Femtosecond Laser Versus Mechanical Microkeratome in Thin-Flap Laser in Situ Keratomileusis (Lasik) for Correction of Refractive Errors an Evidence-Based Effectiveness and Cost Analysis

INTRODUCTION: To compare the efficacy and cost-effectiveness of Femtosecond laser versus mechanical Microkeratome corneal flap creation in correction of refractive errors.METHODS: I this review, a comprehensive search of Medline, SCOPUS, Cochrane, TRIP database, supplemented by HTA and economic databases was performed. We searched for randomized controlled trials (RCTs) of Femtosecond laser which included mechanical Microkeratome in other arm. The quality of the retrieved studies was appraised by two independent reviewers and appropriate articles were finalized.RESULTS: A total of 1142 articles were identified, of which, 1059 were excluded after review of the titles and abstracts and 83 articles remained. Systematic reviews and RCTs were evaluated through CASP international worksheet. Eventually, 61 titles were excluded, leaving 22 articles to be reviewed.Safety: There was no individual evidence to cover all safety components about Femtosecond laser, but in summary, this modality seems a safe method for corneal flap creation.Effectiveness: No statistically significant difference was shown in visual acuity and refractive errors. The important secondary end point of this review was diffuse Lamellar keratitis in 17% of the femtosecond group versus 5% in mechanical Microkeratome. Inflammation was low-grade and improved during the first 3 months of follow-up period with a low dose medication without corneal scarring. The two groups was comparable in all clinical outcomes including Unorrected Visual Acuity (UCVA), Best Special Corrected Visual Acuity (BSCVA), manifest refraction, wave front aberrometry, Schirmer test, and Tear Break up time (TBUT).Cost Analysis: Results showed that marginal cost incurred due to Femtosecond technology adoption may vary from 27 to 117 € (resulted from sensitivity analysis). It is clear that additional cost may be a small proportion of LASIK procedure total cost.CONCLUSION: Although Femtosecond flap creation is a modern method with a good quality of corneal flap, but, there is no high-quality evidence to show superiority of Femtosecond laser in clinical outcomes. Although the efficacy and cost of the systems is almost equal, traditional method still remains as the standard approach.

Green Light Photo Selective Vaporization of the Prostate vs. Transurethral Resection of Prostate for Benign Prostatic Hyperplasia

INTRODUCTION: Green light photo selective vaporization of the prostate (PVP) is a minimally invasive method of treatment for clinical benign prostatic hyperplasia with fewer side effects. The aim of this study is to evaluate the safety, effectiveness and cost analysis of PVP compared with transurethral resection of prostate.METHODS: A systematic search was done in Cochrane, TRIP database, MEDLINE, NHS EED, NIHR HTA, CRD, Health star database, Pro Quest, Psycoinfo and Google Scholar to find randomized control trials, systematic reviews and HTA reports. The searched keywords were Green light laser (PVP or KTP) and prostate. The cost analysis was done by the perspective of society and providers.RESULTS: Complication rate in 12 included evidences ranged from 0-9.3%. The complication rate of TUR-P (Transurethral Resection of Prostate) was more than PVP. Changing in flow rate reducing residual urine, improving patients’ symptoms and QOL (Quality of life), and operative outcome length of operation varied from no significant to significant differences in favor of TURP. Unit cost in both social and provider view was significantly high in PVP in comparison with TURP. Increasing the number of patients did not change the cost analysis.CONCLUSION: PVP is a safe method for treatment of clinical BPH, but there is a lack of evidence for the evaluation of effectiveness. Overall, the unit cost for PVP was significantly more than TURP; for this reason this method could not be conducted in very wide indications, because of high cost

Holmium Laser Prostate Enucleation (HOLEP) Versus Trans-Urethral Resection of Prostate (TURP) in Treatment of Symptomatic Prostatic Enlargement;A Health Technology Assessment

INTRODUCTION: Our aim was to compare the cost effectiveness of holmium laser prostate enucleation (HOLEP) versus trans-urethral resection of prostate.METHODS: We searched all available databases for any controlled trials comparing HOLEP and TURP from January 2000 to February 2009. Two independent reviewers studied and appraised the selected evidences. Then, effectiveness and cost effectiveness of HOLEP was evaluated.RESULTS: We identified four randomized controlled trials and one systematic review according to the inclusion criteria. Most of the studies had moderate quality of evidence with limited sample sizes. Overall success rate of HOLEP was comparable with TURP; but, some secondary outcomes such as pick flow rate twelve months after the surgery was better in HOLEP. A comparison between the original costs and those obtained from sensitivity analysis showed that the cost parameters were sensitive to the number of the patients treated. Increasing the number of the patients from 200 to 300 changed the study’s results in favor of the new techniques.CONCLUSION: Since the holmium and thulium laser sets are sensitive to the number of the patients and multipurpose, they potentially can be applied for stone fragmentation.Thus, utilization of these equipments will divide the costs between two groups of the services. In economic terms, these properties lower overhead costs and justify the purchasing of these equipments

