Public Preference for Financing Preventive Vaccines in Health Shocks: The Case of COVID-19 Vaccines in a Middle-Income Country.

BACKGROUND: To effectively manage health crises such as disease pandemics, health authorities require reliable information regarding people's preferences. This helps to ensure timely and targeted interventions and avoids increasing societal costs through developing evidence-based policies. This study investigates the Iranian people's preference for financing coronavirus disease 2019 (COVID-19) vaccines and the factors affecting this. METHODS: A cross-sectional survey was performed during the third-wave peak of COVID-19 in Iran from 1 to 20 February 2021 utilizing various data collection methods. The public preference regarding imported and domestically produced vaccines, their willingness to fully or partially contribute to the financing of these vaccines, and their willingness to pay (WTP) for domestically produced vaccines using the contingent valuation method was assessed in different scenarios. The determinants of the probability of positive financing preferences were evaluated using an ordered probit regression model. RESULTS: Among the 2071 survey respondents, approximately 60% stated willingness to contribute to vaccine financing in the form of partial or full user fee payments. Forty percent of respondents are willing to be vaccinated if it is provided for free by the government. Interestingly, people's preference for financing the vaccine was not related to the type of vaccine. The regression analysis showed that income, having supplementary insurance, being male, perceived COVID-19 risk, education, and working in the health sector are significantly related to a higher probability of contribution to vaccine financing. CONCLUSIONS: Regardless of country of origin of COVID-19 vaccines, vaccination is very important for the Iranian people, and the majority of respondents in our study showed an inclination to contribute to vaccine funding, from partial to full user fees, to achieve higher protection against COVID-19 disease. Hence, ensuring timely access to vaccines during health crises such as pandemics is imperative, as it saves lives and reduces the economic burden of disease. This commitment from the health system can be supported by financial contributions from the general public. In this regard, considering public preferences is strongly advised to policymakers.

Main drivers of diabetes pharmaceuticals expenditures: evidence from OECD countries and Iran.

Purpose: This study aimed to identify the impact of prominent drivers on drug expenditure for diabetes. Method: Following the examination of previous studies, this study identified possible factors contributing to diabetes pharmaceutical expenditures. The explanatory variables for the study were the median population age, access to innovative drugs, GDP per capita, prevalence, price, and consumption of diabetes drugs. Then, to estimate the per capita expenditure among diabetic patients, this study developed the panel data model and two time-series regression models for OECD countries and Iran, respectively. Results: In the panel data regression model, R2 was 0.43. The influence of the age, prevalence, consumption volume and GDP per capita coefficients were + 1.79, + 0.704, + 3.86057, + 0.00054, respectively. Also, the probability level of all variables was less than 0.05. In Iran's comparative time-series regression model, R2 was 0.9, and the only significant influence coefficient was the age (ß=+0.91). In the another model for Iran, R2 was 0.99, the influence coefficient of age was + 0.249, the prevalence was + 0.131, innovation was + 0.029, and the price was + 0.00054; all the probability levels were less than 0.05. Conclusion: Pharmaceutical per capita expenditure is affected by several factors. These factors are not the same in various counties. Passing a judgment on drug utilization only based on pharmaceutical per capita expenditure cannot be perfect. Also, judging whether the per capita drug expenditure in one country is desirable without attention to the affecting factors and only relying on the value of utilized medicines is defective.

Genetic Characterizations of the Iranian Honey Bee (Apis mellifera meda Skorikov 1929) Populations Using the Microsatellite DNA Markers.

