Publications by authors named "Shirin Nosratnejad"

18 Publications

  • Page 1 of 1

The Study of Out-of-pocket Payment and the Exposure of Households with Catastrophic Health Expenditures Following the Health Transformation Plan in Iran.

Risk Manag Healthc Policy 2020 22;13:1677-1685. Epub 2020 Sep 22.

Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.

Introduction: One of the main objectives of health systems is providing financial protection against out-of-pocket (OOP) health expenditures. According to the 2011 report by the World Health Organization in the Eastern Mediterranean Regional Office (EMRO), a huge portion of health service in Iran is paid OOP, which is around 58% of the total health system expenditure. Furthermore, all over the world, around 25 million households (100 million people) are trapped in poverty as a result of paying health service costs. Therefore, this research was aimed at investigating the OOP and exposure of households with catastrophic health expenditures (CHE) following the implementation of a health transformation plan in Tabriz, Iran.

Methods: A descriptive-analytic study was conducted on a cross-sectional basis. The sample included 400 households, who were interviewed using the World Health Survey questionnaire, and then OOP payment and exposure of households to CHE were estimated, and the effective factors on OOP payment and the determinants of CHE were analyzed using a regression model.

Results: After implementing the health transformation plan, the average share of households' OOP payments, toward their ability to pay was 13.2%. In addition, 11.25% of the households were exposed to CHE in Tabriz. The key determinants of OOP were income, dental services, pharmaceuticals, radiology, and physiotherapy. The factors affecting CHE were income, insurance status, marital status, dental services, pharmacy, physiotherapy, and radiological services.

Conclusion: Based on the results of the current study and compared to similar research conducted prior to this plan, it is obvious that the transformation plan was able to achieve its goal in "reducing OOP payments". However, health services such as dental, pharmacy, physiotherapy, and radiology would increase the likelihood of facing OOP payments. These variables should be considered by health policy-makers in order to review and revise the content of recent reform to provide financial protection against OOP for people.
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http://dx.doi.org/10.2147/RMHP.S264943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519814PMC
September 2020

Direct and Indirect Costs Associated with Coronary Artery (Heart) Disease in Tabriz, Iran.

Risk Manag Healthc Policy 2020 31;13:969-978. Epub 2020 Jul 31.

Department of Health Economics, Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.

Purpose: Cardiovascular diseases (CVDs) are the major causes of mortalities worldwide. This study was conducted to evaluate the direct and indirect costs of coronary artery disease (CAD) in Iran.

Patients And Methods: This is a prevalence-based cost-of-illness (COI) study that estimates the direct and indirect costs of CAD. The study conducted over a six-month period from April to September in 2017. Patients were recruited from Madani hospital in Tabriz, Iran. A total of 379 patients were investigated from societal perspective. Direct costs were estimated using the bottom-up costing approach and indirect costs were estimated using the Human Capital (HC) approach. A generalized linear model of regression was used to explore the relation between total cost and socio-demographic variables. The total annual mean cost was compared to Gross Domestic Product (GDP) per capita which was reported in the form of Purchasing Power Parity (PPP) index. To deal with uncertainty, one-way sensitivity analysis was performed.

Results: Total costs per patient in one year were estimated to be IRR 63452290.17 ($PPP 7736.19) at a 95% confidence interval (58191511.73-68713068.60), the biggest part of which is related to direct medical costs with IRR 33884019.53 per year ($PPP 4131.18) (54%). Direct non-medical costs were estimated IRR 1655936.68 ($PPP 201.89) per patient (2%) and indirect costs were estimated IRR 27912333.97 per patient ($PPP 3403.11) (44%), which 62% of indirect costs is related to patients' work absenteeism.

Conclusion: This study estimates the direct (56%) and indirect (44%) costs associated with CAD. The study explores the essential drivers of the costs and provides the magnitude of the burden in terms of the share of GDP. The outcomes can be used in priority setting, in particular for cost benefit analysis, and adopting new policies regarding insurance coverage and equity issues.
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http://dx.doi.org/10.2147/RMHP.S261612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406327PMC
July 2020

A Systematic Review of Equity in Healthcare Financing in Low- and Middle-Income Countries.

Value Health Reg Issues 2020 May 28;21:133-140. Epub 2019 Nov 28.

Iranian Center of Excellence in Health Services Management, Department of Health Economics, Tabriz University of Medical Sciences, Tabriz, Iran; Tabriz Health Services Management Research Center, Department of Health Services Management, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address:

Objectives: The present systematic review aimed to assess the healthcare financing system by studying the relevant indicators in low- and middle-income countries (LMICs). The focus of this research was on the entire healthcare system without considering any specific healthcare service or population group. This article explains the conditions of equity in people's payments for healthcare services in LMICs and focuses on the strengths and weaknesses of successful or failed healthcare systems.

Methods: A systematic search was conducted in the existing database that included the data up to December 2016. The quantity of equity was estimated using relevant indicators and comparing the results with indicators' specific values. Narrative synthesis was then performed for the purpose of reporting the results.

Results: A total of 17 articles from 14 regions, including Palestine, China, China (Heilongjiang), China (Gansu), Ghana, Hungary, Iran, Tunisia, Tanzania, Malaysia, Malawi, Zimbabwe, Uganda, and Chile met the inclusion criteria. The findings indicated that the insurance system (individual and social) is the most equitable method of financing, whereas direct payment is the most unfair method. Nevertheless, many countries still struggle with various payment methods, and people use direct payments.

Conclusions: Results revealed that several factors can affect a country's failure to establish equity in financing the health system. These factors include an increase in direct payments by people to reduce the government's share, failure to cover insurance for the entire population (and especially the poor), and problems in identifying people from low-income groups and setting rules for exempting them from taxes.
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http://dx.doi.org/10.1016/j.vhri.2019.10.001DOI Listing
May 2020

