不同方案药物治疗泌尿系统感染的经济学探析

目的对不同药物治疗方案在泌尿系统感染治疗中的经济学价值进行评价分析。方法抽取我院收治的泌尿系统感染患者168例,将其按照治疗方法分成甲、乙、丙三组,甲组患者采取左氧氟沙星片联合通淋颗粒进行治疗,乙组患者采取单纯左氧氟沙星片进行治疗,丙组患者采取头孢特仑新戊酯片进行治疗,对比三组患者的临床疗效和经济成本。结果甲乙丙三种方案的成本-效果比值以丙组最高(P<0.05),甲组最低(P<0.05)。结论甲组治疗方案采取中西医结合方式进行治疗,疗效显著,经济成本较低,为治疗最佳方案,值得关注。     

Pharmacoeconomic analysis for pemetrexed as a maintenance therapy for NSCLC patients with patient assistance program in China

Objective: This study is to evaluate the costs, clinical efficacy, and social benefits of a patient assistance program (PAP) implemented by the China Primary Healthcare Foundation for the use of pemetrexed as a first-line non-squamous non-small cell lung cancer (NSCLC) maintenance therapy in China.

Methods: A survival analysis was conducted on the clinical data of 1,366 patients who participated in the PAP. The progression-free survival (PFS) and median maintenance treatment cycle of pemetrexed were analyzed. A 36-month Markov model from a payer’s perspective was constructed to analyze the cost and effectiveness associated with the PAP for pemetrexed. The inputs of the model were sourced from the PAP clinical database and published literature. The study estimated the incremental quality adjusted life-years (QALYs) (pemetrexed plus best supportive care [BSC] vs BSC only), the cost saving of the PAP, the impact on the percentage of catastrophic health expenditures (CHE), and poverty headcount ratio (HCR).

Results: The median of PFS and maintenance treatment cycles were 187 days and five cycles (total nine cycles, which included four cycles of induction therapy), respectively. The pemetrexed plus BSC treatment with PAP resulted in an additional 0.12 QALYs over BSC only. The total cost was $48,034.46 and $96,191.57 for the patients who had or had not joined the PAP in 3 years, respectively. Compared to the patients without PAP, the percentage of CHE and HCR with PAP was reduced from 98.39% to 19.91% and 66.98% to 4.89%, respectively, indicating that the PAP substantially decreased the number of patients who had CHE and fallen into poverty.

Conclusion: The study concluded that the pemetrexed PAP generated noticeable clinical and economic benefits to society and to patients. The program also increased patients’ compliance with chemotherapy by allowing patients, for whom the pemetrexed treatment was unaffordable, to continue to receive it.     

序贯疗法在根除幽门螺杆菌的临床疗效评价

目的 评价序贯疗法根除幽门螺杆菌的效果和不良反应.方法 选取本院消化内科住院或门诊70 例Hp 阳性的患者,随机分为序贯治疗组和对照组,治疗组给予10 日序贯疗法,对照组给予标准三联疗法,疗程10 日,疗程结束后4 周行快速尿素酶试验和银染色.结果 治疗组的Hp 根除率明显优于对照组(P＜0.05),治疗组的快速尿素酶试验和银染色的转阴率分别为91.4%和82.3%,两组比较差异具有显著性(P＜0.05).结论 序贯疗法根除Hp 的效果好于标准三联疗法,副反应发生率低.     

Use of opioid substitution therapies in the treatment of opioid use disorder: results of a UK cost-effectiveness modelling study

Aims: This study investigated the cost-effectiveness of buprenorphine maintenance treatment (BMT) and methadone maintenance treatment (MMT) vs no opioid substitution therapy (OST) for the treatment of opioid use disorder, from the UK National Health Service (NHS)/personal social services (PSS) and societal perspectives over 1 year.

Methods: Cost-effectiveness of OST vs no OST was evaluated by first replicating and then expanding an existing UK health technology assessment model. The expanded model included the impact of OST on infection rates of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection.

Results: Versus no OST, incremental cost-effectiveness ratios (ICERs) for BMT and MMT were £13,923 and £14,206 per quality-adjusted life year (QALY), respectively, from a NHS/PSS perspective. When total costs (NHS/PSS and societal) are considered, there are substantial savings associated with adopting OST; these savings are in excess of £14,032 for BMT vs no OST and £17,174 for MMT vs no OST over 1 year. This is primarily driven by a reduction in victim costs. OST treatment also impacted other aspects of criminality and healthcare resource use.

Limitations: The model’s 1-year timeframe means long-term costs and benefits, and the influence of changes over time are not captured.

Conclusions: OST can be considered cost-effective vs no OST from the UK NHS/PSS perspective, with a cost per QALY well below the UK’s willingness-to-pay threshold. There were only small differences between BMT and MMT. The availability of two or more cost-effective options is beneficial to retaining patients in OST programs. From a societal perspective, OST is estimated to save over £14,032 and £17,174 per year for BMT and MMT vs no OST, respectively, due to savings in victim costs. Further work is required to fully quantify the clinical and health economic impacts of different OST formulations and their societal impact over the long-term.     

