Cost-effectiveness of allopurinol versus febuxostat in the treatment of gout patients: A systematic review.

Background: In recent years, increased longevity, poor dietary habits, and the rising prevalence of metabolic syndrome and hypertension have increased the prevalence of gout. Gout significantly increases direct and indirect costs and reduces the quality of life. Allopurinol and febuxostat are the most commonly used drugs for reducing uric acid levels and controlling this disease with different cost-effectiveness. The present systematic review compares the cost-effectiveness of these drugs. Methods: This was a systematic review of economic evaluations. Cochrane CENTRAL, Web of Science, PubMed, Embase, and the Cost-Effectiveness Analysis (CEA) Registry were searched up to April 30, 2018, based on the specific search strategy of each database. Keywords used in the search include gout, cost-effectiveness, allopurinol, and febuxostat in MeSH and free-text forms. Screening of identified studies, data extraction, and quality assessment were done independently by 2 reviewers. The quality of studies was assessed based on Drummond Checklist. Finally, a qualitative analysis was done to analyze the results. Results: A total of 94 studies were identified through database search and the review of references. After screening the titles, abstracts, and full-texts, 6 economic evaluations were included in the review. The majority of the studies had been conducted in the US using the Markov model, within a 5-year horizon, and from the payer's perspective, with the quality of life as a measure of effectiveness. In most studies, the incremental cost-effectiveness ratios (ICERs) of febuxostat per quality-adjusted life year (QALY) were below the threshold (10 000$/QALY and 30 000€/QALY). Conclusion: Febuxostat has been shown to be more cost-effective than allopurinol in all treatment sequences in studies that have used uric acid levels as the measure of effectiveness. Furthermore, in studies with the quality of life as the measure of effectiveness, febuxostat has been shown to be very cost-effective as the second-line treatment.

Prevalence rate of laboratory defined aspirin resistance in cardiovascular disease patients: A systematic review and meta-analysis.

BACKGROUND: Cardiovascular disease (CVD) is the first cause of mortality worldwide, with all the healthcare systems facing this very challenging issue. Aspirin continues to be the major gold-standard treatment worldwide in the prevention of thrombotic disease in patients with CVD, even though not all individuals respond to antiplatelet therapy in a similar way, being resistant to aspirin. The aim of this study was to determine the prevalence of laboratory defined aspirin resistance in CVD patients worldwide. METHODS: Relevant articles were identified through searching EMBASE, PubMed/ MEDLINE, ISI /Web of Science, Scopus, and the Cochrane Library, from January 2000 to February 2018. The methodological quality of the included studies was critically appraised using the Newcastle-Ottawa scale. The pooled prevalence of laboratory defined aspirin resistance was computed using the Der Simonian-Laird random-effect model. RESULTS: We included 65 studies, with a total of 10,729 patients. The overall prevalence of laboratory defined aspirin resistance in CVD patients was 24.7% ([95%CI 21.4-28.4]. Women were found to be at increased risk of laboratory defined aspirin resistance compared to men, with an odds ratio of 1.16 [95%CI 0.87-1.54]. CONCLUSION: Doctors and healthcare providers should pay special attention to aspirin resistance since lack of awareness could cause problems and increase mortality in these patients, if not properly treated with higher aspirin doses.

Prevalence of Psychiatric Disorders in Iran: A Systematic Review and Meta-analysis.

The prevalence of mental disorders in Iran is rising for many reasons including the population growth and its problems, the collapse of the family foundation, the economic problems, etc. Epidemiological studies of psychiatric disorders play an important role in determining the general mental health of the population and policy-making and future planning of service delivery. To identify the relevant studies, two authors independently searched different scholarly databases including Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, Psych INFO, and Iranian databases such as MagIran, SID, IranPsych, and Irandoc from 1st January 2007 up to 1st July 2018. The gray literature (through Google Scholar) was also mined. Studies written in English or in the Persian language were searched. After searching the databases and removing duplicates cases, a total of 10 studies were selected and included in the study, which reported a total of 14 prevalence rates. There were a total of 72,262 participants, of whom 32,925 were male and 39,337 were female. The prevalence of psychiatric disorders in studies which used screening tool was 31.03% (95% confidence interval: 25.99-36.07). The prevalence was 25.42% in studies which used clinical interviews (95% CI: 15.96-34.88). There is an undeniable fact that the prevalence of mental disorders in Iran has been increasing, and this could be a warning to policy-makers and health system managers. Hence, it is necessary to pay attention to this issue to maintain social capital, vitality, and efficiency of individuals and society as a whole.

