Discussion on the concept of collaboration between clinical pharmacists and physicians in China / 中国药房

OBJECTIVE To make up the research gap of the concept of collaboration between clinical pharmacists and physicians in China， and to provide a theoretical basis for further improving the collaboration. METHODS Literature analysis was used to sort out the existing concepts of collaboration. Combined with the current practice and development trend of the collaboration between clinical pharmacists and physicians in China， the basic elements of the concept were deconstructed and the connotation of each component of the concept was explained in detail. RESULTS & CONCLUSIONS Based on the above theoretical research and practical analysis， the concept of collaboration between clinical pharmacists and physicians in the context of China was defined， that is， clinical pharmacists and physicians adhere to the patient-centered and rational drug use as the core in clinical drug therapy， and make joint decisions on drug management and drug therapy on the basis of communication， respect， trust and sharing， so as to ensure the effectiveness， safety and economy of clinical pharmaceutical care， and improve the coordination and cooperation process of comprehensive disease treatment system.

Current Situation on Clinical Comprehensive Evaluation of Chinese Patent Medicines in China / 中国实验方剂学杂志

ObjectiveTo clarify the development and methodological research status of clinical comprehensive evaluation of Chinese patent medicines in China and identify the problems and difficulties in the evaluation， so as to provide a reference for promoting the subsequent evaluation. MethodFirstly， we analyzed the current situation of clinical comprehensive evaluation in China by reviewing the articles about the process of clinical comprehensive evaluation of drugs and the process of clinical comprehensive evaluation of Chinese patent medicines. Secondly， we comprehensively summarized the formulation background and key points of policies related to clinical comprehensive evaluation of Chinese patent medicines and then show the development status in this field at the national and provincial levels. ResultThe comprehensive clinical evaluation of Chinese patent medicines is still in its infancy in China， and 32 articles of specific evaluation of Chinese patent medicines were included in the study. The dosage forms were mainly capsules （15 articles， 46.88%） and injections （28.13%）. The evaluation mainly involved diseases such as the nervous system （10 articles， 31.25%）， digestive system （5 articles， 15.63%）， and respiratory system （5 articles， 15.63%）. The research results of clinical comprehensive evaluation of Chinese patent medicines were mainly from relevant societies and research institutions. Different research teams have developed technical guidelines or specifications for the evaluation， while the government-leading evaluation guidelines remained to be formulated at the national and provincial levels. In addition， the research articles in this field mainly concentrated on the application of evaluation methods， the building of evaluation index systems， and completed evaluation reports. ConclusionTo reflect the unique value and advantages of Chinese patent medicines， the government needs to build technical guidelines for the clinical comprehensive evaluation of Chinese patent medicines on the basis of the clinical comprehensive evaluation of drugs and create a favorable policy environment for the evaluation work.

Quality evaluation of the research literature on the pharmacoeconomics of traditional Chinese medicines in China from 2018 to 2022 / 中国药房

OBJECTIVE To evaluate the quality of research literature on pharmacoeconomics of traditional Chinese medicine （TCM） in China from 2018 to 2022， to understand the development status and problems of TCM pharmacoeconomic research in China， and to provide a reference for future standardized research on this field. METHODS The systematic search of relevant databases at home and abroad was conducted to obtain the published literature on TCM pharmacoeconomic research in China from January 1， 2018 to November 21， 2022 to summarize the basic information of the literature， the research profile， the method and content of pharmacoeconomic evaluation and to evaluate the quality of the literature by using the CHEERS 2022 checklist； calculate the total literature score by counting the scores of the specific entries of each piece of literature and classifying the quality of the literature as excellent， good， qualified， and unqualified. RESULTS A total of 71 studies were included， involving 60 in Chinese and 11 in English， and 53.52% of the literature was supported by grants； the most studied TCM dosage form was injection （31.03%）； less than half （46.48%） of the literature reported the study angle； short-term economic evaluation was predominantly used （69.01%）； the Chinese studies were dominated by cost-effectiveness analyses （70.00%）， and the English studies were dominated by cost-utility analysis （54.55%）. The average score of literature quality evaluation was 11.02， with two （2.82%） of the literature being of good quality， nine （12.68%） of the literature being of qualified quality， and the majority of the literature （84.51%） being of unqualified quality. The average score of Chinese literature was 9.98， and the average score of English literature was 16.73， with the quality of the latter being significantly better than that of the former. CONCLUSIONS At present， the pharmacoeconomic researches of TCM mainly has problems such as lack of scientific selection of intervention in the control group， nonstandard cost measurement， unreasonable selection of research time limit， quality of evidence for health output indicators to be improved， selection of evaluation methods to be improved， and lack of scientific basis for threshold selection. In order to support the implementation and development of high-level pharmacoeconomics research on TCM， policymakers need to create a favorable policy environment and formulate pharmacoeconomic evaluation guidelines that meet the characteristics of TCM， so as to promote the application and transformation of evaluation results.

