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)

Auto Calibration and Optimization of Large-Scale Water Resources Systems

Water resource systems modelling have constantly been a challenge through history for human being. As the innovative methodological development is evolving alongside computer sciences on one hand, researches are likely to confront more complex and larger water resources systems due to new challenges regarding increased water demands, climate change and human interventions, socio-economic concerns, and environment protection and sustainability. In this research, an automatic calibration scheme has been applied on the Gilan's large-scale water resource model using mathematical programming. The water resource model's calibration is developed in order to attune unknown water return flows from demand sites in the complex Sefidroud irrigation network and other related areas. The calibration procedure is validated by comparing several gauged river outflows from the system in the past with model results. The calibration results are pleasantly reasonable presenting a rational insight of the system. Subsequently, the unknown optimized parameters were used in a basin-scale linear optimization model with the ability to evaluate the system's performance against a reduced inflow scenario in future. Results showed an acceptable match between predicted and observed outflows from the system at selected hydrometric stations. Moreover, an efficient operating policy was determined for Sefidroud dam leading to a minimum water shortage in the reduced inflow scenario