Modeling Anthrax with Optimal Control and Cost Effectiveness Analysis

Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.

High-resolution microendoscopy for esophageal cancer screening in China: A cost-effectiveness analysis

AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.

Cost Effectiveness of Fluvoxamine versus Desvenlafaxine among the Patients with Major Depressive Disorder in China

Objectives: To estimate the cost effectiveness of fluvoxamine against desvenlafaxine in Chinese patients with major depressive disorder (MDD). Methods: A cost effectiveness of treating Chinese patients with MDD for 6 months maintenance period has been estimated by a decision tree model. The relative effectiveness on relapse rates came from a recent network meta analysis by Kishi et al. (2023) along with local drug cost data based on WHO defined daily dose (DDD) and relapse cost for the 6 months estimated from various sources were used in the model. Based on the Quality Adjusted Life Years (QALY) gain reported by Sobocki et al. (2007), QALY loss from a relapse was estimated. Univariate sensitivity analyses were presented by a Tornado diagram and extensive probabilistic sensitivity analysis based on 10,000 simulations was performed. The most recent cost effectiveness threshold of 1.5 times GDP suggested by Cai et al. (2022) was applied. Results: Fluvoxamine dominated desvenlafaxine (cost savings of 4003 CNY and 0.01 QALY higher in 6 months). The most sensitive parameters were relapse rates followed by desvenlafaxine cost and utility loss of relapse. However, the default result of fluvoxamine dominance was not changed for any univariate sensitivity analysis. The probabilistic sensitivity result showed the cost effectiveness acceptability at 1.5 times GDP as 99.93%. Conclusions: The cost effectiveness of fluvoxamine against desvenlafaxine among Chinese patients with MDD in a 6-month maintenance period was cost saving with better effectiveness (i.e., dominating) with low uncertainty.

Cost-Effectiveness Analysis of Oral Hypoglycemics for Type-2 Diabetes Mellitus at a Tertiary Care Hospital, Nepal

An observational follow-up study on 63 newly diagnosed Type-Ⅱ diabetic patients was conducted at Tribhuvan University Teaching Hospital, a tertiary care centre, Kathmandu, Nepal. The aims of the study were to determine demographics, prescribing patterns, drug costs and to analyze the effectiveness of different hypoglycemic therapies. The effectiveness of glucose control was analyzed by Wilcoxon signed rank test. The majority of patients (31%) fell into the age strata of 50-60 years. A total of 63 prescriptions were screened including anti-diabetics drugs and other drugs. The average number of drugs per prescription sheet was 2.72 ± 2.23. Eighty-two percent (82%) of the patients were recommended oral hypoglycemic agents. The prescribing frequency of biguanides was more than sulphonylureas. Biguanides were prescribed more frequently than sulfonylureas. The biguanide monotherapy group (p = 0.001) and the combination of biguanide and sulfonylureas (p = 0.028) were the most effective treatment methods, and the p-value of fasting blood glucose was the lowest at follow-up. Nearly 55% of patients receiving the combination achieved glucose control. In summary, this study reflects the best treatment for patients with diabetes. Future studies of larger patient populations need to evaluate existing treatment models to ensure good practice and quality of care.

Evaluating and Improving the Effectiveness of Vehicle Inspection and Maintenance Programs: A Cost-Benefit Analysis Framework

Motor vehicle inspection and maintenance (I/M) programs are designed to identify high-emitting vehicles and mitigate their impacts on air quality and climate. I/M programs have been traditionally ranked superior among various vehicle emission control measures by the results of cost-benefit analysis, based on the assumption that these programs will achieve the targeted emission reduction outcomes. However, the actual effects of I/M programs may be greatly uncertain and when this uncertainty is taken into account, these programs may become suboptimal. This study develops a new a cost-benefit analysis framework that links various program design consideration, such as program participation rate, identification rate and effective repair rate, to the public health benefits as well as costs of the programs. This framework helps decision makers to investigate minimum implementation requirements that at least ensure the benefits are greater than the costs of implementing the programs in order to improve the overall effectiveness of the I/M programs. To illustrate the applications of the framework, it was applied to a particulate matter oriented I/M program targeting all diesel-fueled vehicles in the city of Bangkok, Thailand, a large metropolitan area that has been suffering from severe ambient PM pollution mainly attributable to its wide use of diesel-fueled vehicles and motorcycles. It was found that the health benefits achieved from the program are sensitive to several key program design elements, including participation rate and problem vehicle identification rate, fraction of effective repairs and illegal operation rate. Other variables, such as the testing cut-points and vehicle population growth rate, only have modest effects on the overall emission reduction and consequent health benefits. Overall, the performance of multiple variables associated with I/M program design needs to be improved simultaneous in order to achieve the targeted benefits of the program.

