Cost-effective threshold (CET) is essential for health technology assessment and decision-making based on health economic evaluations. Recently, it has been argued that the commonly used once and three times of gross domestic product (GDP) per capita CETs of a quality-adjusted life year (QALY) are not necessarily empirically supported in all countries. Therefore, we aimed to estimate the CET of a QALY as times of GDP per capita in China, of which the reimbursement coverage decisions are increasingly engaging economic evaluations. Estimates on the value of statistical life (VSL) in China were identified from several studies in the literature and converted to times of GDP per capita, the weighted average of which was used for subsequent calculation. By pooling data on population mortality, health utility, and age distribution, we estimated the value of a statistical QALY (VSQ) from VSL using an established mathematical process, which represented the theoretical upper bound of CET. The corresponding point estimate and theoretical lower bound were obtained using their numerical relationships with the upper bound. Scenarios analyses were also conducted. The estimated CET, its upper bound, and its lower bound were 1.45, 2.90, and 1.16 times of GDP per capita in China, respectively. In different scenarios, the estimated CET varied but was greater than once GDP per capita in most cases. As such, the CET of a QALY in China is close to 1.5 times of GDP per capita, which should be benchmarked for future ICER-based coverage decisions.

Introduction Productivity loss may contribute to a large proportion of costs of health conditions in an economic evaluation from a societal perspective, but there is currently a lack of methodological consensus on how productivity loss should be measured and valued. Despite the research progress surrounding this issue in other countries, it has been rarely discussed in China. Methods We reviewed the official guidelines on economic evaluations in different countries and regions and screened the literature to summarise the extent to which productivity loss was incorporated in economic evaluations and the underlying methodological challenges. Results A total of 48 guidelines from 46 countries/regions were included. Although 32 (67%) guidelines recommend excluding productivity loss in the base case analysis, 23 (48%) guidelines recommend including productivity loss in the base case or additional analyses. Through a review of systematic reviews and the economic evaluation studies included in these reviews, we found that the average probability of incorporating productivity loss in an economic evaluation was 10.2%. Among the economic evaluations (n=478) that explicitly considered productivity loss, most (n=455) considered losses from paid work, while only a few studies (n=23) considered unpaid work losses. Recognising the existing methodological challenges and the specific context of China, we proposed a practical research agenda and a disease list for progress on this topic, including the development of the disease list comprehensively consisting of health conditions where the productivity loss should be incorporated into economic evaluations. Conclusion An increasing number of guidelines recommend the inclusion of productivity loss in the base case or additional analyses of economic evaluation. We optimistically expect that more Chinese researchers notice the importance of incorporating productivity loss in economic evaluations and anticipate guidelines that may be suitable for Chinese practitioners and decision-makers that facilitate the advancement of research on productivity loss measurement and valuation.

Several randomized clinical trials (RCTs) that investigated the effectiveness of remdesivir for the treatment of coronavirus disease‐2019 (COVID‐19) have generated inconsistent evidence. The present study aimed to synthesize available RCT evidence using network meta‐analyses (NMAs). Both blinded and open‐label RCTs in PubMed database from inception to 7 June 2020 that contained “remdesivir”, “Covid‐19”, and “trial” in the abstracts conducted on hospitalized COVID‐19 persons were identified and screened. The studies must have at least one remdesivir arm and evaluated one of the pre‐specified outcomes. The outcomes were clinical improvement between days 10 to 15 after randomization and clinical recovery during the follow‐up period. The identified literature was supplemented with relatively recent studies that were known to the researchers if not already included. Frequentist NMAs with random effects were conducted. Both 10‐day and 5‐day remdesivir regimens were associated with higher odds of clinical improvement (odds ratio [OR] of 10‐day regimen: 1.35, 95% confidence interval [CI], 1.09‐1.67); OR of 5‐day regimen: 1.81, 95% CI, 1.32‐2.45, and higher probabilities of clinical recovery (relative risk [RR] of 10‐day regimen: 1.24, 95% CI, 1.07‐1.43; RR of 5‐day regimen: 1.47, 95% CI, 1.16‐1.87 compared with placebo. Remdesivir may have clinical benefits among hospitalized COVID‐19 persons.

Background The 5-level EQ-5D (EQ-5D-5L) has been increasingly used in China to measure the health status of the general population and patients. However, its content validity among rural residents in China has not been formally evaluated. This qualitative study aims to assess the content validity of EQ-5D-5L among rural Chinese. Methods Participants were recruited from four regions (North, South, East and West) across China. Eligible participants were those living in the rural area in last three years and making a living by agricultural operations. Semi-structured interviews were conducted. Interview transcripts were analysed to assess the comprehensibility, relevance, clarity and comprehensiveness. Results Sixty-two participants were included, comparable to the national figures regarding age, sex and education. For comprehensibility, participants could understand the ‘mobility’, ‘self-care’ and ‘usual activities’ domains well, but some reported confusions in ‘pain/discomfort’ (n = 42) and ‘anxiety/depression’ (n = 35). Some also reported difficulties in understanding anxiety (n = 6) and depression (n = 9), possibly due to the formal wording used. For relevance, all domains were reported as health-related and participants’ responses were based on their own health. For clarity, all could distinguish the five levels, but suggestions on reducing response levels and alternative wording for ‘slight’ were raised. For comprehensiveness, two aspects (fatigue/energy and appetite) were raised beyond the EQ-5D-5L domains. The ‘mobility’ domain was selected as the most important and ‘anxiety/depression’ as the least important. Conclusion Rural Chinese reported problems on the content validity of Chinese EQ-5D-5L. It might be sensible to consider some revisions to make it more understandable for rural residents.