The genetic characterization of the Iranian honey bee was investigated by analyzing 10 polymorphic DNA microsatellite loci in 300 honey bee samples representative of twenty Iranian provinces. This study evaluated the heterozygosity (Ho and He), the Shannon index, the number of observed alleles, and F-statistics among tested populations as genetic parameters. Our finding demonstrated that the Iranian honey bee populations were described by low genetic diversity in terms of the number of observed alleles, Shannon index, and Heterozygosity values. Most populations had significant deviations from Hardy Weinberg equilibrium cause of heterozygote shortage. Low FST and FIS values proposed the absence or very low genetic diversity within and among A. m. meda populations in the present study. The cluster analysis has categorized the honey bee samples gathered from various regions of Iran into two main groups, including honey bees in the North-West (i.e., North, Northwest, and West) provinces and honey bees in the East-South (i.e., Eastern North, Central part, and Southern) provinces of Iran. Our results also revealed lower genetic differentiation and heterozygosity among tested honey bee populations. The results from this study are consistent with previous investigations in Iran, alarming the loss of genetic diversity in the Iranian honey bee populations, which leads to more homozygosity. This study presented new data and reports on genetic structure in investigated native Iranian honey bee populations, and it will benefit future studies on selection, native biodiversity preservation and other conservation breeding projects.

An adapted model of cost-related medication nonadherence among older adult patients with chronic diseases: an Iranian qualitative study.

BACKGROUND: Following the rapid aging of population, some concerns have emerged regarding increasing demand for health care services and the consequent increase in health costs. Besides, older adult patients with chronic disease are more prone to show cost-related medication non-adherence (CRN) to cope with their medication costs. The objective of this qualitative study was to develop an adopted conceptual framework on the contextual determinants that affect the CRN in older adult patients with chronic diseases. METHODS: Problem-centered, semi-structured, in-depth, and face-to-face interviews, were conducted with healthcare informants in Iran, from Sep. 2021 to Feb. 2022. Collected data were analyzed using deductive and inductive analytic approaches and content analysis methodology was used to develop the model. This study applies to the COREQ checklist. RESULTS: Fifteen informants, including 8 (60%) males, with mean ± SD age of 44.4 ± 9.7 years, entered into the study. Based on the data analysis performed on the information obtained from the interview with 3 subgroups of geriatricians, health policymakers, and pharmacists, six major themes identified as determinants: 1) socio-economic factors, 2) health system-related factors, 3) healthcare provider-related factors, 4) medication-related factors, 5) disease-related factors, and 6) patient-related factors. There were also 23 minor themes which were matched with the aforementioned six major themes. CONCLUSION: The final framework obtained in this qualitative study depicts CRN as an issue that is highly likely affected by six main determinants among older patients with chronic disease. Our findings emphasize that policymakers would focus on certain major themes and allocate resources to programs to improve medication therapy management in older adult patients.

Requirements for improving social capital among faculty members of medical universities: A multicenter qualitative study.

Introduction: Social capital is critical to organizational dynamics, particularly in developing countries. This study explored strategies for enhancing social capital among faculty members at seven medical universities in the south of Iran. Methods: This qualitative study was conducted in 2021. We used a purposeful sampling technique to recruit faculty members and conducted individual semi-structured interviews with them. Thematic analysis was used to analyze and describe the collected data. Results: A total of 49 faculty members (34 males; 15 females) participated in this study. The participants expressed satisfaction with their affiliations with medical universities. Social capital was related to the feeling of belonging to the organization, as well as to interpersonal and intra-organizational relations. Social capital was associated with three components: empowerment, organizational policy change, and organizational identification. Additionally, a dynamic relationship between the individual, interpersonal, and macro-organizational levels reinforced the organization's social capital. This means that, just as the macro-organizational level affects the members' identities, the members' activism affects the macro-organizational level. Conclusion: To strengthen the organization's social capital, managers should work on the mentioned components at the individual, interpersonal, and macro-organizational levels.

