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This study aims to investigate the age, period, and cohort effects on trends in activities of daily living (ADL) disability among Chinese older adults; and to explore these three temporal effects on gender and residence disparities in disability. We utilized multiple cross-sectional waves of the Chinese Longitudinal Healthy Longevity Survey data (1998-2018), including 89,511 participants aged above 65 years old. Our measurement of disability is the number of ADL items (dressing, bathing, indoor transferring, toileting, eating, and continence) participants can't perform independently. Hierarchical age-period-cohort cross-classified random effects models were conducted to investigate age, period and cohort trends in ADL disability. Results showed that ADL disability increased with age at an increasing rate. A V-shaped cohort trend and a fluctuated period trend were identified. Females and urban residents were associated with more ADL limitations. When age increased, the gender and residence gaps in disability further increased. The cohort-based gender and residence inequalities in ADL limitations converged with successive cohorts. The period-based residence gap in ADL limitations diverged throughout the 20-year period, while the corresponding period-based change in gender disparity was not significant. These findings suggested that age, period, and cohort had different and independent effects on ADL disability among Chinese older adults. The age effect on trends in ADL is stronger compared to period and cohort effects. The gender and residence disparities in disability increased with age and decreased with successive cohorts. These patterns might help inform healthcare planning and the priorities for medical resource allocation accordingly.

Background The treatment of relapsed/refractory multiple myeloma (RRMM) dramatically changed with the emergence of chimeric antigen receptor T (CAR-T) cell therapy. The aim of this study was to evaluate the cost-effectiveness of two CAR-T cell treatments for RRMM patients from the perspective of the Chinese healthcare system. Methods Markov modelling was used to evaluate Idecabtagene vicleucel(Ide-cel) and Ciltacabtagene autoleucel (Cilta-cel) compared with currently available salvage chemotherapy for patients with RRMM over a lifetime horizon. The model was developed based on data from the three studies: CARTITUDE-1, KarMMa and MAMMOTH. Each CAR-T cell treatments was compared with currently available salvage chemotherapy. The healthcare cost and utility of RRMM patients were collected in a Chinese single institution. Main outcomes were life-years, discounted lifetime costs, discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Results In the base case analysis, 3.5% and 30.4% of RRMM patients were expected to be long-term survivor after 5 years of Ide-cel and Cilta-cel treatment. Compared to salvage chemotherapy, Ide-cel and Cilta-cel were associated with the incremental QALYs of 1.14 and 3.32, and increment cost of US $166,643 and $111,225, leading to ICERs of $146,764 and $33,547 per QALY. In the scenario analyses, the ICER was $138,249 and $28,844 per QALY under assumption that the model starting age is changed from 60 to 55 for Ide-cel and Cilta-cel, and ICER was $148,486 and $40,691 per QALY under assumption that success rate of CAR-T therapy manufacturing was 100%. Conclusions Under the wiling-to-pay of 3 times China's per capita GDP in 2021, Cilta-cel was cost-effectiveness options compared to salvage chemotherapy for patients with RRMM while Ide-cel not. With younger target people, potential price discount and long-term survival improvement, the ICERs of the two CAR-T cell treatments would decrease.

Background To estimate the cost -utility of imrecoxib compared with diclofenac, as well as the addition of a proton pump inhibitor to both two treatment strategies, for patients with osteoarthritis, from a Chinese healthcare perspective. Methods A Markov model was built. Costs of managing osteoarthritis and initial adverse events were collected from a Medical Database which collected information from 170 hospitals. Other parameters were obtained from the literature. Subgroup analyses were conducted for people at high risk of gastrointestinal or cardiovascular adverse events. Deterministic and probabilistic sensitivity analyses were performed. Results Imrecoxib was highly cost-effective than diclofenac (the ICER was $401.58 and $492.77 in patients at low and high gastrointestinal and cardiovascular risk, respectively). The addition of a proton pump inhibitor was more cost -effective compared with single drug for both treatment strategies. Findings remained robust to sensitivity analyses. 59.04% and 57.16% probability for the co-prescription of imrecoxib and a proton pump inhibitor to be the most cost-effective strategy in all patients considered using the cost-effectiveness threshold of $30,000. Conclusions The addition of a proton pump inhibitor to both imrecoxib and diclofenac was advised. Imrecoxib provides a valuable option for patients with osteoarthritis. Uncertainties existed in the model, and the suggestions can be adopted with caution.

