Comparison of the Therapeutic Effects of Topiramate and Phenobarbital on the Quality of Life of Children under Five with Fever and Convulsion

Background & Objectives: Failure to treat febrile seizure in children leads to physical, psychological and social problems and if not treated timely, might lead to epilepsy which affects the quality of life of children. The purpose of this study was to compare the therapeutic effects of two drugs on the quality of life of children under five with febrile convulsion. Methods: This was a descriptive-analytical study that was done in an interventional manner. In this study, the quality of life of 40 children with febrile convulsion treated with topiramate and 51 children who had the same problem and treated with phenobarbital drug were compared. Data collection tool was EQ5D questionnaire. ANOVA and t-test were used for statistical analysis and data were entered into SPSS statistical software version 22. Results: Mean scores of quality of life in children taking phenobarbital and topiramate were 72.5 and 82.7, respectively. Topiramate had a significant effect on the mean score of quality of life in children with febrile convulsion and increased it. Parental education and early febrile convulsion had a significant relationship with patients' quality of life. Conclusion: Health policy makers, physicians, and other members of health care system must provide access to appropriate educational, medical, and therapeutic services for children with febrile seizure in order to improve their health status. Key­words: Febrile convulsion, Topiramate, Phenobarbital, Quality of Life, Children Citation: Talebianpour H, Talebianpour E, Nemati H, Keshavarz K. Comparison of the Therapeutic Effects of Topiramate and Phenobarbital on the Quality of Life of Children under Five with Fever and Convulsion. Journal of Health Based Research 2019; 5(3): 261-72

A cost-utility analysis of different antiviral medicine regimens in patients with chronic hepatitis C virus genotype 1 infection

Background: Despite the introduction of new drug regimens with high effectiveness for the hepatitis C virus (HCV) patients, especially in HCV genotype 1, no cost-effectiveness study on the selection of the superior drug strategy in Iran has been conducted yet. Objectives: This study is aimed to assess the cost-effectiveness of the three drug regimens of pegylated interferon and ribavirin (PR), sofosbuvir (SOF) + PR and ledipasvir and sofosbuvir (LDV/SOF) in patients with HCV genotype 1 in Iran in the year 2014. Methods: A Markov micro-simulation model was used to evaluate the cost-effectiveness of the three drug strategies for a cohort of 10000 patients. Quality-adjusted life-years (QALYs) were extracted from published studies. Cost data was estimated through the review of medical records and obtaining experts opinion. Results: The results showed that the SOF + PR drug compared with PR had a lower cost and was more effective, but compared with the LDV/SOF, in spite of its lower cost, it was less efficient. The QALY values obtained for PR, SOF + PR and LDV/SOF, respectively, were 10.98, 12.08 and 12.28 and their costs were $41,741,$ 7,676 and $46,993. Moreover, the results obtained from acceptability curves showed that SOF + PR were the most cost-effective treatment for thresholds below$ 45,270 PPP. Conclusions: The use of SOF + PR regimen or LDV/SOF can significantly reduce the incidence of complications associated with the disease. For example, short and long-term outcomes are better than the current drug regimens for HCV genotype 1 patients in all stages of the disease

Cost-effectiveness analysis of topiramate versus phenobarbital in the treatment of children with febrile seizure in Shiraz

Background: Febrile seizure is the most common disorder in childhood, with a prevalence of 2% to 5%. There are many drugs for treatment of this disease; however, the most common prescribed medication in Iran is phenobarbital that is cheap, but it has many side effects. Topiramate is a medication with fewer side effects that is currently prescribed in Iran only for patients with epilepsy; also, it has recently been prescribed and tested for children with febrile seizure. The aim of this study was to compare the cost-effectiveness of topiramate versus phenobarbital in patients with febrile seizure in the south of Iran in 2017.Methods: This econometric cost-effectiveness and cost-utility study was conducted on 91 patients with febrile seizure to assess two strategies of oral drug therapy including phenobarbital and topiramate in 2016-2017. Of all, 51 patients were treated with phenobarbital and 40 patients received topiramate. In order to collect the required data, we followed up the patients for six months, using a randomized and single-blinded approach. In this study, a decision tree model was used. The outcomes of the model included febrile seizure and utility. The study was conducted from the perspective of the community; therefore, direct and indirect costs were included in the study. Excel and TreeAge software (2011) were used to analyze the results.Results: The results showed that topiramate was cheaper and more effective than phenobarbital. In patients in the phenobarbital and topiramate groups, the mean costs were $740 and$674 per ppp, utility scores were 0.72 and 0.82, and febrile seizure without side effects were 0.3 and 0.6, respectively. Moreover, one-way sensitivity analysis confirmed the robustness of the results of the study.Conclusion: According to the results, topiramate in patients with febrile seizure is a fully cost-effective and cost-efficient strategy that can be suggested as a better alternative for children with febrile seizure

