Developing China's roadmap for air quality improvement: A review on technology development and future prospects.

Air pollution control policies in China have been experiencing profound changes, highlighting a strategic transformation from total pollutant emission control to air quality improvement, along with the shifting targets starting from acid rain and NOx emissions to PM2.5 pollution, and then the emerging O3 challenges. The marvelous achievements have been made with the dramatic decrease of SO2 emission and fundamental improvement of PM2.5 concentration. Despite these achievements, China has proposed Beautiful China target through 2035 and the goal of 2030 carbon peak and 2060 carbon neutrality, which impose stricter requirements on air quality and synergistic mitigation with Greenhouse Gas (GHG) emissions. Against this background, an integrated multi-objective and multi-benefit roadmap is required to provide decision support for China's long-term air quality improvement strategy. This paper systematically reviews the technical system for developing the air quality improvement roadmap, which was integrated from the research output of China's National Key R&D Program for Research on Atmospheric Pollution Factors and Control Technologies (hereafter Special NKP), covering mid- and long-term air quality target setting techniques, quantitative analysis techniques for emission reduction targets corresponding to air quality targets, and pathway optimization techniques for realizing reduction targets. The experience and lessons derived from the reviews have implications for the reformation of China's air quality improvement roadmap in facing challenges of synergistic mitigation of PM2.5 and O3, and the coupling with climate change mitigation.

Public health benefits of hair-mercury analysis and dietary advice in lowering methylmercury exposure in pregnant women.

AIMS: To evaluate whether a public health intervention using focused dietary advice combined with a hair-mercury analysis can lower neurotoxic methylmercury exposure among pregnant women without decreasing their overall intake of seafood. METHODS: A total of 146 pregnant women were consecutively recruited from the antenatal clinic at a Danish university hospital at their initial ultrasound scan. Dietary advice was provided on avoiding methylmercury exposure from large predatory fish and a hair sample from each participant was analysed for mercury, with the results being communicated shortly thereafter to the women. A dietary questionnaire was filled in. Follow-up three months later included a dietary questionnaire and a repeat hair-mercury analysis. RESULTS: In the follow-up group, 22% of the women had hair-mercury concentrations above a safe limit of 0.58 µg/g at enrolment, decreasing to 8% three months later. Average hair-mercury concentrations decreased by 21%. However, the total seafood intake remained at the same level after three months. CONCLUSIONS: Increased exposure to methylmercury among pregnant women is an important public health concern in Denmark. The observed lowering of hair-mercury concentrations associated with dietary advice corresponds to a substantial public health benefit that probably makes such an intervention highly profitable.

Measuring the impact of monoclonal antibody therapies.

Objective: Monoclonal antibody (Mab) treatments have significantly improved the quality and quantity of life, but they are some of the most expensive treatments, resulting in a degree of hesitancy to introduce new Mab agents. A system for estimating the effect of Mab drugs, in general, would optimally inform health strategy and fully realize how a single scientific discovery can deliver health benefits. We evaluated such a method with several well-established Mab regimens. Methods: We selected five different Mab regimens in oncology and rheumatology in England. We carried out two systematic literature reviews and meta-analyses to assess health outcomes (Health Assessment Questionnaire-Disability Index for rheumatoid arthritis; overall mortality for melanoma) from real-world data and compared them to the outcomes from randomized control trials (RCTs). We applied economic modeling to estimate the net monetary benefits for health outcomes for the estimated patient population size for each Mab regimen. Results: Meta-analyses of 27 eligible real-world data (RWD) sets and 26 randomized controlled trial (RCT) sets found close agreement between the observed and expected health outcomes. A Markov model showed the net positive monetary benefit in three Mab regimens and the negative benefit in two regimens. However, because of limited access to NHS data, the economic model made several assumptions about the number of treated patients and the cost of treatment to the NHS, the accuracy of which may affect the estimation of the net monetary benefit. Conclusion: RCT results reliably inform the real-world experience of Mab treatments. Calculation of the net monetary benefit by the algorithm described provides a valuable overall measure of the health impact, subject to the accuracy of data inputs. This study provides a compelling case for building a comprehensive, systematized, and accessible database and related analytics, on all Mab treatments within health services.

[Concepts and application of cost-benefit evaluation in an international overview]. / Grundkonzepte und Einsatz von Kosten-Nutzen-Bewertungen im internationalen Überblick.

Due to market access of high-priced new drugs, the financial burden on the health care system and the appropriateness of drug prices are often doubted. Is it time for a broader perspective of health technology assessment in Germany, which has so far focused on clinical value? Should cost and benefit aspects of new technologies be given equal weight in future assessments of market access for new technologies? The experiences of European neighbors and the Standing Committee on Vaccination with cost-benefit analyses are encouraging. Introducing cost-benefit analyses as a further decision criterion in the pricing of new technologies naturally creates additional work for the players involved but also offers the opportunity to provide transparent and understandable answers to the question of what a health improvement is worth. In view of the increasing funding challenges facing the statutory health insurance system in Germany, this question will continue to gain importance.

An Integrated Care Platform System (C3-Cloud) for Care Planning, Decision Support, and Empowerment of Patients With Multimorbidity: Protocol for a Technology Trial.

