OBJECTIVE To evaluate the cost-effectiveness of anlotinib combined with penpulimab versus sorafenib as first- line treatment for unresectable hepatocellular carcinoma （uHCC） from the perspective of China’s healthcare system. METHODS Based on data from the APOLLO study， a partitioned survival model was established with a 21-day model cycle to simulate patient survival status over 10 years under anlotinib combined with penpulimab regimen or sorafenib monotherapy. Quality-adjusted life year （QALY） was used as the core evaluation parameter to assess the incremental cost-effectiveness ratio （ICER） of different treatment regimens. Using 3 times China’s per capita gross domestic product （GDP） in 2024 （287 247 yuan/QALY） as the willingness-to-pay （WTP） threshold， cost-utility analysis was performed to evaluate the cost-effectiveness of the treatment regimens. Sensitivity analysis was conducted to validate the robustness of the baseline analysis conclusion. Scenario analysis was performed to consider the impact of anlotinib and penpulimab assistance programs on the results； the price reduction of penpulimab to ensure the cost-effectiveness of the combination regimen was examined under varying WTP thresholds （specifically， 1， 2， and 3 times China’s per capita GDP in 2024）. RESULTS The baseline analysis revealed that the ICER of anlotinib combined with penpulimab regimen relative to the sorafenib regimen was 338 611.20 yuan/QALY， which exceeded the WTP threshold set in this study. Univariate sensitivity analysis indicated that the utility value of progression free survival and penpulimab price significantly influenced the baseline analysis results. Probabilistic sensitivity analysis validated the robustness of the baseline results. The results of scenario analysis indicated that when considering the assistance programs for anlotinib and penpulimab， the obtained ICER values were all below the WTP threshold set at 3 times China’s per capita GDP in 2024. When the price of penpulimab was reduced by 58%， 35%， and 13%， the ICER values were below the WTP threshold， which was 1， 2 and 3 times the per capita GDP of China in 2024， respectively. CONCLUSIONS From the perspective of China’s healthcare system， anlotinib combined with penpulimab regimen for first-line treatment of uHCC lacks cost-effectiveness compared to sorafenib regimen. However， this conclusion would be reversed if the anlotinib and penpulimab assistance programs are taken into account or if the price of penpulimab is reduced by more than 13% and above.

OBJECTIVE To evaluate the cost-effectiveness of amivantamab combined with lazertinib （hereinafter referred to as “AL”） regimen as first-line treatment for EGFR -mutated advanced non-small cell lung cancer （NSCLC） from the perspective of China’s healthcare system. METHODS A partitioned survival model was established based on updated data from the MARIPOSA study， with a 10-year time horizon and 28-day cycles. The primary outcome index was quality adjusted life year （QALY）， and the willingness-to-pay （WTP） threshold was set at three times China’s per capita GDP in 2024 （287 247 yuan/QALY）. Cost-utility analysis was used to calculate the incremental cost-effectiveness ratio （ICER） of AL regimen versus osimertinib monotherapy regimen as first-line treatment for EGFR -mutated advanced NSCLC. One-way and probabilistic sensitivity analyses were performed to test model robustness. Scena rio analyses were conducted to explore the impact of utility values for different health states on the outcomes and determine the required price reductions of amivantamab and lazertinib to achieve cost-effectiveness. RESULTS Compared with the osimertinib monotherapy regimen， the ICER for the AL regimen as first-line treatment for advanced EGFR -mutated NSCLC was 2 062 096.15 yuan/QALY， significantly exceeding the WTP threshold established in this study. One-way sensitivity analysis revealed that the utility value of progression-free survival state and the price of amivantamab were the primary factors influencing the ICER. Probabilistic sensitivity analysis revealed that the AL regimen only became cost-effective when the WTP threshold was set at 2 050 000 yuan/QALY. Scenario analysis indicated that altering the utility value still rendered the AL regimen non-cost-effective. When amivantamab （350 mg） prices decreased by 80%， 85%， and 90% respectively， lazertinib （80 mg） prices would need to decrease by 95.97%， 40.63%， 5.29%， respectively. This would enable the AL regimen’s ICER to consistently fall within the WTP threshold established in this study. CONCLUSIONS At the WTP threshold established in this study， the AL regimen does not demonstrate cost-effectiveness for first-line treatment of advanced EGFR -mutated NSCLC compared to the osimertinib monotherapy regimen. Significant price reductions for both drugs would be required to alleviate the financial burden on patients.

