丘陵地区氯硝柳胺悬浮剂灭螺费用及效果分析

[目的]了解25%氯硝柳胺悬浮剂(SCN)在丘陵山区果园内灭螺效果,并进行成本-效果评价。[方法]选择宜兴市山丘地区2处有螺果园为试验现场,采用灭螺机喷洒的方法,实验组用SCN按2.0g/m2、对照组用50%氯硝柳胺乙醇胺盐可湿性粉剂(WPN)按4.0g/m2喷洒灭螺,比较两组有螺面积下降率和活螺密度下降率;以有螺面积下降率和活螺密度下降率作为评价指标进行成本-效果分析。[结果]实验组用SCN喷洒4次,灭螺后30d有螺面积下降率和活螺密度下降率均为100.0%,有螺面积和活螺密度每下降1个百分点的费用均为56.00元,分别优于对照组WPN的99.00%、92.25%和92.93元、99.73元。[结论]用SCN山区灭螺,操作方便,成本低,灭螺效果好,具有良好应用前景。     

乙型肝炎血源疫苗免疫后16～18年的长期免疫效果定群研究

目的 评价新生儿乙肝疫苗普种预防乙型肝炎病毒(HBV)感染的长期免疫效果,探讨乙肝血源疫苗免疫持久性.方法 出生队列定群研究结合横断面调查的方法,对象为1987-1989年出生并接种乙肝血源疫苗的人群,用固相放射免疫法(SPRIA)法检测HBV感染标志,结果与前期数据比较分析.结果 (1)1987-1989队列的免疫人群在免疫7年、14年、18年后的疫苗保护效果分别为89.7%,94.8%和87.8%,差别无统计学意义;保护性抗体水平分别为57.37%,32.80%,36.67%,免后14、18年的抗体保持在一致水平;(2)乙肝血源疫苗接种16～18年后,平均HBsAg阳性率为1.99%;保护性抗体水平为36.67%,总表面抗体阳性率为62.91%.结论 新生儿普种乙肝血源疫苗可有效预防HBV感染,疫苗免疫18年后保护效果稳定,不必进行人群加强免疫.     

更昔洛韦、泛昔洛韦治疗带状疱疹的成本-效果分析

目的 评价更昔洛韦注射剂与泛昔洛韦胶囊治疗带状疱疹构成本及其效果。方法 将符合带状疱疹典型临床症状的门诊患者共84例，随机分为两组，分别给予更昔洛韦注射剂与泛昔洛韦胶囊治疗，副反应评价指标按卫生部1994年不良反应制定标准。结果 更昔洛韦与泛昔洛韦的治愈率分别为86．0％和82．9％，显效率分别为100％和95．1％，但泛昔洛韦的成本效果比明显低于更昔洛韦。结论 泛昔洛韦更具有成本-效果优势。     

罗格列酮钠片治疗糖尿病成本效果分析

目的：以罗格列酮钠新药临床试验资料探索性的进行药物经济学分析。方法：药物经济学分析方法采用CEA法，且进行了敏感性分析。结果：以本研究专家假定成本计算，罗格列酮钠组治疗12周平均期望成本为527．7元，而马来酸罗格列酮组期望成本为1034．8元；罗格列酮钠治疗使糖化血红蛋白减少一个单位需成本5245元人民币。马来酸罗格列酮治疗需8225元人民币。敏感性分析结果提示当罗格列酮钠价格接近马来酸罗格列酮的价格时两药品的成本效果才相当。结论：与马来酸罗格列酮相比罗格列酮钠是糖尿病患者治疗的优选方案；本研究可为类似药物经济学研究提供方法学借鉴。     

左氧氟沙星2种给药方案治疗下呼吸道感染的成本-效果分析

目的:评价2种给药方案治疗下呼吸道感染的成本-效果。方法:67例患者随机分为A组与B组,A组采用左氧氟沙星序 贯疗法,B组采用左氧氟沙星连续静脉注射疗法,观察疗效,并进行成本-效果分析。结果:A、B组总有效率分别为91．43％、 93．75％,细菌清除率分别为87．10％、89．29％,不良反应发生率分别为2．86％、3．13％(P>0．05);成本分别为640．50元、 1 151．21元;成本-效果比分别为7．01、12．28;B组相对于A组的增量成本-效果比为220．1。结论:左氧氟沙星序贯给药方案治 疗下呼吸道感染较佳。     

Sorafenib in hepatocellular carcinoma – a post marketing evaluation

Background: Sorafenib is an orally active multikinase inhibitor licensed for the treatment of patients with unresectable hepatocellular carcinoma (HCC).

Patients and methods: The web-based registry, used for appraisal on new drugs, allows developing the observational prospective analysis of innovative drug therapies. To establish clinical impact of Sorafenib, institutional data were collected prospectively through the registry.

Results: A total of 81 patients treated with Sorafenib were reviewed (median age = 65 years) and the follow-up duration was 30 months. Every patient was checked for length of treatment, toxicity and outcomes. Based on the study sample, the median time to progression was 3 months and median overall survival was 8 months. We found 52% progressions at first evaluation and the disease control rate was 32%.

Conclusion: Our data from real life practice showed that the clinical benefit of Sorafenib in unresectable HCC was gained in selected responder patients.     

The budgetary impact of genetic testing for hereditary breast cancer for the statutory health insurance

Abstract

Objectives: Potential opportunities and challenges of predictive genetic risk classification of healthy persons are currently discussed. However, the budgetary impact of rising demand is uncertain. This project aims to evaluate budgetary consequences of predictive genetic risk classification for statutory health insurance in Germany.

Methods: A Markov model was developed in the form of a cohort simulation. It analyzes a population of female relatives of hereditary breast cancer patients. Mutation carriers are offered intensified screening, women with a BRCA1 or BRCA2 mutation can decide on prophylactic mastectomy and/or ovarectomy. The model considers the following scenarios: (a) steady demand for predictive genetic testing, and (b) rising demand. Most input parameters are based on data of the German Consortium for Hereditary Breast and Ovarian Cancer. The model contains 49 health states, starts in 2015, and runs for 10 years. Prices were evaluated from the perspective of statutory health insurance.

Results: Steady demand leads to an expenditure of €49.8 million during the 10-year period. Rising demands lead to additional expenses of €125.5 million. The model reveals the genetic analysis to be the main cost driver while cost savings in treatment costs of breast and ovarian cancer are indicated.

Conclusions: The results contribute to close the knowledge gap concerning the budgetary consequences due to genetic risk classification. A rising demand leads to additional costs especially due to costs for genetic analysis. The model indicates budget shifts with cost savings due to breast and ovarian cancer treatment in the scenario of rising demands.     

Ageing as a global public health challenge: From complexity reduction to aid effectiveness

Since 2002, ageing populations worldwide have received increasing attention by global policy-makers. However, resources committed by inter-governmental donors and US-based private foundations in support of ageing-related policies and interventions in non-Organisation for Economic Co-operation and Development (OECD) countries have remained minimal during this decade and, where mobilised, have rarely responded to actual country-level demographics and institutional capacities. We argue that this lag between issue recognition and effective resource mobilisation, while mirroring known dynamics in global agenda-setting, has also been caused by a depiction of ageing as a uniform trend across the Global South. We develop and apply a comprehensive analytical framework to assess the state of ageing dynamics at the country level and uncover substantial regional and sub-regional variation. In response, we suggest replacing complexity reduction in the interest of issue recognition with targeted support for a more nuanced research agenda and policy debate on country-specific ageing dynamics in order to inform and catalyse effective international assistance.