Evolution of Japanese self-medication tax system and its enlightenment to China / 中国药房

OBJECTIVE To learn from the self-medication tax system in Japan and improve over-the-counter drug cost sharing mechanism in China. METHODS By searching relevant policies and literature ，the evolution ，specific contents ，current situation and effects of Japanese self-medication tax system were summarized. Recommendations were put forward in the light of the actual situation of over-the-counter drug guarantee in China. RESULTS & CONCLUSIONS Japan has implemented the self-medication tax system since 2017. The Ministry of Health ， Labour and Welfare has made clear provisions on the preconditions for applying for the tax system and the deduction standards of the tax system ，and established a list of drugs to be responsible for the regular inclusion and discharge of the drugs under the tax system. The self- medication tax system has a remarkable effect in promoting the self-health management ，disease prevention and reducing medical expenses of Japanese residents. Our country can learn from the self-medication tax system in Japan and the experience of implementing the special deduction system for major medical conditions in China. To promote rational self-medication ，it is advisable to add a special deduction system for over-the-counter drugs into deductions in personal income tax and formulate the criteria and scope of application ，and establish a special list of over-the-counter drugs，thereby reducing the heavy burden of medical expenses of residents ，and exploring a new way to share the costs of over-the-counter drugs which is applicable to our national conditions.

Discussion on calculation methods of drug market share in budget impact analysis / 中国药房

OBJECTIV E To investigate the calculation method of drug market share in budget impact analysis （BIA）in order to provide new ideas for BIA research. METHODS In view of the situation that some drugs had multiple indications or the indications in the drug instructions were not clear enough and inconsistent with the indications in the reimbursement catalogue ， starting from the concept of “times per person ”，the parameters such as sample hospital and average treatment time per person for each time were introduced to develop a new market share calculation method. At the same time ，the calculation process was demonstrated by taking the treatment drugs for liver cirrhosis as an example. RESULTS & CONCLUSIONS Taking treatment drugs of liver cirrhosis as an example ，the calculation results of market share showed that the results of the two calculation methods were quite different. The market share calculated on the basis of “the number of people ”was mostly higher than that calculated on the basis of “times per person ”. Compared with the traditional calculation method based on “the number of people ”，the calculation method of market share based on “times per person ”could calculate the market share more accurately ，which could solve the problem that the traditional method didn ’t fully consider that most drugs had multiple indications ，the indications of drug instructions were not clear enough and inconsistent with the reimbursement catalogue ，resulting in inaccurate calculation of market share；at the same time ，this method could also be used to try to solve the problem that the total number of patients could not be obtained from epidemiological data based on the average treatment time per person of each time in the sample hospital. This method can be considered when the indications of the target drug are not clear enough or there are multiple indications ，or when the researchers collect clinical ，epidemiological and medical insurance data to estimate the number of target population ，the prediction results of market capacity do not conform to the theoretical logic or actual situation due to the lack of necessary data ，or when the target disease has the characteristics of repeated attacks and short course of disease.

Exploration of influential factors for job satisfaction of pharmacists in secondary and tertiary hospitals of China / 中国药房

