Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expen...Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.展开更多
Background: Despite having one of the most successful health systems in the world, annual medical expenditures in Japan have been increasing year to year. We sought to clarify regional differences in medical expenditu...Background: Despite having one of the most successful health systems in the world, annual medical expenditures in Japan have been increasing year to year. We sought to clarify regional differences in medical expenditures by analyzing the relationship between the specific health examination coverage and medical care expenditure by prefecture of Japan. Methods: We used data from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan (2015) and Overview of 2015 National Medical Expenses to compare medical care expenditure per capita and proportions of persons receiving specific health examination between Japan nationally and individual prefectures. Results: National medical expenditures were 42.3 trillion Japanese yen (JPY) (3851 hundred million dollars), with a national per capita rate of JPY347,219 (USD3156). Per capita medical expenditure rates by prefecture ranged from JPY290,900 (USD2645) in Saitama Prefecture to JPY 444,000 (USD4036) in Kochi Prefecture. The proportion of persons receiving specific health examinations was 49.0% for Japan overall and ranged from 39.3% in Hokkaido Prefecture to 63.4% in Tokyo Prefecture. We observed a significant negative correlation between per capita medical expenditures and the proportion of persons receiving specific health examinations (R = 0.553, p < 0.001). Conclusion: We found a significant negative correlation between per capita medical expenditures and the proportion of persons receiving health examinations: prefectures with lower expenditures tended to have higher rates of medical examinations. Interventions to increase the proportion of persons receiving specific health examinations by prefecture could reduce per capita medical expenditures and reduce prefectural disparities in expenditures.展开更多
The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use w...The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use with chronic diseases, this study explored the association between different levels of PA and annual hospital service use and expenditure for inpatients with coronary heart disease (CHD) in China. We analyzed PA information from the first follow-up survey (2013) of the Dongfeng-Tongji cohort study of 1460 CHD inpatients. We examined factors such as PA exercise volume and years of PA and their associations with the number of inpatient visits, number of hospital days, and inpatient costs and total medical costs. We found that the number of hospital days and the number of inpatient visits were negatively associated with intensity of PA level. Similarly, total inpatient and outpatient costs declined when the PA exercise volume levels increased. Furthermore, there were also significant associations between the number of hospital days, inpatient costs or total medical costs and levels of PA years. This study provides the first empirical evidence about the effects of the intensity and years of PA on hospital service use and expenditure of CHD in China. It suggests that the patients' PA, especially the vigorous PA, should be promoted widely to the public and patients in order to relieve the financial burden of CHD.展开更多
This study was undertaken to investigate clothing expen-diture patterns of families in Shanghai, and especially the relationship between age of the family and the expendi-tures . Interview data from 292 families in Sh...This study was undertaken to investigate clothing expen-diture patterns of families in Shanghai, and especially the relationship between age of the family and the expendi-tures . Interview data from 292 families in Shanghai were used in analysis. Families were divided into three groups, including the young, middle - aged, and old families. Descriptive analysis and regression were em-ployed. Major findings concern total expenditures of family members as well as the entire family, and expen-ditures on different categories of clothing. Factors which had impacts on clothing expenditures were also investi-gated. It was concluded that age of the families had an impact on expenditures, and the three groups of families had different patterns of clothing consumption.展开更多
Overweight and obese individuals are at increased risk for many diseases and health conditions, including but not limited to the following: hypertension;osteoarthritis;dyslipidemia;type 2 diabetes;coronary heart disea...Overweight and obese individuals are at increased risk for many diseases and health conditions, including but not limited to the following: hypertension;osteoarthritis;dyslipidemia;type 2 diabetes;coronary heart disease and stroke. Consequently, individuals who are obese are more likely to use health services and are more likely to use costly health services than non-obese individuals. Between 1987 and 2001, growth in obesity related health expenditures accounted for 27 percent of the growth in inflation-adjusted per capita health care spending. Researchers, popular press and the television news media have paid considerable attention to the effect that farm subsidies have on dietary habits and obesity. Prominent researchers in the field have concluded that US farm subsidies have had a negligible impact on obesity. However, even small increases in obesity rates are associated with higher health care expenditures. The primary intent of this study is to break down the linkages from farm subsidy to health expenditure and shed light on the unintended implications of the farm subsidy program. We find that agricultural subsidies have the potential to influence health care expenditures.展开更多
