Objective To systematically review the health state utility values in patients with schizophrenia, and to provide references for subsequent studies on the health economics of schizophrenia. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were searched from inception to December 1st, 2021 to collect studies on health state utility values in patients with schizophrenia. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by Stata 15.0 software. Results A total of 19 studies were included. Patients’ utility values were 0.68 (95%CI 0.59 to 0.77) for direct measures, and 0.77 (95%CI 0.75 to 0.80) and 0.66 (95%CI 0.61 to 0.70) for indirect measures with the EQ-5D-5L and EQ-5D-3L as the primary scales. Utility values varied with measures, tariffs, regions, and populations. Conclusion Studies on health state utility value in schizophrenia are diversified in measurement methods, showing high inter-study heterogeneity. Therefore, it is necessary to promote the study on utility value measurement in schizophrenia in China.
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.
ObjectiveTo evaluate the cost-effectiveness of robot-assisted laparoscopic surgery (RALS) versus conventional laparoscopic surgery (CLS) for early-stage endometrial cancer (EC) from a societal perspective. MethodsA decision-tree model was constructed to conduct cost-utility analysis, simulating the short-term intraoperative to postoperative clinical progression of patients. Primary evaluation metrics included cumulative costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). The willingness-to-pay (WTP) threshold was set at three times the 2024 per capita gross domestic product (GDP) of China. The sensitivity analyses were performed to assess robustness of the model. ResultsThe base-case analysis revealed that patients in the RALS group gained 0.09 more QALYs at an additional cost of ¥39 079.52 compared with CLS group, the derived ICER was ¥437 157.36/QALYs, exceeding the predefined WTP threshold. The results suggested that RALS does not demonstrate superior cost-effectiveness compared with CLS in the management of early-stage EC. Univariate sensitivity analysis indicated that, when the annual surgical volume per robotic device reaches 809 cases, or the cost of Endowrist consumables per robotic surgery drops below ¥6 568.46, RALS will emerge as a more cost-effective surgical strategy. The probabilistic sensitivity analysis revealed that that RALS becomes more cost-effective when the WTP threshold exceeds ¥402 145.80. Conclusion From a Chinese societal perspective, robotic-assisted laparoscopic surgery for early-stage endometrial cancer is not cost-effective compared with conventional laparoscopic surgery at the current WTP threshold of three times per capita GDP.
Objective To assess the cost-utility study of renal transplantation compared with nemodialysis (HD) and peritoneal dialysis (PD). Methods A prospective study of end-stage renal disease patients was followed up for 3 months after renal replacement therapy. The study population included 196 patients (renal transplant [RT] n=63, hemodialysis [HD] n=82 and continious ambulatory peritoneal dialysis [CAPD] n=51) from 6 hospitals of Sichuan province. Health-related quality of life was assessed by using the WHOQOL-BRIEF questionnaire. Utility scores were obtained so as to conduct CUA (cost-utility analysis). Costs were collected from financial department and by patient interview. Results The utility values were 0.539 9± 0.013 for RT, 0.450 8± 0.014 for HD, 0.512 2±0.099 for CAPD, respectively. The mean direct cost of the first three months of renal transplant was significantly higher than dialysis (RT and CAPD). Over 3 months, the average cost per quality-adjusted life year (QALY) for patients after CAPD was lower than HD and RT. Compared to HD, incremental cost analysis showed that CAPD was more ecnomical than RT. Sensitive analysis showed that CAPD was more effective than RT when ΔQALY varied in the limit of 95% confidence interval. However, the cost-utility of RT vs HD and CAPD vs HD was varied with ΔQALY level. Conclusions Cost-utility analysis showed that CAPD was a more favorable cost-utility ratio when compared to RT at early stage RT vs HD and CAPD vs HD, but which cost-utility ratio is better, we can not draw a certain conclusion.
In computer-aided medical diagnosis, obtaining labeled medical image data is expensive, while there is a high demand for model interpretability. However, most deep learning models currently require a large amount of data and lack interpretability. To address these challenges, this paper proposes a novel data augmentation method for medical image segmentation. The uniqueness and advantages of this method lie in the utilization of gradient-weighted class activation mapping to extract data efficient features, which are then fused with the original image. Subsequently, a new channel weight feature extractor is constructed to learn the weights between different channels. This approach achieves non-destructive data augmentation effects, enhancing the model's performance, data efficiency, and interpretability. Applying the method of this paper to the Hyper-Kvasir dataset, the intersection over union (IoU) and Dice of the U-net were improved, respectively; and on the ISIC-Archive dataset, the IoU and Dice of the DeepLabV3+ were also improved respectively. Furthermore, even when the training data is reduced to 70 %, the proposed method can still achieve performance that is 95 % of that achieved with the entire dataset, indicating its good data efficiency. Moreover, the data-efficient features used in the method have interpretable information built-in, which enhances the interpretability of the model. The method has excellent universality, is plug-and-play, applicable to various segmentation methods, and does not require modification of the network structure, thus it is easy to integrate into existing medical image segmentation method, enhancing the convenience of future research and applications.
