The Effectiveness of Health Screening

Using a matched insurant–general practitioner panel data set, we estimate the effect of a general health‐screening program on individuals' health status and health‐care cost. To account for selection into treatment, we use regional variation in the intensity of exposure to supply‐determined screening recommendations as an instrumental variable. We find that screening participation increases inpatient and outpatient health‐care costs up to 2 years after treatment substantially. In the medium run, we find cost savings in the outpatient sector, whereas in the long run, no statistically significant effects of screening on either health‐care cost component can be discerned. In sum, screening participation increases health‐care cost. Given that we do not find any statistically significant effect of screening participation on insurants' health status (at any point in time), we do not recommend a general health‐screening program. However, given that we find some evidence for cost‐saving potential for the sub‐sample of younger insurants, we suggest more targeted screening programs. Copyright © 2014 John Wiley & Sons, Ltd.     

Universal Public Finance of Tuberculosis Treatment in India: An Extended Cost‐Effectiveness Analysis

Universal public finance (UPF)—government financing of an intervention irrespective of who is receiving it—for a health intervention entails consequences in multiple domains. First, UPF increases intervention uptake and hence the extent of consequent health gains. Second, UPF generates financial consequences including the crowding out of private expenditures. Finally, UPF provides insurance either by covering catastrophic expenditures, which would otherwise throw households into poverty or by preventing diseases that cause them. This paper develops a method—extended cost‐effectiveness analysis (ECEA)—for evaluating the consequences of UPF in each of these domains. It then illustrates ECEA with an evaluation of UPF for tuberculosis treatment in India. Using plausible values for key parameters, our base case ECEA concludes that the health gains and insurance value of UPF would accrue primarily to the poor. Reductions in out‐of‐pocket expenditures are more uniformly distributed across income quintiles. A variant on our base case suggests that lowering costs of borrowing for the poor could potentially achieve some of the health gains of UPF, but at the cost of leaving the poor more deeply in debt. © 2014 The Authors. Health Economics published by John Wiley Ltd.     

系统仿真技术在医疗成本控制中的应用

目的探讨将系统仿真技术应用于医疗成本分析的方法。方法对无锡某医院妇科微波治疗室的工作流程进行调查,运用Med Model专业软件建立该治疗室现有工作流程的仿真模型,分析该治疗室医疗成本构成的特点,并在此基础上提出治疗室发展计划,进一步仿真模拟3种成本改进方案。结果在现行的资源分配模式下,微波治疗仪是医疗成本的最大构成部分,其次是护士成本,床位成本和床位消毒费均为相对不重要成本。改进方案通过增加患者收容、优化医疗成本构成,能有效降低人均医疗成本费用。结论运用系统仿真技术进行基于流程的医疗成本分析,能够更加精确地计算医院成本,并为管理者的决策制定提供可靠依据。     

Predicting full thickness skin sensitization using a support vector machine

To assess the public’s propensity for allergic contact dermatitis (ACD), many alternatives to in vivo chemical screening have been developed which generally incorporate a small panel of cell surface and secreted dendritic cell biomarkers. However, given the underlying complexity of ACD, one cell type and limited cellular metrics may be insufficient to predict contact sensitizers accurately. To identify a molecular signature that can further characterize sensitization, we developed a novel system using RealSkin, a full thickness skin equivalent, in co-culture with MUTZ-3 derived Langerhan’s cells. This system was used to distinguish a model moderate pro-hapten isoeugenol (IE) and a model strong pre-hapten p-phenylenediamine (PPD) from irritant, salicylic acid (SA). Commonly evaluated metrics such as CD86, CD54, and IL-8 secretion were assessed, in concert with a 27-cytokine multi-plex screen and a functional chemotaxis assay. Data were analyzed with feature selection methods using ANOVA, hierarchical cluster analysis, and a support vector machine to identify the best molecular signature for sensitization. A panel consisting of IL-12, IL-9, VEGF, and IFN-γ predicted sensitization with over 90% accuracy using this co-culture system analysis. Thus, a multi-metric approach that has the potential to identify a molecular signature may be more predictive of contact sensitization.     

广西药品经营企业实施新版GSP的思考

目的：结合广西壮族自治区新版GSP实施过程中存在的困难,提出对策建议,保障新版GSP的顺利实施。方法：基于广西壮族自治区GSP的实施现状,采用新旧版GSP认证对比分析等方法开展研究。结果与结论：新版GSP实施面临着人员、资金与成本等问题。应加强培训,强化监督,给予适当的政策扶持,确保新版GSP的实施。     

2011—2013年中山市人民医院口服降糖药应用分析

目的:了解中山市人民医院(以下简称"我院")口服降糖药的应用情况,为临床口服降糖药的合理应用提供参考。方法:采用世界卫生组织推荐的限定日剂量法,对2011—2013年我院口服降糖药的应用情况进行回顾性分析。结果:2011—2013年我院口服降糖药的销售金额呈逐年递增趋势(从2011年的519万元增至2013年的1 126万元),其占药品销售总金额的比例也逐年上升(从2011年的0.90%上升至2013年的1.46%)。各类口服降糖药的销售金额、用药频度均逐年增加,磺酰脲类促胰岛素分泌剂为临床常用品种,其DDDs排序稳居首位。二甲双胍片的用药频度排序逐年上升;阿卡波糖片在2012—2013年连续2年销售金额排序居第1位;新引进的西格列汀片销售金额和用药频度的同步性较好。结论:2011—2013年我院口服降糖药中,α-葡萄糖苷酶抑制剂和磺酰脲类促胰岛素分泌剂占主导地位,我院口服降糖药的应用基本合理。     

