“Do not forget your appointment : gender differences in medical appointment attendance and the effect of SMS reminders”

Literature identifies errors in writing down, forgetting, last-minute impediments, financial problems, and fear of pain as main reasons of no show to medical appointments; and shows a positive effect of SMS reminders on medical appointment attendance. With both observational data and experiments, literature concludes that the effect of SMS reminders on attendance is consistent across patient subgroups. However, previous studies tend to use limited samples or to be conducted on limited scales (e.g., specialized establishments with one main medical field). Using large-scale observational data, consisting of more than 400,000 appointments at a general hospital, this research investigates gender differences in medical appointment attendance and the effect of SMS reminders.

Investigators: Dr. Gaël Libert (PhD researcher) and research collaborators (Prof. Dr. G. Goderis¹, Prof. Dr. H. Stevens², Prof. R. Bensliman ^1,3, Prof. Dr. N. Kacenelenbogen ¹, Dr. V. Lesage⁴)

Abstract:

Medication management in the elderly has become a major topic in geriatric research. This population has its own medical and social characteristics: polymedication, inappropriate prescribing, polypathology, multiple prescribers, segregation, combined frailty, etc. Such representations have made interdisciplinarity overriding for healthcare management, however, its implementation remains a complex endeavor. 

The perspectives of the doctoral project are: “Development of an interdisciplinary model of prescription management in the elderly”. In this research process, the objective will be to evaluate how interdisciplinary medication management could be implemented in our healthcare system (although today, multidisciplinarity remains the standard approach) One of the end points will be to define which roles should be assumed by each health professional or facility. In addition, patient and financial considerations will also be assessed to ensure that the model will remain compatible with our modern healthcare system and that the approach will benefit the patient.

¹Université Libre de Bruxelles – General Medicine Department

²Université Libre de Bruxelles – Institute for Interdisciplinary Innovation in Healthcare (I3H)

³Université Libre de Bruxelles – Public Health Départment

⁴Université Libre de Bruxelles – Centre Hospitalier Universitaire Erasme (Bruxelles)

Investigators: Sanae Akodad (PhD researcher), Prof. Hilde Stevens (Promotor), Prof. Nicolas Deconinck (Co-Promotor) and Prof. Delphine De Smedt (Co-promotor)

Abstract:

Rare diseases are commonly debated nowadays. Many rare diseases are life-threatening, chronic and degenerative, making treating the affected patients a public health priority. The question of access to effective treatment in the plethora of rare diseases is prominent. Besides the ongoing medical and biological complexity of developing effective drugs for some of them, in many cases, when an appropriate pathophysiological target is found for a new drug, the drug development path is typically costly and long. Once a drug reaches the market, the potential return on investment is limited due to the small patient population. The lack of transparency over the true costs of innovation poses a real issue. This project will conduct a detailed investigation of the pricing/reimbursement process in the case of Spinal Muscular Atrophy disease. We will draw general lessons from this case study and formulate recommendations for affordable pricing and reimbursement strategies for other rare disease therapies that will reach the market.

In this project, we will take advantage of our expertise in SMA to investigate five key initiatives currently taking place to optimize the pricing/reimbursement process and to facilitate and accelerate access treatment, making the pricing process more transparent and investigate a major issue in this context, the quality of life (QoL) of patients with SMA, each linked to a separate work package : (1) comprehensive value assessment, (2) early dialogues among relevant stakeholders, (3) assessment of societal participation in producing orphan drugs (ODs), (4) innovative reimbursement approaches to allow timely access to ODs, (5) facing new challenges induced by new treatments.

Through our in-depth investigation of the cost of the disease, QOL, reimbursement policies, initiatives in terms of information exchange, early screening of the disease, transparency in terms of pricing and finally Cognition with what it implies in terms of both QOL and cost effectiveness the aim of this project is therefor to reduce the cost of SMA on our healthcare budget by working towards a more cost-effective treatment plan, and through neonatal diagnosis, offer a better disease prospective, and hence QoL for the patient.

The key lessons learned from this project may be applied as a more general model for other rare diseases.