A cost utility and cost effectiveness analysis of different oral antiviral medications in patients with HBeAg-Negative chronic hepatitis B in Iran: an economic microsimulation decision model

Background: Although hepatitis B infection is the major cause of chronic liver disease in Iran, no studies have employed economic evaluations of the medications used to treat Iranian patients with chronic hepatitis B (CHB). Therefore, the cost-effectiveness of the different treatment options for this disease in Iran is unknown. Objectives: The aim of this study was to compare the cost utility and cost-effectiveness of medication strategies tailored to local conditions in patients with HB e antigen (HBeAg)-negative CHB infection in Iran. Methods: An economic evaluation of the cost utility of the following five oral medication strategies was conducted: adefovir (ADV), lamivudine (LAM), ADV + LAM, entecavir (ETV), and tenofovir (TDF). A Markov microsimulation model was used to estimate the clinical and economic outcomes over the course of the patient’s lifetime and based on a societal perspective. Medical and nonmedical direct costs and indirect costs were included in the study and life-years gained (LYG) and quality-adjusted life-years (QALY) were determined as measures of effectiveness. The results are presented in terms of the incremental cost-effectiveness ratio (ICER) per QALY or LYG. The model consisted of nine stages of the disease. The transition probabilities for the movement between the different stages were based on clinical evidence and international expert opinion. A probabilistic sensitivity analysis (PSA) was used to measure the effects of uncertainty in the model parameters. Results: The results revealed that the TDF treatment strategy was more effective and less costly than the other options. In addition, TDF had the highest QALY and LYG in the HBeAg-negative CHB patients, with 13.58 and 21.26 (discounted) in all comparisons. The PSA proved the robustness of the model results. The cost-effectiveness acceptability curves showed that TDF was the most cost-effective treatment in 59% - 78% of the simulations of HBeAg-negative patients, with WTP thresholds less than $14010 (maximum WTP per QALY). Conclusions: The use of TDF in patients with HBeAg-negative CHB seemed to be a highly cost-effective strategy. Compared with the other available medication options, TDF was the most cost-saving strategy. Thus, TDF may be the best option as a first-line medication. Patients can also be switched from other medications to TDF

Activity Based Costing (ABC) to Calculate the Cost of Training Students in School of Management and Medical Information Sciences

Introduction: Public higher education is competing for limited public funds. Activity-basedcosting (ABC) provides detailed evidence that higher education administrators and policymakerscan be employed to allocate scare resources more effectively and better understandwhat education centers do. Conducting context-specific studies on ABC and budgeting foreducational systems is the crux of the matter for cost containment and making decisions. Thepresent study was undertaken with the aim of determining the costs of training undergraduateand postgraduate students.Methods: This is a descriptive-analytic and applied study. The costs incurred by 7 differentdisciplines and degrees including bachelor (n=2), master (n=4), and PhD (n=1) in the Schoolof Management and Medical Information Sciences of the Shiraz University of MedicalScience in the academic year 2015-16 were examined and costs of training undergraduate andpostgraduate students were totaled by ABC method. The total number of students in includeddisciplines was 269; of them, 71% were studying in the bachelor, 26% in the master, and 3%in PhD programs. Since the primary purpose of our study was to calculate the total sum ofcost per student, no sampling was done. After identifying the activity centers and incurredcosts per activity center, the proportion of the schools’ costs to the university headquarter wastraced. In the school level, the costs of non-faculty staff by the deputies of education, research,support, and cultural-student affairs were estimated. Moreover, other costs, namely energycosts, rentals, consumables, depreciation, and missions were determined and assigned basedon the number of students. Data management and analysis were performed using Excel 2007.Results: The cost of training undergraduate students in the disciplines of health servicesmanagement and health information technology was $24413±2891 and$24286±2926,respectively. The maximum cost of schooling a student in the master degree belonged to thediscipline of medical informatics. The total cost of training a PhD student in the academicyear 2014-2015 was $95303±16106.Conclusion: In an era of resource scarcity, the ability to recognize the gaps between resourcesand academic goals and redirect the resources into programs which maximize the valueadded is crucial for all higher education institutes

