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OBJECTIVE: To evaluate the economic impact of pembrolizumab combined with gemcitabine and cisplatin versus placebo combined with gemcitabine and cisplatin for the first-line treatment of patients with advanced biliary tract cancer in China. METHODS: From the perspective of China’ s health system, the willingness-to-pay (WTP) threshold was set at 3 times of China’ s gross domestic product ( GDP) per capita in 2022, that is 257 094. 00 RMB/ quality-adjusted life year (QALY), Markov model and partitioned survival model were constructed to conduct cost-effectiveness analysis, univariate sensitivity analysis and probabilistic sensitivity analysis were used to analyze the effects of parameters on the model’s robustness, and to analyze the economic outcome of pembrolizumab under the patient assistance program scenario. RESULTS: The results of Markov model analysis showed that the incremental cost-effectiveness ratio (ICER) was 2 758 043. 34 RMB/QALY for the pembrolizumab group versus the placebo group, and 730 319. 70 RMB/QALY under the patient assistance program scenario, which were both higher than the set WTP threshold; in the absence of patient assistance program, the cost-effectiveness price of pembrolizumab was 1 452. 45 RMB/100 mg, and the partitioned survival model results had validated the Markov model results. CONCLUSIONS: Under the WTP threshold of 3 times of 2022 China’s per capita GDP, pembrolizumab combined with chemotherapy for the first-line treatment of advanced biliary tract cancer does not have cost-effectiveness advantage, and lowering the price of pembrolizumab can increase the probability of its cost-effectiveness advantage. [ABSTRACT FROM AUTHOR]

This study explored the low-carbon operation and control strategy of wastewater treatment plants based on cost reduction and efficiency improvement, with a South China plant as a case study. Factors influencing phosphorus removal, including sludge age, concentration, dissolved oxygen, reflux ratio, and chemical dosing location, were analyzed. Optimal operation parameters such as sludge concentration, air/water ratio, and dissolved oxygen level were established based on influent characteristics across seasons. Implementation of these low-carbon strategies ensures the plant's effluent quality remained within standards, exhibiting a stable and decreasing trend. Meanwhile, chemical consumption for phosphorus removal decreasesd by approximately 41%, the electricity consumption per ton of treated wastewater decreased by 26.5%, resulting in a reduction of indirect carbon emissions by 0.18 kg/t(calculated by CO2,eq), which had achieved energy conservation, emission reduction, and clean production.

Copyright of Metal Working (1674-165X) is the property of Metal Working Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Under the background of systematic and full-field promotion of sponge city construction, the allocation of Low Impact Development (LID) facilities holds significant implications for urban stormwater management. In this study, we established a stormwater model for he Yixing City area in Jiangsu Province, utilizing the Storm Water Management Model (SWMM) . A comprehensive objective function was ormulated, taking into account the reduction rates of runoff volume, Suspended Solids (SS) load, Life Cycle Cost (LCC), and the area occupied by LID facilities. Through the assignment of weights to objective parameters in different scenarios, the multi-objective optimization problem was transformed into a single objective optimization problem, where each weight represented the priority of the corresponding objecive parameter. The Genetic Algorithm (GA) was then applied to derive the optimal LID layout under diverse scenarios, to analyze and compare the impact of different priorities and recurrence periods of target parameters on optimization results. The results indicate that: (1) Under he same weight conditions, LCC exhibits a more pronounced impact on GA optimization calculations compared to LID area. (2) The spatial alocative optimization of LID facilities in small subcatchments located upstream is particularly susceptible to the rainfall return period. The research findings offer valuable insights for the spatial allocative optimization of LID facility and urban flood control in sponge city construction. [ABSTRACT FROM AUTHOR]

Objectives　To evaluate the cost-effectiveness of typical pharmaceutical smoking cessation intervention strategies in China in the context of primary cancer prevention. Methods　Markov cohort simulation models were established to simulate the burden of 12 smoking caused cancer, including lung cancer, oral cancer, nasopharyngeal cancer, laryngeal cancer, esophageal cancer, gastric cancer, pancreatic cancer, liver cancer, kidney cancer, bladder cancer, cervical cancer, and acute myeloid leukemia. Taking incremental cost effectiveness ratio (ICER) as the main indicator, the model sets one year as the cycling period for 50 periods and simulates the cohort of 10 000 thirty-five-year-old current smokers with various smoking cessation strategies. To ensure the robustness of conclusion, univariate sensitivity analysis, probability sensitivity analysis, and age-group sensitivity analysis were conducted. Results　The results showed that varenicline intervention was the most cost-effective intervention. Compared to the next most effective option, incremental cost of each additional quality-adjusted life year is 11 140.28 yuan, which is below the threshold of willingness to pay (1 year GDP per capita). The value of ICER increased as the increasing age group of adopting intervention, but neither exceeded the threshold of willingness to pay. One-way sensitivity analysis showed that the value of discount rate, the hazard ratio and cost of intervention strategy had a greater impact on the result of ICER. Conclusion　In China, the use of varenicline to quit smoking is highly cost effective in the context of cancer primary prevention, especially for younger smokers. [ABSTRACT FROM AUTHOR]