Cost-Effectiveness Analysis of Atezolizumab plus Pemetrexed and Platinum in First-Line Treatment of Non-Squamous Non-Small Cell Lung Cancer in China

Objective: To evaluate the cost-effectiveness of atezolizumab plus pemetrexed and platinum-based (APP) in the first-line treatment of non-squamous non- small cell lung cancer (NSCLC). Methods: A partitioned survival model (PSM) was constructed based on the IMpower132 clinical trial. Total cost, quality- adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER) were the main outputs of the model. Deterministic sensitivity analysis and probabilistic sensitivity analysis were adopted to test the uncertainty of the parameters. Results: The results of the base-case analysis illustrated that compared with PP, the incremental cost of APP was CNY 591040.94, the incremental utility was 0.46 QALY, and the ICER was CNY 1291414.83/QALY. Deterministic sensitivity analysis results illustrated that atezolizumab and other parameters have a greater impact on ICER. Probabilistic sensitivity analysis results show that no matter how each parameter changes, under the willingness to pay threshold of 3-times Chinese per capita GDP, the probability of APP has cost-effectiveness is 0. Conclusion: From the perspective of the Chinese health system, APP is not cost-effective for first-line treatment of non-squamous non-small cell lung cancer without sensitizing EGFR or ALK genetic alterations.

Desalination and Alternative Water-Shortage Mitigation Options in Israel: A Comparative Cost Analysis

Costs for seawater desalination have dropped significantly over the past decade due to technological advances. This has increased the attractiveness of desalination to policy-makers as a means to address water supply shortages. Israel, a country that faces chronic water scarcity, is in the process of developing wide-scale desalination capacity that is projected to supply all of the nation's domestic water use within a few years. Two issues are often neglected, however, by policy-makers pursuing desalination. The first is that seawater desalination is associated with a number of external costs, consideration of which may influence the optimal scale and timing of desalination implementation. The second is that alternative measures for managing water scarcity, including conservation techniques, are often more cost-efficient. This study estimates the full cost of desalination in Israel, including externalities, and then compares this to the costs of several alternative options for addressing water scarcity, including both demand management and supply augmentation measures. We find that desalination, despite being the primary policy option pursued by Israel, is among the least cost-efficient of all the alternatives considered, even without taking into account the externalities involved.

A cost-effectiveness study on treatment of duodenal ulcer

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Outcomes and Cost Effectiveness of a Respiratory Coordinated Care Program in Patients with Severe or Very Severe COPD

Multidisciplinary community coordinated care programs are widely adopted to optimise care of chronic disease patients, but there is a need for further evaluation in the setting of COPD. This observational study evaluated 147 patients with severe or very severe COPD who were enrolled in a multidisciplinary community respiratory coordinated care program (RCCP) from 2007 to 2012. Comparison was made of hospitalisation rates and length of stay for 12 months prior to joining the program, and the first 12 months after joining the program. This data was used to inform a cost analysis. Enrolment into RCCP halved the annual hospital admission rate from 1.18 to 0.57 admissions per year (relative risk reduction 51.4%, p < 0.001), and annual total length of stay was reduced from 8.06 to 3.59 days per patient per year (p < 0.001). Hospital admissions were reduced from 5.05 days to 2.00 days (p < 0.001). Accounting for the program’s costs, these changes resulted in a $US 906.94 ($AUD 972.80) cost saving per patient per year. A RCCP program can reduce patient hospitalisation and overall costs in the COPD setting.

