Cost-Effectiveness Analysis of Macitentan in Comparison With Bosentan in the Treatment of Pulmonary Arterial Hypertension in Iran.

OBJECTIVES: Pulmonary arterial hypertension (PAH) is a chronic and progressive disease that, if left untreated, shortens the life expectancy of patients. Endothelin receptor antagonists, such as macitentan and bosentan, play an essential role in improving the patient's symptoms, quality of life, and life expectancy. This study aimed to evaluate the cost-utility of macitentan compared with bosentan in treating PAH from the health system perspective in Iran. METHODS: For evaluating the cost-effectiveness of macitentan, a Markov model consisting of 5 states, functional class (FC) I, FC II, FC III, FC IV, and death, was designed using the TreeAge software. The lifetime time horizon and a 3-month cycle length were set. Patients entered the model from FC II or FC III states based on the initial probabilities. Costs were measured in US dollars (USD), and outcomes were measured in terms of quality quality-adjusted life-years (QALYs). Consequently, the incremental cost-effectiveness ratio (ICER) was calculated. In addition, sensitivity analysis was performed to determine the robustness of the model by examining the possible effects of uncertainties on the final result. RESULTS: The costs of treatment with macitentan and bosentan in PAH in Iran were calculated at 19 429 and 17 246 USD, and the outcomes were 4.02 and 3.04 QALYs, respectively. Therefore, ICER was calculated at 2233.46 USD/QALY. One-way sensitivity analysis demonstrates that the model is robust; nevertheless, it is most sensitive to the price of macitentan and bosentan. CONCLUSION: Treatment with macitentan was associated with both higher costs and QALYs than bosentan. Nevertheless, it is considered the cost-effective treatment strategy in Iran given that the calculated ICER falls below the willingness to pay threshold.

The Mediating Role of Organizational Identification on Sustainable Human Resources Management and Organizational Citizenship Behavior's Relationship.

Background: There is a general theme in studying employees in the research and development (R&D) department individual performance studies, where tremendous attention has been paid to innovation performance compared to behavioral and particularly extra-role behavior of employees in this department. Objectives: This study investigates the relationship between sustainable human resource management (s-HRM) and organizational citizenship behavior (OCB) through the mediating role of organizational identification (OI) in R&D employees. Methods: A standard questionnaire was used to evaluate s-HRM, OI, and OCB. Five hundred questionnaires were delivered to all employees of the research and development departments of 59 Iranian pharmaceutical companies, and finally, 316 completed questionnaires were collected. Results: The results of data analysis with WarpPls software revealed a positive and significant relationship between s-HRM and OI, as well as OI and OCB. Investigating the mediating role of OI showed that OI partially mediates the relationship between s-HRM and OCB. The model was checked in terms of its fit indices, which were evaluated as favorable. Conclusions: The findings suggest that s-HRM improves employees' willingness to go beyond their defined job description to display in OCB. Additionally, they imply that strengthening OI can improve OCB in employees.