Global Health Research and Policy最新文献

Background: Understanding policymakers' value judgements in reimbursement decisions is essential for promoting equity and guiding informed healthcare decision-making. This study aimed to estimate and compare Chinese policymakers' willingness-to-pay (WTP) per quality-adjusted life year (QALY) specifically in end-of-life treatment scenarios involving life-threatening common and rare diseases.

Methods: We conducted a contingent valuation study employing single-bounded dichotomous-choice questions among 120 experts formally appointed by China's National Healthcare Security Administration to serve on the National Reimbursement Drug List Expert Committee in recent years. Participants evaluated hypothetical scenarios describing end-of-life treatments providing a one-QALY gain for patients with life-threatening common or rare diseases. Data were collected primarily through face-to-face interviews, supplemented by online responses when in-person meetings were impractical. Statistical analysis was performed using probit regression models, and t-tests were conducted to compare WTP values between scenarios.

Results: A total of 99 policymakers participated. Participants' WTP per QALY for end-of-life treatments in common disease scenarios ranged from CNY 78,031 (0.98 times GDP per capita) to CNY 126,449 (1.58 times GDP per capita). In contrast, WTP was significantly higher for rare diseases, ranging from CNY 183,392 (2.29 times GDP per capita) to CNY 219,691 (2.75 times GDP per capita). Analysis of individual characteristics revealed that female participants and those with expertise in pharmacoeconomics exhibited significantly higher WTP values in common disease scenarios (p < 0.05), though these factors had varied effects in rare disease scenarios.

Conclusions: This study provides novel estimates of Chinese policymakers' WTP per QALY specifically in end-of-life contexts involving common and rare diseases, highlighting the significant impact of disease rarity on reimbursement decisions. These findings offer empirical support for adopting differentiated cost-effectiveness thresholds tailored to end-of-life treatments based on disease rarity in China.

Background: The COVID-19 hospital caseload indicates the quality of hospital care, as resources were redirected to address the surge in COVID-19 cases. The study aimed to evaluate the impact of COVID-19 hospital caseload on hospital tuberculosis (TB) case fatality rate (CFR) mediated by the TB caseload and severity of patients.

Methods: A retrospective analysis of TB patients' hospital admission data in Thailand extracted from the Thai Health Information Portal database between January 2017 and September 2022. Charlson Comorbidity Index (CCI) was used to determine the severity of hospitalised TB patients. An interrupted time series analysis, lag time analysis and serial mediation analysis were done.

Results: During COVID-19 pandemic, there was a 12.9% decrease in monthly hospital TB caseload, and a 14.1% increase in monthly TB hospital CFR compared to the counterfactual scenario had there been no COVID-19. COVID-19 hospital caseload had a strong negative correlation with TB hospital caseload (r = - 0.60, p-value = < 0.001), but a strong positive correlation with TB hospital CFR (r = 0.74, p-value = < 0.001) during the same month. An increase in average CCI score of 0.1 was associated with an increase of 2.3 deaths per 100 TB admissions. After adjusting the TB caseload and CCI of TB patients admitted to the hospital, no association was found between COVID-19 hospital caseload and the hospital CFR of TB patients.

Conclusions: The increase in TB hospital CFR during COVID-19 pandemic was likely driven by a higher proportion of severe cases being admitted, rather than a decline in hospitals' quality of care.

Background: Optimizing the cultural accessibility of digital healthcare tools requires understanding user perspectives on usability features and cultural appropriateness.

Methods: A cross-sectional survey of 3,030 caregivers (mean age 44.0, 52.9% female) and 2,108 inpatients (mean age 49.7, 54.0% female) at a Guangxi medical center (July-October 2024) assessed experiences with digital tools, support needs, and preferences for culturally adaptive features.

Results: Caregivers reported a higher adoption of digital tools than patients (caregivers: 87.1% vs. patients: 62.0%, P-value < .001), yet 81.1% of caregivers reported unmet needs. Both groups (caregivers: 67.0%; patients: 64.0%) prioritized integrating traditional medicine over other cultural factors (language diversity, traditional medicine, folk customs, and medical resource availability). Caregivers valued interactive health management tools (73.3% vs. 66.7% among patients, P-value < .001) and user feedback mechanisms (61.2% vs. 55.0% among patients, P-value < .001) more than patients.

