Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients

AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo period on 340 patients who re-ceived omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS:Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which,only 17% met the guideline criteria for SUP indication,14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis,while the remaining 69% were identifi ed as having an unjustified indication for PPI use. Theinitiation of IV PPIs was appropriate in 55% of pa-tients. Half of these patients were candidates for switching to the oral dosage form during their hos-pitalization,while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%,P = 0.003). The cost analysis associated with the appro-priateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571,respectively. CONCLUSION:This study highlights the over-utili-zation of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.

Non-fragile hybrid guaranteed cost control for a class of uncertain switched linear systems

This paper focuses on the problem of non-fragile hybrid guaranteed cost control for a class of uncertain switched linear systems. The controller gain to be designed is assumed to have additive gain variations. Based on multiple-Lyapunov function technique, the design of non-fragile hybrid guaranteed cost controllers is derived to make the corresponding closed-loop system asymptotically stable for all admissible uncertainties. Furthermore, a convex optimization approach with LMIs constraints is introduced to select the optimal non-fragile guaranteed cost controllers. Finally, a simulation example illustrates the effectiveness of the proposed approach.

伏美替尼对比吉非替尼单药一线治疗表皮生长因子受体突变晚期非小细胞肺癌的成本-效果分析

目的从我国卫生体系角度出发,评价伏美替尼对比吉非替尼单药一线治疗表皮生长因子受体(EGFR)突变阳性晚期非小细胞肺癌的成本效用。方法基于Ⅲ期临床试验FURLONG研究,构建三状态的分区生存模型,并结合治疗成本、效用值、不良反应发生率、贴现率等参数,模拟得到总的增量成本效用比值(ICER),将ICER值与意愿支付值(WTP)进行比较,从而判断伏美替尼相较于吉非替尼单药一线治疗EGFR突变阳性晚期非小细胞肺癌的经济性。结果基础分析结果显示,伏美替尼组比吉非替尼组多支出成本85786元,但多获得了0.62个质量调整生命年(QALY),增量成本效用比值为138306元,小于我国3倍人均国内生产总值(GDP)。单因素敏感性分析显示,最佳支持治疗成本、无进展生存期(PFS)效用值和进展生存期(PD)效用值对ICER结果影响较大。概率敏感性分析结果显示,当WTP为3倍我国人均GDP时,伏美替尼组相比吉非替尼组具有经济性的概率为100.0%。情境分析结果验证了基础分析结果的稳健性。结论在2022年中国3倍人均GDP的意愿支付阈值下,选择伏美替尼单药用于一线治疗EGFR突变阳性晚期非小细胞肺癌相比吉非替尼更具经济性。

贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状NSCLC的成本-效用分析

目的 从我国卫生体系角度出发,评价贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状非小细胞肺癌(NSCLC)的经济性。方法 基于BEVERLY研究数据构建动态Markov模型,循环周期为3周,模拟至模型中99%的患者死亡,年贴现率为5%。模型产出为总成本与质量调整生命年(QALY)以及增量成本-效果比(ICER)。以3倍我国2023年人均国内生产总值(GDP)作为意愿支付(WTP)阈值,采用成本-效用分析法评价贝伐珠单抗联合厄洛替尼相对于厄洛替尼单药一线治疗晚期EGFR突变型非鳞状NSCLC的经济性,并采用单因素敏感性分析和概率敏感性分析验证基础分析结果的稳健性。结果 基础分析结果显示,与厄洛替尼单药方案相比,贝伐珠单抗联合厄洛替尼方案的ICER为1 452 243.01元/QALY,大于以3倍我国2023年人均GDP(268 074元/QALY)作为的WTP阈值,不具有经济性。单因素敏感性分析结果显示,贝伐珠单抗成本、无进展生存期和疾病进展期状态的效用值对结果的影响较大。概率敏感性分析结果显示,当WTP阈值为1 740 000元/QALY时,贝伐珠单抗联合厄洛替尼方案具有经济性的概率为50%。结论 在以3倍我国2023年人均GDP作为WTP阈值时,与厄洛替尼单药方案相比,贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状NSCLC不具有经济性。

