Patterns of case fatality and hospitalization duration among nearly 1 million hospitalized COVID-19 patients covered by Iran Health Insurance Organization (IHIO) over two years of pandemic: An analysis of associated factors.

BACKGROUND: Different populations and areas of the world experienced diverse COVID-19 hospitalization and mortality rates. Claims data is a systematically recorded source of hospitalized patients' information that could be used to evaluate the disease management course and outcomes. We aimed to investigate the hospitalization and mortality patterns and associated factors in a huge sample of hospitalized patients. METHODS: In this retrospective registry-based study, we utilized claim data from the Iran Health Insurance Organization (IHIO) consisting of approximately one million hospitalized patients across various hospitals in Iran over a 26-month period. All records in the hospitalization dataset with ICD-10 codes U07.1/U07.2 for clinically/laboratory confirmed COVID-19 were included. In this study, a case referred to one instance of a patient being hospitalized. If a patient experienced multiple hospitalizations within 30 days, those were aggregated into a single case. However, if hospitalizations had longer intervals, they were considered independent cases. The primary outcomes of study were general and intensive care unit (ICU) hospitalization periods and case fatality rate (CFR) at the hospital. Besides, various demographic and hospitalization-associated factors were analyzed to derive the associations with study outcomes using accelerated failure time (AFT) and logistic regression models. RESULTS: A total number of 1 113 678 admissions with COVID-19 diagnosis were recorded by IHIO during the study period, defined as 917 198 cases, including 51.9% females and 48.1% males. The 61-70 age group had the highest number of cases for both sexes. Among defined cases, CFR was 10.36% (95% CI: 10.29-10.42). The >80 age group had the highest CFR (26.01% [95% CI: 25.75-26.27]). The median of overall hospitalization and ICU days were 4 (IQR: 3-7) and 5 (IQR: 2-8), respectively. Male patients had a significantly higher risk for mortality both generally (odds ratio (OR) = 1.36 [1.34-1.37]) and among ICU admitted patients (1.12 [1.09-1.12]). Among various insurance funds, Foreign Citizens had the highest risk of death both generally (adjusted OR = 2.06 [1.91-2.22]) and in ICU (aOR = 1.71 [1.51-1.92]). Increasing age groups was a risk of longer hospitalization, and the >80 age group had the highest risk for overall hospitalization period (median ratio = 1.52 [1.51-1.54]) and at ICU (median ratio = 1.17 [1.16-1.18]). Considering Tehran as the reference province, Sistan and Balcuchestan (aOR = 1.4 [1.32-1.48]), Alborz (aOR = 1.28 [1.22-1.35]), and Khorasan Razavi (aOR = 1.24 [1.20-1.28]) were the provinces with the highest risk of mortality in hospitalized patients. CONCLUSION: Hospitalization data unveiled mortality and duration associations with variables, highlighting provincial outcome disparities in Iran. Using enhanced registry systems in conjunction with other studies, empowers policymakers with evidence for optimizing resource allocation and fortifying healthcare system resilience against future health challenges.

Burden of ischemic heart disease in the Middle East and North Africa (MENA) and attributable risk factors: An epidemiological analysis from 1990 to 2019.

Introduction: Despite the burden of ischemic heart disease (IHD), there remains a paucity of research on the incidence, mortality, and burden of this condition in the Middle East and North Africa (MENA) regions. This study aimed to evaluate the epidemiology and the risk factors associated with IHD in the MENA region. Methods: This study was performed based on the GBD study 2019 data. We retrieved the data related to the epidemiology and burden of IHD, including prevalence, incidence, years of life lost due to premature death (YLLs), years lived with disability (YLDs), and mortality at the global level and in MENA countries across years and sexes. Results: IHD accounted for approximately 2.55 million (95 % UI 2.29-2.83) incident cases in MENA in 2019, with an age-standardized incidence rate of 613.87 (95 % UI 555.84-675.16) per 100 000 people, which has decreased by 9 % between 1990 and 2019. IHD accounted for 11.01 % of DALYs causes in MENA in 2019, an increase of 68 % compared to 1990. The DALYs rate from IHD increased with age in both men and women and was higher in men than in women in all age groups, except 85-89 years age-group, in 2019. Conclusion: The age-standardized prevalence and incidence of IHD are decreasing in MENA. However, this reduction is lower than the global level, which can be due to a weaker performance of the countries in the region in reducing the prevalence and incidence of the disease compared to the global average.

