Among different groups of hemophiliacs, those suffering from Severe Hemophilia A (SHA) are most v... more Among different groups of hemophiliacs, those suffering from Severe Hemophilia A (SHA) are most vulnerable to the complications of the disease. This study investigated the Health-Related Quality of Life (HR-QoL) among adult patients with SHA. A cross-sectional study was designed to gather demographic and clinical information from adult patients with SHA. Patients with inhibitors were excluded. The remaining were asked to complete the HR-QoL questionnaire after being examined for joint health using the Hemophilia Joint Health Score (HJHS). The HR-QoL and joint conditions were measured in 38 patients. The mean EQ-5D value scores were 0.46 (SD=0.23) while the mean Visual Analogous Scale score was 50 (SD=18.7). The clinical examination of patients indicated that the HJHS were as follows: eight patients had a score of 55-75, 12 patients had a score of 40-55, 7 of them (25-40) and 11 patients had a score of 10-25. The results obtained from this study showed that HR-QoL in hemophilia patients was considerably low. Pain, anxiety/depression, and motion limitations were the main causes of the disutility for these patients respectively.
Introduction Gaucher disease (GD) is an inherited recessive enzyme deficiency with a multisystem ... more Introduction Gaucher disease (GD) is an inherited recessive enzyme deficiency with a multisystem condition. The Iranian government covers the therapeutic expenditure of GD patients as it is not affordable for the patients. The aim of this study is to identify the main components of the cost of care in Gaucher patients (GPs) in Iran. Methods The Gaucher patients were identified from the Iran Food and Drug Administration (IFDA) national registry database. The direct medical costs, including medication, diagnostic services, and physician visits were considered. The prices of therapeutic and diagnostic services were extracted from Iranian medical tariff book 2014-15. Iran Food and Drug Administration determined the cost of medications. Results 164 Gaucher patients have been registered in Iran. A valid and reliable diagnostic tests are not used to identify the type of GD. The average health care cost per annum was 20,758 USD per patient, which is higher than 4 GDP per capita in Iran. Medication cost constitutes 95.2% of the total cost. The average cost of each GP was $1,473,818 in his/her total life. Conclusion GD is amongst the high-cost diseases and should be managed effectively. The application of oral medication for eligible GPs could improve allocative efficiency in GD management significantly. A sound, valid and reliable national clinical guideline could improve the efficiency of healthcare resources effectively. Selecting appropriate strategies for reducing the birth of a child with Gaucher, could support allocative efficiency of the limited resources effectively.
Background: Socioeconomic inequality is one of the important issues in cardiovascular diseases (C... more Background: Socioeconomic inequality is one of the important issues in cardiovascular diseases (CVDs). The aim of this study was to investigate the distribution and relation between selected cardiac risk factors, type of CVD, and the socioeconomic status (SES) in the hospitalized patients with heart disease in Isfahan, Iran. Methods: This analytical and cross-sectional study was conducted in Isfahan in 2013. The population consisted of all patients with CVD admitted to the public and private hospitals. The sample size was 721. Data collection was conducted through one researcher-made questionnaire with three sections: demographic, disease, and SES questionnaires. To determine the SES of the patients, the indicators of income, housing status, occupation, family size, and education were used. Data analysis was conducted in two statistical levels of descriptive and inferential. Results: 69.1% of the patients were placed in the poor status, and there was no wealthy status within the subjects. The five most frequent CVDs were chronic ischemia, unstable angina, arrhythmia, congestive heart failure (CHF), and acute myocardial infarction (MI), respectively. The three highest frequent risk factors in the patients were hypertension (HTN) (47.2%), diabetes (33.6%), and hyperlipidemia (32.6%). Regression analysis of the risk factors and the type of heart disease on the SES revealed that there were statistically significant differences between patients who were smokers (P = 0.030) and those who had valve disease (P = 0.010), adjusted for age, gender, and marital status. Conclusion: Our findings showed that the frequency of CVD risk factors were higher in lower SES groups and thus SES can be a strong predictor for the occurrence of the CVD risk factors as well as the CVDs.
Background This article introduces the updated version of the Iranian guideline for the diagnosis... more Background This article introduces the updated version of the Iranian guideline for the diagnosis and treatment of hypertension in adults. The initial version of the national guideline was developed in 2011 and updated in 2014. Among the reasons necessitating the update of this guideline were the passage of time, the incompleteness of the scopes, the limitation of the target group, and more important is the request of the ministry of health in Iran. The members of the guideline updating group, after reviewing the original version and the new evidence, prepared 10 clinical questions regarding hypertension, and based on the evidence found from the latest scientific documents, provided recommendations or suggestions to answer these questions. Result According to the updated guideline, the threshold for office prehypertension diagnosis should be considered the systolic blood pressure (SBP) of 130-139 mmHg and/or the diastolic blood pressure (DBP) of 80-89 mmHg, and in adults under 75 years of age without comorbidities, the threshold for office hypertension diagnosis should be SBP ≥ 140 mmHg and or DBP ≥ 90 mmHg. The goal of treatment in adults who lack comorbidities and risk factors is SBP < 140 mmHg and DBP < 90 mmHg. The first-line treatment recommended in people with prehypertension is lifestyle modification, while for those with hypertension, pharmacotherapy along with lifestyle modification. The threshold to start drug therapy is determined at SBP ≥ 140 mmHg and or DBP ≥ 90 mmHg, and the first-line treatment is considered a drug or a combined pill of antihypertensive drugs, including ACEIs, ARBs, thiazide and thiazide-like agents, or CCBs. At the beginning of the pharmacotherapy, the Guideline Updating Group members suggested studying serum electrolytes, creatinine, lipid profile, fasting sugar, urinalysis, and an electrocardiogram. Regarding the visit intervals, monthly visits are suggested at the beginning of the treatment or in case of any change in the type or dosage of the drug until achieving the treatment goal, followed by every 3-to-6-month visits. Moreover, to reduce further complications, it was suggested that healthcare unit employees use telehealth strategies. In this guideline, specific recommendations and suggestions have been presented for adults and subgroups like older people or those with cardiovascular disease, diabetes mellitus, chronic kidney disease, and COVID-19.
