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OBJECTIVE To evaluate the cost-effectiveness of Ferric carboxymaltose injection in the treatment of iron deficiency anemia in adult Chinese patients. METHODS From the perspective of China’s health system， the partitioned survival model was constructed to simulate the treatment process and outcome of patients with iron deficiency anemia using ferric carboxymaltose and iron sucrose based on the ferric carboxymaltose phase Ⅲ clinical trial in China （NCT03591406）. The study period was 1 year. Total costs and quality-adjusted life years （QALYs） were calculated for both treatment regimens， and incremental cost-effectiveness ratios were calculated. Scenario analysis was performed with different assumptions for efficacy parameters between 9th week and the end of 1 year， and from the perspective of China’s health system and the entire society. The sensitivity analysis was also performed. RESULTS In the basic analysis， compared with iron sucrose， incremental effectiveness of ferric carboxymaltose therapy was 0.007 QALYs， with an additional savings of 1 038 yuan per patient. Ferric carboxymaltose therapy was more effective and less costly， presenting an absolute advantage. The results of the scenario analysis and single-factor sensitivity analysis were consistent with the basic analysis. Probability sensitivity analysis showed that when the willingness-to-pay threshold was 1， 2， 3 times gross domestic product per capita in 2022， the probability of ferric carboxymaltose with a cost- effectiveness advantage was 88.2%，94.5% and 97.6%，respectively. CONCLUSIONS For Chinese adults with iron deficiency anemia， ferric carboxymaltose is a cost-effective treatment for iron deficiency anemia， compared with iron sucrose.
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Objective:To provide a reference for the hierarchical management of clinical nurses in top three hospitals, the hierarchical management evaluation system was conducted and evaluated in the present study.Methods:On the context of three-dimensional structure theory of medical quality, the Delphi method was applied to conduct two rounds of correspondence consultation among 23 nursing experts, and then related indexes were established based on the evaluation results and recommendations.Results:An evaluation system for hierarchical management of clinical nurse in top three hospitals was finally constructed, which included 3 first-grade and 19 second-grade indexes. The effective recovery rate of the two rounds of expert questionnaires and authority Cr of two rounds of expert consultation were 100% and 0.915, respectively. The Kendall coefficients of concordance for significance and operability of the first-grade and second-grade indexes were 0.353/0.515 and 0.344/0.469, respectively ( P<0.01). Conclusions:The hierarchical management of clinical nurses in top three hospitals constructed based on three-dimensional structure theory has reliability and feasibility.
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OBJECTIVE To ev aluate the economical efficiency of nivolumab versus everolimus in the second-line treatment of metastatic clear cell renal cell carcinoma. METHODS From the perspective of China ’s health system ，cost-effectiveness analysis of the two therapies was carried out by developing a three-state partitioned survival model. The clinical parameters were from the updated CheckMate 025 study，and the cost and health utility were from relevant websites and published literatures. The model adopted a 2-week cycle and a lifetime research time. The robustness of the results was verified by sensitivity analysis. The economical efficiency of two therapy schemes were evaluated in the scenario of model simulation time of 80 months and charitable drug donation scheme. RESULTS The results of basic analysis showed that compared with everolimus ，the incremental cost-effectiveness ratio （ICER）of nivolumab was 586 982.60 yuan/quality-adjusted life year （QALY），which was far higher than 3 times of China ’s per capita gross domestic product （GDP）in 2020. The results of single-factor sensitivity analysis showed that the 3 parameters that had the greatest impact on the economic evaluation results were the cost of nivolumab ，the utility value of nivolumab group and everolimus group in progressive disease state. The results of probability sensitivity analysis verified the robustness of the basic analysis results. Results of scenario analysis showed that in the first scenario analysis ，in which model simulation time lasted for 80 months，ICER of nivolumab was 417 204.52 yuan/QALY；in the second scenario analysis ，in which nivolumab charitable drug donation program for low-income people was considered ，ICER of nivolumab was 124 988.58 yuan/QALY. CONCLUSIONS Under the threshold of 1-3 times of China ’s per capita GDP in 2020，compared with everolimus ，it is not economical to use nivolumab as the second-line treatment for metastatic clear cell renal cell carcinoma ； nivolumab is economical when considering its charitable drug donation program for low-income people.
