ObjectiveTo analyze the efficacy, hospitalization cost and cost-effect of different treatments for multiple myeloma, so as to provide references for the treatment and development medical insurance payment policy of multiple myeloma.MethodsA total of 60 cases of multiple myeloma patients who were treated in the General Hospital of Shenyang Military Command from January 1st, 2013 to December 31st, 2017 were included. According to the treatment method, they were categorized into the traditional treatment group (n=37) and novel drug treatment group (n=23). The total response rate and hospitalisation expenses for patients with medical insurance of the two groups were calculated and compared, and cost-effectiveness analysis was then performed.ResultsThe overall response rate in patients in traditional treatment group was 56.76% (21/37), and in novel drug treatment group was 82.61% (19/23) (χ2=4.366, P=0.039). The annual average drug fee, annual average novel drug fee, secondary average drug fee, secondary average novel drug fee, annual average total cost, and secondary average total cost of the medical insurance patients in the novel drug treatment group were significantly higher than those in the traditional treatment group (P<0.05). The annual average cost of personal and coordinated payment for the medical insurance patients in the novel drug treatment group were 172 229.53 yuan and 48 237.51 yuan, respectively, which were significantly higher than the traditional treatment group (P<0.01). The cost-effectiveness ratio of the traditional treatment group was 884.44 yuan/%, the novel drug treatment group was 2 821.80 yuan/%, the cost-effective incremental ratio was 7 075.75 yuan/%, the incremental cost-effective ratio was 7 075.75 yuan/%, and the sensitivity analysis was consistent with the results.ConclusionsThe total response rate of novel drug treatment is significantly higher than traditional treatment. However, novel drug treatment costs higher, and patient's economic burden is also higher. The traditional treatment is superior to novel drug treatment in cost-effectiveness analysis.
Medicine is a very important health resource in China. Although numerous efforts are paid to pre-marketed medicines, little is done to address practical problems in marketed medicines. The rational use and allocation of marketed medicines remain a major concern for decision-makers in China. It has been recognized that economic evaluation is an efficient tool for prioritizing the choice, and optimizing the use of medicines. This paper has explored the methods and principles for conducting economic evaluation of marketed medicines. Different strategies will be adopted for economic evidence for marketed medicines in terms of adequacy and sufficiency.However, a standard study pathway should be applied in economic evaluation of marketed medicines. Besides, the aspects for developing economic framework and the methods for reviewing existing economic evidence are also introduced in this paper, particularly, for marketed medicines within the same therapeutic group.
Objective To investigate the inpatient’s disease and cost constitution of the Third People’s Hospital of Chengdu in 2009, so as to provide baseline data for further research. Methods The case records of inpatients in the Third People’s Hospital of Chengdu in 2009 were collected, and based on the first diagnose, the diseases were classified according to the International Classification of Diseases (ICD-10). The data including general information of the inpatients, discharge diagnosis and hospitalization expense etc. were rearranged and analyzed using Excel software. Results a) The total number of inpatients was 1 220, and male was more than female. The disease spectrum included 12 categories. b) A total of 1 093 inpatients suffered from the top 3 systematic diseases as follows: trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. c) According to ICD-10, the top 9 diseases of trauma and toxicosis were injuries to the wrist and hand, injuries to the hip and thigh, injuries to the knee and lower leg, injuries to the shoulder and upper arm, injuries to the lower back, lumbar spine and pelvis, injuries to the elbow and forearm, injuries to the thorax, injuries to the neck and injuries to the ankle and foot; the top 4 diseases in musculoskeletal system and connective tissue disorders were dorsopathies, soft tissue disorders, arthrosis, and osteopathies and chondropathies; among the factors affecting health and resulting from contact with health care institutions, removal of fracture fixation device. d) According to ICD-10 (list of three-digit catalogue and four-digit sub-catalogue), the top 5 single diseases in trauma and toxicosis were muscle and tendon injuries of the wrist and hand, intertrochanteric frature, fracture of the femoral neck, fracture of the tibia and fibula, and fracture of the lumbar spine; the top 5 single