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.

A cost-benefit analysis of genetic screening test for breast cancer in Iran.

BACKGROUND: This study aimed to evaluate the implementation of the population- and family history (FH) -based screening for BReast CAncer (BRCA) in Iran, a country where less than 10% of breast cancer cases are attributable to a gene mutation. METHODS: This was an economic evaluation study. The Benefit-Cost Ratio (BCR) for genetic screening test strategies in Iranian women older than 30 was calculated. To this end, the monetary value of the test was estimated using the willingness-to-pay (WTP) approach using the contingent valuation method (CVM) by payment card. From a healthcare perspective, direct medical and non-medical costs were considered and a decision model for the strategies was developed to simulate the costs. A one-way sensitivity analysis assessed the robustness of the analysis. The data were analyzed using Excel 2010. RESULTS: 660 women were included for estimating WTP and 2,176,919 women were considered in the costing model. The cost per genetic screening test for population- and FH-based strategies was $167 and $8, respectively. The monetary value of a genetic screening test was $20 and it was $27 for women with a family history or gene mutation in breast cancer. The BCR for population-based and FH-based screening strategies was 0.12 and 3.37, respectively. Sensitivity analyses confirmed the robustness of the results. CONCLUSIONS: This study recommends the implementation of a FH-based strategy instead of a population-based genetic screening strategy in Iran, although a cascade genetic screening test strategy should be evaluated in future studies.

Subjective valuation of Iranian women for screening for gene-related diseases: a case of breast cancer.

BACKGROUND: About 5-10% of breast cancer cases are attributed to a gene mutation. To perform preventive interventions for women with a gene mutation, genetic screening BRCA tests have recently been implemented in Iran. The present study aimed to determine Iranian women's subjective valuation for screening BRCA tests for early detection of breast cancer to help policymakers to make decisions about genetic screening tests for breast cancer and to know the applicants. METHODS: An online survey was completed by women older than 30 years old in Tehran, the capital of Iran in 2021. A hypothetical scenario about genetic screening tests for breast cancer was defined. The subjective valuation for the tests was assessed by a willingness to pay (WTP) using the contingent valuation method (CVM) by payment card. Demographics, history of breast cancers, knowledge, and physiological variables were considered as independent variables, and a logistic regression model assessed the relationship between WTP and the variables. RESULTS: 660 women were included. 88% of participants intended to participate in BRCA genetic screening for breast cancer if it were free. The mean WTP for the tests was about $ 20. Based on the logistic regression, income, family history of breast or ovarian cancer, and positive attitude were associated with WTP. CONCLUSIONS: Iranian women were willing to intend for genetic screening BRCA tests and pay for them as well. The result of the present study is of great importance for policy makers when it comes to funding and determining co-payments for BRCA genetic screening tests. To achieve a high participation rate of women in breast cancer screening plans, a positive attitude should be promoted as a psychological factor. Educational and informative programs can help.

Systematic review of women's knowledge, attitude, and practice towards breast cancer.

The present study aims to systematically review the women's knowledge, attitude, and practice (KAP) of breast cancer (BC) screening methods to get enough information for policymakers to orient the screening strategies. All English KAP studies on BC screening methods in five databases up to January 2021 were included. The quality of the final articles was assessed using the STROBE checklist. The qualitative synthesis was performed. Out of 5574 retrieved articles, 28 were included. About 64% of the articles were of high quality. Overall, there were poor knowledge, negative attitude, and low practice between women. The educational programs and cultural plans can encourage regular screening. Women's excessive optimism to their BC risk should be eliminated by focusing on the risk of the disease, more.

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.

Population or family history based BRCA gene tests of breast cancer? A systematic review of economic evaluations.

BACKGROUND: Nearly 56% of at-risk carriers are not identified and missed as a result of the current family-history (FH) screening for genetic testing. The present study aims to review the economic evaluation studies on BRCA genetic testing strategies for screening and early detection of breast cancer. METHODS: This systematic literature review is conducted within the Cochrane Library, PubMed, Scopus, Web of Science, ProQuest, and EMBASE databases. In this paper, the relevant published economic evaluation studies are identified by following the standard Cochrane Collaboration methods and adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement reporting some recommendations for articles up to March 2020. Thereafter, the inclusion and exclusion criteria are applied to screen the articles. Disagreements are resolved through a consensus meeting. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist is used in the evaluation of quality. Finally, a narrative synthesis is performed. To compare the different levels of incremental cost-effectiveness ratio (ICER), the net present value is calculated based on a discount rate of 3% in 2019. RESULTS: Among 788 initially retrieved citations, 12 studies were included. More than 60% of the studies were originated from high-income countries and were published after 2016. It is noteworthy that most of the studies evaluated the payer perspective. Moreover, the robustness of the results were analyzed through one-way and probabilistic sensitivity analyses in nearly 66% of these studies. Nearly, 25% of the studies are focused and defined population-based and family history BRCA tests as comparators; afterwards, the cost-effectiveness of the former was confirmed. The highest and lowest absolute values for the ICERs were $65,661 and $9 per quality adjusted life years, respectively. All studies met over 70% of the CHEERs criteria checklist, which was considered as 93% of high quality on average as well. CONCLUSIONS: The genetic BRCA tests for the general population as well as unselected breast cancer patients were cost-effective in high and upper-middle income countries and those with prevalence of gene mutation while population-based genetic tests for low-middle income countries are depended on the price of the tests.

Factors Affecting Panic Buying during COVID-19 Outbreak and Strategies: A Scoping Review.

