https://hull-repository.worktribe.com/preview/1797952/1-s2.0-S0140673618322797-main.pdf

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

https://openresearch-repository.anu.edu.au/bitstream/1885/164632/2/01_Bin%2bSayeed_Global%252C_regional%252C_and_national_2018.pdf

Global, regional, and national incidence, prevalence, andyears lived with disability for 354 diseases and injuries for195 countries and territories, 1990–2017: a systematicanalysis for the Global Burden of Disease Study 2017

China has the largest population of patients with dementia in the world, imposing a heavy burden on the public and health care systems. More than 100 epidemiological studies on dementia have been done in China, but the estimates of the prevalence and incidence remain inconsistent because of the use of different sampling methods. Despite improved access to health services, inadequate diagnosis and management for dementia is still common, particularly in rural areas. The Chinese Government issued a new policy to increase care facilities for citizens older than 65 years, but most patients with dementia still receive care at home. Western medicines for dementia symptoms are widely used in China, but many patients choose Chinese medicines even though they have little evidence supporting efficacy. The number of clinical trials of Chinese and western medicines has substantially increased as a result of progress in research on new antidementia drugs but international multicentre studies are few in number. Efforts are needed to establish a national system of dementia care enhance training in dementia for health professionals, and develop global collaborations to prevent and cure this disease.

Dementia in China: epidemiology, clinical management, and research advances

Introduction The socioeconomic costs of Alzheimer's disease (AD) in China and its impact on global economic burden remain uncertain. Methods We collected data from 3098 patients with AD in 81 representative centers across China and estimated AD costs for individual patient and total patients in China in 2015. Based on this data, we re-estimated the worldwide costs of AD. Results The annual socioeconomic cost per patient was US $19,144.36, and total costs were US $167.74 billion in 2015. The annual total costs are predicted to reach US $507.49 billion in 2030 and US $1.89 trillion in 2050. Based on our results, the global estimates of costs for dementia were US $957.56 billion in 2015, and will be US $2.54 trillion in 2030, and US $9.12 trillion in 2050, much more than the predictions by the World Alzheimer Report 2015. Discussion China bears a heavy burden of AD costs, which greatly change the estimates of AD cost worldwide.

The cost of Alzheimer's disease in China and re-estimation of costs worldwide

Concerns about the potentially corrupting influence of private industry on medical research, education, and practice have been growing since the 1970s, when the U.S. Congress passed the first anti-kickback law applying to medicine. Since then, Congress has banned self-referrals in medicine, enacted laws that regulate the commercialization of publicly funded biomedical research, and held hearings on conflicts of interest in biomedicine. Government agencies have issued policies concerning disclosure of financial interests in research, professional associations have published guidelines pertaining to financial relationships with industry, and scientific journals have developed conflict of interest policies.

The Institute of Medicine (IOM)’s Conflict of Interest in Medical Research, Education, and Practice makes an important contribution to the continuing debate about financial conflicts of interest in medicine. This report reviews empirical studies, analytic essays, regulations, and guidance documents concerning conflicts of interest in medical research and makes recommendations for researchers, educators, physicians, institutions, corporations, and government agencies. The report consists of nine chapters as well as appendices that examine particular topics in greater depth, such as the relevance of psychological research on subconscious biases to conflict of interest policies, and a comparative analysis of conflicts of interest in nonmedical professions.

To draft this report, the IOM assembled experts from various fields including medicine, public health, law, health policy, ethics, philosophy, and economics. The authors acknowledge that collaboration with industry is a double-edged sword: Collaboration can produce important benefits, but it can compromise the integrity of professional judgment and erode the public’s trust in medicine. In crafting their recommendations, the authors strike a balance between protecting medical research, education, and practice from the harmful effects of industry collaboration and avoiding unnecessary administrative burdens that could undermine the benefits of collaboration. They make judicious use of empirical evidence to support their conclusions and recommendations. When evidence was lacking, the authors developed arguments based on their own experience and judgment as well as different approaches found in the literature.

The IOM report makes 16 recommendations for reforming medicine, some of which would require radical changes. For example, the report recommends that all academic medical centers, teaching hospitals, and training sites prohibit faculty, students, residents, and fellows from accepting gifts from pharmaceutical, biotechnology, or medical device companies, except in some circumstances, and not allow drug and medical sales representatives to have access to faculty, except by invitation in specified situations. The IOM report also recommends that academic medical centers, hospitals, and training sites develop a new system of funding continuing medical education that is free from industry influence; that research institutions prohibit investigators from conducting research with human subjects if they have a significant financial interest related to a product that would be affected by the research, except when the investigator’s participation is essential for conducting the research; and that physicians in private practice refrain from accepting items of value from pharmaceutical, biotechnology, or medical device companies.

The report also contains a conceptual framework that provides a foundation for policy recommendations. This includes a definition of conflict of interest (“a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest”) and criteria for assessing conflict of interest policies, such as proportionality (does the policy focus on the most important conflicts and is the policy practical?), transparency (is the policy understandable to those to whom it applies?), accountability (does the policy have enforcement procedures?), and fairness (does the policy apply equally to all relevant people in similar situations?). The authors also discuss problems with interpreting and applying the notion of an apparent conflict of interest.

