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Tarride JE, Okoh A, Aryal K, Prada C, Milinkovic D, Keepanasseril A, Iorio A. Scoping review of the recommendations and guidance for improving the quality of rare disease registries. Orphanet J Rare Dis 2024; 19:187. [PMID: 38711103 PMCID: PMC11075280 DOI: 10.1186/s13023-024-03193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/19/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Rare disease registries (RDRs) are valuable tools for improving clinical care and advancing research. However, they often vary qualitatively, structurally, and operationally in ways that can determine their potential utility as a source of evidence to support decision-making regarding the approval and funding of new treatments for rare diseases. OBJECTIVES The goal of this research project was to review the literature on rare disease registries and identify best practices to improve the quality of RDRs. METHODS In this scoping review, we searched MEDLINE and EMBASE as well as the websites of regulatory bodies and health technology assessment agencies from 2010 to April 2023 for literature offering guidance or recommendations to ensure, improve, or maintain quality RDRs. RESULTS The search yielded 1,175 unique references, of which 64 met the inclusion criteria. The characteristics of RDRs deemed to be relevant to their quality align with three main domains and several sub-domains considered to be best practices for quality RDRs: (1) governance (registry purpose and description; governance structure; stakeholder engagement; sustainability; ethics/legal/privacy; data governance; documentation; and training and support); (2) data (standardized disease classification; common data elements; data dictionary; data collection; data quality and assurance; and data analysis and reporting); and (3) information technology (IT) infrastructure (physical and virtual infrastructure; and software infrastructure guided by FAIR principles (Findability; Accessibility; Interoperability; and Reusability). CONCLUSIONS Although RDRs face numerous challenges due to their small and dispersed populations, RDRs can generate quality data to support healthcare decision-making through the use of standards and principles on strong governance, quality data practices, and IT infrastructure.
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Affiliation(s)
- J E Tarride
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada
- Programs for the Assessment of Technologies in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - A Okoh
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - K Aryal
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - C Prada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Deborah Milinkovic
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
| | - A Keepanasseril
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - A Iorio
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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Peng F, Zheng H. Analysis on the Marketing Trend and Approval Lag of Imported Orphan Drugs from 2010 to 2021 in China. Ther Innov Regul Sci 2023; 57:1314-1321. [PMID: 37651044 DOI: 10.1007/s43441-023-00572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND In order to meet the unmet needs of rare disease patients in China, importing orphan drugs is an important way. The objectives of this study were to investigate the marketing trend of orphan drugs approved by the US Food and Drug Administration (FDA) and imported by China, to examine the orphan drug lag between China and the United States. METHODS This study analyzes the orphan drugs approved by FDA and imported by China from January 2010 to December 2021. The approval lag for orphan drugs between China and the US was calculated and analyzed by approval time. Factors potentially affecting the approval lag, such as target disease, ATC classification, formulation, corporation name, drug type, and whether the indications belong to the first batch of rare diseases catalogue were investigated. RESULTS The number of FDA-approved orphan drugs imported by China is increasing year by year, and the approval lag of these drugs is gradually decreasing, especially in the classification of Non-L, Injections, Non-United States, and biological product. Compared with 2010-2015, the approval lag of total drugs in the study was significantly improved in 2016-2021 (1977 days) compared with 2010-2015 (3928 days). CONCLUSION China's groundbreaking regulatory reforms of drugs since 2015 had made significant progress in reducing orphan drug lags, but there is still considerable room for progress. We should more actively promote the approval of rare disease drugs in China, establish a better approval mechanism, and enable Chinese patients with rare diseases to receive drug treatment in a timely manner.
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Affiliation(s)
- Feifei Peng
- School of Pharmaceutical Sciences, Chongqing Medical University, #1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Hang Zheng
- School of Pharmaceutical Sciences, Chongqing Medical University, #1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.
