Health economic evaluation on population-based Helicobacter pylori eradication and endoscopic screening for gastric cancer prevention

Gastric cancer is a global public health burden, nearly one million new cases are diagnosed per year worldwide, of which 44% of cases occur in China. The prognosis of gastric cancer varies remarkably by the stage of cancer, and most of the patients in China are diagnosed at advanced stages, resulting in poor prognoses. Effective strategies to reduce the burden of gastric cancer include primary prevention through testing and treatment of Helicobacter pylori(H. pylori) and secondary prevention by screening and early detection. Although many countries have issued management guidelines and consensus reports concerning these strategies, the limited availability of healthcare resources often precludes their widespread implementation. Therefore, assessing the costs, benefits, and harms of population-based intervention measures through health economic evaluation is necessary for informed health policy decisions. Accordingly, we synthesize management approaches from different countries on H. pylori eradication and endoscopic screening, and also summarize recent advancements in health economic evaluations on population-based preventive strategies. The goal of the review is to provide empirical evidence supporting optimal resource allocation, maximizing benefits for the population, and ultimately reducing the burden of gastric cancer.

The Body Suffering and Care Possibilities: A Reflective Look from the Health Economics

This article aimed to show ideas about the themes: body suffering, nursing and Medical care, and Health Economics. To this end, we tried to put together a kaleidoscope of references that converged on the promotion of autonomy and empowerment and, as a strategy for action, and then we can think of what to do to alleviate the suffering of patients.

A Schematic Simulation for Health Economic Feasibility Studies: Results from a Model for Cardiac Remote Monitoring

The market for active implants and biosensors is of high economic and medical interest. As health economic considerations get into focus in terms of business planning and reimbursement, valid and flexible economic feasibility studies get more important. Unfortunately, literature mostly provides only single economic views on specific aspects like cost savings from reduced rehabilitation in a special patient cohort. To make planning and technology value negotiation more effective and more valid, a methodology to collect relevant data from different studies and normalize it to a common set of parameters was developed for the field of cardiac monitoring in a mixed example population with an approach of simple external weight, ECG and blood-pressure measurement or implanted devices for cardiac monitoring. The target entities taken into account by the simulation model were the impacts on heart attack, stroke, heart failure and the process of implant monitoring. Simulation took place at an example population of 500 patients with specific morbidity criteria. The health economic value was calculated over a period of three years and was split into a technology effectiveness measurement in Quality-adjusted-Lifetime-Years (QALYs) and a “cost- saving-part”. QALYs were chosen as technology effectiveness parameter for a combined and weighted mortality- and morbidity-reduction. Allocating 24.000 Euro to a saved QALY, 42% of the cost would be allocated to QALYs meaning money being spent for gained lifetime-years. The remaining 58% would be the different real cost savings: a per patient gross saving of 3.308 € per year would result for that part (21% on heart attack, 3% on stroke, 68% on heart failure and 8% on implant monitoring). Up-to-date studies do not provide a simple mechanism to allow custom-tailored health economic feasibility study results in terms of other specific population mixes or outcome parameters. Target audiences for the methodology of the described simulation are payors and solution providers targeting a specific patient population or specific telemedical situations. This way product development can address market-related needs more specific and healthcare providers can compare different outcome parameters in the given entities.

A diagnosis-based health economic analysis of postural orthostatic tachycardia syndrome in Chinese children

Background Postural orthostatic tachycardia syndrome （POTS） is a common clinical problem in children and adolescents. The previous diagnostic approach to POTS of children and adolescents is based on a series of tests to exclude all other causes, which is time and medical resource consuming. Recently, a new diagnostic approach has been developed. The present study was designed to statistically analyze the results of clinical investigation items and the cost for the diagnosis of POTS in children patients, and evaluate cost changes in the diagnosis of POTS. Methods A total of 315 children patients were divided into two groups according to diagnosis period, including group I diagnosed in 2002-2006 （100 cases） and group II in 2007-2010 （215 cases） and the diagnostic item-based distribution of the cost was analyzed. The diagnostic costs were compared between two groups using SPSS17.0. Results The per-capita cost of diagnosis in group I was （621.95±2.1.10） Yuan, costs of diagnostic tests （head-up tilt test standing test, etc） accounted for 8.68% and the exclusive tests for 91.32%. The per-capita cost of diagnosis in group II was （542.69±2.3.14） Yuan, diagnostic tests accounted for 10.50% and exclusive tests for 89.50%. Comparison of the total cost of diagnostic tests between the two groups showed significant differences （P〈0.05）. Conclusion The cost of POTS diagnosis has been declined in recent years, but the cost of exclusive diagnosis is still its major part.