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Authors:
Roy Burstein Nathaniel J Henry Michael L Collison Laurie B Marczak Amber Sligar Stefanie Watson Neal Marquez Mahdieh Abbasalizad-Farhangi Masoumeh Abbasi Foad Abd-Allah Amir Abdoli Mohammad Abdollahi Ibrahim Abdollahpour Rizwan Suliankatchi Abdulkader Michael R M Abrigo Dilaram Acharya Oladimeji M Adebayo Victor Adekanmbi Davoud Adham Mahdi Afshari Mohammad Aghaali Keivan Ahmadi Mehdi Ahmadi Ehsan Ahmadpour Rushdia Ahmed Chalachew Genet Akal Joshua O Akinyemi Fares Alahdab Noore Alam Genet Melak Alamene Kefyalew Addis Alene Mehran Alijanzadeh Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Mohammed J Almalki Hesham M Al-Mekhlafi Khalid Altirkawi Nelson Alvis-Guzman Adeladza Kofi Amegah Saeed Amini Arianna Maever Loreche Amit Zohreh Anbari Sofia Androudi Mina Anjomshoa Fereshteh Ansari Carl Abelardo T Antonio Jalal Arabloo Zohreh Arefi Olatunde Aremu Bahram Armoon Amit Arora Al Artaman Anvar Asadi Mehran Asadi-Aliabadi Amir Ashraf-Ganjouei Reza Assadi Bahar Ataeinia Sachin R Atre Beatriz Paulina Ayala Quintanilla Martin Amogre Ayanore Samad Azari Ebrahim Babaee Arefeh Babazadeh Alaa Badawi Soghra Bagheri Mojtaba Bagherzadeh Nafiseh Baheiraei Abbas Balouchi Aleksandra Barac Quique Bassat Bernhard T Baune Mohsen Bayati Neeraj Bedi Ettore Beghi Masoud Behzadifar Meysam Behzadifar Yared Belete Belay Brent Bell Michelle L Bell Dessalegn Ajema Berbada Robert S Bernstein Natalia V Bhattacharjee Suraj Bhattarai Zulfiqar A Bhutta Ali Bijani Somayeh Bohlouli Nicholas J K Breitborde Gabrielle Britton Annie J Browne Sharath Burugina Nagaraja Reinhard Busse Zahid A Butt Josip Car Rosario Cárdenas Carlos A Castañeda-Orjuela Ester Cerin Wagaye Fentahun Chanie Pranab Chatterjee Dinh-Toi Chu Cyrus Cooper Vera M Costa Koustuv Dalal Lalit Dandona Rakhi Dandona Farah Daoud Ahmad Daryani Rajat Das Gupta Ian Davis Nicole Davis Weaver Dragos Virgil Davitoiu Jan-Walter De Neve Feleke Mekonnen Demeke Gebre Teklemariam Demoz Kebede Deribe Rupak Desai Aniruddha Deshpande Hanna Demelash Desyibelew Sagnik Dey Samath Dhamminda Dharmaratne Meghnath Dhimal Daniel Diaz Leila Doshmangir Andre R Duraes Laura Dwyer-Lindgren Lucas Earl Roya Ebrahimi Soheil Ebrahimpour Andem Effiong Aziz Eftekhari Elham Ehsani-Chimeh Iman El Sayed Maysaa El Sayed Zaki Maha El Tantawi Ziad El-Khatib Mohammad Hassan Emamian Shymaa Enany Sharareh Eskandarieh Oghenowede Eyawo Maha Ezalarab Mahbobeh Faramarzi Mohammad Fareed Roghiyeh Faridnia Andre Faro Ali Akbar Fazaeli Mehdi Fazlzadeh Netsanet Fentahun Seyed-Mohammad Fereshtehnejad João C Fernandes Irina Filip Florian Fischer Nataliya A Foigt Masoud Foroutan Joel Msafiri Francis Takeshi Fukumoto Nancy Fullman Silvano Gallus Destallem Gebremedhin Gebre Tsegaye Tewelde Gebrehiwot Gebreamlak Gebremedhn Gebremeskel Bradford D Gessner Birhanu Geta Peter W Gething Reza Ghadimi Keyghobad Ghadiri Mahsa Ghajarzadeh Ahmad Ghashghaee Paramjit Singh Gill Tiffany K Gill Nick Golding Nelson G M Gomes Philimon N Gona Sameer Vali Gopalani Giuseppe Gorini Bárbara Niegia Garcia Goulart Nicholas Graetz Felix Greaves Manfred S Green Yuming Guo Arvin Haj-Mirzaian Arya Haj-Mirzaian Brian James Hall Samer Hamidi Hamidreza Haririan Josep Maria Haro Milad Hasankhani Edris Hasanpoor Amir Hasanzadeh Hadi Hassankhani Hamid Yimam Hassen Mohamed I Hegazy Delia Hendrie Fatemeh Heydarpour Thomas R Hird Chi Linh Hoang Gillian Hollerich Enayatollah Homaie Rad Mojtaba Hoseini-Ghahfarokhi Naznin Hossain Mostafa Hosseini Mehdi Hosseinzadeh Mihaela Hostiuc Sorin Hostiuc Mowafa Househ Mohamed Hsairi Olayinka Stephen Ilesanmi Mohammad Hasan Imani-Nasab Usman Iqbal Seyed Sina Naghibi Irvani Nazrul Islam Sheikh Mohammed Shariful Islam Mikk Jürisson Nader Jafari Balalami Amir Jalali Javad Javidnia Achala Upendra Jayatilleke Ensiyeh Jenabi John S Ji Yash B Jobanputra Kimberly Johnson Jost B Jonas Zahra Jorjoran Shushtari Jacek Jerzy Jozwiak Ali Kabir Amaha Kahsay Hamed Kalani Rohollah Kalhor Manoochehr Karami Surendra Karki Amir Kasaeian Nicholas J Kassebaum Peter Njenga Keiyoro Grant Rodgers Kemp Roghayeh Khabiri Yousef Saleh Khader Morteza Abdullatif Khafaie Ejaz Ahmad Khan Junaid Khan Muhammad Shahzeb Khan Young-Ho Khang Khaled Khatab Amir Khater Mona M Khater Alireza Khatony Mohammad Khazaei Salman Khazaei Maryam Khazaei-Pool Jagdish Khubchandani Neda Kianipour Yun Jin Kim Ruth W Kimokoti Damaris K Kinyoki Adnan Kisa Sezer Kisa Tufa Kolola Soewarta Kosen Parvaiz A Koul Ai Koyanagi Moritz U G Kraemer Kewal Krishan Kris J Krohn Nuworza Kugbey G Anil Kumar Manasi Kumar Pushpendra Kumar Desmond Kuupiel Ben Lacey Sheetal D Lad Faris Hasan Lami Anders O Larsson Paul H Lee Mostafa Leili Aubrey J Levine Shanshan Li Lee-Ling Lim Stefan Listl Joshua Longbottom Jaifred Christian F Lopez Stefan Lorkowski Sameh Magdeldin Hassan Magdy Abd El Razek Muhammed Magdy Abd El Razek Azeem Majeed Afshin Maleki Reza Malekzadeh Deborah Carvalho Malta Abdullah A Mamun Navid Manafi Ana-Laura Manda Morteza Mansourian Francisco Rogerlândio Martins-Melo Anthony Masaka Benjamin Ballard Massenburg Pallab K Maulik Benjamin K Mayala Mohsen Mazidi Martin McKee Ravi Mehrotra Kala M Mehta Gebrekiros Gebremichael Meles Walter Mendoza Ritesh G Menezes Atte Meretoja Tuomo J Meretoja Tomislav Mestrovic Ted R Miller Molly K Miller-Petrie Edward J Mills George J Milne G K Mini Seyed Mostafa Mir Hamed Mirjalali Erkin M Mirrakhimov Efat Mohamadi Dara K Mohammad Aso Mohammad Darwesh Naser Mohammad Gholi Mezerji Ammas Siraj Mohammed Shafiu Mohammed Ali H Mokdad Mariam Molokhia Lorenzo Monasta Yoshan Moodley Mahmood Moosazadeh Ghobad Moradi Masoud Moradi Yousef Moradi Maziar Moradi-Lakeh Mehdi Moradinazar Paula Moraga Lidia Morawska Abbas Mosapour Seyyed Meysam Mousavi Ulrich Otto Mueller Atalay Goshu Muluneh Ghulam Mustafa Behnam Nabavizadeh Mehdi Naderi Ahamarshan Jayaraman Nagarajan Azin Nahvijou Farid Najafi Vinay Nangia Duduzile Edith Ndwandwe Nahid Neamati Ionut Negoi Ruxandra Irina Negoi Josephine W Ngunjiri Huong Lan Thi Nguyen Long Hoang Nguyen Son Hoang Nguyen Katie R Nielsen Dina Nur Anggraini Ningrum Yirga Legesse Nirayo Molly R Nixon Chukwudi A Nnaji Marzieh Nojomi Mehdi Noroozi Shirin Nosratnejad Jean Jacques Noubiap Soraya Nouraei Motlagh Richard Ofori-Asenso Felix Akpojene Ogbo Kelechi E Oladimeji Andrew T Olagunju Meysam Olfatifar Solomon Olum Bolajoko Olubukunola Olusanya Mojisola Morenike Oluwasanu Obinna E Onwujekwe Eyal Oren Doris D V Ortega-Altamirano Alberto Ortiz Osayomwanbo Osarenotor Frank B Osei Aaron E Osgood-Zimmerman Stanislav S Otstavnov Mayowa Ojo Owolabi Mahesh P A Abdol Sattar Pagheh Smita Pakhale Songhomitra Panda-Jonas Animika Pandey Eun-Kee Park Hadi Parsian Tahereh Pashaei Sangram Kishor Patel Veincent Christian Filipino Pepito Alexandre Pereira Samantha Perkins Brandon V Pickering Thomas Pilgrim Majid Pirestani Bakhtiar Piroozi Meghdad Pirsaheb Oleguer Plana-Ripoll Hadi Pourjafar Parul Puri Mostafa Qorbani Hedley Quintana Mohammad Rabiee Navid Rabiee Amir Radfar Alireza Rafiei Fakher Rahim Zohreh Rahimi Vafa Rahimi-Movaghar Shadi Rahimzadeh Fatemeh Rajati Sree Bhushan Raju Azra Ramezankhani Chhabi Lal Ranabhat Davide Rasella Vahid Rashedi Lal Rawal Robert C Reiner Andre M N Renzaho Satar Rezaei Aziz Rezapour Seyed Mohammad Riahi Ana Isabel Ribeiro Leonardo Roever Elias Merdassa Roro Max Roser Gholamreza Roshandel Daem Roshani Ali Rostami Enrico Rubagotti Salvatore Rubino Siamak Sabour Nafis Sadat Ehsan Sadeghi Reza Saeedi Yahya Safari Roya Safari-Faramani Mahdi Safdarian Amirhossein Sahebkar Mohammad Reza Salahshoor Nasir Salam Payman Salamati Farkhonde Salehi Saleh Salehi Zahabi Yahya Salimi Hamideh Salimzadeh Joshua A Salomon Evanson Zondani Sambala Abdallah M Samy Milena M Santric Milicevic Bruno Piassi Sao Jose Sivan Yegnanarayana Iyer Saraswathy Rodrigo Sarmiento-Suárez Benn Sartorius Brijesh Sathian Sonia Saxena Alyssa N Sbarra Lauren E Schaeffer David C Schwebel Sadaf G Sepanlou Seyedmojtaba Seyedmousavi Faramarz Shaahmadi Masood Ali Shaikh Mehran Shams-Beyranvand Amir Shamshirian Morteza Shamsizadeh Kiomars Sharafi Mehdi Sharif Mahdi Sharif-Alhoseini Hamid Sharifi Jayendra Sharma Rajesh Sharma Aziz Sheikh Chloe Shields Mika Shigematsu Rahman Shiri Ivy Shiue Kerem Shuval Tariq J Siddiqi João Pedro Silva Jasvinder A Singh Dhirendra Narain Sinha Malede Mequanent Sisay Solomon Sisay Karen Sliwa David L Smith Ranjani Somayaji Moslem Soofi Joan B Soriano Chandrashekhar T Sreeramareddy Agus Sudaryanto Mu'awiyyah Babale Sufiyan Bryan L Sykes P N Sylaja Rafael Tabarés-Seisdedos Karen M Tabb Takahiro Tabuchi Nuno Taveira Mohamad-Hani Temsah Abdullah Sulieman Terkawi Zemenu Tadesse Tessema Kavumpurathu Raman Thankappan Sathish Thirunavukkarasu Quyen G To Marcos Roberto Tovani-Palone Bach Xuan Tran Khanh Bao Tran Irfan Ullah Muhammad Shariq Usman Olalekan A Uthman Amir Vahedian-Azimi Pascual R Valdez Job F M van Boven Tommi Juhani Vasankari Yasser Vasseghian Yousef Veisani Narayanaswamy Venketasubramanian Francesco S Violante Sergey Konstantinovitch Vladimirov Vasily Vlassov Theo Vos Giang Thu Vu Isidora S Vujcic Yasir Waheed Jon Wakefield Haidong Wang Yafeng Wang Yuan-Pang Wang Joseph L Ward Robert G Weintraub Kidu Gidey Weldegwergs Girmay Teklay Weldesamuel Ronny Westerman Charles Shey Wiysonge Dawit Zewdu Wondafrash Lauren Woyczynski Ai-Min Wu Gelin Xu Abbas Yadegar Tomohide Yamada Vahid Yazdi-Feyzabadi Christopher Sabo Yilgwan Paul Yip Naohiro Yonemoto Javad Yoosefi Lebni Mustafa Z Younis Mahmoud Yousefifard Hebat-Allah Salah A Yousof Chuanhua Yu Hasan Yusefzadeh Erfan Zabeh Telma Zahirian Moghadam Sojib Bin Zaman Mohammad Zamani Hamed Zandian Alireza Zangeneh Taddese Alemu Zerfu Yunquan Zhang Arash Ziapour Sanjay Zodpey Christopher J L Murray Simon I Hay

