[Clinical comprehensive evaluation of Ginkgolide Injection in treatment of cerebral infarction].

This clinical value-oriented comprehensive evaluation of drugs was carried out in accordance with Guidelines for Management of Comprehensive Clinical Evaluation of Drugs(trial version 2021), with the qualitative and quantitative evaluation methods adopted. Based on the evidence-based medicine, epidemiology, clinical medicine, pharmacoeconomics, mathematical statistics, and health technology evaluation(HTA), the clinical value of Ginkgolide Injection was evaluated from the "6+1" dimension by giving weight to the criterion level and index level and calculating with multi-criteria decision analysis(MCDA) model and CSC v2.0. After entering the market, Ginkgolide Injection has been subjected to phase Ⅳ clinical trial, spontaneous reporting system(SRS)-based data monitoring, systematic review and Meta-analysis, acute toxicity and long-term toxicity assays, active monitoring, and RCTs, and the evidence of safety was sufficient. The results of active monitoring showed that the incidence of adverse reactions was 0.09%(rare), mainly manifested as flushing, dizziness, rash, nausea, and vomiting. According to the nested case-control study, the adverse reactions of this drug had nothing to do with the product batch, implying that the drug quality was controllable. The adverse reactions mainly resulted from the pharmacodynamic reactions. Because the drug was effective in resisting platelet aggregation, the resulting adverse reactions such as flushing, dizziness, headache, and phlebitis were caused by vasodilation. Skin rash and gastrointestinal symptoms were mainly attributed to the patients' sensitivity to drugs and their own allergic constitution. According to the sufficiency of evidence and the incidence of adverse reactions in the safety research, the safety of Ginkgolide Injection was grade A. The results of Meta-analysis showed that Ginkgolide Injection combined with conventional western medicine was superior to conventional western medicine in improving the clinical effective rate, neurological function score, and activity of daily living score of patients with cerebral infarction. The validity evidence was evaluated according to the PICO principle to be high. According to the GREAD evaluation principle, the quality of such evidence as clinical effective rate, National Institute of Health stroke scale(NIHSS), and Barthel Index(BI) was evaluated, and the results demonstrated that the evidence quality of clinical effective rate and activity of daily living score was medium. The effectiveness of Ginkgolide Injection was grade A. According to the economic report of Ginkgolide Injection, it had short-term and long-term pharmacoeconomic advantages in the treatment of ischemic stroke, and the economic evidence value was good. According to the CASP economic evaluation checklist, the overall quality evaluation results of the economic report are basically clear. To be specific, the economic evidence quality was high. Based on the comprehensive economic evidence quality and economic value, the economy of this drug was grade A. The innovation of this product was evaluated from three aspects: clinical innovation, enterprise service system innovation, and industrial innovation. Ginkgolide Injection could be used 24 h after intravenous thrombolysis for improving patients' neurological function without increasing bleeding, indicating its important clinical innovation. There were many innovations in ensuring drug supply, especially at the grass roots, drug safety, effectiveness, and reasonable price, which has provided reference for establishing enterprise philosophy, managing drug resources, developing process and technology, and determining enterprise management and marketing. Therefore, its innovation was grade A. The drug had no special medication plan in use, exhibiting good suitability for doctors, nurses, and patients. The suitability was grade B. Compared with similar drugs, its price was at a medium level, meaning good affordability, sufficient production capacity, and easy accessibility. Its accessibility was therefore grade B. This drug belonged to Chinese medicinal injection. The large-sample real-world research revealed rich human use experience, so it was grade C for the traditional Chinese medicine characteristic. According to the comprehensive evaluation, the clinical value of Ginkgolide Injection in the treatment of cerebral infarction fell into class A. It is suggested that it can be transformed into the relevant policy results of basic clinical medication management according to the procedure.

[Clinical comprehensive evaluation of Huangkui Capsules in treatment of chronic kidney diseases].

