Evaluation of Tobacco Control Measures in the Organization for Economic Co-operation and Development Countries: A Comparative Study Using Data Envelopment Analysis.

BACKGROUND: This study aimed to measure the efficiency and productivity of tobacco control policies across 16 selected Organization for Economic Co-operation and Development (OECD) countries from 2008 to 2014. STUDY DESIGN: A panel-data study. METHODS: Data envelopment analysis was used in this study. Taxation on tobacco products and pictorial warning labels were chosen as the inputs. Percentage of the population of daily smokers above 15 years old and the number of cigarettes used per smoker per day were output variables. Additionally, the Malmquist total factor productivity (TFP) was used to analyze the panel data and measure productivity change and technical efficiency changes over time. RESULTS: The highest technical efficiency score (1.05) was attributed to Norway, while the lowest (0.91) belonged to the UK. Technological change with a total mean of 1.06 implied that the technology and creativity have increased, while countries have been able to promote their creativity over the studied period. Norway with the TFP score of 1.15 was the most productive country, while the UK and Turkey with TFP scores of 0.95 and 0.98, respectively, were the least productive countries in terms of the implementation of the tobacco control policies. CONCLUSION: Most OECD countries have productively implemented tax and pictorial warning policies to reduce tobacco use. To achieve the optimum outcome of the tobacco control policies and overcome the challenges of smoking use, countries need to tackle the difficult underlying factors, i.e. tobacco industry opposition and lobbyists, smuggling, and low socioeconomic status.

Distributional health and financial consequences of increased cigarette tax in Iran: extended cost-effectiveness analysis.

BACKGROUND: To assess the potential impact of a tax-induced cigarette price increase on financial and health outcomes by different socioeconomic groups. METHODS: In a modeled condition using pooled cross-section data from Household Income and Expenditure Survey (2002-2017) and Iran 2019 population data, a methodology of an extended cost effectiveness analysis (ECEA) was applied to model the impact on cigarette consumption of hypothetically increased cigarette tax. The methodology was employed to evaluate: [1] health benefits (premature deaths averted); [2] health expenditures regarding smoking-related disease treatment averted; [3] additional tax revenues raised; [4] change in household expenditures on cigarettes; and [5] financial risk protection among male Iranian smokers in a time span of 60 years following a one-time increase in cigarette price of 75%. The Stata version 15.1 (StataCorp., College Station, TX, USA) was used to perform the relevant analysis and estimate regression models. RESULTS: A 75% increase in cigarettes price through taxation would reduce the number of smokers by more than half a million, 11% of them in the poorest quintile; save about 1.9 million years of life (11% of which would be gained in the lowest quintile compared to 20% in the highest one); eliminate a total of US$196.4 million of health expenditures (9% of which would benefit the bottom quintile). Such a policy could raise the additional annual tax revenues by roughly US$ 1 billion, where the top two quintiles bear around 46% of the total tax burden. We estimated that the tax increase would avert an estimated 56,287 cases of catastrophic expenditure that wholly concentrated among the bottom two expenditure quintiles. CONCLUSION: Increasing cigarette tax can provide health and financial benefits, and would be pro-poor in terms of health gains, Out-of-Pocket (OOP) savings, and financial risk protection against smoking-related diseases.

QALY league table of Iran: a practical method for better resource allocation.

BACKGROUND: The limited health care resources cannot meet all the demands of the society. Thus, decision makers have to choose feasible interventions and reject the others. We aimed to collect and summarize the results of all cost utility analysis studies that were conducted in Iran and develop a Quality Adjusted Life Year (QALY) league table. METHODS: A systematic mapping review was conducted to identify all cost utility analysis studies done in Iran and then map them in a table. PubMed, Embase, Cochrane library, Web of Science, as well as Iranian databases like Iran Medex, SID, Magiran, and Barakat Knowledge Network System were all searched for articles published from the inception of the databases to January 2020. Additionally, Cost per QALY or Incremental Cost Utility Ratio (ICUR) were collected from all studies. The Joanna Briggs checklist was used to assess quality appraisal. RESULTS: In total, 51 cost-utility studies were included in the final analysis, out of which 14 studies were on cancer, six studies on coronary heart diseases. Two studies, each on hemophilia, multiple sclerosis and rheumatoid arthritis. The rest were on various other diseases. Markov model was the commonest one which has been applied to in 45% of the reviewed studies. Discount rates ranged from zero to 7.2%. The cost per QALY ranged from $ 0.144 in radiography costs for patients with some orthopedic problems to $ 4,551,521 for immune tolerance induction (ITI) therapy in hemophilia patients. High heterogeneity was revealed; therefore, it would be biased to rank interventions based on reported cost per QALY or ICUR. CONCLUSIONS: However, it is instructive and informative to collect all economic evaluation studies and summarize them in a table. The information on the table would in turn be used to redirect resources for efficient allocation. in general, it was revealed that preventive programs are cost effective interventions from different perspectives in Iran.

