人们对于生命质量的探究开始于二十世纪初的美国。当时战后的美国经济飞速发展,但人们生活质量的体验抑或预期并没有随着经济的发展而提高。这让人们意识到不能简单的使用经济数据来评价人的生存状况,应该创造出一种新的评价方法来考察...人们对于生命质量的探究开始于二十世纪初的美国。当时战后的美国经济飞速发展,但人们生活质量的体验抑或预期并没有随着经济的发展而提高。这让人们意识到不能简单的使用经济数据来评价人的生存状况,应该创造出一种新的评价方法来考察人的生命质量。在医学领域,健康相关生命质量(Health Related Quality of Life;HRQOL)这一概念就逐渐被人们所应用。它能够将疾病与相关的治疗手段联系起来,以此评价对生命质量的影响。展开更多
Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticanc...Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.展开更多
质量调整生命年(Quality-Adjusted Life Year,QALY)被广泛应用于卫生经济学和药物经济学研究的各个方面,是衡量健康产出的重要指标。近年来,其内涵也随着QALY相关研究的深入而不断迭代发展。目前,还未有中文研究对近年来QALY内涵变化的...质量调整生命年(Quality-Adjusted Life Year,QALY)被广泛应用于卫生经济学和药物经济学研究的各个方面,是衡量健康产出的重要指标。近年来,其内涵也随着QALY相关研究的深入而不断迭代发展。目前,还未有中文研究对近年来QALY内涵变化的最新进展进行系统性梳理。基于过往文献和研究实践,梳理QALY内涵的变化,并将其归纳为QALY定义扩展和赋权QALY的进展和影响。QALY定义扩展主要包括主流量表对健康相关QALY定义的再丰富和对幸福感的补充,对幸福感QALY来源进行回溯,分析QALY定义扩展与传统QALY对比的优势;在赋权QALY上,总结赋权QALY的定义、测量方法和优势。同时,讨论了QALY内涵变化对于效用积分体系构建的影响。建议未来应重视QALY内涵的变化和发展,积极探索具有中国特色的QALY内涵,运用实证研究分析QALY内涵变化带给卫生决策一致性和合理性的影响。展开更多
Background:During the COVID-19 pandemic,many countries used lockdowns as a containment measure.While lockdowns successfully contributed to slowing down the contagion,the related mobility restrictions were reportedly a...Background:During the COVID-19 pandemic,many countries used lockdowns as a containment measure.While lockdowns successfully contributed to slowing down the contagion,the related mobility restrictions were reportedly associated with an increased risk of major depressive and anxiety disorders.We aimed to quantify the trade-off between the quality-adjusted life years(QALY)gain due to lower COVID-19 incidence as a result of a lockdown and QALY loss due to lockdown-induced mental disorders.Methods:We developed an agent-based model of COVID-19 epidemic and coupled mental disorder development in the population of a large city.We used data sources on the places of living,studying and working,public health and census surveys.Modeling of mental disorders was based on diathesis-stress concept.We quantified mental and physical health burden in terms of QALY taking into account major depressive and anxiety disorder episodes,lethal and non-lethal cases of COVID-19,and immunization.Findings:We evaluated the dynamics of new major depressive disorder(MDD)and anxiety disorder(AD)cases during the period between September 2020 and December 2021 in Moscow,Russia.We found that lockdown imposition increases the daily chances of getting MDD or ADD by a vulnerable person by 16.79%(95%CI[12.36%,21.23%]).The QALY loss associated with COVID-19-induced and lockdown-induced mental disorders was estimated to be 18.93%(95%CI[16.94%,19.73%])of the total QALY loss caused by COVID-19,immunization,and all kinds of mental disorders.For a synthetic“strong”lockdown,it had been shown that QALY loss is minimized when about 70%of the population are isolated.Interpretation:The burden associated with mental disorders amounts to a considerable part of COVID-19-related losses.Our findings demonstrate that cost-benefit analysis of mobility restriction should include a forecast of mental disorder development in the population.展开更多
Aim:Targeted muscle reinnervation(TMR)surgery has fundamentally changed the management of patients who have suffered or are about to undergo amputation.Providing nerve stumps with a muscle target has been shown to hav...Aim:Targeted muscle reinnervation(TMR)surgery has fundamentally changed the management of patients who have suffered or are about to undergo amputation.Providing nerve stumps with a muscle target has been shown to have profound effects on levels of post-amputation pain in relation to phantom limb pain(PLP)and neuroma pain(NP).The primary objective of this report was to quantify pain parameters for this population and to measure the impact on health-related quality of life(HRQol)before and after TMR surgery.In this case series,we evaluate the role of TMR in addressing both pain and the impact of the surgery on the patient’s quality of life.Methods:A retrospective analysis of 15 upper limb amputee patients who underwent TMR by the Relimb Unit in London,UK.Participants’perceptions of pain were determined using the 11-point numerical(Pain)rating scale(NRS)and HRQoL was calculated using the Euroqol EQ-5D-5L questionnaire at two time points,comparing both pain and perceived quality of life pre and post surgery.The Wilcoxon Signed Rank Test was used for the NRS data and a paired sample t-test was used for the EQ-VAS data.Results:A total of 15 patients completed the evaluation.We observed statistically significant reductions in both PLP(pre-operative mean:7.6,post-operative mean:2.7,P<0.05)and NP(pre-operative mean:6.4,post-operative mean:2.5,P<0.05)in these patients.Similarly,HRQoL observed on the EQ-VAS scale demonstrated a significant improvement in quality of life,from 68 pre-operatively to 78 post-procedure(P<0.05).Conclusion:This is the first quantified evaluation of changes in HRQoL after TMR surgery for upper limb amputation.There appears to be a significant improvement in both HRQoL and overall perception of pain.This finding may have important implications for funding and national resource allocation for TMR surgery.展开更多
文摘人们对于生命质量的探究开始于二十世纪初的美国。当时战后的美国经济飞速发展,但人们生活质量的体验抑或预期并没有随着经济的发展而提高。这让人们意识到不能简单的使用经济数据来评价人的生存状况,应该创造出一种新的评价方法来考察人的生命质量。在医学领域,健康相关生命质量(Health Related Quality of Life;HRQOL)这一概念就逐渐被人们所应用。它能够将疾病与相关的治疗手段联系起来,以此评价对生命质量的影响。
文摘Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.
