Qualitative Analysis of Newborn Hearing Screening Program in Iran.

Background: Early diagnosis of hearing loss and timely interventions are important to minimize the consequences of this condition, especially for children. This research was conducted to analyze the newborn hearing loss screening program in Iran. Methods: This qualitative study was conducted using the content analysis method and based on the CIPP model in 2023. The snowball method was used to recruit a sample with maximum diversity. The criteria for selecting people for interviews included having at least three years of experience in the newborn hearing loss screening program and sufficient knowledge in the field. To ensure the reliability of the results, four criteria proposed by Lincoln and Guba were used. Data analysis was conducted by MAXQDA2022 software. Results: In the current research, using content analysis in the form of the CIPP model, based on the viewpoints of the interviewees (40 people), the management requirements of the newborn hearing loss screening program were categorized into the four main categories of context (texture), input, process, and output. Eight subcategories were identified in the context dimension, four subcategories in the input dimension, seven subcategories in the process dimension, and four subcategories in the output dimension. Conclusion: According to the findings of this research, in order to properly implement the newborn hearing loss screening program, there is a need to conduct pilot studies, need assessments, evidence-based programs, and epidemiological studies and to prioritize services and resources. Also, communication between service delivery levels needs to be improved, and attention should be paid to personnel motivation and screening programs.

Comparison of Ropivacaine versus Bupivacaine in Spinal-Induced Hypotension in Preeclampsia Patients: A Randomized Control Trial.

Background: Spinal anesthesia is considered to be the safest method of anesthesia for cesarean sections in patients with preeclampsia. Patients with preeclampsia are at an increased risk of experiencing severe hypotension following spinal anesthesia, which could have more profound and deleterious effects on both the fetus and the mother. However, bupivacaine, the most commonly used drug, can induce severe hypotension even at low doses. The purpose of this study is to minimize post-spinal hypotension in both the mother and the fetus. Objectives: To determine and compare the reduction in hypotension following spinal anesthesia in patients with preeclampsia between the ropivacaine and bupivacaine groups. Methods: In a randomized clinical trial, a total of 90 parturients with preeclampsia undergoing spinal anesthesia were enrolled and randomly divided into 2 groups: One receiving ropivacaine and the other receiving bupivacaine. The dose of spinal ropivacaine was 15 mg of a 0.5% solution, and the dose of bupivacaine was also 15 mg of a 0.5 % solution. Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were recorded following the administration of spinal anesthesia. Pain scores and the time until the return of motor movement were also documented. Results: For statistical analysis, the t-test, Chi-square, and ANOVA tests were utilized to compare the groups. Demographic variables, including maternal age, gestational age, parity, and gravidity, were not significantly different between the 2 groups. The trend of mean systolic blood pressure (SBP) was significantly lower in the bupivacaine group compared to the ropivacaine group at all measured time points in the study (P < 0.05). The amount of ephedrine used after spinal anesthesia was significantly different at 2 and 4 minutes in the ropivacaine group compared to the bupivacaine group (P = 0.012, P = 0.025). Post-operative pain scores at 1 hour in recovery were not significantly different between the ropivacaine and bupivacaine groups (P = 0.015). The time to knee movement was also significantly shorter in the ropivacaine group compared to the bupivacaine group (P < 0.001). Conclusions: Ropivacaine reduces the incidence of hypotension in spinal anesthesia compared to bupivacaine for cesarean section in patients with preeclampsia. This is attributed to a lower occurrence of spinal-induced hypotension, improved hemodynamic control, reduced ephedrine usage, and faster patient ambulation. A future study could focus on investigating different dosages of both drugs with a larger number of participants.

Determining the Burden of Suicidal Behaviors Using the DALY Approach: A Case Study in Iran (2018-2021).