Background This study aimed to examine the cost-effectiveness of one-time standard endoscopic screening with Lugol’s iodine staining for esophageal cancer (EC) in China. Methods A Markov decision analysis model with eleven states was built. Individuals aged 40 to 69 years were classified into six age groups in five-year intervals. Three different strategies were adopted for each cohort: (1) no screening; (2) one-time endoscopic screening with Lugol’s iodine staining with an annual follow-up for low-grade intraepithelial neoplasia (LGIN); and (3) one-time endoscopic screening with Lugol’s iodine staining without follow-up. Quality-adjusted life-years (QALYs) indicated the effectiveness of the model. The incremental cost-effectiveness ratio (ICER) was used as the evaluation indicator. Sensitivity analysis was performed to assess the robustness of the model. Results One-time screening with follow-up was the undominated strategy for individuals aged 40–44 and 45–49 years, which saved USD 10,942.57 and USD 6611.73 per QALY gained compared to nonscreening strategy. For those aged 50–69 years, the nonscreening scenarios were undominated. One-time screening without follow-up was the extended dominated strategy. Compared to screening strategies without follow-up, all the screening strategies with follow-up were more cost-effective, with the ICER increasing from 299.57 USD/QALY for individuals aged 40–44 years to 1617.72 USD/QALY for individuals aged 65–69 years. Probabilistic sensitivity analysis (PSA) supported the results of the base case analysis. Conclusions One-time EC screening with follow-up targeting individuals aged 40–49 years was the most cost-effective strategy.

Background: There are multiple glucose-lowering drugs available as alternative initial monotherapy for type 2 diabetes patients with contraindications or intolerance to metformin. However, little comparative and systematic data are available for them as initial monotherapy. This study estimated and compared the treatment effects of glucose-lowering drugs as initial monotherapy for type 2 diabetes. Methods: PubMed, Web of Science, Embase, CNKI, Chongqing VIP, and WanFang Data from 1 January 1990 until 31 December 2020 were searched for randomized controlled trials which compared a glucose-lowering drug with placebo/lifestyle-intervention for type 2 diabetes. Drug classes included metformin, sulfonylureas (SUs), thiazolidinediones (TZDs), glinides (NIDEs), α-glucosidase inhibitors (AGIs), dipeptidyl peptidase-4 inhibitors (DPP-4is), sodium-glucose cotransporter-2 inhibitors (SGLT2is), insulins (INSs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). Results: A total of 185 trials were included, identifying 38,376 patients from 56 countries across six continents. When choosing an initial drug monotherapy alternative to metformin, SUs were most efficacious in reducing HbA1c (−1.39%; 95% CI −1.63, −1.16) and FPG (−2.70 mmol/L; 95% CI −3.18, −2.23), but increased hypoglycemia risks (5.44; 95% CI 2.11, 14.02). GLP-1RAs were most efficacious in reducing BMI (−1.05 kg/m2; 95% CI −1.81, −0.29) and TC (−0.42 mmol/L; 95% CI −0.61, −0.22). TZDs were most efficacious in increasing HDL-C (0.12 mmol/L; 95% CI 0.07, 0.17). SGLT2is were most efficacious in lowering SBP (−4.18 mmHg; 95% CI −4.84, −3.53). While AGIs conferred higher risk of AE-induced discontinuations (2.57; 95% CI 1.64, 4.03). Overall, only GLP-1RAs showed an integrated beneficial effect on all outcomes. Our results also confirmed the intraclass differences in treatment effects across drugs. Most trials were short-term, and no significant differences in mortality, total vascular events, myocardial infarction, heart failure, stroke, or diabetic nephropathy were observed across drug classes. Conclusions: Our results suggest a potential treatment hierarchy for decision-makers, with GLP-1RAs being the preferred alternative therapy to metformin regarding their favorable efficacy and safety profiles.

