The economic burden of coronavirus disease 2019 (COVID-19): evidence from Iran.

This study aimed to estimate both direct medical and indirect costs of treating the Coronavirus disease 2019 (COVID-19) from a societal perspective in the patients at a referral hospital in Fars province as well as the economic burden of COVID-19 in Iran in 2020. METHODS: This study is a partial economic evaluation and a cross-sectional cost-description study conducted based on the data of the COVID-19 patients referred to a referral university hospital in Fars province between March and July 2020. The data were collected by examining the patients' records and accounting information systems. The subjects included all the inpatients with COVID-19 (477 individuals) who admitted to the medical centre during the 4 months. Bottom-up costing (also called micro-costing approach), incidence-based and income-based human capital approaches were used as the main methodological features of this study. RESULTS: The direct medical costs were estimated to be 28,240,025,968 Rials ($ 1,791,172) in total with mean cost of 59,203,409 Rials ($ 3755) per person (SD = 4684 $/ 73,855,161 Rials) in which significant part (41%) was that of intensive and general care beds (11,596,217,487 Rials equal to $ 735,510 (M = 24,310,728 Rials or $ 1542, SD = 34,184,949 Rials or $ 2168(. The second to which were the costs of medicines and medical consumables (28%). The mean indirect costs, including income loss due to premature death, economic production loss due to hospitalization and job absenteeism during recovery course were estimated to be 129,870,974 Rials ($ 11,634) per person. Furthermore, the economic burden of the disease in the country for inpatient cases with the definitive diagnosis was 22,688,925,933,095 Rials equal to $ 1,439,083,784. CONCLUSION: The results of this study showed that the severe status of the disease would bring about the extremely high cost of illness in this case. It is estimated that the high prevalence rate of COVID-19 has been imposing a heavy economic burden on the country and health system directly that may result in rationing or painful cost-control approaches.

Selective serotonin reuptake inhibitors in major depression disorder treatment: an umbrella review on systematic reviews.

BACKGROUND: Major depressive disorder (MDD) is a common mental problem and one of the leading causes of disability worldwide. SSRIs are the most commonly prescribed types of antidepressants which are called Selective Serotonin Reuptake Inhibitors and used as a primary therapeutic intervention in MDD. This umbrella review aimed to assess the efficacy and tolerability of selected SSRIs. METHODS: A systematic review on systematic reviews based on meta-analysis was conducted for head-to-head comparisons on 6 antidepressants (fluoxetine, citalopram, escitalopram, sertraline, paroxetine, and fluvoxamine) as monotherapy in the acute-phase treatment for adults with MDD. The primary outcomes included response rate and remission rate. The secondary outcome was the withdrawal rate due to any cause. All articles published on 6 electronic databases, including PubMed, Embase, Scopus, Cochrane, Web of Science, and ProQuest, until 28 August 2018, were searched and analysed. RESULTS: Fifteen meta-analysis based systematic reviews finally met all the inclusion criteria and pre-defined outcomes were extracted. Regarding the remission rate and withdrawal rate, statistically, significant comparisons showed that escitalopram was the better choice. CONCLUSION: The descriptive analysis of the included articles showed that generally, escitalopram was more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate. Keypoints This work compiles evidence from multiple meta-analyses based on systematic reviews and provides a clearer picture for assessing the efficacy of SSRIs, clarify current gaps and direction of future research in this category of antidepressants. A minority of included articles attained the high-quality rank according to AMSTAR-2. The descriptive analysis of the included articles showed that generally, escitalopram was more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate.

Is it Effective and Cost-saving to Send all Tonsillectomy Specimens for Histopathological Examinations?

INTRODUCTION: The present study aimed to investigate the necessity or unnecessity of sending all tonsillectomy specimens for pathological examinations in Shiraz, Iran; moreover, it examined malignancies, cost-saving, causes, and the ways to prevent sending all specimens. MATERIALS AND METHODS: In the first retrospective phase of the study, a checklist was used to gather demographic, clinical, and cost information of 18,437 tonsillectomy specimens during 2004-2018 in Shiraz, Iran. In order to estimate the cost of each pathology specimen, the cost components, including human resources costs and consumables, were collected in the private and public sectors separately and divided by the number of cases performed. Finally, the financial burden resulting from these services (in the study centers) was calculated by multiplying each item's cost by the total number of these services. RESULTS: Out of the total 18,437 histopathology specimens examined, only 118 (0.64%) samples were identified with unusual diagnoses, of which 66 (56%) cases had malignant tumors, and the remaining 52 (44%) samples included benign tumors (n=41), infections (n=2), and other problems (n=9). The second phase results also indicated that according to the ear, nose, and throat experts, the rules and regulations governing the country's health system and the suspicion of tumors were the main reasons for sending tonsil specimens for pathological examinations. Generally, the annual cost-saving rates in the studied public and private centers were $87,919 and $179,530 purchasing power parity, respectively. CONCLUSIONS: According to the results, sending tonsillectomy specimens should only be limited to nonroutine ones for economic-clinical reasons.