Conclusions: Despite high adoption, caregivers report significant gaps in culturally relevant support. Digital health interventions should prioritize user-centered designs, incorporating traditional medicine and addressing the divergent preferences of caregivers and patients.

Background: While calls for promoting evidence-informed policymaking (EIP) have become stronger in recent years, there is a paucity of methods to prioritize issues for knowledge translation (KT) and EIP. As requested by WHO and as part of efforts to address this gap, we conducted a critical interpretive synthesis (CIS) to develop a conceptual framework that outlines the features of priority-setting processes and contextual factors influencing the prioritization of issues for KT efforts.

Methods: We systematically reviewed the literature and used an interpretive analytic approach-the CIS-to synthesize the results and develop the conceptual framework. We used a "compass" question to create a detailed search strategy and conducted electronic searches to identify papers based on their potential relevance to priority-setting for KT efforts and EIP.

Results: We identified 161 eligible papers. Our findings on key features of the priority-setting process unpacked three 3 levels of constructs: 'pathways' for identifying and prioritizing policy issues for knowledge translation efforts; 'phases' within each pathway; and 'steps' for each phase. There are three main pathways: (1) explicit and systemic priority-setting processes involving policymakers and stakeholders to determine priority topics (collaborative); (2) a policymaker or stakeholder brings an issue forward or asks for evidence on a particular topic (demand-driven); and (3) a need or policy gap is identified by a knowledge translation platform (supply-driven). Within each pathway, four phases emerged: "Preparatory", "prioritization", "knowledge translation" and "scale-up and sustainability". Across these phases, the following steps were identified: establishing a core team, defining a scope, confirming a timeline, sensitizing stakeholders, generating potential issues, gathering contextual information, setting guiding principles, selecting prioritization criteria, applying the method for prioritization, documenting and communicating priorities, validating and revising priorities, selecting venue for decision-making, implementing priorities, monitoring and evaluation, promoting institutionalization, and engaging in peer learning and exchange of experience. We identified engaging stakeholders and strengthening capacity as cross-cutting elements. Our findings on contextual factors unpacked four categories: (1) institutions; (2) ideas; (3) interests; and (4) external factors.

Conclusions: This CIS generated a multi-level conceptual framework for prioritizing issues for KT efforts and laid the foundation for a WHO tool that supports prioritization in practice. The study contributes meaningfully to both the literature and the operationalization of KT and EIP.

Background: Vaccine prescription is being implemented and applied in China to bolster promote vaccination campaigns and mitigate vaccine hesitancy. This study aims to investigate the current vaccine recommendation practices among healthcare workers (HCWs) in China and identify the determinants that influence their willingness to provide vaccination prescription, informing interventions to support the implementation of willingness into practice.

Methods: A cross-sectional survey was conducted among HCWs nationwide in China from July 3 to July 10, 2024. The survey questionnaire was distributed via a link provided by an expert-listening platform at the 2024 World Influenza Conference, representing a diverse group across different healthcare institutions. The study used descriptive and logistic regression analyses performed on attitudes toward providing influenza vaccination prescriptions.

Results: Among 3140 responding HCWs, 68.8% of hospital-based HCWs (N = 778/1131) and 61.9% of community-based HCWs (N = 1243/2009) demonstrate a willingness to provide vaccine prescriptions. HCWs with a history of influenza vaccination (adjusted odds ratio [aOR] = 0.30, 95% confidence interval [CI]: 0.23-0.39, P < 0.001) were significantly more inclined to provide vaccine prescriptions. Incentives including bonus rewards (aOR = 1.84, 95% CI: 1.40-2.43, P < 0.001), and integration into annual/monthly performance evaluations (aOR = 1.60, 95% CI: 1.20-2.13, P = 0.001) further enhanced willingness to provide prescriptions. In terms of communication methods, 63.4% of HCWs (N = 1991) identified official public account promotions on WeChat as the most effective for raising vaccination awareness, significantly surpassing provide vaccine prescriptions (8.7%, N = 350).

Conclusions: Our study emphasizes the necessity for further evaluations of vaccine prescription policies to improve the implementation among HCWs. The findings advocate for tailored strategies, including enhanced incentive mechanisms in hospital settings and optimized digital engagement in community health centers, to facilitate effective vaccine prescription practices.

Background: Ischemic heart disease (IHD) contributed to around 8.9 million deaths and stroke accounting for about 6.2 million deaths each year. This study examines disparities in health services and outcomes for IHD and stroke among different membership types within the national health insurance.

