European Journal of Health Economics最新文献

{"title":"Time value of informal care of people with alzheimer's disease in Spain: a population-based analysis.","authors":"Vilaplana-Prieto C, Oliva-Moreno J","doi":"10.1007/s10198-024-01713-y","DOIUrl":"10.1007/s10198-024-01713-y","url":null,"abstract":"<p><p>The aims of this paper are to estimate the monetary value of informal care for people with Alzheimer's disease (AD) in Spain, to compare results with those obtained in 2008 and to analyse the main determinants of the time of the value of informal care. The Survey on Disabilities, Autonomy and Dependency carried out in Spain in 2020/21 was used to obtain information about disabled individuals with AD and their informal caregivers. Assessment of informal care time was carried out using two alternative approaches: the replacement method, and the contingent valuation method (willingness to pay & willingness to accept). The number of people with AD residing in Spanish households and receiving informal care rose to more than 200,000, representing an increase of 43% compared with 2008. The average number of hours of informal care per week ranged from 86 to 101 h, with an estimated value of between €31,584 - €37,019 per year per caregiver (willingness to accept) or €71,653 - €83,984 per year (replacement). The annual total number of caregiving hours ranged between 896 and 1,061 million hours, representing between 0.52 and 0.62 of GDP in 2021 (willingness to accept) or 1.19-1.40 of GDP (replacement). The level of care needs plays a central role in explaining heterogeneity in estimates. These results should be taken into account by decision-makers for long-term care planning in the coming years.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"377-402"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost effectiveness of a GP delivered medication review to reduce polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity in Irish primary care: the SPPiRE cluster randomised controlled trial.","authors":"Paddy Gillespie, Frank Moriarty, Susan M Smith, Anna Hobbins, Sharon Walsh, Barbara Clyne, Fiona Boland, Tara McEnteggart, Michelle Flood, Emma Wallace, Caroline McCarthy","doi":"10.1007/s10198-024-01718-7","DOIUrl":"10.1007/s10198-024-01718-7","url":null,"abstract":"<p><strong>Background: </strong>Evidence on the cost effectiveness of deprescribing in multimorbidity is limited.</p><p><strong>Objective: </strong>To investigate the cost effectiveness of a general practitioner (GP) delivered, individualised medication review to reduce polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity in Irish primary care.</p><p><strong>Methods: </strong>Within trial economic evaluation, from a healthcare perspective and based on a cluster randomised controlled trial with a 6 month follow up and 403 patients (208 Intervention and 195 Control) recruited between April 2017 and December 2019. Intervention GPs used the SPPiRE website which contained educational materials and a template to support a web-based individualised medication review. Control GPs delivered usual care. Incremental costs, quality adjusted life years (QALYs) generated using the EQ-5D-5L instrument, and expected cost effectiveness were estimated using multilevel modelling and multiple imputation techniques. Uncertainty was explored using parametric, deterministic and probabilistic methods.</p><p><strong>Results: </strong>On average, the SPPiRE intervention was dominant over usual care, with non-statistically significant mean cost savings of €410 (95% confidence interval (CI): - 2211, 1409) and mean health gains of 0.014 QALYs (95% CI - 0.011, 0.039). At cost effectiveness threshold values of €20,000 and €45,000 per QALY, the probability of SPPiRE being cost effective was 0.993 and 0.988. Results were sensitive to missing data and data collection period.</p><p><strong>Conclusions: </strong>The study observed a pattern towards dominance for the SPPiRE intervention, with high expected cost effectiveness. Notably, observed differences in costs and outcomes were consistent with chance, and missing data and related uncertainty was non trivial. The cost effectiveness evidence may be considered promising but equivocal.</p><p><strong>Trial registration: </strong>ISRCTN: 12752680, 20th October 2016.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":"427-454"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health shocks and health behavior: a long-term perspective.","authors":"Christian Bünnings, Irina Simankova, Harald Tauchmann","doi":"10.1007/s10198-024-01747-2","DOIUrl":"https://doi.org/10.1007/s10198-024-01747-2","url":null,"abstract":"<p><p>Several empirical papers suggest that individuals improve health-related behaviors in response to adverse shocks to physical health. However, little evidence exists regarding the questions of (i) how long-lasting these behavioral responses are and (ii) whether individuals respond similarly to mental health shocks. Using individual-level survey data from Germany and combining regression augmented inverse-probability weighting with machine learning prediction algorithms, we compare individuals hit by such shocks to undisturbed individuals up to fifteen years after that shock. The analysis confirms earlier findings that individuals experiencing a sharp deterioration of physical health immediately improve their health-related behaviors in terms of eating more healthily and being less likely to smoke. Contrarily, doing sports is negatively affected. We further find that the immediate response to shocks on mental health is weaker, with the exception of smoking. Tobacco consumption on average becomes more likely after a shock to mental health. We further find that the immediate response to shocks on mental health is weaker, with the exception of smoking behavior, which on average worsens after such kind of a shock. Yet the analysis does not reveal long lasting persistent effects. Significant differences in health behaviors are rarely found more than two years after the shock.