Objective To analyze the cost-effectiveness of carotid endarterectomy carotid endarterectomy (CEA) and medical therapy for asymptomatic carotid stenosis in Chinese patients over 70 years old. Methods Based on the data of different out- comes of asymptomatic carotid stenosis patients who were followed up by CEA and drug therapy for 10 years, a Markov mod- el was established to simulate the cost-effectiveness of the two treatments for 10 years. The outcome index was incremental cost-effectiveness ratio (ICER), which was the ratio of increased cost to increased quality-adjusted life years (QALY), and the thresholds of ICER and willingness to pay (WTP) were compared. In this paper, scenario analysis was carried out, and uncertainty test was carried out by single factor sensitivity analysis and probability sensitivity analysis. Results In the basic case analysis, the patients who received CEA could get 7.53 QALYs, the corresponding cost was 67 079.61 yuan and 31 982.38 yuan, and the ICER was 129 435.97 yuan / QALY, which was lower than the threshold of WTP. In scenario analysis, the ICER was 127 946.82 yuan / QALY and 240 283.17 yuan/ QALY, respectively. The annual mortality of patients after CEA, the operation cost of CEA, and the perioperative mortality after CEA had great influence on the fluctuation of ICER. Conclusion According to the economic evaluation recommendation of WHO, the increased cost of CEA compared with drug therapy is acceptable for Chinese patients with asymptomatic carotid artery stenosis over 70 years old. [ABSTRACT FROM AUTHOR]

OBJECTIVE: From the perspective of health system in China, to evaluate the economical efficiency of abiraterone in first-line treatment of metastatic castration-resistant prostate cancer ( mCRPC ) without previous chemotherapy treatment. METHODS: The partitioned survival model was used to predict lifetime disease course of mCRPC, efficacy and safety data were derived from COU-AA-302 trial. Cost data were came from local data. Results were expressed in terms of cost, quality-adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER). The uncertainty of the model was analyzed by single factor and probabilistic sensitivity. RESULTS: At present, for mCRPC patients who had not previously received chemotherapy, 0. 26 more QALYs were obtained in the abiraterone group than in androgen deprivation therapy (ADT) group, with an ICER of 587 430 yuan / QALY. CONCLUSIONS: Compared with ADT regimens, abiraterone can significantly extend the life years of patients with mCRPC and improve the quality of life, yet the corresponding medical costs will increase. Abiraterone does not have an economic advantage in the treatment of mCRPC at a willingness-to-pay of three times China’s GDP per capita. [ABSTRACT FROM AUTHOR]

Objective To analyze the safety and cost-effectiveness of intermittent pneumatic compression (IPC) during the intermittent pneumatic interval after total knee arthroplasty (TKA). Methods A total of 337 patients who underwent TKA surgery were included and randomly divided into experimental group (n=168) and control group (n=169). The experimental group continued to use IPC for both lower limbs during the anticoagulant window period, while the control group continued to use IPC for both lower limbs immediately after surgery to the time of getting out of bed. Muscular calf vein thrombosis (MCVT) prevention rate, D2 polymer level, total postoperative blood loss, and cost-effectiveness ratio were compared between the 2 groups in 1 d after surgery. Results There were no statistical significances in MCVT prevention effective rate, hemoglobin level, total blood loss, and D2 polymer level between the 2 groups in 1 d after surgery. The IPC time was 6.00 (6.00, 6.00) h in the experimental group, significantly shorter than that in the control group [20.00 (15.00, 24.25) h, P < 0.01]. The total cost of IPC was significantly lower in the experimental group than the control group [172.84 (172.84, 172.84) vs 628.37 (461.82, 758.49) Yuan, P < 0.01]. The cost-effectiveness ratio of the experimental group (2.23) was lower than that of the control group (7.75). Conclusion The use of IPC during the anticoagulant window after TKA has good safety and better cost-effectiveness than the continuous use of IPC after surgery.

With methodological development of assessment on child nutrition interventions, relevant evaluation indicators have been developed from merely for simple health outcomes to for comprehensive economic benefits. The cost accounting on child nutrition interventions has been subdivided into various items and the indicators for cost-effectiveness is no longer limited to a single indicator. A more complete analytical framework for evaluating child nutrition interventions is established with probability method-based cost-utility analysis. In cost-benefit analysis, the income, medical expenses and assigning a value to the life year are all taken into account, which also makes the estimation of intervention benefits more comprehensive. In order to estimate the improvement of human capital for child nutrition interventions, sociological and econometric methods have also been used, and prediction model of human capital is constructed from the changes in height, years of schooling and cognitive ability due to the nutrition improvement. A trend in deep integration of multiple disciplines has been shown in economic evaluation on child nutrition interventions.

Copyright of Journal of Taiwan Agricultural Research is the property of Taiwan Agricultural Research Institute, Council of Agriculture, Executive Yuan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Southeast University (English Edition) is the property of Journal of Southeast University Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lung cancer is the most common malignant tumor in the world. The five-year survival rate is 19.7%, which seriously threatens human health. Lung cancer screening is an effective measure to reduce lung cancer mortality. Existing studies have shown that screening with low-dose computed tomography (LDCT) can reduce lung cancer deaths by 20%. Currently, lung cancer screening is recommended internationally and nationally. Studying the development status of lung cancer screening helps us to identify the high-risk groups of lung cancer, explore reasonable screening programs, improve the cost-effectiveness of screening and reduce the economic burden. Therefore, this article summarizes the current status of lung cancer screening, the cost-effectiveness of lung cancer screening and the existing problems as follows.

To investigate the cost-benefit analysis of peramivir sodium chloride injection in children with influenza virus type A pneumonia. 96 children with influenza virus A pneumonia admitted to our hospital from January 2015 to December 2018 were selected, who were divided into two groups according to the random number table method, each group had 48 cases, group A were given Oseltamivir phosphate granules, group B were given Peramivir sodium chloride injection, the treatment effect, clinical symptoms disappearance time, stay length, medication cost, cost-benefit in two groups were compared, the blood routine and liver and kidney function before and after treatment were compared in two groups, and the incidence of adverse reactions was compared between the two groups. The effective rate of treatment in group B was significantly higher than that in group A (P<0.05). The average drug cost of group A was significantly lower than that of group B (P<0.05), and the cost-benefit of group A was lower than that of group B (P<0.05). Compared with before treatment, the total number of neutrophils was significantly increased, and the total number of white blood cells and lymphocytes were significantly decreased in two groups after treatment (P<0.05). Before and after treatment, there were no statistical significance in blood routine indexes of two groups (P>0.05). Before and after treatment, there was no statistical significance in liver and kidney function of two groups (P>0.05). The incidence of adverse reactions in group B was higher than that in group A, but the comparison between groups was not statistically significant (P>0.05). Compared with Oseltamivir phosphate, Peramivir sodium chloride injection has better efficacy in the treatment of children with influenza virus type A pneumonia, while the cost-benefit was low, and medication could be selected according to the actual situation of children. [ABSTRACT FROM AUTHOR]