OBJECTIVE To provide reference for improving the professional identity of clinical pharmacists and the quality of pharmaceutical care ，and promoting the effects of clinical pharmaceutical intervention. METHODS A questionnaire survey was conducted among clinical pharmacists in secondary and tertiary hospitals in 31 provinces（autonomous regions and municipalities ） in 2019 by stratified semi-random sampling. Through descriptive analysis of survey data ，their job satisfaction status was evaluated ； χ 2 test and Logistic regression analysis were used to analyze the influential factors of job satisfaction ；the robustness test of study results by propensity score matching method and replacement regression model ，and grouping Logistic regression of samples from hospital on different levels. Targeted improvement measures were put forward according to the results of survey . RESULTS There was statistical significance in the difference of job satisfaction among pharmacists of different professional titles （P＜0.05）. Results of Logistic regression showed that whether to participate in standardized training ，whether to obtain communication and support from patients ，whether the pharmaceutical management rules and regulations were sound ，whether to set up economic compensation means such as pharmaceutical service fee ，whether to work overload ，and whether to smoothly perform pharmaceutical care duties were significant influential factors for job satisfaction of clinical pharmacists （P＜0.05）. These results showed good robustness as tested by propensity score matching method and replacement regression model. Heterogeneity analysis results showed that the job satisfaction of clinical pharmacists in tertiary hospitals was more significantly affected by economic compensation ，while clinical pharmacists in secondary hospitals were more concerned about training opportunities and workload conditions （P＜0.05）. CONCLUSIONS The job satisfaction level of Chinese clinical pharmacists remains to be improved. Accordingly ，it is compulsory to continue the promotion of standardized training courses ，consummate the pharmaceutical management system ，and fair remuneration structure in order to improve the job satisfaction of clinical pharmacists and build a high-level clinical pharmacist team.

Enlightenment of Efficiency Frontier Approach on the Methods of Pharmacoeconomic Evaluation in China / 中国药房

OBJECTIVE：To p rovide reference for pharmacoecono mic study in China. METHODS ：The key steps in the operation process of efficiency frontier approach （EFA）were analyzed ；the similarities and differences of EFA with cost-utility analysis（CUA）and cost-effectiveness analysis （CEA）were compared on the basis of case demonstration ；the enlightenment of EFA to pharmacoeconomic evaluation and related decision-making in China were puts forward combined with the practice of China. RESULTS & CONCLUSIONS ：The research framework of EFA could be roughly divided into 5 parts：cost calculation ，benefit definition，model establishment ，incremental analysis and sensitivity analysis. Benefit indicators were the measurement indicators of health output in EFA ，including clinical indicators and comprehensive indicators ，among which comprehensive indicators were more widely used. When constructing the efficiency frontier ，the benefit of the intervention measures was generally taken as the ordinate and the cost of the intervention measures as the abscissa. The cost-benefit coordinate points of each alternative intervention measure in a specific disease field constituted the cost-benefit plane frontier. Researchers conducted economic evaluation by judging the relative position between each alternative intervention measure and the efficiency frontier. Thewillingness to pay threshold was numerically equal to the reciprocal of the ray slope outside the efficiency frontier. Generally speaking ，EFA was similar to CUA and CEA. All of them needed to clarify the cost and health output ，model analysis ， data source and uncertainty analysis ；however，EFA was different from CUA and CEA in intervention measures and control selection，expression form of evaluation results ，willingness to pay threshold ，etc. It is suggested that the payers in China can consider using EFA to calculate the willingness to pay threshold of specific disease areas to ensure the accessibility of some drugs in short supply ；establish a health insurance database of specific diseases to standardize the data quality and form a clear evaluation standard at the same time ，or combine a variety of pharmacoeconomic evaluation methods to enrich the application materials so as to ensure both clinical value and economy of the intervention measure.

Analysis of Output Related Researches on Collaboration Between Clinical Pharmacists and Physicians in China / 中国药房

OBJECTIVE：To summarize the current output research status of collaboration between clinical pharmacists and physicians in China ，and to provide reference for comprehensively understanding the development trend of relevant research and the collaborative value of clinical pharmacists and physicians. METHODS ：Literature analysis was used to sort out the general characteristics，the indexes and results of output related researches ，and investigate the focuses and results of collaboration output indexes from 3 dimensions，such as time ，hospital level and disease type /situation. RESULTS & CONCLUSIONS ：In the aspect of focuses，the number of output related researches in China had decreased in recent years ，among which tertiary hospitals conducted more related researches ；secondary hospitals had few related researches and a limited perspective on evaluating outputs. On the whole，the current researches paid more attention to t he use of antibiotics in bacterial in fection. Most of the research sites were inpatient departments ，and most of the research designs were historical controlled parallel trials and single arm trials. In addition，the three output measurement indexes of safety ， cpulucyxia@163.com effectiveness and economy develop diversely ， scientifically and comprehensively. Ho wever，at the present ，little attention was paid to complex and dif ficult measurement indexes ，such as“cognitive level of patients ”“recurrence rate ”improvement in “quality of life ”“cost-effectiveness/benefit analysis of clinical pharmaceutical care ”. In aspect of research result ，most of the existing researches could prove that the collaboration can significantly improve medication safety ，effectiveness and economy ；the proportion of “significantly improved ”results of most indicators had been stable or had increased stage by stage. However ，there were still a small number of researches that had not carried out statistical test on the results before and after collaboration. In the future ，relevant researchers still need to strengthen the research on outpatient pharmaceutical care ，randomized controlled trials and multi disease and multi situation ，and should scientifically and reasonably select output measurement indicators and pay attention to the application of statistical methods ，so as to further expand the focus of research and comprehensively explore the value of collaboration between clinical pharmacists and physicians.