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Liu J, Yu Y, Zhong M, Ma C, Shao R. Long way to go: Progress of orphan drug accessibility in China from 2017 to 2022. Front Pharmacol 2023; 14:1138996. [PMID: 36969835 PMCID: PMC10031016 DOI: 10.3389/fphar.2023.1138996] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
Introduction: Over 400 million patients worldwide suffer from rare diseases. Access to orphan drugs is, therefore, crucial for this population. China has been actively working on improving orphan drug accessibility in the past decades, especially since 2018 when the First National List of Rare Diseases was announced. This study aimed to evaluate the current status of orphan drug accessibility in China regarding availability, daily cost, and affordability.Methods: Market availability of orphan drugs in China was based on their approval status in China up to May 2022. Information on drug availability in hospitals and the cost of each drug from 2017 to 2021 was obtained from the database of the Science and Technology Development Center of the Chinese Pharmaceutical Association. Affordability was assessed by comparing the disposable daily income per capita to the cost of the defined daily dose of each drug.Results: Market availability rate was 44.3% by May 2022, and the average delay in drug approval in China compared to its orphan approval in the United States of America was 5.9 ± 6.07 years. Drug availability in hospitals showed an upward trend, with availability in tertiary hospitals significantly higher than in secondary hospitals (~20%, p <0.0001). The eastern area was significantly higher in availability from 2019 onwards. Fifty-eight percent of the orphan drugs were still considered to have very low availability (<30%). The national median cost of the defined daily dose across all available orphan drugs had increased to 254.97 RMB in 2021. Only 34.98% of the orphan drugs were considered affordable when compared with the national average disposable daily income in 2021, and drug affordability decreased during the past 5 years.Discussion: Changes in orphan drug regulations in China have enabled progress regarding the drugs’ market availability, but the current status of drug availability at hospitals, drug cost, and affordability were not optimal. Legislation for encouraging domestic drug development and novel payment schemes for high-value drugs are essential to further improve the availability and cost burden of orphan drugs in China
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Affiliation(s)
- Jia Liu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yue Yu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Mingkang Zhong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Chunlai Ma
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Chunlai Ma, ; Rong Shao,
| | - Rong Shao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- *Correspondence: Chunlai Ma, ; Rong Shao,
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Messiaen C, Racine C, Khatim A, Soussand L, Odent S, Lacombe D, Manouvrier S, Edery P, Sigaudy S, Geneviève D, Thauvin-Robinet C, Pasquier L, Petit F, Rossi M, Willems M, Attié-Bitach T, Roux-Levy PH, Demougeot L, Slama LB, Landais P, Jannot AS, Binquet C, Sandrin A, Verloes A, Faivre L. 10 years of CEMARA database in the AnDDI-Rares network: a unique resource facilitating research and epidemiology in developmental disorders in France. Orphanet J Rare Dis 2021; 16:345. [PMID: 34348744 PMCID: PMC8335940 DOI: 10.1186/s13023-021-01957-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In France, the Ministry of Health has implemented a comprehensive program for rare diseases (RD) that includes an epidemiological program as well as the establishment of expert centers for the clinical care of patients with RD. Since 2007, most of these centers have entered the data for patients with developmental disorders into the CEMARA population-based registry, a national online data repository for all rare diseases. Through the CEMARA web portal, descriptive demographic data, clinical data, and the chronology of medical follow-up can be obtained for each center. We address the interest and ongoing challenges of this national data collection system 10 years after its implementation. METHODS Since 2007, clinicians and researchers have reported the "minimum dataset (MDS)" for each patient presenting to their expert center. We retrospectively analyzed administrative data, demographic data, care organization and diagnoses. RESULTS Over 10 years, 228,243 RD patients (including healthy carriers and family members for whom experts denied any suspicion of RD) have visited an expert center. Among them, 167,361 were patients affected by a RD (median age 11 years, 54% children, 46% adults, with a balanced sex ratio), and 60,882 were unaffected relatives (median age 37 years). The majority of patients (87%) were seen no more than once a year, and 52% of visits were for a diagnostic procedure. Among the 2,869 recorded rare disorders, 1,907 (66.5%) were recorded in less than 10 patients, 802 (28%) in 10 to 100 patients, 149 (5.2%) in 100 to 1,000 patients, and 11 (0.4%) in > 1,000 patients. Overall, 45.6% of individuals had no diagnosis and 6.7% had an uncertain diagnosis. Children were mainly referred by their pediatrician (46%; n = 55,755 among the 121,136 total children referrals) and adults by a medical specialist (34%; n = 14,053 among the 41,564 total adult referrals). Given the geographical coverage of the centers, the median distance from the patient's home was 25.1 km (IQR = 6.3 km-64.2 km). CONCLUSIONS CEMARA provides unprecedented support for epidemiological, clinical and therapeutic studies in the field of RD. Researchers can benefit from the national scope of CEMARA data, but also focus on specific diseases or patient subgroups. While this endeavor has been a major collective effort among French RD experts to gather large-scale data into a single database, it provides tremendous potential to improve patient care.