Methods: We analyzed over 30,000 inpatient claim data for IHD and stroke patients from 2017 to 2022 in Indonesia. The associations were assessed between National Health Insurance (Badan Penyelenggara Jaminan Sosial, BPJS) membership types and five dependent variables including treatment/diagnosis, severity, mortality, length of stay, and claim cost. Membership types included the poorest members subsidized by the national budget (Penerima Bantuan Iuran Anggaran Pendapatan dan Belanja Negara, PBI APBN); near poor, subsidized by local governments (Penerima Bantuan Iuran Anggaran Pendapatan dan Belanja Daerah, PBI APBD); informal non-workers (Bukan Pekerja, BP), informal workers (Pekerja Bukan Penerima Upah, PBPU), and formal workers (Pekerja Penerima Upah, PPU).

Results: For treatment access, PBI APBN members with IHD had lower odds of receiving percutaneous coronary interventions (PCI) compared to other groups, though this difference was not statistically significant in the multivariate models. For stroke patients, access to head computed tomography (CT) scans-critical for diagnosing stroke type-was similar across all membership types. Length of stay varied by condition; PBI APBN members experienced longer hospital stays for IHD but shorter stays for stroke. However, claim costs were significantly higher for non-subsidized groups (BP, PBPU, PPU) compared to the PBI APBN group for both IHD and stroke patients. Regarding health outcomes, non-subsidized IHD patients (BP, PBPU, PPU) had significantly lower odds of severe cases with adjusted odds ratios (AORs) of 0.70, 0.76, and 0.66, respectively, and mortality (AORs of 0.61 and 0.64 for BP and PPU) compared to the subsidized PBI APBN group. For stroke patients, although severity levels were comparable across membership types, non-subsidized patients (BP, PBPU, and PPU) had significantly lower odds of mortality, with AORs of 0.66, 0.73, and 0.54, respectively.

Conclusions: Non-subsidized members had lower severity and mortality for IHD and stroke but higher treatment costs, while the poorest (PBI APBN) faced longer stays and worse outcomes-highlighting persistent disparities in Indonesia's national health insurance system. Addressing these inequities requires targeted policies to improve access, care efficiency, and quality for the poorest populations. Strengthening community-based lifestyle promotion and tobacco control can further reduce the burden of IHD and stroke and help close these gaps over time.

Background: Cambodia, a lower-middle-income country, confronts challenges related to childbirth safety. This study investigated the utilization of childbirth care across public and private health facilities, with a particular focus on the use of caesarean section (C-section). It also examined disparities in service utilization across urban and rural areas and among different socioeconomic statuses.

Methods: This study used cross-sectional data from the Demographic and Health Surveys conducted in Cambodia in 2000, 2005, 2010, 2014 and 2021-22. Descriptive analyses were performed to elucidate changes in place of delivery and C-section rates by public and private health facilities. Logistic regressions were applied using data from 2010 to 2021 to identify factors associated with C-section.

Results: The facility-based delivery rate significantly increased to 96.5% by 2021, while the overall C-section rate rose to 15.5%. Within public facilities, the C-section rate grew from 5.1% in 2010 to 9.7% in 2021, consistently higher in urban areas compared to rural ones. Notably, C-section utilization in public facilities did not significantly vary among different wealth index groups. From 2010 to 2021, the C-section rates in private facilities surged from 11.0% to 48.1%, with urban and rural rates reaching 50.5% and 45.7%, respectively. In 2021, the richest and richer groups accounted for most C-section deliveries in private facilities, constituting 38.5% and 28.8%, respectively. C-section use was significantly higher in 2021 compared to 2010 (Adjusted OR 3.32, 95% CI [2.72, 4.07]). Women over 20 years old, living in Central Plain, from richer or richest households, had secondary and higher education level, with female household head and had only one child were more likely to undergo a C-section than other women.

Conclusions: The private facilities have significantly driven the increase in C-sections, particularly among wealthier economic groups. Strengthening health system governance and promoting public-private partnerships are vital to curb C-section overuse and ensure equitable and effective childbirth care coverage.

