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1.
Artigo em Inglês | MEDLINE | ID: mdl-31527787

RESUMO

As of August 2017, China had encountered five seasonal epidemics of H7N9 avian influenza. To prevent people from contracting H7N9 avian influenza, most cities closed live poultry markets (LPMs) to cut off the source of H7N9 virus. The objective of this study is to assess the impact of LPMs closure on reducing zoonotic transmission of avian influenza A (H7N9) virus and to make specific recommendations on the duration of closing the LPMs. Results show that the closure of LPMs can effectively control the spread of H7N9 avian influenza and reduce the incidence of human infection with H7N9. If cases of H7N9 avian influenza continue to occur, LPMs should close for at least 3-4 weeks in susceptible areas to control the spread of infection.

2.
BMC Public Health ; 19(1): 967, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324240

RESUMO

BACKGROUND: The eastern and western regions of China are different in many ways such as socioeconomic characteristics and health resource distribution. This study aimed to explore the outpatient health-seeking behavior and compare the influencing factors of residents in Zhejiang and Qinghai Province, which represent the situation in eastern and western China. Thus, this research will provide evidence for health resource allocation and health reform. METHODS: A cross-sectional study was conducted on a sample selected from 1600 households in Zhejiang and Qinghai province between 2016 to 2017 by the multi-stage stratified cluster random sampling method. Among the 4231 residents aged 15 years or older in the sample, 566 who reported ill-health were selected for data analysis. Two-week outpatient visits and choice of health institutions were used to measure residents' outpatient health-seeking behavior and assessed using Chi-square tests. The binary logistic regression was adopted to demonstrate the association between explanatory variables and outpatient visits. RESULTS: The study revealed that out of the people who reported ill-health, 58 individuals (50.97%) in Zhejiang and 106 (41.41%) in Qinghai went to health institutions to seek medical help (p < 0.05). The difference of residents' choice of health institution between Zhejiang and Qinghai was not statistically significant (p > 0.05). Among these respondents, Self-report severity was the common and significant factor related to their outpatient visits and it had a greater impact on outpatient visits in Zhejiang (4.18, CI 2.23-7.83, p < 0.05). Other factors such as chronic disease, knowledge of medicine and doctors and distance to the nearest health institution were significant influencing factors in Zhejiang, while in Qinghai it was occupation. CONCLUSIONS: The outpatient health-seeking behavior and its influencing factors among residents in Zhejiang and Qinghai province were different. The findings suggest the importance of having discrepant health policies in the two provinces. It's necessary to improve health literacy of residents in both provinces, strengthen the accessibility of health services in remote areas of Zhejiang and pay more attention to people with low socioeconomic status in Qinghai.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , China/epidemiologia , Doença Crônica/epidemiologia , Estudos Transversais , Características da Família , Feminino , Reforma dos Serviços de Saúde/estatística & dados numéricos , Alfabetização em Saúde , Humanos , Renda , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ocupações/estatística & dados numéricos
3.
Geriatr Gerontol Int ; 19(9): 938-944, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31342634

RESUMO

AIM: This study aimed to investigate older adults' choices of first-contact care when they felt ill in Zhejiang and Qinghai province, and the related potential pathways. METHODS: Data were from a cross-sectional survey in Zhejiang and Qinghai. We firstly compared older adults' choices of first-contact care in two provinces. Then, we applied structural equation modeling to explore pathways from socioeconomic status, accessibility and health status to older adults' choices of first-contact care. RESULTS: The proportion of older adults who selected primary healthcare institutions as first-contact care in Qinghai was higher than that in Zhejiang. Socioeconomic status played an important role in the Zhejiang model through direct and indirect pathways. In the Qinghai model, accessibility to primary healthcare institutions was the leading cause for choosing preferred first-contact care. CONCLUSIONS: A better understanding of complex pathways from factors to older adults' choices of first-contact care was essential, which might inform priorities for further maximizing the utilization of primary care. Geriatr Gerontol Int 2019; 19: 938-944.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31013704

