ABSTRACT
BACKGROUND: The present study aimed to examine the cost-effectiveness of fractional flow reserve (FFR) versus angiography in treating borderline coronary lesions in patients with coronary artery stenosis in Iran. Cardiovascular disease is a leading cause of morbidity, mortality, readmission and the most important cause of disability in many countries, including Iran. METHODS: This was a cost-effectiveness study conducted from the perspective of the Ministry of Health in 2019. The effectiveness was determined using four indicators: Quality Adjusted Life Years (QALYs), major adverse cardiac events (MACE), angina, and number of used stents (mean). Only direct medical costs (DMC) were estimated. To evaluate the cost-effectiveness of FFR versus angiography, A decision tree model was built by patient's level data.To coping with uncertainty Probabilistic sensitivity analysis (PSA) was performed. RESULTS: Totally, 98 cases of FFR and 238 cases of angiography were included in the analysis. The average of QALY in FFR and angiography were 0.853 and 0.787, respectively. The cost of these methods were $6128 and $8388, correspondingly. Therefore, FFR was dominant compared to angiography. Results of the scatter plots and acceptability curve showed that FFR was more cost-effective than angiography in 94% and 96% of simulations for a threshold lower than $11,000 PPP. The PSA analysis confirmed the robustness of the study results. CONCLUSION: The results indicated that FFR was more cost-effective than angiography in the cases studied in Iran. Consequently, FFR can be used as a high-priority diagnostic method and it is recommendable to be included in insurance coverage.
ABSTRACT
OBJECTIVES: The aim of the study was to evaluate the cost-effectiveness of different methods of treating tubal ectopic pregnancy in the south of Iran. METHODS: This study was an economic evaluation that analyzed and compared the cost-effectiveness and cost utility of 3 treatment methods, including single-dose methotrexate, double-dose methotrexate, and surgery in patients with tubal ectopic pregnancy. In this study, a decision tree model was used. The outcomes included in the model were the percentage of successful treatment and the average utility score of each treatment method. The study was conducted from the social perspective, and a one-way and probabilistic sensitivity analysis was performed to measure the effects of uncertainty. RESULTS: The incremental cost-effectiveness ratio of surgery compared with single-dose methotrexate was positive and equal to $5812 purchasing power parity; moreover, the results of one-way analysis showed the highest sensitivity toward the effectiveness of single-dose methotrexate. Scatter plots also revealed that surgery in 82% and 96% of simulations was at the acceptable region compared with a single-dose and double-dose methotrexate, respectively and was below the threshold. It was identified as a more cost-effective strategy. Furthermore, the acceptability curves showed that in 81.4% of simulations, surgery was the most cost-effective treatment for thresholds less than $20 950 purchasing power parity. CONCLUSIONS: On the basis of the results of this study, surgery can be used as the first line of treatment for ectopic pregnancy. In addition, the best drug strategy was single-dose methotrexate because this strategy reduced costs and increased treatment success and quality-adjusted life-years compared with double-dose methotrexate.
