Economic evaluation of human urinary kallindinogenase for patients with acute ischemic stroke in China

Objectives: In China, both human urinary kallindinogenase (HUK) and 3-n-butylphthalide (NBP) are recommended for clinical use to improve cerebral blood circulation during an acute ischemic stroke (AIS). The objective was to evaluate the economic value of HUK vs NBP for patients with AIS from a Chinese payer’s perspective.

Methods: An economic evaluation based on data of patients who have been treated with either HUK (n?=?488) or NBP (n?=?885) from a prospective, phase IV, multi-center, clinical registry study (Chinese Acute Ischemic Stroke Treatment Outcome Registry, CASTOR) was conducted to analyze the cost and effectiveness of HUK vs NBP for AIS in China. Before the analysis, the patients were matched using propensity score. Both a cost-minimization analysis and a cost-effectiveness analysis were conducted to compare the matched pairs. A bootstrapping exercise was conducted for the matched arms to demonstrate the probability of one intervention being cost-effective over another for a given willingness-to-pay for an extra quality-adjusted life-year (QALY).

Results: After propensity score matching, 463 pairs were matched. The overall medical cost in the HUK arm is USD 2,701.20, while the NBP arm is USD 3,436.83, indicating HUK is preferred with cost-minimization analysis. Although the QALY gained in the HUK arm (0.77176) compared with the NBP arm (0.76831) is statistically insignificant (p?=?.4862), the cost-effectiveness analysis as exploratory analysis found that, compared with NBP, HUK is a cost-saving strategy with the lower costs of USD 735.63 and greater QALYs gained of 0.00345. Among the 5,000 bootstrapping replications, 100% indicates that HUK is cost-effective compared with NBP under a 1-time-GDP threshold; and 97.12% indicates the same under a 3-time-GDP threshold.

Conclusion: This economic evaluation study indicates that administrating HUK is a cost-saving therapy compared with NBP for managing blood flow during AIS in the Chinese setting.     

巴江口水电站综合办公楼防雷设计方案

随着现代社会的发展，建筑物的规模不断扩大，其内各种电气设备的使用日趋增多，尤其是随着计算机网络信息技术的普及，建筑物越来越多采用各种信息化的电气设备。广西每年因雷击破坏建筑物内电气设备的事件时有发生，所造成的损失非常巨大。因此，建筑物的防雷设计显得尤为重要。笔者结合实际工作，以巴江口水电站综合办公楼防雷设计为例，提出建筑物综合防雷工程设计方案。     

电子系统的避雷设计

为了预防和避免雷电对电子系统设备造成破坏,研究了电子系统的避雷设计,包括直击雷防护、感应雷防护、架高天线防护、地网设置等方面,并用实例进行了验证.     

The impact of public investment in medical imaging technology: an interagency collaboration in evaluation

The Canada Foundation for Innovation (CFI) and the Canadian Institutes of Health Research (CIHR) allied to analyze the impact of their investments in medical imaging research. The CFI funds capital and operating programs for research infrastructure, and CIHR's mandate concentrates its funding on research activity. It happens that CIHR-funded research consumes CFI-funded infrastructure as an input in the innovation process. Apart from a few partnered programs, by design there is no coordination between CFI and CIHR funding decisions. Together, these agencies invested $916 million over a 14-year-period. In this paper, we evaluate the economic and health benefits from advancements in one funded area, namely computed tomography perfusion (CTP). CTP is an imaging technique that uses computed tomography to measure blood flow in organs and tissues. It is mostly used to assess acute ischemic stroke. The net social benefits attributable to these investments are substantially positive: the benefit-to-cost ratio is estimated to be between 6.66-to-1 and 9.99-to-1. We review how public investments from multiple funders comingle in the innovation process to deliver social value and improved health outcomes.     

家庭随访健康教育对缺血性脑卒中并发阻塞性睡眠呼吸暂停综合征的影响

缺血性脑卒中并发阻塞性睡眠呼吸暂停综合征作为一种复杂性疾病,在一定程度上影响了患者的生后质量。本文通过实施家庭随访健康教育,对患者进行干预,从而改善缺血性脑卒中并发阻塞性睡眠呼吸暂停综合征情况,提高患者生活质量。让患者从思想上重视,提高治疗依从性,为提高治疗效果提供参考依据。     

Use of insertable cardiac monitors for the detection of atrial fibrillation in patients with cryptogenic stroke in the United States is cost-effective

Abstract

Objectives: Atrial fibrillation (AF) is the most common arrhythmia and a major marker of ischemic stroke risk. Early detection is crucial and, once diagnosed, anticoagulation therapy can be initiated to reduce stroke risk. The aim of this study was to assess the cost-effectiveness of employing an insertable cardiac monitor (ICM), BIOMONITOR, for the detection of AF compared to standard of care (SoC) ECG and Holter monitoring in patients with cryptogenic stroke, that is, stroke of unknown origin and where paroxysmal, silent AF is suspected.