RESUMO

Social determinants are closely related to health and play a significant role in shaping the quality of life of a population. This study aimed to explore the differences in HRQoL (health-related quality of life) scores of residents in the eastern province of Zhejiang and the western province of Qinghai and probe factors affecting the HRQoL among the two populations. A sample of 4210 residents from a cross-sectional survey was included in the analysis. The EQ-5D-3L instrument was used to measure the HRQoL of residents. A Chi-square test and a t-test were used to examine the differences between different variables and analysis of variance (ANOVA) with interaction effects was used to analyze factors associated with the HRQoL between the two provinces. Residents' EQ-5D index score (EQ VAS score) was 0.963 (82.71) and 0.962 (81.51), respectively, in Zhejiang and Qinghai. Generally, residents in Qinghai displayed significantly worse HRQoL scores than those in Zhejiang. The differences between the two regions lay on mobility, pain/discomfort, and anxiety/depressions. In both regions, an increased education level and being employed were most strongly associated with a positive HRQoL; increased age and presence of chronic diseases were most strongly associated with a negative HRQoL. When formulating health policies, the significant health disparities between western and eastern provinces must be given greater consideration. The health of vulnerable groups should be particularly focused on to improve the observed health disparities.


Assuntos
Nível de Saúde , Qualidade de Vida , Determinantes Sociais da Saúde , Adulto , China/epidemiologia , Doença Crônica , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor , Inquéritos e Questionários
5.
Arch Gerontol Geriatr ; 82: 81-87, 2019 May - Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30716682

RESUMO

OBJECTIVE: This study aims to identify distinctive cognitive trajectories jointly with mortality probabilities and to explore factors related to the particular trajectories of cognitive ageing in China. METHOD: 6842 individuals aged 80 years and above from 7 waves of the Chinese Longitudinal Healthy Longevity Survey were assessed with the Mini-Mental State Examination for up to 16 years. A group-based trajectory model was used to jointly estimate cognitive ageing and mortality trajectories; and to explore the factors related to membership of the trajectory groups. RESULTS: A four-group model best fit the data. For all groups, the cognitive function declined with age according to different rates. Group 4, 3, 2, and 1 showed slow (prevalence 52.8%), moderate (31.1%), progressive (12.6%) and rapid (3.5%) cognitive decline, respectively. Mortality probability trajectories followed a hierarchy in consistence with cognitive trajectories approximately. Females, illiteracy, and those born in rural areas were less likely to belong to the most favorable trajectory group. CONCLUSIONS: The heterogeneity of cognitive ageing was identified among Chinese oldest-old. Childhood socioeconomic status, especially education, was associated with the rate of cognitive decline.

6.
BMC Geriatr ; 19(1): 16, 2019 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-30658578

RESUMO

BACKGROUND: To estimate the potential gains in health-adjusted life expectancy (HALE) after hypothetical elimination of four non-communicable diseases (NCDs) among Chinese elderly from 1990 to 2016, including cardiovascular diseases (CVD), cancers, chronic respiratory diseases (CRD) and diabetes mellitus (DM). METHODS: Based on data from Global Burden of Disease 2016, we generated life table by gender using Sullivan method to calculate HALE. Disease-deleted method was used to calculate cause-elimination HALE, after hypothetical elimination of specific diseases. RESULTS: From 1990 to 2016, HALE increased for all age groups. After hypothetic eliminating the four main NCDs, potential gain in HALE by CVD, DM and cancers increased while by CRD decreased from 1990 to 2016 for both genders. Among four main NCDs, potential gain in HALE after eliminating CVD was largest and increased most for both genders. Although elimination of DM led to the smallest gain in HALE, the increasing speed of gain in HALE by DM was faster than that by CVD and cancers from 1990 to 2016. CONCLUSIONS: This study highlights the potential gains in HALE of NCDs among Chinese elderly from 1990 to 2016. HALE of Chinese elderly could further increase from the reduction of NCDs. Control measures and targeted prevention should be carried out.

