Economic Evaluation for Benign Prostatic Hyperplasia in Iran: Surgical Treatment or Dutasteride.

Benign prostatic hyperplasia is a common chronic disease that is age-dependent. There are two main types of interventional treatment, transurethral resection of prostate as a gold standard (TURP) and open prostatectomy (OP); also, there are two pharmacological groups for managing BPH: alpha-blockers and 5-alpha-reductase inhibitors (5-ARIs). In this economic evaluation study, one 5-ARIs, dutasteride and two main surgical treatments are compared as alternatives for treating moderate BPH in Iran. A cost-utility study with an Iranian health provider perspective was conducted. Markov model in a cohort of 1000 patients with BPH with annual cycle length and ten years' time horizon was developed by using MS EXCEL 2013. The effectiveness measure was an improvement in the IPSS score and transformed to the utility. The transition probabilities, utilities and adverse events were extracted from published clinical trials. The direct medical costs were measured in the 2017 US Dollar. One way sensitivity analysis and scenario analysis were conducted.For treating moderate BPH, seventy-year-old men, in the base case scenario, the utility of pharmacotherapy is 18 QALY less than surgery, and the cost of pharmacotherapy is 136,301.1 $ less than surgery. ICER for pharmacotherapy was 7,572.3 $ compared to surgery. In the sensitivity analysis, the model is not sensitive to most variables but the unit cost of dutasteride. Based on scenario analysis conducted for different age groups, pharmacotherapy with dutasteride is preferred to surgery in patients over 60 years of age in Iran. However, for younger adult men between 40-60 years old, surgery is a cost-effective alternative.

An application of multi-criteria decision-making approach to sustainable drug shortages management: evidence from a developing country.

BACKGROUND: Drug shortage is a significant public health problem, especially for drugs related to life threatening conditions. Almost all countries affected by variety of supply problems and spent a considerable amount of time and resources responding to shortage. The aim of present study is to determine and prioritize strategies to achieve best solutions for these considerable healthcare system challenges and to evaluate this strategies base on practical criteria. METHODS: To achieve the study objectives, the research was conducted in two phases. Determining of the strategies to control drug shortage, and comprehensive assessments of priority of possible strategies. For each phase, a self-design questionnaire was developed. The five main managerial strategies dimensions including: regulatory, financial, supply chain, information system and policy-making were set out. Forty-five alternatives were elicited from literature, and were evaluated and trimmed to 37 strategies based on experts' opinion. The Multiple criteria decision-making (MCDM) methods were applied in second phase. Five important criteria including cost, time, labor, compliance with law and culture were weighed by Analytic Hierarchy Process (AHP) technique. Then, 37 alternatives have been rated base on the five criteria on the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) technique. RESULTS: "Creating integrated Supply chain information system to manage medicines inventory in the country", "Creating and using the databases to predict the shortage of medicines", "Using track and trace system" are alternatives 20th, 24th and 25th, which related to supply chain (SC) and information system (IS) dimensions have higher priority in the experts' point of view. The results show IS dimension has 100 percentage of priority; following that policy and supply chain have higher priority, respectively. CONCLUSION: Health systems rely on consistent supplying of pharmaceuticals to support patient care. The results show that information system, policy-making and supply chain are in the top-ranking priorities. Warning system needs to be improved to the advance system via better collaboration with stakeholders, publish precise and explicit national guidelines for drug shortage management, enforce the guidelines, and improve Iran FDA's pharmaceutical market control capability.

Supply Chain Challenges in Pharmaceutical Manufacturing Companies: Using Qualitative System Dynamics Methodology.

In today's competitive market environment, pharmaceutical companies have learned that improving supply chain performance is critical to maintain competitive advantages. Forecasting, planning, procurement, financing, stock levels, and marketing strategies are some of the areas in which managers have to decide about them and balance their enter-related effects simultaneously, to achieve organizational goals. This study is based on the results of literature review, experts' opinion acquisition, and qualitative system dynamics modeling. So, according to method, triangular researches have been considered. The purpose of this research is to explore pharmaceutical supply chain (PSC) challenges and the dynamics behavior of variables playing a special role in PSC. Also, it provides different policies to overcome the challenges. For the first step to reach this goal, several semi-structured interviews with expert supply chain managers are conducted to explore the main challenges. Inaccuracy in forecasting, long lead times, lack of optimum target inventory, and high SC costs are the most important PSC problems. Then, qualitative system dynamics methodology is used to demonstrate the inter-relationship between variables that have impact on challenges. Finally, three strategic policies are recommended including: Collaborative relationship with suppliers, Investment in new technologies, and Information technology (IT) establishment. Consequently, the results can give PSC managers a comprehensive view for decision making and bringing their attention to the importance of feedback behavior of variables in long term and their effects on organizational decisions and goals.

Agent Based Simulation of Sale and Manufacturing Agents Acting Across a Pharmaceutical Supply Chain.

Agent based modeling and simulation consider the behavior of agents acting in a system. The agents' interactions result in changing the agent's behavior, the whole agent based system, and its environment. In this study, the manufacturing, sale, and receiving orders behaviors pertinent to manufacturing and sale agents acting across a pharmaceutical supply chain of an Iranian manufacturing medicine (as a case) are simulated. The departments related to these two agents have some problems affecting the entire supply chain; the results are interpreted based on agile, lean, and green paradigms. During the research, three medicines were selected and the related data were gathered. Then, mathematical modeling and regression analysis (in some parts) were applied. Next, a computer model was composed on matrix library environment (MATLAB). Finally, four scenarios were simulated. According to the information resulted from simulating the first scenario, none of supply chains pertaining to each medicine is agile. Based on the findings of simulating the second scenario, decreasing waste leads the non-antibiotic medicine supply chain to move toward the lean and green paradigms more. According to the third scenario, although more order requests can be fulfilled by increasing production capacity, the supply chain will not become agile. The last scenario's goal is checking the possibility of receiving 145000 units' orders for the non-antibiotic medicine which should be prepared during next 70 days while the company confronts lack of raw material and the suppliers are domestic; based on the results, the order will be rejected due to lack of time.