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences for health-related quality of life: do they vary by age? A systematic literature review on the EQ-5D measure.","authors":"Alhanouf Alabbad, Madeleine Cochrane, Paul Mark Mitchell","doi":"10.1007/s10198-025-01766-7","DOIUrl":"https://doi.org/10.1007/s10198-025-01766-7","url":null,"abstract":"<p><strong>Introduction: </strong>Cost-utility analysis (CUA) is a commonly used method in Health technology assessment (HTA) that utilises generic metrics such as quality-adjusted life years (QALYs). QALY is a measure derived from individuals' preferences for different health states, with these preferences represented as utility values. However, utility values may differ by age, raising equity concerns in healthcare allocation. Given the globally ageing demographic, understanding the age-utility relationship becomes essential.</p><p><strong>Objectives: </strong>This systematic review aimed to explore the impact of age on utility values derived from the EQ-5D, a widely used instrument in CUA that contributes to calculating QALYs by assessing five dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.</p><p><strong>Methods: </strong>Our search used the comprehensive pearl growing approach and database searching. We included studies that analysed the effect of age on EQ-5D utility values in the general population. We excluded qualitative, non-English, and non-EQ-5D instrument studies. Quality was appraised using the Joanna Briggs Institute tool, and a narrative synthesis was used.</p><p><strong>Results: </strong>Of the 28 studies reviewed, primarily from Europe and the Americas, the average age of participants ranged from 34.1 and 47.7 years. Around 46% (n = 13) associated older age with lower utility values; 28% (n = 8) with higher utility; and 25% (n = 7) found no consistent relationship between age and utility.</p><p><strong>Discussion: </strong>Age was identified as a critical factor affecting EQ-5D-derived utility values, with implications for the equitable distribution of healthcare resources. These findings corroborate previous research on utility measurement across different instruments, highlighting the ethical and policy issues due to age-related utility differences.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health state utilities associated with X-linked retinitis pigmentosa (XLRP).","authors":"Louis S Matza, Nan Li, Katie D Stewart, Mahmoud Hashim, Tom Denee, Feng Pan, Qiaoyi Zhang, Jennifer Lee, Michel Michaelides, Hendrik P N Scholl","doi":"10.1007/s10198-025-01761-y","DOIUrl":"https://doi.org/10.1007/s10198-025-01761-y","url":null,"abstract":"<p><strong>Background: </strong>X-linked retinitis pigmentosa (XLRP) is a rare, inherited retinal disease characterized by impairment in visual field and visual acuity with continuous progression leading to blindness. Gene therapies for XLRP are under investigation, and health state utilities are needed for use in cost-utility analyses examining the value of these treatments.</p><p><strong>Objective: </strong>This study aimed to estimate utilities associated with XLRP severity.</p><p><strong>Methods: </strong>Eleven health state vignettes depicting combinations of impairment in visual field and visual acuity associated with XLRP were developed based on literature review and input from clinicians, patients, and a caregiver. Vignettes included text describing visual acuity impairment, visual field impairment, night blindness, impact on quality of life, and two images representing the combination of visual field and visual acuity impairment for each health state. Health states were valued in time trade-off interviews with general population respondents in the UK.</p><p><strong>Results: </strong>A total of 245 participants completed interviews (51.0% female; mean age = 41.4 years; Newcastle, n = 80; London, n = 85; Edinburgh, n = 80). In a ranking task, participants preferred health states with less severe visual impairment, and this preference was reflected in the utilities. Mean (standard deviation) utilities ranged from 0.900 (0.121) for the health state with no visual acuity impairment and mild visual field impairment to 0.271 (0.478) for the health state describing blindness.</p><p><strong>Conclusion: </strong>Results highlight the substantial impact of visual impairment on health state preference and quality of life. The health state utilities estimated in this study may be appropriate for use in cost-effectiveness models evaluating treatments for XLRP.</p><p><strong>Jel classification codes: </strong>I1; I12; I19.