Background: Suicide is a significant and growing concern in health systems worldwide. It is considered a crucial part of the comprehensive mental health action plan in every country. Kerman, one of the largest provinces of Iran with a relatively high population, has witnessed an increasing trend in this phenomenon, especially during the COVID-19 pandemic. Methods: This was a cross-sectional study conducted in urban and rural areas of Kerman. Suicide data for 2018-2021 were acquired from the Psychosocial Health and Addiction Prevention Group of the Deputy for Health at Kerman University of Medical Sciences. The burden resulting from suicide during these years was measured using the disability-adjusted life years (DALY) index. Findings: During these four years, 23701 suicide attempts were recorded in Kerman, with 59% and 41% of the suicide attempts made by men and women, respectively, and 668 (2.82%) attempts leading to death. The highest rate (68%) was observed in the 15-29 age range and the lowest rate (1.1%) was seen in people older than 60. Poisoning (89.3% of the attempts) was the most common suicide method. The suicide burden in Kerman in 2021 was 4417 according to the DALY index, which is 162.6 per 100000 people; men and women endure 38% and 62% of this burden, respectively. The highest DALY rates were seen in the 15-29 and 30-44 age groups. Conclusion: The burden resulting from suicide highlights the necessity of taking immediate measures to prevent this behavior, especially among vulnerable groups.

Cost-effectiveness analysis of coronary arteries bypass grafting (CABG) and percutaneous coronary intervention (PCI) through drug stent in iran: a comparative study.

BACKGROUND: Cost-effectiveness analysis plays a key role in evaluating health systems and services. Coronary artery disease is one of the primary health concerns worldwide. This study sought to compare the cost-effectiveness of Coronary Arteries Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) through drug stent using Quality-Adjusted Life Years (QALY) index. METHODS: This is a cohort study involving all patients undergoing CABG and PCI through drug stent in south of Iran. A total of 410 patients were randomly selected to be included in the study. Data were gathered using SF-36, SAQ and a form for cost data from the patients' perspective. The data were analyzed descriptively and inferentially. Considering the analysis of cost-effectiveness, Markov Model was initially developed using TreeAge Pro 2020. Both deterministic and probabilistic sensitivity analyses were performed. RESULTS: Compared with the group treated with PCI, the total cost of interventions was higher in the CABG group ($102,103.8 vs $71,401.22) and the cost of lost productivity ($20,228.68 vs $7632.11), while the cost of hospitalization was lower in CABG ($67,567.1 vs $49,660.97). The cost of hotel stay and travel ($6967.82 vs $2520.12) and the cost of medication ($7340.18 vs $11,588.01) was lower in CABG. From the patients' perspective and SAQ instrument, CABG was cost-saving, with a reduction of $16,581 for every increase in effectiveness. Based on patients' perspective and SF-36 instrument, CABG was cost-saving, with a reduction of $34,543 for every increase in effectiveness. CONCLUSION: In the same indications, CABG intervention leads to more resource savings.

Epidemiology and spatial distribution of people diagnosed with HIV between 1997 and 2020 in Kerman, Iran.

OBJECTIVE: This study described the epidemiology and geographical distribution of people diagnosed with HIV in Kerman, Iran, between 1997 and 2020. METHODS: We used case-based HIV surveillance data of all people diagnosed with HIV in Kerman between 1997 and 2020. We compared the age, gender, modes of transmission and spatial distribution of newly diagnosed HIV-infected people in three time periods (1997-2004, 2005-2012 and 2013-2020). The χ2 test for trend, one-sample t-test and Kruskal-Wallis H test were used to compare the differences between the three time periods. We also used ArcGIS to map both HIV services and people living with HIV (PLWH) in 2020. The nearest neighbour index and kernel density were used to identify the spatial distribution of PLWH. RESULTS: A total of 459 (27.5% women) people were diagnosed with HIV during 1997-2020. The proportion of women (9.3% in 1997-2004 and 48.3% in 2013-2020, p<0.001), HIV infection through sexual contacts (11.6% in 1997-2004 and 50.3% in 2013-2020, p<0.001), HIV infection under the age of 5 years (0.8% in 1997-2004 and 5.4% in 2013-2020, p=0.01) and mean age at diagnosis among men (34.9 in 1997-2004 and 39.8 years in 2013-2020, p=0.004) significantly increased over time. 36.2% of diagnosed cases had CD4 counts under 200 x 10ˆ6/L between 2013 and 2020, with no significant improvement over time. Most newly diagnosed cases of HIV were from the eastern parts of the city. The clusters of PLWH in 2020 matched with the locations of HIV services. CONCLUSION: We observed important changes in HIV epidemiology regarding gender, modes of transmission, number of paediatric cases and density maps over time in Kerman. These changes should be considered for precise targeting of HIV prevention and treatment programmes.