Analysis of Direct Medical Expenses Resulting from Road Traffic Injuries in the City of Tabriz

Background: Road crashes as a major global public health problem cost 3 of most countries and 5 of low- and middle-income countries' gross domestic product (GDP). The World Health Organization has predicted that without sustained action, road traffic crashes will become the seventh leading cause of death by 2030. Objectives: The aim of this study was to analyze the death rate, severity of injuries, and direct medical costs caused by road traffic injuries (RTI) in the city of Tabriz in 2014. Methods: Trauma injury admissions due to RTI in Imam Reza Hospital in Tabriz City were investigated in terms of etiology and the direct medical costs during 2014â��2015. Data were collected using a researcher-made checklist after being confirmed by relevant experts in terms of face validity. All information on direct medical costs are extracted from several sources including hospitals, database of the Ministry of Health and Medical Education, disaster and emergency medical management center, and public and private physiotherapy clinics across the city. Results: Review of the hospital records showed that the mean age of the patients (67.9 males and 32.1 females) was 34 ± 17.3 years. In addition, 79.2 of the patients were treated on an outpatient basis, and 20.8 were treated on a hospitalization basis (hospitalization or death). The mean times of inpatient and outpatient hospitalization for injuries were 3 h and 6.7 ± 5.3 days, respectively. Total direct medical costs were 11.631 dollars, of which 8 was for hospital costs, 9.7 for prehospital costs, and 2.3 for physiotherapy costs. Chest and lower part injuries had highest medical costs. From etiological standpoints, the greatest reason of being injured and hospitalization is multiple injuries and bruises, and the prominent cause of death was blow to the head and neck (70). Conclusions: The results of the present study showed that direct medical costs in Tabriz during 2014-2015 were equal to 0.1 of GDP, which is a considerable amount. High economic and social costs of road accidents and their harmful physical and psychological effects on individuals and community require the attention of professionals and experts in the transportation industry and health-care system to determine appropriate strategies for interventions in reducing accidents' burden and injuries

Design and implementation of pay-for-quality in primary healthcare

BackgroundThe common methods of payment to healthcare providers such as capitation and salary are not designed to be stimulation for high quality healthcare. The pay-for -quality (P4Q) programs are designed to provide the financial incentives to the service providers in order to improve quality of services based on specified criteria.AimsThis study describes the design and implementation of a P4Q program in the primary healthcare (PHc) in East Azerbaijan Province, Iran.Methods The present study is a case study that describes the process of designing and implementing the P4Q program in PHC in East-Azerbaijan province in 2015. To design the P4Q program, after identifying core components of the program through literature review and Focus Group Discussion (FGD), final decision about each component was made by achieving consensus from a panel of recognised experts in the area of PHc. Altogether two FGD and seven expert panel sessions were hold in EAPHC in order to design the P4Q program.Results Key components of P4Q program were selected by qualitative studies and the results were categorized in five headings including P4Q formula, quality measures, payment strategy, data reporting and performance evaluation. The formula consists of five elements including fixed payment, individual, team and organization performance and managerial appraisal. A total of 37 measures, which covers the domains of quality of PHc, human resource development and responsibility were selected. 'Improvement' and 'absolute level of measures' were selected as the payment strategy. The methods of data reporting included valid questionnaire, organization’s documents and medical records. The final P4Q program was used for paying incentives to all primary health care providers in public health centres affiliated to Tabriz University of Medical Sciences.ConclusionDesigning and implementing the P4Q program led to a shift in paying the incentives to healthcare providers from passiveness and subjective judgment to rational and quality based payment. Linking the incentive payment to individual, team, and organizational performance, the P4Q program will lead to an increased capacity of staff morale to improve teamwork and integrated health care

Mapping catquest scores onto EQ-5D utility values in patients with cataract disease

Background: Mapping from non-performance-based measures onto generic performance-based measures provides an appropriate solution to derive utilities to be used in economic evaluations. Objectives: This study aimed to create a model through which EQ-5D utilities for cataracts can be obtained from scores on the disease-specific Catquest measure. Patients and Methods: One hundred ninety-nine observations from 103 patients who self-administered the EQ-5D, the Catquest and questions on demographic and clinical characteristics were included in the analysis. Data was divided into estimation and validation datasets. To predict EQ-5D utilities, multiple regression analysis, using the Ordinary Least Square (OLS) and the censored least absolute deviation (CLAD), was performed. Catquest scores, age, gender, and performing surgery were included as explanatory variables. An estimation dataset was used to derive the coefficients, and these coefficients were then validated using a validation dataset. Based on the explanatory power, the consistency, the simplicity, the mean absolute error (MAE) and the correlations between observed and fitted utilities, the most appropriate model was selected. Results: The mean EQ-5D and Catquest scores of the total sample were 0.631 and 15.8, respectively. Age and surgery showed no significant effect for either method. Removing age and surgery, model II was built and given an R2of 0.697, an MAE of 0.1176 for the OLS and an R2of 0.614, and an MAE of 0.1153 for the CLAD method. In the validation stage, the CLAD revealed better prediction ability, with an MAE of 0.198 versus an MAE of 0.209 for the OLS. ICC and Bland-Altman analysis put the CLAD as a preferred method with the following equation: Utilities (EQ-5D) = 0.988 - 0.0281 × Catquest (PD) + 0.102 × gender (male = 1). Conclusions: Based on these results, a mapping function was obtained which appears to be valuable in predicting EQ-5D utilities from Catquest scores. This function gives an appropriate solution to estimate utilities when primary EQ-5D data is not available. Although the model represents good consistency and predictive ability, further examination of obtained function is required with large samples. © 2016, Iranian Red Crescent Medical Journal

