Objective:To evaluate the cost-effectiveness of annual trivalent inactivated influenza vaccine(IIV3)under the context of Zhejiang province.Methods:A state transition simulation model was constructed to estimate the he...Objective:To evaluate the cost-effectiveness of annual trivalent inactivated influenza vaccine(IIV3)under the context of Zhejiang province.Methods:A state transition simulation model was constructed to estimate the health and economic outcomes of IIV3 vaccination program compared to no vaccination for hypothetical cohorts of Zhejiang province stratified by age and risk status.Model input parameters were chosen based on published literatures and expert advices.The analysis used societal perspectives and a one-year time horizon,and permanent outcomes were also included.The primary outcome was the incremental cost-effectiveness ratio(ICER),with expression of US dollars per quality adjusted life years(QALYs)gained.Results:In subgroups not at high risk for influenza-related complications(non-high risk subgroup),ICER ranged from $6268/QALY(for adults aged 50-64 years)to $11260/QALY(for children aged from 6 months to 4 years).In subgroups at high risk for influenza-related complications(high risk subgroup),ICER ranged from cost-saving(adults aged≥65 years)to $5260/QALY(for children aged from 6 months to 4 years).ICER were most sensitive to changes in probability of influenza illness,cost of hospitalization,and probability of death for adults aged 18-49 years with non-high risk status.Conclusions:ICERs of annual influenza vaccination varied by age and risk status but were less than the Gross Domestic Product(GDP)per capita of Zhejiang province($17745 in 2023),which remained cost-effective for all-age and different risk status groups from a societal perspective.展开更多
BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical perf...BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.展开更多
BACKGROUND Approximately 30%of patients with head and neck cancer experience adverse effects caused by anxiety and depression.Considering the high prevalence,implementing customized interventions to ease adverse emoti...BACKGROUND Approximately 30%of patients with head and neck cancer experience adverse effects caused by anxiety and depression.Considering the high prevalence,implementing customized interventions to ease adverse emotional states is imperative.AIM To evaluate the efficacy of cognitive behavioral therapy(CBT)-based psychological interventions in improving the psychological well-being and quality of life(QoL)of patients with laryngeal carcinoma.METHODS This study enrolled 120 patients admitted from February 2022 to February 2024.The control group,comprising 50 participants,received standard supportive psychological care,while the research group,consisting 70 participants,underwent CBT-based interventions.Several clinical outcomes were systematically assessed that included postoperative recovery metrics(duration of tracheostomy and nasogastric tube dependence and length of hospitalization),psychological status(Self-Rating Anxiety Scale and Self-Rating Depression Scale),nutritional markers(serum albumin and hemoglobin levels),sleep quality(Self-Rating Scale of Sleep and Athens Insomnia Scale),and QoL(Functional Assessment of Cancer Therapy-Head and Neck).RESULTS The results demonstrated that the research group experienced superior outcomes,with significantly reduced durations of tracheostomy and nasogastric tube dependence,as well as shorter hospital stays,compared with the control group.Additionally,the research group exhibited markedly lower post-intervention Self-Rating Anxiety Scale,Self-Rating Depression Scale,Self-Rating Scale of Sleep,and Athens Insomnia Scale scores,along with minimal but higher change in serum albumin and hemoglobin levels compared with the control group.All five domains of Functional Assessment of Cancer Therapy-Head and Neck showed notable improvements in the research group,exceeding those observed in the control group.CONCLUSION CBT-based psychological support positively affects the mental well-being and QoL of patients with laryngeal carcinoma,highlighting its potential for broader clinical application.展开更多
The intersection of visual impairment and mental health has profound effects on quality of life and warrants attention from healthcare providers,educators,and policymakers.With 20 million children under the age of 14 ...The intersection of visual impairment and mental health has profound effects on quality of life and warrants attention from healthcare providers,educators,and policymakers.With 20 million children under the age of 14 affected globally,older adults also experience significant psychological impact including depression,anxiety,and cognitive impairment.The implications of vision-related challenges extend far beyond mere sight.Depression and anxiety,exacerbated by social isolation and reduced physical activity,underscore the need for comprehensive interventions that address both medical and psychosocial dimensions.By recognizing the profound impact of ocular morbidities like strabismus,myopia,glaucoma,and age-related macular degeneration on mental health and investing in effective treatments and inclusive practices,society can pave the way for a healthier,more equitable future for affected individuals.There is evidence that myopic children experience a higher prevalence of depressive symptoms compared to their normal peers,and interventions like the correction of strabismus can enhance psychological outcome-demonstrating the value of an integrated management approach.展开更多
