Health technology assessment in traditional and complementary medicine: a scoping review of international activity and examples of acupuncture

BACKGROUND

Traditional therapies are crucial in maintaining and improving human well-being. China's healthcare policymakers are attempting to use health technology assessment (HTA) as a decision-making supportive tool. The value assessment framework for Chinese patent medicine (CPM) has been developed and is being adopted and validated widely by research institutions. Subsequently, the healthcare decision-makers particularly hanker for the value framework of traditional non-pharmacological therapies.

METHODS

To construct a practical value framework for traditional non-pharmacological therapies, a scoping review methodology was adopted to identify the evaluation domains and obstacles. A search, screening, and analysis process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Evidence was retrieved from scientific databases and HTA agencies' websites.

RESULTS

The search strategy identified 5 guidelines records and 17 acupuncture HTA reports. By synthesizing the valuable reports of CPM and acupuncture evaluation in representative countries, this study found that Mainland China was promoting the comprehensive value assessment of CPM, whereas the United Kingdom, Singapore, Canada, the United States, and Malaysia had carried out the HTA evaluation of acupuncture for various conditions among which chronic pain was the most common. UK and Singapore applied the HTA results to support acupuncture reimbursement decisions. Three domains, including safety, effectiveness, and economy, were commonly adopted. The identified biggest challenge of evaluating traditional non-pharmacological therapies is the scarce high-quality clinical evidence.

CONCLUSIONS

This study identified value domains and issues of traditional therapies, and pointed out future research implications, to promote the development value framework of traditional therapies.

Forest Carbon Reserve Calculation and Comprehensive Economic Value Evaluation: A Forest Management Model Based on Both Biomass Expansion Factor Method and Total Forest Value

With the continuous intensification of global climate warming, the carbon cycle has become the focus of global climate change, and the calculation and value evaluation of forest carbon reserves is a key link in promoting the global carbon cycle system. Considering the climatic factors, the biomass expansion factor method (BEF) is used to calculate the forest carbon reserves, selecting the best Gompertz model, adding the time change to the forecast model to predict the growth of forest stock, and the four key indexes of total forest value (TEV) are selected for comprehensive evaluation of forest value. The results show that the carbon fixation efficiency and prediction of forest farms depend largely on the trees, and products can provide more value. Accordingly, it is suggested that broad-leaved trees and younger trees should be planted, and broad-leaved trees should be planted to increase forest stock, increase the vertical distribution of forests to increase carbon reserves, and make trees into wood products with longer retention time to achieve higher total forest value.

Evaluation of Ecological Service Function of Liquidambar formosana Plantations

A Liquidambar formosana plantation is a kind of fast-grown forest in the subtropical region, providing a variety of ecosystem services such as superior wood, carbon fixation and oxygen release, and biodiversity maintenance. However, the ecological service function value of Liquidambar formosana plantations is not clear. To gain insights into the characteristics and importance of its ecological and economic benefits, the Liquidambar formosana plantation in the Tianjiling Forest Farm of Changsha City was taken as the specific research object in this paper. The ecological service function evaluation index system for Liquidambar formosana plantations was established based on the relevant research worldwide and the actual situation. The market value method, shadow engineering method, carbon tax method, and other environmental economics methods were used to estimate the value of seven ecological service functions (including organic matter production, carbon fixation and oxygen release, water conservation, soil conservation, soil improvement, air purification, and biodiversity maintenance) of the forest of Liquidambar formosana. The results indicated that the total economic value of ecological service function provided by the Liquidambar formosana plantation of Changsha was 103,277.82 RMB/(hm²·a), and the indirect economic value was 8.47 times that of the direct economic value. Among the seven ecological service functions, the value of carbon fixation and oxygen release was the highest (36,703.33 RMB·hm^-2·a^-1), thus suggesting that the Liquidambar formosana plantation had strong photosynthesis and significant carbon fixation. This study directly reflects the value of forest ecological service function in the form of currency, which is beneficial to provide more insights into forest ecological service function so as to provide basic data and a scientific basis for the protection, construction, and promotion of the sustainable utilization and development of urban forest resources.