Background Esophageal cancer (EC) is the sixth leading cause of tumor-related deaths worldwide. Estimates of the EC burden are necessary and could offer evidence-based suggestions for local cancer control. Objective The aim of this study was to predict the disease burden of EC in China through the estimation of disability-adjusted life years (DALYs) and direct medical expenditure by sex from 2013 to 2030. Methods A dynamic cohort Markov model was developed to simulate EC prevalence, DALYs, and direct medical expenditure by sex. Input data were collected from the China Statistical Yearbooks, Statistical Report of China Children’s Development, World Population Prospects 2019, and published papers. The JoinPoint Regression Program was used to calculate the average annual percentage change (AAPC) of DALY rates, whereas the average annual growth rate (AAGR) was applied to analyze the changing direct medical expenditure trend over time. Results From 2013 to 2030, the predicted EC prevalence is projected to increase from 61.0 to 64.5 per 100,000 people, with annual EC cases increasing by 11.5% (from 835,600 to 931,800). The DALYs will increase by 21.3% (from 30,034,000 to 36,444,000), and the years of life lost (YLL) will account for over 90% of the DALYs. The DALY rates per 100,000 people will increase from 219.2 to 252.3; however, there was a difference between sexes, with an increase from 302.9 to 384.3 in males and a decline from 131.2 to 115.9 in females. The AAPC was 0.8% (95% CI 0.8% to 0.9%), 1.4% (95% CI 1.3% to 1.5%), and –0.7% (95% CI –0.8% to –0.7%) for both sexes, males, and females, respectively. The direct medical expenditure will increase by 128.7% (from US $33.4 to US $76.4 billion), with an AAGR of 5.0%. The direct medical expenditure is 2-3 times higher in males than in females. Conclusions EC still causes severe disease and economic burdens. YLL are responsible for the majority of DALYs, which highlights an urgent need to establish a beneficial policy to reduce the EC burden.

BACKGROUND Esophageal cancer (EC) is the sixth leading cause of tumor-related deaths worldwide. Estimates of the EC burden are necessary and could offer evidence-based suggestions for local cancer control. OBJECTIVE The aim of this study was to predict the disease burden of EC in China through the estimation of disability-adjusted life years (DALYs) and direct medical expenditure by sex from 2013 to 2030. METHODS A dynamic cohort Markov model was developed to simulate EC prevalence, DALYs, and direct medical expenditure by sex. Input data were collected from the China Statistical Yearbooks, Statistical Report of China Children’s Development, World Population Prospects 2019, and published papers. The JoinPoint Regression Program was used to calculate the average annual percentage change (AAPC) of DALY rates, whereas the average annual growth rate (AAGR) was applied to analyze the changing direct medical expenditure trend over time. RESULTS From 2013 to 2030, the predicted EC prevalence is projected to increase from 61.0 to 64.5 per 100,000 people, with annual EC cases increasing by 11.5% (from 835,600 to 931,800). The DALYs will increase by 21.3% (from 30,034,000 to 36,444,000), and the years of life lost (YLL) will account for over 90% of the DALYs. The DALY rates per 100,000 people will increase from 219.2 to 252.3; however, there was a difference between sexes, with an increase from 302.9 to 384.3 in males and a decline from 131.2 to 115.9 in females. The AAPC was 0.8% (95% CI 0.8% to 0.9%), 1.4% (95% CI 1.3% to 1.5%), and –0.7% (95% CI –0.8% to –0.7%) for both sexes, males, and females, respectively. The direct medical expenditure will increase by 128.7% (from US $33.4 to US $76.4 billion), with an AAGR of 5.0%. The direct medical expenditure is 2-3 times higher in males than in females. CONCLUSIONS EC still causes severe disease and economic burdens. YLL are responsible for the majority of DALYs, which highlights an urgent need to establish a beneficial policy to reduce the EC burden.

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. Electronic supplementary material The online version of this article (10.1186/s12877-019-1032-3) contains supplementary material, which is available to authorized users.

Background The objective of this study is to compare the long-term cost-utility of imrecoxib and celecoxib for patients with osteoarthritis (OA) from the perspective of the Chinese healthcare system. Methods An economic model was built based on the model from the National Institute for Health and Care Excellence (NICE). The simulation was carried out initially for 100 cycles of 3 months each, starting with 10,000 patients. A discount rate of 5% was applied both for cost and utility. Quality-adjusted life years (QALYs) were adopted as the utility indicator, and real-world data from the hospital information systems of 170 hospitals was collected to indicate cost. The relative incidence rates of adverse events (AEs) with imrecoxib and celecoxib were collected from randomized controlled trials. Sensitivity analysis was performed to validate the robustness of the model. Results In the base case analysis (6-month treatment duration, 55 years old and above), imrecoxib was the more cost-effective option compared to celecoxib, with an incremental cost-effectiveness ratio (ICER) of $3,041.14. This finding remained unchanged after varying the treatment duration and the age of the patients. The main drivers of the results were the relative incidence of myocardial infarction (MI), the cost of imrecoxib, and the utility of OA patients without any AEs. Probability sensitivity analysis (PSA) showed that there was a 59.02% probability of imrecoxib as the more cost-effective option, with a threshold of $30,000. Conclusions Although there were uncertainties, imrecoxib was the more cost-effective option compared to celecoxib, with a definite possibility. Due to the limitations of the original model and this study, the results of this study should be adopted with caution.