Materials and methods: A Markov model was developed which consisted of five main health states reflecting the potential lifetime evolution of the AF disease: post cryptogenic stroke (index event), subsequent mild, moderate and severe stroke, and death. Sub-states were included to track a patient’s AF diagnostic status and the use of antiplatelet or anticoagulant therapy. AF detection was assumed to result in a treatment switch from aspirin to anticoagulants, except among those with a history of major bleeding. Detection yield and accuracy, clinical actions and treatment effects were derived from the literature and validated by an expert clinician. All relevant costs from a US Medicare perspective were included.

Results and conclusions: An ICM-based strategy was associated with a reduction of 37 secondary ischemic strokes per 1000 patients monitored compared with SoC. Total per-patient costs with an ICM were higher (US$90,052 vs. US$85,157) although stroke-related costs were reduced. The use of an ICM was associated with a base-case incremental cost-effectiveness ratio of US$18,487 per life year gained compared with SoC and US$25,098 per quality-adjusted life year gained, below established willingness-to-pay thresholds. The conclusions were found to be robust over a range of input values. From a US Medicare perspective the use of a BIOMONITOR ICM represents a cost-effective diagnostic strategy for patients with cryptogenic stroke and suspected AF.     

硫酸镁及乙哌立松结合强化训练对脑卒中偏瘫肢体的影响

目的研究硫酸镁及乙哌立松结合强化训练对脑卒中偏瘫肢体的影响。方法选取自2010年1月～2011年12月在本院接受治疗的脑卒中偏瘫患者127例,随机分为两组,在相同常规治疗的前提下,治疗组患者静滴硫酸镁及口服乙哌立松,而对照组应用安慰剂进行治疗,进行临床对比。结果两组患者治疗后,治疗组的肌张力情况、运动功能情况明显好于对照组,p<0.05有统计学意义。结论硫酸镁及乙哌立松结合强化训练对脑卒中偏瘫肢体的影响十分明显。     

Real-world comparison of all-cause hospitalizations,hospitalizations due to stroke and major bleeding,and costs for non-valvular atrial fibrillation patients prescribed oral anticoagulants in a US health plan

Aims: To compare the risk of all-cause hospitalization and hospitalizations due to stroke/systemic embolism (SE) and major bleeding, as well as associated healthcare costs for non-valvular atrial fibrillation (NVAF) patients initiating apixaban, dabigatran, rivaroxaban, or warfarin.

Materials and methods: NVAF patients initiating apixaban, dabigatran, rivaroxaban, or warfarin were selected from the OptumInsight Research Database from January 1, 2013–September 30, 2015. Propensity score matching (PSM) was performed between apixaban and each oral anticoagulant. Cox models were used to estimate the risk of stroke/SE and major bleeding. Generalized linear and 2-part models were used to compare healthcare costs.

Results: Of the 47,634 eligible patients, 8,328 warfarin-apixaban pairs, 3,557 dabigatran-apixaban pairs, and 8,440 rivaroxaban-apixaban pairs were matched. Compared to apixaban, warfarin patients were associated with a significantly higher risk of all-cause (hazard ratio [HR]?=?1.30; 95% confidence interval [CI]?=?1.21–1.40) as well as stroke/SE-related (HR?=?1.60; 95% CI?=?1.23–2.07) and major bleeding-related (HR?=?1.95; 95% CI?=?1.60–2.39) hospitalization; rivaroxaban patients were associated with a higher risk of all-cause (HR?=?1.15; 95% CI?=?1.07–1.24) and major bleeding-related hospitalization (HR?=?1.71; 95% CI?=?1.39–2.10); and dabigatran patients were associated with a higher risk of major bleeding hospitalization (HR?=?1.46, 95% CI?=?1.02–2.10). Warfarin patients had significantly higher major bleeding-related and total all-cause healthcare costs compared to apixaban patients. Rivaroxaban patients had significantly higher major bleeding-related costs compared to apixaban patients. No significant results were found for the remaining comparisons.

Limitations: No causal relationships can be concluded, and unobserved confounders may exist in this retrospective database analysis.

Conclusions: This study demonstrated a significantly higher risk of hospitalization (all-cause, stroke/SE, and major bleeding) associated with warfarin, a significantly higher risk of major bleeding hospitalization associated with dabigatran or rivaroxaban, and a significantly higher risk of all-cause hospitalization associated with rivaroxaban compared to apixaban. Lower major bleeding-related costs were observed for apixaban patients compared to warfarin and rivaroxaban patients.     

脑卒中治疗与远程监测系统设计

为了满足脑卒中出院患者对居家康复治疗及复发预警监测的需求,设计集治疗、人体生理信号采集和数据分析、预警等多功能为一体的家用脑卒中治疗及远程监测系统.首先,基于经颅直流电刺激技术设计治疗仪,输出恒定、精确的直流电,其次,开发智能手环作为辅助监测设备,实时记录患者心率等数据,通过蓝牙将数据发送至手机APP,最后,通过手机A...     

物理学知识在体育运动中的应用及解读

各种体育运动中都蕴涵着物理学知识,同时为了提高竞技体育运动的成绩,专业人员从物理学中总结了许多规律,用于改进体育训练的效果,达到多、快、好省的目的.下面分别从几个常见的体育活动动来谈一谈物理学知识的应用.