Objective This systematic review examines recent pharmacoeconomic literature on denosumab'cost-effectiveness for bone metastasis treatment,providing evidence-based insights to guide healthcare policy decisions.Met...Objective This systematic review examines recent pharmacoeconomic literature on denosumab'cost-effectiveness for bone metastasis treatment,providing evidence-based insights to guide healthcare policy decisions.Methods A comprehensive literature search was performed across Cochrane,PubMed,EMBASE(Ovid),CNKI,and Wanfang databases to identify original articles published between 2017 and 2023.Key words consisted of bone metastases,denosumab,and cost-effectiveness in the search strategy.The methodological quality of the included studies was assessed utilizing the revised Consolidated Health Economic Evaluation Reporting Standards(CHEERS 2022).Data was extracted regarding methodological characteristics and cost-effectiveness analyses.Results A total of 111 studies were retrieved,of which 6 met the inclusion criteria.All included studies were based on clinical trials and published literature data and exhibited high methodological quality.Up to 83%(5 out of 6)of comparisons demonstrated that denosumab was more cost-effective or dominant compared to zoledronic acid.The adjusted incremental cost-effectiveness ratios varied substantially by tumor type,ranging from CZK 436,339.09 to USD 136,234 per skeletal-related event avoided and from CZK 61,580.95 to USD 118,392.11 per quality-adjusted life year gained.Conclusions The majority of the included studies support denosumab as a more cost-effective treatment option for bone metastases in solid tumors compared to zoledronic acid.The application of CHEER(2022)enhances the reliability of pharmacoeconomic evaluations.展开更多
Objective To evaluate the cost-effectiveness of gadopentetate dimeglumine(Gd-DTPA)and gadobenate dimeglumine(Gd-BOPTA)magnetic resonance imaging(MRI)contrast agents for the early diagnosis of hepatocellular carcinoma(...Objective To evaluate the cost-effectiveness of gadopentetate dimeglumine(Gd-DTPA)and gadobenate dimeglumine(Gd-BOPTA)magnetic resonance imaging(MRI)contrast agents for the early diagnosis of hepatocellular carcinoma(HCC)from the perspective of China’s healthcare system.Methods A decision tree+partitioned survival model was constructed for early diagnosis of HCC based on literature data.Taking quality-adjusted life year(QALY)as the main health outcome measure for incremental cost-effectiveness ratio(ICER)analysis,the sensitivity analysis by Monte Carlo simulation was constructed to generate corresponding tornado diagram,incremental cost-effectiveness scatter plot,and cost-effectiveness acceptability curve.Results and Conclusion The basic analysis results showed that the ICER value of Gd-BOPTA diagnostic scheme compared with Gd-DTPA diagnostic scheme was 17302.46 yuan/QALY,which is less than 1 times of China’s gross domestic product(GDP)per capita.The sensitivity analysis results showed that the cost of delayed treatment and timely treatment had a significant impact on the results.When the willingness to pay(WTP)was 1 time of GDP per capita,the probability of cost-effectiveness advantage of Gd-BOPTA diagnostic scheme was 65.30%.When the WTP value is set at 1 times of GDP per capita,Gd-BOPTA MRI has cost-effectiveness advantages for the early diagnosis of HCC.展开更多
Guangdong’s carbon emissions have surpassed the world’s 11th largest emitter.It is indispensable for this province to find a robust cost-effective strategy for reducing carbon emissions.This study employed the Low E...Guangdong’s carbon emissions have surpassed the world’s 11th largest emitter.It is indispensable for this province to find a robust cost-effective strategy for reducing carbon emissions.This study employed the Low Emissions Analysis Platform model,marginal cost curves,and Monte Carlo methods to simulate the energy consumption,carbon emissions,and economic benefits of emission reduction in Guangdong Province from 2020 to 2030 under the application of various structural optimization policies and energy-saving technologies.The main findings are as follows:In 2030,Guangdong Province is projected to achieve a carbon emission reduction of 273.6 to 304.6million t CO_(2eq),with a total reduction cost ranging from 1030.9 to 1452.2 billion yuan.Increasing the share of renewable energy,which still has significant growth potential,can lead to a 1.4 times greater reduction in carbon emissions compared to the application of energy-saving technologies,despite the latter yielding 2.3 times more energy savings.The emission reduction measures with net-cost can contribute 71.4%to the total carbon reduction of the province,being much larger than those with net benefits.The power sector plays a critical role in carbon emission reduction within Guangdong Province,with its various measures exerting the most substantial impact on emission reduction quantity and cost,contributing cumulative variance contributions of 90.1%and 84.3%,respectively.It has relatively large potential for emission reduction and relatively low cost of structural adjustment.展开更多
While silicon/carbon(Si/C)is considered one of the most promising anode materials for the next generation of high-energy lithium-ion batteries(LIBs),the industrialization of Si/C anodes is hampered by high-cost and lo...While silicon/carbon(Si/C)is considered one of the most promising anode materials for the next generation of high-energy lithium-ion batteries(LIBs),the industrialization of Si/C anodes is hampered by high-cost and low product yield.Herein,a high-yield strategy is developed in which photovoltaic waste silicon is converted to cost-effective graphitic Si/C composites(G-Si@C)for LIBs.The introduction of a binder improves the dispersion and compatibility of silicon and graphite,enhances particle sphericity,and significantly reduces the loss rate of the spray prilling process(from about 25%to 5%).As an LIB anode,the fabricated G-Si@C composites exhibit a capacity of 605 mAh g^(-1) after 1200 cycles.The cost of manufacturing Si/C anode materials has been reduced to approximately$7.47 kg^(-1),which is close to that of commercial graphite anode materials($5.0 kg^(-1)),and significantly lower than commercial Si/C materials(ca.$20.74 kg^(-1)).Moreover,the G-Si@C material provides approximately 81.0 Ah/$of capacity,which exceeds the current best commercial graphite anodes(70.0 Ah/$)and Si/C anodes(48.2 Ah/$).The successful implementation of this pathway will significantly promote the industrialization of high-energydensity Si/C anode materials.展开更多
BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with ...BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest(OHCA) survivors using clinical patient-level data.METHODS: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios(ICERs) were calculated and compared with various decision makers' willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ellipse.RESULTS: Among 925 non-traumatic OHCA survivors, only 30(3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost(delta cost-$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065, P=0.79) and higher survival to hospital discharge(delta effect 6%, 95% CI:-11% to 23%, P=0.41). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane.CONCLUSION: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.展开更多
BACKGROUND Pancreatic exocrine insufficiency(PEI)leads to fat malabsorption and maldigestion and is most commonly treated with pancreatic enzyme replacement therapy(PERT).Patients suffering from PEI in China are more ...BACKGROUND Pancreatic exocrine insufficiency(PEI)leads to fat malabsorption and maldigestion and is most commonly treated with pancreatic enzyme replacement therapy(PERT).Patients suffering from PEI in China are more likely not to receive adequate treatment as this drug is not part of the Chinese national essential medicine list.AIM To examine the cost-effectiveness of PERT for patients suffering from PEI in China.METHODS A decision analytical Markov model was constructed to simulate the progress of patients with PEI in China.The population included in the analyses were patients suffering from PEI with advanced(non-resectable)pancreatic cancer,who have undergone surgery due to pancreatic cancer and who have undergone endoscopic treatment due to chronic pancreatitis.The cost-effectiveness analyses were undertaken from a Chinese societal perspective comparing PERT with no PERT.The incremental cost-effectiveness ratio in United States dollars per quality adjusted life year(QALY)gained is the main outcome.Input was informed by publicly available data supplemented with expert clinical advice.RESULTS The cost-effectiveness analyses estimated that PERT resulted in additional 0.45 to 2.93 QALYs at discounted costs of between 4315 dollars to 15193 dollars.This resulted in an incremental cost-effectiveness ratio of 5178 dollars to 9533 dollars per QALY.The one-way sensitivity analyses showed that the main drivers of the model were the cost of PERT and overall survival.CONCLUSION This study demonstrates that PERT is a cost-effective treatment for patients suffering from PEI in China.展开更多
Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide ...Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide mononitrate sustained-release capsules(IMSRC)combined with conventional treatments,compared to isosorbide mononitrate tablets(IMT)combined with conventional treatments,for managing angina pectoris in patients with coronary heart diseases.A network meta-analysis(NMA)was conducted to assess the efficacy and safety of IMSRC and IMT.Relevant literature was sourced from databases,including PubMed,Embase,Cochrane Library,ScienceDirect,Web of Science,CNKI,Wanfang,and VIP,covering publications up to July 2023.The cost-effectiveness analysis(CEA)was performed from the perspective of China’s healthcare system,utilizing inputs derived from the NMA.The analysis included 15 studies.The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments.However,both combinations were more effective than conventional treatments without isosorbide mononitrate.No differences in safety were observed among the three groups.The surface under the cumulative ranking(SUCRA)of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris,whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT.The incidence of adverse events was ranked as IMT>conventional preparation>IMSRC.The CEA results highlighted that the incremental cost-effectiveness ratios(ICERs)for the markedly effective and total effective rates of angina pectoris were-133.41 and-260.20,respectively.The ICERs for ECG effective rates were-83.34 and-234.24,respectively.In conclusion,while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety,IMSRC proved to be more economical.展开更多
With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role i...With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role in the camouflaging effect. Based on the concept of cost-effectiveness ratio, according to the newly formulated Johnson criterion and the view of discovery and destruction, this paper proposes to take the identification probability as the probability of being destroyed and uses mathematical formulas to calculate the cost of a single use decoy. On this basis, a cost-effectiveness ratio model is established, with the product of the increase in the survival probability of the target and the cost of the target as the benefit, and the sum of the product of the probability of being destroyed and the cost of the decoy and the cost of a single use as the consumption cost. The model is calculated and analyzed, and the number of decoys that conform to the actual situation is obtained.展开更多
This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies,namely chatting while under local anesthesia(Chat-LA),total intravenous anesthesia(TIVA),and general anesthesia with la...This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies,namely chatting while under local anesthesia(Chat-LA),total intravenous anesthesia(TIVA),and general anesthesia with laryngeal mask airway(GA-LMA),employed in transperineal magnetic resonance imaging(MRI)/ultrasound(US)fusion prostate biopsy(TP-MUF-PB).A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University(Suzhou,China).Clinical data and outcomes,including total costs,complications,and quality-adjusted life years(QALYs),were compared.Probability sensitivity and subgroup analyses were also performed.Chat-LA was found to be the most cost-effective option,outperforming both TIVA and GA-LMA.However,subgroup analyses revealed that in younger patients(under 65 years old)and those with smaller prostate volumes(<40 ml),TIVA emerged as a more cost-effective strategy.While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB,personalization of anesthesia strategies is crucial,considering specific patient demographics such as age and prostate volume.展开更多
