Impact of Diagnosis-Related Groups (DRG) reform on cost homogeneity of treatment for patients with malignant tumours.

The cost fluctuations associated with chemotherapy, radiotherapy, and immunotherapy, as primary modalities for treating malignant tumors, are closely related to medical decision-making and impose financial burdens on patients. In response to these challenges, China has implemented the Diagnosis-Related Group (DRG) payment system to standardize costs and control expenditures. This study collected hospitalization data from patients with malignant tumors who received chemotherapy, radiotherapy, and immunotherapy at Hospital H from 2018 to 2022. The dataset was segmented into two groups: the intervention group, treated with traditional Chinese medicine (TCM) alongside standard therapies, and the control group, treated with standard therapies alone. Changes and trends in hospitalization costs under the DRG policy were analyzed using propensity-score matching (PSM), standard deviation (SD), interquartile range (IQR), and concentration index (CI). Findings showed a decreasing trend in the standard deviation of hospitalization costs across all treatment modalities. Radiotherapy exhibited the most significant decrease, with costs reducing by 2547.37 CNY in the control group and 7387.35 CNY in the intervention group. Following the DRG implementation, the concentration indexes for chemotherapy and radiotherapy increased, while those for immunotherapy did not exhibit this pattern. Costs were more concentrated in patients who did not receive TCM treatment. In summary, DRG reform positively impacted the cost homogeneity of inpatient treatments for malignant tumors, particularly in the control group not receiving TCM treatment. The effects of DRG reform varied across different treatment modalities. Although short-term fluctuations in hospitalization costs may occur, initial evidence during the study period shows the positive impact of DRG reform on cost homogeneity.

Analysis of factors influencing hospitalization cost of patients with distal radius fractures: an empirical study based on public traditional Chinese medicine hospitals in two cities, China.

BACKGROUND: Distal radius fractures (DRFs) have become a public health problem for all countries, bringing a heavier economic burden of disease globally, with China's disease economic burden being even more acute due to the trend of an aging population. This study aimed to explore the influencing factors of hospitalization cost of patients with DRFs in traditional Chinese medicine (TCMa) hospitals to provide a scientific basis for controlling hospitalization cost. METHODS: With 1306 cases of DRFs patients hospitalized in 15 public TCMa hospitals in two cities of Gansu Province in China from January 2017 to 2022 as the study object, the influencing factors of hospitalization cost were studied in depth gradually through univariate analysis, multiple linear regression, and path model. RESULTS: Hospitalization cost of patients with DRFs is mainly affected by the length of stay, surgery and operation, hospital levels, payment methods of medical insurance, use of TCMa preparations, complications and comorbidities, and clinical pathways. The length of stay is the most critical factor influencing the hospitalization cost, and the longer the length of stay, the higher the hospitalization cost. CONCLUSIONS: TCMa hospitals should actively take advantage of TCMb diagnostic modalities and therapeutic methods to ensure the efficacy of treatment and effectively reduce the length of stay at the same time, to lower hospitalization cost. It is also necessary to further deepen the reform of the medical insurance payment methods and strengthen the construction of the hierarchical diagnosis and treatment system, to make the patients receive reasonable reimbursement for medical expenses, thus effectively alleviating the economic burden of the disease in the patients with DRFs.

Traditional Chinese medicine (TCM) collaborative care for patients with axial spondyloarthritis (AcuSpA): protocol for a pragmatic randomized controlled trial.

