medication persistence and adherence in allergy immunotherapy (AIT) has been reported to be lower... more Medication persistence and adherence in allergy immunotherapy (AIT) has been reported to be lower in real life than in clinical studies, 1 with manufacturers' sales figures often indicating poorer adherence and persistence than postmarketing studies. 2,3 This might result from patients tending to be more compliant when their behavior is being recorded, which is commonly known as the Hawthorne effect. The low risk of anaphylaxis and serious adverse reactions with sublingual immunotherapy (SLIT) 4,5 has resulted in orodispersible SLIT-tablets being approved in Europe and the United States for self-administration provided that the first dose is tolerated under medical supervision. For many patients, self-administration of SLIT-tablets is an advantage over injection during subcutaneous immunotherapy (SCIT). However, dosing regimen and frequency of physician's office visits differ considerably between the 2 administration routes, and efficacy and safety profiles of individual products administered through each route vary widely. Because these factors have been reported to affect persistence and adherence, 6 we compared medication persistence and adherence with a SLIT-tablet versus SCIT products in patients with grass pollen allergy over a 3-year period from treatment initiation. This retrospective cohort study used prescription renewal rates for a 75,000 standardized quality units tablet (SQ-T), 2,800 BAU grass pollen SLIT-tablet, and 100 to 100,000 SQ-U/mL or 600 to 30,000 SQ1/mL suspension for subcutaneous injection from the German IMS Health Disease Analyzer database for the period of January 2006 to August 2014 to obtain an accurate picture of persistence and adherence in real life. More information about the products and database can be found in the Methods section in this article's

Research paper thumbnail of ChemInform Abstract: Effect of Ga Content on the Instantaneous Structure of Al (1-x) Ga x PO 4 Solid Solutions at High Temperature

ChemInform, 2009

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Research paper thumbnail of Assessment of enveloping distribution sampling to calculate relative free enthalpies of binding for eight netropsin-DNA duplex complexes in aqueous solution

Journal of Computational Chemistry, 2012

The performance of enveloping distribution sampling (EDS) simulations to estimate free enthalpy d... more The performance of enveloping distribution sampling (EDS) simulations to estimate free enthalpy differences associated with seven alchemical transformations of A-T into G-C base pairs at the netropsin binding site in the minor groove of a 13-base pair DNA duplex in aqueous solution is evaluated. It is demonstrated that sufficient sampling can be achieved with a two-state EDS Hamiltonian even for large perturbations such as the simultaneous transformation of up to three A-T into three G-C base pairs. The two parameters required to define the EDS reference state Hamiltonian are obtained automatically using a modified version of a scheme presented in earlier work. The sensitivity of the configurational sampling to a variation of these parameters is investigated in detail. Although for relatively small perturbations, that is, one base pair, the free enthalpy estimate depends only weakly on the EDS parameters, the sensitivity is stronger for the largest perturbation. Yet, EDS offers various convenient measures to evaluate the degree of sampling and thus the reliability of the free enthalpy estimate and appears to be an efficient alternative to the conventional thermodynamic integration methodology to obtain free energy differences for molecular systems.

Research paper thumbnail of Comparison of enveloping distribution sampling and thermodynamic integration to calculate binding free energies of phenylethanolamine N-methyltransferase inhibitors

The Journal of Chemical Physics, 2011

The relative binding free energy between two ligands to a specific protein can be obtained using ... more The relative binding free energy between two ligands to a specific protein can be obtained using various computational methods. The more accurate and also computationally more demanding techniques are the so-called free energy methods which use conformational sampling from molecular dynamics or Monte Carlo simulations to generate thermodynamic averages. Two such widely applied methods are the thermodynamic integration (TI) and the recently introduced enveloping distribution sampling (EDS) methods. In both cases relative binding free energies are obtained through the alchemical perturbations of one ligand into another in water and inside the binding pocket of the protein. TI requires many separate simulations and the specification of a pathway along which the system is perturbed from one ligand to another. Using the EDS approach, only a single automatically derived reference state enveloping both end states needs to be sampled. In addition, the choice of an optimal pathway in TI calculations is not trivial and a poor choice may lead to poor convergence along the pathway. Given this, EDS is expected to be a valuable and computationally efficient alternative to TI. In this study, the performances of these two methods are compared using the binding of ten tetrahydroisoquinoline derivatives to phenylethanolamine N-transferase as an example. The ligands involve a diverse set of functional groups leading to a wide range of free energy differences. In addition, two different schemes to determine automatically the EDS reference state parameters and two different topology approaches are compared.