Objective To evaluate the cost effectiveness of primary prophylaxis (PP) with pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF), PP with recombinant human granulocyte colony stimulating factor (rhG-CSF) and no prophylaxis in women with early-stage breast cancer in China. Methods Two phase Markov models were constructed for a hypothetial cohort of patients aged 45 with stage II breast carrer. The first phase model costs and outcomes of 4 cycles docetaxel combined with cyclophosphamide [TC x 4, febrile neutropenia (FN) risk> 20%] chemotherapy, which assumptions based on literature reviews, including FN rates [base-case (deterministic sensitivity dialysis range), 0.29 (0.24-0.35)] and related events [FN case-fatality, 3.4 (2.7-4. 1)]. Second phase modelled the long term survival which was link with the radative dose intensity (RDI) [mortality, hazard, and ratio (HR) of RDI < 85% vs 85%, I.45 (1.00-2.32) ]. Clinical effectiveness, therapeutic costs, and economic utilities were estimated from peer-reviewed publications and expert opinions in case of unavailability of published evidences. Results Compared to rhG-CSF PP and no prophylaxis, the cost of PEG-rhG-CSF PP increased to 5 208.19 RMB and 5 222.73 RMB, respectively. The quality-adjusted life-years (QALYs) enhanced to 0.066 and 0.297, respectively. Accordingly, the incremental cost effectiveness ratios (ICERs), are 79 146.3 RMB m1d 17 558.77 RMB per QALY, which were both below the willingness to pay (WTP) threshold of three times GDP per capita (I8,000 RMB) recommended hy the WHO. Sensitivity analysis suggested that the more clinically effective the primary prophylaxis with PEG-rhG-GSF is, the more cost-effective primary prophylaxis with PEG-rhG-CSF will he. And the lower the mortality HR of RDI<85%· vs 85%, is the more cost-effective primary prophylaxis with PEG-rhG-CSF will he. Conclusion Although the cost of PP PEGrhG-CSF is higher, considering the additional benefits, the administrating of PP PEG-rhG-CSF is likely to he a cost-effective alternative to PP rhG-CSf and no prophylaxis in patients with early stage hrcast cancer whose FN risks are more than 20% in China. [ABSTRACT FROM AUTHOR]

Objective: To explore the cost-effectiveness of different antibiotics for the perioperative period of patients with tumor. Methods: 93 patients with lung cancer who underwent surgery in our hospital were selected. All patients were divided into three groups according to the random number table method, with 31 cases in each group. Three groups of patients implemented different antibiotic prophylaxis programs. The general surgery conditions of the three groups were compared (surgery time, intraoperative blood loss, postoperative operation). 7 days maximumbody temperature, postoperative hospital stay), antibiotic application effect (postoperative respiratory infection rate, average body temperature at 7 days after surgery, average white blood cell count at 7 days after surgery) and cost-effectiveness of different antibiotic prevention programs. Results: (1) There was no significant difference in the operation time, intraoperative blood loss, maximumbody temperature and hospitalization time between the three groups (P>0.05). (2) There were no significant differences in postoperative respiratory infection rate, mean body temperature at 7 days after surgery, and mean white blood cell count at 7 days after operation (P>0.05). (3) Patients in the group A had the highest cost-effectiveness ratio, and the cost per unit effect was significantly lower than those in the groups B and C (P<0.05). Conclusion: Preoperative prevention and short-term postoperative treatment with cefazolin sodium can significantly reduce postoperative infection rate, reduce antibiotic dosage and cost, and improve perioperative cost-effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To explore the cost-effectiveness of prophylactic antibiotic use in perioperative period of cesarean section, to provide effective and economical antibiotic application program for cesarean section. Methods: 80 cases of parturients who received cesarean section in our hospital in recent three years were selected and randomly divided into study group and control group, 40 cases in each group. In study group, cefuroxime was intravenously dripped immediately after the delivery of the umbilical cord, and no antibiotics were used after the operation. In control group, cefuroxime was intravenously dripped after the operation, cost-effectiveness were compared between the two groups. Results: There was no significant difference between the two groups in body temperature (average body temperature, maximum body temperature), recovery time of body temperature, hospitalization time and incidence of postoperative infection (P>0.05); The cost and effect of the study group was significantly lower than that of the control group (P<0.05). Conclusion: Preventive use of antibiotics during the perioperative period of cesarean section can achieve good anti-infective effect. Choosing cefuroxime as a preventive antibiotic during the perioperative period of cesarean section is an effective and economical scheme, and excessive perioperative antibiotic use can be avoided. [ABSTRACT FROM AUTHOR]