Relevance of the COVID-19 rapid response system to public health policymaking in Islamic Republic of Iran.

Background: The COVID-19 pandemic has increased awareness of the need for high-quality and timely evidence to support policy- and decision-making in emergency situations. Aims: To describe the experiences of the National Institute of Health Research (NIHR), Islamic Republic of Iran, in adopting evidence-informed policymaking during the COVID-19 pandemic. Methods: During the COVID-19 pandemic, NIHR institutionalized a rapid response system that was backed up by evidence-informed policy- and decision-making. Activities included establishment of a preparedness and response management committee, gathering and providing timely pandemic information to policymakers, establishing a timeline of actions and activities, and a feedback system for policy responses and queries. Results: The COVID-19 rapid response committee addressed the questions of 40 policymakers by synthesizing and analysing evidence and making it available to relevant stakeholders. It developed and disseminated knowledge products to provide relevant information. We identified the need for more timely data and more reliable research evidence for pandemic management. Conclusion: National institutions responding to health emergencies need to take responsibility for establishing and managing a robust rapid response systems that can provide valid and timely evidence to policymakers. Over time, their capacity should be monitored, evaluated and strengthened to adapt and respond appropriately to pandemics, outbreaks and epidemics.

Utilization Trend of Parenteral Antidiabetic Drugs in Type 2 Diabetic Patients Covered by Iran Health Insurance Organization from 2011 to 2030.

Background: Exploring and analyzing the cost of medicines is an important tool for their management and planning. This study aims to analyze the utilization and costs of parenteral anti-diabetic medications during the past decade and predict the future trend of these medications from 2021 to 2031 in people that are covered by Iran Health Insurance Organization (IHIO). Methods: This study was based on secondary analysis of data routinely reported to IHIO from 2011 to 2019. For each drug, the Defined Daily Dose (DDDs) and DDDs per 1000 inhabitants per day were calculated for the last 9 years according to the WHO protocol. Then a regression analysis was used to predict the utilization trend of each drug for the following 10 years. Results: The overall utilization of injectable antidiabetic drugs has constantly increased during the last nine years. This increasing trend is estimated to continue during the next decade. Conclusion: In Iran, the increase in the diabetic population and better access in the future will be the main reasons for the increase in the utilization of various insulins. The increasing trend of utilizing injectable anti-diabetic drugs in Iran might be partly due to new patients and partly because of improvement in patient access to new treatments. This also suggests that, compared to the average in the commonwealth countries, Iranian diabetic patients has faced lack of drug utilization in the past decade that is gradually reducing.

Is lifestyle modification with individual face-to-face education and counseling more effective than usual care for controlling hypertension? A systematic review and meta-analysis of randomized controlled trials.

Hypertension (HTN) management continues to be a concern due to challenges with behavioral risk factors. Patient education to modify unhealthy behaviors appears to be effective in managing HTN. Therefore, this meta-analysis aimed to determine whether individualized face-to-face education and counseling have a beneficial effect on systolic and diastolic blood pressure (SBP and DBP) in hypertensive patients. Studies were extracted from PubMed, Scopus, Cochrane Library, and Web of Science databases. Nine studies, comprising 2627 participants, were included. Random effects models were used to pool estimates of mean differences (MDs) with 95% confidence intervals (CIs) in SBP and DBP between the intervention and usual care groups. SBP and DBP were significantly reduced at the 6-month (MD = -4.38 mmHg, 95% CI: -6.95 to -1.81; MD = -2.09 mmHg, 95% CI: -3.69 to -0.50, respectively) and 12-month time points (MD = -2.48 mmHg, 95% CI: -3.96 to -1.01; MD = -1.71 mmHg, 95% CI: -2.88 to -0.55, respectively) with intervention. At the 24-month time point, there was a significant change in SBP (MD = -2.13 mmHg, 95% CI: -3.94 to -0.32) with intervention compared with the usual care group. This study showed that individualized face-to-face education and counseling add significant benefits to usual care for lowering blood pressure in hypertensive patients. Graphical Abstract.

