Resource Utilization and Cost of Hospitalized Patients with COVID-19 in Iran: Rationale and Design of a Protocol

There is little data on direct medical costs and how to overcome the shock introduced by the novel Coronavirus (COVID-19) which emerged in Wuhan, China. The aim of this report is to present the methodology of an observational study for analyzing the resource utilization and direct medical costs of hospitalization. A multicenter retrospective observational study will be conducted on hospitalized patients with COVID-19 in selected hospitals of Tehran University Medical Sciences from February 2020 to June 2020. Cost calculations will be based on micro-costing approaches according to the health insurance perspective. Demographic, clinical, and cost data for the aforementioned patients will be collected through reviews of medical and financial records using a self-made questionnaire categorized in three parts (Form No. 1). The first part consists of demographic characteristics, the second part includes clinical information (e.g., symptoms, comorbidities, and complications), and the third part consists of resource utilization and cost data. Descriptive statistics (means, frequencies, percentages, and 95% confidence intervals) will be used to report data. With this report we sought to provide a valuable framework for estimating the direct medical costs of COVID-19 for hospitalized-patients basis on the severity of presentation. This will be the core for an assessment of the economic burden of COVID-19 in different presentations of the disease

Resource Utilization and Cost of Hospitalized Patients with COVID-19 in Iran: Rationale and Design of a Protocol

There is little data on direct medical costs and how to overcome the shock introduced by the novel Coronavirus (COVID-19) which emerged in Wuhan, China. The aim of this report is to present the methodology of an observational study for analyzing the resource utilization and direct medical costs of hospitalization. A multicenter retrospective observational study will be conducted on hospitalized patients with COVID-19 in selected hospitals of Tehran University Medical Sciences from February 2020 to June 2020. Cost calculations will be based on micro-costing approaches according to the health insurance perspective. Demographic, clinical, and cost data for the aforementioned patients will be collected through reviews of medical and financial records using a self-made questionnaire categorized in three parts (Form No. 1). The first part consists of demographic characteristics, the second part includes clinical information (e.g., symptoms, comorbidities, and complications), and the third part consists of resource utilization and cost data. Descriptive statistics (means, frequencies, percentages, and 95% confidence intervals) will be used to report data. With this report we sought to provide a valuable framework for estimating the direct medical costs of COVID-19 for hospitalized-patients basis on the severity of presentation. This will be the core for an assessment of the economic burden of COVID-19 in different presentations of the disease

Unleashing the potential:the imperative of political support for health technology assessment in Iran

Health Technology Assessment (HTA) is essential for evidence-based healthcare decision-making, yet its integration into Iran’s healthcare system faces political and logistical challenges. Despite HTA’s potential to improve resource allocation, limited awareness, data gaps, and competing priorities hinder its implementation. This commentary emphasizes the need for political support, advocating capacity-building, collaboration, and alignment with long-term health policies. Leveraging international partnerships and monitoring outcomes can enhance HTA’s role in improving healthcare in Iran and contributing to global health advancements

Iran's Health System Transformation Plan: A SWOT analysis

Background: Societies are characterized by evolving health needs, which become more challenging throughout time, to which health system should respond. As such, a constant monitoring and a periodic review and reformation of healthcare systems are of fundamental importance to increase the efficiency and effectiveness of healthcare services delivery, equity, and sustainable funding. The establishment of President Rouhani's government in Iran, on May 5, 2014, the settlement of the new Ministry of Health and Medical Education administration (MoHME) and the need for change in the provision of healthcare services has led to the "Health System Transformation Plan" (HSTP). The aim of the current investigation was to critically evaluate the health transformation plan in Iran. Methods: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis enables to identify and assess the strengths and weaknesses within an organization or program, as well as the threats and opportunities outside the given organization or program. To identify SWOT of the HSTP in Iran, all articles concerning this program published in scholarly databases as well as in the gray literature were systematically searched. Subsequently, all factors identified at the first round were thematically classified into four categories and for reaching consensus on this classification, the list of points and factors was sent to 40 experts - policy- and decisionmakers, professors and academicians, health department workers, health activists, journalists. Results: Thirty-four subjects expressed comments on classification. Incorporating their suggestions, the SWOT analysis of Iran's HSTP was revised, finalized and then performed. Conclusion: HSTP in Iran, like many of the initiatives that have been recently introduced and not fully implemented, have various challenges, difficulties and pitfalls that health policymakers need to pay attention to. Interacting with criticisms, taking into account public opinion and strengthening the plan can make the project more effective, and it can be anticipated that in the future, better conditions in the health sector will be achieved

