Decomposition Analysis of Socioeconomic Inequalities in Utilization of Oral Health Services: A Population-Based Study in Urban and Rural Households of Ahvaz.

Background: Inequality in the use of dental services is a primary concern of global health, and few studies have been done in this field in Iran. Therefore, the present study aimed to conduct a decomposition analysis of socioeconomic inequalities in the utilization of oral health services. Methods: This was a cross-sectional study in which 715 households, including 2680 people living in Ahvaz, were included using a stratified-cluster sampling. Data were collected using a questionnaire. For data analysis and estimating the elasticity of the influencing factors, the logistic model and Stata software were used. The social and economic disparities in oral health variables were broken down into determinant components using the Van Doorslaer and Wagstaff technique. Results: The key factors determining social and economic inequalities in the utilization of these services were insurance status, education level, income quintile, and occupation. Nearly 31% of utilization inequalities can be attributed to the insurance status of households. In addition, the education level of household members (about 28%) was the second factor of inequality. The variables of income quintile and occupation are also considered as the third factor, and the age of household members had a negative role in the socioeconomic inequality. Conclusion: The utilization of oral health services can be improved by improving economic and social variables in society. Therefore, including oral health services in insurance plans and primary health care services and supporting people with low-income levels can play an important role in reducing these inequalities.

Cost-Effectiveness Rivaroxaban versus Enoxaparin for Prevention of Venous Thromboembolism after Knee Replacement Surgery in Iran.

Background: The highest risk of developing venous thromboembolism (VTE) is seen in patients who have undergone orthopedic surgery. One of the most common methods to reduce the risk of thromboembolism in these patients is anticoagulant prophylaxis. Rivaroxaban is one of the anticoagulants that has a lower cost than other anticoagulants and has a significant effect on people's quality of life as it is edible. The study aimed to determine the cost-effectiveness of rivaroxaban as compared with enoxaparin for venous thromboembolism prophylaxis in knee replacement patients in Iran. Methods: It was a quantitative and economic evaluation study with a cost-effectiveness approach and an applied study because its results could be used directly for policy-making and decision-making in the health system. The study was conducted in 2019 and 2020. This study considered the health system perspective. The study population included all knee replacement patients. The sample included 203 patients referred to Shafa Yahyaeian Hospital and 300 patients referred to Rasoul Hospital in Tehran. The study was conducted in two steps. A systematic review of studies was conducted in the first step. The CHEERS checklist was used to evaluate the quality of the studies in the systematic review. The EQ-5D questionnaire was used in the second step to calculate the QALY, and the cost collection form was used to calculate the direct medical cost. The data were analyzed through a decision tree, and Stata and Tree age pro softwares were the analysis tools. Also, according to the per capita GDP index for Iran in 2018, the incremental cost-effectiveness threshold was considered to be $10,000. Results: The results of this study showed that during the prophylaxis period, rivaroxaban was one and a half times less costly than enoxaparin. Quality of life in uncomplicated conditions were 0.85 QALY for rivaroxaban and 0.69 QALY for enoxaparin. Based on the results of this study, the cost of rivaroxaban during the prophylaxis was $ 160.97 and the quality of life was 0.85 QALY and the cost of enoxaparin was $ 276.07 and the quality of life was 0.69 QALY. The cost difference between the two interventions was $ 115.09 and the outcome difference was 0.16 QALY. The incremental cost-effectiveness ratio was $ 189.40 for rivaroxaban and $ 416.28 for enoxaparin. According to the results of this study, rivaroxaban reduced the duration of hospitalization by an average of 2 days in asymptomatic patients (prophylaxis period) compared to enoxaparin. Conclusion: Rivaroxaban, an oral medication, reduced costs and increased the quality of life in people undergoing knee replacement surgery compared with an enoxaparin injection vial. This drug was less costly for the patient and health systems and its use was cost-effective as a thromboprophylaxis drug following knee replacement surgery.

Cost-benefit Analysis of Breast Cancer Screening with Digital Mammography: A Systematic Review.