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OBJECTIVE To eva luate the economy of loratinib versus crizo tinib in the first-line treatment of anaplastic lymphoma kinase （ALK）-positive advanced non-small cell lung cancer （NSCLC）from the perspective of China ’s health system ， and to provide reference for the product pricing and related medical decisions of the drug in other regions of China except for Hong Kong. METHODS Markov model and partition survival model both constructed based on the CROWN data （the simulation time limit was 10 years and the cycle period was 4 weeks）；the quality adjusted life year （QALY）was used as the outcome index to calculate the incremental cost-effectiveness ratio （ICER）. One-way sensitivity analysis ，probability sensitivity analysis and scenario analysis were used to verify the robustness of the results. RESULTS The basic analysis results based on Markov model showed that compared with crizotinib group ，the per capita cost of loratinib group increased by 17 867 588.63 yuan，the per capita utility increased by 1.76 QALYs，and the ICER was 10 152 038.99 yuan/QALY. The basic analysis results based on the partition survival model showed that compared with the crizotinib group ，the Δ 基金项目：江苏省博士后科研资助计划项目（No.2021K496C）； per capita cost of loratinib group increased by 18 009 592.54 2020年度高校哲学社会科学研究一般项目（No.2020SJA0070） yuan，the per capita utility increased by 1.74 QALYs，and the ＊硕士研究生 。研究方向 ：药物经济学 、卫生经济与政策 。 E-mail：sunlei_cpu@163.com ICER was 10 350 340.54 yuan/QALY. The results of one-way # 通信作者：教授，博士生导师。研究方向：药物经济学、卫生经 sensitivity analysis of the two models both showed that 济与政策。E-mail：ma86128@sina.com progression-free survival （PFS）state utility v alue，progression- ·1102· China Pharmacy 2022Vol. 33 No. 9 中国药房 2022年第33卷第9期 disease（PD）state utility value and loratinib cost had great influence on the results. The results of probability sensitivity analysis showed that when 1-3 times of China ’s per capita GDP in 2020 was taken as the willingness to pay threshold ，the probability of loratinib being economical was 0. The recommended unit price of loratinib per 100 mg was 657.10-815.60 yuan. CONCLUSIONS For patients with ALK-positive advanced NSCLC ，loratinib is more effective than crizotinib in the first-line treatment ，but it is not economical under the current price ；reasonably lowering the price of loratinib can increase the probability of its economy.
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OBJECTIVE To evaluate the econo mical efficiency of ensatinib i n the first-line treatment of anaplastic lymphoma kinase（ALK）positive-advanced non-small cell lung cancer （NSCLC），so as to provide reference for China ’s medical insurance decision-making and rational drug use in clinic. METHODS A three-state partitioned survival model was constructed from the perspective of China ’s health system ，based on the data of the international multi-center phase Ⅲ clinical trial （eXalt3 trail），with simulation time limit of 10 years，cycle period of 30 days. The economical efficiency of ensatinib was compared with that of crizotinib（standard treatment ）in the first-line treatment of ALK positive-advanced NSCLC. The incremental cost-effectiveness ratio （ICER） was calculated with quality-adjusted life years （QALYs） as utility index. The stability of basic analysis results was validated through uncertainty analysis. RESULTS The basic analysis results showed that compared with crizotinib group ， incremental cost per capita of ensatinib group was －343 370.36 yuan，incremental utility per capita was 0.76 QALYs，ICER was －454 292.25 yuan/QALY，which was far lower than the willingness-to-pay （WTP）threshold of 1 time of China ’s per capita gross domestic product （GDP，80 976 yuan）in 2021. The results of univariate sensitivity analysis showed that progression-free survival （PFS）status utility ，progression of disease （PD）status utility and subsequent treatment cost of crizotinib had a greater impact on ICER，but these parameters could not cause the reversal of basic analysis results. Probabilistic sensitivity analysis showed that with 1 time of China ’s per capita GDP in 2021 as the WTP threshold ，the probability of ensatinib group ’s treatment possessed economical efficiency was 100％. In the situational analysis ，ICER obtained by changing the ensatinib group ’s follow-up treatment regimen was －217 671.43 yuan/QALY，which was far below WTP threshold. CONCLUSIONS For Chinese patients with ALK positive-advanced NSCLC ，compared with commonly used the first-line treatment （crizotinib），ensartinib is economical and absolutely dominant.