Assessing Iran’s health system according to the COVID-19 strategic preparedness and response plan of the World Health Organization: health policy and historical implications

Background: The role of health systems in the management of disasters including natural hazards like outbreaks and pandemics, is crucial and vital. Healthcare systems which are unprepared to properly deal with crises are much more likely to expose their public health workers and health personnel to harm and will not be able to deliver healthcare provisions in critical situations. This can lead to a drammatic toll of deaths, even in developed countries. The possible occurrence of global crises has prompted the WHO to devise instruments, guidelines and tools to assess the capacity of countries to deal with disasters. Iran’s health system has been hit hardly by the COVID-19 pandemic. In this study, we aimed to assess its preparedness and response to the outbreak. Methods: The present investigation was designed as a qualitative study. We utilized the “COVID-19 Strategic Preparedness and Response Plan” devised by WHO as a conceptual framework. Results: The dimension/pillars which scored the highest was national laboratories, followed by surveillance, rapid response teams and case investigations. Risk communication and community engagement was another pillar receiving a high score, followed by infection prevention and control and by country-level coordination, planning and monitoring. The pillar/dimensions receiving the lowest scores were operational support and logistics; case management; and points of entry. Discussion: The COVID-19 pandemic has represented an unprecedent event that has challenged healthcare systems and facilities worldwide, highlighting their weaknesses and the need for inter-sectoral cooperation and collaboration during the crisis. Analyzing these experiences and capitalizing on them, by strengthening them,will help countries to be more prepared to face opossible future crises

Analysis and evolution of health policies in Iran through policy triangle framework during the last thirty years: a systematic review of the historical period from 1994 to 2021

Background: Health policy analysis as a multi-disciplinary approach to public policy illustrates the need for interventions that highlight and address important policy issues, improve the policy formulation and implementation process and lead to better health outcomes. Various theories and frameworks have been contributed as the foundation for the analysis of policy in various studies. This study aimed to analyze health policies during the historical period of the almost last 30 years in Iran using policy triangle framework. Method: To conduct the systematic review international databases (PubMed / Medline, Scopus, Web of Sciences, CINAHL, PsycINFO, Embase, The Cochran Library) and Iranian databases from January 1994 to January 2021 using relevant keywords. A thematic qualitative analysis approach was used for the synthesis and analysis of data. Results: Out of 731 articles, 25 articles were selected and analyzed. Studies used health policy triangle framework to analyze policies in the Iranian health sector has been published since 2014. All the included studies were retrospective. The main focus of most of studies for the analysis was on the context and process of polices as the elements of the policy triangle. Conclusion: The main focus of health policy analysis studies in Iran over the last thirty years was on the context and process of polices. Although range of actors within and outside the Iran government influence health policies but in many policy processes the power and the role of all actors or players involved in the policy are not recognized carefully. Also, Iran's health sector suffers from lack of a proper framework for evaluating various implemented policies

Navigating barriers to health technology assessment development in Iran: A qualitative exploration of stakeholder perspectives