7.
J Med Econ ; 22(4): 336-343, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30663458

RESUMO

BACKGROUND AND OBJECTIVE: Dapagliflozin is the first SGLT2 inhibitor available in China, where the disease burden of diabetes and its complications is very heavy. Because a new diabetes treatment strategy for diabetes should consider its cost-effectiveness, compared with an existing treatment, this study aimed to examine the cost-effectiveness between dapagliflozin and metformin treatment in China. METHODS: The Cardiff Diabetes Model (CDM) was used to estimate cost effectiveness and macro- and micro-vascular outcomes of dapagliflozin vs metformin. The CDM effectiveness inputs were derived from indirect comparative efficacy data from meta-analysis of 71 studies comparing monotherapy and add-on therapy of dapagliflozin vs metformin: dapagliflozin or metformin monotherapy, add-on therapy with other oral hypoglycemic agents, and add-on therapy with insulin. Direct medication costs and medical costs on treating diabetes were calculated based on published and local sources. A discount rate of 3% was applied to both costs and health effects. Univariate and probabilistic sensitivity analyses (PSA) were performed to assess uncertainties. RESULTS: The total healthcare costs accumulated over the lifetime on dapagliflozin treatment arm was 8,626 Chinese yuan higher than the metformin treatment arm for an individual patient, and the quality adjusted life years (QALYs) gained with dapagliflozin treatment was 0.8 more than metformin treatment. Therefore, an incremental cost-effectiveness ratio was 10,729 yuan per QALY gained for dapagliflozin treatment arm vs metformin treatment arm. The cost-effectiveness results were robust to various sensitivity analyses. CONCLUSION: Dapagliflozin treatment was more cost-effective compared with metformin treatment for Chinese type 2 diabetes patients. However, the findings of favorable cost-effectiveness results for dapagliflozin are largely driven by the effects of favorable weight profile on clinical, utility, and costs in the Cardiff model.


Assuntos
Compostos Benzidrílicos/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glucosídeos/uso terapêutico , Hipoglicemiantes/economia , Hipoglicemiantes/uso terapêutico , Metformina/economia , Metformina/uso terapêutico , Administração Oral , Fatores Etários , Idade de Início , Compostos Benzidrílicos/administração & dosagem , Compostos Benzidrílicos/economia , Peso Corporal , China , Colesterol/sangue , Análise Custo-Benefício , Complicações do Diabetes/economia , Complicações do Diabetes/epidemiologia , Quimioterapia Combinada , Feminino , Glucosídeos/administração & dosagem , Glucosídeos/economia , Hemoglobina A Glicada , Gastos em Saúde , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Metformina/administração & dosagem , Metformina/efeitos adversos , Pessoa de Meia-Idade , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Inibidores do Transportador 2 de Sódio-Glicose/economia , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
8.
Gene ; 689: 51-55, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30552983

RESUMO

AIMS: To diagnose a Chinese family with inherited ectopia lentis in a genetic method and analyze the genotype-phenotype correlation. METHODS: The phenotype of each family member was identified by detailed clinical examination. We used targeted next generation sequencing (NGS) to identify mutations in FBN1 in an efficient and accurate way. The mutation in FBN1 was confirmed in all affected family members by Sanger sequencing. RESULTS: A novel mutation c.385T>C (p.C129R) in FBN1 was identified in the proband by targeted NGS. The mutation was segregated in all affected family members and contributes to specific disease phenotypes. The same mutation was not found in other unaffected relatives and a 100 normal random population by Sanger sequencing. CONCLUSIONS: Our study reports a novel mutation in FBN1 in a Chinese family and to diagnose this family as Marfan syndrome, we also expand the genotype-phenotype correlation of this disease.


Assuntos
Análise Mutacional de DNA/métodos , Ectopia do Cristalino/genética , Fibrilina-1/genética , Sequenciamento de Nucleotídeos em Larga Escala , Síndrome de Marfan/genética , Mutação de Sentido Incorreto , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Criança , China , Ectopia do Cristalino/complicações , Família , Feminino , Estudos de Associação Genética , Humanos , Masculino , Síndrome de Marfan/complicações , Pessoa de Meia-Idade , Linhagem
9.
BMC Health Serv Res ; 18(1): 844, 2018 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-30413169

RESUMO

BACKGROUND: China has made great achievements in health insurance coverage and healthcare financing; however, the rate of catastrophic health expenditure (CHE) was 13.0% in China in 2008, which is higher than that in some other countries. There remain some differences in life-style, national customs, medical conditions, and health consciousness in different provinces in China. This study aimed to compare the rates of households with CHE, further to explore the different performance of factors influencing CHE between Zhejiang and Qinghai province, China. METHODS: Data were derived from the household surveys conducted in Zhejiang and Qinghai. Sampling on multi-stage stratified cluster random method was adopted. Household with CHE occurs when the out-of-pocket payment for health care equals to or exceeds 40% of a household's income. Univariate and multivariate logistic regression analyses were used to identify the performance of factors of CHE. RESULTS: A total of 1598 households were included in this study, including 995 in Zhejiang and 603 in Qinghai. The average rates of CHE in Zhejiang and Qinghai were 9.6 and 30.5%, respectively. We found that economic status of households and households headed by an employed person are the protective factors for CHE; and number of members with chronic diseases and number of inpatients in household are the risk factors for CHE in the two provinces. Besides, poor/low-insured households in Zhejiang; and households having outpatients and households headed by a minority person in Qinghai are more likely to experience the risk of CHE. CONCLUSIONS: This study highlights the importance of improving economic development, expanding employment, and adjusting policies to make greater efforts to protect chronic diseases patients, outpatients, and inpatients, further to reduce the risk of CHE. The Chinese government should pay more attention to the actual conditions in different provinces, further to make policy decisions according to the local knowledge.

