ObjectiveTo systematically review the efficacy and safety of dienogest in the treatment of endometriosis. MethodsThe PubMed, Embase, Cochrane Library, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of dienogest for the treatment of endometriosis from inception to February 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 20 RCTs, involving 2 826 patients were included. Meta-analysis showed that compared with gonadotropin-releasing hormone agonist (GnRH-a), dienogest had similar efficacy. Compared with placebo, dienogest was more effective in reducing endometriosis-related pelvic pain. Compared with oral contraceptives, dienogest performed better in relieving endometriosis-related pelvic pain and improving recurrence and pregnancy rates. Compared with other drugs (such as non-steroidal anti-inflammatory drugs, dydrogesterone, etc.), dienogest could gradually reduce the pain. In terms of safety, dienogest could reduce bone density damage and hot flashes in patients with endometriosis compared with those in the control group. ConclusionCurrent evidence shows that dienogest is effective and safely tolerated in the treatment of endometriosis. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.
The multi-attribute utility function (MAUF) is a commonly used method for measuring health utility, characterized by a solid theoretical foundation and operational feasibility. It contributes to reducing the cognitive burden on respondents, caters to the measurement of utility across multiple dimensions, and represents another most widely applied approach beyond traditional econometrics, warranting exploration and application. However, there is currently a lack of comprehensive and systematic research on this method in China, with insufficient practical application experience. Against this backdrop, this paper aims to systematically explore the methodological background of MAUF and the key points of research design for measuring health utility using this method. By drawing on the utility measurement experiences from internationally developed measurement scales such as HUI 1, HUI 2, HUI 3, 15D, AQol-8D, ASUI, HUG-5, TOOL, and ALSUI, it systematically analyzes the critical steps in the practical implementation of the method. It is hoped that this work will comprehensively and clearly elaborate on the practical approaches of MAUF, promote the further development of MAUF in China, and provide methodological references for future studies on health utility measurement based on MAUF.
ObjectiveTo systematically review the medication adherence of patients with hypertension treated with single-pill combinations (SPC) compared with free combination therapy (FEC). MethodsThe PubMed, Embase, Cochrane Library, Web of Science, CBM, WanFang Data, and CNKI databases were electronically searched to collect cohort studies and randomized controlled trials (RCTs) related to the objectives from inception to March 2025. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using R 4.3.3 software. ResultsA total of 21 studies were included, comprising 4 RCTs and 17 cohort studies, involving 461 030 patients. Meta-analysis showed that SPC therapy significantly improved medication adherence compared with FEC in terms of proportion of days covered (PDC) (OR=2.53, 95%CI 1.67 to 3.82, P<0.01) and medication possession ratio (MPR) (OR=2.05, 95%CI 1.23 to 3.42, P=0.02), with statistically significant differences. However, there was no statistically significant difference in blood pressure reduction between SPC and FEC for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P>0.05). ConclusionCurrent evidence shows that SPC can improve medication adherence in patients with hypertension. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the pharmacoeconomics of hemodialysis and peritoneal dialysis in patients with end-stage renal disease. MethodsCRD, NICE, CADTH, HITAP, NECA, IWIQG, ISPOR, PubMed, EMbase, CNKI, and WanFang Data databases were electronically searched to collect pharmacoeconomic studies on the hemodialysis and peritoneal dialysis in the treatment of end-stage renal disease from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, the conclusions of research models, pharmacoeconomic evaluation results, and sensitivity analysis were summarized. ResultsA total of 15 pharmacoeconomic studies were included, among which 9 studies used the Markov state transition model, and 6 were observational studies. From the perspective of health outcomes, peritoneal dialysis had cost-effectiveness advantages over hemodialysis in the treatment of end-stage renal disease under the condition of a clear threshold. ConclusionsCurrent evidence shows that compared with hemodialysis, peritoneal dialysis has certain cost-effectiveness advantages in the treatment of end-stage renal disease. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
With the rapid global development of artificial intelligence (AI) technology, its applications in various industries continue to deepen. Against this backdrop, AI empowering high-quality development in the pharmaceutical and healthcare sector has become a global research hotspot, and AI-enabled health technology assessment (HTA) constitutes a key component of AI applications in the pharmaceutical field. Currently, the World Health Organization (WHO), International Society for Pharmacoeconomics and Outcomes Research (ISPOR), National Institute for Health and Care Excellence (NICE), and Canada’s Drug Agency (CDA-AMC) are all actively exploring the application pathways, technical challenges, developmental limitations, and solutions of AI in HTA. This paper aims to conduct a systematic analysis of AI-related basic concepts and classifications, typical application scenarios of AI in HTA, risk challenges, and position principles, based on the exploratory findings of the aforementioned entities regarding AI applications in HTA and integrating the technical characteristics of AI and HTA themselves. It further seeks to propose the application pathways, directions, and future prospects of AI in China’s HTA field by drawing on international beneficial experiences.
