La science économique au service de la société
Setti Rais Ali

Setti Rais Ali

Postdoc

Chaire hospinnomics – Adresse postale : Hospinnomics - AP-HP, 1, parvis Notre-Dame 75004 Paris

  • Comportements individuels
  • Santé

Publications

PSE Working Papers Serie

 

Setti Rais Ali, Sandy Tubeuf. Seuil d'acceptabilité des technologies de santé : quel retour d'expérience 20 ans après ?. PSE Working Paper n°2018-20. 2018. 

 

Le National Institute for Health and Care Excellence (NICE) britannique est chargé de définir les recommandations sur les traitements et les soins disponibles au sein du panier de biens et services dans National Health Service (NHS) avec un double objectif d’excellence clinique et d’équilibre budgétaire. Dans le cadre de l’évaluation d’une technologie de santé, les gains de santé et les coûts induits sont mis en regard par le calcul d’un ratio incrémental coût-efficacité (Incremental Cost-Effectiveness Ratio, ICER) exprimant un coût par année de vie gagnée pondérée par la qualité de vie (Quality Adjusted Life Years, QALY). La valeur de l’ICER est alors confrontée au seuil d’acceptabilité ou de coût-efficacité des technologies de santé préalablement défini par le NICE depuis 2000. Ce seuil se situe entre £20,000 et £30,000 par QALY; en deçà de cet intervalle, la technologie de santé est considérée coût efficace et au-delà de £30,000 par QALY, le nouveau traitement est jugé trop coûteux pour le gain attendu en santé. L’objet de cet article est d’offrir une discussion critique sur les fondements méthodologiques du seuil d’acceptabilité des technologies de santé et de son utilisation courante par le NICE, en mettant notamment en évidence les écartements au modèle de référence ainsi que les problématiques d’équité pour les patients du NHS anglais.

 

Setti Rais Ali, Paul Dourgnon, Lise Rochaix. Social Capital or Education: What Matters Most to Cut Time to Diagnosis?. PSE Working Papers n°2018-01. 2018.

 

Time to diagnosis, defined as the time span from first symptoms to final diagnosis, has received little if no attention, although it is perceived as highly variable across conditions, patients and countries and as a key determinant of health prognoses and outcomes. In this paper, we offer one of the first measures of time to diagnosis for four chronic conditions (bipolar trouble, Crohn disease, multiple sclerosis and psoriasis), and analyze the role played by patients’ education and social networks in explaining time to diagnosis. Adopting a patient's perspective, we use self-reported data from an online open access questionnaire administered to a large French social network of patients with chronic conditions. Duration models are used to explain variations in time to diagnosis. Our findings suggest that social participation and social support indeed reduce the probability of experiencing longer time spans to diagnosis. But contrary to expectations, higher levels of education have the reverse effect. We further analyze these results by identifying differences in patients' health care-seeking behavior: more educated patients tend to consult specialists first, which leads to longer time spans to diagnosis as they are less prone than GPs to refer patients to hospitals for additional tests, when needed. While our social networks findings support WHO’s recommendations to enhance individual social capital, results on education provide support for reforms aimed at implementing GP referral systems.

 


Book Chapter 

 

Jean Guo, Setti Rais Ali and Lise Rochaix, Social capital and health interventions: Enhancing social capital to improve health, Elgar Companion to Social Capital and Health - Chapter 11, 2018 Forthcoming

 

Research Dissemination
 
 

Early access schemes for medicines have been increasingly implemented worldwide with the objective of satisfying unmet medical needs or facilitating market access for certain innovative drugs. It allows for pharmaceuticals which have not yet obtained their marketing authorization (MA) to be administered and reimbursed to a pre-defined population of patients. Under the French regulatory framework, this scheme consists in a window of unregulated prices, which stands in contrast with the system of administered prices for reimbursed pharmaceuticals. Our study aims at filling a gap in the literature by analyzing the French Temporary Authorization for Use (TAU) scheme since its implementation in 1994 up to 2016. This long time span allows to document and describe the TAU scheme and its impact on prices. We review the price difference between the freely set price under TAU and the post MA price, after negotiation with the French Pricing Committee. Our main result shows that the 2007 regulatory change, which compelled pharmaceutical companies to reimburse the difference between the TAU price and the Post MA price, is significantly correlated with an increase in the probability to observe decreasing or stable post-MA-to-TAU price ratios.

 

PSE 5 articles... en 5 minutes !  (nov. 2018)  Is social capital good for health?