Publications by authors named "Aziz Rezapour"

103 Publications

Burden of Hypertensive Heart Disease in Iran during 1990-2017: Findings from the Global Burden of Disease study 2017.

PLoS One 2021 22;16(9):e0257617. Epub 2021 Sep 22.

Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Hypertension and its consequent end-organ damage including Hypertensive Heart Disease (HHD) are a major concern that impact health, resulting into impairment and reduced quality of life (QOL). The purpose of this study was to describe the burden of HHD in Iran and comparing it with the World Bank upper middle-income countries (UMICs) in terms of disability-adjusted life years (DALY), mortality and prevalence.

Methods: Using data from the Global Burden of Disease study 2017, we compared the number of DALYs, deaths and prevalence trends for HHD from 1990 to 2017 in all age groups for both sex in Iran, and compared the epidemiology and trends with UMICs and globally.

Results: The age-standardized DALY rate for HHD increased by 51.6% for men (95% uncertainty interval [UI] 305.8 to 436.7 per 100,000) and 4.4% for women (95% UI 429.4 to 448.7 per 100,000) in Iran. The age-standardized prevalence of HHD in Iran was almost twice times higher than globally and 1.5-times more than the World Bank UMICs. The age-standardized death rate for HDD increased by 60.1% (95% UI 17.3 to 27.7% per 100,000) for men and by 21.7% (95% UI 25.85 to 31.48 per 100,000) for women from 1990 to 2017. Age-standardized death rate in Iran was 2.4 and 1.9 times higher than globally and UMICs, respectively.

Conclusions: The higher prevalence and death rate in Iran in comparison with UMICs and globally should encourage health care provider to perform intensive screening activities in at risk population to prevent HHD and mitigate its mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257617PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457465PMC
September 2021

Burden of Transport-Related Injuries in the Eastern Mediterranean Region: A Systematic Analysis for the Global Burden of Disease Study 2017.

Arch Iran Med 2021 07 1;24(7):512-525. Epub 2021 Jul 1.

Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age.

Methods: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs).

Results: In 2017, there were 5.5 million (UI 4.9-6.2) transport-related incident cases in the EMR - a substantial increase from 1990 (2.8 million; UI 2.5-3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5-876.2) per 100000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between countries, such that Oman (1303.9; UI 1167.3-1441.5) and Palestine (486.5; UI 434.5-545.9) had the highest and lowest age-standardized incidence rates per 100000, respectively. In 2017, there were 185.3 thousand (UI 170.8-200.6) transport-related fatalities in the EMR - a substantial increase since 1990 (140.4 thousand; UI 118.7-156.9). The age-standardized death rate for the EMR in 2017 was 29.5 (UI 27.1-31.9) per 100000, which was 30.5% lower than that found in 1990 (42.5; UI 36.8-47.3). In 2017, Somalia (54; UI 30-77.4) and Lebanon (7.1; UI 4.8-8.6) had the highest and lowest age-standardized death rates per 100,000, respectively. The age-standardised DALY rate for the EMR in 2017 was 1,528.8 (UI 1412.5-1651.3) per 100000, which was 34.4% lower than that found in 1990 (2,331.3; UI 1,993.1-2,589.9). In 2017, the highest DALY rate was found in Pakistan (3454121; UI 2297890- 4342908) and the lowest was found in Bahrain (8616; UI 7670-9751).

Conclusion: The present study shows that while road traffic has become relatively safer (measured by deaths and DALYs per 100000 population), the number of transport-related fatalities in the EMR is growing and needs to be addressed urgently.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34172/aim.2021.74DOI Listing
July 2021

Measuring universal health coverage to ensure continuing care for older people: a scoping review with specific implications for the Iranian context.

East Mediterr Health J 2021 Aug 26;27(8):806-817. Epub 2021 Aug 26.

Department of Community Medicine, Preventive Medicine and Public Health Research Centre, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.

Background: To measure progress towards universal health coverage (UHC) in the context of ageing, it is necessary to develop suitable monitoring frameworks. The global UHC monitoring framework is focused on priorities for younger populations and does not adequately address issues relevant to ageing populations.

Aims: This study aims to propose a framework to measure UHC in a way that is relevant to health systems responding to population ageing.

Methods: Based on a search strategy focusing on measures of UHC in relation to older people's care, we searched electronic databases and screened the records to qualitatively analyse the data. We also conducted 2 rounds of expert panel consultations to discuss the findings and examine the feasibility of the recommended indicators using the case of the Islamic Republic of Iran as an example.

Results: We identified main themes and classified core indicators under each theme. Besides 25 indicators for quality of care, there were 22 indicators for financial protection. Ten indicators were retrieved measuring coverage and access to long-term care. Some indicators were excluded owing to limited data availability or absence of related programmes and some alternate indicators were proposed.

Conclusions: We identified several indicators which could be used to measure progress toward UHC in the context of population ageing. However, not all of these indicators are feasible in context of low- and middle-income countries. This study could offer useful general guidance on how to define the exact set of measures in a specific country context.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.26719/emhj.21.040DOI Listing
August 2021

Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning.

PLoS Negl Trop Dis 2021 Jul 28;15(7):e0008824. Epub 2021 Jul 28.

Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana.

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pntd.0008824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318275PMC
July 2021

A Systematic Review of Potentially Inappropriate Medications Use and Related Costs Among the Elderly.

Value Health Reg Issues 2021 Sep 24;25:172-179. Epub 2021 Jul 24.

Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Objective: Potentially inappropriate medications (PIMs) use is a common phenomenon among older adults. This paper aimed to perform a systematic literature review to assess PIMs use and related costs among elderly persons.

Methods: This study was a systematic review. PubMed, Scopus, and the Institute for Scientific Information engines were used to search for all relevant studies published until 2020. Studies were excluded if they did not estimate the cost of PIMs for the elderly. In addition, non-English articles, editorials, letters, and review articles were excluded. All eligible articles were assessed for methodological quality. Finally, we extracted general characteristics from each eligible study.