Nature 2019 10 16;574(7778):353-358. Epub 2019 Oct 16.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
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http://dx.doi.org/10.1038/s41586-019-1545-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800389PMC
October 2019

Analysis of Public-Private Partnership in Providing Primary Health Care Policy: An Experience From Iran.

J Prim Care Community Health 2019 Jan-Dec;10:2150132719881507

Tabriz University of Medical Sciences, Tabriz, Iran.

This study aims to analyze the public-private partnership (PPP) policy in primary health care (PHC), focusing on the experience of the East Azerbaijan Province (EAP) of Iran. This research is a qualitative study. Data were gathered using interviews with stakeholders and document analysis and analyzed through content analysis. Participants considered political and economic support as the most important underlying factors. Improving system efficiency was the main goal of this policy. Most stakeholders were supporters of the plan, and there was no major opponent. Implementing the health evolution plan (HEP) was an opportunity to design this policy. Participants considered the lack of provision of infrastructure as the main weakness, changing the role of the public sector as the main strength, and promoting social justice as the main achievement of policy. The results of the quantitative data review showed that following the implementation of this policy, health indicators have been improved. Based on the results of this study, the PPP model in EAP is a new and successful experience in PHC in Iran. Supporting and developing this policy may improve the quality and quantity of providing care.
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http://dx.doi.org/10.1177/2150132719881507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796199PMC
June 2020

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study.

