A systematic review of cost-effectiveness modeling of pharmaceutical therapies in neuropathic pain: variation in practice,key challenges,and recommendations for the future

Objectives: Complexities in the neuropathic-pain care pathway make the condition difficult to manage and difficult to capture in cost-effectiveness models. The aim of this study is to understand, through a systematic review of previous cost-effectiveness studies, some of the key strengths and limitations in data and modeling practices in neuropathic pain. Thus, the aim is to guide future research and practice to improve resource allocation decisions and encourage continued investment to find novel and effective treatments for patients with neuropathic pain.

Methods: The search strategy was designed to identify peer-reviewed cost-effectiveness evaluations of non-surgical, pharmaceutical therapies for neuropathic pain published since January 2000, accessing five key databases. All identified publications were reviewed and screened according to pre-defined eligibility criteria. Data extraction was designed to reflect key data challenges and approaches to modeling in neuropathic pain and based on published guidelines.

Results: The search strategy identified 20 cost-effectiveness analyses meeting the inclusion criteria, of which 14 had original model structures. Cost-effectiveness modeling in neuropathic pain is established and increasing across multiple jurisdictions; however, amongst these studies, there is substantial variation in modeling approach, and there are common limitations. Capturing the effect of treatments upon health outcomes, particularly health-related quality-of-life, is challenging, and the health effects of multiple lines of ineffective treatment, common for patients with neuropathic pain, have not been consistently or robustly modeled.

Conclusions: To improve future economic modeling in neuropathic pain, further research is suggested into the effect of multiple lines of treatment and treatment failure upon patient outcomes and subsequent treatment effectiveness; the impact of treatment-emergent adverse events upon patient outcomes; and consistent and appropriate pain measures to inform models. The authors further encourage transparent reporting of inputs used to inform cost-effectiveness models, with robust, comprehensive and clear uncertainty analysis and, where feasible, open-source modeling is encouraged.     

替格瑞洛与氯吡格雷治疗急性冠脉综合征的药物经济学分析

目的利用模型估计方法评价中国ACS患者使用替格瑞洛与氯吡格雷相比的成本-效果。方法本研究总体研究设计、样本病例入组标准、样本病例数、临床医学中心数、参与国家数、给药方案、主要疗效和安全性指标均基于全球PLATO试验。利用PLATO试验数据和全球卫生经济学评价模型,收集本土的成本数据和外部资源数据,从短期决策树模型和长期Markov模型评价中国ACS患者使用替格瑞洛与氯吡格雷相比的成本-效果。结果基于替格瑞洛治疗ACS的长期Markov模型,与氯吡格雷治疗ACS相比,每延长1个QALY需增加的医疗费用为14094元;以2010年上海市人均GDP为标准,替格瑞洛的ICER远低于1倍人均GDP。结论从卫生服务提供者的角度考虑,在上海等经济状况较好的地区使用替格瑞洛治疗ACS具有较好的成本-效果。     

Exploring the Influence of Leisure on Adjustment: Development of the Leisure and Spinal Cord Injury Adjustment Model

While recent studies have demonstrated the significance of leisure in the initial phases of spinal cord injury (SCI) rehabilitation, the impact of leisure experience on adjustment and the dynamics of that influence have yet to be adequately clarified. Development of skills to effectively manage leisure becomes critical in the community reintegration process, especially for those who are at risk for poor social and psychological adjustment after injury. Although leisure activities may contribute to well-being among individuals with SCI, the lack of understanding of the dynamics of that influence offers little direction for selection of activity alternatives and design of leisure interventions. This study attempted to answer the following research questions: (1) Does leisure engagement influence the adjustment of individuals with SCI? (2) If leisure engagement does influence adjustment, what influence do variations in leisure activity have on the adjustment of individuals with SCI? (3) Does social support mediate the influence of leisure on adjustment of individuals with SCI? The leisure and SCI adjustment model was constructed to provide one possible explanation of the influence of leisure on the adjustment of individuals with SCI. The model proposed that: (a) leisure engagement has a direct influence on the adjustment of individuals with SCI and (b) leisure engagement has an indirect influence on adjustment to SCI through the promotion of social support. Results from structural equation modeling confirmed that the leisure and SCI adjustment model was an "acceptable" fit to data but left a sufficiently large amount of unexplained variance to suggest the need for further examination of alternative models of SCI adjustment. The use of multiple regression and bivariate correlations suggested that diversity, frequency, and intensity of leisure engagement were associated with the adjustment of individuals with SCI.     

