Availability and affordability of anticancer medicines in Iran based on WHO/HAI standard survey methods.

PURPOSE: Cancer is the second leading cause of death in the world after cardiovascular disease. The present study aimed to investigate the affordability and physical access to chemotherapy drugs among patients with one of the three common cancers of the breast, stomach, and colon in the city of Mashhad, Iran, in 2021. METHODS: This was a descriptive cross-sectional study. Twenty drug stores including two public and 18 privates in Mashhad were evaluated. Data was collected by consistent stay in the drug stores or pharmacies. For each oncology medicine, selling price, lowest general price, and availability were investigated. Three approaches have been experimented to calculate the affordability of anticancer medicines in this study. RESULTS: Out of 28 studied medicines from public and private drug stores, 15 (53.5%) received very low, 8 (28.5%) relatively high, and 2 (7%) high access scores. The generic docetaxel brand's ultra-drug and trastuzumab (AryoTrust) were the most available drugs, but the doxorubicin (Ebewe), oxaliplatin (Mylan), and trastuzumab (Herceptin) were not available to the individuals with cancer. Also, the first approach (based on income decile) indicated that insured patients from all income deciles were able to pay the costs of the lowest price drugs of the DCF drug regimen, and if the patients were insured and belonged to the ninth income decile, they had the financial ability to buy drugs at the lowest price of the FLO drug regimen. CONCLUSION: Unaffordability of cancer medicines can lead to treatment abandonment and increase inequality in access to healthcare services. Therefore, this requires immediate attention of policy makers to be planned in order to ensure to reducing the costs of medicines for patients and increasing patient access to anticancer medicines.

A review on inputs and outputs in determining the efficiency of universities of medical sciences by data envelopment analysis method.

Background: Increasing the number of students in universities, simultaneously limiting allocation of funds to them, and maintaining the highest efficiency level in education and research are of paramount importance. There are several methods to assess the efficiency of universities, and one of the most widely used of which is data envelopment analysis (DEA). The aim of this study was to determine the input and output criteria to evaluate the efficiency of universities of medical sciences through review-related articles using the DEA method. Methods: The time limit for retrieving articles was considered from the beginning of the publication of the first paper in this field until the end of 2017. The data were retrieved from Web of Science, Scopus, Ovid, ProQuest, Science Direct, and PubMed using advanced searches. Inclusion criteria were as follow: relevancy of the articles to the purpose of the research, availability of the articles' full-text, articles published to the end of 2017, and articles published in English. Results: The most inputs used in the literature to determine university efficiency were number of academic staffs, budget and costs, number of students, number of nonacademic staffs, spaces, and equipment and student's entrance scores. Also, the most outputs used in the literature to determine university efficiency were number of graduates, publications, incomes, number of students, and student's scores. Conclusion: This study showed that a large number of researchers have focused on measuring and comparing the efficiency of universities to improve efficiency, reduce costs, and manage the resources. Efficiency analysis by DEA allows the policymakers to define and develop policies and guidelines to improve their performances.

Assessment of the properties of the EQ-5D-5L in patients with type 2 diabetes mellitus: a systematic review and meta-analysis.

OBJECTIVE: This study systematically reviews the validity, reliability, and responsiveness of the EQ-5D-5 L in studies of T2DM. METHODS: Relevant articles were retrieved by searching four databases, namely, the Web of Science, Scopus, PubMed, and Cochrane Library up to November 2020 with English language. All stages of the review conducted by two authors and disagreements were solved by consultation with a third reviewer. RESULTS: Of the 1614 identified studies, 46 were remained for review. The EQ-5D-5 L mean scores ranged from 0.314 (0.4) (n = 141) for diabetic patients undergoing hemodialysis to 0.971 (0.082) (n = 56) for diabetic patient without retinopathy. Mean EQ-5D-5 L scores in men (0.847) were higher those in women (0.747). Construct validity and reliability was confirmed in the studies that reported the properties of the EQ-5D-5 L, and responsiveness reported in a study that was good. There were ceiling effects in seven studies. The overall utility value was higher in Japan (0.86, 95% CI: 0.80-0.92, p = 0.0001) thanCanada (0.79, 95% CI: 0.78-0.80, p = 0.81), and the United Kingdom (0.72, 95% CI: 0.64-0.79, p = 0.0001). CONCLUSION: Findings demonstrated validity, reliability of the EQ-5D-5 L in T2DM and the existence of ceiling effects. However, the assessment of responsiveness and sensitivity needs further observations.

Psychometric properties of the EQ-5D-5L compared with EQ-5D-3L in cancer patients in Iran.

