Characteristics of health-state utilities used in cost-effectiveness analyses: a systematic review of published studies in Asia.

INTRODUCTION: Cost-utility analysis (CUA) is the preferred form of economic evaluation in many countries. As one of the key data inputs in cost-utility models, health state utility (HSU) has a crucial impact on CUA results. In the past decades, health technology assessment has been expanding rapidly in Asia, yet research examining the methodology and process used to generate cost-effectiveness evidence is scarce. The aim of this study was to examine the reporting of the characteristics of HSU data used in CUAs in Asia and how the characteristics have changed over time. METHODS: A systematic literature search was performed to identify published CUA studies targeting Asian populations. Information was extracted for both the general characteristics of selected studies and the characteristics of reported HSU data. For each HSU value identified, we extracted data for four key characteristics, including 1) estimation method; 2) source of health-related quality of life (HRQoL) data; 3) source of preference data; and 4) sample size. The percentage of nonreporting was calculated and compared over two time periods (1990-2010 vs 2011-2020). RESULTS: A total of 789 studies were included and 4,052 HSUs were identified. Of these HSUs, 3,351 (82.7%) were from published literature and 656 (16.2%) were from unpublished empirical data. Overall, the characteristics of HSU data were not reported in more than 80% of the studies. Of HSUs whose characteristics were reported, most of them were estimated using the EQ-5D (55.7%), Asian HRQoL data (91.9%), and Asian health preferences (87.7%); 45.7% of the HSUs was estimated with a sample of 100 or more individuals. All four characteristics showed improvements after 2010. CONCLUSION: Over the past two decades, there has been a significant increase in CUA studies targeting Asian populations. However, HSU's characteristics were not reported in most of the CUA studies, making it difficult to evaluate the quality and appropriateness of the HSUs used in those cost-effectiveness studies.

Preliminary evaluation of a new initiative to centralize colorectal cancer care during the COVID-19 epidemic in Shanghai, China: a retrospective study.

Background: A novel colorectal cancer center (CCC) was developed in the Shanghai Tenth People's hospital of Tongji University during the COVID-19 epidemic. In this study, we aimed to evaluate the CCC model in terms of three aspects. Methods: This retrospective study used data from the Shanghai Tenth People's hospital patient databases. The research hypothesis was that the CCC reduces preoperative waiting time (PWT), length of hospital stay (LOS), and costs of hospitalization, without reducing the quality of surgery. Thus, we compared the time, cost, and quality between March 1 to December 31, 2019, and March 1 to December 31, 2020. Descriptive and inferential analyses of patient demographic characteristics, time, postoperative outcomes, and inpatient costs were conducted. Results: A total of 965 hospitalizations for colorectal cancer (CRC) were identified-415 in 2019 and 550 in 2020. In the CCC, PWT declined by 26.2 hours (P<0.01). Patients in the CCC express group only needed to wait for 24.5 hours before undergoing surgery, with a shorter LOS than the normal group (P<0.01). None of the patients had any symptoms of COVID-19 or were high-risk COVID-19 contacts, and the incidence of immediate postoperative complications was low. The mean total inpatient cost (TIC) for all patients with CRC was 78,309.824 Chinese Yuan in 2020, which was slightly lower than that in 2019. Conclusions: This study found that the centralized management model for CRC care could help patients save the PWT, LOS and costs of hospitalization during the COVID-19 epidemic.

Health-Related Quality of Life and Its Influencing Factors for Elderly Patients With Hypertension: Evidence From Heilongjiang Province, China.

