Background Structured triglyceride (STG) is an emulsion synthesized from long and medium-chain triglycerides. It is a widely accepted lipid component of clinical parenteral nutrition treatment. However, conflict evidence observed for its safety and efficacy with the abdominal surgery patients. Objective We conducted a systematic review and network meta-analysis to systematically summarize the evidence for STG emulsions compared with physically mixed medium-chain/long-chain triglycerides (MCT/LCT) or long-chain triglycerides (LCT) in short-term abdominal surgery parenteral nutrition treatment. Methods We conducted a systematic search of PubMed, Cochrane Library, Web of Science, EMBASE and China National Knowledge Infrastructure (CNKI) to identify qualified studies published in English or Chinese. The search period ranged from the inception of each database to Oct 21, 2024. Eligible studies included trials of hospitalized patients aged 18 or older required parenteral nutrition therapy during short-term hospitalization following abdominal surgery, comparing STG with physically mixed MCT/LCT or LCT. Two independent reviewers extracted data via standardized methods and assessed the risk of bias using the Jadad score. Publication bias was evaluated via funnel plots and Egger's test. Results A total of 34 randomized controlled trials and controlled clinical trials involving 2154 participants were included. These studies showed high level of accountability, as demonstrated by a Jadad score of 3.29 out of 3.5. Significant heterogeneity was detected in studies reporting aspartate aminotransferase (AST), alanine aminotransferase, and triglyceride (TG) levels. The meta-analysis revealed better performance of STG in higher prealbumin (PA) levels weighted mean difference [WMD]: 1.49; 95 % confidence interval [CI]: 0.56 to 2.43), lower AST (WMD: − 12.49; 95 % CI: − 22.58 to − 2.40) and TG (WMD: − 0.30; 95 % CI: − 0.42 to − 0.18) levels compared to physically mixed MCT/LCT or LCT, but no significant difference for other factors. Conclusion This analysis demonstrated that STG has more positive effects for the patient nutritional level and lower level of liver harm, whereas MCT/LCT outperformed LCT in reducing AST levels as well. These findings suggest that STG is at least as safe and effective for hospitalized patients undergoing abdominal surgery, especially patients with hepatic insufficiency, as other lipids. However, further research is needed to confirm its advantages for each subgroup.

Discrete choice experiments (DCEs) are increasingly used in health preference elicitation studies. However, few studies have explored applying a DCE to value long health and wellbeing measures. This study evaluates feasibility, examines the impact of attribute ordering and explores if similar preference exists between countries. A health and wellbeing classification system was derived from the EQ Health and Wellbeing (EQ-HWB) measure based on dimensionality, item performance, stakeholder preference and cultural feasibility. Representative samples of UK and Australian general population completed 13 DCETTO tasks. Feasibility was assessed using data quality, time spent on the survey and each task, logical consistency and respondent understanding. Data were modelled using conditional logit model, to evaluate feasibility and impact of attribute ordering (health or other attributes ordered first). The UK and Australian value sets were compared on key characteristics, such as the relative importance of attributes, value set length and distribution. 2489 UK and Australian general public respondents completed the online DCETTO survey. Participants reported good understanding of the DCETTO questions and the attributes. Most of the more severe dimension levels had increasing disutility, with a higher proportion of insignificance observed with the wellbeing attributes. Physical health attributes had larger disutility than other attributes, with anchored utility values ranging from − 0.791 to − 0.588 to 1 for UK and Australian population. The preference between the two countries differed, with mixed evidence for ordering effects. DCETTO is a viable method for health and wellbeing preference valuation. However, health and wellbeing preference can be influenced by attribute ordering and national setting. The results have implications for the development of future health and wellbeing valuation studies.

