Health Economics Review最新文献

{"title":"Impacts and lessons learned from coronavirus-19 pandemic in the United States: preparing for future public health emergencies.","authors":"Obert Xu","doi":"10.1186/s13561-025-00675-y","DOIUrl":"https://doi.org/10.1186/s13561-025-00675-y","url":null,"abstract":"<p><p>The coronavirus-19 (COVID-19) public health emergency created an economic crisis with unprecedented and far-reaching impacts across the health sector. Among the greatest challenge areas experienced were in areas of changing supply and demand, rising costs, decreased revenue, and widening health inequities (Blumenthal etal. N Engl J Med 383:1483-1488, 2020; Cypress, Nurs Forum 57:323-327, 2022; Centers for Medicare and Medicaid Services, National health spending in 2020 increases due to impact of COVID-19 pandemic, 2021). As we emerge from the pandemic, we must capitalize on the opportunity to transform and adapt to be better equipped to handle the next public health crisis. This article examines the impacts of the COVID-19 pandemic and preparedness strategies within the context of the United States.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"77"},"PeriodicalIF":3.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary endocrine therapy versus surgery plus endocrine therapy for early-stage breast cancer in older women without frailty: a cost-effectiveness and value of implementation analysis.","authors":"Yubo Wang, Li-Chia Chen, Kwok-Leung Cheung, Douglas Steinke, Sean P Gavan","doi":"10.1186/s13561-025-00668-x","DOIUrl":"10.1186/s13561-025-00668-x","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines recommend surgery for early-stage breast cancer in operable patients; however, primary endocrine therapy (PET) is often used in older women aged ≥ 70. This study aimed to estimate the cost-effectiveness and value of implementation of surgery plus adjuvant endocrine therapy (ET) compared with PET for older women with early breast cancer who are fit for surgery.</p><p><strong>Method: </strong>A partitioned survival analysis model was developed using effectiveness data from the published literature (time horizon: lifetime). Health outcomes were measured as quality-adjusted life years (QALYs; EQ-5D-3L UK tariff). Direct costs were estimated from the perspective of NHS England (discount rate: 3.5%). Probabilistic sensitivity analysis and value of implementation analysis were conducted using a cost-effectiveness threshold of £20,000-£30,000 per QALY gained.</p><p><strong>Results: </strong>Surgery + ET resulted in higher QALYs (4.57) compared to PET (3.87) and higher costs (£10,628 vs. £6,102). The incremental cost-effectiveness ratio (ICER) was £6,412.62 per QALY gained, indicating that surgery + ET is cost-effective compared to PET. The value of implementation analysis showed that imperfect implementation of surgery + ET resulted in a loss of 0.12 QALYs per patient, equating to 9,267 QALYs at the population level.</p><p><strong>Conclusion: </strong>Surgery with adjuvant ET is a clinically effective and cost-effective strategy compared with PET for older women with ER + operable early-stage breast cancer. Strengthening adherence to national guidelines will improve population health outcomes and healthcare resource use. Future economic evaluations should focus on the value of management strategies for older patients unfit for surgery due to frailty or comorbidities.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"75"},"PeriodicalIF":3.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The economic benefit of implementing assisted reproductive technology within a national health system: insights from the Italian model.","authors":"Andrea Marcellusi, Matteo Scortichini, Giulio Guarnotta, Mark Connolly, Andrea Busnelli","doi":"10.1186/s13561-025-00672-1","DOIUrl":"10.1186/s13561-025-00672-1","url":null,"abstract":"<p><strong>Background: </strong>Models evaluating both costs and economic benefits of assisted reproductive technology (ART) implementation are lacking. This constitutes a major limitation in the decision-making process of resource allocation. Herein, we aimed to estimate the economic and social impact of female infertility in Italy and examine the benefits generated by investment in ART from a national perspective.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the Italian Hospital Discharge Records database to identify women aged 18-50 undergoing ART between 2014 and 2016 in Italy. Patients were followed for up to 36 months after the first ART complete cycle. Hospitalization costs were analyzed nationally, while outpatient care and drug consumption costs were assessed in a sub-analysis using administrative databases from LHU Umbria 2. A fiscal impact model was developed from a governmental perspective, projecting lifetime tax revenues and public expenditures associated with the ART birth cohort, including costs for healthcare, education, pensions, and social transfers. All future values were discounted at 3% in line with Italian economic evaluation guidelines.