Results: This study showed that the prevalence of PIMs use among older adults was more than 30%. Drugs related to the central nervous system and cardiovascular disease, benzodiazepines, analgesics, and nonsteroidal anti-inflammatory drugs were most commonly used as PIMs. These studies concluded that PIMs could impose a high economic burden on the elderly and society. The mean cost for older adults with PIMs use was almost USD$2000 more than the mean cost for older adults without PIMs. Additionally, the total cost of PIMs use for all elderly persons in Canada in 2013 was estimated at USD$419 million.

Conclusions: Focusing on the most common PIMs, such as benzodiazepines and nonsteroidal anti-inflammatory drugs, helps implementing cost-effective strategies for reducing PIMs use and decreasing their clinical and economic effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.vhri.2021.05.003DOI Listing
September 2021

Willingness to pay for and acceptance of cervical cancer prevention methods: A systematic review and meta-analysis.

Med J Islam Repub Iran 2021 23;35:81. Epub 2021 Jun 23.

Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

The Willingness to pay (WTP) for and acceptance of cervical cancer prevention (CCP) methods have an important role in the control of this type of cancer. Therefore, the aim of this study was to estimate the WTP and acceptance of CCP methods with the contingent valuation method (CVM). In this systematic review and meta-analysis study, the required information was collected by searching relevant keywords in PubMed, Scopus, Embase, Web of Knowledge, and their Persian equivalent in the Scientific Information Database (SID) and Elmnet databases during January 1, 2000 to June 30, 2020. All studies that reported the WTP and CCP methods with the CVM in English or Persian were included. The reporting quality of studies was assessed by strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Comprehensive meta-analysis (CMA: 2) software was used to conduct the meta-analysis. The content analysis method was used for qualitative data analysis. Finally, 28 articles (with 49610 people) were included in the study. Most of the participants were women (35.7%). The HPV vaccine was the most common method of prevention (75%). The overall acceptance rate was 64% and the overall positive WTP rate was 66%. The average WTP was US$30.44, which accounts for about 0.84% of GDP per capita. The most significant effective factors included income, age, education, high-risk sexual behaviors, and awareness of cervical cancer, belief in the risk of cervical cancer, and belief about the effectiveness of prevention methods. The cost was the most important reason for the unwillingness to pay and accept. Results show that the WTP and acceptance rate of CCP methods are relatively high. It is recommended to reduce the cost of prevention methods, especially the HPV vaccine, and to increase awareness and improve the attitude of people. Also, it is recommended to consider other methods of estimation of WTP and other cancers in future studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.47176/mjiri.35.81DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285557PMC
June 2021

The Cost-Effectiveness and Cost-Utility of Statin Drug for the Treatment of Patients with Cardiovascular Disease, A Systematic Review.

Int J Prev Med 2021 15;12:39. Epub 2021 May 15.

Health Human Resources Research Centre, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.

Cardiovascular diseases impose a burden of disease and economic burden on society. With regard to different drugs are used to treat cardiovascular disease; these interventions should be economically evaluated and them that the most cost-effective were selected. The aim of this study was to investigate the studies carried on the cost-effectiveness and cost-utility of statin drugs for the treatment of patients with cardiovascular disease between 2004 and 2020. Quality assessment of the articles was examined by Drummond's checklist. Given that the inclusion criteria, 26 articles included in the review. The results of this review showed that many articles related to the economic evaluation of statin drugs adhered international standards for performing economic evaluation studies. All the studies mentioned the source of effectiveness (the second criteria) and alternative options for the comparison (the third criteria). Atorvastatin and rosuvastatin drugs were the main options for the comparison in the studies. Although the results of the studies were different in some aspects, such as the type of modeling, costs items and the study perspective, they reached the same results which the use of statin drugs versus no-drug can decrease cost, cardiovascular events and deaths and increase QALY. The results were nearly different due to study design, time horizon, efficacy, and drug prices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijpvm.IJPVM_125_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218807PMC
May 2021

Economic evaluation of E-health interventions compared with alternative treatments in older persons' care: A systematic review.

J Educ Health Promot 2021 20;10:134. Epub 2021 May 20.

Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Population aging has increased the need for long-term care of older persons who suffer from multi-morbidity and chronic conditions. Today, the majority of older people are living alone in their home in which they try to cope with highly risky conditions such as sensory impairment, diminished mobility, and medication management. Recent developments in information technologies could improve the access to care for older people as well as reducing the need for full-time caregivers both in homes and institutions such as nursery homes and hospitals. This study aimed to review the economic evaluation of such technological advancements in the care of older people. Through a systematic approach, electronic databases were searched and of 2732 records retrieved, three papers were included in the final review. Three different models of economic evaluation including cost analysis, cost-benefit analysis and cost-effectiveness analysis were applied in these studies in the context of telemedicine and older persons' care. Since the methodological approaches were quite different and the outcomes reported were not consistent between studies, no meta-analysis was applicable and we qualitatively reviewed the papers. All studies have reported cost savings associated with the use of telemedicine technologies such as video visits and smart homes in the care of older persons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jehp.jehp_787_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224483PMC
May 2021

The Economic Burden of Cancer in Iran during 1995-2019: A Systematic Review.

Iran J Public Health 2021 Jan;50(1):35-45

Department of Foreign Languages, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Cancer is the third cause of death following cardiovascular disease and accidents, in Iran. The purpose of this study was to systematically review the economic burden of cancer studies in Iran.

Methods: This systematic review examined the types of direct medical and non-medical costs and indirect costs in cancer patients and includes studies in English and Persian that were reviewed in Scopus, Web of science, SID, Iranmedex, Magiran and databases of Medline, etc., from 1995-2019.

Results: Twenty-one articles were included. Most studies have examined the direct costs of all types of cancers. The articles reviewed different types of cancer, such as prostate cancer (n=2), colorectal cancer (n=2), breast cancer (n=4), gastric cancer (n=2), oral and pharyngeal cancer (n=1), lung cancer (n=3), and blood cancer (n=4). The great number of studies were related to the gastrointestinal, breast and blood cancers. The gastrointestinal (gastric and colorectal) and breast cancer had the major economic burden than others.

