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Hospital Based Health Technology Assessment: an example from Siena 基于医院的卫生技术评估:以锡耶纳为例
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2015-03-30 DOI: 10.7175/FE.V16I1.943
P. Manzi, P. Barberini, F. Dori
The Health Technology Assessment (HTA) has emerged in recent years as a useful tool in healthcare decision-making. It is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology and provides evidence-based information on how to allocate resources. The experience of Siena University Hospital is an example of multidisciplinary hospital-based HTA. In the present paper we summarize the organization of HTA commission and the assessment methodology of the purchase, rental or sale of medical equipment and medical devices. Furthermore we illustrate the data concerning the commission activities in 2013.
近年来,卫生技术评估(HTA)已成为医疗保健决策的有用工具。这是一个多学科的过程,总结与使用卫生技术有关的医学、社会、经济和伦理问题的信息,并提供关于如何分配资源的循证信息。锡耶纳大学医院的经验是以多学科医院为基础的HTA的一个例子。本文总结了医疗器械和医疗器械购销、租赁的佣金组织和评估方法。此外,我们还举例说明了2013年委员会活动的数据。
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引用次数: 1
Cost differentials of dental outpatient care across clinical dentistry branches 跨临床牙科分支的牙科门诊护理的成本差异
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2015-03-30 DOI: 10.7175/FE.V16I1.661
J. Rančić, N. Rančić, N. Majstorović, V. Biočanin, M. Milosavljevic, M. Jakovljevic
Background: Dental care presents affordability issues in Central & Eastern European transitional economies due to lack of insurance coverage in most countries of the region and almost complete out-of-pocket payments by citizens. Objective: Real world estimates on cost differentials across clinical dentistry branches, ICD-10 diagnostic groups and groups of dental services. Methods: Prospective case-series cost analysis was conducted from the patient perspective. A six months time horizon was adopted. Sample size was 752 complete episodes of treatment in 250 patients, selected in 2012/2013 throughout several specialist state- and private-owned dental clinics in Serbia. All direct costs of dental care were taken into account and expressed in Euros (€). Results: Mean total costs of dental care were € 46 ± 156 per single dentist visit while total costs incurred by this population sample were € 34,424. Highest unit utilization of services belongs to conservative dentistry (31.9%), oral surgery (19.5%) and radiology (17.4%), while the resource with the highest monetary value belongs to implantology € 828 ± 392, orthodontics € 706 ± 667 and prosthetics € 555 ± 244. The most frequently treated diagnosis was tooth decay (33.8% unit services provided), pulpitis (11.2%) and impacted teeth (8.5%), while most expensive to treat were anomalies of tooth position (€ 648 ± 667), abnormalities of size and form of teeth (€ 508 ± 705) and loss of teeth due to accident, extraction or local periodontal disease (€ 336 ± 339). Conclusion: Although the range of dental costs currently falls behind EU average, Serbia’s emerging economy is likely to expand in the long run while market demand for dental services will grow. Due to threatened financial sustainability of current health insurance patterns in Western Balkans, getting acquainted with true size and structure of dental care costs could essentially support informed decision making in future.
