Objective We aimed to evaluate the comparative efficacy and cost-effectiveness of the ECMO versus mechanical ventilation through a rapid health technology assessment. Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, and CBM databases were electronically searched to collect randomized controlled trials (RCTs), systematic reviews, meta-analyses, complete economic evaluations, and CRD database for HTA reports from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Descriptive analysis and summary were then performed. Results A total of 21 references were involved, including 2 HTA reports, 5 RCTs, 11 systematic reviews or meta-analyses, and 3 economic evaluations. The quality of the literature evidence was heterogenous, and only 2 RCTs of high quality were included for meta-analysis. The results showed that the difference of 60-day mortality between ECMO and mechanical ventilation was statistically significant (RR=0.73, 95%CI 0.57 to 0.92, P=0.007). The majority of recent meta-analysis literature showed that short-term mortality of ECMO treatment was lower than that of mechanically ventilated patients. The cost-effective literature from different countries all showed that it was cost-effective in their respective health system, however, the quality of the literature varied. Conclusions Current evidence shows that ECMO has better safety, effectiveness and cost-effectiveness for ARDS compared with mechanical ventilation. However, it still required to be verified by high-quality studies with a long-term follow-up. Validate conclusions are needed through rigorous health technology assessments.
Objective To evaluate the correlation between cyclin B1 (CCNB1) gene expression and the prognosis of lung adenocarcinoma. Methods Oncomine, STRING, Human Protein Atlas, The Cancer Genome Atlas and other databases as well as Kaplan-Meier method, Cox regression, receiver operating characteristic (ROC) curve and Spearman correlation analysis were used to verify the effect of CCNB1 on patients with lung adenocarcinoma. Results CCNB1 was highly expressed in lung adenocarcinoma, and the high expression was correlated with T stage (P=0.001), N stage (P<0.001), pathological stage (P<0.001) and gender (P=0.008). Univariate Cox regression analysis showed that the expression of CCNB1, T stage, N stage, M stage and pathological stage were the factors affecting the overall survival rate of patients with lung adenocarcinoma (P<0.05); multivariate Cox regression analysis showed that the expression of CCNB1 and T stage were independent risk factors for overall survival of patients with lung adenocarcinoma (P<0.05). Kaplan-Meier analysis showed that high expression of CCNB1 was associated with shorter overall survival [hazard ratio (HR)=1.60, 95% confidence interval (CI) (1.20, 2.14), P=0.002], disease-specific survival [HR=1.68, 95%CI (1.16, 2.44), P=0.006] and progression-free interval [HR=1.42, 95%CI (1.09, 1.85), P=0.009]. The ROC curve showed that CCNB1 might be a potential diagnostic molecule for lung adenocarcinoma [area under the curve=0.980, 95%CI (0.967, 0.993)]. Spearman correlation analysis showed that CCNB1 expression was positively correlated with the infiltration of T helper cells 2 (rs=0.805, P<0.001) and T helper cells (rs=0.103, P=0.017), and negatively correlated with the infiltration of natural killer cells (rs=−0.195, P<0.001), macrophages (rs=−0.134, P=0.002), and T cells (rs=−0.092, P=0.033). Conclusion CCNB1 is highly expressed in lung adenocarcinoma compared with normal tissues, which is related to poor prognosis and may provide a potential therapeutic target for patients with lung adenocarcinoma.
Objective To systematically review the survival outcome and safety of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) for β-thalassemia. Methods The PubMed, EMbase, CNKI, WanFang Data and CBM databases were electronically searched to collect studies on haplo-HSCT for β-thalassemia from January 1, 2017 to December 31, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4.1 software and Stata 16.0 software. Results A total of 6 case-series studies involving 286 patients were included. The results of meta-analysis indicated that overall survival (OS) and thalassemia-free survival (TFS) for β-thalassemia patients undergoing haplo-HSCT were 92.5% (95%CI 86.1% to 96.1%) and 88.5% (95%CI 74.6% to 95.3%), the incidence of Ⅲ-Ⅳ degree acute graft versus host disease (Ⅲ-Ⅳ aGvHD) and chronic graft versus host disease (cGvHD) were 11.5% (95%CI 6.5% to 20.0%) and 23.1% (95%CI 12.3% to 39.8%), and the transplantation related mortality was 6.5% (95%CI 3.8% to 10.7%). Conclusion Relevant clinical studies published in the past 5 years provide the latest information and progress of haplo-HSCT for β-thalassemia. At present, great efficacy has been shown in NF-14-TM therapeutic regimen, but the long-term efficacy remains unclear. Due to the limited quality and quantity of the included studies, more high-quality evidence from long-term comparative studies is still needed.
ObjectiveTo systematically review the economic evaluation research of anti-novel coronavirus infection drugs at home and abroad, so as to promote clinical rational drug use. MethodsThe PubMed, Cochrane Library, EMbase, Web of Science, INAHTA, SinoMed, WanFang Data, and CNKI databases were systematically searched from January 1, 2020 to March 25, 2023, to collect economic evaluation studies related to anti-novel coronavirus infection drugs. ResultsA total of 22 articles were included, among which 11 studies were conducted from the perspective of health system, and most of the studies performed cost estimation on direct medical costs. The overall compliance rate of the included studies ranged from 42% to 70%, with deficiencies in model setting, incomplete uncertainty analysis, and lack of stakeholder participation. The results showed that immunotherapy drugs (Dexamethasone, Tocilizumab), neutralizing antibody (REGEN-COV antibody), small molecule drugs (Baricitinib, Nirmatrelvir/Ritonavir, Molnupiravir, Favipiravir) and statin were cost-effective. There was some variation in the results of the economic evaluation of Remdesivir. ConclusionAt present, there are few studies on the economic evaluation of drug interventions in COVID-19. Existing studies have pointed out that most drug interventions are cost-effective. It is suggested that more standardized pharmacoeconomic evaluation studies based on the actual situation of China epidemic should be carried out in the future.
ObjectiveTo systematically review the economy of non-pharmaceutical interventions (NPIs) for COVID-19. MethodsThe Web of Science, PubMed, EMbase, Cochrane Library, INAHTA, CNKI, WanFang Data and SinoMed databases were electronically searched to collect studies on health economic evaluations from 1 January 2020 to 20 August 2022. Then the included materials were reviewed, extracted and data integration analysis were conducted based on inclusion and exclusion criteria. ResultsSeventy-one academic publications were finally included, which contained 25 papers about nucleic acid testing, antigen testing and screening, 5 papers about personal protection, 12 papers about social distancing, quarantine and isolation, 11 papers about regional or national lockdown and 18 papers about multiple NPIs. The results showed that compared with no intervention, nucleic acid testing, antigen testing, screening and personal protection measures were economical. Social distancing, quarantine and isolation were also economical compared with no intervention. However, in low-income countries, movement restriction and factory shutdown may exact a heavy toll on the poorest and most vulnerable. Moreover, compared with a single long-term lockdown, multiple short-term lockdowns could be more economical, but the cost was still huge overall. ConclusionNPIs such as nucleic acid testing, antigen testing, personal protection, social distancing, quarantine, isolation and factory shutdown are economical. Although regional or national lockdown can save lives, it is not suitable for wide use. The researches on specific populations, specific variants (especially Omicron) and in the context of China need to be carried out.