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

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

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

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

Relation between Parental Education and Children’s Healthful Lifestyle: Parents’ Education and children’s Lifestyle

Because of the important role of parents’ socioeconomic condition in their children’s health, the present paper aimed to evaluate the relationship between the parents’ education and children’s healthful lifestyle, including breastfeeding, nutrition, supplement intake, smoking, and personal hygiene. Parents’ behavior is an important factor that affects children’s health status. Accordingly, a cross-sectional descriptive analysis was conducted using a self-administrated anonymous questionnaire. A total of 600 anonymous questionnaires were distributed among the children’s parents in primary schools in Tehran, Iran, of which 62% were returned. Responses showed that 89.2% of mothers intended to breastfeed and 69% of children had suitable nutrition. Additionally, the study result indicated a significant correlation between parents’ education and children’s personal hygiene. There was a significant relation between parents’ education and parents’ smoking as well. Furthermore, there was a significant relation between mothers’ education and supplement intake in their children. Therefore, parents’ education and health literacy are the main factors in children’s health that should be addressed by policymakers

Exploring health seeking behaviors for common cold management

Background: The prevalence of common cold can impose financial burden on the healthcare systems, despite its simple and self-limiting symptoms. Objective: This study examines the behavior of patients suffering from symptoms of the common cold and explores the factors that may influence such behaviors. Methods: A descriptive-analytic cross-sectional study was conducted in 2019, in Tehran, Iran, using cluster sampling in socioeconomically diverse areas within the city. The participants' behaviors and related factors were evaluated using a 10-item questionnaire. Data collection process involved selecting 5 shopping centers and 404 individuals participated the study. SPSS version 24 was used for analysis. Results: The results showed that 42.1% of the respondents would consult a physician immediately upon experiencing cold symptoms, while 11.4% would consult a pharmacist.In addition, 14.3% would try self-medication, 28.3% relied on traditional home remedies, and 15%indicated not to make use of any remedies or interventions. The study indicated a correlation between people's behaviors concerning the common cold and their level of health self-confidence, knowledge of the common cold, lifestyle, gender, marital status, occupational status, insurance status, and average family spending. Conclusion: The findings of this study are significant in that they shed light on the behaviors of individuals and associated factors related to seeking medical assistance for the common cold. This knowledge can assist healthcare systems in developing strategies aimed at enhancing treatment outcomes, and decreasing costs

Using Discrete Choice Experiment to Determine Willingness to Pay for Interferon-Beta Drugs by Multiple Sclerosis Patients: Willingness to Pay for Interferon-Beta Drugs in Multiple Sclerosis Patients

This study explores the effects of Interferon-β characteristics such as country of origin, injection frequency and method, monthly cost, effectiveness, and side effects on multiple-sclerosis patients’ willingness to pay. For this purpose, MS patients with a history of using Interferon-β were studied from the three major Isfahan MS centers. Choice sets were designed with a combination of attributes and levels. The variables in this experiment included interferon-β with different levels assigned to each of its attribute. Patient preferences and willingness to pay were calculated through Discreet Choice Experiment. The statistical population consisted of 358 patients deemed eligible for the study. They responded to the questionnaire and took part in interviews. Results showed that the highest willingness-to-pay value of US$ 223 as determined by MS patients belonged to a change of effectiveness from moderate to high. Side-effects and ease of use ranked next among patient preferences. Country of origin recorded the lowest value of the willingness-to-pay parameter. Evaluation of MS patients' preferences as reflected in their willingness to pay plays an important role in patient’s adherence to treatment to achieve more effective results. Due to the variety of drugs in this category, it is necessary to identify and prioritize those features that are of interest to patients and that increase their utility relative to IFN-β drugs

Selecting Reference Countries in External Reference Based Pricing: The Case Study of Iran: Selecting reference countries in external reference based pricing

