The discrete choice experiment (DCE) is a stated preference analysis method used to evaluate the impact of multiple factors on individual choice, which has been explored by scholars around the world for health utility measurement. This method is considered to reduce the cognitive burden of traditional utility measurement methods and has high development potential. By examining empirical studies conducted domestically and internationally that employ DCE for measuring health utility, and drawing on methodological guidelines for constructing DCE models, this paper provides an overview of the methodological background of DCE, the practical process used for measuring health utility, and discusses relevant challenges in its application.
ObjectiveTo evaluate the effect of health economics of census versus high-risk population screening for tuberculosis in Mianyan city, in order to provide references for the selection of suitable tuberculosis screening method in western region of China. MethodsWe included active tuberculosis patients by residents health screening of 21 villages and towns in Mianyan city from June 2013 to March 2013. Relevant data was analyzed by referencing the National Assessment of Tuberculosis Control Program in 2001-2010. Results184047 residents were screened by tuberculosis census and 128 active tuberculosis patients were diagnosed while 61045 residents were screened by high-risk population screening and 76 active tuberculosis patients were diagnosed. The cost-utility ratio and benefit-cost ratio of tuberculosis census were 6174.17 and 3.84, respectively. The cost-utility ratio and benefit-cost ratio of high risk population screening were 3106.16 and 7.62, respectively. ConclusionHigh-risk population screening has higher cost-utility ratio and benefit-cost ratio than tuberculosis census with higher missed diagnosis. Benefits and harms of tuberculosis detection rate and cost should be fully balanced before tuberculosis screening method were chosen in western underdeveloped region of China.
ObjectivesTo systematically review approaches to derive disability weights (DWs) based on EQ-5D instrument.MethodsPubMed, EMbase, Web of Science, CNKI and WanFang Data databases were electronically searched to collect studies on the approaches to derive disability weights based on EQ-5D from inception to June 1st, 2019. Two reviewers independently screened literature, extracted the basic information and evaluated risk of bias of included studies. Then, systematic review on approaches to derive DWs based on EQ-5D instrument was performed.ResultsA total of 18 studies were included, which were published between 2003 and 2018. The included studies involved a variety of diseases, mostly focusing on quality of life and the burden of disease. The approaches to derive DWs based on EQ-5D health instrument were as follows: DWs=health utility scoreNormal or Control−health utility scoreDisease (7 studies), DWs=1−VAS score/100 (6 studies), DWs=1−health utility scoreDisease (3 studies), linear regression model (1 study), and mapping (1 study).ConclusionsAmong all the included studies using EQ-5D-based disability weight measurement methods involves a variety of diseases, with relatively low comparability. More methodological studies are from abroad. Among all the applied approaches, DWs equally to health utility scoreNormal or Control minus health utility scoreDisease is the most commonly used.
ObjectivesTo evaluate the economic efficacy of nab-paclitaxel (NAB-P) combined with gemcitabine (GEM) versus GEM alone in the treatment of metastatic pancreatic cancer in China.MethodsA Markov model simulating the costs and health outcomes was developed to estimate quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). The impact of parameter uncertainty on the model was assessed by deterministic one-way sensitivity analysis.ResultsNAB-P combined with GEM was shown superior efficacy compared to gemcitabine monotherapy, however with higher costs. The ICER between the two groups was 964 780.79￥/QALY.ConclusionsCompared with gemcitabine monotherapy, NAB-P combined with GEM is not cost-effective. The conclusion is confirmed by deterministic one-way sensitivity analysis.
ObjectivesTo systematically review the health utility scores and disability weights of liver cancer and related diseases in China.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were electronically searched to collect the studies of health utility scores and disability weights of liver cancer and related diseases in China from inception to November, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 9 studies were included which covered 10 related diseases, among which chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and liver cancer were the mostly reported. The overall quality was adequate, and EQ-5D was the most common tool in these studies. Results of meta-analysis showed that healthy utility scores of the four common diseases were 0.789 (0.735, 0.843), 0.734 (0.693, 0.776), 0.647 (0.627, 0.666) and 0.636 (0.508, 0.765), respectively. Measures from EQ-5D were 0.825 (0.762, 0.868), 0.761 (0.731, 0.791), 0.643 (0.620, 0.666) and 0.620 (0.473, 0.766), respectively. In addition, the corresponding median (range) utility scores of the four diseases were found to be 0.758 (0.520–0.950), 0.716 (0.570–0.900), 0.538 (0.260–0.662) and 0.541(0.310–0.720). Only one disability weight study was concluded (0.360–0.900 reported for liver cancer).ConclusionIn Chinese population, current evidences on health utility of liver cancer and related diseases are limited, particularly data on disability weights. Utility values from meta-analysis seems more optimistic and centralized than those from descriptive analysis. Different survey tools yield varying outcomes, and attentions should be addressed to their application. The decrease of heath utility scores with the severity of liver disease suggests that early prevention, early diagnosis and treatment can save more years of life with enhanced quality.
