A review and validation of overall survival extrapolation in health technology assessments of cancer immunotherapy by the National Institute for Health and Care Excellence: how did the initial best estimate compare to trial data subsequently made available?

Background: Validation of overall survival (OS) extrapolations of immune-checkpoint inhibitors (ICIs) during the National Institute for Health and Care Excellence (NICE) Single Technology Assessment (STA) process is limited due to data still maturing at the time of submission. Inaccurate extrapolation may lead to inappropriate decision-making. The availability of more mature trial data facilitates a retrospective analysis of the plausibility and validity of initial extrapolations. This study compares these extrapolations to subsequently available longer-term data.

Methods: A systematic search of completed NICE appraisals of ICIs from March 2000 to December 2017 was performed. A targeted search was also undertaken to procure published OS data from the pivotal clinical trials for each identified STA made available post-submission to NICE. Initial Kaplan-Meier curves and associated extrapolations from NICE documentation were extracted to compare the accuracy of OS projections versus the most mature data.

Results: The review identified 11 STAs, of which 10 provided OS data upon submission to NICE. The extrapolations undertaken considered parametric or piecewise survival models. Additional data cut-offs provided a mean of 18 months of OS beyond the end of the original data. Initial extrapolations typically under-estimated OS from the most mature data cut-off by 0.4–2.7%, depending on the choice of assessment method and use of the manufacturer- or ERG-preferred extrapolation.

Conclusion: Long-term extrapolation of OS is required for NICE STAs based on initial immature OS data. The results of this study demonstrate that the initial OS extrapolations employed by manufacturers and ERGs generally predicted OS reasonably well when compared to more mature data (when available), although on average they appeared to underestimate OS. This review and validation shows that, while the choice of OS extrapolation is uncertain, the methods adopted are generally aligned with later-published follow-up data and appear appropriate for informing HTA decisions.     

Definitions and progress of ecosystem health and ecological security

1. Introduction Development of human industrial civilization and predatory exploitation of natural resources have in- duced tremendous changes of ecological environment. In recent years, territorial and global environmental problems have increased, such as greenhouse effect, depletion of ozone, global warming, water scarcity, water pollution, acid rain, decrease of biodiversity, soil erosion desertification etc. These changes seriously intimidate the health and security of ecosystems, and dist…     

道德风险存在下董事责任保险市场的保费水平分析

本文通过对董事责任保险市场的介绍,指出在董事责任保险市场中存在着严重的道德风险问题,通过对市场中保险双方行为的博弈分析,得到在道德风险存在下的保费变动范围,并指出防止或减轻董事责任保险市场中道德风险的方法.     

基于风景健康的海南省自贸区人居环境 空间研究

海南经过30年的经济特区建设已正式迈入自贸区建设的新时代，所面临的地区发展与生态维育矛盾逐步加剧。为保育海南优良的生态品质，提升海南人居环境空间质量，基于“健康、生态、人居”三元耦合与互动多赢的发展关系，提出与之适宜的风景园林健康理论；结合前人经验，以人居环境空间规划为切入点，解析人居环境空间研究内容。运用ArcGIS 10.2.2空间分析和Fragstats 4.2景观格局分析，解析海南省域三生空间敏感性、资源利用效率可持续性，以及资源服务范围与开发建设空间适宜性，结合人居环境空间发展特征，提出从全岛国土空间、资源统筹和空间营造3个方面进行规划引导，并提出以下观点：1)人类活动对资源环境和空间利用的合理性是有效保障海南人居环境空间的前提基础；2)遵循风景园林健康理论指导的全域国土空间规划、资源统筹规划和空间营造规划是提升海南人居环境空间的根本路径；3)“健康、生态、人居”三元耦合和互动多赢的关系均衡与协调是提升海南人居环境空间的终极目标。     

台湾全民健康保险财务危机论析

台湾全民健康保险自1995年实施至今已经取得了显著的成效,民众的健康有了基本的保障.但是,台湾健保也面临着严重的财务问题,至今已经爆发了三次财务危机.本文从台湾健保的管理制度、财务收入制度和财务支出制度等方面对其财务危机进行了分析,并总结出它为完善我国大陆健康保险制度提供的借鉴意义.     

陕西实施农村养老保险制度的经济分析及措施

随着我国人口老龄化的加剧，老年人特别是农村老年人的养老问题日益突出，本文主要通过对陕西农村养老现状和所存在问题的分析，提出了建立农村养老保险制度的建议，旨在于试图为我国农村养老保险制度的实施提供一些借鉴。     

中国保险业的合谋倾向强度:一个理论分析框架

从结构、需求与信息三个维度构建了一个产业合谋倾向强度理论分析框架，并用该框架分析了我国保险业的合谋强度。研究认为，我国保险业合谋强度比较大。     

分红保险合同红利负债的确认与计量研究

近年来分红保险已成为我国保险市场的热销产品,它几乎占据了寿险市场的半壁江山,但分红保险负债的确认与计量问题,特别是分红保险红利负债的确认与计量问题在我国并未形成统一的规范,本文根据分红保险的不同红利分配方式对分红保险合同红利负债的确认与计量问题进行研究。     

The effectiveness of government spending on education and health care in developing and transition economies

Recent studies show that corruption is associated with higher military spending [Eur. J. Polit. Econ. 17 (2001) 794] and lower government spending on education and health care [J. Publ. Econ. 69 (1998) 263]. This suggests that policies aimed at reducing corruption may lead to changes in the composition of government outlays toward more productive spending. However, little empirical evidence has been presented to support the claim that public spending improves education and health indicators in developing and transition countries. This paper uses cross-sectional data for 50 such countries to show that increased public expenditure on education and health care is associated with improvements in both access to and attainment in schools, and reduces mortality rates for infants and children. The education regressions are robust to different specifications, but the relationship between health care spending and mortality rates is weaker.     

构建我国个人信用体系保障机制--韩国"坏银行"重整制度考察之思考

我国个人消费信贷近几年的发展十分迅速，但是在个人消费信贷的快速发展中，银行由于个人不良信贷所引发的不良债权比重逐年上升，而且信用环境不良有恶化这一问题的趋势。个人信用制度的建设、个人不良信贷资产的处置和我国个人信用安全体系的构建，已经成为摆在我们面前的现实问题。韩国资产管理公司在处置信用卡公司不良债权中的“坏银行”重整制度，构成了韩国金融安全网络的重要组成部分，这一制度设计值得我们借鉴。