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Affiliation(s)
- Claude Messiaen
- Banque Nationale de Données Maladies Rares, DSI-WIND, APHP, Paris, France.
| | - Caroline Racine
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU de Dijon, Dijon, France
| | - Ahlem Khatim
- Banque Nationale de Données Maladies Rares, DSI-WIND, APHP, Paris, France
| | - Louis Soussand
- Banque Nationale de Données Maladies Rares, DSI-WIND, APHP, Paris, France
| | - Sylvie Odent
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, Hôpital Sud, CHU de Rennes, Rennes, France
| | - Didier Lacombe
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU Bordeaux, et INSERM U1211, Bordeaux, France
| | - Sylvie Manouvrier
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU de Lille, EA 7364 RADEME Maladies Rares du Développement et du Métabolisme, Université Lille, Lille, France
| | - Patrick Edery
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, Hôpital Femme-Mère-Enfant Hospices Civils de Lyon, Bron, France
| | - Sabine Sigaudy
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, Département de Génétique Médicale, CHU de Marseille - Hôpital de La Timone, Marseille, France
| | - David Geneviève
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU Montpellier, Montpellier, France
| | - Christel Thauvin-Robinet
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU de Dijon, Dijon, France.,Filière AnDDI-Rares, CHU Dijon, Dijon, France.,INSERM UMR1231 et FHU TRANSLAD, Université de Bourgogne, Dijon, France
| | - Laurent Pasquier
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, Hôpital Sud, CHU de Rennes, Rennes, France
| | - Florence Petit
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU de Lille, EA 7364 RADEME Maladies Rares du Développement et du Métabolisme, Université Lille, Lille, France
| | - Massimiliano Rossi
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, Hôpital Femme-Mère-Enfant Hospices Civils de Lyon, Bron, France
| | - Marjolaine Willems
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU Montpellier, Montpellier, France
| | | | | | | | - Lilia Ben Slama
- Filière AnDDI-Rares, CHU Dijon, Dijon, France.,Hôpital Necker-Enfants Malades, Paris, France
| | - Paul Landais
- Service de Biostatistique, Epidémiologie, Santé Publique et d'Information Médicale, CHU de Nîmes, Faculté de Médecine Montpellier Nîmes, Nîmes, France
| | | | - Anne-Sophie Jannot
- Banque Nationale de Données Maladies Rares, DSI-WIND, APHP, Paris, France.,AP-HP. Centre - Université de Paris, Paris, France
| | - Christine Binquet
- Inserm, CIC1432, module épidémiologie clinique, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Epidémiologie Clinique/Essais Cliniques, Dijon, France
| | - Arnaud Sandrin
- Banque Nationale de Données Maladies Rares, DSI-WIND, APHP, Paris, France
| | - Alain Verloes
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, AP-HP-Nord-Université de Paris, Hôpital Robert Debré, Department of Medical Genetics and INSERM UMR 1141, Paris, France
| | - Laurence Faivre
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU de Dijon, Dijon, France. .,Filière AnDDI-Rares, CHU Dijon, Dijon, France. .,INSERM UMR1231 et FHU TRANSLAD, Université de Bourgogne, Dijon, France. .,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, Filière AnDDI-Rares, Hôpital D'Enfants, CHU Dijon, 14 rue Gaffarel, Dijon, France.
