Résumé
The ultimate goal of the development of parenteral and enteral nutrition is to achieve T3 transfer of translational medicine in this field. This study is an international cooperative, multicenter and observational clinical study conducted by CSPEN-NUSOC cooperative group for 15 years which is aimed to observe the effect of standardized nutritional support on clinical outcome and cost/ effect and verify the clinical value parenteral and enteral nutrition through investigating the prevalence of nutritional risk and malnutrition and the application of nutritional support in adult in-patients.
Résumé
The ultimate goal of the development of parenteral and enteral nutrition is to achieve T3 transfer of translational medicine in this field. This study is an international cooperative, multicenter and observational clinical study conducted by CSPEN-NUSOC cooperative group for 15 years which is aimed to observe the effect of standardized nutritional support on clinical outcome and cost/effect and verify the clinical value parenteral and enteral nutrition through investigating the prevalence of nutritional risk and malnutrition and the application of nutritional support in adult in-patients.
Résumé
OBJECTIVE: This study presented the analysis period, the complexity of combined therapy and comparator choice as the key limitations in the economic evaluation of new drugs, and discussed programs for coping with these limitations. METHODS: This study evaluated the post-evaluation, risk-sharing agreement, extra funding program, and flexible incremental cost-effectiveness ratio (ICER) threshold as actions or programs that would increase accessibility to costly new drugs. The study also presented the cases of other countries. The application of the post-evaluation was considered to deal with high uncertainty regarding new drugs. RESULTS: The risk-sharing agreement was introduced in European countries as well as South Korea and has been responsible for the shift from using the financial schemes to outcome-based schemes. The drug funding program has had troubled in securing stable extra funds. The application of higher ICER in the economic evaluation of expensive and innovative oncology drugs was criticized because of the inequity between oncology patients and patients with other diseases. CONCLUSION: Therefore, introducing and applying actions that would increase the accessibility to costly new drugs in South Korea have been deemed necessary after careful reviews and discussions with various stakeholders (insurer, policy makers, pharmaceutical companies and patients).
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Objective To evaluate the impact of fish oil (ω-3 fatty acids) parenteral nutrition (PN) on outcomes for non-ICU postoperative patients.Methods PubMed,Embase,Cochrane,China National Knowledge Infrastructure (CNKI) and Wanfang Database etc.were searched to retrieve the eligible studies published from January 2010 to June 2016.The studies included were randomized controlled trials (RCTs) that evaluated the effects of supplementation of fish oil (Omegawen) in PN regimens for postoperative patients on clinical outcomes.The methodological quality assessment was based on Jadad scale and Schulz allocation concealment tool.Meta-analysis was conducted by RevMan 5.3 software.Results 19 RCTs,1 170 surgical patients,were included.Meta-analysis indicated that short-term fish oil supplementation significantly reduced the incidence of infectious complications [RR =0.44,95％ CI (0.31,0.64),P ＜0.000 1] and shortened the length of hospital stay [MD =-0.85,95％ CI (-1.67,-0.03),P=0.04],while with no significant effect on mortality [RR =0.42,95％ CI (0.07,2.63),P =0.36] and total expenditure of hospitalization [MD =-216.60,95％ CI (-718.94,285.75),P =0.40].Sensitivity analysis showed similar results.Conclusion According to existing evidence,fish oil in PN for surgical patients could reduce the incidence of postoperative infectious com-plications and shorten the length of hospital stay.
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Objective: Drugs for hepatoprotection and enzymes reduction are widely used in China but their economic analysis has been ignored in a rather long period of time. A suitable protocol for hepatoprotection and enzymes reduction was recommended in Longhua Hospital. Methods: This study was conducted as a retrospective piece. Three therapeutic protocols (compound glycyrrhizic glycoside combined with aspartic ornithine injection, compound glycyrrhizic glycoside combined with phosphatidylcholine, and compound glycyrrhizic glycoside combined with tiopronin) were selected. Seventy inpatient cases from January 2011 to February 2012 were enrolled and divided into three groups according to different regimens. The cost effectiveness of the three groups was respectively evaluated by incremental cost-effectiveness ratios (ICERs). A decision tree model and multi attribution utility theory were also adopted to analyze the data. Results: All the three regimens exhibited good effects on protecting liver functions and reducing the levels of enzymes. Among them, the protocol of compound glycyrrhizic glycoside combined with tioproni expressed the least ICER, the lowest cost but the highest score in the multi-utility. Conclusion: The therapeutic method of compound glycyrrhizic glycoside combined with tiopronin is the most cost-effective option in this study.
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Aims: Due to limited resources, to provide a simple and transparent tool for physicians to facilitate budget-related, medical decisions in any patient. Study Design: Comparative study. Methodology: Several articles with topics referring to the 2008 ”Surviving Sepsis Campaign” guidelines in critically ill patients with varying effects on defined clinical endpoints were analyzed regarding the costs of additional treatment success (COATS). A simplified ICER = incremental cost-effectiveness ratio to assess COATS was expressed as the product of the number of patients needed to treat (NNT) and the difference in treatment costs per patient. Results: In publications with significant treatment effects enabling calculation of NNTs, calculating “COATS = NNT x delta costs per patient", mean costs to avoid one additional death or morbidity could be defined. Considering the 95% confidence interval, estimated costs at minimum and maximum to reach distinct clinical endpoints could be expressed. In studies with no significant results, NNTs and COATS were tending to infinity. Conclusion: COATS based on NNT as a simplified ICER is an easy way for the physician at the bedside caring for individual patients to explicitly describe the amount of money which has to be spent to reach definable aims in the clinical setting in one additional patient, such as reduction of mortality or morbidity, or to reassess therapies without significant results. In contrast to COATS, ICER based on quality-adjusted life years may be necessary to perform calculation of the short-term and long-term costs for the community and the adequate allocation of health care resources.