Based on Guidelines for the Management of Clinical Comprehensive Evaluation of Drugs(trial version 2021), this study aims to sort out the clinical evidence of Huangkui Capsules(HC) in the treatment of chronic kidney diseases in aspects of safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine( "6+1" dimensions) from real-world data, secondary literature evaluations, questionnaires, and public data, with the methods in evidence-based medicine, epidemiology, pharmacoeconomics, and health technology. Furthermore, with multi-criteria decision analysis(MCDA) model and CSC v2.0, the clinical value of the medicine is comprehensively assessed. All the above are to highlight the advantages and characteristics of HC and lay a basis for scientific decision-making by the medical management department. The dimensions are graded A, B, C, or D. According to the conclusions from phase Ⅳ clinical trial, spontaneous reporting system(SRS), systematic review and Meta-analysis, acute toxicity and long-term toxicity tests, it mainly results in the adverse reactions of nausea, abdominal distension, vomiting, pruritus, rash, and good prognosis in patients. According to the available research, the safety evidence is sufficient and the risk is controllable, so the safety of this medicine is grade B. According to Meta-analysis, HC in combination with conventional drugs in the treatment of chronic kidney disease is superior to conventional drugs alone in reducing urinary protein, serum creatinine concentration, and blood urea nitrogen. In addition, HC combined angiotensin receptor blocker(ARB) or angiotensin converting enzyme inhibitor(ACEI) is outstanding in improving total clinical effective rate, reducing 24 h urinary protein quantity, urinary albumin excretion rate, serum creatinine concentration, triglyceride, and total cholesterol in the treatment of diabetic nephropathy as compared with ARB or ACEI alone. As for chronic nephritis, the application together with ARB or ACEI can raise the total effective rate, reduce 24 h urinary protein content, serum creatinine concentration, and blood urea nitrogen, and delay the progress of the disease. HC boasts high-quality evidence in treating chronic kidney disease, diabetic nephropathy, and chronic nephritis. It has obvious clinical significance in treating chronic kidney disease and thus its efficacy in this aspect is grade B. It has outstanding clinical significance for diabetic nephropathy and chronic nephritis and corresponding and the effectiveness is grade A. As for the pharmacoeconomic value, HC combined with ARB or ACEI is more economical in the treatment of chronic kidney disease than Bailing Capsules combined with ARB or ACEI, with high-quality evidence, and thus the economy of the formula is grade B. HC is a key solution to the high urinary protein in patients with hypotension and chronic kidney disease. The innovation is evidenced by the methods to ensuring drug supply, community-level supply, drug safety, effectiveness, and reasonable price, as wells as the aspects of enterprise philosophy, equipment management, research and development in process and technology, enterprise management and marketing. Thus, the prescription is grade A in innovation. The suitability, as evidenced in drug administration, technical management, drug storage, information service, and medication, is grade B. The course of the medicine is affordable, and it is accessible in a wide range of areas and hospitals. Thus, the accessibility is grade A. HC was developed from an in-hospital preparation, with application in numerous patients and thus large-scale real-world data. As a result, HC is grade B in terms of characteristics of traditional Chinese medicine. After comprehensive evaluation, the clinical value of HC in treating chronic kidney disease is class B, and that for diabetic nephropathy and chronic nephritis is class A. The result is of great reference value for the basic clinical medication management.

[Clinical comprehensive evaluation of Qilong Capsules in treatment of ischemic stroke with Qi deficiency and blood stasis syndrome].

The present study systematically sorted out the existing research on Qilong Capsules in the treatment of ischemic stroke with Qi deficiency and blood stasis syndrome and comprehensively evaluated its clinical evidence and value to highlight the advantages and characteristics of products and provide references for the decision-making of national pharmaceutical management departments. Based on the evidence-based medicine, epidemiology, clinical medicine, evidence-based pharmacy, and pharmacoeconomics, the qualitative and quantitative evaluation of "6+1" dimensions of safety, effectiveness, economy, innovation, suitability, and accessibility, as well as characteristics of traditional Chinese medicine(TCM) was performed with multi-criteria decision analysis(MCDA) mo-del using the information, such as public data, literature data, pharmaceutical research, and questionnaire survey, and CSC v2.0 was used to calculate the clinical value of Qilong Capsules. The evaluation results were grade A, B, C, or D. Spontaneous reporting system(SRS) monitoring data, literature reports, clinical trials, and other multi-source safety evidence showed that the main adverse reactions of this drug included dry mouth, nausea, and rash, and no severe adverse reactions was found. The evidence was sufficient with small and controllable known risks, and the safety was grade A. Meta-analysis showed that Qilong Capsules combined with conventional western medicine in the treatment of acute ischemic stroke was superior to the control group in improving neurological deficits, clinical total response rate, patients' activities of daily living, and hemorheological indexes. The level of evidence was high with manifest clinical significance, and the effectiveness was grade A. The results of pharmacoeconomic research showed that Qilong Capsules combined with conventional western medicine in the treatment of ischemic stroke were advantageous in cost-effectiveness as compared with conventional western medicine alone, but the incremental effect was not significant. The quality evaluation results of the economic report were comparatively clear, and the economy was grade B. Aiming at major cerebrovascular diseases in the society and giving full play to the advantages of TCM, Qilong Capsules focused on the inheritance of classics and scientific and technological innovation, and innovation was grade B. The results of the questionnaire survey showed that the technical characteristics and drug application could meet the medication needs of clinical doctors and patients, and the suitability was grade B. The price level of this drug was comparatively high and the affordability was good since the treatment cost accounted for a small proportion of disposable income. The drug accessibility was good with a wide range of drug sales, sufficient production capacity, and sustainable medicinal materials resources, and was grade B. This drug was derived from the classic prescription Buyang Huanwu Decoction with rich experience of human application, which could regulate Qi and blood circulation, and the section of TCM characteristics was grade B. Based on the evidence evaluation results of "6+1" dimensions of Qilong Capsules, the comprehensive evaluation of clinical value was class A. It is suggested that it can be transformed into relevant policy results of basic clinical medication management according to procedures.

[Multi-criteria decision analysis in clinical comprehensive evaluation of Chinese patent medicine].

Multi-criteria decision analysis(MCDA), a comprehensive analysis method that can help decision-makers consider multiple criteria systematically, has been used for clinical comprehensive evaluation of drugs, such as chemicals and Chinese patent medicines. The present study summarized the theoretical basis of MCDA and its application in the clinical comprehensive evaluation of drugs and put forward suggestions. MCDA includes problem identification, structuring problem, model building, and using the model to inform and challenge thinking to develop an action plan. The modeling methods include value measurement models, outranking models, and reference-level models. The value measurement model is the most commonly used method in healthcare. The implementation steps of MCDA consist of defining the decision problem, selecting and structuring criteria, measuring performance, scoring alternatives, weighting criteria, calculating aggregate scores, dealing with uncertainty, and reporting and examination of findings. It is urgent to carry out the clinical comprehensive evaluation of Chinese patent medicine, the important part of traditional Chinese medicine(TCM), to promote its scientization, homogenization, and standardization. It is of great significance to carry out the clinical comprehensive evaluation of Chinese patent medicine with MCDA, which should be demand-oriented, coordinated by many parties, and learn from international experience and successful practice to establish the corresponding technical guidelines, specifications, and evaluation tools, so as to provide technical support for Chinese patent medicine supply and policy formulation.