Report on Cardiovascular Health and Diseases in China 2023:An Updated Summary

Since 1990,China has made considerable progress in resolving the problem of“treatment difficulty”of cardiovascular diseases(CVD).The prevalent unhealthy lifestyle among Chinese residents has exposed a massive proportion of the population to CVD risk factors,and this situation is further worsened due to the accelerated aging population in China.CVD remains one of the greatest threats to the health of Chinese residents.In terms of the proportions of disease mortality among urban and rural residents in China,CVD has persistently ranked first.In 2021,CVD accounted for 48.98%and 47.35%of deaths in rural and urban areas,respectively.Two out of every five deaths can be attributed to CVD.To implement a national policy“focusing on the primary health institute and emphasizing prevention”and truly achieve a shift of CVD prevention and treatment from hospitals to communities,the National Center for Cardiovascular Diseases has organized experts from relevant fields across China to compile the“Report on Cardiovascular Health and Diseases in China”annually since 2005.The 2024 report is established based on representative,published,and high-quality big-data research results from cross-sectional and cohort population epidemiological surveys,randomized controlled clinical trials,large sample registry studies,and typical community prevention and treatment cases,along with data from some projects undertaken by the National Center for Cardiovascular Diseases.These firsthand data not only enrich the content of the current report but also provide a more timely and comprehensive reflection of the status of CVD prevention and treatment in China.

Environment, Health and Economic Growth： Study on Optimal Energy Tax Revenue Distribution

Under the dual pressures of economic growth and environmental protection,how to curb pollution and raise public welfare without harming the economy or with minimal economic output losses has become a major question facing China in its efforts to transform growth pattern and accomplish economic transition. On the basis of an overlapping generation(OLG) model, this paper introduces the health effects of environmental pollution to systematically discuss the optimal distribution ratio of energy tax revenues in subsidizing household income and emission abatement under given tax rates to reduce the risks of "environment-health-poverty" trap. Our research shows that an optimal distribution ratio for maximizing per capita output or an optimal distribution ratio for maximizing public welfare exists. Based on China's actual parameters, however, this study has found that China's energy tax revenue distribution policy hardly meets the two optimal targets at the same time. Specific distribution ratio is subject to government decision-making preference, and needs to be adjusted according to actual differences.

Method“Monte Carlo”in healthcare

In public health,simulation modeling stands as an invaluable asset,enabling the evaluation of new systems without their physical implementation,experimentation with existing systems without operational adjustments,and testing system limits without real-world repercussions.In simulation modeling,the Monte Carlo method emerges as a powerful yet underutilized tool.Although the Monte Carlo method has not yet gained widespread prominence in healthcare,its technological capabilities hold promise for substantial cost reduction and risk mitigation.In this review article,we aimed to explore the transformative potential of the Monte Carlo method in healthcare contexts.We underscore the significance of experiential insights derived from simulated experimentation,especially in resource-constrained scenarios where time,financial constraints,and limited resources necessitate innovative and efficient approaches.As public health faces increasing challenges,incorporating the Monte Carlo method presents an opportunity for enhanced system construction,analysis,and evaluation.

New Challenges for Occupational Health Services Facing Economic Reform in China

In China, which is facing economic reform and the rapid development of small-scale industries, various occupational hazards are reappearing. The problems are related to the ignorance of the managers and the workers, a lack of capital, the insufficiency of occupational health services, and the transfer of some hazardous work from large factories in the cities to small plants in the towns and villages. The change in life-style, especially in smoking habits, has aggravated occupational hazards. The problems may be solved by renewing the concept of health among the managers and workers, enforcing legislation related to occupational hazards, strengthening health personnel training, and reinforcing health education and self-help. 1989 Academic Press, Inc.

The health care economic-industrial complex: Concepts and general characteristics

The strategic role of health care within the Brazilian development agenda has been increasingly recognized and institutionalized. Aside from its importance as a structural element of the Welfare State, health care plays a leading role in generating innovation. Despite this, the productive base of Brazil’s health care system is extremely fragile, jeopardizing both the universal provision of health care services and the country’s competitive insertion in the globalized environment. This suggests the need for a more systematic analysis of the complex relationships that exist between the technological and the social interests involved in the productive base of health care provision in Brazil. Therefore, the purpose of this article is to enhance our understanding of the productive base of health care, especially given its potential to contribute to a socially inclusive development model, which is the ultimate goal in Brazil.

