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Antón J, Moreno Ruzafa E, Lopez Corbeto M, Bou R, Sánchez Manubens J, Carriquí Arenas S, Calzada Hernández J, Bittermann V, Estepa Guillén C, Mosquera Angarita J, Rodríguez Díez L, Iglesias E, Marti Masanet M, Lopez Montesinos B, González Fernández MI, de Lossada A, Peral C, Valderrama M, Llevat N, Montoro Álvarez M, Calvo Penadés I. Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:141-149. [PMID: 38145114 PMCID: PMC10742379 DOI: 10.36469/001c.85088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/07/2023] [Indexed: 12/26/2023]
Abstract
Background: Juvenile idiopathic arthritis (JIA) is the most frequent chronic rheumatic disease in children. If inflammation is not adequately treated, joint damage, long-term disability, and active disease during adulthood can occur. Identifying and implementing early and adequate therapy are critical for improving clinical outcomes. The burden of JIA on affected children, their families, and the healthcare system in Spain has not been adequately assessed. The greatest contribution to direct costs is medication, but other expenses contribute to the consumption of resources, negatively impacting healthcare cost and the economic conditions of affected families. Objective: To assess the direct healthcare, indirect resource utilization, and associated cost of moderate-to-severe JIA in children in routine clinical practice in Spain. Methods: Children were enrolled in this 24-month observational, multicentric, cross-sectional, retrospective study (N = 107) if they had been treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), had participated in a previous study (ITACA), and continued to be followed up at pediatric rheumatology units at 3 tertiary Spanish hospitals. Direct costs included medication, specialist and primary care visits, hospitalizations, emergency visits or consultations, surgeries, physiotherapy, and tests. Indirect costs included hospital travel expenses and loss of caregiver working hours. Unitary costs were obtained from official sources (€, 2020). Results: Overall, children had inactive disease/low disease activity according to JADAS-71 score and very low functional disability as measured by Childhood Health Assessment Questionnaire score. Up to 94.4% of children received treatment, mainly with bDMARDs as monotherapy (84.5%). Among anti-TNFα treatments, adalimumab (47.4%) and etanercept (40.2%) were used in similar proportions. Annual mean (SD) total JIA cost was €7516.40 (€5627.30). Average cost of pharmacological treatment was €3021.80 (€3956.20), mainly due to biologic therapy €2789.00 (€3399.80). Direct annual cost (excluding treatments) was €3654.60 (€3899.00). Indirect JIA cost per family was €747.20 (€1452.80). Conclusion: JIA causes significant costs to the Spanish healthcare system and affected families. Public costs are partly due to the high cost of biologic treatments, which nevertheless remain an effective long-term treatment, maintaining inactive disease/low disease activity state; a very low functional disability score; and a good quality of life.
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Affiliation(s)
- Jordi Antón
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Mireia Lopez Corbeto
- Pediatric Rheumatology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rosa Bou
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | - Judith Sánchez Manubens
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
- Servei de Pediatria, Hospital Parc Taulí Sabadell
| | | | | | - Violetta Bittermann
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | | | | | | | - Estíbaliz Iglesias
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | - Miguel Marti Masanet
- Pediatric Rheumatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Berta Lopez Montesinos
- Pediatric Rheumatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Currie GR, Pham T, Twilt M, IJzerman MJ, Hull PM, Kip MMA, Benseler SM, Hazlewood GS, Yeung RSM, Wulffraat NM, Swart JF, Vastert SJ, Marshall DA. Perspectives of Pediatric Rheumatologists on Initiating and Tapering Biologics in Patients with Juvenile Idiopathic Arthritis: A Formative Qualitative Study. THE PATIENT 2022; 15:599-609. [PMID: 35322390 DOI: 10.1007/s40271-022-00575-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Few studies have examined pediatric rheumatologists' approaches to treatment decision making for biologic therapy for patients with juvenile idiopathic arthritis (JIA). This study presents the qualitative research undertaken to support the development of a Best-Worst Scaling (BWS) survey for tapering in JIA. The study objectives were to (1) describe the treatment decision-making process of pediatric rheumatologists to initiate and taper biologics; and (2) select attributes for a BWS survey. METHODS Pediatric rheumatologists across Canada were recruited to participate in interviews using purposeful sampling. Interviews were conducted until saturation was achieved. Interview recordings were transcribed verbatim and transcripts were analyzed