Willingness to pay for complementary health insurance in Iran: Contingent valuation approach.

BACKGROUND: The Iranian health system is based on social health insurance, which is responsible for providing access to basic health care. In addition to basic treatment insurance, complementary health insurance (CHI) offers introductory packages that include surplus services. We recently observed an increase in Iran's health insurance loss coefficient, from 16.5% to 90.4% in 2017. AIM: To determine the willingness to pay (WTP) for (CHI). METHODS: We attempted to determine the WTP for CHI in this study to understand better the potential market and the factors that influence CHI demand. The study surveyed 1023 households in the Kerman Province. A questionnaire developed by the researcher was used in this study, based on the principles of contingent valuation and the bidding game method principles. In each scenario, the factors affecting people's WTP, the demand function, and the effective factors on demand were determined using linear multivariate regression using the ordinary least squares method. FINDINGS: The average WTP was $ 7.01, $ 12.57, $ 16.19, and $ 18.73 for the first to fourth scenarios, respectively. The demand elasticity for health insurance increased from the first to the fourth scenario, indicating that demand is expandable. On the other hand, it was observed that risk aversion dictates the demand for CHI. CONCLUSION: Contrary to the insurance claims theory, demand for CHI did not reverse. To this end, insurance fund policymakers can avoid risks and high financial costs by identifying risk-averse individuals.

Estimating costs of hepatitis B vaccination in infants: experimental evidence of the expanded program on immunization in Southern Iran.

BACKGROUND: Health costs have increased significantly around the world, and cost assessments have become important. This study aimed to collect cost of the resources used in the national hepatitis B immunization program in Southern Iran. METHODS: Costs were calculated by investigating the available documents as well as consulting with knowledgeable personnel. These costs were collected using the data from Shiraz University of Medical Sciences. According to the health payer's perspective, the indirect costs of the people were not taken into account. All current and capital costs in year 2017 were calculated and converted to US dollars (USDs). RESULTS: In 2017, 33 204 children received hepatitis B vaccine. The total cost of the national hepatitis B vaccination program in Shiraz and the cost of vaccination per child were 473 506 and 14.26 USD, respectively. However, the cost of inoculation of hepatitis B vaccine per dose was estimated at 3.20 USD. Personnel costs constituted the highest proportion (53.84%) of total costs. CONCLUSIONS: The cost of hepatitis B vaccination in Iran was lower than other countries. Considering that personnel costs had the largest proportion, it is recommended that proper measures be taken to monitor and modify these costs if necessary.

Quality of Life after Motorcycle Traffic Injuries: A Cohort Study in Northwest of Iran.

OBJECTIVE: To investigate the quality of life (QOL) of injured motorcyclists and associated factors in a period of three months after the accident. METHODS: In the present study, we were included 190 injured motorcyclists who admitted to two referral specialized hospitals (Emam Reza and Shohada) in Tabriz, between June 2018 and January 2019. All injured motorcyclists were contacted through the telephone one and 171 of them (90%) three months after their accident to complete an EQ-5D-3L questionnaire. The baseline measurements were gathered by using face to face interviews in the hospitals. The QOL score could vary between 1 and 3. The higher score showed a lower QOL. RESULTS: The injured motorcyclist's QOL score was relatively better in three months after the accident (mean±Standard Deviation (SD): 1.78±0.51) in comparison with their status a month after the accident (2.15±0.65) (p<0.001). The multivariable model showed that individuals with pelvis injuries (Coef: 0.29, (95% CI: 0.16, 0.42), p=0.001) and knee injuries (Coef: 0.26, (95% CI: 0.10, 0.42), p=0.001), experienced a higher QOL score. Also, those whose accident had happened in rainy weather experienced higher QOL score (Coef: 0.33, (95% CI: 0.12, 0.53), p=0.001). The patients who were in an accident with a vehicle were experienced a better QOL than others (Coef: -0.26, (95% CI: -0.43, -0.09), p=0.002). CONCLUSION: The assessment of three-months post-accident showed that the QOL score of the motorcyclists was reduced. It is recommended that the QOL of patients should be improved in hospital discharge victims.

Evaluating the cost-effectiveness of universal hepatitis B virus vaccination in Iran: a Markov model analysis.