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OBJECTIVE：To evaluate the economy performance of dexamethasone （DXM）combined with rituximab （RTX） for the first-line treatment of chronic primary immune thrombocytopenia （ITP）in adults. METHODS ：From the perspective of China ’s medical and health system ，Markov model for eight states was constructed with a period of 4 weeks and a time limit of 20 years， using DXM regimen as control. The cost-utility of DXM+RTX regimen for the treatment of chronic ITP in adults were evaluated. The parameters of clinical efficacy and utility value were derived from own published literature ；cost parameters were from the MENET website and the official websites of local health committees and medical insurance bureaus ；one-way sensitivity analysis ， probability sensitivity analysis and scenario analysis were performed to observe the uncertainty of model and data source. RESULTS：The average cost of DXM+RTX regimen was 51 064 dollars and that of DXM regimen was 50 455 dollars. Compared with DXM regimen ，DXM+RTX regimen yielded an additional 0.14 QALYs for each patient ；the incremental cost-effectiveness ratio（ICER）was 4 356 dollars/QALY，and was lower than the willingness-to-pay threshold of China ’s per capita gross domestic product（GDP）in 2020. In the one-way sensitivity analysis ，the cost of drugs was the main driver in the model. Probability sensitivity analysis demonstrated that DXM+RTX regimen had 57.5％-61.0％ probability of being cost-effective at a willingness- to-pay threshold of 1-3 times per capita GDP in 2020. The results of scenario analysis showed that DXM+RTX regimen would have obvious long-term benefits ，and the utility value had little impact on the conclusion. CONCLUSIONS ：DXM + RTX is more economical than DXM in the treatment of chronic ITP in adults ，but the results have the uncertainty.
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OBJECTIVE：To evaluate the pharmacoec onomics of Enalapril folic acid tablet and Enalapril tablet for stroke prevention in patients with hypertension. METHODS ：Markov model was constructed by using Excel 2016 software. Patients with essential hypertension were selected as the research object with 1 year cycle and 20 years horizon. From the perspective of health system，the pharmacoeconomics of Enalapril folic acid tablets versus Enalapril tablets for stroke prevention in patients with hypertension was compared by cost-effectiveness analysis ，and the stability of the research results was verified by sensitivity analysis. RESULTS ：Compared with Enalapril tablet ，the incremental cost-effectiveness ratio of Enalapril folic acid tablet was 221 323 yuan/QALY，which was higher than three times of China ’s per capita GDP in 2020（217 341.04 yuan）. The results of single factor sensitivity analysis and probabilistic sensitivity analysis were consistent with that of basic analysis. CONCLUSIONS ： Compared with Enalapril tablet ，Enalapril folic acid tablet doesn ’t have a better economy for patients with hypertension.
