4.7.1. Issues specific to France

The study population is all persons aged 18 or older on January 1st 2014, sampled in the EGB database and alive on December 31st 2014.

In the EGB database for France, three types of data can be used to identify patients with diseases:

  1. The Affection de Longue Durée (ALD) registry

  2. The drug prescription database (pharmacy data from le Système national d’information inter-régimes de l’Assurance maladie (SNIIRAM))

  3. Hospital discharge data (PMSI).

For more information regarding the disease identification methodology, consult [Cortaredona and Ventelous, 2017 [13]].

The outcome variable is the total cost of hospital and ambulatory care in 2014 (annual amount reimbursed by the National Health Insurance) calculated at the patient level. The following costs are included in the French analysis: primary care and consultations with specialists, (reimbursed) medicines, medical procedures, biological tests, medical devices, emergency care and hospital inpatient care. Pricing of ambulatory care also takes into account possible co-payment from the patient, except for over-the-counter drugs which are not available in the EGB database. However, in France, almost all costs for the long-term chronic conditions such as those we are considering (especially those identified as ALD in the LTI database) are almost completely covered by the social security system. Therefore, there are hardly any OOP/other costs not taken into account in the estimation. For more details about the different components as mentioned above, refer to [Cortaredona and Ventelous, 2017 [13]].

Regarding the hospital sector, this cost estimation only takes into account the part of cost which is reimbursed to hospital through the diagnosis-related group (DRG) payment system (through which we can clearly assign a diagnosis using the reason of admission). DRG rates were used as proxies of case costs for public and private not‐for‐profit hospital stays. All other costs supported by the hospitals are not included, such as mission of general interest, clinical research, exploitation deficit.