Value in health regional issues最新文献

{"title":"Cost Analysis of Epilepsy Healthcare in Adults: A Direct Cost Estimate From a Colombian Perspective","authors":"Maritza Alegría-Muñoz RN , César A. Buitrago-Guzmán MD , Camilo Espinosa-Jovel MD , Jorge L. Ramírez-Molina MD , Mateo Enciso-Zuluaga MD , Oscar A. Escobar MD , Gina Montaño-Padilla MD , Carmelo J. Espinosa-Almanza MD , Julieth Martínez MD , Cristian E. Navarro MD, MSc, PhD","doi":"10.1016/j.vhri.2024.101074","DOIUrl":"10.1016/j.vhri.2024.101074","url":null,"abstract":"<div><h3>Objetivos</h3><div>Estimar los costos directos sanitarios que genera la atención ambulatoria y hospitalaria de los adultos con epilepsia en Colombia desde la perspectiva del sistema de salud.</div></div><div><h3>Métodos</h3><div>Análisis de costos a partir de un caso base, que incluyó los costos médicos directos relacionados con el diagnóstico, con el seguimiento, con el tratamiento farmacológico y quirúrgico, y con la atención intrahospitalaria del <em>status epilepticus (SE)</em>. Se llevó a cabo un panel Delphi para la identificación y la cuantificación de los eventos generadores de costos. La valoración monetaria se estimó usando las bases de datos y manuales tarifarios oficiales disponibles en Colombia. Se obtuvo la distribución de los costos utilizando el método de <em>bootstraping.</em> Se ejecutaron dos análisis de sensibilidad determinísticos de una vía.</div></div><div><h3>Resultados</h3><div>El costo total anual de un paciente adulto con epilepsia sin considerar atención hospitalaria por SE es de US dollars $2416.31. Si se incluye al menos una estancia promedio de 8 días en unidad de cuidado intensivo (UCI) para tratar a un paciente con SE, el costo total anual se incrementa a $61 567.72. El costo total de la cirugía resectiva es de $14 894.44, y del implante del estimulador de nervio vago es de $26 565.86.</div></div><div><h3>Conclusión</h3><div>La epilepsia en adultos genera una carga económica para el sistema de salud colombiano similar a la de otros países de ingresos medianos-altos. La fracción principal del gasto la tiene la estancia en UCI, menos recursos económicos se requerirían si los pacientes logran un mejor control de la enfermedad.</div></div><div><h3>Objectives</h3><div>To estimate the direct healthcare costs related to outpatient care and hospital stays for adults with epilepsy in the context of the Colombian healthcare system.</div></div><div><h3>Methods</h3><div>A cost analysis was conducted from a base case, which included direct medical costs related to diagnosis, follow-up, pharmacological and surgical treatment, and in-hospital care for status epilepticus. A Delphi panel was carried out to identify and quantify cost-generating events. The monetary valuation was estimated using official databases and tariff manuals available in Colombia. The cost distribution was obtained using the bootstrapping method. Two one-way deterministic sensitivity analyses were performed.</div></div><div><h3>Results</h3><div>The total annual cost of an adult patient with epilepsy without including hospital stays is US dollars $2416.31. If at least 1 intensive care unit stay (8-day average) is included to treat a patient with status epilepticus, the total annual cost increases to $61 567.72. The total cost of resective surgery is $14 894.44, and the vagus nerve stimulation implant costs $26 565.86.</div></div><div><h3>Conclusions</h3><div>Epilepsy in adults represents a significant economic burden for the Colombian healthcare syst","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"47 ","pages":"Article 101074"},"PeriodicalIF":1.4,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Pain—A Global Problem Demanding Local Evidence and Guidelines","authors":"Rafael Pinedo-Villanueva BA, MSc, PhD , Manuel A. Espinoza MD, MSc, PhD","doi":"10.1016/j.vhri.2024.101069","DOIUrl":"10.1016/j.vhri.2024.101069","url":null,"abstract":"","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"45 ","pages":"Article 101069"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Burden of Alzheimer’s Disease and Its Costs to a Healthcare System in a Large Population in Brazil","authors":"Ana Carolina Vilarinho PhD,&nbsp;Rhainer Guillermo Ferreira PhD","doi":"10.1016/j.vhri.2024.101064","DOIUrl":"10.1016/j.vhri.2024.101064","url":null,"abstract":"<div><h3>Objectives</h3><div>In Brazil, cases of Alzheimer's disease (AD) are particularly prevalent in the southeastern region, including Minas Gerais, the largest state in the area. This study aimed to estimate the disease burden and healthcare costs from 2018 to 2022.</div></div><div><h3>Methods</h3><div>Data on life expectancy, human development index, population size, and gross domestic product per capita were extracted to calculate disability-adjusted life-years (DALYs). Hospital admission data for AD were obtained from the Brazilian Unified Health System Department of Informatics (DATASUS) database, including the number of cases, deaths, age-specific data, and treatment costs. These variables, along with health, social, and environmental data, were processed to create risk factor layers, and the mean cost per DALY was calculated. Generalized estimating equation models were used to analyze the relationship between DALYs and various predictors, controlling for spatial autocorrelation. Maps were created to visualize the distribution of DALYs and cost per DALY.