Strategy Analysis of Tiered Diagnosis and Treatment Based on Evolutionary Game / 中国医院管理

Objective To explore the tripartite dynamic game strategy involving the interest relationship between government,hospital and patients in the tiered diagnosis and treatment system,which is conducive to improving the theoretical paradigm and policy logic of tiered diagnosis and treatment system.Methods It built a tripartite evolu-tionary game model to analyse their strategy choices and evolutionary paths,and to solve for stable strategies in the three-way evolutionary game.MATLAB R2018b was used to simulate the model,and the evolution paths and the in-fluence of different strategy choices on the promotion of the tiered diagnosis and treatment system were further ana-lyzed.Results Government,hospitals,and patients will influence each other and eventually evolve to the ideal stable state(1,1,1).Increasing government subsidies will accelerate the convergence of the initial participation probability of hospitals and patients to 1,while excessive subsidies will gradually cause the government to deviate from the strategy of encouraging.Conclusions The government should restrict subsidies for high-quality medical resources to a reasonable range,attract hospital experts,and strengthen regulations.It is important for large hospitals and basic medical institutions to realize the free flow and rational distribution of the resources available to doctors.Patients need to change their inherent concept of medical treatment to achieve orderly medical treatment.

Interpretation of pharmacokinetic-based criteria for supporting alternative dosing regimens of programmed cell death receptor-1 (PD-1) or programmed cell death-ligand 1 (PD-L1) blocking antibodies for treatment of patients with cancer guidance for industry / 中国临床药理学与治疗学

In recent years, modeling and simulation technology based on pharmacometrics has received increasing attention in the development of innovation drugs. In August of 2021, FDA issued a guidance named Pharmacokinetic-Based Criteria for Supporting Alternative Dosing Regimens of Programmed Cell Death Receptor-1 (PD-1) or Programmed Cell Death-Ligand 1 (PD-L1) Blocking Antibodies for Treatment of Patients with Cancer Guidance for Industry, claiming the necessity of using population PK-based simulation method for the optimization of dosing regimens, and the corresponding implementation standards. This article first summarized the existing therapeutic regimens of PD-1/PD-L1 blocking antibodies in clinic as well as the main content of the guidance, and then cited some actual examples where population PK-based simulation method did contribute to the approval of the alternative dosing regimens. Besides, some critical considerations for the dosing regimen optimization of PD-1/PD-L1 blocking antibodies were also analyzed. In our view, this guidance would have positive impacts on the development of PD-1/PD-L1 blocking antibodies in the future. We hope that this article may provide some references for the colleagues in China.