The cost of illness analysis of inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic inflammatory condition involving individuals across all age groups. Recent data suggests the increase in the prevalence of IBD and the surge in applying the biologic drugs in which both change the cost of IBD in recent years. Comprehensive assessment of direct and indirect cost profiles associated with IBD in our area is scarce. This study aimed to determine the economic burden of IBD in Iran from a societal perspective, using cost diaries. METHODS: Patients available on clinic registry and hospital information system (HIS), who were diagnosed with IBD, were invited to take part in this study. Demographic and clinical data, the healthcare resource utilization or cost items, absenteeism for the patients and their caregivers were obtained. The cost of the used resources were derived from national tariffs. The data regarding premature mortality in IBD patients was extracted from HIS. Productivity loss was estimated based on the human capital method. Then, cost date were calculated as mean annual costs per patient. RESULTS: The cost diaries were obtained from 240 subjects (Ulcerative colitis: n = 168, Crohn's disease, n = 72). The mean annual costs per patient were 1077 US$ (95% CI 900-1253), and 1608 (95% CI 1256, 1960) for the patients with ulcerative colitis and Crohn's disease, respectively. Of the total costs, 58% and 63% were in terms of the indirect costs for the patients with ulcerative colitis and Crohn's disease, respectively. The cost of illness for country was found to be 22,331,079 US$ and 15,183,678 US$ for patients with ulcerative colitis and Crohn's disease, respectively. Highest nationwide economic burden of IBD was found for patients older than 40 years were estimated to be 8,198,519 US$ and 7,120,891 US$, for ulcerative colitis and Crohn's disease, respectively. CONCLUSION: The medication was found to be the greatest contributor of direct medical costs. Productivity loss in terms of long-term disability and premature mortality were major components of IBD's economic burden in Iran.

Mental Health Status of Healthcare Workers During the Coronavirus Disease 2019 Pandemic: A Survey of Hospitals in Shiraz, Iran.

BACKGROUND: Healthcare workers (HCWs) directly or indirectly involved in the coronavirus disease 2019 (COVID-19) treatment process may experience severe mental consequences of the pandemic. Hence, this study aimed to evaluate the mental health status of HCWs in hospitals affiliated with Shiraz University of Medical Sciences, Iran. MATERIALS AND METHODS: This cross-sectional study was performed on 503 HCWs from five hospitals in Shiraz, including one COVID-19 front-line hospital, two COVID-19 second-line hospitals, and two without COVID-19 wards. Then, to assess the levels of anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD) among HCWs, the Persian versions of the Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), and Global Psychotrauma Screen (GPS) questionnaires were placed, respectively. RESULTS: The mean age of participants was 33.94±8.26 years, and 252 (50.1%) were females. Anxiety, depression, insomnia, and moderate to high levels of PTSD were observed in 40.4%, 37.8%, 24.5%, and 71% of participants, respectively. A history of mental disorders was associated with all four outcomes (P0.05). Females gender and living with elderly and/or children were correlated with anxiety and PTSD (P0.05). Working at COVID-19 front- and second-line hospitals were similarly linked to higher insomnia and PTSD levels (P0.05). Also, working in COVID-19 wards or non-clinical settings was associated with anxiety and depression (P0.05). CONCLUSION: Most of the HCWs in this study may experience mental difficulties. Some factors may increase their risk of experiencing these difficulties. Hence, in the crisis era, mental health monitoring and identification of groups with predisposing factors are required to provide appropriate care as quickly as feasible.

Catastrophic pharmaceutical expenditure in patients with type 2 diabetes in Iran.

OBJECTIVES: This study aimed to assess the financial burden of out-of-pocket (OOP) payments to purchase antidiabetic medicines for type 2 patients in Iran. METHOD: The "budget share" and "capacity to pay" approaches were employed to assess the catastrophic pharmaceutical expenditures of antidiabetic medication therapies. The catastrophic thresholds were adjusted for pharmaceutical sectors. The data was 2019 monthly household expenditures in rural and urban areas, insurance coverages of antidiabetic medicines and patients' out-of-pocket (OOP) payments in 30-day treatment schedules. RESULTS: The results show that expenditure on diabetes medication therapies in the form of mono-dual therapy and some cases triple oral therapies were not catastrophic even for rural households. Insulin puts patients at risk of catastrophic pharmaceutical expenditures when added to the treatment schedules, and lack of financial protection intensifies it. In general, the poorer households and those resistant to first-line treatments were at increased risk of catastrophic pharmaceutical expenditures. The number of treatments that put patients at risk of catastrophic pharmaceutical expenditure in "budget share" was higher than the "capacity to pay" approach. CONCLUSIONS: Assessing medication treatment affordability instead of a single medicine assessment is needed. Assessment could be done by utilizing a macro-level data approach and applying adjusted pharmaceutical sector threshold values. Considering the variation between treatment schedules that put patients at risk of catastrophic pharmaceutical expenditures, targeted pharmaceutical policies and reimbursement decisions are recommended to promote Universal Health Coverage (UHC) and to protect vulnerable populations from hardship.