Introduction: Screening can prevent colorectal cancer from becoming advanced by early detection o... more Introduction: Screening can prevent colorectal cancer from becoming advanced by early detection of precancerous lesions. Cost-effectiveness analysis of colorectal cancer screening methods is highly necessary due to increased prevalence, decreased age at onset and the limited budget in Iran. Methods: Methods of screening currently available in Iran were selected. A systematic search revealed the sensitivity and specificity of each method. For this study, a model for a 20 year screening period of a population of 100,000 apparently healthy persons of ages 45-65 years in Isfahan Province was used. The cost-effectiveness of each method and the ratio of cost-effectiveness were calculated based on this model. Results: The most and the least effective methods were CT colonography and fecal occult blood test, respectively. The highest and lowest expenditures in the governmental sector were related to fecal occult blood test and flexible sigmoidoscopy and in the private sector, to CT colonography and fecal occult blood test, respectively. The cost per cancer detected in 20 years of screening in the governmental sector was 0.28, 0.22 and 0.42 billion Rials, respectively for screening by colonoscopy, flexible sigmoidoscopy and fecal occult blood test. In the private sector, these were 1.54 (colonoscopy), 1.68 (flexible sigmoidoscopy), and 1.60 (fecal occult blood test) billion and 2.58 billion Rials for CT colonography, respectively. Conclusions: Although CT colonography is the most effective method, it needs a budget of 2.58 billion Rials for each screened patient. If costs in the governmental sector are considered, flexible sigmoidoscopy would be the most cost-effective method for screening the 45 - 65-year-old population in Iran.
Introduction Diabetes is a relatively common disease (1); and a top priority for achieving Univer... more Introduction Diabetes is a relatively common disease (1); and a top priority for achieving Universal Health Coverage (UHC) especially in the low and middle income countries (1, 2). In Iran in 2016 the preva-Abstract Background: Exploring and analyzing the cost of medicines is an important tool for their management and planning. This study aims to analyze the utilization and costs of parenteral anti-diabetic medications during the past decade and predict the future trend of these medications from 2021 to 2031 in people that are covered by Iran Health Insurance Organization (IHIO). Methods: This study was based on secondary analysis of data routinely reported to IHIO from 2011 to 2019. For each drug, the Defined Daily Dose (DDDs) and DDDs per 1000 inhabitants per day were calculated for the last 9 years according to the WHO protocol. Then a regression analysis was used to predict the utilization trend of each drug for the following 10 years. Results: The overall utilization of injectable antidiabetic drugs has constantly increased during the last nine years. This increasing trend is estimated to continue during the next decade. Conclusion: In Iran, the increase in the diabetic population and better access in the future will be the main reasons for the increase in the utilization of various insulins. The increasing trend of utilizing injectable antidiabetic drugs in Iran might be partly due to new patients and partly because of improvement in patient access to new treatments. This also suggests that, compared to the average in the commonwealth countries, Iranian diabetic patients has faced lack of drug utilization in the past decade that is gradually reducing.
to better understand payers perceptions and general interest to the particular parts of the econo... more to better understand payers perceptions and general interest to the particular parts of the economic value story. When GA is paired with embedded questioners or interface elements designed to record reaction, the service may provide data and insights required to continuously refine and upgrade an economic model to reflect real world payers perceptions. GA events is a powerful tracking tool also allowing to understand what data was changed and what were the input values entered by decision makers in a particular setting. GA also provide means to collect direct medical cost data during payer facing. Client-server software architecture of interactive economic models enable integration of different analytics web services. The majority of modern analytics services provide API for integration of necessary functionality in web based or standalone interactive health economics models.
A865 selected for the study. Their first hospitalization was defined as the index event. And then... more A865 selected for the study. Their first hospitalization was defined as the index event. And then their medical records including outpatient and inpatient were followed until September 2013. 4,061 IS patients were identified and 922 patients had atrial fibrillation. Demographics, co-morbidities and health resource use were analyzed. The descriptive statistics and Kruskal-Walls test analyses were used. The discount rate was 3.5%. Results: Compared with non-AF patients, 992 IS patients with AF were elder(73.82±11.72 years vs 66.71±14.18 years, p< 0.01), had more frequent co-morbidities such as hypertension(39% vs 29%), diabetes mellitus(30% vs 19%), hyperlipidemia(25% vs 19%), heart failure(10% vs 3%), and coronary heart disease (7% vs 2%)(p< 0.05). The average follow-up time for patients with AF and without AF was similar (15.44±5.05 months vs 15.44±4.60 months). In the observational period, 74.21% patients with AF had re-hospitalization, which was more than non-AF patients (44.02%) (p< 0.01); and the average hospitalization frequency was 3.96 times for patients with AF and 1.97 times for non-AF patients. The median total length of hospital stay for patients with AF was 49 days (mean 69.04), which was higher non-AF patients (median 21, mean 36.09), (p< 0.01). The median annual total cost of IS patients with AF was ¥105,443.60, (mean 167,644.20±212,437.60), which was higher than non-AF patients (median ¥33,303.16, mean 72,558.26±164,669.9) (p< 0.01). ConClusions: IS Patients with AF was elder, and had more frequent co-morbidities than non-AF stroke patients. Those patients were associated with more health resource use including more frequent hospitalization and higher medical cost.
