Universal screening and treatment towards the elimination of chronic hepatitis C in China: an economic evaluation.

OBJECTIVES: China has the largest number of hepatitis C virus (HCV) infection in the world, but current levels of diagnosis and treatment are low. The objective of this study was to assess the cost-effectiveness of various universal HCV screening and treatment strategies in China and inform decisions on health policy. STUDY DESIGN: A cost-effectiveness analytical study. METHODS: We developed a Markov model to investigate cost-effectiveness of different HCV screening and treatment strategies in China. We simulated several screening scenarios for Chinese people aged 18-70 years. We estimated incremental cost-effectiveness ratios (ICERs) of different intervention scenarios compared with status quo. RESULTS: Expanded HCV screening and treatment strategy with prioritisation for high-risk groups (Scenario S5) was the most cost-effective strategy (ICER: USD $11,667.71/quality-adjusted life-year [QALY] gained), which resulted in great reduction in HCV-related diseases and deaths, with a 67.11% reduction in cases of chronic HCV. Universal HCV screening and treatment implementation remains a cost-effective strategy when delayed until 2025 (ICER: USD $17,093.69/QALY), yet the delayed strategy is less effective in reducing HCV-related deaths. CONCLUSIONS: Expanded HCV screening and treatment strategy with prioritisation for high-risk groups is the most cost-effective strategy and has lead to a significant reduction in both HCV morbidity and mortality in China, which would essentially eliminate HCV as a public threat.

Global burden and trends of neglected tropical diseases from 1990 to 2019.

BACKGROUND: An updated analysis of neglected tropical diseases (NTDs) from a global perspective is missing from the literature. We aimed to assess the global burden and trends of NTDs from 1990 to 2019. METHODS: Yearly incident case, mortality and disability-adjusted life years (DALYs) data for NTDs were extracted from the Global Burden of Disease Study 2019 (GBD 2019) based on global, regional, country, social development index (SDI), age and sex categories. The age-standardized rate (ASR) and number of incident cases, mortality and DALYs were computed from 1990 to 2019. The estimated annual percentage change (EAPC) in the ASR was calculated to quantify the changing trend. RESULTS: Globally, the age-standardized incidence rate (ASIR) and the number of incident cases of total NTDs increased between 1990 and 2019, whereas the age-standardized mortality rate (ASMR), mortality, age-standardized DALY rate and DALYs of total NTDs decreased. Although tropical Latin America, South Asia, Southeast Asia and Oceania had the highest ASIR for total NTDs in 2019, tropical Latin America was the only region to experience a decreasing trend in ASIR from 1673.5 per 100 000 in 2010 to 1059.2 per 100 000 in 2019. The middle, high-middle and high SDI regions experienced increasing ASIR trends between 1990 and 2019, whereas the low-middle SDI region remained stable, and the low SDI region presented a decreasing trend. Children and older adults were vulnerable to dengue, rabies and leishmaniasis (cutaneous and mucocutaneous). Females had a higher ASIR but a lower ASMR and age-standardized DALY rate than males. CONCLUSIONS: NTDs still represent a serious problem for public health, and the increasing ASIR and incident cases globally may require more targeted strategies for prevention, control and surveillance, especially among specific populations and endemic areas.

[Assessment of Potential Risk of Diffuse Pollution in Haihe River Basin Based Using DPeRS Model].

Considering the Haihe River Basin as an example, the DPeRS model was used to analyze the spatial distribution characteristics and pollution sources of the diffuse pollution by remote sensing pixel scale. Combined with the evaluation standard of surface water quality, a potential risk grading method for diffuse pollution was constructed to assess the potential risk of diffuse pollution in Haihe River Basin. The results showed that, in 2016, the diffuse discharge loads of total nitrogen (TN), total phosphorus (TP), ammonia nitrogen (NH4+-N), and chemical oxygen demand (COD) were 429.2, 25.7, 288.3, and 1017.0 kg ·km-2, respectively, with the amount of river entry being 2.5×104 ton, 1597.2 ton, 1.7×104 ton, and 6.6×104 ton in Haihe River Basin, respectively. Farmland runoff is the most important source of diffuse pollution of TN, TP and NH4+-N in the Haihe River Basin. For COD index, urban life is the primary type of pollution, followed by livestock. The diffuse pollution is relatively severe in the central and southern areas of Haihe River Basin, and this area is also a high-risk concentrated distribution area of diffuse pollution in the basin. The distribution of high-risk areas of nitrogen-phosphorus diffuse pollution are relatively concentrated, and the chemical oxygen demand is relatively scattered. More than 36% of the Haihe River Basin has a nitrogen-phosphorus diffuse pollution risk, and 2.94% of the area has a chemical oxygen demand diffuse pollution risk.