The Impact of Behavioural Insights on Effective Prescription of Antibiotics by Doctors: A Case Study from Latifa Hospital for Women and Children, Dubai Health Authority

Introduction: Wise prescription of antibiotics is an ethical duty of physicians in view of rising antimicrobial resistance in the community, it should be balanced between the health requirements of the patients and resulting long-term antibiotics resistance. Overuse of antimicrobials is a major cause of emerging resistance to antimicrobials. There are multiple factors in the community that influence the physician’s antibiotic prescriptions. Methods: This is a systematic case-control study on antibiotics prescription for paediatric patients attending Latifa Hospital for Women and Children (LWCH), Dubai Health Authority, to know the effects of behavioral interventions on rates of inappropriate antimicrobials prescription by doctors in the Paediatric Emergency Department. Results: The results of our study showed the effectiveness of behavioral insights by peer comparison in antibiotic use among paediatricians in Latifa Hospital had a statistical significance (P = 0.0038). The rate of the prescription decreased from 41% to 21%, a difference of 20%. Conclusion: The study concluded behavioural intervention is an effective measure in reducing the improper prescription of antibiotics in the hospital setting.

Dilemma of healthcare reform and invention of new discipline of health fiscalogy

Background:China's Reform and Open up Policy in 1980s has brought rapid economic development to Chinese society.With the deepening of economic reform,the withdrawal of the state in China has had visible and worrisome consequences for health and for the functioning of health services.The new round of healthcare reform after 2009 has made significant achievements on improving fundamental health and bringing back the nature of welfare of health.However,the financing mechanism of health system has not been established,and the underlying reason behind the healthcare reform dilemma and the theoretical solution need to be found.Methods:This study used the methods of literature review,theoretical research and comparative research to summarize and analyze the reasons and solutions of current dilemma in healthcare reform,and created the new discipline of health fiscalogy through theoretical analysis and vertical and horizontal comparison of healthcare system,especially health financing.Results:Dilemma in healthcare system emerged from the circumstances of rapid process of industrialization,urbanization and population aging,including the profit-driven phenomena,tendency of excessive marketization in public hospitals,strained doctor-patient relationship,high disease burden on individuals and families,and so on.It can be concluded that the theoretical basis of healthcare system and the nature of health resources are crucial in solving the dilemma of healthcare reform.The theoretical basis of healthcare reform should be health fiscalogy focusing on government as the main body of health care responsibility rather than health economics focusing on anti-monopoly.There are two key differences between health economics and health fiscalogy:responsible person/department of disease and health welfare,and nature of resource.The new discipline of health fiscalogy has universal and important implications on both China’s healthcare reform and the healthcare reform in the world.Conclusions:China’s healthcare reform should return from the paradigm of health economics and marketization financing model to the paradigm of health fiscalogy and government-led financing model,which is reflected in the main position of government and social welfare.

Estimated cost for cardiovascular disease risk-based management at a primary healthcare center in Nepal

Background:Low-and middle-income countries are facing an increasing burden of disability and death due to cardiovascular diseases.Policy makers and healthcare providers alike need resource estimation tools to improve healthcare delivery and to strengthen healthcare systems to address this burden.We estimated the direct medical costs of primary prevention,screening,and management for cardiovascular diseases in a primary healthcare center in Nepal based on the Global Hearts evidence based treatment protocols for risk-based management.Methods:We adapted the World Health Organization’s non-communicable disease costing tool and built a model to predict the annual cost of primary CVD prevention,screening,and management at a primary healthcare center level.We used a one-year time horizon and estimated the cost from the Nepal government’s perspective.We used Nepal health insurance board’s price for medicines and laboratory tests,and used Nepal government’s salary for human resource cost.With the model,we estimated annual incremental cost per case,cost for the entire population,and cost per capita.We also estimated the amount of medicines for one-year,annual number of laboratory tests,and the monthly incremental work load of physicians and nurses who deliver these services.Results:For a primary healthcare center with a catchment population of 10,000,the estimated cost to screen and treat 50%of eligible patients is USD21.53 per case and averages USD1.86 per capita across the catchment population.The cost of screening and risk profiling only was estimated to be USD2.49 per case.At same coverage level,we estimated that an average physician’s workload will increase annually by 190 h and by 111 h for nurses,i.e.,additional 28.5 workdays for physicians and 16.7 workdays for nurses.The total annual cost could amount up to USD18,621 for such a primary healthcare center.Conclusion:This is a novel study for a PHC-based,primary CVD risk-based management program in Nepal,which can provide insights for programmatic and policy planners at the Nepalese municipal,provincial and central levels in implementing the WHO Global Hearts Initiative.The costing model can serve as a tool for financial resource planning for primary prevention,screening,and management for cardiovascular diseases in other low-and middleincome country settings globally.

