Comparative cost-effectiveness of open, laparoscopic, and robotic liver resection: A systematic review and network meta-analysis.

BACKGROUND: This study evaluated the cost-effectiveness of open, laparoscopic, and robotic liver resection. METHODS: A comprehensive literature review and Bayesian network meta-analysis were conducted. Surface under cumulative ranking area values, mean difference, odds ratio, and 95% credible intervals were calculated for all outcomes. Cluster analysis was performed to determine the most cost-effective clustering approach. Costs-morbidity, costs-mortality, and costs-efficacy were the primary outcomes assessed, with postoperative overall morbidity, mortality, and length of stay associated with total costs for open, laparoscopic, and robotic liver resection. RESULTS: Laparoscopic liver resection incurred the lowest total costs (laparoscopic liver resection versus open liver resection: mean difference -2,529.84, 95% credible intervals -4,192.69 to -884.83; laparoscopic liver resection versus robotic liver resection: mean difference -3,363.37, 95% credible intervals -5,629.24 to -1,119.38). Open liver resection had the lowest procedural costs but incurred the highest hospitalization costs compared to laparoscopic liver resection and robotic liver resection. Conversely, robotic liver resection had the highest total and procedural costs but the lowest hospitalization costs. Robotic liver resection and laparoscopic liver resection had a significantly reduced length of stay than open liver resection and showed less postoperative morbidity. Laparoscopic liver resection resulted in the lowest readmission and liver-specific complication rates. Laparoscopic liver resection and robotic liver resection demonstrated advantages in costs-morbidity efficiency. While robotic liver resection offered notable benefits in mortality and length of stay, these were balanced against its highest total costs, presenting a nuanced trade-off in the costs-mortality and costs-efficacy analyses. CONCLUSION: Laparoscopic liver resection represents a more cost-effective option for hepatectomy with superior postoperative outcomes and shorter length of stay than open liver resection. Robotic liver resection, though costlier than laparoscopic liver resection, along with laparoscopic liver resection, consistently exceeds open liver resection in surgical performance.

Evaluating the economic efficiency of open, laparoscopic, and robotic distal pancreatectomy: an updated systematic review and network meta-analysis.

BACKGROUND: This study compared the cost-effectiveness of open (ODP), laparoscopic (LDP), and robotic (RDP) distal pancreatectomy (DP). METHODS: Studies reporting the costs of DP were included in a literature search until August 2023. Bayesian network meta-analysis was conducted, and surface under cumulative ranking area (SUCRA) values, mean difference (MD), odds ratio (OR), and 95% credible intervals (CrIs) were calculated for outcomes of interest. Cluster analysis was performed to examine the similarity and classification of DP approaches into homogeneous clusters. A decision model-based cost-utility analysis was conducted for the cost-effectiveness analysis of DP strategies. RESULTS: Twenty-six studies with 29,164 patients were included in the analysis. Among the three groups, LDP had the lowest overall costs, while ODP had the highest overall costs (LDP vs. ODP: MD - 3521.36, 95% CrI - 6172.91 to - 1228.59). RDP had the highest procedural costs (ODP vs. RDP: MD - 4311.15, 95% CrI - 6005.40 to - 2599.16; LDP vs. RDP: MD - 3772.25, 95% CrI - 4989.50 to - 2535.16), but incurred the lowest hospitalization costs. Both LDP (MD - 3663.82, 95% CrI - 6906.52 to - 747.69) and RDP (MD - 6678.42, 95% CrI - 11,434.30 to - 2972.89) had significantly reduced hospitalization costs compared to ODP. LDP and RDP demonstrated a superior profile regarding costs-morbidity, costs-mortality, costs-efficacy, and costs-utility compared to ODP. Compared to ODP, LDP and RDP cost $3110 and $817 less per patient, resulting in 0.03 and 0.05 additional quality-adjusted life years (QALYs), respectively, with positive incremental net monetary benefit (NMB). RDP costs $2293 more than LDP with a negative incremental NMB but generates 0.02 additional QALYs with improved postoperative morbidity and spleen preservation. Probabilistic sensitivity analysis suggests that LDP and RDP are more cost-effective options compared to ODP at various willingness-to-pay thresholds. CONCLUSION: LDP and RDP are more cost-effective than ODP, with LDP exhibiting better cost savings and RDP demonstrating superior surgical outcomes and improved QALYs.

