Pregabalin and gabapentin in neuropathic pain management after spinal cord injury: a systematic review and meta-analysis

Neuropathic pain after spinal cord injury (SCI) has a significant negative impact on the patients’ quality of life. The objective of this systematic review is to examine the safety and efficacy of pregabalin (PGB) and gabapentin (GBP) in the treatment of neuropathic pain due to SCI. PubMed, the Cochrane Library, Embase, Scopus, and the Web of Science were searched up to December 2018. The reference lists of key and review studies were reviewed for additional citations. The quality of the studies was evaluated using the Cochrane Collaboration’s tools for assessing the risk of bias. A meta-analysis was performed for primary and secondary outcomes.Eight studies were eligible for inclusion. Meta-analysis of PGB vs. placebo showed that PGB was effective for neuropathic pain (standardized mean difference [SMD] = –0.40; 95% confidence interval [CI]: –0.78, –0.01), anxiety (MD = –0.68; 95% CI:–0.77, –0.59), depression (mean difference [MD] = –0.99; 95% CI: –1.08, –0.89), and sleep interference (MD = –1.08; 95% CI: –1.13, –1.02). Also, GBP was more effective than a placebo for reducing pain. No significant difference was observed between the efficacy of the two drugs (MD = –0.37; 95% CI: –1.67, 0.93). There was no significant difference between the two drugs for discontinuation due to adverse events (risk ratio = 3.00; 95% CI: 0.81, 11.15). PGB and GBP were effective vs. placebos in decreasing neuropathic pain after SCI. Also, there was no significant difference between the two drugs for decreasing pain and adverse events.

Socioeconomic status and catastrophic health expenditure evaluation in IR Iran: a comparative study in 2004 and 2011

Background: Health equity is a main principle of all healthcare systems in the world. Family Physician [FP] program, as a health sector reform [HSR] in Iran, was executed to reduce households' health care cost and to achieve health equity in 2004. Meanwhile, catastrophic health expenditure is known as an accepted indicator in HSR evaluation. In this context, after determining and comparing socioeconomic status [SES] among different periods, we made an attempt to evaluate households' health financial protection in different quintiles after implementation of FP program

Methods: The current cross-sectional study was based on the data obtained from Household Income and Expenditure Survey in 2004 and 2011. The health expenditures, catastrophic health expenditure [CHE], and SES were determined by this data during these years. Descriptive analyses and comparisons using Chi-squared test were carried out via SPSS, version 20

Results: A total of 1716 households were included in the survey during 2004 and 2011. The highest proportion of households was related to quintiles very poor and poor with respect to each year. Moreover, it was observed that SES in 2011 had the worse situation compared to that in 2004; this situation was worse in urban areas. In the present study, CHE is related to poorer quintiles, and in rural areas no household was faced with CHE in 2011

Conclusions: Implementation of FP program in rural areas with more primary care has prevented hospitalization. This was considerable for poorer quintiles and has led to financial protection for rural households

direct medical costs of breast cancer in Iran: analyzing the patient's level data from a cancer specific hospital in Isfahan

Breast cancer is one of the main causes of mortality and morbidity world-wide. The estimation of the direct medical costs of breast cancer can help payers of the cost to understand the burden of breast cancer on their limited financial resources as well as the society. We used a cross-sectional study to calculate the direct medical costs of breast cancer among women in Isfahan, Iran. The medical records of all patients which were registered in Seyed Al-Shohada Hospital between March 2005 and March 2010 were reviewed. The relevant data from patients' profiles extracted. The direct medical costs of received services were calculated with both public and private tariffs. The total numbers of 467 patients in various disease stages were included into the study. The average age of patients was 49 years. The average direct cost per patient per month in stages I to IV were 222.17, 224.61, 316.51 and 828.52 US$, respectively. The surgery cost was the main cost driver for stages I and II with private tariffs. However for stages III and IV, the medication cost was the main cost component for managing breast cancer. The direct economic cost of breast cancer in Iran is very high; nonetheless, as the age of breast cancer in Iran is nearly 10 years lower than Western countries, the burden of the disease in Iran is expected to be significantly high. Medication therapy is the main cost component of the breast cancer

direct medical costs of colorectal cancer in Iran; analyzing the patient's level data from a cancer specific hospital in Isfahan

The Immense cost of cancer treatment is one of the main challenges of health care systems all over the world including Iran. The aim of this study was to analyze the direct treatment costs of colorectal cancer patients in Isfahan, Iran. In this cross sectional study, the medical records of colorectal cancer [CRC] patients admitted to the Seyyed-al-Shohada Hospital "SSH" from 2005-2010 were reviewed. The profiles of 452 patients were examined. However based on inclusion, exclusion criteria a total number of 432 profiles were analyzed. All records including age, sex, treatment processes and treatment costs were extracted from the patients' profiles and analyzed using Kruskal-Wallis test. The results showed that 56.1% of CRC patients were male. The mean age of patients suffering from CRC was 56 +/- 13.4. More than Thirty-six percent of the patients were in stages 1-3 of CRC and more than half of them [64.4%] were in the 4[th] stage. The higher the stage of the cancer the higher the percentage of treatments used. 5-Fluorouracil and Leucovorin [5FU/LV] was the most common used chemical treatment protocol. The mean treatment cost for stage one was 10715 [ +/- 4927], for stage two 15920 [ +/- 3440], stage three 16452 [ +/- 2828] and for stage four was 16723 [ +/- 2555] US Dollars. The cost of drug treatment was the first cost driven between the medical services. CRC in Iranian population starts in younger age than people in western countries. This imposed considerable direct and indirect economic cost to the society. The direct medical cost of colorectal cancer in Iran is very higher than 38 million [dollar sign]. Screening programs could reduce the economic cost of CRC significantly

estimation of direct medical costs of treating patients with chronic hepatitis B and C in Iran

The objective of this study is to estimate the average diagnosis and treatment costs of chronic hepatitis B and C, with respect to different therapeutic strategies in Iran. This is a descriptive, analytical, and cross sectional study carried out on patients with hepatitis B and C, who were referred to the Liver Disease Research Center for Prevention and Treatment of Hepatitis, Isfahan University of Medical Sciences, in 2011. We have estimated the direct medical costs including doctors' fees, cost of para clinical tests, medical treatments, and liver biopsy, in different treatment strategies. The results of this study showed that the total cost of diagnostic services for hepatitis B virus [HBV] and hepatitis C virus [HCV] patients, with state medical tariffs, was US$ 1499.07 and US$ 2084.89, respectively. The patients' profiles showed that there were currently seven therapeutic strategies available to treat HBV patients. The total cost of treatment strategies varied significantly from US$ 73 to US$ 8256. There were also four main strategies for HCV patients, each of these could be applied in two periods of time. The total cost of these treatment strategies showed a high disc repancy from US$ 242 t o US$ 8256. The results confirmed that the total direct medical cost for an HBV patient in Iran exceeded US$ 5.5 Milliard in 2011. The results implied that the market price of direct medical cost of HBV and HCV patients in Iran is much higher than the estimated state costs. These costs would likely be saved or reduced by effective disease management and early prevention

Cost-effectiveness analysis of colorectal cancer screening methods in Iran

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 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 100000 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. 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. 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