Chemical and morphological characteristics of common bean seed and evaluating genetic advance in commercial classes.

Common bean (Phaseolus vulagris L.) is a nutritionally important food crop with prospective health benefits in the world. The current study was evaluated the chemical components, morphological characteristics, and genetic advance of 22 common bean cultivars/lines seeds from three commercial classes (white, red, pinto beans) adapted to different climates of Iran. The results showed significant variations among 22 common bean cultivars/lines for all studied seed traits. The commercial group comparisons showed that pinto beans were the best in terms of seed morphological characteristics but red beans were superior for seed protein percentage and zinc content. White beans had high amounts of iron, calcium and magnesium, and also presented high amounts of starch and uronic acid as anti-nutritional factors. Among the chemical components, crude fat had the highest genetic and phenotypic coefficients of variation, whereas starch percentage showed the lowest values. The genetic advance over the mean ranged from 6.73% (starch percentage) to 66.31% (100-seed weight), and high heritability was estimated for calcium content (0.99). AND1007 Line demonstrated the high seed protein, iron and zinc contents. To confirm the results, a genotype-by-trait biplot was done. These results could help to achieve a common bean cultivar with a high amount of nutritional value of seeds and appropriate seed characteristics with a low amount of anti-nutritional factors.

The prevalence and risk factors of death anxiety and fear of COVID-19 in an Iranian community: A cross-sectional study.

Background and Aims: COVID-19 has adversely impacted the public's mental health. One of the causes of psychopathology during the present pandemic is death anxiety and fear of COVID-19. The present study aimed to determine the prevalence and risk factors of death anxiety and fear of COVID-19 in Shiraz city, south of Iran. Methods: This cross-sectional study was conducted among 982 participants in Shiraz from October to November 2021. Data were collected using Templer's Death Anxiety Scale and the Fear of COVID-19 Scale. Trained interviewers collected data throughout different city districts. A data-driven approach (latent class analysis) was applied to categorize the participants and determine the risk factors. Results: Among the participants, 507 (51.6%) were female, and 475 (48.4%) were male. The participants' mean age was 38.26 ± 15.16 years. Based on the analysis, 259 (26.4%), 512 (52.1%), and 211 (21.5%) participants had low, moderate, and severe levels of death anxiety. Also, 393 (40.06%) and 588 (59.94%) of the participants had low and high levels of fear, respectively. Higher death anxiety was significantly associated with being female, having an associate degree, being retired, share of medical expenditure from total expenditure of more than 10%, having a history of hospital admission due to COVID-19, history of COVID-19 in relatives, and having fear of COVID-19. Also, being female, expenses equal to income, history of hospital admission due to COVID-19, death in relatives, and higher death anxiety were linked to higher levels of fear of COVID-19. Conclusions: Death anxiety and fear of COVID-19 are closely associated with each other and affected by various sociodemographic and economic factors. Given this pandemic's unpredictable nature and chronicity, interventions at the community level to support high-risk groups are crucial.

All-Trans Retinoic Acid (atRA) effectively improves liver steatosis in a rabbit model of high fat induced liver steatosis.

The aim of this study is to evaluate the role of All-Trans Retinoic Acid, the biologically active metabolite of retinoids, on liver steatosis in a rabbit model of high fat induced lever steatosis. 30 male rabbits were evaluated in 5 groups: group 1 treated with normal diet, group 2-5 included rabbit's groups 2 to 5 were fed on high cholesterol diet, group 2 received no drugs, group 3 received atorvastatin, group 4 received atRA, and group 5 received both the drugs. the liver was obtained for histopathological evaluation. oral administration of atRA, atorvastatin or their combination significantly decreased serum levels of total cholesterol, LDL, AST and ALT. atorvastatin slightly but atRA remarkably decreased liver steatosis where the difference was significant. atRA group showed the highest TAC and the lowest PCO concentrations. atRA can be effective in reducing liver steatosis and its antioxidant effect plays a crucial role in the process.HighlightsNon-alcoholic fatty liver disease (NAFLD) is the most common disorder of the liver in general population and is strongly associated with metabolic risk factors including hyperlipidaemia, obesity and diabetes.atRA is very effective in reducing liver steatosis and its antioxidant effect plays a crucial role in the process.we suggest focussing on other aspects of liver steatosis such as carbohydrate metabolism and insulin resistance in order to find better ways of controlling and treating liver steatosis.

