Cost-effectiveness of a population-based AAA screening program for men over 65 years old in Iran

Background: Screening program tend to recognized patients in their early stage and consequently improve health outcomes. Cost-effectiveness of the abdominal aortic aneurysm (AAA) screening program has been scarcely studied in developing countries. We sought to evaluate the cost-effectiveness of a screening program for the abdominal aortic aneurysm (AAA) in men aged over 65 years in Iran. Methods: A Markov cohort model with 11 mutually exclusive health statuses was used to evaluate the cost-effectiveness of a population-based AAA screening program compared with a no-screening strategy. Transitions between the health statuses were simulated by using 3-month cycles. Data for disease transition probabilities and quality of life outcomes were obtained from published literature, and costs were calculated based on the price of medical services in Iran and the examination of the patients� medical records. The outcomes were life-years gained, the quality-adjusted life-year (QALY), costs, and the incremental cost-effectiveness ratio (ICER). The analysis was conducted for a lifetime horizon from the payer�s perspective. Costs and effects were discounted at an annual rate of 3. Uncertainty surrounding the model inputs was tested with deterministic and probabilistic sensitivity analyses. Results: The mean incremental cost of the AAA screening strategy compared with the no-screening strategy was 140 and the mean incremental QALY gain was 0.025 QALY, resulting in an ICER of 5566 (14,656 PPP) per QALY gained. At a willingness-to-pay of 1 gross domestic product (GDP) per capita (5628) per QALY gained, the probability of the cost-effectiveness of AAA screening was about 50. However, at a willingness-to-pay of twice the GDP per capita per QALY gained, there was about a 95 probability for the AAA screening program to be cost-effective in Iran. Conclusions: The results of this study showed that at a willingness-to-pay of 1 GDP per capita per QALY gained, a 1-time AAA screening program for men aged over 65 years could not be cost-effective. Nevertheless, at a willingness-to-pay of twice the GDP per capita per QALY gained, the AAA screening program could be cost-effective in Iran. Further, AAA screening in high-risk groups could be cost-effective at a willingness-to-pay of 1 GDP per capita per QALY gained. © 2021, The Author(s)

The patency rate of the primary and exchanged femoral haemodialysis catheters

Background: This prospective cohort study aims to evaluate the primary and exchanged femoral catheter patency rates, as well as mortality rates and determine the probable risk factors affecting femoral catheter survival. Methods: All 79 tunneled femoral catheters created in our hospital from 2017 to 2020 were included in this study. Patients having no other means for dialysis access other than the femoral catheter was recruited in this study. Data collected included patient age, sex, comorbidities (diabetes and hypertension), transplant history, dialysis duration, catheter complications, femoral access history, and primary and exchanged femoral patency rates. Patients were followed for 4�36 months. Results: The median catheter primary patency was 7 months (95 confidence interval CI: 5.77, 8.22) and the primary patency rates at 2, 4 and 6 months were 79%, 68% and 48%, respectively. The median exchanged catheter survival was 8 months (95% CI: 0.83, 15.17) and the exchanged patency rates at 1, 3 and 8 months were 72%, 64% and 32%, respectively. Of the patients (n = 62), 8% (5 patients) died because they had no other option for dialysis access. Conclusion: Tunneled femoral catheters have a low patency rate and should be the last option for haemodialysis patients when other probable accesses are not available. © Penerbit Universiti Sains Malaysia, 2021

Predicting factors of reducibility of invagination with barium enema in children

Background: Intussusception is the telescoping of one portion of the intestine in to another. The appropriate treatment can reduce the complication, mortality and morbities. The first line of non surgical treatment is contrast enema. This study was done to identification the clinical and laboratory predictors of success of barium enema. Methods: This was a cross-sectional study that considered all the children with intussusceptions, who were refered in 2009 and 2010 to Alzahra hospital, Iran. All of the needed information including age, sex, fever, leukocytosis, free fluid in sonography, time of symptom appearance and positive bloody stool was recorded in a questionnaire. Then we committed Barium enema for all of them, and evaluate the relationship between the success of barium enema with gathered data by chi square and Student t-test. Findings: In this study we evaluated 45 children with intussusceptions. In 18 subjects the barium enema treatment was success. The results of this study showed a significant correlation between positive blood stool and free fluid in sonography with unsuccessful of barium enema treatment. Conclusion: According to our results in children with bloody stool or free fluid in sonography we recommend only one time barium enema. If the treatment is unsuccessful, it is better to advise patients for open surgery

Frequency of Complications Following Endovascular Repair of Abdominal Aortic Aneurysm in Tehran Sina Hospital, 2011-2019

Background and purpose: Abdominal aortic aneurysms (AAA) is a localized enlargement of infrarenal abdominal aorta. Endovascular aneurysm repair (EVAR) is a surgical method introduced for AAA repair. This study, for the first time in Iran, investigated the complications and mortality rate associated with EVAR. Materials and methods: In this cross-sectional study, medical records were reviewed and all patients admitted to Sina Referral Hospital with infra renal abdominal aortic aneurysms who underwent elective EVAR between 2011 and 2019 (n=130) were studied. Results: There were 121 complete files, including those of 104 (85.9) men and 17 (14.1) women. The mean age of patients was 70.56±9.4. Renal complications were the most frequent systemic complication after elective EVAR (n=15, 12.6). Cardiac complications (n=10, 8.4), respiratoty complications (n=6, 5), cerebral complications (n=3, 2.5), and deep vein thrombosis (n=2, 1.7) were also reported. There was no graft infection. More than half of the procedure-related complications occurred in 6 months of surgery (n= 29, 24). Conclusion: Endovascular repair of abdominal aortic aneurysm especially in patients with comorbidities has acceptable results in short term and long term surveillance. © 2022, Mazandaran University of Medical Sciences. All rights reserved