Economic burden and influencing factor analysis of outpatients with epilepsy: A cross-sectional study in Shanghai,Shanxi and Sichuan

Objective: To better understand the economic burden of patients with epilepsy receiving outpatient services in China and to analyze potential factors influencing epileptic economic burden through a cross-sectional study. Methods: Using a self-designed questionnaire, we collected information retrospectively from 754 patients with epilepsy evaluated in neurology clinics in Shanghai Municipality, Shanxi Province and Sichuan Province. Descriptive analyses were used after cost variables were presented as logarithms, and multiple linear regressions were performed to explore influencing factors. Results: Fifty percent of the investigated patients experienced an epilepsy attack before the age of 15, and 51.3% had suffered from epilepsy for more than five years. In the past year, 87.9% of patients had visited different hospitals multiple times for evaluation(40.3%) and maintenance treatment(40.7%). The total economic burden of epilepsy was US$ 1143.2. The average direct economic burden and indirect economic burden were US$ 939.0 and US$ 110.2, respectively. Multiple linear regressions showed that patients had to bear greater economic burden if they were hospitalized,using multiple antiepileptic drugs, experiencing illness for less than 5 years, in severe seizure index or active epilepsy with drug resistance, which was statistically significant. Totally only14.3% of patients could get reimbursement in outpatient services. Conclusions: Patients with epilepsy must present to hospitals regularly for satisfactory prognosis, which results in economic burden. Patients bear greater economic burden, especially direct medical costs, if they are newly diagnosed, experience severe seizures, or undergo multiple drug treatments that require more frequent monitoring. However, current insurance policy for outpatient services do not help reduce economic burden of patients efficiently.

Seasonal malaria chemoprevention in Africa and China's upgraded role as a contributor:a scoping review

Background Children under five are the vulnerable population most at risk of being infected with Plasmodium para-sites,especially in the Sahel region.Seasonal malaria chemoprevention(SMC)recommended by World Health Organi-zation(WHO),has proven to be a highly effective intervention to prevent malaria.Given more deaths reported during the COVID-19 pandemic than in previous years due to the disruptions to essential medical services,it is,therefore,necessary to seek a more coordinated and integrated approach to increasing the pace,coverage and resilience of SMC.Towards this end,fully leverage the resources of major players in the global fight against malaria,such as China could accelerate the SMC process in Africa.Methods We searched PubMed,MEDLINE,Web of Science,and Embase for research articles and the Institutional Repository for Information Sharing of WHO for reports on SMC.We used gap analysis to investigate the challenges and gaps of SMC since COVID-19.Through the above methods to explore China's prospective contribution to SMC.Results A total of 68 research articles and reports were found.Through gap analysis,we found that despite the delays in the SMC campaign,11.8 milion children received SMC in 2020.However,there remained some challenges:(1)a shortage of fully covered monthly courses;(2)lack of adherence to the second and third doses of amodiaquine;(3)four courses of SMC are not sufficient to cover the entire malaria transmission season in areas where the peak transmission lasts longer;(4)additional interventions are needed to consolidate SMC efforts.China was certified malaria-free by WHO in 2021,and its experience and expertise in malaria elimination can be shared with high-burden countries.With the potential to join the multilateral cooperation in SMC,including the supply of quality-assured health commodities,know-how transfer and experience sharing,China is expected to contribute to the ongoing Scale-up of SMC.Conclusions A combination of necessary preventive and curative activities may prove beneficial both for targeted populations and for health system strengthening in the long run.More actions are entailed to promote the partner-ship and China can be one of the main contributors with various roles.

Bibliometric study of research and development for neglected diseases in the BRICS

Background:Large numbers of people are suffering from a group of diseases that mainly affect developing countries,as there are no available or affordable products for prevention or treatment.Research and development(R&D)for these diseases is still a low priority on the health agenda.Brazil,Russia,India,China and South Africa(BRICS)are quickly growing economies and having more and more positive impact on global health.Additionally,their R&D capacity is believed to be enhanced through decades of investment in education and life science research.The BRICS,as a group of emerging and developing countries,are expected to make greater contributions to solving the problem that mainly affects the entire developing countries community.However,there has been little research to provide a macroscopic overview of BRICS’effort in R&D for neglected diseases.The aim of this study is to investigate scientific production in BRICS countries in this area and their main research hotspots.Methods:Global relevant literature was searched without time limits through PubMed and high yield countries were identified using GoPubMed.Literature up to the end of 2013 from the BRICS was obtained and high frequency words were extracted and clustered using Bibliography Item Co-occurrence Mining System 2.0(BICOMS)and Graphical Clustering Toolkit 1.0(gCLUTO).Results:In total,32,47,51,31 and 44 high frequency words from Brazil,Russia,India,China and South Africa respectively were extracted for clustering analysis.The clustering indicated that eight diseases were research hotspots in BRICS countries.India had the most extensive hotspots and Brazil came in second.The other three countries shared common research foci:helminthiasis,Human Immunodeficiency Virus infection and Acquired Immune Deficiency Syndrome(HIV/AIDS)and tuberculosis.Conclusions:Developed countries still make the majority of contributions to R&D on neglected diseases,but BRICS countries are playing a growing role.Instead of the“big three diseases”(HIV/AIDS,malaria and tuberculosis)recognized by WHO,the BRICS focus more on major causes of disease burden in their own countries.Disease burden and domestic policy,especially patent law,exert primary influence on the research focus.