[Objectives] To compare the clinical efficacy and cost-effectiveness of Yangxin Dingji capsule in conjunction with conventional Western medicine therapy against the use of conventional Western medicine therapy alone i...[Objectives] To compare the clinical efficacy and cost-effectiveness of Yangxin Dingji capsule in conjunction with conventional Western medicine therapy against the use of conventional Western medicine therapy alone in the treatment of tachyarrhythmia.[Methods] A meta-analysis was conducted to evaluate the efficacy of Yangxin Dingji capsule in conjunction with conventional Western medicine therapy for the treatment of tachyarrhythmia, compared to conventional Western medicine therapy alone. A decision tree model was developed to conduct a cost-effectiveness analysis from the perspective of the healthcare system. The effect parameter was the clinical effectiveness rate obtained from a meta-analysis of clinical literature. The cost parameter was represented by the drug treatment cost. The incremental cost-effectiveness ratio (ICER) was subsequently calculated, and the robustness of the primary analysis results was assessed through one-way sensitivity analysis.[Results] The results of the meta-analysis indicated that, over an 8-week treatment period, the clinical efficacy of Yangxin Dingji capsule in conjunction with conventional Western medicine for the treatment of tachyarrhythmia was superior to that of conventional Western medicine therapy alone, and the difference was found to be statistically significant [ OR =3.32, 95% CI (2.22-4.96), P <0.000 01]. The clinical efficacy of Yangxin Dingji capsule in conjunction with conventional Western medicine for the treatment of tachyarrhythmia was found to be superior when the treatment duration was 4 weeks, and the difference was found to be statistically significant [ OR =2.39, 95% CI (1.45-3.96), P =0.000 7]. The cost-effectiveness analysis indicated that with an 8-week treatment regimen, each 1% increase in the clinical effectiveness rate of Yangxin Dingji capsule in conjunction with conventional Western medical therapy for the treatment of arrhythmia, as compared to conventional Western medical therapy alone, resulted in an increase in cost of 91.78 yuan. Conversely, when the treatment duration was 4 weeks, each 1% increase in the clinical effectiveness rate of the Yangxin Dingji capsule combined with conventional Western medical therapy led to a cost increase of 70.84 yuan.[Conclusions] In the management of tachyarrhythmia, the clinical efficacy of Yangxin Dingji capsule in conjunction with conventional Western medicine therapy is superior to that of conventional Western medicine therapy alone. When the willingness-to-pay value exceeds the corresponding ICER, the combination of Yangxin Dingji capsule with conventional Western medicine therapy is deemed more cost-effective than the use of conventional Western medicine therapy alone.展开更多
To investigate the cost-effectiveness of different maintenance treatments of highways in Jiangsu Province, the historical pavement maintenance records, traffic load information and pavement performance data in the pav...To investigate the cost-effectiveness of different maintenance treatments of highways in Jiangsu Province, the historical pavement maintenance records, traffic load information and pavement performance data in the pavement management system （PMS） are recorded and analyzed. Compared with the growth model, the linear model, the logarithm model and the exponential model, the cubic model has higher regression accuracy R2 and it can capture the sigmoid shape of the deterioration curve. So it is selected to simulate the pavement rotting development. The benefit over cost ratio is calculated to quantify the treatment cost- effectiveness. The analysis results show that thin hot mix asphalt （HMA） overlays and micro surfacing are more cost- effective than the. other two treatments on light and moderate traffic roads. Hot in-place recycling and thick HMA overlays have much longer service lives and greater cost-effectiveness under heavy or extra heavy traffic.展开更多
Cost-effectiveness analysis（CEA） is increasingly important in health care decision making.Cost-effectiveness threshold is a critical parameter in the cost-effectiveness analysis.This review introduces the concept of...Cost-effectiveness analysis（CEA） is increasingly important in health care decision making.Cost-effectiveness threshold is a critical parameter in the cost-effectiveness analysis.This review introduces the concept of cost-effectiveness threshold, summarizes its determining methods,and classifies the existing methods into two kinds according to budget constraints,then analyzes the merit and demerit of every methods.When there is a flexible budget,the methods for determining the cost-effectiveness threshold include inferring the threshold from previous decisions,comparison with other health care technology or transfer from elsewhere in the public sector,social willingness-to-pay approach,GDP per capita criteria,and rule of thumb.When there is a fixed budget,the methods for determining the cost-effectiveness threshold include shadow price approach,opportunity cost approach,and ICER threshold-searcher model.Each approach to determining threshold has its strength and weakness.The aim of this article is to introduce the existing methods and discuss the features of each method.The background information,such as the definition of threshold,is also described.The basic theory of cost-effectiveness threshold is elaborated,and we recommend the establishment of a cost-effectiveness threshold in the Chinese health care.展开更多
Objective: To compare metal versus plastic biliary stent implantation for treatment of malignant biliary obstruction in cost-effectiveness ratio (CER). Methods: Percutaneous transhepatic self-expandable metal stent (M...Objective: To compare metal versus plastic biliary stent implantation for treatment of malignant biliary obstruction in cost-effectiveness ratio (CER). Methods: Percutaneous transhepatic self-expandable metal stent (MS, n=61) or 10F plastic stent (PS, n=34) implantation was performed in 95 patients with malignant biliary obstruction in three hospitals of Guangdong province. All patients were followed up until death or at least one year after the procedure. Kaplan-Meier analysis was used to compare the survival and stent patency rates of the patients in the two groups. CERs of two groups were calculated. The main indexes were CERsurvival period (total cost/median survival period), CERpatency period (total cost/median patency period). Results: The total costs of treatment were 53177±3139 yuan (RMB) in MS group and 42564±4950 yuan (RMB) in PS group respectively (P>0.05). CER in MS group was superior to that in PS group (CERsurvival period was 237.4 yuan /d vs 452.6 yuan /d, respectively; CERpatency period was 231.2 yuan /d vs 472.9 yuan /d, respectively). Conclusion: The metal stent implantation is superior to the plastic stent in the CER for treatment of malignant biliary obstruction.展开更多