10.
J Int Med Res ; 46(7): 2810-2827, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29781357

RESUMO

Objectives This study was performed to describe the health status of Chinese oldest-old individuals aged ≥80 years from 1998 to 2014 and explore differences in their health status based on demographic characteristics and socioeconomic status. Methods Data were obtained from the seven waves of the Chinese Longitudinal Healthy Longevity Survey. The Mini Mental State Examination, Katz Index of Independence in Activities of Daily Living, and chair stand test were used to examine cognitive and physical function. Logistic regression was used to evaluate the changes in health outcomes. Results Regression results showed increasing cognitive impairment trends and decreasing disability trends, indicating that the oldest-old individuals had worse body function in more recent years. Older people and women had a weaker health status. Rural elders had better physical performance but worse cognitive function. Participants with an education had better overall functioning. Individuals with severe disability had the shortest survival time among the study population. Conclusions From 1998 to 2014, the health status of oldest-old individuals was relatively stable in China. These findings indicate the need for specific and continuing attention to the oldest-old population to improve their health condition.

11.
Int J Equity Health ; 17(1): 36, 2018 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-29566758

RESUMO

BACKGROUND: Equity is the core of primary care. The issue of equity in health has become urgent, and China has attached increasing attention to it. With rapid economic development and great changes in medical insurance policy, the pattern of equity in health has changed tremendously. The reform of healthcare in Zhejiang Province is at the forefront in China, and studies on Zhejiang Province are of great significance to the entire country. This paper aimed to measure health equity from the perspectives of health needs and health-seeking behavior and to provide suggestions for the next policy formulations, with respect to timeliness. METHODS: The investigator's household survey was conducted in August 2016. A sample of 1000 households, which included2807 individuals in Zhejiang, China, was obtained with the multi-stage stratified cluster sampling method. Descriptive analysis and chi-square tests were adopted in the analysis. The value of the concentration index was used to measure the equity. RESULTS: This study found that the poor have more urgent health needs and poorer health situations than the rich. Through studies on health-seeking behavior, the utilization of outpatient services was almost equitable, while the utilization of hospitalization showed a pro-rich inequity (i.e., the rich use more services). Individuals with employer-based medical insurance used more outpatient services than those with rural and urban medical insurance. More people in the poorer income groups did not use inpatient services due to financial difficulties. CONCLUSIONS: Absolute medical prices and medical insurance may explain the equity in the utilization of outpatient services and the inequity in the utilization of hospitalization. In view of the pro-rich inequity of hospitalization, more financial protection should be provided for the poor.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Renda/estatística & dados numéricos , Adulto , Assistência Ambulatorial/estatística & dados numéricos , China , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , População Urbana/estatística & dados numéricos
12.
Value Health Reg Issues ; 12: 123-129, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28648310

RESUMO

OBJECTIVE: To estimate and compare the health-related quality of life (HRQOL) between Chinese farmers and workers and study the relationships between the sociodemographic factors and HRQOL of the 2 populations. METHODS: We conducted 2 cross-sectional surveys in Zhejiang Province in China by using multistage cluster sampling; we applied the EuroQOL 5-dimensions 3-level (EQ-5D-3L) self-report questionnaire to assess the HRQOL of farmers and workers through face-to-face interviews. The χ2 test, 1-way analysis of variance (ANOVA), and multiple linear regression models were used to compare the HRQOL between farmers and workers and identify the factors that influence HRQOL. RESULTS: We included 3675 farmers and 2836 workers in the analysis. The HRQOL differed between the 2 populations. The most prevalent problems reported were Pain/Discomfort and Anxiety/Depression; workers reported significantly more Pain/Discomfort and Anxiety/Depression compared with farmers (P < 0.001). The mean EQ-5D index scores were 0.987 for farmers and 0.959 for workers (P < 0.001), and the EQ-VAS scores were 83.59 for farmers and 81.11 for workers (P < 0.001), indicating that farmers had better HRQOL compared with workers. Sex, age, marital status, education level, and personal monthly income were reported to influence the HRQOL of farmers, whereas marital status and education level were reported to influence that of workers. CONCLUSIONS: The HRQOL of farmers was better than that of workers. To improve the HRQOL, it is important to pay more attention to mental health, especially in workers.