Cost-Utility Analysis of Liraglutide in Type 2 Diabetes Patients in China after Chinese Reformation of Medical Care System

Objectives: The cost-utility analysis of Liraglutide is aimed at evaluating whether Liraglutide is cost-effective or not after Chinese reformation on medical insurance. The analysis is based on the results of clinical trial conducted in Asia. Methods: We applied a Markov model to estimate the quality-adjusted life years, medical cost and incidence of diabetes-related complications for patients receiving the Liraglutide as an add-on to the metformin treatment. Baseline characteristics were taken from a China’s study while the treatment effect is from an Asian study. The related medical cost and utility score were obtained from a local study in China. Having set 30 years’ simulations, the incremental cost-effectiveness ratio was calculated comparing with glimepiride treatment. The ratio would be compared with the willingness to pay for a quality-adjusted-life-year (QALY) which is three times of the GDP per capita in Beijing. Sensitivity analysis was also performed. Result: During a period of 30 years, the base-case analysis which takes discount rate at 3% shows that Liraglutide 1.8 mg results in an average incremental cost of CNY 82,671.49, an improvement in 0.12 QALYs and a reduction of incidence of diabetes-related complications comparing to glimepiride. The associated incremental cost-effectiveness ratio is CNY 688,929.08. Conclusion: Long-term project shows that taking Liraglutide as an add-on to the metformin treatment will lead to increasing quality-adjusted life years and reduction of incidence of diabetes-related complications. When the price of Liraglutide is reduced by 43 percent in China’s yuan, Liraglutide will be cost-effective in China from the healthcare system perspective taking three times of GDP per capita as our WTP threshold.

角蛋白18、CEA、CA19-9、CA72-4在胃癌诊断中的成本-效果分析

目的利用成本-效果分析探讨细胞角蛋白18片段(CK18)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)和糖类抗原72-4(CA72-4)联合检测对胃癌的诊断价值。方法检测已确诊胃癌患者115例,胃良性病变者70例,健康体检者95例的血清CK18、CEA、CA19-9、CA72-4含量,进行成本-效果分析。结果肿瘤标志物的联合检测可以提高胃癌诊断的灵敏度和特异性。4种肿瘤标记物联合检测灵敏度最高(68.70%),特异性也较好(79.39%)。每增加1%的灵敏度所需追加的成本以CK18、CA72-4组合最低。结论CK18、CEA、CA19-9、CA72-4组合灵敏度最高,对胃癌辅助诊断的价值也最大。CK18、CA72-4组合的成本-效果比最小,适用于胃癌的高危人群筛查。

Analysis of a Community-based Intervention to Reduce Heat-related Illness during Heat Waves in Licheng,China:a Quasi-experimental Study

Objective To reduce health-related threats of heat waves, interventions have been implemented in many parts of the world. However, there is a lack of higher-level evidence concerning the intervention efficacy. This study aimed to determine the efficacy of an intervention to reduce the number of heat-related illnesses. Methods A quasi-experimental design was employed by two cross-sectional surveys in the year 2024 and 2015, including 2,240 participants and 2,356 participants, respectively. Each survey was designed to include one control group and one intervention group, which conducted in Licheng, China. A representative sample was selected using a multistage sampling method. Data, collected from questionnaires about heat waves in 2014 and 2015, were analyzed using a difference-in-difference analysis and cost effectiveness analysis. Outcomes included changes in the prevalence of heat-related illnesses and cost-effectiveness variables. Results Relative to the control participants, the prevalence of heat-related illness in the intervention participants decreased to a greater extent in rural areas than in urban areas （OR=0.495 vs. OR=2.282）. Moreover, the cost-effectiveness ratio in the intervention group was tess than that in the control group （usS25.06 vs. us$25.69 per participant）. Furthermore, to avoid one additional patient, the incremental cost-effectiveness ratio showed that an additional USS14.47 would be needed for the intervention compared to when no intervention was applied. Conclusion The intervention program may be considered a worthwhile investment for rural areas that are more likely to experience heat waves. Meanwhile, corresponding improving measures should be presented towards urban areas. Future research should examine whether the intervention strategies could be spread out in other domestic or international regions where heat waves are usually experienced.