Conclusion: It is necessary that special attention to patients, supportive measures to reduce the share of costs, and more budget allocation for prevention, screening and early detection being at priorities in the health system planning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/ijph.v50i1.5070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213609PMC
January 2021

Barriers in the performance-based payment in Iran health system: Challenges and solutions.

J Educ Health Promot 2021 31;10:106. Epub 2021 Mar 31.

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: One of the main goals of hospital management is to attract, maintain, and increase the number of qualified and efficient human resources, and one of the key and most important factors in achieving this goal is to design and implement a fair and efficient payment system. The purpose of this project is to determine the challenges of the performance-based payment system and provide solutions to overcome its obstacles in the city of Tehran.

Materials And Methods: This qualitative research sought to perform content analysis so as to explore the experiences and perceptions of a purposeful group of specialists and managers of Tehran's educational and medical centers ( = 10). Data were collected using in-depth semi-structured interviews and were ongoing until the point of saturation.

Results: On analysis of data by Specialists and managers of Tehran's educational and medical centers, three main themes including behavior, organization, rules and regulation were defined alongside seven subthemes includes scheduling, platform, education, quantity-oriented, motivation, implementation, and payment system.

Conclusion: In general, it can be concluded that for the successful implementation of any project, the necessary infrastructure must be provided for implementation. In this plan, despite the challenges in the field of behavior, organization, and rules and regulations, the need for necessary training before implementing the plan, special attention to quality instead of quantity, motivating employees to cooperate in implementing the plan as successfully as possible, creating a platform Appropriate before the implementation of the plan and most importantly, the pilot implementation of the plan before its widespread implementation seems necessary.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jehp.jehp_797_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150088PMC
March 2021

Cost-effectiveness of cardiac resynchronization therapy plus an implantable cardioverter-defibrillator in patients with heart failure: a systematic review.

Cost Eff Resour Alloc 2021 May 21;19(1):31. Epub 2021 May 21.

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Heart failure (HF) is an unusual heart function that causes reduction in cardiac or pulmonary output. Cardiac resynchronization therapy (CRT) is a mechanical device that helps to recover ventricular dysfunction by pacing the ventricles. This study planned to systematically review cost-effectiveness of CRT combined with an implantable cardioverter-defibrillator (ICD) versus ICD in patients with HF.

Methods: We used five databases (NHS Economic Evaluation Database, Cochrane Library, Medline, PubMed, and Scopus) to systematically reviewed studies published in the English language on the cost-effectiveness of CRT with defibrillator (CRT-D) Vs. ICD in patients with HF over 2000 to 2020. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was applied to assess the quality of the selected studies.

Results: Five studies reporting the cost-effectiveness of CRT-D vs ICD were finally identified. The results revealed that time horizon, direct medical costs, type of model, discount rate, and sensitivity analysis obviously mentioned in almost all studies. All studies used quality-adjusted life years (QALYs) as an effectiveness measurement. The highest and the lowest Incremental cost-effectiveness ratio (ICER) were reported in the USA ($138,649per QALY) and the UK ($41,787per QALY), respectively.

Conclusion: Result of the study showed that CRT-D compared to ICD alone was the most cost-effective treatment in patients with HF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12962-021-00285-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139093PMC
May 2021

Scaling-up a new socio-mental health service model in Iran to reduce burden of neuropsychiatric disorders: an economic evaluation study.

Int J Ment Health Syst 2021 May 20;15(1):47. Epub 2021 May 20.

Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: The integration of core packages of mental health care into routine primary health care has been introduced as an effective way to achieve universal health coverage in mental health care. Based on the transition of mental health care in Iran, from introducing basic mental health care in PHC to the experience of community-based mental health centers for urban areas, a new socio-mental health service model has been so far proposed. This study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs.

Methods: This study was a cost-consequence analysis following One Health Tool methodology. The data required for the study were collected in the first quarter of the year 2020 with a time horizon from 2020 to 2030. The selected metric for summarizing health effects is healthy life years gained. Resources used in terms of drug and supply, staff salaries and outpatient visits were documented and associated costs were subsequently estimated in order to estimate the average cost of each intervention per case.

Results: The health impacts are calculated in terms of healthy life years gained for 2020-2030, after adjusting the prevalence and incidence rates for each disorder. In total, 1,702,755 healthy life years were expected to be gained. Considering total 1,363,581,654 US dollars cost in base case scenario, each healthy life years gained will cost around 801 US dollars. Based on the WHO criteria for cost-effectiveness threshold, all of the values ranged from 724 to 1119 US dollars obtained through eight different scenarios were considered as cost-effective given the GDP per capita of 5550 US dollars for Iran in 2018.

Conclusions: Mental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar per capita for scaling up this comprehensive mental health service model can convince high-level policy-makers to increase the share of mental health budget accordingly. The present study demonstrated that the cost in this new socio-mental services model is not substantial compared with GDP per capita of Iran.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13033-021-00468-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139035PMC
May 2021

The association between diabetic complications and health-related quality of life in patients with type 2 diabetes: a cross-sectional study from Iran.

Qual Life Res 2021 Jul 26;30(7):1963-1974. Epub 2021 Apr 26.

Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: This study aimed to investigate the health-related quality of life (HRQoL) of type 2 diabetic patients and its relationship with the complications of diabetes in Farashband County, Fars, Iran.

Methods: Data of this cross-sectional study were collected by a researcher-made demographic questionnaire, EuroQol-5 Dimensions questionnaire (EQ-5D) and Visual Analog Scale (VAS) and also from patient records. Multivariate regression model was used to investigate the net effect of diabetes complications on HRQoL after controlling for other independent variables.

