ABSTRACT
BACKGROUND: Today, heart failure is one of the leading causes of death and disability in most developed and developing countries. By 2030, more than 23.3 million people are projected to die of cardiovascular diseases each year, and the prevalence of heart failure is expected to increase by 25%. One of the preventive interventions is pharmacological interventions which can be used to reduce the complications of cardiovascular diseases such as heart failure. One of the most important pharmacological interventions in patients with heart failure is the use of antihypertensive drugs such as candesartan, enalapril, and valsartan. This study aimed to compare the cost-utility of candesartan, enalapril, and valsartan in patients with heart failure using the Markov model in Iran in 2020. METHODS: In the present study, a four-state Markov model was designed to compare the cost-utility of candesartan, enalapril, and valsartan for a hypothetical cohort of 10,000 heart failure patients older than 24 years. The payers' perspective was used to calculate the costs. The Markov states included outpatients with heart failure, patients with heart failure admitted to general hospital wards, patients with heart failure admitted to the intensive care units (ICUs), and death. The effectiveness measure in this study was the quality-adjusted life years (QALYs). The one-way and probabilistic sensitivity analyses were used to determine the robustness of the results. The TreeAge Pro 2011 software was used for data analysis. RESULTS: The results showed that the average expected costs and QALYs were 119645.45 USD and 16.15 for valsartan, 113,019.68 USD and 15.16 for enalapril, and 113,093.37 USD and 15.06 for candesartan, respectively. Candesartan was recognized as the dominated option. Because the calculated incremental cost-effectiveness ratio (ICER) value (6,692.69 USD) was less than the threshold value (7,256 USD), valsartan was cost-effective compared to enalapril. The results of the cost-effectiveness acceptability curve showed that at the threshold of 7,256 USD, valsartan had a 60% chance of being cost-effective compared to enalapril. The results of one-way and probabilistic sensitivity analyses confirmed the robustness of the results. Moreover, the results showed that ICU (1,112 USD) had the highest cost among cost items. CONCLUSION: According to the results, it is recommended that health policymakers consider the use of valsartan by cardiologists when designing clinical guidelines for the treatment of patients with heart failure.
ABSTRACT
Objective: To estimate the economic burden of hemophilia A and B in the patients referred to the related referral hospital in the south of Iran in 2017.Methods: This cross-sectional study was a partial economic evaluation and a cost of illness study, carried out in 2017. All the patients with hemophilia A and B referred to the related hospital affiliated to Shiraz University of Medical Sciences in the south of Iran were included in the study (N = n = 253). A data collection form was used to collect the required data, including patients' direct and indirect costs.Results: The mean annual cost was 36028 USD. The mean costs per patient with hemophilia A and B were 37661 USD and 30775 USD, respectively, in which the greatest part were related to direct medical costs (98.32% in hemophilia A, 98.18% in hemophilia B, and 98.29% of the total costs), and the cost of clotting factor concentrates accounted for the largest share of the patients' direct medical costs. Also, considering the number of hemophilia patients in Iran, the mean annual cost of the patients in 2017 was 414480325 USD, of which 381503701 USD was for hemophilia A and 32976624 USD was for hemophilia B patients.Conclusion: Considering the significant economic burden of hemophilia and in order to reduce the costs, the following suggestions can be offered: provision of clotting factor concentrates domestically in accordance with the world standards, and providing specialized services and care to hemophilia patients in towns.