Calculation Method of Medical Insurance Fund Expenditure of Intervention Scheme for Cross-year Survival Patients Based on Survival Data of Cohort Model / 中国药房

OBJECTIVE：To construct a calculation method which can accurately reflect the medical insurance fund expenditure of intervention scheme for cross-year survival patients ，and to provide reference for the research of medical insurance budget impact analysis（BIA）. METHODS ：Based on survival data of cohort model ，taking the patients diagnosed in each cycle in each year as a cohort，the number of per capita survival cycle of cohort patients in each state in the study year was calculated ，i.e. the average survival time ；on this basis ，the total cost of patients in all cohorts in the study year was calculated according to the number of people in each cohort and the per capita cost each cycle in each state. Taking the intervention scheme of a cancer as an example ， the calculation was carried out by the established algorithm ，and the calculation results were compared with the results of several common algorithms ；at the same time ，the application suggestions were put forward for the expansion of the constructed algorithm in special cases. RESULTS & CONCLUSIONS ：Compared with the several common algorithms ，the calculation process of the constructed algorithm is more in line with the process of medical insurance fund expenditure related to drug intervention scheme in the real world ，and it can flexibly adapt to the calculation needs in a variety of special situations. This algorithm can more accurately calculate the medical insurance fund expenditure of a intervention scheme in a specific year ，and to a certain extent solve the problem of inaccurate prediction of medical insurance fund expenditure due to insufficient consideration of cross-year survival patients or simple and rough calculation process. It can provide a more accurate method choice for the research of medical insurance BIA in China.

New Price Conversion Method of Anti-cancer Drugs under the Buy-and-gift Strategy Based on Survival Data / 中国药房

OBJECTIVE：To provid e a more accurate calculation method for the determination of drug negotiation base price ， pharmacoeconomic calculation and budget impact analysis and calculation in the process of medical insurance access with buy-and-gift strategy. METHODS ：By the model method and literature research ，understanding the existing price conversion methods of the anti-cancer drugs that currently implement the buy-and-gift strategy ，a new method of drug price conversion was explored on the basis of the survival data of patients in different disease states ，and the core idea and calculation process of the algorithm were analyzed by an example. RESULTS ：The new algorithm was combined with the survival data of patients under different disease states. Its calculation process mainly included obtaining the actual duration of medication use per unit cycle and the theoretical amount of medication ，determining the aid model for anti-cancer drugs under buy-and-gift strategy ，converting the actual price. The simulation calculation was carried out under the one-step drug donation mode ，periodic drug donation mode and preferential installment drug donation mode. CONCLUSIONS ：The conversion method of anti-cancer drug price under buy-and-gift strategy based on survival data makes up for the shortcoming that the existing calculation methods are difficult to reflect the actual price of anti-cancer drugs ，and provides a new calculation method for calculating the actual reference price of anti-cancer drugs for medical insurance access.

Discussion on Budget Impact Analysis Based on the Increment of Users / 中国药房

OBJECTIVE：To pr ovide reference for the development of pharmacoeconomic budget impact analysis and related decision-making. METHODS ：Taking the incremental number of people using new intervention measures as the starting point ，a new algorithm was designed ，and the advantages and potential application scope of the new algorithm were compared with those of common algorithms. RESULTS & CONCLUSIONS ：The new algorithm directly used the sales data from the real world to calculate the number of users and their increment of each intervention scheme. Compared with common algorithms ，the new algorithm did not consider the unchanged part of the number of users of each intervention scheme ，but focused on the changing part of the number of users ，avoided the estimation of the number of the target population and the users of some intervention schemes ，and could solve the problem of unreasonable or inaccurate prediction of the target population and market share by common algorithms to a certain extent ；moreover，it could be flexibly adjusted to adapt to different market conditions and medical insurance access conditions. However ，due to the strong subjectivity of key parameters （such as preemption rate ）or inaccurate data sources ，the calculation results of the new algorithm are still uncertain.