BACKGROUND: Axial spondyloarthritis (AxSpA) is a chronic disease which results in fatigue, pain, and reduced quality of life (QoL). Traditional Chinese medicine (TCM), especially acupuncture, has shown promise in managing pain. Although a TCM collaborative model of care (TCMCMC) has been studied in cancer, there are no randomized controlled trials investigating TCM in AxSpA. Therefore, we will conduct a pragmatic trial to determine the clinical effectiveness, safety, and cost-effectiveness of TCMCMC for patients with AxSpA. We define TCMCMC as standard TCM history taking and physical examination, acupuncture, and TCM non-pharmacological advice and communications with rheumatologists in addition to usual rheumatologic care. The purpose of this paper is to describe the rationale for and methodology of this trial. METHODS/DESIGN: This pragmatic randomized controlled trial will recruit 160 patients who are diagnosed with AxSpA and have inadequate response to non-steroidal anti-inflammatory drugs (NSAIDs). Simple randomization to usual rheumatologic care or the intervention (TCMCMC) with a 1:1 allocation ratio will be used. Ten 30-min acupuncture sessions will be provided to patients assigned to the TCMCMC arm. All participants will continue to receive usual rheumatologic care. The primary endpoint - spinal pain - will be evaluated at week 6. Secondary endpoints include clinical, quality of life, and economic outcome measures. Patients will be followed up for up to 52 weeks, and adverse events will be documented. DISCUSSION: This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of a TCMCMC for patients with AxSpA. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03420404 . Registered on 14 February 2018.

Linking resource supplies and price drivers: Lessons from Traditional Chinese Medicine (TCM) price volatility and change, 2002-2017.

ETHNOPHARMACOLOGICAL RELEVANCE: Worldwide, one of the drivers of substitution and adulteration is the cost of the natural resources (plants, animals, fungi) that are ingredients of traditional medicines. Relatively few studies have been done that link prices of traditional medicine ingredients to what drives changes in price, yet this is an important topic. Theoretically, prices have been widely considered as an economic indicator of resource scarcity. Rare, slow growing medicinal plants sell for high prices and common, less popular species for low prices. Price levels also influence the viability of farming vs. wild harvest (and incentives to overharvest high value species when tenure is weak). Prices can also influence the harvesting or buying behaviour of harvesters, traders or manufacturers. When prices are high, then there is a greater incentive to use cheaper substitute species or adulterants. As previous studies on herbal medicine ingredients have shown, adulteration applies in a wide variety of cases, including to some Traditional Chinese Medicine (TCM) species. AIM OF THE STUDY: The aim of this study was to gain a better understanding of which factors influenced changes in the market prices of document prices for four popular, but very different traditional Chinese medicine (TCM) species (2002 - 2017). MATERIALS AND METHODS: Fluctuations in market prices were followed over a 15-year period (2002-2017) for four very different TCM ingredients: two plant species (one wild harvested for fruits (Schisandra sphenanthera Rehder & E.H. Wilson) the other in a transition from wild harvest to cultivation (Paris polyphylla Smith), an animal species (the Tokay gecko (Gekko gecko L.)) and the entomophagous "caterpillar fungus" (Ophiocordyceps sinensis (Berk). G.H. Sung, J.M. Sung, Hywel-Jones & Spatafora). RESULTS: High prices of medicinal plants are widely considered to reflect resource scarcity. Real-time market prices for three of the four very different TCM species we studied all showed major price fluctuations. The exception was P. polyphylla, whose wild populations are widely known to be increasingly scarce, where there was a steady increase in price, with few fluctuations in the upward price trend. The three other species showed significant price fluctuations. These were driven by multiple factors. Ecological and biogeographic factors that influence abundance or scarcity of supply certainly played a role. But other factors were also influential. These included both national and global economic factors (the influence of the Global Financial Crisis (GFC)), national policy changes that in turn influenced businessmen giving expensive gifts (that included O. sinensis)), climate change (influencing fruiting success of S. sphenanthera), price speculation by traders and lack of information (e.g: reduction in G. gecko prices due to traders incorrectly believing that domestication would increase supplies). CONCLUSIONS: Price fluctuations in the four TCM species we examined are influenced by many factors and not just resource scarcity. And the situation is more complex than the trajectory based on Homma's (1992) model, where he predicted that higher prices would result in a shift to cultivation, thus replacing wild harvest. In case of both O. sinensis and P. polyphylla, Homma (1992, 1996) was right in terms of scarcity and high prices stimulating a major investment in cultivation (P. polyphylla) and artificial production (O. sinensis). But in both cases, intensive production through cultivation or artificial propagation do not yet occur on a large enough scale to reduce harvest of wild stocks. Substitution and adulteration occur with all four species. Improving information to medicinal plant traders on the supply status of TCM stocks, whether from wild harvest or from cultivation could benefit product quality, cultivation initiatives and conservation efforts.