Most countries are using some kinds of pharmaceutical policies, like external reference-based pricing, to control the costs of medicines. This policy could be implemented in different ways and there is no systematic method for selecting reference countries. In this study, we tried to identify and classify the factors affecting the selection of reference countries in Iran .Delphi method was employed to elicit experts’ opinion in pharmaceutical sector on the parameters affecting the choice of reference countries. Members of the panel were experts in the field of policymaking, manufacturing, distribution, and importation of medicines, insurance companies, and academics who were more familiar with the purpose of the research. Panels were run in three rounds. The results of this study reveal that the impact of pharmaceutical, economy, and health sectors characteristics has been more effective, in selecting reference countries. Health insurance coverage was the most important index among all the different sectors. Other important indexes included pharmaceutical pricing system, mechanism of drug registration, gross national income (GNI) per capita, health expenditure per capita, health expenditure (share of GDP) and the out-of-pocket health expenditure. To have an efficient pharmaceutical external reference-based pricing, it is important to select reference countries with more similar important parameters. Obviously, any change in these parameters has to be considered and adjusted during the time

A Participative Process of Strategy-Making and Firm Performance in Iranian Pharmaceutical Companies: Strategy-Making and Firm Performance in Iranian Pharmaceutical Companies

Pharmaceutical companies are regarded as principal contributors to national economies all over the world owing to their substantial assistance to public health system; GDP, employment, and market growth. Consequently, pharmaceutical managers must take the necessary steps to improve strategy-making and firm performance. This study investigates the relationship between four conventional modes of strategy-making process and performance in pharmaceutical companies in Iran. This paper argues that small or knowledge-based pharmaceutical companies, similar to large pharmaceutical companies, place differing emphasis on strategy-making and could apply different approaches to strategy-making. Furthermore, the present research offers an explanation of the nature of these processes in pharmaceutical companies and hypothesizes how they are related to firm performance. It then describes the results of an empirical study on the strategy-making processes of pharmaceutical companies in Iran. Analysis of the data obtained from 125 pharmaceutical companies indicates that participative approaches to strategy-making exist in these pharmaceutical companies and could have a significant and strong relationship with firm performance

Factors Influencing Hematologists-Oncologists’ Prescription of Chemotherapy Drugs in Cancer Treatment in Iran: an Interview Questionnaire Study: Factors influencing hematologists-oncologists’ prescription of chemotherapy drugs

Cancer can be treated by surgery, chemotherapy, radiation therapy, hormonal therapy, and targeted therapy. The choice of treatment depends on the type and stage of the cancer. Chemotherapy drugs play an important role in cancer treatment. The objective of this interview-questionnaire study is to explore what influences Iranian hematologists-oncologists’ prescription when prescribing chemotherapy drug. Data collection can be divided into two categories: the interview and the questionnaire. The qualitative part consists of depth interviews, utilizing closed- and open-ended questions, were conducted with oncologists, selected through theoretical sampling. The interview questions consisted of two parts, in the first part; open-ended questions were posed about factors influencing prescription. In the second part, the oncologists were asked to rate predefined factors that might influence their prescription decisions. The quantitative part of the study consists of questionnaire included two parts; the first part consisted of general questions including gender, age, membership in scientific committees and professional background. The second part consisted of 24 specialized questions that covered all the indexes of the effective factors on oncologists’ prescription decisions. Ten oncologists were interviewed. Factors affecting chemotherapy drug prescription were grouped into three categories based on qualitative studies carried out and is presented as they were mentioned and rated by the hematologists-oncologists: 1) Products properties, 2) Pharmaceutical marketing, 3) Scientific, experimental confirmation. The findings from the questionnaire suggest products properties particularly (clinical effectiveness) is the most important factor considered in drug prescription choice. Also, the socialized medicine sponsorship and clinical trial respectively are the most effective on increasing the frequency of prescribing. Whilst, prescribing by brand name or higher prices for a drug are not necessarily justified. The results of this study provide new insights to the nature prescribing behavior driven to develop measures which could be used to achieve greater clinical effectiveness and economic efficiency from drug prescribing