using deductive thematic analysis. Initial codes were organized into themes and subthemes using an iterative process. Attributes for the BWS survey were developed from these themes and a literature review was conducted in parallel to inform survey development. Further refinement of the attributes was done through consultation with the research team. RESULTS Five pediatric rheumatologists participated in the interviews. Shared decision making was part of the approach to initiating and tapering biologics in their practice. Tapering approaches differed; some pediatric rheumatologists preferred to stop biologics immediately, while others tapered by reducing dose and/or increasing the dose interval over time. A total of 14 attributes were developed for the BWS. Thirteen attributes were selected from the themes that emerged from the qualitative interviews and one attribute was included after review with the research team. Attributes related to patient characteristics included JIA subtype, time in remission, history or presence of joint damage or erosive disease, how challenging it was to achieve remission, and history of flares. Contextual attributes included accessibility of biologics and willingness to taper biologics. CONCLUSION This study contributes to the limited literature on pediatric rheumatologists' approaches to treatment decision making for biologics in JIA and identifies attributes that affect the decision to both initiate and taper. Further research is planned to implement the BWS survey to understand the importance of the attributes identified. Additional investigation is required to determine if these characteristics align with patient and parent preferences.
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Affiliation(s)
- Gillian R Currie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Tram Pham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marinka Twilt
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Pauline M Hull
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Susanne M Benseler
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Glen S Hazlewood
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rae S M Yeung
- Departments of Paediatrics, Immunology and Medical Science, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital/UMC Utrecht, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital/UMC Utrecht, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sebastian J Vastert
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital/UMC Utrecht, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Health Research Innovation Centre, University of Calgary, Room 3C56, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Direct Healthcare Costs Associated with Oligoarticular Juvenile Idiopathic Arthritis at a Single Center. Int J Rheumatol 2020; 2020:5640425. [PMID: 32952562 PMCID: PMC7482013 DOI: 10.1155/2020/5640425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/22/2020] [Accepted: 08/25/2020] [Indexed: 12/04/2022] Open
Abstract
Oligoarticular juvenile idiopathic arthritis (JIA) is a common disease in pediatric rheumatology. The management of oligoarticular JIA can result in a considerable economic burden. This study is a four-year, retrospective cost identification analysis performed to determine the annual direct cost of care for patients with oligoarticular JIA and possible predictive clinical factors. Direct healthcare costs were defined as those associated with office visits, laboratory studies, hospital admissions, joint injections, medications, infusions, radiology tests, and emergency room visits. Disease characteristics and patient information included ANA status, gender, age at diagnosis, duration from diagnosis to initial visit during the study period, and whether uveitis had been diagnosed. We identified 97 patients with oligoarticular JIA eligible for the study. The median age of diagnosis was 4.3 years. Positive ANA were noted in 75% of patients. 34% of patients received at least one intra-articular steroid injection. 32% of patients were prescribed a biologic during the study period, predominantly with other medications, while 23% of patients received only NSAIDs. 20% of patients were prescribed oral steroids. The average total direct medical cost in this study per year for an oligoarticular JIA patient was $3929 ± 6985. Medications accounted for 85% of annual direct medical costs. Clinic visits and laboratory testing accounted for 8% and 5%, respectively. Patient characteristics and demographics were tested for association with direct medical costs by the Wilcoxon rank sum test and Kruskal-Wallis test. Patients who were ANA positive had increased annual costs compared to patients who are ANA negative. ANA-positive patients were found to have statistically significant costs, particularly, in laboratory tests, procedural costs, radiology costs, and medication costs. The results reported here provide information when allocating healthcare resources and a better understanding of the economic impact oligoarticular JIA has on the United States healthcare system.