Objective . To compare the therapeutic effect, cost, cost-effectiveness and utility between internet-based cognitive behavioral therapy (ICBT) and cognitive behavioral group therapy (CBGT) in the patients with obsessive-compulsive disorder (OCD). Methods . Twenty-eight patients who met the OCD diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) were assigned to ICBT group (n=16) and CBGT group (n=12) according to the patients' willingness. Both groups were treated for 6 weeks. The study compared differences in the severity of OCD and symptoms of anxiety and depressive at baseline, during treatment and after treatment, as well as differences in cost, cost-effectiveness and utility between two groups. Results . There was no significant difference in the scores of Yale-Brown Obsessive Compulsive Scale (YBOCS), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Visual Analog Scale (VAS) [a component of EuroQol Five Dimensions Questionnaire, (EQ-5D)] between the two groups at baseline (P=0.291, P=0M4, P=0A7Z, P=OJ99). After treatment, the YBOCS scores decreased compared to prc-trcatment in two groups. There was no statistical difference in subtraction rate of YBOCS between the two groups (P=0.291). The SDS scores of ICBT group also decreased after treatment compared to pre-treatment (P=0.003). The average cost per patient in ICBT group was 2 710.50 yuan less than that in CBGT group. When one YBOCS score per patient reduced, ICBT group spent 281.33 yuan less than CBGT group. The VAS scores were significantly improved after 6-week treatment and ICBT group has a more significant improvement Conclusion . ICBT and CBGT have comparable and significant efficacy. And ICBT is a lower cost and more cost-effectiveness and utility treatment than CBGT. [ABSTRACT FROM AUTHOR]

Copyright of China Tropical Medicine is the property of China Tropical Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study aims to evaluate the effectiveness and economic efficiency of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of chronic rhinosinusitis(CRS). The randomized controlled trial(RCT) of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS was searched against EMbase, PubMed, Cochrane Library, CNKI, VIP, SinoMed, and Wanfang. The efficacy, nasal mucociliary transport time, and safety of the therapy above in the treatment of CRS were analyzed with single-group rate and Meta-analysis, and the economy and sensitivity were evaluated from the perspective of payer. A total of 9 RCTs were included, including 1 145 patients. Meta-analysis showed that compared with Triamcinolone Acetonide Nasal Spray alone, Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS patients increased the effective rate(RR=1.17, 95%CI[1.11, 1.24], P&lt;0.000 01) and shortened the nasal mucociliary transport time(MD=-3.32, 95%CI[-5.86,-0.78], P=0.01), there was no significant difference in the incidence of adverse reactions between the two groups. The incremental cost-effectiveness analysis showed that the treatment costs of the control group and the observation group were 44.15 yuan and 1 044.96 yuan, respectively. In the Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray treatment group, 75.48 yuan was spent to improve the effective rate of CRS by 1%. The one-way sensitivity analysis indicated the days of treatment, the RR of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray, the price of unit preparation of Biyuan Tongqiao Granules, and the effective rate of Triamcinolone Acetonide Nasal Spray alone had great influence on the incremental cost-effectiveness ratio. In conclusion, Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray improves the therapeutic effect on CRS. The probabilistic sensitivity analysis showed that when the willingness to pay was greater than 7 920 yuan(less than 0.1 of GDP per capita 8 098 yuan), the combined therapy was economically superior to the control. Due to the limited number of articles published, it is necessary to carry out a real-world clinical trial of Biyuan Tongqiao Gra-nules and Triamcinolone Acetonide Nasal Spray in the treatment of CRS, so as to compare the cost-effectiveness of Biyuan Tongqiao Granules and Triamcinolone Acetonide Nasal Spray.

Objectives: Hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) is the most common type of liver failure in China, with a high mortality. Early rapid reduction of HBV-DNA load can improve the survival rate of HBV-ACLF patients. At present, the commonly used drugs are nucleoside (acid) analogues, such as entecavir (ETV), tenofovir, and so on. The newly listed tenofovir alafenamide fumarate (TAF) has attracted great attention of clinicians because of its stronger antiviral effect, higher transaminase normalization rate, better bone and kidney safety, and zero drug resistance. However, there are few clinical research data on the efficacy and safety of TAF in the treatment of Chinese HBV-ACLF patients, and there is a lack of pharmacoeconomic evaluation. This study aims to compare the efficacy, safety, and cost-effectiveness between TAF and ETV in patients with HBV-ACLF., Methods: The data were collected from 196 HBV-ACLF patients (80 patients in the TAF group and 116 patients in the ETV group) who were hospitalized in Xiangya Hospital, Central South University from May 2020 to March 2021. Biochemistry and virology were detected before and after treatment (at baseline, Week 2, 4, and 12). Clinical features, disease prognosis, and cost-effectiveness were compared between the 2 groups. According to the baseline, HBV-ACLF patients were divided into 4 stages including pre-liver failure stage, early stage, medium stage, and end stage. And the liver transplantation rate and mortality was also compared. Pharmacoeconomic evaluation was taken using cost-effectiveness analysis and cost minimization analysis．., Results: After 4 weeks of treatment, there were no significant differences in the efficacy (liver function, viral load) between the 2 groups (all P >0.05). The TAF group showed lower creatinine [(80.35±18.77) μmol/L vs (105.59±82.32) μmol/L, P <0.05] and higher estimated glomerular filtration rate (eGFR) levels [(95.65±23.21) mL/(min·1.73 m 2 ) vs (82.68±26.32) mL/(min·1.73 m 2 ), P <0.05] than the ETV group. After 12 weeks of treatment, the analysis of overall the liver transplantation rate and mortality between the 2 groups showed similar conclusion. However, the TAF group had a lower the liver transplantation rate and mortality than the ETV group in patients with pre-liver failure (0vs13.89%, P <0.05). No evident distinction was found in the liver transplantation rate and mortality during the early, medium, or end stages of liver failure (13.04% vs 17.65%, 37.50% vs 37.04%, and 54.55% vs 68.42%, respectively). Ratio of cost to effectiveness in the ETV group was higher than that in the TAF group., Conclusions: TAF is not more efficient than ETV group in improving liver function and reducing viral load for HBV-ACLF patients and they also show similar safety. However, TAF has a greater advantage over ETV not only in preserving renal function, but also in reducing the liver transplantation rate and mortality in patients with pre-liver failure. TAF can provide economic benefit to patients with HBV-ACLF.