diseases in musculoskeletal system and connective tissue disorders were lumbar disc herniation, spondylosis, arthrosis of the knee, osteoporosis with pathological fracture, and osteonecrosis. e) The average hospital stay were 23.55 days, and the average cost per capita were 13 073.73 yuan which were constituted by material cost, drug cost including western and Chinese medicines, treatment expenses including blood transfusion fee, operation expenses including anesthetic fee, examination expenses including radiation fee and laboratory fee, bed fee and others. The inpatient costs were mainly at patient’s own expense, nearly a half of those expenses were paid by social security, and public medical care only accounted for less than 3% of the total payment. Conclusion In 2009: a) The male inpatients were mainly the young and middle-aged, and the female were the elderly. The main 3 systematic diseases were trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. b) The top 3 single diseases were lumbar disc herniation, muscle and tendon injuries of the wrist and hand, and intertrochanteric fracture. Except lumbar disc herniation, the other 2 single diseases were mostly seen in male rather than in female. c) The average hospital stay was 23.55 days. The overall costs were mainly constituted by material and drug cost (59.25%), with rationality worthy of attention. d) Inpatient costs were mainly at patient’s own expense or paid by social security, and the proportion of public medical care was low in the payment.
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 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.
Objective To investigate constitution and costs of inpatients with circulation system diseases in Karamay Central Hospital in 2014 and provide baseline data for further evidence-based pharmacy studies of circulation system single disease. Methods The information of drug use and expenditure of circulation system diseases were collected from the hospital information system (HIS). We analyzed the data of frequency, constituent ratio and cumulative frequency by using Excel 2007 software. Results A total of 2 898 inpatients with circulation system diseases were included. The top three diseases were cerebral infarction, angina and hypertension. The cerebral infarction and coronary heart disease accounted for the largest proportion in the cost. The top one disease of total hospitalization cost, drug expense per capita and inspection cost per capita was cerebral infraction. Conclusion Based on the above results, cerebral infraction and angina were selected as the evidence-based pharmacy study goal of single disease.
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 evaluate the economics of duplizumab in combination with optimal supportive care versus optimal supportive care for moderate-to-severe atopic dermatitis in adults from the perspective of our health system. MethodsA Markov model embedded in a decision tree was constructed to compare the long-term cost-utility of dupilumab combined with optimal supportive care versus optimal supportive care, and a sensitivity analysis was performed on the results. ResultsThe results of the basic analysis showed that compared with the optimal supportive care, dupliyuzumab in combination with optimal supportive care resulted in 3.82 more QALYs, while its cost was 125 549.42 yuan more. The ICER was 32 854.83 yuan/QALY, which was less than one times China's per capita GDP in 2022, and was economical. Univariate sensitivity analysis showed that factors such as Dupilumab-16-week post - no response utility value, Dupilumab-52-week post response rate and Dupilumab-52-week adherence had a greater impact on the cost changes. The results of the probabilistic sensitivity analysis showed a stable model structure and good robustness. ConclusionIn adult patients with moderate-to-severe atopic dermatitis, dupliyuzumab in combination with an optimal supportive care regimen is more cost-effective compared to an optimal supportive care regimen.
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.
ObjectivesTo systematically review the disease burden of osteoporotic fracture (OPF) in China.MethodsWe searched PubMed, EMbase, CNKI, WanFang Data and VIP database for observational studies of the disease burden of osteoporosis in China from inception to Jan 30th, 2018. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies.The descriptive analysis was used to analyze the economic burden of OPF in China.ResultsA total of 23 studies were included. The average cost of OPF was 27 561.27 yuan. Women were more prone to OPF than men. Hip and spinal fractures were the diseases which had higher average hospital costs.ConclusionsWomen are more prone to osteoporotic fractures than men. The higher hospital costs of OPF may cause the reason for growing financial burden of patients. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify conclusions.