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing a heterogeneous chronic patient population for redesigning person-centred bundled payment models using risk-mitigating measures.","authors":"Sterre S Bour, Lucas M A Goossens, Maureen P M H Rutten-van Mölken","doi":"10.1007/s10198-025-01762-x","DOIUrl":"https://doi.org/10.1007/s10198-025-01762-x","url":null,"abstract":"<p><p>Since 2010, most Dutch patients with diabetes mellitus type 2 (DM2), an increased risk of cardiovascular diseases (CVR), and chronic obstructive pulmonary disease (COPD), have been treated in single-disease management programs (SDMPs) provided by primary care cooperatives (PCCs). These SDMPs are funded through bundled payments. However, given the prevalence of multimorbidity among patients, there is a growing need for care that is more person-centred. We have previously published an alternative payment model that stimulates the integration of care required for a person-centred approach and in this paper, we demonstrate an operationalization of this model. We performed cluster analysis on claims data to distinguish between different subgroups of patients, predicted cluster probabilities with data available to general practitioners, designed different care packages and investigated the expected financial risk for PCCs of different sizes. We showed that mainly the size of the PCC and the content of the care package influenced the predicted losses or profits for the PCC. Two risk-mitigating measures-risk-adjustment and cost-capping-resulted generally in predicted losses or profits closer to 0, and therefore a reduced risk for the PCC.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric benefits of adding bolt-ons to the EQ-5D-5L in populations undergoing minimally invasive cosmetic procedures.","authors":"Eszter Mercédesz Müller, Anna Nikl, Máté Krebs, Péter Holló, Valentin Brodszky, Lajos Vince Kemény, Fanni Rencz","doi":"10.1007/s10198-025-01772-9","DOIUrl":"https://doi.org/10.1007/s10198-025-01772-9","url":null,"abstract":"<p><strong>Objectives: </strong>There is growing interest in measuring health outcomes associated with minimally invasive cosmetic procedures (MICPs), such as botulinum toxin and hyaluronic acid injections. However, the EQ-5D may have limited content validity for this purpose. This study aims to psychometrically test five additional dimensions ('bolt-ons') for the EQ-5D-5L in individuals planning or undergoing MICPs.</p><p><strong>Methods: </strong>In 2023, a cross-sectional, online survey was conducted with 149 women planning MICPs and 215 who had recently undergone them. Respondents completed the EQ-5D-5L, five bolt-ons (skin irritation, self-confidence, sleep, social relationships, tiredness), the Rosenberg Self-Esteem Scale (RSES) and the Brief Fear of Negative Evaluation Scale-Straightforward Items (BFNE-S). The following psychometric properties were tested for the EQ-5D-5L + bolt-on(s): ceiling, convergent and divergent validity, explanatory power and known-groups validity.</p><p><strong>Results: </strong>Adding tiredness (22%), self-confidence (23%) or sleep bolt-ons (27%) substantially reduced the ceiling of the EQ-5D-5L (47%). The self-confidence and social relationships bolt-ons showed a moderate or strong correlation with the RSES and BFNE-S total scores (-0.462 to -0.679). The tiredness and self-confidence bolt-ons improved the EQ-5D-5L's explained variance in EQ VAS scores from 37% to 45%. The self-confidence and social relationships bolt-ons improved the EQ-5D-5L's discrimination between known groups based on self-esteem and bodily appearance (relative efficiency: 2.72 to 2.82).</p><p><strong>Conclusions: </strong>Relevant bolt-ons substantially enhance the psychometric performance of the EQ-5D-5L in MICP populations. The self-confidence and tiredness bolt-ons may be recommended as primary choices for use alongside the EQ-5D-5L, both in clinical studies and as part of sensitivity analyses in economic evaluations of MICPs.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in spending, quality indicators, and provider experiences following the introduction of a population-based payment model in dutch primary care: a mixed methods evaluation.","authors":"Tadjo Gigengack, Daniëlle Cattel, Frank Eijkenaar","doi":"10.1007/s10198-025-01765-8","DOIUrl":"https://doi.org/10.1007/s10198-025-01765-8","url":null,"abstract":"<p><strong>Background: </strong>In July 2017, a Dutch health insurer and primary care organization jointly implemented the All-In Contract (AIC), a population-based payment model for general practitioners (GPs). Affiliated GP-practices received a capitated payment per enrolled patient covering all GP care and multidisciplinary primary care for chronic conditions. Additionally, the care organization shared in savings and losses on total healthcare spending, contingent upon meeting quality targets. This study investigates the AIC's impact on spending, quality indicators, and provider experiences 2.5 years after implementation.</p><p><strong>Methods: </strong>We employed a difference-in-differences approach comparing individual-level claims spending from enrollees of participating GP-practices (N = 16,425) with a control group (N = 212,251). Changes in indicators of chronic care management and patient satisfaction were investigated in a before-after analysis due to limited data availability. To contextualize the findings and explore provider experiences, focus groups were conducted with stakeholders involved in the development and/or implementation of the AIC.