Objective: To investigate the effectiveness and cost of 50% and 80% wettable powder of niclosamide ethanolamine salt (NESWP) and 26% metaldehyde and niclosamide suspension concentrate (MNSC) in hilly schistosomiasis-endemic regions, so as to provide insights into the selection of chemical molluscicides in hilly regions., Methods: In September 2020, a wasteland in Guanshanqiao Village, Yanrui Township, Yushan County of Jiangxi Province was selected as the experimental region, which was sectioned into five blocks and defined as four experimental groups (A 1 , A 2 , B, C) and a blank control group (D). 80% NESWP were given at doses of 1 g/m 2 and 1.5 g/m 2 in groups A 1 and A 2 using the spraying method, 50% NESWP was given at a dose of 2 g/m 2 in Group B using the spraying method, and 26% MNSC was at a dose of 4 g/m 2 in Group C using the spraying method, while no chemical treatment was given in Group D. Snail survey was performed using a systematic sampling method before chemical treatment and 1, 3, 7 d and 15 d post-treatment to examine the molluscicidal effect, and all molluscicidal costs were estimated to calculate the cost of chemical treatment per 1 m 2 and the cost of the reduction in the mean density of living snails per 1%., Results: The highest mortality of snails was 78.95% and the lowest density of living snails was 0.2388 snails/0.1 m 2 in the experimental groups within 7 d of chemical treatment, and the highest mortality of snails was 94.74% and the lowest density of living snails was 0.058 0 snails/0.1 m 2 7 d post-treatment. There were no significant differences in the snail mortality among the A 1 , A 2 , B and C groups 1 ( χ 2 = 2.250, P > 0.05), 3 ( χ 2 = 1.779, P > 0.05) or 15 d post-treatment ( χ 2 = 2.286, P > 0.05), while a significant difference was detected in the snail mortality among the four groups 7 d post-treatment ( χ 2 = 7.990, P = 0.046). In addition, there were no significant differences in the snail mortality between A 1 and A 2 groups 1 ( χ 2 = 0.724, P > 0.05), 3 ( χ 2 = 0.584, P > 0.05), 7 ( χ 2 = 0.400, P > 0.05) or 15 d post-treatment ( χ 2 = 0.251, P > 0.05). The costs of chemical treatment per 1 m 2 were 0.58, 0.60, 0.64 Yuan and 0.73 Yuan in groups A 1 , A 2 , B and C, and the costs of the mean density of living snail per 1% reduction were 19.29, 20.44, 21.68 Yuan and 23.53 Yuan in groups A 1 , A 2 , B and C, respectively., Conclusions: 80% NESWP shows a high molluscicidal efficacy and low cost in hilly schistosomiasis-endemic regions.

Objective: To analyze the results and cost-effectiveness of colorectal cancer (CRC) screening program among Zhejiang urban residents so as to provide evidence for further optimization of CRC screening strategies. Methods: Based on the Cancer Screening Program in Urban China which was conducted in Zhejiang province from 2013-2018, data related to the rates on compliance and detection through the CRC screening program among the 40-74 year-old residents were analyzed. Chi-square tests were used to compare the differences among groups, and multivariate logistic regression models were applied to explore the potential risk factors. Cost-effectiveness ratio (CER) was calculated by using the cost per lesion detected as the indicator. Results: Among all the 166 285 participants who completed the risk assessment questionnaire, 21 975 (13.2%) were recognized as under the high risk of CRC and 4 389 (20.0%) of them received the colonoscopy. The detection rates of CRC, advanced adenoma, and non-advance adenoma were 0.3% (11 cases), 2.7% (119 cases), and 5.2% (229 cases), respectively. Results from the multivariate logistic regression analyses showed that factors as age, gender, education level, smoking, drinking alcohol, previous fecal occult blood test (FOBT), polyp history, and family history of CRC were significantly associated with the compliance rate of colonoscopy while age, smoking and polyp history were significantly associated with the detection rate of advanced neoplasms (CRC and advanced adenoma). The costs were ￥22 355.74 Yuan for every CER advanced neoplasm detection and ￥264 204.18 Yuan per CRC detection, respectively. The CER decreased along with ageing. Sensitivity analysis showed that CERs were expected to decrease when the compliance rate of colonoscopy was increasing. Conclusions: The current screening program seems effective in detecting the precancerous colorectal lesions, but the relatively low compliance rate of colonoscopy restricting both the diagnostic yields and economic benefits. It is necessary to improve the awareness and acceptance of colonoscopy among the high-risk CRC population.

Lung cancer is the most common malignant tumor in the world. The five-year survival rate is 19.7%, which seriously threatens human health. Lung cancer screening is an effective measure to reduce lung cancer mortality. Existing studies have shown that screening with low-dose computed tomography (LDCT) can reduce lung cancer deaths by 20%. Currently, lung cancer screening is recommended internationally and nationally. Studying the development status of lung cancer screening helps us to identify the high-risk groups of lung cancer, explore reasonable screening programs, improve the cost-effectiveness of screening and reduce the economic burden. Therefore, this article summarizes the current status of lung cancer screening, the cost-effectiveness of lung cancer screening and the existing problems as follows.
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Objective: To evaluate the cost effectiveness of primary prophylaxis (PP) with pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF), PP with recombinant human granulocyte colony stimulating factor (rhG-CSF) and no prophylaxis in women with early-stage breast cancer in China. Methods: Two phase Markov models were constructed for a hypothetical cohort of patients aged 45 with stage Ⅱ breast cancer. The first phase modelled costs and outcomes of 4 cycles docetaxel combined with cyclophosphamide [TC×4, febrile neutropenia (FN) risk>20%] chemotherapy, which assumptions based on literature reviews, including FN rates [base-case (deterministic sensitivity analysis range), 0.29 (0.24-0.35)] and related events [FN case-fatality, 3.4 (2.7-4.1)]. Second phase modelled the long term survival which was link with the relative dose intensity (RDI) [mortality hazard ratio ( HR ) of RDI < 85% vs ≥85%, 1.45 (1.00-2.32)]. Clinical effectiveness, therapeutic costs, and economic utilities were estimated from peer-reviewed publications and expert opinions in case of unavailability of published evidences. Results: Compared to rhG-CSF PP and no prophylaxis, the cost of PEG-rhG-CSF PP increased to 5 208.19 RMB and 5 222.73 RMB, respectively. The quality-adjusted life-years (QALYs) enhanced to 0.066 and 0.297, respectively. Accordingly, the incremental cost effectiveness ratios (ICERs) are 79 146.3 RMB and 17 558.77 RMB per QALY, which were both below the willingness to pay (WTP) threshold of three times GDP per capita (18, 000 RMB) recommended by the WHO. Sensitivity analysis suggested that the more clinically effective the primary prophylaxis with PEG-rhG-CSF is, the more cost-effective primary prophylaxis with PEG-rhG-CSF will be. And the lower the mortality HR of RDI<85% vs ≥85% is, the more cost-effective primary prophylaxis with PEG-rhG-CSF will be. Conclusion: Although the cost of PP PEG-rhG-CSF is higher, considering the additional benefits, the administrating of PP PEG-rhG-CSF is likely to be a cost-effective alternative to PP rhG-CSF and no prophylaxis in patients with early stage breast cancer whose FN risks are more than 20% in China.