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Li X, Liu M, Lin J, Li B, Zhang X, Zhang S, Lu Z, Zhang J, Zhou J, Ou L. A questionnaire-based study to comprehensively assess the status quo of rare disease patients and care-givers in China. Orphanet J Rare Dis 2021; 16:327. [PMID: 34294091 PMCID: PMC8296703 DOI: 10.1186/s13023-021-01954-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/11/2021] [Indexed: 12/20/2022] Open
Abstract
Background There are over 16.8 million rare disease patients in China, representing a large community that should not be neglected. While the public lack the awareness of their existence and difficult status quo, for one reason that they exist as a rare and special group in our society, for another reason that all sectors of the community haven’t introduced and propagandized them suitably. However, as a special group with more difficulties in all aspects than normal healthy persons, they need enough care and love from us. To provide a basis for policy-makers to better understand the status quo of rare disease patients and care-givers in China and to devise some new policies to improve their quality of life, a comprehensive analysis of the status quo, unmet needs, difficulty caused by the rare disease is essential.
Methods A questionnaire-based online study of patients and care-givers (usually family members) was performed. The questionnaire was composed of 116 questions, such as the diagnosis process, treatment access, financial burden, views on patients’ organizations, and a series of standardized tests to assess the quality of their life, including the SF-36, PHQ-9, PHQ-15, GAD-7, and PSQI. To examine the influence of age, disease type, and relationship to patients on the scores in these tests, statistical analysis with a general linear model was conducted. Findings A total of 1959 patients and care-givers participated in the survey, representing 104 rare diseases, such as lysosomal storage diseases, hemophilia, and muscular dystrophy diseases. The diagnosis was delayed for 1.4 ± 3.0 years, and patients experienced 1.6 ± 3.8 misdiagnoses between 3.2 ± 2.4 hospitals. The hospitals where diagnoses were made were highly concentrated in 10 large hospitals (43.8%) and 5 big cities (42.1%), indicating a significant inequality of medical resources. The disease often led to difficulty in social life, education, and employment, as well as financial burden that was seldom covered by medical insurance. A battery of standardized tests demonstrated poor health status, depression, somatization, anxiety, and sleeping issues among both patients and care-givers (p < 0.05). Statistical analysis of the questionnaire also showed that poor health, anxiety, depression, somatization, and sleeping problems were more prevalent in patients than in care-givers, and more prevalent in more severe diseases (e.g., hemophilia, Dravet) or undiagnosed than in other diseases. Interpretations This study identified the lack of rare disease awareness and legislative support as the major challenge to rare diseases in China, and makes key recommendations for policy-makers, including legislating orphan drug act, raising rare disease awareness, providing sufficient and fair opportunities about education and employment, expanding the medical insurance coverage of treatments, and protecting rights in education and employment. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01954-7.
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Affiliation(s)
- Xuefeng Li
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, People's Republic of China.,State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China.,Shenzhen Luohu People's Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, 518001, People's Republic of China
| | - Meiling Liu
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, People's Republic of China.,State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China
| | - Jinduan Lin
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, People's Republic of China.,State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China
| | - Bingzhe Li
- School of Electrical and Computer Engineering, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Xiangyu Zhang
- School of Statistics, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Shu Zhang
- Department of Oral Implantology, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, 650106, People's Republic of China
| | - Zijuan Lu
- School of Humanities, Tongji University, Shanghai, 200092, People's Republic of China
| | - Jianyong Zhang
- Jinhaishiji, 333 Jichanglu, Panzhihua, 617000, Sichuan, People's Republic of China
| | - Jincheng Zhou
- Center for Design and Analysis, Amgen Inc., Thousand Oaks, CA, 91320, USA
| | - Li Ou
- Gene Therapy Center, Department of Pediatrics, University of Minnesota, 5-174 MCB, 420 Washington Ave SE, Minneapolis, MN, 55455, USA.
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Abstract
Rare diseases pose unique challenges to health care delivery. In August 2016, the West China Hospital of Sichuan University (WCHSU) established a rare diseases center. This center has created a multidisciplinary team of rare disease experts. The center provides expedited pathways online and offline for patients with rare diseases to save them time and money, to improve their experience, and to increase the hospital's efficiency. At the same time, the center regularly organizes public education campaigns and it offers free consultations to enhance awareness of rare diseases. Establishment of the rare disease alliance and facilitation of 5G-based remote multi-disciplinary consultations will help to improve the level of diagnosis and treatment and to solve problems with diagnosis and treatment encountered by local patients with rare diseases. WCHSU's rare diseases center has been feasible, acceptable, and effective in Western China and it should benefit patients, doctors, and hospitals. The center should lead to significant improvements in treatment for patients with rare diseases. The successful establishment of a rare diseases center here may be a useful reference for other parts of the world.