</div></div><div><h3>Results</h3><div>There were 323 221 deaths from AD in Brazil, with cities averaging 3.61 deaths (range 1-73) and 5.43 hospitalizations (range 1-91) annually. The mean cost per city over these years was $9935.87 (range $44.22 to $787 307.93). In Minas Gerais, significant predictors of the estimated burden of AD include the percentage of the population aged 65 years and older, the human development index, and the prevalence of cardiovascular diseases. DALYs were higher than observed, indicating potential underreporting and insufficient resource allocation for AD treatment and prevention.</div></div><div><h3>Conclusions</h3><div>These results emphasize the need for region-specific policies and strategies to address the AD burden effectively. Policy makers should use this information to improve planning and allocate resources appropriately for treatment and prevention.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"45 ","pages":"Article 101064"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing the Travel Burden for Patients to Access Specialized Medicines in Paraná, Brazil.","authors":"Paula Rossignoli, Roberto Pontarolo, Fernando Fernandez-Llimos","doi":"10.1016/j.vhri.2024.101065","DOIUrl":"10.1016/j.vhri.2024.101065","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the potential reduction in distance and travel time with a hypothetical municipal distribution of specialized component medicines in the state of Paraná.</p><p><strong>Methods: </strong>This was a cross-sectional study. Distances and travel times from all the 1025 residential locations in the state of Paraná to dispensing pharmacies were calculated in 2 different models: centralized model with drugs dispensed in the 22 state-owned pharmacies and decentralized model with drugs dispensed in the 399 municipal pharmacies. Road routes were calculated using the Google Maps Distance Matrix API and Euclidean distance using the haversine formula for the southern hemisphere. A sinuosity index was computed by the quotient between these 2 distances. Differences were evaluated through bivariate analyses and effect size measures were reported.</p><p><strong>Results: </strong>In the centralized model, the mean distance to the pharmacy was 59.5 km (SD 34.1), with a travel time of 1.0 hour (SD 0.5) and 579 residential locations (56.7%) more than 50 km away from the pharmacy, 286 (28.0%) between 25 and 50 km, and 156 (15.3%) less than 25 km. In the decentralized model, the mean distance was 10.8 km (SD 16.6), with a travel time of 0.2 hours (SD 0.3) and 14 locations (1.4%) more than 50 km away from the pharmacy, 96 (9.4%) between 25 and 50 km, and 911 (89.2%) less than 25 km. The decentralized model significantly reduced the sinuosity index.</p><p><strong>Conclusions: </strong>Implementing a decentralized dispensing of the specialized component drugs in the state of Paraná would produce a significant reduction in distance and travel time for patients enhancing drug accessibility.</p>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":" ","pages":"101065"},"PeriodicalIF":1.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Aerial Logistics for Immunization: A Model-Based Evaluation of Centralized Storage and Drone Delivery of Vaccines in Ghana Using Empirical Data","authors":"Maria J. Ospina-Fadul MSc ,&nbsp;Pedro Kremer PhD ,&nbsp;Scott E. Stevens MSc ,&nbsp;Florence Haruna MPhil ,&nbsp;Marion Okoh-Owusu MD ,&nbsp;Godfred K. Sarpong MPH ,&nbsp;Kingsley Osei-Kwakye MD ,&nbsp;Billy Joshua BSc ,&nbsp;Osei Sakyi MPH","doi":"10.1016/j.vhri.2024.101066","DOIUrl":"10.1016/j.vhri.2024.101066","url":null,"abstract":"<div><h3>Objectives</h3><div>In mid-2020, the Ghana Health Service introduced Zipline’s aerial logistics (centralized storage and delivery by drones) in the Western North Region to enhance health supply chain resilience. This intervention led to improved vaccination coverage in high-utilization districts. This study assessed the cost-effectiveness of aerial logistics as an intervention to improve immunization coverage.</div></div><div><h3>Methods</h3><div>An attack rate model, adjusted for vaccination coverage and vaccine efficacy, was used to estimate disease incidence among vaccinated and unvaccinated populations, focusing on 17 022 infants. Incremental cost-effectiveness ratios of US dollar per averted disability-adjusted life-year (DALY) were evaluated from societal and government perspectives, using real-world operations data. Probabilistic sensitivity analysis was performed using Monte Carlo simulations.