Journal of Pharmaceutical Health Services Research, Jan 12, 2022
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</ja... more <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>Hypertension-related illness increases healthcare expenditure and reduces productivity. There is inadequate information about work productivity loss associated with hypertension in Ethiopia. This study was conducted to determine the extent of paid and unpaid worker productivity loss among adult hypertensive patients in Southern Ethiopia. Facility-based descriptive cross-sectional study was conducted by using the valuation of lost productivity (VOLP) tool adapted to the Ethiopian context. The data entry and analysis were done by using Microsoft Excel 2013 and SPSS version 21.0.</jats:p> </jats:sec> <jats:sec> <jats:title>Key findings</jats:title> <jats:p>A total of 301 adult hypertensive patients on regular follow-up at selected public hospitals were included in this study. One hundred ninety-five patients were females with a mean age of 50.7 ± 7.3 years. Less than one in five 39 (13.0%) of patients achieved their BP control target. Fifty-three (17.7%) of patients reported that hypertension reduced their work performance by 50%. One hundred twenty-five (60.1%) patients reported that they would complete the same work in less time, if they have no health problem. After adjusting for team impact and work substitutability, 3247.4 USD and 1844.81 USD were lost per month from paid and unpaid work. Overall annual work productivity loss was 38 968.4 USD, and the percentage of lost productivity per month was 18.7%.</jats:p> </jats:sec> <jats:sec> <jats:title>Summary</jats:title> <jats:p>Hypertension reduced the work productivity of adults by one-fifth. Therefore, it is important to devise strategies by involving all relevant stakeholders for preventing hypertension to save this productivity loss. In addition to this, improving the blood pressure control rate could help to reduce associated productivity loss.</jats:p> </jats:sec>
BackgroundClassical galactosaemia is an autosomal recessive inborn error of metabolism caused by ... more BackgroundClassical galactosaemia is an autosomal recessive inborn error of metabolism caused by a deficiency of the enzyme galactose‐1‐phosphate uridyltransferase. This is a rare and potentially lethal condition that classically presents in the first week of life once milk feeds have commenced. Affected babies may present with any or all of the following: cataracts; fulminant liver failure; prolonged jaundice; or Escherichia coli sepsis. Once the diagnosis is suspected, feeds containing galactose must be stopped immediately and replaced with a soya‐based formula. The majority of babies will recover, however a number will not survive. There are long‐term complications of galactosaemia, despite treatment, including learning disabilities and female infertility. It has been postulated that galactosaemia could be detected on newborn screening and this would prevent the immediate severe liver dysfunction and sepsis. This is an update of a previously published review.ObjectivesTo assess whether there is evidence that newborn screening for galactosaemia prevents or reduces mortality and morbidity and improves clinical outcomes in affected neonates and the quality of life in older children.Search methodsWe searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from electronic database searches, handsearches of relevant journals and conference abstract books. We also searched online trials registries and the reference lists of relevant articles and reviews.Date of the most recent search of Cochrane Cystic Fibrosis Group's Trials Register: 12 December 2019.Date of the most recent search of additional resources: 02 February 2020.Selection criteriaRandomised controlled studies and controlled clinical studies, published or unpublished comparing the use of any newborn screening test to diagnose infants with galactosaemia and presenting a comparison between a screened population versus a non‐screened population.Data collection and analysisNo studies of newborn screening for galactosaemia were found.Main resultsNo studies were identified for inclusion in the review.Authors' conclusionsWe were unable to identify any eligible studies for inclusion in this review and hence it is not possible to draw any conclusions based on randomised controlled studies. However, we are aware of uncontrolled studies which support the efficacy of newborn screening for galactosaemia. There are a number of reviews and economic analyses of non‐trial literature suggesting that screening is appropriate.
Clinical Medical Reviews and Case Reports, May 4, 2020
Background: Hypertension (Blood pressure ≥ 140/90 mmHg) is the modifiable risk factor responsible... more Background: Hypertension (Blood pressure ≥ 140/90 mmHg) is the modifiable risk factor responsible for a host of complications. Evidence based guidelines are important for prevention and control of hypertension. However, there is variation and inconsistencies among published guidelines concerning, diagnosis and treatment approach. Therefore, this review was conducted with intension to evaluatequality and comprehensiveness of published national adult hypertension treatment guideline, diagnosis and treatment approach in comparison with other national and international guidelines. Methods: We selected national guidelines of five countries (USA of America, Canada, Europe, Australia and Ethiopia) and one international guideline.We used clinical guideline appraisal tool to evaluate the quality of guidelines, and comprehensiveness of the guidelines was evaluated by using a tool developed reach team. Evidence synthesis: We qualitatively synthesized the evidence by reviewing quality and comprehensiveness ofselected guidelines. Results: National adult hypertension treatment guideline of Ethiopia addressed only 22 (64.7%) of quality appraisal tool components. The guideline is least comprehensive 15 (51.7%). Major problems the guideline were; lack of diagnostic approach for masked, white-coat and resistant hypertension; failure to address child hood risk factors and secondary cases of hypertension. Similarly, management of hypertension in patients undergoing surgery, specific patient groups, access to medicine and social determinants of health are not addressed. Conclusion: Quality and comprehensiveness of National hypertension guideline of Ethiopia is poor. Therefore, we recommend the guideline development committee and other relevant stakeholders to: update the blood pressure targets for elderly population, determine when to initiate and intensify antihypertensive drug therapy; address social determinants and socioeconomic status of population including maternal nutrition and Access of medicines.