Vaccination is an essential way to prevent the transmission of hepatitis B virus (HBV). Various studies have been published on the cost-effectiveness of HBV vaccination, but since the results vary according to the target population and related health outcomes, this study examined the cost-effectiveness of the universal HBV vaccination in Iran. In this economic evaluation study, a decision tree with the Markov model was used to compare the universal HBV vaccination with a strategy of non-vaccination. Health states used in the model included healthy, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and death. Analyses were performed from a payer's perspective. Incremental cost-effectiveness ratio (ICER) per life-year gained, and quality-adjusted life-years (QALYs) gained were calculated at a 5% annual discount rate. The sensitivity analysis was conducted using Monte Carlo simulation. Analyses were performed using Microsoft Excel and TreeAge Pro 2011 software. In 2017, the estimated cost per dose for any HBV vaccine was $3.20 USD. The universal HBV vaccination was economically advantageous compared to non-vaccination, and the estimated cost of this program per life-year and QALY gained were $6,319 and negative (-) $1,183.85 USD, respectively. Given the uncertainty of all parameters, the model remained robust and reliable. In Iran, the universal HBV vaccination strategy for both health outcomes of QALY and life-years gained was cost-effective and advantageous. The vaccination strategy saved money, increased life years and improved quality of life. Therefore, it is recommended that this program continues to be provided.

Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System: A systematic review.

In health insurance, a reimbursement mechanism refers to a method of third-party repayment to offset the use of medical services and equipment. This systematic review aimed to identify challenges and adverse outcomes generated by the implementation of reimbursement mechanisms based on the diagnosis-related group (DRG) classification system. All articles published between 1983 and 2017 and indexed in various databases were reviewed. Of the 1,475 articles identified, 36 were relevant and were included in the analysis. Overall, the most frequent challenges were increased costs (especially for severe diseases and specialised services), a lack of adequate supervision and technical infrastructure and the complexity of the method. Adverse outcomes included reduced length of patient stay, early patient discharge, decreased admissions, increased re-admissions and reduced services. Moreover, DRG-based reimbursement mechanisms often resulted in the referral of patients to other institutions, thus transferring costs to other sectors.

Cost-benefit Analysis of IUI and IVF based on willingness to pay approach; case study: Iran.

Assisted reproductive technologies (ARTs) are often considered luxury services by policy-makers and the general population, which are always susceptible of removal from public funding of health care. The analysis of the economic aspects of this scope seems essential due to the high prevalence of infertility in Iran and the high costs of infertility treatments. This study aimed to investigate the value put on IUI and IVF treatments by communities in Iran and the affordability of services based on community preferences. A cost-benefit analysis (CBA) was performed based on the WTP approach, and the contingent valuation method (CVM) was used to estimate WTP for IUI and IVF using a researcher-made survey in two cities of Kerman and Isfahan, Iran, in 2016-17. The sample size was 604, and the study sample frame to estimate WTP included two groups of couples who were/were not aware of their fertility statuses. The costs of one cycle of IUI and IVF were calculated according to the treatment protocols, tariffs of 2016-17, and medical information records of patients. The mean direct and indirect medical costs of one cycle of IUI and IVF were equivalent to 19561140 and 60897610 IRR, respectively. Also, the mean WTP for IUI and IVF treatments were obtained of 15941061 and 28870833 IRR, respectively. The demand for IUI and IVF treatments was elastic and the community was sensitive to price changes of these treatment methods. IUI and IVF treatments brought no positive net benefits, and economic variables had the highest impact on the WTP and community preferences, indicating the significant role of financial constraints in the community's valuation for advanced infertility treatments in Iran.

Hospital service quality - patient preferences - a discrete choice experiment.