Barriers to Mental and Social Health Programs in Schools: A Qualitative Study.

Objective: In order to achieve development goals, in addition to providing students with physical health, their mental and social health should be considered as a necessity and priority in development programs. This program, called the Nemad Project in Iran was formally established in 2015. This study aims to explore the challenges of the Nemad project in Iranian schools based on stakeholders' views. Method : The present qualitative study, with a contractual content analysis approach, was conducted on 21 experts in the field of social harm prevention and mental health promotion at the senior, intermediate, and operational levels in educational institutions and schools, Ministry of Health, the Judiciary and the Planning and Budget Organization. These experts also included project technical officers. Participants were selected using snowball and purposeful sampling methods. Data were collected through semi-structured interviews and analyzed by coding, classification, and extraction of the main themes. Results: Six main themes were derived that included inefficiency in resource management (with subcategories of inadequate facilities and equipment, inadequate human resource management, and information management system deficiencies), weakness in program organization (with subcategories of poor cross-sectoral and weak inter-sectoral subgroups), challenges of laws/regulations/policies (with sub-categories of defective protocols and guidelines and lack of specific task descriptions), barriers and challenges to implementation of policies (with macro and school policy implementation subcategories), structural factors (with subcategories of financial resources allocation problems, inconsistency in managerial levels, and deficiencies in decision-making principles), weaknesses in educational processes (with subcategories of inadequate teacher education, weaknesses in parenting courses, and weaknesses in student education), and ultimately, weaknesses in monitoring and evaluation (with the subcategory of lack of a monitoring and evaluation system). Conclusion: According to experts, implementation of mental and social programs in schools is not in a desirable situation and is faced with certain challenges. To enhance the management of the Nemad project in Iranian schools, it is necessary to compile flowcharts of service delivery and inter-device communication, allocate resources to meet the expectations of each organization, do performance-based budgeting, take a comprehensive look at parental issues, and design a system of monitoring and evaluating the requirements.

Iranian medical students' tendency to migrate and its associated factors.

BACKGROUND: Medical staff migration is one of the challenges for both developed and developing countries affecting society's health and welfare, which limits access to equity. Therefore, this study was designed and conducted to investigate the tendency to migrate and the factors affecting it among medical students of the Tehran University of medical sciences, Tehran, Iran, in 2019. METHODS: This cross-sectional study was performed among 472 medical students using a valid questionnaire which was designed after reviewing the literature and using the opinions of experts. The tendency to migrate and its associated factors were analyzed and reported using the Pearson correlation test, independent t-test, one-way ANOVA test, Tukey post-hock test, and Kruskal-Wallis non-parametric test. RESULTS: According to this study, the tendency to migrate was 6.13 ± 2.82 out of 10. While there was no significant relationship between age, marital status, medical educational phase and the tendency to migrate (p > 0.05); There was a significant relationship between willingness to migrate with variables of gender (p = 0.027), pre-university study region (p < 0.001), father's academic degree (p = 0.007), mother's academic degree (p < 0.001), having the relative abroad (p < 0.001), foreign trip experience (p < 0.001), foreign language skills (p < 0.001), number of published articles (p = 0.005) and Iran's National Elite Foundation membership (p = 0.039). CONCLUSIONS: Females, elites, and those with higher socioeconomic state, previous exposure to foreign countries, the ability to speak foreign languages, and research activity are more likely to migrate. Considering the high tendency to migrate among Iranian medical students, urgent and severe strategies must be undertaken to solve this social and health problem.

