Development of attributes and levels of mental health insurance services using a discrete choice experiment.

BACKGROUND: Despite the fact that mental illness is among the ten top diseases with the highest burden, the health services required by these patients do not have adequate insurance coverage. The purpose of this study is to develop the attributes and levels of mental health insurance services using a discrete choice experiment (DCE). MATERIALS AND METHOD: This study involved a qualitative phase of the DCE that was conducted in Iran in 2020-2021 and included several stages. First, during a literature review, the attributes and levels were determined. Then, the attributes of health insurance were identified and weighed through virtual and in-person interviews with 16 mental health insurance professionals and policymakers in this field who were selected by purposive sampling. Finally, after a few sessions, through review studies, interviews, and a group of the expert panel, attributes and levels were finalized. RESULTS: This study showed that coverage of inpatient services, outpatient services, place of receiving services, use of online internet services, limitation of services, and monthly premiums were the most important attributes of mental health insurance services. CONCLUSION: To promote mental health insurance, policymakers and health insurance organizations should pay attention to premiums to be commensurate with the payment of people, packages of mental health services, and the ability of people to pay in appropriation with inflation. Identifying these attributes can determine people's willingness to pay and preferences for mental health insurance and lead to better planning for more comprehensive coverage for patients and increase the desirability of individuals in receiving services.

Cost-effectiveness analysis of fractional flow reserve versus angiography among patients with coronary artery disease undergoing borderline coronary lesions treatment in Iran.

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.

Inequality in Cosmetic Services and Surgery among Iranian Households in 2019: A Decomposition Analysis.

Background: The demand for cosmetic surgery is on the rise worldwide, making it the common form of surgery globally while the use of cosmetic surgery being exponentially high in Iran. The aim of this study was to investigate inequality in the use of cosmetic services and surgery (CSS) among Iranian households concerning demographic and socio-economic characteristics. Methods: This study used data of 38960 Iranian household from the income-expenditure survey of the statistical center of Iran (SCI) in 2019. Concentration index (C) was used to measure inequalities in the use of CSS. Microsoft Excel sheet 2019 was used to extract the data, and the analysis was performed using Stata statistical package version 14.2. Results: Households with female head, with single head, households with 3 - 4 people, headed with undergraduate education person, households with insurance coverage, with higher socio-economic quintiles, rural households and residents of northwestern Iran were accounted for the highest use of CSS. Also, according to the decomposition analysis, wealth and education level are the two main factors in creating inequality, with wealth, having the highest positive share (88.11%) and education level having the most negative share (-5.26%) in creating measured inequality. Conclusion: The use of CSS is more concentrated in well-off households in Iran. As the resources of health system are limited, the government and the policy makers should have defined plans with regards to CSS use especially taking factors like socioeconomic status and education status of target groups in to account.

Cost-utility analysis of factor VIII diet therapies prepared using blood plasma vs. recombinant technique for patients with hemophilia A.

BACKGROUND: Hemophilia is known as one of the most common coagulation disorders whose treatment costs are particularly high in developing countries, and about 90% of them are related to factor VIII (FVIII) and direct medical costs (DMCs). Thus, the present study aimed to analyze cost-utility of two FVIII diet therapies prepared using blood plasma and recombinant technique. METHODS: This study was an economic evaluation fulfilled through a cost-utility approach. To this end, a total number of 120 patients were randomly selected using Krejcie & Morgan's Table and then received blood plasma and recombinant FVIII. The decision tree structure was also utilized to estimate economic and clinical outcomes. Moreover, costs were reviewed from societal perspective. Quality-adjusted life year (QALY) was subsequently determined as the measure of effectiveness (MOE). Besides, one-way (univariate) sensitivity analysis was performed to quantify uncertainty effects of the study parameters. The information was ultimately analyzed using the TreeAge Pro 2011 and the Microsoft Office Excel 2010 software. RESULTS: The results revealed that the recombinant diet therapy had higher costs and effectiveness compared with blood-plasma-derived FVIII, so that the mean costs of these two diet therapies were equal to 37,624 and 20,349 purchasing power parity (PPP) $ with utility scores of 0.78 and 0.62; respectively. Since the incremental cost-effectiveness ratio (ICER) for the recombinant medications was over three times of the threshold level, it was considered as overwhelming because of its high cost in spite of its better effectiveness. Moreover, the results of one-way (univariate) sensitivity analysis demonstrated the highest sensitivity to the utility in patients who had been injected with blood-plasma-derived FVIII and had been successfully treated. CONCLUSION: The study results revealed that FVIII prepared using blood plasma for hemophilia A patients had higher cost-effectiveness compared with that made using recombinant technique. Graphical abstract.

Cost-Effectiveness Analysis of Topiramate versus Phenobarbital in the Treatment of Children with Febrile Seizure.

OBJECTIVES: Febrile seizure is common disorder in childhood, with a prevalence of 2% to 5%. There are many drugs for treatment of this disease; however, the most common prescribed medication in Iran is phenobarbital that is cheap, but it has many side effects. We aimed to compare the cost-effectiveness of topiramate versus phenobarbital in patients with febrile seizure in the south of Iran. MATERIALS & METHODS: This econometric cost-effectiveness and cost-utility study were conducted on 91 patients with febrile seizure to assess two strategies of oral drug therapy including phenobarbital and topiramate in 2016-2017. Of all, 51 patients were treated with phenobarbital and 40 patients received topiramate. We followed up the patients for six months, using a randomized and single-blinded approach. A decision tree model was used. The outcomes of the model included febrile seizure and utility. The study was conducted from the perspective of the community; therefore, direct and indirect costs were included in the study. Excel and Tree Age software (2011) were used to analyze the results. RESULTS: Topiramate was cheaper and more effective than phenobarbital. In patients in the phenobarbital and topiramate groups, the mean costs were $740 and $674 per PPP, utility scores were 0.72 and 0.82, and febrile seizure without side effects were 0.3 and 0.6, respectively. Moreover, one-way sensitivity analysis confirmed the robustness of the results of the study. CONCLUSION: Topiramate in patients with febrile seizure is a fully cost-effective and cost-efficient strategy suggested as a better alternative for children with febrile seizure.

Quality Assessment of Published Articles in Iranian Journals Related to Economic Evaluation in Health Care Programs Based on Drummond's Checklist: A Narrative Review.

Health economic evaluation research plays an important role in selecting cost-effective interventions. The purpose of this study was to assess the quality of published articles in Iranian journals related to economic evaluation in health care programs based on Drummond's checklist in terms of numbers, features, and quality. In the present review study, published articles (Persian and English) in Iranian journals related to economic evaluation in health care programs were searched using electronic databases. In addition, the methodological quality of articles' structure was analyzed by Drummond's standard checklist. Based on the inclusion criteria, the search of databases resulted in 27 articles that fully covered economic evaluation in health care programs. A review of articles in accordance with Drummond's criteria showed that the majority of studies had flaws. The most common methodological weakness in the articles was in terms of cost calculation and valuation. Considering such methodological faults in these studies, it is anticipated that these studies would not provide an appropriate feedback to policy makers to allocate health care resources correctly and select suitable cost-effective interventions. Therefore, researchers are required to comply with the standard guidelines in order to better execute and report on economic evaluation studies.