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OBJECTIVE：To provide reference for impro ving the quality of programmed cell death protein 1 （PD-1）/ programmed cell death 1 ligand（PD-L1）inhibitors in the treatment of non-small cell lung cancer related pharmacoeconomic studies in China. METHODS ：Retrieved from Embase ，PubMed，Medline，Cochrane Library ，CNKI，Wanfang database ，VIP and other Chinese and English database ，cost-utility studies about PD- 1/PD-L1 inhibitors in the treatment of non-small cell lung cancer published during Jan. 2016-Jan. 2021 were collected. The data of the included studies were extracted. After the quality of the included studies was evaluated by using the Consolidated Health Economic Evaluation Reporting Standards list ，the relevant data were summarized and compared from the aspects of model framework ，model parameters and uncertainty analysis. RESULTS & CONCLUSIONS：A total of 17 studies were finally included ，the overall quality of them was high but the differences in methodology were great. Markov model or partition survival model based on three states was adopted for 16 studies. The time horizon ranged from 5 years to lifetime ；the cycle length ranged from 1 week to 6 weeks. A total of 8 studies used the standard parameter distribution method for parameter fitting ，and 7 studies additionally adopted other parameters estimation methods as KM curves or spline models. Eleven studies performed the validation of model extrapolation. All studies considered the direct medical costs and reported the incremental cost-effectiveness ratio using quality-adjusted life years as the health outcome. Sixteen studies conducted the deterministic sensitivity analysis and probabilistic sensitivity analysis to improve the stability of the model. It is suggested that studies should keep the integrity of the report ； format，choose the appropriate positive comparators ，selectthe health economic model and construct reasonable assumptions according to the available data format ， use Cholesky decomposition to explore the uncertainty of the parameter fitting ， perform the validation of extrapolation combined with external data and use the appropriate indirect comparison in the absence of the head-to-head clinical trials to improve the quality of related pharmacoeconomic studies in China.
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OBJECTIVE：To com pare the efficacy and safety of 5 direct antiviral agents in the treatment of chronic hepatitis C infection as glecaprevir （GLE）/pibrentasvir（PIB），ledipasvir（LDV）/sofosbuvir（SOF），SOF/velpatasvir（VEL），elbasvir（EBR）/ grazoprevir（GZR）compound preparation and danoprevir （DNV）+ peginterferon combined with ribavirin （P/R）. METHODS ： Retrieved from PubMed ，Embase，Cochrane Library ，Web of Science ，CNKI，VIP，Wanfang database and other databases ，RCTs about 5 direct antiviral agents in the treatment of chronic hepatitis C infection were collected during the inception to Jun. 2020. After literature screening and data extraction ，the quality of included literatures were evaluated with bias risk evaluation tool recommended by Cochrane system evaluator manual 5.1.0. Meta-analysis was performed by using Stata 15.0 software. RESULTS ： A total of 48 RCTs with 12 227 patients in trial group were included. Results of Meta-analysis showed that the descending order of sustained virological response （SVR）rate was GLE/PIB ＞LDV/SOF＞SOF/VEL＞EBR/GZR＞DNV+P/R；weighted SVR rates of GLE/PIB，LDV/SOF，SOF/VEL and EBR/GZ were more than 95％. The incidence of any severe adverse event and adverse event in ascending order was EBR/GZR ＜GLE/PIB＜SOF/VEL＜LDV/SOF＜DNV+P/R. The incidence of nausea/vomiting in ascending order was GLE/PIB ＜LDV/SOF＜EBR/GZR＜SOF/VEL＜DNV+P/R. The incidence of rash in ascending order was LDV/SOF ＜ GLE/PIB＜SOF/VEL＜EBR/GZR＜DNV + P/R. The incidence of insomnia from low to high was GLE/PIB ＜EBR/GZR＜SOF/ VEL＜LDV/SOF＜DNV+P/R. CONCLUSIONS ：GLE/PIB，LDV/SOF，SOF/VEL and EBR/GZR have higher and similar effective rates in the treatment of chronic hepatitis C ，especially the weighted SVR rate of GLE/PIB is the best ，and the safety of EBR/GZR and GLE/PIB is relatively better.