The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents(DES) vs bare metal stent(BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, t...The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents(DES) vs bare metal stent(BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years(60% of success) when compared to BMS(58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs(P < 0.05) per success for the BMS strategy(15520 €/success), as compared to the DES strategy(15588 €/success). Incremental costeffectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.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
BACKGROUND Obesity impacts 42%of United States adults and results in an estimated economic burden of nearly 1.4 trillion dollars annually.Endoscopic sleeve gastroplasty(ESG)is a United States Food and Drug Administrat...BACKGROUND Obesity impacts 42%of United States adults and results in an estimated economic burden of nearly 1.4 trillion dollars annually.Endoscopic sleeve gastroplasty(ESG)is a United States Food and Drug Administration authorized procedure with an excellent safety,efficacy,and durability profile.The cost-effectiveness of ESG compared to lifestyle modification(LM)in real-world patients with class I-III obesity represents a critical knowledge gap.AIM To approximate the cost-effectiveness of ESG vs LM using a real-world dataset of 860 United States adults with class I-III obesity undergoing ESG.METHODS A 6-state Markov model was employed,including healthy weight,overweight,class I-III obesity,and death.The LM control group was built using transition states previously described in the literature,supplemented by expert opinion.Cycles lasted six-months in the model’s first year and twelve-months thereafter.Existing literature informed approximations of each health state utility,adverse event disutility,and incidence of obesity-associated comorbidities.One-way sensitivity and probabilistic sensitivity analyses were performed.RESULTS The base-case incremental cost-effectiveness ratio(ICER)for ESG vs LM was 5904 dollars per quality-adjusted life year(QALY).In a one-way sensitivity analysis,the utilities assigned to the three obesity classes most greatly influenced the ICER.Probabilistic sensitivity analysis estimated an increase in upper-bound ICER of 8038 dollars per QALY,well under the generally cited United States willingness to pay ratio of 100000 dollars per QALY.CONCLUSION The results of this model support that ESG is overwhelmingly cost-effective compared to LM across all obesity classes.Payors should consider expanding coverage for their members.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
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
Objective:To investigate the preventive effect of targeted nursing interventions on deep vein thrombosis in patients with hemodialysis catheter indwelling.Methods:A prospective study was conducted involving patients w...Objective:To investigate the preventive effect of targeted nursing interventions on deep vein thrombosis in patients with hemodialysis catheter indwelling.Methods:A prospective study was conducted involving patients who underwent hemodialysis catheter indwelling and were admitted between August 2023 and August 2025,totaling 108 cases.These patients were randomly divided into two groups using a random number table method,with 54 cases in each group.The control group received routine nursing interventions,while the observation group received targeted nursing interventions.The incidence of deep vein thrombosis and hemodynamic indicators were compared between the two groups.Results:The incidence of deep vein thrombosis in the observation group was lower than that in the control group(p<0.05).After two weeks of nursing,the hemodynamic indicators in the observation group were higher than those in the control group(p<0.05).Conclusion:Targeted nursing interventions can effectively prevent deep vein thrombosis and improve hemodynamics in patients with hemodialysis catheter indwelling,making them worthy of clinical promotion.展开更多
