Model-Based Economic Evaluations of Interventions for Dementia: An Updated Systematic Review and Quality Assessment.

BACKGROUND: There has been an increase in model-based economic evaluations of interventions for dementia. The most recent systematic review of economic evaluations for dementia highlighted weaknesses in studies, including lack of justification for model assumptions and data inputs. OBJECTIVE: This study aimed to update the last published systematic review of model-based economic evaluations of interventions for dementia, including Alzheimer's disease, with a focus on any methodological improvements and quality assessment of the studies. METHODS: Systematic searches in eight databases, including PubMed, Cochrane, Embase, CINAHL, PsycINFO, EconLit, international HTA database, and the Tufts Cost-Effectiveness Analysis Registry were undertaken from February 2018 until August 2022. The quality of the included studies was assessed using the Philips checklist and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. The findings were summarized through narrative analysis. RESULTS: This review included 23 studies, comprising cost-utility analyses (87%), cost-benefit analyses (9%) and cost-effectiveness analyses (4%). The studies covered various interventions, including pharmacological (n = 10, 43%), non-pharmacological (n = 4, 17%), prevention (n = 4, 17%), diagnostic (n = 4, 17%) and integrated (n = 1, 4%) [diagnostics-pharmacologic] strategies. Markov transition models were commonly employed (65%), followed by decision trees (13%) and discrete-event simulation (9%). Several interventions from all categories were reported as being cost effective. The quality of reporting was suboptimal for the Methods and Results sections in almost all studies, although the majority of studies adequately addressed the decision problem, scope, and model-type selection in their economic evaluations. Regarding the quality of methodology, only a minority of studies addressed competing theories or clearly explained the rationale for model structure. Furthermore, few studies systematically identified key parameters or assessed data quality, and uncertainty was mostly addressed partially. CONCLUSIONS: This review informs future research and resource allocation by providing insights into model-based economic evaluations for dementia interventions and highlighting areas for improvement.

Inputs of Iranian health system reform plan from health sector managers and policy-makers' points of view.

CONTEXT: Health system reform plan refers to conducting some fundamental, systematic, and sustainable changes. AIMS: The aim of the present study was to evaluate different required inputs of Iran Health Transformation Plan from experts' viewpoints. SETTINGS AND DESIGN: The data of this qualitative study were collected using semi-structured interviews. SUBJECTS AND METHODS: The purposive sampling method led to 18 participant selection and then they were interviewed. Interviewees were assured about confidentiality of information. STATISTICAL ANALYSIS USED: The thematic analysis method and MAXQDA software were employed for analyzing the data. RESULTS: There were 4 main themes and 35 subthemes extracted including management requirements for health development plan, human resources, information resources, and financial resources. Each theme had subthemes such as "resource allocation," "development of required standards for human resources," "human resources' motivation," "failures in IT infrastructures," "hospital information management software," "guidelines and instructions," "costs controlling," and "financing the plan". CONCLUSIONS: Results of the present study put significant emphasis on the path of improving the effectiveness and efficacy of applying the discussed inputs, which can be a light for revising past policies and taking better future steps, it also can be a resource guide for policy-makers and managers of the health-care system.

Electronic health indicators in the selected countries: Are these indicators the best?

BACKGROUND: Many changes have been made in different sciences by developing and advancing information and communication technology in last two decades. E-health is a very broad term that includes many different activities related to the use of electronic devices, software as well as hardware in health organizations. AIMS: The aim of this study is comparing electronic health indicators in the selected countries and discussion on the best indicators. SETTINGS AND DESIGN: This study has chosen 12 countries randomly based on the regional division of the WHO. The relevant numbers of health indicators and general indicators and information technology indicators are extracted of these countries. We use data from the Bitarf's comparative study, which is conducted by the Iranian Supreme Council of Information Technology in 2007. MATERIALS AND METHODS: By using Pearson correlation test, the relations between health general indicators and IT indicators are studied. STATISTICAL ANALYSIS USED: Data was analyzed based on the research objectives using SPSS software and in accordance with research questions Pearson correlation test were used. RESULTS: The findings show that there is a positive relation between indicators related to IT and "Total per capita health, healthy life expectancy, percent literacy". Furthermore, there is a mutual relation between IT indicators and "mortality indicator". CONCLUSION: This study showed differences between selective indicators among different countries. The modern world, with its technological advances, is not powerless in the face of these geographic and health disparity challenges. Researchers must not rely on the available indicators. They must consider indicators like e-business companies, electronic data internet, medical supplies, health electronic record, health information system, etc., In future, continuous studies in this field, to provide the exact and regular reports of amount of using of these indicators through different countries must be necessary.