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Affiliation(s)
- Li Gong
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian He
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Address correspondence to:Qian He, Department of Outpatient, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan, China. E-mail:
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Urtizberea JA, Kaplan JC. [The Frozen Man and the Chinese Alphabet]. Med Sci (Paris) 2020; 36 Hors série n° 2:38-50. [PMID: 33427635 DOI: 10.1051/medsci/2020266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Confucian philosophy teaches us that the search for truth does not always follow a straight line. The clinical observation presented here illustrates this perfectly and is about a child afflicted by a rare neuromuscular disorder (in Chinese, the word 'myopathy' is translated to meaning 'frozen man') in whom was suspected a deficit in αB crystallin. The authors take the opportunity to put the spotlight on China, this great country which did not wait for Alain Peyrefitte to wake up or, more precisely, to rewake. In the light of past and recent missions in the former Middle Kingdom, an update is made on the medico-scientific but also societal issues of this country on the verge of becoming, perhaps, a giant in the field of neuromuscular diseases.
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Zhang S, Chen L, Zhang Z, Zhao Y. Orphan drug development in China: progress and challenges. Lancet 2019; 394:1127-1128. [PMID: 31571591 DOI: 10.1016/s0140-6736(19)32179-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Shuyang Zhang
- Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Limeng Chen
- Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Zongjiu Zhang
- Medical Administration Hospital Authority, National Health Commission, Beijing, China
| | - Yupei Zhao
- Department of Surgery, Peking Union Medical College Hospital, Beijing, China.
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9
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He J, Song P, Kang Q, Zhang X, Hu J, Yang Y, Tang M, Chen D, Hu S, Jin C. Overview on social security system of rare diseases in China. Biosci Trends 2019; 13:314-323. [PMID: 31434816 DOI: 10.5582/bst.2019.01209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
China has initiated the special security project for rare diseases from the national strategic level since 2018. Chinese government has formulated China's First List of Rare Diseases (121 diseases included), established Expert Committee of Diagnosis, Treatment and Security of Rare Diseases and China Alliance of Rare Diseases. The government also encouraged all the provinces to include the security plan and strategies of rare diseases into key work and promoted the establishment of rare diseases clinical research center and the formulation of diagnosis and treatment guidelines. All these actions led to the further improvement of scientific research ability and diagnosis and treatment ability. In terms of the treatment drug of the 121 diseases in China's First List of Rare Diseases, 83 of them are on the market in China and 50 have been included in the national medical insurance accompanied with the tax reduction policy on rare diseases drug and several charity foundations and enterprise donation programs were developed so that drug availability and accessibility for patients are increased. However, there is no clear definition and corresponding coding of rare diseases; the economic burden of most rare diseases could not be calculated accurately because of the difficulty in diagnosis and misclassification. Regarding the service provision system, social security system of rare diseases in China needs further improvement because of the rather few kinds of rare diseases involved in the screening, low level of diagnostic ability, rather few rehabilitation programs and the lack of social caring and knowledge training. It is necessary for China to provide comprehensive and well-rounded health care and social caring for rare diseases patients. Since the formulation and implementation conditions of the policy are different among different regions, the pilot should be carried out first in regions with desired qualifications when China is formulating the rare diseases policy and then a mature national plan should be developed.