An amendment to this paper has been published and can be accessed via the original article.

Background Antibiotic resistance (AR) threats public health in China. National-level estimation of economic burden of AR is lacking. We aimed to quantify the economic costs of AR in inpatients in China. Methods We performed a multicentre and retrospective cohort study including 15,990 patient episodes at four tertiary hospitals in China from 2013 to 2015 to assess the impact of AR on hospital mortality, length of stay, and costs. We estimated the societal economic burden of AR using findings from the cohort study and secondary data from national surveillance hubs and statistical reports. Results Patients with multi-drug resistant (MDR) infection or colonisation caused by Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa, and Acinetobacter baumannii experienced higher individual patient cost ($3391, 95% uncertainty interval (UI) $3188–3594), longer hospital stay (5.48 days, 95% UI 5.10–5.87 days), and higher in-hospital mortality rates (1.50%, 95% UI 1.29–1.70%). In China, 27.45% of bacterial infection or colonisation that occurred in inpatients were resistant, of which 15.77% were MDR. A societal economic burden attributed to AR was estimated to be $77 billion in 2017, which is equivalent to 0.37% of China’s yearly gross domestic product, with $57 billion associated with MDR. Conclusions This is the first study to estimate national-level economic burden of AR in China. AR places a significant burden on patient health and healthcare systems. Estimation of economic costs of resistant infection or colonisation is the essential step towards building an economic case for global and national actions to combat AMR.

Additional file 1.

Additional file 1. Additional tables/figures.

Objectives Few studies in China have focused on the economic evaluation of newborn screening (NBS) for inherited metabolic disorders (IMDs) by tandem mass spectrometry (MS/MS). This study assesses the total costs, benefits, benefit–cost ratio (BCR), cost–utility ratio (CUR) and incremental cost–utility ratio (ICUR) of NBS using MS/MS compared to the non-screened group. Methods The NBS outcomes of newborns who underwent MS/MS screening for IMDs in 2009–2018 were retrospectively reviewed. Records were extracted from a screening management system at the NBS Center of Zhejiang province. A cost–benefit analysis of screening was conducted, assessing screening costs for each subject, and direct and indirect treatment costs for IMDs detected by screening. The putative benefit of clinical outcomes related to early diagnosis was assumed to be improvement in quality of life and prolonged life expectancy in the screened group, as compared to the non-screened group. Results Of the 3,040,815 newborns screened, 735 (2.86%) cases were diagnosed through gene sequence analysis. The most frequently occurring types of IMD were amino acid disorders ( n = 276), then fatty acid oxidation disorders ( n = 248), followed by organic acidaemias ( n = 211). The difference in quality-adjusted life-years (QALYs) ranged from 0.78 to 15.4 in the screened group. The CUR was CNY¥ 116,183.89/QALY in the screened group and CNY¥ 3,078,823.65/QALY in the non-screened group. The ICUR was CNY¥ –768,428.76/QALY, and the BCR was 6.09. Conclusions NBS using MS/MS can be considered cost-effective in China. The nationwide promotion of NBS using MS/MS deserves priority consideration and sufficient publicity.