In this paper, we analyzed length of stay (LOS) in hospitals and medical expenditures for type 2 diabetes patients. LOS was analyzed by the power Box-Cox transformation model when variances differed among hospitals. W...In this paper, we analyzed length of stay (LOS) in hospitals and medical expenditures for type 2 diabetes patients. LOS was analyzed by the power Box-Cox transformation model when variances differed among hospitals. We proposed a new test and consistent estimator. We rejected the ho-moscedasticity of variances among hospitals, and then analyzed the LOS of 12,666 type 2 diabetes patients hospitalized for regular medical treatments collected from 60 general hospitals in Japan. The variables found to affect LOS were age, number of comorbidities and complications, introduced by another hospital, one-week hospitalization, 2010 revision, specific-hospitalization-period (SHP), and principal diseases E11.5, E11.6 and E11.7. There were surprisingly large differences in ALOS among hospitals even after eliminating the influence of characteristics and conditions of patients. We then analyzed daily medical expenditure (DME) by the ordinary least squares methods. The variables that affected DME were LOS, number of comorbidities and complications, acute hospitalization, hospital’s own outpatient, season, introduced by another hospital, one-week hospitalization, 2010 revision, SHP, time trend, and principal diseases E11.2, E11.4 and E117. The DME did not decrease after the SHP. After eliminating the influences of characteristics and conditions of patients, the differences among hospitals were relatively small, 12% of the overall average. LOS is the main determinant of medical expenditures, and new incentives to reduce LOS are needed to control Japanese medical expenditures. Since at least 99% of patients require medical care after leaving the hospital, systems that take proper care of patients for long periods of time after hospitalization are absolutely necessary for efficient treatment of diabetes.展开更多
Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect e...Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly income.Participants who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>25-35 years,above 50 years of age and those who are separated from their partners.展开更多
Introduction:Chronic diseases and multimorbidity are increasingly prevalent among older adults in China,contributing substantially to hospitalization burden.However,real-world evidence on their direct medical expendit...Introduction:Chronic diseases and multimorbidity are increasingly prevalent among older adults in China,contributing substantially to hospitalization burden.However,real-world evidence on their direct medical expenditures remains limited.Methods:This study employed a retrospective analysis by using hospital discharge data from Guangzhou during 2017–2019,and adopted generalized linear models(GLMs)to estimate hospitalization expenditures across chronic disease and multimorbidity patterns.Results:Older patients with multimorbidity incurred nearly double the median annual hospitalization expenditures(3,708 USD vs.1,844 USD)and 45%higher costs per additional condition compared to single diseases.Hospitalization cost varied by specific diseases and multimorbidity patterns.Schizophrenia(7,421.3 USD)has the highest annual total hospitalization expenditure(THE)among single chronic diseases while the combination of cancer+CVD+heart disease(10,698.8 USD for THE,4,024.6 USD for out-of-pocket expenditure)ranked the top expenditures among multimorbidity patterns.Approximately 57.1%of disease combinations exhibited super-additive spending.Conclusion:This study provides robust evidence of the substantial economic burden of chronic diseases and multimorbidity.The findings underscore the need for an integrated care model,evidence-based strategies to optimize healthcare resource allocation and health outcomes in aging populations.展开更多
Background:Investigate into the medical expenditures of chronic kidney disease(CKD)patients through path analysis method of three consecutive years within a Grade-A tertiary hospital in Beijing to conduct the main inf...Background:Investigate into the medical expenditures of chronic kidney disease(CKD)patients through path analysis method of three consecutive years within a Grade-A tertiary hospital in Beijing to conduct the main influencing factors in diagnosis-related groups(DRGs)grouping of the diagnosis,and reassess the present grouping process to provide information and reference on cost control for hospitals and medical management departments.Methods:Eight hundred and fifty-five inpatient cases whose first diagnosis were defined as CKD in the year 2014-2016 within the hospital were selected as the sample of the study,multiple linear regression and path analysis method were adopted in DRGs grouping process to investigate the main influencing factors of total medical expenditures and DRGs grouping process.Results:The maximum proportion of the medical costs within CKD patients was the costs on treatment,with the highest of 35.3%on the year 2014,the second was the costs on drug,which accounted for〈30%during consecutive years,and the third was the costs on examination,which accounted for about 20%on average.The main influencing factors of medical expenditures included the type of dialysis,length of hospitalization,the admission of Intensive Care Unit(ICU),and so on.The coefficients toward the effect for total costs were 0.416,0.376,and 0.094.respectively.Conclusions:It is suggested that the type of dialysis and the admission of ICU were the major influencing factors of inpatient medical expenditures on CKD patients,and should be taken into consideration into the reassessment of DRGs grouping process to realize the localization and generalization of prospective payment system based on DRGs within the regional area and promote the implementation of medical cost control measures to reduce the economic burdens among patients and the society.展开更多
This paper examines the individual financial risk of health care expenditures over time in urban China, .using longitudinal health expenditure data from 2005 to 2007 in Kunshan City, Jiangsu Province, China. We find t...This paper examines the individual financial risk of health care expenditures over time in urban China, .using longitudinal health expenditure data from 2005 to 2007 in Kunshan City, Jiangsu Province, China. We find that the stochastic process of log total health care expenditures is well represented by the sum of an AR（3） process and white noise process. Simulating this model, we find that the urban health insurance system protects enrollees from the risk of catastrophic health care expenditures by bearing the majority of the health care expenditures. However, out-of-pocket health care expenditures represents a considerable risk to an individual＇s financial status.展开更多
