The usage and costs of national drug price-negotiated anticancer medicines in a first-tier city in Northeast China: a study based on health insurance data.

BACKGROUND: The National Drug Price Negotiation (NDPN) policy has entered a normalisation stage, aiming to alleviate, to some extent, the disease-related and economic burdens experienced by cancer patients. This study analysed the use and subsequent burden of anticancer medicines among cancer patients in a first-tier city in northeast China. METHODS: We assessed the usage of 64 negotiated anticancer medicines using the data on the actual drug deployment situation, the frequency of medical insurance claims and actual medication costs. The affordability of these medicines was measured using the catastrophic health expenditure (CHE) incidence and intensity of occurrence. Finally, we used the defined daily doses (DDDs) and defined daily doses cost (DDDc) as indicators to evaluate the actual use of these medicines in the region. RESULTS: During the study period, 63 of the 64 medicines were readily available. From the perspective of drug usage, the frequency of medical insurance claims for negotiated anticancer medicines and medication costs showed an increasing trend from 2018 to 2021. Cancer patients typically sought medical treatment at tertiary hospitals and purchased medicines at community pharmacies. The overall quantity and cost of medications for patients covered by the Urban Employee Basic Medical Insurance (UEBMI) were five times higher than those covered by the Urban and Rural Resident Medical Insurance (URRMI). The frequency of medical insurance claims and medication costs were highest for lung and breast cancer patients. Furthermore, from 2018 to 2021, CHE incidence showed a decreasing trend (2.85-1.60%) under urban patients' payment capability level, but an increasing trend (11.94%-18.42) under rural patients' payment capability level. The average occurrence intensities for urban (0.55-1.26 times) and rural (1.27-1.74 times) patients showed an increasing trend. From the perspective of drug utilisation, the overall DDD of negotiated anticancer medicines showed an increasing trend, while the DDDc exhibited a decreasing trend. CONCLUSION: This study demonstrates that access to drugs for urban cancer patients has improved. However, patients' medical behaviours are affected by some factors such as hospital level and type of medical insurance. In the future, the Chinese Department of Health Insurance Management should further improve its work in promoting the fairness of medical resource distribution and strengthen its supervision of the nation's health insurance funds.

Study protocol: How does cognitive flexibility relate to other executive functions and learning in healthy young adults?

BACKGROUND: Cognitive flexibility (CF) enables individuals to readily shift from one concept or mode of practice/thoughts to another in response to changes in the environment and feedback, making CF vital to optimise success in obtaining goals. However, how CF relates to other executive functions (e.g., working memory, response inhibition), mental abilities (e.g., creativity, literacy, numeracy, intelligence, structure learning), and social factors (e.g., multilingualism, tolerance of uncertainty, perceived social support, social decision-making) is less well understood. The current study aims to (1) establish the construct validity of CF in relation to other executive function skills and intelligence, and (2) elucidate specific relationships between CF, structure learning, creativity, career decision making and planning, and other life skills. METHODS: This study will recruit up to 400 healthy Singaporean young adults (age 18-30) to complete a wide range of cognitive tasks and social questionnaires/tasks. The richness of the task/questionnaire battery and within-participant administration enables us to use computational modelling and structural equation modelling to examine connections between the latent constructs of interest. SIGNIFICANCE AND IMPACT: The current study is the first systematic investigation into the construct validity of CF and its interrelationship with other important cognitive skills such as learning and creativity, within an Asian context. The study will further explore the concept of CF as a non-unitary construct, a novel theoretical proposition in the field. The inclusion of a structure learning paradigm is intended to inform future development of a novel intervention paradigm to enhance CF. Finally, the results of the study will be useful for informing classroom pedagogy and the design of lifelong learning policies and curricula, as part of the wider remit of the Cambridge-NTU Centre for Lifelong Learning and Individualised Cognition (CLIC).

Female perspective: the burden of Alzheimer's disease and other dementias in China from 1990 to 2019 and prediction of their prevalence up to 2044.