Effects of retirement on inpatient healthcare utilisation: an observational study in China.

OBJECTIVE: Previous studies have presented mixed evidence on retirement and inpatient healthcare utilisation. We aimed to examine the causal effect of retirement on inpatient healthcare utilisation in China and explore the heterogenous effects of sex, disease types and ways of hospital admission. DESIGN: This was a retrospective observational study from the electronic medical record at 376 tertiary hospitals in China between 2013 and 2018. SETTING: Nationwide data from China. PARTICIPANTS: We included the male sample aged between 50 and 70, and the female sample aged between 40 and 60 and with basic medical insurance system or public medical insurance. Observations with total expenditures per visit at the top or bottom 1% were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Inpatient expenditures per visit and inpatient days per visit. METHODOLOGY: We examined the effects by a non-parametric fuzzy regression discontinuity design, exploiting the mandatory retirement age as a source of exogenous variation in retirement status. RESULTS: Retirement reduced drug expenditures (ß=-467.46, p<0.05) and inpatient days per visit (ß=-0.99, p<0.05). The mitigation effect was concentrated on people admitted into hospital due to chronic diseases (ß=-551.28, p<0.05 for drug expenditures; ß=-1.08, p<0.05 for inpatient days per visit) and people admitted into hospital through outpatient services (ß=-353.75, p<0.001 for drug expenditures). For males, retirement significantly reduced diagnostic tests expenditures (ß=-302.38, p<0.05) and drug expenditures (ß=-728.31, p<0.05). Retirement significantly reduced inpatient days per visit (ß=-1.13, p<0.05) for females. CONCLUSION: The empirical findings suggested that retirement may lead to a reduction in inpatient healthcare utilisation, which underlined the importance for policy-makers to consider the externalities of retirement policies on inpatient healthcare utilisation.

The role of primary health care in improving health status, financial protection and health equity in the context of China's health system reform.

BACKGROUND: Stronger primary health care (PHC) is critical to achieving the United Nations' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity. METHODS: We obtained province-level and individual-level data to conduct a longitudinal study across the period of China's health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations. RESULTS: From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density. CONCLUSIONS: In China, an increased PHC physician supply was associated with improved health system performance. While China's PHC system has been strengthened in the context of China's health system reforms, further effective incentives should be developed to attract more qualified PHC workers.

Relationship between household financial debt and depressive symptoms: a longitudinal study in China.

OBJECTIVES: To examine the impacts of household financial debt on depressive symptoms and its possible mediating mechanisms. DESIGN: A nationally representative longitudinal study using the ordinary least squares regression model, fixed-effects model, and instrumental variable approach to explore the relationship between household financial debt and depressive symptoms and further using structural equation models and the Bootstrap method to analyse the mediating effects. SETTING: The China Family Panel Studies (CFPS) database. PARTICIPANTS: Three waves of longitudinal data in 2012, 2016, and 2018 from CFPS were used. A total of 103,247 individuals over the age of 18 were included in our study sample. OUTCOME MEASURES: Depression symptoms were assessed using an eight-item version of the Center for Epidemiologic Studies Depression Scale (CES-D8). We summed these eight items to conduct a depressive symptoms index to measure depressive symptoms. RESULTS: Among the sample, 35.3% of the households have financial debt, 49.7% of the sample are male, 73.2% of them have rural hukou, and the average age was 46.6. Regression results showed that household financial debt had a negative effect on depressive symptoms (ß=0.655, 95% CI 0.602 to 0.707, p<0.01). This result remained robust after using instrumental variables with fixed effects (ß=0.483, 95% CI 0.311 to 0.656, p<0.01). Household financial debt could affect depressive symptoms through mediating variables such as working pressure (p<0.05) and life happiness (p<0.01). CONCLUSION: Our study showed that household indebtedness in China had a negative effect on depressive symptoms. Also, we found some mediating mechanisms for this effect, which might help provide new guidance for psychological interventions to promote the mental health of indebted residents.

