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Le scrutin de septembre 98 traduit et contribue à créer une situation nouvelle en Allemagne. Après une longue campagne, marquée par une personnalisation extrême au détriment de propositions touchant aux grandes orientations politiques possibles, les sociaux-démocrates et les Verts ont formé une coalition gouvernementale qui n'a pas tardé à être confrontée aux contradictions de la société d'outre-Rhin. Celles-ci s'étaient déjà exprimées depuis deux ans au travers de mouvements sociaux importants. Le nouveau chancelier et son gouvernement devront également compter avec une opposition de gauche au Bundestag, puisque le Parti du socialisme démocratique (PDS) franchit pour la première fois la barre des 5 % sur le plan national, grâce à ses scores dans l'ancienne RDA. La persistance d'un fossé économique, social, mais aussi politique et culturel entre l'Est et l'Ouest reste une des questions majeures pour les années qui viennent.

"Needing guidance and seeking insight, the Council of Europe approached Pierre Lévy, one of the world's most important and well-respected theorists of digital culture, for a report on the state (and, frankly, the nature) of cyberspace. The result is this extraordinary document, a perfectly lucid and accessible description of cyberspace-from infrastructure to practical applications-along with an inspired, far-reaching exploration of its ramifications. A window on the digital world for the technologically timid, the book also offers a brilliant vision of the philosophical and social realities and possibilities of cyberspace for the adept and novice alike. In an overview, Lévy discusses the distinguishing features of cyberspace and cyberculture from anthropological, philosophical, cultural, and sociological points of view. An optimist about the future potential of cyberspace, he eloquently argues that technology-and specifically the infrastructure of cyberspace, the Internet-can have a transformative effect on global society. Some of the issues he takes up are new art forms; changes in relationships to knowledge, education, and training; the preservation of linguistic and cultural differences; the emergence and implications of collective intelligence; the problems of social exclusion; and the impact of new technology on the city and democracy in general. In considerable detail, Lévy describes the ways in which cyberspace will help promote the growth of democracy, primarily through the participation of individuals or groups. His analysis is enlivened by his own personal impressions of cyberculture-garnered from bulletin boards, mailing lists, virtual reality demonstrations, andsimulations. Immediate in its details, visionary in its scope, deeply informed yet free of unnecessary technical language, Cyberculture is the book we require in our digital age". -- From English edition

International audience ; Aims: The burden of diabetes-related complications is important and increasing in France. Early screening of microvascular complications could avoid the occurrence of more severe consequences. An economic model using a 5-year time horizon was developed to estimate the potential impact in France of large screening of diabetic autonomic neuropathy using Sudoscan, a quick, non-invasive and quantitative method developed for screening of small fiber neuropathy.Methods: A disease progression model was first developed to describe the long-term evolution of patients with type 2 diabetes regarding microvascular complications over successive time periods and patients were classified in 4 groups according to the severity. Complication-related costs were then calculated for a cohort of patients treated according to the current pattern of care and compared with the costs incurred by the same cohort assuming the introduction and widespread use of a large screening of small fiber neuropathy using the Sudoscan method. Comparison of treatment costs between the two situations was used to evaluate the potential budget impact of such a prevention policy in France.Results: According to this general screening of early complications more than 25,000 patients could avoid more severe complications. The gross benefit of such a new prevention strategy would be around € 280 million at 5th year. After 5 years of follow-up, the cumulated gross benefit would be € 837 million and in the worst case scenario (decrease of 20% for each uncertain parameter, namely the distribution of patients among severity groups, the death rates in each severity group, and the distribution of newly diagnosed patients in each severity group) gross benefit would remain at more than € 50 million for the first year and more than € 255 million at the 5th year (using 6% as global efficacy of screening method as basal value).Conclusion: Large screening of small fiber neuropathy could avoid more severe peripheral neuropathy and consequently ...