Assuntos
Fazendeiros/estatística & dados numéricos , Nível de Saúde , Qualidade de Vida/psicologia , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , China , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Autorrelato , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
13.
Diabetes Obes Metab ; 19(12): 1688-1697, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28452095

RESUMO

AIMS: To estimate the long-term cost-effectiveness of exenatide twice daily vs insulin glargine once daily as add-on therapy to oral antidiabetic agents (OADs) for Chinese patients with type 2 diabetes (T2DM). METHODS: The Cardiff Diabetes Model was used to simulate disease progression and estimate the long-term effects of exenatide twice daily vs insulin glargine once daily. Patient profiles and treatment effects required for the model were obtained from literature reviews (English and Chinese databases) and from a meta-analysis of 8 randomized controlled trials comparing exenatide twice daily with insulin glargine once daily add-on to OADs for T2DM in China. Medical expenditure data were collected from 639 patients with T2DM (aged ≥18 years) with and without complications incurred between January 1, 2014 and December 31, 2015 from claims databases in Shandong, China. Costs (2014 Chinese Yuan [¥]) and benefits were estimated, from the payers' perspective, over 40 years at a discount rate of 3%. A series of sensitivity analyses were performed. RESULTS: Patients on exenatide twice daily + OAD had a lower predicted incidence of most cardiovascular and hypoglycaemic events and lower total costs compared with those on insulin glargine once daily + OAD. A greater number of quality-adjusted life years (QALYs; 1.94) at a cost saving of ¥117 706 gained was associated with exenatide twice daily vs insulin glargine once daily. (i.e. cost saving of ¥60 764/QALY) per patient. CONCLUSIONS: In Chinese patients with T2DM inadequately controlled by OADs, exenatide twice daily is a cost-effective add-on therapy alternative to insulin glargine once daily, and may address the problem of an excess of medical needs resulting from weight gain and hypoglycaemia in T2DM treatment.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Incretinas/uso terapêutico , Insulina Glargina/uso terapêutico , Modelos Econômicos , Peptídeos/uso terapêutico , Peçonhas/uso terapêutico , Administração Oral , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , China/epidemiologia , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/economia , Angiopatias Diabéticas/economia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/prevenção & controle , Angiopatias Diabéticas/terapia , Cardiomiopatias Diabéticas/economia , Cardiomiopatias Diabéticas/epidemiologia , Cardiomiopatias Diabéticas/prevenção & controle , Cardiomiopatias Diabéticas/terapia , Custos Diretos de Serviços , Esquema de Medicação , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/economia , Exenatida , Humanos , Hiperglicemia/economia , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Hiperglicemia/terapia , Hipoglicemia/economia , Hipoglicemia/epidemiologia , Hipoglicemia/terapia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/economia , Incidência , Incretinas/administração & dosagem , Incretinas/efeitos adversos , Incretinas/economia , Injeções Subcutâneas , Insulina Glargina/administração & dosagem , Insulina Glargina/efeitos adversos , Insulina Glargina/economia , Pessoa de Meia-Idade , Peptídeos/administração & dosagem , Peptídeos/efeitos adversos , Peptídeos/economia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Peçonhas/administração & dosagem , Peçonhas/efeitos adversos
14.
PLoS One ; 11(11): e0167190, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27875596

RESUMO

OBJECTIVE: This study assessed the long-term cost-effectiveness of saxagliptin+metformin (SAXA+MET) versus acarbose+metformin (ACAR+MET) in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled on MET alone. METHODS: Systematic literature reviews were performed to identify studies directly comparing SAXA+MET versus ACAR+MET, and to obtain diabetes-related events costs which were modified by hospital surveys. A Cardiff Diabetes Model was used to estimate the long-term economic and health treatment consequences in patients with T2DM. Costs (2014 Chinese yuan) were calculated from the payer's perspective and estimated over a patient's lifetime. RESULTS: SAXA+MET predicted lower incidences of most cardiovascular events, hypoglycemia events and fatal events, and decreased total costs compared with ACAR+MET. For an individual patient, the quality-adjusted life-years (QALYs) gained with SAXA+MET was 0.48 more than ACAR+MET at a cost saving of ¥18,736, which resulted in a cost saving of ¥38,640 per QALY gained for SAXA+MET versus ACAR+MET. Results were robust across various univariate and probabilistic sensitivity analyses. CONCLUSION: SAXA+MET is a cost-effective treatment alternative compared with ACAR+MET for patients with T2DM in China, with a little QALYs gain and lower costs. SAXA is an effective, well-tolerated drug with a low incidence of adverse events and ease of administration; it is anticipated to be an effective second-line therapy for T2DM treatment.