The influencing factors of health-related quality of life of the general population of Iran during the COVID-19 Pandemic.

COVID-19 is a global challenge that negatively affects the health-related quality of life (HRQoL) of the general population. The current study aimed to evaluate HRQoL and its associated factors among the Iranian general population during the COVID-19 pandemic. The data were collected in 2021 using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) and EQ-5D Visual Analog Scale (EQ VAS) questionnaires through an online survey. Participants were recruited via social media from the Fars province. The multiple binary logistic regression model was used to identify factors influencing participants' HRQoL. Kolmogorov-Smirnov, the t-test, ANOVA, and the chi-square test were used. All tests were conducted at a significance level of 5% using Stata 14.2 and SPSS 16. A total of 1,198 participants were involved in this cross-sectional study. The mean age of participants was 33.3 (SD:10.2), and more than half were women (55.6%). The mean EQ-5D-3L index value and EQ-VAS of the respondents were 0.80 and 77.53, respectively. The maximum scores of the EQ-5D-3L and EQ-VAS in the present study were 1 and 100, respectively. The most frequently reported problems were anxiety/depression (A/D) (53.7%), followed by pain/discomfort (P/D) (44.2%). Logistic regression models showed that the odds of reporting problems on the A/D dimension increased significantly with supplementary insurance, including concern about getting COVID-19, hypertension, and asthma, by 35% (OR = 1.35; P = 0.03), 2% (OR = 1.02; P = 0.02), 83% (OR = 1.83; P = 0.02), and 6.52 times (OR = 6.52; P = 0.01), respectively. The odds of having problems on the A/D dimension were significantly lower among male respondents, those in the housewives + students category, and employed individuals by 54% (OR = 0.46; P = 0.04), 38% (OR = 0.62; P = 0.02) and 41% (OR = 0.59; P = 0.03), respectively. Moreover, the odds of reporting a problem on the P/D dimension decreased significantly in those belonging in a lower age group and with people who were not worried about getting COVID-19 by 71% (OR = 0.29; P = 0.03) and 65% (OR = 0.35; P = 0.01), respectively. The findings of this study could be helpful for policy-making and economic evaluations. A significant percentage of participants (53.7%) experienced psychological problems during the pandemic. Therefore, effective interventions to improve the quality of life of these vulnerable groups in society are essential.

Payment systems for dialysis and their effects: a scoping review.

BACKGROUND: End stage renal disease (ESRD) is a major health concern and a large drain on healthcare resources. A wide range of payment methods are used for management of ESRD. The main aim of this study is to identify current payment methods for dialysis and their effects. METHOD: In this scoping review Pubmed, Scopus, and Google Scholar were searched from 2000 until 2021 using appropriate search strategies. Retrieved articles were screened according to predefined inclusion criteria. Data about the study characteristics and study results were extracted by a pre-structured data extraction form; and were analyzed by a thematic analysis approach. RESULTS: Fifty-nine articles were included, the majority of them were published after 2011 (66%); all of them were from high and upper middle-income countries, especially USA (64% of papers). Fee for services, global budget, capitation (bundled) payments, and pay for performance (P4P) were the main reimbursement methods for dialysis centers; and FFS, salary, and capitation were the main methods to reimburse the nephrologists. Countries have usually used a combination of methods depending on their situations; and their methods have been further developed over time specially from the retrospective payment systems (RPS) towards the prospective payment systems (PPS) and pay for performance methods. The main effects of the RPS were undertreatment of unpaid and inexpensive services, and over treatment of payable services. The main effects of the PPS were cost saving, shifting the service cost outside the bundle, change in quality of care, risk of provider, and modality choice. CONCLUSION: This study provides useful insights about the current payment systems for dialysis and the effects of each payment system; that might be helpful for improving the quality and efficiency of healthcare.

The health system barriers to a healthy diet in Iran.