背景:由于该地区大多数国家缺乏保险覆盖以及公民几乎完全自掏腰包,牙科保健在中欧和东欧转型经济中呈现出负担能力问题。目的:真实世界估算牙科临床分支、ICD-10诊断组和牙科服务组之间的成本差异。方法:从患者角度进行前瞻性病例系列成本分析。采用了六个月的时间期限。样本量为250名患者的752次完整治疗,于2012/2013年在塞尔维亚的几个专科国家和私营牙科诊所中选择。所有牙科护理的直接费用都被考虑在内,并以欧元表示。结果:牙科护理的平均总费用为€46±156每次牙医就诊,而该人口样本的总费用为€34,424。单位服务利用率最高的是保守牙科(31.9%)、口腔外科(19.5%)和放射科(17.4%),而货币价值最高的资源是种植科(828±392欧元)、正畸科(706±667欧元)和修复科(555±244欧元)。最常见的治疗诊断是蛀牙(提供的单位服务占33.8%)、牙髓炎(11.2%)和阻生牙(8.5%),而治疗费用最高的是牙齿位置异常(648±667欧元)、牙齿大小和形状异常(508±705欧元)以及因事故、拔牙或局部牙周病导致的牙齿脱落(336±339欧元)。结论:虽然目前塞尔维亚的牙科费用范围落后于欧盟平均水平,但从长远来看,塞尔维亚的新兴经济可能会扩大,而牙科服务的市场需求将会增长。由于西巴尔干地区目前健康保险模式的财政可持续性受到威胁,了解牙科保健费用的真实规模和结构可以从根本上支持今后作出明智的决策。
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引用次数: 5
Impact of new healthcare legislation and price policy on healthcare services provider at the time of financial crisis. A 10 years study 金融危机时期新的医疗保健立法和价格政策对医疗保健服务提供商的影响。一项为期10年的研究
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2015-03-30 DOI: 10.7175/FE.V16I1.1040
I. Malovecká, Konstantinos Papargyris, D. Mináriková, V. Foltán, Anežka Jankovská
Monitoring, calculation and assessment of healthcare services prosperity in the community pharmacy with the help of financial analysis indicators for the years 2003-2012, using financial statements was conducted, with respect to profitability, debt, liquidity, working capital, and efficiency parameters. These ratios reflect various changes that hold between years 2003 and 2012. Under the time of financial crisis, recession and serious socio-economic changes the profitability parameter Gross Profit ranged from 2003-2011 = 16.12-22.79% (average = 19.20%; mean = 19.78%; σ = 2.41), but in 2012 decreased on 14.35%. Net Profit ranged 2003-2011 = 10.96-18.3% (average = 14.62%; mean = 16.62%; σ = 4.92), while in 2012 reached only 2.29%. Debt ratio ranged from 2003-2012= 2.33-4.81 (average = 3.44; mean = 3.07; σ = 0.82). Liquidity parameters Current Ratio spread between 2003-2012 = 1.13-1.71 (average = 1.43; mean = 1.46; σ = 0.15) and Quick Ratio spread between 2003-2012 = 0.72-1.27 (average = 1.07; mean = 1.09; σ = 0.15). Working Capital Ratio ranged from 2003-2012 = 2.66-12.94 (average = 9.58; mean = 10.06; σ = 3.1) and efficiency ratios were measured either. All changes that have taken place in the society had an impact on community pharmacy finance by worsening its profitability, liquidity, working capital and some of efficiency parameters. Therefore the stability of community pharmacy may be threatened and may affect its future performance.
利用财务报表,利用2003-2012年财务分析指标,对社区药房的保健服务繁荣情况进行了监测、计算和评估,涉及盈利能力、债务、流动性、营运资金和效率参数。这些比率反映了2003年至2012年间的各种变化。在金融危机、经济衰退和严重的社会经济变化时期,盈利能力参数毛利润在2003-2011年为16.12-22.79%(平均为19.20%;平均值= 19.78%;σ = 2.41),但2012年下降了14.35%。净利润区间2003-2011 = 10.96-18.3%(平均14.62%;平均值= 16.62%;σ = 4.92),而2012年仅为2.29%。2003-2012年的负债率为2.33-4.81(平均为3.44;平均值= 3.07;σ = 0.82)。2003-2012年流动比率差= 1.13-1.71(平均= 1.43);平均值= 1.46;σ = 0.15),速动比率差= 0.72-1.27(平均= 1.07;平均值= 1.09;σ = 0.15)。2003-2012年营运资本比率为2.66-12.94(平均为9.58;平均值= 10.06;σ = 3.1)和效率比。社会发生的各种变化对社区药房财务产生了影响,使其盈利能力、流动性、营运资金和一些效率参数恶化。因此,社区药房的稳定性可能受到威胁,并可能影响其未来的表现。
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引用次数: 3
Hospital oncology costs among the cohort of elderly in an aging South-Eastern European nation 东南欧一个老龄化国家老年人的医院肿瘤费用
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2015-03-30 DOI: 10.7175/FE.V16I1.1167
M. Jakovljevic, M. Folic, A. Dagović
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引用次数: 3
The trend of pharmaceutical expenditure in Italy: from the report OsMed 2013 to the monitoring 2014 意大利药品支出趋势:从2013年OsMed报告到2014年监测
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2014-12-23 DOI: 10.7175/FE.V15I4.975
M. Eandi
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引用次数: 0