Authors:
Christina Fitzmaurice Degu Abate Naghmeh Abbasi Hedayat Abbastabar Foad Abd-Allah Omar Abdel-Rahman Ahmed Abdelalim Amir Abdoli Ibrahim Abdollahpour Abdishakur S M Abdulle Nebiyu Dereje Abebe Haftom Niguse Abraha Laith Jamal Abu-Raddad Ahmed Abualhasan Isaac Akinkunmi Adedeji Shailesh M Advani Mohsen Afarideh Mahdi Afshari Mohammad Aghaali Dominic Agius Sutapa Agrawal Ayat Ahmadi Elham Ahmadian Ehsan Ahmadpour Muktar Beshir Ahmed Mohammad Esmaeil Akbari Tomi Akinyemiju Ziyad Al-Aly Assim M AlAbdulKader Fares Alahdab Tahiya Alam Genet Melak Alamene Birhan Tamene T Alemnew Kefyalew Addis Alene Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Fatemeh Allah Bakeshei Majid Abdulrahman Hamad Almadi Amir Almasi-Hashiani Ubai Alsharif Shirina Alsowaidi Nelson Alvis-Guzman Erfan Amini Saeed Amini Yaw Ampem Amoako Zohreh Anbari Nahla Hamed Anber Catalina Liliana Andrei Mina Anjomshoa Fereshteh Ansari Ansariadi Ansariadi Seth Christopher Yaw Appiah Morteza Arab-Zozani Jalal Arabloo Zohreh Arefi Olatunde Aremu Habtamu Abera Areri Al Artaman Hamid Asayesh Ephrem Tsegay Asfaw Alebachew Fasil Ashagre Reza Assadi Bahar Ataeinia Hagos Tasew Atalay Zerihun Ataro Suleman Atique Marcel Ausloos Leticia Avila-Burgos Euripide F G A Avokpaho Ashish Awasthi Nefsu Awoke Beatriz Paulina Ayala Quintanilla Martin Amogre Ayanore Henok Tadesse Ayele Ebrahim Babaee Umar Bacha Alaa Badawi Mojtaba Bagherzadeh Eleni Bagli Senthilkumar Balakrishnan Abbas Balouchi Till Winfried Bärnighausen Robert J Battista Masoud Behzadifar Meysam Behzadifar Bayu Begashaw Bekele Yared Belete Belay Yaschilal Muche Belayneh Kathleen Kim Sachiko Berfield Adugnaw Berhane Eduardo Bernabe Mircea Beuran Nickhill Bhakta Krittika Bhattacharyya Belete Biadgo Ali Bijani Muhammad Shahdaat Bin Sayeed Charles Birungi Catherine Bisignano Helen Bitew Tone Bjørge Archie Bleyer Kassawmar Angaw Bogale Hunduma Amensisa Bojia Antonio M Borzì Cristina Bosetti Ibrahim R Bou-Orm Hermann Brenner Jerry D Brewer Andrey Nikolaevich Briko Nikolay Ivanovich Briko Maria Teresa Bustamante-Teixeira Zahid A Butt Giulia Carreras Juan J Carrero Félix Carvalho Clara Castro Franz Castro Ferrán Catalá-López Ester Cerin Yazan Chaiah Wagaye Fentahun Chanie Vijay Kumar Chattu Pankaj Chaturvedi Neelima Singh Chauhan Mohammad Chehrazi Peggy Pei-Chia Chiang Tesfaye Yitna Chichiabellu Onyema Greg Chido-Amajuoyi Odgerel Chimed-Ochir Jee-Young J Choi Devasahayam J Christopher Dinh-Toi Chu Maria-Magdalena Constantin Vera M Costa Emanuele Crocetti Christopher Stephen Crowe Maria Paula Curado Saad M A Dahlawi Giovanni Damiani Amira Hamed Darwish Ahmad Daryani José das Neves Feleke Mekonnen Demeke Asmamaw Bizuneh Demis Birhanu Wondimeneh Demissie Gebre Teklemariam Demoz Edgar Denova-Gutiérrez Afshin Derakhshani Kalkidan Solomon Deribe Rupak Desai Beruk Berhanu Desalegn Melaku Desta Subhojit Dey Samath Dhamminda Dharmaratne Meghnath Dhimal Daniel Diaz Mesfin Tadese Tadese Dinberu Shirin Djalalinia David Teye Doku Thomas M Drake Manisha Dubey Eleonora Dubljanin Eyasu Ejeta Duken Hedyeh Ebrahimi Andem Effiong Aziz Eftekhari Iman El Sayed Maysaa El Sayed Zaki Shaimaa I El-Jaafary Ziad El-Khatib Demelash Abewa Elemineh Hajer Elkout Richard G Ellenbogen Aisha Elsharkawy Mohammad Hassan Emamian Daniel Adane Endalew Aman Yesuf Endries Babak Eshrati Ibtihal Fadhil Vahid Fallah Omrani Mahbobeh Faramarzi Mahdieh Abbasalizad Farhangi Andrea Farioli Farshad Farzadfar Netsanet Fentahun Eduarda Fernandes Garumma Tolu Feyissa Irina Filip Florian Fischer James L Fisher Lisa M Force Masoud Foroutan Marisa Freitas Takeshi Fukumoto Neal D Futran Silvano Gallus Fortune Gbetoho Gankpe Reta Tsegaye Gayesa Tsegaye Tewelde Gebrehiwot Gebreamlak Gebremedhn Gebremeskel Getnet Azeze Gedefaw Belayneh K Gelaw Birhanu Geta Sefonias Getachew Kebede Embaye Gezae Mansour Ghafourifard Alireza Ghajar Ahmad Ghashghaee Asadollah Gholamian Paramjit Singh Gill Themba T G Ginindza Alem Girmay Muluken Gizaw Ricardo Santiago Gomez Sameer Vali Gopalani Giuseppe Gorini Bárbara Niegia Garcia Goulart Ayman Grada Maximiliano Ribeiro Guerra Andre Luiz Sena Guimaraes Prakash C Gupta Rahul Gupta Kishor Hadkhale Arvin Haj-Mirzaian Arya Haj-Mirzaian Randah R Hamadeh Samer Hamidi Lolemo Kelbiso Hanfore Josep Maria Haro Milad Hasankhani Amir Hasanzadeh Hamid Yimam Hassen Roderick J Hay Simon I Hay Andualem Henok Nathaniel J Henry Claudiu Herteliu Hagos D Hidru Chi Linh Hoang Michael K Hole Praveen Hoogar Nobuyuki Horita H Dean Hosgood Mostafa Hosseini Mehdi Hosseinzadeh Mihaela Hostiuc Sorin Hostiuc Mowafa Househ Mohammedaman Mama Hussen Bogdan Ileanu Milena D Ilic Kaire Innos Seyed Sina Naghibi Irvani Kufre Robert Iseh Sheikh Mohammed Shariful Islam Farhad Islami Nader Jafari Balalami Morteza Jafarinia Leila Jahangiry Mohammad Ali Jahani Nader Jahanmehr Mihajlo Jakovljevic Spencer L James Mehdi Javanbakht Sudha Jayaraman Sun Ha Jee Ensiyeh Jenabi Ravi Prakash Jha Jost B Jonas Jitendra Jonnagaddala Tamas Joo Suresh Banayya Jungari Mikk Jürisson Ali Kabir Farin Kamangar André Karch Narges Karimi Ansar Karimian Amir Kasaeian Gebremicheal Gebreslassie Kasahun Belete Kassa Tesfaye Dessale Kassa Mesfin Wudu Kassaw Anil Kaul Peter Njenga Keiyoro Abraham Getachew Kelbore Amene Abebe Kerbo Yousef Saleh Khader Maryam Khalilarjmandi Ejaz Ahmad Khan Gulfaraz Khan Young-Ho Khang Khaled Khatab Amir Khater Maryam Khayamzadeh Maryam Khazaee-Pool Salman Khazaei Abdullah T Khoja Mohammad Hossein Khosravi Jagdish Khubchandani Neda Kianipour Daniel Kim Yun Jin Kim Adnan Kisa Sezer Kisa Katarzyna Kissimova-Skarbek