Against the backdrop of the rapid development of modern medical science and technology and the continuous advancement of China's medical innovation policies, the early management of innovative health technologies is still trapped in a vicious circle of "failure to effectively identify the potential of technological value" and "unclear entry points for policy intervention". China's medical innovation model still has the characteristics of passive follow-up, lacking a continuous monitoring mechanism and attention channels for cutting-edge health technologies. Horizon scanning (HS) can systematically identify (rather than randomly discover) emerging technologies that may have potential impacts on health, medical services and/or society, as well as outdated and soon-to-be eliminated technologies. It provides a scientific basis for innovation incentives, resource allocation and the formulation of relevant policies, and is an important international tool for exploring and discovering innovative technologies. This paper systematically sorts out the conceptual connotation, development history and standardized implementation path of HS, and demonstrates the application value of HS in specific medical scenarios through typical cases. In general, HS can expand the forward-looking vision of decision-makers, improve the full-life-cycle evaluation system of health technologies, and promote the transformation of China's medical innovation from passive follow-up to leading development. For the localized application of this technology in China, it is necessary to clarify its conceptual boundaries, application scenarios and implementation paths with early health technology assessment. It is hoped that this paper can promote the application and development of HS, a new technical tool, in China's health field, and provide methodological references for subsequent related research.
ObjectiveTo compare the safety and efficacy of powered anastomosis versus mechanical anastomosis in gastrointestinal surgery. MethodsComputerized searches were conducted in PubMed, EMbase, Web of Science, CNKI, and CBM databases to collect studies comparing the safety and efficacy of powered versus mechanical anastomosis in gastrointestinal surgery. The search period was from the inception of each database to March 2025. Literature was screened according to inclusion and exclusion criteria, data were extracted, and the risk of bias was assessed. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using the Metan package in Stata/MP 17.0 software. ResultsA total of 15 observational studies (13 retrospective and 2 prospective) involving 21,424 patients were finally included, with 9 823 patients in the experimental group (powered anastomosis) and 11 601 patients in the control group (mechanical anastomosis). The NOS scores of all included studies were ≥5 points. Meta-analysis results showed that, compared to the mechanical anastomosis group, the powered anastomosis group had significantly lower incidence rates of anastomotic leakage [RR=0.60, 95%CI (0.37, 0.96), P=0.031], postoperative complications [RR=0.68, 95%CI (0.53, 0.86), P<0.01], intraoperative bleeding rate [RR=0.29, 95%CI (0.15, 0.56), P<0.01], and 30-day readmission rate [RR=0.62, 95%CI (0.39, 0.97), P<0.05]. No statistically significant differences were found in anastomotic stenosis [RR=0.53, 95%CI (0.18, 1.57), P=0.25], intraoperative blood loss [SMD=?0.03, 95%CI (?0.15, 0.08), P=0.57], operation time [SMD=?0.00, 95%CI (?0.08, 0.07), P=0.90], or postoperative hospital stay [SMD=?0.05, 95%CI (?0.13, 0.02), P=0.15]. ConclusionIn gastrointestinal surgery, powered anastomosis may offer potential advantages over traditional mechanical anastomosis in improving the aforementioned safety and efficacy outcomes.