ObjectivesTo systematically review the association between the level of blocking antibody and recurrent spontaneous abortions.MethodsPubMed, CNKI, CBM, WanFang Data and VIP databases were searched online to collect case-control studies on the association between the level of blocking antibody and recurrent spontaneous abortions from inception to May, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 12 case-control studies involving 3 413 patients were included. The results of meta-analysis showed that: there was a strong association between the blocking antibody negative and recurrent spontaneous abortions with statistical significance (OR=6.10, 95%CI 2.40 to 15.51, P=0.000 1).ConclusionsCurrent evidence shows that the blocking antibody negative is a risk factor for recurrent spontaneous abortions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectivesTo systematically review approaches to derive disability weights (DWs) based on EQ-5D instrument.MethodsPubMed, EMbase, Web of Science, CNKI and WanFang Data databases were electronically searched to collect studies on the approaches to derive disability weights based on EQ-5D from inception to June 1st, 2019. Two reviewers independently screened literature, extracted the basic information and evaluated risk of bias of included studies. Then, systematic review on approaches to derive DWs based on EQ-5D instrument was performed.ResultsA total of 18 studies were included, which were published between 2003 and 2018. The included studies involved a variety of diseases, mostly focusing on quality of life and the burden of disease. The approaches to derive DWs based on EQ-5D health instrument were as follows: DWs=health utility scoreNormal or Control−health utility scoreDisease (7 studies), DWs=1−VAS score/100 (6 studies), DWs=1−health utility scoreDisease (3 studies), linear regression model (1 study), and mapping (1 study).ConclusionsAmong all the included studies using EQ-5D-based disability weight measurement methods involves a variety of diseases, with relatively low comparability. More methodological studies are from abroad. Among all the applied approaches, DWs equally to health utility scoreNormal or Control minus health utility scoreDisease is the most commonly used.
Objective To investigate the status of the knowledge, attitudes and intervention behaviors in medical professionals in the prevention and treatment of deep vein thrombosis (DVT), and explore the weak links in knowledge-attitude-practice of DVT. Methods From December 2017 to February 2018, a convenient sampling method was used to extract 158 medical professionals out of 204 medical professionals from Department of Orthopedics, West China Hospital of Sichuan University. The questionnaire included the general information and basic situation of DVT learning, the knowledge of DVT, intervention attitude and implementation of preventive measures. The survey involved orthopedic doctors, nurses, rehabilitation therapists and nutrition managers. Results A total of 158 questionnaires were distributed and 150 valid questionnaires were completed. The effective questionnaire recovery rate was 94.9%. The mean score of basic knowledge of DVT was 6.45±1.83, the mean score of risk factors was 13.29±3.38, the mean score of intervention attitudes was 9.57±0.78, and the mean score of prevention implementation was 23.33±5.85. Conclusions The knowledge-practice of DVT intervention in orthopedic medical staff is moderate, and the attitude of DVT intervention is better among medical staff. There are various characteristics and weaknesses in knowledge-practice. It is necessary to regularly carry out knowledge about DVT among medical staff to improve the professional level of medical staff to prevent and treat DVT.
Objective To systematically review the health utility scores for patients with breast cancer in China. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were searched from inception to November, 2016 to collect studies for health utility scores for breast cancer in China. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was performed using Stata 12.0 software. Results A total of 6 studies were included. Compared with modeling studies, the range of utility scores from cross-sectional studies was narrower. The results of meta-analysis showed the utility scores for breast cancer were 0.77 (95%CI 0.67 to 0.87), 0.77 (95%CI 0.68 to 0.86) at stage 0 to Ⅰ, 0.76 (95%CI 0.66 to 0.85) at stage Ⅱ, 0.74 (95%CI 0.65 to 0.83) at stage Ⅲ and 0.73 (95%CI 0.65 to 0.81) at stage Ⅳ, respectively. Meanwhile, we descripted the median of utility scores of all studies, and the corresponding values were 0.81 (range 0.65 to 0.83), 0.82 (range 0.65 to 1.00) at stage 0, 0.82 (range 0.65 to 0.90) at stage Ⅰ, 0.77 (range 0.67 to 0.86) at stage Ⅱ, 0.70 (range 0.64 to 0.82) at stage Ⅲ and 0.70 (range 0.30 to 0.80) at stage Ⅳ, respectively. Conclusion Research on the health utility scores of breast cancer is still limited in China. Utility scores are decreasing among different clinical stages, with lowest score at late stage cancer. These findings can be used in further cost-utility evaluation on various breast cancer interventions.
