Cost-effectiveness of serplulimab as first-line therapy for extensive-stage small cell lung cancer in China.

Objective: The ASTRUM-005 trial demonstrated that adding serplulimab to chemotherapy significantly prolonged the survival of patients with extensive-stage small cell lung cancer (SCLC), but also increased the risk of adverse events. Given the high cost of serplulimab compared to chemotherapy, this study aimed to evaluate the cost-effectiveness of serplulimab plus chemotherapy as a first-line treatment for extensive-stage SCLC from the perspective of China's healthcare system. Methods: A Markov model was developed to simulate the disease process of extensive-stage SCLC and estimate the health outcomes and direct medical costs of patients. Scenario analyses, univariate sensitivity analyses, and probabilistic sensitivity analyses were conducted to explore the impact of different parameters on model uncertainty. The primary model outcomes included costs, life-years (LYs), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Results: Compared to placebo plus chemotherapy, serplulimab plus chemotherapy resulted in an additional 0.25 life-years and 0.15 QALYs, but also increased costs by $26,402, resulting in an ICER of 179,161 USD/QALY. Sensitivity analysis showed that the ICER was most sensitive to the cost of serplulimab, and the probability that serplulimab was cost-effective when added to chemotherapy was only 0 at the willingness-to-pay threshold of 37,423 USD/QALY. Scenario analysis revealed that price discounts on serplulimab could increase its probability of being cost-effective. Conclusion: Serplulimab plus chemotherapy is not a cost-effective strategy for first-line treatment of extensive-stage SCLC in China. Price discounts on serplulimab can enhance its cost-effectiveness.

Measuring equality in access to urban parks: A big data analysis from Chengdu.

Spatial equality of parks is a significant issue in environmental justice studies. In cities with high-density development and limited land resources, this study uses a supply-demand adjusted two-step floating catchment area model (2SFCA), paying attention to residents' subjective preferences and psychological accessibility. It assesses equality of access to urban parks from two dimensions: spatial equality and quantitative equality at a fine scale of 100 × 100 m grid resolution. The spatial equality of urban parks in Chengdu is measured under different transportation modes (walking, cycling, and driving) based on multi-source geospatial big data and machine learning approaches. The results show: (1) There were significant differences in the spatial distribution of park accessibility under different modes of transportation. The spatial distribution under walking was significantly influenced by the park itself, while the distribution of rivers significantly influenced the spatial distribution under cycling and driving; (2) Accessibility to urban parks was almost universally equal in terms of driving, relatively equal in terms of cycling, and seriously unequal in terms of walking; (3) Spatial local autocorrelation analysis shows that park accessibility tended to be significantly clustered, with little spatial variation; and (4) The supply and demand of urban parks were relatively equal. The results can help urban planners to formulate effective strategies to alleviate spatial inequality more reasonably and precisely. The applied research methods can further improve the system of scientific evaluation from a new perspective.

The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients.

BACKGROUND & AIMS: In the newly emerged Coronavirus Disease 2019 (COVID-19) disaster, little is known about the nutritional risks for critically ill patients. It is also unknown whether the modified Nutrition Risk in the Critically ill (mNUTRIC) score is applicable for nutritional risk assessment in intensive care unit (ICU) COVID-19 patients. We set out to investigate the applicability of the mNUTRIC score for assessing nutritional risks and predicting outcomes for these critically ill COVID-19 patients. METHODS: This retrospective observational study was conducted in three ICUs which had been specially established and equipped for COVID-19 in Wuhan, China. The study population was critically ill COVID-19 patients who had been admitted to these ICUs between January 28 and February 21, 2020. Exclusion criteria were as follows: 1) patients of ＜18 years; 2) patients who were pregnant; 3) length of ICU stay of ＜24 h; 4) insufficient medical information available. Patients' characteristics and clinical information were obtained from electronic medical and nursing records. The nutritional risk for each patient was assessed at their ICU admission using the mNUTRIC score. A score of ≥5 indicated high nutritional risk. Mortality was calculated according to patients' outcomes following 28 days of hospitalization in ICU. RESULTS: A total of 136 critically ill COVID-19 patients with a median age of 69 years (IQR: 57-77), 86 (63%) males and 50 (37%) females, were included in the study. Based on the mNUTRIC score at ICU admission, a high nutritional risk (≥5 points) was observed in 61% of the critically ill COVID-19 patients, while a low nutritional risk (<5 points) was observed in 39%. The mortality of ICU 28-day was significantly higher in the high nutritional risk group than in the low nutritional risk group (87% vs 49%, P ＜0.001). Patients in the high nutritional risk group exhibited significantly higher incidences of acute respiratory distress syndrome, acute myocardial injury, secondary infection, shock and use of vasopressors. Additionally, use of a multivariate Cox analysis showed that patients with high nutritional risk had a higher probability of death at ICU 28-day than those with low nutritional risk (adjusted HR = 2.01, 95% CI: 1.22-3.32, P = 0.006). CONCLUSIONS: A large proportion of critically ill COVID-19 patients had a high nutritional risk, as revealed by their mNUTRIC score. Patients with high nutritional risk at ICU admission exhibited significantly higher mortality of ICU 28-day, as well as twice the probability of death at ICU 28-day than those with low nutritional risk. Therefore, the mNUTRIC score may be an appropriate tool for nutritional risk assessment and prognosis prediction for critically ill COVID-19 patients.

[Application of the Children's Impact of Event Scale (Chinese Version) on a rapid assessment of posttraumatic stress disorder among children from the Wenchuan earthquake area].

OBJECTIVE: To explore the reliability and validity of the Children's Impact of Event Scale (Chinese version, CRIES-13) and to determine the value and the optimal cutoff point of the score of CRIES-13 in screening posttraumatic stress disorder (PTSD), so as to provide evidence for PTSD prevention and identify children at risk in Wenchuan earthquake areas. METHODS: A total of 253 children experienced the Wenchuan earthquake were tested through Stratified random cluster sampling. The authors examined CRIES-13's internal consistency, discriminative validity and predictive value of the cut-off. PTSD was assessed with the DSM-IV criteria. Area under the curve while sensitivity, specificity and Youden index were computed based on the receiver operating characteristic curve analysis. Optimal cutoff point was determined by the maximum of Youden index. RESULTS: 20.9% of the subjects were found to have met the DSM-IV criteria for PTSD 7 months after the Wenchuan earthquake accident. The Cronbach's coefficient of CRIES-13 was 0.903 and the mean inter-item correlation coefficients ranged from 0.283 to 0.689, the correlation coefficient of the three factors with the total scale scores ranged from 0.836 to 0.868 while the correlation coefficient among the three factors ranged from 0.568 to 0.718, PTSD cases indicated much higher scores than non-PTSD cases, the Youden index reached maximum value when the total score approached 18 in CRIES-13 with sensitivity and specificity as 81.1% and 76.5% respectively. Consistency check showed that there were no significant differences between the results of CRIES-13 score >/= 32 and clinical diagnosis (Kappa = 0.529) from the screening program. CONCLUSION: CRIES-13 appeared to be a reliable and valid measure for assessing the posttraumatic stress symptoms among children after the earthquake accident in the Wenchuan area. The CRIES-13 seemed to be a useful self-rating diagnostic instrument for survivors with PTSD symptoms as a clinical concern by using a 18 cut-off in total score. Consistency check showed that there was no significant difference between the screening result of CRIES-13 score >/= 32 and clinical diagnosis.