Cost-effectiveness of intravitreal therapy in Age-Related Macular Degeneration 玻璃体内治疗老年性黄斑变性的成本-效果
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2014-12-23 DOI: 10.7175/fe.v15i4.976
P. Neri, I. Arapi, C. Eandi, V. Pirani, C. Mariotti, A. Giovannini
Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. Advances in medical research have identified vascular endothelial growth factor (VEGF) as an important pathophysiological player in neovascular AMD and intraocular inhibition of VEGF as one of the most efficient therapies. Anti-VEGFs currently used to treat AMD included a monoclonal antibody (bevacizumab), an antibody fragments (ranibizumab), a fusion protein (aflibercept), and an aptamer (pegaptanib). The wide introduction of anti-VEGF therapy has led to an improvement in the prognosis of patients affected by AMD, with a consequent effects on the burden of care due to highly priced drugs, increasing patient numbers, and long-term disease chronicity. Aim of this review is to present an overview of available therapeutic strategies in AMD in term of clinical efficacy and economic sustainability.
年龄相关性黄斑变性(AMD)仍然被认为是世界范围内严重和不可逆转的视力丧失的主要原因。随着医学研究的进展,血管内皮生长因子(VEGF)在新生血管性AMD中起着重要的病理生理作用,眼内抑制VEGF是最有效的治疗方法之一。目前用于治疗AMD的抗vegf包括单克隆抗体(贝伐单抗)、抗体片段(雷尼单抗)、融合蛋白(afliberept)和适配体(pegaptanib)。抗vegf治疗的广泛应用改善了AMD患者的预后,但由于药物价格高昂、患者数量增加和疾病的长期慢性,治疗负担随之增加。这篇综述的目的是在临床疗效和经济可持续性方面概述AMD的可用治疗策略。
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引用次数: 1
Pharmacoeconomic aspects related to the 13-valent pneumococcal conjugate vaccine: preliminary analysis of the data from the ASL of Viterbo 与13价肺炎球菌结合疫苗相关的药物经济学方面:对维特博ASL数据的初步分析
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2014-12-23 DOI: 10.7175/FE.V15I4.980
S. Dari, F. Verginelli, S. Aquilani
INTRODUCTION: Streptococcus pneumoniae is a pathogen of considerable importance to public health because it causes morbidity and mortality on the world population. It has more than 90 serotypes with different epidemiological characteristics and pathogenicity. Some categories of the population are particularly vulnerable to infection. The Regional Plan for the Prevention of Lazio for vaccination, based on the national plan for the prevention for vaccination involves the active offer of vaccination no 13-valent PCV, with a target of at least 90% in children 24 months of age. OBJECTIVE: To begin to assess the real economic impact of disease attributable to Pneumococcus, starting from the analysis of hospital discharge records (SDO) of the Viterbo's ASL. METHODS: The model is structured follows the observational approach of 33 months, from January 2012 to September 2014, selecting the SDO with a principal diagnosis of Streptococcus Pneumoniae diseases and those with a principal diagnosis of respiratory diseases without etiological diagnosis, which, with good approximation, it can be considered responsible for Streptococcus pneumoniae 40%. RESULTS: From the preliminary analysis of the data, evaluating only patients diagnosed due to Pneumococcus, is known as the only pediatric cases hospitalized are between 0 and 1 year. Therefore one might assume that vaccination disbursed to the child population with 13-valent PCV, has ensured effective protection to persons of the age group 2-18 years. CONCLUSIONS: The importance of this study is the observation conducted on an ASL, (similar in size and catchment area to many Italian realty) of the vaccination coverage effects, as provided by PRPV Lazio Region, on hospitalizations by Pneumococcus. The study offers a moment of reflection for decision makers, as it would be interesting to conduct pharmacoeconomic’s analysis in the presence of vaccination strategies extended to adults, especially for those at risk, associated with diagnostic tests etiological more specific.
