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

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