Importance Innovative nuclear medicine services offer substantial clinical value to patients. However, these advancements often come with high costs. Traditional payment strategies do not incentivize medical institutes to provide new services nor determine the fair price for payers. A shift towards a value-based pricing strategy is imperative to address these challenges. Such a strategy would reconcile the cost of innovation with incentives, foster transparent allocation of healthcare resources, and expedite the accessibility of essential medical services. Objective This study aims to develop and present a comprehensive, value-based pricing model for new nuclear medicine services, illustrated explicitly through a case study of the radium [223Ra] treatment for bone metastases. In constructing the pricing model, we have considered three primary value determinants: the cost of the new service, associated service risk, and the difficulty of the service provision. Our research can help healthcare leaders design an evidence-based Fee-For-Service (FFS) payment reference pricing with nuclear medicine services and price adjustments. Design, setting and participants This multi-center study was conducted from March 2021 to February 2022 (including consultation meetings) and employed both qualitative and quantitative methodologies. We organized focus group consultations with physicians from nuclear medicine departments in Beijing, Chongqing, Guangzhou, and Shanghai to standardize the treatment process for radium [223Ra] bone metastases. We used a specially designed 'Radium Nuclide [223Ra] Bone Metastasis Data Collection Form' to gather nationwide resource consumption data to extract information from local databases. Four interviews with groups of experts were conducted to determine the add-up ratio, based on service risk and difficulty. The study organized consultation meeting with key stakeholders, including policymakers, service providers, clinical researchers, and health economists, to finalize the pricing equation and the pricing result of radium [223Ra] bone metastases service. Main outcomes and measures We developed and detailed a pricing equation tailored for innovative services in the nuclear medicine department, illustrating its application through a step-by-step guide. A standardized service process was established to ensure consistency and accuracy. Adhering to best practice guidelines for health cost data analysis, we emphasized the importance of cross-validation of data, where validated data demonstrated less variation. However, it required a more advanced health information system to manage and analyze the data inputs effectively. Results The standardized service of radium [223Ra] bone metastases includes: pre-injection assessment, treatment plan, administration, post-administration monitoring, waste disposal and monitoring. The average duration for each stage is 104 min, 39 min, 25 min, 72 min and 56 min. A standardized monetary value for medical consumables is 54.94 yuan ($7.6), and the standardised monetary value (medical consumables cost plus human input) is 763.68 yuan ($109.9). Applying an agreed value add-up ratio of 1.065, the standardized value is 810.19 yuan ($116.9). Feedback from a consultation meeting with policymakers and health economics researchers indicates a consensus that the pricing equation developed was reasonable and well-grounded. Conclusion This research is the first study in the field of nuclear medicine department pricing methodology. We introduce a comprehensive value-based nuclear medical service pricing method and use radium[223Ra] bone metastases treatment pricing in China as a case study. This study establishes a novel pricing framework and provides practical instructions on its implementation in a real-world healthcare setting.

This study aimed to assess the cost-utility of romiplostim (ROMI) compared to eltrombopag (EPAG) as a second-line treatment for chronic primary immune thrombocytopenia (cITP) in Chinese adults. A decision tree-embedded Markov model with a lifetime horizon was used to estimate the quality-adjusted life years (QALYs) and costs for ROMI versus EPAG from the perspective of the Chinese health care system. The model was driven by platelet response with a 4-week cycle. Both QALYs and costs were discounted 5% per year. Clinical data comparing ROMI and EPAG were obtained by matching-adjusted indirect comparison (MAIC), utilizing individual patient data on ROMI and published Chinese Phase III trial data on EPAG. Costs were reported in 2022 US dollars and included drug acquisition costs, monitoring costs, bleeding-related costs, and costs associated with adverse events. Deterministic and probabilistic sensitivity analyses were performed. The CEA model indicated that treatment with ROMI resulted in an average of $4,344.4 higher costs for 0.004 QALYs. One-way sensitivity analysis (OSA) indicated that the model was most sensitive to the high bleeding rate in response (Markov stage) for EPAG and ROMI. Probabilistic sensitivity analysis (PSA) indicated that ROMI was likely to be cost effective in 0.16% cases at a willingness-to-pay threshold of $12039.1 (China per capita GDP in 2022) per QALY. If the price of ROMI is either lower than or equal to that of EPAG, ROMI could likely be considered cost-effective as a second-line treatment for Chinese adults with cITP.

BackgroundVaccination can be viewed as comprising the most important defensive barriers to protect susceptible groups from infection. However, vaccine hesitancy for COVID-19 is widespread worldwide. ObjectiveWe aimed to systematically review studies eliciting the COVID-19 vaccine preference using discrete choice experiments. MethodsA literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments, COVID-19, and vaccines and related synonyms. Descriptive statistics were used to summarize the study characteristics. Subgroup analyses were performed by factors such as high-income countries and low- and middle-income countries and study period (before, during, and after the pandemic wave). Quality appraisal was performed using the 5-item Purpose, Respondents, Explanation, Findings, and Significance checklist. ResultsThe search yield a total of 623 records, and 47 studies with 53 data points were finally included. Attributes were grouped into 4 categories: outcome, process, cost, and others. The vaccine effectiveness (21/53, 40%) and safety (7/53, 13%) were the most frequently reported and important attributes. Subgroup analyses showed that vaccine effectiveness was the most important attribute, although the preference varied by subgroups. Compared to high-income countries (3/29, 10%), a higher proportion of low- and middle-income countries (4/24, 17%) prioritized safety. As the pandemic progressed, the duration of protection (2/24, 8%) during the pandemic wave and COVID-19 mortality risk (5/25, 20%) after the pandemic wave emerged as 2 of the most important attributes. ConclusionsOur review revealed the critical role of vaccine effectiveness and safety in COVID-19 vaccine preference. However, it should be noticed that preference heterogeneity was observed across subpopulations and may change over time. Trial RegistrationPROSPERO CRD42023422720; https://tinyurl.com/2etf7ny7