Efficacy, Safety, and Cost of Therapy of the Traditional Chinese Medicine, Catalpol, in Patients Following Surgical Resection for Locally Advanced Colon Cancer.

BACKGROUND The aim of this study was to evaluate the efficacy, safety, and cost of treatment of the traditional Chinese herbal medicine, catalpol, in patients following surgical resection for locally advanced colon cancer. MATERIAL AND METHODS The 345 patients who had undergone surgical resection for locally advanced colon adenocarcinoma, were divided into three groups: a placebo-treated group (n=115); patients treated with an intraperitoneal injection of 10 mg/kg catalpol twice a day for 12 weeks (treatment group) (n=115); patients treated with 5 mg/kg intravenous bevacizumab twice a week for 12 weeks (control group) (n=115). Serum levels of carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), matrix metalloproteinases-2 (MMP-2), and matrix metalloproteinases-9 (MMP-9) were measured. Patient overall survival (OS), cancer-free survival (CFS), adverse effects, and cost of therapy were evaluated. Statistical analysis included the Wilcoxon rank sum test and Tukey's test for clinicopathological response at 95% confidence interval (CI). RESULTS Patients in the catalpol-treated group had significantly reduced serum levels of CA 19-9 (p=0.0002, q=3.202), CEA (p=0.0002, q=3.007), MMP-2 (p£0.0001, q=6.883), and MMP-9 (p<0.0001, q=3.347). Only non-fatal adverse effects occurred in the catalpol treatment group (p<0.0001, q=5.375). OS and CFS were significantly increased in the catalpol treatment group compared with the placebo group (p<0.0001 q=7.586). The cost of catalpol treatment compared favorably with other treatments (p<0.0001, q=207.17). CONCLUSIONS In this preliminary study, treatment with the Chinese herbal medicine, catalpol, showed benefits in clinical outcome, at low cost, and with no serious complications.

Treatment patterns and healthcare resource utilization and costs in heavy menstrual bleeding: a Japanese claims database analysis.

AIMS: Heavy menstrual bleeding (HMB) is a highly prevalent condition, characterized by excessive menstrual blood loss and cramping, that interferes with activities of daily life. The aim of this study was to investigate treatment patterns in HMB in Japan, and to assess healthcare resource utilization and costs among women newly-diagnosed with the condition. MATERIALS AND METHODS: This study retrospectively analyzed health insurance data available in the Japan Medical Data Center (JMDC) database on women aged 18-49 years who were newly-diagnosed with primary or secondary HMB. Treatment patterns were analyzed, and healthcare utilization and costs were evaluated and compared to matched controls. RESULTS: The study included a total of 635 patients, 210 with primary HMB and 425 with secondary HMB. In the primary HMB cohort, 60.0% of patients received one or more pharmacological or surgical treatments, compared with 76.2% in the secondary HMB cohort. The most commonly prescribed medications in all patients were hemostatic agents (28.7%), traditional Chinese medicine (TCM) (12.1%), and low-dose estrogen progestins (LEPs) (10.1%). After adjustment for patient baseline characteristics, healthcare costs were 1.93-times higher in primary HMB cases (p < .0001) and 4.44-times higher in secondary HMB cases (p < .0001) vs healthy controls. Outpatient care was the main cost driver. LIMITATIONS: The main limitations of this study are related to its retrospective nature, and the fact that only reimbursed medications were captured in the source database. CONCLUSIONS: A substantial proportion of HMB patients did not receive the recommended treatments. Healthcare costs were considerably increased in the presence of an HMB diagnosis.