BACKGROUND: There is an increasing need to organize the care around the patient and not the disease, while considering the complex realities of multiple physical and psychosocial conditions, and polypharmacy. Integrated patient-centered care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced information and communication technology solutions for semiautomated clinical decision support. OBJECTIVE: The Collaborative Care and Cure Cloud project (C3-Cloud) has developed 2 collaborative computer platforms for patients and members of the multidisciplinary team (MDT) and deployed these in 3 different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients with 2 or more chronic conditions (diabetes mellitus type 2, heart failure, kidney failure, depression), their informal caregivers, health care professionals, and, to some extent, health care systems. METHODS: This paper describes the protocol for conducting an evaluation of user experience, acceptability, and usefulness of the platforms. For this, 2 "testing and evaluation" phases have been defined, involving multiple qualitative methods (focus groups and surveys) and advanced impact modeling (predictive modeling and cost-benefit analysis). Patients and health care professionals were identified and recruited from 3 partnering regions in Spain, Sweden, and the United Kingdom via electronic health record screening. RESULTS: The technology trial in this 4-year funded project (2016-2020) concluded in April 2020. The pilot technology trial for evaluation phases 3 and 4 was launched in November 2019 and carried out until April 2020. Data collection for these phases is completed with promising results on platform acceptance and socioeconomic impact. We believe that the phased, iterative approach taken is useful as it involves relevant stakeholders at crucial stages in the platform development and allows for a sound user acceptance assessment of the final product. CONCLUSIONS: Patients with multiple chronic conditions often experience shortcomings in the care they receive. It is hoped that personalized care plan platforms for patients and collaboration platforms for members of MDTs can help tackle the specific challenges of clinical guideline reconciliation for patients with multimorbidity and improve the management of polypharmacy. The initial evaluative phases have indicated promising results of platform usability. Results of phases 3 and 4 were methodologically useful, yet limited due to the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT03834207; https://clinicaltrials.gov/ct2/show/NCT03834207. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/21994.

General medical services by non-medical health professionals: a systematic quantitative review of economic evaluations in primary care.

BACKGROUND: Previous systematic reviews have found that nurses and pharmacists can provide equivalent, or higher, quality of care for some tasks performed by GPs in primary care. There is a lack of economic evidence for this substitution. AIM: To explore the costs and outcomes of role substitution between GPs and nurses, pharmacists, and allied health professionals in primary care. DESIGN AND SETTING: A systematic review of economic evaluations exploring role substitution of allied health professionals in primary care was conducted. Role substitution was defined as 'the substitution of work that was previously completed by a GP in the past and is now completed by a nurse or allied health professional'. METHOD: The following databases were searched: Ovid MEDLINE, CINAHL, Cochrane Library, National Institute for Health and Care Excellence (NICE), and the Centre for Reviews and Dissemination. The review followed guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: Six economic evaluations were identified. There was some limited evidence that nurse-led care for common minor health problems was cost-effective compared with GP care, and that nurse-led interventions for chronic fatigue syndrome and pharmacy-led services for the medicines management of coronary heart disease and chronic pain were not. In South Korea, community health practitioners delivered primary care services for half the cost of physicians. The review did not identify studies for other allied health professionals such as physiotherapists and occupational therapists. CONCLUSION: There is limited economic evidence for role substitution in primary care; more economic evaluations are needed.

Comprehensive evaluation on energy-water saving effects in iron and steel industry.

The production of iron and steel is energy-intensive that motivated the emergence of various energy-saving technologies to reduce energy consumption. However, the effects of water-saving brought by these energy-saving technologies are rarely examined which can lead to misevaluation of their economic feasibility. In this regard, material flow analysis (MFA) was used in this study to establish the water-energy nexus and examine the potential of water-saving and energy-saving effects in the condition of applying various mixes of the 16 technologies (Ministry of Industry and Information Technology, 2015-2016) in iron and steel industry. Meanwhile, this study classified the selected 16 energy-saving technologies into three groups: direct water-saving technology, indirect water-saving technology, and water consumption technology. The low-temperature steel rolling technology is the only water-consuming energy-saving technology in this study; its indirect specific water computation reaches 0.06 m3/t. The remaining 15 energy-saving technologies have the potential of saving water indirectly, with averaged indirect specific water-saving amounting to 0.28 m3/t. This study also built an evaluation scheme of cost-benefit analysis for energy-saving technologies. With consideration of benefits brought by water saving, eleven technologies have the potential to achieve economic feasibility compared to nine in which mere energy-saving effects being considered. The results show that if the studied 16 technologies are implemented simultaneously, the comprehensive specific energy consumption will be reduced by 4.28 MJ, and the specific fresh water consumption will be reduced by 0.68 m3. Meanwhile, this research found that the cost of most energy-saving technologies will be decreased by an average of 5.52 CNY/GJ, despite the cost of low-temperature steel rolling technology increased by 0.68 CNY/GJ. This study evaluated the cost-effectiveness of energy-saving technologies taking the benefits of water conservation into consideration. It could provide references for decision-makers to develop commercialization strategies on energy saving technologies in the steel industry.

The costs and value of modelling-based design in healthcare delivery: five case studies from the US.

In the nineties and noughties, Hollocks surveyed the use of Discrete Event Simulation (DES) in industry and listed (although he could not quantify the value of) benefits. This paper explores how DES is now used to design healthcare facilities and services, developing a value-for-money case with a protocol on collecting information. We present a set of five DES case studies from the US care system and, following Hollocks, focus on modelling as part of a rigorous design process, capturing as many of the benefits as possible. Healthcare offers the possibility of ascribing value to health improvement, but in these cases it is primarily the operational benefits of a better service that are reported and monetarised. By estimated the cost of modelling and the value of the operation gains, this paper contributes significantly to the literature. We conclude with a protocol for collecting information and a discussion of methods by which different types of benefit may be captured.