A cost-utility analysis of different antiviral medicine regimens in patients with chronic hepatitis C virus genotype 1 infection

Background: Despite the introduction of new drug regimens with high effectiveness for the hepatitis C virus (HCV) patients, especially in HCV genotype 1, no cost-effectiveness study on the selection of the superior drug strategy in Iran has been conducted yet. Objectives: This study is aimed to assess the cost-effectiveness of the three drug regimens of pegylated interferon and ribavirin (PR), sofosbuvir (SOF) + PR and ledipasvir and sofosbuvir (LDV/SOF) in patients with HCV genotype 1 in Iran in the year 2014. Methods: A Markov micro-simulation model was used to evaluate the cost-effectiveness of the three drug strategies for a cohort of 10000 patients. Quality-adjusted life-years (QALYs) were extracted from published studies. Cost data was estimated through the review of medical records and obtaining experts opinion. Results: The results showed that the SOF + PR drug compared with PR had a lower cost and was more effective, but compared with the LDV/SOF, in spite of its lower cost, it was less efficient. The QALY values obtained for PR, SOF + PR and LDV/SOF, respectively, were 10.98, 12.08 and 12.28 and their costs were $41,741,$ 7,676 and $46,993. Moreover, the results obtained from acceptability curves showed that SOF + PR were the most cost-effective treatment for thresholds below$ 45,270 PPP. Conclusions: The use of SOF + PR regimen or LDV/SOF can significantly reduce the incidence of complications associated with the disease. For example, short and long-term outcomes are better than the current drug regimens for HCV genotype 1 patients in all stages of the disease

Is Albumin-based Resuscitation in Severe Sepsis and Septic Shock Justifiable? An Evidence from a Cost-effectiveness Evaluation

BACKGROUND: Fluid and antimicrobial therapy are the essential parts of sepsis management. The type of fluid to resuscitate with is an unsettled issue in the treatment of severe sepsis and septic shock. The objective of this study was to evaluate the cost effectiveness of albumin-based resuscitation over crystalloids.METHODS: A cost-effectiveness analysis was conducted by extracting data from a database of Sina Hospital, Islamic Republic of Iran. A decision tree was constructed by using Tree Age Pro2011. The patients were grouped based on the types of fluids used for resuscitation into crystalloid alone or crystalloid + albumin groups at the initial decision node. The patients were followed from the onset of severe sepsis and septic shock upto 28 days. The healthcare payers’ perspective was considered in constructing the model. The cost was measured in US dollars and the effectiveness was measured by life years gained.RESULTS: The addition of albumin during resuscitation of patients with severe sepsis and septic shock has an effectiveness gain of 0.09 life years and cost increment of 495.00 USD. The estimated ICER for this analysis was 5500.00 USD per life year gained. The probability that albumin is cost-effective at one GDP per capita is 49.5%.CONCLUSION: Albumin-based resuscitation is not cost-effective in Iran when a GDP per capita was considered for a life year gain. The cost-effectiveness was insensitive to the cost of standard care. We recomend the caustious use albumin as per the Surviving Sepsis Campaign guideline.

A cost utility and cost effectiveness analysis of different oral antiviral medications in patients with HBeAg-Negative chronic hepatitis B in Iran: an economic microsimulation decision model

Background: Although hepatitis B infection is the major cause of chronic liver disease in Iran, no studies have employed economic evaluations of the medications used to treat Iranian patients with chronic hepatitis B (CHB). Therefore, the cost-effectiveness of the different treatment options for this disease in Iran is unknown. Objectives: The aim of this study was to compare the cost utility and cost-effectiveness of medication strategies tailored to local conditions in patients with HB e antigen (HBeAg)-negative CHB infection in Iran. Methods: An economic evaluation of the cost utility of the following five oral medication strategies was conducted: adefovir (ADV), lamivudine (LAM), ADV + LAM, entecavir (ETV), and tenofovir (TDF). A Markov microsimulation model was used to estimate the clinical and economic outcomes over the course of the patient’s lifetime and based on a societal perspective. Medical and nonmedical direct costs and indirect costs were included in the study and life-years gained (LYG) and quality-adjusted life-years (QALY) were determined as measures of effectiveness. The results are presented in terms of the incremental cost-effectiveness ratio (ICER) per QALY or LYG. The model consisted of nine stages of the disease. The transition probabilities for the movement between the different stages were based on clinical evidence and international expert opinion. A probabilistic sensitivity analysis (PSA) was used to measure the effects of uncertainty in the model parameters. Results: The results revealed that the TDF treatment strategy was more effective and less costly than the other options. In addition, TDF had the highest QALY and LYG in the HBeAg-negative CHB patients, with 13.58 and 21.26 (discounted) in all comparisons. The PSA proved the robustness of the model results. The cost-effectiveness acceptability curves showed that TDF was the most cost-effective treatment in 59% - 78% of the simulations of HBeAg-negative patients, with WTP thresholds less than $14010 (maximum WTP per QALY). Conclusions: The use of TDF in patients with HBeAg-negative CHB seemed to be a highly cost-effective strategy. Compared with the other available medication options, TDF was the most cost-saving strategy. Thus, TDF may be the best option as a first-line medication. Patients can also be switched from other medications to TDF

