Objectives To describe the mechanism of means testing used in health programs for targeting poor population and to describe how the authors have assessed effects of means testing approaches where applicable. Method We searched 24 electronic resources which included evidence-based, health, economic and social databases, 7 international institution websites, grey literature review resources and Google. Screening and data extraction were conducted by two reviewers separately, and the differences were discussed by the third person or a review group. We systematically analyzed the included studied by theme analysis method from different dimensions. We also described the evaluation outcomes by the authors. Result A total of 10244 records were searched, and 58 studies were included after screening by title, abstract and full texts. A total of 13 studies described verified means testing (VMT) conducted as a targeting method in the US; simple testing method (SMT) was conducted in 16 countries; 26 studies described how proxy means testing (PMT) was used in 14 countries; andmixed means testing (MA) was conducted in 14 countries. Means testing as a targeting method was widely used in four health programs which included health insurance, cash transfer, provision of free health service and fee structure. The target population was poor. Only few studies analyzed the outcomes of means testing; 3 studies analyzed under-coverage and 11studies analyzed leakage as their indicators. Scare cost information could be obtained from the included studies. Conclusion Means testing is widely used in various health programs for targeting the eligible population in distributing benefits, especially in developing countries. Targeting as a means for allocating health resources is particularly important in LMICs for their constraints in budgets available for health. Meanwhile, a universal coverage strategy has become a worldwide issue, and how current health resources can be used equitably and efficiently is a concern from the policy practice. Means testing, as one of the tools in targeting eligible population, would help in this process.
Objective To explore the effect of antihypertensive treatment on target-organ damage in very elderly patients (gt;80 years). Methods One hundred and sixty-seven very elderly hypertensive patients were randomized into two groups, i.e. anti-hypertension treatment group and placebo-control group. All the patients received echocardiographic examination of left ventricular mass index, laboratory tests of urinary creatinine and urinary albumin and 24-hour ambulatory blood pressure monitoring 2 months after placebo washout period and at the end of the one year treatment, respectively. Results After treatment, the improvement in all the dynamic blood pressure parameters except daytime diastolic blood pressure and heart rate(24 h, daytime and night time), were significantly better than that of placebo-control group(Plt;0.05).The improvement in left ventricular and renal functional parameters were significantly better than that of placebo-control group(Plt;0.05). Conclusion Anti-hypertension treatment may significantly improve left ventricular pachynsis and renal function damage in very elderly hypertensive patients.
MicroRNA-92a (miR-92a) is an evolutionarily highly conserved pathogenic microRNA that is a member of the microRNA-17-92 gene cluster and is involved in the regulation of biological activities such as cell proliferation, apoptosis and differentiation. Recent studies have revealed that disorders of miR-92a expression are associated with disease development and exert pathogenic effects mainly through the regulation of target genes or target proteins. The current research related to miR-92a is mainly focused on malignant tumors, and its high expression has been found to be associated with cancer cell malignancy and reduced sensitivity of tumors to radiotherapy. miR-92a targeting target genes or target proteins to cause disease and its relationship with radiotherapy has been a hot research topic in recent years. Based on this, This article reviews the latest research on miR-92a target gene or target protein pathogenesis and its impact on chemotherapy in order to provide targets for clinical disease treatment.
Objective To evaluate the efficacy and safety of anti-vascular endothelial growth factor (VEGF) agents for advanced renal cell carcinoma. Methods We searched MEDLINE, EMbase, The Cochrane Library, CBMdisc and China Academic Periodical database from the establishment of each database to April 2009. We included randomized controlled trials (RCTs) that evaluated anti-VEGF agents (sunitinib, sorafenib and bevacizumab). The quality of the included trials was evaluated by two reviewers independently. Meta-analyses were conducted by the Cochrane Collaboration’s RevMan 4.2 software. Results Four RCTs involving 2 320 patients were identified. According to the different interventions for advanced renal cell carcinoma, we divided the patients into two groups: anti-VEGF agents monotherapy and anti-VEGF agents plus interferon combination treatment. Our meta-analyses showed: monotherapy was superior to interferon on inhibition of tumor progression [OR=0.38, 95%CI (0.29, 0.51), Plt;0.01] and control of tumor [OR=2.53, 95%CI (1.87, 3.43), Plt;0.01], but was not significantly different from interferon on the overall effective rate [OR=1.97, 95%CI (0.20, 19.57), P=0.56] and serious side effects [OR=1.98, 95%CI (0.90, 4.34), P=0.09]. There were significant differences between anti-VEGF agents plus interferon and interferon alone on inhibition of tumor progression [OR=0.67, 95%CI (0.53, 0.84), P=0.000 5], overall effective rate [OR=2.65, 95%CI (1.94, 3.61), Plt;0.01], control of tumor [OR=2.14, 95%CI (1.65, 2.78), Plt;0.01] and serious side effects [OR=2.63, 95%CI (2.09, 3.31), Plt;0.01]. Conclusion Compared with interferon, anti-VEGF agents could inhibit tumor progression more effectively. Moreover, the combination therapy with interferon could offer a more favorable overall effective rate for advanced renal cell carcinoma, but then followed by more serious side effects. We need to weigh the merits and demerits of drugs before making a clinical decision for advanced renal cell carcinoma.