Objective To explore the impact of number of positive regional lymph nodes (nPRLN) in N1 stage on the prognosis of non-small cell lung cancer (NSCLC) patients. Methods Patients with TxN1M0 stage NSCLC who underwent lobectomy and mediastinal lymph node dissection from 2010 to 2015 were screened from SEER database (17 Regs, 2022nov sub). The optimal cutoff value of nPRLN was determined using X-tile software, and patients were divided into 2 groups according to the cutoff value: a nPRLN≤optimal cutoff group and a nPRLN>optimal cutoff group. The influence of confounding factors was minimized by propensity score matching (PSM) at a ratio of 1 : 1. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate overall survival (OS) and lung cancer-specific survival (LCSS) of patients. Results A total of 1316 patients with TxN1M0 stage NSCLC were included, including 662 males and 654 females, with a median age of 67 (60, 73) years. The optimal cutoff value of nPRLN was 3, with 1165 patients in the nPRLN≤3 group and 151 patients in the nPRLN>3 group. After PSM, there were 138 patients in each group. Regardless of before or after PSM, OS and LCSS of patients in the nPRLN≤3 group were superior to those in the nPRLN>3 group (P<0.001). N1 stage nPRLN>3 was an independent prognostic risk factor for OS [HR=1.52, 95%CI (1.22, 1.89), P<0.001] and LCSS [HR=1.72, 95%CI (1.36, 2.18), P<0.001]. Conclusion N1 stage nPRLN>3 is an independent prognostic risk factor for NSCLC patients in TxN1M0 stage, which may provide new evidence for future revision of TNM staging N1 stage subclassification.

OBJECTIVE To evaluate the cost-effectiveness of culmerciclib combined with fulvestrant as second-line treatment for patients with hormone receptor-positive（HR+）/human epidermal growth factor receptor 2-negative （HER2–） locally advanced or metastatic breast cancer， within the context of the Chinese healthcare system. METHODS A partitioned survival model was established based on the CULMATE-1 study， with a simulation time horizon set at 15 years and a cycle length of 28 days. The incremental cost-effectiveness ratio （ICER） of culmerciclib combined with fulvestrant versus fulvestrant monotherapy as second-line treatment for HR+/HER2– breast cancer was calculated. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the model. Meanwhile， scenario analysis of culmerciclib price reduction was conducted； the required price reduction and price to reach the willingness-to-pay （WTP） threshold in this study were calculated. RESULTS The results of the base-case analysis indicated that， compared with the fulvestrant monotherapy regimen， culmerciclib combined with fulvestrant yielded an additional 0.823 quality-adjusted life year （QALY）， with a corresponding ICER of 371 696.26 yuan/QALY， which exceeded the WTP threshold （199 330 yuan/QALY）. The results of the univariate sensitivity analysis indicated that the cost of culmerciclib， the discount rate， the utility values for progression disease and progression free survival status were significant factors influencing the ICER； both the univariate sensitivity analysis and the probabilistic sensitivity analysis validated the robustness of the model results. Scenario analysis indicated that when the price of culmerciclib was reduced by 30%， 55% and 85% respectively， the corresponding ICER values fell below 3， 2， and 1 times China’s per capita GDP in 2025， with the probability of cost-effectiveness being 3.00%， 94.90%， 100%. When the cost of culmerciclib （60 mg） was reduced by 52.6% to 50.96 yuan， the ICER value met the WTP threshold established in this study. CONCLUSIONS When the WTP threshold is set at twice China’s per capita GDP in 2025， second-line treatment with culmerciclib combined with fulvestrant for HR+/HER2– locally advanced or metastatic breast cancer does not exhibit cost-effectiveness advantage over fulvestrant monotherapy. Therefore， a reasonable price reduction is required to alleviate the financial burden on patients.