Reveal the inequality hidden in industry land use by integrating domestic trade and the industry efficiency.

Although industrial land accounts for a low percentage of the land surface, it can significantly affect the development of the economy and the environment. Unbalanced development makes industry efficiency differ vastly across China. Industry products embodied in domestic trade link the indirect use of industry inputs and outputs. Regional inequality needs to be more scientifically checked by comprehensively considering both trade and the efficiency, which may be determined by diverse indices. Accordingly, this study examined industrial land use among provinces and the efficiency, identified the embodied land, developed approaches to ascertain how industrial land use would change without domestic trade, and revealed the inequalities in industrial land by considering the trade. Results found that provinces along China's coastline usually have a highly industrialised area, and the developed regions usually have high efficiency. Guangdong, Henan, Jiangsu, Shanghai, Shandong, Liaoning, Anhui, Hebei, and Heilongjiang have high values in both industrial land serving external provinces and the reverse use in external provinces. Through domestic trade, China saved a total of 462 km2 of land to be converted into industrial land, which is mainly due to developed regions providing industrial land use to undeveloped regions with low efficiency. The inequality analysis shows that most provinces were in a moderate state. Heilongjiang, Gansu, and Guangxi have obvious disadvantages. Some suggestions have been made for harmonious industry development and enhanced efficiency, such as the implementation of efficiency and price-based land use policies, industry and energy structure optimisation, technological improvement, and appropriate compensation.

Cost-Effectiveness Analysis of Hearing Aids for Middle-Aged and Older Adults in China: A Randomized Controlled Trial.

OBJECTIVE: To assess the cost-effectiveness of hearing aid interventions to middle-aged and older adults in rural China. STUDY DESIGN: Randomized controlled trial. SETTING: Community centers. PATIENTS: A total of 385 subjects 45 years and older with moderate or above hearing loss participated in the trial, of which 150 were in the treatment group and 235 in the control group. INTERVENTION: Participants were randomly assigned to the treatment group prescribing with hearing aids or to the control group with no intervention. MAIN OUTCOME AND MEASURES: The incremental cost-effectiveness ratio was calculated by comparing the treatment group with the control group. RESULTS: Assuming that the average life span of hearing aids is N years, the cost of the hearing aid intervention included the annual purchase cost of 10,000/N yuan, the annual maintenance cost of 41.48 yuan. However, the intervention led to annual healthcare costs of 243.34 yuan saved. The effectiveness of wearing a hearing aid included an increase of 0.017 quality-adjusted life years. It can be calculated that if N > 6.87, the intervention is very cost-effective; if 2.52 < N < 6.87, the increased cost-effectiveness of the intervention is acceptable; if N < 2.52, the intervention is not cost-effective. CONCLUSION: In general, the average life span of hearing aids is between 3 and 7 years, so hearing aid interventions can be considered cost-effective with high probability. Our results can provide critical reference for policy makers to increase accessibility and affordability of hearing aids.

Quantitative assessment of retinal microvascular remodeling in eyes that underwent idiopathic epiretinal membrane surgery.

Purpose: To explore the surgical outcomes of the macular microvasculature and visual function in eyes with idiopathic epiretinal membrane (iERM) using spectral-domain optical coherence tomography angiography (SD-OCTA). Methods: This observational, cross-sectional study included 41 participants who underwent iERM surgery with a 3-month (3M) follow-up. Forty-one healthy eyes formed the control group. The assessments included best-corrected visual acuity (BCVA) and mean sensitivity (MS) by microperimetry and SD-OCTA assessment of vessel tortuosity (VT), vessel density (VD), foveal avascular zone, and retinal thickness (RT). Results: The findings showed statistically significant differences in VT, foveal avascular zone parameters, RT, BCVA, and MS between the iERM and control groups (p < 0.05). After iERM surgery, the macular VT, SCP VD, and RT decreased significantly (p < 0.01) while the DCP VD increased (p = 0.029). The BCVA improved significantly (p < 0.001) and was associated with the MS (rs = -0.377, p = 0.015). MS was associated with the SCP VD and RT at 3M (SCP VD rs = 0.511, p = 0.001; RT rs = 0.456, p = 0.003). In the superior quadrant, the MS improved significantly (p < 0.001) and the improvement of MS was associated with the reduction of VT (ß = -0.330, p = 0.034). Conclusion: Microcirculatory remodeling and perfusion recovery were observed within 3 months after iERM surgery. VT was a novel index for evaluating the morphology of the retinal microvasculature in eyes with iERM and was associated with MS in the superior quadrant.

