2021年 · 第101卷第32期

This study compared the cost-effectiveness value of using MRI and ultrasound for semi-annual liver cancer surveillance in patients with liver cirrhosis by constructing a decision analysis Markov model, and identified the population that achieved the best cost-effectiveness through MRI surveillance. The study compares cost and quality-adjusted life years (QALYs) between the two surveillance strategies mentioned above from a healthcare system perspective. The model simulated a cohort of cirrhotic patients with a starting age of 50 years. 71% of them were infected with hepatitis B virus. The cycle length was 6 months and the operation period was 20 years. The transition probability and cost in the model parameters were mainly from a prospective cohort study, and the other parameters were from the literature. The cost-effectiveness value of MRI monitoring strategies was evaluated by calculating the incremental cost-effectiveness ratio (ICER) between strategies, and the stability of the results was evaluated by sensitivity analysis. The results showed that if the annual incidence of liver cancer was 3%, the cost of MRI surveillance compared with ultrasound surveillance strategy was $5,562 more, the QALY increased by 0.221, and the ICER was $25,202/QALY. The ICER was less than $50 000/QALY when the incidence of liver cancer was>1.81%. With the increasing incidence of liver cancer, even if the cost ratio of MRI and ultrasound increases, MRI monitoring strategies still have cost-effective value. The results of this study suggest that, despite the high cost of MRI monitoring strategies, for patients with hepatitis B virus-associated compensated cirrhosis with a sufficiently high risk of liver cancer, the use of MRI for semi-annual liver cancer monitoring may be more cost-effective than ultrasound.

Sleep problems can seriously affect physical health and quality of life. Previous studies have suggested that patients with dry eye generally have shorter sleep time and poorer sleep quality, while individuals with sleep problems are more likely to suffer from dry eye, but the sample size is small. To prevent sampling bias and interference from multiple factors, the study used large population-based cohorts to elucidate the association between dry eye and sleep quality. From the health and health-related behavior database of 167 729 people in the north of the Netherlands, the researchers screened for analysis the data of 71 761 people who completed data collection between 2014 and 2018, aged (50.2±12.3) years, of which 59.4% were women. Dry eye was diagnosed using the self-reported Women's Health Study Dry Eye Questionnaire (WHS), and dry eye was defined by those who reported dry and/or irritating feelings as frequent or persistent or who had been diagnosed with dry eye in the past. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), with a PSQI>5 defined as poor sleep quality and a PSQI ≤5 defined as good sleep quality. Dry eye was diagnosed in 6 414 (8.9%) participants and 18 563 (25.9%) participants were evaluated as having poor sleep quality. The proportion of poor sleep quality was significantly higher in the dry eye group than in the non-dry eye group (36.4% vs 24.8%), and the results of multivariate logistic regression analysis showed that dry eye and poor sleep quality were associated after adjustment for sex and age (OR=1.52，95%CI：1.44~1.60，P<0.000 1）； After adjusting for 51 possible confounding factors such as sex, age, BMI, education, and income, dry eye remained an associated factor for poor sleep quality (OR=1.20，95%CI：1.11~1.28，P<0.001), and this correlation was present in different genders and in all age groups. Therefore, dry eye is closely related to the quality of sleep in patients.

In modern society, the prevalence of dry eye and depression continues to rise. This study used a mobile App (DryEyerRhythm) to investigate the association between dry eye and depressive symptoms. From September 2, 2016 to January 12, 2018, data were collected and statistically analyzed for 4 454 Japanese users who downloaded and used DryEyeRhythm, aged (27.9 ± 12.6) years, of which 2 971 were female, accounting for 66.7%. The ocular surface disease index (OSDI) and Zung self-rated depression scale (SDS) were used to evaluate dry eye symptoms and depressive symptoms. The OSDI score ≥13 was defined as dry eye, of which 13-22 were classified as mild dry eye, 23-32 were classified as moderate dry eye, and 33-100 were classified as severe dry eye; Those with SDS ≥40 were defined as having depressive symptoms. The SDS scores were (42.4±9.3), (45.5±9.7), (47.8±9.6), and (50.5±10.4) in 1 160, 1 139, 778, and 1 377 patients with mild, moderate, and severe dry eyes, respectively. Compared with the normal control group, the SDS scores of patients with mild, moderate, and severe dry eyes were all higher (allP<0.001）。 The number of patients with SDS ≥40 accounted for 58.2%, 70.9%, 79.4% and 85.0% of the normal control group and mild, moderate and severe dry eye groups, respectively. The proportion of depressive symptoms in mild, moderate and severe dry eye patients was significantly higher than that in the normal control (allP<0.001）。 The results of multivariate logistic regression analysis showed that compared with normal controls, mild, moderate and severe dry eye were correlated with depressive symptoms.ORValues were 1.62 (95%CI：1.35~1.95，P<0.001）、2.39（95%CI：1.92~2.97，P<0.001) and 3.29 (95%CI：2.70~4.00，P<0.001）。 Depressive symptoms are more common in patients with severe dry eye, and DryEyeRhythm can play a corresponding role in early prevention or prediction of depressive symptoms in patients with dry eye.

The effectiveness of alcohol use treatments such as medication-assisted therapy (MAT) and physician consultations to promote alcohol abstinence has been demonstrated, but the cost-effectiveness of alcohol use treatment for patients with alcohol-associated compensated cirrhosis remains to be explored. Therefore, this study simulated 1 group of patients with alcohol-related compensated cirrhosis who received liver disease clinic care throughout their lives by constructing a decision analysis Markov model and predicted the costs to be paid and quality-adjusted life years (QALY) obtained throughout their lives after receiving different alcohol use therapies from a healthcare and social perspective. The parameters of conversion probability, cost, and health utility value in the model of this study were taken from the literature. The study used FDA-approved MAT (acamboxylic acid and naltrexone), non-FDA-approved MAT (baclofen, gabapentin and topiramate) and physician consultation as the research strategy, and did not perform any interventions as the control strategy. The incremental cost-benefit ratio (ICER) between strategies was calculated. From a healthcare perspective, MAT provides cost savings and more health outputs compared to the non-intervention strategy, with an ICER of $3,724/QALY for the physician consultation strategy, which is below the cost-effectiveness threshold ($50,000/QALY). Among them, the acamboxylic acid and naltrexone strategies were the lowest cost and obtained the most QALY compared to other intervention strategies. At the same time, one-dimensional and probabilistic sensitivity analysis were carried out to evaluate the parameter uncertainty, and the results suggest that the results of this study are stable and reliable. The results of this study suggest that interventions such as MAT and physician consultation for patients with alcohol-related compensated cirrhosis have extremely high cost-effectiveness value, can be used to prevent decompensated cirrhosis and improve patient health, and should be encouraged to be widely used. Furthermore, health policies should emphasize appropriate subsidies for these interventions.