Objective:Robotic-assisted spine surgeries(RASS)have been shown to enhance precision,reduce operative time,prevent complications,facilitate minimally invasive spinal surgery,and decrease revision surgery rates,leading...Objective:Robotic-assisted spine surgeries(RASS)have been shown to enhance precision,reduce operative time,prevent complications,facilitate minimally invasive spinal surgery,and decrease revision surgery rates,leading to improved patient outco mes This study aimed to compare the cost-effectiveness of RAs's and non-robotic-assisted surgery for degenerative spine disease at a single center.Me thods:This retrospective study,including 122 patients,was conducted at a single center from March 2015 to February 2022.Patients who underwent ro bot-assisted surgery were assigned to the robotgroup,and patients who underwent non-robotic-assisted surgery were assigned to the non-mmbot group.Various data,indluding demographic information,surgical details,outcomes,and cost-effectiveness,were colected for both groups.The cost-effectiveness was determined using the incremental cost-effectiveness ratio(ICER),and subgroup analysis was conducted for patients with 1 or 2 levels of spi-nal instrumentation.The analysis was performed using STATA SE version 15 and Tree.Age Pro 2020,with Monte Caro simulations for the cost-effectiveness acceptability curve.Results The owerallICER was$22,572,but it decreased to$16,980 when considering cases with only 1or 2 levels of instrumentation.RASS is deemed cost-effective when the willi ingness to pay is$3000-$4000 if less than 2 levels of the spine are instrumented.Conchsions:The cost-effectiveness of robot icassistance be comes apparent whenthere isa reduced need for open surgeries,leading to decreased d revision rates caused by complications such as misplaced screwsor infctions.Therefore,it is advisable to allocate healthcare budget resou Irces to spine robots,as RASS PIDves to be cost-effective,partic cularly when only two or Ewer spinal levels require instrumentation.展开更多
The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerg...The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture＇s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, andneonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.展开更多
AIM： To assess the economics of various chemotherapeutic regimens for advanced gastric cancer （AGC）, and to select the best cost-effective regimen for the common Chinese patients. METHODS： Data source used in this...AIM： To assess the economics of various chemotherapeutic regimens for advanced gastric cancer （AGC）, and to select the best cost-effective regimen for the common Chinese patients. METHODS： Data source used in this study was the Chinese Biomedical Disk Database. Patients were diagnosed as AGC and any regimen was eligible. Outcome measures included median survival time （MST） and percentage of complete and partial response （CR＋PR）. Economic statistics was per capita direct medical cost （DMC） of a single cycle. TreeAge Pro Healthcare 2007 software was used to carry out costeffectiveness and incremental cost-effectiveness analysis. Sensitivity analyses were applied by altering willingness- to-pay and annual discount rate, and also re-analyzed by excluding the studies with apparent heterogeneity. RESULTS： Seven retrospective economics studies on 760 patients were included. S-fluorouracil-based regimens were universal, and also some new agents were involved, such as docetaxel, paclitaxel, andoxaliplatin. By processing analysis, we could recommend etoposide, leucovorin and 5-fluorouracil （ELF） regimen as preference, with a DMC/MST ratio of 2543 RBM/11.7 mo and a DMC/CR＋PR ratio of 2543 RMB/53.3%. Uraciltegafur, etoposide and cisplatin （FEP） or 5-fluorouracil, adrimycin/epirubin and mitomycin （FAM） regimens could be regarded as optional first-line chemotherapy for AGC in common Chinese patients. With no regard for willingness-to-pay, the docetaxel, cisplatin and 5-fluorouracil （DCF） regimen could be chosen as either a first- or a second-line chemotherapy, with a DMC/CR＋PR ratio of 9979 RMB/56.3%. CONCLUSION： 5-fluorouracial regimens are still considered the mainstream for AGC, while new agents such as taxanes are optional. More randomized clinical trials are required before any mandatory recommendation of certain regimens for patients with AGC in China is made.展开更多
AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separa...AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.展开更多
AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In ...AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.展开更多
Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make inform...Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make informed decisions. This study aimed to perform the economic evaluation of lifelong annual influenza vaccination for cardiovascular events and well-established pneumonia prevention. Methods Lifetime costs, life-expectancy, and quality-adjusted live years （QALYs） were estimated beyond one-year cycle length of a six-health states Markov model condition on whether a hospitalization for ACS, stroke, heart failure, pneumonia, no hospitalizations occurred, or death. The comparison of three age-groups of 40-49, 50-65, and 〉 65 years scenario was performed. Incremental cost-effectiveness ratio （ICER） and net monetary benefit （NMB） were presented as a societal perspective in 2016. The model robustness was determined by one-way and prob- abilistic sensitivity analyses. Results The influenza vaccination was cost-effective in all age-groups, by dominant ICERs （lower cost with higher effectiveness） which was completely lower than acceptable willingness-to-pay threshold of Thailand [160,000 THB （4,466.8 USD） per QALYs], with a great incremental value of NMB. Especially, the 50-year-old-and- above scenario was shown as the most benefit at 129,092 THB （3,603.9 USD） for each patient. Conclusions The annually additional influenza vaccination to standard treatment in ACS was cost-effective in all age-groups, which should be considered in clinical practice and health-policy making process.展开更多
AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk datab...AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.展开更多
文摘Objective This systematic review examines recent pharmacoeconomic literature on denosumab'cost-effectiveness for bone metastasis treatment,providing evidence-based insights to guide healthcare policy decisions.Methods A comprehensive literature search was performed across Cochrane,PubMed,EMBASE(Ovid),CNKI,and Wanfang databases to identify original articles published between 2017 and 2023.Key words consisted of bone metastases,denosumab,and cost-effectiveness in the search strategy.The methodological quality of the included studies was assessed utilizing the revised Consolidated Health Economic Evaluation Reporting Standards(CHEERS 2022).Data was extracted regarding methodological characteristics and cost-effectiveness analyses.Results A total of 111 studies were retrieved,of which 6 met the inclusion criteria.All included studies were based on clinical trials and published literature data and exhibited high methodological quality.Up to 83%(5 out of 6)of comparisons demonstrated that denosumab was more cost-effective or dominant compared to zoledronic acid.The adjusted incremental cost-effectiveness ratios varied substantially by tumor type,ranging from CZK 436,339.09 to USD 136,234 per skeletal-related event avoided and from CZK 61,580.95 to USD 118,392.11 per quality-adjusted life year gained.Conclusions The majority of the included studies support denosumab as a more cost-effective treatment option for bone metastases in solid tumors compared to zoledronic acid.The application of CHEER(2022)enhances the reliability of pharmacoeconomic evaluations.
