人们对于生命质量的探究开始于二十世纪初的美国。当时战后的美国经济飞速发展,但人们生活质量的体验抑或预期并没有随着经济的发展而提高。这让人们意识到不能简单的使用经济数据来评价人的生存状况,应该创造出一种新的评价方法来考察...人们对于生命质量的探究开始于二十世纪初的美国。当时战后的美国经济飞速发展,但人们生活质量的体验抑或预期并没有随着经济的发展而提高。这让人们意识到不能简单的使用经济数据来评价人的生存状况,应该创造出一种新的评价方法来考察人的生命质量。在医学领域,健康相关生命质量(Health Related Quality of Life;HRQOL)这一概念就逐渐被人们所应用。它能够将疾病与相关的治疗手段联系起来,以此评价对生命质量的影响。展开更多
质量调整生命年(Quality-Adjusted Life Year,QALY)被广泛应用于卫生经济学和药物经济学研究的各个方面,是衡量健康产出的重要指标。近年来,其内涵也随着QALY相关研究的深入而不断迭代发展。目前,还未有中文研究对近年来QALY内涵变化的...质量调整生命年(Quality-Adjusted Life Year,QALY)被广泛应用于卫生经济学和药物经济学研究的各个方面,是衡量健康产出的重要指标。近年来,其内涵也随着QALY相关研究的深入而不断迭代发展。目前,还未有中文研究对近年来QALY内涵变化的最新进展进行系统性梳理。基于过往文献和研究实践,梳理QALY内涵的变化,并将其归纳为QALY定义扩展和赋权QALY的进展和影响。QALY定义扩展主要包括主流量表对健康相关QALY定义的再丰富和对幸福感的补充,对幸福感QALY来源进行回溯,分析QALY定义扩展与传统QALY对比的优势;在赋权QALY上,总结赋权QALY的定义、测量方法和优势。同时,讨论了QALY内涵变化对于效用积分体系构建的影响。建议未来应重视QALY内涵的变化和发展,积极探索具有中国特色的QALY内涵,运用实证研究分析QALY内涵变化带给卫生决策一致性和合理性的影响。展开更多
Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticanc...Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.展开更多
文摘人们对于生命质量的探究开始于二十世纪初的美国。当时战后的美国经济飞速发展,但人们生活质量的体验抑或预期并没有随着经济的发展而提高。这让人们意识到不能简单的使用经济数据来评价人的生存状况,应该创造出一种新的评价方法来考察人的生命质量。在医学领域,健康相关生命质量(Health Related Quality of Life;HRQOL)这一概念就逐渐被人们所应用。它能够将疾病与相关的治疗手段联系起来,以此评价对生命质量的影响。
文摘质量调整生命年(Quality-Adjusted Life Year,QALY)被广泛应用于卫生经济学和药物经济学研究的各个方面,是衡量健康产出的重要指标。近年来,其内涵也随着QALY相关研究的深入而不断迭代发展。目前,还未有中文研究对近年来QALY内涵变化的最新进展进行系统性梳理。基于过往文献和研究实践,梳理QALY内涵的变化,并将其归纳为QALY定义扩展和赋权QALY的进展和影响。QALY定义扩展主要包括主流量表对健康相关QALY定义的再丰富和对幸福感的补充,对幸福感QALY来源进行回溯,分析QALY定义扩展与传统QALY对比的优势;在赋权QALY上,总结赋权QALY的定义、测量方法和优势。同时,讨论了QALY内涵变化对于效用积分体系构建的影响。建议未来应重视QALY内涵的变化和发展,积极探索具有中国特色的QALY内涵,运用实证研究分析QALY内涵变化带给卫生决策一致性和合理性的影响。
文摘Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.