Economical Analysis of Milk Production in the Farms of Siedlce Region

Last years the most profitable line of activity in agriculture is considered with milk production. The-effectiveness of this project depends primarily on the direct costs and the obtained of purchase price. Therefore the aim of this work was to analyze the financial results of dairy farms in the east part of Mazovia region. Completing the research in 2010, to the owners of 36 farms were sent a questionnaire containing 18 questions. The obtained data were used to characterize the various research facilities. And then the whole population was devoted on the 6 production groups, depend on the number of physical units of dairy cows. Moreover, based on survey data, an analysis of the profitability of milk production was done. It was the following economic values： direct costs, revenue, gross margin and the index of production profitability. Also the statistical analysis by calculating the Pearson linear correlation coefficient （r） and coefficient of determination （R2） was done. The study showed that the highest annual yield of milk from a cow at the level of 7500 kg, reached the farmers with the area of l 9.7 ha of with the density of 1.82 BFU/ha and with 8 years of cow utilization. Respondents from this group also received the highest value of effectiveness index （184.60%）. In addition, the performed regression analysis showed significant positive correlation between the effectiveness index and the surface agricultural lands occurring in the farms, density of agricultural lands, and efficiency from a cow and the price of milk.

三种联合用药方案治疗宫颈癌的药物经济学评价

目的在决策树模型的基础上对宫颈癌化疗的药物进行药物经济学评价,确定期望成本最低、效果最佳的宫颈癌化疗方案,以期为临床宫颈癌化疗药物的合理搭配提供决策依据。方法采用决策树模型对顺铂+紫杉醇脂质体,拓扑替康+紫杉醇脂质体和顺铂+紫杉醇脂质体+贝伐珠单抗三种用药方案治疗宫颈癌进行成本-效果分析,成本参数来源于九江市第三人民医院药品信息系统,同时根据本项目的随机对照研究所获取的化疗效果参数评估三种化疗方案短期内的经济性,决策树模型模拟的干预时间为12周。采用Treeage Pro 2011软件进行概率敏感性分析(成本-效果可接受曲线)和单因素敏感性分析(旋风图),对研究结果进行稳健性验证。结果基础分析结果表明,顺铂+紫杉醇脂质体的增量成本-效果比为12329.8,顺铂+紫杉醇脂质体+贝伐珠单抗的增量成本-效果比为36290.9,拓扑替康+紫杉醇脂质体的增量成本-效果比为19113.7。单因素敏感性分析结果显示,顺铂+紫杉醇脂质体的治疗成本和临床有效率对研究结果有最显著影响;当患者的个人意愿支付价格低于7376.6元时,顺铂+紫杉醇脂质体干预方案更具有经济性;当患者个人意愿支付价格高于7376.6元后,使用拓扑替康+紫杉醇脂质体治疗宫颈癌更具有经济性。结论若以2022年人均可支配收入作为患者个人意愿支付价格,宫颈癌患者选用顺铂+紫杉醇脂质体方案治疗最具有经济性。

益母草注射液药物经济学评价

目的:通过成本-效果和成本-效用分析评价益母草注射液联合缩宫素与缩宫素单独使用在预防产后出血和促进子宫复旧的经济学优劣,为医疗保险、药品支付制度改革以及缩宫产品等临床应用提供参考依据。方法:采用前瞻性队列研究设计,根据益母草注射液销售的地区和不同等级医院分布,随机选取全国25家医院2270例分娩产妇,其中自然分娩1100例,剖宫产1170例。根据生产过程中缩宫产品实际使用情况,不同分娩方式产妇均分为缩宫素单独使用和益母草注射液与缩宫素联合使用两个队列,自然分娩组中缩宫素单独使用队列578例,益母草注射液与缩宫素联合使用队列522例;剖宫产组中缩宫素单独使用队列601例,益母草注射液与缩宫素联合使用队列569例。以产后出血率、子宫复旧不良发生率、产后72 h宫底高度和恶露持续时间为效果指标,质量调整生命年(QALYs)为效用指标,进行成本-效果和成本-效用分析。结果:自然分娩组中缩宫素单独使用队列和益母草注射液与缩宫素联合使用队列产妇产后出血率分别为3.11%和2.49%,剖宫产组相应队列分别为2.33%和2.28%。与胎儿娩出时相比,无论何种分娩方式,益母草注射液与缩宫素联合使用队列产妇产后72 h宫底高度改善程度均优于缩宫素单独使用队列(自然分娩组4.0 vs.5.0,P=0.0005;剖宫产组4.93 vs.5.16,P=0.0567)。自然分娩和剖宫产组缩宫素单独使用队列子宫复旧不良发生率分别为11.94%和10.98%,均高于益母草注射液与缩宫素联合使用队列的8.62%和7.03%。采用生存分析方法对不同分娩方式中不同队列产妇恶露消失时间进行分析,自然分娩组和剖宫产组中益母草注射液与缩宫素联合使用队列产妇恶露中位消失时间均比缩宫素单独使用队列少1 d,log-rank检验P值分别为0.0159和0.8578。益母草注射液联合缩宫素使用效果优于缩宫素单独使用,但治疗成本相应提高(自然分娩组3842.8元vs.3901.14元;剖宫产组6106.7元vs.6510.5元),自然分娩组产后产后出血率、产后72 h宫底高度改善、子宫复旧不良发生率和恶露持续时间增量成本效果比(ICER)分别为94.11、58.35、17.58和58.35元;剖宫产组产后产后出血率、产后72 h宫底高度改善、子宫复旧不良发生率和恶露持续时间增量成本效果比(ICER)分别为8003、1755、101和400元。结论:在分娩中,益母草注射液与缩宫素联合使用相比于缩宫素单独使用,不但能减少缩宫素的使用次数和使用剂量,同时在降低产后出血率、子宫复旧等方面更有优势,具有一定的成本-效益。