文摘Objective To evaluate the cost-effectiveness of gadopentetate dimeglumine(Gd-DTPA)and gadobenate dimeglumine(Gd-BOPTA)magnetic resonance imaging(MRI)contrast agents for the early diagnosis of hepatocellular carcinoma(HCC)from the perspective of China’s healthcare system.Methods A decision tree+partitioned survival model was constructed for early diagnosis of HCC based on literature data.Taking quality-adjusted life year(QALY)as the main health outcome measure for incremental cost-effectiveness ratio(ICER)analysis,the sensitivity analysis by Monte Carlo simulation was constructed to generate corresponding tornado diagram,incremental cost-effectiveness scatter plot,and cost-effectiveness acceptability curve.Results and Conclusion The basic analysis results showed that the ICER value of Gd-BOPTA diagnostic scheme compared with Gd-DTPA diagnostic scheme was 17302.46 yuan/QALY,which is less than 1 times of China’s gross domestic product(GDP)per capita.The sensitivity analysis results showed that the cost of delayed treatment and timely treatment had a significant impact on the results.When the willingness to pay(WTP)was 1 time of GDP per capita,the probability of cost-effectiveness advantage of Gd-BOPTA diagnostic scheme was 65.30%.When the WTP value is set at 1 times of GDP per capita,Gd-BOPTA MRI has cost-effectiveness advantages for the early diagnosis of HCC.
基金supported by Hainan Provincial Natural Science Foundation of China(No.721RC525).
文摘Guangdong’s carbon emissions have surpassed the world’s 11th largest emitter.It is indispensable for this province to find a robust cost-effective strategy for reducing carbon emissions.This study employed the Low Emissions Analysis Platform model,marginal cost curves,and Monte Carlo methods to simulate the energy consumption,carbon emissions,and economic benefits of emission reduction in Guangdong Province from 2020 to 2030 under the application of various structural optimization policies and energy-saving technologies.The main findings are as follows:In 2030,Guangdong Province is projected to achieve a carbon emission reduction of 273.6 to 304.6million t CO_(2eq),with a total reduction cost ranging from 1030.9 to 1452.2 billion yuan.Increasing the share of renewable energy,which still has significant growth potential,can lead to a 1.4 times greater reduction in carbon emissions compared to the application of energy-saving technologies,despite the latter yielding 2.3 times more energy savings.The emission reduction measures with net-cost can contribute 71.4%to the total carbon reduction of the province,being much larger than those with net benefits.The power sector plays a critical role in carbon emission reduction within Guangdong Province,with its various measures exerting the most substantial impact on emission reduction quantity and cost,contributing cumulative variance contributions of 90.1%and 84.3%,respectively.It has relatively large potential for emission reduction and relatively low cost of structural adjustment.
基金supported by the Major Science and Technology Projects in Yunnan Province(Grant No.202402AF080005)National Natural Science Foundation of China(Grant Nos.52274408,22468029,52274412)+2 种基金Yunnan Fundamental Research Projects(Grant No.202201AW070014)the Program for Innovative Research Team in University of Ministry of Education of China(Grant No.IRT 17R48)the German Research Foundation(DFG,Project number 501766751).
文摘While silicon/carbon(Si/C)is considered one of the most promising anode materials for the next generation of high-energy lithium-ion batteries(LIBs),the industrialization of Si/C anodes is hampered by high-cost and low product yield.Herein,a high-yield strategy is developed in which photovoltaic waste silicon is converted to cost-effective graphitic Si/C composites(G-Si@C)for LIBs.The introduction of a binder improves the dispersion and compatibility of silicon and graphite,enhances particle sphericity,and significantly reduces the loss rate of the spray prilling process(from about 25%to 5%).As an LIB anode,the fabricated G-Si@C composites exhibit a capacity of 605 mAh g^(-1) after 1200 cycles.The cost of manufacturing Si/C anode materials has been reduced to approximately$7.47 kg^(-1),which is close to that of commercial graphite anode materials($5.0 kg^(-1)),and significantly lower than commercial Si/C materials(ca.$20.74 kg^(-1)).Moreover,the G-Si@C material provides approximately 81.0 Ah/$of capacity,which exceeds the current best commercial graphite anodes(70.0 Ah/$)and Si/C anodes(48.2 Ah/$).The successful implementation of this pathway will significantly promote the industrialization of high-energydensity Si/C anode materials.