Results: A total of 685 patients with a mean age of 58.36 and a disease duration of 7.64 years participated in the study. The mean EQ-5D and EQ-VAS scores of all patients were 0.64 and 56.53, respectively. The HRQoL dimensions in which the largest portions of the population had problems were Pain/Discomfort (77.23%) and Anxiety/Depression (63.50%). Among the studied diabetic patients, women, divorcees, and widows were more likely to report problems in all dimensions of HRQoL, and people without complications, people with university degrees, and employed people were more likely to report fewer problems in these dimensions (P < 0.05). After controlling for the effect of all independent variables in the multivariate regression model, a significant negative relationship was found between diabetes complications and EQ-5D: β =  - 0.149 (95% CI - 0.186, - 0.112) and EQ-VAS: β =  - 6.697 (95% CI - 9.947, - 3.747). This indicates that for each additional diabetic complication, 0.149 and 6.697 units of EQ-5D Index and EQ-VAS were reduced, respectively.

Conclusion: This study indicated that type 2 diabetic patients in the studied region, especially those with complications, suffer from poor HRQoL. Therefore, more attention should be paid to the main determinants of HRQoL when adopting policies for diabetes management in order to ultimately improve the HRQoL of these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11136-021-02792-7DOI Listing
July 2021

Economic Evaluation of New Oral Anticoagulants in Prevention of Venous Thrombosis Following Joint Replacement Surgery: A Systematic Review.

Clin Ther 2021 05 17;43(5):e139-e156. Epub 2021 Apr 17.

Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Purpose: The main purpose of prescribing oral anticoagulants in patients undergoing total knee and total hip replacement surgery is to prevent venous thromboembolism (VTE). The present study aimed to summarize evidence from economic evaluations regarding new oral anticoagulants (NOACs) used in VTE prophylaxis after joint replacement surgery.

Methods: To obtain relevant literature on economic evaluations of NOACs used in the prevention of VTE following joint replacement surgery, we searched the Cochrane Library, PubMed, Web of Science, Embase, and Scopus, as well as specialized economic evaluation databases, for articles published from January 2008 to December 2019. Next, 2 reviewers screened the titles and abstracts of studies, extracted data from the full-text articles, and assessed the quality of the methodologies using the Quality of Health Economic Studies checklist.

Findings: Twenty-eight studies of economic evaluations met the inclusion criteria of the research. The quality assessment showed that 20 articles had scores within the range of 75 to 100 (high quality), and 9 studies had scores within the range of 50 to 74 (moderate quality). All of the identified studies had been carried out based on modelling, and 23 studies used decision trees to model acute events after surgery. In addition, 20 studies utilized a Markov model to capture long-term complications of VTE. The results showed that rivaroxaban was more cost-effective than apixaban and dabigatran from a perspective of the health care system in the prevention of VTE after total knee and total hip replacement surgery. In addition, apixaban was associated with a lower risk for bleeding events than other NOACs, making it the most cost-effective NOAC from the perspective of the payer.

Implications: The results suggest that NOACs are cost-effective alternatives to low-molecular-weight heparins. Rivaroxaban and dabigatran were assessed as the most and least cost-effective prophylaxis options, respectively, after joint replacement surgery for the prevention of VTE. It is recommended that future research be conducted on economic evaluations of edoxaban.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinthera.2021.03.012DOI Listing
May 2021

Technical efficiency and its affecting factors in Tehran's public hospitals: DEA approach and Tobit regression.

Med J Islam Repub Iran 2020 29;34:176. Epub 2020 Dec 29.

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Ira.

Measuring hospital efficiency is one of the tools for determining how to use resources. Considering the necessity of measuring the efficiency in hospitals, the current study was conducted to evaluate the efficiency and its determining factors in the Hospitals affiliated to medical universities in Tehran. This was a descriptive-analytical and longitudinal study. In the first stage of the research, the variables affecting the efficiency of hospitals were extracted using the Delphi method. In the second stage, th. Efficiency of 29 public hospitals in Tehran from 2012 to 2016 was calculated using data envelopment analysis techniques. We performed a sensitivity analysis of the efficiency scores by running the DEA model several times using different combinations of input variables. At last, applying the Tobit regression, factors explaining the inefficiencies of hospitals were determined. Data analysis was done by STATA 12 and SPSS 16 software. Significance level of all the tests was set at .05. In the first stage, 10 input variables and 10 output variables necessary from the mangers' point of view were identified to test efficiency. In the second stage, the mean of hospital efficiency was ascending from 2012 to 2015, and then it descending after 2015. According to the results of sensitivity analysis, despite the variability of technical efficiency during the study period (p<0.0001), the difference between the mean performance scores among different scenarios was not significant (p=0.066). Based on the third stage results, the average length of stay (Beta=-1.60E-12, p=0.030) and educational status (Beta=-2.89E+00, p=0.001) had a significant negative effect on hospitals' efficiency. The study results indicated that the efficiency changes during the years investigated were significant among Tehran public hospitals. The optimal use of inputs to produce hospital services should be on the agenda of health managers and policymakers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.47176/mjiri.34.176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004568PMC
December 2020

Cost-effectiveness analysis of intraoperative radiation therapy versus external beam radiation therapy for the adjuvant treatment of early breast cancer: A systematic review.

Med J Islam Repub Iran 2020 10;34:167. Epub 2020 Dec 10.

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

Breast-conserving surgery (BCS) is the recommended treatment for early breast cancer. After BCS. Whole-breast external beam radiotherapy (WB-EBRT) is the standard of care. A possible alternative to post-operative WB-EBRT is intraoperative radiation therapy (IORT). The objectives of this systematic review were to analyses the cost-effectiveness of IORT versus EBRT for early-stage breast cancer and to assess the reporting quality of the included studies to inform future studies. A systematic literature search was carried out in five main databases (PubMed, Scopus, Embase, Cochrane library, and Web of Science) to identify original studies published to June 25, 2020. We included all full economic evaluation studies (cost-effectiveness analysis (CEA), cost-utility analysis (CUA), and cost-benefit analysis (CBA), Model-based or trial-based) that assessed and compared IORT and EBRT in patients with early operable breast cancer. Study outcomes included cost per life-years gained or cost per quality-adjusted life-years (QALYs) gained or in monetary units or incremental cost-effectiveness ratio (ICER). The quality of the included articles was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. This review has been conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of 1155 studies identified, eight studies met the inclusion criteria. In four studies, IORT was associated with lower costs and higher effectiveness than EBRT. In three studies, the dominant option was EBRT. In these studies, IORT also had lower costs and lower effectiveness than EBRT. Existing evidence suggests that IORT can be a cost-effective alternative to early breast cancer treatment by reducing therapeutic costs. Variables of cost-effectiveness were treatment costs, health state utilities, local and distant recurrence rates, and the probabilities of metastasis after treatment, recurrent cancer and death for both IORT and EBRT. The reporting quality of the included studies was "high" in five, "medium quality" in one and "low" in two studies. Current evidence is sparse, and the number of studies was small but this evidence proposes that IORT can be a potential cost-saving strategy to the health systems for the adjuvant treatment of early breast cancer if the technology was carried out routinely in eligible patients. However, these results should be interpreted with caution because of the heterogeneity of studies and possible publication bias.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.47176/mjiri.34.167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004571PMC
December 2020