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OBJECTIVE：To evaluate the econo mics of pembrolizumab in the second-line treatment of advanced hepatocellular carcinoma in China. METHODS ：From the perspective of Chinese healthcare system ，a three-state PartSA model and Markov model were established ；the cost and utility for the second-line treatment of advanced hepatocellular carcinoma in China were compared between pembrolizumab and placebo. The circulation cycle of the model was 3 weeks and the study time limit was lifetime；one-way sensitivity analysis ，probability sensitivity analysis and scenario analysis were used to verify the robustness of the base-case analysis results. RESULTS ：PartSA results showed that the ICER for the second-line treatment of advanced hepato- cellular carcinoma with pembrolizumab was 1 266 846.18 yuan/QALY，which is far more than 1-3 times of China ’s per capita GDP in 2020. The results of one-way sensitivity analysis showed that the three parameters that had the greatest impact on ICER were the PFS status utility of the placebo group ，the PFS status utility of the pembrolizumab group ，and the cost of pembrolizumab. The results of probability sensitivity analysis verified the robustness of the base-case analysis. The scenario analysis showed that the treatment cost of pembrolizumab had dropped significantly when the charity donation of pembrolizumab was considered. Although it was still not economical ，ICER was close to 3 times of per capita GDP of China in 2020. When WTP threshold was 1 and 3 times of China ’s per capita GDP ，the economic prices of pabolizumab （100 mg）were 4 157.67 and 5 829.24 yuan，respectively. The results of Markov model were similar to those of PartSA model. CONCLUSIONS ：Under the WTP threshold of 1-3 times China ’s per capita GDP in 2020，pembrolizumab is not economical for second-line treatment of advanced hepatocellular carcinoma.
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OBJECTIVE：To provide referenc e for selectin g antitumor drugs economic evaluation models and improving the quality of evidence for antitumor drugs economics evaluation in China. METHODS ：A systematic search of the antitumor drug health technology evaluation （pCODR）reports were conducted on the official website of the Canadian Agency for Drugs and Technologies in Health （CADTH）. The search time was limited to Jan. 1st，2015 to Sep. 6th，2020. The basic information ，model types and structure ，and key limitations were extracted and summarized. RESULTS & CONCLUSIONS ：A total of 185 pCODR reports were finally retrieved ，involving 114 types of tumor indications and 98 types of antitumor drugs. The number of CADTH antitumor drugs economics evaluations in the past 5 years had shown an increasing trend. Among 137 pCODR reports with final economic guidance report ，98 reports（71.5％）adopted the PartSA model ，21 reports（15.3％）used the Markov model ，and some reports（6 reports，4.3％）used both PartSA and Markov models to explore the uncertainty of the model structure. In terms of model health status setting ，86 reports（62.8％）used three-state models to evaluate the economy of different anti tumor drugs ，and 16 reports（11.7％）used no less than four health states to simulate the outcome of disease state. However ，there were still some problems in CADTH models ，such as the unreasonable choice of research time limit ，the unreasonable extrapolation method or uncertain extrapolation results of efficacy （survival）data，the uncertainty of efficacy data obtained by indirect comparison ，and some assumptions or parameter settings did not conform to the actual diagnosis and treatment environment. In view of the advantages of PartSA model ，it is suggested that PartSA model or Markov model combined with PartSA model should be used first to verify the uncertainty of model structure in the future economic evaluation of antitumor drugs ；reasonable settings of key model parameters should be considered to improve the quality of evidence for antitumor drugs economics evaluation in China.
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OBJECTIVE：To provide reference for scientific decision-making of evaluation and application of clinical comprehensive value of drugs from the perspective of the public decision-making in China. METHODS ：Based on relevant documents and literatures ，drug clinical comprehensive value in other countries and areas ，the core indicators of drug clinical comprehensive value evaluation in China were confirmed. The concept and evaluation methods of each indicator were evaluated ， and relevant suggestions were put forward. RESULTS & CONCLUSIONS ：It’s suggested that the core indicators of China ’s drug clinical comprehensive value evaluation are safety and efficacy ，economy and affordability ，accessibility and fairness adherence ， suitability. The concepts of safety ，efficacy，economy，affordability and adherence indexes are clearly defined ，evaluation methods are systematic ，data sources are sufficient ，and international consensus exists in research design. There is no uniform definition of accessibility which composed of availability ，deliverability，availability，affordability and timeliness. The concept of equity is clearly defined and the evaluation method is systematic ，but the data source is insufficient. Appropriateness is evaluated by drug suitability index but there is no clear definition. Taking efficacy as an example ，efficacy includes intermediate indicators ，outcome indicators and quality of life indicators ，which are often confirmed by epidemiological research ，systematic evaluation and expert consensus. It ’s suggested that the Real World Study data should be used as much as possible when selecting or formulating the clinical comprehensive value indicators of drugs. With the help of multi-criteria decision-making analysis ，technical support should be provided by professional evaluation institutions ，and with the support of experts and researchers ，the above indicators should be empowered to form the clinical comprehensive value judgment of a drug by different public decision-making departments ，so as to decide whether to purchase ，use clinically ，or incorporate medical insurance reimbursement.