Monitoring of National Drug Policy (NDP) and its standardized indicators; conformity to decisions of the national drug selecting committee in Iran

BACKGROUND: Pharmaceuticals have made an important contribution to global reductions in morbidity and mortality. To help save lives and improve health, it is important to be sure about equity to access to drugs, drug efficacy, quality and safety, and rational use of drugs, which are standardized National Drug Policy (NDP) objectives. NDP's indicators are useful to evaluate the pharmaceutical system performance in a country. Iran has adapted a National Drug List (NDL). Since management of drug supply in Iran takes place only for drugs that have been selected in NDL and this list is selected by the member of Iran Drug Selecting Committee (IDSC), thus evaluation of IDSC's decision making during last 5 years is an appropriate way to evaluate the implementation of drug supply system in the country. METHODS: To identify strengths and weaknesses of pharmaceutical policy formation and implementation in Iran, four standard questionnaires of the World Health Organization (WHO) were used. To assess the agreement between decisions of IDSC and standardized NDP indicators in the last 5 years (1998–2002), a weighted questionnaire by nominal group technique based on the questions that should be answered during discussion about one drug in IDSC was designed and used. RESULTS: There is a totally generics based NDP with 95% local production, that provides affordable access to drugs. The system, structures, and mechanisms were in place; however, they did not function properly in some topics. Assessment of 59 dossiers of approved drugs for adding to NDL during last 5 years showed that IDSC's members pay more attention to efficacy, safety, and rationality in use rather than accessibility and affordability. CONCLUSION: Revision of drug system in term of implementation of the processes to achieve NDP's objectives is necessary to save public health. Clarification of NDP's objectives and their impact for IDSC's members will result in improvement of the equity in access to pharmaceuticals

Prescribing patterns of physicians working in both the direct and indirect treatment sectors in Iran; findings and implications

Objective: There can be different incentives in the private versus public healthcare systems across countries influencing the delivery of health care. The implementation of regulations along with financial incentives and quality targets are key initiatives to improve rational prescribing. However, there are concerns in Iran that the different incentives in the Direct versus Indirect sectors can influence the delivery of care even among the same physicians. Consequently, the objective of this study was to evaluate the effect of Social Security Organization (SSO) rules and regulations on the prescribing patterns of physicians working simultaneously in both sectors of the SSO in Iran. Subsequently use the findings to suggest initiatives to improve future prescribing if needed. Methods: Retrospective cross-sectional study on claims data. All prescriptions written by general practitioners, internists, gynaecologists and paediatricians that had at least 100 claims and working in both sectors were collected. Non-parametric tests were undertaken to compare prescribing patterns. Key findings: 455 549 prescriptions were analysed. The average number of medicine items per prescription was 4 in the direct treatment setting versus 2 in the indirect treatment setting, while the proportion of prescriptions including at least one antibiotic, injectable, corticosteroid and injectable corticosteroid, were 31.5, 16.1, 8.7 and 3% respectively in the indirect treatment setting versus 28.7,13.7, 7.7 and 3.2% in the direct treatment setting. Except for antibiotic prescribing, all other differences were significant. Conclusions: There are a number of areas of potential concern with physician prescribing in this study. These include the high use of antibiotics in both sectors, potentially inappropriate polypharmacy in the Direct sector, as well as possibly the overuse of injections especially in the Indirect sector, increasing costs and potentially patient harm. These will be the subject of future research projects

