The Cost of Services Provided in the Physiotherapy Department of Shafa Yahyaian Hospital

Background & Objectives: Our country is facing increasing costs of treatment and funding shortages. The reason for this crisis is the increase in the cost of medicine, medical equipment, and skilled manpower. The physiotherapy unit is one of the cost centers and accounts for a large share of hospital costs. Managers and policymakers must pay special attention to cost centers in order to make decisions about reducing costs and increasing efficiency. Methods: The present study was a retrospective economic evaluation that was conducted in 2018 based on activity-based costing. The data were collected by referring to the Physiotherapy, Employment, Finance, Medical Equipment and Warehouse Units. To calculate the cost of physiotherapy services, the salaries of staff working in the units as well as the cost of the consumables, depreciation of buildings and equipment and energy were estimated in detail. Results: The total annual costs of the physiotherapy unit amounted to 8415722668 rials and the annual loss of the mentioned unit amounted to 1287632108 rials. The highest costs were for physiotherapists, accounting for 82% of the total costs, overhead costs, accounting for 8.1%, and depreciation of medical equipment. Conclusion: According to the losses imposed on physiotherapy unit, one of the suggested options is unit outsourcing. Running evening shifts, paying fee-for-service due to high personnel costs, and hiring a non-faculty technical manager with a lower salary can be effective in reducing the average unit cost. Key­words: Activity-Based Costing, Tariff, Physiotherapy, Teaching Hospital, Overhead Cost Citation: Golmohammad A, Ebadi Fard Azar F, Abutorabi A. The Cost of Services Provided in the Physiotherapy Department of Shafa Yahyaian Hospital. Journal of Health Based Research 2020; 5(3): 355-367. [In Persian

The Effect of 8-week Aquatic and Terrestrial Exercises on Functional Balance and Psychological Factors of Spastic Cerebral Palsy Girls

Background: Considering the stature problems and the insufficient levels of physical activity in people with cerebral palsy, balance and its influencing factors can play an important role in these patients’ activities. In this study, we aimed to investigate the effect of eight weeks of aquatic and terrestrial trainings on the functional balance and psychological factors of spastic cerebral palsy girls. Methods: This semi-experimental study was conducted based on a pretest-posttest design. We investigated 19 girls with diplegia and quadriplegia spastic cerebral palsy who aged from 8-15 years and lived in Yazd, Iran. The participants were selected based on the available population and categorized into two groups of terrestrial training (N = 10) and aquatic training (N = 9). Both groups received training for eight weeks (three times a week). In order to evaluate the participants’ functional balance, Berg’s functional balance test was performed for both groups before and after the intervention. In addition, Depression Anxiety and Stress Scales (DASS-21) were applied to study the psychological factors of both groups before and after the intervention. To analyze the data, the Shapiro-Wilk test, independent t-test, and dependent t-test were used. Results: The results showed that both terrestrial and aquatic training groups improved considering functional balance, but this improvement was just significant in aquatic training group (P=0.042). However, no significant difference was observed in the psychological factors as well as depression, anxiety, and stress. Conclusion: We suggest aquatic trainings to improve the functional balance

Modeling, exergy analysis and optimization of cement plant industry

This study investigates the recovery of wasted heat in the cement plant industries (Neka Cement Factory) in order to reduce the use of fossil fuels and greenhouse gas emissions. Cement is the most widely used man-made material. The global cement industry produces about 3.3 billion tons of cement annually. A lot of energy is needed to produce cement. About 200 kg of coal is used to produce each ton of cement. The cement industry also produces about five percent of the world's greenhouse gases. The method studied in this research is based on heat recovery from boilers installed at the outlet of a clinker cooler and a preheater in a cement factory. Due to the low temperature of the gases available, three different fluids, i.e. water, R134a and R245fa were considered as the operating fluids. Also, energy and exergy analyses are performed in a Rankin cycle and the selection of optimal parameters is considered by using genetic algorithm. The results of this study showed that water with optimized parameters leads to an increase in the production capacity from 5 to 9 MW. However, fluid R134a with optimized parameters leads to a 4% increase in exergy losses and it also increases the production capacity from 5 to 9 MW

Assessment of the Value of Air Quality Improvement in Tehran

Air pollution in Tehran, the capital city of Iran, has led to poor air quality, with consequences for the health of residents. This study uses a contingent valuation method to estimate the willingness to pay of Tehran's residents for air quality improvement. Open-ended and stochastic payment card approaches were used to determine the willingness to pay of the sample. The mean individual willingness to pay for a specified air quality improvement was approximately US 6.40 per month, and the variance of the willingness to pay was approximately U.S. 4, as estimated using the SPC approach. Open-ended questions revealed that the mean individual willingness to pay was approximately U.S. 4 per month. Significant positive effects of income, use of public transportation, marriage, job and health status on the mean willingness to pay were observed. Although most respondents believed that air quality improvement is the government's responsibility, they are willing to bear the cost as a supplement to achieve better air quality. © 2017 World Scientific Publishing Europe Ltd