简介:肺炎链球菌是一种对公共卫生相当重要的病原体,因为它引起世界人口的发病率和死亡率。它有90多种血清型,具有不同的流行病学特征和致病性。某些类别的人口特别容易受到感染。在国家预防疫苗接种计划的基础上,拉齐奥预防疫苗接种区域计划涉及积极提供13价PCV疫苗接种,目标是24月龄儿童的接种率至少达到90%。目的:从维泰博ASL的出院记录(SDO)分析入手,评估肺炎球菌所致疾病的实际经济影响。方法:采用2012年1月至2014年9月33个月的观察方法构建模型,选取主要诊断为肺炎链球菌疾病的SDO和主要诊断为呼吸道疾病但未进行病因学诊断的SDO,在较好的近似下,可认为其对肺炎链球菌疾病的发生率为40%。结果:从初步分析的资料来看,仅评估因肺炎球菌诊断的患者,已知仅住院的儿科病例均在0 ~ 1岁之间。因此,人们可能会认为,向儿童接种13价PCV疫苗,确保了对2-18岁年龄组的人的有效保护。结论:本研究的重要性在于对一个ASL(规模和集水区与许多意大利地区相似)进行的疫苗接种覆盖效果的观察,该观察由PRPV拉齐奥地区提供,对肺炎球菌住院治疗的影响。这项研究为决策者提供了一个反思的时刻,因为在疫苗接种策略扩展到成年人的情况下进行药物经济学分析将是有趣的,特别是对于那些有风险的人,与病因学更具体的诊断测试相关。
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引用次数: 0
How do European patients feel about the listening skills of primary care physicians? Results from the EUprimecare Project 欧洲病人对初级保健医生的倾听技巧有何看法?EUprimecare项目的结果
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2014-12-23 DOI: 10.7175/FE.V15I4.979
C. Piedra, S. Garcia-Perez, F. Prado-Galbarro, A. Sarría-Santamera
OBJECTIVE: EUprimecare is a study funded by the 7th Framework Programme of the European Union aimed at analyzing the quality of the different models of primary care (PC) in Europe. The objective of this study was to describe and analyze the determinants associated with patient satisfaction with the listening skills of their PC physicians. METHODS: Telephone population survey in each EUprimecare consortium countries (Germany, Spain, Estonia, Finland, Hungary, Italy and Lithuania) among PC users. The questionnaire included sociodemographic variables, health status, use and satisfaction with PC services. The survey was conducted in 3020 patients. It was developed descriptive analysis, bivariate correlations and ordinal regression model to study the direct relation between levels of satisfaction and the explanatory variables on demographics, state and health services for patients. We show the regression coefficients (β) with 95% confidence interval and statistical significance associated. RESULTS: We found significant relation between the level of satisfaction and age (β = 0.016), visits to specialist (β = ‑0.040), having a general practitioner (GP) (β = 0.619), having a chronic disease (β = 0.255), measuring weight, cholesterol and blood pressure (β = 0.650), countries (β1 Estonia= 0.938; β2 Germany = 0.469; β3 Lithuania = 0.483; β5 Italy = 0.544 and β6 Hungary = 1.010) and a better perception of health status (β = 0.388). Specialist visits have a negative influence with the higher degree of satisfaction. CONCLUSIONS: Overall, the results indicate some areas that may be related to greater doctor‑patient satisfaction. Different factors are converging to explain satisfaction with listening skills.