Objective To evaluate the cost-effectiveness of deucravacitinib in the treatment of moderate to severe plaque psoriasis from the perspective of the Chinese health system.Methods Based on POETYK PSO-1 study and related cost and utility data,a decision tree combined with Markov model was established.The model period was 10 years,and the output indicators of the model were cost and quality-adjusted life year(QALY).The evaluation index of the model was the incremental cost-effectiveness ratio(ICER).The willingness-to-pay threshold(WTP)was 3 times of China's per capita GDP in 2023.Sensitivity analysis was performed to evaluate the robustness of the model results.Results The incremental utility and incremental cost were 0.598QALYs and 130 677.51 yuan(RMB),respectively.The ICER of the two strategies was 218 487.11 yuan(RMB)per QALY gained,which was less than 3 times GDP per capita in 2023.Sensitivity analyses confirmed the robustness of the model.Conclusion Under the threshold of 3 times the GDP per capita in China,deucravacitinib is cost-effective in the treatment of moderate to severe plaque psoriasis.

Objective To evaluate the cost-effectiveness of deucravacitinib in the treatment of moderate to severe plaque psoriasis from the perspective of the Chinese health system.Methods Based on POETYK PSO-1 study and related cost and utility data,a decision tree combined with Markov model was established.The model period was 10 years,and the output indicators of the model were cost and quality-adjusted life year(QALY).The evaluation index of the model was the incremental cost-effectiveness ratio(ICER).The willingness-to-pay threshold(WTP)was 3 times of China's per capita GDP in 2023.Sensitivity analysis was performed to evaluate the robustness of the model results.Results The incremental utility and incremental cost were 0.598QALYs and 130 677.51 yuan(RMB),respectively.The ICER of the two strategies was 218 487.11 yuan(RMB)per QALY gained,which was less than 3 times GDP per capita in 2023.Sensitivity analyses confirmed the robustness of the model.Conclusion Under the threshold of 3 times the GDP per capita in China,deucravacitinib is cost-effective in the treatment of moderate to severe plaque psoriasis.

OBJECTIVE To evaluate the cost-effectiveness of capecitabine metronomic chemotherapy combined with aromatase inhibitor(AI)versus AI monotherapy as first-line treatment for hormone receptor-positive(HR+)/human epidermal growth factor receptor 2-negative(HER2-)metastatic breast cancer,thereby providing evidence-based support for clinical therapeutic decision-making and healthcare policy formulation.METHODS Based on the MECCA trial,a partitioned survival model was constructed using a 4-week cycle length to simulate outcomes over patients'lifetime.The model outputs included total costs,quality-adjusted life year(QALY),and incremental cost-effectiveness ratio(ICER).Sensitivity analyses were performed to validate the robustness of base-case results,while scenario analyses examined the cost-effectiveness of both treatment strategies under 10-year,20-year,and lifetime time horizons.RESULTS With the willingness-to-pay(WTP)threshold set at 1 times China's 2024 per capita gross domestic product(GDP)(95 749 yuan/QALY),patients receiving capecitabine metronomic chemotherapy combined with AI regimen gained incremental utility(0.66 QALYs)while incurring higher costs,with ICER of 27 684.85 yuan/QALY.Results of the one-way sensitivity analysis showed that factors with significant impacts on ICER included the cost discount rate,drug costs of the capecitabine metronomic chemotherapy combined with AI group,utility value in the progression-free survival state,follow-up costs,and treatment costs in the subsequent stable phase.Probabilistic sensitivity analysis indicated that when the WTP threshold≥49 250 yuan/QALY,the capecitabine metronomic chemotherapy combined with AI regimen had a 100%probability of being cost-effective.Scenario analysis results demonstrated that capecitabine metronomic chemotherapy combined with AI regimen was more cost-effective than the AI alone regimen across 10-year,20-year,and lifetime study horizons.CONCLUSIONS Under the premise that the WTP threshold is set at 1 times China's per capita GDP in 2024,capecitabine metronomic chemotherapy combined with AI regimen is more cost-effective than the AI alone regimen as the first-line treatment for HR+/HER2-metastatic breast cancer.