Objective: Hypertension is one of the most common public health issues worldwide. However, few existing studies examining health-related quality of life (HRQoL) were conducted on elderly patients with hypertension in China. Hence, this study aimed to assess the HRQoL of elderly patients with hypertension and its influencing factors using EuroQol five-dimensional-three-level (EQ-5D-3L) in China. Methods: Data were obtained from the 6th National Health Service Survey in Heilongjiang province from June to July 2018, with a stratified multistage random cluster sampling method. All eligible participants were interviewed using a standardized questionnaire, which included the EQ-5D-3L, socio-demographics characteristics, clinical and lifestyle characteristics. The mean EQ-5D index scores for the different subgroups were evaluated using ANOVA. A Tobit regression model was also employed to analyze the potential factors influencing HRQoL. Results: A total of 705 elderly patients with hypertension were included in this study. The mean EQ-5D utility score was 0.79 [standard deviation (SD) = 0.23]. The proportion of participants reporting pain/discomfort problems was the highest (57.0%), while problems in self-care was the lowest (17.2%). Influencing factors of HRQoL for elderly patients with hypertension included gender, age, income, education level, physical activity, health examination and coexisting diseases. Specifically, the female gender, being above 80 years old, having a lower education and/or higher income, and the presence of coexisting diseases were associated with lower utility index. In contrast, regular physical activity and medical examination had a positive impact on the HRQoL of elderly hypertension patients. Conclusion: Overall, elderly patients with hypertension in China have a lower HRQoL than the general population. To improve the HRQoL of elderly patients with hypertension, it is imperative that better public health education is provided to enhance the knowledge of hypertension, encourage the adoption of healthy habits such as regular physical activity and medical examination, and improve the management of coexisting diseases. More care should also be directed to males with hypertension who are above 80 years old.

Prognostic and clinicopathological significance of C-reactive protein/albumin ratio (CAR) in patients with gastric cancer: A meta-analysis.

BACKGROUND: In recent years, many studies have explored the potential prognostic utility of C-reactive protein/albumin ratio (CAR) in patients with gastric cancer (GC), however, the results remain conflicting. We thus performed a meta-analysis to determine the association of CAR and prognosis of GC. METHODS: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. PubMed, Web of science, Embase, and Cochrane Library were searched. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and cancer-specific survival (CSS) of included studies were pooled to estimate the prognostic value of CAR. RESULTS: Eight studies with a total of 3,216 patients were included in this meta-analysis. High CAR was significantly associated with poor OS (HR = 1.59, 95%CI = 1.36-1.85, p<0.001) and worse CSS (HR = 1.65, 95%CI = 1.21-2.25, p = 0.002). In addition, high CAR was significantly associated with male sex (OR = 1.80, 95%CI = 1.31-2.47, p<0.001), advanced tumor stage (OR = 2.14, 95%CI = 1.48-3.09, p<0.001), and tumor size ≥3cm (OR = 2.69, 95%CI = 1.84-3.93, p<0.001). CONCLUSION: Elevated pretreatment CAR is a prognostic marker of poor OS and CSS in patients with GC. Furthermore, high CAR levels are associated with clinicopathological features reflecting tumor progression.

Assessment of the health utility of patients with leukemia in China.

OBJECTIVES: This study aimed to assess the health utility of leukemia patients in China using the EQ-5D-5L, compare it with the population norms, and identify the potential factors associated with health utility. METHODS: A hospital based cross-sectional survey was conducted in three tertiary hospitals from July 2015 to February 2016. A total of 186 patients with leukemia completed the EQ-5D-5L and their health utility scores were calculated using the Chinese value set. EQ-5D-5L utility and dimensions scores of leukemia patients were compared with China's population norms using Kruskal-Wallis test and chi square test. Potential factors associated with health utility were identified using Tobit regression. RESULTS: The mean EQ-5D-5L utility scores of patients with leukemia, grouped by either gender or age, were significantly lower than those of the general population (p < 0.001). The same results were found for individual dimensions of EQ-5D-5L, where leukemia patients reported more health problems than the general population (p < 0.001). The utility score of leukemia patients was found to be significantly related to medical insurance, religious belief, comorbidities, social support and ECOG performance status. CONCLUSION: This study indicated that leukemia patients have worse health status compared to the general population of China and that multiple factors affect the health utility of the patients. The utility scores reported in this study could be useful in future cost-utility analysis.

A head-to-head comparison of measurement properties of the EQ-5D-3L and EQ-5D-5L in acute myeloid leukemia patients.

PURPOSE: This study aimed to compare the measurement properties of EQ-5D-3L(3L) and EQ-5D-5L(5L) in patients with acute myeloid leukemia (AML) in China. METHODS: We consecutively recruited 168 patients with AML from three tertiary hospitals to complete two rounds of interviews using the two versions of the EQ-5D. We compared (i) the ceiling effect using the McNemar's test, (ii) test-retest reliability using intraclass correlation coefficient (ICC) and Cohen's weighted Kappa, (iii) convergent validity using Spearman's rank correlation coefficient (r) and iv) discriminatory ability using F statistic and area under the receiver operating characteristics curve (AUROC) of the 5L and the 3L. RESULTS: The 5L descriptive system showed significantly lower ceiling effects in comparison to the 3L descriptive system (p < 0.001). While 5L showed superior reproducibility (Cohen's weighted Kappa = 0.56-0.67 and ICC = 0.89), both instruments exhibited good test-retest reliability. Even though both 3L and 5L showed good convergent and known-groups validity, 5L showed better convergent validity and discriminatory ability. CONCLUSION: The current study found both 3L and 5L to be suitable for use in AML patients. However, 5L showed superior measurement properties compared to 3L. Thus, 5L could be the preferred instrument over 3L for use in AML patients.

