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.
ObjectiveTo systematically review the status of economic evaluation of liver cancer screening in China, so as to provide reference for further studies.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were searched to collect economic evaluation studies of liver cancer screening in China from inception to December, 2017. Two reviewers independently screened literature, extracted data and conducted descriptive analysis of basic characteristics, methods of economic evaluation and main results as well as quality and uniformity of reporting.ResultsA total of 5 studies were included. Among them, the starting age of screening were found to be 35 to 45 years old; α-fetoprotein (AFP) testing and ultrasound examination combined procedure and screening interval of every 6 months were mostly evaluated. The quality of the 5 studies was satisfactory, and the uniformity of reporting was relatively acceptable, with a median score of 78% (range: 60% ~ 78%). Two population-based studies reported cost per liver cancer detected (44 thousand and 575 thousand yuan). Three studies reported cost-effectiveness ratio(CER) based on life year saved (LYS) and quality adjusted life year (QALY). Among these results, only 1 study from mainland China reported CER based on LYS (1 775 yuan), and the calculated ratio of CER to local GDP per capita was estimated as 0.1, while 2 studies from Taiwan province reported 4 CERs, and the ratios of CER to local GDP per capita ranged from 1.0 to 2.2.ConclusionsInformation from liver cancer endemic areas such as Taiwan province indicates promising cost-effectiveness to conduct liver cancer screening in local general population, while data from mainland suggests that conducting liver cancer screening combining AFP and ultrasound in high-risk population will be cost-effective, however only supported by 1 regional study. This needs to be verified by further economic evaluations based on randomized controlled trials or cohort studies as well as health economic evaluations.
ObjectiveTo evaluate the comparative cost-effectiveness of thrombolysis treatment of ischemic stroke based on outcomes of CT perfusion (CTP).
MethodsWe applied the methods of systematic review to evaluate the studies abroad about the cost effectiveness of CTP diagnosis outcomes used for selecting stroke patients for thrombolysis treatment. We also evaluated the domestic studies about the cost-effectiveness of CTP in China by establishing a decision tree model.
ResultsA total of 2 economics studies were included. The results showed that, the cost-effectiveness ratios of CT, CTP and MRI for selecting stroke patients for thrombolysis treatment were 2 983.7 ￡/QALY, 2 951.4 ￡/QALY and 2 982.9 ￡/ QALY, respectively, in the UK; 100 483.5＄/QALY and 99 406.1＄/QALY just for CT and CTP, respectively, in the US; and the evaluation outcomes by establishing the decision tree model showed that, 113 492.4 ￥/QALY, 113 615￥/QALY and 120 831.9 ￥/QALY, respectively, in China.
ConclusionAll international and domestic studies' results show that CTP is more cost-effective than CT/MRI in selecting stroke patients for thrombolysis treatment.
ObjectivesTo compare the common application methods of meta-analysis results used in economic evaluations so as to provide reference and suggestions for similar economic evaluations in future.MethodsFour methods were used to calculate the effectiveness deriving from meta-analysis of omeprazole and esomeprazole in the treatment of peptic ulcer, then substituted into the decision tree model to perform cost-effectiveness analysis.ResultsMethod 1 used the risk difference as the incremental effectiveness. The ICER was ￥2 420, and the equal probability point of the cost-effectiveness acceptability curve (CEAC) in the probability sensitivity analysis was approximately ￥2 600. Method 2 used the effective rate of the study group in high-quality literatures as the benchmark, calculated the effective rate of the control group according to the RR. The ICER was ￥2 016, and the equal probability point of the CEAC was approximately￥2 000. Method 3 was based on the effective rate of the control group in high-quality literatures to calculate the effective rate of the study group according to RR. The ICER was ￥2 420 and the equal probability point of the CEAC was approximately￥2 200; Method 4 used literature weights to calculate the effectiveness, the ICER is ￥2 420, and the equal probability point of the CEAC was about ￥2 400.ConclusionsThe results of the four methods share little difference, and the sensitivity analysis results show that the base case analysis results are more robust. However, in the application process, method 1 lacks specific effectiveness of the two groups and underestimate the variation range of the effectiveness difference when one-way sensitivity analysis was performed. Relevant assumptions are further required to limit the possibility of effectiveness calculated greater than 1 in sensitivity analysis among method 2 and 3. Comprehensively, method 4 can be recommended in the economic evaluations for fewer defects of calculating effectiveness.
ObjectivesThis study aimed to study the economic effect of five kinds of detection systems for nucleic acid, which were based on five kinds of working electrodes: gold electrode, glassy carbon electrode, carbon paste electrode, screen printing electrode, and indium-tin-oxide (ITO) glass electrode.MethodsThe cost of completing a single test was taken as the cost of economic analysis. The Youden index was used to represent the effect of cost-effectiveness analysis (CEA). Meanwhile, the cost-utility analysis (CUA) and incremental cost-effectiveness ratio (ICER) were used for the economic analysis of the corresponding system.ResultsThe cost of five detection systems based on gold electrode, glass carbon electrode, carbon paste electrode, screen printing electrode, and ITO glass electrode was 3.70 yuan/unit, 4.20 yuan/unit, 5.25 yuan/unit, 33.98 yuan/unit and 5.01 yuan/unit, respectively. The Youden indexes of all five systems were 1. The cost effectiveness (C/E) were 3.70, 4.20, 5.25, 33.98, and 5.01, respectively. The cost utility (C/U) were 6.61, 6.89, 9.91, 62.93, and 9.45, respectively. The C'/E and C'/U of the gold electrode detection system were the minimum (2.96 and 5.29). Compared with the system applying the gold electrode, the system using the glassy carbon electrode had ΔC >0 and ?E0 >0; When carbon paste electrode, screen printing electrode, and ITO glass electrode system were used, ?C was >0 and ?E0 was <0.ConclusionsFrom the perspective of CEA and CUA, the system using the gold electrode has the best economic effect. The sensitivity analysis proved the reliability of CEA and CUA results. According to the ICER, gold electrode or glassy carbon electrode can be used in clinical practice with the choice depending on the user.
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.
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.
The application of economic tools to evaluate the cost and health benefits and screen out more cost-effective drugs and technologies is an important measure to improve efficiency of medical resource allocation in China. Given the inherent differences between strict clinical trials and clinical routine practice, using trial-based economic evaluations to guide relevant medical decisions may lead to a certain risk of value deviation. Recent development of real-world data provides opportunities to assess the cost-effectiveness of drugs under the practical utilization, and has gradually become a new research hotspot. However, the complexity of the actual clinical environment also puts higher demands on researchers and decision makers to construct, understand and apply real-world evidence. In order to further prompt the normalization of economic evaluation based on real-world data and promote the scientific application of real-world evidence in medical and health decision-making, this project aims at the crucial issues including scope, research design and quality evaluation, to clarify the key considerations on the using of real-world evidence in medical decision-making. Combined with the international guidelines, the latest advancement of relevant research areas and the advice and opinions from multidisciplinary experts, we aim to provide technical references and guidance for researchers and decision makers, and to strengthen the evidence base of management policies.
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.
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.
