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…     

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.     

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.     

Using data envelopment analysis approach to estimate the health production efficiencies in China

By using Data Envelopment Analysis approach, we treat the health production system in a certain province as a Decision Making Unit (DMU), identify its inputs and outputs, evaluate its technical efficiency in 1982, 1990 and 2000 respectively, and further analyze the relationship between efficiency scores and social-environmental variables. This paper has found several interesting findings. Firstly, provinces on frontier in different year are different, but provinces far from the frontier keep unchanged. The average efficiency of health production has made a significant progress from 1982 to 2000. Secondly, all provinces in China can be divided into six categories in terms of health production outcome and efficiency, and each category has specific approach of improving health production efficiency. Thirdly, significant differences in health production efficiencies have been found among the eastern, middle and western regions in China, and among the eastern and middle regions. At last, there is significant positive relationship between population density and health production efficiency but negative relationship (not very significant) between the proportions of public health expenditure in total expense and efficiency. Maybe it is the result of inappropriate tendency of public expenditure. The relationship between abilities to pay for health care services and efficiency in urban areas is opposite to that in rural areas. One possible reason is the totally different income and public services treatments between rural and urban residents. Therefore, it is necessary to adjust health policies and service provisions which are specifically designed to different population groups. __________ Translated from Jingji Yanjiu 经济研究 (Economic Research Journal), 2006, (7): 92–105     

“绿康城市”论

城市是人类聚集和生活的场所，随着人类的进化不 断发展。理想城市应当符合人类对美好生活的向往，既能满足 生态可持续的绿色发展需求，也能提供有益人类健康的适宜人 居环境。“绿康城市”论就是当今缓解“城市病”与“城市人 群病”的理想模式之一，而日本东京城市中心“大手町之森” 正是“绿康城市”论的实践先驱案例。基于人、自然和城市三 者之间的关系，追溯欧美、日本与中国理想城市的发展历程， 并对进行建设“绿康城市”实践时应坚持的原则与构成要素进 行了较为深入的探讨。     

Unexpected windfalls,education, and mental health: evidence from lottery winners in Germany

This paper investigates the causal impact of large unexpected windfalls on individual mental health, physical health, as well as health behaviors. I use a large individual-level panel data set of lottery winners from Germany between the years 2000 and 2011 and observe lottery winners before and after winning a large lottery prize. Mental health declines immediately after winning a large lottery prize for individuals with low education and low levels of financial literacy. While these individuals report being happier after winning the lottery, evidence from commonly used SF-12 measures of mental health indicates that winners with low education experience increased role limitations due to emotional problems, are more anxious, and have less energy after their win. The impact on various measures of mental health is highly robust, statistically significant, economically significant, and persists for up to two years after the win. Unexpected windfalls have no impact on the mental health of individuals with high education or high financial literacy. Winning the lottery has no impact on individuals’ health behaviors such as smoking or alcohol consumption, and it has no impact on doctor visits, hospital stays, or illness-related work absences regardless of education level.     

我国城乡居民健康公平性研究

本文采用历史的、比较的分析方法,运用基尼系数、洛伦茨曲线等分析工具,分别从筹资公平、服务提供公平和健康公平三个方面对我国城乡居民健康公平问题进行了定性与定量分析,得出了新型农村合作医疗制度的开展显著降低了城乡卫生服务筹资的基尼系数等一系列结果.根据研究结果,对城乡健康公平性与二元社会结构,与政府干预、市场调节之间的关系作了分析,并对提高城乡健康公平性提出了相关政策建议.     

Comprehensive assessment of patients with irritable bowel syndrome with constipation and chronic idiopathic constipation using deterministically linked administrative claims and patient-reported data: the Chronic Constipation and IBS-C Treatment and Outcomes Real-World Research Platform (CONTOR)

Abstract

Aims

To characterize a US population of patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC) using CONTOR, a real-world longitudinal research platform that deterministically linked administrative claims data with patient-reported outcomes data among patients with these conditions.