ObjectiveTo investigate the feasibility, safety, cost, and patient satisfaction of ambulatory laparo-scopic cholecystectomy(ALC). MethodsThe clinical data of patients who divided into ALC group(678 cases) and in-patient laparoscopic cholecystectomy(IPLC) group(1 534 cases) in our hospital from April 2011 to December 2012 were retrospectively analyzed. The operative time, conversion rate, complication rate, hospitalization time, cost of hospi-talization, rehospitalization rate, and patient satisfaction were analyzed and evaluated. ResultsThere were no significant differences of the operative time, postoperative complication rate, and rehospitalization rate between the 2 groups(P > 0.05). The conversion rate(0.44%), and hospitalization time[(1.2±0.5)d] of the ALC group were significantly lower or shorter than those of IPLC group[3.19%, (4.8±1.3) d], P < 0.05. The direct, indirect health care costs, and the total costs of the ALC group were (6 555.6±738.7), (230.0±48.0), and (8 856.0±636.0) yuan, respec-tively; and lower than those of the IPLC group[(7 863.71, 014.6), (973.0±136.5), and(8 856.0±636.0)yuan], P < 0.05. ConclusionALC is safe and feasible, and could shorten the hospitalization time, lower the medical cost, speed up the bed turnover, and increase the efficiency in the use of health resource.
Objective From the viewpoint of health economics, to analyse the cost-utility of Coflex interspinous dynamic reconstruction and 360° fusion in the treatment of single level lumbar degenerative disease, so as to provide references to doctors and patients for making the best solution. Methods From October 2008 to November 2010, a prospective non-randomized controlled study was carried out on the patients diagnosed as L4-L5 degenerative lumbar spinal disorders, of whom Group A were treated by posterior decompression combined with Coflex interspinous dynamic reconstruction and Group B accepted lumbar 360° fusion treatment. The SF-36 questionnaire was used to survey the life quality of patients and to calculate the quality-adjusted life year (QALY); meanwhile, the costs of the treatment were collected to compare the cost-utility ratio between the two groups. Results A total of 60 patients were included, among whom 29 patients including 20 males and 9 females were in Group A, and the other 31 patients including 16 males and 15 females were in Group B; and the mean time of follow-up was 16.4 months (12-23 months). The average age of Group A and Group B was 45.1 years (21-67 years) and 56.2 years (32-86 years), respectively; the medical costs were 51 509.9±2 422.9 yuan and 57 409.7±9 072.9 yuan, respectively; the life quality compared with that of pre-operation improved by 42.60% and 42.82%, respectively; the cost-utility ratios were 69165.6±4716.0 yuan/QALY and 77 976.7±12 757.4 yuan/QALY, respectively. For each increase of one QALY, Group A could save 12.74% of the cost compared with Group B. Conclusion Coflex interspinous dynamic reconstruction has the equal short-term effects to lumbar 360° fusion in the treatment of L4-L5 degenerative lumbar spinal disorders, but it has lower costs than the latter, and is more in line with the requirements of health economics.
Acute kidney injury (AKI) is common in hospitalized individuals, associated with adverse outcomes and increased cost. Continuous renal replacement therapy (CRRT) is used to treat critically ill patients with AKI, of which the cost in acute phase is higher than that of intermittent renal replacement therapy (IRRT). However, if treatment for subsequent chronic kidney disease or dialysis dependency following AKI is also considered, CRRT might be more cost-effective than IRRT. In this editorial, the cost and health economic evaluation of CRRT for critically ill patients is discussed.
Objective To systematically review the current situation of health economics evaluation of gastric cancer screening. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect the health economics evaluation studies on gastric cancer screening from January 1st, 1975 to September 30th, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Then, qualitative analysis was performed. Results A total of 44 studies were included. Most of the targeted populations of the study were high-risk groups in areas with a high incidence of gastric cancer. Screening methods such as endoscopy and Helicobacter pylori infection detection were mainly evaluated in those studies. According to the results, about 47% of the studies evaluated a single screening method. A total of 35 studies showed that they established models, however, only a few calibrated the models. Conclusion Most studies of gastric cancer screening reviews neither calibrate the results nor consider the effect of smoking on the progression of gastric cancer. Those evaluated screening programs are limited.
