COMPARISON OF MEDICAL COSTS AND CARE OF APPENDECTOMY PATIENTS BETWEEN FEE-FOR-SERVICE AND SET FEE FOR DIAGNOSIS-RELATED GROUP SYSTEMS IN 20 CHINESE HOSPITALS.

The objective of this study was to compare the fee-for-service and set fee for diagnosis-related group systems with regard to quality of medical care and cost to appendectomy patients. We conducted a retrospective study of 208 inpatients (from 20 hospitals) who undergone appendectomy in Changsha, China during 2013. Data were obtained from databases of medical insurance information systems directly connected to the hospital information systems. We collected and compared patient ages, length of study, and total medical costs for impatient appendectomies between patients using fee-for-service and set fee for diagnosisrelated group systems. One hundred thirty-three patients used the fee for service system and 75 used the set fee diagnosis related group system. For those using the diagnosis-related group system, the mean length of hospitalization (6.2 days) and mean number of prescribed antimicrobials (2.4) per patient were significantly lower than those of the patients who used the fee-for-service system (7.3 days and 3.0, respectively; p = 0.018; p < 0.05) and were accompanied by lower medical costs and cost of antimicrobials (RMB 2,518 versus RMB 4,484 and RMB476 versus RMB1,108, respectively; p = 0.000, p = 0.000). There were no significant differences in post-surgical complications between the two systems. The diagnosis-related group system had significantly medical costs for appendectomy compared to the fee-for-service system, without sacrificing quality of medical care.

Comprehensive assessment of the association between miRNA polymorphisms and gastric cancer risk.

Single nucleotide polymorphisms (SNPs) in pri- or pre-microRNAs (miRNAs) were found to be associated with gastric cancer risk. The aim of this study was to systematically review with update meta-analysis for the association of miRNA SNPs with gastric cancer risk. We systematically reviewed a total of 31 SNPs in the precursor genes of 29 miRNAs associated with overall cancer risk. Meanwhile, 13 case-control studies with a total of 9044 gastric cancer cases and 11,762 controls were included in a meta-analysis of five highly studied pre-miRNA SNPs (miR-146a rs2910164, miR-196a2 rs11614913, miR-499 rs3746444, miR-149 rs2292832 and miR-27a rs895819). Our results show both the homozygous miR-27a rs895819 and the miR-149 rs2292832 heterozygote genotype were associated with a decreased risk of gastric cancer when compared with wild type. In the stratified analysis, in some subgroup, heterozygous miR-146a rs2910164 was associated with a decreased risk of gastric cancer; and the variant genotype of miR-196a-2 rs11614913 was associated with an increased risk. No association was found between miR-499 rs3746444 and gastric cancer risk. In summary, miR-27a rs895819 and miR-149 rs2292832 are of potential forewarning ability for gastric cancer risk.