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.
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.
Based on the principles and methods of systematic review of randomized controlled clinical trials, systematic review of economic analyses can integrate information from multiple economic studies which focus on the same clinical questions. It can also provide important insights by systematically examining how differences among studies lead to different results. Generally, there are seven steps to conduct such a review: 1) formulating questions; 2) establishing eligibility criteria; 3) searching and selecting eligible economic analyses; 4) assessing the validity of economic analyses; 5) acquiring data; 6) analyzing and synthesizing data; and 7) presenting results. Owing to the specificity of economic analyses, many methodological challenges exist, including the varieties of economic models, analytic perspectives, time horizons, and uncertainty and sensitivity analysis among different economic analyses. This may cause difficulties for critical assessment of the economic analyses.
Objective To critically appraise and systematically reviewe the economic evaluations of all alternative interventions for hepatitis B in China. Methods We searched MEDLINE and the four largest Chinese electronic databases. The references of eligible studies were also screened. Economic evaluations of any type, which studied interventions for hepatitis B, were eligible for inclusion. A 25-item quality checklist modified from a BMJ checklist was used to appraise the quality of studies. The overall quality score was calculated against 100 points to indicate the risk of bias. Quality appraisal and data extraction were conducted by two independent reviewers. Results Nineteen full economic evaluations and two cost studies were included of which fourteen studies were scored 25-44 points, and seven scored 45-61 points. Most studies adequately documented effectiveness of interventions. However, the costs of interventions were not well reported in over 50% of studies. Many studies inadequately conducted data analysis, particular in sensitivity analysis and discounting. Ten studies compared lamivudine with interferon or conventional therapy for 1-year (or 6-month) effects, which indicated that lamivudine was generally cost-effective. Three evaluations studied 30-year outcomes of interferon compared with conventional therapy, which suggested that interferon usually saved additional costs and years of life. Another three studies compared interferon with less frequently used antiviral agents, however the comparative cost-effectiveness varied. Two cost studies showed the total costs and the percentage of medical costs increased rapidly in proportion to disease severity.Conclusions Of alternative interventions, lamivudine is cost effective for short-term effects. Interferon is superior to conventional therapy for long-term outcomes. However, the long-term economic outcomes cannot be justified by the current evidence. Quality of methods, particularly, that of costing and analytical methods, is a major limitation. There remains a b need to improve the quality of reporting. Careful considerations should be paid before applying the results to decision making.
Economic evaluation used alongside clinical trials has become a hot spot in the development of clinical studies. The definition and classification of the cost were introduced in this article. The ways to conduct cost analysis in clinical trials were introduced systematically, including the identification, collection and analysis of the data of costs, and the concern of the analysis.
【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 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.
ObjectiveTo evaluate the effect of health economics of census versus high-risk population screening for tuberculosis in Mianyan city, in order to provide references for the selection of suitable tuberculosis screening method in western region of China. MethodsWe included active tuberculosis patients by residents health screening of 21 villages and towns in Mianyan city from June 2013 to March 2013. Relevant data was analyzed by referencing the National Assessment of Tuberculosis Control Program in 2001-2010. Results184047 residents were screened by tuberculosis census and 128 active tuberculosis patients were diagnosed while 61045 residents were screened by high-risk population screening and 76 active tuberculosis patients were diagnosed. The cost-utility ratio and benefit-cost ratio of tuberculosis census were 6174.17 and 3.84, respectively. The cost-utility ratio and benefit-cost ratio of high risk population screening were 3106.16 and 7.62, respectively. ConclusionHigh-risk population screening has higher cost-utility ratio and benefit-cost ratio than tuberculosis census with higher missed diagnosis. Benefits and harms of tuberculosis detection rate and cost should be fully balanced before tuberculosis screening method were chosen in western underdeveloped region of China.