Attitudes of physicians and specialists towards the best approach of government in reducing the cost of prescription drugs in Tehran in 2015-2016

Background and aims: Interference in the different components of the drug sector can cause different and unpredictable effects in other parts of the health system. This study aimed to evaluate the attitude of physicians and specialists towards the best approach of government in reducing the cost of prescription drugs. Methods: This cross-sectional, questionnaire-based, observational study was conducted by the following the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines among 360 general practitioners and specialists of the city of Tehran in 2015-2016. The descriptive statistics used in order to define the best approach of government in reducing the cost of prescription drugs, and Chi-square and Cross Tab has used for evaluating the relationship between the attitudes of the physicians and specialists with choosing each one of the approaches. Results: The response rate of the participants in the study was about 97%. By considering the fact that the participants were allowed to choose more than one option in answering the questions, attitudes of surveyed physicians about the best approach of government in reducing the cost of prescription drugs is as follows, respectively: 45.6% of them have chosen the approach of creation and enforcement of price controls on pharmaceutical companies, 41.5% of them provide subsidies such as tax benefits and other concessions to pharmaceutical companies, 20.4% starting Government drug manufacturing units, and 10% of them have selected some other approaches, different from proposed approaches, according to the questionnaire. It is noteworthy that there was no significant relationship between being a general practitioner or specialist and choosing each one of the approaches. Conclusion: In most of the studies, role of the government in promoting the Cost Containment Strategies for prescription drugs and controlling the costs in health care system and managing the imposed costs on patients is undeniable. According to this study and most of the current studies, the best approach of government in reducing the cost of prescription drugs is the creation and enforcement of price controls on pharmaceutical companies. In addition, the government has a dominant role to play in upbringing and cultivating a new generation of cost-conscious physicians and medical staff. Ultimately, government can make a remarkable contribution to reduce the cost of prescription drugs and making healthcare affordable

Combination therapy with everolimus and tacrolimus in kidney transplantation recipients: A systematic review

Background and aims: Immunosuppressive regimens are a key component for successful kidney transplantation. This systematic review aimed to assess the efficacy and safety of combination therapy of everolimus with tacrolimus in kidney transplantation recipients. Methods: Results were limited to English-language articles. Trials where recipients received another regimen were excluded. The Cochrane Central Register of Controlled Trials and MEDLINE were searched via the optimally sensitive strategies for the identification of randomized trials, combined with the following MeSH headings and text words: Everolimus, Certican, Zortress, tacrolimus, prograf, and kidney transplantation. Results: Five relevant studies of everolimus in combination with tacrolimus were identified and results of them were interpreted. Two trials investigated Fix dose of everolimus in combination with low (1.5-3 mg) versus standard dose of tacrolimus (4-7 mg). One trial investigated variable doses of everolimus (1.5 mg/day or 3 mg/day) in combination with fix dose of tacrolimusand two trials compared fix dose of everolimus versus reduction or elimination of tacrolimus. Sample size of RCTs ranged from 20 to 398 and the follow up time ranged from six to 24 months. The quality score on the Jadad score was 3 in all five trials indicating moderate quality. Conclusion: Immune suppressive regimens including everolimus in combination with tacrolimus therapy show better safety and efficacy compared with single-mode but these differences were not significant in overall studies. In general, compared with a regimen without combination of everolimus with tacrolimus, the newer immunosuppressive regimen consistently reduced the incidence of short-term biopsy-proven acute rejection. However, evidence about impact on side-effects, long term graft loss, compliance and overall health-related quality of life is limited

A Survey of Organizational Health in University Hospitals of Isfahan

Background & Objectives: Hospitals, due to their role in improving the health of populations, should have adequate organizational health. Organizational health is critical for organizational productivity. This study aimed to evaluate the organizational health of university hospitals of Isfahan, Iran. Methods: This descriptive-analytic and cross- sectional study was conducted in 7 hospitals in 2015. A researcher-made questionnaire with 18 dimensions and 54 questions was used to gather data. A total of 283 hospital employees were randomly selected from seven hospitals. Data analysis was performed through SPSS21 and using descriptive statistics such as frequency, percent, mean ± SD as well as inferential statistics like regression and ANOVA. Results: The mean score Mean score of organizational health in studied hospitals was 3.08 ± 0.63 from 5. Organizational health was good in one hospital, moderate in five hospitals and poor in one hospital. Dimensions of morale, planning and formality had the highest and dimensions of justice, decision- making and control had the lowest scores. Intra-ward relationships, efficient use of resources, adaptability, leadership and independence showed the most effect on organizational health. Specialty hospitals had better organizational health compared to general hospitals. There was significant relationship between managers’ work experience and organizational health. Conclusion: University hospitals of Isfahan have moderate organizational health and hospital managers should apply necessary activities for improvement of organizational health. Key¬words: Organization, Teaching hospital, Organizational health, Organizational pathology, Productivity ¬Citation: Mosadeghrad AM, Akbari sari A, Esmaeili M. A Survey of Organizational Health in University Hospitals of Isfahan. Journal of Health Based Research 2016; 2(4): 329-344

