Cost-utility analysis of Cryoballoon ablation versus Radiofrequency ablation in the treatment of paroxysmal atrial fibrillation in Iran.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia (Calkins H, et al. 2012). There are various methods to treat AF of which Ablation is one of the most effective. We aimed to assess the cost-utility of Cryoballoon ablation (CBA) compared to Radiofrequency ablation (RFA) to treat patients with paroxysmal AF in Iran. A cost-utility analysis was done using a decision-analytic model based on a lifetime Markov structure which was drawn considering the nature of interventions and the natural progress of the disease. Costs data were extracted from medical records of 47 patients of Shahid Rajaie Cardiovascular Medical Center in Tehran in 2019. Parameters and variables such as transition probabilities, risks related to side effects, mortality rates, and utility values were extracted from the available evidence. Deterministic and probabilistic sensitivity analysis was also done. TreeAge pro-2020 software was used in all stages of analysis. In the base case analysis, the CBA strategy was associated with higher cost and effectiveness than RFA, and the incremental cost-effectiveness ratio was $11,223 per Quality-adjusted life year (QALY), which compared to Iran's GDP per capita as Willingness to pay threshold, CBA was not cost-effective. On the other hand, considering twice the GDP per capita as a threshold, CBA was cost-effective. Probabilistic sensitivity analysis confirmed the findings of base case analysis, showed that RFA was cost-effective and the probability of cost-effectiveness was 59%. One-way sensitivity analysis showed that the results of the study have the highest sensitivity to changes in the RFA cost variable. Results of sensitivity analysis showed that the cost-effectiveness results were not robust and are sensitive to changes in variables changes. Primary results showed that CBA compared to RFA is not cost-effective in the treatment of AF considering one GDP per capita. But the sensitivity analysis results showed considerable sensitivity to changes of the ablation costs variable

The impact of health transformation plan on health services fees: brief report

Background: Tariff setting in healthcare is an important control knob affecting the quality, access and cost of services. As part of Iran Health Transformation Plan (HTP) in 2014, the relative value of health care and services was increased to motivate healthcare providers to deliver high quality services. This study aimed to examine the impact of HTP on health services tariffs. Methods: This descriptive and cross-sectional study used the data from California Tariff Book (2013 edition) and the new relative value book (2016 edition). The weighted average of the relative value of the anesthetic and surgical services in both books was calculated and compared. Results: The California book and the new relative value book had 5281 and 3448 service codes respectively in 13 major medical specialties (34.7 percent reduction of service codes in the new tariff book). Overall, 64985.9 K and 125133.6 K were considered in the California book and the new relative value book (92.6% growth). The California book and the new relative value book considered 25,976 K and 22,307 K for anesthesia services, respectively in those 13 medical specialties (14.1% reduction). The HTP has increased the relative value of healthcare services tariff by 1.9 times in average. Conclusion: The HTP has doubled the tariff of healthcare services. A rise in the relative value of healthcare services has incurred financial burden on Iranian public health insurance companies and made it difficult to finance health system of the country. A sustainable health financing system should be developed as well a change should be applied in provider payment system to control the cost and increase the health system efficiency

Electronic Health Record Implementation: A SWOT Analysis

Electronic Health Record (EHR) is one of the most important achievements of information technology in healthcare domain, and if deployed effectively, it can yield predominant results. The aim of this study was a SWOT (strengths, weaknesses, opportunities, and threats) analysis in electronic health record implementation. This is a descriptive, analytical study conducted with the participation of a 90-member work force from Hospitals affiliated to Tehran University of Medical Sciences (TUMS). The data were collected by using a self-structured questionnaire and analyzed by SPSS software. Based on the results, the highest priority in strength analysis was related to timely and quick access to information. However, lack of hardware and infrastructures was the most important weakness. Having the potential to share information between different sectors and access to a variety of health statistics was the significant opportunity of EHR. Finally, the most substantial threats were the lack of strategic planning in the field of electronic health records together with physicians’ and other clinical staff’s resistance in the use of electronic health records. To facilitate successful adoption of electronic health record, some organizational, technical and resource elements contribute; moreover, the consideration of these factors is essential for HER implementation

Investigating the Cytotoxic Effect of Urolithin B and Cerium Oxide Nanoparticles Synthesized from Aloe Vera Plant on Brain Cancer Cell Colony (U87MG)

Background: Brain cancer is one of the types of cancer that appears with the growth of cancer cells in the brain. In this experimental study, we investigated and compared the effect of cerium oxide nanoparticles synthesized by the green method from Aloe vera with urolithin B on U87MG cancer cells. Materials and Methods: Cerium oxide nanoparticles were produced by the green synthesis method from the Aloe vera plant and confirmed by nanoparticle size characterization tests and an FESEM microscope. The U87MG cells were obtained from Pasteur Institute of Tehran, Iran, and after passage, they were treated with cerium oxide nanoparticles and urolithin B drug for 72 h and cell colonies for 15 days. Results: The IC50 of cancer cells in the MTT test for urolithin B and cerium oxide nanoparticles synthesized by green method from Aloe vera plant with urolithin B were 170 μM and 135 μM, respectively. In addition, the survival percentage results from the clonogenic test at a concentration of 30 μM for cerium oxide nanoparticles (78%), urolithin B(61%), and cerium oxide nanoparticles with urolithin B(30%), and for a concentration of 60 μM, it was 60, 42, and 16%, respectively. Conclusion: Urolithin B has a higher cytotoxic effect (170μM) than cerium oxide nanoparticles synthesized by the green method from the Aloe vera plant, and when combined with cerium oxide nanoparticles, this cytotoxic effect increased more (135μM). It also reduced the survival percentage of colonies within 15 days of treatment