ObjectivesThis study aimed to study the economic effect of five kinds of detection systems for nucleic acid, which were based on five kinds of working electrodes: gold electrode, glassy carbon electrode, carbon paste electrode, screen printing electrode, and indium-tin-oxide (ITO) glass electrode.MethodsThe cost of completing a single test was taken as the cost of economic analysis. The Youden index was used to represent the effect of cost-effectiveness analysis (CEA). Meanwhile, the cost-utility analysis (CUA) and incremental cost-effectiveness ratio (ICER) were used for the economic analysis of the corresponding system.ResultsThe cost of five detection systems based on gold electrode, glass carbon electrode, carbon paste electrode, screen printing electrode, and ITO glass electrode was 3.70 yuan/unit, 4.20 yuan/unit, 5.25 yuan/unit, 33.98 yuan/unit and 5.01 yuan/unit, respectively. The Youden indexes of all five systems were 1. The cost effectiveness (C/E) were 3.70, 4.20, 5.25, 33.98, and 5.01, respectively. The cost utility (C/U) were 6.61, 6.89, 9.91, 62.93, and 9.45, respectively. The C'/E and C'/U of the gold electrode detection system were the minimum (2.96 and 5.29). Compared with the system applying the gold electrode, the system using the glassy carbon electrode had ΔC >0 and ∆E0 >0; When carbon paste electrode, screen printing electrode, and ITO glass electrode system were used, ∆C was >0 and ∆E0 was <0.ConclusionsFrom the perspective of CEA and CUA, the system using the gold electrode has the best economic effect. The sensitivity analysis proved the reliability of CEA and CUA results. According to the ICER, gold electrode or glassy carbon electrode can be used in clinical practice with the choice depending on the user.
In computer-aided medical diagnosis, obtaining labeled medical image data is expensive, while there is a high demand for model interpretability. However, most deep learning models currently require a large amount of data and lack interpretability. To address these challenges, this paper proposes a novel data augmentation method for medical image segmentation. The uniqueness and advantages of this method lie in the utilization of gradient-weighted class activation mapping to extract data efficient features, which are then fused with the original image. Subsequently, a new channel weight feature extractor is constructed to learn the weights between different channels. This approach achieves non-destructive data augmentation effects, enhancing the model's performance, data efficiency, and interpretability. Applying the method of this paper to the Hyper-Kvasir dataset, the intersection over union (IoU) and Dice of the U-net were improved, respectively; and on the ISIC-Archive dataset, the IoU and Dice of the DeepLabV3+ were also improved respectively. Furthermore, even when the training data is reduced to 70 %, the proposed method can still achieve performance that is 95 % of that achieved with the entire dataset, indicating its good data efficiency. Moreover, the data-efficient features used in the method have interpretable information built-in, which enhances the interpretability of the model. The method has excellent universality, is plug-and-play, applicable to various segmentation methods, and does not require modification of the network structure, thus it is easy to integrate into existing medical image segmentation method, enhancing the convenience of future research and applications.
Objective To assess the cost-utility study of renal transplantation compared with nemodialysis (HD) and peritoneal dialysis (PD). Methods A prospective study of end-stage renal disease patients was followed up for 3 months after renal replacement therapy. The study population included 196 patients (renal transplant [RT] n=63, hemodialysis [HD] n=82 and continious ambulatory peritoneal dialysis [CAPD] n=51) from 6 hospitals of Sichuan province. Health-related quality of life was assessed by using the WHOQOL-BRIEF questionnaire. Utility scores were obtained so as to conduct CUA (cost-utility analysis). Costs were collected from financial department and by patient interview. Results The utility values were 0.539 9± 0.013 for RT, 0.450 8± 0.014 for HD, 0.512 2±0.099 for CAPD, respectively. The mean direct cost of the first three months of renal transplant was significantly higher than dialysis (RT and CAPD). Over 3 months, the average cost per quality-adjusted life year (QALY) for patients after CAPD was lower than HD and RT. Compared to HD, incremental cost analysis showed that CAPD was more ecnomical than RT. Sensitive analysis showed that CAPD was more effective than RT when ΔQALY varied in the limit of 95% confidence interval. However, the cost-utility of RT vs HD and CAPD vs HD was varied with ΔQALY level. Conclusions Cost-utility analysis showed that CAPD was a more favorable cost-utility ratio when compared to RT at early stage RT vs HD and CAPD vs HD, but which cost-utility ratio is better, we can not draw a certain conclusion.
ObjectiveTo evaluate the efficacy and cost-effectiveness of thymalfasin (Tα1) as an adjuvant therapy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after surgery.MethodsPatients with HBV-related HCC who underwent hepatectomy from February 2007 to December 2015 in West China Hospital of Sichuan University, Chengdu Military General Hospital, or the Third Affiliated Hospital of Sun Yat-sen University were retrospectively collected and divided into the Tα1 group and the observation group. Log-rank test and Kaplan-Meier curve were used to assess the overall survival, recurrence-free survival, and safety of patients. A Markov model was used to calculate the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) of the Tα1 group compared with the observation group. Cost data was from the hospital information system of the three hospitals. Utility scores mainly came from published data. Sensitivity analyses were applied to explore the impact of essential variables.ResultsA total of 208 patients with HCC after liver resection were enrolled, among them 48 received Tα1 treatment (the Tα1 group) and 160 were only followed up (the observation group). There was no significant difference between the two groups in the baseline characteristics. The median overall survival of the Tα1 group and the observation group was 102.0 months [95% confidence interval (CI) (74.8, 129.2) months] and 81.6 months [95%CI (65.7, 97.6) months], respectively, and the difference was statisitically significant (P=0.047); the median recurrence-free survival was 66.7 months [95%CI (17.3, 116.1) months] and 37.4 months [95%CI (28.7, 46.2) months], respectively, and the difference was statistically significant (P=0.044). There were no grade Ⅲ-Ⅳ adverse events and no treatment-related death occurred. The ICER of Tα1 group was ￥108 050.02/QALY, which was less than the willingness to pay (￥177 785.25/QALY).ConclusionsTα1, as an adjuvant therapy for HBV-related HCC patients, can improve the prognosis of the patients, and the cost is within the acceptable level in our country, so this strategy is likely to be a cost-effective option compared with the observation group.