Cost-Effectiveness Analysis of Risk Factor-Based Lung Cancer Screening Program by Low-Dose Computer Tomography in Current Smokers in China.

Although the effectiveness of lung cancer screening by low-dose computed tomography (LDCT) could be shown in China, there could be variation in the evidence concerning the economic impact. Our study explores the cost-effectiveness of lung cancer screening and optimizes the best definition of a high-risk population. A Markov model consisting of the natural history and post-diagnosis states was constructed to estimate the costs and quality-adjusted life years (QALYs) of LDCT screening compared with no screening. A total of 36 distinct risk factor-based screening strategies were assessed by incorporating starting ages of 40, 45, 50, 55, 60 and 65 years, stopping ages of 69, 74 and 79 years as well as smoking eligibility criteria. Screening data came from community-based mass screening with LDCT for lung cancer in Guangzhou. Compared with no screening, all screening scenarios led to incremental costs and QALYs. When the willingness-to-pay (WTP) threshold was USD37,653, three times the gross domestic product (GDP) per capita in China, six of nine strategies on the efficiency frontier may be cost-effective. Annual screening between 55 and 79 years of age for those who smoked more than 20 pack-years, which yielded an incremental cost-effectiveness ratio (ICER) of USD35,000.00 per QALY gained, was considered optimal. In sensitivity analyses, the result was stable in most cases. The trends of the results are roughly the same in scenario analyses. According to the WTP threshold of different regions, the optimal screening strategies were annual screening for those who smoked more than 20 pack-years, between 50 and 79 years of age in Zhejiang province, 55-79 years in Guangdong province and 65-74 years in Yunnan province. However, annual screening was unlikely to be cost-effective in Heilongjiang province under our modelling assumptions, indicating that tailored screening policies should be made regionally according to the local epidemiological and economic situation.

Collaborative optimal allocation of water resources and sewage discharge rights in watershed cities: considering equity among water sectors.

Water supply systems in watershed cities face challenges due to increasing water demand and arbitrary sewage discharge allocations. Previous studies have primarily focused on water resource allocation and sewage discharge rights, neglecting the intricate interactions between the two. This study introduces a novel approach by integrating sewage discharge rights into the watershed's water resource allocation mechanism. A multi-objective optimization model was developed, employing the Gini coefficient to balance the equitable and economic aspects across various water sectors. This model takes into account the distinct water demands and sewage discharge requirements of different sectors. The findings of this study are as follows: (a) the Gini coefficients for water demand allocation and sewage discharge rights allocation exhibit simultaneous optimization and display consistent trends; (b) when the importance of sewage discharge relative to other water users increases, the return on investment for domestic and industrial water use decreases, but the fairness of water distribution improves; (c) proper allocation of sewage discharge rights can effectively enhance the economic value of agricultural water use. Overall, this strategy has the potential to enhance both the equality and economic benefits of the water supply system while ensuring the sustainable utilization of water and sewage rights in the basin cities.

Corporate social responsibility and corporate financialization-Based on information effect and reputation insurance effect.

China has witnessed the trend of corporate financialization (CF) with some potential risks as the economy slows down its pace in the past decade. In this paper, we explore whether corporate social responsibility (CSR) could work as an information channel to restrain CF or as reputation insurance to promote CF. We find a significant positive relation between CSR and CF, especially for non-SOEs and enterprises with low ownership concentration and high CSR scores. It verifies that the reputation insurance effect by CSR outweighs the information effect and denies the opposite. The results prove robust in tests including sensitivity and endogeneity test. By expanding the scale and adding new aspects to the discussion about how CSR affects CF, this paper provides valuable empirical support to both theorists and practitioners.

Environmental impact assessment of dam-break floods considering multiple influencing factors.

Dam-break floods cause substantial damage to the environment, and evaluating the negative impacts of dam-break floods on the environment (EI) is an important part of flood risk management. EI has been evaluated using various methods with different indices. However, the evaluation results of EI are typically one-sided or inaccurate because of diverse indices and complex influencing factors. A new method was proposed herein to calculate EI with an index system, including geomorphic changes (GC), water pollution (WP), plant biomass loss (PB), and biodiversity loss (BL). Eight factors that influence EI were sorted out, namely, erosion or deposition depth, non-point source (NPS) and point source (PS) pollution, plant biomass, species richness, plant height, and flood depth, velocity, and duration. After combining the proposed damage functions to calculate the influence of flood depth, velocity, and duration, and plant height on the environment, methods to calculate GC, WP, PB, BL, and EI were proposed. A dam-break flood scenario for Luhun Reservoir was used to verify the method. The results showed that (1) the trend in EI was similar to that in geomorphic changes in the inundated area and seriously affected by PS in local areas, (2) the average EI of woodland was the highest, while that of towns was the slowest, and (3) GC and WP contributed 93.7% of EI in the entire inundated area. This study summarized the complex impacts of dam-break floods on the environment from four aspects and proposed a method to quantify the overall impact of dam-break floods on the environment. The evaluation model could evaluate the impact of floods on the environment accurately, presenting the results on a flood inundation map. This provides a scientific basis for evaluating flood consequences and managing flood risk.