Background: Dementia is more prevalent in women than in men across the world, and sex differences are reflected in the burden of dementia borne by women and men. However, a few studies have specifically analyzed the disease burden of dementia in Chinese women. Objective: This article aims to raise awareness of Chinese females with dementia (CFWD), outline an effective response to future trends in China from a female perspective, and provide a reference for the scientific formulation of dementia prevention and treatment policies in China. Methods: In this article, epidemiological data on dementia in Chinese women were obtained from the Global Burden of Disease Study 2019, and three risk factors, namely, smoking, a high body mass index, and a high fasting plasma glucose, were selected for the analysis. This article also predicted the burden of dementia in Chinese women in the next 25 years. Results: The prevalence of dementia, mortality, and disability-adjusted life year rates increased with age in CFWD in 2019. All three risk factors provided by the Global Burden of Disease Study 2019 showed positive correlations for the effect of disability-adjusted life years (DALYs) rates on CFWD. Among them, a high body mass index had the greatest effect (8%) and smoking had the smallest effect (6.4%). Over the next 25 years, the number of CFWD and its prevalence are expected to be on the rise, while mortality is expected to remain relatively stable and decline slightly, but deaths from dementia will continue to increase. Conclusions: The situation arising due to the spread of dementia among Chinese women in the future is going to become a serious issue. To reduce the burden of dementia, the Chinese government should prioritize its prevention and treatment. A multi-dimensional, long-term care system involving families, community, and hospitals should also be established and supported.

Influencing Factors of Health Technology Assessment to Orphan Drugs: Empirical Evidence in England, Scotland, Canada, and Australia.

This study summarizes the intrinsic criteria for the recommendation of orphan drugs in England, Scotland, Canada, and Australia with the aim of understanding the rationale for the variability in decision-making and to provide a reference for the establishment of criteria in the process of access to health insurance for orphan drugs in different countries and the construction of national uniform criteria. A comparative analysis of 60 health technology assessment (HTA) guidelines of 15 drug-indication pairs appraised by four countries (England, Scotland, Canada, and Australia) from 2017 to 2018 was done, including an in-depth analysis of a case study. Agreement levels were measured using kappa scores. Associations were explored through correspondence analysis. The four countries possess some homogeneity in the assessment, but each has its own preferences. Poor agreement exists between England, Scotland, and Canada (-0.41 < kappa score < 0.192). In the correspondence analysis, England placed more emphasis on treatment methods in terms of control type when making recommendations. Canada and Scotland focused more on trial type with Canada placing more emphasis on phase III and open-label trials and on cost-utility analysis, while Australia was less studied in terms of economic models. Different countries have different goals when establishing HTA decisions for orphan drugs due to their different degrees of orphan drug coverage. Different countries should not only combine their unique values of clinical benefit and cost-effectiveness in the assessment of orphan drugs but also give different weights during the HTA process, after considering account the development of the country itself.

Burden and trends of multiple sclerosis in China from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.

OBJECTIVE: To compare the burden of multiple sclerosis disease indicators in the Asia-Pacific countries, China and globally through the Global Burden of Disease 2019 (GBD2019) Database, and to analyse the changes of multiple sclerosis disease burden in China from 1990 to 2019. STUDY DESIGN: Observational study based on the Global Burden of Disease. SETTING: The relevant incidence, prevalence, death and disability-adjusted life year (DALY) rates and corresponding age-standardised rates (ASRs) and sociodemographic index (SDI) in China, globally and in Asia-Pacific countries were extracted from the GBD2019 Database to further study the age-standardised incidence, prevalence and mortality, and the relationship between DALY rate and SDI. RESULTS: Various disease burden indicators of multiple sclerosis in China are at low level in the world, and the prevalence, incidence and DALY rates have slowly increased from 1990 to 2019. During this period, the age-standardised prevalence rate (ASPR) of multiple sclerosis in China showed an upward trend, while the age-standardised death rate (ASDR), age-standardised DALY rate (ASR-DALY) and age-standardised incidence rate all decreased to varying degrees, which were roughly consistent with the global amplitude changes, and all indicators are similar to most countries in the Asia-Pacific region. As the value of the SDI increases, the ASPR of multiple sclerosis was trending upward, and the ASDR was trending downward. CONCLUSION: Compared with other countries in the Asia-Pacific region, China is in a low state of disease burden indicators. However, as a developing country and the most populous country in the world, the total number of patients is not small, and as a rare disease, the treatment cost is relatively expensive, and the treatment cost of the complications caused by the disease is not low. The construction of the medical security system should be strengthened to reduce its burden on individuals, families and society.