Objectives There is inadequate information on the economic burden of hypertension treatment in Et... more Objectives There is inadequate information on the economic burden of hypertension treatment in Ethiopia. Therefore, this study was conducted to determine the societal economic burden of hypertension at selected hospitals in Southern Ethiopia. Methods Prevalence-based cost of illness study from a societal perspective was conducted. Disability-adjusted life years (DALYs) were determined by the current WHO's recommended DALY valuation method. Adjustment for comorbidity and a 3% discount was done for DALYs. The data entry, processing and analysis were done by using SPSS V.21.0 and Microsoft Excel V.2013. Results We followed a cohort of 406 adult patients with hypertension retrospectively for 10 years from September 2010 to 2020. Two hundred and fifty (61.6%) of patients were women with a mean age of 55.87±11.03 years. Less than 1 in five 75 (18.5%) of patients achieved their blood pressure control target. A total of US$64 837.48 direct cost was incurred due to hypertension. A total of 11 585 years and 579.57 years were lost due to hypertension-related premature mortality and morbidity, respectively. Treated and uncontrolled hypertension accounted for 50.83% (6027) of total years lost due to premature mortality from treated hypertension cohort. Total productivity loss due to premature mortality and morbidity was US$449 394.69. The overall economic burden of hypertension was US$514 232.16 (US$105.55 per person per month). Conclusion Societal economic burden of hypertension in Southern Ethiopia was substantial. Indirect costs accounted for more than 8 out of 10 dollars. Treated and uncontrolled hypertension took the lion's share of economic cost and productivity loss due to premature mortality and morbidity. Therefore, designing and implanting strategies for the prevention of hypertension, early screening and detection, and improving the rate of blood pressure control by involving all relevant stakeholders at all levels is critical to saving scarce health resources.
The aim of this study was to evaluate the effect of antiretroviral therapy (ART) with or without ... more The aim of this study was to evaluate the effect of antiretroviral therapy (ART) with or without condom use on the risk of sexual transmission of HIV. Methods A search of the literature was conducted in the PubMed, Web of Science, Cochrane, SCOPUS and EMBASE databases for studies dating back to 2008. The results were summarized as relative risks and incidence rates with 95% confidence intervals (CIs). The effect sizes were pooled using random-effects models and heterogeneity was evaluated using the Cochrane Q test and I 2. Results Of the 1424 studies retrieved in the initial search, 10 met the eligibility requirements. ART was associated with a 52% reduction in transmission risk compared to no ART, with a relative risk of 0.48 (95% CI 0.439-0.525) (Q = 0.524; I 2 = 0.0%; overall effect Z = 15.99, P < 0.0001). ART vs. no ART caused a reduction in the risk from 5.6 person-years (95% CI 3.26-9.62 person-years) (Q = 0.771; I 2 = 0.0%; overall effect Z = 6.25, P < 0.0001) in the untreated group to 0.85 person-years (95% CI 0.28-2.99 person-years) (Q = 0.038; I 2 = 76.7%; overall effect Z = 0.11, P = 0.772) in the treated group, but not significantly so, which is equivalent to an 84% reduction in the risk of sexual transmission. In accordance with the Swiss National AIDS Commission declaration, ART with suppressed viral loads was associated with a minimal risk of transmission, with a median time at risk of 0.00 person-years (95% CI 0.00-0.00 person-years) (Q = 1.00; I 2 = 0.0%; overall effect Z = 6.80, P < 0.0001). Conclusions ART and condom use were found to cause a significant reduction in the risk of sexual transmission of HIV in both homosexual and heterosexual populations, based on previous systematic reviews and meta-analyses.
Background: Ischemic heart disease (IHD) is the first cause of mortality in the world. Stable cor... more Background: Ischemic heart disease (IHD) is the first cause of mortality in the world. Stable coronary artery disease (CAD) is the most common IHD. Medical therapy (MT), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) are three strategies for the management of this disease. The main aim of this study was the comparison of MT with PCI or CABG in terms of cardiovascular (CV) mortality, myocardial infarction (MI), unplanned revascularization (UR), stroke, and freedom from angina in managing stable CAD. Methods: The Cochrane Central Register of Controlled Trials, Embase, PubMed, and Scopus were searched. Two reviewers independently appraised the titles and abstracted data of the identified studies. After the Full-text reviewing phase, eligible studies were analyzed through the random-effect meta-analysis method. Finally, a sensitivity analysis was conducted for the robustness of findings. Results: Nine randomized controlled trials (RCTs) were included. The pooled RR of CV mortality associated with MT compared with PCI and CABG was 1.22 and 1.385, respectively. Overall, The RR of MT associated with MI, UR, stroke, and freedom from angina compared with PCI was 1.001, 1.151, 0.799, and 0.801, respectively. Conclusion: Our results revealed no statistically significant difference between MT and PCI in terms of studied primary outcomes. The findings also highlighted that there is no statistically significant difference between MT and CABG in terms of CV mortality.