[Clinical comprehensive evaluation of Guanxin Shutong Capsules in treatment of coronary heart disease angina pectoris with heart blood stasis syndrome].

This study aims to comprehensively summarize articles on the treatment of coronary heart disease angina pectoris with heart blood stasis syndrome(CHD-AP-HBSS) by Guanxin Shutong Capsules(GSC), and comprehensively evaluate the evidence and value of the formula in "6+1" dimensions based on multi-criteria decision analysis(MCDA) model and Guidelines for Management of Comprehensive Clinical Evaluation of Drugs(trial version 2021) with quantitative and qualitative methods, which is expected to highlight the clinical characteristics and advantages of the prescription and serve as a reference for medical and health departments. The dimensions are grade A, B, C, or D. In terms of safety, according to the reports from the spontaneous reporting system of National Center for ADR Monitoring, and literature analysis, GSC mainly results in the adverse reactions of mild or moderate nausea, diarrhea, rash, palpitation, and headache, with favorable prognosis in patients. Nevertheless, severe adverse reactions have been reported after marketing. Thus, additional evidence for its safety should be accumulated, and the current safety is grade B. Meta-analysis proves that GSC in combination with conventional treatment is superior to conventional treatment alone in alleviating AP and symptoms indicated by electrocardiogram(ECG). Therefore, the effectiveness of the medicine is grade A. As for the pharmacoeconomic value, based on the assumption that the per capita disposable income in 2020 is the willingness-to-pay threshold, it is more economical for CHD-AP patients to use GSC combined with conventional treatment than conventional treatment alone. However, as the currently available clinical parameters fail to support the difference in indirect cost between the two groups, the accuracy in the cost of intervention plan needs to be further improved. Therefore, the economy of the prescription is grade B. GSC has been awarded 13 national invention patents and 1 utility model patent, and won a lot of national and provincial patent awards, marking the enterprise service awareness and innovativeness. As a result, it is grade A in aspect of innovation. A questionnaire on the suitability of GSC suggests that publicity and promotion influence patients' choice and thus additional efforts should be made in this aspect. The suitability of this formula is grade B. Both rural and urban residents can afford the medicine for the whole course and the price is close to that of similar Chinese patent medicines. In addition, it is accessible regardless of season and place, so accessibility is grade A. As a Mongolian empirical formula destined to treat heart stabbing pain, it has the effects of activating blood and resolving stasis, dredging channels and activating collaterals, and moving Qi to relieve pain, and boasts the empirical evidence of more than 2 000 human cases. With prominent characteristics of traditional Chinese medicine, it is grade B. Based on the MCDA model and CSC v2.0, GSC is comprehensively class A in the treatment of CHD-AP-HBSS. The result can serve as a reference for basic clinical medication management.

[Clinical comprehensive evaluation of Chinese patent medicine based on EVIDEM].

The clinical comprehensive evaluation of Chinese patent medicine is an important direction in the evaluation of traditional Chinese medicine(TCM), which positively promotes the development of TCM industry. The evaluation system of Chinese patent medicine is helpful to comprehensively evaluate the clinical value of different Chinese patent medicine in the same category, different dosage forms, and specifications, from different manufacturers on the basis of evidence and value. The establishment of a scientific and reasonable comprehensive evaluation index system for Chinese patent medicine is an important prerequisite to ensure clinical value. However, there has been neither a recognized systematic review on the clinical comprehensive evaluation of Chinese patent medicine nor a methodological system used for reference. The evidence and value: impact on decision-making(EVIDEM), developed by the international research team, is used to evaluate the comprehensive value of medical interventions. EVIDEM provides a methodological tool for scientific decision-making to evaluate evidence and value for health technologies on the basis of the multi-criteria decision analysis(MCDA) model and health technology assessment(HTA). Based on the ongoing EVIDEM research, the present study put forward that EVIDEM-based clinical comprehensive evaluation of Chinese patent medicine consisted of four aspects, seven modules, and ten steps, which is expected to references and practical experience for the follow-up comprehensive evaluation of Chinese patent medicine in the TCM field.

Impact on decision making framework for medicine purchasing in Chinese public hospital decision-making: determining the value of five dipeptidyl peptidase 4 (DPP-4) inhibitors.