目的 基于史密斯政策执行过程模型的国家医保药品目录准入谈判(以下简称"国谈")罕见病药品落地的关键和难点,探索罕见病药品在进入国家基本医疗保险和工伤保险药品目录后政策实施过程中存在的问题并提出对策建议.方法 通过文献复习和政策梳理、专家访谈、焦点小组访谈收集资料,结合史密斯政策执行过程模型的理论框架从多角度探索国谈罕见病药品政策执行情况的现状、问题以及解决方案.结果 目前我国罕见病药品行业管理尚处于初级阶段;医疗服务提供方在意识、管理等方面仍存在不足;罕见病药品保障渠道有待优化,医疗保险支付机制尚不完善.结论 建议进一步加强行业管理,提升罕见病用药保障;加强医疗服务提供方能力建设,取消罕见病用药考核限制;畅通罕见病用药保障渠道,完善医疗保险支付机制.

质量调整生命年(Quality-Adjusted Life Year,QALY)被广泛应用于卫生经济学和药物经济学研究的各个方面,是衡量健康产出的重要指标.近年来,其内涵也随着QALY相关研究的深入而不断迭代发展.目前,还未有中文研究对近年来QALY内涵变化的最新进展进行系统性梳理.基于过往文献和研究实践,梳理QALY内涵的变化,并将其归纳为QA- LY定义扩展和赋权QALY的进展和影响.QALY定义扩展主要包括主流量表对健康相关QALY定义的再丰富和对幸福感的补充,对幸福感QALY来源进行回溯,分析QALY定义扩展与传统QALY对比的优势;在赋权QALY上,总结赋权QALY的定义、测量方法和优势.同时,讨论了QALY内涵变化对于效用积分体系构建的影响.建议未来应重视QALY内涵的变化和发展,积极探索具有中国特色的QALY内涵,运用实证研究分析QALY内涵变化带给卫生决策一致性和合理性的影响.

目的:对已发表的罗普司亭治疗成人原发免疫性血小板减少症(ITP)的经济学评价进行系统综述.方法:通过检索3个中文数据库(中国知网、万方数据库、维普数据库)、3个英文数据库(PubMed、Embase、Web of Science)并进行文献筛选、资料提取和信息汇总,按照卫生经济研究质量评价工具(QHES)对文献质量进行评价.结果:共纳入6篇文献,且研究质量较好.其中一半从卫生体系视角出发,一半从医保支付方视角出发.大部分研究采用Markov模型模拟的成本-效用分析(CUA)方法,也有研究基于决策树的CUA、成本-效果分析、最小成本分析、成本-结果模型等方法开展评价.模型状态设置主要由血小板反应驱动,模拟周期均为4周,关注的结局指标涉及反应率、出血、不良反应、生命年(LY)、质量调整生命年(QALY)、增量成本-效果比(ICER).有2篇研究认为,与艾曲泊帕相比,罗普司亭治疗成人ITP具有成本-效果优势.结论:罗普司亭用于治疗成人ITP的经济性价值有待进一步探讨,罗普司亭用于治疗我国成人ITP需要高质量的本土经济学评价以提供决策依据.

Background: In light of the limited availability of healthcare resources, providing universal access to healthcare is a challenging task. As a result, prioritizing healthcare services has emerged as a crucial issue. This study aims to explore the preferences of the public regarding healthcare prioritization for rare and common diseases. By examining public attitudes, this study seeks to inform government decisions concerning resource allocation and distribution within healthcare.Methods: "Social preference" and "rare disease" were searched as MeSH terms in the electronic databases of Ovid Medline, Web of Science, Embase, and Econlit for articles published since their establishment, and the information on the characteristics of the articles and the results of social preferences for rare diseases were analyzed and summarized.Results: The public held predominantly neutral views on the setting of healthcare priorities for rare and common diseases. The results of the included studies showed that with all else being equal, no social preference for rarity was found, but when the public considered the proportional advantage of rare diseases or when the respondents were young, a social preference for rarity existed. In addition, the public weighed attributes such as the health benefits of treatments, the effectiveness of treatment options, the safety of treatment, equity, unmet needs, and disease severity in the process of setting of treatment priorities for rare diseases. Furthermore, in consideration of equity, the public showed a willingness to pay for rare diseases in spite of the high medical costs.Conclusion: International studies on social preferences provide some evidence for the setting of healthcare priorities for rare diseases, and health policymakers should consider social preferences in an integrated manner in order to set healthcare priorities appropriately.