The prevalence, characteristics, and factors associated with purchasing Chinese herbal medicine among adults in Taiwan.

BACKGROUND: The objective of this study was to investigate the prevalence and factors associated with purchasing Chinese herbal medicine (CHM) without a physician's prescription among adults. METHODS: Using data from the 2005 National Health Interview Survey and National Health Insurance, we identified 16,756 individuals aged 20 years and older. Socio-demographic factors, lifestyle, medical services utilization and health behaviors were compared between people with and without a history of purchasing CHM by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in a multiple logistic regression analysis. RESULTS: The one-month prevalence of purchasing CHM without a physician' prescription was 5.2% in Taiwan. People more likely to purchase CHM included people aged ≥70 years (OR 2.84, 95% CI 2.03-3.99), women (OR 1.28, 95% CI 1.11-1.48), non-indigenous people (OR 2.61, 95% CI 1.29-5.30), and people with an illness not receiving medical care (OR 2.69, 95% CI 2.19-3.31). CONCLUSION: The prevalence of purchasing CHM without a physician's prescription is high in Taiwan and is correlated with factors such as socio-demographics, disease history, and behaviors surrounding the utilization of medical care.

Use of Chinese medicine correlates negatively with the consumption of conventional medicine and medical cost in patients with uterine fibroids: a population-based retrospective cohort study in Taiwan.

BACKGROUND: Chinese medicine is commonly used and covered by health insurance to treat symptoms of uterine fibroids in Taiwan. This retrospective cohort study compared the consumption of conventional western medicine and medical cost between Chinese medicine (CM) users and nonusers among patients with uterine fibroids. METHODS: We extracted 44,122 patients diagnosed with uterine fibrosis between 1996 and 2010 from the National Health Insurance reimbursement database, which is a population-based database released by a government-run health insurance system. Multivariate linear regression models were used to find association between using Chinese medicine and the consumption of conventional medicine, and between using Chinese medicine and medical cost. RESULTS: The total fibroid-related conventional western medicine consumed by CM users was less than that by nonusers (ß = -10.49, P < 0.0001). Three categories of conventional medicines, including antianemics (-3.50 days/year/patient, P < 0.0001), hemostatics (- 1.89 days/year/patient, P < 0.0001), and hormone-related agents (-3.13 days/year/patient, P < 0.0001), were used less in patients who were CM users. Moreover, although using CM increased 16.9 USD per patient in CM users annually (P < 0.0001), the total annual medical cost for treating fibroid was 5610 USD less in CM users than in nonusers (P < 0.0001). CONCLUSIONS: Our results suggested that CM reduced the consumption of conventional medicine, and might be a potential therapeutic substitute for conventional western medicines to treat uterine fibroids with low cost.

Use of Chinese medicine among colorectal cancer patients: a nationwide population-based study.

BACKGROUND: Traditional Chinese medicine (CM) appears to be used worldwide, especially by cancer patients. The aim of the present study was to explore CM uses and CM non-users by patients with colorectal cancer (CRC). MATERIALS AND METHODS: A retrospective study was conducted using registration and claims data sets for 2007 from the National Health Insurance Research Database. Patients with colorectal cancer were identified from the Registry for Catastrophic illness Patients. Binary logistic regression was used to estimate odds ratios as the measure of association with the use of CM. RESULTS: A total of 61,211 CRC patients diagnosed in 2007 were analysis. Most CM users preferred to visit private clinics (46.9%) with 306,599 visits. In contrast, the majority of CM non-users preferred to visit private hospitals (42.2%) with 538,769 visits. Among all 176,707 cancer-specific CM visit, there were 66.6% visits to CM outpatient department (OPD) of private hospitals, while in 477,612 non-cancer-specific CM visits, 62.0% was for private clinics. The proportion of expenses for diagnostic fees for CM user in CM visits was much less than that for WM visits and CM non-users (US$4.6 vs. 29.3 vs. 33.5). The average cost for CM user in CM was less than that for WM visits and CM non-users (US$6.3 vs. 25.9 vs. 30.3). Female patients, younger age, and patients not living in the northern region, with higher EC or more comorbidities were more likely to receive CM treatment. CONCLUSION: The prevalence and costs of insurance-covered CM among CRC patients were low. Further longer longitudinal study is needed to follow up this trend.