International audience ; Aims: The burden of diabetes-related complications is important and increasing in France. Early screening of microvascular complications could avoid the occurrence of more severe consequences. An economic model using a 5-year time horizon was developed to estimate the potential impact in France of large screening of diabetic autonomic neuropathy using Sudoscan, a quick, non-invasive and quantitative method developed for screening of small fiber neuropathy.Methods: A disease progression model was first developed to describe the long-term evolution of patients with type 2 diabetes regarding microvascular complications over successive time periods and patients were classified in 4 groups according to the severity. Complication-related costs were then calculated for a cohort of patients treated according to the current pattern of care and compared with the costs incurred by the same cohort assuming the introduction and widespread use of a large screening of small fiber neuropathy using the Sudoscan method. Comparison of treatment costs between the two situations was used to evaluate the potential budget impact of such a prevention policy in France.Results: According to this general screening of early complications more than 25,000 patients could avoid more severe complications. The gross benefit of such a new prevention strategy would be around € 280 million at 5th year. After 5 years of follow-up, the cumulated gross benefit would be € 837 million and in the worst case scenario (decrease of 20% for each uncertain parameter, namely the distribution of patients among severity groups, the death rates in each severity group, and the distribution of newly diagnosed patients in each severity group) gross benefit would remain at more than € 50 million for the first year and more than € 255 million at the 5th year (using 6% as global efficacy of screening method as basal value).Conclusion: Large screening of small fiber neuropathy could avoid more severe peripheral neuropathy and consequently ...

International audience ; Aims: The burden of diabetes-related complications is important and increasing in France. Early screening of microvascular complications could avoid the occurrence of more severe consequences. An economic model using a 5-year time horizon was developed to estimate the potential impact in France of large screening of diabetic autonomic neuropathy using Sudoscan, a quick, non-invasive and quantitative method developed for screening of small fiber neuropathy.Methods: A disease progression model was first developed to describe the long-term evolution of patients with type 2 diabetes regarding microvascular complications over successive time periods and patients were classified in 4 groups according to the severity. Complication-related costs were then calculated for a cohort of patients treated according to the current pattern of care and compared with the costs incurred by the same cohort assuming the introduction and widespread use of a large screening of small fiber neuropathy using the Sudoscan method. Comparison of treatment costs between the two situations was used to evaluate the potential budget impact of such a prevention policy in France.Results: According to this general screening of early complications more than 25,000 patients could avoid more severe complications. The gross benefit of such a new prevention strategy would be around € 280 million at 5th year. After 5 years of follow-up, the cumulated gross benefit would be € 837 million and in the worst case scenario (decrease of 20% for each uncertain parameter, namely the distribution of patients among severity groups, the death rates in each severity group, and the distribution of newly diagnosed patients in each severity group) gross benefit would remain at more than € 50 million for the first year and more than € 255 million at the 5th year (using 6% as global efficacy of screening method as basal value).Conclusion: Large screening of small fiber neuropathy could avoid more severe peripheral neuropathy and consequently ...

International audience ; Background: Morbidity and mortality associated with non-valvular atrial fibrillation (NVAF) imposes a substantial economic burden on the UK healthcare system. Objectives: An existing Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban and apixaban, each compared with a vitamin K antagonist (VKA), for stroke prevention in patients with NVAF from the National Health Service (NHS) and personal and social services (PSS) perspective. Methods: The model considered a cycle length of 3 months over a lifetime horizon. All inputs were drawn from real-world evidence (RWE): baseline patient characteristics, clinical event and persistence rates, treatment effect (meta-analysis of RWE studies), utility values and resource use. Deterministic and probabilistic sensitivity analyses were performed. Results: The incremental cost per quality-adjusted life year was £14,437 for rivaroxaban, and £20,101 for apixaban, compared with VKA. The probabilities to be cost-effective compared with VKA were 90% and 81%, respectively for rivaroxaban and apixaban, considering a £20,000 threshold. In both comparisons, the results were most sensitive to clinical event rates. Conclusions: These results suggest that rivaroxaban and apixaban are cost-effective vs VKA, based on RWE, considering a £20,000 threshold, from the NHS and PSS perspective in the UK for stroke prevention in patients with NVAF. This economic evaluation may provide valuable information for decision-makers, in a context where RWE is more accessible and its value more acknowledged.