[Clinical comprehensive evaluation of Diemailing~® Kudiezi Injection in treatment of cerebral infarction]

Clinical comprehensive evaluation was conducted in "6+1" dimensions(safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine) to reflect the advantages and characteristics of Diemai-ling~® Kudiezi Injection in the treatment of cerebral infarction. This study adopted a combination of qualitative and quantitative evaluation methods. Based on the methodologies of evidence-based medicine, epidemiology, clinical medicine, evidence-based pharmacy, pharmacoeconomics, mathematical statistics, and health technology assessment(HTA), experts gave weight to the criterion layer and index layer, and multi-criteria decision analysis(MCDA) model and CSC v2.0 were used for calculations to evaluate the clinical value of Diemailing~® Kudiezi Injection. The existing evidence showed that active monitoring and a number of randomized controlled trials(RCTs) have been carried out after the listing of Diemailing~® Kudiezi Injection. Since the total incidence of adverse reactions is 0.099% and the incidence of adverse drug reactions(ADR) is rare, the safety evaluation is grade A. The evidence value of effectiveness demonstrated that Diemailing~® Kudiezi Injection combined with conventional western medicine improves the total effective rate of neurological deficit score and quality of daily life in the acute stage of cerebral infarction, which is superior to that in the conventional western medicine treatment group, and the level of evidence is high. Therefore, its efficacy is assessed as grade A. According to the results of economic research, when Diemailing~® Kudiezi Injection combined with conventional western medicine treatment is compared with conventional western medicine treatment, the Diemailing~® Kudiezi Injection group has a greater incremental effect, but the cost is affordable. Given the overall quality evaluation results of economic report is clear, it is evaluated as grade B. The innovation is grade A. The drug is favorable for clinical operation by medical staff and can be accepted by patients due to easy usage without special technical and management requirements. Since the drug exhibits good suitability for clinicians, nurses, pharmacists, and patients, it is evaluated as grade B. Considering its moderate price among similar drugs and good affordability and availability, it is evaluated as grade B. Diemailing~® Kudiezi Injection can evidently improve the clinical symptoms and neurological deficits of fire toxin syndrome of acute cerebral infarction, and this medicine belongs to ethnic medicine. Large-sample active monitoring research has been conducted with rich experience in human use. Therefore, the characteristics of traditional Chinese medicine are evaluated as grade A. The comprehensive clinical evaluation of Diemailing~® Kudiezi Injection is class A. We suggest that it can be directly transformed into relevant policy results of basic clinical medication management by procedure.

Effects of Design Aesthetics on the Perceived Value of a Product

Design aesthetics play a crucial role in product design. Stakeholders expect to develop highly valuable premium products by improving the design aesthetics of products. Nevertheless, the question of how to evaluate the value of design aesthetics has not been fully addressed. In this study, the effects of design aesthetics on the evaluation of the value of a product were investigated through a strictly controlled experiment in which the neural responses of the participants were measured. Forty participants completed the design aesthetics experiment in a laboratory setting. Images of products were divided into two categories: those representing high- and low-design-aesthetic stimuli. Both types of images were labeled with the same price. Overall, the images representing high design aesthetics elicited smaller N100 and lower P200 amplitudes than did the images representing low design aesthetics. This finding indicates that low design aesthetics attracted more attention than high design aesthetics did and that high design aesthetics triggered positive emotions. Low-design-aesthetic products elicited a larger N400 amplitude. This finding reveals the inconsistency between labeled and expected prices. The present study indicates that the N400 component can be used as an indicator for measuring the perceived value of a product in a future product design study. Our study provides event-related potential indicators that can be easily applied in decision making for measuring the perceived value of a product's design.

A Neural Mechanism of Cue-Outcome Expectancy Generated by the Interaction Between Orbitofrontal Cortex and Amygdala

Taste perception is important for animals to take adequate nutrients and avoid toxins for their survival. Appetitive and aversive behaviors are produced by value evaluation of taste and taste expectation caused by other sensations. The value evaluation, coupled with a cue presentation, produces outcome expectation and guides flexible behaviors when the environment is changed. Experimental studies demonstrated distinct functional roles of basolateral amygdala (ABL) and orbitofrontal cortex (OFC) in value evaluation and adaptive behavior. ABL is involved in generating a cue-outcome association, whereas OFC makes a contribution of generating a cue-triggered expectation to guide adaptive behavior. However, it remains unclear how ABL and OFC form their functional roles, with the learning of adaptive behavior. To address this issue, we focus on an odor discrimination task of rats and develop a computational model that consists of OFC and ABL, interacting with reward and decision systems. We present the neural mechanisms underlying the rapid formation of cue-outcome association in ABL and late behavioral adaptation mediated by OFC. Moreover, we offer 2 functions of cue-selective neurons in OFC: one is that the activation of cue-selective neurons transmits value information to decision area to guide behavior and another is that persistent activity of cue-selective neurons evokes a weak activity of taste-sensitive OFC neurons, leading to cue-outcome expectation. Our model further accounts for ABL and OFC responses caused by lesions of these areas. The results provide a computational framework of how ABL and OFC are functionally linked through their interactions with the reward and decision systems.