BackgroundComplicated with the impact of aging population and urbanization, coronary heart disease (CHD) incurs more and more disease burdens in China. Salvianolate injection is a Chinese patent drug widely used for treating CHD in China. A series of studies have verified the efficacy of salvianolate injection
, but the high drug cost has raised concerns. It is, therefore, important to conduct cost-consequence analysis to demonstrate whether salvianolate injection is associated with outcome improvement and cost containment. The aim of this study was to retrospectively evaluate the cost-consequence of salvianolate injection for the treatment of coronary heart disease by combining salvianolate injection with conventional treatment from a societal perspective.MethodsWe retrospectively studied hospitalized patients with CHD from August 2011 to December 2015 by using electronic medical record database. Patients who received salvianolate injection combined with conventional treatment were selected as exposed group, while those who received conventional treatment alone were selected as unexposed group. Propensity score matching (PSM) analysis was used to balance the characteristics of patients. After PSM, we evaluated hospital stay, total nitrates dosage, total medical costs, and subcategories costs. Patients with chronic ischemic heart disease were analyzed as a highly selected subcohort.ResultsFor the overall group, hospital stay was significantly decreased by 2.9 days (P < 0.05) and total nitrates dosage was significantly decreased by 172.4 mg (P < 0.05) in exposed group; cost savings of pharmacy cost, examination cost, laboratory cost, operation cost and treatment was observed as significant (at P < 0.05); and the additional expenditure of Chinese patent drug (1174.9 CNY) was less than the saving of total medical costs (2636.4 CNY). For chronic ischemic heart disease subcohort, compared with unexposed group, significant decreases were also found in hospital stay and total nitrates dosage (P < 0.05); cost savings were significant (P < 0.05) for exposed group in terms of total medical costs (4339.5 CNY) and subcategories costs (including pharmacy cost, examination cost, operation cost and treatment cost); and the additional expenditure of Chinese patent drug (1189.3 CNY) was less than the saving of total medical costs.ConclusionCompared with conventional treatment for the treatment of CHD, combination of salvianolate injection and conventional treatment was associated with a reduction in hospital stay and total nitrates dosage. The acquisition cost of Chinese patent drug (including salvianolate injection) was offset by a higher reduction in total medical costs, especially for chronic ischemic heart disease.Electronic supplementary materialThe online version of this article (10.1186/s13020-018-0185-x) contains supplementary material, which is available to authorized users.
Background
Previous studies have revealed that current secondhand smoke exposure showed highly suggestive evidence for increased risk of simultaneous sleep problems in children. Data on the associations between early-life exposure to SHS with subsequent sleep problems in children were scarce. We aimed to evaluate the associations of early-life SHS exposure with sleep problems in children.
Methods
In this cross-sectional study, children were recruited from elementary and middle schools in Liaoning Province, China between April 2012 and January 2013. We assessed early-life SHS exposure (pregnancy and the first 2 years of life) via questionnaires. Sleep problems and different types of sleep-related symptoms were measured based on the validated tool of the Sleep Disturbance Scale for Children (SDSC). Generalized linear mixed models were applied to estimate the associations of early-life SHS exposure with sleep problems.
Results
We included a total of 45,562 children (22,657 [49.7%] males; mean [SD] age, 11.0 [2.6] years) and 6167 of them (13.5%) were exposed to early-life SHS during both pregnancy and the first 2 years of life. Compared with unexposed counterparts, children exposed to early-life SHS had higher total T-scores of SDSC (β = 4.32; 95%CI: 4.06, 4.58) and higher odds of increased sleep problems (OR = 2.14; 95%CI: 1.89, 2.42). When considering different sleep-related symptoms, the associations between early-life SHS exposure and symptom of sleep-wake transition disorders (i.e., bruxism) were the strongest in all analyses.
Conclusions
Early-life SHS exposure was associated with higher odds of global sleep problems and different sleep-related symptoms in children aged 6–18 years. Our findings highlight the importance to strengthen efforts to support the critical importance of maintaining a smoke-free environment especially in early life.
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