Cost-Utility Analysis of Negative Pressure Wound Therapy Compared With Traditional Wound Care in the Treatment of Diabetic Foot Ulcers in Iran.

Wounds 2021 Feb;33(2):50-56

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Negative pressure wound therapy (NPWT; also known as vacuum-assisted wound closure) has emerged as a promising option that may result in better health outcomes.

Objective: This study analyzed the cost-utility of NPWT compared with traditional wound care (TWC) for the treatment of patients with diabetic foot ulcers in Iran from the perspective of health care providers.

Materials And Methods: This economic evaluation study was conducted in 2016 to estimate the incremental cost effectiveness ratio of NPWT compared with TWC. The Markov model was applied, incorporating the 7 health states of uninfected, infected, infected post-amputation, healed, healed post-amputation, amputation, and death for a 1-year time period and monthly cycles (12 cycles). Quality-adjusted life years (QALYs) were calculated from utility weights of each diagnosis, which were derived from the published literature. Costs for each diagnosis were estimated monthly and separately based on inpatient and outpatient care. The analysis of cost-effectiveness and sensitivity for uncertain parameters was carried out using TreeAge Pro 2011 software.

Results: A total of 200 patient records (NPWT = 100; TWC = 100) were analyzed in this study. The results indicated that annual cost per patient for NPWT and TWC strategies were $5165 ± $3258 and $9833 ± $5861, respectively. In addition, mean effectiveness per patient per year for NPWT and TWC strategies were 8.9026 ± 1.7622 and 8.7974 ± 1.855 QALYs, respectively. When treatment with NPWT was compared with TWC using the incremental cost-effectiveness ratio of -$44 370 per QALY, NPWT was shown as a more cost-effective treatment strategy than TWC.

Conclusions: The results of the study show that NPWT is less costly and more effective compared with TWC. In addition, NPWT reduces the number of amputations and increases the number of healed wounds, decreasing patients' and payers' costs. The sensitivity analysis of parameters proved the robustness of the Markov model.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2021

Evidence-based medicine among health-care workers in hospitals in Iran: A nationwide survey.

J Educ Health Promot 2020 29;9:365. Epub 2020 Dec 29.

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Evidence-based medicine (EBM) plays an important and dominant role in promoting effective decision-making in the health system. This study was aimed to evaluate the EBM performance among health-care workers (HCWs) in hospitals in Iran.

Methods: In this study (a cross-sectional study), participants were 2800 HCWs in hospitals. A researcher-made questionnaire was designed, and judgments of 10 experts were used for the improvement of content validity. The reliability of the questionnaire was assessed by the test-retest method (α = 0.85). Data were analyzed using the descriptive statistics, -test, and one-way ANOVA, in SPSS.16 software.

Results: Eventually, 1524 questionnaires were completed (response rate: 54.4%). The results of the study show that 62%of participants have not accessed scientific journals, 52% of them have difficulties using the Internet at work, guidelines were not reachable for 76% of them, and about 80% have not access to databases. About 39% of participants were not well informed about databases of EBM, and 15.8% of them were immensely knowledgeable about EBM terminology. The most important problems to increase HCWs information about EBM include research methodology- related problems, lack of resources and motivation, and coordination problems. The most prominent facilitators include: providing training courses in EBM and increased facilities. Only work experience showed a significant correlation with barriers and facilitators, and gender revealed a significant correlation with barriers ( < 0.05).

Conclusion: It seems that prioritizing the increased access to information resources and databases, considering the research skills of the HCWs, extending the opportunities and increasing the facilities such as workforce, equipment, physical environment, and accessibility can have a great impact on the improvement of the activities associated with EBM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jehp.jehp_335_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871975PMC
December 2020

Elderly's food security and its associated socioeconomic determinants in Tehran: A cross-sectional study.

Health Sci Rep 2021 Mar 26;4(1):e240. Epub 2021 Jan 26.

Health Management and Economics Research Center Iran University of Medical Sciences Tehran Iran.

Introduction: The mechanism by which a suppressed immune system of a cancer patient makes them susceptible to COVID-19 is still unclear. Any delay or discontinuation of cancer care due to the pandemic is expected to have a detrimental impact on the outcome of cancer. A few studies have addressed the incidence of COVID-19 among cancer patients, but the small sample size of such studies makes it difficult to draw inference to the general population.

Methods: For our review, 'Pubmed' database and Google search engines were used for searching the relevant articles. The criterion used for review includes their relevance to the defined review question, which is the pathophysiological mechanism of COVID-19 among cancer patients and the relevant therapeutic interventions therewith. This review includes 20 studies and other relevant literature which address the determinants of COVID-19 among Cancer patients.

Results: Delay in cancer diagnosis will increase the stage progression of cancer patients and increased mortality in the future. A short delay in administering cancer related treatment to aid the odds of patient surviving the acute SARS-CoV-2 infection, should be at the discretion of the treating Physician. Oncologists dilemma in the current situation includes titrating the density of drug doses and intensity of treatment regimen, for the optimal management of metastatic and adjuvant cancer patients. Patients are thus subjected to suboptimal treatment and undetected disease recurrence, To circumvent the immunosuppressive effects of chemotherapy, Providers need to consider staggered regimen or alternate therapies such as biological/immunotherapy, targeted therapy, anti-angiogenic drugs, hormone therapy and/or antibody-based therapeutics.