effectiveness of endovascular versus open surgical repair for thoracic aortic aneurysm:a systematic review and meta-analysis

iNTroduCTioN: since the approval, the thoracic endovascular aortic repair (TeVar) is widely used for the repair of thoracic aortic aneurysm. however, the long-term mortality and re-intervention rates compared to open surgical repair (osr) are unclear. We aimed to compare the effectiveness of TEVAR with OSR specifically for thoracic aortic aneurysms. eVideNCe aCQuisiTioN: We conducted a comprehensive search in MedliNe, PubMed, eMBase, CiNahl, ProsPero, Centre for reviews and dissemination, and the Cochrane library up to November 2020. The main outcomes were early mortality, mid-to-long-term survival, and re-intervention. The quality of the evidence was assessed using the grade methodology. all analyses were performed using revMan with the random effect model and Comprehensive Meta-analysis software. eVideNCe syNThesis: one systematic review and 15 individual studies were included. Pooled analysis showed that 30-day mortality, stroke, renal failure, and pulmonary complications were significantly lower in TEVAR versus open surgery. The pooled rate of re-intervention significantly favored the OSR. The long-term survival and mortality favored TEVAR and OSR in one and two studies, respectively, but was non-significant in seven analyzes. CONCLUSIONS: Early clinical outcomes including the 30-day mortality, stroke, renal failure, and pulmonary complications significantly favored the TeVar. however, the mid-to-long-term re-intervention rate favored the osr and long-term survival was inconsistent among the studies. The quality of evidence was very low. More studies with longer follow-ups are needed. The use of TeVar should be decided by taking into account other factors including patient characteristics and preferences, cost, and surgeon expertise.</p

Cost-effectiveness analysis of seasonal influenza vaccination during pregnancy:A systematic review

Background: Seasonal influenza vaccination is clinically important and reduces hospitalization costs for pregnant women. However, is it also a cost-effective intervention? Method: We conducted a systematic search of Medline (via PUBMED), EMBASE, SCOPUS, and Web of Science databases. We included any economic evaluation studies that reported Incremental Cost-Effectiveness Ratios for vaccinating pregnant women against influenza. Result: Out of 927 potentially eligible articles, only 14 full texts met our inclusion criteria. In almost all studies, vaccinating pregnant women was a cost-effective and cost-saving strategy. In one study, it was not cost-effective when the researchers used costs and probabilities related to other groups (healthy adults) due to the lack of data for pregnant women. The main factors influencing the cost-effectiveness of the studies were vaccine efficacy and vaccination cost. Conclusion: Influenza vaccination of pregnant women is a cost-effective intervention. More studies on the cost-effectiveness of this intervention in underdeveloped countries are needed. Keywords: pregnancy, cost-effectiveness, cost-utility, cost-benefit, influenza vaccine, women, economic evaluation.</p

A systematic review of effectiveness and economic evaluation of Cardiohelp and portable devices for extracorporeal membrane oxygenation (ECMO)

In recent years, there have been substantial advancements in the development of different technologies for extracorporeal membrane oxygenation (ECMO) for in-hospital and out of hospital applications. However the effectiveness of these devices is not clearly known. The objective of this study was to evaluate the cost-effectiveness of Cardiohelp compared to other portable ECMO devices. In this systematic review, we searched Medline (via Ovid), Embase, Pubmed, Cochrane Library, SCOPUS, CRD and NICE. Articles were assessed by two independent reviewers for eligibility and quality of the evidence. Studies which compared Cardiohelp to other ECMO devices were included. Seven out of 1316 publication were included in this review, three of them were clinical trials and four were observational studies. The majority of the studies had limited quality. According to the measures of safety, Cardiohelp had safer technological features, but on the other hand, was more complex to use. Considering the effectiveness, Cardiohelp was not statistically different from other technologies. Cardiohelp showed slightly better performance than Centrimag in terms of cost per patient and cost-effectiveness. However, when clinical criteria were used to select the patients with good prognosis to administer the ECMO, incremental cost utility ratios (ICURs) for both Cardiohelp and Centrimag were below the level of willingness-to-pay threshold. According to the measures of safety and effectiveness, ECMO with Cardiohelp was not considerably different from other evaluated technologies. Moreover, ECMO with Cardiohelp or Centrimag can be considered cost-effective, provided that the patients are selected carefully in terms of neurological outcomes.</p