The usage and costs of national drug price-negotiated anticancer medicines in a first-tier city in Northeast China: a study based on health insurance data.

BACKGROUND: The National Drug Price Negotiation (NDPN) policy has entered a normalisation stage, aiming to alleviate, to some extent, the disease-related and economic burdens experienced by cancer patients. This study analysed the use and subsequent burden of anticancer medicines among cancer patients in a first-tier city in northeast China. METHODS: We assessed the usage of 64 negotiated anticancer medicines using the data on the actual drug deployment situation, the frequency of medical insurance claims and actual medication costs. The affordability of these medicines was measured using the catastrophic health expenditure (CHE) incidence and intensity of occurrence. Finally, we used the defined daily doses (DDDs) and defined daily doses cost (DDDc) as indicators to evaluate the actual use of these medicines in the region. RESULTS: During the study period, 63 of the 64 medicines were readily available. From the perspective of drug usage, the frequency of medical insurance claims for negotiated anticancer medicines and medication costs showed an increasing trend from 2018 to 2021. Cancer patients typically sought medical treatment at tertiary hospitals and purchased medicines at community pharmacies. The overall quantity and cost of medications for patients covered by the Urban Employee Basic Medical Insurance (UEBMI) were five times higher than those covered by the Urban and Rural Resident Medical Insurance (URRMI). The frequency of medical insurance claims and medication costs were highest for lung and breast cancer patients. Furthermore, from 2018 to 2021, CHE incidence showed a decreasing trend (2.85-1.60%) under urban patients' payment capability level, but an increasing trend (11.94%-18.42) under rural patients' payment capability level. The average occurrence intensities for urban (0.55-1.26 times) and rural (1.27-1.74 times) patients showed an increasing trend. From the perspective of drug utilisation, the overall DDD of negotiated anticancer medicines showed an increasing trend, while the DDDc exhibited a decreasing trend. CONCLUSION: This study demonstrates that access to drugs for urban cancer patients has improved. However, patients' medical behaviours are affected by some factors such as hospital level and type of medical insurance. In the future, the Chinese Department of Health Insurance Management should further improve its work in promoting the fairness of medical resource distribution and strengthen its supervision of the nation's health insurance funds.

Health-related quality of life and influencing factors of patients with paroxysmal nocturnal hemoglobinuria in China.

BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare blood disorder, leading to various complications and impairments in patients' health-related quality of life (HRQOL). Limited research has been conducted to evaluate the HRQOL of Chinese patients with PNH. Understanding the HRQOL in this specific population is crucial for providing effective healthcare interventions and improving patient' health outcomes. This study aimed to assess HRQOL of Chinese patients with PNH, and identify key determinants. METHODS: A cross-sectional study was conducted during 2022 to recruit patients with PNH in China. The study population was recruited from PNH China, one of the largest public welfare PNH patient mutual aid organization in China. Data were collected via an online questionnaire including the EQ-5D-5L (5L), and social-demographic and clinical characteristics. Descriptive statistics were employed to summarize the characteristics of the participants and their HRQOL. Multiple linear and logistic regression analyses were adopted to explore key factors affecting HRQOL. RESULTS: A total of 329 valid questionnaires were collected. The mean (SD) age of the patients was 35.3 (10.0) years, with 52.3% of them being male. The patients reported more problems in Anxiety/Depression (81.5%) and Pain/Discomfort (69.9%) dimensions compared to the other three 5L dimensions. The mean (SD) of 5L health utility score (HUS) and EQ-VAS score were 0.76 (0.21) and 62.61 (19.20), respectively. According to multiple linear regression, initial symptoms (i.e., Anemia [fatigue, tachycardia, shortness of breath, headache] and back pain) and complication of thrombosis were significant influencing factors affecting 5L HUS. Total personal income of the past year, initial symptom of hemoglobinuria and complication of thrombosis were significantly influencing factors of VAS score. Social-demographic and clinical characteristics, such as gender, income, and thrombosis, were also found to be significantly related to certain 5L health problems as well. CONCLUSION: Our study manifested the HRQOL of PNH patients in China was markedly compromised, especially in two mental-health related dimensions, and revealed several socio-demographic and clinical factors of their HRQOL. These findings could be used as empirical evidence for enhancing the HRQOL of PNH patients in China.