Among different groups of hemophiliacs, those suffering from Severe Hemophilia A (SHA) are most v... more Among different groups of hemophiliacs, those suffering from Severe Hemophilia A (SHA) are most vulnerable to the complications of the disease. This study investigated the Health-Related Quality of Life (HR-QoL) among adult patients with SHA. A cross-sectional study was designed to gather demographic and clinical information from adult patients with SHA. Patients with inhibitors were excluded. The remaining were asked to complete the HR-QoL questionnaire after being examined for joint health using the Hemophilia Joint Health Score (HJHS). The HR-QoL and joint conditions were measured in 38 patients. The mean EQ-5D value scores were 0.46 (SD=0.23) while the mean Visual Analogous Scale score was 50 (SD=18.7). The clinical examination of patients indicated that the HJHS were as follows: eight patients had a score of 55-75, 12 patients had a score of 40-55, 7 of them (25-40) and 11 patients had a score of 10-25. The results obtained from this study showed that HR-QoL in hemophilia patients was considerably low. Pain, anxiety/depression, and motion limitations were the main causes of the disutility for these patients respectively.
Introduction Gaucher disease (GD) is an inherited recessive enzyme deficiency with a multisystem ... more Introduction Gaucher disease (GD) is an inherited recessive enzyme deficiency with a multisystem condition. The Iranian government covers the therapeutic expenditure of GD patients as it is not affordable for the patients. The aim of this study is to identify the main components of the cost of care in Gaucher patients (GPs) in Iran. Methods The Gaucher patients were identified from the Iran Food and Drug Administration (IFDA) national registry database. The direct medical costs, including medication, diagnostic services, and physician visits were considered. The prices of therapeutic and diagnostic services were extracted from Iranian medical tariff book 2014-15. Iran Food and Drug Administration determined the cost of medications. Results 164 Gaucher patients have been registered in Iran. A valid and reliable diagnostic tests are not used to identify the type of GD. The average health care cost per annum was 20,758 USD per patient, which is higher than 4 GDP per capita in Iran. Medication cost constitutes 95.2% of the total cost. The average cost of each GP was $1,473,818 in his/her total life. Conclusion GD is amongst the high-cost diseases and should be managed effectively. The application of oral medication for eligible GPs could improve allocative efficiency in GD management significantly. A sound, valid and reliable national clinical guideline could improve the efficiency of healthcare resources effectively. Selecting appropriate strategies for reducing the birth of a child with Gaucher, could support allocative efficiency of the limited resources effectively.
Background: Socioeconomic inequality is one of the important issues in cardiovascular diseases (C... more Background: Socioeconomic inequality is one of the important issues in cardiovascular diseases (CVDs). The aim of this study was to investigate the distribution and relation between selected cardiac risk factors, type of CVD, and the socioeconomic status (SES) in the hospitalized patients with heart disease in Isfahan, Iran. Methods: This analytical and cross-sectional study was conducted in Isfahan in 2013. The population consisted of all patients with CVD admitted to the public and private hospitals. The sample size was 721. Data collection was conducted through one researcher-made questionnaire with three sections: demographic, disease, and SES questionnaires. To determine the SES of the patients, the indicators of income, housing status, occupation, family size, and education were used. Data analysis was conducted in two statistical levels of descriptive and inferential. Results: 69.1% of the patients were placed in the poor status, and there was no wealthy status within the subjects. The five most frequent CVDs were chronic ischemia, unstable angina, arrhythmia, congestive heart failure (CHF), and acute myocardial infarction (MI), respectively. The three highest frequent risk factors in the patients were hypertension (HTN) (47.2%), diabetes (33.6%), and hyperlipidemia (32.6%). Regression analysis of the risk factors and the type of heart disease on the SES revealed that there were statistically significant differences between patients who were smokers (P = 0.030) and those who had valve disease (P = 0.010), adjusted for age, gender, and marital status. Conclusion: Our findings showed that the frequency of CVD risk factors were higher in lower SES groups and thus SES can be a strong predictor for the occurrence of the CVD risk factors as well as the CVDs.
Background This article introduces the updated version of the Iranian guideline for the diagnosis... more Background This article introduces the updated version of the Iranian guideline for the diagnosis and treatment of hypertension in adults. The initial version of the national guideline was developed in 2011 and updated in 2014. Among the reasons necessitating the update of this guideline were the passage of time, the incompleteness of the scopes, the limitation of the target group, and more important is the request of the ministry of health in Iran. The members of the guideline updating group, after reviewing the original version and the new evidence, prepared 10 clinical questions regarding hypertension, and based on the evidence found from the latest scientific documents, provided recommendations or suggestions to answer these questions. Result According to the updated guideline, the threshold for office prehypertension diagnosis should be considered the systolic blood pressure (SBP) of 130-139 mmHg and/or the diastolic blood pressure (DBP) of 80-89 mmHg, and in adults under 75 years of age without comorbidities, the threshold for office hypertension diagnosis should be SBP ≥ 140 mmHg and or DBP ≥ 90 mmHg. The goal of treatment in adults who lack comorbidities and risk factors is SBP < 140 mmHg and DBP < 90 mmHg. The first-line treatment recommended in people with prehypertension is lifestyle modification, while for those with hypertension, pharmacotherapy along with lifestyle modification. The threshold to start drug therapy is determined at SBP ≥ 140 mmHg and or DBP ≥ 90 mmHg, and the first-line treatment is considered a drug or a combined pill of antihypertensive drugs, including ACEIs, ARBs, thiazide and thiazide-like agents, or CCBs. At the beginning of the pharmacotherapy, the Guideline Updating Group members suggested studying serum electrolytes, creatinine, lipid profile, fasting sugar, urinalysis, and an electrocardiogram. Regarding the visit intervals, monthly visits are suggested at the beginning of the treatment or in case of any change in the type or dosage of the drug until achieving the treatment goal, followed by every 3-to-6-month visits. Moreover, to reduce further complications, it was suggested that healthcare unit employees use telehealth strategies. In this guideline, specific recommendations and suggestions have been presented for adults and subgroups like older people or those with cardiovascular disease, diabetes mellitus, chronic kidney disease, and COVID-19.