Background: Carbapenem resistant Klebsiella pneumoniae (CRKP), Pseudomonas aeruginosa (CRPA), and Acinetobacter baumannii (CRAB) pose significant threats to public health. However, the clinical and economic impacts of CRKP, CRPA, and CRAB remain largely uninvestigated in China. This study aimed to examine the clinical and economic burden of CRKP, CRPA, and CRAB compared with carbapenem susceptible cases in China. Method: We conducted a retrospective and multicenter study among inpatients hospitalized at four tertiary hospitals between 2013 and 2015 who had K. pneumoniae, P. aeruginosa, and A. baumannii positive clinical samples. Propensity score matching (PSM) was used to balance the impact of potential confounding variables, including age, sex, insurance, number of diagnosis, comorbidities (disease diagnosis, and Charlson comorbidity index), admission to intensive care unit, and surgeries. The main indicators included economic costs, length of stay (LOS), and mortality rate. Results: We included 12,022 inpatients infected or colonized with K. pneumoniae, P. aeruginosa, and A. baumannii between 2013 and 2015, including 831 with CRKP and 4328 with carbapenem susceptible K. pneumoniae (CSKP), 1244 with CRPA and 2674 with carbapenem susceptible P. aeruginosa (CSPA), 1665 with CRAB and 1280 with carbapenem susceptible A. baumannii (CSAB). After PSM, 822 pairs, 1155 pairs, and 682 pairs, respectively were generated. Compared with carbapenem-susceptible cases, those with CRKP, CRPA, and CRAB were associated with statistically significantly increased total hospital cost ($14,252, p &lt, 0.0001, $4605, p &lt, $7277, p &lt, 0.0001) and excess LOS (13.2 days, p &lt, 5.4 days, p = 0.0003, 15.8 days, p = 0.0004). In addition, there were statistically significantly differences in hospital mortality rate between CRKP and CSKP, and CRAB and CSAB group (2.94%, p = 0.024, 4.03%, p = 0.03), however, the difference between CRPA and CSPA group was marginal significant (2.03%, p = 0.052). Conclusion: It highlights the clinical and economic impact of CRKP, CRPA, and CRAB to justify more resources for implementing antibiotic stewardship practices to improve clinical outcomes and to reduce economic costs.

Background The imbalance between health needs and healthcare resources has become more serious in China. The hierarchical diagnosis and treatment system has played an important role in solving the problem, one goal of which was to increase the use of basic-level medical facilities. This study aimed to compare the choice of and equity in first-contact care among residents in Zhejiang and Qinghai provinces, China. Methods First-hand data were obtained through a cross-sectional survey of residents of Zhejiang and Qinghai. We first compared the proportion of residents who select primary healthcare institutions as the setting for first-contact care. Then we compared horizontal equity using the concentration index decomposition method. An urban-rural subgroup analysis was carried out for both provinces. Results A total of 4899 residents were enrolled, 2872 from Zhejiang and 2027 from Qinghai. The proportion of residents selecting a PHI as their first-contact care provider was 82.5% in Qinghai, and 54.4% in Zhejiang. The horizontal inequity index of selecting a PHI as first-contact care was − 0.180 and 0.007 in Zhejiang and Qinghai, respectively. The HI was − 0.088, -0.160, 0.069, and − 0.058 in rural Zhejiang, urban Zhejiang, rural Qinghai, and urban Qinghai, respectively. Conclusions The proportion of residents selecting a PHI as their first-contact care provider in Zhejiang was lower and the extents of horizontal inequity were more serious compared with Qinghai’s. We suggest that medical reform should be implemented based on socioeconomic development, because of China’s geographic vastness and the considerable amount of difference in development among geographic areas. Larger gaps in the medical insurance reimbursement ratio between different levels of medical institutions might aid in increasing the equitable utilization of PHIs.

To estimate the health-related quality of life (HRQoL) of type 2 diabetes (T2DM) inpatients hospitalized for a complication in China and to explore the associated factors. This was a cross-sectional study. T2DM inpatients (aged ≥ 18 years) hospitalized for a complication, including ischemic heart disease (IHD), acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, impaired vision, end-stage renal disease (ESRD), ulcer, and amputation were recruited from a tertiary hospital in China from January to May 2017. The EuroQoL-5 dimensions were used to measure HRQoL. A one-way analysis of variance and a multivariate regression analysis were performed. Eight hundred and two T2DM inpatients hospitalized for a complication were included. The mean age was 62.67 years, and 43% of the inpatients were female. The mean utility-based HRQoL was 0.562 (95% CI 0.548, 0.577). The utility varied significantly between the complications: IHD = 0.620 (95% CI 0.597, 0.642), AMI = 0.434 (95% CI 0.394, 0.473), CHF = 0.471 (95% CI 0.433, 0.510), stroke = 0.472 (95% CI 0.436, 0.508), impaired vision = 0.714 (95% CI 0.692, 0.737), ESRD = 0.693 (95% CI 0.670, 0.717), ulcer = 0.431 (95% CI 0.375, 0.487), and amputation = 0.395 (95% CI 0.341, 0.448). Inpatients with a complication, who were female, and who had no daily exercise had a lower HRQoL. The HRQoL of T2DM inpatients with a complication was considerably impaired. Our estimates provide supplementary data for public health and cost-effectiveness modeling, and increase the breadth of knowledge of HRQoL in T2DM.