Literature Analysis of Application of the Pediatric Quality of Life Inventory / 中国药房

OBJECTIVE：To p rovide reference for th e development and application of the pediatric quality of life inventory （PedsQL）. METHODS ：Using“PedsQL”as keyword ，retrieved from foreign databases as Medline ，ScienceDirect，Cochrane Library，ISI Web of Science ，SpringerLink and Embase ，Chinese databases as CNKI ，Wanfang database ，VIP and SinoMed ， research literatures about the application of PedsQL at home and abroad were collected during Jan. 1999-Dec. 2019. RESULTS & CONCLUSIONS：A total of 2 117 literatures were included ，including 1 836 foreign literatures and 281 domestic literatures （242 in Chinese，39 in English ）. The number of published literatures was increasing year by year. PedsQL had a wide range of applications and divided into 4 main areas according to purpose ，including analysis of health influencing factors （63 items），assessment of diseases burden （1 720 items），evaluation of intervention measures （285 items），theoretical study of other scales （49 items）. The application of PedsQL in clinical trials had made fast progress ，but there were still some problems in China ，such as improper selection and use of the scale ，less application in pediatric clinical practice ，and insufficient evaluation of intervention measures. It is suggested that future researcher should consider both universality and disease specificity ，self-administered and parental surrogate version of PedsQL when selecting tools ，and apply PedsQL to perform routine clinical health-related quality of life screening to optimize the utilization efficiency of pediatric health 一 resources，and construct PedsQL mapping function based on Chinese population preference to realize the economic evaluation of drug intervention measures.

Research on the Feasibility and Supervision Strategy of Using Intermediate Products to Prepare Children ’s Small- sized Preparations in Medical Institutions in China / 中国药房

OBJECTIVE：To provide reference for improving th e availability of clinical medication for children in China. METHODS：Based on the current laws and regulations of China ，referring to the relevant excellent experience and mode of foreign countries，the definition and regulatory attributes of intermediate products and final small-sized children ’s preparations were analyzed，and the feasible regulatory pathway of children ’s medicine preparedby intermediate products entering medical institutions were discussed. RESULTS & CONCLUSIONS ：According to the clinical dosage and characteristics of medication ，small-sized preparations for children in medical institutions could be divided into preparations for children ’s medical institutions and personalized preparations for children. From the analysis of foreign experience ，legal policies and technical conditions ，it was feasible for medical institutions to use intermediate products to formulate children ’s small-sized preparations ，but they also faced certain difficulties as the difficulty to supervise ，unclear quality standards ，vague subject and scope of use ，etc. In terms of supervision，it wa s suggested that intermediate products should be taken as the main quality management object when children ’s small-sized preparations prepared by intermediate products entered medical institutions. Meanwhile ，quality risk management should be paid attention to it. In the management of small-sized preparations for children in medical institutions ，it is necessary to formulate the preparation specifications of small-sized preparations for children in medical institutions ，prepare guidelines for the use of excipients and improve the quality inspection standards of preparations ；in the aspect of preparation supervision ，the small-sized preparations for children in medical institutions with large clinical demand are strictly controlled ，and those with high personalized degree in medical institutions are under loose supervision ；in terms of registration and approval ，technical evaluation should be carried out at the same time as the implementation of registration/filing management ；in terms of price setting ，appropriate profit margins should be formulated according to the innovation degree ，clinical demand ，children’s family affordability and public opinion feedback of price of children ’s small-sized preparations in medical institutions. Indiviclualized preparations are forma- lated ased on the price of preparations inmedical institutions ， with reference to the differential price comparice rules. Mean- while，pharmaceutical service fees are charged to compensate pharmacists’time and labor ；in terms of medical insurancepayment，the drugs are classified and managed according to whether they are included in the medical insurance list ，so as to ensure the same drug availability for children and adults .