Cost-utility of new film-coated tablet formulation of deferasirox vs deferoxamine among major beta-thalassemia patients in Iran.

OBJECTIVES: Thalassemia is a hereditary disease, which caused economic burden in developing countries. This study evaluated the cost utility of new formulation of deferasirox (Jadenu) vs deferoxamine (Desferal) among B-Thalassemia-major patients from payer perspective in Iran. METHODS: An economic-evaluation through Markov model was performed. A systematic review was conducted in order to evaluate the clinical effectiveness of comparators. Because of chelating therapy is weight-dependent, patients were assumed to be 2 years-old at initiation in first and 18 years-old in second scenario, and model was estimated lifetime costs and utilities. Costs were calculated to the Iran healthcare system through payer perspective and measured effectiveness using quality-adjusted life years (QALYs). One-way sensitivity analysis and budget impact analysis was also employed. RESULTS: The 381 studies were retrieved from systematic searching through databases. After eliminating duplicate and irrelevant studies, 2 studies selected for evaluating the effectiveness. Jadenu was associated with an incremental cost-effectiveness ratio (ICER) of 1470.6 and 2544.7 US$ vs Desferal in first and second scenario respectively. The estimated ICER for Jadenu compared to generic deferoxamine was 2837.0 and 6924.1 US$ for first and second scenario respectively. For all scenarios Jadenu is presumed as cost-effective option based on calculated ICER which was lower than 1 gross domestic product per capita in Iran. Sensitivity analysis showed that different parameters except discount rate and indirect cost did not have impact on results. Based on budget impact analysis the estimated cost for patients using Desferal (based on the market share of brand) was 44,021,478 US$ in 3 years vs 42,452,606 US$ in replacing 33% of brand market share with Jadenu. This replacement corresponded to the cost saving of almost 1,568,872 US$ for the payers in 3 years. The calculated cost of using generic deferoxamine in all patients was 68,948,392 US$. The increase in the cost of using Jadenu for 10% of all patients in this scenario would be 934,427 US$ (1.36%) US$ at the first year. CONCLUSIONS: Based on this analysis, film-coated deferasirox appeared to be cost-effective treatment in comparison with Desferal for managing child and adult chronic iron overload in B-thalassemia major patients of Iran.

Measuring Equity in Access to Pharmaceutical Services Using Concentration Curve; Model Development.

This paper has two objectives. First, it establishes a model for scoring the access to pharmaceutical services. Second, it develops a model for measuring socioeconomic indicators independent of the time and place of study. These two measures are used for measuring equity in access to pharmaceutical services using concentration curve. We prepared an open-ended questionnaire and distributed it to academic experts to get their ideas to form access indicators and assign score to each indicator based on the pharmaceutical system. An extensive literature review was undertaken for the selection of indicators in order to determine the socioeconomic status (SES) of individuals. Experts' opinions were also considered for scoring these indicators. These indicators were weighted by the Stepwise Adoption of Weights and were used to develop a model for measuring SES independent of the time and place of study. Nine factors were introduced for assessing the access to pharmaceutical services, based on pharmaceutical systems in middle-income countries. Five indicators were selected for determining the SES of individuals. A model for income classification based on poverty line was established. Likewise, a model for scoring home status based on national minimum wage was introduced. In summary, five important findings emerged from this study. These findings may assist researchers in measuring equity in access to pharmaceutical services and also could help them to apply a model for determining SES independent of the time and place of study. These also could provide a good opportunity for researchers to compare the results of various studies in a reasonable way; particularly in middle-income countries.

Personality Traits and Their Relationship to Demographic Features in Addicts Referring to a Drug Rehabilitation Center in the City of Isfahan, Iran.

BACKGROUND: Addiction is one of the most serious social damages and due to its progressive nature in all aspects, adversely affects people's physical and psychological health. Hence, this paper investigates the characteristics of drug addicts in a drug rehabilitation center in the city of Isfahan. METHODS: In this cross-sectional study conducted in 2012, the population consisted of all addicts that referred to Shefa Drug Rehabilitation Center. A sample of 201 individuals was selected randomly. Two questionnaires were drawn up to collect data; the first questionnaire examined demographic characteristics and the second was the 71-item Minnesota Multiphase Personality Inventory short form. Chi-square test, Fisher's exact test and Kruskal-Wallis test were used in SPSS20 to analyze the data. RESULTS: Overall, 98% of participants were men, 65.7% were married, and 13.3% were unemployed. Depression and hypomania were respectively the most and the least prevalent disorders among individuals with high-risk psychological profiles of clinical scales respectively. Psychopathic deviation and schizophrenia were seen among the unemployed more than the employed ones. CONCLUSION: Considering the fact that depression was the most common personality disorder among the addicts participating, it is recommended that this disorder be given priority in investigations in the treatment programs of these patients. In addition, the scales of disorder, schizophrenia, mental infirmity, mental deviation, and paranoia had a significant relationship to aggression, delirium and hallucination, which must be taken into consideration in the treatment of such patients.