Using strategic price negotiations to contain costs and expand access to medicines in China

On 28 November 2019, China’s Nation Healthcare Security Administration and the Ministry of Human Resources and Social Security released: Notice on Including Year 2019 Negotiated Medicines in ‘National Basic Medical Insurance, Work-related Injury Insurance and Childbirth Insurance Medicine List (Category B)’. A key feature of the amendment to the list was a process of centralised strategic price negotiation with pharmaceutical companies underpinned by health technology assessment (HTA) evidence. In addition, medicines for cancers, rare diseases, chronic diseases and children’s diseases were prioritised in the price negotiations. In China, there is a nascent HTA network housed in 48 academic centres across the country and routinely called on to conduct such studies and deliver workshops and seminars. Although it draws on much guidance from HTA institutions in high-income countries (eg, UK and Australia), it differs in its independence from government and its decentralised nature. It is vital for China to continue to build capacity in the field of HTA and institutionalise it into health sector decision making to expand access to healthcare at reasonable cost and thereby achieve universal health coverage

How patients think about social responsibility of public hospitals in China?

Questionnaire for the patients of public hospitals. The questionnaire was designed and implemented in the survey to understand patients’ opinion of the medical services, especially the view of social responsibility of this public hospital. (DOC 32 kb

Examining the level and distribution of catastrophic health expenditure from 2013 to 2018 : a province-level study in China

Since 2018, 96.8% of China’s population has received universal health coverage; however, changes in the general population’s level and distribution of catastrophic health expenditure (CHE) remain unclear. This study aims to quantify the incidence and intensity of CHE by adopting a multistage stratified random sampling procedure that used a threshold of 25% of non-food household expenditures. We use the concentration index to measure the extent of inequality in CHE. Furthermore, logistic regression was applied to identify the socio-demographic and economic determinants of CHE, thereby revealing that the incidence and intensity of CHE increased between 2013 and 2018. A greater concentration of CHE was identified in low-income households. Our results imply that expanding the existing public health insurance benefit packages and introducing universal supplementary private insurance to more population segments is necessary

Learning-driven Physically-aware Large-scale Circuit Gate Sizing

Gate sizing plays an important role in timing optimization after physical design. Existing machine learning-based gate sizing works cannot optimize timing on multiple timing paths simultaneously and neglect the physical constraint on layouts. They cause sub-optimal sizing solutions and low-efficiency issues when compared with commercial gate sizing tools. In this work, we propose a learning-driven physically-aware gate sizing framework to optimize timing performance on large-scale circuits efficiently. In our gradient descent optimization-based work, for obtaining accurate gradients, a multi-modal gate sizing-aware timing model is achieved via learning timing information on multiple timing paths and physical information on multiple-scaled layouts jointly. Then, gradient generation based on the sizing-oriented estimator and adaptive back-propagation are developed to update gate sizes. Our results demonstrate that our work achieves higher timing performance improvements in a faster way compared with the commercial gate sizing tool

Cost-effectiveness of a Multicomponent Intervention for Hypertension Control in Low-Income Settings in Argentina

Importance: Hypertension is highly prevalent in low- and middle-income countries, and it is an important preventable risk factor for cardiovascular diseases (CVDs). Understanding the economic benefits of a hypertension control program is valuable to decision-makers. Objective: To evaluate the long-term cost-effectiveness of a multicomponent hypertension management program compared with usual care among patients with hypertension receiving care in public clinics in Argentina from a health care system perspective. Design, Setting, and Participants: This economic evaluation used a Markov model to estimate the cost-effectiveness of a hypertension management program among adult patients with uncontrolled hypertension in a low-income setting. Patient-level data (743 individuals for multicomponent intervention; 689 for usual care) from the Hypertension Control Program in Argentina trial (HCPIA) were used to estimate treatment effects and the risk of CVD. Three health states were included in each strategy: (1) low risk of CVD, (2) high risk of CVD, and (3) death. The total time horizon was the lifetime, and each cycle lasted 6 months. Main Outcomes and Measures: Model inputs were based on trial data and other published sources. Cost and utilities were discounted at a rate of 5% annually. The incremental cost-effectiveness ratio (ICER) between the multicomponent intervention and usual care was calculated using the difference in costs in 2017 international dollars (INT $) divided by the difference in effectiveness in quality-adjusted life-years (QALYs). One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the uncertainty and robustness of the results. Results: In the original trial, the 743 participants in the intervention group (349 [47.0$3096 discounted costs, while usual care yielded 8.29 discounted QALYs and accrued INT $2473 discounted costs. The ICER for the HCPIA program was INT$4907/QALY gained. The model results remained robust in sensitivity analyses, and the model was most sensitive to parameters of program costs. Conclusions and Relevance: In this study, the HCPIA multicomponent intervention vs usual care was a cost-effective strategy to improve hypertension management and reduce the risk of associated CVD among patients with hypertension who received services at public clinics in Argentina. This intervention program is likely transferable to other settings in Argentina or other lower- and middle-income countries.Fil: Zhang, Yichen. University of Tulane; Estados UnidosFil: Yin, Lei. University of Tulane; Estados UnidosFil: Mills, Katherine. University of Tulane; Estados UnidosFil: Chen, Jing. University of Tulane; Estados UnidosFil: He, Jiang. University of Tulane; Estados UnidosFil: Palacios, Alfredo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Pichón-riviere, Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Augustovski, Federico Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Shi, Lizheng. University of Tulane; Estados Unido

Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province

(1) Background: The management of multiple chronic diseases challenges China’s health system, but current research has neglected how multimorbidity is associated with poor health-related quality of life (HRQOL) and high health service demands by middle-aged and older adults. (2) Methods: A cross-sectional study was conducted in Shandong province, China in 2018 across three age groups: Middle-aged (45 to 59 years), young-old (60 to 74 years), and old-old (75 or above years). The information about socio-economic, health-related behaviors, HRQOL, and health service utilization was collected via face-to-face structured questionnaires. The EQ-5D-3L instrument, comprising a health description system and a visual analog scale (VAS), was used to measure participants’ HRQOL, and χ2 tests and the one-way ANOVA test were used to analyze differences in socio-demographic factors and HRQOL among the different age groups. Logistic regression models estimated the associations between lifestyle factors, health service utilization, and multimorbidity across age groups. (3) Results: There were 17,867 adults aged 45 or above in our sample, with 9259 (51.82%) female and 65.60% living in rural areas. Compared with the middle-aged adults, the young-old and old-old were more likely to be single and to have a lower level of education and income, with the old-old having lower levels than the young-old (P < 0.001). We found that 2465 (13.80%) suffered multimorbidities of whom 75.21% were older persons (aged 60 or above). As age increased, both the mean values of EQ-5D utility and the VAS scale decreased, displaying an inverse trend to the increase in the number of chronic diseases (P < 0.05). Ex-smokers and physical check-ups for middle or young-old respondents and overweight/obesity for all participants (P < 0.05) were positively correlated with multimorbidity. Drinking within the past month for all participants (P < 0.001), and daily tooth-brushing for middle (P < 0.05) and young-old participants (P < 0.001), were negatively associated with multimorbidity. Multimorbidities increased service utilization including outpatient and inpatient visits and taking self-medicine; and the probability of health utilization was the lowest for the old-old multimorbid patients (P < 0.001). (4) Conclusions: The prevalence and decline in HRQOL of multimorbid middle-aged and older-aged people were severe in Shandong province. Old patients also faced limited access to health services. We recommend early prevention and intervention to address the prevalence of middle-aged and old-aged multimorbidity. Further, the government should set-up special treatment channels for multiple chronic disease sufferers, improve medical insurance policies for the older-aged groups, and set-up multiple chronic disease insurance to effectively alleviate the costs of medical utilization caused by economic pressure for outpatients and inpatients with chronic diseases

Induction of Escherichia coli Into a VBNC State by Continuous-Flow UVC and Subsequent Changes in Metabolic Activity at the Single-Cell Level

A viable but non-culturable (VBNC) state of bacteria induced by disinfection in water treatment poses serious health risks because of possible resuscitation of VBNC cells during transportation. In this study, a setup using continuous-flow ultraviolet (UVC) irradiation ranging from 0 to 172.2 mJ cm-2 was designed to simulate real-world disinfection in both drinking water (SDW) and reclaimed water (SRW) treatment plants. A systematic investigation of UVC-induced VBNC bacteria, including occurrence, resuscitation, and time-dependent recovery of metabolic activity during post-incubation, was conducted. Different techniques including two new ones of “single cell culture” and D2O-labeled single-cell Raman spectroscopy were employed to gain comprehensive insights into VBNC cells. Heterotrophic plate counts (HPC) and 5-cyano-2,3-ditoyl tetrazolium chloride flow cytometry (CTC-FCM) assay demonstrated that exposure to continuous-flow UVC can induce E. coli into a VBNC state. Membranes integrity and 16S rRNA transcription level of VBNC bacteria were demonstrated to be unaffected by UVC exposure even at a high dose of 172.2 mJ cm-2. Resuscitation of VBNC bacteria was identified in a more accurate way based on “single cell culture.” Finally, time-dependent evolution of metabolic activity of UVC-treated cells during post-incubation was examined by D2O-labeled Raman spectroscopy at a high-resolution of single-cell level. C-D Raman bands resulting from incorporation of D2O-derived D into bacterial biomass were used as a sensitive and quantitative indicator of bacterial metabolic activity. A lower UVC dose, longer post-incubation time, and higher initial number of bacteria were demonstrated to result in a faster recovery of metabolic activity. Heterogeneous metabolic activity and subpopulation with higher metabolic activity were also revealed by single-cell Raman, even for UVC-treated cells losing cultivability. The comprehensive assessment of VBNC bacteria in UVC-disinfected drinking and reclaimed water points out treatment deficiencies of UVC and the necessity to develop more effective strategies to eliminate VBNC cells

Evolving Availability and Standardization of Patient Attributes for Matching

Variation in availability, format, and standardization of patient attributes across health care organizations impacts patient-matching performance. We report on the changing nature of patient-matching features available from 2010-2020 across diverse care settings. We asked 38 health care provider organizations about their current patient attribute data-collection practices. All sites collected name, date of birth (DOB), address, and phone number. Name, DOB, current address, social security number (SSN), sex, and phone number were most commonly used for cross-provider patient matching. Electronic health record queries for a subset of 20 participating sites revealed that DOB, first name, last name, city, and postal codes were highly available (\u3e90%) across health care organizations and time. SSN declined slightly in the last years of the study period. Birth sex, gender identity, language, country full name, country abbreviation, health insurance number, ethnicity, cell phone number, email address, and weight increased over 50% from 2010 to 2020. Understanding the wide variation in available patient attributes across care settings in the United States can guide selection and standardization efforts for improved patient matching in the United States