Objective:To determine the pathogens causing viral diarrhea in children under 5 years of age and the epidemiological patterns in Chengdu from 2021 to 2024.Methods:Fecal samples were collected from hospitalized children under 5 years of age with diarrhea in a sentinel surveillance hospital for viral diarrhea in Chengdu from 2021 to 2024. Norovirus（NoV），sapovirus（SaV），astrovirus（AstV），and enteric adenovirus（EAdV）were detected by real-time PCR or real-time RT-PCR. Group A rotavirus（RVA）was detected by enzyme-linked immunosorbent assay. The results were analyzed statistically by using SPSS 20.0 software.Results:RVA，NoV，SaV，AstV，and EAdV were detected in 329 fecal samples from 719 hospitalized children with diarrhea under 5 years of age. The total detection rate was 48.8%（329/719）. The detection rate of RVA，NoV，SaV，AstV，and EAdV was 17.0%（122/719），20.9%（150/719），4.0%（29/719），2.8%（20/719），8.6%（62/719），separately. The detection rate of mixed infection with multiple pathogens was 7.1%（51/719），among which RVA combined with NoV infection was the most common（2.2%，16/719）. Except for EAdV（ χ2=14.368， P=0.002），there was no significant difference in the detection rates of RVA，NoV，SaV，and AstV in different years. Except for SaV and EAdV，the detection rates of RVA（ χ2=11.106， P<0.001），NoV（ χ2=65.164， P<0.001）and AstV（ χ2=19.612， P<0.001）were statistically significant in different quarters. There was no statistically significant difference in the detection rates of the five pathogens between males and females. Except for NoV，there were statistically significant differences in the detection rates of RVA（ χ2=32.209， P<0.001），SaV（ χ2=13.983， P=0.002），AstV（ χ2=9.56， P=0.015）and EAdV，（ χ2=8.992， P=0.029）in children of different months of age. Conclusion:RVA and NoV are the main pathogens causing viral diarrhea in children under 5 years of age in Chengdu. The peak infection period of viral diarrhea tends to occur in winter and spring and occurs most frequently in 12-24 months old and 24-59 months old children.