Background： Renal cell carcinoma （RCC） is the most common type of malignant renal tumors with a growing incidence in tile recent years. This study aimed to investigate the influencing factors and variation trend of...Background： Renal cell carcinoma （RCC） is the most common type of malignant renal tumors with a growing incidence in tile recent years. This study aimed to investigate the influencing factors and variation trend of hospitalization expenditures among RCC patients in a single-centered hospital in Beijing during 5 consecutive years and to find the major cost items and fluctuation tendency of inpatient medical expenditures. Methods： The inlbrmation of medical expenditures among RCC patients in a Grade-A tertiary hospital during the years 2012-2016 was investigated to find the main cost items and changes affecting the medical cost structure. Gray correlation method was adopted in quantitative analysis to analyze the composition of medical expenditures, and the variation of hospitalization expense structure during tile five years was studied by analyzing the degree of structural variation. Results： The cost item constitution of the hospitalization expenditures among RCC patients was relatively stable in the sample hospital during the past five years. To be specific, drug costs accounted for tile largest proportion of medical expenditures each year, with the highest of 37.81% in 2012, and showed a slowly declining tendency in the coming years. The cost item with the highest correlation degree ~as drug costs, with the value of 1.0000; followed by the costs of surgeries, 0.8423. Furthermore, drug costs shared the largest proportion （40.95%） of structural variation, followed by the costs of surgeries （18.35%）. Conclusions： Drug costs are the major influencing factors of the hospitalization expenditures among RCC patients. Thus, reasonable control on excessive drugs as well as the standardization of the diagnosis and treatment behaviors is conducive in reducing medical expenditures as well as easing patients＇ economic burdens. Besides, the positive growth on surgery costs suggests that the labor value of medical staffs has been gradually recognized.展开更多
Aiming to control rising medical expenditures and help improve China＇s healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and hea...Aiming to control rising medical expenditures and help improve China＇s healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitals＇ C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China （2004-2013）, and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform. We also used paired sample t-tests and linear regression models to compare the mean medical expenditures between insured and uninsured women undergoing caesarean delivery during the post-reform period. After the scheme＇s implementation, medical expenditures for caesarean deliveries declined and the medical expenditures of women covered by the scheme were significantly lower than those of uninsured patients. These findings indicated the scheme＇s effectiveness in minimizing caesarean delivery expenditures. The cap-based medical insurance scheme with shared financial interest between insurance and healthcare providers would likely steer healtbcare providers＇ behaviors in a more cost-effective direction.展开更多
Facing rapid social and economic transformation,China has taken steps to extend and strengthen the Minimum Living Standard Scheme(MLSS).The MLSS is a social assistance programme which initially focused on urban povert...Facing rapid social and economic transformation,China has taken steps to extend and strengthen the Minimum Living Standard Scheme(MLSS).The MLSS is a social assistance programme which initially focused on urban poverty,but later will extend to the rural inhabitants.As the extension of the MLSS,the questions how many poor there are and how much MLSS will cost arise immediately.In line with the data from National Bureau of Statistics(NBS)and Ministry of Civil Affairs(MOCA),this paper estimates different types of poor and reckons how much Chinese government will expenditure.The author also outlines the government financial capabilities on MLSS and discusses the related lessons.展开更多
Under the dual drivers of global climate governance and carbon neutrality goals,agricultural carbon emission reduction has become a pivotal component of regional green transformation.This study focuses on Guangdong,a ...Under the dual drivers of global climate governance and carbon neutrality goals,agricultural carbon emission reduction has become a pivotal component of regional green transformation.This study focuses on Guangdong,a major province,employing the LMDI decomposition mode to systematically analyze the driving mechanis of agricultural carbon emissions.It reveals that the low ecological compensation standard,industrial path dependence,and high-carbon energy lock-in consti-tute core constraints.The research finds that the absence of ecological compensation standards and the structural imbalance of traditional subsidy policies induce diminishing marginal benefits in carbon reduction due to structural imbalances,while persistent funding shortages in low-carbon technology R&D further weaken emission reduction efficacy,exacerbating compatibility contradictions between emission policies and production practices.Through the comparison of domestic and foreign experiences,it is found that under the global wave of low-carbon transformation in agriculture,the ecological compensation optimization layer should establish a calculation system for the carbon sink value of cultivated land and differentiated compensation standards;the fiscal and taxation policy coordination layer should implement a tiered carbon tax on agricultural inputs and carbon sink pledge financing incentives.Constructing a fiscal expenditure and fiscal and taxation coordination mechanism that suits regional characteristics is the key path to resolving the contradiction between the technical economy and ecological sustainability of emission reduction.展开更多