Country size bias in global health:crosscountry comparison of malaria policy and foreign aid

Background:Foreign aid has been shown to be favourably biased towards small countries.This study investigated whether country size bias also occurs in national malaria policy and development assistance from international agencies.Methods:Data from publicly available sources were collected with countries as observational units.The exploratory data analysis was based on the conceptual framework with socio-economic,environmental and institutional parameters.The strength of relationships was estimated by the Pearson and polychoric correlation coefficients.The correlation matrix was explored by factor analysis.Results:Malaria burden is strongly correlated with GDP per capita,total health expenditure per capita,HDI;moderately with latitude,weakly with elevation,urban population share,per capita funding from the Global Fund,PMI USAID,UK government and UNICEF.Small country status is strongly correlated with population size,land area,island status;moderately with development assistance received per capita,weakly with funding per capita from Global Fund,government NMP and PMI USAID.Policy score 1,a variable derived from our factor analysis and related to malaria endemicity,is significantly strongly correlated with the malaria burden,moderately with HDI,GDP per capita,total health expenditure per capita,PMI USAID funding;weakly with island status,urban population share,latitude,coastal population share,total government expenditure and trade openness,Global Fund funding,World Bank funding,UK government funding,and UNICEF funding per capita.Policy score 2,which captures variation not related to malaria endemicity,is significantly weakly related to the ICRG index,PMI USAID funding per capita and small country status.Conclusions:The results suggest that malaria burden and economic development are bidirectionally related.Economic development can contribute to a reduction in the malaria burden.Country size does not negatively impact malaria burden,but it does account for greater development assistance per capita from selected international agencies.National malaria policy is associated with parameters related to public governance and is modified in small countries.Small country bias is present in the distribution of socio-economic resources and the allocation of foreign aid.Small countries are characterized by distinct environmental and socio-political properties.

国家组织药品集中采购的卫生经济学理论基础及完善建议

探讨国家组织药品集中采购的卫生经济学理论基础和实践。总结国家组织药品集中采购的8条经验及存在的一些问题。评价国家组织药品集中采购的效果。建议从确保质量、供应、使用和回款4个方面,对药品带量采购进行全方位的监测。

Synthesized economic evidence on the cost-effectiveness of screening familial hypercholesterolemia

Background Familial hypercholesterolemia(FH)is a prevalent genetic disorder with global implications for severe cardiovascular diseases.Motivated by the growing recognition of the need for early diagnosis and treatment of FH to mitigate its severe consequences,alongside the gaps in understanding the economic implications and equity impacts of FH screening,this study aims to synthesize the economic evidence on the cost-effectiveness of FH screen-ing and to analyze the impact of FH screening on health inequality.Methods We conducted a systematic review on the economic evaluations of FH screening and extracted informa-tion from the included studies using a pre-determined form for evidence synthesis.We synthesized the cost-effective-ness components involving the calculation of synthesized incremental cost-effectiveness ratios(ICERs)and net health benefit(NHB)of different FH screening strategies.Additionally,we applied an aggregate distributional cost-effective-ness analysis(DCEA)to assess the impact of FH screening on health inequality.Results Among the 19 studies included,over half utilized Markov models,and 84%concluded that FH screening was potentially cost-effective.Based on the synthesized evidence,cascade screening was likely to be cost-effective,with an ICER of$49,630 per quality-adjusted life year(QALY).The ICER for universal screening was$20,860 per QALY as per evidence synthesis.The aggregate DCEA for six eligible studies presented that the incremental equally distrib-uted equivalent health(EDEH)exceeded the NHB.The difference between EDEH and NHB across the six studies were 325,137,556,36,50,and 31 QALYs,respectively,with an average positive difference of 189 QALYs.Conclusions Our research offered valuable insights into the economic evaluations of FH screening strategies,highlighting significant heterogeneity in methods and outcomes across different contexts.Most studies indicated that FH screening is cost-effective and contributes to improving overall population health while potentially reducing health inequality.These findings offer implications that policies should promote the implementation of FH screening programs,particularly among younger population.Optimizing screening strategies based on economic evidence can help identify the most effective measures for improving health outcomes and maximizing cost-effectiveness.