Copanlisib plus rituximab combination therapy vs. rituximab monotherapy for relapsed indolent non-Hodgkin lymphoma: a cost-effectiveness analysis.

Background: In the clinical use of third-line treatment of non-Hodgkin lymphoma (NHL), the combination treatment is increasingly used due to problems such as drug resistance, and while their efficacy has been proven, whether they are economical has become a new issue. A recent trial showed copanlisib plus rituximab combination therapy (CRCT) had better efficacy in the treatment of relapsed indolent NHL (iNHL) compared to rituximab monotherapy (RM). However, the long-term cost and effectiveness of this regimen is not known. We are the first to evaluate the cost effectiveness of CRCT in third-line treatment of relapsed iNHL from the perspective of US payers. Methods: We used a Markov model to evaluate cost and quality-adjusted life years (QALYs) which included a population from CHRONOS-3 with mean age of 62.5 years and total cycle length of 16.3 years. The cycle length was 1 month, adverse reaction rates were from CHRONOS-3, mean body surface area was referenced from published literature, cost values are referenced from published literature and Drugbank, utility values were referenced from the published literature, and the primary endpoint was the incremental cost-effectiveness ratio (ICER). The willingness to pay (WTP) threshold was set at $150,000 per QALYs, and one-way sensitivity analysis and probabilistic sensitivity analysis were used to verify the robustness of the model. All costs are expressed in 2021 dollars and costs and utilities have been calculated at a discount rate of 3% per year. Results: CRCT and RM obtained 6.53 QALYs and 5.15 QALYs, respectively, and the ICER of CRCT vs. RM was $358,895.2/QALYs. Parameters having the greatest impact on the robustness of the model were the drug cost of copanlisib and the utility value of the progression-free survival (PFS) state. When the WTP threshold was $150,000, the probability of CRCT and RM being the most cost effective was 0.4% and 99.6% respectively. Conclusions: From a US payer perspective, CRCT is not cost-effective in treating relapsed iNHL at current prices compared to RM. But given its positive clinical efficacy, appropriate price discounts or assistance programs should be considered to make CRCT more affordable to patients with relapsed iNHL.

Functional assessment of heart-specific enhancers by integrating ChIP-seq data.

BACKGROUND: Identification and functional annotations of regulatory sequences play a pivotal role in heart development and function. METHODS: To generate a map of human heart-specific enhancers, we performed an integrative analysis of 148 chromatin immunoprecipitation coupled to massively parallel sequencing (ChIP-seq) samples with enhancer-associated epigenetic marks from the heart, liver, brain, and kidney. Functional validation of heart-specific enhancer activity was then performed using cultured cells. RESULTS: A 144.6-Mb candidate heart-specific enhancer compendium was generated by integrating the analysis of 148 epigenomic data sets from human and mouse hearts and control tissues. To validate in vivo enhancer activity, we tested 12 of these sequences around 45 CHD-related genes in cultured cells and found that 8 (67%) have reproducible heart-specific enhancer activity. A functional analysis demonstrated that the identified human heart-specific enhancer wf1 regulates the FBN1 gene which is involved in heart disease. CONCLUSIONS: Our study provides an integrative analysis pipeline for ChIP-seq data and identified a comprehensive catalog of human heart-specific enhancers for clinical CHD-related studies. IMPACT: Establishing an efficient way to analyze regulatory regions in CHD is very important. A highly qualified heart-specific enhancer compendium was generated by integrating 148 online ChIP-seq samples. Sixty-seven percent of predicted regulatory sequences have reproducible heart-specific enhancer activity in vivo. Human heart-specific enhancer wf1 regulates the CHD-related FBN1 gene.

Disease burden of liver cancer attributable to specific etiologies in China from 1990 to 2019: An age-period-cohort analysis.