Washed microbiota transplantation (WMT) is a new concept and technique of fecal microbiota transplantation. The delivery routes of WMT include oral capsule, nasogastric tube, nasojejunal tube, gastroscopy, colonic transendoscopic enteral tubing, and anal enema. The research results among different indications or different designs based on the same indication are quite different, partially because of the influence of WMT delivery route. In the process of clinical research design and clinical practice, there are four aspects that affect the decision-making of WMT delivery route: safety, efficacy, cost-effectiveness, and patients' willingness. This article focuses on how to integrate the four aspects mentioned above in the decision-making process of choosing proper delivery of WMT for the final goal of mutual satisfaction between doctors and patients.

Objective: To examine the effect of the integrated schistosomiasis control measures in Hunan Province from 2004 to 2019, so as to provide insights into the development of the schistosomiasis elimination strategy., Methods: The integrated schistosomiasis control measures implemented by the health, agriculture, water resources, forestry, land and resources sectors were retrospectively collected in Hunan Province from 2004 to 2019, and the completion of each measure, cost of control measures, Schistosoma japonicum infections in humans and bovines, and snail status were analyzed each year. An index system for assessing the integrated schistosomiasis control effect was constructed using the Delphi method to calculate the integrated schistosomiasis control effect index. In addition, a cost-effect analysis was performed in terms of the decline in the prevalence of S. japonicum infections in humans and bovines, areas with snails in inner embankments, and areas with infected snails., Results: A total of 7 110 926 500 Yuan were invested into the integrated schistosomiasis control program of Hunan Province from 2004 to 2019. During the 16-year period, a total of 277 437.12 hm 2 snail habitats received molluscicidal treatments, 6 927 230 person-times given expanded chemotherapy, 2 116 247 bovine-times given expanded chemotherapy, 954 850 harmless toilets built, 290 359 bovines fenced, 136 666 bovines eliminated, 141 905 machines used to replace bovines, 39 048.63 hm 2 water lands improved as dry lands, 724.12 km irrigation regions improved, 3 994 300 populations covered with safe water, 191 102.89 hm 2 forests planted and 38 535.27 hm 2 lands leveled. The prevalence of S. japonicum infections was 4.29% in humans and 4.48% in bovines in Hunan Province in 2004, with 2 449.37 hm 2 snail habitats in inner embankments and 3 423.74 hm 2 infected snail areas. In 2019, the prevalence of S. japonicum infections reduced to 0 in both humans and bovines, and areas of snail habitats reduced to 540.92 hm 2 (77.92% reductions), while the areas with infected snails reduced to 0. The overall integrated schistosomiasis control effect index appeared a tendency towards a rise over years since 2004, and the integrated schistosomiasis control effect index was 97.35 in 2019; the annual mean costs for a 1% reduction in the prevalence of S. japonicum infections in 100 populations and 100 bovines were 70.11 Yuan and 4 204.78 Yuan, and the annual mean costs for a 1% reduction in the snail areas in inner embankments and infected snail areas were 2 010.20 Yuan and 1 298.09 Yuan, respectively., Conclusions: The integrated control measures achieve remarkable effectiveness for schistosomiasis control in Hunan Province, with a remarkable decline in the prevalence of S. japonicum infections in humans and bovines and great shrinking of snail areas in inner embankments and infected snail areas. Adequate fund investment is required to improve the integrated schistosomiasis control measures and consolidate the control achievements.

Meningococcal meningitis is an acute, severe respiratory infectious disease caused by Neisseria meningitidis . Immunization with meningococcal vaccine is the most effective measure to control and prevent transmission of meningococcal meningitis. Meningococcal vaccines in the Chinese market include meningococcal polysaccharide vaccine, meningococcal polysaccharide conjugate vaccine, and a combined vaccine containing meningococcal polysaccharide conjugate vaccine. This article reviews research progress on the efficacy, safety, and cost-effectiveness of meningococcal vaccines, particularly in the Chinese market, to support appropriate use of the various meningococcal vaccines for preventing meningococcal meningitis.

Meningococcal meningitis is an acute, severe respiratory infectious disease caused by Neisseria meningitidis. Immunization with meningococcal vaccine is the most effective measure to control and prevent transmission of meningococcal meningitis. Meningococcal vaccines in the Chinese market include meningococcal polysaccharide vaccine, meningococcal polysaccharide conjugate vaccine, and a combined vaccine containing meningococcal polysaccharide conjugate vaccine. This article reviews research progress on the efficacy, safety, and cost-effectiveness of meningococcal vaccines, particularly in the Chinese market, to support appropriate use of the various meningococcal vaccines for preventing meningococcal meningitis.