BACKGROUND: Decreasing calories, salt, sugar and fat intake is considered the golden solution to reduce obesity and cardiovascular diseases (CVDs) related to unhealthy diet. This study aimed to investigate the health system induced barriers to a healthy diet in Iran. METHODS: This is a qualitative health policy analysis. We collected data through 30 semi-structured, face-to-face interviews with purposefully identified experts, including policy-makers, top-level managers and related stakeholders. All interviews were transcribed verbatim, and analyzed with qualitative content analysis, facilitated by MAXQDA 11 software. RESULTS: We identified six categories of barriers: structural problems within the Ministry of Health and Medical Education (MoHME), i.e. Supreme Council of Health and Food Security (SCHFS); the MoHME's inadequate stewardship of public health, the short life of the deputy of social affairs within the MoHME and its possible impact on the National Health Assembly; inefficient traffic lights labelling for foods; lack of adequate policies and guidelines for monitoring restaurants and fast foods and insufficient incentive policies for the food industry. CONCLUSION: In line with the World Health Organization (WHO) Global Action Plan, in 2015, Iran defined its roadmap for prevention and control of NCDs, i.e. some nutritional interventions. However, different stakeholders including MoHME and other sectors need to provide series of interventions to change people's approach about food choice so that they might reduce the consumption of foods with excessive salt, fat and sugar.

Economic barriers and gaps to reach the desirable consumption of salt, sugar, and fat in Iran: a qualitative study.

BACKGROUND: Non-communicable diseases (NCDs), also known as chronic diseases, specifically cardiovascular diseases (CVD), cancers, respiratory diseases, and diabetes are the main reason for more than two-thirds of global deaths, in which the unhealthy diet is one of the primary risk factors. The golden solution to reducing obesity and CVD linked to an unhealthy diet is to reduce calories, salt, sugar, and fat intake. Besides, activities highlighting lifestyles that contain healthy diets usually focus on reducing salt, sugar, and saturated fat consumption. As a result, the researchers aimed to study the gaps and economic barriers to recommended consumption of salt, sugar, and fat in Iran, based on WHO recommendations. METHODS: This is a qualitative study. We conducted semi-structured and in-depth interviews with 30 stakeholders, including academics, experts, and key informants in different sectors from December 2018 until August 2019 in Tehran, Iran. We used a purposeful and snowball sampling method to select participants. All interviews were transcribed verbatim and thematically analyzed using MAXQDA 11. RESULTS: Economic problems and inflation in Iran caused people to eat more unhealthy foods, while a healthy diet consumption was reduced due to higher prices. Unfair political sanctions imposed on the country caused economic pressure and adversely affected family nutrition. Worse still, despite legal bans, advertising unhealthy foods via media, mainly to generate revenue, encouraged more consumption of unhealthy food. The lack of targeted subsidies and failure in tax legislation and implementation related to the unhealthy products deteriorated the conditions. CONCLUSION: Some economic barriers have hampered plans to reduce salt, fat, and sugar consumption in Iran. Fundamental reforms in the tax and subsidy system are required to improve people's eating habits. In particular, citizens' income that has been continuously shrinking due to economic conditions, imposed sanctions, and the inevitably high inflation needs to be addressed urgently. Unless the government of Iran deals with the economic barriers to healthy nutrition, the pathway for implementing the national action plan for prevention and control of NCDs toward a 30% mortality reduction due to NCDs by 2030 looks unlikely to reach.

Risk Mapping and Spatial Modeling of Human Cystic Echinococcosis in Iran from 2009 to 2018: A GIS-Based Survey.