Assuntos
Adamantano/análogos & derivados , Diabetes Mellitus Tipo 2/economia , Dipeptídeos/economia , Metformina/economia , Modelos Econômicos , Qualidade de Vida , Adamantano/efeitos adversos , Adamantano/economia , Adamantano/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/mortalidade , China , Custos e Análise de Custo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/mortalidade , Dipeptídeos/efeitos adversos , Dipeptídeos/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/economia , Hipoglicemia/mortalidade , Masculino , Metformina/efeitos adversos , Metformina/uso terapêutico
15.
PLoS One ; 11(11): e0165629, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27806087

RESUMO

OBJECTIVE: To estimate the long-term cost-effectiveness of dapagliflozin versus acarbose as monotherapy in treatment-naïve patients with type 2 diabetes mellitus (T2DM) in China. METHODS: The Cardiff Diabetes Model, an economic model designed to evaluate the cost-effectiveness of comparator therapies in diabetes was used to simulate disease progression and estimate the long-term effect of treatments on patients. Systematic literature reviews, hospital surveys, meta-analysis and indirect treatment comparison were conducted to obtain model-required patient profiles, clinical data and costs. Health insurance costs (2015¥) were estimated over 40 years from a healthcare payer perspective. Univariate and probabilistic sensitivity analyses were performed. RESULTS: The model predicted that dapagliflozin had lower incidences of cardiovascular events, hypoglycemia and mortality events, was associated with a mean incremental benefit of 0.25 quality-adjusted life-years (QALYs) and with a lower cost of ¥8,439 compared with acarbose. This resulted in a cost saving of ¥33,786 per QALY gained with dapagliflozin. Sensitivity analyses determined that the results are robust. CONCLUSION: Dapagliflozin is dominant compared with acarbose as monotherapy for Chinese T2DM patients, with a little QALY gain and lower costs. Dapagliflozin offers a well-tolerated and cost-effective alternative medication for treatment-naive patients in China, and may have a direct impact in reducing the disease burden of T2DM.


Assuntos
Acarbose/economia , Compostos Benzidrílicos/economia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glucosídeos/economia , Hipoglicemiantes/economia , Acarbose/administração & dosagem , Compostos Benzidrílicos/administração & dosagem , China , Análise Custo-Benefício , Feminino , Glucosídeos/administração & dosagem , Humanos , Hipoglicemiantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento
16.
Invest Ophthalmol Vis Sci ; 57(8): 3935-43, 2016 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-27472081

RESUMO

PURPOSE: Previous studies have shown that vitreous stimulates degradation of the tumor suppressor protein p53 and that knockdown of phosphatidylinositol 5-phosphate 4-kinases (PI5P4Kα and -ß) abrogates proliferation of p53-deficient cells. The purpose of this study was to determine whether vitreous stimulated expression of PI5P4Kα and -ß and whether suppression of PI5P4Kα and -ß would inhibit vitreous-induced cellular responses and experimental proliferative vitreoretinopathy (PVR). METHODS: PI5P4Kα and -ß encoded by PIP4K2A and 2B, respectively, in human ARPE-19 cells were knocked down by stably expressing short hairpin (sh)RNA directed at human PIP4K2A and -2B. In addition, we rescued expression of PI5P4Kα and -ß by re-expressing mouse PIP4K2A and -2B in the PI5P4Kα and -ß knocked-down ARPE-19 cells. Expression of PI5P4Kα and -ß was determined by Western blot and immunofluorescence. The following cellular responses were monitored: cell proliferation, survival, migration, and contraction. Moreover, the cell potential of inducing PVR was examined in a rabbit model of PVR effected by intravitreal cell injection. RESULTS: We found that vitreous enhanced expression of PI5P4Kα and -ß in RPE cells and that knocking down PI5P4Kα and -ß abrogated vitreous-stimulated cell proliferation, survival, migration, and contraction. Re-expression of mouse PIP4Kα and -ß in the human PI5P4Kα and -ß knocked-down cells recovered the loss of vitreous-induced cell contraction. Importantly, suppression of PI5P4Kα and -ß abrogated the pathogenesis of PVR induced by intravitreal cell injection in rabbits. Moreover, we revealed that expression of PI5P4Kα and -ß was abundant in epiretinal membranes from PVR grade C patients. CONCLUSIONS: The findings from this study indicate that PI5P4Kα and -ß could be novel therapeutic targets for the treatment of PVR.