某院2020-2022年门诊药房非甾体抗炎药的用药分析

目的:分析某院门诊药房非甾体抗炎药的使用情况,探讨临床非甾体抗炎药的用药特点及存在的问题,为促进其合理应用与规范管理提供参考。方法:选取2020—2022年某院门诊药房非甾体抗炎药的用药数据,统计分析其用药频度(DDDs)、日均费用(DDC)及排序比(B/A)等,并对其进行数据分析。结果:某院2020—2022年所使用的非甾体抗炎药共有22种,包含了口服剂型、注射剂型,外用剂型。各剂型总体销售金额呈逐年上升趋势。洛索洛芬钠贴剂和氟比洛芬凝胶贴剂的销售金额居第一、二位。阿司匹林肠溶片的DDDs居第一位,B/A远大于1,其他非甾体抗炎药的B/A均与1相近。结论:2020—2022年某院门诊药房的非甾体抗炎药的临床选用情况与指南推荐基本相符,根据不同患者的特点选用不同治疗方案,做到个体化给药,确保临床用药安全有效,为临床合理用药提供参考依据。

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.

Fuzzy Geometric Programming in Multivariate Stratified Sample Surveys in Presence of Non-Response with Quadratic Cost Function

In this paper, the problem of non-response with significant travel costs in multivariate stratified sample surveys has been formulated of as a Multi-Objective Geometric Programming Problem (MOGPP). The fuzzy programming approach has been described for solving the formulated MOGPP. The formulated MOGPP has been solved with the help of LINGO Software and the dual solution is obtained. The optimum allocations of sample sizes of respondents and non respondents are obtained with the help of dual solutions and primal-dual relationship theorem. A numerical example is given to illustrate the procedure.

Robust Non-Fragile Guaranteed Cost Control for Nonlinear Time Delay Discrete-Time Systems Based on T-S Model

This paper concerns the robust non-fragile guaranteed cost control for nonlinear time delay discrete-time systems based on Takagi-Sugeno （T-S） model. The problem is to design a guaranteed cost state feedback controller which can tolerate uncertainties from both models and gain variation. Sufficient conditions for the existence of such controller are given based on the linear matrix inequality （LMI） approach combined with Lyapunov method and inequality technique. A numerical example is given to illustrate the feasibility and effectiveness of our result.

肥胖儿童non-HDL-C、remnant cholesterol与亚临床动脉粥样硬化的关系

目的:了解non-HDL-C和remnant cholesterol与肥胖儿童亚临床动脉粥样硬化(AS)的关系。方法:根据甘油三酯(TG)水平将65例肥胖儿童(肥胖组)分为I组(TG≥2.3 mmol/L)32例,II组(TG<2.3 mmol/L)33例,与肥胖组儿童性别年龄相匹配的正常体质量儿童30例为III组(对照组)。比较3组儿童血脂指标,对肥胖组各项血脂指标与血浆致动脉粥样硬化指数(AIP)进行相关性分析,肥胖患儿体质指数、血脂指标与颈动脉内径、内膜-中层厚度(c-IMT)、血流参数进行相关性分析。结果:I组、II组的TG、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、non-HDL-C、remnant cholesterol、AIP均较对照组升高,高密度脂蛋白胆固醇(HDL-C)较对照组降低,且I组的remnant cholesterol、AIP均较II组升高。肥胖组儿童AIP与TG、non-HDL-C、remnant cholesterol呈正相关,与HDL-C呈负相关。37例行颈动脉超声检查的肥胖儿童的c-IMT较正常儿童的增厚。结论:non-HDL-C、remnant cholesterol在肥胖儿童亚临床AS中有重要作用,在肥胖儿童血脂异常的治疗中应关注non-HDL-C、remnant cholesterol的变化。

A system-wide approach to minimize the operational cost of bench production in open-cast mining operations

The production cycle of open-cast coal mines generally in eludes drilling, blasting, loading, hauling and coal preparation activities. Individual optimization of these activities does not mean that the whole system is optimized. This paper proposes a cost model considering all activities in mining cycle and system-wide approach to minimize the total mining cost of bench production. Since the fragmentation size and blast-hole diameter are linked to all activities of mining system, they are considered as decision variables in the problem form ul at io n. The operatio n costs are then minimized by using the evolutionary algorithm. Moreover, the impact of the change in the explosive price, and the hourly unit cost of equipment on total mining cost is quantified by sensitivity analysis. A case study is implemented to demonstrate the developed model.