Background: Cystic echinococcosis (CE) is one of the most important parasitic infections in subgroup seven common neglected diseases of humans and animals. It is in the list of 18 neglected tropical diseases of the WHO. We aimed to analyze the situation of the disease in Iran using Geographical Information System (GIS) and satellite data analysis. Methods: The data obtained from the Ministry of Health and Medical Education, Tehran, Iran and other related centers from 2009 to 2018 were analyzed using GIS. Then, the spatial distribution maps of the disease were generated, and the hot spots of the disease in Iran were determined using spatial analysis of ArcGIS10.5 software. Geographically weighted regression (GWR) analysis in ArcGIS10.5 was used to correlate the variables affecting the disease including temperature, relative humidity, normalized different vegetation index (NDVI) and incidence of hydatidosis. Data analysis was performed by Linear regression analysis and SPSS 21 software using descriptive statistics and chi-square test. Results: Zanjan, Khorasan Razavi, North Khorasan, Chaharmahal Bakhtiari, Hamedan, Semnan, and Ardabil provinces were the hot spots of CE. The results of geographical weighted regression analysis showed that in Khorasan Razavi, North Khorasan, Chaharmahal Bakhtiari, Hamedan, Semnan, Ardabil, Zanjan, Qazvin, and Ilam provinces, the highest correlation between temperature, humidity, vegetation density and the incidence of hydatidosis was observed (P<0.001). Conclusion: The use of maps could provide reliable estimates of at-risk populations. Climatic factors of temperature, humidity, NDVI had a greater impact on the probability of hydatidosis. These factors can be an indicator used to predict the presence of disease. Environmental and climatic factors were associated with echinococcosis.

Breastfeeding Duration and Its Effective Factors in Kerman Province, Iran.

Introduction: Complete cessation of breastfeeding (CCB) at the right time is as important as starting breastfeeding, as well as identifying the factors that affect the duration of breastfeeding, so that breastfeeding promotion programs focus on these causes, to increase mothers' ability and desire to breastfeed. This study aimed to determine the time of CCB and its related factors. Methods: This analytical cross-sectional study was conducted in 2020. This study was performed at all health centers and health homes affiliated to Kerman University of Medical Sciences, in Kerman province, Iran. A total of 802 urban and rural mothers with children aged from 30 to 36 months completed the questionnaire. The validity and reliability of the questionnaire were confirmed by Cronbach's alpha of 85%. Data were analyzed using SPSS software version 16. Results: The mean time of breastfeeding was 19.23 ± 7.09 months and the median was 22-month-year. About 41% of children were breastfed until 24-month. There was a significant relationship between the time of CCB with contraception, number of households, place of residence, and weight at 6-month at the level of 0.05. Conclusion: Duration of breastfeeding is influenced by some demographic and cultural factors. The timing of the CCB is near to the suggestions of the World Health Organization (WHO) and religious teachings.

Ranking Universities of Medical Sciences as Public Health Services Provider Institutions in Iran: A Result-Chain Analysis.

BACKGROUND: Universities of medical sciences (UMSs) in Iran have geographic catchment areas (normally a province) in which they are responsible for public health services as well as provision of care by public providers. The present study strived to analyze and rank the performance of the medical sciences universities in improving the public health and primary healthcare. METHODS: Data on 41 indicators on the output (16 indicators), outcome (16 indicators), and impact (9 indicators) levels were extracted from various data sources. Principal component analysis (PCA) was used to calculate the weight for each of the indicators. The score range for each level of performance is between 0 and 1. A score of 1 indicates the highest and a score of 0 indicates the lowest level of performance. Finally, the UMSs were ranked by their scores. RESULTS: The national mean performance scores of the UMSs on the output, outcome, impact, and the composite indicator levels were 0.756, 0.641, 0.561, and 0.563, respectively. The results show that the changes in performance scores at different levels of the results chain are remarkable. CONCLUSION: The national mean performance of the UMSs of Iran is not satisfactory. However, there is considerable dispersion in their performance. Designing effective interventions in proportion to the conditions of universities on different levels of the results chain, developing a robust information system, conducting continuous monitoring and evaluation of public health are recommended for balanced improvements in public health and primary healthcare indicators in the country.

Healthcare Utilization and Expenditures among Iranian Chemical Warfare Survivors Exposed to Sulfur Mustard.