Objective:To analyze the effect of interventional nursing on the therapeutic effect,negative emotion and quality of life of patients undergoing cardiovascular and cerebrovascular interventional therapy.Methods:Eighty-...Objective:To analyze the effect of interventional nursing on the therapeutic effect,negative emotion and quality of life of patients undergoing cardiovascular and cerebrovascular interventional therapy.Methods:Eighty-four patients who received cardio-cerebral vascular interventional therapy in a hospital during January 2024–December 2024 were selected,and were divided into the control group and the observation group by the mean score method,each with 42 cases.The control group was given standardized perioperative care,and the observation group was given interventional nursing intervention on this basis.The two groups were compared in terms of clinical efficacy,negative emotion score,incidence of related complications,quality of life score and nursing satisfaction.Results:The total effective rate of treatment of patients in the observation group(95.24%)was significantly higher than that of the control group(78.57%),and the difference was statistically significant(P<0.05);before nursing care,the difference between SDS and SAS scores of patients in the two groups was insignificant(P>0.05);after nursing care,the scores of various indexes of the two groups were significantly reduced and the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05);the patients in the observation group had more negative moods than those in the control group;the complication rate of patients in the observation group(2.38%)was significantly lower than that of the control group(19.04%),and the difference was statistically significant(P<0.05);the quality of life scores of patients in the observation group were higher than that of the control group,and the difference was statistically significant(P<0.05);the satisfaction rate of patients’nursing care in the observation group was 97.62%,which was higher than that of the control group(78.57%),and the difference was statistically significant(P<0.05).The difference is statistically significant(P<0.05).Conclusion:The implementation of interventional nursing intervention for patients with cardiovascular and cerebrovascular interventional therapy can further enhance the clinical therapeutic effect,improve the negative emotions of patients’anxiety and depression,reduce the risk of related complications,improve the quality of life of patients,and obtain higher satisfaction.展开更多
BACKGROUND Esophageal cancer is a malignancy that originates in the epithelium of the esophageal mucosa and has a high mortality rate.Although radiotherapy is the primary treatment modality,it can easily lead to nutri...BACKGROUND Esophageal cancer is a malignancy that originates in the epithelium of the esophageal mucosa and has a high mortality rate.Although radiotherapy is the primary treatment modality,it can easily lead to nutritional deterioration and psychological distress,affecting treatment efficacy and quality of life.Currently,there are relatively few postoperative rehabilitation interventions for esophageal cancer.As such,it is particularly important to develop a systematic and comprehensive intervention model to improve the quality of life and nutritional status of patients.AIM To evaluate exercise,nutritional,and psychological interventions on the postoperative nutritional and mental status of patients with esophageal cancer.METHODS Data from 104 patients,who were diagnosed with postoperative esophageal cancer between August 2023 and February 2024,were retrospectively analyzed.Patients were divided into 2 groups using a random numbers table:control[routine nursing measures(n=53)];and observation[routine nursing+exercise,nutritional support,and psychological interventions(n=51)].Nutritional status,anxiety and depression,quality of life,incidence of complications,treatment compliance,and satisfaction with nursing care were compared between the two groups.RESULTS Serum albumin,prealbumin,hemoglobin,transferrin,and World Health Organization Quality of Life-Brief Version scores were higher in the observation group than those in the control group.After treatment,Self-rating Anxiety Scale,Self-rating Depression Scale,and Hamilton Anxiety and Depression Scale scores in the observation group were lower than those in the control group.No significant differences were observed in the incidence of complications between the observation and control groups.The observation group exhibited more satisfaction with nursing care and treatment compliance than the control group.CONCLUSION Exercise,nutritional support,and psychological interventions effectively improves the nutritional status and negative emotions of patients undergoing radiotherapy for esophageal cancer,and enhances treatment compliance and satisfaction with nursing.展开更多
Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifes...Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifest through physiological symptoms,cognitive distortions,behavioral avoidance,and cardiacspecific concerns and typically emerge within 1-2 weeks post-procedure.Key risk factors include female sex,younger age(<55 years),psychiatric history,procedural complexity,and poor social support.Anxiety negatively affects cardiovascular outcomes when left untreated,leading to higher readmission rates(HR=1.47)and recurrent cardiovascular events(HR=1.31),as well as lower medication adherence and quality of life.Screening is optimally conducted 7-10 days postprocedure via validated tools such as the Hospital Anxiety and Depr-ession Scale,Anxiety.Heart-specific cognitive behavioral therapy(SMD=-0.72),selective serotonin reuptake inhibitors(especially sertraline),and integrated cardiac rehabilitation programs that incorporate both psychological and physical elements are among the beneficial interventions that have been supported by evidence.These all-encompassing strategies show long-term improvements in cardiovascular outcomes,functional ability,and healthcare expenses in addition to immediate benefits in lowering anxiety.Digital initiatives have the potential to increase access,especially in underprivileged areas.Early identification of highrisk patients and implementation of timely,targeted interventions represent crucial strategies for improving both psychological and cardiovascular outcomes in this vulnerable population.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
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
Background Quantitative flow ratio(QFR)based lesion selection for percutaneous coronary intervention(PCI)treatment has shown clinical benefits in terms of reduced risk for myocardial infarction and repeat revasculariz...Background Quantitative flow ratio(QFR)based lesion selection for percutaneous coronary intervention(PCI)treatment has shown clinical benefits in terms of reduced risk for myocardial infarction and repeat revascularization.Whether this benefit is consistent across different age groups still needs further investigation.Methods In this prespecified subgroup study of FAVORⅢChina trial,we compared long-term clinical outcomes between QFR-guided and angiography-guided PCI among different age groups among 3825 enrolled subjects.The primary endpoint was major adverse cardiac events(MACEs),a composite of all-cause death,myocardial infarction,and ischemia-driven revascularization.Results Of the 3825 patients,1717(44.9%)were aged≥65 years.At baseline,patients≥65 had higher rates of hypertension,hyperlipidaemia,stroke history(P<0.0001),and peripheral vascular disease(P=0.024)and had higher SYNTAX scores(P=0.0095).Compared with standard angiography guidance,the QFR-guided strategy consistently reduced the 1-year(≥65 years,6.04%vs.9.19%,HR=0.65,95%CI:0.46–0.92;<65 years,5.53%vs.8.43%,HR=0.65,95%CI:0.47–0.91)and 3-year MACE rates in both age groups(≥65 years,11.8%vs.15.2%,HR:0.75,95%CI:0.58–0.98;<65 years,9.5%vs.14.6%,HR=0.63;95%CI:0.49–0.81),without a significant interaction(Pinteraction=0.99).Within the QFR-guided group,the 3-year MACE rate in patients with deferred vessels was numerically greater in patients aged≥65 years than in those aged<65 years(8.3%vs.3.0%,P=0.10).Conclusions Although with higher rate of comorbidities and more complex coronary anatomy,the long-term benefit of the QFR-guided PCI strategy remained consistent in patients≥65 years,compared with those<65 years.展开更多
BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid er...BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid era,but direct head-to-head cost comparisons between the two modalities are not available in literature.AIM To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.METHODS A prospective observational single-center case control study including adult patients with ARF(PaO2/FiO2 ratio<300)admitted from January 1,2024 to December 31,2024 in medical intensive care unit(ICU)of a tertiary care hospital requiring either NIV or invasive ventilation.NIV and IMV groups were compared based on average length of ICU and hospital stay,mortality,net cost of ICU treatment,need for intubation and tracheostomy.RESULTS A total of 319 patients were included in the study(197 in NIV,122 in IMV group).Statistically significant difference in length of ICU stay(NIV group:5±3.25 days,IMV group:9±2.6 days;P<0.05)and mortality rate was seen(11%NIV vs 34%IMV;P<0.01).On multivariate analyses,mortality showed a stronger association with IMV[odds ratio(OR)=7.73;95%CI:3.12-19.18]as compared to ICU stay(OR=2.73;95%CI:2.15-3.48).A total of 33 patients(17%)in NIV group required intubation of which 3 were tracheostomized,while 14 patients(11%)in IMV group needed tracheostomy.The net average cost of ICU stay was₹83902 in NIV group while in IMV group,the net ICU cost was₹476216.The average cost of ICU stay was five times higher with IMV.CONCLUSION NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.展开更多
There have been an increasing number of studies on climate change and population health over the past 20 years,with most focusing on health risk assessment,targeting different locations and populations with various di...There have been an increasing number of studies on climate change and population health over the past 20 years,with most focusing on health risk assessment,targeting different locations and populations with various diseases[1−2].While these studies have provided the necessary epidemiological evidence for health authorities in policymaking,it is time to develop and implement tailored health interventions to protect the health and well-being of communities,and particularly that of vulnerable groups.展开更多
基金funded by Medical and Health Science and Technology Project of Zhejiang province(Grant number:2023KY633).