Cost-effectiveness analysis of ceftazidime avibactam versus colistin in carbapenem-resistant enterobacteriaceae in Iran

Abstract Introduction Ceftazidime avibactam (CA) is an effective treatment against carbapenem-resistant Enterobacteriaceae (CRE), but its cost-effectiveness is unclear. This study was performed to evaluate the cost-effectiveness of CA against the best available treatment colistin (Col) for patients with CRE-related infections in Iran. Methodology A model of a decision tree was designed to evaluate the cost-effectiveness of CA in CRE patients over a period of 5 years. The Iran health system was the perspective of the study, and the discount rates of 5.8% and 3% were considered for the data of cost and utility, respectively. The clinical inputs were obtained from a prospective observational study. We established the costs of medical services and medical tariffs of Iran’s health system, and obtained the rate of medical service resources used by patients from specialists. The results of this model included the quality-adjusted life years (QALYs), increasing costs, and incremental cost-utility ratio (ICUR). We also performed the deterministic and probabilistic sensitivity analyses. Results CA reduced the burden of related to treatment failure and the need for treatment of nephrotoxicity and chronic failure, whereas, the costs related to drug procurement and long-term care (due to longer survival) increased. Treatment with CA versus Col resulted in a 53% increase in QALYs and $425 in costs, leading to an ICUR equal to 798$/QALYs. Sensitivity analyses proved the model’s strength and indicated that the cost-effectiveness of CA can reach 88% when paying 1111 $/QALY. Budget impact analysis estimated CA regimen will increase the health system costs by$1,270,462 in 5 years. Conclusion In Iranian settings, CA can significantly increase the quality of life and patients’ survival; therefore, in comparison to the Col drug regimen, CA is a cost-effective strategy

Cost-effectiveness of radiotherapy during surgery compared with external radiation therapy in the treatment of women with breast cancer

Introduction: Intraoperative radiation therapy device (IORT) is one of the several options for partial breast irradiation. IORT is sent to the tumor bed during surgery and can be replaced with conventional standard therapy (EBRT). The aim of this study was to evaluate the safety and effectiveness of IORT machine compared with EBRT and to determine the dominant option in terms of the cost-effectiveness. Method: This study was conducted in two phases; the first phase was a comprehensive review of the electronic databases search that was extracted after extraction and selection of the articles used in this article on effectiveness outcomes. Data collection form was completed by professionals and experts to estimate the cost of treatment, intraoperative radiotherapy and radiotherapy cost when using external radiation therapy process; direct costs were considered from the perspective of service provider and they were calculated in the second phase to determine the option of cost-effective ICER. Excel software was used for data analysis and sensitivity analysis was performed to determine the strength of the results of cost-effectiveness. Results:18 studies were selected but only 8 of them were shown to have acceptable quality. The consequences like “rate of cancer recurrence”, “seroma”, “necrosis”, “toxic”, “skin disorders and delayed wound healing” and “spread the pain” were among the consequences used in the selected articles. The total costs for each patient during a course of treatment for EBRT and IORT were estimated 1398 and $5337.5, respectively. During the analysis, cost-effectiveness of the consequences of cancer recurrence, seroma, necrosis and skin disorders and delayed wound healing ICER was calculated. And IORT was found to be the dominant supplier in all cases. Also, in terms of implications of toxicity and prevalence of pain, IORT had a lower cost and better effectiveness and consequently the result was more cost effective than EBRT. Conclusion: According to the results of this study, the difference between the two devices in terms of effectiveness was much lesser than that in terms of the cost of the two devices. According to the results of IORT machine, it is the dominant supplier compared with EBRT. From the cost-effectiveness perspective, Iran Ministry of Health can consider IORT system as an option for entering Iranian health system. But the ethical and cultural considerations in the use of the device must be taken into account