Utilization pattern of traditional Chinese medicine for liver cancer patients in Taiwan.

BACKGROUND: Traditional Chinese Medicine (TCM) is one of the most popular complementary and alternative medicine modalities worldwide. In Chinese and East Asian societies, TCM plays an active role in the modern health care system and is even covered by the National Health Insurance Program of Taiwan. Liver cancer is the second most common cancer in Taiwan. This study aimed to analyze the TCM utilization patterns of patients with liver cancer from 1996-2007 using a population-based random sample of one million insured patients. METHODS: A cross-sectional study was conducted using registration and claim data sets from 1996 to 2007 obtained from the Longitudinal Health Insurance Database 2005 (LHID2005). The outpatient datasets contained the encounter form-based dates of visit, three items from the International Classification of Diseases (Ninth Revision, Clinical Modification codes), the primary procedure (e.g., drug or diagnostic procedure), type of copayment, billed amount, and paid amount. Only ambulatory care was analyzed. RESULTS: A total of 6358 liver cancer patients utilized ambulatory care during the study period. Among them, 1240 (19.50%) availed of TCM outpatient services. The prevalence of TCM use fluctuated during the study period, with a peak of 25.11% in 2001. After multivariable adjustment, the likelihood of TCM users was lower in participants aged 70 years and older (odds ratio, OR = 0.79, 95% confidence interval, CI: 0.64-0.97), males (OR = 0.60, 95% CI: 0.52-0.68), residents of Taipei (OR = 0.75, 95% CI: 0.58-0.96) as well as farmers and fishermen (OR = 0.71, 95% CI: 0.54-0.94), but was higher in residents of central Taiwan (OR = 1.99, 95% CI: 1.56-2.54. Most biomedicine and TCM outpatient services were provided by private clinics, followed by private hospitals. The two most frequently recorded coexisting diseases for both biomedicine and TCM outpatient visits specifically for liver cancer were (1) chronic liver disease and cirrhosis, and (2) malignant neoplasm of the liver and hepatic bile duct. The mean fee per visit for biomedicine was much higher than that for TCM, and the average expenditure was NT$429.73 (US$13.25) per biomedicine visit and NT$301.93 (US$9.32) per TCM visit (US$1 = NT$32.4 in 2007). For outpatient visits specifically for liver cancer, the mean fee per visit for biomedicine was much higher than that for TCM. The average cost per visit was NT$1457.31 (US$44.98) for biomedicine and NT$1080.76 (US$33.36) for TCM. CONCLUSION: TCM was widely used by the patients with liver cancer, and the prevalence of TCM use remained stably high during the study period. The costs of insurance covering TCM were consistently lower than those covering biomedicine in patients with liver cancer. The findings of this study should be useful for health policy makers as well as researchers considering the integration of TCM and biomedicine.

Use of Chinese medicine by women with breast cancer: a nationwide cross-sectional study in Taiwan.