Hamidreza Komaki Ai Koyanagi Kristopher J Krohn Burcu Kucuk Bicer Nuworza Kugbey Vivek Kumar Desmond Kuupiel Carlo La Vecchia Deepesh P Lad Eyasu Alem Lake Ayenew Molla Lakew Dharmesh Kumar Lal Faris Hasan Lami Qing Lan Savita Lasrado Paolo Lauriola Jeffrey V Lazarus James Leigh Cheru Tesema Leshargie Yu Liao Miteku Andualem Limenih Stefan Listl Alan D Lopez Platon D Lopukhov Raimundas Lunevicius Mohammed Madadin Sameh Magdeldin Hassan Magdy Abd El Razek Azeem Majeed Afshin Maleki Reza Malekzadeh Ali Manafi Navid Manafi Wondimu Ayele Manamo Morteza Mansourian Mohammad Ali Mansournia Lorenzo Giovanni Mantovani Saman Maroufizadeh Santi Martini S Martini Tivani Phosa Mashamba-Thompson Benjamin Ballard Massenburg Motswadi Titus Maswabi Manu Raj Mathur Colm McAlinden Martin McKee Hailemariam Abiy Alemu Meheretu Ravi Mehrotra Varshil Mehta Toni Meier Yohannes A Melaku Gebrekiros Gebremichael Meles Hagazi Gebre Meles Addisu Melese Mulugeta Melku Peter T N Memiah Walter Mendoza Ritesh G Menezes Shahin Merat Tuomo J Meretoja Tomislav Mestrovic Bartosz Miazgowski Tomasz Miazgowski Kebadnew Mulatu M Mihretie Ted R Miller Edward J Mills Seyed Mostafa Mir Hamed Mirzaei Hamid Reza Mirzaei Rashmi Mishra Babak Moazen Dara K Mohammad Karzan Abdulmuhsin Mohammad Yousef Mohammad Aso Mohammad Darwesh Abolfazl Mohammadbeigi Hiwa Mohammadi Moslem Mohammadi Mahdi Mohammadian Abdollah Mohammadian-Hafshejani Milad Mohammadoo-Khorasani Reza Mohammadpourhodki Ammas Siraj Mohammed Jemal Abdu Mohammed Shafiu Mohammed Farnam Mohebi Ali H Mokdad Lorenzo Monasta Yoshan Moodley Mahmood Moosazadeh Maryam Moossavi Ghobad Moradi Mohammad Moradi-Joo Maziar Moradi-Lakeh Farhad Moradpour Lidia Morawska Joana Morgado-da-Costa Naho Morisaki Shane Douglas Morrison Abbas Mosapour Seyyed Meysam Mousavi Achenef Asmamaw Muche Oumer Sada S Muhammed Jonah Musa Ashraf F Nabhan Mehdi Naderi Ahamarshan Jayaraman Nagarajan Gabriele Nagel Azin Nahvijou Gurudatta Naik Farid Najafi Luigi Naldi Hae Sung Nam Naser Nasiri Javad Nazari Ionut Negoi Subas Neupane Polly A Newcomb Haruna Asura Nggada Josephine W Ngunjiri Cuong Tat Nguyen Leila Nikniaz Dina Nur Anggraini Ningrum Yirga Legesse Nirayo Molly R Nixon Chukwudi A Nnaji Marzieh Nojomi Shirin Nosratnejad Malihe Nourollahpour Shiadeh Mohammed Suleiman Obsa Richard Ofori-Asenso Felix Akpojene Ogbo In-Hwan Oh Andrew T Olagunju Tinuke O Olagunju Mojisola Morenike Oluwasanu Abidemi E Omonisi Obinna E Onwujekwe Anu Mary Oommen Eyal Oren Doris D V Ortega-Altamirano Erika Ota Stanislav S Otstavnov Mayowa Ojo Owolabi Mahesh P A Jagadish Rao Padubidri Smita Pakhale Amir H Pakpour Adrian Pana Eun-Kee Park Hadi Parsian Tahereh Pashaei Shanti Patel Snehal T Patil Alyssa Pennini David M Pereira Cristiano Piccinelli Julian David Pillay Majid Pirestani Farhad Pishgar Maarten J Postma Hadi Pourjafar Farshad Pourmalek Akram Pourshams Swayam Prakash Narayan Prasad Mostafa Qorbani Mohammad Rabiee Navid Rabiee Amir Radfar Alireza Rafiei Fakher Rahim Mahdi Rahimi Muhammad Aziz Rahman Fatemeh Rajati Saleem M Rana Samira Raoofi Goura Kishor Rath David Laith Rawaf Salman Rawaf Robert C Reiner Andre M N Renzaho Nima Rezaei Aziz Rezapour Ana Isabel Ribeiro Daniela Ribeiro Luca Ronfani Elias Merdassa Roro Gholamreza Roshandel Ali Rostami Ragy Safwat Saad Parisa Sabbagh Siamak Sabour Basema Saddik Saeid Safiri Amirhossein Sahebkar Mohammad Reza Salahshoor Farkhonde Salehi Hosni Salem Marwa Rashad Salem Hamideh Salimzadeh Joshua A Salomon Abdallah M Samy Juan Sanabria Milena M Santric Milicevic Benn Sartorius Arash Sarveazad Brijesh Sathian Maheswar Satpathy Miloje Savic Monika Sawhney Mehdi Sayyah Ione J C Schneider Ben Schöttker Mario Sekerija Sadaf G Sepanlou Masood Sepehrimanesh Seyedmojtaba Seyedmousavi Faramarz Shaahmadi Hosein Shabaninejad Mohammad Shahbaz Masood Ali Shaikh Amir Shamshirian Morteza Shamsizadeh Heidar Sharafi Zeinab Sharafi Mehdi Sharif Ali Sharifi Hamid Sharifi Rajesh Sharma Aziz Sheikh Reza Shirkoohi Sharvari Rahul Shukla Si Si Soraya Siabani Diego Augusto Santos Silva Dayane Gabriele Alves Silveira Ambrish Singh Jasvinder A Singh Solomon Sisay Freddy Sitas Eugène Sobngwi Moslem Soofi Joan B Soriano Vasiliki Stathopoulou Mu'awiyyah Babale Sufiyan Rafael Tabarés-Seisdedos Takahiro Tabuchi Ken Takahashi Omid Reza Tamtaji Mohammed Rasoul Tarawneh Segen Gebremeskel Tassew Parvaneh Taymoori Arash Tehrani-Banihashemi Mohamad-Hani Temsah Omar Temsah Berhe Etsay Tesfay Fisaha Haile Tesfay Manaye Yihune Teshale Gizachew Assefa Tessema Subash Thapa Kenean Getaneh Tlaye Roman Topor-Madry Marcos Roberto Tovani-Palone Eugenio Traini Bach Xuan Tran Khanh Bao Tran Afewerki Gebremeskel Tsadik Irfan Ullah Olalekan A Uthman Marco Vacante Maryam Vaezi Patricia Varona Pérez Yousef Veisani Simone Vidale Francesco S Violante Vasily Vlassov Stein Emil Vollset Theo Vos Kia Vosoughi Giang Thu Vu Isidora S Vujcic Henry Wabinga Tesfahun Mulatu Wachamo Fasil Shiferaw Wagnew Yasir Waheed Fitsum Weldegebreal Girmay Teklay Weldesamuel Tissa Wijeratne Dawit Zewdu Wondafrash Tewodros Eshete Wonde Adam Belay Wondmieneh Hailemariam Mekonnen Workie Rajaram Yadav Abbas Yadegar Ali Yadollahpour Mehdi Yaseri Vahid Yazdi-Feyzabadi Alex Yeshaneh Mohammed Ahmed Yimam Ebrahim M Yimer Engida Yisma Naohiro Yonemoto Mustafa Z Younis Bahman Yousefi Mahmoud Yousefifard Chuanhua Yu Erfan Zabeh Vesna Zadnik Telma Zahirian Moghadam Zoubida Zaidi Mohammad Zamani Hamed Zandian Alireza Zangeneh Leila Zaki Kazem Zendehdel Zerihun Menlkalew Zenebe Taye Abuhay Zewale Arash Ziapour Sanjay Zodpey Christopher J L Murray

