Economic and disease burden of RSV-associated hospitalizations in young children in France, from 2010 through 2018

Background Respiratory syncytial virus (RSV) is the main cause of infant and child hospitalizations. The study objective is to estimate the RSV-associated hospitalizations and economic burden in young children in France to inform future preventive strategies. Methods We conducted a retrospective analysis of RSV-associated hospitalizations data from the French Hospital database (PMSI-MCO) which covers the entire French population. All children aged < 5 years hospitalized with RSV ICD-10 codes (J210, J219, J45, J121, J205, R062) from 2010 to 2018, were included. Descriptive analyses were conducted by RSV seasons (Oct to March), by respiratory years (July to June) and per age groups. Results On average 45,225 RSV-associated hospitalizations (range: 43,715 – 54,616) per season was reported in France, 69% among children < 1 year old. This represents 28% of all-cause hospitalizations that occurred among children < 1 year old, and less than 10% of all-cause hospitalizations in older children. Number of RSV-associated hospitalizations were similar for infants born during (Oct-March) or outside (April–September) their first RSV season. The highest risk being reported for infants born from September through November. The associated hospitalization cost increased between 2010 - 11 and 2017–18, from €93.2 million to €124.1 million, respectively, and infants < 1 year old represented 80% of the economic burden. Conclusion RSV is an important cause of child hospitalization in France. The burden on healthcare system is mainly driven by < 1 year olds, and preventive strategies should be implemented before the first RSV season.

Impact of test-and-treat and risk reduction strategies on HCV transmission among MSM living with HIV in France: a modelling approach

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.

Is the Risk of Myocardial Infarction in People With Human Immunodeficiency Virus (HIV) Associated With Atazanavir or Darunavir? A Nested Case-Control Study Within the French Hospital Database on HIV

Background The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) study has reported an increased risk of cardiovascular diseases in people with human immunodeficiency virus who were exposed to darunavir (DRV) but not to atazanavir (ATV). Our objective was to evaluate associations between ATV or DRV exposures and the risk of myocardial infarction (MI) in a nested case-control study within ANRS-CO4 French Hospital Database on HIV (FHDH). Methods Cases were individuals who had a first validated MI between 2006 and 2012. Up to 5 controls were selected at random with replacement among individuals with no history of MI, followed at the time of MI diagnosis, and matched for age and sex. Conditional logistic regression models were used to adjust for potential confounders (MI risk factors and HIV-related parameters) and for cumulative exposure to each antiretroviral drug (ARV). Results Overall, 408 MI cases and 1250 controls were included: 109 (27%) cases and 288 (23%) controls had been exposed to ATV, and 41 (10%) cases and 107 (9%) controls had been exposed to DRV. There was no significant association between exposure to ATV (adjusted odds ratio [OR] = 1.54; 95% confidence interval [CI], .87–2.73) or DRV (adjusted OR = 0.51; 95% CI, .11–2.32) and the risk of MI. Conclusions In FHDH, exposures to ATV or to DRV were not significantly associated with the risk of MI, adjusting for complete ARV history, contrary to the analysis in DAD.

Validation of Hemolytic Anemia Codes in the French Hospital Database

Introduction: Hemolytic anemia is a group of rare diseases. National databases are useful data sources to assess the epidemiology and the management of such diseases. The French national health database covers the entire French population (66 million inhabitants). It links sociodemographic data, out-hospital data including dispensing data and hospital data. As a consequence, this database is very useful for population-based studies on rare diseases. For instance, it has been used for epidemiological and pharmacoepidemiological studies on immune thrombocytopenia. Diseases are identified using the national hospital database (named PMSI) that contains discharge diagnoses for all hospital stays in all private and public hospitals in France. This study was aimed at assessing the positive predictive value (PPV) of hemolytic anemia diagnoses in the French hospital database. Methods: In the PMSI database, every hospital stay contains one primary diagnosis, and possibly one related and several associated diagnoses. They are coded using the International Classification of Diseases, 10th revision (ICD-10) by the physician in charge of the patient or trained nurses from the medical chart. We selected all hospital stays at Toulouse University Hospital, South of France (2860 beds) with a diagnosis of hemolytic anemia (D55.0-D59.9 ICD-10 codes) between January 2017 and December 2017. Medical charts and biological data were reviewed. Hemolytic anemia was defined by anemia with high reticulocyte count (&gt;150 x 109/L), plus at least two of the three following signs of hemolysis: low serum haptoglobin level, hyperbilirubinemia and elevated serum lactate dehydrogenase level. PPVs and their 95% confidence intervals (CI) were calculated by categories of hemolytic anemia: autoimmune hemolytic anemia (AIHA; D59.1 ICD-10 code), enzyme deficiency (D55.0-D55.9 ICD-10 codes), hereditary spherocytosis (D58.0 ICD-10 code) and hemoglobinopathy (D56.0-D57.9 and D58.2 ICD-10 codes). AIHA was defined by positive direct antiglobulin test (DAT); enzyme deficiency was defined by low enzyme dosage and negative DAT; hereditary spherocytosis was defined by negative DAT and either positive flow cytometry osmotic fragility test either positive eosin-5'-maleimide binding test; hemoglobinopathy was defined by compatible blood count and positive hemoglobin electrophoresis. Results: During the study period, 54 patients had at least one hospital stay with a discharge diagnosis of AIHA, 12 with enzyme deficiency, 10 with hereditary spherocytosis, 92 with thalassemia and 285 with sickle cell disease. We further excluded 13 patients due to missing data, precluding disease classification. AIHA was confirmed in 49/53 patients; the PPV was 92.5% (95% CI: 85.3%-99.6%). Enzyme deficiency was confirmed in 8/12 patients (including G6PD deficiency: 7/9) and hereditary spherocytosis in 10/10 patients. Thalassemia was confirmed in 72/83 patients; the PPV was 86.7% (95% CI: 79.5%-94.0%); however, the code of thalassemia type was not adequately coded in most cases (PPV&lt;30%). Sickle cell disease was confirmed in 279/284 patients; the PPV was 98.2% (95% CI: 96.7%-99.8%). Conclusions: Overall, this study confirms high PPV values for hemolytic anemia discharge diagnoses recorded in the French hospital database, allowing epidemiological studies using this source of data. Disclosures Moulis: CSL Behring: Research Funding; Amgen pharma: Research Funding, Speakers Bureau; Novartis pharma: Research Funding, Speakers Bureau.