Conclusion: This review provides insights on the pathogenesis of SARS-CoV-2, which could enable Physicians in formulating therapeutic strategies for the management of severe patients, more so in Oncology settings, thus reducing the mortality. The key is to balance the continuation of urgent cancer care, but rationing the elective treatment according to the circumstances.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hsr2.240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837673PMC
March 2021

Economic Burden of Stroke in Iran: A Population-Based Study.

Value Health Reg Issues 2021 May 28;24:77-81. Epub 2021 Jan 28.

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

Objectives: This study was conducted to estimate the annual societal costs in Iran associated with the treatment of ischemic and hemorrhagic stroke patients using a prevalence-based cost-of-illness framework.

Methods: A prevalence-based cost-of-illness framework was applied. Key model parameters included annual incidence of stroke; use of stroke therapies, medicines, and other medical care resources; work days missed; wage rates; and annual costs per patient. The outcomes measured were total societal costs, societal cost per year, and societal cost per patient-year.

Results: For the studied 1940 patients, the economic burden of stroke in 2018 was roughly $4 081 124 in US dollars. Bearing in mind that there are about 100 000 cases of stroke, including new (35%) and old cases (65%) of 2 types of strokes, per year in Iran, the estimated economic impact is about $368 925 000. Lodging, medication, and consumables account for 69% of all direct medical costs ($299 959). The main cost factors were mortality costs (76.6%) and disability costs (14.7%).

Conclusion: The economic impact of stroke in Iran is considerable. The premature deaths and resulting disability from strokes accounted for the main productivity losses and all societal costs of stroke (approximately 91% of all costs). To control hypertension and decrease the burden of stroke, especially in elderly age groups, it is recommended that Iran look into how to focus on and expand healthy lifestyle choices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.vhri.2020.04.004DOI Listing
May 2021

Medical therapy versus percutaneous coronary intervention in ischemic heart disease: A cost-effectiveness analysis.

Med J Islam Repub Iran 2020 16;34:155. Epub 2020 Nov 16.

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

Ischemic heart disease is categorized into two acute and chronic groups, and its treatments include revascularization and medical therapy. The aim of this study is to evaluate the economic burden of medical therapy compared to percutaneous coronary intervention in ischemic heart disease. This study has been done in two steps. The first was a systematic review and meta-analysis to measure the effectiveness of two interventions and the second step was a cost-effectiveness analysis from the perspective of society. The data analysis included a meta-analysis and the Markov cohort simulation. RewMan v5 and tree age software were utilized. Uncertainties related to the model parameters were evaluated using one-way and two-way sensitivity analyses. Regarding the effectiveness of interventions, the odd ratio of the quality of life in the medical therapy group (CI: 0.76-1.10) was 0.91 times the PCI group (p=0.34). This rate for mortality in medical therapy (CI: 0.52-9.68) was 2.23 times more than the PCI group; this result was not significant (p=0.02). In the cost-effectiveness analysis, the cost-effectiveness threshold was $ 16,482; ICER in increasing the QoL and reduction in the mortality rate was $ 25320.11 and $ 562.6691, respectively. Regarding the sensitivity analysis, the model was not sensitive in changing parameters in a specific domain. According to this study, PCI is more cost-effective than medical therapy in the reduction of mortality rate and in the field of increasing quality of life. MT strategy is more cost-effective than the PCI. This study considers controversies regarding the most appropriate treatment for patients with ischemic heart disease that is helpful for health policymakers, cardiologists and health managers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.47176/mjiri.34.155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813149PMC
November 2020

Economic burden of osteoporosis in the world: A systematic review.

Med J Islam Repub Iran 2020 12;34:154. Epub 2020 Nov 12.

Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Osteoporosis is a skeletal disease that is associated with a reduction in bone mass and microstructures and deterioration of bone tissue. It is also associated with an increased risk of fracture that is the most important complication of osteoporosis. The knowledge about costs and economic aspects of osteoporosis plays an important role in making policies and planning measures for the prevention and management of this disease; hence, this study systematically investigated the available evidence on the costs associated with osteoporosis worldwide. In this systematic review, electronic searches were performed on various online databases, including PubMed, Embase, Scopus, web of science, ProQuest, and Cochrane. The timeframe selected for searching articles was from 1980 to 2018. Of a total of 1989 papers, 28 papers were included in the study on the basis of inclusion criteria. Based on the data extracted from the mentioned studies, the mean age of people with osteoporotic fractures was 50 years, with the highest costs associated with hip fractures. Our review indicated that the cost of osteoporosis carries a significant economic burden on countries in the world. The main cost drivers in this study were Fracture-related costs. The direct annual cost of treating osteoporotic fractures of people on average is reported to be between 5000 and 6500 billion USD in Canada, Europe and the USA alone, not taking into account indirect costs such as disability and loss of productivity. Prevention of this disease can significantly reduce the costs incurred by the health system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34171/mjiri.34.154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787041PMC
November 2020

Iranian public hospitals' challenges regarding revenue deficits: A mixed-method study.

Med J Islam Repub Iran 2020 21;34:124. Epub 2020 Sep 21.

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

The main part of hospitals' funding comes from insurance organizations. In some cases, for different reasons such as not filed services or unpaid health insurance bills, a part of these funding cannot be derived from health insurance companies. This study aims to describe different aspects of the hospitals' revenue deficits in Iranian public hospitals. This was a mixed-method study consisting of qualitative and quantitative studies. Qualitative data were collected through 17 semi-structured interviews and were analyzed using the analytical framework by MAXQDA.10. Quantitative data were analyzed by the TOPSIS method and Smart TOPSIS Solver.3.2.0. Based on the framework analysis, five sets of the underlying causes of hospital revenue deficits were identified and categorized in 5 themes: bottlenecks, direct causes of revenue deficits, root causes of revenue deficits, revenue deficits management strategies, and challenges and barriers to managing revenue deficits. Through inadequate clinical documentation and failed to provide the insurance organization's requirements, the surgical units, operating rooms, and inpatient units were found as the main sources of revenue deficit. Lack of senior management commitment and inconsistency of insurance organizations for evaluating claims are often listed as the major barriers to effective implementation of corrective interventions. Revenue deficits occurs in most hospital departments and in all stages of converting services into revenue, and a variety of human and organizational factors contribute to them. Therefore, focusing on the main causes of deductions and the participation of all individuals and departments involved in it is critical to reducing deductions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34171/mjiri.34.124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787021PMC
September 2020

Decomposition of gendered socioeconomic-related inequality in outpatient health care utilization: A cross-sectional study from Iran.