BACKGROUND: This study aims to explore the healthcare utilization (HCU) and expenditures from complementary health insurance among Iranian people who survived sulfur mustard (SM) exposure during the Iran-Iraq war. METHODS: This study was conducted between March 21, 2018 and March 21, 2019 using secondary data. Data on the HCU and expenditure of war survivors after their exposure to SM were obtained from the Iran Veterans and Martyr Affair Foundation (VMAF) database and the national complementary insurance organization that covers their medical expenses. Multiple linear and zero-inflated poison regression (ZIP) models were used to estimate the costs and HCU. Analyses were performed in R software version 3.6.3. RESULTS: Among 58880 survivors who were included in study, 36383 (61.7%) used at least one service during a year. The total frequency of HCU was 15.6 services per person per year. The annual mean medical cost of each survivor was US$807.6 (±2901.2). The highest number of utilizations was related to medicine and physician visits. The highest median cost was related to rehabilitation (US$151.7), medical equipment (US$84.5), medicine (US$83.3) and inpatient services (US$ 48.8). With increasing age, disability, weight, severity of injury in lung or eye injuries, the rate of health service utilization rose significantly. CONCLUSION: Over 30 years after the Iran-Iraq war, Iranian people who were exposed to SM and survived still suffer from injuries and pose a significant drain on healthcare resources.

Adaptation Frameworks for Clinical Guidelines and Proposing a Framework for Iran: A Review and Comparative Study.

Background: Clinical Practice Guidelines (CPGs) can be adapted to local conditions to prevent any resources from being wasted. Adaptation of CPGs implies a systematic view of developed guidelines through maintaining evidence-based principles in order to find the ones most relevant with patients' conditions and its integration with the cultural and regional requirements of the target population and health system facilities. The main purpose of the study was to describe, interpret and compare different frameworks for adaptation of clinical guidelines and proposing a comprehensive framework for Iran. Methods: This study was based on a review and comparative analysis of adaptation frameworks of CPGs. Initially, all adaptation frameworks were collected by systematic search in the literature. We searched the following electronic databases: PubMed, Scopus, Trip Database, Science Direct, and Google Scholar. Then, based on the stages of the comparative study, frameworks were described, interpreted, juxtaposed, and compared. Finally, a comprehensive framework for the adaptation of clinical guidelines was proposed by consulting a panel of experts. Results: Our literature search resulted in 26 frameworks, of which 18 were potentially relevant. Based on inclusion/exclusion criteria, nine frameworks were included in the study and have been described, interpreted, and compared. The proposed comprehensive framework for the adaptation of clinical guidelines consists of ten main steps. Conclusion: The proposed comprehensive framework is an appropriate tool for the adaptation of clinical guidelines in Iran that can be used in other countries. However, further validation of the framework requires case studies and expert consultation to determine its application to the adaptation of clinical guidelines.

Public Preferences and Willingness to Pay for a COVID-19 Vaccine in Iran: A Discrete Choice Experiment.

BACKGROUND AND OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic is a major international threat and vaccination is the most robust strategy to terminate this crisis. It is helpful for policymakers to be aware of community preferences about vaccines. The present study aims to investigate the public's preferences and willingness to pay for the COVID-19 vaccine in Iran. METHODS: This research is a cross-sectional study performed using a discrete choice experiment for a sample of the public population of several provinces of Iran in 2021. The samples were divided into two groups: one group expressed their preferences regarding the vaccine's attributes, and another group expressed their preferences regarding prioritizing individuals to get the vaccine. The discrete choice experiment design included five attributes including effectiveness, risk of severe complications, price, location of vaccine production, and duration of protection related to preferences for vaccine selection and six attributes including age, underlying diseases, employment in the healthcare sector, the rate of virus spread, the necessary job, and cost to the community related to preferences for prioritizing individuals to get the vaccine. A total of 715 individuals completed the questionnaire. The conditional logit regression model was used to analyze the discrete choice experiment data. Willingness to pay for each attribute was also calculated. RESULTS: The willingness to pay for the COVID-19 vaccine with 90% (70%) efficacy, the risk of severe complications for 1 (5) person per one million people, imported (domestic) vaccine, and 24-month (12-month) duration of protection attributes was about US$71 (US$37). The preference for vaccination for respondents was enhanced by increasing the efficacy and the duration of vaccine protection and decreasing complications and costs. The likelihood of prioritizing individuals to get a vaccination was increased for a person with an underlying disease, employment in the healthcare sector, the necessary job for the community, the high potential for virus spread in the community, and the high cost of death to the community. The age variable was not statistically significant for prioritizing individuals to get the vaccine. CONCLUSIONS: In the setting of the COVID-19 vaccination program, the public's preferences identified in this study should be considered. The obtained results provide useful information for policymakers to identify individual and social values for an appropriate vaccination strategy.