JAMA Oncol 2019 12;5(12):1749-1768

Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.

Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.

Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).

Conclusions And Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.
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http://dx.doi.org/10.1001/jamaoncol.2019.2996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777271PMC
December 2019

Willingness to pay for one quality-adjusted life year in Iran.

Cost Eff Resour Alloc 2019 28;17. Epub 2019 Feb 28.

6Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Recent years have witnessed a strong tendency to apply economic evidence as a guide for making health resource allocation decisions, especially those related to reimbursement policies. One such measure is the use of the cost-effectiveness threshold as a benchmark. This study explored the threshold for use in the health system of Iran by determining society's preferences.

Methods: A cross-sectional household survey based on the contingent valuation method was administered to a representative general population of 1002 in Tehran, Iran from April to June 2015. The survey was intended to estimate the respondents' willingness-to-pay (WTP) preferences for one quality-adjusted life year (QALY) gained. The valuation scenarios featured 12 vignettes on mild to severe diseases that can change people's quality of life. The mean of WTP for QALY was estimated using different health instruments, and the determinants of such willingness were analyzed using the Heckman selection model.

Results: WTP for QALY varied depending on the severity of a disease and the instrument used to determine health preferences. Mean low health state value were associated with high valuation. The best estimated WTP values ranged from US$1032 to US$2666 and 0.22-0.56 of Iran's local gross domestic product (GDP) per capita in 2014. Except for educational level, significant variables differed across different disease scenarios. Generally, a high health state valuation for target diseases, high income, high educational level, and being married were associated with high WTP for QALY.

Conclusion: From the general public's perspective, the monetary value of QALY for mild to severe diseases with no risk of death was less than one GDP per capita. Therefore, the obtained valuation range is recommended as reference only for the adoption of interventions designed to improve quality of life. Future studies should estimate the threshold of interventions for life-threatening diseases or formulate transparent policies in such contexts.
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http://dx.doi.org/10.1186/s12962-019-0172-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396529PMC
February 2019

The Worth of a Quality-Adjusted Life-Year in Patients with Diabetes: An Investigation Study using a Willingness-to-Pay Method.

Pharmacoecon Open 2019 Sep;3(3):311-319

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

Background: A limited number of studies have specifically examined the value of quality-adjusted life-years (QALYs) from the patient's perspective.

Objective: The goal of this study was to investigate the worth of QALYs from the perspectives of patients with diabetes using health and willingness-to-pay (WTP) measures.

Methods: A hypothetical treatment characterized by a permanent cure was presented to 149 patients with diabetes in Tehran, Iran, to elicit the monetary value that they attach to QALYs. The QALY gains of the participants were determined using the EuroQol-5 Dimensions, 3 Levels instrument, the visual analogue scale, and the time trade-off method. A mixed closed-ended WTP model supported by an open-ended question was used to ascertain the monetary value of a QALY gained. Finally, we used each respondent's ratio of WTP to QALY gained and the mean of the ratios to estimate the worth of a QALY to all respondents.

Results: In total, 96% of respondents were willing to pay out of pocket for the restoration of full health, whereas 4% exhibited a zero WTP because of an inability to pay. The mean WTP per QALY varied depending on the health measure and discount rate used, ranging from $US1191 to $US5043 in sensitivity analysis, which is equal to 0.23-0.95 of Iran's gross domestic product (GDP) per capita in 2015.

