The Impact of Prescribing Monitoring Policy on Drug Use and Expenditures in China: A Multi-center Interrupted Time Series Study.

BACKGROUND: A prescribing monitoring policy (PMP) was implemented in November 2015 in Anhui province, China, the first province to pilot this policy to manage the use and costs of select drugs based on their large prescription volumes and/ or costs in hospitals. This study evaluated the impact of PMP on the use and expenditures of different drugs in three tertiary hospitals in Anhui. METHODS: We obtained monthly drug use and expenditures data from three tertiary hospitals in Anhui (November 2014 through September 2017). An interrupted time series (ITS) design was used to estimate changes in defined daily doses (DDDs per month) and drug expenditures (dollars per month) of policy-targeted and non-targeted drugs after PMP implementation. Drugs were grouped based on whether they were recommended (recommended drugs) by any clinical guidelines or not (non-recommended drugs), or if they were potentially over-used (proton pump inhibitors, PPIs). RESULTS: After PMP, DDDs and costs of the targeted PPIs (omeprazole) declined while use of non-targeted PPIs increased correspondingly with overall sustained declines in total PPIs. The policy impact on recommended drugs varied based on whether the targeted drugs have appropriate alternatives. The DDDs and costs of recommended drugs that have readily accessible appropriate alternatives (atorvastatin) declined, which offset increases in its alternative non-target drugs (rosuvastatin), while there was no significant change in those recommended drugs that did not have appropriate alternative drugs (clopidogrel and ticagrelor). Finally, the DDDs and costs of non-recommended drugs decreased significantly. CONCLUSION: PMP policy impact was not the same across different drug groups. PMP did help contain the use and costs of potentially over-used drugs and non-recommended drugs. PMP did not seem to reduce the use of first-line therapeutic drugs recommended by clinical treatment guidelines, especially those lacking alternatives; such drugs are unlikely appropriate candidates for PMP.

The impact of China's zero markup drug policy on drug costs for managing Parkinson's disease and its complications: an interrupted time series analysis.

Background: In April 2009, the Chinese government launched Zero Markup Drug Policy (ZMDP) to adjust medical institutions' revenue and expenditure structures. Objective: This study evaluated the impact of implementing ZMDP (as an intervention) on the drug costs for managing Parkinson's disease (PD) and its complications from the healthcare providers' perspective. Methods: The drug costs for managing PD and its complications per outpatient visit or inpatient stay were estimated using electronic health data from a tertiary hospital in China from January 2016 to August 2018. An interrupted time series analysis was conducted to evaluate the immediate change following the intervention (step change, ß1) and the change in slope, comparing post-intervention with the pre-intervention period (trend change, ß2). Subgroup analyses were conducted in outpatients within the strata of age, patients with or without health insurance, and whether drugs were listed in the national Essential Medicine List (EML). Results: Overall, 18,158 outpatient visits and 366 inpatient stays were included. Outpatient (ß1 = -201.7, 95%CI: -285.4, -117.9) and inpatient (ß1 = -372.1, 95% CI: -643.6, -100.6) drug costs for managing PD significantly decreased when implementing ZMDP. However, for outpatients without health insurance, the trend change in drug costs for managing PD (ß2 = 16.8, 95% CI: 8.0, 25.6) or PD complications (ß2 = 12.6, 95% CI: 5.5, 19.7) significantly increased. Trend changes in outpatient drug costs for managing PD differed when stratifying drugs listed in EML (ß2 = -1.4, 95% CI: -2.6, -0.2) or not (ß2 = 6.3, 95%CI: 2.0, 10.7). Trend changes of outpatient drug costs for managing PD complications significantly increased in drugs listed in EML (ß2 = 14.7, 95% CI 9.2, 20.3), patients without health insurance (ß2 = 12.6, 95% CI 5.5, 19.7), and age under 65 (ß2 = 24.3, 95% CI 17.3, 31.4). Conclusions: Drug costs for managing PD and its complications significantly decreased when implementing ZMDP. However, the trend in drug costs increased significantly in several subgroups, which may offset the decrease at the implementation.

Adsorption Equilibrium and Mechanism and of Water Molecule on the Surfaces of Molybdenite (MoS2) Based on Kinetic Monte-Carlo Method.

The oxidation/weathering of molybdenite (MoS2) is too slow to be monitored, even under pure oxygen and high temperatures, while it proceeds rapidly through humid air. The adsorption of water molecules on molybdenite is necessary for the wet oxidation/weathering of molybdenite. Therefore, we employ kinetic Monte Carlo modeling to clarify the adsorption isotherm, site preferences and kinetics of water on different surfaces of molybdenite. Our results indicate that (1) the adsorption capacity and adsorption rate coefficient of H2O on the (110) surface are significantly larger than those on the (001) surface at a temperature of 0~100 °C and a relative humidity of 0~100%, suggesting that the (110) surface is the predominant surface controlling the reactivity and solubility of molybdenite in its interaction with water; (2) the kinetic Monte Carlo modeling considering the adsorption/desorption rate of H2O, dissociation/formation rate of H2O and adsorption/desorption of dissociated H indicates that the adsorption and dissociation of H2O on the (110) surface can be completed in one microsecond (ms) at 298 K and in wet conditions; (3) the adsorption and dissociation of H2O on molybdenite are not the rate-limiting steps in the wet oxidation/weathering of molybdenite; and (4) kinetic Monte Carlo modeling explains the experimental SIMS observation that H2O and OH (rather than H+/H- or H2O) occupy the surface of MoS2 in a short time. This study provides new molecular-scale insights to aid in our understanding of the oxidation/weathering mechanism of molybdenite as the predominant mineral containing molybdenum in the Earth's crust.