Pharmacoeconomic Evaluation of Sodium Tanshinone ⅡA Sulfonate in the Treatment of Angina Pectoris of Co- ronary Heart Disease / 中国药房

OBJECTIVE：To e valuate the clinical efficacy and economics of Sodium tanshinone Ⅱ A sulfonate injection combined with conventional medication versus conventional medication in the treatment of angina pectoris of coronary heart disease. METHODS ：Using“Sodium tanshinone Ⅱ A sulfonate”“Danshentong”“angina pectoris ”as Chinese key words and “Sodium tanshinone Ⅱ A sulfonate”“Danshentong”“Angina pectoris ”as English keywords ，the studies were retrieved from Wanfang database ，CNKI，CBM，Cochrane Library ，Medline，Embase，ISI Web of Science and BIOSIS Previews during the inception to Apr. 2019. After literature screening and data extraction ，the included real world cohort studies were evaluated with bias risk tool of Cochrane systematic evaluator manual 5.2.0. Meta-analysis was conducted by using Stata 15.0 software，and publication bias of results was analyzed . The cost-effectiveness analysis was used for pharmacoeconomic evaluate ，and single factor sensitivity analysis and probability sensitivity analysis were carried out for the results of pharmacoeconomic evaluation. RESULTS ： A total of 29 literatures were included ，involving 31 studies and 2 857 patients. Meta-analysis showed that clinical effective rate [RR ＝1.23，95％CI（1.18，1.28），P＜0.001]，ECG effective rate [RR ＝1.29，95％CI（1.20，1.39），P＜0.001] and angina pectoris effective rate [RR ＝1.22，95％CI（1.15，1.29），P＜0.001] of trial group were significantly higher than those of control group. The adverse reactions of the two groups were mild. The above results were likely to be biased in publication. Cost-effectiveness analysis showed that ICER was 72.02 of 2 groups. The sensitivity analysis showed that above results were stable. CONCLUSIONS ： For patients with angina pectoris of coronary heart disease ，therapeutic efficacy of Sodium tanshinone ⅡA sulfonate injection combined with conventional medication is better that of conventional medication ，and the cost is also slightly higher. When the willingness to pay is higher than 7 202 yuan，the combination scheme has the advantage of cost-effectiveness.

Quality Appraisal of Pediatric Pharmacoeconomic Research Literatures in China from 2009 to 2018 / 中国药房

OBJECTIVE：To provide reference for improving the level of pediatric pharmacoeconomic research in China. METHODS： Using “Pediatric”“Pharmacoeconomics”“Cost-effectiveness”“Cost-utility”“Cost-benefit”“Minimum cost ” as keywords，pediatric pharmacoeconomic research literatures published during Jan. 2009 to Dec. 2018 were retrieved from CNKI ， Wanfang，VIP and CBMdisc. The Pediatric Quality Appraisal Questionnaire was used to evaluate the quality of the literatures. The problems of these literatures were analyzed to put forward the suggestions. RESULTS & CONCLUSIONS ：Totally 140 literatures were eventually included. The number of published literatures was increasing and the distrubtion of journals was scattered. The first auther was mainly from medical institutions. Included literatures mainly involved respiratory disease and drug treatment ，etc. Among them ，15 literatures indicated the research angle ；research time limit of 109 literatures was equal to or less than one year ；6 literatures carried out sensitivity analysis. Most of them adopted cost-effectiveness analysis and decision analysis model. The results of quality evaluation showed that the economic evaluation ，camparators，target population ，outcomes，analysis and conclusions domains had high scores （0.62 to 1.00 score），time horizon and discounting domains had middle scroes （0.49 and 0.53 score respectively），but perspective ，costs and resource use ，incremental analysis ，sensitivity analysis and conflict of intrest domains had low scores （0.10 to 0.31 score）. The main problems of pediatric pharmacoeconomic literatures in China focused on selection of research perspective ，measurement of costs and clinical outcomes ，and selection of analytical methods. The quality of pediatric pharmacoeconomic evaluations in China need to improve. It is suggested to supplement the content of pediatric pharmacoeconomics in China Guidelines for Pharmacoeconomic Evaluations . It is also suggested for pediatric pharmacoeconomic evaluations to clarify the perspective ，standardize the cost identification ，reasonably select health outcome indicators and correctly apply analysis method in order to improve the quality.