基于改进NSGA-Ⅱ的铁路项目进度计划多目标优化

以总工期最短和总费用最低为目标,针对包含线性活动、条状活动、块状活动等多种施工场景的铁路工程项目,基于RSM方法构建铁路项目多目标优化模型,并提出一种改进的NSGA-Ⅱ算法对模型进行求解.算法设计一种分层次选取种群个体的均匀进化精英选择策略,以提高种群多样性和收敛性;同时引入差分进化算法的变异、交叉算子,构造分层多策略自适应变异、交叉算子,以平衡整个种群的局部搜索能力和全局搜索能力.结果表明,增加对特殊活动和施工方向的考虑,可增强模型对铁路项目的适用性;改进后的算法收敛速度快,运行稳定,得到的结果更优,能够满足较大规模铁路项目进度计划优化.

Shenqi Fuzheng injection combined with GP chemotherapy in the treatment of advanced non-small cell lung cancer： a meta-analysis

Objective： To evaluate the clinical efficacy of Shenqi Fuzheng injection combined with gemcitabine plus cisplatin（GP） in the treatment of advanced non-small cell lung cancer （NSCLC）. Methods： we performed a systematicsearch in the electronic databases such as Cochrane Library, Pubmed, Embase, Chinese Journal Full-text Database,Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Full-text Database andWanfang Database up to 30 January 2017. Randomized controlled trials （RCT） of Shenqi Fuzheng Injectioncombined with GP chemotherapy in the treatment of advanced NSCLC were searched, and all the RCTs wereconducted on methodological quality assessment. Data extraction and data analysis were according to standards ofCochrane systematic review. Results： Eight trials were included including a total of 701 patients. Meta-analysisresults： Shenqi Fuzheng injection combined with GP chemotherapy could significantly improve the functionalstatus of patients with NSCLC （OR = 3.44, 95% CI [2.26, 5.25], P 〈 0.0001） and clinical treatment efficacy （OR =（OR = 0.31, 95%CI [0.20, 0.47], P 〈 0.0001. The rate of leukopenia （OR = .31, 95%CI [0.20,0.47], P 〈 0.0001）,thrombocytopenia （OR = 0.58, 95%CI [0.37, 0.91], P = 0.020）, hemoglobin decline （（OR = 0.31, 95%CI [0.16,0.59], P = 0.0004） and incidence of gastrointestinal reactions （OR = 0.58,P 〈 0.05） could be reduced. Conclusion：Shenqi Fuzheng injection combined with GP chemotherapy in the treatment of advanced NSCLC obtainedsignificantly clinical efficacy. The quality of the literature incorporated is low, the conclusion requires high-qualityresearch to further prove.

Analysis of Numerical Results in High Temperature Congealment and Chemistry Non-equilibrium Flow Field

Using the air plasma ignition technique, physicochemical process of burning can be accelerated; concentration limit ofretrofires both can be extended; reliability of retrofires and stability of burning can be improved. In this paper, using internalequivalent heat area in place of electric are that created Ohm heat, the flow fields of thermodynamic equilibrium chemistry con-gealment and chemistry non-equilibrium in the plasma generator were simulated. The influences of the inlet prerotation angleof air, the inlet total pressure of air and the airflow compression angle of spray nozzle on the temperature on the surface of elec-

Turbulent Flow Action of Pulp in Wet - Laid Non - Woven Processes

The paper deals with the fluid field of web forming in wet-laid non-woven production.The influence of the turbulent flow on blending fiber and occluded fluid produced in pulp flow has been discussed in theory and practice.The suitable use of the imported velocity of pulp is very important in producing wet-laid products of good quality.