Applying Interpretive Structural Modeling to the Planning of a Sequence of Marketing Strategies: A Case Study of the Architectural Tourism in Taiwan

Architectural tourism, the popular activity of visiting traditional buildings primarily for seeing and enjoying their architecture, offers opportunities for tourism industry. This study is focused on developing marketing strategies for architectural tourism in Taiwanese context. As a result of rapid development in Taiwan with the increasing population and higher residential density, most of the old houses in Taiwan have been replaced by the modern buildings. Despite this irreversible development, the remaining old styles can generate fresh business opportunities in the new age through adequate planning. Therefore, this study will use literature reviews and Interpretive Structural Modeling in order to determine an effective and scientific decision-making process to help develop marketing strategies for this sector. It will also be used as a reference for future researchers and as a benchmarking object for the other countries facing similar challenges.     

Learning before the storm: Modeling multiple stakeholder activities in support of crisis management,a practical case

The severe consequences of a Critical Infrastructure (CI) crisis demand continued research directed toward proactive and reactive management strategies. Despite the best efforts of governments and communities, the diversity of stakeholders, conflicting demands for resources, and a lack of trust among organizations create complexities that limit the effectiveness of the response. This paper identifies four specific problems that appear to reoccur when CIs are challenged: heterogeneity, multiple and inconsistent boundaries, resilience building and knowledge transfer and sharing. A combination of collaborative modeling and software simulation methodologies is proposed in order to identify the interrelationships among diverse stakeholders when managing the preparation for and reaction to a CI crisis. This approach allows experts to work together and share experiences through the modeling process which can lead them to a better understanding of how other organizations work and integrate different perspectives. In addition, simulation models enable domain experts to understand the consequences of certain policies in the short and long terms, thus improving the crisis managers' knowledge for future crisis situations. This paper presents a practical case of a hypothetical crisis in the CI sector and the approach used in order to deal with the four problems identified above.     

现代科学技术革命与建筑业信息化

现代科学技术革命的影响已拓展到社会的各个领域,信息化成为在建筑业激烈的竞争中提升企业竞争力的核心技术。本文首先明确了现代科学技术革命的涵义与基本特征,在对建筑业信息化简要概括的基础上,将现代科学技术革命作用于建筑业的影响进行了重点剖析,并结合《2011-2015年建筑业信息化发展纲要》,指明未来五年内国内建筑业信息化发展的重点方向。     

引入土地流转因素的新型农村社会养老保险基金预测

本文以政策外部性关联与协同效应为切入点,通过陕西省西安市新农保试点区县农民问卷调查,对引入土地流转因素的新型农村社会养老保险基金预测进行精算建模和政策仿真研究。结果表明：土地流转因素对新农保参保率、缴费率具有显著影响,基金收支呈现由盈余转向缺口、并逐年扩大的趋势,基金、制度存在双重失衡风险。通过关键制度因素的单一、组合调整结果分析对比,提出促进土地流转与新农保制度良性融合与可持续发展的对策建议。     

集群企业资源获取、吸收能力与技术创新绩效——珠三角传统产业集群中的企业研究

以珠三角传统产业集群中的企业为研究对象,从资源依赖理论出发,探索集群企业技术创新的影响因素和路径。构建了资源获取、吸收能力与技术创新绩效的概念模型,编制问卷,并使用结构方程模型对其进行检验。结果表明,企业的"软资源的获取"(信息、技术、人才)能够积极提高企业的潜在吸收能力,进而促进企业的模仿创新和率先创新。企业的"硬资源的获取"(资金)虽然可以提高企业的现实吸收能力,但对两种技术创新的作用都不显著。根据所得结论,从企业、政府、行业协会3个方面提出要构建良好的外部网络和发展环境,促进其资源获取从而提高企业的技术创新绩效。     

风景园林信息模型(LIM)技术实践探究 与应用实证

：在风景园林行业信息化发展的大趋势下，风景园林 信息模型(LIM)技术的推广和实践应用愈发重要和迫切。以 北京市通州区云景公园项目为例，结合Autodesk Civil 3D 和Revit等软件，从地形、道路与铺装场地、建构筑物、给排 水工程、植物景观，以及模型协同组织6个方面介绍公园类实 践项目中LIM模型的组织构建方法。以LIM模型中的数据信息 为核心，探索图纸类、数据类信息的获取，以及将模型作为成 果进行整体交付的方式。将建模方法与应用需求相结合，总结 LIM技术在项目全生命周期中的应用路径，并对LIM技术的发 展前景和潜在应用领域做出展望。