Cost-effectiveness of single-photon emission computed tomography for diagnosis of coronary artery disease: A systematic review of the key drivers and quality of published literature

Background: Single-photon-emission computed tomography (SPECT) being one of the most commonly used methods that significantly improved the detection of coronary artery disease. The objective of this study was to perform a systematic review of the cost-effectiveness of SPECT in diagnosis of coronary artery disease. Methods: Electronic databases including PubMed, Scopus and Web of Science were searched from 1997 through 2017. The full economic evaluations of SPECT as the first and only test in diagnosis of coronary artery disease were included in this study. Non-English studies, conference abstracts and letters/editorials were excluded. The Consolidated Health Economic Evaluation Reporting Standards checklist was used to review the methodological quality of included studies. Results: Eight studies met the systematic review inclusion criteria. In general, the quality of the included studies was high. The abstract of studies had the least degree of compliance with the Consolidated Health Economic Evaluation Reporting Standards checklist. The majority of the papers used decision tree model and estimated cost from a payer's perspective. This study revealed wide heterogeneity in the methodology particularly in setting, comparators, time horizon, and perspective. Conclusion: By conducting this systematic review on 8 valid studies, it was found that the cost-effectiveness of an imaging test strongly depends on the pretest likelihood of disease. The included studies on cost-effectiveness provide conflicting evidence in support of the use of SPECT in diagnosis of coronary artery disease. This study showed that the cost-effectiveness of an imaging test varied between subgroups of patients. © 201

Impact of the economic crisis on healthcare resources: A panel data analysis in Eastern Mediterranean countries during 2005 to 2013

Background: Studying the impact of economic crisis on healthcare resources is important because the economic crisis is an important socio-economic determinant of healthcare resources and is strongly linked to a number of health outcomes. We aimed to examine the impact of the economic crisis on healthcare resources in the Eastern Mediterranean countries of World Health Organization (WHO). Methods: In this study, health expenditure per capita was considered as the indicator of healthcare resources and the unemployment rate was assumed as a proxy of economic crisis. Hausman test showed that to perform the analysis it is required to use a random effect panel data model from 2005 to 2013. The data were taken from the World Bank database and the calculations were performed using the statistical software STATA 12. Results: The results showed that the unemployment rate and out-of-pocket payment (OOP) had a strong relationship with healthcare resources. So, a 1 increase in unemployment rate leads a 138 decrease in health expenditure per capita and a 1 increase in OOP is accompanied with a 12 decrease in health expenditure per capita (p-value < 0.01). In this regard, countries having an unemployment rate more than 5 and OOP more than 25 indicate 260 health expenditure per capita less than countries with OOP less than 25 and an unemployment rate less than 5. Conclusions: The findings imply that during the economic crisis there is a decrease in healthcare resources for Eastern Mediterranean countries. In this connection, the unemployment rate and OPP are important predictors of healthcare resources. © 201

Can public-private partnership (PPP) improve hospitals' performance indicators?

Background: This study was conducted to compare the main performance indicators of Hasheminejad hospital before and after implementing PPP model. Methods: This cross sectional study was conducted in Iran in 2015. Performance indicators of Hasheminejad hospital, the only Iranian unit that implemented PPP model, were applied. Data were collected based on a researcher-designed checklist after ensuring its validity and reliability. Data were analyzed applying SPSS21, and the Shapiro-Wilk test was used to examine the relevant data normalization. After confirming the normality of the data, descriptive statistics and paired t test were used to analyze the data at a significant level of 0.05. Results: Dramatic variations were observed in the status of the studied indicators after the implementation of PPP in Hasheminejad hospital, and the changes were statistically significant in all these indicators (p < 0.05). Conclusion: It seems that implementing PPP in Hasheminejad hospital can be considered as a successful experience in Iran's health sector. The significant improvement in this hospital's performance indicators can emphasize the effective role of PPP in administration of this hospital. However, service quality and patient satisfaction should be considered as qualitative indicators, along with the present quantitative indicators because better judgment about the changes was achieved in this hospital after implementing PPP. © Iran University of Medical Sciences

Quality of life in breast cancer patients using neoadjuvant ac (Doxorubicin and cyclophosphamide) in comparison with pg (paclitaxel and gemcitabine) therapy