BACKGROUND Accurate measurement of energy expenditure(EE)is critical for optimizing nutritional support in critically ill patients.Indirect calorimetry(IC)is the reference method used,but its availability at the bedsi...BACKGROUND Accurate measurement of energy expenditure(EE)is critical for optimizing nutritional support in critically ill patients.Indirect calorimetry(IC)is the reference method used,but its availability at the bedside is limited.As a result,numerous predictive equations have been devised to estimate EE in critically ill patients,along with other more novel methods recently proposed.AIM To evaluate current methods of measuring EE in critical care,focusing on practical challenges,accuracy,feasibility,and limitations.We will also discuss how these methods contribute to improving nutrition support strategies for intensive care unit patients for a more personalised and effective solution.METHODS A comprehensive search was conducted in PubMed and EMBASE for studies published from December 2014 to December 2024.Eligible studies compared EE measurement methods in critically ill populations.Data extraction and quality assessment followed PRISMA guidelines.Adherence to reporting standards was assessed using the TRIPOD questionnaire and risk of bias was evaluated using the PROBAST tool.RESULTS Twenty five original studies met the inclusion criteria and were analysed.CONCLUSION Each method has unique strengths and limitations.We found that while IC remains the reference standard,less accurate predictive equations have greater accessibility and ease of implementation.Emerging technologies show promise for bedside applicability.Future research should address practical barriers and validate newer approaches.展开更多
AIM： To investigate the role of subjective global assessment （SGA） in nutritional assessment and outcome prediction of Chinese patients with gastrointestinal cancer. METHODS： A total of 751 patients diagnosed with...AIM： To investigate the role of subjective global assessment （SGA） in nutritional assessment and outcome prediction of Chinese patients with gastrointestinal cancer. METHODS： A total of 751 patients diagnosed with gastrointestinal cancer between August 2004 and August 2006 were enrolled in this study. Within 72 h after admission, SGA, anthropometric parameters, and laboratory tests were used to assess the nutritional status of each patient. The outcome variables including hospital stay, complications, and in-hospital medical expenditure were also obtained.RESULTS： Based on the results of SGA, 389 （51.8%）, 332 （44.2%）, and 30 （4.0%） patients were classified into well nourished group （SGA-A）, mildly to moderately malnourished group （SGA-B）, and severely malnourished group （SGA-C）, respectively. The prevalence of malnutrition classified by SGA, triceps skinfold thickness （TSF）, mid-upper arm muscle circumference （MAMC）, albumin （ALB）, prealbumin （PA）, and body mass index （BMI） was 48.2%, 39.4%, 37.7%, 31.3%, 21.7%, and 9.6%, respectively. In addition, ANOVA tests revealed significant differences in body mass index （BMI）, TSF, PA, and ALB of patients in different SGA groups. The more severely malnourished the patient was, the lower the levels of BMI, TSF, PA, and ALB were （P 〈 0.05）. x^2 tests showed a significant difference in SGA classification between patients receiving different types of treatment （surgery vs chemotherapy/radiotherapy）. As the nutritional status classified by SGA deteriorated, the patients stayed longer in hospital and their medical expenditures increased significantly. Furthermore, multiple regression analysis showed that SGA and serum ALB could help predict the medical expenditures and hospital stay of patients undergoing surgery. The occurrence of complications increased in parallel with the increasing grade of SGA, and was the highest in the SGA-C group （23.3%） and the lowest in the SGA-A group （16.8%）. CONCLUSION： SGA is a reliable assessment too and helps to predict the hospital stay and medica expenditures of Chinese surgical gastrointestina cancer patients.展开更多
能量消耗有多种,如静息能量消耗(resting energy expenditure,REE)、基础能量消耗(basal energy expenditure,BEE)、每日静息能量消耗(resting daily energy expenditure,RDEE)、每日总能量消耗(total daily energy expenditure,TDEE)等。
Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and...Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.展开更多
Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of ...Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of the contemporary treatment paradigm for mCRPC.Methods:We devised a treatment protocol consisting of sipuleucel-T,enzalutamide,abiraterone,docetaxel,radium-223,and cabazitaxel.We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials.We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA.Our analysis assumed US$100,000 per life year saved(LYS)as the threshold societal willingness to pay.Results:Incremental cost-effectiveness ratios(ICER)for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS,the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS.Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.Conclusion:Based on the available survival data and current costs of treatment,all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS.Improvements in this regard can only comewith a reduction in pricing,better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.展开更多
基金co-supported by the National Natural Science Foundation of China (No. 81773521)CAMS Innovation Fund for Medical Sciences (No. 2017-I2M-1006, No. 2016-12M-2-004)+4 种基金the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (No. 2018RC330001)the National Key Projects of Research and Development of China (No. 2018 YFC1315000)China Scholarship Council (No. 201908110180)the Sanming Project of Medicine in Shenzhen (No. SZSM201911015)the Cancer Screening Program in Urban China funded by National Health Commission of People’s Republic of China
文摘Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.