This comprehensive and insightful report will undoubtedly have considerable influence over research, scholarship, and policy development for years to come. It is highly recommended reading for physicians, medical researchers, and medical educators.

Conflict of Interest in Medical Research, Education, and Practice

Introduction According to the 2013 Alzheimer's Disease International report, about 44.4 million people were living with dementia in 2013 and this number is expected to reach an estimated 75.6 million by 2030. (1) In China, which has the largest population of people with dementia, the prevalence of dementia appears to have increased steadily between 1990 and 2010. (2,3) However, this trend might be partly attributed to temporal variations in the methods used to estimate such prevalence. (4) The results of a national survey in 2008-2009 indicated that dementia was more common in rural areas than in urban settings. (5) Given the rapid growth of the elderly population in China, (6) dementia is expected to pose tremendous challenges to the national health-care system and to the sustainable development of the national economy. Most cost-of-illness studies for dementia have been carried out in high-income countries such as Sweden, the United Kingdom of Great Britain and Northern Ireland and the United States of America. (7-11) The economic costs of dementia in China --which have yet to be investigated in detail--are likely to differ, both in magnitude and type, from those in such distant high-income countries. In this study, we sought to estimate and predict the costs of dementia in China for the periods 1990-2010 and 2020-2030, respectively. It was hoped that, by quantifying the economic costs of dementia, Chinese policy-makers would be motivated to develop a nationwide action plan, prioritize policies on dementia-related care and research and reduce the economic and societal burdens of dementia in China. Methods In this cost-of-illness study, we used a prevalence-based, bottom-up approach to quantify or predict the costs of dementia in China between 1990 and 2030, from a societal perspective. We categorized all the costs into three classes: (11,13) (i) direct medical costs, that is goods and service costs related to the diagnosis and treatment of inpatients and outpatients with dementia; (ii) direct non-medical costs, that is transport costs and costs related to formal care in nursing homes or informal care at home; and (iii) indirect costs resulting from dementia-attributable loss of productivity. Data sources We used multiple data sources for all estimates. We used age-specific prevalence of dementia in China, for the period 1990-2010, derived from a comprehensive systematic review. (3) From the electronic health records of the facilities, we collected cost data for patients with diagnosed dementia who were admitted either to the Shandong Centre for Mental Health--the only provincial psychiatric hospital in the eastern province of Shandong--between 1 January 2005 and 31 March 2014 or to the Daizhuang Psychiatric Hospital--one of the oldest psychiatric hospitals in China and also in Shandong province --between 1 January 2012 and 30 September 2014. The routine electronic health records include sociodemographic data and data on clinical diagnosis and disease classification, itemized costs, e.g. for drugs, examinations and beds. In each of the two study facilities, dementia was diagnosed and defined according to the International statistical classification of diseases and related health problems, 10th revision. (14) We excluded 26 patients with dementia who were diagnosed as having other chronic conditions that needed treatment, e.g. anxiety, diabetes or hypertension, leaving data from the records of 146 patients with dementia in our analysis. We also searched the China National Knowledge Infrastructure, Pub Med and Wan fang bibliographic databases for studies, on the use of health resource by people with dementia in China, published between 1 January 1990 and 31 July 2015. The search terms included "Alzheimer's disease", "China", "cost burden", "dementia", "economic burden", "formal care" and "informal care". We obtained costs for outpatient visits and transportation from a published study. …

The economic burden of dementia in China, 1990-2030: implications for health policy.

Mental disorders represent a major contributor to disease burden worldwide. We sought to quantify the national economic burden of mental disorders in China. We used a prevalence-based, bottom-up approach to estimate the economic costs of mental disorders in 2005–2013 in China. Prevalence data were derived from a national survey. Cost data were derived from the electronic health records of two psychiatric hospitals that consisted of 25,289 outpatients (10 %) and inpatients (90 %) who were diagnosed with a mental disorder. Cost items included direct medical costs, direct non-medical costs, and indirect costs. The total annual costs of mental disorders in China increased from $1,094.8 in 2005 to $3,665.4 in 2013 for individual patients, and from $21.0 billion to $88.8 billion for the whole society. The total costs of mental disorders in 2013 accounted for more than 15 % of the total health expenditure in China, and 1.1 % of China’s gross domestic product. If the needs of the professional care for all patients with mental illnesses were fully met, the potential economic costs would have been almost five times higher than the actual estimated costs. Mental disorders imposed a huge economic burden on individuals and the society in China. A nation-wide strategic action plan for preventing mental disorders and promoting mental health and well-being is in urgent need to reduce the individual and societal costs of mental illnesses.

/pdf/the-economic-burden-of-mental-disorders-in-china-2005-2013-5e4egd059e.pdf

Jian Wang

Papers

The economic burden of dementia in China, 1990-2030: implications for health policy.

The economic burden of mental disorders in China, 2005-2013: implications for health policy.

Synthèses de preuves adaptées aux décideurs de la santé dans les pays à revenu faible ou intermédiaire