Analysis of the Status and Tendency of R&D Input in the Field of Rare Diseases Funded by the National Natural Science Foundation of China.

Background: Through collection and sorting of rare disease projects funded by the National Natural Science Foundation of China, an understanding was gained of the categories of projects funded by the foundation in the field of rare diseases, types of diseases, categories of disease systems, regional distribution, distribution of supporting institutions, and their dynamic changes, followed by an analysis of focuses and influences of relevant state policies. This will help improve the rare disease-relating policies of the state in supporting the key fields, thus promoting healthy and sustainable development in the field of rare diseases. Method: Through the website of inquiry of projects funded by the National Natural Science Foundation of China, a retrieval was made concerning the projects funded by the foundation in the field of rare diseases during the period from 1986 to 2019, followed by descriptive analysis of fund input of rare disease projects, number of projects, temporal and regional distribution, and the analysis of the law of their dynamic changes. Result: As of the end of 2019, there were 57 rare diseases and 678 related projects funded by the National Natural Science Foundation of China, with accumulated total funding of ¥ 253,525,000. Among the categories of projects, the most-funded projects were general (¥ 150,145,000, 59.22%), followed by Youth Foundation projects (¥ 53,719,000, 21.19%) and key projects (¥ 15,870,000, 6.26%); among the categories of disease systems, the most funded disease system was the nervous system (¥ 93,186,000, 37.76%), followed by the respiratory system (¥ 35,444,000, 13.98%); the most funded diseases were multiple sclerosis (¥ 34,870,000, 13.75%), idiopathic pulmonary fibrosis (¥ 29,854,000, 11.78%), and retinitis pigmentosa (¥ 27,005,000, 10.65%); the most funded regions were East China (¥ 106,987,000, 42.20%) and North China (¥ 71,844,000, 28.34%), while the least funded region was Northwest China (¥ 7,295,000, 2.88%); among the supporting institutions, the most funded institutions were Peking University (¥ 24,720,000, 9.75%), and Sun Yat-sen University (¥ 14,505,000, 5.72%). Conclusion: With the promulgation of more policies on encouragement of innovation and accelerated approval procedures, etc., the National Natural Science Foundation of China has been increasing its funding to rare diseases, covering increasingly more categories of funded projects, more types of diseases, and wider regions. Nonetheless, the support for scientific research in China is still relatively weak. Therefore, it is proposed that the healthy and sustainable development in the course of rare diseases should be promoted through the improvement of relevant rare disease policies, encouragement of R&D of medicine for rare diseases, the establishment of special funds for rare diseases, acceleration of fund circulation, and combination of balanced development and preferential funding to key regions and major diseases.

Utilization willingness of institutional care between disabled and non-disabled seniors: evidence from Jiangsu, China.

BACKGROUND: Due to rapidly growing number of old adults and diminishing supportive functions of family in China, the issue of willingness to use institutional care is of high priority, especially for disabled seniors. The objective of this study is to compare the willingness of institutional care and its determinants between disabled and non-disabled seniors in China. METHODS: 2493 seniors (60+) were randomly selected from a cross-sectional study conducted in three urban districts and three rural counties in Jiangsu Province. Binary logistic regression model was employed to examine differences towards the preference for institutional care between two subgroups, and to identify factors associated with willingness of institutional care between disabled and non-disabled seniors. RESULTS: Of 2493 respondents, 402 (16.1%) were disabled seniors. Overall, 14.2% of the participants had willingness for institutional care in Jiangsu, China. The willingness for institutional care among non-disabled seniors (OR = 0.513; 95%CI 0.387-9.680) was significantly lower than that among disabled ones. The preference for institutional care of both disabled and non-disabled seniors was associated with household income. The willingness of institutional care was also related to age, education and living arrangement among disabled seniors. Meanwhile, non-disabled seniors who had non-communicable diseases were found to be more likely to choose elder care in institution. CONCLUSIONS: Our findings indicated that the willingness for institutional care among disabled seniors was significantly higher than that among non-disabled ones. Household income was determinant of utilization willingness for institutionalization both in disabled and non-disable seniors. Different policies should be made or modified for disabled and non-disabled seniors separately.