Cost-Effectiveness of Sorafenib for Metastatic Renal Cell Carcinoma: A Systematic Review

Introduction: Sorafenib is a multi-kinase inhibitor and decreases tumor cell proliferation. This study aimed to systematically review the existing evidence related to its cost-effectiveness.  Methods and Results: EMBASE, MEDLINE, PUBMED, Google Scholar, and the Scopus database were searched and articles were selected on the basis of their correlation with the economic evaluations of Sorafenib. The quality of the selected studies was assessed using the Quality of Health Economic Studies instrument. This review revealed costs per quality-adjusted life years in the range of US $89,160 to$118,825, depending on whether the setting was first-line or second-line and which comparator is utilized. The results indicated that Sorafenib had not been considered as an appropriate treatment option for patients with metastasis Renal Cell Carcinoma (mRCC). Sorafenib was dominated (i.e. higher cost and lower efficacy) in comparison with Sunitinib in all cases. However, Sorafenib would be more cost-effective in comparison with bevacizumab plus interferon alfa in the treatment of mRCC.  Conclusion: Sorafenib was more effective with higher cost than Best Supportive Care but Sorafenib was not cost-effective in view of current willingness to pay threshold

Multi-dimensional geometric complexity in urban transportation systems

Transportation networks serve as windows into the complex world of urban systems. By properly characterizing a road network, one can better understand its encompassing urban system. This study offers a geometrical approach toward capturing inherent properties of urban road networks. It offers a robust and efficient methodology toward defining and extracting three relevant indicators of road networks—area, line, and point thresholds—through measures of their grid equivalents. By applying the methodology to 50 U.S. urban systems, one can successfully observe differences between eastern versus western, coastal versus inland, and old versus young cities. Moreover, we show that many socioeconomic characteristics, as well as travel patterns, within urban systems are directly correlated with their corresponding area, line, and point thresholds

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

Exploration of the Complex Similarity of Urban System Components

Similar to countless natural phenomena, cities have inherent orders that can be properly captured and expressed through a complex analysis of their components. Using Geographic Information Systems (GIS), this work offers a ring-buffer fractal approach to analyze the spatial characteristics of the components of an urban system. This approach was applied to road length, number of intersections, population+employment, and building gross floor area for the city of Chicago. The complex nature of these four components manifested itself in power-law relationships and represented by their fractal dimensions. Results showed that road length and number of intersections were closely related, albeit their fractal patterns followed slightly different trends. Additionally, population+employment and building gross floor area are significantly similar and one can explain the other. Moreover, the method developed in this study was able to identify the boundary of the old city of Chicago, highlighting its ability to capture hidden characteristics of an urban system. The proposed method could further be used to correlate complex properties of urban transportation systems to other relevant measures, including connectivity, accessibility, and mobility to name a few

An application of analytic network process model in supporting decision making to address pharmaceutical shortage

Background: The present study aimed to develop an Analytic Network Process (ANP) model to assist policymakers in identifying and prioritizing allocation indicators, which are being used or should be used to distribute drugs in short supply among different provinces. Methods: The model encompasses the interactions between various indicators and efficiency, equity, and effectiveness paradigms. Accordingly, a set of clusters and elements, which were associated with the allocation of drugs in short supply in Iran's pharmaceutical system, were detected to develop the model and were then compared in pairs in terms of a specified factor to show the priorities. Results: Equity had the highest priority (0.459) following by Efficiency (0.37), and Effectiveness (0.171). The 4 most important allocation indicator were "number of prescriptions"(0.26) and "total bed occupancy rate"(0.19) related to equity, "total population"(0.21) in efficiency and "the burden of rare and incurable disease"(0.07) in effectiveness paradigm. Conclusions: The capability to overcome inefficient resource allocation patterns caused by both oversupply and undersupply derived from historic resource allocation may be highly limited in the absence of the need indicators. The quality of the decision is related to a careful balancing act of the three paradigms which represents roughly the triple aim of public healthcare systems: clinical improvement (effectiveness), population health improvement (equity and access), and reducing cost (economic aspects -efficiency). © 2020 The Author(s)

How does external reference pricing work in developing countries: evidence from Iran

Introduction: Governments apply different pricing policies to ensure public accessibility, availability, and affordability of medicines. In this way, external reference pricing (ERP) because of its easy implementation is used widely across countries. However, ERP is completely path dependent, and it would both bring pros and cons, related to its implementing strategy which makes understanding of its impact in different countries challenging. In this study, we examine the performance of the ERP approach in Iran as a pricing tool.Method: We conducted a cross-sectional descriptive study. Although Iran officially uses a reference country basket for ERP, in this study, we use different reference countries based on socioeconomic comparability, access to their price data, medicine pricing approaches, and pharmaceutical expenditure to examine the effect of reference countries as well as the method performance. Then, an empirical study was applied to a list of selected samples of medicines in the Iranian market to compare their price with our new reference countries. Then, we discuss the performance of ERP process based on the real prices in the Iranian pharmaceutical market.Result: The prices of 57 medicines, which contain about 69.2% of the imported Iran pharma market in value, were compared with their prices in selected reference countries. It was found that 49.1% of prices were more expensive in at least one of the reference countries, and in 21% of products, the average price in Iran was higher than the average price in reference countries.Conclusion: Achieving efficient and fair pricing of pharmaceuticals between and within countries is still a complex conceptual and policy problem that ERP in short term can handle. ERP cannot be considered a perfect tool for pricing alone, although its effectiveness is acceptable. It is expected that using other pricing methods alongside the ERP will improve patients’ access to medicines. In Iran, we use value base pricing as the main pricing method for every new molecule. Then, we use other methods such as ERP as a complementary method