Affordability of Medication Therapy in Diabetic Patients: A Scenario-Based Assessment in Iran's Health System Context.

BACKGROUND: Diabetes imposes an enormous burden on patients, families, societies, and healthcare systems. Determining the affordability of medications is an important complicated and vague task, especially in low- and middle-income countries (LMICs). This study aimed to assess the affordability of diabetes medication therapy in Iran's health system. METHODS: This paper presents a scenario-based assessment of the affordability of all registered anti-diabetes medications in Iran in 2017. To this end, 4 medication therapy scenarios were defined as mono, dual, triple, and insulin therapy in accordance with the existing guidelines and clinicians' opinions. Then the affordability ratio of each treatment scenario was determined for type 1 and type 2 diabetes drawing on the World Health Organization (WHO)/Health Action International (HAI) Methodology. If the affordability ratio for treatment schedules was more than 1, the patients' out-of-pocket (OOP) expenses exceeded the lowest-paid unskilled government worker (LPGW)' wage per day, and the treatment was labelled as non-affordable. RESULTS: The results revealed that the mono, dual, and triple (non-insulin) medication therapies in type 2 diabetes were affordable, despite an increase in the dosage or a switch from the monotherapy to the combination therapy of oral medications. However, some treatment scenarios in the triple therapy, including oral plus insulin and some insulin only therapies, were proved to be non-affordable. In type 1 diabetes, only insulin glulisine, detemir, and lispro were non-affordable in monotherapy. Regarding the combination therapy, only isophane insulin with aspart or regular insulin were affordable treatments. CONCLUSION: Although oral medication therapies were documented to be affordable, insulin therapy, with current coverage conditions, for patients with lowest paid wages and those receiving even less is unaffordable and a major barrier to treatment; hence, policy-maker should consider targeting and more financial protection policies to improve the affordability of insulin therapies among this group of patients.

Recommendations to improve insurance coverage for physiotherapy services in Iran: a multi criteria decision-making approach.

BACKGROUND: High toll of traffic-related injuries, climate change, natural disasters, population aging, as well as chronic diseases have all made considerable demands on receiving physiotherapy services in Iran. Nevertheless, there is an assortment of complications facing utilization of such services, particularly poor insurance coverage. Therefore, the present study investigated and identified gaps in insurance coverage in order to inform future policy reforms and the design of a more comprehensive and universal benefits package for physiotherapy services in Iran. METHODS: This project was carried out in Iran, using a mix-methods (viz. qualitative-quantitative) approach. Within the first phase, a qualitative study was completed to find policy recommendations. Such recommendations were then prioritized through the Analytical Hierarchy Process (AHP), in the second phase, based on effectiveness, acceptability, cost, fairness, feasibility, and time. RESULTS: Within the first phase, a total number of 30 semi-structured interviews with health policy-makers, health insurers, faculty members, rehabilitation experts, and physiotherapists were completed. Several policy recommendations were also proposed by the study participants. Following the second phase, prioritized recommendations were provided to promote stewardship (e.g., informing policy-makers about physiotherapy services), collection of funds (e.g., placing value-added taxes on luxury goods and services), pooling of funds (e.g., moving allocated resources towards insurance (viz. third-party) mechanism), purchasing (e.g., using strategic purchasing), and benefit package (e.g., considering preventive interventions) as the main components of insurance coverage. CONCLUSION: The study findings provided a favorable ground to improve insurance coverage for physiotherapy services in Iran. As well, decision- and policy-makers can place these recommendations on the agenda in the health sector to protect population health status, especially that of groups with disabilities.

Private Demand for Covid-19 Vaccine: A Contingent Assessment from a Low-and Middle-income Country.