</div></div><div><h3>Results</h3><div>In 2021, aerial logistics averted 688 disease cases. Incremental cost-effectiveness ratios were $41 and $58 per averted DALY from the societal and government perspectives, respectively. The intervention was cost-saving when at least 20% of vaccines delivered by aerial logistics replaced those that would have been delivered by ground transportation, with potential government savings of up to $250 per averted DALY. Sensitivity analysis confirmed the robustness of these findings.</div></div><div><h3>Conclusions</h3><div>Under conservative assumptions, aerial logistics was a highly cost-effective intervention to increase immunization coverage. The intervention was cost-saving even with low levels of replacement of traditional last mile delivery. These findings support expanding aerial logistics within the national immunization program and have significant implications for other low- and middle-income countries seeking cost-effective health supply chain solutions.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101066"},"PeriodicalIF":1.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Real-World Evidence for Health Technology Assessment in Asia: Suggested Typology and Scoping Review","authors":"Ryan R. Nugraha MD, MPH ,&nbsp;Arie Rahadi PhD ,&nbsp;Christian Suharlim MD, MPH","doi":"10.1016/j.vhri.2024.101068","DOIUrl":"10.1016/j.vhri.2024.101068","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to provide the typology of real-world evidence (RWE) and challenges associated with improving the use of RWE in Asian countries.</div></div><div><h3>Methods</h3><div>This article is divided into 2 subsections. First, a narrative review was conducted to classify RWE based on available real-world data. This method was also used to develop a typology of RWE, particularly considering the nature of the data, the potential evidence generated, and the integration methods into health technology assessment (HTA). Finally, a scoping review was undertaken to identify and filter studies focusing on the implementation of RWE in Asia.</div></div><div><h3>Results</h3><div>The use of RWE is associated with many caveats, and therefore, its use in Asia is particularly limited. Based on the narrative review, RWE is divided into 3 broad categories: macro-, meso-, and micro-RWE; each represents a different quality of evidence and range of use as evidence for HTA. Although typology helps with consolidating RWE choices for supporting HTA decision making, challenges still persist in using it for HTA purposes. Institutional support, technical capacity, and infrastructure, including data-related issues, may hinder progress in improving the RWE ecosystem for HTA in Asia.</div></div><div><h3>Conclusions</h3><div>RWE is a helpful tool that can assist in decision making, especially in reimbursement-related decisions. Although knowing facets of RWE helps in choosing appropriate evidence to assist in policy making, challenges associated with its implementation, especially in the Asian context, need to be anticipated.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"46 ","pages":"Article 101068"},"PeriodicalIF":1.4,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Screening for Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus: A Cost-Effectiveness Analysis in Singapore","authors":"Andrea Cremaschi PhD ,&nbsp;Willem van den Boom PhD ,&nbsp;Nicholas Beng Hui Ng MMed ,&nbsp;Beatrice Franzolini PhD ,&nbsp;Kelvin B. Tan PhD ,&nbsp;Jerry Kok Yen Chan PhD ,&nbsp;Kok Hian Tan MMed ,&nbsp;Yap-Seng Chong MD ,&nbsp;Johan G. Eriksson DMSc ,&nbsp;Maria De Iorio PhD","doi":"10.1016/j.vhri.2024.101048","DOIUrl":"10.1016/j.vhri.2024.101048","url":null,"abstract":"<div><h3>Objectives</h3><div>In Singapore, diabetes imposes a huge population health and economic burden. Despite that, there is paucity of evidence on the health economics of screening programs for type 2 diabetes, especially in the context of screening after gestational diabetes (GDM). The objective of this study is to assess cost-effectiveness of universal lifelong screening for type 2 diabetes after GDM, which is supported by current guidelines, compared with elective screening where 54% of mothers with GDM undertake one-off screening. Despite the recommendation for universal lifelong screening, only 54% comply with this in the first postpartum year.</div></div><div><h3>Methods</h3><div>We perform a cost-effectiveness analysis comparing 5 screening strategies, accounting for lifetime costs to the healthcare system and quality of life for Singapore women diagnosed with GDM. In particular, a hybrid decision model, based on a decision tree and Markov models, is implemented to estimate cost and quality-adjusted life-years (QALY). Probabilities, costs, and utilities are obtained from existing literature, governmental databases, the Growing Up in Singapore Towards Healthy Outcomes birth cohort study, and the National University Hospital.