RESUMO
BACKGROUND: Recently, the endovascular treatment (EVT) of acute ischemic stroke has made significant progress in many aspects. Intravenous thrombolysis (IVT) is usually recommended before endovascular treatment in clinical practice, but the value of the practice is controversial. The latest meta-analysis evaluation was that the effect of EVT versus EVT plus IVT did not differ significantly. The cost-effectiveness analysis of EVT plus IVT needs further analysis. This study assesses the health benefits and economic impact of EVT plus IVT in Shandong Peninsula of China. METHOD: We followed a cross-section design using the Chinese-Shandong Peninsula public hospital database between 2013 and 2023. The real-world costs and health outcomes were collected through the Hospital Information System (HIS) and published references. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of Chinese healthcare using the complex decision model to compare the costs and effectiveness between EVT versus EVT + IVT. One-way and Monte Carlo probabilistic sensitivity analyses were performed to assess the robustness of the economic evaluation model. RESULTS: EVT alone had a lower cost compared with EVT + IVT whether short-term or long-term. Until 99% dead of AIS patients, the ICER per additional QALY was RMB696399.30 over the willingness-to-pay (WTP) threshold of 3× gross domestic product (GDP) per capita in Shandong. The probabilistic sensitivity analysis of 3 months, 1 year and long-term horizons had a 97.90%, 97.43% and 96.89% probability of cost-effective treatment under the WTP threshold (1×GDP). The results of the one-way sensitivity analysis showed that direct treatment costs for EVT alone and EVT + IVT were all sensitive to ICER. CONCLUSIONS: EVT alone was more cost-effective treatment compared to EVT + IVT in the Northeast Coastal Area of China. The data of this study could be used as a reference in China, and the use of the evaluation in other regions should be carefully considered.
RESUMO
BACKGROUND: Physical functional limitations (PFLs) increase the vulnerability of adults, but their pathogenesis remains unclear. METHODS: We conducted a nationwide longitudinal study on 62 749 records from 18 878 adults (aged ≥45) from 28 provinces in China. Risk of PFLs was assessed using a validated 9-item questionnaire. Exposure levels of air pollutants (PM10, PM2.5, and PM1) and greenness (normalized difference vegetation index, NDVI) were estimated using a satellite-based spatiotemporal model. We used the cumulative link mixed effects model to estimate the associations between short-term and long-term exposure to air pollutants, greenness, and risk of PFLs. We employed the interaction effect model to evaluate interactions between air pollutants and greenness. RESULTS: Participants were 60.9â ±â 9.6 years, with an average follow-up of 5.87 (1.65) years. Exposure to air pollution was significantly associated with a higher risk of PFLs. For instance, the odds ratio (OR) associated with each 10 µg/m3 higher in 6-month averaged PM10, PM2.5, and PM1 were 1.025 (95% CI: 1.015-1.035), 1.035 (95% CI: 1.018-1.054), and 1.029 (95% CI: 1.007-1.050), respectively. Conversely, exposure to greenness was associated with decreased risk of PFLs; the OR associated with each 1-unit higher in 1-year averaged NDVI was 0.724 (95% CI: 0.544-0.962). Furthermore, higher greenness levels were found to mitigate the adverse effects of 1-year, 6-month, 1-month averaged PM10, and 1-year averaged PM2.5 on the risk of PFLs. CONCLUSIONS: Air pollution raises the risk of PFLs, whereas greenness could mitigate the adverse effects. Reducing air pollution and enhancing greenness could prevent physical functioning.