CYFRA 21-1 as an early predictor of first line chemotherapy response in advanced non small cell lung cancer

Objective： In an era of ever evolving, promising new therapies for advanced non small cell lung cancer （NSCLC）, early predictors of response to therapy, are needed. We evaluated early variations in CYFRA 21-1 serum levels of patients with advanced NSCLC receiving first line chemotherapy and correlated the results with objective tumor response. Methods： 29 consecutive, previously untreated, patients of advanced non small cell lung cancer, with measurable disease on CT scan were evaluated. All patients were treated with conventional systemic chemotherapy, although the choice of chemotherapy was left to the discretion of the treating physicians. Serum samples were obtained immediately before the start of 1st and 2nd cycles of chemotherapy. CYFRA 21-1 was measured with an electrochemiluminescense immunoassay on an automatic analyzer （Elecsys 2000; Roche Diagnostics）. Response was evaluated using Response evaluation criteria in solid tumors （RECIST） criteria. Results： 10 patients had partial response, 9 patients had stable disease and 9 had progressive disease. None of the patients had complete response. 21/29 （72%） patients had an elevated baseline value of CYFRA 21-1.62% patients （18/29） had a decrease in CYFRA 21-1 after 1 cycle of chemotherapy. The average reduction in the 2nd reading was irrespective of whether baseline value was normal or not. The average reduction was statistically significant （P = 0.002; 95% CI, from 0.8369 to 3.49464; t test）. 8 out of 10 （80%） patients with partial response had a reduction in their 2nd reading of. CYFRA （P = 0.019; 95% CI, from 0.81965 to 7.20035; t test） which was significant. We also observed that 6/9 （66%） patients whose disease remains stable also had a decrease in their subsequent reading （P = 0.0106; 95% CI, from -0.44942 to 3.82720; t test）, though it was not significant statistically. Although 5 out of 9 （55%） patients, who had an increase in their CYFRA 21-1 level, had progressive disease, but it was not statistically significant （P = 0.537; 95% CI, from -1.20021 to 2.13354; ttest）. 14 out of 19 （73%） who either had partial response or had stable disease, had a reduction in their 2nd value of CYFRA 21-1 and was significant statistically （P = 0.004; 95% CI, from 0.74792 to 3.50208; t test）. We also observed that except for 1 patient, all patients who had a decrease of 42% or more in their subsequent CYFRA 21-1 level, were those who had either responded to chemotherapy or had stable disease （P = 0.001）, which was statistically significant. Conclusion： We can conclude that monitoring of serum marker CYFRA 21-1, early dudng first-line chemotherapy may be a useful prognostic tool for evaluation of early tumor response in patients with advanced NSCLC.

MiR-16-5p plays an inhibitory role in human non-small cell lung cancer through Fermitin family member 2

Increasing evidence indicates that aberrant expressions of some microRNAs are associated with cancer progression.However,the roles and biological mechanisms of miRNA-16-5p in human non-small cell lung cancer(NSCLC)are not to be well studied.Here,we validated that the expression of miR-16-5p was decreased significantly in NSCLC samples and cell lines.The correlation between the clinicopathological features of NSCLC and the miR-16-5p expression showed that the expression of miR-16-5p in non-small cell lung cancer was linked with the advanced TNM stage,positive lymph node metastasis,with short overall survival(OS).Also,a negative correlation between miR-16-5p and Fermitin family member 2(FERMT2)was observed,implying there may be a potential link about their regulation.The hypothesis was further confirmed by in-silico analysis and dual-luciferase reporter assay.Moreover,we demonstrated that the transfections of miR-16-5p mimics could alter some biological characteristics of NSCLC cells remarkably accomplished by the expression variance of FERMT2 in vitro and in vivo assays.Summarily,this study demonstrated that miR-16-5p,as a tumor suppression factor in NSCLC by targeting FERMT2,could serve as one promising biomarker in the prediction for NSCLC patients.

Net Present Value Method: A Method Recommended by ISO 15686-5 for Economic Evaluation of Building Life Cycle Costs

The publication of ISO 15686-5 is significant for studies related to the life-cycle costs of buildings. Among the many economic evaluation methods, the NPV method is recommended for use by this standard. This study explains the concept and method of PV, and then provides an explanation of the concept and method of NPV, and points out the limitations in the practical application of the method.

