Applying a Simple Model of Cost Effectiveness Study of HPV Vaccine for Iran

Abstract HPV vaccine has been recently added to the Iran Drug List, so decision makers need information beyond that available from RCTs to recommend funding for this vaccination. Modeling and economic studies have addressed some of those information needs. We reviewed cost effectiveness studies to find a suitable model for Iranian population to determine the potential cost effectiveness of HPV vaccine program based on domestic available epidemiologic data. Articles were obtained from an extensive literature search to determine the cost effectiveness of implementing an HPV vaccination program with routine cervical cancer screening. A total of 64 studies were included in this review. Although the studies used different model structures, baseline parameters and assumptions (either a Markov, Hybrid, or Dynamic model). Most of the proposed cost effectiveness models need to model the probability of HPV acquisition, the possible progression from HPV infection to CIN I, CIN II, CIN III and cervical cancer, the probability of HPV transmission which are not available in Iranian epidemiologic data. Based on the available epidemiologic data in Iran, the simplified and it requires substantially fewer assumptions than the other more complex Markov and hybrid models, therefore we decided to use this model for the evaluation of cost effectiveness of HPV vaccine in Iran

A performance measurement model for pharmaceutical industry

Up to now, many efforts have been done for creation of an enterprise performance measurement model by researchers and organization, nevertheless the problem is neglected performance value. The performance of functional and processes should be seen in organization at the same time. In this study retrospective research of performance was done and proposes a cross process/function oriented performances measurement model. This model able to measure both values from functional and processes performance in organization. In order to accomplish this, in the first step all process and functions in pharmaceutical industry were established according to literature review. The second step was field study with help of experts to find the most effective processes and functions. This is followed by define key factors and critical success factor with respect to every process or function from past researches

Dose-Dense Epirubicin and Cyclophosphamide Followed by Docetaxel as Adjuvant Chemotherapy in Node-Positive Breast Cancer

Background. Adding taxanes to anthracycline-based adjuvant chemotherapy has shown significant improvement particularly in node-positive patients, but optimal dose and schedule remain undetermined. Objectives. This study aimed to assess the feasibility of dose-dense epirubicin and cyclophosphamide followed by docetaxel in node-positive breast cancer. Methods. All Patients first received 4 cycles of epirubicin (100 mg/m2) and cyclophosphamide (600 mg/m2) at 2-week interval then followed by docetaxel (100 mg/m2) at 2-week interval for 4 cycles, with daily Pegfilgrastim (G-CSF) that was administered in all patients on days 3–10 after each cycle of epirubicin and cyclophosphamide infusion. Results. Fifty-eight patients with axillary lymph node-positive breast cancer were enrolled in the study, of whom 42 (72.4%) completed the regimen. There were two toxicity-related deaths, one patient due to grade 4 febrile neutropenia and the other due to congestive heart failure. Grade 3/4 neutropenia and febrile neutropenia were 13.8% and 5.1%. The most common grade 3/4 nonhematological complications were as follows: skin-nail disorders (48.3%), hand-foot syndrome (34.4%), paresthesia (38%), arthralgia (27.5%), and paresis (24.1%). Conclusions. Dose-dense epirubicin and cyclophosphamide followed by docetaxel with G-CSF support are not feasible, and it is not recommended for further investigation

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

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