基金supported by Faculty of MedicineChiang Mai University+2 种基金supported by the National Center for Advancing Translational SciencesNational Institutes of Healththrough grant number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH。
文摘BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest(OHCA) survivors using clinical patient-level data.METHODS: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios(ICERs) were calculated and compared with various decision makers' willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ellipse.RESULTS: Among 925 non-traumatic OHCA survivors, only 30(3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost(delta cost-$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065, P=0.79) and higher survival to hospital discharge(delta effect 6%, 95% CI:-11% to 23%, P=0.41). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane.CONCLUSION: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.
文摘BACKGROUND Pancreatic exocrine insufficiency(PEI)leads to fat malabsorption and maldigestion and is most commonly treated with pancreatic enzyme replacement therapy(PERT).Patients suffering from PEI in China are more likely not to receive adequate treatment as this drug is not part of the Chinese national essential medicine list.AIM To examine the cost-effectiveness of PERT for patients suffering from PEI in China.METHODS A decision analytical Markov model was constructed to simulate the progress of patients with PEI in China.The population included in the analyses were patients suffering from PEI with advanced(non-resectable)pancreatic cancer,who have undergone surgery due to pancreatic cancer and who have undergone endoscopic treatment due to chronic pancreatitis.The cost-effectiveness analyses were undertaken from a Chinese societal perspective comparing PERT with no PERT.The incremental cost-effectiveness ratio in United States dollars per quality adjusted life year(QALY)gained is the main outcome.Input was informed by publicly available data supplemented with expert clinical advice.RESULTS The cost-effectiveness analyses estimated that PERT resulted in additional 0.45 to 2.93 QALYs at discounted costs of between 4315 dollars to 15193 dollars.This resulted in an incremental cost-effectiveness ratio of 5178 dollars to 9533 dollars per QALY.The one-way sensitivity analyses showed that the main drivers of the model were the cost of PERT and overall survival.CONCLUSION This study demonstrates that PERT is a cost-effective treatment for patients suffering from PEI in China.
基金The 2022 Ministry of Education General Project for Humanities and Social Sciences Research(Grant No.22YJAZH147)the General Subject of Guangzhou Philosophy and Social Science Development“14th Five-Year Plan”in 2023(Grant No.2023GZYB68)+2 种基金China University Industry-Academia-Research Innovation Fund-Huatong Guokang Medical Research Special Project(Grant No.2023HT017)2024 Guangdong Province General Project for the Planning of Philosophy and Social Sciences(Grant No.GD24CGL29)the Innovation Team Project of Colleges and Universities in Guangdong Province(Grant No.2022WCXTD011).
文摘Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide mononitrate sustained-release capsules(IMSRC)combined with conventional treatments,compared to isosorbide mononitrate tablets(IMT)combined with conventional treatments,for managing angina pectoris in patients with coronary heart diseases.A network meta-analysis(NMA)was conducted to assess the efficacy and safety of IMSRC and IMT.Relevant literature was sourced from databases,including PubMed,Embase,Cochrane Library,ScienceDirect,Web of Science,CNKI,Wanfang,and VIP,covering publications up to July 2023.The cost-effectiveness analysis(CEA)was performed from the perspective of China’s healthcare system,utilizing inputs derived from the NMA.The analysis included 15 studies.The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments.However,both combinations were more effective than conventional treatments without isosorbide mononitrate.No differences in safety were observed among the three groups.The surface under the cumulative ranking(SUCRA)of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris,whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT.The incidence of adverse events was ranked as IMT>conventional preparation>IMSRC.The CEA results highlighted that the incremental cost-effectiveness ratios(ICERs)for the markedly effective and total effective rates of angina pectoris were-133.41 and-260.20,respectively.The ICERs for ECG effective rates were-83.34 and-234.24,respectively.In conclusion,while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety,IMSRC proved to be more economical.
文摘With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role in the camouflaging effect. Based on the concept of cost-effectiveness ratio, according to the newly formulated Johnson criterion and the view of discovery and destruction, this paper proposes to take the identification probability as the probability of being destroyed and uses mathematical formulas to calculate the cost of a single use decoy. On this basis, a cost-effectiveness ratio model is established, with the product of the increase in the survival probability of the target and the cost of the target as the benefit, and the sum of the product of the probability of being destroyed and the cost of the decoy and the cost of a single use as the consumption cost. The model is calculated and analyzed, and the number of decoys that conform to the actual situation is obtained.
基金Key Medical Research Projects in Jiangsu Province(No.ZD2022021)the Key Research and Development Program of Jiangsu Province(No.BE2020654).
文摘This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies,namely chatting while under local anesthesia(Chat-LA),total intravenous anesthesia(TIVA),and general anesthesia with laryngeal mask airway(GA-LMA),employed in transperineal magnetic resonance imaging(MRI)/ultrasound(US)fusion prostate biopsy(TP-MUF-PB).A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University(Suzhou,China).Clinical data and outcomes,including total costs,complications,and quality-adjusted life years(QALYs),were compared.Probability sensitivity and subgroup analyses were also performed.Chat-LA was found to be the most cost-effective option,outperforming both TIVA and GA-LMA.However,subgroup analyses revealed that in younger patients(under 65 years old)and those with smaller prostate volumes(<40 ml),TIVA emerged as a more cost-effective strategy.While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB,personalization of anesthesia strategies is crucial,considering specific patient demographics such as age and prostate volume.