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Kip MMA, Currie G, Marshall DA, Grazziotin Lago L, Twilt M, Vastert SJ, Swart JF, Wulffraat N, Yeung RSM, Benseler SM, IJzerman MJ. Seeking the state of the art in standardized measurement of health care resource use and costs in juvenile idiopathic arthritis: a scoping review. Pediatr Rheumatol Online J 2019; 17:20. [PMID: 31060557 PMCID: PMC6501309 DOI: 10.1186/s12969-019-0321-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to describe current practice in identifying and measuring health care resource use and unit costs in economic evaluations or costing studies of juvenile idiopathic arthritis (JIA). METHODS A scoping review was conducted (in July 2018) in PubMed and Embase to identify economic evaluations, costing studies, or resource utilization studies focusing on patients with JIA. Only English language peer-reviewed articles reporting primary research were included. Data from all included full-text articles were extracted and analysed to identify the reported health care resource use items. In addition, the data sources used to obtain these resource use and unit costs were identified for all included articles. RESULTS Of 1176 unique citations identified by the search, 20 full-text articles were included. These involved 4 full economic evaluations, 5 cost-outcome descriptions, 8 cost descriptions, and 3 articles reporting only resource use. The most commonly reported health care resource use items involved medication (80%), outpatient and inpatient hospital visits (80%), laboratory tests (70%), medical professional visits (70%) and other medical visits (65%). Productivity losses of caregivers were much more often incorporated than (future) productivity losses of patients (i.e. 55% vs. 15%). Family borne costs were not commonly captured (ranging from 15% for school costs to 50% for transportation costs). Resource use was mostly obtained from family self-reported questionnaires. Estimates of unit costs were mostly based on reimbursement claims, administrative data, or literature. CONCLUSIONS Despite some consistency in commonly included health care resource use items, variability remains in including productivity losses, missed school days and family borne costs. As these items likely substantially influence the full cost impact of JIA, the heterogeneity found between the items reported in the included studies limits the comparability of the results. Therefore, standardization of resource use items and unit costs to be collected is required. This standardization will provide guidance to future research and thereby improve the quality and comparability of economic evaluations or costing studies in JIA and potentially other childhood diseases. This would allow better understanding of the burden of JIA, and to estimate how it varies across health care systems.
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Affiliation(s)
- Michelle M. A. Kip
- 0000 0004 0399 8953grid.6214.1Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | - Gillian Currie
- 0000 0004 1936 7697grid.22072.35Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada ,0000 0004 1936 7697grid.22072.35Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Deborah A. Marshall
- 0000 0004 1936 7697grid.22072.35Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Luiza Grazziotin Lago
- 0000 0004 1936 7697grid.22072.35Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Marinka Twilt
- 0000 0004 1936 7697grid.22072.35Division of Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Sebastiaan J. Vastert
- 0000 0004 0620 3132grid.417100.3Division of Paediatrics, Department of Paediatric Rheumatology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Joost F. Swart
- 0000 0004 0620 3132grid.417100.3Division of Paediatrics, Department of Paediatric Rheumatology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Nico Wulffraat
- 0000 0004 0620 3132grid.417100.3Division of Paediatrics, Department of Paediatric Rheumatology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Rae S. M. Yeung
- 0000 0001 2157 2938grid.17063.33Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada
| | - Susanne M. Benseler
- 0000 0004 1936 7697grid.22072.35Division of Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Maarten J. IJzerman
- 0000 0004 0399 8953grid.6214.1Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
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Hernández-Vásquez A, Alarcon-Ruiz CA, Bendezu-Quispe G, Comandé D, Rosselli D. A bibliometric analysis of the global research on biosimilars. J Pharm Policy Pract 2018; 11:6. [PMID: 29599984 PMCID: PMC5870206 DOI: 10.1186/s40545-018-0133-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/05/2018] [Indexed: 12/13/2022] Open
Abstract