OBJECTIVES: The National Health Insurance (NHI) provided Western medicine (WM) and Chinese medicine (CM) in Taiwan. This study aims to explore CM use by women with breast cancer under NHI. METHODS: Using NHI Research Database, a retrospective cross-sectional study was conducted. Women with breast cancer were identified by diagnosis codes. Their claims of CM and WM outpatient services of 2007 were analyzed. RESULTS: Among 70,012 female breast cancer patients, the prevalence of insurance covered CM was 35.6%. Among all CM users, 4379 (17.5%) patients visited CM for breast cancer. More than half CM users (67.6%) had less than 6 visits and 16.3% users had more than 12 visits. The majority of CM users (87.6%) also used WM ambulatory services. Private clinics (76.7%) provided the most CM services, followed by private hospitals (16.9%). The most frequently used CM therapies were Chinese herbal medicine (80.5%), followed by acupuncture/traumatology manipulative therapies (22.3%). The average cost of CM was US$17.6 per visit and US$119.7 per user annually. CM users were more likely to be younger than 60 years old, employees, with higher income, and not living in Northern Taiwan. CONCLUSIONS: A significant portion of breast cancer patients used insurance covered CM. Most CM users also used WM. The potential of drug-herb interactions should be concerned.

Trends in Chinese medicine use among prostate cancer patients under national health insurance in Taiwan: 1996-2008.

BACKGROUND: Taiwan National Health Insurance (NHI) provides Western medicine and Chinese medicine (CM). This study aims to explore the trends of CM use among prostate cancer patients under NHI. METHODS: Claims of CM outpatient services from 1996 to 2008 were obtained from NHI Research Database. CM visits of prostate cancer patients were identified. Claims with diagnosis code of prostate cancer were defined as cancer-specific visits. RESULTS: Among 78 323 prostate cancer patients identified during 1996-2008, there were 30 383 (38.8%) CM users and 327 063 CM outpatient visits. The prevalence of CM use in each cross-sectional year increased slightly from 24.9% to 25.6%. Most CM visits (92.7%) were non-cancer-specific. There were greater increases in the proportion of cancer-specific CM visits (from 2.3% to 10.6%) and high-utility CM users (from 3.1% to 19.7%). Most CM services were provided by private clinics (68.1% to 79.2%). The most frequently used CM therapies were Chinese herbal medicine (72.8% to 78.8%), followed by acupuncture/traumatology manipulative therapies (28.1% to 36.8%). Total CM cost increased from $122 247 to $825 454. The average cost per CM visit increased from $14.0 to $19.6. The annual cost per CM user increased from $88.0 to $134.4. Copayment accounted for 6.6% to 11.7%. CONCLUSIONS: There was a trend of increased CM use among prostate cancer patients under NHI. Although prostate cancer patients used CM mostly for noncancer diseases, CM visits for prostate cancer increased remarkably. The utilization patterns of CM visits for cancer and for noncancer diseases were distinctly different.

El costo de la enfermedad: La migraña y su tratamiento desde la medicina tradicional china en comparación con el manejo descrito basado en la evidencia occidental / Cost of illness study: Migraine and its treatment from traditional Chinese medicine in comparison with the method described in Occidental medicine