BACKGROUND: Medicine purchasing in Chinese public hospitals is decided by the hospital Pharmacy Management Committee (PMC), that is complex, subjective and requires efficient approaches to ensure transparency and consistency for the factors being considered. This study aimed to use the Evidence and Value: Impact on Decision Making (EVIDEM) framework to assess medicine in these hospitals. In this study anti-diabetic drugs DPP-4 inhibitors, which work by inhibiting the activation of the Dipeptidyl Peptidase 4 (DPP-4) inhibitors, were appraised. METHODS: Following EVIDEM methodology (EVIDEM-10th), we convened an appraisal group and asked each individual to express their perspectives by assigning weights to each criterion. A systematic literature search for information of each criterion of five DPP-4 inhibitors was completed. Then the appraisal group scored for each criterion of the five DPP-4 inhibitors. The estimated value of the five DPP-4 inhibitors was obtained by Multi-Criteria Decision Analysis (MCDA) which combined individual weighting of each criterion with individual scoring for each intervention in each criterion. RESULTS: By assigning weights, the most important criterion was the quality of evidence (4.01±0.52), and that the comparative cost consequences-non-medical cost was the least important criterion (2.87±1.03). Criteria included disease severity, size of the affected population, comparative effectiveness, type of therapeutic/preventive benefit and cost of intervention, all of which were assigned the same weight of 3.58. After MCDA, the overall value orders for each DPP-4 inhibitor included Sitagliptin (0.45), Linagliptin (0.44), Vildagliptin (0.43), Alogliptin (0.42) and Saxagliptin (0.40). CONCLUSIONS: Based on EVIDEM framework and MCDA, we found that overall value of five DPP-4 inhibitors was similar. It is feasible to use the EVIDEM framework and MCDA in purchasing medicine for Chinese public hospitals.

[Clinical comprehensive evaluation of Wenxin Granules in treatment of arrhythmia with deficiency of Qi and Yin].

This study evaluated the safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine of Wenxin Granules in the treatment of arrhythmia(ventricular premature beat and atrial premature beat) with deficiency of Qi and Yin. The multi-criteria decision analysis(MCDA) model was adopted, and the criterion layer and index layer were weighted by experts. CSC v2.0 was used for clinical comprehensive evaluation. This study embodies the clinical value of Wenxin Granules, promotes its safe, effective and rational use, and provides a basis for national medical decision-making. The multi-source evidence shows that the major adverse reaction of Wenxin Granules is gastrointestinal damage. According to the available studies, Wenxin Granules has controllable risk and thus is rated as grade B in terms of safety. The systematic evaluation of effectiveness shows that compared with antiarrhythmic western medicine, Wenxin Granules demonstrates improved clinical efficacy and electrocardiogram efficacy, which is supported by high-quality evidence, and thus the effectiveness of Wenxin Granules is evaluated as grade A. Economic research shows that Wenxin Granules is more economical than antiarrhythmic western medicine, which is supported by sufficient evidence and clear results, and thus the economy of this preparation is rated as grade B. The indications and contraindications of Wenxin Granules are clear and detailed to different types of arrhythmia, which, together with the precise positioning and prominent clinical innovation and industrial innovation, rates it as grade A in terms of innovation. The suitability of drug storage, prescription circulation, dosage form and course of treatment basically meet the clinical medication needs of doctors and patients, and thus the suitability of Wenxin Granules is evaluated as grade B. Because of the few restrictions and the sustainable resources of medicinal materials, the accessibility of Wenxin Granules is evaluated as grade A. The prescription compatibility focuses on the pathogenesis characteristics of deficiency of Qi and Yin, and there are more than 3 000 cases studied. Therefore, the characteristics of traditional Chinese medicine of Wenxin Granules are evaluated as grade B. Based on the evidence from all the above dimensions, Wenxin Granules has the clinical comprehensive value of class A and prominent characteristics of traditional Chinese medicine. It is suggested to include Wenxin Granules into the policy results related to basic clinical medication management according to the procedure.

[Clinical comprehensive evaluation of Diemailing~® Kudiezi Injection in treatment of cerebral infarction].

Clinical comprehensive evaluation was conducted in "6+1" dimensions(safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine) to reflect the advantages and characteristics of Diemai-ling~® Kudiezi Injection in the treatment of cerebral infarction. This study adopted a combination of qualitative and quantitative evaluation methods. Based on the methodologies of evidence-based medicine, epidemiology, clinical medicine, evidence-based pharmacy, pharmacoeconomics, mathematical statistics, and health technology assessment(HTA), experts gave weight to the criterion layer and index layer, and multi-criteria decision analysis(MCDA) model and CSC v2.0 were used for calculations to evaluate the clinical value of Diemailing~® Kudiezi Injection. The existing evidence showed that active monitoring and a number of randomized controlled trials(RCTs) have been carried out after the listing of Diemailing~® Kudiezi Injection. Since the total incidence of adverse reactions is 0.099% and the incidence of adverse drug reactions(ADR) is rare, the safety evaluation is grade A. The evidence value of effectiveness demonstrated that Diemailing~® Kudiezi Injection combined with conventional western medicine improves the total effective rate of neurological deficit score and quality of daily life in the acute stage of cerebral infarction, which is superior to that in the conventional western medicine treatment group, and the level of evidence is high. Therefore, its efficacy is assessed as grade A. According to the results of economic research, when Diemailing~® Kudiezi Injection combined with conventional western medicine treatment is compared with conventional western medicine treatment, the Diemailing~® Kudiezi Injection group has a greater incremental effect, but the cost is affordable. Given the overall quality evaluation results of economic report is clear, it is evaluated as grade B. The innovation is grade A. The drug is favorable for clinical operation by medical staff and can be accepted by patients due to easy usage without special technical and management requirements. Since the drug exhibits good suitability for clinicians, nurses, pharmacists, and patients, it is evaluated as grade B. Considering its moderate price among similar drugs and good affordability and availability, it is evaluated as grade B. Diemailing~® Kudiezi Injection can evidently improve the clinical symptoms and neurological deficits of fire toxin syndrome of acute cerebral infarction, and this medicine belongs to ethnic medicine. Large-sample active monitoring research has been conducted with rich experience in human use. Therefore, the characteristics of traditional Chinese medicine are evaluated as grade A. The comprehensive clinical evaluation of Diemailing~® Kudiezi Injection is class A. We suggest that it can be directly transformed into relevant policy results of basic clinical medication management by procedure.