Background: This study aimed to assess factors affecting panic buying and strategies to deal with them during COVID-19 with a scoping review. Method: The review was performed based on Arksey and O'Malley. PubMed, Embase, Scopus, ProQuest, and Science Direct databases were selected to search. All English language full-text articles from Jan 2020 to May 2021 were included. Initially, the titles and abstracts of the retrieved articles were read and screening was accomplished based on the research question. After that, the full text of eligible studies was examined. A third reviewer was resolved disagreements at any stage by a consensus meeting. A self-assessment form was designed for data extraction. The causes of panic buying were assessed as a descriptive study. Results: The search process returned 23 articles after deletion for complete data extraction and analysis. Through thematic analysis, the factors influencing panic buying were divided into six categories including cognitive, emotional, behavioral, social, and economic factors as well as government action, and finally, the recommended strategies were categorized in two categories included psychosocial and economic. Conclusion: A holistic view of panic buying's causes allows planners and decision-makers to design categorized strategies beyond the suggested strategies. Increasing customer awareness and monitoring the flow of information through social media and mass media, psychotherapy, counseling, and economic strategies are considered by planners to combat panic buying.

Medical costs of osteoporosis in the Iranian elderly patients.

Background: In the coming years and near future, Iran will experience a main demographic transition resulting in an aging phenomenon and increased number of people over 65 years. Aging leads to increased medical expenditures associated with chronic diseases such as osteoporosis. This study aimed to investigate the patient-specific hospitalization costs of osteoporosis treatment in elderly patients. Methods: A retrospective cost analysis of hospitalization arising from osteoporosis conducted on all the elderly patients (adults aged 65 years and above) in a teaching hospital in Tehran through examining hospital admissions during 2017. The elderly patients consisted of 295 with a length of stay ≥ 24 hours. Cost analysis was performed using a bottom-up micro-costing approach and payer perspective (patient and insurer); and the result was statistically significant (p≤0.05). Nonparametric tests, including Mann-Whitney and Kruskal-Wallis tests, were used to investigate the relationship between affecting variables. Hospital training was considered as a control variable. The data were analyzed using SPSS 11 software Results: The mean age of the patients was 71.3 years; of the patients, 79% were female and 21% male. The overall crude prevalence of osteoporosis was 80% among people ≥ 65 years and 85% among patients who experienced relevant surgeries. The average cost of hospitalization was $3794.13. Also, 3 main areas of hospital costs were identified: consumables (57.70%), hoteling (17.24%), and surgical services (15.76%). The prevalence of osteoporosis was 4 times higher in women compared with men. Moreover, there were significant differences between the variables affecting hospital costs, such as gender, length of stay, diagnosis, intensive care unit services, and surgery (p<0.05). Conclusion: Age-associated diseases such as osteoporosis increase the health care costs. The dominant cost drivers in this study were the consumables, hoteling, and surgical services, respectively. Policymakers and health care planners should consider such variables as gender, previous surgeries in the patients' records, length of stay, and intensive care unit services as driving factors and determinants of hospital costs for older seniors with osteoporosis.

Determinants of Hospital Inpatient Costs in the Iranian Elderly: A Micro-costing Analysis.

OBJECTIVES: Aging is assumed to be accompanied by greater health care expenditures. The objective of this retrospective, bottom-up micro-costing study was to identify and analyze the variables related to increased health care costs for the elderly from the provider's perspective. METHODS: The analysis included all elderly inpatients who were admitted in 2017 to a hospital in Tehran, Iran. In total, 1288 patients were included. The Mann-Whitney and Kruskal-Wallis tests were used. RESULTS: Slightly more than half (51.1%) of patients were males, and 81.9% had a partial recovery. The 60-64 age group had the highest costs. Cancer and joint/orthopedic diseases accounted for the highest proportion of costs, while joint/orthopedic diseases had the highest total costs. The surgery ward had the highest overall cost among the hospital departments, while the intensive care unit had the highest mean cost. No statistically significant relationships were found between inpatient costs and sex or age group, while significant associations (p<0.05) were observed between inpatient costs and the type of ward, length of stay, type of disease, and final status. Regarding final status, costs for patients who died were 3.9 times higher than costs for patients who experienced a partial recovery. CONCLUSIONS: Sex and age group did not affect hospital costs. Instead, the most important factors associated with costs were type of disease (especially chronic diseases, such as joint and orthopedic conditions), length of stay, final status, and type of ward. Surgical services and medicine were the most important cost items.

Curriculum gaps in teaching clinical skills to Iranian undergraduate medical students.

INTRODUCTION: The inefficacy of clinical skill education during the clerkship has been reported in several studies. The present study was conducted to evaluate the competency of medical students in performing several clinical skills through an Objective Structured Clinical Examination (OSCE), aiming to evaluate the quality of the existing curriculum in the clerkship phase. MATERIAL AND METHODS: The cross sectional study was conducted at the end of the clerkship period, before the students had entered the internship. The OSCE exam was conducted in the morning (2 different tracts) and in the evening (2 similar tracts) and 86 students participated in the exam. Each tract consisted of seven stations. The students' points in the stations assessing history taking and clinical skills were compared. RESULTS: The students gained the highest points in the history taking stations, whereas the procedure stations accounted for the lowest points; there was a significant difference between these stations (p < 0.001). The female students achieved higher scores in the OSCE exam compared to males (p = 0.004). CONCLUSIONS: The OSCE exam revealed the inefficacy of the current medical curriculum in teaching the required clinical skill to undergraduate medical students during the clerkship.