Conclusion: Applying the upper limit of the World Health Organization's (WHO) cost-effectiveness threshold (i.e., three times the local GDP per capita) in resource allocation decisions requires caution and investigation, particularly in low- and middle-income countries with limited healthcare resources. To generalize our findings, especially for application to decision making, additional surveys involving more representative samples from different settings are recommended.
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http://dx.doi.org/10.1007/s41669-018-0111-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710303PMC
September 2019

Never will I give advice till you please to ask me thrice: Estimating willingness to pay for health insurance using 3 different methods with evidence from Iran.

Int J Health Plann Manage 2019 Jan 28;34(1):e594-e601. Epub 2018 Sep 28.

Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.

Objective: The current study was aimed at providing a monetary assessment of households' preferences for basic and complementary health insurance based on willing to pay for health insurance coverage.

Method: The open-ended (OE), take-it-or-leave-it (TIOLI), and double-bounded dichotomous choice (DBDC) methods of contingent valuation (CV) were compared in calculating the participants' willingness to pay (WTP) for joining health insurance coverage. The data for the current study were taken from 2 equivalent samples of households.

Results: The (trimmed) mean of monthly WTP per person for basic health insurance coverage elicited by the OE, TIOLI, and DBDC methods was respectively US$ 4.01, US$ 6.2, and US$ 5.5. Moreover, the (trimmed) mean of monthly WTP per person for complementary health insurance elicited by the OE, TIOLI, and DBDC methods was respectively US$ 4.6, US$ 9.8, and US$ 8.

Conclusions: The results indicated a significant value difference in the various CV approaches. The findings suggest that the TIOLI, OE, and DBDC can be used as an upper bounded, a lower bounded, and a median value respectively. The findings also suggest that the choice of different CV approaches is needed to estimate a boundary of WTP for health insurance plans as a more reliable estimate of stated preference of health insurance.
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http://dx.doi.org/10.1002/hpm.2675DOI Listing
January 2019

Development of age-sex adjusted capitation payment: The experience of Iranian public health complexes.

Int J Health Plann Manage 2019 Jan 30;34(1):e183-e193. Epub 2018 Aug 30.

Iranian Center of Excellence in Health Services Management, Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Flat capitations are not necessarily able to compensate health providers equitably due to the variability of resource consumption among different age and sex groups. The aim of this study is to develop a risk adjusted capitation formula as a base for primary health care payment in Health Complexes of Tabriz, in Iran.

Method: This cross-sectional study was conducted in four stages: (1) determining health service package, (2) calculating unit cost of services, (3) estimating service utilization, and (4) calculating age/sex weighted capitation. We calculated unit cost of services with and without building and equipment expenses. Data collection was carried out through a data extraction checklist. Data management and analysis was carried out via Microsoft Excel 2007.

Result: A list of 99 services and their processes were identified and then assigned each to one of 10 categories according to their resource consumption. The lowest and highest unit cost, respectively, belonged to prenatal care and group training by family physicians. The risk adjusted capitation was calculated with and without renting cost of building and equipment, respectively, 347 000 and 332 000 Rials (1 US$ worth 35 000 Iranian Rials).

Conclusion: The development of health risk adjusted capitation could improve equity in payment system and the efficiency of delivering primary health care services. Estimated weights proposed with our study can be adapted then applied in contexts with similar characteristics.
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http://dx.doi.org/10.1002/hpm.2631DOI Listing
January 2019

Knowledge of and attitudes toward HIV/AIDS among Iranian women.

Epidemiol Health 2018 3;40:e2018037. Epub 2018 Aug 3.

Tabriz Health Service Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Objectives: This study investigated the knowledge of Iranian women about HIV/AIDS and whether they had accepting attitudes towards people living with human immunodeficiency virus (HIV), and sought to identify factors correlated with their knowledge and attitudes.

Methods: The data analyzed in the present study were taken from Iran's Multiple Indicator Demographic and Health Survey, a national survey conducted in 2015. In total, 42,630 women aged 15-49 years were identified through multi-stage stratified cluster random sampling and interviewed. Associations of the socio-demographic characteristics of participants with their knowledge and attitudes were examined using multiple logistic regression analysis.

Results: The majority (79.0%) of Iranian women had heard about HIV/AIDS, but only 19.1% had a comprehensive knowledge. In addition, only 15.4% of women had accepting attitudes toward people with HIV. Being older, married, more highly educated, and wealthier were factors associated with having more comprehensive knowledge of HIV/AIDS, and living in urban areas was associated with having more positive attitudes toward people with HIV.

Conclusions: The relatively poor knowledge of Iranian women and the low prevalence of accepting attitudes toward people living with HIV highlight the need to develop policies and interventions to overcome this issue, which would be a basis for further prevention of HIV/AIDS in Iran.
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http://dx.doi.org/10.4178/epih.e2018037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232658PMC
September 2018

Willingness to Pay for Complementary Health Care Insurance in Iran.

Iran J Public Health 2017 Sep;46(9):1247-1255

Food and Drug Administration, Ministry of Health and Medical Education, Tehran, Iran.

Background: Complementary health insurance is increasingly used to remedy the limitations and shortcomings of the basic health insurance benefit packages. Hence, it is essential to gather reliable information about the amount of Willingness to Pay (WTP) for health insurance. We assessed the WTP for health insurance in Iran in order to suggest an affordable complementary health insurance.

Methods: The study sample consisted of 300 household heads all over provinces of Iran in 2013. The method applied was double bounded dichotomous choice and open-ended question approach of contingent valuation.

Results: The average WTP for complementary health insurance per person per month by double bounded dichotomous choice and open-ended question method respectively was 199000 and 115300 Rials (8 and 4.6 USD, respectively). Household's heads with higher levels of income and those who worked had more WTP for the health insurance. Besides, the WTP increased in direct proportion to the number of insured members of each household and in inverse proportion to the family size.

Conclusion: The WTP value can be used as a premium in a society. As an important finding, the study indicated that the households were willing to pay higher premiums than currently collected for the complementary health insurance coverage in Iran. This offers the policy makers the opportunity to increase the premium and provide good benefits package for insured people of country then better risk pooling.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632327PMC
September 2017

Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries.

PLoS One 2016 30;11(6):e0157470. Epub 2016 Jun 30.

Micro Insurance Academy, New Delhi, India.

Objective: Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature.

Methods: We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP.

Result: 16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP.

Conclusions: The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157470PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928775PMC
July 2017

The Efficacy of Written Information Intervention in Reduction of Hospital Re-admission Cost in Patients With Heart Failure; A Systematic Review and Meta-Analysis.

J Cardiovasc Thorac Res 2015 29;7(1):1-5. Epub 2015 Mar 29.

Road Traffic Injury Research Centre, Department of Statistical and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran.

Objective: To assess the efficacy of written information versus non written information intervention in reducing hospital readmission cost, if prescribed or presented to the patients with HF.