Direct economic burden attributable to age-related diseases in China: An econometric modelling study.

Background: Aging is a strong risk factor for many chronic diseases. However, the economic burden attributable to age-related diseases remains unclear. We aimed to calculate the economic burden attributable to age-related diseases in China. Methods: We used an econometric modelling approach from the China Health and Retirement Longitudinal Survey (CHARLS), which is based on a longitudinal observational data set from middle-aged and older adults aged 45+ in 2011, 2013, and 2015. Results: We calculated the total direct economic burden attributable to age-related diseases for outpatient and inpatient services among adults aged 45 and above in China, which was approximately 288.368 billion US dollars (US$), US$379.901 billion, and US$616.809 billion in 2011, 2013, and 2015, respectively, taking up 19.48%, 21.11% and 32.03% of the overall health care expenses in the same year. The proportion of dyslipidemia was the largest, followed by hypertension in all the three years; hearing problems accounted for the lowest proportion. Conclusions: The alarming upward trend in age-related economic burden in China calls for urgent interventions to prevent or slow down the accumulation of damage associated with age-related diseases.

Association of Urban-Rural Health Insurance Integration With Health Outcomes Among Middle-aged and Older Adults in Rural China.

This cohort study examines the association of urban-rural health insurance integration with health outcomes among middle-aged and older adults in rural China.

The Impact Mechanism of Household Financial Debt on Physical Health in China.

In recent years, Chinese household financial debt has been growing rapidly due to the expansion of mortgage lending. This study aims to examine the impact mechanism of Chinese household financial debt on physical health. Using the 2010-2018 China Household Tracking Survey (CFPS) panel data, we developed fixed effects models to explore the effect of household financial debt on individuals' psychical health, and we also used an instrumental variable to address endogeneity. The findings suggest that there is a negative effect of household financial debt on physical health and these findings still hold after a series of robustness tests. In addition, household financial debt can affect individuals' physical health through mediating variables, such as healthcare behaviors and mental health, and the effects are more significant for those who are middle-aged, married, and with low-income levels. The findings of this paper are important for developing countries to clarify the relationship between household financial debt and population health, and to develop appropriate health intervention policies for highly indebted households.

Impacts of the hearing aid intervention on healthcare utilization and costs among middle-aged and older adults: results from a randomized controlled trial in rural China.

Background: Hearing impairment has become a major global health issue. To reduce the burden of hearing impairment, we explored impacts of the hearing aid intervention on healthcare utilization and costs. Methods: In this randomized controlled trial, participants aged 45+ were allocated with a ratio of 1:1.5 (intervention: control). Neither the investigators nor the assessors were blinded to the allocation status. Those in the intervention group were fitted with hearing aids, and those in the control group received no care. We applied the difference-in-difference (DID) approach to examine the impacts on healthcare utilization and costs. Given that social network and age can be significant variables affecting effectiveness of the intervention, subgroup analyses by social network and age were used to explore the heterogeneity. Findings: 395 subjects were successfully recruited and randomized. 10 subjects did not meet the inclusion criteria and therefore, 385 eligible subjects (150 in the treatment group and 235 in the control group) were analyzed. The intervention significantly reduced their total healthcare costs (average treatment effect (ATE) = -1.26, 95% CI = -2.39, -0.14, p = 0.028) and total out-of-pocket (OOP) healthcare costs (ATE = -1.29, 95% CI = -2.37, -0.20, p = 0.021) in the 20-month follow-up. To be exact, it reduced self-medication costs (ATE = -0.82, 95% CI = -1.49, -0.15, p = 0.016) and OOP self-medication costs (ATE = -0.84, 95% CI = -1.46, -0.21, p = 0.009). Subgroup analysis showed that the impacts on self-medication costs and OOP self-medication costs varied by social network (ATE for self-medication costs = -0.26, 95% CI = -0.50, -0.01, p = 0.041; ATE for OOP self-medication costs = -0.27, 95% CI = -0.52, -0.01, p = 0.038). The impacts also varied by age groups (ATE for self-medication costs = -0.22, 95% CI = -0.40, -0.04, p = 0.019; ATE for OOP self-medication costs = -0.17, 95% CI = -0.29, -0.04, p = 0.010). There were no adverse events or side effects during the trial. Interpretation: Hearing aid use significantly lowered self-medication costs and total healthcare costs, but had no impacts on inpatient or outpatient services utilization or costs. The impacts were manifested among people with active social network or younger age. It can be speculated that the intervention may be adapted to other similar settings in developing countries to reduce healthcare costs. Funding: P.H. reports grants from National Natural Science Foundation of China (No. 71874005) and Major Project of the National Social Science Fund of China (No. 21&ZD187). Trial registration: Chinese Clinical Trial Registry: ChiCTR1900024739.