文摘Background: Despite having one of the most successful health systems in the world, annual medical expenditures in Japan have been increasing year to year. We sought to clarify regional differences in medical expenditures by analyzing the relationship between the specific health examination coverage and medical care expenditure by prefecture of Japan. Methods: We used data from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan (2015) and Overview of 2015 National Medical Expenses to compare medical care expenditure per capita and proportions of persons receiving specific health examination between Japan nationally and individual prefectures. Results: National medical expenditures were 42.3 trillion Japanese yen (JPY) (3851 hundred million dollars), with a national per capita rate of JPY347,219 (USD3156). Per capita medical expenditure rates by prefecture ranged from JPY290,900 (USD2645) in Saitama Prefecture to JPY 444,000 (USD4036) in Kochi Prefecture. The proportion of persons receiving specific health examinations was 49.0% for Japan overall and ranged from 39.3% in Hokkaido Prefecture to 63.4% in Tokyo Prefecture. We observed a significant negative correlation between per capita medical expenditures and the proportion of persons receiving specific health examinations (R = 0.553, p < 0.001). Conclusion: We found a significant negative correlation between per capita medical expenditures and the proportion of persons receiving health examinations: prefectures with lower expenditures tended to have higher rates of medical examinations. Interventions to increase the proportion of persons receiving specific health examinations by prefecture could reduce per capita medical expenditures and reduce prefectural disparities in expenditures.
文摘The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use with chronic diseases, this study explored the association between different levels of PA and annual hospital service use and expenditure for inpatients with coronary heart disease (CHD) in China. We analyzed PA information from the first follow-up survey (2013) of the Dongfeng-Tongji cohort study of 1460 CHD inpatients. We examined factors such as PA exercise volume and years of PA and their associations with the number of inpatient visits, number of hospital days, and inpatient costs and total medical costs. We found that the number of hospital days and the number of inpatient visits were negatively associated with intensity of PA level. Similarly, total inpatient and outpatient costs declined when the PA exercise volume levels increased. Furthermore, there were also significant associations between the number of hospital days, inpatient costs or total medical costs and levels of PA years. This study provides the first empirical evidence about the effects of the intensity and years of PA on hospital service use and expenditure of CHD in China. It suggests that the patients' PA, especially the vigorous PA, should be promoted widely to the public and patients in order to relieve the financial burden of CHD.
文摘This study was undertaken to investigate clothing expen-diture patterns of families in Shanghai, and especially the relationship between age of the family and the expendi-tures . Interview data from 292 families in Shanghai were used in analysis. Families were divided into three groups, including the young, middle - aged, and old families. Descriptive analysis and regression were em-ployed. Major findings concern total expenditures of family members as well as the entire family, and expen-ditures on different categories of clothing. Factors which had impacts on clothing expenditures were also investi-gated. It was concluded that age of the families had an impact on expenditures, and the three groups of families had different patterns of clothing consumption.
文摘Overweight and obese individuals are at increased risk for many diseases and health conditions, including but not limited to the following: hypertension;osteoarthritis;dyslipidemia;type 2 diabetes;coronary heart disease and stroke. Consequently, individuals who are obese are more likely to use health services and are more likely to use costly health services than non-obese individuals. Between 1987 and 2001, growth in obesity related health expenditures accounted for 27 percent of the growth in inflation-adjusted per capita health care spending. Researchers, popular press and the television news media have paid considerable attention to the effect that farm subsidies have on dietary habits and obesity. Prominent researchers in the field have concluded that US farm subsidies have had a negligible impact on obesity. However, even small increases in obesity rates are associated with higher health care expenditures. The primary intent of this study is to break down the linkages from farm subsidy to health expenditure and shed light on the unintended implications of the farm subsidy program. We find that agricultural subsidies have the potential to influence health care expenditures.