BACKGROUND:Discrete choice experiments (DCEs) are increasingly used in health state valuation studies.OBJECTIVE:This systematic review updates the progress and new findings of DCE studies in the health state valuation, covering the period since the review of June 2018 to November 2022. The review reports the methods that are currently being used in DCE studies to value health and study design characteristics, and, for the first time, reviews DCE health state valuation studies published in the Chinese language.METHODS:English language databases PubMed and Cochrane, and Chinese language databases Wanfang and CNKI were searched using the self-developed search terms. Health state valuation or methodology study papers were included if the study used DCE data to generate a value set for a preference-based measure. Key information extracted included DCE study design strategies applied, methods for anchoring the latent coefficient on to a 0-1 QALY scale and data analysis methods.RESULTS:Sixty-five studies were included; one Chinese language publication and 64 English language publications. The number of health state valuation studies using DCE has rapidly increased in recent years and these have been conducted in more countries than prior to 2018. Wide usage of DCE with duration attributes, D-efficient design and models accounting for heterogeneity has continued in recent years. Although more methodological consensus has been found than in studies conducted prior to 2018, this consensus may be driven by valuation studies for common measures with an international protocol (the 'model' valuation research). Valuing long measures with well-being attributes attracted attention and more realistic design strategies (e.g., inconstant time preference, efficient design and implausible states design) were identified. However, more qualitative and quantitative methodology study is still necessary to evaluate the effect of those new methods.CONCLUSIONS:The use of DCEs in health state valuation continues to grow dramatically and the methodology progress makes the method more reliable and pragmatic. However, study design is driven by international protocols and method selection is not always justified. There is no gold standard for DCE design, presentation format or anchoring method. More qualitative and quantitative methodology study is recommended to evaluate the effect of new methods before researchers make methodology decisions.

目的:分析与传统基因检测技术相比,二代测序法用于非小细胞肺癌突变基因检测的经济性.方法:对国际二代测序法用于非小细胞肺癌的经济学评价进行系统综述.从卫生体系视角出发,构建决策树模型,测算二代测序法(8基因突变联合检测)对比荧光实时定量PCR法(3基因突变联合检测)的成本-效果,并进行敏感性分析.结果:纳入4篇研究,其中2篇研究认为与传统基因检测技术相比,二代测序法用于非小细胞肺癌的突变基因检测具有一定的经济性,但仍需要结合具体情况进一步研究.模型研究结果表明,对比荧光实时定量PCR法(3基因突变联合检测),采用二代测序法(8基因突变联合检测),非小细胞肺癌患者多存活1年所需要增加的诊断成本为97 501.18元,以3倍人均GDP为阈值时,具有成本-效果.结论:二代测序法用于非小细胞肺癌突变基因检测具有一定经济性,但未来仍需要更新数据和结果.

介绍了关于医用耗材的定义、市场和医保准入以及医保支付的核心机制,并总结其特点.基于我国目前医用耗材改革现状与基本做法分析现存难点与问题,提出有针对性的建议:(1)医用耗材支付改革按通用名管理,(2)前置统一的产品安全、质量标准,(3)分类设置新医用耗材市场准入和医保准入途径,(4)建立以卫生技术评估为基础的医保准入体系.