Internet use and rural-urban mental health inequalities: Evidence from China.

Introduction: In the context of the new digital era, clarifying the relationship between Internet use and urban and rural residents' mental health is of important value for reducing rural-urban health inequalities. This paper aims to study the association between Internet use and rural-urban mental health inequalities. Methods: Based on the data of the China Family Panel Studies (CFPS) in 2020, we firstly examined the existence and specific manifestation of mental health inequalities between urban and rural residents. Secondly, we examined the mediating effect of Internet use by the Bootstrap mediating effect measure. Finally, we verified the robustness of the mediating effect. Results: There are significant mental health inequalities between urban and rural residents, and urban residents have better mental health than rural residents (p < 0.01). In addition, the test results for the mediating effect of Internet use on mental health inequalities between urban and rural residents were significant (p < 0.01), with a direct effect of -0.028 (p < 0.01) and an indirect effect of -0.49 (p < 0.01), and this result remained significant in the robustness test. Discussion: In such a new age of the Internet, mental health inequalities between urban and rural residents objectively did exist, and the use of the internet played a positive mediation effect on the formation of mental health inequalities between urban and rural areas.

Ecological engineering induced carbon sinks shifting from decreasing to increasing during 1981-2019 in China.

Substantial evidence shows that most of China's terrestrial ecosystems are important carbon sinks. However, the nonlinear trend of the carbon sinks and their nonlinear response to driving factors are unclear. Taking the net ecosystem productivity (NEP) as a proxy for the ecosystem carbon sink, the nonlinear relationships between the monotonically increasing trends and decreasing to increasing shifts in the carbon sink to climate change and ecological engineering were investigated based on ensemble empirical mode decomposition (EEMD) and machine learning algorithm (boosted regression tree model, BRT). The results suggest that 16.75 % of the carbon sinks in China experienced a monotonic increase. Additionally, 20.55 % of the carbon sinks shifted from decreasing to increasing trends, primarily after 1995, and these carbon sinks were located in the key ecological engineering areas, such as the middle reaches of the Yellow River shelterbelt program area, the Liaohe shelterbelt program area, the Grain to Green program area, and the Three-North Forest shelterbelt program area. Moreover, carbon sinks exhibited strong spatial autocorrelation with low-low clustering in the north and high-high clustering in the south. The increase in CO2 (slope of CO2 < 1.8 g/m2/s/y) and solar radiation (slope of radiation >1 w/m2/y) promoted the monotonic increase in the carbon sinks in the center of China. The increase in the areas of forest and grassland shifted the carbon sink trend from decreasing to increasing in the key ecological engineering program areas, and economic development reversed the carbon sink reduction in the Pearl River shelterbelt program area. These findings highlight the positive effect of ecological engineering on carbon sinks and provide adaptation strategies and guidance for China to achieve the "carbon neutrality" target.

Economic Burden of Hearing Loss inMiddle-Aged and Older Adults in China.

