Is Aspirin Cost-Effective for the Primary Prevention of Stroke among Women in Iran?: A Pharmacoeconomic Evaluation

Introduction: In spite of undebated benefits of the use of aspirin for the prevention of cardiovascular disease (CVD), due to the side effects of aspirin, which are  mainly gastrointestinal bleeding and hemorrhagic stroke, its use in primary prevention is still contentious. Stroke is one of the important CVD events which is responsible for a major cause of death among Iranian women. For the first time, the cost-effectiveness and cost-utility of the use of aspirin for the primary prevention of stroke among women in Iran with an average risk of CVD was evaluated in this study. Methods and Results: The incremental cost-effectiveness ratios (ICERs) were estimated using a semi-Markov model in which the cost-effectiveness of the use of 80mg aspirin  was compared to control group The adopted time horizon was life-long and the analysis was performed from the payer's perspective. The target population was a hypothetical cohort of 55-year women with a 10-year CVD risk of 15% and no history of previous CVD. A loss of 0.4 QALYs (Quality-Adjusted-Life-Years) and 0.58 LYG (Life-Years-Gained) with an extra cost of 6,150,946 Rials per patient were estimated in this study,. The implemented one-way and probabilistic sensitivity analyses represented the robustness of the model. Conclusion: The use of aspirin for the primary prevention of stroke among women with an average CVD risk, seems not to be a cost-effective intervention in Iran. However the cost-effectiveness of the use of aspirin for other CVD including myocardial infarction (MI) needs to be taken into account in decision making

The synergic effects of presynaptic calcium channel antagonists purified from spiders on memory elimination of glutamate-induced excitotoxicity in the rat hippocampus trisynaptic circuit

The hippocampus is a complex area of the mammalian brain and is responsible for learning and memory. The trisynaptic circuit engages with explicit memory. Hippocampal neurons express two types of presynaptic voltage-gated calcium channels (VGCCs) comprising N and P/Q-types. These VGCCs play a vital role in the release of neurotransmitters from presynaptic neurons. The chief excitatory neurotransmitter at these synapses is glutamate. Glutamate has an essential function in learning and memory under normal conditions. The release of neurotransmitters depends on the activity of presynaptic VGCCs. Excessive glutamate activity, due to either excessive release or insufficient uptake from the synapse, leads to a condition called excitotoxicity. This pathological state is common among all neurodegenerative disorders, such as Alzheimer’s and Parkinson’s diseases. Under these conditions, glutamate adversely affects the trisynaptic circuitry, leading to synaptic destruction and loss of memory and learning performance. This study attempts to clarify the role of presynaptic VGCCs in memory performance and reveals that modulating the activity of presynaptic calcium channels in the trisynaptic pathway can regulate the excitotoxic state and consequently prevent the elimination of neurons and synaptic degradation. All of these can lead to an improvement in learning and memory function. In the current study, two calcium channel blockers—omega-agatoxin-Aa2a and omega-Lsp-IA—were extracted, purified, and identified from spiders (Agelena orientalis and Hogna radiata) and used to modulate N and P/Q VGCCs. The effect of omega-agatoxin-Aa2a and omega-Lsp-IA on glutamate-induced excitotoxicity in rats was evaluated using the Morris water maze task as a behavioral test. The local expression of synaptophysin (SYN) was visualized for synaptic quantification using an immunofluorescence assay. The electrophysiological amplitudes of the field excitatory postsynaptic potentials (fEPSPs) in the input-output and LTP curves of the mossy fiber and Schaffer collateral circuits were recorded. The results of our study demonstrated that N and P/Q VGCC modulation in the hippocampus trisynaptic circuit of rats with glutamate-induced excitotoxicity dysfunction could prevent the destructive consequences of excitotoxicity in synapses and improve memory function and performance

Ameliorative effects of omega-lycotoxin-Gsp2671e purified from the spider venom of Lycosa praegrandis on memory deficits of glutamate-induced excitotoxicity rat model