Economic Evaluation of Rivaroxaban Versus Enoxaparin for Prevention of Venous Thromboembolism After Total Knee Replacement and Total Hip Replacement: A Systematic Review

Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) together are called venous thromboembolism (VTE) and impose a high economic burden on healthcare systems. Thousands of people are hospitalized annually due to benign and treatable diseases but die due to PE; with the adoption of appropriate prevention, these deaths can be prevented. Objective: To investigate the cost-effectiveness of using rivaroxaban versus enoxaparin in published economic analyses for prevention of VTE after total knee (TKR) or hip replacement (THR). Method: In a systematic review electronic searches were performed on various online databases, including PubMed, Web of science, Embase, Scopus, Health Economic Evaluations Database (HEED), and ProQuest. The inclusion criteria were: studies that were conducted on the cost-effectiveness of rivaroxaban versus enoxaparin for the prevention of VTE after TKR and THR; cost-effectiveness studies conducted using decision analysis models based on the economic evaluation approach; studies with available full-text papers; and studies written in English and published between 2007 and 2019. The exclusion criteria were: studies with partial cost effectiveness (such as effectiveness assessment, cost assessment, quality-of-life assessment); studies written in languages other than English; and all protocols, conference abstracts, and letters to the editor. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to qualitatively evaluate the studies. Results: Of a total of 537 initial studies, nine papers met the inclusion criteria. The time scope of studies ranged from 3 months to 5 years. Among the selected studies, some studies had included discount rates (n = 4) and the other studies did not utilize discount rates and were set to zero percent by default (n = 5). In all studies, direct medical costs, including costs related to the prevention, diagnosis, and treatment of VTE and PE, and management and monitoring of treatment costs were reviewed. Conclusion: The results of this systematic review showed that using rivaroxaban in patients undergoing total knee or hip replacement reduced costs and increased quality of life. However, since most of the studies had been conducted in developed countries, it is not possible to generalize the results to developing countries. Nonetheless, given that rivaroxaban is administered orally and does not require continuous monitoring, it will be less costly for patients and health systems and is more appropriate to administer it as a thromboprophylactic drug following total knee or hip replacement surgery. © 2020, Springer Nature Switzerland AG

Assessment of the Value of Air Quality Improvement in Tehran

Air pollution in Tehran, the capital city of Iran, has led to poor air quality, with consequences for the health of residents. This study uses a contingent valuation method to estimate the willingness to pay of Tehran's residents for air quality improvement. Open-ended and stochastic payment card approaches were used to determine the willingness to pay of the sample. The mean individual willingness to pay for a specified air quality improvement was approximately US 6.40 per month, and the variance of the willingness to pay was approximately U.S. 4, as estimated using the SPC approach. Open-ended questions revealed that the mean individual willingness to pay was approximately U.S. 4 per month. Significant positive effects of income, use of public transportation, marriage, job and health status on the mean willingness to pay were observed. Although most respondents believed that air quality improvement is the government's responsibility, they are willing to bear the cost as a supplement to achieve better air quality. © 2017 World Scientific Publishing Europe Ltd

Cost-Effectiveness of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm: A Systematic Review

Purpose: Abdominal aortic aneurysm (AAA) is a life-threatening condition which, in the absence of increasing diameter or rupture, often remains asymptomatic, and a diameter greater than 5.5 cm requires elective surgical repair. This study aimed to evaluate the cost-effectiveness of endovascular repair (EVAR) versus open surgical repair (OSR) in patients with AAA through a systematic review of published health economics studies. Methods: Using a systematic review method, an electronic search was conducted for cost-effectiveness studies published on AAA (both in English and Persian) on PubMed, Embase, ISI/Web of Science (WoS), SCOPUS, Global Health databases, and the national databases of Iran from 1990 to 2020 including the keywords �cost-effectiveness�, �endovascular�, �open surgical�, and �abdominal aortic aneurysms�. The quality of the studies was assessed using the Quality of Health Economic Studies (QHES) checklist. Results: In total, 958 studies were found, of which 16 were eligible for further study. All studies were conducted in developed countries, and quality-adjusted life years (QALY) and life years (LY) were used to measure the outcomes. According to the QHES checklist, most studies were of good quality. In European countries and Canada, EVAR has not been cost-effective, while most studies in the United States regard this technique as a cost-effective intervention. For example, incremental cost-effectiveness ratio (ICER) values ranged from 14,252.12 to 34,446.37 per QALY in the USA, while ICER was �116,600.40 per QALY in Portugal. Conclusion: According to the results, the EVAR technique has been more cost-effective than OSR for high-risk patients, but the need for continuous follow-up, increased costs, and re-intervention over the long term and for low-risk patients has reduced the cost-effectiveness of this method. As the health systems vary among different countries (i.e. quality of care, cost of devices, etc.), and due to the heterogeneity of studies in terms of the follow-up period, time horizon, and threshold, all of which are inherent features of economic evaluation, generalizing the results should be done with much caution, and policymaking must be based on national evidence. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature 2021