Background: Breast cancer is a non-communicable and common disease that accounts for a high percentage of deaths. Early diagnosis of this disease reduces the death rate. Screening methods such as digital mammography can help prevent or identify the disease earlier. Therefore, this study aims to analyze the cost-benefit of breast cancer using digital mammography. Methods: This systematic review was conducted based on PRISMA 2020 checklist. PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, and Google Scholar were searched without any time limitation on June 2022. The quality of the studies was evaluated with the CHEERS checklist. After data extraction, the results were synthesized by thematic content analysis. Results: During the search, 3468 records were identified, of which 1061 were duplicates. 2407 titles and abstracts screened in terms of inclusion criteria. Finally, after studying 20 fulltexts, three of them were included in the study. The quality of these articles was scored between 10 and 16. These studies were from Spain, Denmark, and the United States from 2000 to 2019. Two studies showed that digital mammography is not as effective as other screening methods. Conclusion: The results of this study showed that digital mammography is not very cost-benefit for the health care system. An increase in its repetition frequency imposes more costs on the health system and doesn't have more benefits for it.

Cost-Effectiveness Analysis of Rapid Test Compared to Polymerase Chain Reaction (PCR) in Patients with Acute Respiratory Syndrome.

Background: It is important to have a rapid and cost-effective laboratory test for the early diagnosis of respiratory diseases.The aim of this study was to analyze the cost-effectiveness of rapid tests and PCR in patients with suspected influenza. Methods: This study was a cost-effectiveness analysis from a community perspective that in which patients who were referred to the emergency department of selected hospitals of IUMS university with suspected respiratory symptoms of influenza were studied by convenience sampling method. The intervention and comparator were rapid tests and PCR respectively. effectiveness indicators in this study include sensitivity, specificity, positive and negative predictive value of both tests, and it examines costs from a community perspective. After drawing the decision tree model in the TreeAge software, the incremental cost-effectiveness ratio was calculated and to evaluate the strength of the analysis results, one-way and two-way sensitivity analyses on all cost and effectiveness parameters were used. Results: According to the findings of this study, the effectiveness index in rapid test and PCR is equal to 0.90 and 0.91, respectively, and the average cost of the two tests is equal to 62.157 and 201.37$, respectively, the ICERwas 25450.27 and the cost-effectiveness threshold was estimated equal to 6000 according to the per capita GDP of the country. One-way and two-way sensitivity analysis showed that the result of cost-effectiveness analysis did not change, and the rapid test is cost-effective. Conclusion: Rapid test is less costly and effective than PCR, but the cost difference is greater than the difference in effectiveness and in terms of effectiveness indicators, both diagnostic tests are almost similar, and this cost difference has led to the choice of the rapid test as a cost-effective option. Therefore, it is recommended that physicians prioritize rapid tests in the diagnosis of respiratory diseases.

Cost-effectiveness Analysis of Air Emergency Versus Ground Emergency Medical Services Regarding the Patient's Transportation and Treatment in Selected Hospital.

Background: The prehospital emergency system is the first initiator of medical care as an alternative to hospitals and health care services that helps patients and injured people in critical situations and accidents. This study aimed to evaluate the cost-effectiveness of air ambulance versus ground ambulance regarding the patient's transportation and treatment. Methods: In this cost-effectiveness analysis study, 300 patients who were transferred to the Shohadaye HaftomTir hospital by air ambulance and 300 patients transferred by ground ambulance during the study period were selected in 2021-2022. This study examined the costs from the society's perspective. After drawing the decision tree model in TreeAge software, the incremental cost-effectiveness ratio was calculated; and to evaluate the strength of the analysis results, one-way and two-way sensitivity analyses were done on all costs and consequence parameters. Results: The effectiveness rate in the ground ambulance group and in the air ambulance group was 0.42591 and 0.5566, respectively, and the total cost of transportation and treatment by ambulance in these patients was $412.88 and for patients transported and treated by air ambulance was $11898.05. Therefore, air ambulance costs more and is more effective than ground ambulance, and the amount of incremental cost and effectiveness of air ambulance compared with ground ambulance was $11485.17 and 0.130773 units, respectively. The incremental cost-effectiveness ratio (ICER) of the 2 strategies was 87825.28, and the cost-effectiveness threshold was $7200. To determine the strength of the study results, one-way and two-way sensitivity analyses were done and the results of the cost-effectiveness analysis was not changed. Conclusion: Our study showed that ground ambulance is more cost-effective than air ambulance and the most important reason is that the total cost of air ambulance is 26 times more than ground ambulance, however, it is more effective than ground ambulance.