文摘Objective:To evaluate the cost-effectiveness of annual trivalent inactivated influenza vaccine(IIV3)under the context of Zhejiang province.Methods:A state transition simulation model was constructed to estimate the health and economic outcomes of IIV3 vaccination program compared to no vaccination for hypothetical cohorts of Zhejiang province stratified by age and risk status.Model input parameters were chosen based on published literatures and expert advices.The analysis used societal perspectives and a one-year time horizon,and permanent outcomes were also included.The primary outcome was the incremental cost-effectiveness ratio(ICER),with expression of US dollars per quality adjusted life years(QALYs)gained.Results:In subgroups not at high risk for influenza-related complications(non-high risk subgroup),ICER ranged from $6268/QALY(for adults aged 50-64 years)to $11260/QALY(for children aged from 6 months to 4 years).In subgroups at high risk for influenza-related complications(high risk subgroup),ICER ranged from cost-saving(adults aged≥65 years)to $5260/QALY(for children aged from 6 months to 4 years).ICER were most sensitive to changes in probability of influenza illness,cost of hospitalization,and probability of death for adults aged 18-49 years with non-high risk status.Conclusions:ICERs of annual influenza vaccination varied by age and risk status but were less than the Gross Domestic Product(GDP)per capita of Zhejiang province($17745 in 2023),which remained cost-effective for all-age and different risk status groups from a societal perspective.
文摘BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.
文摘BACKGROUND Approximately 30%of patients with head and neck cancer experience adverse effects caused by anxiety and depression.Considering the high prevalence,implementing customized interventions to ease adverse emotional states is imperative.AIM To evaluate the efficacy of cognitive behavioral therapy(CBT)-based psychological interventions in improving the psychological well-being and quality of life(QoL)of patients with laryngeal carcinoma.METHODS This study enrolled 120 patients admitted from February 2022 to February 2024.The control group,comprising 50 participants,received standard supportive psychological care,while the research group,consisting 70 participants,underwent CBT-based interventions.Several clinical outcomes were systematically assessed that included postoperative recovery metrics(duration of tracheostomy and nasogastric tube dependence and length of hospitalization),psychological status(Self-Rating Anxiety Scale and Self-Rating Depression Scale),nutritional markers(serum albumin and hemoglobin levels),sleep quality(Self-Rating Scale of Sleep and Athens Insomnia Scale),and QoL(Functional Assessment of Cancer Therapy-Head and Neck).RESULTS The results demonstrated that the research group experienced superior outcomes,with significantly reduced durations of tracheostomy and nasogastric tube dependence,as well as shorter hospital stays,compared with the control group.Additionally,the research group exhibited markedly lower post-intervention Self-Rating Anxiety Scale,Self-Rating Depression Scale,Self-Rating Scale of Sleep,and Athens Insomnia Scale scores,along with minimal but higher change in serum albumin and hemoglobin levels compared with the control group.All five domains of Functional Assessment of Cancer Therapy-Head and Neck showed notable improvements in the research group,exceeding those observed in the control group.CONCLUSION CBT-based psychological support positively affects the mental well-being and QoL of patients with laryngeal carcinoma,highlighting its potential for broader clinical application.