From the perspective of improving the environmental benefits of the supply chain, in this paper, the evaluation index system of manufacturing cloud service is established. It is oriented to the environmental benefits of the supply chain and takes into account the environmental indicators of the candidate providers. The fuzzy DEMATEL modified entropy method is used to calculate the comprehensive weight of the evaluation index. Then, the candidate manufacturing cloud service providers are selected based on gray relational analysis to ensure the rationality of the evaluation results. The evaluation system not only objectively considers the situation of each supplier but also reflects the platform's emphasis on low-carbon environmental factors. Finally, this paper takes the seat suppliers' selection problem in the supply chain of Tianjin industrial cloud automotive mold supply chain as examples to verify the practical significance of this model. At the same time, this paper can provide ideas for the application of cloud manufacturing mode and the solution of supply chain environment problems.

Background: This study aimed to predict the disease burden of esophageal cancer (EC) over the period 2013-2030 in China. Methods : A dynamic cohort Markov model was developed to simulate the EC prevalence, disability-adjusted life years (DALY), and the medical direct expenditure based on gender. JoinPoint Regression Program was used to calculate the average annual percentage change (AAPC) of EC prevalence and DALY rates, while the regression model was applied to analyze the changing trend of economic burden over time. Results: The predicted DALY rates per 100 000 people increased in both-sex (219.17 - 252.39) and males (302.89 – 384.31), while it decreased in females (131.21- 115.91). The years of life lost (YLL) accounted for the majority of DALYs. The AAPC were 0.8%(95% CI, 0.8%-0.9%), 1.4%(95% CI, 1.3%- 1.5%), and -0.7%(95% CI, -0.8%- -0.7%) in both-sex, males and females, respectively. The medical direct expenditure in both-sex, males, and females was predicted to increase by 165.35%, 194.04%, and 94.20%, respectively. Conclusions: EC still caused a severe burden on society. YLL was responsible for the majority of the DALYs, which highly suggesting the implementation of accurate prevention like screening and early diagnosis and treatment programs.

Background: Clinical guidelines recommend type 2 diabetes (T2DM) patients with contraindications or intolerance of metformin to consider a glucose-lowering agent from another class as initial monotherapy. The availability of multiple alternative agents increases the complexity of clinical drug use. However, little systematic data is available for these agents as monotherapy for T2DM. This study aims to estimate and compare the efficacy and safety of eight commonly-used classes of glucose-lowering agents as monotherapy for T2DM. Methods: Systematic review was conducted by searching eight English and Chinese databases to identify randomized controlled trials (1990-2016) comparing treatment effect of a glucose-lowering agent with placebo/lifestyle-intervention in Chinese patients. The agents included metformin, sulfonylurea, thiazolidinedione, α-glucosidase inhibitor, glinide, DPP-4 inhibitor, GLP-1 receptor agonist, and insulin. They were firstly compared with placebo/lifestyle-intervention using meta-analysis, then compared against each other using indirect treatment comparison with placebo/lifestyle-intervention as common comparator. Findings: 46 studies were included. The agents significantly reduced HbA1c level by 0·69% to 2·37% compared with placebo/lifestyle-intervention. Comparing them against each other, insulin was most efficacious while glinide was most inefficacious in reducing HbA1c, metformin was most efficacious while sulfonylurea was most inefficacious in reducing BMI and TC, thiazolidinedione was most efficacious while α-glucosidase inhibitor was most inefficacious in increasing HDL-C. The agents (except sulfonylurea and insulin) had no significant differences on hypoglycemia risks. Only metformin and GLP-1 receptor agonist achieved a comprehensive control on multiple outcomes including HbA1c, BMI, TC and HDL-C. Interpretation: Treatment effect varied by agents. Our results, along with individualized patient factors, preferences and needs, should be considered when selecting an agent in clinical practice. Funding Statement: The authors stated there was no funding source for this study. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

Additional file 1. Additional tables.

