Quelles sont les modalités de prescription et de remboursement du forfait nicotine dans le cadre du sevrage tabagique en région PACA

Abstract : Introduction: Nearly 7 million deaths worldwide are attributable to smoking. In France, multiple smoking cessation aids were gradually introduced including the nicotine package in 2007. After writing on a prescription, a refund of certain nicotine substitutes is offered to the patient with this package. The reimbursement threshold was increased to 150 euros on 1 November 2016. The purpose of our study was to examine the prescriptions and the use of the package and to evaluate the impact of the increase of the threshold to 150 euros in Provence-Alpes-Côte d'Azur. Materials and methods: A retrospective, descriptive and analytical study with extraction of PACA Health Insurance databases was carried out over two comparable periods of 6 months: from January 1st, 2016 to June 30th, 2016 and from January 1st, 2017 to June 30th, 2017. We collected the datas of the prescribers and beneficiaries of the package as well as the prescribed surrogates and amounts reimbursed. Results: General practitioners are the largest prescribers of the nicotine package, depending on the total number of prescribers: 1988 prescribers (89%) in 2016, 2910 (86%) in 2017 or according to their workforce in PACA: 26% in 2016 and 39 % in 2017. It is also the general practitioners which benefit from the most patient package: 3092 (70.3%) in 2016 against 5831 (75%) in 2017. Beneficiaries are divided equally between men and women with a female predominance of 54.1% in 2016 and 53.6% in 2017. The 31-65 year-olds are those who use the device the most 78.3% in 2016 and 78% in 2017. Regarding complementary, the patients benefiting from CMU-C and AME are respectively 8.1% in 2016 and 7.1% in 2017; 0% in 2016 and 2017 for AME. For exemptions, the ALD represent 28.1% in 2016 and 2017. The ALD n ° 23 "psychiatric affection" being the principal ALD with 23% of the ALD for the two years. The majority of patients use less than 50 euros during the year: 67.1% in 2016 and 57.4% in 2017. The increase of the threshold to 150 euros of the nicotine package nevertheless influences its prescription. (p <0.0000001). Patches are the most used nicotine replacement products with 74% of devices in 2016 and 68% in 2017. The amounts reimbursed by the Health Insurance under this package correspond to 204,962.48 euros in 2016 and 461,944.22 euros in 2017. Conclusion: General practitioners have fully integrated the nicotine package in the smoking cessation of their patient. The change in reimbursement to 150 euros has influenced its prescription and has allowed, with other public health measures, greater coverage of the population. To make the device more efficient it would be interesting to study the brakes that limit its prescription and its use.
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Submitted on : Thursday, November 29, 2018 - 10:20:05 AM
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Benoît Fouquere. Quelles sont les modalités de prescription et de remboursement du forfait nicotine dans le cadre du sevrage tabagique en région PACA. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01939005⟩

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