Over the past decade, the integration of information and communications technologies (ICTs) in healthcare has grown significantly, as has the rapid increase in internet access and mobile device ownership by individuals. However, challenges such as the digital divide, encompassing disparities in access, usage skills, and the benefits derived from ICT use, persist. Addressing this divide is crucial for maximizing the potential of digital health technologies, particularly for more vulnerable people in society who often require the most support. This commentary paper's aim is to advocate training, in both educational and healthcare settings, so as to contribute towards bridging the digital divide. We propose that educational programs for healthcare professionals in academic institutions can integrate modules on the digital health divide within existing courses on social determinants of health (e.g., sociology, epidemiology, and health informatics) or in specific courses on digital health. The recommended courses should include modules on the digital divide, its causes, implications, and strategies to first assess and then enhance digital and health literacy among patients. Training healthcare professionals in work settings would be part of continuous professional development. This training should include assessing digital health literacy, identifying barriers to uptake, engagement and impact of digital health tools, and providing tailored education on digital health tools or interventions. Healthcare professionals should follow protocols to ensure the effective use of digital health tools by diverse patients and have access to community resources for ongoing support. Finally, the paper suggests service-wide international standards for ameliorating the digital divide.

Background: Patient involvement in health technology assessment (HTA) has been extensively explored and implemented in high-income countries, but little is known about it in low- and middle-income countries (LMICs). This study aimed to provide a comprehensive picture of the current state and trends of patient involvement in HTA research, which can inform future research in the LMICs.

Methods: Publications on patient involvement in HTA from January 1, 1900, to December 31, 2023, were retrieved from the core databases of the Web of Science. We applied a bibliometric analysis to reveal the collaboration patterns, hot topics, and evolution of the research field. Co-occurrence, clustering, citation, and burst analyses were performed using VOSviewer and CiteSpace, with results visualized for interpretation.

Results: A total of 175 articles were eligible for inclusion. The first valid article was published in 2000. The number of publications has increased since 2011. The most productive countries and institutions were Canada and McMaster University. The studies focused on five hot topics: patient preferences, priority setting, qualitative research, drug development, and hospital-based HTA. The burst analysis revealed that priority setting and cost effectiveness were the research frontiers.

Conclusions: While patient involvement in HTA research has gained increasing attention, the research conducted in the LMICs remain limited. It is recommended that LMICs participate in international research collaborations, and focus on the five hot topics and emerging frontiers to advance both their research capacity and practical implementations.

Background: Osteoarthritis (OA) is a leading cause of disability worldwide, yet global estimates of lifetime risk remain limited. This study aims to provide comprehensive global, regional, and national lifetime risk estimates for OA, including knee, hand, and hip subtypes, from 1990 to 2021.

Methods: Using data from the Global Burden of Disease (GBD) Study 2021, we estimated the lifetime risk of developing OA from age 20 onwards, stratified by sex, location, and Socio-demographic Index (SDI). Average annual percentage change (AAPC) was also calculated. Spatial heterogeneity in 2021 lifetime risks and their AAPCs was evaluated using the Factor Detector of the Geographic Detector method, with q-statistics quantifying the explanatory power of demographic, socioeconomic, health system and OA-related risk factors.

Results: In 2021, the global lifetime risk of OA was 14.21% (95% confidence interval: 14.21%, 14.22%), with knee OA at 9.31% (95% CI: 9.31%, 9.32%), hand OA at 3.45% (95% CI: 3.45%, 3.46%), and hip OA at 0.71% (95% CI: 0.71%, 0.71%). Lifetime risk increased with higher socio-demographic Index (SDI), from 11.62% in low-SDI regions to 16.10% in high-SDI regions. The highest risk was observed in the High-income Asia Pacific region (18.10%), led by the Republic of Korea (21.20%). Between 1990 and 2021, global lifetime OA risk increased with an AAPC of 0.30% (95% CI: 0.30%, 0.30%), with the most notable increases in East Asia (AAPC: 0.53%). Spatial heterogeneity analysis revealed that the historical proportions employed in agriculture and with upper secondary education had the strongest associations with 2021 lifetime risks and their trends (q-statistics up to 0.84), followed by life expectancy, SDI, and health-system indicators.

Conclusions: In 2021, 1 in 7 individuals globally were projected to develop OA, with the highest risks in high-SDI regions. The steady rise in OA risk, especially in East Asia, highlights the need for targeted public health strategies that focus on prevention, early diagnosis, and ensuring equitable access to treatment to mitigate the increasing OA burden.