How do patients value features of biological medicine in rheumatoid arthritis? A discrete choice experiment.

BACKGROUND: The aim of this study was to quantify the preference of the patients regarding biological DMARDs. RESEARCH DESIGN AND METHODS: Patients' preferences were assessed using a discrete choice experiment. Eighteen different surveys describing eight attributes were designed using experimental design methods. Each survey presented eight choice tasks with two options for patients to choose one. A conditional logit model was used to calculate relative importance and willingness to pay. Subgroup analysis was conducted to evaluate the effect of the patients' characteristic on their preferences. RESULTS: A total of 306 patients were included in the study. All attributes had significant effects on the patients' choices. The most important feature was the ability to preserve physical function. The least important feature was the route of administration. Surprisingly, the out-of-pocket cost was one of the last priorities for respondents. According to the relative importance calculations, 80% of the patients' preferences can be obtained by clinical attributes. Based on subgroup analysis, the most important patient characteristic that affected their choices was the monthly out-of-pocket history. CONCLUSIONS: Different features of treatment had different effects on the patients' preferences. Quantification of the impact of each attribute not only revealed their relative importance but also determined the trade-off rate among them.

Relationship between Depression and Cognitive Impairment among Elderly: A Cross-sectional Study.

Introduction: Depression and cognitive impairment are common mental health problems among elderly, although few studies have examined their co-occurrence in aging population. So the aim of this study was to determine the relationship between depression and cognitive impairment in older adults. Methods: This cross-sectional population-based study was conducted on 506 older adults were presented to the health centers of the municipality of Tehran, Iran. Data were collected using the sociodemographic questionnaire, Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS). Data were analyzed by using SPSS-17 with correlation analysis and logistic regression. Results: The mean age of the participants was 65.71 years. Older people (>75 years) had more twice risk (95% CI: 1.01-4.90) for cognitive dysfunction. There was a significant correlation between MMSE and GDS. Elderly with collegiate education had 85% (95% CI: 0.1-0.5) and employed elderly had 56% (95% CI: 0.04-0.74) lower risk for cognitive dysfunction. Elderly with severe depression had twice risk (95% CI: 1.41-4.8) for cognitive dysfunction. Conclusion: Findings suggest there is a relationship between depression and cognitive impairment among the elderly. These findings emphasis on assessing cognitive impairment and depression in geriatric assessment in elderly.

Patient and physician preferences for type 2 diabetes medications: a systematic review.

BACKGROUND: There are several treatments to cure type 2 diabetes (T2D) and every one of them has certain attributes which is lead patients and specialists to have different preferences and select power. Therefore, we did this systematic study to evaluate patients̓ and physicians̓ preferences for type 2 diabetes medications by extracting attributes of anti-diabetic medications and identifying their relative importance. METHODS: We searched the PubMed, Ovid, Web of science, Scopus and Embase databases for articles which have been published on or before May 8th, 2018(The start time of the search in our study was May 8th, 2018). RESULTS: The searches identified 3346 studies, of which 17 (from 2009 to 2017) were included in the final synthesis and 27 attributes of type 2 anti-diabetic have been investigated. The most important attributes are changes of blood glucose and HbA1c level, hypoglycemia events, weight changes, gastrointestinal complications, cardiovascular effects, medicines cost, and administration mode and dosage of medicines. CONCLUSION: physicians and patients prefer antidiabetics which is reduce blood glucose and HbA1c level effectively and have low side effects too (hypoglycemic event, cardiovascular and gastrointestinal). The effect of weight reduction, low cost, low dosing and low frequency of using. Health care providers, Specialist, and manufacturers should consider to these attributes in treatment process and marketing. It can increase adherence to management approaches, and reduce morbidity of patients with type 2 diabetes.

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.

Comparison of the Cost-utility Analysis of Electroacupuncture and Nonsteroidal Antiinflammatory Drugs in the Treatment of Chronic Low Back Pain.

INTRODUCTION AND OBJECTIVE: Chronic low back pain (CLBP) is among the most common and important reasons for visiting a spine surgeon by patients; it is the second cause of visiting a doctor. Low back pain can cause considerable suffering and is a major financial burden in the society. There are many different methods available for the treatment of CLBP. This study aimed to compare the cost-utility of electroacupuncture (EA) and nonsteroidal antiinflammatory drugs (NSAIDs), as two common treatment methods for patients with CLBP. METHODS: This study was conducted on 100 patients suffering from CLBP. Cases were randomly selected from patients referring to two hospitals and four acupuncture clinics in Tehran. Forty-one patients received EA, and 59 patients were prescribed NSAIDs. The EuroQol five dimensions questionnaire was used to calculate quality-adjusted life-year. For calculating the total cost of the two treatment methods, face to face interview with patients was conducted by the researchers (using specific basic literature questionnaire), neurologists, and spine surgeons. The study perspective was social (direct and indirect costs calculated). RESULTS: The mean age for EA group was 41 ± 2.3 years, and for NSAIDs group, it was 38.0 ± 4.4 years. The average of the utility of patients under treatment by EA and NSAIDs was estimated as 0.70 and 0.627, respectively. The difference in utility between the two groups was significant (p ≤ 0.05). The total cost of EA and NSAIDs was estimated as 461.48 ± 57.8$ and 497.77 ± 85.2$ for one year (2016), respectively, which was also significant (p ≤ 0.05). CONCLUSION: The results indicate a significant difference between EA and NSAIDs in cases of both utility and total cost. The findings demonstrate that EA is more cost-effective than NSAIDs, as therefore can be considered as an alternative treatment for CLBP, with reasonable cost-utility.

The Clinical Efficacy of Imiglucerase versus Eliglustat in Patients with Gaucher's Disease Type 1: A Systematic Review.

Gaucher's disease (GD) is one of the most common lysosomal diseases in humans. It results from ß-glucosidase deficiency and leads to necrosis, especially in macrophages with the accumulation of glucosylceramidase in cells. Most of the deleterious effects of the disease are seen in the liver, spleen, and bone marrow. The aim of this study was to compare the efficacy of Imiglucerase with Eliglustat in treating patients with GD. PubMed/Medline, Cochrane Library, Scopus, Web of Science, Embase, and Google Scholar were searched from inception to August, 2018. Predefined inclusion criteria for included studies were based on search methodology and are as follows: All randomized, quasi-randomized controlled, and cohort studies about patients with GD Type 1 that Imiglucerase was compared with Eliglustat were included. Two authors independently choose the papers based on the inclusion criteria. From 2979 recognized studies, three studies including two randomized clinical trials and one cohort study were recognized to meet the inclusion criteria. The primary outcomes were hemoglobin level, platelets count, liver, and spleen size, and the secondary outcomes were the immunological side effects of the medicines and bone complications. The results showed that there is no meaningful difference between the two medicines in terms of increasing blood hemoglobin, platelets count, and reducing the liver and spleen size. The findings of this review showed that both medicines are effective in the treatment of GD Type 1 and there is no statistically significant difference between their efficacies.