文摘The intersection of visual impairment and mental health has profound effects on quality of life and warrants attention from healthcare providers,educators,and policymakers.With 20 million children under the age of 14 affected globally,older adults also experience significant psychological impact including depression,anxiety,and cognitive impairment.The implications of vision-related challenges extend far beyond mere sight.Depression and anxiety,exacerbated by social isolation and reduced physical activity,underscore the need for comprehensive interventions that address both medical and psychosocial dimensions.By recognizing the profound impact of ocular morbidities like strabismus,myopia,glaucoma,and age-related macular degeneration on mental health and investing in effective treatments and inclusive practices,society can pave the way for a healthier,more equitable future for affected individuals.There is evidence that myopic children experience a higher prevalence of depressive symptoms compared to their normal peers,and interventions like the correction of strabismus can enhance psychological outcome-demonstrating the value of an integrated management approach.
基金Supported by An unrestrictive grant from Sanofi-Aventis
文摘The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents(DES) vs bare metal stent(BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years(60% of success) when compared to BMS(58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs(P < 0.05) per success for the BMS strategy(15520 €/success), as compared to the DES strategy(15588 €/success). Incremental costeffectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.
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.
文摘BACKGROUND Obesity impacts 42%of United States adults and results in an estimated economic burden of nearly 1.4 trillion dollars annually.Endoscopic sleeve gastroplasty(ESG)is a United States Food and Drug Administration authorized procedure with an excellent safety,efficacy,and durability profile.The cost-effectiveness of ESG compared to lifestyle modification(LM)in real-world patients with class I-III obesity represents a critical knowledge gap.AIM To approximate the cost-effectiveness of ESG vs LM using a real-world dataset of 860 United States adults with class I-III obesity undergoing ESG.METHODS A 6-state Markov model was employed,including healthy weight,overweight,class I-III obesity,and death.The LM control group was built using transition states previously described in the literature,supplemented by expert opinion.Cycles lasted six-months in the model’s first year and twelve-months thereafter.Existing literature informed approximations of each health state utility,adverse event disutility,and incidence of obesity-associated comorbidities.One-way sensitivity and probabilistic sensitivity analyses were performed.RESULTS The base-case incremental cost-effectiveness ratio(ICER)for ESG vs LM was 5904 dollars per quality-adjusted life year(QALY).In a one-way sensitivity analysis,the utilities assigned to the three obesity classes most greatly influenced the ICER.Probabilistic sensitivity analysis estimated an increase in upper-bound ICER of 8038 dollars per QALY,well under the generally cited United States willingness to pay ratio of 100000 dollars per QALY.CONCLUSION The results of this model support that ESG is overwhelmingly cost-effective compared to LM across all obesity classes.Payors should consider expanding coverage for their members.
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.
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.
文摘Objective:To investigate the preventive effect of targeted nursing interventions on deep vein thrombosis in patients with hemodialysis catheter indwelling.Methods:A prospective study was conducted involving patients who underwent hemodialysis catheter indwelling and were admitted between August 2023 and August 2025,totaling 108 cases.These patients were randomly divided into two groups using a random number table method,with 54 cases in each group.The control group received routine nursing interventions,while the observation group received targeted nursing interventions.The incidence of deep vein thrombosis and hemodynamic indicators were compared between the two groups.Results:The incidence of deep vein thrombosis in the observation group was lower than that in the control group(p<0.05).After two weeks of nursing,the hemodynamic indicators in the observation group were higher than those in the control group(p<0.05).Conclusion:Targeted nursing interventions can effectively prevent deep vein thrombosis and improve hemodynamics in patients with hemodialysis catheter indwelling,making them worthy of clinical promotion.