2013年乌鲁木齐地区部分CT机工作场所周围剂量当量率及质量控制检测

目的 了解2013年乌鲁木齐地区部分医疗机构CT机工作场所周围剂量水平,并进行质量控制检测,为放射防护工作提供科学依据.方法 对乌鲁木齐地区31台CT机进行质量控制检测,对CT机工作场所进行周围剂量当量率检测.结果 31台CT机工作场所周围剂量当量率检测合格率为96.77％,周围剂量当量率检测结果值为(0.19±0.17) μGy/h.质量控制检测合格率为93.55％,CTDIW的离散性最大,其后依次为重建层厚偏差、CT值(水)、均匀性、高对比分辨力、低对比可探测能力、定位光精度、噪声.结论 所监测的31台CT机质量性能符合国家标准要求,影像质量符合临床诊断需求,CT机工作场所的屏蔽效果满足防护要求.     

An economic model of haemophilia in Mexico

A model was developed to assess the lifetime costs and outcomes associated with haemophilia in Mexico. A retrospective chart review of 182 type A haemophiliacs was conducted for patients aged 0-34 years receiving one of three treatments: (i) cryoprecipitate at clinic; (ii) concentrate at home; or (iii) concentrate at clinic. Patients treated at home experienced 30% less joint damage, used 13-54% less factor VIII, had four times fewer clinic visits, and utilized half as many hospital days than those treated at a clinic. For cryoprecipitate at clinic patients, the annual incidence rates of HCV and HIV were calculated to be 3.6% and 1.4% respectively. The life expectancy for patients receiving cryoprecipitate and those receiving concentrate was estimated to be 49 years and 69 years respectively, with 58% of cryoprecipitate patients predicted to die of AIDS before age 69. Across the lifespan, the average annual cost of care was US$11,677 (MN$110,464) for cryoprecipitate at clinic patients, US$10,104 (M$95,580) for concentrate at home patients and US$18,819 (MN$178,027) for concentrate at clinic patients. Using a 5% discount rate, the incremental lifetime cost per year of life added for treatment with concentrate at home compared with cryoprecipitate at a clinic was US$738 (MN$6981). Rank order stability analysis demonstrated that the model was most sensitive to the cost of fVIII. These results indicate that treatment with concentrate at home compared with cryoprecipitate at a clinic substantially improves clinical outcomes at reduced annual cost levels.     

The impact of symptom severity on the cost of Alzheimer's disease

OBJECTIVES: ITo examine the economic impact of Alzheimer's disease (AD) as the disease progresses on patients' medical costs and caregivers' productivity. DESIGN: A 12-page, self-administered mail survey, fielded in November 1999. SETTING: Households with AD caregivers, selected from a nationwide (U.S.) consumer database. PARTICIPANTS: One thousand seven hundred fifteen caregivers of noninstitutionalized AD patients. MEASUREMENTS: Disease progression was measured using a scale of symptom frequency and measures of instrumental and physical functioning. Cost components included hospital days, physician visits, and emergency room visits. Lost productivity was assessed using hours per week that caregivers provided care and the number of days that they missed from work because of caregiving. RESULTS: The direct costs of caring for AD patients for 6 months totaled $3,129, whereas the indirect costs were $26,080. Patients with more-frequent symptoms used all healthcare resources, including the hospital, emergency room, and physicians, more often than those with less-frequent symptoms. Those with lower levels of physical and instrumental functioning also used the hospital and physicians more often than those with higher levels of physical and instrumental functioning. Caregivers of these more severely impaired patients spent more hours providing care and reported missing more work than those caring for higher-functioning patients. These relationships remained after controlling for potentially confounding factors. CONCLUSIONS: This large study of patients at all stages of AD shows that the direct and indirect costs of AD are considerably lower for patients with fewer symptoms. Longitudinal studies will determine the impact on the overall cost of care of interventions that reduce symptoms and maintain patients at earlier stages of the disease.     

Cost-sparing effect of twice-weekly targeted endurance training in type 2 diabetics: a one-year controlled randomized trial

OBJECTIVE: We evaluated the effects of targeted, moderate endurance training on healthcare cost, body composition and fitness in type 2 diabetes patients routinely followed within the French healthcare system. DESIGN AND METHODS: A total of 25 type 2 diabetic patients was randomly assigned to one of two groups: 13 underwent a training programme (eight sessions, followed by training twice a week for 30-45 minutes at home at the level of the ventilatory threshold [V(T)]); and 12 received their usual routine treatment. Both groups were followed for one year to evaluate healthcare costs, exercise effectiveness and a six-minute walking test. RESULTS: The training prevented loss of maximum aerobic capacity, which decreased slightly in the untrained group (P=0.014), and resulted in a higher maximum power output (P=0.041) and six-minute walking distance (P=0.020). The Voorrips activity score correlated with both V(O2max) (r=0.422, P<0.05) and six-minute walking distance (r=0.446, P<0.05). Changes in V(O2max) were negatively correlated with changes in body weight (r=0.608, P<0.01). Training decreased the insulin-resistance index (HOMA-IR) by 26% (P<0.05). Changes in percentages of fat were correlated to changes in waist circumference (r=0.436, P<0.05). The total healthcare cost was reduced by 50% in the trained group (euro 1.65+/-1 per day versus euro 3.00+/-1.47 per day in the untrained group; P<0.02) due to fewer hospitalizations (P=0.05) and less use of sulphonylureas (P<0.05). CONCLUSION: Endurance training at V(T) level prevented the decline in aerobic working capacity seen in untrained diabetics over the study period, and resulted in a marked reduction in healthcare costs due to less treatments and fewer hospitalizations.