</p><p><strong>Results: </strong>A total of 33,713 women met the inclusion criteria. During the follow-up, 48.4% achieved pregnancy resulting in childbirth. The average hospital care cost per patient was €5,853, with a projected national expenditure of €337 million for ART management. Younger women (18-33 years) had the highest success rates (61.8%). Assuming 16,300 live births, the model estimated net fiscal benefits of €3.3 billion over the lifetime of these individuals, equivalent to €203,856 per live birth.</p><p><strong>Conclusion: </strong>This study highlights the economic and fiscal benefits of ART, emphasizing the need for policies promoting early access to treatment. ART investment represents a strategic approach to mitigate demographic decline, with each live birth substantially contributing to national fiscal stability.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"76"},"PeriodicalIF":3.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lorenz curves of urban and rural health care expenditure in Colombia: analysis of a cohort of 4.6 million patients.","authors":"Oscar Espinosa, Giancarlo Buitrago, Valeria Bejarano, Ramon Castaño","doi":"10.1186/s13561-025-00662-3","DOIUrl":"10.1186/s13561-025-00662-3","url":null,"abstract":"<p><p>In Colombia, health expenditure is highly concentrated, with a small portion of the population incurring most costs, particularly in rural areas. Men show greater inequality than women. The study suggests that current risk-adjustment models have opportunities for improvement, emphasizing the need for better health premium definitions and stronger health policies.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"74"},"PeriodicalIF":3.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12403389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic burden and cost drivers of generalized pustular psoriasis: a systematic review.","authors":"Xin Qian Seah, Mustapha Mohammed, Siew Chin Ong","doi":"10.1186/s13561-025-00670-3","DOIUrl":"10.1186/s13561-025-00670-3","url":null,"abstract":"","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"73"},"PeriodicalIF":3.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12403385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for postpartum depression at well child visits: evaluating the impact of Michigan's statewide initiative.","authors":"Janet Currie, Anna Malinovskaya","doi":"10.1186/s13561-025-00671-2","DOIUrl":"10.1186/s13561-025-00671-2","url":null,"abstract":"<p><strong>Objective: </strong>To examine a 2018 rule change allowing pediatric providers to bill the child's Medicaid ID for post-partum depression (PPD) screening of mothers conducted during well-child visits, and document its relationship with PPD treatment and infant hospitalizations.</p><p><strong>Study setting and design: </strong>Screening rates during well-child visits are calculated at the zip code level and used in linear probability and Instrumental Variable (IV) models to examine increases in screening after the policy change and relate them to PPD treatment and infant hospitalizations.</p><p><strong>Data sources and analytic sample: </strong>Individual-level Medicaid claims were used to compute PPD screening rates and measures of PPD treatment and infant hospitalization.</p><p><strong>Principal findings: </strong>The policy was associated with increases in screening rates, although take up was uneven and overall screening rates remained low at 8.8%. There was little overall increase in treatment, although in zip codes in the top third of screening rates, higher screening was associated with 10.1% higher probability of maternal treatment. Zip codes with high fractions in poverty and/or minority had low screening rates, but screening was more likely to be associated with increases in treatment in these areas. There are no effects in the full sample of children, but among children above the poverty line, the observed increases in screening reduced the probability of infant hospitalization in the first six months by 7.7%.</p><p><strong>Conclusions: </strong>The policy change had only limited success increasing screening, but increased screening could lead to more maternal PPD treatment and lower infant hospitalization rates if accompanied by expanded access to PPD treatment.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"72"},"PeriodicalIF":3.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of the perceived financial threat of COVID-19 and implications for household economic stability: an application of the partial proportional odds model.","authors":"Maru Zewdu Kassie, Seyifemickael Amare Yilema, Alebachew Taye Belay, Najmeh Nakhaei Rad, Ding-Geng Chen","doi":"10.1186/s13561-025-00637-4","DOIUrl":"10.1186/s13561-025-00637-4","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has been one of the most significant global health crises in recent years. This study aimed to assess the determinants of perceived financial threat of COVID-19 and its implications on household's economic stability in Ethiopia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted on 3058 households from the third round of the COVID-19 high-frequency phone survey of households (HFPS-HH) data, executed by the Central Statistical Agency of Ethiopia in partnership with the World Bank. The data were extracted and managed using STATA version 17. A partial proportional odds model was applied to assess the significant predictors that affect the perceived financial threat of COVID-19.