Ongoing research projects

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Life style after health shocks

This project looks into changes in life-style choices following a health shock. It deals with a large cohort, GAZEL, which has been used by Ana Muresan (PSE) for an M1 internship. It will be continued for an M2 dissertation and should lead to a publication, jointly with Stéfanie Schütte (Centre Virshow Villermé – CVV). The objective will be to extend this analysis to the newly released French CONSTANCES cohort, in collaboration with Marcel Goldberg (INSERM).

Code projet: ME11

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Screening for breast cancer

A 3 years research project on Breast Cancer screening which is funded by IRESP – French Institute for Research in Economics and Public Health. Mattéo Galizzi (LSE, UK) and Lise Rochaix will jointly supervise a Ph.D. student, Antoine Marsaudon, on this Breast Cancer screening project. This large project brings researchers from other Universities, especially Christine le Clainche (Lille 2 University), together with a number of researchers interested in using behavioral economics from Paris 1/PSE experimental lab (Léontine Goldzahl, Jean-Christophe Vergnaud).

Code projet: ME12

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Administrative information sharing (“voisin malin”)

This project (“Voisin-malin”) is the evaluation of an intervention, which consists in providing information on various services through information dissemination from neighbours that are hired for this purpose. Vincent Pons (CREST, MIT) has developed the randomized experiment and hospinnomics has funded an additional question on access to health services (following one of the SAB recommendations). Data access will be given to Jean Guo, (US Fulbright Fellow) joining hospinnomics in October 2015, who will carry out the analysis on issues related to access health care.

Code projet: ME21

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Case management for professional injuries

This study, using randomization, is the evaluation of case management after a work accident. It is financed by CNAMTS for three years. Randomization was ruled out initially but, following Hospinnomics’ methodological advice, it has been accepted as the proper evaluation design to implement. Hospinnomics will be in charge of evaluating this intervention. Noémie Kiefer, research assistant at hospinnomics, is managing this project. Anastasia Boeva has also worked on this project for her M2 Master thesis, using a large database (HYGIE) to measure the determinants of patients’ return to work after a professional accident.

Code projet: ME22

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Interactive network for chronic renal failure

This project deals with the evaluation of a website for patient education, using social networking functionalities. This project originally came to Hospinnomics as an AP-HP request by a consultant, Evangéline Pillebout, but it has since been elaborated under Hospinnomics’ driving initiative into a 3 years RCT proposal, with 6 kidney transplant services within AP-HP, 4 regional hospitals, and 1 private dialysis center, in addition to Saint-Louis hospital (coordinating center, not included in the randomization); funding has been requested from the Ministry of Health. J-Pal is part of the project, with Luc Behaghel and the project also brings together other economists, Lionel Perrier (Lyon Centre Léon Bérard de lutte contre le cancer) and Valérie Clément (LAMETA, Montpellier).

Code projet: ME23

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Data Linkage

Following the recruitment of Mattéo Galizzi as invited researcher by Hospinnomics for 2014-2015, this new project has been developed. The objective is to use the new approach to data merging from different sources (bio-banks, administrative data, experimental data), currently developed by Mattéo Galizzi in the UK. This approach will be used in the project mentioned in the section ME12.

Code projet: ME24

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Ambulatory surgery

This project brings together economists specialized in PROs and QoL measures (Jean-Michel Josselin, Valérie Clément, Jean-Claude K. Dupont) in order to identify the robustness of the benefits’ measures when using different perspectives (patients versus population). The economic analysis will be undertaken jointly with Isabelle Durand-Zaleski (URC-Eco). A letter of intention has been submitted in April for funding to an HTA funding program (Programme de Recherches Médico-Economiques – PRME) financed jointly by the French Cancer institute (INCA) and MoH and it has been accepted. The full project has been submitted early in September. It offers an original approach to the assessment of benefits of an ambulatory care pathway compared to hospitalisation for patients with endometrial cancer undergoing hysterectomy. Patients’ preferences will be elicited through discrete choice experiments and ICECAP methods will be used to measure patients’ wellbeing. The final decision will be known in November 2015.