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Affiliation(s)
- Jiangjiang He
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center.,School of Public Health, Fudan University
| | - Peipei Song
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center.,The Institute for Global Health Policy Research, National Center for Global Health and Medicine
| | - Qi Kang
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center
| | - Xueyan Zhang
- School of Economics and Management, Jiangxi University of Traditional Chinese Medicine
| | - Jiahao Hu
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet
| | - Yan Yang
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center
| | - Mi Tang
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center
| | - Duo Chen
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center
| | | | - Chunlin Jin
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center
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10
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Min R, Zhang X, Fang P, Wang B, Wang H. Health service security of patients with 8 certain rare diseases: evidence from China's national system for health service utilization of patients with healthcare insurance. Orphanet J Rare Dis 2019; 14:204. [PMID: 31429789 PMCID: PMC6700821 DOI: 10.1186/s13023-019-1165-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 07/22/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Rare diseases are one of the major challenges in the era of precision medicine and reflect the social security level of minority groups. This study aimed to investigate healthcare service utilization and health security of patients with rare diseases in China. METHODS From 29 provinces of Mainland China, 7,747 visits with eight common rare diseases who were linked to the national insurance database between 2014 and 2016 were selected as the study population, whose demographic and healthcare service information was collected from China's national monitoring system for health service utilization of patients with healthcare insurance. Univariate analysis was performed to describe the basic statement of healthcare service, such as visit type, institution type, length of stay, healthcare insurance utilization, and the results of disease burden for different groups and its factors were analyzed by multivariate analysis. RESULTS Medical treatment from general tertiary hospitals was sought by 61.4% of the patients with rare diseases. Of the total treatment cost (TTC) of 40.18 million Chinese Yuan, 63.3% was paid by basic health insurance, and 54.2% of the medical cost resulted from medicine expenditure. Demography, geography and social-economic factors, security level, and health institution situation had an effect on the TTC. The correlations between these factors and TTC were different for outpatients and inpatients. Reimbursement rate had the highest effect on inpatients' TTC. Basic insurance was effective for providing support for patients with rare diseases that involved high costs; however, the coverage was limited. CONCLUSIONS Healthcare insurance is an effective safeguard for patients with rare diseases; however, affordable and accessible treatment is still lacking for such patients. There remains a need to further improve the diagnostic and treatment technology for rare diseases and expertise among doctors, as well as the security level of healthcare policies.
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Affiliation(s)
- Rui Min
- Tongji Medical College, Huazhong University of Science& Technology, No.13 Hankong Road, Wuhan City, 430030 Hubei Province China
| | - Xiaoyan Zhang
- College of Politics & Law and Public Administration, Hubei University, Wuhan, China
| | - Pengqian Fang
- Tongji Medical College, Huazhong University of Science& Technology, No.13 Hankong Road, Wuhan City, 430030 Hubei Province China
| | - Biyan Wang
- School of Public Health and Management, Guangxi University of Chinese Medicine, Nanning, China
| | - He Wang
- Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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11
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Song P, Tang W, Kokudo N. Policy measures taken in Japan to improve the quality of life for patients with rare/intractable diseases. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1623668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Peipei Song
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Wei Tang
- National Center for Global Health and Medicine, Tokyo, Japan
- The University of Tokyo Hospital, Tokyo, Japan
| | - Norihiro Kokudo
- National Center for Global Health and Medicine, Tokyo, Japan
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12
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Yang Y, Kang Q, Hu J, Kong F, Tang M, He J, Jin C. Accessibility of drugs for rare diseases in China: Policies and current situation. Intractable Rare Dis Res 2019; 8:80-88. [PMID: 31218157 PMCID: PMC6557233 DOI: 10.5582/irdr.2019.01068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
"Poor accessibility to drugs" is the most problematic issue for patients with rare diseases in China. In recent years, China has issued a number of policies, such as prioritizing speeding up the evaluation for rare disease drugs, publishing national rare disease lists and giving priority to treatments for severe diseases like rare diseases during annual adjustments of National Medical Insurance Medicine Catalogue to improve the accessibility of rare disease drugs. From the outcome perspective, the evaluation of rare disease drugs takes 3 months shorter than ordinary drugs, basic research projects have been started and the number of rare disease drugs included in National Medical Insurance Medicine Catalogue has increased to 50. However, the policies' effects on new drug research and development, rare disease diagnosis and treatment as well as drug pricing are limited. It is recommended to learn the tilt policy of research and development for rare disease drugs from foreign countries and the mechanism of medical insurance funding and patient co-payments. Thus it is important to improve the availability, accessibility and affordability of rare diseases drugs based on the Chinese context.