【摘要】 目的 比较腹腔镜胆囊切除术（LC）与开腹胆囊切除术（OC）的费用，并进行卫生经济学评价。 方法 对2009年5-7月行胆囊择期手术的124例患者，随机分为LC组72例、OC组52例。比较两组的手术住院情况、直接和间接医疗成本、总成本。 结果 LC组的直接医疗成本、间接医疗成本、总成本分别为（4891±231）元、（338±76）元、（5229±387）元，均低于OC组的（5505±389）元、（540±82）元、（5945±412）元，两组间各项成本比较有统计学意义（Plt;0.001）。 结论 LC能缩短手术时间、住院时间，降低医疗费用，加快床位周转，提高卫生资源的利用效率。【Abstract】 Objective To compare the cost of the laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) and make the health economic evaluation. Methods From May to July 2009, 124 patients who underwent selective cholecystectomy were divided into LC group (72 cases), and OC group (52 cases). The hospitalizations, direct and indirect medical costs and the total costs were analyzed and evaluated. Results The direct, indirect health care costs and the total costs of the LC group were (4891±231), (338±76),(5229±387) yuan; and were lower than those of the OC group [(5505±389), (540±82), (5945±412) yuan]. The cost comparison between the two groups were significant different (Plt;0.001). Conclusion LC could shorten the operative time, hospitalization time, lower the medical cost, speed up the bed turnover and increase the efficiency in the use of health resource.
ObjectiveTo evaluate the health economics indexes of day surgery mode and traditional specialist hospitalization mode, and to provide reference for the selection of different hospitalization mode of inguinal-type cryptorchidism in children.MethodsThe patients with unilateral cryptorchidism under 5 years old between January 2017 and January 2018 in Chongqing Children’s Hospital were selected in this study. According to different inpatient surgery modes, the included children were divided into day surgery group (day group) and special in-hospital surgery group (specialty group). The general data of patients, treatment indicators, incidence of complications, postoperative testicular atrophy rate, recurrence, nosocomial infection, hospitalization time, hospitalization cost, satisfaction of patients, and other health effect indicators between the two operation modes were compared. The treatment effect indexes and cost-effect ratio of the two modes were statistically analyzed.ResultsA total of 198 children were included, including 83 in the day group and 115 in the specialty group. The patients in both groups underwent orchiopexy by small inguinal dermatoglyph and scrotal incision. There was no statistically significant difference in the affected side, source area, postoperative complications, or nosocomial infection between the two groups (P>0.05). The patients in the specialty group were older than those in the day group [(27.60±11.04) vs. (20.88±9.48) months old; t=4.586, P<0.001]; the bed occupancy time [(118.60±10.80) vs. (23.95±5.90) h; t=72.353, P<0.001] and operation time [(0.45±0.15) vs. (0.38±0.12) h; t=2.946, P=0.004] in the specialty group were longer than those in the day group. The difference was statistically significant in hospitalization expenses between the two groups (χ2=155.374, P<0.001); 92.8% of the children in the day group spent less than 5 000 yuan, while 95.7% of the children in the specialty group spent more than 5 000 yuan. The American Society of Anesthesiologists scores in the specialty group were higher than those in the day group (χ2=44.870, P<0.001). The treatment effect indexes in the day group and the specialty group were 0.99 and 1.01, respectively, and the cost-effect ratios were 3 850 and 6 657, respectively. The economic benefit of the day group was better.ConclusionsThe cost-effectiveness of day surgery is better than that of specialized inpatient surgery. Therefore, this model can be recommended for children who meet the indications of day surgery.
Objective To retrospectively compare short-term outcomes and health economics of PHS versus UHS for inguinal hernia repair. Methods We included 105 patients suffering from reducible inguinal hernia hospitalized in the First Affiliated Hospital of Lanzhou University from September, 2007 and September, 2012. The referred hernia types involved direct and indirect hernia (unilateral and bilateral). Based on different repair materials, the patients were divided into two groups, PHS group (n=53) and UHS group (n=52). Outcome parameters for comparison included incidences of seroma and scrotum edema, hospital duration, costs, etc. Results There were no differences in age, sex, hernia type, incidences of seroma and scrotum edema after surgery, hospital duration and costs between the two groups. However, the patients in the PHS group spent less money than those in the UHS group regarding the costs of materials and hospitalization, with significant differences. Conclusion For inguinal hernia repair, PHS and UHS are alike in reducing short-term complications, but PHS can significantly reduce patients’ economic burden due to less costs.
