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Studies suggest that hepatitis C virus (HCV) micro-elimination is feasible among men who have sex with men (MSM) living with human immunodeficiency virus (HIV), through treatment-as-prevention and interventions aimed at reducing risk behaviours. However, their economic impact is poorly understood. The aim of this study was to assess the cost-effectiveness of HCV screening and risk reduction strategies in France. A compartmental deterministic mathematical model was developed to describe HCV disease transmission and progression among MSM living with HIV in France. We evaluated different combinations of HCV screening frequency (every 12, 6 or 3 months) and risk reduction strategies (targeting only high-risk or all MSM) from 2021 onwards. The model simulated the number of HCV infections, life-expectancy (LYs), quality-adjusted life-expectancy (QALYs), lifetime costs and incremental cost-effectiveness ratio (ICER) over a lifetime horizon (leading to an end of the simulation in 2065). All strategies increased QALYs, compared with current practices, that is yearly HCV screening, with no risk reduction. A behavioural intervention resulting in a 20% risk reduction in the high-risk group, together with yearly screening, was the least expensive strategy, and, therefore, cost-saving compared to current practices. The ICER per QALY gained for the strategy combining risk reduction for the high-risk group with 6-month HCV screening, compared to risk reduction with yearly screening, was €61,389. It also prevented 398 new HCV infections between 2021 and 2065, with a cost per infection averted of €37,790. All other strategies were dominated (more expensive and less effective than some other available alternative) or not cost-effective (ICER per QALY gained > €100,000). In the French context, current HCV screening practices without risk reduction among MSM living with HIV cannot be justified on economic grounds. Risk reduction interventions targeted to high-risk individuals-alongside screening either once or twice a year-could be cost-effective depending on the policymaker's willingness-to-pay.

Objectives Health information technology (HIT) can help coordinate health and social actors involved in patients’ pathways. We assess five regional HIT-based programmes (‘Territoires de Soins Numériques’ or TSN) introduced in France, covering the period 2012–2018. Methods This was a quasi-experimental controlled before/after mixed design. We used data from the French National Health Insurance database, qualitative and quantitative surveys, and information extracted from project documents and databases. We assessed the impact of TSN using four main impact indicators: emergency room visits, unplanned hospitalizations, avoidable hospitalizations and rehospitalization within 30 days. We also collected qualitative and secondary quantitative data covering perceived needs, knowledge, use, satisfaction, adoption and understanding of projects, pathway experience, impact on professional practices and appropriateness of hospitalizations. Results TSN implemented a heterogeneous mix of HIT. Implementation was slower than expected and was not well documented. Users perceived the HIT as having a positive but weak overall effect. There were no significant differences in trends for the main impact indicators, nor on the appropriateness of hospitalizations, but favourable trends on secondary polypharmacy indicators. Conclusions If similar innovations take place in future, they should be based on a logical framework that defines causal, measurable links between services provided and expected impacts.

Background Communities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility. Methods This study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states—Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars. Results State-level average and median start-up cost (representing 8–10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost. Conclusion We identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.

ObjectiveSince the early 2000s, there has been an epidemic of HCV occurring among men who have sex with men (MSM) living with HIV, mainly associated with high-risk sexual and drug-related behaviours. Early HCV diagnosis and treatment, and behavioural risk-reduction, may be effective to eliminate HCV among MSM living with HIV.DesignWe developed a deterministic dynamic compartmental model to simulate the impact of test-and-treat and risk-reduction strategies on HCV epidemic (particularly on incidence and prevalence) among MSM living with HIV in France. We accounted for HIV and HCV cascades of care, HCV natural history and heterogeneity in HCV risk behaviours. The model was calibrated to primary HCV incidence observed between 2014 and 2017 among MSM living with HIV in care (ANRS CO4-French hospital database on HIV (FHDH)).ResultsWith current French practices (annual HCV screening and immediate treatment), total HCV incidence would fall by 70%, from 0.82/100 person-years in 2015 to 0.24/100 person-years in 2030. It would decrease to 0.19/100 person-years in 2030 with more frequent screening and to 0.19 (0.12)/100 person-years in 2030 with a 20% (50%) risk-reduction. When combining screening every 3 months with a 50% risk-reduction, HCV incidence would be 0.11/100 person-years in 2030, allowing to get close to the WHO target (90% reduction from 2015 to 2030). Similarly, HCV prevalence would decrease from 2.79% in 2015 to 0.48% in 2030 (vs 0.71% with current practices).ConclusionCombining test-and-treat and risk-reduction strategies could have a marked impact on the HCV epidemic, paving the way to HCV elimination among MSM living with HIV.