Methods: The study was a systematic review and meta-analysis. We searched Medline (Ovid) and Cochrane library during the past 20 years from 1993 to 2013. We also conducted a manual search through Google Scholar and a direct search in the group of related journals in Black Well and Science Direct trough their websites. Two reviewers appraised the identified studies, and meta-analysis was done to estimate the mean saving cost of patient readmission. All the included studies must have been done by randomization to be eligible for study.

Result: We assessed the full-texts 3 out of 65 studies with 754 patients and average age of 74.33. The mean of estimated saving readmission cost in intervention group versus control group was US $2751 (95% CI: 2708 - 2794) and the mean of total saving cost in intervention group versus control group was US $2047 (base year 2010) with (95% CI: 2004 - 2089). No publication bias was found by testing the heterogeneity of studies.

Conclusion: One of the effective factors in minimizing the healthcare cost and preventing from hospital re-admission is providing the patients with information prescription in a written format. It is suggested that hospital management, Medicare organizations, policy makers and individual physicians consider the prescription of appropriate medical information as the indispensable part of patient's care process.
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http://dx.doi.org/10.15171/jcvtr.2015.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378668PMC
April 2015

Willingness to pay for the social health insurance in Iran.

Glob J Health Sci 2014 May 30;6(5):154-63. Epub 2014 May 30.

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

Objective: The substantial level of out-of-pocket expenditure for health care by the population causes policy makers to draw particular attention to the proposal of a social health insurance for uninsured members of the community. Hence, it is essential to gather reliable information about the amount of Willingness To Pay (WTP) for health insurance. We assessed the WTP for health insurance in Iran in order to suggest an affordable social health insurance.

Methods: The study sample included 300 household heads in all Iranian provinces. The double bounded dichotomous choice approach was used to elicit the WTP.

Results: The average WTP for social health insurance per person per month was 137 000 Rial (5.5 $US). Household heads with higher levels of education, income and those who worked had more WTP for the health insurance. Besides, the WTP increased in direct proportion to the number of insured members of each household and in inverse proportion to the family size.

Conclusions: From a policy point of view, the WTP value can be used as a premium in a society. An important finding of this study is that although households' Willingness To Pay is not more than the total insurance premium, households are willing to pay more than the premium they ought to pay for health insurance coverage. That is, total insurance premium is 150 000 Rials and households ought to pay approximately half of this sum. This can afford policy makers the ideal opportunity to provide good insurance coverage for medical services according to the need of society.
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http://dx.doi.org/10.5539/gjhs.v6n5p154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825503PMC
May 2014

Cost-effectiveness of Anemia Screening in Vulnerable Groups: A Systematic Review.

Int J Prev Med 2014 Jul;5(7):813-9

Department of Health Management and Economics, School of Public Health and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Anemia is the most common blood disorder observed in vulnerable groups and affects their efficiency in their everyday activities. Possible complications of the disease may be reduced or prevented by screening of patients. Screening programs impose certain costs upon the health system, which may offset their positive effects. Whether the positive impacts of screening outweigh its costs is a subject of debate among policy-makers. In this research, we have conducted a systematic review of the cost-effectiveness of anemia screening.

Methods: The Pubmed, Science Direct, SCOPUS, EMBASE, and CINAHL databases were searched for relevant results dating between 1962-2010 using key words. The references of the related articles were gone over manually. In the end, Persian databases were also examined for results.

Results: Using data from the four mentioned databases, a total of 722 articles were elected, which, after evaluation, were narrowed down to 4. Of these, 3 focused on newborns and infants. Disparity existed among obtained results, such that no two articles were similar, and this made making comparisons between them cumbersome and sometimes even impossible. Only one study evaluated cost-effectiveness of anemia screening in vulnerable target groups.

Conclusions: Research findings show that there is not enough evidence of cost-effectiveness of screening for decision-making. Bearing in mind the importance of the matter to health policy-makers, due to high prevalence of iron-deficiency anemia in low- and middle-income countries, conduction of research in this field seems necessary.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124557PMC
July 2014

Cost-effectiveness of mammography screening for breast cancer in a low socioeconomic group of Iranian women.

Arch Iran Med 2014 Apr;17(4):241-5

Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.

Background: Breast cancer is the most common cancer among women. Mammography screening has been used in many countries to reduce early deaths caused by breast cancer. It is important to ensure that screening programs are effective and efficient. We conducted a study to assess the cost-effectiveness of a national breast cancer screening program implemented in Iran.

Methods: The perspective of the present study was the health system. Over 26,000 women aged 35 and higher, of low socioeconomic background were recruited from ten cities in the program. We used case-finding as the outcome indicator for assessing effectiveness of the program. We measured the service provision costs, the coordination costs and supervision costs of the program that included the staff costs, and measured cost per detected case. We also conducted sensitivity analyses and calculated false-positive rates as a result of the screening program.

Results: The total cost of breast cancer screening program was estimated at $377,797. The program resulted in the identification of 24 patients with breast cancers, not different from baseline expectations without a screening program. The cost per cancer detected was calculated $15,742. The minimum and maximum cost per breast cancer detected were about $13,524 and $16,947, respectively. We observed a false-positive rate of 7.5% among the target population.

Conclusion: Our findings suggest that the mammography screening program was not cost-effective. Although there were technical efficiency issues in the conduct of the program, the findings do not support the implementation of national mammography screening programs in Iran in women aged less than 50 years. Careful studies of such programs for higher age groups are also recommended before they are rolled-out nationally.
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http://dx.doi.org/014174/AIM.005DOI Listing
April 2014

Cost effectiveness of breast cancer screening using mammography; a systematic review.

Iran J Public Health 2013 1;42(4):347-57. Epub 2013 Apr 1.

Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Breast cancer is the leading cause of malignancy among women. Screening using mammography is proposed as an effective intervention for reducing early deaths due to breast cancer. We conducted a systematic review to assess the cost-effectiveness of such screening programs. We searched Medline, Scopus and Google Scholar and complemented it by other searches using sensitive search terms from 1993-2010. We screened the titles and abstracts, assessed the full texts of the remaining studies, and extracted data to a pre-designed data extraction sheet. Studies were categorized according to the age groups of the target population. We used narrative synthesis approaches for analyzing the data. Twenty-eight articles met the minimum inclusion criteria, mostly from high income settings. All studies used secondary data, and a variety of modeling techniques, age groups, screening intervals and outcome measures. Cost per life year gained, ranging from $1,634 (once at the age of 50 in India) to $65,000 (extending the lower age limit of screening to 40 Australian study), was the most commonly used outcome measure. Biennial screening test for those aged 50-70 years seems to be the most cost-effective option ($2685). Biennial screening for aged 50-70 years is the most cost-effective option among alternative scenarios. Screening those aged less than 50 is not recommended. Further studies in low-income and middle-income countries, and cost effectiveness studies along with randomized trials are required. To improve the comparability of the findings, future studies should include biennial screening in 50-70 age groups as an alternative strategy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684720PMC
June 2013