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Objective To investigate the clinical characteristics of metabolically healthy obese ( MHO) individuals, and to explore the risk of progression into metabolic disorders after 3 years. Methods A total of 3943 residents in Jining City were evaluated twice from February 2012 to August 2015, and 3766 individuals were enrolled excluding those with missing data. Of the subjects, 875 subjects were screened as metabolic normal population, which were divided into MHO(n = 127), metabolically healthy overweight (MHOW, n = 386), and metabolically healthy normal weight ( MHNW, n = 362) groups. T test, x2 test, and logistic regression analysis were used for data analysis. Results The incidence of MHO was 11. 63％ (127 / 1092) in obesity, and the proportion of MHO in females was higher than that in males(13. 91％ vs 7. 82％ , P<0. 05). Compared with MHNW group, the levels of HbA1C , fasting insulin, low density lipoprotein-cholesterol ( LDL-C), triglyceride ( TG), glutamyl transpeptidase (GGT), systolic blood pressure(SBP), diastolic blood pressure(DBP), and waist circumference(WC) were higher in MHO while glomerular filtration rate (GFR) and high density lipoprotein-cholesterol (HDL-C) were lower(all P<0. 05); and fasting insulin, LDL-C, TG, GGT, SBP, WC were higher in MHOW while HDL-C was lower (all P<0. 05). The levels of fasting insulin, TG, SBP, WC were higher in MHO while GFR and HDL-C were lower compared with MHOW(all P<0. 05). Following up for 3 years, the incidences of dyslipidemia in MHNW, MHOW, and MHO were 17. 96％ (65 / 362), 32. 90％ (127 / 386), 42. 52％ (54 / 127), respectively, with significant difference among three groups(P<0. 05). The incidences of hyperglycemia in the three groups were 20. 17％ (73 / 362), 22. 80％(88 / 386), 26. 77％ (34 / 127), respectively, without significant difference among groups ( all P > 0. 05). After adjustment for some factors including sex, age, fasting insulin, glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, GGT, and creatinine, the risks of dyslipidemia in MHO ( OR = 2. 193, 95％ CI 1. 359-3. 539, P<0. 05) and MHOW(OR= 1. 705, 95％ CI 1. 190-2. 443, P<0. 05) were significantly increased as compared with MHNW. Conclusion Compared with MHNW individuals, MHOW/ MHO individuals show an obviously different clinical feature as well as with higher risks of dyslipidemia after 3 years.
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OBJECTIVE: To compare randomized controlled trial (RCT) study and observational study systematically, and to provide reference for selecting suitable study design types for clinical researchers. METHODS: RCT study and observational study were compared in respects of study design and study report paradigm. Relevant literatures were retrieved from PubMed database and Chinese Journal Full-text Database. The differences of literature publication of RCT study and observational study were compared at home and abroad. RESULTS: There were differences in design principles, objectives, subjects, interventions and validity between RCT study and observational study. The requirements of CONSORT statemtnt and STROBE statement to the topics, abstracts, introduction, results and discussions of report paradigm of two studies were basically consistent, and main difference of them were in aspects of methods and other information. The number of literatures about RCT study and observational study had little gap at abroad, but had great gap at home, especially in cohort study with high-level evidence of evidence-based medicine. CONCLUSIONS: The observational study has developed rapidly in recent years, but RCT study is still a "gold standard" to evaluate the causal effect of clinical study. The researchers should choose the appropriate type of design according to the actual situation.