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Affiliation(s)
- Yan Yang
- Department of Health Policy Research, Shanghai Health and Development Research Center, Shanghai, China
| | - Qi Kang
- Department of Health Policy Research, Shanghai Health and Development Research Center, Shanghai, China
| | - Jiahao Hu
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
| | - Fanxin Kong
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Mi Tang
- Department of Health Policy Research, Shanghai Health and Development Research Center, Shanghai, China
| | - Jiangjiang He
- Department of Health Policy Research, Shanghai Health and Development Research Center, Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
| | - Chunlin Jin
- Department of Health Policy Research, Shanghai Health and Development Research Center, Shanghai, China
- Address correspondence to:Dr. Chunlin Jin, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai 200040, China. E-mail:
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13
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He J, Tang M, Zhang X, Chen D, Kang Q, Yang Y, Hu J, Jin C, Song P. Incidence and prevalence of 121 rare diseases in China: Current status and challenges. Intractable Rare Dis Res 2019; 8:89-97. [PMID: 31218158 PMCID: PMC6557238 DOI: 10.5582/irdr.2019.01066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 11/05/2022] Open
Abstract
In order to ascertain the current status of and challenges posed by the incidence and prevalence of rare diseases in China, this study teases out data on the incidence and prevalence of 121 rare diseases listed in China's First List of Rare Disease to provide rationales and references for the development and promotion of rare-disease-related policies. The National Health Commission of the People's Republic of China issued the Rare Disease Diagnosis and Treatment Guide (2019) (denoted here as China's Rare Disease Diagnosis and Treatment Guide), which cited data on the incidence/prevalence of 21 rare diseases (21 of 121 rare diseases, 17.36%). Data on 68 diseases (56.20%) were found in monographs, literature databases, and official websites. Data on the incidence/prevalence of 70 diseases were compiled, though no data were available for the 51 remaining diseases. There are published data on the incidence/prevalence of only 14 diseases at the national level. Sources of data on the incidence and prevalence of rare diseases mainly include cases counts from hospitals (40.56%), other sources of data (24.48%), screening (20.98%), cross-sectional studies (8.39%), and estimates from models (7.69%). Data on the incidence/prevalence of rare diseases in China are limited and typically lack accuracy, uniformity, and timeliness. Epidemiological data at the national level are greatly lacking, and data are not amenable to comparison. China recently initiated epidemiological studies of rare diseases at the national and regional level. The country will continue to promote, use, and update its list of common rare diseases, actively encourage the coding and registration of cases of rare diseases, and take actions to collect, share, and use that information.
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Affiliation(s)
- Jiangjiang He
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
| | - Mi Tang
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Xueyan Zhang
- School of Economics and Management, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Duo Chen
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Qi Kang
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Yan Yang
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Jiahao Hu
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Solna, Sweden
| | - Chunlin Jin
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Peipei Song
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
- The Institute for Global Health Policy Research, National Center for Global health and Medicine, Japan
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14
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Kang Q, Hu J, Song P, He J. System building and improvement for the diagnosis and treatment of rare diseases in Shanghai, China. Intractable Rare Dis Res 2018; 7:291-294. [PMID: 30560025 PMCID: PMC6290848 DOI: 10.5582/irdr.2018.01129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Shanghai has always attached importance to the prevention and treatment of rare diseases and has been at the forefront in China. The Shanghai Rare Diseases Diagnosis and Treatment Center, Shanghai Children's Rare Diseases Diagnosis and Treatment Center, and Shanghai Rare Diseases Specialist Clinic were established in February 2018. Moreover, with the development of clinical pathways for rare diseases and the provision of related services such as diagnosis, treatment, screening, information and training, the service system for diagnosis and treatment of rare diseases in Shanghai has formed, which greatly improves the accessibility of medical services for patients with rare diseases in Shanghai and surrounding areas, and is of great significance in reducing the burden on patients with rare diseases. Meanwhile, it also gives an important reference for other regions of China for providing rare disease diagnosis and treatment services.
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Affiliation(s)
- Qi Kang
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Jiahao Hu
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
| | - Peipei Song
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Jiangjiang He
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
- Address correspondence to:Jiangjiang He, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai 200040, China. E-mail:
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Khosla N, Valdez R. A compilation of national plans, policies and government actions for rare diseases in 23 countries. Intractable Rare Dis Res 2018; 7:213-222. [PMID: 30560012 PMCID: PMC6290840 DOI: 10.5582/irdr.2018.01085] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/21/2018] [Accepted: 09/05/2018] [Indexed: 01/01/2023] Open
Abstract
Previous studies have focused on the comparison of specific laws among multiple countries and regions; for example, laws related to facilitating treatments with orphan drugs or laws seeking to address the multiple needs of patients with rare diseases. The purpose of this scoping review is to examine and compare published reports on national plans, polices and legislation related to all rare diseases in different countries. We also examine strategies or programs that countries may have for these diseases. Articles were obtained from journals and books published between January 1, 2000, through December 15, 2017. Reports from the grey literature (documents issued by government and private organizations) were included if they were available on the internet. The databases used were Google and Google Scholar, PubMed, and the websites of Orphanet and the National Organization for Rare Disorders (NORD). We obtained information on 23 countries. Among these countries, the way in which rare diseases were defined varied from having similar definitions to no definition. Multinational programs supported by common or similar laws are likely to have a greater impact on rare diseases than single country programs.
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Affiliation(s)
- Neil Khosla
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rodolfo Valdez
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Derayeh S, Kazemi A, Rabiei R, Hosseini A, Moghaddasi H. National information system for rare diseases with an approach to data architecture: A systematic review. Intractable Rare Dis Res 2018; 7:156-163. [PMID: 30181934 PMCID: PMC6119672 DOI: 10.5582/irdr.2018.01065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The study aims to systematically review literature on the rare diseases information system to identify architecture of this system from a data perspective. The search for relevant English language articles, based on keywords in title, abstract, Mesh and Emtree terms, was done in Pubmed and Embase (from 1980 to June 2017), Scopus, Science Direct and Cochran (from 1980 to July 2017). Articles were selected if they addressed data architecture of information systems with a focus on rare disease, and if at least one of their objectives dealt with design, implementation, and development of rare diseases information systems. Thirty-five studies met the inclusion criteria. The findings were categorized into six groups. This first group addressed organizations acting as data generators, data users, and data governors. The second group was related to data sources and databases. Datasets and data elements formed the third group of findings, including common datasets, specific datasets, and complementary datasets. The fourth group of findings was in relation to data standards. Data sharing and interactions among relevant bodies included the fifth group of the findings. The last group of findings was pertinent to procedures and criteria used for checking the quality of data, as cross review checking was a main procedure assessing the accuracy, consistency, and completeness of data. Design and development of an integrated information system for rare diseases considering data architecture principles in practice could help eliminating issues with management of rare diseases through facilitating sharing information and experiences.
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Affiliation(s)
| | | | - Reza Rabiei
- Department of Health Information Technology and Management, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Address correspondence to:Dr. Reza Rabiei, Department of Health Information Technology and Management, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Darband St., Qods Square (Tajrish), Tehran, Iran, Post Code: 1971653313. E-mail:
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17
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Rare Diseases: Drug Discovery and Informatics Resource. Interdiscip Sci 2017; 10:195-204. [PMID: 29094320 DOI: 10.1007/s12539-017-0270-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 12/13/2022]
Abstract
A rare disease refers to any disease with very low prevalence individually. Although the impacted population is small for a single disease, more than 6000 rare diseases affect millions of people across the world. Due to the small market size, high cost and possibly low return on investment, only in recent years, the research and development of rare disease drugs have gradually risen globally, in several domains including gene therapy, enzyme replacement therapy, and drug repositioning. Due to the complex etiology and heterogeneous symptoms, there is a large gap between basic research and patient unmet needs for rare disease drug discovery. As computational biology increasingly arises researchers' awareness, the informatics database on rare disease have grown rapidly in the recent years, including drug targets, genetic variant and mutation, phenotype and ontology and patient registries. Along with the advances of informatics database and networks, new computational models will help accelerate the target identification and lead optimization process for rare disease pre-clinical drug development.
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