Assessment and prioritization of the WHO "best buys" and other recommended interventions for the prevention and control of non-communicable diseases in Iran.

BACKGROUND: The WHO's "best buys" and other recommended interventions are a menu of policy options and cost-effective interventions for the prevention and control of major noncommunicable diseases (NCDs). The menu has six objectives, implementing which by member states is expected to promote the achievement of the nine NCD targets by 2025. In line with their context, countries can select from the menu of best buys and other recommended interventions. Iran adopted its national action plan on NCDs, 2015, including global as well as some specific goals and targets. This study had two objectives: analyzing the gaps to reach the national targets on NCDs; and prioritizing the best buys and other recommended interventions based on multi-criteria decision-making (MCDA) method for the context of Iran. METHODS: This is a mixed-methods study. We used qualitative textual evidence (documentary content analysis) and MCDA for prioritization of interventions based on five criteria, including a number of people to be potentially affected by the intervention, cost-effectiveness of the intervention, attributable burden (DALY per 100,000), hospitalization and variations among income levels. Data related to five criteria for each intervention were extracted from national studies and relevant international organizations. The weight of each criterion determines based on the opinions of national experts. RESULTS: Out of 105 actions and interventions recommended by WHO, only 12 of them were not on the national agenda in Iran, while the six missed interventions were related to objective number 4. Only one of the best buys Group's interventions was not targeted (vaccination against human papillomavirus, two doses of 9-13-year-old girls), for which arrangements are being made for the implementation. Encouraging and educating healthy dietary habits and increasing public awareness about the side effects of smoking and exposure to second-hand smoke, e.g., through mass media campaigns, are among the interventions in need of serious prioritization. The priority of interventions was independently calculated in the area of risk factors and clinical preventive interventions. CONCLUSION: Due to limited resources, low and middle-income countries (LMICs) need to identify and prioritize more cost-effective and more equitable interventions to combat the NCD epidemic. Based on our findings, we advocate more investment in the mass and social media campaigns to promote a healthy diet, avoid tobacco use, as well as the inclusion of some effective clinical preventive interventions into the national action plan, along the long pathway to tackle NCDs and ultimately reach sustainable health development in Iran. The use of the MCDA approach assisted us in formulating a simultaneous use of efficiency and equity, and other indices for prioritizing the interventions.

Multi-criteria decision analysis to evaluate foot and mouth disease control strategies with the perspectives of Chief Veterinary Officers in the Asia-Oceania region.

The objective of this study was to evaluate the effectiveness of foot and mouth disease (FMD) control strategies using multi-criteria decision analysis (MCDA). The FMD control strategies were evaluated for epidemiological, economic and social-environmental criteria, accounting for the preferences of Chief Veterinary Officers (CVOs) from the Asia-Oceania region, with the preferences quantified using a questionnaire study. Previously reported simulation results of an FMD epidemic were used to measure the epidemiological effectiveness of FMD control strategies. The simulated FMD epidemic results, such as the number of infected farms, the duration of the epidemic and the outbreak area, were compared for a number of FMD control strategies. Based on previous simulation and economic modelling results and incorporating a literature search to quantify the social and environmental outcomes of an FMD outbreak, MCDA analysis was conducted to evaluate control strategies. According to the overall score in the MCDA results, an FMD control strategy which consisted of a 3-km radius of pre-emptive slaughter, 100 days of movement restriction and vaccinating all FMD-susceptible animals (baseline strategy) was the preferred strategy, with the highest overall score of 62.99. In contrast, the same duration of movement restriction and vaccination strategy with a 0.5-km radius of pre-emptive slaughter was least preferred, with the lowest overall score of 37.05. The evaluation of the FMD control strategies presented here using MCDA has provided scientific evidence for selecting an appropriate baseline FMD control strategy, based on the preferences of CVOs.

Les auteurs présentent les résultats d'une étude qui visait à évaluer l'efficacité d'un certain nombre de stratégies de lutte contre la fièvre aphteuse en recourant à une analyse décisionnelle multicritères (ADMC). Diverses stratégies de lutte contre la fièvre aphteuse ont été évaluées au regard de critères épidémiologiques, économiques et socio-environnementaux, en prenant en compte les préférences exprimées par les chefs des Services vétérinaires de la région Asie-Océanie, recueillies et quantifiées lors d'une étude par questionnaire. L'efficacité des stratégies de lutte contre la fièvre aphteuse au plan épidémiologique a été évaluée à partir des résultats d'une simulation d'épidémie de fièvre aphteuse effectuée au préalable. Les résultats de la simulation, notamment le nombre d'exploitations infectées, la durée de l'épidémie et l'extension de la zone focale, ont été comparés au regard de chacune des stratégies de lutte pouvant être appliquées contre la fièvre aphteuse. Une ADMC a été réalisée pour évaluer les stratégies de lutte en s'appuyant sur les résultats de simulations antérieures et de modélisations économiques, ainsi que sur les données réunies lors d'une recherche documentaire visant à quantifier les répercussions sociales et environnementales d'un foyer de fièvre aphteuse. Il ressort du classement des notes globales attribuées par l'ADMC que la stratégie préférée de lutte contre la fièvre aphteuse (note globale de 62,99) était celle associant l'abattage préventif dans un rayon de 3 km à une restriction des déplacements d'animaux pendant une période de 100 jours et à la vaccination de toutes les espèces sensibles au virus de fièvre aphteuse (stratégie de référence). En revanche, la stratégie associant une restriction des déplacements d'animaux de même durée, la vaccination et l'abattage préventif dans un rayon de 0,5 km recueillait le score le plus bas dans l'ordre de préférence (note globale de 37,05). Les évaluations des stratégies de lutte contre la fièvre aphteuse présentées par les auteurs à partir des résultats de l'ADMC fournissent des éléments scientifiques probants pour choisir une stratégie de référence appropriée afin de lutter contre la fièvre aphteuse, fondée sur les préférences des chefs des Services vétérinaires.