Evaluating the direct medical cost, drug utilization and expenditure for managing Parkinson's disease: a costing study at a medical center in China.

Background: With long-term pharmacotherapy, Parkinson's disease (PD) is expectedly to incur a significant healthcare burden. However, drug utilization and costing study is limited, so is the cost composition and its impact on resource allocation. This study took a healthcare provider's perspective to quantify medical and drug expenses and the utilization of drugs for managing PD and its complications. Methods: Medical resources use and associated cost of outpatient visits and inpatient admission episodes for PD patients were extracted from electronic medical records at a tertiary hospital in China from 1 January 2016 to 15 August 2018. Total and average direct medical (costs of outpatient visits and inpatient admission episodes) and drug costs were calculated during the study period and each calendar year. Drug cost was quantified by defined daily dose cost (DDDc) and levodopa equivalent dose cost (LEDc) per outpatient visit or inpatient admission episode for PD in Chinese yuan (¥), stratified by medication categories, and presented in descriptive statistics. Results: Overall, 18,158 outpatient visits and 366 inpatient admissions were incurred by 2,640 outpatients and 330 inpatients, with a median age of 71.0 and 73.5 years, respectively. Drug cost accounted for 97.82% and 23.33% of outpatient and inpatient medical expenditure. The average cost of drugs for managing PD accounted for 60.48% (¥952.50) and 2.70% (¥564.90) of cost per outpatient visit and inpatient episode, while drugs for managing PD complications was 11.38% and 0.70%, respectively. The highest DDDc and LEDc of drugs for managing PD per outpatient visit or inpatient episode were incurred by pramipexole (¥56.90-72.70 and ¥227.48-290.67) and entacapone (¥37.70-45.70 and ¥228.64-276.77). The DDDc and LEDc of pramipexole is more than 10 times that of levodopa/benserazide (DDDc: ¥4.90-5.70; LEDc: ¥10.14-11.98) and carbidopa/levodopa (DDDc: ¥4.00-5.00; LEDc: ¥11.02-13.95). Conclusions: The outpatient direct medical cost for patients with PD was predominantly attributed to drug cost for managing PD, but drug cost weighed less of the inpatient cost. After adjusting the dose and number of patients, drugs with indirect dopamine effects had an excessively higher cost than dopamine precursors. Their long-term cost-effectiveness in real-world settings warrants further studies.

[Potential ecological risks assessment of heavy metals in the reservoir sediment of the western Haihe River basin].

The reservoirs distributed in the western part of Haihe River basin play a key role in drinking water supply in the densely populated region. The potential ecological risk of heavy metals stored in the reservoir sediments has drawn more attention during recent decades. In this study, a total of 10 reservoirs in the western Haihe River basin were sampled. The sediment samples were assessed by the Hakanson potential ecological risk evaluation index. The sediments of upstream and downstream rivers were also sampled for comparative analysis with those of the reservoirs. The results indicated the concentration of Cd was significantly higher than the background value in this region, it was 1.67 times of the background value on average and the highest was 2.77 times. The concentration of Pb was higher than the background value for more than half of the reservoirs. The potential ecological risk was evaluated by the toxic coefficient. The ecological risk level was decreased in the order of Cd>As>Pb>Ni>Cu>Cr>Zn. The ecological risk of Cd in most reservoir sediments belonged to a moderate harm. Xidayang Reservior, which supplied the drinking water for Beijing and Baoding, had the highest level of Cd pollution. The ecological risk of Cd in the upstream and downstream rivers was significantly higher than that of the reservoirs. In addition, the ecological risks of Pb, Cu and Ni in the upstream rivers were also higher than the reservoirs. The difference of ecological risks of Zn and Cr was not significant between reservoirs and rivers.

[Ecological risk assessment of heavy metals in surface sediments in the southern and central Haihe River Basin].

Several heavy metals, including Cu, Zn, Cr, Ni, Pb, and Cd, were investigated at 80 sampling sites in the southern and central areas of Haihe River Basin. The spatial patterns and potential anthropogenic impacts of heavy metals were evaluated by several methods, such as the potential ecological risk index and enrichment factors (EFs). Results showed that, (1) The concentrations of heavy metals in the sediments were higher than the background values in most sites except for Cr, Ni. The concentration of Cd was 2.64 times higher than its background value. Based on the potential ecological risk index for single heavy metal, Cd in river sediments showed a high potential ecological risk while the other elements showed a slight potential ecological risk at most sampling sites. Generally, the decreasing order of the heavy metals was Cd > Cu > Pb > Ni > Cr > Zn. (2) The concentration of heavy metals in surface sediment varied in different regions. The concentration of heavy metals and the potential ecological risks were higher in the Ziya river (RI = 155. 64) and Daqing river (RI = 111.84) than those in the other rivers. For example, slight pollution of heavy metals was found in the Tuhai, Majia river (RI = 69. 54) and Heilonggang river (RI = 84. 50) due to a relatively low level of industrialization. (3) Cd, Pb, Zn, Cr were positively correlated with each other and might be derived from similar sources. The increasing order of anthropogenic impacts on heavy metals was Ni < Cr < Cu < Zn < Pb < Cd according to the calculated EFs. The anthropogenic impacts differed in different rivers. For example, strong impacts were found in the Ziya, Daqing, Yongding and Zhangwei rivers whereas weak impacts were showed in Tuhai, Majia and Heilonggang rivers.