Pharmacoeconomic Evaluation of Rosiglitazone Sodium and Metformin in the Treatment of Type 2 Diabetes Mell i- tus / 中国药房

OBJECTIVE：To provid e reference for safe ，effective and economical medication scheme for type 2 diabetes mellitus（T2DM）. METHODS ：Markov model was established for rosiglitazone sodium and metformin in the treatment of T 2DM. According to the development characteristics of T 2DM，the development of T 2DM was simulated by the dynamic changes of event-free，complications and deaths of T 2DM. The long-term cost and effect of rosiglitazone sodium and metformin in the treatment of T 2DM were obtained by regression analysis and queue simulation analysis. QALYs was used as a health output indicator，and t he superiority and inferiority of different schemes were judged by the ICER value ，and in our study ICER value was WTP（12 000 yuan per year ）of diabetics. The sensitivity of cost ，utility and discount was analyzed to check the stability of the analysis results. RESULTS ：Cost-effectiveness analysis of Markov model showed that the cumulative cost and health effectiveness of rosiglitazone sodium therapy were 25 164.00 yuan and 7.50 QALYs，while 17 773.36 yuan and 7.36 QALYs for metformin ； ICER of rosiglitazone sodium relative to metformin was 50 983.08 yuan/QALYs，which was greater than WTP ，so the metformin treatment was an advantageous scheme. Sensitivity analysis showed that health utility value and discount rate of diabetes mellitus greatly influenced analysis results of the model ，but advantage plan had not changed within the sensiitivity analysis range seted in this study. CONCLUSIONS ：For T 2DM，metformin is more cost-effective than rosiglitazone sodium.

Discussion on Within-cycle Correction of Markov Model in Pharmacoeconomic Evaluation / 中国药房

OBJECTIVE：To pro vide reference for reducing the error of Markov model in pharmacoeconomic evaluation. METHODS：Referring to foreign literatures ，the errors in Markov model were explained. The commonly used correction methods were introduced ：half-cycle correction ，trapezoidal rule ，Simpson’s 1/3 rule，Simpson’s 3/8 method and life table method and their implementation in Excel and TreeAge software. RESULTS & CONCLUSIONS ：The error of Markov model was caused by the discretization process and could be corrected by the within-cycle correction methods. Half-cycle correction ，was the most commonly used correction method and could be corrected by adding half of the results of the first cycle and subtracting half of the results of the last cycle. By trapezoidal rule ，the interval was represented by the mean value of the first end point value of the interval ，and the area of right trapezoid was the cummulative result. Simpson’s 1/3 rule and Simpson ’s 3/8 rule took another point in the interval on the basis of trapezoidal correction and the continuous curve where these three points were represented the whole curve. By life table method ，the person-years of survival was the product of the group distance of the age group and the mean value of the number of survivors of the age group and the next age group ，and the total person-years of survival was the sum of person-years of survival of each age group. In Excel ，the fuction was set according to the method principle to realize the correction ；in Tree Age software，the function expression of Init Rwd ，Inor Rwd and Final Rwd were set to realize the correction. When using Markov model for pharmacoeconomic evaluation ，if the selection of periodic correction method is based on the ease of modeling and the universality of application ，the trapezoid rule method is recommended ；based on the accuracy of results ，it is suggested to use Simpson’s 1/3 method，so as to improve the accuracy of Markov model.

Current Situation and Deficiencies of Economics Evaluation for Pediatric Therapeutic Regime in China / 中国药房

OBJECTIVE： To provide reference for improving the economics evaluation studies for pediatric therapeutic regime in China. METHODS： By searching the literature published in domestic journals from Jan. 1st， 2009 to Dec. 31th， 2018， the current situation of the measurement of cost （including time range， cost calculation） and health output （including outcome indicators and measurement scales） were explored. Combined with relevant literature at home and abroad， the deficiencies of economics evaluation for pediatric therapeutic regime in terms of cost measurement and health outcome measurement were summarized in China， and the corresponding research prospects were put forward. RESULTS & CONCLUSIONS： Totally 140 related literatures were finally included. In terms of cost measurement， short-term （≤1 year） research accounted for the highest proportion （109 literatures， 77.86％）. Cost calculation mostly had no clear research perspective （125 literatures， 89.29％）. It did not involve the cost of child productivity. The main shortcomings were unclear time range， incomplete cost calculation （lack of productivity， hidden cost） and so on. In terms of health output measurement， 103 （73.57％） used cost-effectiveness analysis， 23 （16.43％） used cost-benefit analysis， and only 4 （2.86％） related to the use of measurement scales. Main shortcomings included that the difficulty in obtaining outcome indicators， lack of child health output measurement scale and so on. Based on this， it is suggested that related demands should be complied before conducting economics evaluation research， we should clarify the research angle， formulate unified and standardized cost measurement methods， rationally select technical analysis methods and health outflow indicators according to research purposes and disease characteristics， and develop appropriate measurement scales according to the physiological and psychological characteristics of children in different age groups. At the same time， future studies can report on the status of family members when reporting on children's related conditions， and conduct an economic evaluation of therapeutic regimen in the family unit.