This study aimed to estimate Iranian willingness to pay (WTP) for a hypothetical COVID-19 vaccine and its determinants. A cross-sectional online survey was conducted from May 2nd to 20th, 2020 among the general population of Iran to estimate WTP for hypothetical COVID-19 vaccines. Four scenarios with different levels of efficacy and duration of protection were presented to respondents in the payment card scale of the contingent valuation method (CVM). With the corresponding WTPs under different scenarios, mean, trimmed mean, median WTP values, and vaccine demand was estimated. A semi-log regression model was employed to identify key factors. The vaccine acceptance rate and positive WTP were about 70% and 80%, respectively. The reluctant individuals believed free vaccination is a government responsibility. The highest trimmed mean and median WTP values were the US $15 and $4 for the vaccine with more than 80% efficacy and one-time vaccination. The median decreased to the US $2 in less effective scenarios. The vaccine demand was price-inelastic. Price, self-assessment virus risk, age, gender, education, income, and working in the health sector were significant factors. Given the price inelasticity of the COVID-19 vaccine, providing free vaccination by the Iranian government is highly recommended, particularly for low-income and vulnerable individuals.

Transparency in public pharmaceutical sector: the key informants' perceptions from a developing country.

BACKGROUND: Policymaking in the pharmaceutical sector plays a pivotal role in achieving the health systems' goals. Transparency in the pharmaceutical policy could increase confidence in decision-making processes. This study aims to assess transparency in the public pharmaceutical sector of Iran. METHODS: This qualitative study with a content analysis approach was conducted in 2017 using the World Health Organization tool to explore pharmaceutical transparency. The perceptions of the various stakeholders of the health system through semi-structured interviews with a maximum variation of stakeholders were obtained in eight functions, including registration, licensing, inspection, promotion, clinical trials, selection, procurement, and distribution of medicines. RESULTS: There are some problems in two main categories: (1) General problems, including lack of transparency, conflict of interest, centralization, and monopoly. (2) Ethical problems include illegal payments, gifts, bribes, conflicts of interest, hidden power, hoarding, relationship-oriented behavior, medicine trafficking, and counterfeit medicine. Suggested solutions include evidence-based decision-making, the use of transparent and accountable processes, standardization, needs assessment, declaring a conflict of interest, skilled human resources, and tracking prescription. CONCLUSION: Despite the development of effective pharmaceutical policy in the health care system and government interventions for the control of the market, in some functions, reviewing the pharmaceutical policy is essential. Additionally, declaring a conflict of interest statement must be at the core of policy development to provide greater transparency.

Public sphere attitudes towards the rumor sources of the COVID-19 pandemic: evidence from community perceptions in Iran.

BACKGROUND: In the COVID-19 pandemic, rumors travel far faster than the outbreak itself. The current study aimed to evaluate the factors affecting the attitudes of individuals towards the rumors-producing media in Iran. METHODS: An online cross-sectional survey was conducted in Iran in March 2020 on the source of information and rumors, along with the perception of individuals regarding the reasons for rumors propagation during the COVID-19 pandemic. RESULTS: Results showed that the majority of the participants (59.3%) believed that social media were the main source of rumors. The lack of a reliable and formal news resource was also considered the most common cause of rumoring by the participants (63.6%). An evaluation was carried out to identify the main source of misinformation and rumors. Results showed that Retired participants considered foreign media (P < 0.001) as the main resource. The middle-income level participants believed that social media (P < 0.001) were the main source. In this regard, the highly educated participants (P < 0.001), government employees, and middle-income individuals (P = 0.008) believed that national media produced rumors. CONCLUSION: Although findings were achieved during the first peak of the COVID-19 pandemic, the authorities immediately introduced the national media as a reliable news resource, which allowed both media and its journalists to reduce the gap between themselves and the public sphere. It was suggested that social networks and foreign media be more accountable in pandemics.

Investigation the determinants of pharmaceutical expenditure share of GDP in Iran and selected OECD countries.