Investigators: Shiri Mermelstein (PhD researcher), Prof. Hilde Stevens (Promotor), Prof. Mathias Dewatripont (Co-promotor) and Prof. Patrick Legros (Co-promotor)

Abstract:

Access to health technologies for people living in the low- and middle-income countries (LMICs) is problematic. An increasing number of collaborative initiatives stimulate both research and development (R&D), and access to health technologies in LMICs. This project aims to investigate how collaborative partnerships can be mobilized to ensure affordable access to innovative health technologies. The case of COVID-19 vaccine development will be reviewed to define how various PPPs can be incentivized to foster health system transformation and to address the health challenges in developing countries. In particular, this project sheds a light on the role of Intellectual Property (IP) as a mechanism to promote innovation by providing incentives to invest in (collaborative) R&D, to define pricing models to promote healthcare delivery, to provide access to innovative health technologies and by doing so, to reduce global health disparities.

Investigators: Marie Neunez, Anna Wozniak, Hilde Stevens, Michel Goldman, Olivier Klein, Pierre Smeesters

Abstract:

The complex phenomena of vaccine hesitancy varies over time, in place and between vaccines, and is linked to a cultural, local or national context, but threatens to reverse medical progress made in tackling vaccine-preventable diseases. As one of the most cost-effective ways of avoiding disease, vaccination prevents 2-3 million deaths a year, a number that could potentially be doubled if global coverage of vaccinations would further be improved, consequently bringing down the costs related to healthcare. In 2019, vaccine hesitancy has been declared as one of the ten major threats for global health, which legitimates the need for coordinated actions and collective intelligence of all stakeholders involved in vaccine strategies for development and implementation, both on the national and the international level.

The situation in Belgium, although less chaotic than in France, raises questions, especially since uniformity is lacking between the vaccination programs in the Flanders Region and the Brussels- Wallonia Region (e.g., HPV vaccination programs reach a level of 90% in Flanders and only 36% in the Brussels-Wallonia Region). For this research, Marie Neunez was awarded with a Pediatric Research Fellow grant from The Belgian Kids’ Fund. She is investigating the impact of anti-vaxx movements and « fakes news » on this problem of vaccine reluctance) and will test an educational tool for school children in the Brussels-Wallonia Region. Finally, recommendations for strategies are made to improve the situation and increase vaccine confidence.

Odiparcil for the use in MPS VI

Investigators: Hilde Stevens, Isabelle Huys

Impact of the COVID-19 pandemic for R&D on therapies for rare diseases

Investigators: Hilde Stevens, Sofia Amaral-Garcia, Sandy Tubeuf

Investigators: Hilde Stevens, Micael Castanheira, Mathias Dewatripont, Denis Herbaux

Investigators: Victor Ginsburgh, Glenn Magerman, Ilaria Natali

Abstract:

In this paper, we examine the variation in the outbreak of COVID-19 across departments in continental France. We use information on the cumulated number of deaths, discharged patients and infections from COVID-19 at the department level, and study how these relate to income inequality, controlling for other factors. We find that unfortunately, inequality kills: departments with higher income inequality face more deaths, more discharged (gravely ill) patients and more infections. While other papers have studied the impact of the level of income on the severity of COVID-19, we find that it is in fact the dispersion across incomes within the same department that drives the results. Our results suggest that individuals in relatively more precarious conditions deserve dedicated policies, to avoid that temporary shocks such as COVID-19 lead to permanent increases in inequality.

Investigators: Ilaria Natali

Abstract:

The abuse and misuse of opioid analgesics is a serious public health problem in the US and has recently raised serious concerns in France as well. In this context, the research of effective interventions aimed at limiting the abuse of narcotic medications becomes a topic of primary importance. This paper assesses the impact of laws that restrict access to opioid products and builds on previous studies by showing how local economic conditions, as proxied by the level of poverty, matter for the magnitude of responses to these policies. The empirical investigation is performed by using OpenHealth monthly data on Codeine- product sales for the year 2017 and for the 94 departments composing Metropolitan France. By using a difference in differences (DiD) approach, I first estimate the causal impact of a new regulation that forbids over-the-counter (OTC) sales of Codeine products. I then exploit a triple difference (TD) strategy to evaluate the existence of possible heterogeneous responses across French departments, depending on their economic prosperity. I find that the new law proved effective in reducing Codeine consumption and that departments in eco- nomic disadvantage exhibit smaller decreases in consumption following the new law. Hence, poorer departments are more ‘regulatory-inelastic’. This means that demand-side factors can contribute to amplify or hinder the effect of supply-side interventions. Policy-makers should, therefore, take into account the former when evaluating the impact of the latter. Moreover, results suggests that additional measures, such as intensified pharmacovigilance, healthcare professional education and support services, should be addressed towards the most disadvantaged local communities.

Investigators: Sofia Amaral-Garcia, Ilaria Natali