The Cost-effectiveness Analysis of Percutaneous Transhepatic Metal Versus Plastic Biliary Stent Implantation for Treating Malignant Biliary Obstruction (Multiple Center Investigation)

Objective: To compare metal versus plastic biliary stent implantation for treatment of malignant biliary obstruction in cost-effectiveness ratio (CER). Methods: Percutaneous transhepatic self-expandable metal stent (MS, n=61) or 10F plastic stent (PS, n=34) implantation was performed in 95 patients with malignant biliary obstruction in three hospitals of Guangdong province. All patients were followed up until death or at least one year after the procedure. Kaplan-Meier analysis was used to compare the survival and stent patency rates of the patients in the two groups. CERs of two groups were calculated. The main indexes were CERsurvival period (total cost/median survival period), CERpatency period (total cost/median patency period). Results: The total costs of treatment were 53177±3139 yuan (RMB) in MS group and 42564±4950 yuan (RMB) in PS group respectively (P>0.05). CER in MS group was superior to that in PS group (CERsurvival period was 237.4 yuan /d vs 452.6 yuan /d, respectively; CERpatency period was 231.2 yuan /d vs 472.9 yuan /d, respectively). Conclusion: The metal stent implantation is superior to the plastic stent in the CER for treatment of malignant biliary obstruction.

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 analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening

AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.

Cost-effectiveness analysis of tele-retinopathy of prematurity screening in Iran

AIM:To conduct a cost-utility analysis of the teleretinopathy of prematurity(ROP)screening program against no screening.METHODS:A decision tree model was developed to identify and treat the infants with threshold ROP through the tele-screening system compared with no screening program from the societal perspective.We used the quality adjusted life years(QALY)index to measure the scenarios’effectiveness,which was discounted for the future years by 0.058.One hundred twenty-six randomly selected newborns with ROP required treatment were investigated to extract the treatment information.We considered the direct medical and non-medical costs in cost calculations analysed by the bottom-up approach.The figures of the model’s inputs were calculated using the Monte Carlo simulation that generated 1000 random iteration of the data,and a one-way sensitivity analysis was performed on the model to cope with the potential uncertainties.RESULTS:The total and per capita needed the budget to establish a tele-ROP screening system were estimated at over 1.5 million and 35.13 USD,respectively.The total cost of identifying and treating an ROP case in tele-screening and no screening strategies were obtained as 108.72 and 63.52 USD,respectively,and their lifetime discounted QALY gained were calculated as 15.39 and 15.11,respectively.Therefore,incremental cost-effectiveness ratio(ICER)of tele-screening strategy against the competitive strategy was achieved as 161.43 USD.CONCLUSION:Tele-ROP screening program is one of the most cost-effective interventions in the Iranian health system and has a high priority to receive a budget for implementation.

AN ANALYSIS OF THE COST-EFFECTIVENESS OF AIR DEFENSE SURVEILLANCE RADARS

This paper is a study of the quantitative evaluation on the cost-effectiveness of air defense surveillance radars. The composition of life cycle cost of the radar is analysed at first. Then the radar performance and effectiveness formulas are derived. By calculating the values of many radars' cost, performance and effectiveness, tendency curves are plotted. The application of cost-effectiveness calculation and the tendency curves in radar system analysis is discussed at last.

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.

Cost-effectiveness Analysis of Insulin Degludec and Liraglutide Injection in the Treatment of Type 2 Diabetes

Objective To analyze the cost-effectiveness of insulin degludec and liraglutide injection(IDegLira)compared with insulin glargine plus insulin aspart(IGar plus IAsp)in the treatment of type 2 diabetes mellitus(T2DM)based on the price of IDegLira before and after it was successfully admitted to the National Reimbursable Drug List(NRDL).Methods Cost and effectiveness parameters were obtained through systematic retrieval from PubMed,ScienceDirect,CNKI,and Wanfang database.A cost-effectiveness analysis(CEA)model was established to analyze the economics using IDegLira for T2DM patients with 1 to 5 years of medication.Results and Conclusion Before IDegLira was admitted to NRDL,its economic advantages over the IGlar plus Iasp regimen became more significant as patients’medication time prolonged.After being admitted to NRDL,with 1 year of medication,the medical cost of IDegLira decreased by 2853.91 yuan and the quality adjusted life years(QALY)increased by 0.12055 than IGar plus IAsp.The sensitivity analysis was highly consistent with the results of the baseline result.After being admitted to NRDL,for patients with T2DM who have poor blood glucose control,IDegLira is absolutely an economic advantage scheme compared with IGar plus IAsp.