目的:EUprimecare是由欧盟第7框架计划资助的一项研究,旨在分析欧洲不同初级保健(PC)模式的质量。本研究的目的是描述和分析与患者满意度相关的决定因素与他们的PC医生的听力技巧。方法:对欧盟各成员国(德国、西班牙、爱沙尼亚、芬兰、匈牙利、意大利和立陶宛)的PC用户进行电话人口调查。问卷包括社会人口学变量、健康状况、PC服务的使用和满意度。调查对象为3020例患者。采用描述性分析、双变量相关和有序回归模型,研究患者满意度与人口统计学、状态和卫生服务等解释变量之间的直接关系。我们显示回归系数(β)与95%置信区间和统计显著性相关。结果:满意度与年龄(β = 0.016)、看专科医生(β =‑0.040)、看全科医生(β = 0.619)、患有慢性疾病(β = 0.255)、测量体重、胆固醇和血压(β = 0.650)、国家(β1爱沙尼亚= 0.938;β2德国= 0.469;β3立陶宛= 0.483;β5意大利= 0.544,β6匈牙利= 1.010)和更好的健康状况感知(β = 0.388)。专科就诊对满意度有负向影响,满意度越高。结论:总体而言,结果表明一些领域可能与更高的医患满意度有关。不同的因素共同解释了人们对听力技能的满意度。
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引用次数: 2
Economic impact of the use of Hyalubrix® in the treatment of hip osteoarthritis in Italy 在意大利使用Hyalubrix®治疗髋关节骨关节炎的经济影响
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2014-12-23 DOI: 10.7175/fe.v15i4.977
A. Migliore, A. Belisari, Lucia S D'Angiolella, E. Bizzi, U. Massafra, P. Piscitelli, L. Mantovani
The present study aims at evaluating the economic impact of the use of hyaluronic acid (Hyalubrix®60/HyalOne) as an alternative to surgery in the treatment of hip osteoarthritis, consistently with the therapeutic protocol envisaged in the Ortobrix study. To quantify the cost and efficacy of the treatment options under evaluation, the perspective of both the Italian NHS and the Society was considered. To this end, a decision analysis model was created over a 4-year period, to quantify the cost of treatments, procedures and adverse events, as well as the benefits expressed as survival rates and reduced lost workdays. The results show that, since the treatment with Hyalubrix® enables to avoid or delay the need for Total Hip Replacement (THR) surgery, it is possible to reduce mortality, adverse events and total costs. Hyalubrix®, given in the hip by ultrasound-guided intra-articular injection as an alternative to surgery is the most favourable option, helping preserve the survival rate over a 4-year period, of approximately 1 in 100 patients considered candidates for THR, preserve work capacity for a total differential amount of 500 days, and achieve considerable savings in economic terms, of approximately 550,000 € and 600,000€ euros from the NHS and the Societal perspectives, respectively.