</p><p><strong>Result: </strong>The analysis revealed that 79.9% of respondents (95% CI: 78.5-81.4%) experienced some level of financial threat from the COVID-19 pandemic, with the majority of them (61.7%; 95% CI: 60.0-63.4%) perceiving it as a substantial financial threat. Key factors of financial threat included Age [AOR = 1.280, P = 0.008]; COVID-19 illness worry for substantial threat (AOR = 0.546, p < 0.001), for moderate threat (AOR = 0.562, P = 0.005)]; Ability to buy medicine for substantial threat [AOR = 0.546, p < 0.001], for moderate threat [AOR = 0.562, p = 0.005]; employed [AOR = 1.310, p = 0.014]; engagement in additional income activities for substantial threat [AOR = 3.428, p < 0.001], and for moderate threat [AOR = 3.043, P = 0.018].</p><p><strong>Conclusion: </strong>The findings revealed that a significant proportion of respondents perceived COVID-19 as a financial threat, which adversely affected their economic stability. Vulnerability to financial threat was notably higher among older individuals, the unemployed, those unable to afford essential medicine, and respondents who expressed heightened concern about illness. In contrast, engagement in additional income-generating activities served as a protective factor. These results underscore the need for policymakers to prioritize inclusive social protection systems, expand access to affordable healthcare, promote employment opportunities, and facilitate income diversification. Such interventions are critical to enhancing household economic resilience and enabling a rapid response to future public health and economic crises. Additionally, future research should consider longitudinal designs to track changes in perceptions over time and incorporate broader economic indicators.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"71"},"PeriodicalIF":3.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of outpatient palliative care on healthcare costs in Germany - an analysis of cancer and non-cancer patients based on health insurance data.","authors":"Melissa Hemmerling, Sabrina Schütte, Sveja Eberhard, Katharina van Baal, Stephanie Stiel, Jona Theodor Stahmeyer","doi":"10.1186/s13561-025-00604-z","DOIUrl":"10.1186/s13561-025-00604-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Palliative care (PC) aims at improving the quality of life of patients suffering from life-threatening and life-limiting illnesses. International studies have found that PC is not only helpful for controlling symptoms and reducing hospital stays at the end of life, but also associated with reduced healthcare costs. However, evidence on the economic implications of outpatient PC in Germany is scarce. Accordingly, the current study aimed at assessing the impact of outpatient PC on end-of-life costs, and measuring differences between cancer and non-cancer patients who did and did not receive outpatient PC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study involved a retrospective, cross-sectional analysis of statutory health insurance data for individuals who died in 2019 and were older than 18 years at the time of death (34,012 individuals). To explore the impact of outpatient PC on end-of-life costs, three groups were formed: (1) all individuals, (2) individuals with a cancer diagnosis and (3) individuals with no cancer diagnosis. The data were analysed descriptively and linear regression models were conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The descriptive results showed in the group of all individuals, patients receiving outpatient PC had higher costs in all healthcare sectors compared to those who did not receive outpatient PC. Cancer patients receiving outpatient PC had higher total healthcare costs (outpatient PC: 34,822€; no outpatient PC: 26,343€; p &lt; 0.001) but lower hospital costs (outpatient PC: 17,485€; no outpatient PC: 18,713€; p = 0,004). Non-cancer patients receiving outpatient PC had similar total healthcare costs (p = 0.174) but lower hospital costs (outpatient PC: 11,505€; no outpatient PC: 12,667€; p = 0.001). The regression models showed significantly higher total healthcare costs (p &lt; 0.001), outpatient physician costs (p &lt; 0.001) and pharmaceutical costs (p &lt; 0.001) for patients receiving outpatient PC in all groups. Also across all groups, hospital costs were similar between patients who were and were not receiving outpatient PC (all patients: + 40€, p = 0.808; cancer patients: -580€, p = 0.072; non-cancer patients: + 301€, p = 0.166).