PURPOSE: High quality healthcare is important to all patients. If healthcare is felt to be high quality, then patients will be satisfied, and the relationship between patients and healthcare providers will improve. Patient satisfaction is among the most commonly used service quality indicators; however, it is not fully known which factors influence satisfaction. Therefore, it is necessary to pay attention to the elements that affect both healthcare quality and patient satisfaction. Nowadays, several methods are used in health economics to assess patient preferences, prioritize them and help health policy makers improve services. Discrete choice experiment (DCE) is one method that is useful to elicit patient preferences regarding healthcare services. The purpose of this paper is to apply DCE and elicit patient preferences in medical centers to rank certain healthcare quality factors. DESIGN/METHODOLOGY/APPROACH: The descriptive, analytical study used a cross-sectional questionnaire that the authors developed. In total, 12 scenarios were chosen after applying fractional factorials. The questionnaire was completed by patients who were admitted to Kerman General Teaching Hospitals, South-East Iran in 2015. Patient preferences were identified by calculating the characteristics' marginal effects and prioritizing them. The generalized estimation equation (GEE) model was used to determine attribute effects on patient preferences. FINDINGS: In total, 167 patients completed the questionnaire. Prioritizing the attributes showed that "physical examination" was the most important attribute. Other key features included "cleanliness," "training after discharging," "medical staff attention," "waiting for admission" and "staff attitude." All attributes were statistically significant ( p<0.05) except staff behavior. No demographic characteristic was significant. PRACTICAL IMPLICATIONS: To increase hospital patient satisfaction, health policy makers should develop programs to enhance healthcare quality and hospital safety by increasing physical examination quality and other services. ORIGINALITY/VALUE: To estimate DCE independent variables, logistic regression models are usually used. The authors used the GEE model to estimate discrete choice experiment owing the explanatory variables' dependency.

Measuring the net profit of laboratory services: A case study in Iran.

Background: Clinical laboratories need to manage resources properly and scientifically to survive in today's highly competitive environment. In this context, scientific-economic principles should be considered to determine the profitability or loss of laboratories. Thus, in this study, the net profit of laboratory services was measured based on scientific-economic principles. Methods: This was an applied research with descriptive-retrospective approach. A laboratory was selected from 61 laboratories of Kerman, Iran, which performed the highest number of tests among the laboratories of this city. In addition, due to easy access, it was the most visited laboratory by patients. The present study had 2 main phases: (1) measuring the price of services and (2) calculating the net profit of the studied laboratory. Data analysis was performed using activity- based costing (ABC) as an econometric model and Excel software. Results: The highest charges were related to direct costs (78.28%); consumable goods (47.26%) and professional and logistic human resources (46.31%) had the highest share of these costs. In the test groups, the most expensive tests belonged to the hormones (23.03%) and clinical chemistry (20.84%). Total cost, revenue, and the net profit of the studied laboratory were 641 645, 1 390 942, and 749 297 USD, respectively. After doing sensitivity analysis (50% increase in the frequency of tests), the following values were obtained: 987 071, 2 086 413, and 1 099 342, respectively. Conclusion: Some test groups in the studied laboratory were not profitable, and this was due to the high cost of these tests and illogical tariffs. One way to overcome this problem is to increase the frequency of laboratory tests.

The Challenges and Barriers to the Integration of Laboratory Services in Iran from Laboratory Experts' Point of View.

BACKGROUND: Laboratory services fragmentation creates problems such as non-accountability for costs and quality, not being patient-centered and unsustainability of services in long run. Therefore, health systems consider laboratory services integration an inevitable way. This study aimed to investigate the challenges and barriers to the integration of laboratory services in Iran. METHODS: This qualitative case study was conducted in 2016. Using purposive sampling, semi-structured interviews were conducted with 34 informed participants. Each interview lasted between 30 to 60 min. Acceptability, transferability, reliability, and verifiability were used to assess the validity, accuracy and reliability of qualitative data. Framework approach was used to analyze data. RESULTS: Lack of economy of scale, unfair access, lack of grading, low quality, development of national strategies to create an integrated network of laboratories, criteria of the laboratories establishment, creation of necessary infrastructure, empowering the private sector and standardization of indicators were considered the most important problems of laboratory services integration in Iran; they were classified into two main themes. CONCLUSION: Identified issues are challenges which adversely impact the integration of laboratory services. Therefore, providing infrastructures with increased cooperation between various organizations to increase access to laboratory services in the form of an integrated network is essential.

Cost-price estimation of clinical laboratory services based on activity-based costing: A case study from a developing country.