Code projet: ME31

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European Social Sciences Platform for paediatric oncology

Jean-Claude K. Dupont (Hospinnomics) is developing a social sciences cross-tumour program for paediatric oncology under the auspices of the European branch of the International Society for Paediatric Oncology (SIOP- E), as an extension of the EU-FP7 ENCCA project ending in 2015. This program has been defined with Pr. Gilles Vassal (Institut Gustave Roussy and SIOP-E Chair) and Pr. François Doz, (Institut Curie), who will chair its scientific advisory board. A primary objective is to validate new methods to involve patients and organizations in decision-making about standards of care and research orientations.

Code projet: ME32

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Benchmark study

Both French and English versions of the benchmark study are available on this page. The French version of the benchmark study will be published in the ‘Revue Française des Affaires Sociales’.

Code projet: RE11

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Linking value of statistical life (VSL) and QALYs

Daniel Herrera, who has joined Hospinnomics as post-doctoral fellow early in September for two years, will carry out this project. The approach adopted here is to combine the empirical approach on the happiness literature from Finkelstiein et. al. (2012), the empirical approach on VSL estimation from wage compensating variation from Viscusi (2004) and the theoretical approach from Hammitt (2013). The empirical estimates will be generated from the CONSTANCES dataset.

Code projet: RE12

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Hospital performance measurement

Patrice Degoulet (AP-HP) has carried out a first comparison of hospital performance using AP-HP data. This research is developed further at Hospinnomics, with collaborations from economists trained as hospital directors (Erwann Paul and Vincent Hirsch). Methods developed by Zeynep Or (IRDES) to compare performance across hospitals will be used.
Another objective is to develop a comparison with Quebec, where a similar data base has been produced by AQESSS (Association Québécoise des Etablissements Sanitaires, Sociaux et de Santé). Erin Strumpf (McGill, Qc) and Thomas Poder (Québec hospital) have been asked to collaborate on this project, but data availability for Quebec is halting this comparative project.

Code projet: RE21

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Hospital competition, collaboration and merging

Public hospitals are increasingly forced, including by Law, to merge or collaborate. One of the objectives of the Legislator is to ensure that healthcare pathways are tailored to patients’ severity levels. For hospital care, this requires developing an explicit collaboration between teaching and local hospitals. One of the initial requests put forward to hospinnomics by AP-HP was to contribute towards developing optimal hospital care pathways. This is part of a large project jointly led by AP-HP and the regional health authority (ARS –Ile de France). Funding has been secured for the initial part of the project, which entails choosing geographical areas and illnesses on which to base the clinical part of the care pathway definition. Since no funding has been earmarked for the economic part, an original project has been developed by Hospinnomics and submitted for funding to the MoH PRME.
The project entailed an analysis of existing care pathways and their determinants, a measure of competition/collaboration between the hospitals included in the study and a comparison with similar hospitals in another region in France. The letter of intention has not been accepted but suggestions have been made to resubmit next year to another MoH program, which specifically addresses organizational issues. In the meantime, hospinnomics will continue to assist AP-HP by actively participating in this project development, under its ‘advice to decision-making’ activity.
Daniel Herrera will investigate the effect of competitive pressures on hospital quality, profits and consumer welfare.

Code projet: RE22

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Incentivizing ambulatory care

Ambulatory care is developing slowly in France, compared to other countries and the government has introduced incentives for hospitals to invest in ambulatory surgery. In this project, we analyze the impact of this change in payments for ambulatory care, using DREES hospital data. Engin Ylmaz and Alexandre Cazenave-Lacrouz are in charge of this project at DREES. Both researchers are jointly supervised by Philippe Choné and Lise Rochaix, respectively for a Ph.D thesis and an MSc. Dissertation at ENSAE. This research project will lead to the publication of a joint paper.
Further developments are expected at AP-HP as hospitals compete for national funding to set up experiments with innovative ambulatory care pathways. This project also deals with comparing ambulatory versus standard surgery care pathways. This topic has also led to a request by AP-HP, the objective being to support the development of economic evaluations of ambulatory care pathways in the AP-HP hospitals and to assess the role played by co-morbidities or low income levels in explaining the low rate of ambulatory surgery at AP-HP and more widely. Isabelle Hirtzlin, author of HAS’ 2012 report on developing ambulatory care will take part in this analysis. In addition, active collaboration has been developed with Pr. Henri-Jean Philippe, Chair of the “Collège de l’AP-HP” for ambulatory surgery. Henri-Jean Philippe intends to work with Hospinnomics on several projects in the field of ambulatory surgery and hired Jean- Claude K. Dupont on a shared-time basis.

