Pharmacoeconomics of obesity in China: a scoping review

Enzyme-esterified grape seed proanthocyanidin derivatives as novel lipid-lowering agents

Grape seed proanthocyanidin (GSP), as a natural antioxidant, has great potential to be developed into a lipid-lowering agent, but its low lipophilicity and stability greatly limit its application. In this study, an enzymatic esterification strategy was developed to introduce fatty acid chains into GSP, resulting in the successful synthesis of a series of new GSP derivatives. The results showed that up to 85% conversion of GSP and 35% TAG inhibition rate of GSP derivatives were achieved. The structures of GSP derivatives were identified by UPLC-MS/MS, and seven derivatives were confirmed as catechin-3'-O-laurate, epicatechin-3'-O-laurate, epicatechin gallate-3″,5″-di-O-laurate, epicatechin gallate-3',3″,5″-tri-O-laurate, procyanidin B1-3',3″-di-O-laurate, procyanidin B2-3',3″-di-O-laurate and procyanidin C1-3',3″,3‴-tri-O-laurate by NMR. GSP derivatives exhibited higher inhibitory effects on lipid accumulation, intracellular TAG and TC than parent GSP. These results indicate that GSP derivatives have potential as lipid-lowering agents for utilization in the food industry.

Breast Cancer Screening Should Embrace Precision Medicine: Evidence by Reviewing Economic Evaluations in China

The cost-effectiveness of conventional population-based breast cancer screening strategies (e.g. mammography) has been found controversial, while evidence shows that genetic testing for early detection of pathogenic variants is cost-effective. We aimed to review the economic evaluations of breast cancer screening in China to provide an information summary for future research on this topic. We searched the literature to identify the economic evaluations that examined breast cancer screening and testing in China, supplemented by hand-searching the reference lists of the included studies. We finally included five studies satisfying our inclusion criteria. Four articles examined mammography while the rest investigated multigene testing. The existing breast cancer screening programmes were found to be cost-effective among urban Chinese women, but one study concluded that they might cause harm to women in rural areas. Contextual factors, such as data absence, urban-rural disparity, willingness-to-pay threshold, and model design, imposed barriers to cost-effectiveness analysis. Multigene testing was found to be cost-effective and has a promising population impact among all women with breast cancer in China. Future research should investigate the cost-effectiveness of screening and identifying breast cancer through precision medicine technologies, including genetic testing, genome sequencing, cascade testing, and the return of secondary findings.

Incorporating productivity loss in health economic evaluations: a review of guidelines and practices worldwide for research agenda in China

Introduction

Productivity loss may contribute to a large proportion of costs of health conditions in an economic evaluation from a societal perspective, but there is currently a lack of methodological consensus on how productivity loss should be measured and valued. Despite the research progress surrounding this issue in other countries, it has been rarely discussed in China.

Methods

We reviewed the official guidelines on economic evaluations in different countries and regions and screened the literature to summarise the extent to which productivity loss was incorporated in economic evaluations and the underlying methodological challenges.

Results

A total of 48 guidelines from 46 countries/regions were included. Although 32 (67%) guidelines recommend excluding productivity loss in the base case analysis, 23 (48%) guidelines recommend including productivity loss in the base case or additional analyses. Through a review of systematic reviews and the economic evaluation studies included in these reviews, we found that the average probability of incorporating productivity loss in an economic evaluation was 10.2%. Among the economic evaluations (n=478) that explicitly considered productivity loss, most (n=455) considered losses from paid work, while only a few studies (n=23) considered unpaid work losses. Recognising the existing methodological challenges and the specific context of China, we proposed a practical research agenda and a disease list for progress on this topic, including the development of the disease list comprehensively consisting of health conditions where the productivity loss should be incorporated into economic evaluations.

Conclusion

An increasing number of guidelines recommend the inclusion of productivity loss in the base case or additional analyses of economic evaluation. We optimistically expect that more Chinese researchers notice the importance of incorporating productivity loss in economic evaluations and anticipate guidelines that may be suitable for Chinese practitioners and decision-makers that facilitate the advancement of research on productivity loss measurement and valuation.