Measurement Properties of the EQ-5D-5L and EQ-5D-3L in Six Commonly Diagnosed Cancers.

BACKGROUND: This study aimed to compare the measurement properties of the EQ-5D-3L (3L) and EQ-5D-5L (5L) in cancer patients. METHODS: A consecutive sample of inpatients with lung, breast, colorectal, liver, gastric, or thyroid cancer were interviewed using the 3L, 5L, and Functional Assessment of Cancer Therapy-General (FACT-G) questionnaires, and a subgroup was invited to complete the 3L and 5L again. Kappa and intraclass correlation coefficient were used to assess test-retest reliability, and Spearman's correlation between the EQ-5D and FACT-G was evaluated to assess convergent validity. Comparison of subgroups defined using Eastern Cooperative Oncology Group status and cancer stage were performed to assess known-group validity and discriminatory power using the F-statistic and area under the receiver-operating characteristics curve. All analyses were also performed for each subgroup of cancer patients. RESULTS: A total of 416 cancer patients completed the baseline questionnaire and 90 patients also completed the follow-up survey after 2 days. Ceiling effects were smaller in 5L (10.1%) than in 3L (17.8%). The test-retest reliability and convergent validity of the 5L were slightly better than those of the 3L. Both the 3L and 5L showed known-group validity; however, the 5L index showed better discriminatory power. Similar trends were found in the six types of cancers. CONCLUSION: In general, 5L appears to have better measurement properties than 3L for measuring the health-related quality of life of cancer patients. While both the 3L and 5L are suitable, 5L should be preferable to 3L for use in cancer outcomes research.

Learning Social Media Content Optimization: How Can SMEs Draw the Users' Attention on Official WeChat Accounts?

Application of artificial intelligence is accelerating the digital transformation of enterprises, and digital content optimization is crucial to take the users' attention in social media usage. The purpose of this work is to demonstrate how social media content reaches and impresses more users. Using a sample of 345 articles released by Chinese small and medium-sized enterprises (SMEs) on their official WeChat accounts, we employ the self-determination theory to analyze the effects of content optimization strategies on social media visibility. It is found that articles with enterprise-related information optimized for content related to users' psychological needs (heart-based content optimization, mind-based content optimization, and knowledge-based content optimization) achieved higher visibility than that of sheer enterprise-related information, whereas the enterprise-related information embedded with material incentive (benefits-based content optimization) brings lower visibility. The results confirm the positive effect of psychological needs on the diffusion of enterprise-related information, and provide guidance for SMEs to apply artificial intelligence technology to social media practice.

Entrepreneurship: Tenacity, Future Self-Continuity, and Inter-Temporal Risky Choice.

This study examines entrepreneurship. It focuses on the effect of tenacity and future self-continuity (FSC) on inter-temporal risky choice in the entrepreneurial context. A total of 129 Chinese undergraduates participated in this survey. The results formulate that tenacity positively correlates with the risky choices and inter-temporal risky choices, in which commitment, endurance, and challenge play a major role. Meanwhile, FSC predicts the risk-return of the subjects. Higher FSC corresponds to higher expected inter-temporal risk-return. Furthermore, the multivariable regression analysis shows that there is a reciprocal effect when tenacity and FSC work together on subjects' inter-temporal risky decision-making. FSC slightly mitigates both the pursuit of risky-return and the tolerance of time delay for the subjects with high tenacity. This implies that their worthwhile goal is to seek smooth income rather than to pursue an extreme high risk-return. These findings extend the research on personality, choice, and entrepreneurship and provide a guiding significance to the start-up.

Proton-Conductive Coordination Polymers Based on Diphenylsulfone-3,3'-disulfo-4,4'-dicarboxylate with Well-Defined Hydrogen Bonding Networks.