ijps.sums.ac.ir R Original Article

Abstract Geographic proximity has been shown to be a significant factor in healthcare utilization and also one of the important dimensions in the concept of accessibility. In this study, we aimed to evaluate the geographic accessibility to pharmacies in city of Shiraz. A geographic information system approach was obtained to evaluate geographic accessibility to pharmacies. A stratified random sampling was conducted to choose adequate points as the representative of whole city to measure their distance in both pedestrian and driving condition to the pharmacies. To measure the pedestrian accessibility of selected blocks in Shiraz, different distances of 150, 300, 450, 600 and 750 meter, and to measure driving accessibility different network distances of 5, 10 and 15 min were considered as acceptable levels of geographic accessibility. In terms of pedestrian accessibility, the analysis showed that about 45% and 15% of sample blocks have accessibility to at least one pharmacy in their 750 meters in normal days and holidays, respectively, based on straight line distance. In terms of driving accessibility, our analysis indicated that in normal days and also in holidays about 98% of sample blocks in Shiraz have at least one pharmacy in their 15 min based on network analysis and considering traffic limitation. In spite of implemented policy by food and drug organization to distribute pharmacies equitably through the whole city, geographic accessibility to pharmacy doesn't seem to be desirable in Shiraz and some other policies may be needed to make the situation better

A Geographic Information System Analysis of Accessibility to Community Pharmacy in Shiraz, Iran: Geographic accessibility to pharmacy in Shiraz

Geographic proximity has been shown to be a significant factor in healthcare utilization and also one of the important dimensions in the concept of accessibility. In this study, we aimed to evaluate the geographic accessibility to pharmacies in city of Shiraz. A geographic information system approach was obtained to evaluate geographic accessibility to pharmacies. A stratified random sampling was conductedto choose adequate points as the representative of whole city to measure their distance in both pedestrian and driving condition to the pharmacies. To measure the pedestrian accessibility of selected blocks in Shiraz, different distances of 150, 300, 450, 600 and 750 meter, and to measure driving accessibility different network distances of 5, 10 and 15 min were considered as acceptable levels of geographicaccessibility. In terms of pedestrian accessibility, the analysis showed that about 45% and 15% of sample blocks have accessibility to at least one pharmacy in their 750 meters in normal days and holidays, respectively, based on straight line distance. In terms of driving accessibility, our analysis indicated that in normal days and also in holidays about 98% of sample blocks in Shiraz have at least one pharmacy in their 15 min based on network analysis and considering traffic limitation. In spite of implemented policy by food and drug organization to distribute pharmacies equitably through the whole city, geographic accessibility to pharmacy doesn’t seem to be desirable in Shiraz and some other policies may be needed to make the situation better

Factors affecting the economic burden of breast cancer in southern Iran

Abstract Background Breast cancer (BC) is the most common cancer in the world, and is associated with significant economic costs for patients and communities. Therefore, the information on the costs of the disease and the identification of its underlying factors will provide insights into designing effective interventions and reducing the costs. Thus, the present study aimed to identify the factors affecting the economic burden of breast cancer from all medical centers providing diagnostic and treatment services in southern Iran. Methods A list of factors affecting the economic burden of breast cancer was obtained based on the effective factors searched in the databases, including PubMed, ProQuest, Scopus, ISI Web of Science, SID, and Magiran, and the opinions of BC cancer specialists. Then, the data on 460 breast cancer patients was collected from March 2020 to March 2022. The relationship between the factors affecting Breast Cancer costs was analyzed using SPSS 13.0 software by the use of multiple regression analysis. Results The results of the multiple regression analysis showed that stages (P-value < 0.001), being an extreme user (p = 0.025), type of treatment center (P-value < 0.001), income (P-value < 0.001), chemotherapy side effects (P-value < 0.001), and distance to the nearest health center (P-value < 0.001) were important factors affecting the costs of breast cancer patients. Conclusions According to the results, encouraging people to undergo annual screenings, increasing insurance coverage, assuring the patients about the desirability and adequacy of the provided medical services, deploying specialists in chemotherapy centers (especially nutritionists) to recommend special diets, and establishing cancer diagnostic and treatment centers in high-population cities could help reduce the costs of breast cancer patients