Objective To review the advances of target gene therapy of liver cancer. MethodsWe analyze and compare the tissuespecific carrier system or cellspecific gene expressing system from current researches of liver cancer gene therapy. ResultsArtificial synthetic DNA transfer system and modified viral vectors could efficiently transfect target cells and get highlevel expression. The ciselements of alpha fetal protein or albumin gene have been often adopted in the regulation of therapeutic gene and have shown their effectiveness. Some other gene therapy strategies also promised a good future. Conclusion Searching for more specific and universal liver cancer antigens is the key to improve the target gene therapy efficiency. The individual situation is the basis to select the best transfer system or regulatory elements in the future.
Objective To systematically review the health economic evaluation studies of medicines for the treatment of acute myeloid leukemia (AML). MethodsThe PubMed, EMbase, Cochrane Library, CBM, CNKI, and WanFang Data, as well as the CRD database specifically for health economics were electronically searched from inception to June 2022, and related journals in the field of health economics and the websites of HTA institutions in various countries were manually searched. The quality of the studies was assessed using the CHEERS checklist. The basic characteristics of health economics evaluation publications were summarized, the quality of model structures and methodologies was assessed and economic evaluation results were compared among different treatments. Results A total of 17 studies were included, and cost-effectiveness analyses were conducted from the perspectives of the health system, patients, the whole society, and medical insurance payers. The economic evaluation models were relatively unified, but there were differences in methods and results reporting, and the quality needed to be improved. The research objects were mainly the comparison of hypomethylating agents, targeted medicine and traditional chemotherapy regimens, as well as the comparison of different chemotherapy combinations and different drug dosages. Conclusion Real-world studies are mainly focused on traditional chemotherapy regimens, and model-based health economic evaluations, such as Markov models, are more frequently applied to newly developed targeted drugs and demethylation drugs. Among all treatments, the chemotherapy regimens including cytarabine, midostaurin, and decitabine are found to be more cost-effective.
In recent years, along with more importance having been given by health care facilities and health administrative departments nationally, the work force of infection prevention and control is constantly increasing. In the new era, to help infection prevention and control practitioners and all health care workers make the right direction in infection prevention and control professional business and make sure the infection prevention and control measures are implemented, what we need is to define the target of infection prevention and control scientifically, identify obligation subjects, and improve the infection prevention and control system and working mechanism from the top-level.
Angiopoietin-like protein (ANGPTL), a group of secreted glycoproteins, is widely expressed in vivo and is involved in many pathophysiological processes such as glycolipid metabolism, stem cell growth, local inflammation, vascular leakage and angiogenesis. Many kinds of ANGPTL are closely related to the occurrence and development of diabetic retinopathy (DR), especially ANGPTL4, which has gradually become a new hotspot in the field of DR Research. ANGPTL is involved in glucose metabolism and lipid metabolism, promotes increased vascular permeability, pathological angiogenesis, and participates in intraocular inflammation. ANGPTL is a promising molecular target. It can not only be used as a biomarker to predict the occurrence and progression of DR, but also provide new ideas for the treatment of DR by making antibody drugs to interfere with this molecule.
ObjectiveTo analyze the efficacy, hospitalization cost and cost-effect of different treatments for multiple myeloma, so as to provide references for the treatment and development medical insurance payment policy of multiple myeloma.MethodsA total of 60 cases of multiple myeloma patients who were treated in the General Hospital of Shenyang Military Command from January 1st, 2013 to December 31st, 2017 were included. According to the treatment method, they were categorized into the traditional treatment group (n=37) and novel drug treatment group (n=23). The total response rate and hospitalisation expenses for patients with medical insurance of the two groups were calculated and compared, and cost-effectiveness analysis was then performed.ResultsThe overall response rate in patients in traditional treatment group was 56.76% (21/37), and in novel drug treatment group was 82.61% (19/23) (χ2=4.366, P=0.039). The annual average drug fee, annual average novel drug fee, secondary average drug fee, secondary average novel drug fee, annual average total cost, and secondary average total cost of the medical insurance patients in the novel drug treatment group were significantly higher than those in the traditional treatment group (P<0.05). The annual average cost of personal and coordinated payment for the medical insurance patients in the novel drug treatment group were 172 229.53 yuan and 48 237.51 yuan, respectively, which were significantly higher than the traditional treatment group (P<0.01). The cost-effectiveness ratio of the traditional treatment group was 884.44 yuan/%, the novel drug treatment group was 2 821.80 yuan/%, the cost-effective incremental ratio was 7 075.75 yuan/%, the incremental cost-effective ratio was 7 075.75 yuan/%, and the sensitivity analysis was consistent with the results.ConclusionsThe total response rate of novel drug treatment is significantly higher than traditional treatment. However, novel drug treatment costs higher, and patient's economic burden is also higher. The traditional treatment is superior to novel drug treatment in cost-effectiveness analysis.
【 Abstract 】 Objective To investigate the clinical effects of targeting therapy with iodine-131 labeled monoclonal antibody for hepatocellular carcinoma (HCC). Methods The related published literatures were reviewed and summarized. Results The reasonable application of targeting therapy with iodine-131 labeled monoclonal antibody could improve the prognosis for patients with HCC especially for some primary HCC. It was used in various kinds of HCC patients with no severe side effects. ConclusionThe targeting therapy with iodine-131 labeled monoclonal antibody may be considered as a safe and effective method to treat HCC and an adjuvant therapy for liver surgery.