Our study aimed to estimate the economic burden of hearing loss. Using data from the China Health and Retirement Longitudinal Study (CHARLS), hearing loss attributed fraction based on the rate of hearing loss was derived. Then, we calculated the direct and indirect economic burden of hearing loss. The base year for the monetary amounts shown was 2015. For middle-aged and older people aged 45+ in China, the economic burden of hearing loss in 2011, 2013, and 2015 was US$6.13 billion, US$7.39 billion, and US$8.50 billion, respectively. The direct economic burden of hearing loss accounted for 46.99%-50.24%, the indirect economic burden of premature death accounted for 49.41%-52.70%, and the indirect economic burden of productivity loss accounted for the least proportion of 0.31%-0.35%. Immediate measures such as hearing loss prevention, hearing screening, and hearing aid wearing should be taken, so as to reduce the economic burden of hearing loss.

Direct Costs Attributable to Hearing Loss in China: Based on an Econometric Model.

OBJECTIVES: To our knowledge, hearing loss has been proved by a few studies from developed countries to bring a high economic burden of disease, but there is no relevant cost estimate in China. The purpose of our study was to measure the direct costs attributable to hearing loss among middle-aged and older people aged 45 and above in China in 2011, 2013, and 2015. DESIGN: On the basis of data from the China Health and Retirement Longitudinal Study and the China Statistical Yearbook, an econometric model was used to obtain the hearing-attributable fraction, and then the direct costs attributable to hearing loss of middle-aged and older people aged 45 and above in China in 2011, 2013, and 2015 were calculated. RESULTS: In 2011, 2013, and 2015, the direct costs attributable to hearing loss of middle-aged and older people aged 45 and above in China were $50.699 billion, $81.783 billion, and $106.777 billion, accounting for 3.43, 4.54, and 5.54% of the overall healthcare costs in the same year, respectively. Among the direct costs attributable to hearing loss, direct outpatient costs accounted for 75.75 to 81.13%, and direct inpatient costs accounted for 18.87 to 24.25%. CONCLUSIONS: The direct costs attributable to hearing loss for Chinese adults aged 45 and above have placed a heavy burden on Chinese society. The government should give priority and take effective measures to the prevention and treatment of hearing loss.

Effects of the Long-term Care Insurance on Health Among Older Adults: A Panel Data From China.

BACKGROUND: China's long-term care insurance (LTCI) has been launched since 2016 to ensure that older disabled people obtain affordable care services. However, rigorous evaluations of the health effects of China's LTCI pilots have been limited. This paper aimed to examine the effects of LTCI on health among older adults aged 60 years and above. METHODS: Drawing from panel data of the China Health and Retirement Longitudinal Study (CHARLS), we used a propensity score matching (PSM) and difference-in-difference (DID) approach to identify the health effects of the LTCI program and reduce the selection bias. Further, heterogeneity of the effects was examined by physical and intellectual function to evaluate whether the effects differed among subgroups of older population. RESULTS: The implementation of LTCI significantly improved self-rated health (ß = 0.15, P<.05) and cognitive function (ß = 0.59, P<.01) for older adults. The results were robust when keeping only those living in pilot cities (ß = 0.31, P<.05 for self-rated health status; ß = 0.98, P<.001 for cognitive function) or non-pilot cities (ß = 0.14, P<.05 for self-rated health status; ß = 0.60, P<.01 for cognitive function) as the control group. The effects of LTCI were especially manifested in older adults with physical disability (ß = 0.13, P<.01 for self-rated health; ß = 0.76, P<.001 for cognitive function) or intellectual disability (ß = 0.16, P<.01 for self-rated health). CONCLUSION: From a policy perspective, these findings suggested that LTCI in China could benefit the health outcomes of older adults, especially those with physical or cognitive disabilities. Policy-makers can target resources more effectively to improve health outcomes for the most vulnerable populations.

Cost and effectiveness of microwave ablation versus video-assisted thoracoscopic surgical resection for ground-glass nodule lung adenocarcinoma.