La migraña es la cefalea más frecuente, afecta entre el 6-7% de los hombres y 15-18% de las mujeres en edad laboral. En el 2002 las perdidas por incapacidad se estimaron en 19,600 millones de dólares para EEUU en 1990 se estimó entre 250 millones y 611 millones de libras el costo anual de la enfermedad en UK. Tanto el tratamiento alopático recomendado por el NICE y la acupuntura han mostrado eficacia. El costo del tratamiento con acupuntura en Alemania es de € 365,64 para el 2008 sin embargo a pesar de la relevancia económica y sobre la calidad de vida de este padecimiento no se ha estimado su costo en Colombia. Metodología: Se realizó un estudio basado en la prevalencia con metodología botton up para la estimación de los costos asociados a la prestación de servicios de salud, tanto para el tratamiento con acupuntura como para el tratamiento propuesto por el NICE. La probabilidad de las complicaciones se tomó de la literatura indexada. y una aproximación basada en la prevalencia tipo top down para la estimación de los costos directos diferentes a servicios de salud. Las frecuencias de uso para la acupuntura se estimaron mediante consenso formal de expertos y las frecuencias de uso para el protocolo propuesto por NICE se extrajeron de las recomendaciones del mismo, los costos unitarios para acupuntura se levantaron mediante un estudio de corte transversal de una muestra representativa a juicio de experto, los costos unitarios para los medicamentos alopáticos fueron tomados del PLM y el costo de los servicios de los manuales tarifarios vigentes. El horizonte temporal fue un año, la perspectiva usada fue la del tercer pagador. Resultados: El costo del tratamiento con acupuntura equivale a: (1801323/505627,20 (valor upc) 3.56 UPC frente al costo del tratamiento definido con medicina alopatica que fue de (2760110+2778258 /505627,20) 10.95 UPC. El costo directo de aspectos distintos a servicios de salud fue de (# de días de incapacidad por la enfermedad en Colombia * pacientes afectados por la enfermedad *PIB per capita promedio 2010/ 365)/ Valor UPC (3 *438590*5400*2159/ 365) =42.027.496.225 /505627,2 = 83120 UPC.

Prevalence, patterns, and costs of Chinese medicine use among prostate cancer patients: a population-based study in Taiwan.

BACKGROUND: Taiwan's National Health Insurance (NHI) is a comprehensive and universal program, providing Western medicine (WM) and Chinese medicine (CM). This study aims to explore CM use among prostate cancer patients in NHI. METHODS: A cross-section retrospective analysis was conducted using registration and claim data sets from the NHI Research Database. In 2007, 22,352 prostate cancer patients with 265,497 visits of CM and WM ambulatory services were identified. Patient demographics, patterns of therapies, and costs were analyzed. RESULTS: In 2007, 592 prostate cancer patients (2.6%) had 4141 CM outpatient visits (7.0 on average). The median age was 73.9. The majority (90.5%) of CM users also used WM ambulatory services. About one third of CM outpatient services were provided by private clinics. The most frequently used CM therapies were Chinese herbal medication (93.6%), followed by acupuncture/traumatology manipulative therapies (7.0%). CM accounted for 0.2% expenditure ($87,500) and 1.6% visits of ambulatory services. The average cost per visit for WM was 6.3 times higher than that for CM ($133.6 vs $21). CONCLUSIONS: The prevalence and costs of insurance-covered CM among prostate cancer patients were low. Most prostate cancer patients did not use insurance-covered CM. The majority of CM users also used WM. CM appeared to play a complementary rather than an alternative role.

Orthochina.org: case-based orthopaedic Wiki project in China.

Traditional continuing medical education (CME) depended primarily on periodic courses and conferences. The cost-effectiveness of these courses has not been established, and often the content is not tailored to best meet the needs of the students. Internet training has the potential to accomplish these goals. Over the last 10 years, we have developed a Web site entitled "Orthochina.org," based upon the wiki concept, which uses an interactive, case-based format. We describe the development of online case discussions, and various technical and administrative requirements. As of December 31, 2007, there were 33,984 registered users, 9,759 of which passed the confirmation procedures. In 2007, an average of 211 registrants visited daily. The average number of first page clicks was 4,248 per day, and the average number of posts was 70 per day. All cases submitted for discussion include the patient's complaint, physical examination findings, and relevant images based on specific criteria for case discussion. The case discussions develop well professionally. No spam posting or unauthorized personal advertisement is permitted. In conclusion, online academic discussions proceed well when the orthopaedic surgeons who participate have established their identities.

Insurance covered and non-covered complementary and alternative medicine utilisation among adults in Taiwan.