他克莫司常释与缓释胶囊预防肝移植术后排斥反应成本-效果分析

目的评价他克莫司常释胶囊与缓释胶囊预防肝移植术后排斥反应的成本-效果。方法选取首都医科大学附属北京友谊医院肝移植门诊2016年1月1日至2023年6月30日收治的肝移植术后患者1520例。其中,1031例患者术后口服常释胶囊,489例患者口服缓释胶囊,并在此基础上加用吗替麦考酚酯胶囊(用法用量相同)行免疫抑制治疗。利用TreeAge Pro 2021软件构建Markov模型,研究时限设为30年。以我国医疗卫生体系视角收集成本(直接医疗成本)及效果参数,对缓释胶囊和常释胶囊预防肝移植术后排斥反应的成本-效果进行分析,并通过单因素敏感性分析和概率敏感性分析验证模型。结果与常释胶囊比较,缓释胶囊的增量成本-效果比(ICER)为159357.86元/质量调整生命年(QALY),小于意愿支付阈值(25.7094万元)。缓释胶囊的价格、贴现率和常释胶囊的价格对模型结果影响较大。肝移植术后30年,缓释胶囊具有成本-效果的概率为63.72%。结论肝移植术后30年时限内,与常释胶囊比较,缓释胶囊预防肝移植术后排斥反应更有药物经济学优势。

达肝素钠注射液和依诺肝素钠注射液用于骨科手术后预防静脉血栓栓塞症的成本效果分析

目的分析达肝素钠注射液和依诺肝素钠注射液在骨科手术后患者中预防静脉血栓栓塞症(VTE)的成本效果,为临床用药决策提供经济学依据。方法回顾性分析2021年7月~2022年12月成都市新都区人民医院收治的106例骨科手术患者的病历资料,根据不同的术后干预方法分为观察组和对照组,每组53例。观察组行达肝素钠注射液预防骨科手术后VTE的发生,对照组则采用依诺肝素钠注射液进行预防,对两组患者用药的成本效果进行分析。结果达肝素钠注射液和依诺肝素钠注射液的成本分别为481.32元和616.42元,预防有效率分别为98.11%和94.34%,两者有效性和安全性的差异无统计学意义(P>0.05),但两者的成本效果比分别为490.59和653.40。结论在骨科手术后,采用达肝素钠注射液和依诺肝素钠注射液预防VTE发生的疗效相当,均具备较高应用价值;但在药物治疗成本上,达肝素钠注射液则更具经济优势。

