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OBJECT IVE To evaluate the efficacy ，safety and cost-effectiveness of Qili qiangxin capsule in the treatment of chronic heart failure ，and provide reference for drug selection and evaluation in relevant institutions. METHODS Meta-analysis was performed to investigate clinical efficacy and safety of Qili qiangxin capsule combined with routine treatment （combined treatment group）versus routine treatment （routine treatment group ）in the treatment of chronic heart failure. From the perspective of Chinese health care system ，a decision tree model was constructed. The time horizon of the model was 1 year. The effective rate obtained by meta-analysis was taken as the effect parameter ，and the total cost was calculated by drug cost and hospitalization cost ，to evaluate the cost-effectiveness of combined treatment versus routine treatment in the treatment of chronic heart failure. Subgroup analysis was carried out according to the course of treatment and literature quality ，and one-way sensitivity analysis and probability sensitivity analysis were adopted to check the robustness of basic analysis results. RESULTS Total of 72 literatures involving 9 575 patients were included in meta-analysis. Results of meta-analysis showed that effective rate ，left ventricular ejection fraction ， N-terminal fragment of the prohomone brain-type natriuretic peptide and 6 minute walking distance in combined treatment group were all better than those of routine treatment group ， while its safety was similar to routine therapy. The results of cost-effectiveness analysis showed that the cost of combined therapy was 1 867 yuan higher than that of routine therapy ，patients could get 0.016 QALYs more ，and the incremental cost-effectiveness ratio （ICER）was 117 861 yuan/QALY. If only high-quality literature were included for meta-analysis and the effectiveness parameters were obtained ，the ICERs of the combined therapy versus routine therapy were 102 162 yuan/QALY（based on all high-quality literature ）and 72 354 yuan/QALY（based on high-quality literature with treatment course of 24 weeks）. The results of the probability sensitivity analysis showed that taking twice China ’s per capita gross domestic product in 2020 as the willingness to pay threshold ，the probability of cost-effectiveness for Qili qiangxin capsule combined with routine therapy was 67.1％ . CONCLUSIONS Compared with routine therapy ，Qili qiangxin capsule combined with routine therapy has better clinical efficacy ，equivalent safety and cost-effective.
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OBJECTIVE： To provide reference for improving medication compliance and therapeutic efficacy in community patients with type 2 diabetes mellitus （T2DM） in China. METHODS： The data was from the “Economic Study of Diabetic Medications in Patients with T2DM in China”， which was conducted by China Center for Health Economic Research of Peking University. Both univariate analysis and Logistic regression model were used for single factor analysis and multiple factor analysis of medication compliance. RESULTS： Totally 2 236 community T2DM patients were included. The rate of good medication compliance was estimated at as low as 23.48％. Monthly household income and duration of the disease had significant impact on medication compliance. Incidence of good the medication compliance for patients with monthly household income ≥6 000 yuan and during 3 000-＜6 000 yuan， compared to those with monthly household income ＜3 000 yuan， were 70.8％ [95％CI（0.532，0.944）] and 78.5％ [95％CI（0.614，1.004）] respectively. Incidence of good medication compliance for the patients with 5 to 10 years and ＞10 years of disease duration， compared to those with ＜5 years of disease duration， were 69.0％ [95％CI（0.542， 0.878）] and 59.1％ [95％CI（0.459， 0.760）] respectively. CONCLUSIONS： The medication compliance among community patients with T2DM in China was generally poor. Longer duration of the disease and higher monthly household income are associated with poorer medication adherence.
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OBJECTIVE： To provide reference for improving the treatment compliance and therapeutic effect of patients with type 2 diabetes mellitus （T2DM） in China. METHODS： The follow-up data was from the issue of Pharmacoeconomic Study of Diabetic Drugs in China， which was conducted by China Center for Health Economic Research （CCHER） of Peking University. Using follow-up endpoint HbA1c level as clinical output indicator， univariate analysis and multivariable regression analysis of binary and numerical variables were performed to evaluate the effect of treatment compliance on short-term clinical outcomes. RESULTS： Totally 2 236 community T2DM patients were included for the analysis. The patients with good and poor medication compliance accounted for 23.48％ and 76.52％； the patients with good and poor blood glucose monitoring compliance accounted for 7.02％ and 93.98％； 66.3％， 23.5％ and 10.2％ of the patients had good， medium and poor diet control compliance， respectively. Univariate analysis showed that there was a significant difference in the “good control” group of blood glucose and the “poor control” group of blood glucose in terms of patient age， body mass index， education level， duration of disease， exercise， and eating habits，etc （P＜0.05）. Similar results were obtained in the analysis of multiple Logistic regression and multivariate loglinear regression models， that is， blood glucose monitoring compliance and diet control compliance had significant positive effects on end-point HbA1c （P＜0.05）， but drug compliance had no significant effect （P＞0.05）. CONCLUSIONS： The treatment compliance among community patients with T2DM in China was generally poor. After controlling for other variables， patients’ treatment compliance has a positive effect on end-point HbA1c， especially better blood glucose monitoring compliance and diet control compliance contribute to blood glucose control， but medication compliance has no significantly effect.