Challenges and opportunities for China entering global research and development for emerging infectious diseases:a case study from Ebola experience

Background:China has emerged as a powerful platform for global pharmaceutical research and development(R&D)amid the 2014 Ebola outbreak.The research and development impact of developing countries on prevention and control of infectious disease outbreaks has long been underestimated,particularly for emerging economies like China.Here,we studied its research and development progress and government support in response to Ebola outbreak by timeline,input,and output at each research and development stage.This study will contribute to a deeper understanding of the research and development gaps and challenges faced by China,as well as providing evidence-based suggestions on how to accelerate the drug development process to meet urgent needs during future outbreaks.Methods:Data were obtained from the National Nature Science Foundation of China database,PubMed database,Patent Search System of the State Intelleaual Property Office of China,National Medical Products Administration,national policy reports and literature between Jan 1st,2006 and Dec 31st,2017.An overview of research funding,research output pharmaceutical product patent,and product licensed was described and analyzed by Microsoft Excel.A descriptive analysis with a visualization of plotting charts and graphs was conducted by reporting the mean±standard deviation.Results:China has successfully completed the research and development of the Ebola Ad5-EBOV vaccine within 26 months,while the preparation and implementation of clinical trials took relative long time.The National Nature Science Foundation of China funded CNY 44.05 million(USD 6.27 million)for Ebola-related researches and committed strongly to the phase of basic research(87.8%).A proliferation of literature arose between 2014 and 2015,with a 1.7-fold increase in drug research and a 2.5-fold increase in diagnostic research within 1 year.Three years on from the Ebola outbreak,six Ebola-related produas in China were approved by the National Medical Products Administration.Conclusions:China has started to emphasize the importance of medical produa innovation as one of the solutions for tackling emerging infectious diseases.Continuing research on the development of regulatory and market incentives,as well as a multilateral collaboration mechanism that unifies cross-channel supports,would advance the process for China to enter global R&D market more effectively.

The production and sales of antituberculosis drugs in China

Background:Tuberculosis(TB)is a major infectious disease globally.Adequate and proper use of anti-TB drugs is essential for TB control.This study aims to study China’s production capacity and sales situation of anti-TB drugs,and to further discuss the potential for China to contribute to global TB control.Methods:The production data of anti-TB drugs in China from 2011 to 2013 and the sales data from 2010 to 2014 were extracted from Ministry of Industry and Information Technology database of China and IMS Health database,respectively.The number of drugs was standardized to the molecular level of the key components before calculating.All data were described and analyzed by Microsoft Excel.Results:First-line drugs were the majority in both sales(89.5%)and production(92.3%)of anti-TB drugs in China.The production of rifampicin held the majority share in active pharmaceutical ingredients(APIs)and finished products,whilst ethambutol and pyrazinamide were the top two sales in finished products.Fixed-dose combinations only held small percentages in total production and sales weight,though a slight increase was observed.The production and sales of streptomycin showed a tendency of decrease after 2012.The trends and proportion of different anti-TB drugs were similar in production and sales,however,the production weight was much larger than that of sales,especially for rifampicin and isoniazid.Conclusions:First-line drugs were the predominant medicine produced and used in China.While the low production and sales of the second-line TB drugs and FDCs rose concerns for the treatment of multiple drug resistant TB.The redundant production amount,as well as the prompt influence of national policy on drug production and sales,indicated the potential for China to better contribute to global TB control.

Domestic trends in malaria research and development in China and its global influence

Background:Though many countries,including China,are moving towards malaria elimination,malaria remains a major global health threat.Due to the spread of antimalarial drug resistance and the need for innovative medical products during the elimination phase,further research and development(R&D)of innovative tools in both epidemic and elimination areas is needed.This study aims to identify the trends and gaps in malaria R&D in China,and aims to offer suggestions on how China can be more effectively involved in global malaria R&D.Methods:Quantitative analysis was carried out by collecting data on Chinese malaria-related research programmes between 1985 and 2014,invention patents in China from 1985 to 2014,and articles published by Chinese researchers in PubMed and Chinese databases from 2005 to 2014.All data were screened and extracted for numerical analysis and were categorized into basic sciences,drug/drug resistance,immunology/vaccines,or diagnostics/detection for chronological and subgroup comparisons.Results:The number of malaria R&D activities have shown a trend of increase during the past 30 years,however these activities have fluctuated within the past few years.During the past 10 years,R&D on drug/drug resistance accounted for the highest percentages of research programmes(32.4%),articles(55.0%in PubMed and 50.6%in Chinese databases)and patents(45.5%).However,these R&D activities were mainly related to artemisinin.R&D on immunology/vaccines has been a continuous interest for China’s public entities,but the focus remains on basic science.R&D in the area of high-efficiency diagnostics has been rarely seen or reported in China.Conclusions:China has long been devoted to malaria R&D in multiple areas,including drugs,drug resistance,immunology and vaccines.R&D on diagnostics has received significantly less attention,however,it should also be an area where China can make a contribution.More focus on malaria R&D is needed,especially in the area of diagnostics,if China would like to contribute in a more significant way to global malaria control and elimination.