Dutasteride plus Tamsulosin therapy versus Tamsulosin Monotherapy in the treatment of lower urinary tract symptoms: A Cost-utility analysis

Introduction: Lower Urinary Tract symptoms (LUTS)? impacts the quality of life of about 23.8% of the male population in Iran, diagnosed with Benign Prostatic Hyperplasia, annually . The current pharmacological treatment protocol for LUTS are α-blockers and 5-alpha reductase inhibitors (such as Dutasteride). This study was designed to estimate the cost-utility of dutasteride plus tamsulosin therapy for LUTS from the perspective of the Iran Health System. Methods and Results: A Markov model was developed to estimate healthcare costs and patient outcomes, measured by quality-adjusted life years (QALYs), for patients with moderate to severe LUTS. The model, compared four mutually exclusive health states in two alternative treatment options: tamsulosin (0.4 mg/day) and dutasteride plus tamsulosin (0.5mg+0.4 mg/day). time horizon was 35 years, with the duration of one year per cycle. The discount rates for utilities and costs were 3% and 5% respectively. A meta-analysis was conducted to estimate advese drug reactions (ADRs) and After Surgery Events (ASEs) probabilities. Total Cost consists of the direct costs of medications, as well as inpatient and outpatient services (general practice and urology specialist examinations, hospitalizations, laboratory services, diagnostic procedures, TURP surgical procedures, treatment of AUR, and treatment in emergency care services). One-way sensitivity testing and Probabilistic Sensitivity Analyses (PSA) were performed for virtual cohort of 1,000 patients with LUTS. Utility weights for each health states were obtained from a meta-analysis of published studies with EQ5D method. These weights are calculated 0.86, 0.79, 0.72 and 0 in mild, moderate, severe and death states, respectively. The probability of ASEs (CI 95%) were calculated as: TUR syndrome (0-0.0109), Blood transfusion (0.0296-0.0676), Urinary incontinence (0.0198-0.1894), urethral stricture (0.0392-0.0769) and UTI (0.0169-0.0787). After 35 years, the incremental cost-effectiveness ratio for combination therapy was $5159, well within the threshold range typically applied in Iran. PSA showed that the probability of being cost-effective in combination therapy is 89% to 94%, also the model showed the most sensitivity to dutasteride unit price and surgery incidence with monotherapy. Conclusions: Combination therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in Iran

Preparation and Evaluation of Nicotine Slow Release Mucoadhesive Film for NRT**

Abstract Introduction: Nicotine replacement therapy (NRT) with gradual decreasing the amount of nicotine is one of the smoking cessation methods. Nicotine dosage forms on the market are including gum and skin patches. Mucoadhesive formulations are the novel drug delivery systems that can be used for NRT. Mucoadhesive nicotine film (MNF) when placed in the upper gum, will adhere to mucosa and release the nicotine in a controlled manner. MNF will meet the immediate and long-term need of the individual to the nicotine, and could decrease his/her dependency on smoking. Methods and Results: The mucoadhesive films were prepared using different conventional bioadhesive polymers such as HPMC, PVP, Na Alginate, Ethyl cellulose and Eudragit RL100; and Glycerin as the plasticizer for formulations of nicotine hydrogen tartrate, which is more stable form of nicotine. The pharmaceutics characteristics of film include rate of drug release and in vitro adhesion, disintegration time and swallow amount were evaluated. The formulations make with PVP have improved adhesion properties and formulation with HPMC (6 cP) or Na.Alginate released nicotine in the average less than an hour. Drug release from formulations contains HPMC (15000cP) took long about 120 minutes, but in formulations contains Eudragit was within 4.5 to over 6 hours. Conclusions: The best formulation with suitable adhesion and rate of release contains Eudragit RL100 and Glycerin that release nicotine for 5 hour. NRT: Nicotine replacement therapy (NRT) gives you nicotine – in the form of gum, patches, sprays, inhalers, or lozenges – but not the other harmful chemicals in tobacco. NRT can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological (emotional) aspects of quittin

Country Pharmaceutical Situation Based on World Health Organization Indicators: Evidence from an Upper-Middle Income Country