Survey and Consideration on the Current Situation of Service Ability and Pharmaceutical Service Construction of Primary Healthcare Institutions in Jiangsu Province / 中国药房

OBJECTIVE： To explore the current situation of service ability and pharmaceutical service construction of primary healthcare institutions in Jiangsu province. METHODS： Questionnaire survey was conducted among primary healthcare institutions of 13 prefecture level cities in Jiangsu province， involving basic service information （such as serving mode， medical departments）， resource allocation （such as hardware， human resource） and pharmaceutical care construction （such as the leaders of the drug procurement， pharmaceutical departments allocation， mediation safety management）. The current situation of service ability and pharmaceutical service construction was evaluated in primary healthcare institutions of Jiangsu province. RESULTS： A total of 579 primary healthcare institutions in Jiangsu province were investigated and 579 questionnaires were collected （some items in the questionnaires were not answered）. Outpatient service （543/555，97.8％） was the main mode of service provided by primary healthcare institutions in Jiangsu province， followed by emergency call （321/555，57.8％） and hospitalization （292/555，52.6％）； the frequently established department in primary healthcare institutions was the medical department for all （452/568，79.6％）， preventive healthcare department（401/568，70.6％）， internal medicine department （365/568，64.3％）； 16.1％ （93/533）of the primary healthcare institutions had no beds； 36.4％ （211/579）of the institutions had no chief physician； 20.9％ （111/532）of the primary healthcare institutions medicine procurement were managed by pharmacists； 42.5％ （212/499）of the institutions had no pharmaceutical departments； physicians were responsible for patients' medication safety in 43.9％ （236/537） of the primary healthcare institutions and pharmacists were responsible for patients' medication safety in only 16.2％ （87/537）of the institutions. CONCLUSIONS： Primary healthcare institutions in Jiangsu province have made some achievements in service capability building. Human resources， equipment and facilities， pharmaceutical care construction and other aspects still need to be improved.

Analysis and Consideration of Pediatric Medication in National Essential Medicine List （2018 Edition） / 中国药房

OBJECTIVE： To provide reference for improving pediatric medication of National Essential Medicine List （NEML） and establishing Chinese essential medicine list for children. METHODS： NEML （2018 edition） were compared with WHO Essential Medicines List for Children （WHO EMLc） in respects of target population， special symbols， categories and varieties， dosage form and specification. The related suggestions were put forward. RESULTS & CONCLUSIONS： WHO EMLc is specifically used for children under 12 years old， and defines specific age and body mass. NEML is applicable to all age groups （including children）. WHO EMLc includes 4 types of special symbols， i.e. “□” （the drug with the best efficacy and safety in the same kind of drugs， which matches the selection principle of NEML）， “a” （limited age or body weight， not found in NEML）， “*” （special dosage， specially emphasized indications and age not recommended for use， listing substitute drugs， not found in NEML）， “[c]” （placed next to a drug or a specification indicating that they are only used by children； and placed next to a supplementary list indicating that they need expert diagnosis， monitoring facilities， medical care for children， similar to the “Δ” in NEML）. NEML in China includes chemical drugs and biological products， Chinese patent medicines and TCM decoction pieces. Among them， there are 26 categories and 417 types of chemical drugs and biological products. Compared with WHO EMLc， NEML has no blood products and special drugs for newborns. As far as antimicrobial agents are concerned， WHO EMLc has strict limits and classifications. However， due to the lack of guidelines for special antimicrobial agents for children in China， the application of NEML antimicrobial agents in pediatrics is still difficult to define and classify. The number of coincident varieties in the 2 lists was 149， and the coincidence rate was 35.2％. In terms of drug dosage， WHO EMLc’s dosage form are more abundant and flexible， such as scored tablet， compressible fragments， intramuscular injections， and oral solutions suitable for children which are not included in NEML. In terms of drug specifications， 2 lists basically consider about the special needs of children taking small dosage and to some extent take into account the complementarity of dosage forms and specifications. The author suggests that the relevant departments in China should draw lessons from the mature experience of WHO EMLc， add new labeling symbols in NEML， expand drug dosage forms， implement classified management of antimicrobial drugs， and timely launch Chinese Essential Medicines List for Children so as to lay a solid foundation for further improving the accessibility and safety of essential medicines for children in China.