Economic evaluation used alongside clinical trials has become a hot spot in the development of clinical studies. The definition and classification of the cost were introduced in this article. The ways to conduct cost analysis in clinical trials were introduced systematically, including the identification, collection and analysis of the data of costs, and the concern of the analysis.
ObjectiveTo systematically review the status of economic evaluation of liver cancer screening in China, so as to provide reference for further studies.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were searched to collect economic evaluation studies of liver cancer screening in China from inception to December, 2017. Two reviewers independently screened literature, extracted data and conducted descriptive analysis of basic characteristics, methods of economic evaluation and main results as well as quality and uniformity of reporting.ResultsA total of 5 studies were included. Among them, the starting age of screening were found to be 35 to 45 years old; α-fetoprotein (AFP) testing and ultrasound examination combined procedure and screening interval of every 6 months were mostly evaluated. The quality of the 5 studies was satisfactory, and the uniformity of reporting was relatively acceptable, with a median score of 78% (range: 60% ~ 78%). Two population-based studies reported cost per liver cancer detected (44 thousand and 575 thousand yuan). Three studies reported cost-effectiveness ratio(CER) based on life year saved (LYS) and quality adjusted life year (QALY). Among these results, only 1 study from mainland China reported CER based on LYS (1 775 yuan), and the calculated ratio of CER to local GDP per capita was estimated as 0.1, while 2 studies from Taiwan province reported 4 CERs, and the ratios of CER to local GDP per capita ranged from 1.0 to 2.2.ConclusionsInformation from liver cancer endemic areas such as Taiwan province indicates promising cost-effectiveness to conduct liver cancer screening in local general population, while data from mainland suggests that conducting liver cancer screening combining AFP and ultrasound in high-risk population will be cost-effective, however only supported by 1 regional study. This needs to be verified by further economic evaluations based on randomized controlled trials or cohort studies as well as health economic evaluations.
ObjectiveTo systematically review the health economic evaluation of nasopharyngeal carcinoma (NPC). MethodsThe PubMed, Web of Science, EMbase, CNKI, WanFang Data and CBM databases were electronically searched to collect the health economic evaluations on NPC from inception to December 18, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A descriptive analysis was performed. ResultsA total of 20 studies were included, which contained 14 about different drug combinations, 6 about chemotherapy and the comparison among intensity modulated radiotherapy, conventional radiotherapy and surgery. The results showed that for patients with recurrent, metastatic, or advanced NPC, compared with docetaxel plus cisplatin, fluorouracil plus cisplatin or docetaxel and cisplatin plus fluorouracil, gemcitabine plus cisplatin (GP) was the most economical, and compared with GP or camrelizumab plus GP, toripalimab plus GP (TGP) was more economical. For early-stage NPC, intensity modulated radiotherapy was not economical compared with conventional radiotherapy and surgery. ConclusionCurrent evidence shows that GP and TGP are economical and can be popularized clinically.
ObjectiveTo systematically review the economy of non-pharmaceutical interventions (NPIs) for COVID-19. MethodsThe Web of Science, PubMed, EMbase, Cochrane Library, INAHTA, CNKI, WanFang Data and SinoMed databases were electronically searched to collect studies on health economic evaluations from 1 January 2020 to 20 August 2022. Then the included materials were reviewed, extracted and data integration analysis were conducted based on inclusion and exclusion criteria. ResultsSeventy-one academic publications were finally included, which contained 25 papers about nucleic acid testing, antigen testing and screening, 5 papers about personal protection, 12 papers about social distancing, quarantine and isolation, 11 papers about regional or national lockdown and 18 papers about multiple NPIs. The results showed that compared with no intervention, nucleic acid testing, antigen testing, screening and personal protection measures were economical. Social distancing, quarantine and isolation were also economical compared with no intervention. However, in low-income countries, movement restriction and factory shutdown may exact a heavy toll on the poorest and most vulnerable. Moreover, compared with a single long-term lockdown, multiple short-term lockdowns could be more economical, but the cost was still huge overall. ConclusionNPIs such as nucleic acid testing, antigen testing, personal protection, social distancing, quarantine, isolation and factory shutdown are economical. Although regional or national lockdown can save lives, it is not suitable for wide use. The researches on specific populations, specific variants (especially Omicron) and in the context of China need to be carried out.
This article aims to explore the application of health economics evidence in the development of clinical practice guidelines and evidence recommendations, and to provide better references for clinical decision-making. By reviewing the use of health economics evidence in domestic and international clinical practice guidelines, the difficulties in the application of health economics evidence in the development of clinical practice guidelines and evidence recommendations were summarized. It was found that there were significant differences in the use of health economics evidence in clinical practice guidelines in different countries, and these differences were affected by the goals of clinical practice guidelines and limitations of health economics evidence itself, lacking standardized methodological guidance, resulting in limited use of health economics evidence in clinical practice guidelines. Therefore, further research is needed to optimize the integration of health economics and clinical practice guidelines, and develop standardized methodological guidance.
ObjectiveUnder the principle of promoting the reform of TCM payment methods, analyzing the difference in efficacy and cost of treatment using Western medicine or traditional Chinese medicine, and providing health economics basis for the reform of payment methods for advantageous diseases of TCM. MethodsData from the first page of medical records of 4 Chinese hospitals and 4 western hospitals of the same level were collected from 2020 to 2021 in typical areas, focusing on four typical TCM advantageous diseases that were consistent with diabetes, cervical spondylosis, arthralgia syndrome in the lumbar area or pelvic inflammation, and a total of 14 958 cases were included through propensity score matching. Under the assumption of same disease, same effect and same price, the age, bed days, total cost, discharge condition and reoperation condition of the same disease in 90 days were analyzed and compared between the two groups. ResultsIn terms of outcomes, the experimental group showed significantly better discharge outcomes compared with the control group for the four diseases. In terms of cost, the control group had higher total costs for arthralgia syndrome in the lumbar area and cervical spondylosis, while the control group had lower total costs for diabetes. After controlling for treatment effects, the control group had higher costs for cervical spondylosis and pelvic inflammatory disease compared to the experimental group, while the control group had lower costs for diabetes and arthralgia syndrome in the lumbar area compared to the experimental group. ConclusionThe experimental group shows better treatment effectiveness for the four TCM-dominant diseases. The control group has higher costs for cervical spondylosis and pelvic inflammatory disease when discharge outcomes are limited, while the control group has lower costs for diabetes and arthralgia syndrome in the lumbar area. This highlights the necessity of reforming the payment methods for TCM-dominant diseases. Additionally, the development of TCM-dominant diseases should focus on addressing the high demand for elderly chronic diseases in TCM.