Impact of simulated cigarette excise tax increase on its consumption in Iran.

OBJECTIVES: To assess the impact of a simulated tax-induced cigarette price increase on its consumption by different expenditure clusters in Iran. METHODS: Employing consecutive cross sections for cigarette consumption, a two-part model was applied for different expenditure groups. RESULTS: A 75% price increase in cigarettes noticeably- as is common in some countries with strong tobacco control policies-reduces current consumption in all five social classes, causing nearly 8% of current male smokers to quit or not to start. CONCLUSIONS: Findings of the current study suggest that Iranian policy makers go through to implement tobacco taxation policies to control smoking prevalence, which in turn might lead to a reduction in national healthcare expenditures as well as enhance the global community's capacity to meet Sustainable Development Goals.

A review of incidence and mortality of colorectal, lung, liver, thyroid, and bladder cancers in Iran and compared to other countries.

In Iran, a developing country in southwest Asia, an epidemiologic transition is underway from communicable to noncommunicable diseases. In Iran, cancer is the second largest group of chronic non-communicable diseases (NCDs) and the third most common cause of death following heart disease, accidents and other natural phenomena. There are some studies reporting an increasing trend in the incidence and mortality rate of a variety of cancers in Iran. Therefore, controlling and preventive interventions pertaining to cancers must be a main priority for health policy and it is recommended that the high-risk population receive earlier screening. In this review, incidence and mortality of colorectal, lung, liver, thyroid, and bladder cancers in Iran are reported.

A comparison of the earnings of specialist physicians and nurses before and after implementing the Iran's New Tariffs Book.

Background: The fair wage to specialist physicians and nurses can enhance their job motivation, quality of work, job satisfaction level, and improve the delivery of services to patients. The present study aimed to compare the proportion of changes in earnings of specialist physicians and nurses before and after implementing the Iran's New Tariffs Book and compare their average income with a number of selected countries. Methods: This descriptive-analytical study was conducted cross-sectional in the hospitals affiliated to Iran University of Medical Sciences (IUMS) in 2016. Six months before and after the announcement and implementation of the Iran's New Tariffs Book, the relative values of healthcare services were compared. Study population included all specialist physicians and nurses working in the hospitals affiliated to IUMS. Sample size was determined by sampling formula. Results: The proportion of changes in the income of medical specialists and nurses after establishing the book varied between 8% and 184%. Based on our findings, the highest increases were observed in internal medicine (184%), surgery (160%), gastroenterology (153%), and pediatrics (120%), whereas, the lowest ones belonged to ophthalmology (8%), emergency medicine (11%), neurology (24%) and anesthesia (32%). Nurses' income was surged by 43%. Conclusion: Pursuant to the findings, the income belonged to all examined medical specialists and nursing groups has increased after implementing the Iran's New Tariffs Book. The result suggested that income differences among groups have been broadened after the implementation of the Book. There was a wide and significant difference in specialist physicians' income vis-à-vis nursing groups' income before and after establishing the New Book.

Cost-effectiveness of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in two hospitals of Tehran city in 2014.

Background: Bariatric surgery with the improvement of obesity-related diseases, increases longevity and quality of life and is more cost-effective when compared to non-surgical Procedures. Objective: The aim of this study is to compare the cost-effectiveness of Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). METHOD: This study was performed in two stages. Initially, a cross-sectional study was carried out for costing LSG and LRYGB in Rasoul Akram and Bahman hospitals in Tehran in the year 2014. Direct costs for each surgical procedure were calculated according to the average time of surgery in both the private and public sectors. In the second stage, using Outcome (ΔBMI) collected by means of a systematic review study and cost data; cost effectiveness of two surgical procedures was examined by ICER analysis and compared with threshold limit. The Perspective of this analysis was health system. Results: The direct cost of services for LRYGB was $ 2991.5 (98121659 Rials) in the public sector and $4221.9 in the private sector. In LSG, it was $ 1952.9 (64055468 R) in the public sector and $ 3177.2 in the private sector. ICER for LSG was 720.48(23631855 R) and $716.27 (23493924 R) in private and public sector respectively. Conclusion: In this study, LSG procedure when compared to LRYGB was cost effective. The ICER obtained indicated that LSG surgery in comparison to LRYGB was $716.27 (23493924 R) and $720.48(23631855 R) in the public and private sector respectively. Moreover, per unit change in BMI was less than the threshold.