International audience ; Background: Morbidity and mortality associated with non-valvular atrial fibrillation (NVAF) imposes a substantial economic burden on the UK healthcare system. Objectives: An existing Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban and apixaban, each compared with a vitamin K antagonist (VKA), for stroke prevention in patients with NVAF from the National Health Service (NHS) and personal and social services (PSS) perspective. Methods: The model considered a cycle length of 3 months over a lifetime horizon. All inputs were drawn from real-world evidence (RWE): baseline patient characteristics, clinical event and persistence rates, treatment effect (meta-analysis of RWE studies), utility values and resource use. Deterministic and probabilistic sensitivity analyses were performed. Results: The incremental cost per quality-adjusted life year was £14,437 for rivaroxaban, and £20,101 for apixaban, compared with VKA. The probabilities to be cost-effective compared with VKA were 90% and 81%, respectively for rivaroxaban and apixaban, considering a £20,000 threshold. In both comparisons, the results were most sensitive to clinical event rates. Conclusions: These results suggest that rivaroxaban and apixaban are cost-effective vs VKA, based on RWE, considering a £20,000 threshold, from the NHS and PSS perspective in the UK for stroke prevention in patients with NVAF. This economic evaluation may provide valuable information for decision-makers, in a context where RWE is more accessible and its value more acknowledged.

International audience ; Background: Morbidity and mortality associated with non-valvular atrial fibrillation (NVAF) imposes a substantial economic burden on the UK healthcare system. Objectives: An existing Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban and apixaban, each compared with a vitamin K antagonist (VKA), for stroke prevention in patients with NVAF from the National Health Service (NHS) and personal and social services (PSS) perspective. Methods: The model considered a cycle length of 3 months over a lifetime horizon. All inputs were drawn from real-world evidence (RWE): baseline patient characteristics, clinical event and persistence rates, treatment effect (meta-analysis of RWE studies), utility values and resource use. Deterministic and probabilistic sensitivity analyses were performed. Results: The incremental cost per quality-adjusted life year was £14,437 for rivaroxaban, and £20,101 for apixaban, compared with VKA. The probabilities to be cost-effective compared with VKA were 90% and 81%, respectively for rivaroxaban and apixaban, considering a £20,000 threshold. In both comparisons, the results were most sensitive to clinical event rates. Conclusions: These results suggest that rivaroxaban and apixaban are cost-effective vs VKA, based on RWE, considering a £20,000 threshold, from the NHS and PSS perspective in the UK for stroke prevention in patients with NVAF. This economic evaluation may provide valuable information for decision-makers, in a context where RWE is more accessible and its value more acknowledged.

International audience ; Aim: In order to integrate malaria Intermittent Preventive Treatment in infants (IPTi) into the Ghana national immunization programme, there was the need to evaluate the feasibility of IPTi by assessing the intervention operational issues including its implementation costs, and its cost effectiveness. Study Design: Cross-sectional study. Place and Duration of Study: Upper East Region, Ghana, between July 2007 and July 2009 Methods: We calculated the costs of administrating IPTi during vaccination sessions; the costs of programme implementation during the first year of implementation (start-up costs) and in routine years (recurrent costs). For the purposes of cost-effectiveness analysis, all economic costs (including financial and opportunity costs) and the net cost were estimated. To estimate the cost effectiveness ratios of IPTi, the aggregate cost of providing the intervention for a reference target population of 1,000 infants was divided by its health outcome. Sensitivity analyses were carried out to understand the results robustness. Results: IPTi gross costs in start up and in routine years were estimated at 70.66 cents and 29.72 cents per dose, or $2.0 and $0.87 per infant, respectively. The gross cost per DALY saved was estimated at $3.49 and the net cost of IPTi for 1,000 infants was $-3,416.38 in the routine years rending IPTi a highly cost saving intervention. Sensitivity analyses showed that the cost per DALY saved never went up more than $4.50 maintaining the intervention still highly cost effective. Conclusion: IPTi in Ghana is a highly and robust cost effective intervention. The intervention is cost-saving and should be scaled up nationally to save children's health and economic capital.