大学生心理疾病的体育疗法探讨

体育疗法对大学生心理疾病是一种行之有效的治疗方法,它具有主动、自然、易接受等特点,选择合适的体育项目和训练方法可治疗一些常见的心理疾病,如神经衰弱、焦虑、抑郁、恐惧症等。     

病痛的抒写与病房的隐喻——论新时期文学的"病房写作"现象

“病房写作”是新时期文学的一个重要现象。病房写作的主题思路是从病房意识出发,以医院小病房隐喻批判社会大病房。新时期文学出现的病房写作则从社会宏大主题的批判走向了平常百姓病痛的抒泄和呢喃,具有文学治疗的功用。     

Mechanism of retail therapy during stressful life events: The psychological compensation of revenge consumption toward luxury brands

During times of stress and challenging life events, individuals often seek coping mechanisms to build resilience and manage emotional distress. Recently, Korean consumers have exhibited a rise in revenge consumption of luxury products as a response to the uncontrollable COVID-19, deemed one of their most stressful life events. Consequently, this study explores the precursors of revenge consumption and investigates whether indulging in luxury goods can improve consumers' psychological well-being within the context of retail therapy. Drawing on Compensatory Control Theory (CCT), our proposed model empirically tests the relationship between negative emotions, shopping motivations, revenge consumption behaviors, self-esteem, and subjective well-being. Data were gathered from 324 South Korean participants via an online survey, all of whom had purchased luxury products during the pandemic. The results of the Partial Least Squares Structural Equation Modeling (PLS-SEM) analysis reveal the process of psychological compensation through luxury consumption, which had a therapeutic effect on self-esteem and subjective well-being. Additionally, Multi-Group Analysis (MGA) depicts income-based differences in the revenge consumption mechanism. These findings highlight that when individuals experience a lack of control, anxiety, or fear, they seek measures to recover their psychological state through luxury purchases. This study also offers valuable insights for luxury brands considering strategies to support customers’ well-being during stressful life events.     

Cost-effectiveness of pembrolizumab for the adjuvant treatment of resected high-risk stage III melanoma in the United States

Abstract

Aims: To evaluate the cost-effectiveness of adjuvant pembrolizumab relative to observation alone following complete resection of high-risk stage III melanoma with lymph node involvement, from a US health system perspective.

Materials and methods: A Markov cohort model with four health states (recurrence-free, locoregional recurrence, distant metastases, and death) was developed to estimate costs, life-years, and quality-adjusted life-years (QALYs) associated with pembrolizumab vs observation over a lifetime (46-year) horizon. Using a parametric multi-state modeling approach, transition probabilities starting from recurrence-free were estimated based on patient-level data from KEYNOTE-054 (NCT02362594), a direct head-to-head phase 3 trial. Post-recurrence transition probabilities were informed by real-world retrospective data and clinical trials in advanced melanoma. Health state utilities and adverse event-related disutility were derived from KEYNOTE-054 trial data and published literature. Costs of drug acquisition and administration, adverse events, disease management, and terminal care were estimated in 2018?US dollars. Deterministic and probabilistic sensitivity analyses were conducted to assess robustness.

Results: Over a lifetime horizon, adjuvant pembrolizumab and observation were associated with total QALYs of 9.24 and 5.95, total life-years of 10.54 and 7.15, and total costs of $489,820 and $440,431, respectively. The resulting incremental cost-effectiveness ratios (ICERs) for pembrolizumab vs observation were $15,009/QALY and $14,550/life-year. Across the range of input values and assumptions tested in deterministic sensitivity analyses, pembrolizumab ranged from being a dominant strategy to having an ICER of $57,449/QALY vs observation. The ICER was below a willingness-to-pay threshold of $100,000/QALY in 90.2% of probabilistic simulations.

Limitations: Long-term extrapolation of outcomes was based on interim results from KEYNOTE-054, with a median follow-up of 15?months.

Conclusions: Based on common willingness-to-pay benchmarks, pembrolizumab is highly cost-effective compared with observation alone for the adjuvant treatment of completely resected stage III melanoma in the US.     

The economic implications of switching to rivaroxaban from enoxaparin plus vitamin K antagonist in the treatment of venous thromboembolism

Abstract

Objective:

Venous thromboembolism (VTE) impacts ～900,000 individuals annually in the US, causing up to 100,000 deaths. Patients experiencing VTE have heightened risk of recurrence. Initial parenteral anti-coagulation is standard therapy for acute VTE followed by ≥3 months of warfarin, which introduces the risk of major bleeding. Balancing increased risks of bleeding and recurrent VTE remains challenging. Recent clinical trials suggest that rivaroxaban, an oral direct inhibitor of factor Xa, provides an effective, safe, simplified approach to treatment. This study considers the economic implications of these data.