BACKGROUND: It is believed that laboratory tariffs in Iran don't reflect the real costs. This might expose private laboratories at financial hardship. Activity Based Costing is widely used as a cost measurement instrument to more closely approximate the true cost of operations. OBJECTIVE: This study aimed to determine the real price of different clinical tests of a selected private clinical laboratory. METHODS: This study was a cross sectional study carried out in 2015. The study setting was the private laboratories in the city of Kerman, Iran. Of 629 tests in the tariff book of the laboratory (relative value), 188 tests were conducted in the laboratory that used Activity Based Costing (ABC) methodology to estimate cost-price. Analyzing and cost-price estimating of laboratory services were performed by MY ABCM software Version 5.0. RESULTS: In 2015, the total costs were $641,645. Direct and indirect costs were 78.3% and 21.7% respectively. Laboratory consumable costs by 37% and personnel costs by 36.3% had the largest share of the costing. Also, group of hormone tests cost the most $147,741 (23.03%), and other tests group cost the least $3,611 (0.56%). Also after calculating the cost of laboratory services, a comparison was made between the calculated price and the private sector's tariffs in 2015. CONCLUSION: This study showed that there was a difference between costs and tariffs in the private laboratory. One way to overcome this problem is to increase the number of laboratory tests with regard to capacity of the laboratories.

The Efficiency Assessment of Dental Units Using Data Envelopment Analysis Approach: The Case of Iran.

BACKGROUND: During the last decades, the number of dentistry units increased significantly across the country. The aim of this study was to assess the efficiency of dental units of Iran provinces regarding dental health inputs and outputs using Data Envelopment Analysis approach. METHODS: In this applied descriptive-analytical study, the study population included all of Iran 31 provinces. The output variables included DMFT and DMFT indices of 6-12 yr old students. The data about DMFT and DMFT indices were taken from 2013 Nationwide School Pupils Screening Program. Input variables included active dental chairs located in the public sector, general dentists of public sector, general and specialist dentists of private sector by different provinces. The data were analyzed using Deap software version 2.1. RESULTS: The lowest amount of scale efficiency was for Tehran Province (0.204) followed by Isfahan Province (0.205). Provinces of Isfahan, Razavi Khorasan, Kerman, Zanjan, Hamedan, Kordestan, Golestan, Yazd and Tehran, Iran had decreasing return to scale and provinces of Gilan, West Azerbaijan, Mazandaran, Fars, Kermanshah, Markazi, Lorestan, Qazvin, Sistan-and-Baluchestan, Bushehr, Alborz, Hormozgan and Khuzestan had increasing return to scale. CONCLUSION: Despite provinces of Isfahan, Razavi Khorasan, Kerman, Zanjan, Hamedan, Kordestan, Golestan, Yazd and Tehran which had a better situation in terms of the number of dentistry chairs, public dentists, general and specialist dentists of private sector than other provinces, they had decreasing return to scale. Investment in dental primary health care, preventive and educational programs can be more cost-effective.

Estimation of the Cost of Smoking-Attributable Diseases (Five Selected Diseases): A Case in Kerman City, Iran, 2014.

BACKGROUND: Cigarette seems to be the least valuable of addictive drugs. It is easily accessible to the public, and its harmful personal and social effects have attracted less attention. Therefore, the present research was carried out with the aim of presenting cost estimations of smoking-related diseases in smokers who aged 35 or higher in Kerman City, Iran, in 2014. METHODS: Using the prevalence approach, the direct and indirect costs of smoking-attributable diseases including lung cancer, gastric cancer, myocardial infarction, stroke, and chronic obstructive pulmonary disease (COPD) were estimated. The initial data were obtained from the information in documents of medical document units as well as the 2014 income statements of teaching hospitals of Kerman University of Medical Sciences, Kerman City. FINDINGS: In this research, total economic costs of diseases attributed to smoking were estimated to be 50 million dollars in 2014 in Kerman City, and calculations suggest that this figure accounts for 0.02% of Iran's gross domestic product (GDP). Total direct cost of diseases caused by smoking in Kerman City adds up to 17 million dollars, whereas the estimated indirect cost of diseases caused by smoking is 33 million dollars. The yearly per capita cost of any of the selected five diseases is 270 dollars. CONCLUSION: Smoking places a high economic burden on health system and society as a whole. Therefore, stronger intervention measures against smoking should be taken without delay to reduce the health and financial losses caused by smoking.

Cost-effectiveness of Methadone Maintenance Treatment Centers in Prevention of Human Immunodeficiency Virus Infection.