Temporal trends of total liver cancer have been well reported in China, especially the trends caused by hepatitis B (HBV); however, the trends of liver cancer attributable to specific etiologies have rarely been reported in China. Thus, this study aims to describe the temporal trends in the incidence, mortality and DALYs of total and etiology-specific liver cancer in China from 1990 to 2019. We extracted the incidence, mortality and disability-adjusted life years (DALYs) of total and etiology-specific liver cancer in China from 1990 to 2019 from global disease burden (GBD) 2019. We plotted the trends in the age-standardized rates for incidence, mortality, and DALYs using locally weighted regression (LOESS)-smoothed data from 1990 to 2019. The age-standardized rate for the incidence of liver cancer was analyzed with an age-period-cohort method. The age-standardized rates for incidence, death, and DALYs decreased by -58.8%, -63.8%, and -65.6%, respectively, between 1990 and 2019. The age-standardized rates of incidence, mortality, and DALYs of total liver cancer showed similar temporal patterns, presenting an overall decline, with the average annual percentage change (AAPC) ranging from -3.3% to -3.8%. People in the period before 2007 had a higher risk, and people after 2007 had a lower risk. The cohort risk ratios (RRs) showed decreasing patterns, with the most rapid decline observed in the 1910 to 1960 cohorts. Our study generally revealed favorable decreasing trends for total and etiology-specific liver cancer in China from 1990 to 2019. Despite the overall decline in liver cancer due to heavy alcohol use and obesity from 1990 to 2019, there have been apparent upward trends since 2006. Planned population-wide interventions targeting heavy alcohol use and obesity may mitigate the increasing trends in liver cancer attributable to alcohol use and NASH.

Cost-effectiveness of pembrolizumab plus axitinib as first-line therapy for advanced renal cell carcinoma.

Aim: To evaluate the cost-effectiveness of first-line treatments for advanced renal cell carcinoma with pembrolizumab plus axitinib compared with sunitinib from the US payer perspective. Patients & methods: A Markov model was developed for this purpose. The clinical data were obtained from the KEYNOTE-426 trial. Utility values and direct costs related to the treatments were gathered from the published studies. Results: The incremental cost-effectiveness ratios of pembrolizumab plus axitinib versus sunitinib was $249,704 per quality-adjusted life year, which was higher than a willingness-to-pay threshold of $150,000 per quality-adjusted life year. Conclusion: Pembrolizumab plus axitinib was not considered to be cost-effective versus sunitinib as a first-line treatment for patients with advanced renal cell carcinoma from the US payer perspective.

Trade-off between equity and efficiency for allocating wastewater emission permits in watersheds considering transaction.

As the management of wastewater emission permits in watershed has become a growing worldwide concern, a substantial challenge has been created in balancing the social stability, economic construction, and ecological function. Therefore, the equitable and efficient allocation of wastewater emission permits in watershed integrating sustainability is vital for environmental management. Considering the wastewater discharge permits transaction between subareas, a multi-objective model is proposed to analyze the allocation of wastewater emission permits in a watershed. The first objective function is to maximize the allocation equity using the environmental Gini coefficient, and the second is to maximize the economic efficiency for the sustainable development of a watershed as the constraint. In this study, the trade-off between the equity and economic efficiency of allocation is balanced. A case study of the Tuojiang River Basin in China is conducted to demonstrate the feasibility, rationality and practicality of the model. The multi-principle and multi-objective allocation model was found to be more reliable and feasible than the previous models, indicating that the equity and efficiency should be balanced to mitigate the water scarcity and deteriorating water quality when managing the basin, and trading is an effective measure for ensuring the equity.

Text Mining and Quantitative Research of Medical Service Policy: Sichuan Province as an Example.

Medical service policy plays a prominent role in the development of a "Healthy China." This paper constructs a three-dimensional framework for text mining of medical service policy using the elements of policy instruments, policy strength, and types of medical service activity. Taking Sichuan Province as an example, 221 medical service policy documents, issued by the government and related departments, are selected as the research sample; the policy instruments, policy strength, and medical service activity types are analyzed using ROST and Nvivo 11.0 software. It is concluded that the government needs to optimize the structure of policy instruments, to appropriately reduce the use of environmental policy instruments in particular, while increasing the use of demand-based policy instruments. It is necessary to strengthen the interaction between the various sub-policy instruments, and to increase the use of financial services, fiscal taxes, overseas communications, and strategic measures. An increase in the implementation of government policy assists the acceleration of the policy landing, the further improvement of the supervision system, and the safeguard mechanism of the three medicine policy linkage, which can improve the sustainability of the medical service policy, and further resolve the difficulty and expense of seeing a doctor.