Code projet: RE23

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Access to Accident and Emergency services

Access to Accident and Emergency (A&E) services is becoming a major concern in France: access is increasingly delayed, due to inadequate use of the services as well as inefficiencies in delivery. AP-HP has made of improved access to A&E departments a priority. A request has been made by AH-HP for hospinnomics to define a questionnaire. To do so, a first analysis is carried out on a large national survey on emergencies from DREES. A special request has been made to have patient individual information available, including information on the hospital that patients used.

Code projet: RE24

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Drug pricing

A research group has been set up on drug pricing issues. It involves members of AP-HP’s central pharmacy, AGEPS (Pascal Paubel, Albane Degrassat, François Bocquet), members of the MoH research division DREES (Denis Raynaud, Renaud Legal, Céline Pilorge), and a member of HAS (Véronique Raimond). Hospinnomics has invested in this area, under the support of Marisa Miraldo, 2014 Hospinnomics invited researcher, two post- doctoral fellows (Eliana Barrenho and Ivy Lu), and Margaret Kyle (Mines Tech). Access to AGEPS data has been given to Hospinnomics for a subset of drugs with special status (Autorisation Temporaire d’Utilisation) and access to an original DREES database on drugs has also been given to Hospinnomics. DREES has also secured access to IMS data for Hospinnomics. A first paper has been presented by Ivy Lu and Véronique Raimond on ATU and should be submitted for publication this month. Another paper by Ivy Lu deals with depression and the use of Daily Drug Dose for measurement. Marisa Miraldo and Eliana Barrenho have also submitted for publication papers acknowledging Hospinnomics’ support. Ivy Lu has structured DREES database and produced a first short paper on depression with the help of an M1 intern, Audrey Cordon. Other researchers interested in joining the team will use this rich database (Léa Toulemon and Laurie Baquet – Sc. Po).

Code projet: RE31

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Rare cancers and Orphan Drugs: innovation & inequality

A letter of intention has been submitted to INCA on a joint project led by Philippe Gorry (Bordeaux University). The letter has been selected in February and the project submitted in March has been accepted. Hospinnomics is in charge of WP2 and WP4. This two years project addresses three issues related to anticancer innovation that follow up from Eliana Barrenho’s Ph.D: i) Failure in cancer innovation, ii) future availability of anticancer drugs and iii) inequalities in anticancer innovation. It will require recruiting a new post-doctoral fellow and Mujaheed Shaikh, currently supervised by Marisa Miraldo and PhD Candidate at Frankfurt School of Finance and Management, who will join the project in September 2016.

Code projet: RE32

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Out-of-pocket payments in hospitals

In France, access to hospital care is usually free of charge. However, a recent study at AP-HP has shown that for some patients, this is not the case. A request has been made to Hospinnomics to identify the types of patients facing these large out-of-pocket expenses and access to AP-HP data has been given to Hospinnomics. Bénédicte Apouey (PSE), is in charge of this project, with a Master 2 PSE student, Dinh-Van Colomban, supervised jointly with Lise Rochaix. It will lead to an academic publication in 2016.

Code projet: RE41

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Migrant population access to hospital care

Special consultations have been set up in hospitals for migrant patients with no knowledge of French (PASS). The national PASS coordinator, Claire Georges has asked Hospinnomics to carry out an economic evaluation of this consultation, in partnership with the French national agency for hospital performance enhancement (Agence Nationale d’Appui à la Performance – ANAP). Jean Guo has defined her Fulbright fellow application on the issue of language support for migrants in hospital consultations and she will carry out this analysis for Hospinnomics from October 2015.

Code projet: RE42

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Rare diseases and inequalities

A 3 years PhD grant has been obtained from the IMAGINE foundation, at Necker Hospital, AP-HP. Setti Raïs holds the grant. Setti’s thesis will address inequality issues in access to diagnostic and treatment. This issue is particularly relevant as patients’ wandering before being given a final diagnostic can be longer for rare genetic diseases. This topic has been chosen as a follow-up of a Master 2 thesis at PSE, based on a questionnaire sent to patients belonging to a large social network. Setti Raïs will submit a publication on this topic, together with Paul Dourgnon (IRDES) and Lise Rochaix. The thesis will also include a joint econometric analysis with Eliana Barrenho (Hospinnomics) on the impact on price levels of the EU regulation on orphan drugs.

Code projet: RE43

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