Trend Analysis of the Pharmaceutical Market in Iran; 1997–2010; Policy Implications for Developing Countries

Background:So far, no detailed study of the Iranian pharmaceutical market has been conducted, and only a few studies have analyzed medicine consumption and expenditure in Iran. Pharmaceutical market trend analysis remains one of the most useful instruments to evaluate the pharmaceutical systems efficiency. An increase in imports of medicines, and a simultaneous decrease in domestic production prompted us to investigate the pharmaceutical expenditure structure. On the other hand, analyzing statistics provides a suitable method to assess the outcomes of national pharmaceutical policies and regulations.Methods:This is a descriptive and cross-sectional study which investigates the Iranian pharmaceutical market over a 13-year period (1997–2010). This study used the Iranian pharmaceutical statistical datasheet published by the Iranian Ministry of Health. Systematic searches of the relevant Persian and English research literature were made. In addition, official government documents were analyzed as sources of both data and detailed statements of policy.Results:Analysis of the Iranian pharmaceutical market in the 13-year period shows that medicine consumption sales value growth has been 28.38% annually. Determination of domestic production and import reveals that 9.3% and 42.3% annual growth, respectively, have been experienced.Conclusions:The Iranian pharmaceutical market has undergone great growth in comparison with developing countries and the pharmerging group, and the market is expanding quickly while a major share goes to biotechnology drugs, which implies the need to commercialization activities in novel fields like pharmaceutical biotechnology. This market expansion has been in favor of imported medicine in sales terms, caused by the reinforcement of suspicious policies of policy makers that necessitates fundamental rearrangements

ijps.sums.ac.ir R Original Article

Abstract Geographic proximity has been shown to be a significant factor in healthcare utilization and also one of the important dimensions in the concept of accessibility. In this study, we aimed to evaluate the geographic accessibility to pharmacies in city of Shiraz. A geographic information system approach was obtained to evaluate geographic accessibility to pharmacies. A stratified random sampling was conducted to choose adequate points as the representative of whole city to measure their distance in both pedestrian and driving condition to the pharmacies. To measure the pedestrian accessibility of selected blocks in Shiraz, different distances of 150, 300, 450, 600 and 750 meter, and to measure driving accessibility different network distances of 5, 10 and 15 min were considered as acceptable levels of geographic accessibility. In terms of pedestrian accessibility, the analysis showed that about 45% and 15% of sample blocks have accessibility to at least one pharmacy in their 750 meters in normal days and holidays, respectively, based on straight line distance. In terms of driving accessibility, our analysis indicated that in normal days and also in holidays about 98% of sample blocks in Shiraz have at least one pharmacy in their 15 min based on network analysis and considering traffic limitation. In spite of implemented policy by food and drug organization to distribute pharmacies equitably through the whole city, geographic accessibility to pharmacy doesn't seem to be desirable in Shiraz and some other policies may be needed to make the situation better

A Geographic Information System Analysis of Accessibility to Community Pharmacy in Shiraz, Iran: Geographic accessibility to pharmacy in Shiraz

Geographic proximity has been shown to be a significant factor in healthcare utilization and also one of the important dimensions in the concept of accessibility. In this study, we aimed to evaluate the geographic accessibility to pharmacies in city of Shiraz. A geographic information system approach was obtained to evaluate geographic accessibility to pharmacies. A stratified random sampling was conductedto choose adequate points as the representative of whole city to measure their distance in both pedestrian and driving condition to the pharmacies. To measure the pedestrian accessibility of selected blocks in Shiraz, different distances of 150, 300, 450, 600 and 750 meter, and to measure driving accessibility different network distances of 5, 10 and 15 min were considered as acceptable levels of geographicaccessibility. In terms of pedestrian accessibility, the analysis showed that about 45% and 15% of sample blocks have accessibility to at least one pharmacy in their 750 meters in normal days and holidays, respectively, based on straight line distance. In terms of driving accessibility, our analysis indicated that in normal days and also in holidays about 98% of sample blocks in Shiraz have at least one pharmacy in their 15 min based on network analysis and considering traffic limitation. In spite of implemented policy by food and drug organization to distribute pharmacies equitably through the whole city, geographic accessibility to pharmacy doesn’t seem to be desirable in Shiraz and some other policies may be needed to make the situation better