Objective:To investigate the functional characteristics of the prefrontal cortex in patients with schizophrenia (SCZ) during resting state and analyze its association with clinical symptoms.Methods:Twenty-eight hospitalized patients with SCZ (SCZ group) were selected from November 2023 to May 2024, and 28 healthy controls (HC group) were recruited concurrently. By using functional near-infrared spectroscopy (fNIRS) technology, data on the concentration changes of oxygenated hemoglobin (HbO) and deoxygenated hemoglobin (HbR) in the prefrontal cortex during resting state were collected from all subjects to measure cortical hemodynamic activity. Regional activation values and functional connectivity (FC) values among brain areas were analyzed. Clinical symptoms in patients were assessed using the positive and negative syndrome scale (PANSS).SPSS 25.0 software was employed for statistical analysis. Between-group comparisons were performed using independent samples t-tests or Mann-Whitney U tests. Spearman correlation analysis and general linear regression models were applied to examine relationships between prefrontal cortical functional characteristics and clinical symptoms. Results:The levels of HbO in the right inferior frontal gyrus and left frontal pole area were significantly higher in the SCZ group (1.5 (1.0, 3.0)μmol/L, 1.0 (1.0, 2.8)μmol/L) than those in the HC group (-0.01 (-0.05, 0.02)μmol/L, -0.02 (-0.07, 0.03)μmol/L) ( Z=-6.46, -6.50, both P<0.01). The levels of HbR in the bilateral dorsolateral prefrontal cortex were significantly higher in the SCZ group (0.02 (-0.01, 0.07)μmol/L, 0.01 (-0.01, 0.03)μmol/L) than those in the HC group (-0.01 (-0.03, 0.01)μmol/L, -0.01 (-0.02, 0.01)μmol/L) ( Z=-2.46, -1.98, both P<0.05).The SCZ group showed significantly higher HbO-based FC values in the frontal pole-temporal pole (0.49±0.21) and temporal pole-dorsolateral prefrontal cortex (0.36±0.25) compared to the HC group (0.33±0.18, 0.15±0.19) ( t=3.02, 3.44, both P<0.01). Conversely, the SCZ group exhibited significantly lower HbR-based FC in the frontal pole-inferior frontal gyrus (0.15±0.13) and inferior frontal gyrus-temporal pole (0.27±0.37) compared to the HC group (0.33±0.26, 0.77±0.48) ( t=-3.17, -4.23, both P<0.01). Correlation analysis revealed that in the SCZ group, the level of HbO in the right inferior frontal gyrus was positively correlated with negative symptoms, positive symptoms, excitement/hostility, and PANSS total score ( r=0.45-0.64, all P<0.05), and the level of HbO in the left frontal pole area was positively correlated with excitement/hostility and PANSS total score ( r=0.57, 0.50, both P<0.01), while the FC value between the frontal pole and temporal pole areas showed a negative correlation with excitement/hostility ( r=-0.39, P<0.05). Regression analysis demonstrated that, the HbO concentration in the right inferior frontal gyrus significantly positively predicted PANSS total score, positive symptoms, and negative symptoms ( β=0.70, 0.64, 0.55, all P<0.01).The HbO concentration in the left frontal pole area significantly positively predicted excitement/hostility ( β=0.77, P<0.01).The frontal pole-temporal pole HbO-based FC significantly negatively predicted excitement/hostility scores ( β=-0.42, P<0.01). Conclusion:Patients with SCZ exhibit hyperactivation of localized prefrontal cortex brain regions and dysfunction of functional connectivity during resting state, which are significantly associated with core clinical symptoms including positive, negative, and excitement/hostility symptoms.

Objective To observe the value of right ventricular free wall longitudinal strain(RVFWLS)to pulmonary artery systolic pressure(PASP)ratio(RVFWLS/PASP)for evaluating systolic function of right ventricle(RV)in patients with hypertrophic cardiomyopathy(HCM).Methods Fifty-two HCM patients were retrospectively collected and divided into group A(RVFWLS/PASP≤0.75,n=26)and B(RVFWLS/PASP＞0.75,n=26)according to median RVFWLS/PASP.Meanwhile,26 healthy individuals were included as control group.Parameters of echocardiography and speckle tracking imaging(STI)were obtained and compared among 3 groups.The correlations of RVFWLS/PASP and other parameters were analyzed with linear regression.Results In group A and B,left ventricular ejection fraction(LVEF),RV septal longitudinal strain(RVSepLS),RVFWLS,RV end-diastolic volume index(RVEDVi),RV stroke volume(RVSV),RV fractional area change(RVFAC)and left ventricular global longitudinal strain(LVGLS)were all lower,while the ratio of peak E blood flow velocity at mitral orifice diastole to early mitral intervalal annulus diastole velocity(E/e′)were higher than those in control group(all adjusted P＜0.05).Compared with group B and control group,group A had higher PASP but lower RV ejection fraction(RVEF)(all adjusted P＜0.05).Furthermore,RVFWLS and LVGLS were both lower in group A than in group B(both adjusted P＜0.05).Linear regression analysis showed that RVSepLS and RVEF were independently linearly related to RVFWLS/PASP(both P＜0.05).Conclusion RVFWLS/PASP could be used to monitor changes of RV systoic function in HCM patients at early stage.