title: [Prescription of diphosphonates in ambulatory oncology. A study of the health insurance medical services].
abstract: OBJECTIVE
  As requested by the Health Ministry, the Agricultural (Mutualité Sociale Agricole) and Independant Professions (Assurance Maladie des Professions Indépendantes) Health Insurances carried out a survey to analyse the use of second generation oral biphosphonates.
  
  
  METHODS
  The data, from 3,414 prescriptions, gathered over the twelve months from May '93, showed that clodronate is prescribed mainly for breast cancer (35%), prostate cancer (23%), multiple myeloma (19%) and carcinoma of the lung (7%). The other prescriptions (16%) were either related to various malignant diseases (18 types encountered) or non-malignant diseases (mainly osteoporosis, but also Paget's disease of bone and hyperparathyroidism). The initial prescriber was most often a cancerologist (49%) but also quite frequently (17%) a general practitioner. The treatment was prescribed for an average of 41 days. 1600 mg daily was the most frequent dose (79%). However, in non-authorised indications, especially osteoporosis, the dose was lower, generally 800 mg a day. Altogether 14% non-authorised indications were linked either to non-metastatic malignant diseases (for the prevention of metastases) or with osteo-condensing type metastases (prostate cancer: 43%) or non-malignant diseases (osteoporosis, Paget's disease of bone, hyperparathyroidism, chronic renal insufficiency, sympathetic algodystrophy, bedbound decalcification, etc.). The prescription for these cases was motivated by the expected beneficial effect on bone mineralisation. Such treatment authorised was more often initiated by a general practitioner (23%) than a specialist (12%).
  
  
  CONCLUSIONS
  These data raise the problem of limiting the possibility of prescribing second generation biphosphonates as initial treatment to a specialist. They also reaffirm the need to have precise guidelines in the field of medical prescription controls.
authors.affiliation: Service Médical, Caisse Nationale d'Assurance-Maladie des Professions Indépendantes (CANAM), Saint-Denis.
authors.forename: C
authors.initials: C
authors.lastname: Vicrey
authors.forename: J F
authors.initials: JF
authors.lastname: Bayet
authors.forename: J M
authors.initials: JM
authors.lastname: Extra
authors.forename: J
authors.initials: J
authors.lastname: Grebet
authors.forename: J L
authors.initials: JL
authors.lastname: Ricard
authors.forename: M
authors.initials: M
authors.lastname: Vinot
authors.forename: P
authors.initials: P
authors.lastname: Ouanhnon
authors.forename: H
authors.initials: H
authors.lastname: Kurz
authors.forename: J
authors.initials: J
authors.lastname: Vernaz
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D004164:Diphosphonates; D004363:Drug Utilization; D005194:Family Practice; D005260:Female; D005602:France; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008495:Medical Oncology; D009369:Neoplasms / Q000188:drug therapy*
chemical_list: D004164:Diphosphonates