文摘In this paper, we analyzed length of stay (LOS) in hospitals and medical expenditures for type 2 diabetes patients. LOS was analyzed by the power Box-Cox transformation model when variances differed among hospitals. We proposed a new test and consistent estimator. We rejected the ho-moscedasticity of variances among hospitals, and then analyzed the LOS of 12,666 type 2 diabetes patients hospitalized for regular medical treatments collected from 60 general hospitals in Japan. The variables found to affect LOS were age, number of comorbidities and complications, introduced by another hospital, one-week hospitalization, 2010 revision, specific-hospitalization-period (SHP), and principal diseases E11.5, E11.6 and E11.7. There were surprisingly large differences in ALOS among hospitals even after eliminating the influence of characteristics and conditions of patients. We then analyzed daily medical expenditure (DME) by the ordinary least squares methods. The variables that affected DME were LOS, number of comorbidities and complications, acute hospitalization, hospital’s own outpatient, season, introduced by another hospital, one-week hospitalization, 2010 revision, SHP, time trend, and principal diseases E11.2, E11.4 and E117. The DME did not decrease after the SHP. After eliminating the influences of characteristics and conditions of patients, the differences among hospitals were relatively small, 12% of the overall average. LOS is the main determinant of medical expenditures, and new incentives to reduce LOS are needed to control Japanese medical expenditures. Since at least 99% of patients require medical care after leaving the hospital, systems that take proper care of patients for long periods of time after hospitalization are absolutely necessary for efficient treatment of diabetes.
基金support from the US National Institutes of Health D43 TW009595 and P30 AI064518 programsCharles Muiruri was supported by the National Heart,Lung,And Blood Institute of the National Institutes of Health trader Award U01HL142099.
文摘Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly income.Participants who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>25-35 years,above 50 years of age and those who are separated from their partners.
基金Supported by the National Natural Science Foundation(Grant No.:72174098).The funding organization had no role in study design,data collection,analysis,interpretation,or manuscript preparation.
文摘Introduction:Chronic diseases and multimorbidity are increasingly prevalent among older adults in China,contributing substantially to hospitalization burden.However,real-world evidence on their direct medical expenditures remains limited.Methods:This study employed a retrospective analysis by using hospital discharge data from Guangzhou during 2017–2019,and adopted generalized linear models(GLMs)to estimate hospitalization expenditures across chronic disease and multimorbidity patterns.Results:Older patients with multimorbidity incurred nearly double the median annual hospitalization expenditures(3,708 USD vs.1,844 USD)and 45%higher costs per additional condition compared to single diseases.Hospitalization cost varied by specific diseases and multimorbidity patterns.Schizophrenia(7,421.3 USD)has the highest annual total hospitalization expenditure(THE)among single chronic diseases while the combination of cancer+CVD+heart disease(10,698.8 USD for THE,4,024.6 USD for out-of-pocket expenditure)ranked the top expenditures among multimorbidity patterns.Approximately 57.1%of disease combinations exhibited super-additive spending.Conclusion:This study provides robust evidence of the substantial economic burden of chronic diseases and multimorbidity.The findings underscore the need for an integrated care model,evidence-based strategies to optimize healthcare resource allocation and health outcomes in aging populations.
基金supported by a grant of BeijingMunicipal Commission of Science and Technology(No.Z151100004015083).
文摘Background:Investigate into the medical expenditures of chronic kidney disease(CKD)patients through path analysis method of three consecutive years within a Grade-A tertiary hospital in Beijing to conduct the main influencing factors in diagnosis-related groups(DRGs)grouping of the diagnosis,and reassess the present grouping process to provide information and reference on cost control for hospitals and medical management departments.Methods:Eight hundred and fifty-five inpatient cases whose first diagnosis were defined as CKD in the year 2014-2016 within the hospital were selected as the sample of the study,multiple linear regression and path analysis method were adopted in DRGs grouping process to investigate the main influencing factors of total medical expenditures and DRGs grouping process.Results:The maximum proportion of the medical costs within CKD patients was the costs on treatment,with the highest of 35.3%on the year 2014,the second was the costs on drug,which accounted for〈30%during consecutive years,and the third was the costs on examination,which accounted for about 20%on average.The main influencing factors of medical expenditures included the type of dialysis,length of hospitalization,the admission of Intensive Care Unit(ICU),and so on.The coefficients toward the effect for total costs were 0.416,0.376,and 0.094.respectively.Conclusions:It is suggested that the type of dialysis and the admission of ICU were the major influencing factors of inpatient medical expenditures on CKD patients,and should be taken into consideration into the reassessment of DRGs grouping process to realize the localization and generalization of prospective payment system based on DRGs within the regional area and promote the implementation of medical cost control measures to reduce the economic burdens among patients and the society.
