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Master Thesis

Étude au CMRR de Brest de l’impact du déremboursement sur la prescription des traitements symptomatiques de la Maladie d’Alzheimer

Abstract : Alzheimer’s disease is the leading cause of acquired major cognitive impairment. It affects 1.1 million patients in France, a number which should be doubled in 2050. There are 4 drugs authorized for this disease: Donepezil, Rivastigmine, Galantamine and Memantine. In 2016, after a new study of the data in the literature, the HAS considered the actual benefit of these drugs insufficient to justify their refund by national solidarity. These drugs can still be prescribed but have not been reimbursed since August 1, 2018. It is estimated that around two-thirds of patients benefited from these treatments. The main objective of our study was to determine the number of symptomatic treatments for Alzheimer's disease stopped at CMRR Brest due to the delisting. The secondary objectives were to find out the rate of new prescriptions for symptomatic treatments for AD after delisting. To analyze the factors for prescribing treatments. To compare the evolution of MMS scores between treated and untreated patients, to study the impact of treatment on the number of falls, on autonomy and on the prescription of psychotropic drugs. Method : this was a retrospective study, with patients over 70 years old followed at the CMRR of the Brest University Hospital for Alzheimer's disease and who consulted at least once between August 1, 2018 and September 1, 2020. We have read individually each consultation report and record if the first consultation took place before or after the delisting and if the patient benefited from the introduction of a treatment. We also analyzed the reasons for stopping treatment, the cognitive assessment, autonomy and psychotropic treatments of each patient. Results : of the 308 patients included, 210 patients (68.2%) were seen in consultation for the first time before the delisting. 132 (62.9%) of these patients received treatment and 83 stopped (62.9%), the reason for stopping was delisting for 39 of them (47.0%). After the delisting the rate of patient treated was 33.1% against 62.9% before, so a decrease of 47.3%. The patients who benefited from the initiation of treatment were on average 79.4 years +/- 4.5 compared to 81.6 years +/- 4.9 for the untreated and were more independent. The patients being treated had an average follow-up of 5.0 +/- 2.5 years versus 3.2 +/- 1.8 years for the untreated and had fewer hypnotics, 3.7% versus 13.1 %. Conclusion : in this study, we observe that the delisting of symptomatic treatments for Alzheimer's disease led to the discontinuation of 29.5% of treatments at CMRR in Brest. There is a 47% decrease in the rate of patients treated after delisting. De-reimbursement was the first cause of discontinuation of treatment found. However, despite the de-reimbursement, we note that symptomatic treatments for AD and mainly anticholinesterase drugs are still used by specialist practitioners and a third of patients remain treated.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03357979
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Submitted on : Wednesday, September 29, 2021 - 10:21:38 AM
Last modification on : Sunday, November 7, 2021 - 3:48:18 AM

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Paul Floch. Étude au CMRR de Brest de l’impact du déremboursement sur la prescription des traitements symptomatiques de la Maladie d’Alzheimer. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03357979⟩

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