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.
ObjectivesTo systematically review the health utility scores and disability weights of liver cancer and related diseases in China.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were electronically searched to collect the studies of health utility scores and disability weights of liver cancer and related diseases in China from inception to November, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 9 studies were included which covered 10 related diseases, among which chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and liver cancer were the mostly reported. The overall quality was adequate, and EQ-5D was the most common tool in these studies. Results of meta-analysis showed that healthy utility scores of the four common diseases were 0.789 (0.735, 0.843), 0.734 (0.693, 0.776), 0.647 (0.627, 0.666) and 0.636 (0.508, 0.765), respectively. Measures from EQ-5D were 0.825 (0.762, 0.868), 0.761 (0.731, 0.791), 0.643 (0.620, 0.666) and 0.620 (0.473, 0.766), respectively. In addition, the corresponding median (range) utility scores of the four diseases were found to be 0.758 (0.520–0.950), 0.716 (0.570–0.900), 0.538 (0.260–0.662) and 0.541(0.310–0.720). Only one disability weight study was concluded (0.360–0.900 reported for liver cancer).ConclusionIn Chinese population, current evidences on health utility of liver cancer and related diseases are limited, particularly data on disability weights. Utility values from meta-analysis seems more optimistic and centralized than those from descriptive analysis. Different survey tools yield varying outcomes, and attentions should be addressed to their application. The decrease of heath utility scores with the severity of liver disease suggests that early prevention, early diagnosis and treatment can save more years of life with enhanced quality.
ObjectiveTo evaluate the efficacy and cost-effectiveness of thymalfasin (Tα1) as an adjuvant therapy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after surgery.MethodsPatients with HBV-related HCC who underwent hepatectomy from February 2007 to December 2015 in West China Hospital of Sichuan University, Chengdu Military General Hospital, or the Third Affiliated Hospital of Sun Yat-sen University were retrospectively collected and divided into the Tα1 group and the observation group. Log-rank test and Kaplan-Meier curve were used to assess the overall survival, recurrence-free survival, and safety of patients. A Markov model was used to calculate the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) of the Tα1 group compared with the observation group. Cost data was from the hospital information system of the three hospitals. Utility scores mainly came from published data. Sensitivity analyses were applied to explore the impact of essential variables.ResultsA total of 208 patients with HCC after liver resection were enrolled, among them 48 received Tα1 treatment (the Tα1 group) and 160 were only followed up (the observation group). There was no significant difference between the two groups in the baseline characteristics. The median overall survival of the Tα1 group and the observation group was 102.0 months [95% confidence interval (CI) (74.8, 129.2) months] and 81.6 months [95%CI (65.7, 97.6) months], respectively, and the difference was statisitically significant (P=0.047); the median recurrence-free survival was 66.7 months [95%CI (17.3, 116.1) months] and 37.4 months [95%CI (28.7, 46.2) months], respectively, and the difference was statistically significant (P=0.044). There were no grade Ⅲ-Ⅳ adverse events and no treatment-related death occurred. The ICER of Tα1 group was ￥108 050.02/QALY, which was less than the willingness to pay (￥177 785.25/QALY).ConclusionsTα1, as an adjuvant therapy for HBV-related HCC patients, can improve the prognosis of the patients, and the cost is within the acceptable level in our country, so this strategy is likely to be a cost-effective option compared with the observation group.
Objective To systematically review the health utility scores for patients with breast cancer in China. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were searched from inception to November, 2016 to collect studies for health utility scores for breast cancer in China. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was performed using Stata 12.0 software. Results A total of 6 studies were included. Compared with modeling studies, the range of utility scores from cross-sectional studies was narrower. The results of meta-analysis showed the utility scores for breast cancer were 0.77 (95%CI 0.67 to 0.87), 0.77 (95%CI 0.68 to 0.86) at stage 0 to Ⅰ, 0.76 (95%CI 0.66 to 0.85) at stage Ⅱ, 0.74 (95%CI 0.65 to 0.83) at stage Ⅲ and 0.73 (95%CI 0.65 to 0.81) at stage Ⅳ, respectively. Meanwhile, we descripted the median of utility scores of all studies, and the corresponding values were 0.81 (range 0.65 to 0.83), 0.82 (range 0.65 to 1.00) at stage 0, 0.82 (range 0.65 to 0.90) at stage Ⅰ, 0.77 (range 0.67 to 0.86) at stage Ⅱ, 0.70 (range 0.64 to 0.82) at stage Ⅲ and 0.70 (range 0.30 to 0.80) at stage Ⅳ, respectively. Conclusion Research on the health utility scores of breast cancer is still limited in China. Utility scores are decreasing among different clinical stages, with lowest score at late stage cancer. These findings can be used in further cost-utility evaluation on various breast cancer interventions.