Methods and criteria for the assessment of orphan drugs: a scoping review.

OBJECTIVES: This study aimed to identify different criteria for priority setting of rare diseases to help policy makers in making evidence-informed decisions. METHODS: A scoping review was conducted to comprehensively examine the existing various methods and criteria for prioritizing orphan drugs and rare diseases. We performed searching in Scopus, PubMed, Embase, and websites of health technology assessment (HTA) agencies, 2000-21, and data were extracted. RESULTS: From the 1,580 identified publications, eleven articles were included. Multicriteria decision analysis was the most frequent method (seven out of eleven studies) used for priority setting. The extracted criteria for priority setting of orphan products were analyzed based on six main categories as follows: health outcomes and clinical implications (six subsets which showed clinical implications), economic aspects (four subsets that indicated the economic effects of orphan drugs and rare diseases), disease and population characteristics (six subsets that included the characteristics of the rare diseases), therapeutic alternatives and uniqueness of orphan technologies (two subsets which discussed the alternatives and uniqueness of orphan technologies), evidence (three subsets which regarded the quality and availability of evidence), and other criteria (three subsets dealing with social and organizational criteria). Cost-effectiveness, budget impact, and disease severity were the most frequent criteria in the studies. CONCLUSIONS: Because of the high price of orphan drugs and limitations of using HTA for reimbursement of them, it is critical to explore them by precise technical methods like multiple criteria decision making in priority setting.

A comprehensive review of official discount rates in guidelines of health economic evaluations over time: the trends and roots.

BACKGROUND: The question of discounting in health economics is anything but settled, so much so that a section of the Health Technology Assessment (HTA) guidelines is devoted to it. OBJECTIVE: This study aimed to review the trend of the value of the official discount rates (DRs) of costs and health outcomes and their roots worldwide. METHODS: Four methods were combined to identify official DRs over time globally. These methods included a systematic review of the HTA/pharmacoeconomic/health economic evaluation guidelines, a review of methodological documents or guidelines accessible on the websites of HTA organizations, and two separated reviews of the websites of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Guide to Health Economic Analysis and Research (GEAR). RESULTS: Our systematic search eventually yielded 339 documents from the literature, 35 links from the website of the HTA organizations, 51 documents from the website of the ISPOR, and 29 documents from the website of the GEAR. These documents referred to 48 countries over 30 years and 43 transnational guidelines over 43 years. DRs of 3% and 5% had the most frequent value. Among them, 38 countries always used an equal DR of costs and health outcomes. We categorized the rationales for selecting DRs into eight groups for the national documents and six groups for the transnational documents. CONCLUSION: The comparability approach was the most frequent rationale for choosing the DR in national and transnational guidelines. The value of DR of costs and health outcomes ranged from zero to 10% over the years, but the most common values were 3% and 5%, mainly arising from the comparability approach chosen. Several transnational guidelines have suggested a specific DR without taking into account countries' economic conditions. It is useful to establish a specific guideline for calculating and updating the DR of the health sector in each country.

Protocol Design for Surveillance of Risk Factors of Non-communicable Diseases During the COVID-19 Pandemic: An Experience from Iran STEPS Survey 2021.

BACKGROUND: Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present. METHODS: In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey. RESULTS: By amending the required changes, we could include a total of 27874 individuals in the first step of the survey. This number was 27745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants. CONCLUSION: The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.