</p><p><strong>Results: </strong>The AIC was associated with an insignificant 1.2% reduction of average quarterly total spending per enrollee (p = 0.476). We did find a - 10.2% decrease in primary care spending growth (p < 0.01), which was likely related to the indexation rate used for the capitation payment. Spending in other subcategories showed insignificant changes. Changes in patient satisfaction and chronic care management indicators were mixed and modest, but due to the lack of data from non-participating GPs, the extent to which these changes can be attributed to the AIC remains uncertain. The focus group participants reported improvements in provider flexibility in care provision, autonomy, and reduced administrative burdens. However, the focus group results may not fully capture the broader or more diverse experiences of all providers involved.</p><p><strong>Conclusions: </strong>In its first 2.5 years, the AIC had no significant effect on total healthcare spending growth. Trends in quality indicators suggest mixed results for patient satisfaction and chronic care management, while focus group results indicated improved provider experiences. To comprehensively evaluate population-based payment reforms, stakeholders should improve data collection strategies to enable causal assessment of population health, patient experiences, and provider well-being.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of parastomal hernia on quality of life using data from the CIPHER prospective cohort study.","authors":"Joel Glynn, William Hollingworth, Jessica Harris, Syed Mohiuddin, Lucy Ellis, Barnaby C Reeves, Neil Smart","doi":"10.1007/s10198-025-01768-5","DOIUrl":"https://doi.org/10.1007/s10198-025-01768-5","url":null,"abstract":"<p><strong>Objectives: </strong>Despite being a common side effect of stoma surgery, little is known about the health-related quality-of-life (HRQoL) impact of parastomal hernia (PSH). We studied the association between HRQoL and self-reported PSH using data from the large CIPHER prospective cohort study of patients living with a stoma.</p><p><strong>Methods: </strong>Over 12 months, HRQoL was captured at up to four time points for 2,341 individuals with stomas using EuroQol-5D-5L (EQ-5D-5L). Applying a repeated measures regression, we analysed the association between HRQoL and the incidence of self-reported PSH in the year following surgery. Using ordinal regressions, we estimated the odds of reporting worse function in each of the five EQ-5D-5L dimensions among those reporting PSH. We estimated the average number of quality-adjusted life days (QALDs) lost in those reporting PSH.</p><p><strong>Results: </strong>Patients experiencing PSH reported significantly lower EQ-5D-5L scores at 12 months following stoma formation (-0.099 [95%CI: -0.126 to -0.071]), amounting to 22.3 QALDs lost per-person-per year. Patients reporting PSH at 12 months had more problems in all EQ-5D-5L dimensions. In four of five dimensions, patients with PSH had more than double the odds of reporting worse HRQoL levels; the difference was most substantial for pain/discomfort (odds ratio 2.80 [95%CI: 2.17 to 3.62]).</p><p><strong>Conclusion: </strong>Developing PSH significantly reduces HRQoL across a range of health outcomes, including pain/ discomfort, usual activities, self-care, mobility, and anxiety/depression. Therefore, developing and evaluating surgical techniques to prevent PSH is important to reduce the prevalence of PSH following stoma formation. Estimates of HRQoL presented here can be used in cost-effectiveness studies evaluating such interventions.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public versus private healthcare systems in the OECD area- a broad evaluation of performance.","authors":"Per Molander","doi":"10.1007/s10198-025-01767-6","DOIUrl":"https://doi.org/10.1007/s10198-025-01767-6","url":null,"abstract":"<p><p>Healthcare systems can be categorised along the public/private axis into two main types: publicly administered systems and systems based on compulsory health insurance provided by the private sector. Within the OECD area, the latter group has expanded over time, particularly with the inclusion of new member states from Eastern Europe and Central and Latin America. This study compares the efficiency of these two models across the 38 member countries, utilising a broad spectrum of performance indicators developed by the OECD secretariat. Data from the most recent available year, typically 2021, were analysed. On average, performance improves with an increase in healthcare budgets; however, further enhancements come at rising costs. The analysis concludes that there is no evidence supporting the hypothesis that transitioning from a publicly administered system to a privately dominated system will enhance efficiency. By contrast, there is strong evidence that overall efficiency increases with the public share of financing. These conclusions also hold true for the more restricted group of OECD countries in Europe.</p>","PeriodicalId":51416,"journal":{"name":"European Journal of Health Economics","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}