Memory impairment is one of the main complications of Alzheimer’s disease (AD). This condition can be induced by hyper-stimulation of N-Methyl-D-aspartate receptors (NMDARs) of glutamate in the hippocampus, which ends up to pyramidal neurons determination. The release of neurotransmitters relies on voltage-gated calcium channels (VGCCs) such as P/Q-types. Omega-lycotoxin-Gsp2671e (OLG1e) is a P/Q-type VGCC modulator with high affinity and selectivity. This bio-active small protein was purified and identified from the Lycosa praegrandis venom. The effect of this state-dependent low molecular weight P/Q-type calcium modulator on rats was investigated via glutamate-induced excitotoxicity by N-Methyl-D-aspartate. Also, Electrophysiological amplitude of field excitatory postsynaptic potentials (fEPSPs) in the input–output and Long-term potentiation (LTP) curves were recorded in mossy fiber and the amount of synaptophysin (SYN), synaptosomal-associated protein, 25 kDa (SNAP-25), and synaptotagmin 1(SYT1) genes expression were measured using Real-time PCR technique for synaptic quantification. The outcomes of the current study suggest that OLG1e as a P/Q-type VGCC modulator has an ameliorative effect on excitotoxicity-induced memory defects and prevents the impairment of pyramidal neurons in the rat hippocampus

Pharmacoeconomics in Iran: It Is Time to Take It into Practice

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Cost-effectiveness of surgical excision versus Mohs micrographic surgery for nonmelanoma skin cancer: A retrospective cohort study

Background: Nonmelanoma skin cancer rates are increasing worldwide. Mohs micrographic surgery and surgical excision (SE) are the two treatment methods for this type of cancer. The current paper aims at determining and comparing the cost-effectiveness of SE and Mohs micrographic surgery. Materials and Methods: The current study has a retrospective cohort design. A number of 630 patients suffering from nonmelanoma skin cancer who at some point of time during the years 2007–2014 referred to the Al-Zahra or Seyed Al-Shohada Hospitals in Isfahan. Patients were followed up for 4 years, and then the incremental cost-effectiveness ratio (ICER) of the two methods was calculated. Results: The average (minimum-maximum) cost of the SE and Mohs surgery methods in Iran was obtained as 18,550,170 (2335,800–260,898,262) and 12,236,890 (6488,340–41,161,700) Iranian Rial, respectively. Recurrence percentage was also reported as 7.9% and 8.7% for SE and Mohs micrographic surgery, respectively (P > 0.05). The ICER of SE in comparison with Mohs surgery was calculated as 7891,600 Iranian Rials per recurrence avoided. Conclusion: Mohs surgery is less expensive than SE, it seems like Mohs surgery is more affordable, however further studies in different populations of the country are needed

Utilization and Prescribing Pattern of Rivaroxaban in a Large Teaching Hospital in Iran: Drug Utilization Evaluation of Rivaroxaban

This medication utilization evaluation aims to describe the use of rivaroxaban in a tertiary care teaching hospital and to audit the hospital physician’s prescribing practice. A prospective cross-sectional study was performed from March to December 2019 in Alzahra teaching hospital, Isfahan, Iran. All patients who received at least one dose of rivaroxaban were eligible for inclusion. Data were collected on patient demographics, indication, dosing regimen, adverse events, concurrent anticoagulant therapy, and laboratory tests (including renal function). A total of 104 patients were included in our study. Most patients (N=39, 37.5%) were prescribed rivaroxaban for deep vein thrombosis (DVT) prophylaxis. Overall, more than 34% of rivaroxaban prescriptions was appropriate. Rivaroxaban was indicated correctly in all the patients (100% appropriate indication). However, 58.6% and 50% of patients received correct dosing, respectively, based on indication and renal function. High-dose prescribing was the major fault of prescriptions when the renal function was taken into account (82.6%). An appropriate switch occurred in 48.7% of the patients who switched from one anticoagulant to another. Inappropriate prescription of rivaroxaban for many patients in the current study emphasizes the requirement of developing a scientifically well-defined protocol for the use of rivaroxaban in the evaluated hospital. Accordingly, establishing a structured educational program for prescribers and assigning the rivaroxaban prescription to specialized services with consultation with clinical pharmacists is recommended