Background In the latter of 20th century, a global growth in allergic diseases has been witnessed, accompanying with spring-out of therapeutic drugs. However, trials did not clarify the comparative effectiveness and pharmaceutical economics of these agents. Severe adverse drug effects have been reported increasingly in the last few years. These made it difficult for clinical practice and selection of national essential drugs. Objective To assess astemizole, loratadine, cetirizine and tefenadine for allergic rhinitis (AR) and urticaria in terms of effectiveness, heart-related drug adverse effects and pharmaceutical economics. Search strategy Cochrane Library, Medline, Embase and Chinese Biomedical Database will be searched. Additional database should be searched for safety and economic studies. Selection Criteria The publication languages are restrained to English and Chinese. 1) Effectiveness: high-quality randomized controlled trials (RCTs) and systematic Reviews (SRs)/ meta-analysis for AR and uritcaria are included, with comparisons restrained to among these four drugs; 2) Safety: a hierarchy of evidences of these four drugs for allergic diseases are included. 3) Economical evaluation: cost-effectiveness and cost-utility assessment of these four drugs for AR and urticaria should be included. Methods of review data extraction sheet and quality appraisal table are separately designed. QUOROM STATEMENT and Jadad Scale are applied, respectively, to SRs and RCTs. Two reviewers independently select the studies, appraise the quality and extract the data. Any disagreement is solved by discussion. Data analysis Fixed effect model is first applied. Sensitivity analysis is employed to study the heterogeneity between trials. Randomized effect model is alternatively used when compromised.
ObjectivesTo explore classification management method of evidence-based evidence for medical consumables based on cost multiplication and to conduct empirical test.MethodsFour quadrants was used to explore the classification management of consumables evidence.Results95.22% of the “recommended” items in the consumables department were “recommended” by the group. 100% of group “recommended” items passed the committee resolution. Advice of consumables department and group was highly relevant with decision of commission.ConclusionsOne-dimensional recommendations allow the decision-making of group and committee to be more convenient. Cost calculation is based on all consumables required for medical treatment, which is similar to reality. The classification threshold requires further optimization, and the classification basis requires continual adjustment under different conditions of hospital. The evidence-based evidence evaluation method for medical consumables based on incremental cost ratio is a simple and rapid hospital health technology assessment method suitable for China’s national conditions.
Hospital-based health technology assessment (HB-HTA) refers to the practice of health technology assessment for hospital management decision-making based on the actual situations in hospitals. It includes processes and methods of health technology assessment carried out in and for hospitals. Under the background of comprehensively promoting the reform of public hospitals in China, HB-HTA is undoubtedly an important scientific method to enhance the fine management of public hospitals and implement the policy of medical reform. This paper introduced the concept, the international and domestic development status, the characteristics of HB-HTA, and put forward the scheme of development of HB-HTA macroscopically, so as to promote the popularization and applications of HB-HTA in China.
With the increasing demand for health technology decision making in hospitals, the activities of hospital-based health technology assessment are increasing globally. Several developed countries, such as France, Finland, Denmark, Italy, Canada, The United State and Australia have carried out hospital-based health technology assessment activities. In order to further promote the development of health technology assessment in China and establish evidence-based management and decision-making concept of hospitals, the National Center for Medical Service Administration has carried out theoretical and practical research on hospital technology assessment by fully drawing on foreign advanced experience. This paper introduces the background, object, method and content of the research, the achievements of the pilot project and the prospect of the future, so as to provide a reference for readers to understand the overall situation of the project and related work.