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Unlike the findings of international studies, the present study found that outpatient PC is not associated with lower end-of-life costs. The results for hospital costs were heterogeneous, but there was a trend towards lower costs for cancer patients receiving outpatient PC. Comparability with (inter)national studies remains difficult because financing systems and access to healthcare services are not internationally consistent. Many studies recommend the early integration of PC. Further analyses should investigate the connection between the time of initiating PC and end-of-life costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;The main study was registered in the German Clinical Trials Register (Registration N° DRKS00024785; date of ","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"70"},"PeriodicalIF":3.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal denervation for hypertension: cross-country cost-effectiveness insights from mainland China, Japan, and Thailand.","authors":"Dai Lian, Yue Suo, Ruoyan Gai, Ning Li, Yunfeng Ren, Dunming Xiao, Jiaxin Zhao, Mingdong Zhang, Shimeng Liu, Yingyao Chen","doi":"10.1186/s13561-025-00669-w","DOIUrl":"10.1186/s13561-025-00669-w","url":null,"abstract":"<p><strong>Background: </strong>Renal denervation (RDN) has been introduced as a novel non-pharmacological intervention for patients with hypertension that is poorly controlled by pharmacological means. Our study aims to evaluate the cost-effectiveness of the Netrod RDN treatment plus antihypertensives compared with antihypertensives alone for hypertension in Mainland China, Japan and Thailand.</p><p><strong>Methods: </strong>A Markov decision-analytic model was developed to simulate the long-term clinical events, quality-adjusted life years (QALYs) and related costs among patients who underwent RDN regimen and antihypertensive regimen in line with Netrod-HTN trial, with yearly cycles over a 30-year horizon. This study adopted the perspectives of the healthcare systems. Cost and utility inputs were collected from published literature, price databases, expert consultations, and hospital information systems. Both costs and outcomes were discounted at a rate of 5%. Model validation, univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to verify the robustness of the results.</p><p><strong>Results: </strong>Compared with the antihypertensive regimen alone, the RDN regimen yielded a 30.61% reduction in cardiovascular, cerebral and renal events. Cost-effectiveness analysis showed the RDN regimen yielded the most favorable incremental cost-effectiveness ratio in Japan at $3,451 per QALY, followed by Thailand at $13,932 per QALY, and Mainland China at $19,049 per QALY. Sensitivity and scenario analyses confirmed the robustness of the findings.</p><p><strong>Conclusions: </strong>Netrod RDN is a cost-effective intervention from the healthcare system perspective in Mainland China, Japan, and Thailand. However, its cost-effectiveness varies across countries, reflecting differences in socioeconomic contexts. In middle- and low-income countries, appropriate pricing strategies may play a key role in enhancing its affordability and cost-effectiveness.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"69"},"PeriodicalIF":3.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Governance and public health expenditure in Côte d'Ivoire: examination of the dynamic relationship.","authors":"Alliou Salihini Diarrassouba, Foungnigué Noé Coulibaly, Anzoumana Comoé","doi":"10.1186/s13561-025-00627-6","DOIUrl":"10.1186/s13561-025-00627-6","url":null,"abstract":"<p><strong>Background: </strong>The difficulties in mobilizing financial resources in developing countries combined with the low level of health of populations reveal the need to seek levers for optimal use of available resources. This paper aims at analyzing the dynamics of the relationship between governance and public health expenditure in Côte d'Ivoire as part of the \"health for all\" policy.</p><p><strong>Methods: </strong>The estimates show, from a cointegration model based on the ARDL (self-regressive with staggered delays) approach and causality in the sense of that corruption influences and causes the increase in public health expenditure in the long term.</p><p><strong>Results: </strong>The results includes poor health outcomes due to the diversion of resources on budgetary allocations. A 1% increase in the level of corruption generates 0.9% short-term and 0.5% long-term decrease in public health spending. Also, causality indicates a unidirectional link between the two variables ranging from corruption to the level of public health resources.</p><p><strong>Conclusions: </strong>The authorities should therefore strengthen the institutional framework and the quality of central and internal governance of vertical health structures and programs in order to induce better use of resources likely to improve health outcomes.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"68"},"PeriodicalIF":3.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}