Evaluating the performance of national authorities has a pivotal role in the development of evidence-based policymaking. Regarding the complexity of the pharmaceutical sector and its severe impacts on public health, Food and Drug Administrations' (FDA) performance should be evaluated at regular intervals. This study aims to depict a comprehensive picture of the Iranian pharmaceutical situation and its structural gaps. In this cross-sectional descriptive study, inspired by indicators proposed by the world health organization (WHO), a checklist was developed with six component topics and 239 indicators. These topics considered the existence and performance of six critical structures, including national drug policy (NDP), regulatory system, medicine supply system, medicine financing, production and trade, and rational use of drugs (RUD). Afterward, the translation validity and then face and content validity of the research tool was confirmed by relevant experts. The data were collected by referring to official documents, reports, and critical informants in the Iranian Food and Drug Administration (IRFDA). According to the WHO indicators, the scores for structures of IRFDA are 80% in NDP, 61.5% in the regulatory system, 64.7% in the medicines supply system, 84.8% in medicines financing, and 60% in production, and trade, and 71.7% in RUD. Considering the status of structures and processes, IRFDA should attempt to provide an action plan commensurate with the NDP. Besides, it should modify the regulations regarding its responsibilities and authorities, develop transparency and accountability in its offices, publish a national essential medicines list, and revise motivational and punitive policies to create RUD

Assessing Pharmacies’ Preparedness for Disasters and Emergencies: The Case of Tehran, Iran: Assessing Pharmacies’ Preparedness for Emergencies

Large-scale disasters and emergencies can pose serious challenges to various aspects of social life. Pharmacies’ preparedness further comes to the fore in these times. This study design and implement a model for assessing the disaster and emergency preparedness of pharmacies in Iran. The study utilized qualitative and quantitative methods. An exploratory interview was conducted with experts to identify and select relevant indicators. A survey was then conducted to collect data from a sample of pharmacies from five geographical districts of Tehran, Iran’s capital and largest and most populated city. The developed preparedness assessment tool includes five dimensions and 67 indicators. Employing the tool on the study samples, it was found that only 27.5% of pharmacies were ready in terms of medicine supplies, 41.7% in terms of medical consumables, 55.8% in terms of physical facilities, 52% in terms of software, and 32.7% in terms of human resource training and management. The level of preparedness for pharmaceutical services and medicine providing centers revealed serious deficiencies in all dimensions. Since these centers are not adequately prepared for disasters and emergencies, improving the level of preparedness for this important element of the health sector should be the government’s immediate pressing concern

Use Pattern of Personal Care Products: A Cross-Sectional National Survey: IRANCUP 2019: Use Pattern of Personal Care Products

Personal care products are amongst the most consistently used goods in every population. To evaluate the market trends of these products in Iran, this study considers their use frequency, use prevalence, cross-sectional perceptions of retail brand loyalty, purchase location preferences, and sources, be them domestic or foreign. Usage patterns of 125 types of personal care products  were collected in over 2021 households in 8 cities of Iran by means of a checklist fill out. The strength of the study were the separation of data by socio-demographic factors such as gender, education level, economic status, occupational status, and level of religiosity. Daily shampoo, bath soap, toothpaste, and face and hand moisturizer were the most frequent products used while the use of face and eye care products was less prevalent. The most repeatedly use-pattern was once-daily for sunscreens, moisturizers, lightnings, deodorants, toothpastes, mouth-washes, eye-care, anti-acne, and anti-chap products. Men and women with a higher economic status were more likely to use eye moisturizer, intense anti-acne-peeling, nourishing antiaging, cream soap, and body lotion/oil. Moreover, in all products studied, respondents prefer domestic over foreign ones except in deodorants and anti-perspirants. In addition, 42% and 29.8% of respondents prefer to purchase their personal care products from pharmacies and beauty shops, respectively. Given the immense popularity of such products, their impact on community health an  consumers’ preferences, results of this study can have far-reaching implications for manufacturing companies and health authorities in terms of developing strategies and regulations to optimize the use pattern of these products