Assuntos
Fosfotransferases (Aceptor do Grupo Álcool)/metabolismo , Vitreorretinopatia Proliferativa/prevenção & controle , Animais , Movimento Celular/fisiologia , Proliferação de Células/fisiologia , Sobrevivência Celular/fisiologia , Células Cultivadas , Técnicas de Silenciamento de Genes , Humanos , Camundongos , Camundongos Knockout , Fosfotransferases (Aceptor do Grupo Álcool)/antagonistas & inibidores , Fosfotransferases (Aceptor do Grupo Álcool)/deficiência , Coelhos , Descolamento Retiniano/prevenção & controle , Vitreorretinopatia Proliferativa/etiologia , Corpo Vítreo/metabolismo
17.
Pharmacoeconomics ; 34(8): 751-70, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26951248

RESUMO

BACKGROUND: The increasing survival of patients with pulmonary arterial hypertension (PAH) has shifted attention towards the disease burden that PAH imposes on patients and healthcare systems. Most studies emphasize epidemiology and medications, while large observational studies reporting on the health-related quality of life (HRQOL) of patients with PAH are lacking. OBJECTIVE: Our objective was to study the HRQOL of patients with PAH and to summarize the factors that influence it. METHODS: We conducted systematic literature searches in English (PubMed, Web of Knowledge, ScienceDirect and OVID) and Chinese (China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP and SinoMed) databases to identify studies published from 2000 to 2015 assessing the HRQOL of patients with PAH. Search results were independently reviewed and extracted by two reviewers. RESULTS: Of 3392 records identified in the initial search, 20 eligible papers (19 English, 1 Chinese) were finally included. Studies used a range of instruments; the generic 36-item Short Form Survey (SF-36) was the most widely used, and the disease-specific Cambridge Pulmonary Hypertension Outcome Survey (CAMPHOR) was the second mostly widely used. Mean HRQOL scores assessed via the SF-36 (physical component summary [PCS] 25.4-80.1; mental component summary [MCS] 33.2-76.0) and CAMPHOR (symptom scores 3.1-17; total HRQOL 2.8-12.6; activity scores 3.8-18.1) varied across studies, reporting decreased HRQOL in patients. Mental health (depression, anxiety, stress), physical health (exercise capacity, symptoms) and medical therapies were reported to affect HRQOL. CONCLUSION: We found that PAH places a substantial burden on patients, particularly in terms of HRQOL; however, the paucity of large observational studies in this area requires the attention of researchers, especially in China.


Assuntos
Efeitos Psicossociais da Doença , Hipertensão Pulmonar/psicologia , Qualidade de Vida , China , Assistência à Saúde/economia , Nível de Saúde , Humanos , Saúde Mental
18.
Pharmacoeconomics ; 34(6): 533-50, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26714685

RESUMO

BACKGROUND: Pulmonary arterial hypertension (PAH), as a life-threatening disease with no efficient cure, may impose a tremendous economic burden on patients and healthcare systems. However, most existing studies have mainly emphasised epidemiology and medications, while large observational studies reporting on the economic burden are currently lacking. OBJECTIVES: To review and evaluate evidence on the costs of PAH and the cost effectiveness of PAH treatments, and to summarise the corresponding cost drivers. METHODS: Systematic literature searches were conducted in English-language databases (PubMed, Web of Science, ScienceDirect) and Chinese-language databases (China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP) to identify studies (published from 2000 to 2014) assessing the costs of PAH or the cost effectiveness of PAH treatments. The search results were independently reviewed and extracted by two reviewers. Costs were converted into 2014 US dollars. RESULTS: Of 1959 citations identified in the initial search, 19 papers were finally included in this analysis: eight on the economic burden of PAH and 11 on economic evaluation of PAH treatments. The economic burden on patients with PAH was rather large, with direct healthcare costs per patient per month varying from $2476 to $11,875, but none of the studies reported indirect costs. Sildenafil was universally reported to be a cost-effective treatment, with lower costs and better efficacy than other medications. Medical costs were reported to be the key cost drivers. CONCLUSION: The economic burden of patients with PAH is substantial, while the paucity of comprehensive country-specific evidence in this area and the lack of reports on indirect costs of PAH warrant researchers' concern, especially in China.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Hipertensão Pulmonar/economia , Análise Custo-Benefício , Humanos , Hipertensão Pulmonar/terapia , Inibidores da Fosfodiesterase 5/economia , Inibidores da Fosfodiesterase 5/uso terapêutico , Citrato de Sildenafila/economia , Citrato de Sildenafila/uso terapêutico
19.
J Med Econ ; 18(11): 974-89, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26134916