Economic Analysis Study of Agricultural and Solar Complementary System

Agro-photovoltaic complementary system(APCS)is an innovative land use model combining agricultural production with photovoltaic power generation,aiming to realize dual land use and improve land use efficiency and economic benefits by installing photovoltaic panels on farmland.With the growth of global energy demand and the intensification of climate change,agro-photovoltaic(APV)systems have received widespread attention as a sustainable energy solution.Studies have shown that agro-photovoltaic systems exhibit significant economic benefits in different regions and crop types.Through reasonable system design and optimization,the agricultural and photovoltaic complementary system is not only technically feasible,but also has significant economic advantages,which provides a strong support for achieving the goal of sustainable development.

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.

Cost effectiveness analysis of population-based serology screening and ^(13)C-Urea breath test for Helicobacter pylori to prevent gastric cancer:A markov model

AIM:To compare the costs and effectiveness of no screening and no eradication therapy, the population- based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) with eradication therapy. METHODS:A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses. RESULTS:Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The cost- effectiveness of serology screening over the UBT was robust to most parameters in the model. CONCLUSION:The population-based serologyscreening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.

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.

Cost-effectiveness of enhanced liver fibrosis test to assess liver fibrosis in chronic hepatitis C virus and alcoholic liver disease patients

AIM To assess liver fibrosis(LF) in hepatitis C virus(HCV) and alcoholic liver disease(ALD), estimate health outcomes and costs of new noninvasive testing strategies METHODS A Markov model was developed to simulate LF progression in HCV and ALD for a cohort of 40-yearold men with abnormal levels of transaminases. Three different testing alternatives were studied: a single liver biopsy; annual Enhanced liver fibrosis(ELF?) followed by liver stiffness measurement(LSM) imaging as a confirmation test if the ELF test is positive; and annual ELF test without LSM. The analysis was performed from the perspective of a university hospital in Spain.Clinical data were obtained from published literature. Costs were sourced from administrative databases of the hospital. Deterministic and probabilistic sensitivity analyses were performed.RESULTS In HCV patients, annual sequential ELF test/LSM and annual ELF test alone prevented respectively 12.9 and 13.3 liver fibrosis-related deaths per 100 persons tested, compared to biopsy. The incremental costeffectiveness ratios(ICERs) were respectively €13400 and €11500 per quality-adjusted life year(QALY). In ALD, fibrosis-related deaths decreased by 11.7 and 22.1 per 100 persons tested respectively with sequential ELF test/LSM and annual ELF test alone. ICERs were €280 and €190 per QALY, respectively.CONCLUSION The use of the ELF test with or without a confirmation LSM are cost-effective options compared to a single liver biopsy for testing liver fibrosis in HCV and ALD patients in Spain.

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.

Considering the cost-effectiveness of statins in family practice in Turkey from a payer perspective

The percentage of mortality caused by cardio-vascular events in European Countries and European Union Countries is respectively 49% and 42% of all mortality causes. Our estimates about cardiovascular mortality in Turkey depend on TEKHARF (Hearth Disease and Risk Factors in Turkish Adults) which depended on a 12 year observation. It has been reported that cardio-vascular mortality rates for Turkey in men and women were 0.082% and 0.043% respectively. In Turkey, Atorvastatin, Fluvastatin, Pravastatin, Rosuvastatin and Simvastatin are the different alternatives found in the statin market. All stat-ins are reimbursed by insurance companies. The aim of this study is to determine the cost- effectiveness of statins. In conclusion, simvas-tatin and rosuvastatin comprised the optimal two statin alternatives.

Cost-effectiveness analysis of different anesthesia strategies for transperineal MRI/US fusion prostate biopsy

This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies,namely chatting while under local anesthesia(Chat-LA),total intravenous anesthesia(TIVA),and general anesthesia with laryngeal mask airway(GA-LMA),employed in transperineal magnetic resonance imaging(MRI)/ultrasound(US)fusion prostate biopsy(TP-MUF-PB).A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University(Suzhou,China).Clinical data and outcomes,including total costs,complications,and quality-adjusted life years(QALYs),were compared.Probability sensitivity and subgroup analyses were also performed.Chat-LA was found to be the most cost-effective option,outperforming both TIVA and GA-LMA.However,subgroup analyses revealed that in younger patients(under 65 years old)and those with smaller prostate volumes(<40 ml),TIVA emerged as a more cost-effective strategy.While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB,personalization of anesthesia strategies is crucial,considering specific patient demographics such as age and prostate volume.