AIM: This study estimated the GDP share of pharmaceuticals in Iran based on the drivers of pharmaceutical expenditure and compared it with that of 31 members of the Organisation for Economic Cooperation and Development (OECD). SUBJECT AND METHODS: The factors contributing to pharmaceutical expenditure were identified through literature review and studied by 8 experts to classify the factors. Then, using the panel data method, a model was built to estimate the GDP share of pharmaceutical expenditure based on the extracted factors of the selected countries in Iran's model. To explain the observed differences, several regression analyses were performed based on cross-sectional data. The analyses were performed using EVIEWS software, version 10. RESULTS: The explanatory variables for the selected countries in the panel model (R2 = 0.98) were specified. Government health expenditure (ß = 0.1432), the share of generic drugs (ß = - 0.0143), gross domestic product (GDP) per capita (ß = - 0.0058) and the rate of disability-adjusted life-years (DALY) (ß = 0.0028) contributed most to pharmaceutical expenditure. In comparison, in the Iranian estimation model (R2 = 0.84), government health expenditure (ß = 0.0536) and the share of generic drugs (ß = 0.0369) had a significant impact on pharmaceutical expenditure. In the estimation model with more estimators for Iran (R2 = 0.99), government health expenditure (ß = 0.1694), disease prevalence (ß = 0.0537), the share of generic drugs (ß = 0.0102), the DALY rate (ß = 0.0039), GDP per capita (ß = - 0.0033), and the drug price index (ß = 0.0007) contribute most to pharmaceutical expenditure. CONCLUSION: In the models of the study, factors related to the structure of the healthcare system and the pharmaceutical system contributed most to pharmaceutical expenditure as a share of GDP. Moreover, disease profiles show its predictive role in the second model for Iran.

Public and decision-maker stated preferences for pharmaceutical subsidy decisions in Iran: an application of the discrete choice experiment.

BACKGROUND: The argument about funding criteria poses challenges for health decision-makers in all countries. This study aimed to investigate the public and decision-maker preferences for pharmaceutical subsidy decisions in Iran. METHODS: A discrete choice experiment (DCE) was used for eliciting the preferences of the public and decision-makers. Four attributes including health gain after treatment, the severity of the disease, prevalence of the disease, and monthly out of pocket and relevant levels were designed in the form of hypothetical scenarios. The analysis was done by using conditional logit analysis. RESULTS: The results show all of four attributes are important for pharmaceutical subsidy decisions. But a medicine that improves health gain after treatment is more likely to be a choice in subsidy decisions (by relative importance of 28% for public and 42% for decision-makers). Out of pocket, severity, and prevalence of disease subsequently influence the preferences of the public and decision-makers, respectively. The greatest difference is observed in changing the health gain after treatment and out of pocket levels, between public and decision-makers. CONCLUSION: This research reveals that the public is willing and able to provide preferences to inform policymakers for pharmaceutical decision-making; it also sets grounds for further studies.

Assessing the Performance of Community Pharmacies in Iran by Measuring Responsiveness to Non-Medical Needs: An Application of WHO Responsiveness Framework.

OBJECTIVE: Despite growing debates about the health systems' nonmedical performance, there has not been any empirical research on nonmedical performance and patients' rights consideration as a driver of human rights in the pharmaceutical sector. This study's main objective was to assess the nonmedical performance of community pharmacies of Shiraz, Iran. METHODS: A cross-sectional study was conducted using two self-administrated Likert-based questionnaires based on the World Health Organization (WHO) responsiveness framework and the legal charter communicated by the Ministry of Health and Medical Education of Iran. The population was patients older than 18 years who took a prescription from community pharmacies located in Shiraz and willing to answer the questions voluntarily, from 2018 to 2019. Considering the weights of subdimensions of responsiveness provided by the WHO framework, the total score of responsiveness was calculated ranging from 0 to 100. FINDINGS: The response rate was 80.5%. The mean (standard deviation) overall score of responsiveness was 57.18 (21.61), with a median of 56.71. The mean score of client orientation was lower in respondents with a high education level than those with a diploma and under diploma (P = 0.028). CONCLUSION: Nonmedical pharmacy performance was considered either medium or high in more than half of the cases based on the participants' views. Regarding client, orientation was seen less often in patients with high education level compared to those with a lower education level.