Introduction: Screening can prevent colorectal cancer from becoming advanced by early detection o... more Introduction: Screening can prevent colorectal cancer from becoming advanced by early detection of precancerous lesions. Cost-effectiveness analysis of colorectal cancer screening methods is highly necessary due to increased prevalence, decreased age at onset and the limited budget in Iran. Methods: Methods of screening currently available in Iran were selected. A systematic search revealed the sensitivity and specificity of each method. For this study, a model for a 20 year screening period of a population of 100,000 apparently healthy persons of ages 45-65 years in Isfahan Province was used. The cost-effectiveness of each method and the ratio of cost-effectiveness were calculated based on this model. Results: The most and the least effective methods were CT colonography and fecal occult blood test, respectively. The highest and lowest expenditures in the governmental sector were related to fecal occult blood test and flexible sigmoidoscopy and in the private sector, to CT colonography and fecal occult blood test, respectively. The cost per cancer detected in 20 years of screening in the governmental sector was 0.28, 0.22 and 0.42 billion Rials, respectively for screening by colonoscopy, flexible sigmoidoscopy and fecal occult blood test. In the private sector, these were 1.54 (colonoscopy), 1.68 (flexible sigmoidoscopy), and 1.60 (fecal occult blood test) billion and 2.58 billion Rials for CT colonography, respectively. Conclusions: Although CT colonography is the most effective method, it needs a budget of 2.58 billion Rials for each screened patient. If costs in the governmental sector are considered, flexible sigmoidoscopy would be the most cost-effective method for screening the 45 - 65-year-old population in Iran.
Introduction Diabetes is a relatively common disease (1); and a top priority for achieving Univer... more Introduction Diabetes is a relatively common disease (1); and a top priority for achieving Universal Health Coverage (UHC) especially in the low and middle income countries (1, 2). In Iran in 2016 the preva-Abstract Background: Exploring and analyzing the cost of medicines is an important tool for their management and planning. This study aims to analyze the utilization and costs of parenteral anti-diabetic medications during the past decade and predict the future trend of these medications from 2021 to 2031 in people that are covered by Iran Health Insurance Organization (IHIO). Methods: This study was based on secondary analysis of data routinely reported to IHIO from 2011 to 2019. For each drug, the Defined Daily Dose (DDDs) and DDDs per 1000 inhabitants per day were calculated for the last 9 years according to the WHO protocol. Then a regression analysis was used to predict the utilization trend of each drug for the following 10 years. Results: The overall utilization of injectable antidiabetic drugs has constantly increased during the last nine years. This increasing trend is estimated to continue during the next decade. Conclusion: In Iran, the increase in the diabetic population and better access in the future will be the main reasons for the increase in the utilization of various insulins. The increasing trend of utilizing injectable antidiabetic drugs in Iran might be partly due to new patients and partly because of improvement in patient access to new treatments. This also suggests that, compared to the average in the commonwealth countries, Iranian diabetic patients has faced lack of drug utilization in the past decade that is gradually reducing.
to better understand payers perceptions and general interest to the particular parts of the econo... more to better understand payers perceptions and general interest to the particular parts of the economic value story. When GA is paired with embedded questioners or interface elements designed to record reaction, the service may provide data and insights required to continuously refine and upgrade an economic model to reflect real world payers perceptions. GA events is a powerful tracking tool also allowing to understand what data was changed and what were the input values entered by decision makers in a particular setting. GA also provide means to collect direct medical cost data during payer facing. Client-server software architecture of interactive economic models enable integration of different analytics web services. The majority of modern analytics services provide API for integration of necessary functionality in web based or standalone interactive health economics models.
A865 selected for the study. Their first hospitalization was defined as the index event. And then... more A865 selected for the study. Their first hospitalization was defined as the index event. And then their medical records including outpatient and inpatient were followed until September 2013. 4,061 IS patients were identified and 922 patients had atrial fibrillation. Demographics, co-morbidities and health resource use were analyzed. The descriptive statistics and Kruskal-Walls test analyses were used. The discount rate was 3.5%. Results: Compared with non-AF patients, 992 IS patients with AF were elder(73.82±11.72 years vs 66.71±14.18 years, p< 0.01), had more frequent co-morbidities such as hypertension(39% vs 29%), diabetes mellitus(30% vs 19%), hyperlipidemia(25% vs 19%), heart failure(10% vs 3%), and coronary heart disease (7% vs 2%)(p< 0.05). The average follow-up time for patients with AF and without AF was similar (15.44±5.05 months vs 15.44±4.60 months). In the observational period, 74.21% patients with AF had re-hospitalization, which was more than non-AF patients (44.02%) (p< 0.01); and the average hospitalization frequency was 3.96 times for patients with AF and 1.97 times for non-AF patients. The median total length of hospital stay for patients with AF was 49 days (mean 69.04), which was higher non-AF patients (median 21, mean 36.09), (p< 0.01). The median annual total cost of IS patients with AF was ¥105,443.60, (mean 167,644.20±212,437.60), which was higher than non-AF patients (median ¥33,303.16, mean 72,558.26±164,669.9) (p< 0.01). ConClusions: IS Patients with AF was elder, and had more frequent co-morbidities than non-AF stroke patients. Those patients were associated with more health resource use including more frequent hospitalization and higher medical cost.