Does Information Asymmetry Impact Sub-Regions' Cooperation of Regional Water Resource Allocation?

Water resources allocation is an urgent problem for basin authorities. In order to obtain greater economic benefits from limited water supplies, sub-regions must cooperate with each other. To study the influence of cooperation among sub-regions and the symmetry of cooperation information on the interests of the basin authority and each sub-region, this study proposes a regional water allocation model in three different situations: (1) non-cooperation; (2) cooperation and information symmetry; (3) cooperation and information asymmetry. The proposed model clearly reflects the Stackelberg game relationship between the basin authority and sub-regions. Finally, the model is applied to the Qujiang River Basin in China, and the decisions of the basin authority and sub-regional managers of the Qujiang River Basin under three different situations are discussed. The results show that regional cooperation benefits both the cooperative regions and the social welfare value of the entire river basin, when compared with non-cooperation.

Cost-effectiveness analysis of gemcitabine plus cisplatin versus fluorouracil plus cisplatin for first-line treatment of recurrent or metastatic nasopharyngeal carcinoma.

PURPOSE: Compared with conventional fluorouracil plus cisplatin (FP) regimen, gemcitabine plus cisplatin (GP) can prolong survival in patients with recurrent or metastatic nasopharyngeal carcinoma, but the economic impact of this practice remains unknown. It's significant to evaluate its values by taking both efficacy and cost into consideration. METHODS: We developed a Markov model with 10 years horizon to compare the cost-effectiveness of GP and FP regimen. Clinical data came from a multicentre, randomised, open-label, phase 3 trial. Direct costs related to the treatment were estimated from the perspective of the Chinese healthcare system. Utility values were gathered from published study. Sensitivity analysis was conducted to confirm the robustness of the model. RESULTS: The total cost of FP regimen was $12,587 and yielded 0.964 QALYs, while the total cost of GP regimen was $17,920 and yielded 1.685 QALYs. The ICER of GP regimen versus FP regimen was $7,386 which was far less than the willingness-to-pay threshold ($26,508) in China. CONCLUSION: From the perspective of Chinese healthcare system, GP regimen with superior efficacy was proved to be more cost-effective than the traditional FP regimen. It is likely that GP regimen may be recommended as the primarily first-line treatment option for recurrent or metastatic nasopharyngeal carcinoma.

An Improved Shapley Value Method for a Green Supply Chain Income Distribution Mechanism.

Low-carbon development and environmental remediation are key factors for green resource-based supply chains in China. With this aim in mind, by applying game theory under uncertain market demand, this paper incorporates low-carbon development and environmental remediation into a resource-based supply chain coordination model for decentralized and centralized markets. The results show that a centralized market can lead to improvement in total profit. Furthermore, based on an improved Shapley value method, a theoretical model for the centralized market income distribution mechanism is developed that incorporates three corrective risk factors, ecological investment, and technological level. Finally, a numerical analysis is conducted using a MATLAB simulation to obtain intuitive results, which, in turn, show the validity of incentive income distribution mechanisms for green supply chain development in China.

Processing Technology Selection for Municipal Sewage Treatment Based on a Multi-Objective Decision Model under Uncertainty.

This study considers the two factors of environmental protection and economic benefits to address municipal sewage treatment. Based on considerations regarding the sewage treatment plant construction site, processing technology, capital investment, operation costs, water pollutant emissions, water quality and other indicators, we establish a general multi-objective decision model for optimizing municipal sewage treatment plant construction. Using the construction of a sewage treatment plant in a suburb of Chengdu as an example, this paper tests the general model of multi-objective decision-making for the sewage treatment plant construction by implementing a genetic algorithm. The results show the applicability and effectiveness of the multi-objective decision model for the sewage treatment plant. This paper provides decision and technical support for the optimization of municipal sewage treatment.

An overview of municipal solid waste management in China.

Municipal solid waste management (MSWM) in China warrants particular attention as China has become the largest MSW generator in the world and the total amount of MSW it produces continues to increase. In recent years, central and local governments have made great efforts to improve MSWM in China. New regulations and policies have been issued, urban infrastructure has been improved, and commercialization and international cooperation have been encouraged. Considering these developments, an overview is necessary to analyze the current state as well as new opportunities and challenges regarding MSWM in China. This paper shows that since the late 1990s, the amount of MSW collected has been largely decoupled from economic growth and incineration has become an increasingly widespread treatment method for MSW. We identify and discuss four major challenges and barriers related to China's MSWM, and propose an integrated management framework to improve the overall eco-efficiency of MSWM.