血清CEA、CA19-9、β_(2)-MG表达与膀胱癌患者吡柔比星膀胱灌注化疗疗效和生存期相关分析

目的探讨膀胱癌患者血清癌胚抗原(CEA)、癌抗原199(CA19-9)、β_(2)微球蛋白(β_(2)-MG)水平与膀胱癌患者吡柔比星膀胱灌注化疗疗效和生存期的关系。方法选取2021年3月~2023年4月在南阳市第一人民医院接受吡柔比星膀胱灌注化疗的98例膀胱癌患者作为研究对象,根据化疗结果分为化疗有效组(52例)和化疗无效组(46例)。比较两组患者的临床资料和血清CEA、CA19-9、β_(2)-MG水平,并进行单因素和多因素分析、生存分析及Cox回归分析。结果化疗有效组血清CEA、CA19-9、β_(2)-MG水平均低于化疗无效组(P<0.001)。进一步经多因素Logistic回归分析显示血清CEA水平是影响化疗效果和生存期的独立危险因素,高表达者化疗效果差,预后不良。血清CA19-9、β_(2)-MG水平也与化疗效果相关,但不是独立影响因素。结论血清CEA水平是预测膀胱灌注化疗疗效和生存期的重要指标,建议对膀胱癌患者进行血清CEA、CA19-9、β_(2)-MG检测,以指导个体化治疗方案的制定。

联合检测CA125 CA199和CEA对卵巢癌诊断价值的Meta分析

目的:评价联合检测血清CA125、CA199、CEA在卵巢癌诊断中的价值。方法:计算机检索Pubmed、CBMdisc、CNKI、维普等数据库,收集关于卵巢癌诊断中联合检测CA125、CA199、CEA的文献。采用Meta-DiSc 14.0、Stata10.0进行Meta分析。结果:按照统一的纳入标准和排除标准获得12篇文献。结果显示在卵巢癌诊断中,联合检测CA 125、CA199、CEA的灵敏度(SE)、特异度(SP)、诊断比值比(DOR)、SROC曲线下面积(AUC)、Q指数分别为0.90(0.88～0.93)、0.83(0.80～0.86)、39.75(22.58～69.97)、0.953、0.895。单独检测CA125的SE、SP、DOR、AUC、Q指数分别为0.73(0.69～0.77)、0.88(0.86～0.91)、17.45(9.95～30.48)、0.804、0.739。两种检测方式的诊断效能比较差异有统计学意义(Z=4.859,P<0.05)。结论:卵巢癌的临床辅助诊断中,与单独检测CA125比较,联合检测CA125、CA199、CEA的判别能力较强、准确率较高,可提高诊断效能。

腮腺肿瘤患者唾液CEA及CA125的ROC分析

目的通过ROC分析方法,观察并对比唾液样本及血液样本的CA125及CEA水平变化对腮腺肿瘤的临床诊断效能。方法检测正常对照组(30例)和腮腺肿瘤患者(101例)的腮腺液、混合唾液及血液的CA125及CEA水平,通过ROC分析,观察两种标志物单独及联合应用时,诊断腮腺肿瘤的敏感度(SE)、特异度(SP)、AUC值及界值(cutoff)。结果 ROC分析结果显示,混合唾液CA125及CEA对腮腺肿瘤的诊断效能最高(AUC分别为80.4%,78.4%),二者独立应用的诊断效能与联合应用无显著差异。腮腺液及血液样本CA125及CEA的诊断效能处于较低水平(AUC<65%)。结论混合唾液样本CA125与CEA水平的变化可以较好地反映腮腺肿瘤的存在,其临床效能优于腮腺液及血液样本。

AFP、CEA在2种不同化学发光分析系统间的对比分析和偏倚评估

目的探讨AFP、CEA在我院两化学发光分析系统之间检测结果是否具有可比性,并进行偏倚评估。方法依据美国临床实验室标准化委员会(NCCLS)EP9-A文件方案,每天选取临床样本6～9份,分别在雅培I2000SR和强生VitrousECI两分析系统进行测定,共测定6d43个样本,以雅培I2000SR分析系统为比较方法,强生VitrousECI分析系统作为实验方法,对检测结果进行对比分析和偏倚评估。结果AFP、CEA在两分析系统间的检测结果线性回归方程良好,相关性较好(r2均大于0.999),但当AFP浓度在小于30ng/ml,CEA浓度在小于15ng/ml时,预期偏倚和相对偏倚均在允许偏倚之外,两分析系统间的结果不能被接受。其它预期偏倚均在允许偏倚内,结果可被接受。结论在做好室内质量控制和室间质量评价的基础上,必须对不同检验系统、分析方法进行比对与偏倚评估,并根据情况进行校准,才能保证真正意义上的检验结果的一致性。

2869例健康体检者AFP和CEA结果分析

目的：分析部分成人健康体检者各年龄段的AFP和CEA情况。方法：采用电化学发光法检测AFP和CEA。结果：AFP除30-39岁组与≥60岁组有明显差异（P〈0．05）外，其余各组之间均无明显差异（P〉0．05）。CEA在≥60岁组最高，与50岁前各年龄段结果均有明显差异（P〈0．05）；阳性率：AFP在40—49岁年组最高，除与20-29岁年龄段有明显差异（P〈0．05）外，与其他各年龄段均无明显差异（P〉0．05）；CEA在≥60岁组最高，与各年龄段均有明显差异（P〈0．05）。结论：AFP和CEA在健康人群中有一定阳性率，其作为肿瘤标志物的特异性不高，应与其它临床相关指标结合分析，才能做出可靠诊断。