Los autores describen un estudio encaminado a evaluar la eficacia de distintas estrategias de control de la fiebre aftosa, para lo cual se siguió un proceso de análisis de decisiones con empleo de múltiples criterios de tipo epidemiológico, económico y socioambiental que recogían las preferencias de los jefes de los Servicios Veterinarios de la región Asia-Oceanía (preferencias cuantificadas con empleo de un cuestionario). Para medir la eficacia epidemiológica de las estrategias de lucha se utilizaron los resultados previamente descritos de simulaciones de una epidemia de fiebre aftosa. Después se compararon entre sí los resultados (por ejemplo, número de explotaciones infectadas, duración de la epidemia o territorio afectado por el brote) que deparaban distintas estrategias de lucha en una epidemia simulada de fiebre aftosa. A partir de los resultados de simulaciones y modelizaciones económicas anteriores e incorporando una búsqueda bibliográfica para cuantificar los efectos sociales y ambientales de un brote de fiebre aftosa, se procedió a evaluar las estrategias de lucha empleando el análisis de decisiones por criterios múltiples. A tenor de la puntuación global que arrojaban los resultados de este análisis, se determinó que la estrategia preferible de lucha contra la fiebre aftosa era la consistente en sacrificios sanitarios preventivos en un radio de 3 kilómetros, restricciones de desplazamientos durante 100 días y vacunación de todos los animales sensibles a la enfermedad (estrategia básica), pues era la que deparaba la puntuación global más elevada (62,99). La menos eficaz, es decir, la que deparaba la puntuación global más baja (37,05), preveía la aplicación de restricciones de desplazamientos durante el mismo período e idéntica estrategia de vacunación, pero con sacrificios sanitarios preventivos en un radio de solo 0,5 kilómetros. La evaluación de estrategias de lucha mediante un análisis de decisiones por criterios múltiples que aquí se presenta ha aportado sólidos datos científicos con los que seleccionar, partiendo de las preferencias de los jefes de los Servicios Veterinarios, una estrategia básica adecuada para combatir la fiebre aftosa.

Developing quantifiable approaches for delineating suitable options for irrigating fallow areas during dry season-a case study from Eastern India.

Harvesting surface runoff during monsoon season for further utilization in crop production during the post-monsoon season is now becoming an effective solution to mitigate water scarcity problems. In this study, multi-criteria analysis-analytic hierarchy process (MCA-AHP)-based approach was envisaged for rainwater harvesting (RWH) zoning for a case study area, i.e., two districts of Odisha state situated in Eastern India. In spite of having a large irrigation network in the study area, major portion of these two densely populated and agriculture dominated districts remains fallow during dry seasons. Suitable locations for RWH structures such as farm pond, check dam, and percolation tanks were identified through Boolean conditions. RWH potential map was generated using different thematic layers namely land use/land cover (LU/LC), geomorphology, slope, stream density, soil type, and surface runoff. AHP-based MCA technique was used to integrate these thematic layers by assigning weights to the thematic layers and ranks to the individual theme features on 1-9 AHP Saaty's scale, considering their relative importance on RWH potential of the study area. The Natural Resources Conservation Service-Curve Number method was used to derive surface runoff using Climate Hazards Group Infra-Red Precipitation with Station rainfall data, satellite-derived LU/LC and FAO soil maps. In comparison to single cropped areas in 48% of the total study area, only 4% area was under double and triple cropped areas during 2016-2017. Moderate runoff was observed in > 50% of the study area dominated by agricultural landscape. Nearly 40%, 25.11%, and 32.45% of the study area indicated very high, high, and moderate RWH potentials, respectively. Particularly, very high RWH potential is observed in the eastern and central portion of the study area. The use of appropriate RWH structures in less irrigated areas will facilitate multiple cropping and will substitute the use of sub-surface water harvesting practices. In these two districts, 73 check dams and 153 percolation tanks are prescribed along the 2nd- and 3rd-order streams. In coarser textured soil, nearly 306 km2 and 608 km2 areas are identified as moderate and highly suitable zones for percolation tank construction on ground, while in fine soil, around 786 km2 area is identified as suitable for farm pond construction. Majority of the suitable zones for percolation tanks is found in Jajpur district, while suitability for adoption of farm pond and check dam is more in Bhadrak district. It is expected that implementation of the prescribed RWH structures can mitigate the threats of flood, drought, soil erosion, and enhance the soil moisture and cropping intensity significantly. The use of GIS platform with the spatial layers and the methodology adopted can be updated and replicated in larger regions in a shorter time. The spatially explicit maps are offering insights to different themes, providing useful information to the water resource managers, and may improve the decision-making process.

