Availability and affordability of anticancer medicines in Iran based on WHO/HAI standard survey methods.

PURPOSE: Cancer is the second leading cause of death in the world after cardiovascular disease. The present study aimed to investigate the affordability and physical access to chemotherapy drugs among patients with one of the three common cancers of the breast, stomach, and colon in the city of Mashhad, Iran, in 2021. METHODS: This was a descriptive cross-sectional study. Twenty drug stores including two public and 18 privates in Mashhad were evaluated. Data was collected by consistent stay in the drug stores or pharmacies. For each oncology medicine, selling price, lowest general price, and availability were investigated. Three approaches have been experimented to calculate the affordability of anticancer medicines in this study. RESULTS: Out of 28 studied medicines from public and private drug stores, 15 (53.5%) received very low, 8 (28.5%) relatively high, and 2 (7%) high access scores. The generic docetaxel brand's ultra-drug and trastuzumab (AryoTrust) were the most available drugs, but the doxorubicin (Ebewe), oxaliplatin (Mylan), and trastuzumab (Herceptin) were not available to the individuals with cancer. Also, the first approach (based on income decile) indicated that insured patients from all income deciles were able to pay the costs of the lowest price drugs of the DCF drug regimen, and if the patients were insured and belonged to the ninth income decile, they had the financial ability to buy drugs at the lowest price of the FLO drug regimen. CONCLUSION: Unaffordability of cancer medicines can lead to treatment abandonment and increase inequality in access to healthcare services. Therefore, this requires immediate attention of policy makers to be planned in order to ensure to reducing the costs of medicines for patients and increasing patient access to anticancer medicines.

Assessment of the properties of the EQ-5D-5L in patients with type 2 diabetes mellitus: a systematic review and meta-analysis.

OBJECTIVE: This study systematically reviews the validity, reliability, and responsiveness of the EQ-5D-5 L in studies of T2DM. METHODS: Relevant articles were retrieved by searching four databases, namely, the Web of Science, Scopus, PubMed, and Cochrane Library up to November 2020 with English language. All stages of the review conducted by two authors and disagreements were solved by consultation with a third reviewer. RESULTS: Of the 1614 identified studies, 46 were remained for review. The EQ-5D-5 L mean scores ranged from 0.314 (0.4) (n = 141) for diabetic patients undergoing hemodialysis to 0.971 (0.082) (n = 56) for diabetic patient without retinopathy. Mean EQ-5D-5 L scores in men (0.847) were higher those in women (0.747). Construct validity and reliability was confirmed in the studies that reported the properties of the EQ-5D-5 L, and responsiveness reported in a study that was good. There were ceiling effects in seven studies. The overall utility value was higher in Japan (0.86, 95% CI: 0.80-0.92, p = 0.0001) thanCanada (0.79, 95% CI: 0.78-0.80, p = 0.81), and the United Kingdom (0.72, 95% CI: 0.64-0.79, p = 0.0001). CONCLUSION: Findings demonstrated validity, reliability of the EQ-5D-5 L in T2DM and the existence of ceiling effects. However, the assessment of responsiveness and sensitivity needs further observations.

Estimating the Cost of Illness of Prostate Cancer in Iran.

PURPOSE: Prostate cancer is the second most common cancer among men worldwide. In the past 10 years in Iran, prostate cancer has increased and become more common among hormone-related cancers. As the percentage of seniors in the population increases, the economic burden of this cancer will likely increase significantly. This study aims to estimate direct and indirect costs of treatment at different stages of prostate cancer in Iran. METHODS: This cross-sectional study was conducted on 263 patients diagnosed with prostate cancer who were referred to prostate treatment centers in 2016. Data on direct medical costs were collected by face-to-face interviews with patients and from health care files and medical and financial documents available in the educational or referral centers. Direct nonmedical costs and indirect costs were based on self-reports by patients through face-to-face interview. FINDINGS: The results indicate that mean (SD) direct medical costs for low-risk metastatic prostate cancer, local nonmetastatic prostate cancer, local regionalized nonmetastatic prostate cancer nonresistant metastatic prostate cancer, and resistant metastatic prostate cancer were $102.79 ($33.03), US$2673.43 ($87.42), $2210.51 ($306.92), $4133.15 ($650.87), and $7747.89 ($455.80), respectively. The results indicate that mean (SD) direct nonmedical costs for low-risk, local, local regionalized, nonresistant, and resistant cancers were $97.06 ($45.00), $339.71 ($58.02), $485.29 ($36.77), $776.47 ($99.25), and $1067.65 ($600.92), respectively, and mean (SD) indirect costs for these categories were $23.85 ($20.44), $83.49 ($65.06), $119.27 ($32.59), $238.54 ($87.35), and $357.81 ($73.00), respectively. IMPLICATIONS: The findings of this research indicate that patients diagnosed with prostate cancer must bear high costs at advanced stages of the disease, whereas in the early stages of the disease, the medical costs are relatively low. The health system of Iran should work to prevent patients from reaching the metastatic stages of the disease by implementing a suitable screening system for timely diagnosis of the disease and its effective treatment.