Complementary and alternative medicine (CAM) has been characterized by prevalence, cost, and patterns of use. Factors determining its utilization have also been analyzed, either generally or for specific diseases, but few studies have considered the determinants of its frequency of use. Taiwan's pluralistic health care system and comprehensive insurance program covering Western medicine and traditional Chinese medicine (TCM) provide an interesting case to explore what forms of CAM people use, why and how often they use them. By using Taiwan's 2001 National Health Interview Survey and linking it with National Health Insurance (NHI) claims data, this study aims to investigate the socio-demographic, economic, behavioral and health determinants of use and frequency of use for both non-covered and covered CAM in Taiwan. The former consists of services practiced by non-regulated or non-NHI contracted practitioners and the latter includes those TCM covered by NHI. Our study showed that the determinants of using non-covered and covered CAM differ with respect to socio-demographic and behavioral factors, and health needs. Our evidence suggests that future CAM research must delineate between use and frequency of use to better understand the underlying factors contributing to initiation and continuity of CAM use.

Ethnobotanical survey of medicinal plants at periodic markets of Honghe Prefecture in Yunnan Province, SW China.

In China, traditional markets are considered as important places for trading of medicinal plants harvested by rural villagers, which also play a social role of exchanging traditional use of herbal medicine among different cultural and social groups at local level. Market survey is often engaged in ethnobotanical studies for documenting locally used herbal plants and associated traditional knowledge. Information collected from market survey is also useful for plant conservation in the habitat areas. However, information on the market traded medicinal plants is not well documented from traditional markets in Honghe Prefecture, Yunnan. The study aimed to look into medicinal plants that are used by local people for curing various ailments. Ethnobotanical market survey methods, interviews, Participatory Action Research (PAR) and field visits were planned to elicit information on the uses of various medicinal plants. It was found that 216 plant species are commonly used by local people for curing various diseases, of which 173 species (80.1%) are wild plants and 43 species (19.9%) are home garden plants. A total of 278 records of medical uses in 60 herbal recipes for the treatment of 16 types of common diseases were recorded. In most of the recipes recorded, digestion diseases (30.6%) were used. The rest are rheumatological diseases (13.0%), respiratory system diseases (10.4%), infectious diseases (7.9%) and surgery uses (7.9%). The knowledge about the number of medicinal plants available in that area and used by interviewees was positively correlated with the threats on medicinal plants in the wild habitats of the study area, indicating that the diversity of medicinal plants and the associated traditional knowledge trends to disappear in the area.

A clinical study on global TCM therapy in treating senile advanced non-small cell lung cancer.

OBJECTIVE: To assess the clinical efficacy of global traditional Chinese medicine (TCM) therapy in treating senile advanced non-small cell lung cancer (NSCLC), with the aim of seeking a standardized, rational and economical way to treat advanced NSCLC in old patients. METHODS: A retrospective analysis and comparison was carried out in 86 patients with senile advanced NSCLC, 44 treated by global TCM (TCM group) and 42 by chemotherapy (control group) through dynamical observation on related indexes including tumor size, quality of life and the survival time, as well as on the fee for medical service at various time points in the course of the treatment. RESULTS: The changes of tumor size, score of clinical main symptoms and behavior condition (by ZPS scoring), as well as survival rates in the two groups at corresponding time points, were not different significantly (P>0.05). The mean survival time in the TCM group was 13.20+/-1.52 months and that in the chemotherapy group was 13.45+/-1.94 months, showing insignificant difference between them. However, the median survival time in the TCM group (12 months) was actually longer than that in the chemotherapy group (9 months, P<0.05). The mean daily expense and the mean expense (RMB yuan) for each patient in the TCM group were significantly lower than that in the control group, which was 180.73+/-93.21 vs 825.84+/-329.63 for the mean daily expense and 34077.21+/-14638.04 vs 58516.59+/-45429.76 for the mean expense for each patient (both P<0.01). CONCLUSION: Treatment of senile advanced NSCLC with TCM alone has its apparent superiority in stabilizing tumor focus, improving clinical symptoms, elevating quality of life and prolonging the survival time. TCM is also less expensive, making it a good alternative therapeutic approach for this specific group of people.