Evaluation of watershed health using Fuzzy-ANP approach considering geo-environmental and topo-hydrological criteria.

Assessment of watershed health and prioritization of sub-watersheds are needed to allocate natural resources and efficiently manage watersheds. Characterization of health and spatial prioritization of sub-watersheds in data scarce regions helps better comprehend real watershed conditions and design and implement management strategies. Previous studies on the assessment of health and prioritization of sub-watersheds in ungauged regions have not considered environmental factors and their inter-relationship. In this regard, fuzzy logic theory can be employed to improve the assessment of watershed health. The present study considered a combination of climate vulnerability (Climate Water Balance), relative erosion rate of surficial rocks, slope weighted K-factor, topographic indices, thirteen morphometric characteristics (linear, areal, and relief aspects), and potential non-point source pollution to assess watershed health, using a new framework which considers the complex linkage between human activities and natural resources. The new framework, focusing on watershed health score (WHS), was employed for the spatial prioritization of 31 sub-watersheds in the Khoy watershed, West Azerbaijan Province, Iran. In this framework, an analytical network process (ANP) and fuzzy theory were used to investigate the inter-relationships between the above mentioned geo-environmental factors and to classify and rank the health of each sub-watershed in four classes. Results demonstrated that only one sub-watershed (C15) fell into the class that was defined as 'a potentially critical zone'. This article provides a new framework and practical recommendations for watershed management agencies with a high level of assurance when there is a lack of reliable hydrometric gauge data.

Setting health sector priorities: a brief overview of Ethiopia's experience.

As a country with significant resource constraints, a fair and efficient health priority setting should be at the cornerstone of Ethiopia's commitment to attain universal health coverage by 2035. This paper draws on the current national strategies including the national essential health service package to explore the criteria and processes used to set the existing national health sector priorities. Additionally, it reviews Ethiopia's experience in comparison with the multi-criteria decision analysis proposed by Baltussen et al. Finally, the paper highlights the importance of strengthening country-led efforts and investing in human capital to shape priority setting in a developing country context.

Resource allocation in decision support frameworks.

BACKGROUND: Cost-benefit and cost-effectiveness analysis place limits on the dimensions of value that the models can incorporate. Cost-benefit analysis requires monetization of all measures of value (including life), a task sometimes deemed either difficult to accomplish or even repugnant. Cost-effectiveness analyses include health care gains in natural units (e.g., quality-adjusted life years or QALYs) rather than purely monetizing them (e.g., in dollars) and offers an efficiency perspective based on the ratio of cost per QALYs or similar health measures. These two methods use different rules for investment. Cost-benefit analysis says to invest whenever benefits exceed costs. Cost-effectiveness analysis says to invest if the intervention has a cost per QALY that meets-or is below-a designated cutoff value. METHODS: Multi-criteria frameworks expand decision analyses by considering value tradeoffs from decision makers, and then producing a synthetic measure that summarizes the performance of investment options. This evaluation is done across all chosen dimensions of value, based on the weights provided by the decision makers, but this flexibility comes at a cost. To date, no approach is widely accepted to suggest how much to invest (how to determine a budget constraint) using multi-attribute models. Moreover, there is no agreed-upon method to measure willingness to pay for incremental multi-attribute value improvements. Our paper proposes a way forward. RESULTS: Based on existing dollar estimates of willingness to pay for QALYs, our concept creates a comparable cutoff for multi-criteria value measures. Our proposed method expands the acceptable cost per QALYs in proportion to how much of the total measure is accounted for by the QALY component. Agreed-upon values for cost per QALY are thus extrapolated to account for extra value created by non-QALY attributes of each intervention. CONCLUSION: Using our proposed methods, the cost per QALY cutoff can serve as a benchmark toward creating a resource allocation cutoff in multi-criteria frameworks.

Land-use evaluation for sustainable construction in a protected area: A case of Sara mountain national park.

The process of making decisions on sustainable development and construction begins in spatial and urban planning when defining the suitability of using land for sustainable construction in a protected area (PA) and its immediate and regional surroundings. The aim of this research is to propose and assess a model for evaluating land-use suitability for sustainable construction in a PA and its surroundings. The methodological approach of Multi-Criteria Decision Analysis was used in the formation of this model and adapted for the research; it was combined with the adapted Analytical hierarchy process and the Delphi process, and supported by a geographical information system (GIS) within the framework of ESRI ArcGIS software - Spatial analyst. The model is applied to the case study of Sara mountain National Park in Kosovo. The result of the model is a "map of integrated assessment of land-use suitability for sustainable construction in a PA for the natural factor".

[Aconitum in treatment of rheumatoid arthritis: benefit-risk assessment].