本研究旨在评估使用透明质酸(Hyalubrix®60/HyalOne)作为髋关节骨关节炎手术治疗的替代方案的经济影响,与Ortobrix研究中设想的治疗方案一致。为了量化评估中治疗方案的成本和疗效,考虑了意大利NHS和社会的观点。为此,我们创建了一个为期4年的决策分析模型,以量化治疗、程序和不良事件的成本,以及以存活率和减少的工作日为表示的收益。结果表明,由于Hyalubrix®治疗能够避免或延迟全髋关节置换术(THR)手术的需要,因此有可能降低死亡率、不良事件和总成本。Hyalubrix®通过超声引导关节内注射在髋关节内,作为手术的替代方案,是最有利的选择,有助于保持4年期间的生存率,大约100名THR候选人中有1名,保持500天的总差异量的工作能力,并在经济方面实现可观的节省,从NHS和社会角度分别约为55万欧元和60万欧元。
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引用次数: 0
The economic impact associated with cerebrovascular events related to non-valvular atrial fibrillation (NVAF) in Italy: the role of apixaban 意大利非瓣膜性心房颤动(NVAF)相关脑血管事件的经济影响:阿哌沙班的作用
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2014-12-22 DOI: 10.7175/fe.v15i1s.972
L. Pradelli, M. Calandriello, R. D. Virgilio, M. Bellone, M. Tubaro
Farmeconomia. Health economics and therapeutic pathways 2014; 15(Suppl 1) © SEEd All rights reserved appropriate therapeutic choice: taking into account the embolic and hemorrhagic patient risk, and the risk associated with the use of anticoagulant therapy. The pharmacoeconomic analyses below have been carried out by adapting a decision tree/ Markov model simulating the clinical experience of NVAF patients according to their probability of incurring an ischemic event, or cardiovascular disease. The first paper reports on a cost/effectiveness analysis of the use of apixaban relative to the standard of care in the prevention of thromboembolic events in vitamin K antagonist suitable and unsuitable patients. The second presents a budget impact analysis that compares NVAF patients eligible for treatment with NOACs in two scenarios – with and without apixaban. Clinical comparative effectiveness parameters among NOACs originate from on adjusted indirect comparison (Bucher’s method) using warfarin as common comparator. We hope that this information will support informed decisions by clinicians and especially payers. The presented supplement of Farmeconomia. Health Economics and Therapeutic Pathways focuses on the economic impact associated with cerebrovascular events related to non-valvular atrial fibrillation (NVAF) from the Italian National Health System (NHS) perspective. A brief look into the scientific literature provides an overview on the burden of AF in the Italian population. In 2010, it was estimated that about one million of Italian patients are living with AF [1] and about 70% of them is affected by NVAF [2]. The prevalence of NVAF increases with age: much more than 10% of NVAF patients are over 80 years. The number of affected patients is expected to increase in the next years [2]. AF is associated with stroke and systemic embolism, and increased mortality. The current preventive measures include Vitamin K antagonists and antiplatelet agents, and recently new oral anticoagulants (NOACs) joined them. NOACs are offering a new option at the disposal of physicians to better manage risk of stroke and systemic embolism in NVAF patients. Physicians have to take the
Farmeconomia。卫生经济学和治疗途径2014;15(补充1)©SEEd保留所有权利适当的治疗选择:考虑栓塞和出血患者的风险,以及与使用抗凝治疗相关的风险。以下药物经济学分析是通过采用决策树/马尔可夫模型,根据非瓣瓣性房颤患者发生缺血性事件或心血管疾病的概率,模拟其临床经验进行的。第一篇论文报告了阿哌沙班相对于维生素K拮抗剂适用和不适用患者预防血栓栓塞事件的标准护理的成本/效果分析。第二项研究提出了预算影响分析,比较了在两种情况下(有阿哌沙班和没有阿哌沙班)有资格接受NOACs治疗的非瓣膜性房颤患者。noac的临床比较疗效参数来源于以华法林为共同比较剂的调整间接比较(Bucher法)。我们希望这些信息将支持临床医生,特别是付款人做出明智的决定。《农业经济学》增刊。健康经济学和治疗途径侧重于从意大利国家卫生系统(NHS)的角度与非瓣膜性心房颤动(NVAF)相关的脑血管事件相关的经济影响。对科学文献的简要研究提供了对意大利人口房颤负担的概述。2010年,据估计约有100万意大利患者患有房颤[1],其中约70%为非瓣膜性房颤[2]。非瓣膜性房颤的患病率随着年龄的增长而增加:超过10%的非瓣膜性房颤患者年龄在80岁以上。预计未来几年受影响的患者数量还会增加[2]。房颤与中风、全身栓塞和死亡率增加有关。目前的预防措施包括维生素K拮抗剂和抗血小板药物,最近新的口服抗凝剂(NOACs)也加入其中。noac为医生提供了一种新的选择,可以更好地管理非瓣瓣性房颤患者的中风和全身性栓塞风险。医生必须采取
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引用次数: 1
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Farmeconomia-Health Economics and Therapeutic Pathways
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