腹腔镜胆囊切除效费比聚类分析及其人工智能机器学习预测模型构建

目的探讨腹腔镜胆囊切除手术的效费比,并通过聚类分析及人工智能机器学习方法构建预测模型。方法回顾性分析中山市人民医院腹腔镜胆囊切除术206例患者的临床资料。将患者住院总费用、总住院时间、住院至手术时间、术后住院时间、术前止痛药物应用次数、术后止痛药物应用次数等维度作为效费比指标进行聚类分析分类指标,分为三类,效费比优、中、差;以CT炎症情况、CT病灶情况、CT病灶部位、病理诊断、CA19-9、AFP、术前血糖、ALB、AST、ALT、PLT、HBG、RBC、WBC、CT距手术时间、伤口疼痛程度、手术时间、术前血压、CT病灶大小、住院至手术时间、术前禁食时间等指标作为变量,进行多分类logistic回归分析及机器学习进行预测模型构建,包括逻辑回归、线性支持向量机、支持向量机、决策树、随机森林、K近邻等分类器进行模型拟合。结果多分类logistic回归分析显示模型拟合卡方值为156.986,P<0.001,似然比ALB、WBC、CT距手术时间、住院至手术时间、高血压、肾脏疾病、手术人员差异有统计学意义,P值分别为0.001、0.019、0.029、<0.001、0.005、0.027、<0.001,模型拟合分类总符合率为74.8%(即准确率为0.748)。多层感知机模型K折验证评分0.461,预测评分0.802;逻辑回归模型K折验证评分0.437,预测评分0.726;支持向量机模型K折验证评分0.529,预测评分0.755;决策树模型K折验证评分0.462,预测评分0.585;随机森林模型K折验证评分0.529,预测评分0.726;K近邻模型K折验证评分0.388,预测评分0.623。结论分析腹腔镜胆囊切除手术效费比中,机器学习建模可有效预测效费比指标,可用于术前评估,按效费比优化医疗资源分配。

数字贸易规则对“一带一路”国家ICT产品出口的影响研究

数字贸易规则是驱动“一带一路”国家ICT产品出口的关键力量。本文利用2000~2023年间123个国家的双边数据,结合社会网络分析法,揭示了数字贸易规则网络结构的变化,并构建了衡量其广度和深度的指标。研究发现,在考虑内生性问题并进行稳健性检验后,数字贸易规则广度和深度的提升显著促进了“一带一路”国家ICT产品出口,主要通过缩小境内监管质量差异、降低境外贸易成本等渠道改善数字贸易环境。异质性分析表明,在规则特征层面,贸易方式数字化规则效应更为显著;在贸易关系层面,签署数字贸易规则对贸易关系疏远国家尤为有利;在网络节点结构权力层面,缔约国度数中心度强化了数字贸易规则的积极效应。进一步研究还发现,数字贸易规则的影响呈现出非线性特征,随着缔约国数字基础设施差异扩大,其效应呈现出“强促进-弱促进-牵制”的轨迹。本文丰富了“把规则标准‘软联通’作为共建‘一带一路’重要支撑”思想的理论研究,对发展中国家如何开展数字贸易规则谈判、加快ICT产品发展提供了实证参考和政策启示。

基于Markov链的上海市枫林社区骨质疏松全人群防治工作的成本效果分析

背景随着社区卫生服务综合改革的逐步深化,社区对全人群的单病种防治工作也在不断优化,但目前仍缺乏合适的方法来评价社区防治的成效。目的通过分析2016—2022年度上海市徐汇区枫林街道社区卫生服务中心现有骨质疏松全人群防治措施的成本效果,探究社区单病种全人群防治的初步成效及可能存在的问题。方法本研究以4293例枫林社区2016—2022年度接受骨质疏松防治的社区居民为研究对象进行成本-效果分析。根据骨密度值将研究对象划分为三种状态:健康、低骨量、骨质疏松,以此构建Markov模型,分析不同状态转移的影响因素,并依据Markov模型预测值结合质量调整生命年(QALY)计算QALY增量,统计2016—2022年防治工作投入的所有成本,以成本/QALY增量比来评价防治效果,通过文献检索确定的健康效用值和期望寿命计算求得QALY。结果枫林社区骨质疏松防治总成本为33814102.15元。第一次诊断时社区骨质疏松防治人群的总QALY为77098.2889,人均均值为17.959,标准差为9.34;第二次诊断时防治人群的总QALY为79616.9361,人均均值为18.546,标准差为9.342,两次诊断QALY的差值为2518.6472。增量成本效果比(ICER)为2132.9070元/QALY,ICER值小于1倍(66965.10元)人均GDP,表明干预方案完全具有成本效果。结论本研究结合Markov模型及QALY对枫林社区持续接受骨质疏松随访管理的人群的防治效果进行了初步评价,结果显示枫林社区的骨质疏松防治干预方案是值得投入的,为后续骨质疏松的精准防治决策提供了一定的依据。