Objective: To evaluate the molluscicidal effects of different formulations of niclosamide ethanolamine salt in marshlands., Methods: The molluscicidal effects of spraying with 25% suspension concentrate of niclosamide ethanolamine salt (25% SCN) and 50% wettable powder formulation of niclosamide ethanolamine salt (50% WPN), and dusting with 4% niclosamide ethanolamine salt dustable powder (4% DP) for controlling Oncomelania hupensis snails were investigated and compared in the fields, and the cost-effectiveness was analyzed., Results: The corrected mortalities and the reduced rates of density of snails were 54.37%, 91.70%, 92.76%, 79.50%, and 59.55%, 95.93%, 97.63%, 94.15%, respectively, on 3, 7, 15, 30 d after spaying with 25% SCN, those on 3, 7, 15, 30 d after dusting with 4% DP were 59.10%, 91.83%, 95.56%, 93.34% and 65.03%, 94.93%, 97.61%, 97.28%, respectively; and those on 3, 7, 15, 30 d after spraying with 50% WPN were 76.29%, 91.68%, 93.12%, 81.59% and 81.24%, 97.02%, 97.84%, 95.27%, respectively. The cost of spraying with 25% SCN was 0.21 Yuan/m 2 , that of dusting with 4% DP was 0.39 Yuan/m 2 , and that of spraying with 50% WPN was 0.23 Yuan/m 2 for snail control in the marshland. The cost of reduced one percentage of the corrected mortalities and the density of snails in controlling snails by 25% SCN, 4% DP and 50% WPN on 15 d were 22.68, 40.63, 25.17 Yuan and 21.54, 39.78, 23.95 Yuan, respectively., Conclusions: The three different formulations of niclosamide are reliable and effective for snail control in marshlands. There are some differences among the different molluscicides in start time, pharmacodynamic characteristics, spraying methods in the field, cost of snail control, and influencing factors. Therefore, we need reasonably select the suitable molluscicides according to the environmental characteristics and working condition.

Objective: To evaluate the effect and cost-effectiveness of three commonly used molluscicides, 4% "Luo-wei" (tea-seed distilled saponins, TDS), 50% niclosamide ethanolamine salt wettable powder (NESWP), and 26% metaldehyde and niclosamide suspension concentrate (MNSC) in large-scale field application, so as to provide the references for formulating the strategy of snail control., Methods: The field test and parallel comparison were implemented. A marshland with Oncomelania hupensis snails of the Yangtze River was divided into 4 parts (10 hm 2 ) for the research, and three of them were experimental areas while the last one was a blank control area. The experimental areas were sprayed with 4% "Luo-wei", 50% NESWP and 26% MNSC respectively for 3 times and the interval was 1 week. Seven days after each spraying the effect of snail control was investigated, and the costs of molluscicides, labor, transportation, fuel consumption and mechanical loss were recorded. The cost of each molluscicide, snail mortality, snail density, and the cost of increasing 1% of snail mortality per 100 m 2 were analyzed and compared., Results: After the first, second and third spraying, the corrected snail mortality rates were 67.34%, 76.55% and 84.60% respectively in the 4% "Luo-wei" group; the corrected snail mortality rates were 64.71%, 75.17% and 83.89% respectively in the 50% NESWP group; the corrected snail mortality rates were 66.55%, 76.27% and 86.67% respectively in the 26% MNSC group. There was no significant difference among the 3 groups in the snail mortality at the same spraying time (χ 2 = 1.590, 0.571, 3.238, all P > 0.05) . In addition, along with the increase of the spraying times, the snail mortality of each group was increased significantly compared to that of the control group (χ 2 = 79.333, 94.718, 117.020, all P < 0.01) . After the first, second and third spraying, the reduction rates of snail density were 69.82%-86.60% in the 4% "Luo-wei" group, 68.66%-86.55% in the 50% NESWP group, and 71.89%-88.87% in the 26% MNSC group respectively. The decreasing amplitude of the snail density was more than 85% in all the experimental areas after 3 rounds of spraying molluscicide. The snail control costs per 100 hm 2 were 19.57, 11.97 Yuan and 10.47 Yuan in the 4% "Luo-wei" group, 50% NESWP group, and 26% MNSC group respectively. After the first, second and third spraying, the costs of increasing 1% of snail mortality per 100 m 2 were 0.30, 2.08 Yuan and 2.38 Yuan in the 4% "Luo-wei" group, 0.20, 1.10 Yuan and 1.32 Yuan in the 50% NESWP group, and 0.17, 1.04 Yuan and 0.97 Yuan in the 26% MNSC group respectively, and the cost-effectiveness was the highest at the first spraying in all the three groups., Conclusions: The effects of the three molluscicides for snail control are similar, but the efficacy of snail control is reduced as the spraying time increases.