Economic Burden of Epidermolysis Bullosa Disease in Iran.

Background: Epidermolysis bullosa (EB) is prevalent in Iran and incurs direct and indirect costs on the health care system and the patient. Therefore, this study was conducted to estimate the economic burden of this disease in Iran. Methods: This study includes all patients with EB disease who had been referred to the medical centers of Iran in 2019-2020 for treatment of their disease, especially Hazrat Fatimah Hospital and their medical records are available in Iran EB Patients Association (IEBPA). In estimating the economic burden of diseases and costing studies, we calculated the average direct and indirect costs for a patient and used it to estimate the costs of the patient population. In this study, a prevalence approach was used to calculate the economic burden of this disease. For this purpose, the existing cases of the disease in 2019-2020 were calculated. The data collected from the questionnaires that were completed through interviews with patients as well as the data extracted from the review of their files were entered into Excel software and analyzed. Results: The total direct medical costs of direct non-medical and indirect are equal to 7.319.428.315 & 5.390.440.775 and 45.875.654.514 Rials respectively, and the total economic burden of the disease and the average of each patient is 58.585.514.604 and 155.890.789 respectively. Conclusion: High indirect costs, especially informal care, represent the socio-economic burden of this disease and constitute more than half of the total indirect costs. Therefore, the obvious gap and hidden social costs of this disease are related to health policymakers, especially when they want to study the impact of this disease on different income classes of families.

Medical therapy versus percutaneous coronary intervention in ischemic heart disease: A cost-effectiveness analysis.

Background: Ischemic heart disease is categorized into two acute and chronic groups, and its treatments include revascularization and medical therapy. The aim of this study is to evaluate the economic burden of medical therapy compared to percutaneous coronary intervention in ischemic heart disease. Methods: This study has been done in two steps. The first was a systematic review and meta-analysis to measure the effectiveness of two interventions and the second step was a cost-effectiveness analysis from the perspective of society. The data analysis included a meta-analysis and the Markov cohort simulation. RewMan v5 and tree age software were utilized. Uncertainties related to the model parameters were evaluated using one-way and two-way sensitivity analyses. Results: Regarding the effectiveness of interventions, the odd ratio of the quality of life in the medical therapy group (CI: 0.76-1.10) was 0.91 times the PCI group (p=0.34). This rate for mortality in medical therapy (CI: 0.52-9.68) was 2.23 times more than the PCI group; this result was not significant (p=0.02). In the cost-effectiveness analysis, the cost-effectiveness threshold was $ 16,482; ICER in increasing the QoL and reduction in the mortality rate was $ 25320.11 and $ 562.6691, respectively. Regarding the sensitivity analysis, the model was not sensitive in changing parameters in a specific domain. Conclusion: According to this study, PCI is more cost-effective than medical therapy in the reduction of mortality rate and in the field of increasing quality of life. MT strategy is more cost-effective than the PCI. This study considers controversies regarding the most appropriate treatment for patients with ischemic heart disease that is helpful for health policymakers, cardiologists and health managers.

Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis.

Background: Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy. Methods: Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software. Results: A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I2 = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I2= 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy. Conclusion: This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.

Technical efficiency and resources allocation in university hospitals in Tehran, 2009-2012.