Background: Health Technology Assessment (HTA) plays a crucial role in informing healthcare policy and decision-making, especially in low- and middle-income countries like Iran. Despite its potential, the development of HTA in Iran faces significant barriers due to political, financial, technical, and social challenges. This study aims to explore stakeholder perspectives on the barriers hindering HTA development in Iran and to identify strategies for overcoming these obstacles. Methods: This qualitative study utilized semi-structured interviews to collect data from 18 stakeholders involved in the healthcare sector in Iran, including policymakers, healthcare professionals, and experts in health economics and policy. Thematic analysis was applied to identify key barriers and overarching themes related to HTA development. Results: Seven overarching themes emerged: [1] lack of a comprehensive legal and regulatory framework [2], financial constraints and limited funding [3], shortage of trained professionals and organizational resistance [4], low public and professional awareness [5], weak technical infrastructure and data systems [6], poor inter-organizational collaboration, and [7] political interference in health decision-making. These barriers hinder the effective integration of HTA into Iran’s healthcare system. Despite these barriers, participants suggested actionable recommendations, including strengthening governance structures, increasing financial investment, enhancing stakeholder engagement, and improving technical capacity. Conclusion: This study highlights the unique misalignment between HTA priorities and national health policies in Iran, barriers less frequently reported in other LMICs. Addressing these barriers through targeted policy reforms, investment in human resources, and enhanced collaboration could facilitate HTA development and improve healthcare decision-making in Iran

Exploring the landscape of health technology assessment in Iran: Perspectives from stakeholders on needs, demand and supply

Background: The evaluation of health technologies plays a crucial role in the allocation of resources and the promotion of equitable healthcare access, known as health technology assessment (HTA). This study focuses on Iran’s efforts to integrate HTA and aims to gain insights into stakeholder perspectives regarding capacity needs, demand and implementation. Methods: In this study, we employed the HTA introduction status analysis questionnaire developed by the International Decision Support Initiative (iDSI), which has been utilized in various countries. The questionnaire consisted of 12 questions divided into three sections: HTA need, demand and supply. To identify key informants, we conducted a literature review and consulted with the Ministry of Health and Medical Education (MOHME), as well we experts in policy-making, health service provision and HTA. We selected stakeholders who held decision-making positions in the healthcare domain. A modified Persian version of the questionnaire was administered online from September 2022 to January 2023 and was pretested for clarity. The analysis of the collected data involved quantitative methods for descriptive analysis and qualitative methods for thematic analysis. Results: In this study, a total of 103 questionnaires were distributed, resulting in a favourable response rate of 61% from 63 participants, of whom 68% identified as male. The participants, when assessing the needs of HTA, rated allocative efficiency as the highest priority, with a mean rating of 8.53, thereby highlighting its crucial role in optimizing resource allocation. Furthermore, healthcare quality, with a mean rating of 8.17, and transparent decision-making, with a mean rating of 7.92, were highly valued for their impact on treatment outcomes and accountability. The importance of budget control (mean rating 7.58) and equity (mean rating 7.25) were also acknowledged, as they contribute to maintaining sustainability and promoting social justice. In terms of HTA demand, safety concerns were identified as the top priority, closely followed by effectiveness and cost-effectiveness, with an expanded perspective on the economy. However, limited access to local data was reported, which arose from various factors including data collection practices, system fragmentation and privacy concerns. The priorities of HTA users encompassed coverage, payment reform, benefits design, guidelines, service delivery and technology registration. Evidence generation involved the participation of medical universities, research centres and government bodies, albeit with ongoing challenges in research quality, data access and funding. The study highlights government support and medical education as notable strengths in this context. Conclusions: This study provides a comprehensive evaluation of Iran’s HTA landscape, considering its capacity, demand and implementation aspects. It underlines the vital role of HTA in optimizing resources, improving healthcare quality and promoting equity. The study also sheds light on the strengths of evidence generation in the country, while simultaneously identifying challenges related to data access and system fragmentation. In terms of policy priorities, evidence-based decision-making emerges as crucial for enhancing healthcare access and integrating technology. The study stresses the need for evidence-based practices, a robust HTA infrastructure and collaboration among stakeholders to achieve better healthcare outcomes in Iran

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations