Methodological quality and transferability will be important issues for the credibility and usefulness of both published studies and administrative methods for evaluating the socio-economic value of marketed medicines in China. This paper critically examines factors commonly contributing to, or inhibiting, the quality and transferability of socio-economic evidence of the value of medicines, with specific reference to the Chinese community. It discusses appropriate approaches to design, performance, and reporting of published economic evaluation studies, as well as guides on assessment of quality of economic evaluations and recommends two internationally established methods that may be suitable for training in this setting.
Objective To investigate cost-effectiveness of no indwelling urinary catheter in pulmonary lobectomy patients and to confirm the advances of no indwelling urinary catheter. Methods We recruited 148 lung cancer patients who were scheduled for pulmonary lobectomy under general anesthesia in West China Hospital from July through December 2015. These patients were divided into two groups including an indwelling urinary catheter group (74 patients, 45 males and 29 females, at age of 52.55±19.87 years) and a no indwelling urinary catheter group (74 patients, 42 males and 32 females, at age of 54.03±16.66 years). Indexes of cost-effectiveness of the two groups were compared. Results There was no statistical difference between the two groups in duration of indwelling catheter (1.56±0.0.65 d versus 1.68±0.91 d, P=0.077). Material expense(4 811.48 yuan versus 296.74 yuan, P=0.045), cost of nursing care (7 413.32 yuan versus 457.32 yuan, P=0.013), and total expense (12 224.8 yuan versus 754.06 yuan, P=0.000) in the indwelling catheter group were higher than those in the no indwelling catheter group. Material expense per patient (65.02±5.62 yuan/patient-time versus 4.01±0.00 yuan/patient-time, P=0.000), cost of nursing care per patient (100.18±7.19 yuan/patient-time versus 6.18±1.22 yuan/patient-time, P=0.000), and total cost per patient (165.20±12.81 yuan/patienttime versus 10.19±1.22 yuan/patient-time, P=0.000) in the indwelling catheter group were higher than those in the no indwelling catheter group. Conclusion Both costs and labor of nurse can be cut down for appropriate lung cancer patients undergoing lobectomy without routine indwelling urinary catheter.
Objective To evaluate the cost-effectiveness of three LTBI screening strategies: the tuberculin skin test (TST), the T-SPOT.TB and the combination of TST and T-SPOT (TST+T.SPOT), to provide economic evidence for T.SPOT application in China. Methods A decision analysis model evaluated three strategies among a cohort of 1000 tuberculosis (TB) close contacts, using incremental cost-effectiveness of prevention a active TB patient (1 year post contact). Meta analyses were conducted to calculate the key parameters of T.SPOT and TST. The official data or literature was searched and the unaccessible data was to specify other parameters, such as cost, LTBI prevalence, etc. The one-way sensitivity analysis was performed, varying key parameters over a wide range of reasonable values to evaluate the impact of data uncertainties and to determine the robustness of our overall conclusion. Results a) As for the total cost, the TST+T.SPOT strategy (?212 213.81 per 1 000 contacts) cost the least, while the single T.SPOT strategy cost the most; b) Subsequently, the TST+T.SPOT strategy required less contacts to be treated to prevent an active case of TB (8.31) than the single TST strategy (25.67); c) the TST+T.SPOT strategy shared the most cost-effectiveness (?3 063.50 per active TB case prevented) than the single TST or T.SPOT strategy; and d) The results of one-way sensitivity analyses showed that cost-effectiveness values were sensitive to changes in LTBI prevalence (gt;60%), Sen and Spn of TST test (gt;70%), with the single TST being superior to the single T.SPOT. Conclusion The Single T.SPOT strategy enjoys the most cases prevented from active TB, while the TST+S.SPOT strategy is the most cost-effective. The conclusion is sensitive to a few parameters, such as LTBI prevalence, but the TST+T.SPOT strategy is always the best.
Onehealth, an evidence-based decision-making software, is based on the United Nations' epidemiological reference modules to predict the effect of health services. Onehealth is a large database. The software is using activitybased costing, simulating investment costs of health system and changes of mortality in different coverage levels. By the cost of inputs/avoid deaths, it could quantify the cost of health services effectiveness and provide an intuitive basis for the rational allocation of health resources. This study introduces the relevant concepts, model structures and applications of Onehealth. We took the study of child nutrition interventions in Sudan for example and to present Onehealth tool's operating. As a new auxiliary and evidence-based decision-making software with scientific and rigorous theoretical approach, Onehealth has practical significance on the national or regional macro decision-making.
ObjectiveTo compare the cost-effectiveness between endoscopic retrograde cholangio-pancreatography (ERCP) treatment and laparotomy treatment for simple common bile duct stone or common bile duct stone combined with gallbladder benign lesions. MethodsA total of 596 patients with common bile stone received ERCP (ERCP group) and 173 received open choledocholithotomy (surgical group) in our hospital between January 2009 and December 2012. Their clinical data were retrospectively analyzed. The curing rate, postoperative complications, hospital stay, preoperational preparation and total cost were compared between the two groups of patients. Meanwhile, for common bile stone combined with gallbladder benign lesion, 29 patients received ERCP combined with laparoscopic cholecystectomy (LC) (ERCP+LC group), 38 received pure laparoscopy treatment (laparoscopy group) and 129 received open choledocholithotomy combined with cholecystectomy (surgery group). ResultsFor simple common bile stone patients, no significant difference was found in cure rate and post-operative complication between endoscopic and surgical treatment groups (P>0.05). However, total hospitalization expenses[(13.1±6.3) thousand yuan, (20.6±7.5) thousand yuan)], hospital stay[(8.91±4.95), (12.14±5.15) days] and preoperative preparation time[(3.77±3.09), (5.13±3.99) days] were significantly different between the two groups (P<0.05). For patients with common bile stone combined with gallbladder benign lesion, no significant discrepancy was detected among the three groups in curing rate and post-operative complications (P>0.05). Significant differences were detected between ERCP+LC group and surgical group in terms of total hospitalization expense[(18.9±4.6) thousand yuan, (23.2±8.9) thousand yuan] hospital stay[(9.00±3.74), (12.47±4.50) days] and preoperative preparation time[(3.24±1.83), (5.15±2.98) days]. No significant difference was found in total hospitalization expense and hospital stay, while significant difference was detected in preoperative preparation time between ERCP+LC group and simple LC group. ConclusionFor patients with simple common bile stone, ERCP is equivalent to surgery in the curing rate, and has more advantages such as less cost, shorter length of hospital stay, and lower preoperative preparation time. For the treatment of common bile duct stone with gallbladder benign disease, ERCP combined with LC also has more advantages than traditional surgery.
ObjectiveTo compare the cost-effectiveness of etanercept combined with methotrexate to methotrexate plus placebo in the treatment of rheumatoid arthritis and to provide references for clinical practice.MethodsDecision tree model was developed to estimate the cost-effectiveness from the perspective of the health care system by TreeAge Pro 2016 software. The cost-effectiveness of the two treatments were compared by incremental analysis, and the robustness of the results were analyzed by sensitivity analysis.ResultsThe cost of etanercept combined methotrexate group in one year duration was ￥212 692, the effective rate (ACR50) was 66.4%; the cost of methotrexate combined with placebo group in one year duration was ￥572, the effective rate (ACR50) was 40.6%. The incremental cost-effectiveness ratio of two groups was ￥818 000/person, and the sensitivity analysis showed that the results were robust.ConclusionEtanercept combined methotrexate is significant more effective than methotrexat. But the cost of etanercept combined methotrexate is too high to afford and is not economical compared to methotrexate.
ObjectiveTo evaluate the efficacy and cost-effectiveness of thymalfasin (Tα1) as an adjuvant therapy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after surgery.MethodsPatients with HBV-related HCC who underwent hepatectomy from February 2007 to December 2015 in West China Hospital of Sichuan University, Chengdu Military General Hospital, or the Third Affiliated Hospital of Sun Yat-sen University were retrospectively collected and divided into the Tα1 group and the observation group. Log-rank test and Kaplan-Meier curve were used to assess the overall survival, recurrence-free survival, and safety of patients. A Markov model was used to calculate the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) of the Tα1 group compared with the observation group. Cost data was from the hospital information system of the three hospitals. Utility scores mainly came from published data. Sensitivity analyses were applied to explore the impact of essential variables.ResultsA total of 208 patients with HCC after liver resection were enrolled, among them 48 received Tα1 treatment (the Tα1 group) and 160 were only followed up (the observation group). There was no significant difference between the two groups in the baseline characteristics. The median overall survival of the Tα1 group and the observation group was 102.0 months [95% confidence interval (CI) (74.8, 129.2) months] and 81.6 months [95%CI (65.7, 97.6) months], respectively, and the difference was statisitically significant (P=0.047); the median recurrence-free survival was 66.7 months [95%CI (17.3, 116.1) months] and 37.4 months [95%CI (28.7, 46.2) months], respectively, and the difference was statistically significant (P=0.044). There were no grade Ⅲ-Ⅳ adverse events and no treatment-related death occurred. The ICER of Tα1 group was ￥108 050.02/QALY, which was less than the willingness to pay (￥177 785.25/QALY).ConclusionsTα1, as an adjuvant therapy for HBV-related HCC patients, can improve the prognosis of the patients, and the cost is within the acceptable level in our country, so this strategy is likely to be a cost-effective option compared with the observation group.