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OBJECTIVE:To provide reference for guarantee the supply of short-landed drugs.METHODS:A questionnaire survey was conducted to investigate the drug shortage in 40 medical institutions in China.Based on the survey data,the econometric model was built to analyze the reasons for drug shortage in medical institutions.RESULTS:40 questionnaires were issued and 26 valid questionnaires were collected with effective recovery rate of 65.0％.The institutions surveyed received 87 samples of short-landed drugs,involving 33 drugs;82.8％ of short-landed drug samples were in short supply for more than 3 months,and even 21.8％ short-landed drug samples were in short supply for more than 12 months.The common reasons for drug shortage mainly included:not entering the provincial bidding directory;adopting the government pricing method;being redistribution system;not establishing provincial normal reserve mechanism.In addition to common reasons,there were some personality reasons for drug shortage based on the necessity of clinical needs,drug attributes and drug price.CONCLUSIONS:There are many reasons for the shortage of drugs in medical institutions.There are both common causes and personality reasons.It is necessary to solve many problems of drug shortage from the source,and it needs many policies and systems to cooperate with them.
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OBJECTIVE:To provide reference for guarantee the supply of short-landed drugs.METHODS:A questionnaire survey was conducted to investigate the drug shortage in 40 medical institutions in China.Based on the survey data,the econometric model was built to analyze the reasons for drug shortage in medical institutions.RESULTS:40 questionnaires were issued and 26 valid questionnaires were collected with effective recovery rate of 65.0％.The institutions surveyed received 87 samples of short-landed drugs,involving 33 drugs;82.8％ of short-landed drug samples were in short supply for more than 3 months,and even 21.8％ short-landed drug samples were in short supply for more than 12 months.The common reasons for drug shortage mainly included:not entering the provincial bidding directory;adopting the government pricing method;being redistribution system;not establishing provincial normal reserve mechanism.In addition to common reasons,there were some personality reasons for drug shortage based on the necessity of clinical needs,drug attributes and drug price.CONCLUSIONS:There are many reasons for the shortage of drugs in medical institutions.There are both common causes and personality reasons.It is necessary to solve many problems of drug shortage from the source,and it needs many policies and systems to cooperate with them.
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Objective To estimate the bladder symptoms, and explore its impact on patients′ quality of life in type 2 diabetes mellitus. Methods Overactive bladder symptom score (OABSS) was used to evaluate patients′ bladder symptoms, and Medical Outcome Study 12-Item Short Form Health Survey Scale (SF-12), Overactive Bladder Questionnaire Short Form(OABq-SF)were conducted to test the effect of bladder symptoms on general and disease-specific quality of life. Results Among the four bladder symptoms, nocturia was the most prevalent symptom (46.7%,479/1025 ), followed by urinary frequency (14.9%,153/1025 ),urinary urgency (14.2%,146/1025 ), urge urinary incontinence (7.9%, 81/1025). Nocturia and urge urinary incontinence significantly increased symptom bother (nocturia B=0.337,P<0.01;urge urinary incontinence B=0.437,P<0.01) and decreased disease-specific quality of life (nocturia B=-0.364,P<0.01;urge urinary incontinence B=-0.346, P<0.01) in these patients. Meanwhile, urge urinary incontinence was negatively associated with general mental health (B=-0.255, P=0.011). Conclusions The prevalence of bladder symptoms in type 2 diabetes patients was high, and was found to be associated with patients′general and disease-specific quality of life. Health care providers should be aware of the high prevalence of bladder symptoms and its impact on QOL to facilitate early diagnosis and treatment of bladder symptoms during diabetic care.