文摘Objective:To analyze the effect of interventional nursing on the therapeutic effect,negative emotion and quality of life of patients undergoing cardiovascular and cerebrovascular interventional therapy.Methods:Eighty-four patients who received cardio-cerebral vascular interventional therapy in a hospital during January 2024–December 2024 were selected,and were divided into the control group and the observation group by the mean score method,each with 42 cases.The control group was given standardized perioperative care,and the observation group was given interventional nursing intervention on this basis.The two groups were compared in terms of clinical efficacy,negative emotion score,incidence of related complications,quality of life score and nursing satisfaction.Results:The total effective rate of treatment of patients in the observation group(95.24%)was significantly higher than that of the control group(78.57%),and the difference was statistically significant(P<0.05);before nursing care,the difference between SDS and SAS scores of patients in the two groups was insignificant(P>0.05);after nursing care,the scores of various indexes of the two groups were significantly reduced and the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05);the patients in the observation group had more negative moods than those in the control group;the complication rate of patients in the observation group(2.38%)was significantly lower than that of the control group(19.04%),and the difference was statistically significant(P<0.05);the quality of life scores of patients in the observation group were higher than that of the control group,and the difference was statistically significant(P<0.05);the satisfaction rate of patients’nursing care in the observation group was 97.62%,which was higher than that of the control group(78.57%),and the difference was statistically significant(P<0.05).The difference is statistically significant(P<0.05).Conclusion:The implementation of interventional nursing intervention for patients with cardiovascular and cerebrovascular interventional therapy can further enhance the clinical therapeutic effect,improve the negative emotions of patients’anxiety and depression,reduce the risk of related complications,improve the quality of life of patients,and obtain higher satisfaction.
基金Supported by the Special Project on Intravenous Therapy of Shanghai Nursing Society,No.2023JL-B08Naval Medical University Nursing“Zhuyuan”Talent Program.
文摘BACKGROUND Esophageal cancer is a malignancy that originates in the epithelium of the esophageal mucosa and has a high mortality rate.Although radiotherapy is the primary treatment modality,it can easily lead to nutritional deterioration and psychological distress,affecting treatment efficacy and quality of life.Currently,there are relatively few postoperative rehabilitation interventions for esophageal cancer.As such,it is particularly important to develop a systematic and comprehensive intervention model to improve the quality of life and nutritional status of patients.AIM To evaluate exercise,nutritional,and psychological interventions on the postoperative nutritional and mental status of patients with esophageal cancer.METHODS Data from 104 patients,who were diagnosed with postoperative esophageal cancer between August 2023 and February 2024,were retrospectively analyzed.Patients were divided into 2 groups using a random numbers table:control[routine nursing measures(n=53)];and observation[routine nursing+exercise,nutritional support,and psychological interventions(n=51)].Nutritional status,anxiety and depression,quality of life,incidence of complications,treatment compliance,and satisfaction with nursing care were compared between the two groups.RESULTS Serum albumin,prealbumin,hemoglobin,transferrin,and World Health Organization Quality of Life-Brief Version scores were higher in the observation group than those in the control group.After treatment,Self-rating Anxiety Scale,Self-rating Depression Scale,and Hamilton Anxiety and Depression Scale scores in the observation group were lower than those in the control group.No significant differences were observed in the incidence of complications between the observation and control groups.The observation group exhibited more satisfaction with nursing care and treatment compliance than the control group.CONCLUSION Exercise,nutritional support,and psychological interventions effectively improves the nutritional status and negative emotions of patients undergoing radiotherapy for esophageal cancer,and enhances treatment compliance and satisfaction with nursing.
文摘Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifest through physiological symptoms,cognitive distortions,behavioral avoidance,and cardiacspecific concerns and typically emerge within 1-2 weeks post-procedure.Key risk factors include female sex,younger age(<55 years),psychiatric history,procedural complexity,and poor social support.Anxiety negatively affects cardiovascular outcomes when left untreated,leading to higher readmission rates(HR=1.47)and recurrent cardiovascular events(HR=1.31),as well as lower medication adherence and quality of life.Screening is optimally conducted 7-10 days postprocedure via validated tools such as the Hospital Anxiety and Depr-ession Scale,Anxiety.Heart-specific cognitive behavioral therapy(SMD=-0.72),selective serotonin reuptake inhibitors(especially sertraline),and integrated cardiac rehabilitation programs that incorporate both psychological and physical elements are among the beneficial interventions that have been supported by evidence.These all-encompassing strategies show long-term improvements in cardiovascular outcomes,functional ability,and healthcare expenses in addition to immediate benefits in lowering anxiety.Digital initiatives have the potential to increase access,especially in underprivileged areas.Early identification of highrisk patients and implementation of timely,targeted interventions represent crucial strategies for improving both psychological and cardiovascular outcomes in this vulnerable population.