文摘[Objectives] To compare the clinical efficacy and cost-effectiveness of Yangxin Dingji capsule in conjunction with conventional Western medicine therapy against the use of conventional Western medicine therapy alone in the treatment of tachyarrhythmia.[Methods] A meta-analysis was conducted to evaluate the efficacy of Yangxin Dingji capsule in conjunction with conventional Western medicine therapy for the treatment of tachyarrhythmia, compared to conventional Western medicine therapy alone. A decision tree model was developed to conduct a cost-effectiveness analysis from the perspective of the healthcare system. The effect parameter was the clinical effectiveness rate obtained from a meta-analysis of clinical literature. The cost parameter was represented by the drug treatment cost. The incremental cost-effectiveness ratio (ICER) was subsequently calculated, and the robustness of the primary analysis results was assessed through one-way sensitivity analysis.[Results] The results of the meta-analysis indicated that, over an 8-week treatment period, the clinical efficacy of Yangxin Dingji capsule in conjunction with conventional Western medicine for the treatment of tachyarrhythmia was superior to that of conventional Western medicine therapy alone, and the difference was found to be statistically significant [ OR =3.32, 95% CI (2.22-4.96), P <0.000 01]. The clinical efficacy of Yangxin Dingji capsule in conjunction with conventional Western medicine for the treatment of tachyarrhythmia was found to be superior when the treatment duration was 4 weeks, and the difference was found to be statistically significant [ OR =2.39, 95% CI (1.45-3.96), P =0.000 7]. The cost-effectiveness analysis indicated that with an 8-week treatment regimen, each 1% increase in the clinical effectiveness rate of Yangxin Dingji capsule in conjunction with conventional Western medical therapy for the treatment of arrhythmia, as compared to conventional Western medical therapy alone, resulted in an increase in cost of 91.78 yuan. Conversely, when the treatment duration was 4 weeks, each 1% increase in the clinical effectiveness rate of the Yangxin Dingji capsule combined with conventional Western medical therapy led to a cost increase of 70.84 yuan.[Conclusions] In the management of tachyarrhythmia, the clinical efficacy of Yangxin Dingji capsule in conjunction with conventional Western medicine therapy is superior to that of conventional Western medicine therapy alone. When the willingness-to-pay value exceeds the corresponding ICER, the combination of Yangxin Dingji capsule with conventional Western medicine therapy is deemed more cost-effective than the use of conventional Western medicine therapy alone.
基金The Science and Technology Project of Jiangsu Provincial Communications Department(No.7621000078)
文摘To investigate the cost-effectiveness of different maintenance treatments of highways in Jiangsu Province, the historical pavement maintenance records, traffic load information and pavement performance data in the pavement management system （PMS） are recorded and analyzed. Compared with the growth model, the linear model, the logarithm model and the exponential model, the cubic model has higher regression accuracy R2 and it can capture the sigmoid shape of the deterioration curve. So it is selected to simulate the pavement rotting development. The benefit over cost ratio is calculated to quantify the treatment cost- effectiveness. The analysis results show that thin hot mix asphalt （HMA） overlays and micro surfacing are more cost- effective than the. other two treatments on light and moderate traffic roads. Hot in-place recycling and thick HMA overlays have much longer service lives and greater cost-effectiveness under heavy or extra heavy traffic.
文摘Cost-effectiveness analysis（CEA） is increasingly important in health care decision making.Cost-effectiveness threshold is a critical parameter in the cost-effectiveness analysis.This review introduces the concept of cost-effectiveness threshold, summarizes its determining methods,and classifies the existing methods into two kinds according to budget constraints,then analyzes the merit and demerit of every methods.When there is a flexible budget,the methods for determining the cost-effectiveness threshold include inferring the threshold from previous decisions,comparison with other health care technology or transfer from elsewhere in the public sector,social willingness-to-pay approach,GDP per capita criteria,and rule of thumb.When there is a fixed budget,the methods for determining the cost-effectiveness threshold include shadow price approach,opportunity cost approach,and ICER threshold-searcher model.Each approach to determining threshold has its strength and weakness.The aim of this article is to introduce the existing methods and discuss the features of each method.The background information,such as the definition of threshold,is also described.The basic theory of cost-effectiveness threshold is elaborated,and we recommend the establishment of a cost-effectiveness threshold in the Chinese health care.
文摘Objective: To compare metal versus plastic biliary stent implantation for treatment of malignant biliary obstruction in cost-effectiveness ratio (CER). Methods: Percutaneous transhepatic self-expandable metal stent (MS, n=61) or 10F plastic stent (PS, n=34) implantation was performed in 95 patients with malignant biliary obstruction in three hospitals of Guangdong province. All patients were followed up until death or at least one year after the procedure. Kaplan-Meier analysis was used to compare the survival and stent patency rates of the patients in the two groups. CERs of two groups were calculated. The main indexes were CERsurvival period (total cost/median survival period), CERpatency period (total cost/median patency period). Results: The total costs of treatment were 53177±3139 yuan (RMB) in MS group and 42564±4950 yuan (RMB) in PS group respectively (P>0.05). CER in MS group was superior to that in PS group (CERsurvival period was 237.4 yuan /d vs 452.6 yuan /d, respectively; CERpatency period was 231.2 yuan /d vs 472.9 yuan /d, respectively). Conclusion: The metal stent implantation is superior to the plastic stent in the CER for treatment of malignant biliary obstruction.