Int J Health Plann Manage 2021 May 8;36(3):656-667. Epub 2021 Jan 8.

Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Unequal access to required health care services could deteriorate inequality in health outcomes and increase mortality and morbidity, especially among disadvantaged groups. One of the most debated factors in shaping health care inequalities is gender. This study aimed to measure and explains gendered socioeconomic-related inequality in outpatient health care utilization in Iran.

Methods: This is a cross-sectional research conducted at a national level in Iran. The required data was obtained from an Iranian health care utilization household survey conducted in 2015. Erreygers Concentration Index (ECI) was used to measure the socioeconomic inequality in outpatient health care utilization. A regression-based decomposition analysis was also used to explain socioeconomic-related inequalities.

Results: There was a significant pro-rich inequality in outpatient health care utilization between males (ECI = 0.115, SE = 0.014) and females (ECI = 0.083 SE = 0.011) indicating that utilization of these services was concentrated on the better-offs. The decomposition analysis revealed that economic status (males = 50.58%, females = 37.42%) was the main contributor to the observed inequality. Location of residence, health insurance and education were other main driver of these inequalities.

Conclusions: Different factors have different contribution to socioeconomic-related inequality in utilization of outpatient health care services and these could be diversified considering gender. Hence, it seems that policy makers could be able to address these inequalities effectively through gender-oriented policies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hpm.3109DOI Listing
May 2021

Men's willingness to pay for prostate cancer screening: a systematic review.

Syst Rev 2020 12 9;9(1):290. Epub 2020 Dec 9.

Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute. Community and Family Medicine Departmentm School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Background: This study aimed to review studies on willingness to pay (WTP) for prostate cancer screening.

Methods: This systematic-review was conducted based on the Preferred Reporting Items for Systematic Reviews guidelines. By searching six-health-database, WTP studies on prostate cancer screening using contingent valuation method published in English until March 2020 were included and those with unavailable full-text and inadequate quality-assessment scores were excluded. Smith checklist was used for the quality assessment. Extracted WTPs were converted to US dollar in 2018 using exchange rate parity and net present value formula to make comparison. Factors' effect was assessed by vote counting.

Results: Six final studies published after 2006 reported above 70% Smith checklist items needed to be considered in contingent valuation study reports. Seven factors have positive effects on WTP. The reported WTP value varied from 11$ to 588$ in Japan and Germany, respectively.

Conclusion: WTP for prostate cancer screening was positive among all studied men. The results of factors' effect assessment showed that better understanding prostate cancer risks or screening tests and factors such as age, income, family history of cancer, hospitalization history, and educational level have positive effects. Moreover, prostate-specific antigen history, health insurance, employment, and subject's health assessment received less attention. The results' generalization to all countries is not applicable because there are no studies for low- and middle-income countries.

Systematic Review Registration: PROSPERO 2020 CRD42020172789.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13643-020-01522-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727201PMC
December 2020

Cost-effectiveness analysis of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation: a systematic review.

Heart Fail Rev 2021 May 24;26(3):587-601. Epub 2020 Nov 24.

Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Canada.

To assess the cost-effectiveness of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation and heart failure, a systematic literature search was conducted in various electronic databases to January 3, 2020. Eligibility criteria are the population (patients with mitral regurgitation (MR)), intervention (transcatheter mitral valve repair using the MitraClip), comparator (conventional medical treatment), outcomes, and designs (Model-based or trial-based full economic evaluations).The quality of included studies was assessed using the CHEERS checklist. Mortality and survival rate, quality-adjusted life year (QALY), life years gained (LYG), total cost, and the incremental cost-effectiveness ratio (ICER) regarding the use of MitraClip System were considered as the key outcomes. Eight articles were eligible for full-text assessment. Ultimately, a total of seven studies were considered in the current systematic review. Results demonstrated that MitraClip reduces mortality rate and increases survival rate. The mortality rate at 1 year and 10 years was 16.7% versus 29.77% and 70.9% versus 98.8%, respectively. Total cost data based on 2019 USD show that the MitraClip has the highest cost in the USA ($121,390) and the lowest cost in Italy ($33,062). The results showed that in all selected countries, willingness-to-pay (WTP) thresholds are upper than the cost per QALY; also, the highest ICER for the MitraClip is in the USA ($55,600/QALY) and the lowest in Italy ($10,616/QALY). To conclude, evidence from this systematic review suggests that MitraClip Delivery System improved both life expectancy and QALY compared with medical treatment in patients at high surgical risk and it was also a cost-effective treatment option for patients with mitral regurgitation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10741-020-10055-9DOI Listing
May 2021

Economic evaluation of programs against COVID-19: A systematic review.

Int J Surg 2021 Jan 21;85:10-18. Epub 2020 Nov 21.

Department of Medical Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: The COVID-19 pandemic has become a public health emergency and raised global concerns in about 213 countries without vaccines and with limited medical capacity to treat the disease. The COVID-19 has prompted an urgent search for effective interventions, and there is little information about the money value of treatments. The present study aimed to summarize economic evaluation evidence of preventing strategies, programs, and treatments of COVID-19.

Material And Methods: We searched Medline/PubMed, Cochrane Library, Web of Science Core Collection, Embase, Scopus, Google Scholar, and specialized databases of economic evaluation from December 2019 to July 2020 to identify relevant literature to economic evaluation of programs against COVID-19. Two researchers screened titles and abstracts, extracted data from full-text articles, and did their quality assessment by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Then, quality synthesis of results was done.

