Cost-effectiveness of dipeptidyl peptidase-4 inhibitor monotherapy versus sulfonylurea monotherapy for people with type 2 diabetes and chronic kidney disease in Thailand

Objective: With a high prevalence of chronic kidney disease (CKD) in type 2 diabetes (T2DM) in Thailand, the appropriate treatment for the patients has become a major concern. This study aimed to evaluate long-term cost-effective of dipeptidyl peptidase-4 (DPP-4) inhibitor monothearpy vs sulfonylurea (SFU) monotherapy in people with T2DM and CKD.

Methods: A validated IMS CORE Diabetes Model was used to estimate the long-term costs and outcomes. The efficacy parameters were identified and synthesized using a systematic review and meta-analysis. Baseline characteristics and cost parameters were obtained from published studies and hospital databases in Thailand. Costs were expressed in 2014?US Dollars. Outcomes were presented as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to estimate parameter uncertainty.

Results: From a societal perspective, treatment with DPP-4 inhibitors yielded more quality-adjusted life years (QALYs) (0.024) at a higher cost (>66,000 Thai baht (THB) or >1,829.27 USD) per person than SFU, resulting in the ICER of >2.7 million THB/QALY (>74,833.70 USD/QALY). The cost-effectiveness results were mainly driven by differences in HbA1c reduction, hypoglycemic events, and drug acquisition cost of DPP-4 inhibitors. At the ceiling ratio of 160,000 THB/QALY (4,434.59 USD/QALY), the probability that DPP-4 inhibitors are cost-effective compared to SFU was less than 10%.

Conclusions: Compared to SFU, DPP-4 inhibitor monotherapy is not a cost-effective treatment for people with T2DM and CKD in Thailand.     

马克思理论视角下我国城市贫困及反贫困研究

20世纪90年代以来,中国城市贫困问题日益显现,已成为国家经济增长、社会稳定、家庭和个人全面发展的阻碍。依据马克思贫困理论的三个层面,从技术基础、表现形态和制度决定,分析转型期我国城市贫困的产生背景、社会构成和结构成因,提出了城市反贫困的途径,旨在为我国的城市贫困研究提供借鉴。     

关于翻译产生变译现象的原因及结果探究

本文从勒菲弗尔的操纵理论出发,结合实例分析翻译中变译现象存在的必然性及其影响因素,揭示研究该现象的现实意义及对翻译界造成的影响。     

文学与疾病题材关系简论

以疾病为题材的文学作品揭示了文学与疾病的种种联系,它们把疾病组合进个人-疾病-社会这个特殊的三角形中。从心理学角度看,对读者可起到交流和治疗作用;从接受美学角度看,可成为健康人的学习资料和生活指南。     

县域总部经济发展动因研究--以浙江省为例

总部经济亦日益成为县域经济转型升级的重要战略之一。文章以浙江为例，运用唯物辩证法内外因理论分析了县域总部经济发展的动因及作用机理，指出浙江县域总部经济发展是在宏观、微观、行政三种动因耦合作用的结果，并基于发展动因的作用机理对浙江县域总部经济路径来源提出对策建议。     

焦虑因素对高职生英语口语表达的影响及对策研究——以广西职业技术学院为例

焦虑是妨碍大学生英语学习的负面因素之一。本文在前人研究的启发下，重点研究高职学生的英语口语焦虑状况，寻找分析造成口语焦虑的因素，提出减轻口语焦虑的策略。     

一座人行天桥的病害成因分析及处治技术

全面分析厦门市疏港路1#人行天桥病害产生原因及工程处治方法,同时对业界旧桥病害成因分析及处治提供一种借鉴.     

社区自组织能力建设面临的难题及其成因

报告了当前社区自组织能力建设的现状,进行了非接触性的文献检索和接触性的实地调查,发现社区自组织能力建设正面临着工作人员整体素质偏低、社区自我管理任务繁重、居民民主参与不足、集体决策能力虚弱、资源协调能力较差等诸多方面的难题;认为这些难题的成因可以归结为:作为能力承载主体的社区自组织自身、作为能力外在环境的社区自组织客体和作为能力作用规则的社区自组织体制等三个方面;提出要有效解决这些难题,可以从内核、环境和制度等方面来探寻对策.     

完善我国重大疾病商业健康保险的若干建议

本文通过对我国社会医疗保险和商业健康保险的比较,揭示重大疾病商业健康保险的必要性和重要性,并基于我国当前商业健康保险的种种缺失提出若干意见和建议。     

An evaluation of consumer participation in hospital breast services

Community expectations and research demonstrate that consumers play an important role in shaping services for women with breast cancer. Consumer contribution has been mandated recently in Victoria, Australia, to ensure the inclusion of consumer involvement in the planning and decision‐making processes within health organizations. As part of the redevelopment of breast services in Victoria, Southern Health has been funded to plan local improvements to care co‐ordination for women diagnosed with breast cancer in the southern metropolitan area of Melbourne. The establishment of effective consumer participation in breast services is an integral aspect of this project and a range of initiatives has been undertaken to achieve meaningful consumer involvement including the appointment of a consumer advisor; appointment of staff with extensive knowledge in women's health and community development to the project; establishment of a consumer reference group; and plans made to improve the receptivity of health service systems to consumer input. A preliminary evaluation of this ongoing project has indicated that a productive role for consumers in service practice review and policy and planning activities has been established and some change and engagement of staff has occurred. There is still work to be done to promote the involvement of a wider range of health professionals and to increase the level of trust between consumers and staff.