Medical malpractice in Iran: A systematic review.

Background: Medical malpractice represents a serious problem in the health system and is one of the risk factors for patient safety which damages the patient and increases costs for the patient and the health care provider. The importance of these complaints against physicians is that litigation may continue for a long time and become problematic for patients and physicians. The objective of this study was to investigate the complaints of medical malpractices which were referred to Iran Medical Council to provide solutions to reduce the complaints and improve service delivery. Methods: Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, and Iranian databases, such as MagIran, SID, and Irandoc, were searched from 01/01/1990 to 07/01/2018. Also, the grey literature (via Google Scholar) was searched. Studies written in English or in Persian were searched, and keywords used included malpractice, negligence, medical malpractice, physician impairment, Iran, and professional impairment. Results: Nearly 1455 complaints (36%) of the total number of 3977 complaints were proved to be medical malpractice, and physicians were acquitted in 2542 (64%) cases. Most complaints were from gynaecologists, accounting for 43% of all complaints, followed by orthopaedic specialists who ranked second with 21.4% of the total complaints. The most type of failure was due to lack of skill (30.4%), followed by negligence (29.2%). Imprudence or indiscretion (26.3%) and noncompliance with governmental requirements (14.1%) were also in the next ranks, respectively. Conclusion: Improving patient and physician relationships, observing medical ethics, increasing the scientific and technical skills of the medical staff, and following the guidelines and medical protocols will prevent medical malpractice. Therefore, health policymakers can reduce errors and failures by adopting continuing education on medical, ethical, and legal issues.

A Description of the Temporal Pattern of Out-of-Pocket Expenditure Related to Iranian Healthcare Services during 1995-2014.

BACKGROUND: Out-of-pocket (OOP) expenditure directly impacts on poverty and household welfare, especially when there is a decline in healthcare financing. This study was aimed to describe the temporal pattern of OOP expenditures related to Iranian healthcare services during 1995-2014. METHODS: For describing the trend of OOP spending in Iran, the database of the World Bank was mined for the period under study. Further, the trend analysis has been complemented by an exhaustive and comprehensive review of the extant literature. RESULTS: From 1995 to 2014, out-of-pocket decreased from 53.59% to 47.8% of the total health expenditure, probably because of the different health reforms implemented throughout the years. However, out-of-pocket expenditure in Iran remains higher than the world average (roughly 3 times higher). CONCLUSION: It is an onus of the Iranian government to make serious attempts in order to reduce out-of-pocket expenditure, as well as to protect particularly poor and vulnerable subjects against catastrophic health expenditure. In order to ensure an equitable and affordable access to the healthcare system, decision- and policy-makers in Iran should implement a review of health care costs, insurance tariffs, and healthcare services packages covered by insurance organizations as well as introduce a progressive tax-based financing scheme as soon as possible.

Health-related quality of life among healthy elderly Iranians: a systematic review and meta-analysis of the literature.

BACKGROUND: Health-related quality of life (HRQoL) measurement in elderly people can provide appropriate information for an optimal management of physical/mental conditions. The main objective of the present study was to quantitatively assess the HRQoL among healthy elder Iranian individuals as measured by the Short-Form 36 (SF-36) questionnaire, both overall and at the level of each its single component/domain. METHODS: This study was designed as a systematic review and meta-analysis, following the "Preferred Reporting Results of Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, and Iranian databases such as MagIran, SID and Irandoc were mined from inception up to 1st September 2017. Also the grey literature (via Google Scholar) was mined. Two reviewers independently screened titles/abstracts, assessed full-text articles, extracted data, and appraised their quality using the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) checklist. RESULTS: Twenty five studies were included. Mean overall HRQoL was 54.92 [95%CI 51.50-58.33], lower than the value found by studies done in other countries, especially in those economically developed. The sensitivity analysis indicated stability and reliability of results. Pooled scores of each HRQoL domain/sub-scale of the SF-36 questionnaire ranged from 49.77 (physical role functioning) to 63.02 (social role functioning). CONCLUSIONS: HRQoL among healthy elder Iranian individuals is generally low. Health policy-makers should put HRQoL among the elderly as a priority of their agenda, implementing ad hoc programs and providing social, economic and psychological support, as well as increasing the participation of old people in the community life and use their experiences.