The diphenylsulfone-3,3'-disulfo-4,4'-dicarboxylic acid (H4-DPSDSDC) ligand and its coordination polymers, [K2Zn(C14H6S3O12)(H2O)4]n (1) and {[Cu3(µ3-OH)2(C14H6S3O12)(H2O)3(DMF)]·3(H2O)}n (2) (C14H6S3O12 = diphenylsulfone-3,3'-disulfo-4,4'-dicarboxylate), were synthesized. The Zn(H2O)4 units in 1 are connected by DPSDSDC4- ligands to generate a one-dimensional (1D) chain, which is bridged by K-O bonds associated with bridging water molecules and sulfonate groups to yield a two-dimensional (2D) layer. In 2, the 1D hydroxyl-bridging Cu(II) chains are connected by DPSDSDC4- ligands to give a 2D layer. The 2D layers in 1 and 2 are further connected by interlayered hydrogen bonds to give three-dimensional (3D) frameworks. Compounds 1 and 2 have good conductivities of 1.57 × 10-4 and 5.32 × 10-5 S cm-1, respectively. Continuous well-defined hydrogen bonding networks associated with water molecules, sulfonate groups, and carboxylate groups were observed in compounds 1 and 2. Such hydrogen bonding networks provide hydrophilic domains and effective transfer pathways for protons. Here, we present elegant examples of a precise determination of the pathways for proton transport.

Catastrophic health expenditures of households living with pediatric leukemia in China.

BACKGROUND: Leukemia can create a significant economic burden on the patients and their families. The objective of this study is to assess the medical expenditure and compensation of pediatric leukemia, and to explore the incidence and determinants of catastrophic health expenditure (CHE) among households with pediatric leukemia patients in China. METHODS: A cross-sectional interview was conducted among households living with pediatric leukemia using a questionnaire in two tertiary hospitals. CHE was defined as out-of-pocket (OOP) payments that were greater than or equal to 40% of a household's capacity to pay (CTP). Chi-square tests and logistic regression analysis were performed to identify the determinants of CHE. RESULTS: Among 242 households living with pediatric leukemia, the mean OOP payment for pediatric leukemia healthcare was $9860, which accounted for approximately 35.7% of the mean household's CTP. The overall incidence of CHE was 43.4% and showed a downward trend with the lowest income group at 69.0% to the highest income group at 16.1%. The logistic regression model found that medical insurance, frequency of hospital admissions, charity assistance, and income level were significant predictors of CHE. CONCLUSION: The results revealed that pediatric leukemia had a significant catastrophic effect on families, especially those with lower economic status. The occurrence of CHE in households living with pediatric leukemia could be reduced by addressing income disparity. In addition, extending coverage and improving compensation from medical insurance could also alleviate CHE. Some other measures that can be implemented are to address the barriers of charity assistance for vulnerable groups.

Validity and reliability of the EQ-5D-5 L in family caregivers of leukemia patients.

PURPOSE: This study aimed to test the validity and reliability of the five-level EuroQol five-dimensional (EQ-5D-5 L) instrument in family caregivers (FCs) of leukemia patients in Heilongjiang of China. METHODS: A cross-sectional survey was conducted on 298 family caregivers (FCs) of leukemia patients from three major cancer centers in the capital city of Heilongjiang province of China. Their dimensional scores of the EQ-5D-5 L were compared with those of the WHOQOL-BREF to test the convergent validity (constructs measuring the same concept) and divergent validity (constructs measuring different concepts) of the EQ-5D-5 L. Repeated surveys were conducted on 271 participants to determine the test-retest reliability of the EQ-5D-5 L. RESULTS: The four physical dimensions (mobility, self-care, usual activities, and pain/discomfort) of the EQ-5D-5 L had moderate or high correlations with the physical health domain of the WHOQOL-BREF, with a correlation coefficient (r) ranging from 0.459 to 0.559. The anxiety/depression dimension of the EQ-5D-5 L had a high correlation (r = 0.667) with the psychological domain of the WHOQOL-BREF. By contrast, lower but still significant physical-to-psychological correlations were found between the two instruments (r ranging from 0.219 to 0.396). In addition, the EQ-5D-5 L dimensional scores showed no or weak correlations with the environment and social domains of the WHOQOL-BREF (r ranging from 0.016 to 0.207). High test-retest reliability (> 0.7) was evident. CONCLUSION: The Chinese version of the EQ-5D-5 L has satisfactory reliability and validity in FCs of leukemia patients. It can be used to elicit utility of health-related quality of life in FCs of leukemia.