Background Biosimilars could be a promising option to help decrease healthcare costs and expand access to treatment. There is no previous evidence of a global bibliometric analysis on biosimilars. Therefore, we aimed to assess the quantity and quality of worldwide biosimilars research. Methods We performed a bibliometric analysis using documents about biosimilars published until December 2016 in journals indexed in Scopus. We extracted the annual research, languages, countries, journals, authors, institutions, citation frequency, and the metrics of journals. The data were quantitatively and qualitatively analyzed using Microsoft Excel 2013. Additional information about authors' participation was obtained using the R-package Bibliometrix. Publication activity was adjusted for the countries by population size. Also, author co-citation analysis and a term co-occurrence analysis with the terms included in the title and abstract of publications was presented as network visualization maps using VOSviewer. Results A total of 2330 biosimilar-related documents identified in the Scopus database, most of them were articles (1452; 62.32%). The number of documents published had an exponential increased between 2004 and 2016 (p < 0.001). The United States was the country with the highest production with 685 (29.40%) documents followed by Germany and UK with 293 (12.58%) and 248 (10.64%), respectively. Switzerland (11.05), Netherlands (5.85) and UK (3.83) showed the highest per capita ratio. The highest citation/article ratio were for the Netherlands (28.06), Spain (24.23), and France (20.11). Gabi Journal published 73 (3.13%) documents; both Biopharm International and Pharmaceutical Technology and Mabs, 41 (1.76%). Three out of top ten journals were Trade publications. Amgen Incorporated from the USA was the most prolific institution with 51 documents followed by Pfizer Inc. with 48. Terms about specific diseases and drugs were found in recent years, compared with terms such as legislation, structure, protein, dose and generic in the early years. Conclusions Research production and publication of documents on biosimilars are increasing. The majority of publications came from high-income countries. The trends in terminology use are according to state of the art in the topic, and reflects the interest in the utilization of biosimilars in diseases who are expected to obtain benefits of its use.
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Affiliation(s)
| | | | | | - Daniel Comandé
- 4Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Diego Rosselli
- 5Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
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Lee WJ, Briars L, Lee TA, Calip GS, Suda KJ, Schumock GT. Use of Tumor Necrosis Factor-Alpha Inhibitors in Children and Young Adults With Juvenile Idiopathic Arthritis or Rheumatoid Arthritis. Pharmacotherapy 2016; 36:1201-1209. [DOI: 10.1002/phar.1856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Wan-Ju Lee
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Leslie Briars
- Department of Pharmacy Practice; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Gregory S. Calip
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Katie J. Suda
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center of Innovation for Complex Chronic Healthcare; Hines VA Hospital; Hines Illinois
| | - Glen T. Schumock
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
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Gidman W, Meacock R, Symmons D. The humanistic and economic burden of juvenile idiopathic arthritis in the era of biologic medication. Curr Rheumatol Rep 2016; 17:31. [PMID: 25874347 DOI: 10.1007/s11926-015-0508-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a poorly understood, heterogeneous, incurable, inflammatory syndrome. Long-term outcomes are uncertain, and this painful condition can result in lifelong disability. JIA is associated with considerable financial and humanistic burden for those affected and the healthcare system. Early diagnosis and effective treatment are indicated to optimise outcomes. Modern treatment aims to achieve remission and preserve joint function by using disease-modifying antirheumatic drugs (DMARDs) early. DMARDs can be classified as conventional/traditional or biologic. Biologic medications may be more effective but cost approximately ten times more than traditional DMARDs. Decision-makers in healthcare are increasingly comparing the cost and consequences of alternative treatment strategies to guide resource allocation decisions. There have been few economic evaluations to date to guide medicines optimisation in JIA. This systematic review highlights the lack of existing evidence relating to the humanistic and economic burden of JIA in the era of biologic medication.
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Affiliation(s)
- Wendy Gidman
- Centre for Health Economics, University of Manchester, Oxford Road, Manchester, UK,
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Twilt M, Tzaribachev N. Juvenile idiopathic arthritis: A frequent cause for chronic joint inflammation in childhood. Semin Orthod 2015. [DOI: 10.1053/j.sodo.2015.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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