Prevalence of Depression in Hemodialysis Patients in Iran: a Systematic Review and Meta-analysis.

INTRODUCTION: Chronic kidney disease is a public health problem worldwide that is highly associated with psychological disorders. This study aimed to assess prevalence of depression in hemodialysis patients in Iran. MATERIALS AND METHODS: Relevant studies were identified from the PubMed, ISI Web of Science, Ovid, Scopus, EMBase, and Iranian databases including Magiran, SID, IranMedex, and Irandoc, up to December 2015. The DerSimonian-Laird random effects model was employed to estimate the overall pooled prevalence. Heterogeneity was investigated and subgroup analyses were carried out by sample size and time of study. RESULTS: Twenty-seven studies on 2822 patients met the inclusion criteria for analysis. The pooled analysis of depressive symptoms in hemodialysis patients in Iran was estimated to be 62% (95% confidence interval, 0.54 to 0.71) with a maximum rate of 95% (95% confidence interval, 0.88 to 1.02) and a minimum rate of 9% (95% confidence interval, 0.02 to 0.16). Statistical heterogeneity was high (I2 = 96.9%). CONCLUSIONS: The results of this study showed that depression is common among dialysis patients in Iran. Early diagnosis and effective treatment of depression can improve quality of life, prognosis, and survival of patients.

Seroprevalence of Hepatitis E Virus in Iran: A Systematic Review and Meta-analysis.

BACKGROUND Hepatitis E virus (HEV) is one of common causes of viral hepatitis worldwide with higher prevalence in tropical and subtropical regions. Although epidemics of HEV have been reported from Iran, there are variable reports of this infection out of epidemics from different parts of Iran. This study aimed to determine the seroprevalence of HEV in Iran. METHODS In this systematic review and meta-analysis we searched PubMed, Scopus, Science direct, Google Scholar, Scientific Information Databank (SID), IranMedex, and Magiran for all relevant studies published in either English or Persian languages, up to 2015. Pooled seroprevalence estimates with a DerSimonian-Laird random-effects model were calculated. Statistical heterogeneity among the included studies was evaluated by Cochrane Q statistic and I2. RESULTS 38 studies fulfilled the inclusion criteria compromising 18461 participants. The pooled seroprevalence rate of HEV in Iran was estimated about 10% (95% CI=0.09-0.12) with maximum and minimum of 46% (95 % CI=0.42-0.50), and 0.01% (95 % CI=0.000-0.002), respectively. CONCLUSION HEV is common in Iran although the prevalence is lower than some neighbor countries.

The Prevalence of Migraine in Iran: A Systematic Review and Meta-Analysis.

CONTEXT: Migraine is a major dilemma and problem which affects public health and results to reduced quality of life. This study aimed to determine the prevalence of migraine in Iran. EVIDENCE ACQUISITION: A systematic search was conducted using Pub Med, Web of Science, Embase, Scopus, Ovid, Google Scholar, as well as Iranian databases including: MagIran, IranMedex and Scientific Information Databank, from 2000 to November, 2015. The Der-Simonian/Laird's random-effects model, with a 95% confidence interval was employed to estimate the overall pooled prevalence. Heterogeneity was investigated using subgroup analysis based on sample size and time of study. RESULTS: Thirty studies comprising 33,873 participants met the inclusion criteria for the analysis. The overall prevalence of migraine in Iran was 14% (95% CI, 12% to 17%), respectively. The overall prevalence was (8%; 95% CI 6% to 11%) according to the international classification of headache disorders (ICHD-1), (17%; 95% CI 13% to 21%) according to ICHD-2, and (18%; 95% CI 7% to 30%) according to the other questionnaire for migraine screener (ID Migraine), respectively. Meta-regression demonstrated that the prevalence of migraine increased by year of publication and decreased by sample size. CONCLUSIONS: The prevalence of migraine in Iran, which was estimated as 14%, was similar or even higher than that reported world-wide. Migraine can have impact on the economic productivity of any country; therefore it is necessary to educate people on the early detection and the discovery of an effective treatment of migraine. More thorough review of further studies in this field is recommended.