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

Health Technology Assessment of TNK-ase vs. Reteplase in the Treatment of Acute Myocardial Infarction in Iran

Background & Objectives: Due to the lack of evidence about the most cost-effective thrombolytic drug in the treatment of acute myocardial infarction with the ascension of the ST segment, this study was conducted to evaluate the cost effectiveness of tenecteplase, as a new medicine, versus Reteplase in the treatment of acute myocardial infarction patients with the ascension of the ST segment in Iran. Methods: This study was a type of health technology assessment study. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE databases (from March1980 to March 2017) by using related keywords for finding cost-effectiveness, safety and economic studies. The qualities of studies were independently assessed by STROBE checklist and data were extracted using Cochrane data extraction form. Results: Three studies were eligible for inclusion and all three were of high quality. Mortality had been compared between Tenecteplase and Reteplase. The results of two studies with 781 samples had showed the same efficacy for Tenecteplase and Reteplase in regard to mortality rate. According to the cost-effectiveness analysis, Reteplase is more cost effective than TNKase (250 $versus 537.49$). Conclusion: Reteplase, due to the same safety and effictiveness but lower cost, is preferred to Tenecteplase and considering the current economic conditions of Iran, it is recommended to be used in the treatment of acute myocardial infarction patients with the ascension of the ST segment. Keywords: Health Technology Assessment, Acute Myocardial Infarction, Tenecteplase, Reteplase, Economic evaluation Citation: Bashzar S, Tourani S, Nikfar S, Ravaghi H, Habibi M. Health Technology Assessment of TNK-ase vs. Reteplase in the Treatment of Acute Myocardial Infarction in Iran. Journal of Health Based Research 2018; 4(1): 51-62

Evaluating the expression of IL-17 and IL-23R genes in Peripheral Blood Mononuclear cells in Rheumatoid Arthritis patients

Background Rheumatoid arthritis (RA) is an autoimmune disease caused by accumulation of numerous inflammatory cells in the joints and secretion of various cytokines leading to cartilage and bone damage. IL-17 and IL-23 are inflammatory cytokines that their definite role has not been clearly distinguished in RA pathogenesis. Therefore, this study aimed to investigate the expression and association of IL-17 and IL-23R in Peripheral Blood Mononuclear cells (PBMCs) in RA patients. Methods This study was case-control. We gathered peripheral blood from 37 patients with RA and the same number of healthy individuals as a control group. In brief, PBMCs were isolated by Ficoll centrifugation. After RNA extraction and cDNA synthesis, IL-17 and IL-23R expression mRNA levels were determined in PBMCs by real-time PCR technique and Taqman probe method. Results The mean±standard deviation of the ages in patient group was 46.86±1.328 yr. and in controls was 44.73±1.392 yr. The expression of IL-17 was increased in RA patients in comparison to healthy controls (P= 0.002). Whereas, after comparison of IL-23R expression in patient and healthy groups, no significant difference was observed (P = 0.22). Conclusion In this study, upregulated expression of IL-17 implicated the important role of this cytokine in RA pathogenesis. Therefore, novel therapeutic and more effective strategies can be suggested by further investigations to specifically inhibit IL-17 using monoclonal antibodies (biologic drugs) Keywords:Rheumatoid Arthritis , Peripheral Blood Mononuclear cells , IL , 17 , IL , 23

Designing a New Framework Using Type-2 FLS and Cooperative-Competitive Genetic Algorithms for Road Detection from IKONOS Satellite Imagery

The growing availability of high-resolution satellite imagery provides an opportunity for identifying road objects. Most studies associated with road detection are scene-related and also based on the digital number of each pixel. Because images can provide more details (including color, size, shape, and texture), object-based processing is more advantageous. Therefore, in this paper, to handle the existing uncertainty of satellite image pixel values, using type-2 fuzzy set theory in combination with object-based image analysis is proposed. Because the main challenges of the type-2 fuzzy set are parameter tuning and extensive computations, a hybrid genetic algorithm (GA) consisting of Pittsburgh and cooperative-competitive learning schemes is proposed to address these problems. The most prominent feature of our research in this work is to establish a comprehensive object-based type-2 fuzzy logic system that enables us to detect roads in high-resolution satellite images with no training data. The validation assessment of road detection results using the proposed framework for independent images demonstrates the capability and efficiency of our method in identifying road objects. For more evaluation, a type-1 fuzzy logic system with the same structure as type-2 is tuned. Evaluations show that type-1 fuzzy logic system quality in training is very similar to that of the proposed type-2 fuzzy framework. However, in general, its lower accuracy, as inferred by validation assessments, makes the type-1 fuzzy logic system significantly different from the proposed type-2

Effects of Different Times of Glutaraldehyde 2% on Bacillus subtilis Spores (In Vitro)

Background: Due to the importance of disinfectant and sterilization of dental instruments, in total, 14%–28% of dentists, 13% of assistants, and 17% of healthcare workers (HCWs) have been subjected to the hepatitis B virus (HBV), and more than 200 healthcare providers (HCPs) pass away annually in the United States from HBV infection catched from their work place. Objective: This study examined the effects of glutaraldehyde 2% on Bacillus subtilis spores in the Surgery and Microbiology Department of the Dental Branch of Islamic Azad University. Methods: This experimental research evaluated a total of 58 samples, one called first evidence (pure glutaraldehyde not exposed to spore suspension), one called second evidence (spore suspension not exposed to glutaraldehyde), and 40 samples including a suspension with a normal turbidity of 1×108 CFU/mL according to 0.5 McFarland with exposure to glutaraldehyde 2%. Experiments were done in time intervals of 10, 15, 20, 25, 30, 40, and 60 minutes with 8 repeats. In all times, a B. subtilis spore suspension was used as evidence and also as a case. Results: This research was done on 58 samples. The results showed that in the 10th minute there were 102 colonies, 18.6 ± 3.4 in the 15th minute, 6.2 ± 1.4 in the 20th minute, 2.1 ± 0.8 in the 25th minute, and no colonies after 30 minutes. In an overall observation, it was seen that there were more colonies in the first 10 minutes, and from 15 to 20 minutes, this amount significantly decreased; after 30 minutes in each 8 repeats, the growth of colonies had stopped completely, while in the evidence samples, B. subtilis spores grew. Conclusion: It seems that the density of 2% glutaraldehyde in 30 minutes time was enough to destroy the spores of B. subtilis

Mapping routine measles vaccination in low- and middle-income countries

The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1–4. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5–8. Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children