Journal of Pharmaceutical Health Services Research, Jan 12, 2022
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</ja... more <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>Hypertension-related illness increases healthcare expenditure and reduces productivity. There is inadequate information about work productivity loss associated with hypertension in Ethiopia. This study was conducted to determine the extent of paid and unpaid worker productivity loss among adult hypertensive patients in Southern Ethiopia. Facility-based descriptive cross-sectional study was conducted by using the valuation of lost productivity (VOLP) tool adapted to the Ethiopian context. The data entry and analysis were done by using Microsoft Excel 2013 and SPSS version 21.0.</jats:p> </jats:sec> <jats:sec> <jats:title>Key findings</jats:title> <jats:p>A total of 301 adult hypertensive patients on regular follow-up at selected public hospitals were included in this study. One hundred ninety-five patients were females with a mean age of 50.7 ± 7.3 years. Less than one in five 39 (13.0%) of patients achieved their BP control target. Fifty-three (17.7%) of patients reported that hypertension reduced their work performance by 50%. One hundred twenty-five (60.1%) patients reported that they would complete the same work in less time, if they have no health problem. After adjusting for team impact and work substitutability, 3247.4 USD and 1844.81 USD were lost per month from paid and unpaid work. Overall annual work productivity loss was 38 968.4 USD, and the percentage of lost productivity per month was 18.7%.</jats:p> </jats:sec> <jats:sec> <jats:title>Summary</jats:title> <jats:p>Hypertension reduced the work productivity of adults by one-fifth. Therefore, it is important to devise strategies by involving all relevant stakeholders for preventing hypertension to save this productivity loss. In addition to this, improving the blood pressure control rate could help to reduce associated productivity loss.</jats:p> </jats:sec>
BackgroundClassical galactosaemia is an autosomal recessive inborn error of metabolism caused by ... more BackgroundClassical galactosaemia is an autosomal recessive inborn error of metabolism caused by a deficiency of the enzyme galactose‐1‐phosphate uridyltransferase. This is a rare and potentially lethal condition that classically presents in the first week of life once milk feeds have commenced. Affected babies may present with any or all of the following: cataracts; fulminant liver failure; prolonged jaundice; or Escherichia coli sepsis. Once the diagnosis is suspected, feeds containing galactose must be stopped immediately and replaced with a soya‐based formula. The majority of babies will recover, however a number will not survive. There are long‐term complications of galactosaemia, despite treatment, including learning disabilities and female infertility. It has been postulated that galactosaemia could be detected on newborn screening and this would prevent the immediate severe liver dysfunction and sepsis. This is an update of a previously published review.ObjectivesTo assess whether there is evidence that newborn screening for galactosaemia prevents or reduces mortality and morbidity and improves clinical outcomes in affected neonates and the quality of life in older children.Search methodsWe searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from electronic database searches, handsearches of relevant journals and conference abstract books. We also searched online trials registries and the reference lists of relevant articles and reviews.Date of the most recent search of Cochrane Cystic Fibrosis Group's Trials Register: 12 December 2019.Date of the most recent search of additional resources: 02 February 2020.Selection criteriaRandomised controlled studies and controlled clinical studies, published or unpublished comparing the use of any newborn screening test to diagnose infants with galactosaemia and presenting a comparison between a screened population versus a non‐screened population.Data collection and analysisNo studies of newborn screening for galactosaemia were found.Main resultsNo studies were identified for inclusion in the review.Authors' conclusionsWe were unable to identify any eligible studies for inclusion in this review and hence it is not possible to draw any conclusions based on randomised controlled studies. However, we are aware of uncontrolled studies which support the efficacy of newborn screening for galactosaemia. There are a number of reviews and economic analyses of non‐trial literature suggesting that screening is appropriate.
Clinical Medical Reviews and Case Reports, May 4, 2020
Background: Hypertension (Blood pressure ≥ 140/90 mmHg) is the modifiable risk factor responsible... more Background: Hypertension (Blood pressure ≥ 140/90 mmHg) is the modifiable risk factor responsible for a host of complications. Evidence based guidelines are important for prevention and control of hypertension. However, there is variation and inconsistencies among published guidelines concerning, diagnosis and treatment approach. Therefore, this review was conducted with intension to evaluatequality and comprehensiveness of published national adult hypertension treatment guideline, diagnosis and treatment approach in comparison with other national and international guidelines. Methods: We selected national guidelines of five countries (USA of America, Canada, Europe, Australia and Ethiopia) and one international guideline.We used clinical guideline appraisal tool to evaluate the quality of guidelines, and comprehensiveness of the guidelines was evaluated by using a tool developed reach team. Evidence synthesis: We qualitatively synthesized the evidence by reviewing quality and comprehensiveness ofselected guidelines. Results: National adult hypertension treatment guideline of Ethiopia addressed only 22 (64.7%) of quality appraisal tool components. The guideline is least comprehensive 15 (51.7%). Major problems the guideline were; lack of diagnostic approach for masked, white-coat and resistant hypertension; failure to address child hood risk factors and secondary cases of hypertension. Similarly, management of hypertension in patients undergoing surgery, specific patient groups, access to medicine and social determinants of health are not addressed. Conclusion: Quality and comprehensiveness of National hypertension guideline of Ethiopia is poor. Therefore, we recommend the guideline development committee and other relevant stakeholders to: update the blood pressure targets for elderly population, determine when to initiate and intensify antihypertensive drug therapy; address social determinants and socioeconomic status of population including maternal nutrition and Access of medicines.