银行发展金融科技会影响流动性吗?--基于中国银行业的实证研究

基于百度新闻高级检索以及Python爬虫技术,本文构建了银行金融科技指数,并利用2008-2019年我国80家银行的面板数据,实证检验了银行发展金融科技对流动性的影响及其机制。研究发现,银行发展金融科技显著提高了自身流动性;降低付息成本和提高非利息收入占比是银行金融科技影响流动性的重要传导机制。此外,面板门限回归结果表明,随着银行规模变大,银行金融科技对流动性的提升作用逐渐增强;随着资本充足率提高,银行金融科技对流动性的提升作用先减弱后增强,呈现U型趋势。研究结论有助于厘清银行金融科技与流动性的关系,为我国银行金融科技发展与流动性风险防范提供参考。

脑卒中患者三级康复治疗6个月间的成本-效果研究

目的:对脑卒中患者三级康复治疗方案作成本-效果的经济学分析评价。方法:按分层区组随机化的方法将82例脑卒中患者随机纳入到康复组和对照组,康复组在常规内科治疗基础上给予规范的三级康复治疗,对照组仅一般的常规内科治疗,分别采集两组患者自发病到发病后6个月的直接医疗费用、直接非医疗费用和间接费用,以及各费用的详细费用构成。对于每例样本在入选时(V0)和第六个月月末(V3)分别采用功能综合评定量表进行功能评价。结果:康复组患者运动功能每提高1分,则需要消耗的住院相关费用、西药费、规范的康复费、总的康复费、直接医疗费和总的成本费用分别为:$314.90、$133.79、$100.12、$187.49、$579.25和$851.65,认知功能每提高1分消耗的成本费用分别为:$1905.36、$809.50、$605.82、$1134.48、$3504.94和$5153.17,综合功能每提高1分消耗的成本费用分别为:$272.85、$115.92、$86.75、$162.46、$501.92和$737.95。不管是运动功能、认知功能,还是综合功能每提高1分,康复组所耗费的成本费用明显较对照组为低,对照组约是康复组的2—3倍。结论:三级康复治疗是一种经济的、有效的脑卒中患者的康复治疗方案。

4种非甾体抗炎药治疗类风湿关节炎的成本-效果分析

目的 :探讨 4种口服非甾体抗炎药治疗类风湿性关节炎 6mo的成本和效果。方法 :4 6 1例病人随机分成 4组 ,双氯芬酸组 131例 ,服用双氯芬酸 75～ 10 0mg·d- 1,萘丁美酮组 131例 ,服用萘丁美酮 10 0 0mg·d- 1,美洛昔康组 14 4例 ,服用美洛昔康 15mg·d- 1,塞来昔布组 5 5例 ,服用塞来昔布 2 0 0mg·d- 1,疗程均为 6mo。运用成本 -效果分析对 4组病人进行分析评价。结果 :双氯芬酸、萘丁美酮、美洛昔康、塞来昔布 4组完成疗程病例数分别为12 5 ,12 7,139和 5 5例。在疗程结束时 ,4组间疗效无显著差异 (P >0 .0 5 ) ,塞来昔布组不良反应率明显低于其他 3组 (P <0 .0 1)。 4组总成本分别为(14 0 0±s 32 6 ) ,(15 31± 36 ) ,(2 0 18± 5 2 7) ,(32 2 5±76 7)元 ;成本 -效果比为 (2 0 4 1± 6 12 ) ,(2 5 6 0±6 81) ,(2 985± 70 6 ) ,(4 6 6 7± 1389)元·例 - 1;经敏感度分析后的成本 -效果比为 (1896± 4 5 5 ) ,(2 36 6±6 38) ,(2 6 6 9± 5 89) ,(3978± 96 3)元·例 - 1。结论 :双氯芬酸为治疗类风湿性关节炎的较佳方案 ,在经济许可的情况下 ,偏重考虑药物安全性 ,塞来昔布也是一个较佳选择。