Results: Twenty-six studies of economic evaluations met our inclusion criteria. The CHEERS scores for most studies (n = 9) were 85 or higher (excellent quality). Eight studies scored 70 to 85 (good quality), eight studies scored 55 to 70 (average quality), and one study < %55 (poor quality). The decision-analytic modeling was applied to twenty-three studies (88%) to evaluate their services. Most studies utilized the SIR model for outcomes. In studies with long-time horizons, social distancing was more cost-effective than quarantine, non-intervention, and herd immunity. Personal protective equipment was more cost-effective in the short-term than non-intervention. Screening tests were cost-effective in all studies.

Conclusion: The results suggested screening tests and social distancing to be cost-effective alternatives in preventing and controlling COVID-19 on a long-time horizon. However, evidence is still insufficient and too heterogeneous to allow any definite conclusions regarding costs of interventions. Further research as are required in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijsu.2020.11.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7679235PMC
January 2021

A comparison of global surgery tariffs and the actual cost of bills at Hazrate Rasoole Akram educational and medical center.

Cost Eff Resour Alloc 2020 29;18:38. Epub 2020 Sep 29.

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: the health service tariff is an appropriate policymaking tool and the financial leverage of the health system control which affects quality, availability, cost, efficiency, equity and accountability of health services. Global surgeries include 91 common cases of general and specialized surgeries in hospitals; fixed tariffs are annually defined for these surgeries, and insurance companies must pay medical centers based on these tariffs. The aim of this study was to examine and compare hospital bills with global surgery tariffs at Hazrate Rasoole Akram Educational and Medical Center in 2017.

Methods: This descriptive-analytic study was conducted retrospectively and compared the global and actual costs of global surgeries performed in the third quarter of the year 2017 at Hazrate Rasoole Akram Educational and Medical Center. Required data on the actual costs of surgeries was collected through the Hospital Information System (HIS) and patients' records. Information on the global costs was obtained from the Annual Circulars of Insurance Council for the studied period about the cost of global surgeries. Linear regression (STATA13 software) was used to investigate the effect of items on tariff and invoice differences; concerning other calculations, EXCEL software was used.

Results: The highest frequency of global surgeries was related to ophthalmic surgery which accounted for approximately half of total surgeries performed at Hazrate Rasoole Akram Hospital. The most significant difference between global tariff and invoice was also related to ophthalmic surgery (188709.3 Dollar a year).Overall, the actual hospital bills were much higher than the tariffs approved for global surgeries, and the total difference was 461805.5 Dollar. The results revealed that there was a significant relationship between some of the items such as the cost of operating rooms, anesthesia and other services.

Conclusions: Referral hospitals which are at the level three of referral networks usually treat more complex patients; this should be taken into account when defining surgery tariffs of these centers. On the other hand, hospitals need to control the costs and reduce the end cost of these surgeries by improving clinical management and cost management. In addition, prospective and case-based payment methods can control health costs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12962-020-00232-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525997PMC
September 2020

Effectiveness of the non-pharmaceutical public health interventions against COVID-19; a protocol of a systematic review and realist review.

PLoS One 2020 29;15(9):e0239554. Epub 2020 Sep 29.

Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Without any pharmaceutical intervention and vaccination, the only way to combat Coronavirus Disease 2019 (COVID-19) is to slow down the spread of the disease by adopting non-pharmaceutical public health interventions (PHIs). Patient isolation, lockdown, quarantine, social distancing, changes in health care provision, and mass screening are the most common non-pharmaceutical PHIs to cope with the epidemic. However, there is neither systematic evidence on the effectiveness of non-pharmaceutical PHIs in controlling the COVID-19 nor on how these interventions work in different contexts. Therefore, in this study we will address two main objectives: 1) to assess the effectiveness of the non-pharmaceutical PHIs in controlling the spread of COVID-19 using a systematic review and meta-analyses; 2) to explore why, how, and for whom these interventions work using a realist review.

Materials And Methods: This review study has two main phases. In the first phase of this study, we will extract data from two main types of studies including quasi-experimental studies (such as quasi-randomized trials, controlled before-after studies (CBAs) and interrupted time series studies (ITSs)) and observational studies (such as cohort, case-control, and cross-sectional studies), written in the English language. We will explore effectiveness of the non-pharmaceutical PHIs targeted either suppression or mitigation strategies (or a combination of both) in controlling the COVID-19 epidemics in the community level. Effectiveness will be considered as the changes in mortality rate, incidence rate, basic reproduction number rate, morbidity rate, rates of hospitalization, rates of intensive care unit (ICU) hospitalization, and other health outcomes where possible. We will perform random-effects meta-analyses, if possible, using CMA software. In the second phase, we will conduct a realist review to find out how, why, for whom, and in what circumstances the non-pharmaceutical PHIs work. At the realist review, we will identify and explore Context-Mechanism-Outcome configurations to provide a robust explanation on the effectiveness of the interventions in different contexts using Pawson's 5-step realist review template including: "clarify scope; search for evidence; appraise primary studies and extract data; synthesize evidence and draw conclusions; and disseminate, implement and evaluate". Although the steps are presented in a linear manner, in practice, we will follow them in iterative stages to fill any potential overlap.

Discussion: The findings of this research will provide a crucial insight into how and in which context the non-pharmaceutical PHIs work in controlling the spread of COVID-19. Conducting a systematic review and meta-analysis in line with a realist review will allow us to draw a robust conclusion on the effects and the way in which the interventions work. Understanding the role of contextual factors in the effectiveness of non-pharmaceutical PHIs and the mechanism of this process could enable policymakers to implement appropriate policies and manage the COVID-19 epidemics more efficiently.

Systematic Review Registration: CRD42020186855.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239554PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523985PMC
October 2020

COVID-19: The Challenge of Disadvantaged Groups and their Access to Care.

Arch Iran Med 2020 09 1;23(9):647-648. Epub 2020 Sep 1.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34172/aim.2020.79DOI Listing
September 2020
-->