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Objective To learn quality of life of acute upper respiratory tract infection patients and their influence factors.Methods We conducted questionnaire investigation on acute upper respiratory tract infection patients from five hospitals,respectively located in Wuhan,Hefei and Jinhua.The scale we used is EQ-5D.We calculated EQ-5D score through three different integration systems,which are from China,Korea and the UK,in order to compare difference among different countries' integration systems.Then econometric model was used to carry out regression analysis on factors affected EQ-5D score.Results 659 samples was included,with 319 from Wuhan,235 from Hefei and 105 from Jinhua.Among EQ-5D five dimensions,the first three dimensions do not have problems.However,81.94％ of the patients have problems in pain/discomfort and 47.8％ of them have problems in anxiety/depression.In regression analysis,location,severity level of disease and whether accompanied by chronic diseases or not have influence on EQ-5D score.Compared with utilities of patients who are suffered from other diseases,utilities of acute upper respiratory tract infection patients are lower than that of cerebral apoplexy,hypertension,coronary heart diseaseand diabetes patients;but are higher than that of Chronic lymphatic filariasis,chronic obstructive pneumonia and rheumatoid arthritis patients.Conclusion Chinese acute upper respiratory tract infection patients mainly have problems in the dimension of pain/discomfort and anxiety/depression.Compared to British integration system,Korean's is more applicable to Chinese population.Acute upper respiratory tract infection patients' utilities are lower than that of healthy population and chronic invalids with no obvious symptoms,and higher than that of chronic invalids with obvious symptoms.
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Objective To understand the global economic burden of diseases due to needle stick injuries(NSIs), obtain relevant evidence,and prompt the relevant departments to pay attention to the precaution of NSIs.Methods Literatures about NSIs published from 1990 to May 2016 were searched from PubMed,ScienceDirect,EBSCO-host,Cochrane,CNKI,and Wanfang database.According to world bank inflation rate and currency rate in 2015, cost of needle stick injury in each study was adjusted to US dollars in December 2015,merge comparison analysis was performed.Results A total of 7 literatures were included,3 American studies and 4 studies from Sweden,Ko-rea,Belgium,and Taiwan Region of China respectively.Studies in mainland China only focused on the incidence of NSIs,studies about cost were not found.Two studies did not identify studied population,the remaining 5 studies were about all staff in the medical institutions.Cost analysis method:Of 7 literatures,3 were first-hand data analy-sis,4 were derived from the model.Scope of cost research:4 studies estimated the direct cost,2 calculated direct and indirect cost respectively,only 1 study estimated the summation of direct and indirect cost.The total cost per inj ury (direct cost + indirect cost)was $747-$2173,direct and indirect cost were $167-$617 and $322-$455 respectively.Conclusion Global economic burden of NSIs is heavy and still undervalued;NSIs occur frequently in China,but attention is inadequate,research on economic burden is lacking,relevant departments should pay atten-tion to the prevention and follow-up treatment process of NSIs.
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OBJECTIVE:To evaluate technology innovation capability of pharmaceutical industry in 30 provinces(regions and cities)and explore suitable innovation mode for each type. METHODS:The entropy method was adopted to establish comprehen-sive evaluation mode of technology innovation capability of pharmaceutical industry. The mode was used to measure comprehensive score and ranking of pharmaceutical industry in 30 provinces(regions and cities). Those 30 provinces(regions and cities)were di-vided into 3 types,including high technology innovation ability (type Ⅰ),medium technology innovation ability (type Ⅱ) and low technology innovation ability (type Ⅲ),and relevant suggestions on innovation mode were put forward. RESULTS & CON-CLUSIONS:According to the establishment of evaluation index system that included innovation resources input capability,innova-tion output capability,innovation potentiality and innovation environment,significant differences were found among these regions in technology innovation capability. For those 8 provinces (regions and cities) with high technology innovation ability,such as Shandong,Jiangsu and so on,which belongs to the type Ⅰ,local pharmaceutical enterprises should adopt the innovation mode of independent innovation dominant,cooperative innovation as a supplement;for those 9 provinces(regions and cities)with medium technology innovation ability,such as Hebei,Sichuan and so on,which belongs to the type Ⅱ,local pharmaceutical enterprises should select the mode of cooperative innovation of the combination of production,teaching and research;for those 13 provinces (regions and cities) with low technology innovation ability,such as Hainan,Ningxia,which belongs to the type Ⅲ,should the mode of giving priority to imitation innovation and cooperative innovation as a supplement.