Objectives There is inadequate information on the economic burden of hypertension treatment in Et... more Objectives There is inadequate information on the economic burden of hypertension treatment in Ethiopia. Therefore, this study was conducted to determine the societal economic burden of hypertension at selected hospitals in Southern Ethiopia. Methods Prevalence-based cost of illness study from a societal perspective was conducted. Disability-adjusted life years (DALYs) were determined by the current WHO's recommended DALY valuation method. Adjustment for comorbidity and a 3% discount was done for DALYs. The data entry, processing and analysis were done by using SPSS V.21.0 and Microsoft Excel V.2013. Results We followed a cohort of 406 adult patients with hypertension retrospectively for 10 years from September 2010 to 2020. Two hundred and fifty (61.6%) of patients were women with a mean age of 55.87±11.03 years. Less than 1 in five 75 (18.5%) of patients achieved their blood pressure control target. A total of US$64 837.48 direct cost was incurred due to hypertension. A total of 11 585 years and 579.57 years were lost due to hypertension-related premature mortality and morbidity, respectively. Treated and uncontrolled hypertension accounted for 50.83% (6027) of total years lost due to premature mortality from treated hypertension cohort. Total productivity loss due to premature mortality and morbidity was US$449 394.69. The overall economic burden of hypertension was US$514 232.16 (US$105.55 per person per month). Conclusion Societal economic burden of hypertension in Southern Ethiopia was substantial. Indirect costs accounted for more than 8 out of 10 dollars. Treated and uncontrolled hypertension took the lion's share of economic cost and productivity loss due to premature mortality and morbidity. Therefore, designing and implanting strategies for the prevention of hypertension, early screening and detection, and improving the rate of blood pressure control by involving all relevant stakeholders at all levels is critical to saving scarce health resources.
The aim of this study was to evaluate the effect of antiretroviral therapy (ART) with or without ... more The aim of this study was to evaluate the effect of antiretroviral therapy (ART) with or without condom use on the risk of sexual transmission of HIV. Methods A search of the literature was conducted in the PubMed, Web of Science, Cochrane, SCOPUS and EMBASE databases for studies dating back to 2008. The results were summarized as relative risks and incidence rates with 95% confidence intervals (CIs). The effect sizes were pooled using random-effects models and heterogeneity was evaluated using the Cochrane Q test and I 2. Results Of the 1424 studies retrieved in the initial search, 10 met the eligibility requirements. ART was associated with a 52% reduction in transmission risk compared to no ART, with a relative risk of 0.48 (95% CI 0.439-0.525) (Q = 0.524; I 2 = 0.0%; overall effect Z = 15.99, P < 0.0001). ART vs. no ART caused a reduction in the risk from 5.6 person-years (95% CI 3.26-9.62 person-years) (Q = 0.771; I 2 = 0.0%; overall effect Z = 6.25, P < 0.0001) in the untreated group to 0.85 person-years (95% CI 0.28-2.99 person-years) (Q = 0.038; I 2 = 76.7%; overall effect Z = 0.11, P = 0.772) in the treated group, but not significantly so, which is equivalent to an 84% reduction in the risk of sexual transmission. In accordance with the Swiss National AIDS Commission declaration, ART with suppressed viral loads was associated with a minimal risk of transmission, with a median time at risk of 0.00 person-years (95% CI 0.00-0.00 person-years) (Q = 1.00; I 2 = 0.0%; overall effect Z = 6.80, P < 0.0001). Conclusions ART and condom use were found to cause a significant reduction in the risk of sexual transmission of HIV in both homosexual and heterosexual populations, based on previous systematic reviews and meta-analyses.
Background: Ischemic heart disease (IHD) is the first cause of mortality in the world. Stable cor... more Background: Ischemic heart disease (IHD) is the first cause of mortality in the world. Stable coronary artery disease (CAD) is the most common IHD. Medical therapy (MT), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) are three strategies for the management of this disease. The main aim of this study was the comparison of MT with PCI or CABG in terms of cardiovascular (CV) mortality, myocardial infarction (MI), unplanned revascularization (UR), stroke, and freedom from angina in managing stable CAD. Methods: The Cochrane Central Register of Controlled Trials, Embase, PubMed, and Scopus were searched. Two reviewers independently appraised the titles and abstracted data of the identified studies. After the Full-text reviewing phase, eligible studies were analyzed through the random-effect meta-analysis method. Finally, a sensitivity analysis was conducted for the robustness of findings. Results: Nine randomized controlled trials (RCTs) were included. The pooled RR of CV mortality associated with MT compared with PCI and CABG was 1.22 and 1.385, respectively. Overall, The RR of MT associated with MI, UR, stroke, and freedom from angina compared with PCI was 1.001, 1.151, 0.799, and 0.801, respectively. Conclusion: Our results revealed no statistically significant difference between MT and PCI in terms of studied primary outcomes. The findings also highlighted that there is no statistically significant difference between MT and CABG in terms of CV mortality.
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