文摘质量调整生命年(Quality-Adjusted Life Year,QALY)被广泛应用于卫生经济学和药物经济学研究的各个方面,是衡量健康产出的重要指标。近年来,其内涵也随着QALY相关研究的深入而不断迭代发展。目前,还未有中文研究对近年来QALY内涵变化的最新进展进行系统性梳理。基于过往文献和研究实践,梳理QALY内涵的变化,并将其归纳为QALY定义扩展和赋权QALY的进展和影响。QALY定义扩展主要包括主流量表对健康相关QALY定义的再丰富和对幸福感的补充,对幸福感QALY来源进行回溯,分析QALY定义扩展与传统QALY对比的优势;在赋权QALY上,总结赋权QALY的定义、测量方法和优势。同时,讨论了QALY内涵变化对于效用积分体系构建的影响。建议未来应重视QALY内涵的变化和发展,积极探索具有中国特色的QALY内涵,运用实证研究分析QALY内涵变化带给卫生决策一致性和合理性的影响。
基金supported by the Ministry of Education and Science of Russia:Grant No.075-11-2020-011(13.1902.21.0040).
文摘Background:During the COVID-19 pandemic,many countries used lockdowns as a containment measure.While lockdowns successfully contributed to slowing down the contagion,the related mobility restrictions were reportedly associated with an increased risk of major depressive and anxiety disorders.We aimed to quantify the trade-off between the quality-adjusted life years(QALY)gain due to lower COVID-19 incidence as a result of a lockdown and QALY loss due to lockdown-induced mental disorders.Methods:We developed an agent-based model of COVID-19 epidemic and coupled mental disorder development in the population of a large city.We used data sources on the places of living,studying and working,public health and census surveys.Modeling of mental disorders was based on diathesis-stress concept.We quantified mental and physical health burden in terms of QALY taking into account major depressive and anxiety disorder episodes,lethal and non-lethal cases of COVID-19,and immunization.Findings:We evaluated the dynamics of new major depressive disorder(MDD)and anxiety disorder(AD)cases during the period between September 2020 and December 2021 in Moscow,Russia.We found that lockdown imposition increases the daily chances of getting MDD or ADD by a vulnerable person by 16.79%(95%CI[12.36%,21.23%]).The QALY loss associated with COVID-19-induced and lockdown-induced mental disorders was estimated to be 18.93%(95%CI[16.94%,19.73%])of the total QALY loss caused by COVID-19,immunization,and all kinds of mental disorders.For a synthetic“strong”lockdown,it had been shown that QALY loss is minimized when about 70%of the population are isolated.Interpretation:The burden associated with mental disorders amounts to a considerable part of COVID-19-related losses.Our findings demonstrate that cost-benefit analysis of mobility restriction should include a forecast of mental disorder development in the population.
文摘Aim:Targeted muscle reinnervation(TMR)surgery has fundamentally changed the management of patients who have suffered or are about to undergo amputation.Providing nerve stumps with a muscle target has been shown to have profound effects on levels of post-amputation pain in relation to phantom limb pain(PLP)and neuroma pain(NP).The primary objective of this report was to quantify pain parameters for this population and to measure the impact on health-related quality of life(HRQol)before and after TMR surgery.In this case series,we evaluate the role of TMR in addressing both pain and the impact of the surgery on the patient’s quality of life.Methods:A retrospective analysis of 15 upper limb amputee patients who underwent TMR by the Relimb Unit in London,UK.Participants’perceptions of pain were determined using the 11-point numerical(Pain)rating scale(NRS)and HRQoL was calculated using the Euroqol EQ-5D-5L questionnaire at two time points,comparing both pain and perceived quality of life pre and post surgery.The Wilcoxon Signed Rank Test was used for the NRS data and a paired sample t-test was used for the EQ-VAS data.Results:A total of 15 patients completed the evaluation.We observed statistically significant reductions in both PLP(pre-operative mean:7.6,post-operative mean:2.7,P<0.05)and NP(pre-operative mean:6.4,post-operative mean:2.5,P<0.05)in these patients.Similarly,HRQoL observed on the EQ-VAS scale demonstrated a significant improvement in quality of life,from 68 pre-operatively to 78 post-procedure(P<0.05).Conclusion:This is the first quantified evaluation of changes in HRQoL after TMR surgery for upper limb amputation.There appears to be a significant improvement in both HRQoL and overall perception of pain.This finding may have important implications for funding and national resource allocation for TMR surgery.