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Objective To evaluate the change of renal function in patients with acute stroke by estimate glomerular filtration rate (e-GFR). Methods One hundred patients with acute stroke admitted into hospital from emergency department in 72 h were enrolled. There were 100 patients, with 50 male patients and 50 female patients. Fifty-eight patients were older than 50 years old, and 42 patients were less than 50 years. Blood samples were collected from the next day in hospital to detect the level of creatinine (Cr), then e-GFR was calculated with a simplified method of modification of diet in renal disease. According to the National Kidney Foundation published kidney disease outcome quality initiative (K/DOQI), the renal function of these 100 patients was estimated. The outcome of e-GFR and Cr were compared. The differences of e-GFR in patients with acute stroke were analyzed from the aspects of age and gender. Results 56.0% (56/100) patients were determined as decreased renal function according to the standard of GFR 124μmol/L. The abnormal rate of e-GFR in patients older than 50 years old was 93.1%(54/58), in patients less than 50 years old was 4.8%(2/42), and there was significantly difference (χ2=77.16, P 0.05. Conclusions The decreased renal function in patients with acute stroke is common. The detection of e-GFR can more accurately assess the patient′s renal function and provide a basis for individual choice of drugs.
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OBJECTIVE:To systematically review the cost-effectiveness of insulin degludec(IDeg)in the treatment of type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM). METHODS:A systematic review of literatures was conducted via PubMed,EMBase,The Cochrane Library,CNKI,Wanfang Data,VIP,IDF,ISPOR,ADA and EASD from the inception to Janu-ary 2016,to identify pharmacoeconomics evaluation literatures and non-economic studies related to IDeg in the treatment of T1DM and T2DM,compared with other basic insulin [insulin glargine(IGlar),insulin detemir(IDet),neutral protamine hagedom insulin (NPH)]. RESULTS:A total of 8 studies were included and all of them were carried out in European countries. In the short-term (one year),IDeg was more economical when compared with other basic insulin in patients with T1DM. The studies related to the long-term treatment of T1DM demonstrated different conclusions,but most of studies came to a conclusion that IDeg had good cost-effectiveness. For patients with T2DM,all of the studies demonstrated that IDeg was cost-effectiveness compared with IGlar. CONCLUSIONS:Compared with other basic insulin,IDeg can improve therapeutic efficacy and the quality of life,as well as re-duce the cost of ADR as hypoglycaemia. IDeg is a dominant or cost-effective treatment opinion.
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Object:The paper aims to analyze Taiwanese experience in pharmaceutical procurement, pharma-ceutical benefits and reimbursement schedule, and make references for the Mainland China. Methods:Through read-ing and analyzing the Taiwanese government policy and the literature published to find out the pharmaceutical pro-curement measures, different medicines’ pricing strategy and its reimbursement mode compared with the Mainland China. Results: Hospitals can purchase medicines based on their own needs, and the purchase price was formed through negotiating with providers and buyers. It has been found that Taiwan only controls the medicines reimburse-ment prices. The international reference pricing is adopted for new medicines, and the originators, bioequivalence/bioavailability generic medicines and general generics reimbursement prices are very high at international reference prices, and need to be weakened in order to fit the requirements. Moreover, the medicine quality is one of the stand-ards considered in case of making decisions on the reimbursement prices. In addition, the reimbursement price is as-sociated with procurement price. When the spread is larger than 30%, the government will adjust the reimbursement to fill the gap. Conclusions: Through the system design and adjustment, the Taiwanese Government have set up a better procurement and reimbursement co-ordination in the pharmaceutical segment, and formed the reasonable prices for the case. The Taiwanese experience can be taken as a reference for the mainland China to refine its procurement reforms and reimbursement policy.
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Objective: To analyze the status and general trend of urban residents’ health equity and health performance. Methods:Adopting standardization of concentration index, the extended concentration index and health performance index. Results: Chronic disease and self-assessed health of urban residents in China gradually improved from 2007 to 2011, while disability of those people did not improve significantly. Health inequity exists among urban residents with different incomes. Chronic disease and disability are inclined to the poor while self-assessed health is inclined to the rich, but the unfair degree has decreased gradually by year; the self-assessed health and the health performance of chronic disease has been improved from the comprehensive health level and equity, the disability sustains serious condition. Conclusion: China’s new health care reform does not significantly improve the domestic urban residents’ health equity and health performance, the objective set of the health care reform in China should pay more attention to health equity.