Background: Quality of life has become a part of the evaluation criteria for cancer therapy. The aim of this study was to evaluate the quality of life in breast cancer patients under chemotherapy regimens that contained doxorubicin and cyclophosphamide (AC) compared to paclitaxel and gemcitabine (PG). Methods: This cohort study evaluated 100 women with breast cancer treated by doxorubicin and cyclophosphamide or gemcitabine and paclitaxel regimens. We used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 to assess health related quality of life at the beginning and end of chemotherapy. Data were analyzed by the independent t-test at a significance level of 0.05. Results: Most of the 100 patients were married (68), aged 41-50 years (36), non-college educated (76), and had insurance (97). The mean quality of life scores at the first session of chemotherapy and prior to the onset of treatment-related adverse events were 71.33 for the doxorubicin and cyclophosphamide groups and 71.15 for the gemcitabine and paclitaxel groups. Analysis of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 at the last chemotherapy session showed that the quality of life in both groups deteriorated as a result of side effects. The mean of quality of life scores at the first session of chemotherapy were 66.49 for the doxorubicin and cyclophosphamide group and 59.99 for the gemcitabine and paclitaxel group. Conclusion: Strategies to improve the emotional and role functions of the patients who undergo treatment should be given priority. Financial difficulties faced by breast cancer patients should be addressed from a policy making level at the initiating health financing system. © 2018, Shiraz University of Medical Sciences. All rights reserved

Quality of life in breast cancer patients using neoadjuvant ac (Doxorubicin and cyclophosphamide) in comparison with pg (paclitaxel and gemcitabine) therapy

Background: Quality of life has become a part of the evaluation criteria for cancer therapy. The aim of this study was to evaluate the quality of life in breast cancer patients under chemotherapy regimens that contained doxorubicin and cyclophosphamide (AC) compared to paclitaxel and gemcitabine (PG). Methods: This cohort study evaluated 100 women with breast cancer treated by doxorubicin and cyclophosphamide or gemcitabine and paclitaxel regimens. We used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 to assess health related quality of life at the beginning and end of chemotherapy. Data were analyzed by the independent t-test at a significance level of 0.05. Results: Most of the 100 patients were married (68), aged 41-50 years (36), non-college educated (76), and had insurance (97). The mean quality of life scores at the first session of chemotherapy and prior to the onset of treatment-related adverse events were 71.33 for the doxorubicin and cyclophosphamide groups and 71.15 for the gemcitabine and paclitaxel groups. Analysis of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 at the last chemotherapy session showed that the quality of life in both groups deteriorated as a result of side effects. The mean of quality of life scores at the first session of chemotherapy were 66.49 for the doxorubicin and cyclophosphamide group and 59.99 for the gemcitabine and paclitaxel group. Conclusion: Strategies to improve the emotional and role functions of the patients who undergo treatment should be given priority. Financial difficulties faced by breast cancer patients should be addressed from a policy making level at the initiating health financing system. © 2018, Shiraz University of Medical Sciences. All rights reserved

Quality assessment of services provided by health centers in Mashhad, Iran: SERVQUAL versus HEALTHQUAL scales

Background: Primary health care is the entry point to the health-care system and regarded as an essential step to achieving universal health coverage. The present study aimed at evaluating the quality of health-care services provided in health centers in Mashhad, Iran. Methods: This was a cross-sectional study implemented among 200 health service users who were referring to four health centers in Mashhad during January to June 2019. The quality of services in health centers was evaluated with the SERVQUAL and HEALTHQUAL models. Data was analyzed by employing paired t-test and independent sample t-test using SPSS version 16 software. The Levene test was used for examining the equality of variance (homogeneity). Significance level of all the tests was considered when p � 0.05. Results: According to the results of SERVQUAL questionnaire, the average scores of health service users� expectations and perceptions were 4.97 and 3.26, respectively, and the quality gap in the provided services was equal to � 1.7. Based on HEALTHQUAL questionnaire, the average scores of health service users� perception and expectations were 4.72 and 3.25, respectively, and the quality gap in the provided services was equal to � 1.16. Empathy was the highest quality dimension (� 2.019) based on SERVQUAL model, and efficiency dimension was the highest based on HEALTHQUAL model (� 1.761). Conclusions: The findings of the current study showed a negative gap between the service users� expectations and perceptions in both models. Therefore, the results of this study helps the health managers and policymakers to plan effective interventions for improving the provided services emphasizing the dimensions with the wider gaps. © 2021, The Author(s)

Decomposition of Socioeconomic Inequality in Catastrophic Health Expenditure: An Evidence from Iran

Background: Evidences showed that the incidence of catastrophic health expenditure is unequally distributed among disadvantaged populations. The present study has tried to explain the contributors of this unfair inequality in Hamadan, Iran. Methods: The target population was households that utilized inpatient services in hospitals of Hamadan. A proportional stratified random sampling method was used to determine study sample (N = 770). The associated factors of catastrophic health expenditure were estimated using logistic regression analysis. The inequality of catastrophic health expenditure was measured by concentration index and explained by decomposition analysis. The data were analyzed by using STATA version 12. Results: The key determinants of catastrophic health expenditure were poor economic status, lower household size, lack of supplementary insurance and the number of hospitalizations. The overall concentration index of catastrophic health expenditure in Hamadan was �0.163 (95 CI: �0.242 to �0.083). Household economic status (63.60) and household size (39.90) were considered as the first and the second largest contributors of catastrophic health expenditure inequality, respectively. Conclusion: It is demonstrated that catastrophic health expenditure inequality in Iran could be explained by the factors beyond the health sector scope. Hence, future policy efforts need to consider both health system factors and the factors beyond the health system to eliminate catastrophic health spending burden and its inequality. © 2019 INDIACLE