Objective:Shanghai is one of the pioneers proposing family doctor contract service (FDCS). However, there is no quantitative research focusing on the Shanghai experience from a demand-side perspective. This study investigated Shanghai chronic patients' relative preferences for FDCS using a discrete choice experiment method.Methods:A face-to-face discrete choice experiment (DCE) was performed to elicit the preference with 300 samples. Attributes and levels were extracted from the literature review and focus group consultation with patients. Seven attributes, follow-up frequency, medicine accessibility, family doctor competency, health management, referral convenience, appointment flexibility, and shared decision-making, were decided. Three levels were attached to each attribute. A mixed logit model was used to evaluate the multiple-choice data.Results:A total of 248 patients completed the survey. Patient valued FDCS medicine accessibility (β=0.57, P < 0.05), and high family doctor competency (β= 0.43, P < 0.05), regular health management activities (β=0.36, P < 0.05), high follow-up frequency (β=0.31, P < 0.05) the most. The good doctor-patient shared decision-making atmosphere (β=0.12, P < 0.05), high referral convenience (β=0.06, P < 0.05) and high appointment flexibility (β=0.04, P < 0.05) are valued as less important. No significant preference heterogeneity was identified for patients with different sociodemographic characteristics. Respondents reported other FDCS needs, including online health consultation, specialist services in local institutes, higher reimbursement rates, free rehabilitation guidance for the disabled and personal health management.Conclusion:This research is the first discrete choice experiment FDCS preference research targeting on Chinese urban population. The results suggested that to increase the quality of FDCS, policy-makers should prioritize follow-up frequency, medicine accessibility, family doctor competency and health management. The service package should consider a higher reimbursement rate and rehabilitation guidance for the disabled if extra health-care resources available. Future FDCS policy should consider stated societal preference and be congruent with it.

目的:分析目前我国健康医疗大数据发展的政策环境,并为我国健康行业决策制定和完善提供理论依据,为我国健康医疗大数据行业高质量发展提供方向指引.方法:以我国国家层面出台的与健康医疗大数据相关的政策为研究对象,采用文本挖掘的方法遴选出政策文本中的高频词,结合专家访谈结果构建PMC指数模型,对我国健康医疗大数据的相关政策进行量化评价.结果:PMC指数模型结果表明,我国9项健康医疗大数据政策PMC指数的平均值为4.72,其中2项政策表现良好,7项政策表现及格;国家层面健康医疗大数据政策整体质量良好,但仍有较大提升空间.结论:我国健康医疗大数据管理政策基本完善,政策在性质与功能上较为明确,本文着重从政策内容、激励约束和生命周期三方面进行具体分析并提出改进建议.

目的 对国内外发表的关于"互联网+"医疗服务项目的定价及支付准入的文献进行系统综述,为我国"互联网+"医疗服务项目的定价及支付提供依据.方法 计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据、中国生物医学文献数据库,搜集"互联网+"医疗服务项目定价及支付准入相关文献资料,检索时限为建库至2020年11月30日.由2名研究者独立筛选文献、提取资料,进行描述分析.结果 共纳入16项研究."互联网+"定价项目类型包括实时、电话及影像咨询等3种形式.项目涉及诊断、治疗、监测等多种服务及多个学科.支付定价的关键要素包括时间、服务形式、服务强度、应用场景、服务区域及专科类型等,线上医师技术劳务支付标准与线下基本相同.结论 我国"互联网+"项目仍需进一步拓展,需要进一步细化定价分层颗粒度,探索创新支付方式,以促进"互联网+"医疗服务的发展.

卫生技术评估(HTA)已广泛应用于发达国家耗材技术的评审、目录准入和报销政策制定.本研究重点介绍了英国和澳大利亚两国将卫生技术评估应用于耗材准入和支付的流程和经验,为我国医疗保障部门下一步将卫生技术评估应用于耗材管理、出台相关政策文件提供依据.

基于价值的医疗服务供给是世界范围内的热点议题.通过系统梳理价值医疗内涵,分析价值重塑下我国卫生技术评估面临的挑战,提出建立科学的HTA运作机制,加强HTA筹资及服务购买机制建设,制定HTA方法指南、加强HTA相关数据库建设等建议,旨在为我国卫生事业高质量发展提供参考.

诊断技术评估有助于充分了解新技术价值,进一步优化临床资源配置.在梳理层次分析和决策理论、逐步评估理论、多准则决策分析理论、检测-治疗价值评估理论四大主要诊断技术评估方法的基础上,以两种急诊肝性脑病血氨诊断方法的评估为例,阐述了检测-治疗价值评估理论模型的应用价值.建议研究者基于具体问题选择适合的评估模型,政策决策者制定诊断产品的HTA指南,助推我国诊断技术HTA的标准化发展.

高值医用耗材价值评估能够为高性价比的医疗服务提供证据.文章在系统梳理英国、澳大利亚、韩国医用耗材价值评估框架基础上,采用专家咨询法建立高值医用耗材价值评估框架,包括需求评估、技术特性评估、临床获益评估、学习曲线评估、经济性评估和社会影响评估等6个维度,以期为高值医用耗材的评估和准入提供参考.