![]() |
Bernard Floccard 1
Auteur
Gisele Kanny 2
Auteur Etablissement employeur : Université de Lorraine
Elinor Baker
Auteur
Ludovic Martin 3
Auteur
Eric Vicaut 4
Auteur
Frederic Adnet 5
Auteur
Nicolas Javaud 6
Auteur
Olivier Fain 7, 8, 9, 10
Auteur
Isabelle Durand-Zaleski 11
Auteur
David Launay 12, 13, 14
Auteur
Laurence Bouillet 15
Auteur
Anne Gompel 16, 17
Auteur
Frédéric Lapostolle 5, 18
Auteur
Isabelle Boccon-Gibod 19, 15
Auteur
Paul-Georges Reuter 20
Auteur
Philippe Bertrand 21
Auteur
Malha Mezaour 5
Auteur
Brigitte Coppere 1
Auteur
STUDY OBJECTIVE: Hereditary angioedema is a rare disease associated with unpredictable, recurrent attacks of potentially life-threatening edema. Management of severe attacks is currently suboptimal because emergency medical teams are often unaware of new specific treatments. The objective of this trial is to test whether a dedicated national telephone care-management strategy would reduce resource use during severe hereditary angioedema attacks.
METHODS: We conducted a cluster-randomized multicenter prospective trial of patients with a documented diagnosis of hereditary angioedema (type I, II or FXII hereditary angioedema). Participants were enrolled between March 2013 and June 2014 at 8 participating reference centers. The randomized units were the reference centers (clusters). Patients in the intervention arm were given a national free telephone number to call in the event of a severe attack. Emergency physicians in the SOS-hereditary angiœdema (SOS-HAE) call center were trained to advise or prescribe specific treatments. The primary outcome was number of admissions for angioedema attacks. Economic evaluation was also performed.
RESULTS: We included 100 patients in the SOS-HAE group and 100 in the control group. During the 2 years, there were 2,368 hereditary angioedema attacks among 169 patients (85%). Mean number of hospital admissions per patient in the 2-year period was significantly greater in the usual-practice group (mean 0.16 [range 0 to 2] versus 0.03 [range 0 to 1]); patient risk difference was significant: -0.13 (95% confidence interval -0.22 to -0.04; P=.02). Probabilistic sensitivity graphic analysis indicated a trend toward increased quality-adjusted life-years in the SOS-HAE group.
CONCLUSION: A national dedicated call center for management of severe hereditary angioedema attacks is associated with a decrease in hospital admissions and may be cost-effective if facilities and staff are available to deliver the intervention alongside existing services.
UNIV-ANGERS | HCL | RIIP | HEH | U938 | UNIV-LORRAINE | UNIV-LILLE | SU-MEDECINE | CNRS | CARDIOVASCULAR-MARKERS-IN-STRESSED-CONDITIONS | SORBONNE-PARIS-NORD | UNIV-PARIS13 | UNIV-PARIS5 | UNIV-PARIS7 | UP-SANTE | MITOVASC | USPC | SORBONNE-UNIVERSITE | UNIV-PARIS-SACLAY | UNIV-PARIS