BACKGROUND: Acquired immune deficiency syndrome (AIDS) is one of the greatest social health problems in many communities in the twenty-first century. Methadone maintenance treatment (MMT) could decrease HIV infection among injection drug users (IDU). The main aim of this paper was to determine the cost-effectiveness of the governmental MMT program to prevent human immunodeficiency virus (HIV) infection among IDU. METHODS: This analytical study was performed through a before-after assessment during a one-year period. Using census sampling, 251 IDU referred to the public MMT program of Kerman, Iran, were selected. The expenditures of MMT centers were calculated in the view of government (public sector). The cost-effectiveness was calculated using TreeAge software. FINDINGS: MMT centers averted 86 new cases of HIV infection. The total cost of centers was US$471 per client in the year. The share of IDU from current expenditures was 35% and from capital expenditures was 32%. Also, methadone per capita for each person who injected drug was US$514. Per capita expenditure of HIV drug treatment was estimated US$8535 per year. Incremental cost effectiveness ratio (ICER) was US$2856 per year, which means governmental MMT program is cost-effective according to the World Health Organization (WHO) criteria. CONCLUSION: MMT centers are cost-effective in preventing HIV infection and the access to this program should be facilitated for IDU.

Cost-effectiveness analysis of dialysis and kidney transplant in patients with renal impairment using disability adjusted life years in Iran.

BACKGROUND: This cross-sectional study was conducted to compare the cost-effectiveness of three therapeutic methods of long-term hemodialysis, kidney transplant from a living person and kidney transplant from a cadaver utilizing Disability Adjusted Life Years (DALY) using data from the records of patients referred to Afzalipour Hospital of Kerman in 2012. METHODS: This cross-sectional study utilizing Disability Adjusted Life Years (DALY) as outcome measure, used data from the records of patients referred to Afzalipour Hospital of Kerman in 2012. The decision tree model and decision tree software (Tree Age pro 11) were used for data analysis. In this research, costs and effects were studied from the patients and healthcare providers' perspective. RESULTS: In the patient's perspective, the CER of dialysis was 5.04 times greater than transplant from a living person and 6.15 times higher than transplant from a cadaveric donor. In the hospital's perspective, the average cost-effectiveness ratio of dialysis was 8.4 times greater than transplant from a living person and 14.07 times higher than transplant from a cadaver. The smaller the C-E ratio, the greater was the cost-effectiveness. In both perspectives, the order of effectiveness of treatment methods were transplant from a cadaver, transplant from a living person and dialysis. CONCLUSION: Considering the results obtained in this study, measures should be taken to increase the desire for organ donation from brain-dead patients, living people and patients' relatives.

Evaluating Direct Costs of Gastric Cancer Treatment in Iran - Case Study in Kerman City in 2015.

BACKGROUND: Gastrointestinal cancers are common malignancies associated with high mortality rates. Health- care systems are always faced with high costs of treatment of gastrointestinal cancers including stomach cancer. Identification and prioritization of these costs can help determine economic burden and then improve of health planning by policy-makers. This study was performed in 2015 in Kerman City aimed at estimating the direct hospital costs for patients with gastric cancer. MATERIALS AND METHODS: In this cross-sectional study, the medical records of 160 patients with stomach cancer admitted from 2011 to 2014 to Shafa Hospital were examined, the current stage of the disease and the patients' health status were identified, and the direct costs related to the type of treatment in the public and private sectors were calculated. SPSS-19 was used for statistical analysis of the data. RESULTS: Of the patients studied, 103 (65%) were men and 57 (35%) were women. The mean age of patients was 65 years. Distribution into four stages of the disease was 5%, 20%, 30%, and 45%, respectively. Direct costs in four stages of the disease were calculated as 2191.07, 2642.93, 2877, and 2674.07 USD (63,045,879, 76,047,934, 82,783,019, and 76,943,800 IRR), respectively. The highest percentage of costs was related to surgery in Stage I and to medication in Stages II, III, and IV. According to the results of direct costs of treatment for stomach cancer in Kerman, the mean total cost of treating a patient in the public sector was estimated at 74,705,158 IRR, of which averages of 60,141,384 IRR and 14,563,774 IRR were the shares of insurance and patients, respectively. CONCLUSIONS: The high prevalence and diagnosis of disease in old age and at advanced stages of disease impose great costs on the patients and the health system. Early diagnosis through screening and selecting an appropriate treatment method might largely ameliorate the economic burden of the disease.