文摘This paper examines the individual financial risk of health care expenditures over time in urban China, .using longitudinal health expenditure data from 2005 to 2007 in Kunshan City, Jiangsu Province, China. We find that the stochastic process of log total health care expenditures is well represented by the sum of an AR（3） process and white noise process. Simulating this model, we find that the urban health insurance system protects enrollees from the risk of catastrophic health care expenditures by bearing the majority of the health care expenditures. However, out-of-pocket health care expenditures represents a considerable risk to an individual＇s financial status.
文摘Background： Renal cell carcinoma （RCC） is the most common type of malignant renal tumors with a growing incidence in tile recent years. This study aimed to investigate the influencing factors and variation trend of hospitalization expenditures among RCC patients in a single-centered hospital in Beijing during 5 consecutive years and to find the major cost items and fluctuation tendency of inpatient medical expenditures. Methods： The inlbrmation of medical expenditures among RCC patients in a Grade-A tertiary hospital during the years 2012-2016 was investigated to find the main cost items and changes affecting the medical cost structure. Gray correlation method was adopted in quantitative analysis to analyze the composition of medical expenditures, and the variation of hospitalization expense structure during tile five years was studied by analyzing the degree of structural variation. Results： The cost item constitution of the hospitalization expenditures among RCC patients was relatively stable in the sample hospital during the past five years. To be specific, drug costs accounted for tile largest proportion of medical expenditures each year, with the highest of 37.81% in 2012, and showed a slowly declining tendency in the coming years. The cost item with the highest correlation degree ~as drug costs, with the value of 1.0000; followed by the costs of surgeries, 0.8423. Furthermore, drug costs shared the largest proportion （40.95%） of structural variation, followed by the costs of surgeries （18.35%）. Conclusions： Drug costs are the major influencing factors of the hospitalization expenditures among RCC patients. Thus, reasonable control on excessive drugs as well as the standardization of the diagnosis and treatment behaviors is conducive in reducing medical expenditures as well as easing patients＇ economic burdens. Besides, the positive growth on surgery costs suggests that the labor value of medical staffs has been gradually recognized.
基金We are indebted to the doctors and staff at the Affiliated Hospital of Jiangnan University for their contributions. This study was funded by National Natural Science Foundation of China （Nos. 71373051, 71403056, and 71603187）, Zhejiang Provincial Natural Science Foundation （No. LQ16G030011）, and the Key Social Science Project for University Teachers of Zhejiang, China （No. 2014QN005）.
文摘Aiming to control rising medical expenditures and help improve China＇s healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitals＇ C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China （2004-2013）, and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform. We also used paired sample t-tests and linear regression models to compare the mean medical expenditures between insured and uninsured women undergoing caesarean delivery during the post-reform period. After the scheme＇s implementation, medical expenditures for caesarean deliveries declined and the medical expenditures of women covered by the scheme were significantly lower than those of uninsured patients. These findings indicated the scheme＇s effectiveness in minimizing caesarean delivery expenditures. The cap-based medical insurance scheme with shared financial interest between insurance and healthcare providers would likely steer healtbcare providers＇ behaviors in a more cost-effective direction.
文摘Facing rapid social and economic transformation,China has taken steps to extend and strengthen the Minimum Living Standard Scheme(MLSS).The MLSS is a social assistance programme which initially focused on urban poverty,but later will extend to the rural inhabitants.As the extension of the MLSS,the questions how many poor there are and how much MLSS will cost arise immediately.In line with the data from National Bureau of Statistics(NBS)and Ministry of Civil Affairs(MOCA),this paper estimates different types of poor and reckons how much Chinese government will expenditure.The author also outlines the government financial capabilities on MLSS and discusses the related lessons.
基金Financial support from Guangdong Science and Technology(20230505)Guangdong Provincial Philosophy and Social Science Planning Project(GD20SQ25)Guangdong Provincial Special Fund for Science and Technology Innovation Strategy in 2024(Cultivation of College Students’Science and Technology Innovation)(pdjh2024a391)during preparation of this manuscript.
文摘Under the dual drivers of global climate governance and carbon neutrality goals,agricultural carbon emission reduction has become a pivotal component of regional green transformation.This study focuses on Guangdong,a major province,employing the LMDI decomposition mode to systematically analyze the driving mechanis of agricultural carbon emissions.It reveals that the low ecological compensation standard,industrial path dependence,and high-carbon energy lock-in consti-tute core constraints.The research finds that the absence of ecological compensation standards and the structural imbalance of traditional subsidy policies induce diminishing marginal benefits in carbon reduction due to structural imbalances,while persistent funding shortages in low-carbon technology R&D further weaken emission reduction efficacy,exacerbating compatibility contradictions between emission policies and production practices.Through the comparison of domestic and foreign experiences,it is found that under the global wave of low-carbon transformation in agriculture,the ecological compensation optimization layer should establish a calculation system for the carbon sink value of cultivated land and differentiated compensation standards;the fiscal and taxation policy coordination layer should implement a tiered carbon tax on agricultural inputs and carbon sink pledge financing incentives.Constructing a fiscal expenditure and fiscal and taxation coordination mechanism that suits regional characteristics is the key path to resolving the contradiction between the technical economy and ecological sustainability of emission reduction.