文摘Objective:Robotic-assisted spine surgeries(RASS)have been shown to enhance precision,reduce operative time,prevent complications,facilitate minimally invasive spinal surgery,and decrease revision surgery rates,leading to improved patient outco mes This study aimed to compare the cost-effectiveness of RAs's and non-robotic-assisted surgery for degenerative spine disease at a single center.Me thods:This retrospective study,including 122 patients,was conducted at a single center from March 2015 to February 2022.Patients who underwent ro bot-assisted surgery were assigned to the robotgroup,and patients who underwent non-robotic-assisted surgery were assigned to the non-mmbot group.Various data,indluding demographic information,surgical details,outcomes,and cost-effectiveness,were colected for both groups.The cost-effectiveness was determined using the incremental cost-effectiveness ratio(ICER),and subgroup analysis was conducted for patients with 1 or 2 levels of spi-nal instrumentation.The analysis was performed using STATA SE version 15 and Tree.Age Pro 2020,with Monte Caro simulations for the cost-effectiveness acceptability curve.Results The owerallICER was$22,572,but it decreased to$16,980 when considering cases with only 1or 2 levels of instrumentation.RASS is deemed cost-effective when the willi ingness to pay is$3000-$4000 if less than 2 levels of the spine are instrumented.Conchsions:The cost-effectiveness of robot icassistance be comes apparent whenthere isa reduced need for open surgeries,leading to decreased d revision rates caused by complications such as misplaced screwsor infctions.Therefore,it is advisable to allocate healthcare budget resou Irces to spine robots,as RASS PIDves to be cost-effective,partic cularly when only two or Ewer spinal levels require instrumentation.
文摘The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture＇s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, andneonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.
基金Supported by Multidisciplinary Treatment Project of Gastrointestinal Tumors, West China Hospital, Sichuan University,the Scientific Foundation of West China Hospital of Sichuan University
文摘AIM： To assess the economics of various chemotherapeutic regimens for advanced gastric cancer （AGC）, and to select the best cost-effective regimen for the common Chinese patients. METHODS： Data source used in this study was the Chinese Biomedical Disk Database. Patients were diagnosed as AGC and any regimen was eligible. Outcome measures included median survival time （MST） and percentage of complete and partial response （CR＋PR）. Economic statistics was per capita direct medical cost （DMC） of a single cycle. TreeAge Pro Healthcare 2007 software was used to carry out costeffectiveness and incremental cost-effectiveness analysis. Sensitivity analyses were applied by altering willingness- to-pay and annual discount rate, and also re-analyzed by excluding the studies with apparent heterogeneity. RESULTS： Seven retrospective economics studies on 760 patients were included. S-fluorouracil-based regimens were universal, and also some new agents were involved, such as docetaxel, paclitaxel, andoxaliplatin. By processing analysis, we could recommend etoposide, leucovorin and 5-fluorouracil （ELF） regimen as preference, with a DMC/MST ratio of 2543 RBM/11.7 mo and a DMC/CR＋PR ratio of 2543 RMB/53.3%. Uraciltegafur, etoposide and cisplatin （FEP） or 5-fluorouracil, adrimycin/epirubin and mitomycin （FAM） regimens could be regarded as optional first-line chemotherapy for AGC in common Chinese patients. With no regard for willingness-to-pay, the docetaxel, cisplatin and 5-fluorouracil （DCF） regimen could be chosen as either a first- or a second-line chemotherapy, with a DMC/CR＋PR ratio of 9979 RMB/56.3%. CONCLUSION： 5-fluorouracial regimens are still considered the mainstream for AGC, while new agents such as taxanes are optional. More randomized clinical trials are required before any mandatory recommendation of certain regimens for patients with AGC in China is made.
基金Supported by National Institutes of Health,United States,No.R01-CA140574 and No.U01-CA152926(to Hur C)No.R21-CA156704 and No.R01-CA181275(to Anandasabapathy S)and No.K25-CA133141(to Kong CY)
文摘AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.
基金Supported by Kaohsiung Municipal Min-Seng Hospital(KMSH 9702)
文摘AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.
文摘Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make informed decisions. This study aimed to perform the economic evaluation of lifelong annual influenza vaccination for cardiovascular events and well-established pneumonia prevention. Methods Lifetime costs, life-expectancy, and quality-adjusted live years （QALYs） were estimated beyond one-year cycle length of a six-health states Markov model condition on whether a hospitalization for ACS, stroke, heart failure, pneumonia, no hospitalizations occurred, or death. The comparison of three age-groups of 40-49, 50-65, and 〉 65 years scenario was performed. Incremental cost-effectiveness ratio （ICER） and net monetary benefit （NMB） were presented as a societal perspective in 2016. The model robustness was determined by one-way and prob- abilistic sensitivity analyses. Results The influenza vaccination was cost-effective in all age-groups, by dominant ICERs （lower cost with higher effectiveness） which was completely lower than acceptable willingness-to-pay threshold of Thailand [160,000 THB （4,466.8 USD） per QALYs], with a great incremental value of NMB. Especially, the 50-year-old-and- above scenario was shown as the most benefit at 129,092 THB （3,603.9 USD） for each patient. Conclusions The annually additional influenza vaccination to standard treatment in ACS was cost-effective in all age-groups, which should be considered in clinical practice and health-policy making process.
基金Supported by The National Natural Science Foundation of China, No.30500684 and Clinical Research Foundation for Residency Granted by the Cooperative Project of West China Hospital and Daiichi Pharmaceutical Co. Ltd., the level Ⅰ
文摘AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.