BACKGROUND: Assessment of hospitals' performance in achieving its goals is a basic necessity. Measuring the efficiency of hospitals in order to boost resource productivity in healthcare organizations is extremely important. The aim of this study was to measure technical efficiency and determining status of resource allocation in some university hospitals, in Tehran, Iran. METHODS: This study was conducted in 2012; the research population consisted of all hospitals affiliated to Iran and Tehran medical sciences universities of. Required data, such as human and capital resources information and also production variables (hospital outputs) were collected from data centers of studied hospitals. Data were analyzed using data envelopment analysis (DEA) method, Deap2,1 software; and the stochastic frontier analysis (SFA) method, Frontier 4,1 software. RESULTS: According to DEA method, average of technical, management (pure) and scale efficiency of the studied hospitals during the study period were calculated 0.87, 0.971, and 0.907, respectively. All kinds of efficiency did not follow a fixed trend over the study time and were constantly changing. In the stochastic frontier's production function analysis, the technical efficiency of the studied industry during the study period was estimated to be 0.389. CONCLUSION: This study represented hospitals with the highest and lowest efficiency. Reference hospitals (more efficient states) were indicated for the inefficient centers. According to the findings, it was found that in the hospitals that do not operate efficiently, there is a capacity to improve the technical efficiency by removing excess inputs without changes in the level of outputs. However, by the optimal allocation of resources in most studied hospitals, very important economy of scale can be achieved.

Association of Emotional Response Indicators with the Risk of Recurrence and Hospitalization in Coronavirus Patients.

Anxiety, stress, and fear can adversely affect the mental and physical health of people. The present study aimed to examine the association of these emotional response indicators with outcomes (recurrence, hospitalization, and mortality) in coronavirus 2019 (COVID-19) patients. A prospective cohort study was conducted between February 2020 and July 2021 in three hospitals in Tehran, Iran. The included patients (n=350) completed three questionnaires on COVID-19-related anxiety, stress, and fear. Patients with at least one emotional response indicator were assigned to the exposed group (n=157) and those without to the unexposed group (n=193). After one month of follow-up, the medical condition of all participants was determined through phone calls. Data were analyzed with logistic and multivariate regression models using STATA 9 software. The number of patients with COVID-19 recurrence in the exposed and unexposed groups was 71 (45%) and 16 (8%), respectively, and for hospitalization 79 (50%) and 16 (8%), respectively. The relative risk of recurrence and hospitalization due to COVID-19 in the exposed group was 5.62 and 6.25 higher than in the unexposed group, respectively (P<0.001 for both). The results of regression analysis showed that underlying diseases were not significantly associated with recurrence and hospitalization. The total number of deaths was six, all of which were in the exposed group. Given the greater risk of recurrence and hospitalization in COVID-19 patients with anxiety, stress, or fear, there is a need to devise and implement appropriate strategies to prevent and manage mental disorders.

Effectiveness of revascularization interventions compared with medical therapy in patients with ischemic cardiomyopathy: A systematic review protocol.

BACKGROUND: Cardiomyopathies is a group of heart diseases that directly affects the heart muscle, and their causes is not just high blood pressure, congenital and pericardial diseases but ischemic cardiomyopathy disease are also caused by vascular disorders, and to confirm the diagnosis, angiography is required. There are several methods for treating and controlling ischemic cardiomyopathy in world health systems and especially in the Iran health system, which include medical treatment, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG). METHODS: This systematic review will includes observational and interventional studies in English and Persian languages and evaluates effectiveness of revascularization interventions and medical therapy in patients with ischemic cardiomyopathy. Animal studies will not be considered. In this systematic review, our sources of information will be electronic databases, trial registries, and different types of grey literature. An electronic search is performed through PubMed, Cochrane library, Scopus, Web of Science, EMBASE, Tufts Medical Center Cost-Effectiveness Analysis Registry, NHS Economic Evaluations Database. To integrate the results of studies with similar results, meta-analysis will be used, for which Comprehensive Meta-Analysis (CMA) software will be used. Results are provided using relative risk with a 95% confidence interval for information. RESULTS: The results of this systematic review will be published in a peer-reviewed journal. CONCLUSION: To our knowledge, this systematic review will be the first to evaluate existing research on the effectiveness of revascularization interventions compared with medical therapy in patients with ischemic cardiomyopathy. The review will benefit patients, healthcare providers, and policymakers.