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.
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Background Quantitative flow ratio(QFR)based lesion selection for percutaneous coronary intervention(PCI)treatment has shown clinical benefits in terms of reduced risk for myocardial infarction and repeat revascularization.Whether this benefit is consistent across different age groups still needs further investigation.Methods In this prespecified subgroup study of FAVORⅢChina trial,we compared long-term clinical outcomes between QFR-guided and angiography-guided PCI among different age groups among 3825 enrolled subjects.The primary endpoint was major adverse cardiac events(MACEs),a composite of all-cause death,myocardial infarction,and ischemia-driven revascularization.Results Of the 3825 patients,1717(44.9%)were aged≥65 years.At baseline,patients≥65 had higher rates of hypertension,hyperlipidaemia,stroke history(P<0.0001),and peripheral vascular disease(P=0.024)and had higher SYNTAX scores(P=0.0095).Compared with standard angiography guidance,the QFR-guided strategy consistently reduced the 1-year(≥65 years,6.04%vs.9.19%,HR=0.65,95%CI:0.46–0.92;<65 years,5.53%vs.8.43%,HR=0.65,95%CI:0.47–0.91)and 3-year MACE rates in both age groups(≥65 years,11.8%vs.15.2%,HR:0.75,95%CI:0.58–0.98;<65 years,9.5%vs.14.6%,HR=0.63;95%CI:0.49–0.81),without a significant interaction(Pinteraction=0.99).Within the QFR-guided group,the 3-year MACE rate in patients with deferred vessels was numerically greater in patients aged≥65 years than in those aged<65 years(8.3%vs.3.0%,P=0.10).Conclusions Although with higher rate of comorbidities and more complex coronary anatomy,the long-term benefit of the QFR-guided PCI strategy remained consistent in patients≥65 years,compared with those<65 years.
文摘BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid era,but direct head-to-head cost comparisons between the two modalities are not available in literature.AIM To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.METHODS A prospective observational single-center case control study including adult patients with ARF(PaO2/FiO2 ratio<300)admitted from January 1,2024 to December 31,2024 in medical intensive care unit(ICU)of a tertiary care hospital requiring either NIV or invasive ventilation.NIV and IMV groups were compared based on average length of ICU and hospital stay,mortality,net cost of ICU treatment,need for intubation and tracheostomy.RESULTS A total of 319 patients were included in the study(197 in NIV,122 in IMV group).Statistically significant difference in length of ICU stay(NIV group:5±3.25 days,IMV group:9±2.6 days;P<0.05)and mortality rate was seen(11%NIV vs 34%IMV;P<0.01).On multivariate analyses,mortality showed a stronger association with IMV[odds ratio(OR)=7.73;95%CI:3.12-19.18]as compared to ICU stay(OR=2.73;95%CI:2.15-3.48).A total of 33 patients(17%)in NIV group required intubation of which 3 were tracheostomized,while 14 patients(11%)in IMV group needed tracheostomy.The net average cost of ICU stay was₹83902 in NIV group while in IMV group,the net ICU cost was₹476216.The average cost of ICU stay was five times higher with IMV.CONCLUSION NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.
文摘There have been an increasing number of studies on climate change and population health over the past 20 years,with most focusing on health risk assessment,targeting different locations and populations with various diseases[1−2].While these studies have provided the necessary epidemiological evidence for health authorities in policymaking,it is time to develop and implement tailored health interventions to protect the health and well-being of communities,and particularly that of vulnerable groups.