ObjectiveTo compare medical cost and utilization efficiency of medical resources between manual layered anastomosis with mechanical stapling technique in esophagectomy. MethodsClinical data of 132 patients who underwent surgical resection of esophageal carcinoma in the Department of Thoracic Surgery of Gansu Tumor Hospital between January and October 2011 were respectively analyzed. According to different anastomotic techniques, all the patients were divided into a manual layered anastomosis group (including 40 males and 20 females with their age of 36-72 (49.3±7.6) years) and a mechanical stapling technique group (including 50 males and 22 females with their age of 30-79 (51.0±8.6) years). Demographic data, operation data, postoperative complications, direct and indirect medical cost, and constitution of direct medical cost were compared between the 2 groups. ResultsMedical cost of esophagectomy was 14 505.03± 1 523.37 yuan in the manual layered anastomosis group and 19 891.05±1 634.58 yuan in the mechanical stapling technique group respectively, which were statistically different (P < 0.05). Material cost was 2 242.00±751.08 yuan in the manual layered anastomosis group and 5 424.00±1 876.22 yuan in the mechanical stapling technique group respectively, which were statistically different (P < 0.05). Cost-effectiveness analysis showed that cost-effectiveness ratio in the manual layered anastomosis group was lower, thus this anastomotic technique was more reasonable. ConclusionMedical cost of manual layered anastomosis is lower than that of mechanical stapling technique in esophagectomy, as the utilization efficiency of medical resources of manual layered anastomosis is higher than that of mechanical stapling technique.
ObjectiveTo systematically review the economics evaluation studies on the early screening or diagnosis of primary immunodeficiency diseases (PID). MethodsWeb of Science, CRD, PubMed, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect the economics evaluation studies on the early screening or diagnosis of PID from inception to July 1st, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, a descriptive systematic review was performed. ResultsA total of 10 studies focusing on SCID were included. The results showed that under a relatively high threshold, the early screening and diagnosis of SCID were cost-effective, which can reduce severe infections in patients and treatment costs while improving patient’s survival. ConclusionCurrent evidence shows that early diagnosis of PID can reduce costs and improve benefits. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objective To systematically review the cost-effectiveness of gefitinib for advanced non-small cell lung cancer (NSCLC), in order to provide the economics values of gefitinib for clinical application. Method We electronically searched databases including PubMed, Ovid, Embase, Cochrane Library, Medline, China National Knowledge Internet, VIP, and Wanfang database for articles about the cost-effectiveness of gefitinib for advanced NSCLC patients from January 1946 to October 2017, and then performed a systematic literature review of economic evaluations of geftinib. Results A total of 20 independent studies were included in the present systematic review, in which 8 were the first-line treatment, 9 were the second-line treatment, 1 was the third-line treatment, and 2 were maintenance treatment. The most common comparison was gefitinib vs. chemotherapy (n=7), and other comparisons were gefitinib vs. erlotinib (n=4), gefitinib vs. docetaxel (n=3), gefitinib vs. placebo (n=2), gefitinib vs. icotinib (n=2), gefitinib vs. afatinib (n=1), and gefitinib vs. other treatments (n=1). For the advanced NSCLC patients, the first- or second-line treatment with gefitinib compared to chemotherapy was considered to be more cost-effective, especially in patients with mutated epidermal growth factor receptor gene. As the second-line treatment, gefitinib was considered to be more economical than erlotinib and docetaxel. Conclusion Gefitinib is considered to be a cost-effective strategy for the advanced NSCLC patients as the first- or second-line therapy.