Background and Objective: Psychometric evidence to support the validity and reliability of the EuroQol-5 Dimensions (EQ-5D) in cancer patients is limited. This study aimed to test the validity and reliability of the EQ-5D-5L (5L) in comparison with EQ-5D-3L (3L) in cancer patients. Methods: Data of 650 cancer patients were collected through consecutive sampling method from three largest governmental cancer centers in Iran between June 2021 and January 2022. The data were gathered using the 3L, 5L, and the European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) instruments. The 3L and 5L were compared in terms of ceiling effect, discriminatory power, convergent and known-groups validity, relative efficiency, inconsistency, agreement, and reliability. Results: Compared with the 3L, ceiling effect decreased by 27.86%. Absolute and relative informativity of discriminatory power improved by 45.93% and 22.92% in the 5L, respectively. All convergent validity coefficients with 5L were stronger than with 3L. Both 3L and 5L demonstrated good known-groups validity, and the relative efficiency was higher for 5L in 4 out of 7 patients' characteristics. The two instruments showed low overall inconsistency (1.45%) and 92.57% of the differences of observations between the 3L and 5L were within the 95% limit of agreement. The interclass correlation coefficient (ICC) for 3L and 5L indexes were 0.88 and 0.85, respectively, and kappa coefficients in the 3L dimensions (range=0.66-0.92) were higher than the 5L(range=0.64-0.79). Conclusions: The 5L demonstrated to be better than the 3L in terms of ceiling effect, inconsistency, discriminatory power, convergent validity, relative efficiency.

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.

Linagliptin versus sitagliptin in patients with type 2 diabetes mellitus: a network meta-analysis of randomized clinical trials.

BACKGROUND: Diabetes is one of the most common chronic and costly diseases worldwide and type 2 diabetes is the most common type which accounts for about 90% of cases with diabetes. New medication-therapy regimens such as those containing linagliptin alone or in combination with other medications (within the category of DDP-4 inhibitors) must be evaluated in terms of efficacy and compared with other currently used drugs and then enter the medication list of the country. Hence, this study aimed to compare the clinical efficacy of the two drugs, i.e. linagliptin and sitagliptin, in patients with type 2 diabetes. METHODS: A systematic review was conducted to identify all clinical trials published by 2015 which compared the two drugs in patients with type 2 diabetes. Using keywords such as "linagliptin", "type 2 diabetes mellitus", "sitagliptin" and related combinations, we searched databases including Scopus, PubMed, and Web of Science. The quality of the selected studies was evaluated using the Jadad score. Considering primary and secondary outcomes extracted from the reviewed studies, a network meta-analysis was used to conduct a systematic comparison between the two studied drugs. RESULTS: This network meta-analysis included 32 studies (Linagliptin vs PLB: n = 8, Sitagliptin vs PLB: n = 13, Linagliptin + MET vs PLB + MET: n = 4, and Sitagliptin + MET vs PLB + MET: n = 7) and a total of 13,747 patients. The results showed no significant difference between linagliptin and sitagliptin in terms of key efficacy and safety outcomes such as HbA1c changes from baseline, body weight change from baseline, percentage of patients achieving HbA1c <7, and percentage of patients experiencing hypoglycemic events (p > 0.05). The results showed that the efficacy of the two drug regimens was the same. CONCLUSIONS: Based on the results, there was no significant difference between the two drugs, i.e. linagliptin and sitagliptin, in terms of efficacy; in other words, the efficacy of the two drugs was the same. Therefore, the use of these two drugs depends on their availability and cost. Graphical abstract of the network meta-analysis performed to evaluate the alternatives under the study.

A novel method to produce solid lipid nanoparticles using n-butanol as an additional co-surfactant according to the o/w microemulsion quenching technique.

Solid Lipid Nanoparticles (SLN) and Nanostructured Lipid Carriers (NLC) are novel medicinal carriers for controlled drug release and drug targeting in different roots of administration such as parenteral, oral, ophthalmic and topical. These carriers have some benefits such as increased drug stability, high drug payload, the incorporation of lipophilic and hydrophilic drugs, and no biotoxicity. Therefore, due to the cost-efficient, proportionally increasable, and reproducible preparation of SLN/NLC and the avoidance of organic solvents used, the warm microemulsion quenching method was selected from among several preparation methods for development in this research. To prepare the warm O/W microemulsion, lipids (distearin, stearic acid, beeswax, triolein alone or in combination with others) were melted at a temperature of 65°C. After that, different ratios of Tween60 (10-22.5%) and glyceryl monostearate (surfactant and co-surfactant) and water were added, and the combination was stirred. Then, 1-butanol (co-surfactant) was added dropwise until a clear microemulsion was formed and titration continued to achieve cloudiness (to obtain the microemulsion zone). The warm o/w microemulsions were added dropwise into 4°C water (1:5 volume ratio) while being stirred at 400 or 600 rpm. Lipid nanosuspensions were created upon the addition of the warm o/w microemulsion to the cold water. The SLN were obtained over a range of concentrations of co-surfactants and lipids and observed for microemulsion stability (clearness). For selected preparations, characterization involved also determination of mean particle size, polydispersity and shape. According to the aim of this study, the optimum formulations requiring the minimum amounts of 1-butanol (1.2%) and lower temperatures for creation were selected. Mono-disperse lipid nanoparticles were prepared in the size range 77 ± 1 nm to 124 ± 21 nm according to a laser diffraction particle size analyzer and transmission electron microscopy. This method for preparing lipid nanoparticles by warm o/w microemulsion quenching was found to be more cost efficient and proportionally increasable in comparison with other preparation methods such as high pressure homogenization. These lipid nanoparticles, due to the combination of hard lipids with soft and/or liquid lipids, become good candidates for a wide range of medicaments as carriers for pharmaceutical and medicinal purposes.