Objective: To edentify the increased cost, the decreased benefits and effectiveness of hepatitis B vaccine event reported by media in 2013 in China both in Chinese nationwide and in Shenzhen. Methods: The decision analytic-Markov models were constructed. The cohort born in 2013 in nationwide and in Shenzhen were respectively introduced to the models. The vaccination coverage and the rates of antibody to hepatitis B surface antigen were determined as major parameters. The average costs and benefits per case, the effectiveness which included the numbers of hepatitis B virus (HBV) infection and the patients with HBV-related diseases, the average quality-adjusted life years (QALYs) per case were calculated from the medical-care and societal perspectives. The benefit cost ratio (BCR), ratio of the total costs and the net QALYs were as indicators of cost-benefit and cost-effectiveness analysis, respictively. Results: In nationwide, the BCRs decreased from 9.10 and 8.58 to 2.48 and 2.43, respectively, because the average costs increased to 6 796.60 yuan (RMB) and 8 451.45 yuan, and average benefits decreased to 6 799.57 yuan and 8 484.41 yuan, respectively, from the medical-care and societal perspectives. In Shenzhen, the BCRs decreased from 16.21 and 14.51 to 3.11 and 3.04 with the average costs of 5 244.88 yuan and 8 937.64 yuan, and average benefits of 5 248.11 yuan and 8 977.27 yuan. Totally, the increase of 2.1314 million and 181 hundreds of the HBV infectors occurred for the event in nationwide and in Shenzhen, respectively. Of all the infectors increased the most, the numbers of acute and chronic hepatitis B were 1 904 hundreds and 807 hundreds in nationwide, 794 and 395 in Shenzhen, espectively. The decreases of average QALY per case were 0.119 8 in nationwide and 0.090 6 in Shenzhen. The costs per averted a QALY increased from 6 231.90 yuan to 22 883.51 yuan in nationwide, from 3 567.25 yuan to 1 8571.49 yuan in Shenzhen (for medical-care perspective), from 8 252.79 yuan and 6 807.45 yuan to 29 091.92 yuan and 32 553.60 yuan (for societal perspective). Conclusion: The hepatitis B vaccine event reported by media in 2013 in China caused the costs increased, both benefits and the economic values obviously decreased.

Objective: To verify the costs, benefit and effectiveness of hepatitis B immunoprophylaxis strategies in Shenzhen during 2006-2030. Methods: The markov model was constructed to reflect the reality of the newborn vaccination and prevention of mother to child transmission (PMTCT) strategy, the cost, benefit and effectiveness during 2006-2015 and 2016-2030 was evaluated and predicted by the model. The model was constructed with the basic parameters such as the positive rate of hepatitis B surface antibody, perinatal HBV infection rate, the screening rate and positive rate of HBsAg of pregnant women, the utility value of hepatitis B and the parameters of markov model. and the coverage rates, vaccination fee of hepatitis B and the expenditures of patients with HB-related diseases.The costs were calculated from the payer, medical-care and all society perspective. The effectiveness and benefits of the strategy were evaluated and predicted by the numbers of HBV infection and the patients with HBV-related diseases prevented, life years (LYs), quality adjusted life years (QALYs), the net benefits (NBs) and benefit cost ratio (BCRs). Results: From the payer, medical-care and all society perspectives, the costs for the strategy were 153 million Yuan, 5.51 billion Yuan and 10.92 billion Yuan, respectively from 2006 to 2030 of which the forecast costs for 2016-2030 were 120 million Yuan, 3.87 billion yuan and 7.81 billion yuan. During the year 2006-2030, the numbers of HBV infection and the HBV-related diseases was 2.48 million, more than 1.335 million LYs and 1.619 million QALYs should be obtained from the strategy implemented. From medical-care and all society perspectives, NBs should be 88.68 billion yuan and 150.13 billion yuan with the BCRs of 17.08 and 14.75, respectively. Particularly, the NBs value of 22.37 billion yuan and 37.98 billion yuan and the BCR value of 14.62 and 13.20 was calculated for the past period, but the future NBs of 66.31 billion yuan and 112.15 billion yuan and BCR of 18.12 and 15.36 in the year 2016-2030. The further benefits were increased evidently in the future. Conclusion: The hepatitis B immunization in Shenzhen has a high economic effectivenee and benefits, and it is worth to invest sustainably.

Objective: To evaluate the cost-effectiveness of comprehensive schistosomiasis control measures with focus on total removal of cattle and sheep in Juanshan District, Yueyang City., Methods: The schistosome infection status of human, cattle, sheep and Oncomelania hupensis snails and costs of control measures were gathered during the period of 2006 to 2016. The costs for different periods and cost-effectiveness ratios were calculated., Results: The prevalence of schistosome infection in residents in the pilot villages decreased from 3.44% in 2006 to 0 in 2016. The annual costs of schistosomiasis prevention and control were 4 708 500 yuan from 2006 to 2008, 5 094 700 yuan from 2009 to 2012 and 9 522 700 yuan from 2013 to 2016. The cost-effectiveness analysis showed that the average annual cost of reduction in the residents'infection rate by 1% were 79 500 yuan from 2006 to 2008, 101 200 yuan from 2009 to 2012, and 95 200 yuan from 2013 to 2016, respectively., Conclusions: The comprehensive schistosomiasis control strategy with focus on cattle and sheep removal in Junshan District is cost effective which could be extended to other lake and marshland schistosomiasis endemic areas.

Objective: To determine the most cost-effective modality for breast cancer screening in women living in Shanghai. Methods: A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district, Shanghai, during 2008 to 2012. Parameters of the model were derived from literatures. General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years. Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality. Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness. Results: The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one. The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved, which were within the threshold of 2-3 times of local per capita Gross Domestic Product. Results from sensitivity analysis showed that, due to higher incidence rate of breast cancer in Shanghai, the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China. Conclusion: Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai, and thus be widely promoted in this population elsewhere.

Objective: To evaluate the cost-effectiveness of colorectal cancer screening program in different age groups from the view of health economics. Methods: The screening compliance rates, detection rates in different age groups were calculated by using the data from colorectal cancer screening program in Jiashan county, Zhejiang province. The differences in indicator among age groups were analyzed with χ (2) test or trend χ (2) test. The ratios of cost to the number of case were calculated according to cost statistics. Results: The detection rates of immunochemical fecal occult blood test (iFOBT) positivity, advanced adenoma and colorectal cancer and early stage cancer increased with age, while the early diagnosis rates were negatively associated with age. After exclusion the younger counterpart, the cost-effectiveness of individuals aged >50 years could be reduced by 15 %- 30 % . Conclusion: From health economic perspective, it is beneficial to start colorectal cancer screening at age of 50 years to improve the efficiency of the screening.