Factors affecting the technical efficiency of rural primary health care centers in Hamadan, Iran: data envelopment analysis and Tobit regression

Background: Studying and monitoring the efficiency of primary health care centers has a special place in the health system. Although studies have been conducted in the field of efficiency in Iran, few have focused on rural primary health care centers. In addition, previous studies have not used the child mortality rate and Behvarzes as input and output. Objective: The present study was conducted aimed to estimate the technical efficiency of rural primary health care centers and determinant factors in Hamadan using data envelopment analysis and Tobit regression. Methods: This is a Longitudinal study of rural primary health care centers in Hamadan province (2002�2016). Data Envelopment Analysis was employed to estimate technical efficiency of sampled health facilities while Panel Tobit Analysis was applied to predict factors associated with efficiency levels. The outputs were child mortality rate under 1 year of age and child mortality rate 1 year to 5 years of age. The input was Behvarzes (rural health workers). Results: The results of efficiency analysis showed that the average efficiency scores of the centers had a fluctuating trend during the period of the study, but the average performance scores generally decreased in 2016, as compared with 2002. The highest and lowest average performance scores were observed in 2003 (0.78) and 2013 (0.56), respectively. Number of physicians and rural primary healthcare centers per population had a positive statistically significant and the number of midwives and the total fertility per population had a negative statistically significant effect on efficiency. Conclusions: The findings suggest some level of wastage of health resources in primary health centers. Findings indicate a level of waste of health resources in primary health centers. Behvarz functions in providing primary care services can be considered in the reallocation and optimal use of available resources at the level of rural health centers. © 2020, The Author(s)

Impact of the economic crisis on healthcare resources: A panel data analysis in Eastern Mediterranean countries during 2005 to 2013

Background: Studying the impact of economic crisis on healthcare resources is important because the economic crisis is an important socio-economic determinant of healthcare resources and is strongly linked to a number of health outcomes. We aimed to examine the impact of the economic crisis on healthcare resources in the Eastern Mediterranean countries of World Health Organization (WHO). Methods: In this study, health expenditure per capita was considered as the indicator of healthcare resources and the unemployment rate was assumed as a proxy of economic crisis. Hausman test showed that to perform the analysis it is required to use a random effect panel data model from 2005 to 2013. The data were taken from the World Bank database and the calculations were performed using the statistical software STATA 12. Results: The results showed that the unemployment rate and out-of-pocket payment (OOP) had a strong relationship with healthcare resources. So, a 1 increase in unemployment rate leads a 138 decrease in health expenditure per capita and a 1 increase in OOP is accompanied with a 12 decrease in health expenditure per capita (p-value. <. 0.01). In this regard, countries having an unemployment rate more than 5 and OOP more than 25 indicate 260 health expenditure per capita less than countries with OOP less than 25 and an unemployment rate less than 5. Conclusions: The findings imply that during the economic crisis there is a decrease in healthcare resources for Eastern Mediterranean countries. In this connection, the unemployment rate and OPP are important predictors of healthcare resources. © 2018

Impact of the economic crisis on healthcare resources: A panel data analysis in Eastern Mediterranean countries during 2005 to 2013

Background: Studying the impact of economic crisis on healthcare resources is important because the economic crisis is an important socio-economic determinant of healthcare resources and is strongly linked to a number of health outcomes. We aimed to examine the impact of the economic crisis on healthcare resources in the Eastern Mediterranean countries of World Health Organization (WHO). Methods: In this study, health expenditure per capita was considered as the indicator of healthcare resources and the unemployment rate was assumed as a proxy of economic crisis. Hausman test showed that to perform the analysis it is required to use a random effect panel data model from 2005 to 2013. The data were taken from the World Bank database and the calculations were performed using the statistical software STATA 12. Results: The results showed that the unemployment rate and out-of-pocket payment (OOP) had a strong relationship with healthcare resources. So, a 1 increase in unemployment rate leads a 138 decrease in health expenditure per capita and a 1 increase in OOP is accompanied with a 12 decrease in health expenditure per capita (p-value. <. 0.01). In this regard, countries having an unemployment rate more than 5 and OOP more than 25 indicate 260 health expenditure per capita less than countries with OOP less than 25 and an unemployment rate less than 5. Conclusions: The findings imply that during the economic crisis there is a decrease in healthcare resources for Eastern Mediterranean countries. In this connection, the unemployment rate and OPP are important predictors of healthcare resources. © 2018