RESUMO

OBJECTIVE: To estimate cost-effectiveness of exenatide twice daily (BID) vs insulin glargine once daily (QD) as add-on therapy in Chinese type 2 diabetes patients not well controlled by oral anti-diabetic (OAD) agents. METHODS: The Cardiff model was populated with data synthesized from three head-to-head randomized clinical trials of up to 30 weeks in China comparing exenatide BID vs insulin glargine as add-on therapies to oral therapies in the Chinese population. The Cardiff model generated outputs including macrovascular and microvascular complications, diabetes-specific mortality, costs, and quality-adjusted life years (QALYs). Cost and QALYs were estimated with a time horizon of 40 years at a discount rate of 3% from a societal perspective. RESULTS: Compared with insulin glargine plus OAD treatments, patients on exenatide BID plus OAD gained 1.88 QALYs, at an incremental cost saving of Chinese Renminbi (RMB) 114,593 (i.e., cost saving of RMB 61078/QALY). The cost-effectiveness results were robust to various sensitivity analyses including probabilistic sensitivity analysis. The variables with the most impact on incremental cost-effectiveness ratio included HbA1c level at baseline, health utilities decrement, and BMI at baseline. CONCLUSIONS: Compared with insulin glargine QD, exenatide BID as add-on therapy to OAD is a cost-effective treatment in Chinese patients inadequately controlled by OAD treatments.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/economia , Hipoglicemiantes/economia , Insulina Glargina/economia , Peptídeos/economia , Peçonhas/economia , Adulto , Idoso , China , Comorbidade , Análise Custo-Benefício , Esquema de Medicação , Quimioterapia Combinada , Exenatida , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Insulina Glargina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Peptídeos/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Peçonhas/uso terapêutico
20.
PLoS One ; 10(5): e0126704, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25961824

RESUMO

BACKGROUND: Metformin is the first-line oral hypoglycemic agent for type 2 diabetes mellitus recommended by international guidelines. However, little information exists comparing it with acarbose which is also commonly used in China. This study expanded knowledge by combining direct and indirect evidence to ascertain the glucose lowering effects of both drugs. METHODS: PubMed (1980- December 2013) and China National Knowledge Infrastructure databases (1994-January 2014) were systematically searched for eligible randomized controlled trials from Chinese and English literatures. Meta-analysis was conducted to estimate the glucose lowering effects of metformin vs. acarbose, or either of them vs. common comparators (placebo or sulphonylureas), using random- and fixed-effect models. Bucher method with indirect treatment comparison calculator was applied to convert the summary estimates from the meta-analyses into weighted-mean-difference (WMD) and 95% confidence intervals (CIs) to represent the comparative efficacy between metformin and acarbose. RESULTS: A total of 75 studies were included in the analysis. In direct comparison (8 trials), metformin reduced glycosylated hemoglobin (HbA1c) by 0.06% more than acarbose, with no significant difference (WMD,-0.06%; 95% CI, -0.32% to 0.20%). In indirect comparisons (67 trials), by using placebo and sulphonylureas as common comparators, metformin achieved significant HbA1c reduction than acarbose, by -0.38% (WMD,-0.38%, 95% CI, -0.736% to -0.024%) and -0.34% (WMD, -0.34%, 95% CI, -0.651% to -0.029%) respectively. CONCLUSION: The glucose lowering effects of metformin monotherapy and acarbose monotherapy are the same by direct comparison, while metformin is a little better by indirect comparison. This implies that the effect of metformin is at least as good as acarbose's.


Assuntos
Acarbose/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Masculino
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