Objective To evaluate the efficacy, safety and economical values of nucleic acid/nueleotides for clinical nutritional support and immune treatment. Methods The following electronic databases were searched: Chinese Biomedicine database (CBM), MEDLINE, EMBASE and SCI. Data were extracted by two reviewers. Applied RevMan 4.1 for statistical analyse. Results Forty-six randomized controlled trials were identified, involving nucleic acids/nucleotides for clinical nutritional support, infant feed, immune treatment. Eighteen randomized trials comparing the use of immunonutrition which comprises nucleotides with standard enteral nutrition in surgical and critical ill patients. Combined analysis directed that immunonutrition therapy decrease infection events, length of hospitalization and the cost. Only one trial reported the effects of adding nucleotides to breast milk substitute, but there is no valuable results for clinical practice. Twenty-seven low quality trials compared the use of "immune RNA (iRNA)" with standard methods in hepatitis, carcinoma and burn patients, combined analysis directed that there are not valid evidences to confirm the value of iRNA. Conclusions Immunonutrition may decrease infection rates, length of hospitalisation and cost in surgery and critical ill patients, but we can not affirm the role of the nucleotides in irmnunonutrition. No evidences support the point of adding nucteotides in breast milk substitute. Also, we can not affirm the role of iRNA in clinical immune regulation treatment. There are no available evidences in nucleic acids for caducity prevention and improvement of aging people’s health. Consequently, we advice Chinese health officials to enhance the management for applying "nucleic acids nutrients".
Objective To assess the effectiveness and safety of one kind of ACEI—Ramipril, for providing proofs for clinical implement and we also tried to explore the practical method of evidence-based drug assessment. Method By using the methods and principles of systematic review (SR), and health technology assessment (HTA), we searched Medline and Cochrane Library, together with related materials provided by pharmaceutics and collected all the published clinical research reports on Ramipril. Based on principles of SR and HTA, we assessed all the included reports comprehensively. Results We totally collected 214 articles about Ramipril, in which there were 18 articles meeting the inclusion criteria and 31 139 patients were enrolled in these studies. The research contents include: hypertension, diabetes mellitus, heart failure, myocardial infarction, nephropathy and secondary prevention for cardio-cerebral vascular disease. Conclusion According to our clinical evidence assessment, Ramipril is an effective, safe and easy to take drug and is worthy to spread.
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.
Compared with traditional HTA, the most fundamental feature of HB-HTA is “organizational perspective”, which is based on the actual situation of the hospital and supports hospital management decision-making. The new health care reform has set higher goals and requirements for hospitals. HB-HTA has management, economic and technical functions, and it can provide methodological support for health care policy management and decision-making based on the current optimal evidence, and promote the transformation of hospital from administrative decision-making to evidence informed decision-making. As an integral part of HTA network, HB-HTA plays a role in health technology networks through vertical cooperation mechanism and horizontal diffusion mechanism. It can interact and cooperate with national and regional HTA, as well as spread based on a specific medical field.
Objective To systematically review the efficacy, safety, cost-effectiveness, indications, contraindications, and ethical issues for surgical treatment of Alzheimer's disease (AD). Methods The CNKI, WanFang Data, VIP, PubMed, Web of Science, Embase and Cochrane Library databases were electronically searched to collect for relevant studies on surgical treatment of AD from inception to November 26, 2024. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed by using Stata 17 software. Results A total of 59 studies were included. The results revealed that surgical treatment for AD had higher safety (OR=0.44, 95%CI 0.17 to 0.72, P<0.05), and patients had better ADAS-cog scores (SMD=0.54, 95%CI 0.18 to 0.90, P<0.05), with statistically significant differences. The economic burden of surgical treatment for AD increased with the severity of the disease. Deep brain stimulation may offer high economic benefits in the treatment of mild AD. The surgical indications can be summarized as: short disease duration, mild to moderate severity, and insufficient response to pharmacological interventions. Regarding contraindications, analysis of the included literature identified four core aspects: physiological and pathological contraindications, medical comorbidities and surgical risk contraindications, cognitive and psychological factor contraindications, and other contraindications. Ethical issues can be categorized into: informed consent and autonomy, ethical review and approval of research, and assessment of risks and benefits. Conclusion Current evidence suggests that surgical treatment for AD has certain benefits, but the surgical approaches for treating AD are still in the exploratory stage. Limited by the number and quality of the included studies, the above conclusion still requires more high-quality research to be verified.