文摘BACKGROUND Accurate measurement of energy expenditure(EE)is critical for optimizing nutritional support in critically ill patients.Indirect calorimetry(IC)is the reference method used,but its availability at the bedside is limited.As a result,numerous predictive equations have been devised to estimate EE in critically ill patients,along with other more novel methods recently proposed.AIM To evaluate current methods of measuring EE in critical care,focusing on practical challenges,accuracy,feasibility,and limitations.We will also discuss how these methods contribute to improving nutrition support strategies for intensive care unit patients for a more personalised and effective solution.METHODS A comprehensive search was conducted in PubMed and EMBASE for studies published from December 2014 to December 2024.Eligible studies compared EE measurement methods in critically ill populations.Data extraction and quality assessment followed PRISMA guidelines.Adherence to reporting standards was assessed using the TRIPOD questionnaire and risk of bias was evaluated using the PROBAST tool.RESULTS Twenty five original studies met the inclusion criteria and were analysed.CONCLUSION Each method has unique strengths and limitations.We found that while IC remains the reference standard,less accurate predictive equations have greater accessibility and ease of implementation.Emerging technologies show promise for bedside applicability.Future research should address practical barriers and validate newer approaches.
基金Supported by Shanghai Municipal Health Bureau Foundation No. 054049
文摘AIM： To investigate the role of subjective global assessment （SGA） in nutritional assessment and outcome prediction of Chinese patients with gastrointestinal cancer. METHODS： A total of 751 patients diagnosed with gastrointestinal cancer between August 2004 and August 2006 were enrolled in this study. Within 72 h after admission, SGA, anthropometric parameters, and laboratory tests were used to assess the nutritional status of each patient. The outcome variables including hospital stay, complications, and in-hospital medical expenditure were also obtained.RESULTS： Based on the results of SGA, 389 （51.8%）, 332 （44.2%）, and 30 （4.0%） patients were classified into well nourished group （SGA-A）, mildly to moderately malnourished group （SGA-B）, and severely malnourished group （SGA-C）, respectively. The prevalence of malnutrition classified by SGA, triceps skinfold thickness （TSF）, mid-upper arm muscle circumference （MAMC）, albumin （ALB）, prealbumin （PA）, and body mass index （BMI） was 48.2%, 39.4%, 37.7%, 31.3%, 21.7%, and 9.6%, respectively. In addition, ANOVA tests revealed significant differences in body mass index （BMI）, TSF, PA, and ALB of patients in different SGA groups. The more severely malnourished the patient was, the lower the levels of BMI, TSF, PA, and ALB were （P 〈 0.05）. x^2 tests showed a significant difference in SGA classification between patients receiving different types of treatment （surgery vs chemotherapy/radiotherapy）. As the nutritional status classified by SGA deteriorated, the patients stayed longer in hospital and their medical expenditures increased significantly. Furthermore, multiple regression analysis showed that SGA and serum ALB could help predict the medical expenditures and hospital stay of patients undergoing surgery. The occurrence of complications increased in parallel with the increasing grade of SGA, and was the highest in the SGA-C group （23.3%） and the lowest in the SGA-A group （16.8%）. CONCLUSION： SGA is a reliable assessment too and helps to predict the hospital stay and medica expenditures of Chinese surgical gastrointestina cancer patients.
文摘能量消耗有多种,如静息能量消耗(resting energy expenditure,REE)、基础能量消耗(basal energy expenditure,BEE)、每日静息能量消耗(resting daily energy expenditure,RDEE)、每日总能量消耗(total daily energy expenditure,TDEE)等。
基金supported by the Bill and Melinda Gates Foundation (No. OPP1216421)CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2021-I2M-1004)。
文摘Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.
文摘Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of the contemporary treatment paradigm for mCRPC.Methods:We devised a treatment protocol consisting of sipuleucel-T,enzalutamide,abiraterone,docetaxel,radium-223,and cabazitaxel.We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials.We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA.Our analysis assumed US$100,000 per life year saved(LYS)as the threshold societal willingness to pay.Results:Incremental cost-effectiveness ratios(ICER)for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS,the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS.Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.Conclusion:Based on the available survival data and current costs of treatment,all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS.Improvements in this regard can only comewith a reduction in pricing,better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.