Purpose: To retrospectively evaluate the cost and effectiveness in consecutive patients with ground-glass nodules (GGNs) treated with video-assisted thoracoscopic surgery (VATS; i.e., wedge resection or segmentectomy) or microwave ablation (MWA). Materials and methods: From May 2017 to April 2019, 204 patients who met our study inclusion criteria were treated with VATS (n = 103) and MWA (n = 101). We calculated the rate of 3-year overall survival (OS), local progression-free survival (LPFS), and cancer-specific survival (CSS), as well as the cost during hospitalization and the length of hospital stay. Results: The rates of 3-year OS, LPFS, and CSS were 100%, 98.9%, and 100%, respectively, in the VATS group and 100%, 100% (p = 0.423), and 100%, respectively, in the MWA group. The median cost of VATS vs. MWA was RMB 54,314.36 vs. RMB 21,464.98 (p < 0.001). The length of hospital stay in the VATS vs. MWA group was 10.0 vs. 6.0 d (p < 0.001). Conclusions: MWA had similar rates of 3-year OS, LPFS, and CSS for patients with GGNs and a dramatically lower cost and shorter hospital stay compared with VATS. Based on efficacy and cost, MWA provides an alternative treatment option for patients with GGNs.

Impacts of price changes on public hospital reforms in China: evidence from 25 million patients at tertiary hospitals.

China's public hospital price change reform was progressively piloted at urban-level tertiary hospitals in 2015, aiming to adjust the healthcare expenditure structure, reorient public hospitals towards social objectives and control inflated healthcare expenditure. This study investigates the impacts of price changes on inpatient expenditure, service quantity, quality and efficiency and whether the impacts varied in different specialities, treatments and hospitals. A difference-in-differences analysis was conducted using data from 25 million patients from 124 nationally representative tertiary hospitals between 2013 and 2018. The study analyses changes in total expenditure, drug, medical services and diagnostic test/medical consumables expenditure per admission, the use of antibiotics, performed surgery, readmission within 30 days and length of stay (LOS). These factors are examined before and after adjusting the price changes for demographic, socioeconomic and clinical covariates. The price changes decreased drug expenditure per admission (-13.5%, P < 0.001, USD 96.6) and increased medical services expenditure per admission (30.9%, P < 0.001, USD 153.3). They also reduced the LOS (-1.2%, P = 0.019, 0.1 days) while not significantly affecting total expenditure per admission, diagnostic test/medical consumables per admission and the use of antibiotics, surgery performed and readmission rates. In heterogeneity analysis, price changes reform increased efficiency in major diagnostic categories (MDCs) with high drug share and improved quality in nonoperating room surgical groups and hospitals with high drug share; however, it increased total expenditure in MDCs with low drug share or surgical groups. China's public hospital price change reform generally adjusted the inpatient expenditure structure and reduced the LOS in tertiary public hospitals. Sufficient compensation from medical services and government subsidies that minimize the income effects may be the key to the success of price change reform.

Association of sex with the global burden of vision impairment caused by neonatal preterm birth: An analysis from the global burden of disease study 2019.

Aims: To investigate the sex-specific global burden of neonatal preterm birth (NPB) vision impairment by year, age, and socioeconomic status using years lived with disability (YLDs). Methods: The global, regional, and national sex-specific YLD numbers, crude YLD rates, and age-standardized YLD rates of NPB-related moderate and severe vision loss and blindness were obtained from the Global Burden of Disease Study 2019. The Wilcoxon test and linear regression were used to investigate the relationship between sex difference in age-standardized YLD rates and the Human Development Index (HDI). Results: Between 1990 and 2019, the gender disparity in age-standardized YLD rates for NPB-related vision impairment remained stable, increasing from 10.2 [95% uncertainty interval (UI) 6.7-14.6] to 10.4 (95% UI 6.9-15.0) for men and 10.3 (95% UI 6.8-14.7) to 10.7 (95% UI 7.2-15.1) for women, with women consistently having higher age-standardized YLD rates. Between the ages of 25 and 75, women had higher YLD rates than males, with the biggest disparity in the 60-64 age group. In 2019, sex difference in age-standardized YLD rates across 195 nations was statistically significant. Women had higher age-standardized YLD rates than men in both low (Z = -3.53, p < 0.001) and very high HDI countries (Z = -4.75, p < 0.001). Additionally, age-standardized YLD rates were found to be adversely associated with HDI (male: Standardized ß = -0.435, female: Standardized ß = -0.440; p < 0.001). Conclusion: Despite advancements in worldwide NPB health care, sexual differences in NPB-related vision impairment burden showed little change. Female had higher burden than male, particularly in low and very high socioeconomic status countries.