Economic Evaluation of Gastroscopy for Detecting Gastric Cancer in Chinese Natural Population

Objective To evaluate the economy of detecting gastric cancer by electronic gastroscope in Chinese natural population of different ages and genders.Methods A Markov model was constructed for the population,including both men and women of different ages.The model cycle was one year and the simulation time was 60 years.The cost-effectiveness of electronic gastroscopy in detecting gastric cancer of general population in China was analyzed from the perspective of the whole society,and the stability of the results was verified by sensitivity analysis.Results and Conclusion For the general population,the incremental cost-effectiveness ratio(ICER)of gastric cancer screening from the age of 50 is 50143 yuan/QALY(quality-adjusted life-year),which is less than two times of per capita gross domestic product(GDP)compared with the screening from the age of 55.For men who start gastric cancer screening at the age of 50,the ICER is 38525 yuan/QALY,which is less than two times of per capita GDP,and it is economical.For women who start the screening from the age of 55,the ICER is 47814 yuan/QALY,which is less than two times of per capita GDP,so it is economical.The results of sensitivity analysis are consistent with the conclusions of basic analysis,and the results of basic analysis are stable.For the general population,it is more economical to start gastric cancer screening from the age of 50,while for men and women,it is more economical to start gastric cancer screening from the age of 50 and 55,respectively.

Systematic review of long-term Xingnao Kaiqiao needling efficacy in ischemic stroke treatment

OBJeCTIve：To systematically evaluate the long-term effect and safety ofXingnao Kaiqiao nee-dling method in ischemic stroke treatment. DATA ReTRIevAL： We retrieved relevant random and semi-random controlled trials that used theXingnao Kaiqiao needling method to treat ischemic stroke compared with various control treatments such as conventional drugs or other acupuncture therapies. Searched databases included China National Knowledge Infrastructure, Weipu Information Resources System, Wanfang Medical Data System, Chinese Biomedical Literature Database, Cochrane Library, and PubMed, from May 2006 to July 2014. SeLeCTION CRITeRIA： Two authors independently conducted literature screening, quality evaluation, and data extraction. The quality of articles was evaluated according to the Cochrane Reviewers’ Handbook 5.1, and the study was carried out using Cochrane system assessment methods. RevMan 5.2 was used for meta-analysis of the included studies. MAIN OUTCOMe MeASUReS： Mortality rate, recurrence rate, and disability rate were observed. ReSULTS：Nine randomized and semi-randomized controlled trials treating 931 cases of ischemic stroke were included in this review. Meta-analysis results showed that there were no sig-niifcant differences in mortality reduction （risk ratio （RR） = 0.58, 95% conifdence interval （CI）： 0.17–1.93,Z = 0.89,P = 0.37） or recurrence rate （RR = 0.55, 95%CI： 0.18–1.70,Z = 1.04,P = 0.30） of ischemic stroke patients between theXingnao Kaiqiao needling and control treatment groups. However, theXingnao Kaiqiao needling method had a tendency towards higher efifcacy in mor-tality reduction and recurrence rates. TheXingnao Kaiqiao needling method was signiifcantly better than that of the control treatment in reducing disability rate （RR = 0.51, 95%CI： 0.27–0.98, Z = 2.03,P 〈 0.05）. CONCLUSION：TheXingnao Kaiqiao needling method has a better effect than control treatment in reducing disability rate. The long-term effect ofXingnao Kaiqiao needling against ischemic stroke is better than that of control treatment. However, the limitations of this study limit the strength of the conclusions. Randomized controlled trials with a strict, reasonable design, and multi-center, large-scale samples and follow-up are necessary to draw conclusions aboutXingnao Kaiqiao needling.

Cost-effectiveness analysis of early veno-venous hemofiltration for severe acute pancreatitis in China

AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.

Cost-effectiveness of Crohn's disease post-operative care

AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.