Research paper thumbnail of Microtexture of Lamellar Structures in Al Heavily Deformed by Accumulative Roll-Bonding (ARB)

Materials Science Forum, 2002

ABSTRACT The microtexture of lamellar structures in a commercial purity Al deformed to high strai... more ABSTRACT The microtexture of lamellar structures in a commercial purity Al deformed to high strains (εvM=3.2-6.4) by accumulative roll-bonding was analyzed based on the local orientation measurements along the ND direction. Volumes between lamellar boundaries of random orientations was observed instead of volumes of rolling orientations observed in conventionally cold rolled aluminum. As a consequence, a distribution rather close to the Mackenzie distribution was obtained for the misorientation angles across the lamellar boundaries. The randomization of the crystallographic orientations in ARB was related to the introduction of a large redundant shear through the sample thickness, which may change the slip pattern from that which characterizes conventional rolling.

Research paper thumbnail of EBSD and TEM Characterization of Ultrafine Grained High Purity Aluminum Produced by Accumulative Roll-Bonding

Materials Science Forum, 2006

Research paper thumbnail of Structure and Strength of IF Steel After Large Strain Deformation

Microstructure and Texture in Steels, 2009

ABSTRACT Interstitial free (IF) steel with an ultrafine microstructure has been produced by three... more ABSTRACT Interstitial free (IF) steel with an ultrafine microstructure has been produced by three different routes: (i) cold rolling, (ii) accumulative roll-bonding (ARB) and (iii) martensitic transformation followed by cold rolling. The microstructure refines with increasing strain without saturation to a value of about 100 nm at an equivalent strain (εVM) of 8, which is the maximum strain investigated. At all strains a microscopic analysis by transmission electron microscopy (TEM) and electron backscatter diffraction (EBSD) shows that the microstructure is subdivided by dislocation boundaries and high-angle boundaries. For both cold rolled samples and ARB samples the flow stress increases as the boundary spacing decreases. For the finest structures this leads to a flow stress at room temperature in the range 900–1000 MPa. Finally structure-property relationships are discussed especially the effect of post-processing treatments by annealing and by low strain deformation.

Research paper thumbnail of Flow Stress Anisotropy - Effect of Microstructure and Texture in Aluminium and IF Steel

Materials Science Forum, 2005

Research paper thumbnail of Thermal Behavior of Nickel Deformed to Ultra-High Strain by High Pressure Torsion

Materials Science Forum

Polycrystalline Ni (99.5 %) has been deformed to an ultra-high strain of εvM=100 (εvM, von Mises ... more Polycrystalline Ni (99.5 %) has been deformed to an ultra-high strain of εvM=100 (εvM, von Mises strain) by high pressure torsion (HPT) at room temperature. The deformed sample is nanostructured with an average boundary spacing of 90 nm, a high density of dislocations of >1015m-2 and a large fraction of high angle boundaries (>15o) 68% as determined by transmission electron microscopy and 80% as determined by electron backscatter diffraction. The thermal behavior of this nanostructued sample has been investigated by isochronal annealing for 1h at temperatures from 100 to 600°C, and the evolution of the structural parameters (boundary spacing, average boundary misorientation angle and the fraction of high angle boundaries), crystallographic texture and hardness have been determined. Based on microstructural parameters the stored energy in the deformed state has been estimated to be 24 MPa. The isochronal annealing leads to a hardness drop in three stages: a relatively small dec...