Rheumatoid arthritis (RA) has the characteristics of long course of disease and difficulty in treatment. The conventional therapy may easily induce adverse drug reactions or events (ADR/ADE) due to the long-time medication. Thus, it should be given special attentions to treatment benefit and medication risk of RA patients. Aconitum, a kind of toxic traditional Chinese herbs, is an important complement therapy for RA, with some controversy in clinical application. Coming straight to the practical problem of combined use of traditional Chinese medicines (TCM) and Western medicines (WM), this study conducted quantitative assessment on the benefits and risks of Aconitum using combined with WM or not, which was carried out by the method of multi-criteria decision analysis model. RevMan 5.2 software was used to separately analyze the results of every index of 21 random clinical trials (RCTs) of Aconitum exclusive use in the treatment of RA, and 49 RCTs of Aconitum combined use with WM. The merged results indicated that as compared with the conventional therapy of WM, no matter the exclusive use or the combined use of Aconitum could improve the efficacy and decrease the incidence of ADR/ADEs. Based on the benefit-risk assessment decision tree of RA treatment, Hiview 3 software and Crystal Ball Monte Carlo simulation were used to calculate the benefit value, risk value and benefit-risk value of Aconitum exclusive use and the combined use of Aconitum with WM. The results showed that the combination therapy had significantly better benefits than Aconitum exclusive using, difference value was 15, (95%CI[9.72, 20.25]), but the risk of combined use was higher difference value=23, （95%CI[15.57, 30.55]）. In comprehensive consideration of the benefit and risk, the total benefit-risk value of using Aconitum alone was 58, while that of the combination therapy was 55, and the probability of the former superior to the latter was 81.07%. The study showed that Aconitum was the important therapy to supply RA treatment. In clinical application, the patient's acceptability of benefit and risk need to be considered; if patients cannot bear the risk, the combination use of Aconitum and WM is not recommended.

Alignment of port policy to the context of the Physical Internet.

The Physical Internet (PI) is a paradigm-changing and technology-driven vision, which is expected to significantly impact the development of the freight transport and logistics (FTL) system of today. However, the development of the FTL system towards the PI creates much uncertainty for its current stakeholders. Ports are one of those stakeholders that are expected to be profoundly affected by these developments. However, research that focuses on port policy, under the uncertain developments towards the PI, is still lacking. By providing port authorities with insights and recommendations on robust policy areas, we address this void in literature. We conduct a scenario analysis in combination with multi-criteria decision analysis (MCDA) to determine the importance of port performance indicators and policy areas in different scenarios. The most significant, uncertain, and orthogonal factors for the development of the PI are technological development and institutional development. We find that for a proper alignment with the PI vision, in three out of four scenarios, ports should prioritize the implementation of digital solutions and standards, as opposed to an infrastructure focused policy.

Value contribution of blood-based neurofilament light chain as a biomarker in multiple sclerosis using multi-criteria decision analysis.

Introduction: Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease that represents a leading cause of non-traumatic disability among young and middle-aged adults. MS is characterized by neurodegeneration caused by axonal injury. Current clinical and radiological markers often lack the sensitivity and specificity required to detect inflammatory activity and neurodegeneration, highlighting the need for better approaches. After neuronal injury, neurofilament light chains (NfL) are released into the cerebrospinal fluid, and eventually into blood. Thus, blood-based NfL could be used as a potential biomarker for inflammatory activity, neurodegeneration, and treatment response in MS. The objective of this study was to determine the value contribution of blood-based NfL as a biomarker in MS in Spain using the Multi-Criteria Decision Analysis (MCDA) methodology. Materials and methods: A literature review was performed, and the results were synthesized in the evidence matrix following the criteria included in the MCDA framework. The study was conducted by a multidisciplinary group of six experts. Participants were trained in MCDA and scored the evidence matrix. Results were analyzed and discussed in a group meeting through reflective MCDA discussion methodology. Results: MS was considered a severe condition as it is associated with significant disability. There are unmet needs in MS as a disease, but also in terms of biomarkers since no blood biomarker is available in clinical practice to determine disease activity, prognostic assessment, and response to treatment. The results of the present study suggest that quantification of blood-based NfL may represent a safe option to determine inflammation, neurodegeneration, and response to treatments in clinical practice, as well as to complement data to improve the sensitivity of the diagnosis. Participants considered that blood-based NfL could result in a lower use of expensive tests such as magnetic resonance imaging scans and could provide cost-savings by avoiding ineffective treatments. Lower indirect costs could also be expected due to a lower impact of disability consequences. Overall, blood-based NfL measurement is supported by high-quality evidence. Conclusion: Based on MCDA methodology and the experience of a multidisciplinary group of six stakeholders, blood-based NfL measurement might represent a high-value-option for the management of MS in Spain.

Forest fire risk zoning based on fuzzy logic and analytical network process.

Forest fires have a significant impact on human life, property safety, and ecological environment. Deve-loping high-quality forest fire risk maps is beneficial for preventing forest fires, guiding resource allocation for firefighting, assisting in fire suppression efforts, and supporting decision-making. With a multi-criteria decision analysis (MCDA) method based on geographic information systems (GIS) and literature review, we assessed the main factors influencing the occurrences of forest fires in Youxi County, Fujian Province. We analyzed the importance of each fire risk factor using the analytic network process (ANP) and assigned weights, and evaluated the sub-standard weights using fuzzy logic assessment. Using ArcGIS aggregation functions, we generated a forest fire risk map and validated it with satellite fire points. The results showed that the areas classified as level 4 or higher fire risk accounted for a considerable proportion in Youxi County, and that the central and northern regions were at higher risk. The overall fire risk situation in the county was severe. The fuzzy ANP model demonstrated a high accuracy of 85.8%. The introduction of this novel MCDA method could effectively improve the accuracy of forest fire risk mapping at a small scale, providing a basis for early fire warning and the planning and allocation of firefighting resources.