ABSTRACT
Background: Since approximately 45% of basic health insurance (BHI) resources are spent and distributed based on the Relative Value of Health Services (RVHS) book, therefore, any revision in this book will most probably affect the behavior of health insurance organizations. The present study was prospected to determine the effect of revising RVHS on behavior of BHI funds as the main providers of treatment resources. Methods: This is a qualitative study in which data were analyzed using content analysis method. Semi-structured interviews were used to gather the required data. 27 interviewees were chosen using purposive sampling method. Finally, MAXQDA software was used to analyze and code the data. Results: According to the results, revision of RVHS influenced the behavior of health insurance organizations. The most important changes in the behavior of health insurance funds involved the following: formation of a committee for cost management and handling the insurance documents, creating a uniform coding system for health services, redesigning the handling process of documents, increased share of insurance funds from health expenditures, with 300 new services added to basic package and revising the package according to the new version of the book. Furthermore, the rest of the changes included in the global payment method based on the new book, delay in paying claims, increased deductions based on the payment of expensive services on treatment protocols, holding periodic training courses, and teaching the new book as well as the procedures for handling the documents. Conclusion: With regard to the revision of RVHS and considering the incremental approach in revision of relative values, the increased claims of health services delivery centers and delay in payment of these claims were the most important changes in the behavior of health insurance funds. Health policy makers can overcome such issues and provide proper financial conditions through reduction of conversion factor and mobilization of resources. Such policies will open the space for best management of the behaviors affected by revision of relative values.
ABSTRACT
Background: Hip, vertebral and wrist fractures are the most common consequences of osteoporosis. This study aimed at analyzing the cost-effectiveness of teriparatide (CinnoPar®), compared with alendronate and risedronate, in the treatment of women aged 60 and over with postmenopausal osteoporosis in Iran. Methods: A decision tree model with a 2-year time horizon was used to compare treatment with teriparatide (CinnoPar®) with the following treatment strategies: two years of treatment with alendronate and two years of treatment with risedronate in women aged 60 years and over or those at risk of osteoporosis. Cost per QALY was calculated for 3 treatment strategies from the model. After base case analysis, one-way sensitivity analysis was performed on key parameters of the model to assess their impact on the study results and the cost-effectiveness of different treatment strategies and the model robustness. TreeAge Pro 2006 software was used for modeling and data analysis. Results: Incremental cost-effectiveness ratio (ICER) of alendronate and teriparatide than risedronate (base treatment) were US$- 2178.03 and US$483,783.67 per QALY, respectively. Therefore, the dominant and cost-effective treatment option was alendronate. In the one-way sensitivity analysis, the impact of annual 25% increase or decrease in the teriparatide cost on its ICER was remarkable. Also, reducing the discount rate from 0.03 to 0.0 had the greatest impact on the ICER of the teriparatide. Conclusion: The treatment strategy of teriparatide is more expensive than risedronate and alendronate and is associated with very little increase in QALYs. A significant reduction in teriparatide price and a limit in its use only for high-risk women and for acute and short-term treatment courses can contribute to its cost-effectiveness.