Screening Novel Per- and Polyfluoroalkyl Substances in Human Blood Based on Nontarget Analysis and Underestimated Potential Health Risks.

Nontarget analysis has gained prominence in screening novel perfluoroalkyl and polyfluoroalkyl substances (PFASs) in the environment, yet remaining limited in human biological matrices. In this study, 155 whole blood samples were collected from the general population in Shijiazhuang City, China. By nontarget analysis, 31 legacy and novel PFASs were assigned with the confidence level of 3 or above. For the first time, 11 PFASs were identified in human blood, including C1 and C3 perfluoroalkyl sulfonic acids (PFSAs), C4 ether PFSA, C8 ether perfluoroalkyl carboxylic acid (ether PFCA), C4-5 unsaturated perfluoroalkyl alcohols, C9-10 carboxylic acid-perfluoroalkyl sulfonamides (CA-PFSMs), and C1 perfluoroalkyl sulfonamide. It is surprising that the targeted PFASs were the highest in the suburban population which was impacted by industrial emission, while the novel PFASs identified by nontarget analysis, such as C1 PFSA and C9-11 CA-PFSMs, were the highest in the rural population who often drank contaminated groundwater. Combining the toxicity prediction results of the bioaccumulation potential, lethality to rats, and binding affinity to target proteins, C3 PFSA, C4 and C7 ether PFSAs, and C9-11 CA-PFSMs exhibit great health risks. These findings emphasize the necessity of broadening nontarget analysis in assessing the PFAS exposure risks, particularly in rural populations.

Ligand Substitution: An Effective Way for Tuning Structures of ZIF-7 Nanoparticles (NPs) and Improving Energy Recovery Performance of ZIF/PA TFN Membranes.

It is an important initiative to reduce the building energy consumption using energy recovering ventilation (ERV) systems. The application of ERV systems is hindered by the low CO2 barrier performance of commercial total heat exchange membranes (THEMs) that lead to unsatisfactory indoor air refreshing rate, and there is an urgent need for THEMs that have improved CO2 barrier properties and effective energy recovery efficiencies. Here, we report the formation of novel ZIF/PA TFN THEMs based on ZIF-7-X nanoparticles (NPs) with "core-shell" structures and tunable particle sizes, formed from benzimidazole (BIM) ligands and BIM substituted by -NH2, -CH3, -C2H5, and -C3H7 functional groups. The NPs were mixed with pyr omellitic triformyl chloride (TMC) in the organic phase during the interface polymerization process to form ZIF/PA TFN membranes. The total heat exchange performance of ZIF/PA TFN membranes could be effectively modified by the type and quantity of ZIF-7-X NPs added. The CO2 barrier properties and water vapor permeability of ZIF/PA TFN membranes could be improved by the addition of optimal levels of ZIF-7-X NPs, showing low CO2 permeance of 7.76 GPU, high H2O permeance of 663.8 GPU, and excellent enthalpy exchange efficiency of 72.1%. This work provided an effective strategy for tuning not only the nanostructures of ZIF-7 fillers but also the CO2 barrier properties of the formed ZIF/PA TFN membranes.

The mechanisms of improving coastal saline soils by planting rice.

Planting rice is one of the effective ways to improve saline soils, but the underlying mechanisms are unknown. We studied basic soil properties (including pH, salt content, total nitrogen, etc.) and microbial diversity of the bare soil (salt content >4 g/kg, CK), the Suaeda (Suaeda glauca (Bunge) Bunge) soil (JP), and the soil in which rice (cv. Huaidao 5) grew for one (1Y) and three (3Y) years. The results showed that the soil salinity decreased in the order: CK > JP > 1Y > 3Y. The contents of soil organic matter, total nitrogen, dissolved organic carbon, readily oxidizable carbon, microbial biomass carbon, and particulate organic carbon were higher in 1Y and 3Y compared with CK. The Chao 1 index of soil microbiome diversity was about 1.20 times and 1.49 times higher in the soils after rice compared with JP and CK, respectively. Among the soil microorganisms, the top four abundant phyla were Proteobacteria, Chloroflexi, Bacteriodetes, and Firmicutes. In summary, planting rice decreased soil salinity, and increased the content of nutrients and diversity of microorganisms, thereby improving the saline soil.