Objective To review drug policies, health technology assessment (HTA), and HTA's use in drug policies in China, to further improve the quality and efficiency of drugs. Methods This study draws on multiple methods. A systematic review of the literature, review of Chinese government documents and statistical handbooks, and authors' experiences in drug policies and HTA in China were combined to achieve the objective. Results Of 571 studies identified in the initial search, 14 eligible articles (6 English, 8 Chinese) were finally included. On the Web site of the National Health and Family Planning Commission, the National Development and Reform Commission, and the Ministry of Human Resources and Social Security, we found that HTA or pharmacoeconomics evaluation is mentioned in recent years and its frequency has been increasing; however, there was not one hit about HTA or PE on the Web site of China Food and Drug Administration. Conclusions The decision makers have realized the importance and value of HTA and have tried to integrate HTA into drug policies and regulations. However, the application of HTA findings to drug policymaking is not yet widespread and there are a number of challenges in using HTA in China. Therefore, it is necessary to establish a national HTA commission and develop pharmacoeconomics guidelines to support the use of HTA in decision making. Moreover, the most important steps are to encourage technology innovation, groom more HTA experts, and build reliable databases in China.

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.

Due to the long operation cycle of maritime transportation and frequent fluctuations of the bunker fuel price, the refueling expenditure of a chartered ship at different time or ports of call make significant difference. From the perspective of shipping company, an optimal set of refueling schemes for a ship fleet operating on different voyage charter routes is an important decision. To address this issue, this paper presents an approach to optimize the refueling scheme and the ship deployment simultaneously with considering the trend of fuel price fluctuations. Firstly, an ARMA model is applied to forecast a time serials of the fuel prices. Then a mixed-integer nonlinear programming model is proposed to maximize total operating profit of the shipping company. Finally, a case study on a charter company with three bulk carriers and three voyage charter routes is conducted. The results show that the optimal solution saves the cost of 437,900 USD compared with the traditional refueling scheme, and verify the rationality and validity of the model.

By selecting nine indicators related to Tianjin Port throughput in the new era, a PCA-SVR prediction model is constructed and the throughput of Tianjin port in 2017–2018 years is predicted. Based on the predicted results, the growth rate and influencing factors of Tianjin port throughput are analyzed. The research shows that the growth rate of Tianjin Port throughput has a downward trend in the next two years. In numerous influencing factors, the three indicators of the total value of imports and exports of foreign trade commodities, the added value of tertiary industry and Hebei port throughput accounts for the percentage of total throughput of Beijing-Tianjin-Hebei port have a significant impact on Tianjin Port throughput.

Methicillin-resistant Staphylococcus aureus (MRSA) has become a serious threat to global health. In China, the proportion of S. aureus isolates that were MRSA was 44.6% in 2014. The clinical and economic impact of MRSA in China remains largely uninvestigated. This study aims to compare the differences in hospital costs, length of hospital stay, and hospital mortality rate between MRSA and methicillin-susceptible S. aureus (MSSA) colonization or infection and between MRSA cases and those without an S. aureus infection. A retrospective and multicentre study was conducted in four tertiary hospitals in China between 2013 and 2015. Inpatient characteristics and hospital costs were collected from electronic medical records. We conducted propensity score matching (PSM) to eliminate selection bias by balancing the potential confounding variables between the two groups. The main indicators included hospital costs, length of hospital stay, and hospital mortality rate. A total of 1,335 inpatients with MRSA, 1,397 with MSSA, and 33,606 without an S. aureus infection were included. PSM obtained 954 and 1,313 pairs between the MRSA and MSSA groups and between the MRSA and S. aureus-free groups, respectively. After PSM, MRSA colonization or infection is associated with an increased total hospital cost ranging from $3,220 to $9,606, an excess length of hospital stay of 6 days–14 days, and an attributable hospital mortality rate of 0–3.58%. Between the MRSA and MSSA groups, MRSA colonization or infection was significantly associated with a higher total hospital cost and longer length of hospital stay among survivors but not among non-survivors; however, there were no differences in the hospital mortality rate between these two groups. Between the MRSA and the S. aureus-free groups, MRSA colonization or infection was significantly associated with an increased total hospital cost, a prolonged length of hospital stay and a higher hospital mortality rate among both survivors and non-survivors. It is critical to quantify the clinical and economic impact of MRSA to justify resource allocation for the development of strategies to improve clinical outcomes and to reduce the economic burden.

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). 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

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&rsquo, 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.