Objective To evaluate the diagnosis value of temporal Done high-resolution computed tornography (HRCT) in cholesteatoma. Methods There were 30 causes that had received the mastoid surgery because of cholesteatoma. Each patient’s mastoid plain films (Schuller’s and Mayer’s ) and HRCT had been taken and compared with each other and surgical findings and evaluated with health economic evaluation methods. Results The sensitivity rate in diagnosing cholesteatoma with HRCF was much higher than that with mastoid film (Plt;0.005). The more important benefit with HRCT was that it can afford the detail information in ear such as the ossicular chain, facial nerve canal, tympanic sinus, etc. which were basis for otologist in surgery to remove the focus thoroughly and reconstruct the middle ear function at the same time. In the view of health economic evaluation, HRCT is also much better than mastoid X-ray film. Conclusion HRCT should replace masloid Schuller’s and Mayer’s film in diagnosis cholesteatoma and HRCT should use as ordinary examination in chronic otitis media.
ObjectiveTo systematically review the status of economic evaluation of liver cancer screening in China, so as to provide reference for further studies.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were searched to collect economic evaluation studies of liver cancer screening in China from inception to December, 2017. Two reviewers independently screened literature, extracted data and conducted descriptive analysis of basic characteristics, methods of economic evaluation and main results as well as quality and uniformity of reporting.ResultsA total of 5 studies were included. Among them, the starting age of screening were found to be 35 to 45 years old; α-fetoprotein (AFP) testing and ultrasound examination combined procedure and screening interval of every 6 months were mostly evaluated. The quality of the 5 studies was satisfactory, and the uniformity of reporting was relatively acceptable, with a median score of 78% (range: 60% ~ 78%). Two population-based studies reported cost per liver cancer detected (44 thousand and 575 thousand yuan). Three studies reported cost-effectiveness ratio(CER) based on life year saved (LYS) and quality adjusted life year (QALY). Among these results, only 1 study from mainland China reported CER based on LYS (1 775 yuan), and the calculated ratio of CER to local GDP per capita was estimated as 0.1, while 2 studies from Taiwan province reported 4 CERs, and the ratios of CER to local GDP per capita ranged from 1.0 to 2.2.ConclusionsInformation from liver cancer endemic areas such as Taiwan province indicates promising cost-effectiveness to conduct liver cancer screening in local general population, while data from mainland suggests that conducting liver cancer screening combining AFP and ultrasound in high-risk population will be cost-effective, however only supported by 1 regional study. This needs to be verified by further economic evaluations based on randomized controlled trials or cohort studies as well as health economic evaluations.
Objective To systematically review the health economic evaluations of using long-term rhythm-control antiarrhythmic drugs (AAD) for patients with paroxysmal or persistent atrial fibrillation (AF). Methods Databases including PubMed, EMbase, Scopus, CNKI, SinoMed, WanFang Data, and official websites of well-established health technology assessment (HTA) institutions were electronically searched to present the economic evaluations of AAD and the recommendations of HTA institutions based on drug economy from inception to April 23rd, 2022. Two reviewers independently screened the literature, extracted data and systematic review was then performed. Results A total of 19 studies were included, including 11 cost-effectiveness or cost-utility analysis studies and 8 official documents from HTA institutions. Only 5 (45.5%) economic evaluations were of relatively high quality, and English language studies were of higher quality than Chinese language studies ones. The included studies lacked elements that CHEERS 2022 concerns, such as health economics analysis plans, equity and distributional effects, engagement with patients and other stakeholders and the impact on the study. Dronedarone and amiodarone were the main focus of the evaluation, and the study results showed that dronedarone was cost-effective compared with other drugs in different study designs and national settings. However, there were differences between the recommendations of HTA agencies and the results of economic evaluation studies. Conclusion The completeness of health economics evaluations needs to be improved, along with the quality of clinical evidence in the field of AF-AAD for Chinese patients. Additionally, the informational value of drugs should be thoroughly investigated through budget impact analysis and distributional cost-effectiveness analysis to provide evidence of high-quality studies for decision-makers in China.