ObjectivesTo systematically review the health utility scores and disability weights of liver cancer and related diseases in China.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were electronically searched to collect the studies of health utility scores and disability weights of liver cancer and related diseases in China from inception to November, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 9 studies were included which covered 10 related diseases, among which chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and liver cancer were the mostly reported. The overall quality was adequate, and EQ-5D was the most common tool in these studies. Results of meta-analysis showed that healthy utility scores of the four common diseases were 0.789 (0.735, 0.843), 0.734 (0.693, 0.776), 0.647 (0.627, 0.666) and 0.636 (0.508, 0.765), respectively. Measures from EQ-5D were 0.825 (0.762, 0.868), 0.761 (0.731, 0.791), 0.643 (0.620, 0.666) and 0.620 (0.473, 0.766), respectively. In addition, the corresponding median (range) utility scores of the four diseases were found to be 0.758 (0.520–0.950), 0.716 (0.570–0.900), 0.538 (0.260–0.662) and 0.541(0.310–0.720). Only one disability weight study was concluded (0.360–0.900 reported for liver cancer).ConclusionIn Chinese population, current evidences on health utility of liver cancer and related diseases are limited, particularly data on disability weights. Utility values from meta-analysis seems more optimistic and centralized than those from descriptive analysis. Different survey tools yield varying outcomes, and attentions should be addressed to their application. The decrease of heath utility scores with the severity of liver disease suggests that early prevention, early diagnosis and treatment can save more years of life with enhanced quality.
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.
ObjectivesTo estimate the latest burden of disability adjusted life years (DALYs) for liver cancer in China and the long-term trend, and to make future prediction.MethodsBased on the visualization platform of Global Burden of Disease 2016, data on the DALYs for liver cancer in China was extracted. The very recent status in 2016 and the previous trend from 1990 to 2016 were described, using annualized rate of change (ARC). The burden from 2017 to 2050 was further predicted by combining the ARC and the Chinese population data projected by the United Nation.ResultsIn 2016, the total DALYs for liver cancer in China was estimated as 11 539 000 person years (accounting for 54.6% of the global burden), and years of life lost (YLLs) and years lived with disability (YLDs) contributed 98.9% and 1.1%, respectively. The age-standardized DALY rate was 844.1 per 100 000 (3.0 times of the global average) and the male-to-female ratio was 3.4. The DALY rate continuously increased from 1990–2016 (ARC=0.57%), particularly in recent 5 years (ARC=1.75%). Among the DALYs for all cancers, liver cancer contributed approximately 20% and constantly remained as the top 2 (ranking as the number one before year 2005). There were inverse trends in gender, with increasing in males and decreasing in females (ARC was 0.77% and –0.11%, respectively). Hepatitis B infection continually kept the leading cause of DALYs for liver cancer (accounting for nearly 57%), and the DALY rate was gradually increasing (ARC=0.43%). Although the peak age of DALY rate was stable at 65to 69 years, the peak age of the DALYs changed from 55 to 59 years in 1990 to 60 ~ 64 years in 2016. In 2050, the estimated DALYs for liver cancer in China will reach 14.37 million person years, 20.0% more than that in 2017.ConclusionsThe DALYs caused by liver cancer in China exceeds the overall burden of all other countries in the world, and accounts for 1/5 of DALYs for all cancers in local population. The burden in males has been continuously rising, and the leading cause remained unchanged as hepatitis B infection. With population aging, the DALYs for liver cancer in China will be incessant to increase, suggesting the necessity to implement continuous effort in risk factors prevention (e.g. hepatitis B infection), and efficient management in high risk population of liver cancer.