There is little knowledge about French students’ access and recourse to health care. This observation raises the issue of health care utilization, especially among those facing economic difficulties, as they may renounce care. Using data from the i-Share (internet-based students health research enterprise) study, this article aims to examine the factors associated with self-assessed unmet healthcare needs for financial reasons among French university students. We focused on three types of care: medical doctor consultations (either general practitioners or specialists), dentist consultations, and optical care. Our findings suggest the existence of marked inequalities in the access to healthcare services among French students. The analyses show that older students are more likely to report unmet need for financial reasons. We also observed that college students’ renouncement of health care for financial reasons is associated with a set of variables describing their material and socioeconomic situation (e.g., type of accommodation, job status, parental financial support, whether they receive a grant). These results encourage an assessment of the potential medium- and long-term impact of these difficulties in accessing care. They also suggest the need for adapted public policies in order to improve students’ access to services and complementary health insurance. JEL codes: I14, I13

Nos connaissances sur l’accès et le recours aux soins des étudiants en France sont très parcellaires, alors que la population étudiante est confrontée pour une partie d’entre elle à des situations de précarité économique. A partir de l’exploitation des données de l’étude i-Share ( Internet-based students health research enterprise ) cet article propose d’analyser les déterminants du renoncement aux soins pour raisons financières des étudiants français. Trois types de soins sont considérés : la consultation d’un médecin (généraliste ou spécialiste), celle d’un dentiste et l’achat de lunettes. Les résultats sont cohérents avec ceux de la littérature et suggèrent l’existence d’inégalités marquées d’accès aux soins au sein de la population étudiante. Les analyses réalisées montrent que l’avancée en âge des étudiants est liée à une plus forte probabilité de renoncer à des soins pour raisons financières. Elles mettent également en évidence que le renoncement financier est lié à un ensemble de variables caractérisant la situation matérielle, sociale et financière des étudiants (type de logement, activité rémunérée, aides financière de la famille, statut de boursier, etc.) Ces résultats invitent à évaluer l’impact à moyen et long terme de ces difficultés d’accès aux soins ainsi qu’à suggérer des politiques publiques adaptées, notamment en améliorant le recours des étudiants à leurs droits et à l’obtention d’une complémentaire santé. Classification JEL : I14, I13 There is little knowledge about French students’ access to health care. This observation raises the issue of health care utilization, especially among those facing economic difficulties as they could renounce to some care. Using data from the i-Share ( Internet-based students health research enterprise ) study, this article aims to examine factors associated with self-assessed unmet healthcare needs for financial reasons among university students. We focused on three types of care : medical doctor consultations (either generalist or specialist), dentist consultations and optical care. Our findings suggest the existence of strong inequalities in access to healthcare services among French students. The analyses show that older students are more likely to report unmet need for financial reasons. We also observed that college students’ financial unmet need is associated with a set of variables describing their material and socioeconomic situation ( e.g. type of accommodation, job status, receiving social grants, parental financial support). These results encourage to assess the potential long term impact of such economic difficulties to access care. They also suggest the need for adapted public policies in order to improve students’ access to services and complementary health insurance. Classification JEL : I14, I13