</div></div><div><h3>Results</h3><div>Compared with elective screening, universal annual screening reduces cost by SG$19.4 million while adding 3.8 thousand QALYs by each annual cohort of pregnant women. Furthermore, annual screening is cost-effective (lower cost and higher QALY) compared with triennial screening. Sensitivity analysis shows that the findings are robust to parameter specifications.</div></div><div><h3>Conclusions</h3><div>Universal annual screening of women with a history of GDM is cost-effective for reducing diabetes complications compared with strategies with less frequent screening in Singapore.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"45 ","pages":"Article 101048"},"PeriodicalIF":1.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of the Recombinant Zoster Vaccine Among People Living with Human Immunodeficiency Virus in Japan [VHRI Volume 44, November 2024, 101025]","authors":"So Sato MD,&nbsp;Takaaki Konishi MD, PhD,&nbsp;Hiroyuki Ohbe MD, PhD,&nbsp;Hideo Yasunaga MD, PhD","doi":"10.1016/j.vhri.2024.101061","DOIUrl":"10.1016/j.vhri.2024.101061","url":null,"abstract":"","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"44 ","pages":"Article 101061"},"PeriodicalIF":1.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Reform Dynamics of State Management Practices in the Healthcare Sector of the Republic of Kazakhstan: A Global and Local Perspective","authors":"Talgat Zharlygassinov ,&nbsp;Rashid Ruzanov PhD ,&nbsp;Manshuk Dosmanbetova PhD","doi":"10.1016/j.vhri.2024.101047","DOIUrl":"10.1016/j.vhri.2024.101047","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to analyze the changes in public administration practices in this area in the Republic of Kazakhstan and to assess the general state of healthcare in the country.</div></div><div><h3>Methods</h3><div>The study used various methods, including analysis, historical research, deduction, and forecasting, to assess the current state and prospects for healthcare development in the Republic of Kazakhstan and some post-Soviet countries in Eastern Europe.</div></div><div><h3>Results</h3><div>The findings indicate that although these countries have lower qualitative and quantitative healthcare characteristics than more developed nations, they still outperform Kazakhstan. This suggests that Kazakhstan should take a more proactive approach toward developing its healthcare system and prioritizing the well-being of its citizens, their standard of living, and their ability to combat diseases, including financially.</div></div><div><h3>Conclusions</h3><div>The article contributes new insights into the healthcare systems of developing countries, including post-Soviet nations.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"45 ","pages":"Article 101047"},"PeriodicalIF":1.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of a Specialized Oral Nutritional Supplement in the Management of Chronic Wounds in Patients With and Without Diabetes Mellitus: Cost-Effectiveness Analysis","authors":"Adriano Antonio Mehl MD, MSc, PhD ,&nbsp;Victoria Marzagão Ribeiro Pagliosa BSc ,&nbsp;Débora Auad Tauil BSc ,&nbsp;Valéria Abrahão Schilling Rosenfeld MD","doi":"10.1016/j.vhri.2024.101049","DOIUrl":"10.1016/j.vhri.2024.101049","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze the cost-effectiveness of the use of a specialized oral nutritional supplement (ONS) with proline, arginine, vitamins, and micronutrients to stimulate the healing of chronic wounds in patients with and without diabetes mellitus.</div></div><div><h3>Methods</h3><div>This is a quantitative study on cost-effectiveness. This model used a decision-tree model followed by a budget impact analysis from the Brazilian public healthcare system’s perspective. For this analysis, the population and data from a randomized trial of an oral specialized-ONS-containing supplement were considered. For budget impact analysis, an epidemiologic approach was used to estimate the eligible population. The eligible population comprised 3 different groups: patients with pressure ulcers, patients with vascular ulcers, and patients with diabetic feet. The budget impact analysis used the results of the cost-effectiveness analysis.</div></div><div><h3>Results</h3><div>The results demonstrate that the use of specialized ONS, when compared with control ONS, proved to be cost saving (cheaper and more effective), considering the presence of predictive scar factor. The aggregated budget impact analysis results shows that the total reduction of costs after 5 years is USD 332 628 437.00.</div></div><div><h3>Conclusions</h3><div>The use of a specialized ONS was cost-effective in the healing of chronic wounds, when compared with control. The budget impact analysis showed a significant decrease in costs in a 5-year time horizon for the management of pressure ulcers, vascular ulcers, and diabetic feet.</div></div>","PeriodicalId":23497,"journal":{"name":"Value in health regional issues","volume":"45 ","pages":"Article 101049"},"PeriodicalIF":1.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}