Malaria elimination in Iran, importance and challenges

Background: The aim of study is to assess the importance and challenges of Malaria elimination (ME) in Iran's health system. Material: Opinion of experts from Ministry of Health and Medical Education and the chancellors of medical universities affected by malaria were gathered using Focus Group Discussions and in­depth interviews. We asked them about the importance and main challenges of ME in Iran. Results: Main factors on importance of ME were: it's a struggle to reach to equity in the poorest regions of county, prevention of emerging disease in susceptible regions, lowering the cost of control and its effects on the region's socioeconomic condition. Main challenges were Iran's long border with malaria­endemic countries Pakistan and Afghanistan and illegal immigrants, underdevelopment in rural areas, system's insensitivity and diagnosis problem due to reduction of cases. Conclusion: Quantitative and holistic researches are needed for assessing the consequences of ME

Incidence and Disability-Adjusted Life Years (Dalys) Attributable to Leishmaniasis In Iran, 2013

Background: Leishmaniasis covers a range of clinical manifestations. Estimation of the burden of leishmaniasis may help guide healthcare management personnel and policy-makers in applying effective interventions. The present study aimed to calculate the incidence and burden of cutaneous and visceral leishmaniasis in Iran in 2013.Methods: To evaluate the epidemiological aspects of the disease in Iran, published studies over the past 20 years were searched and the viewpoints of relevant  specialists in Iran were obtained. Data were collected from the Ministry of Health and from the Tehran University of Medical Sciences. To calculate years of life lost due to premature death, standard expected years of life lost was used. Standard life table of Global Burden of Disease (GBD) 2010 with the life expectancy of 86.02 years for both sexes was used to calculate the remaining potential years of life at any age from death.Results: The overall incidence of cutaneous and visceral leishmaniasis was  calculated as 22 and 0.092 per 100000 population of Iran, respectively. The  burden of leishmaniasis was 99.5 years: 95.34 and 4.16 years for cutaneous and visceral, respectively. Sensitivity was analyzed and deaths predicted by the  Institute of Health Metrics and Evaluation added, the burden of visceral  leishmaniasis was 726 years.Conclusion: The share of leishmaniasis burden in Iran is lower than the global burden of the disease. GBD 2010 standard method is recommended to calculate the burden of leishmaniasis in different countries and set local priorities on the basis of these measures.Keywords: Incidence, Disability-adjusted life years, Cutaneous leishmaniasis, Visceral leishmaniasis, Ira

Cost effectiveness of Malaria interventions from preelimination through elimination: a study in Iran

Background: Malaria still is considered as a public health problem in Iran. The aim of the National Malaria Control Department is to reach the elimination by 2024. By decreasing the number of malaria cases in preelimination phase the cost effectiveness of malaria interventions decreases considerably. This study estimated the cost effectiveness of various strategies to combat malaria in preelimination and elimination phases in Iran. Methods: running costs of the interventions at each level of intervention was estimated by using evidence and expert opinions. The effect of each intervention was estimated using the documentary evidence available and expert opinions. Using a point estimate and distribution of each variable the sensitivity was evaluated with the Monte Carlo method. Results: The most cost-effective interventions were insecticide treated net (ITN), larviciding, surveillance for diag- nosis and treatment of patients less than 24 hours, and indoor residual spraying (IRS) respectively, No related evi- dence found for the effectiveness of the border facilities. Conclusion: This study showed that interventions in the elimination phase of malaria have low cost effectiveness in Iran like many other countries. However ITN is the most cost effective intervention among the available interventions

Exploring Measures to Control Road Traffic Injuries in Iran: Key Informants Points of View

Background: Injuries and fatalities from road traffic Injuries are global public health concerns, and a major problem in the Iran. This study aimed to explore strategies to control road traffic Injuries (RTI) in Iran. Methods: We conducted a qualitative study to explore possible ways to reduce the occurrence of road traffic Injuries in Iran in 2016. Interviewees were purposively sampled from various sectors due to multidisciplinary nature of RTIs. Participants were mainly representatives from the police, Ministry of Road, Municipal, emergency services and Minis-try of Health. Besides, public health authorities, researchers, and university professors were interviewed. We con-ducted in-depth interviews using generic guides. Data was analyzed using MAXQDA 10 software. Through content analysis, we interpreted core themes relevant to the accomplishment of our study objectives. Results: Themes that emerged from our study include; road traffic management, governance, education, improving accident database, enforcement, driving license restrictions, and construction of pedestrian overpass. Conclusion: This study revealed key informants’ views regarding available and affordable solutions to reduce RTIs in Iran. Many applicable strategies are identified in the control of RTIs in Iran. Although some solutions such as highway construction and/or expanding rail transportation have been suggested as effective measures for reducing accident, but they are costly and may not be fully applied in developing countries like Iran

Eliciting Preferences for Health Insurance in Iran Using Discrete Choice Experiment Analysis

Background: The preferences of Iranians concerning the attributes of health insurance benefit packages are not well studied. This study aimed to elicit health insurance preferences among insured people in Iran during 2016.Methods: A mixed methods study using a discrete choice experiment (DCE) approach was conducted to elicit health insurance preferences on a total sample of 600 insured Iranians residing in Tehran. The final design of the DCE included 8 health insurance attributes. Data were analyzed using conditional logistic regression models.Results: The final model of this DCE study included 8 attributes, and the findings indicated statistically significant (P < .001) increase in the odds ratio (OR) of choosing health insurance at all levels of cost coverage except for the rehabilitation and para-clinical benefits, where at 70% cost coverage there was insignificant (P = .485) disutility (OR = 0.95). With the increase in cost coverage level, the probability of choosing health insurance was significantly (P < .001) the highest for the private hospitals’ benefits (OR = 2.82) followed by public hospitals’ benefits (OR = 2.02) and outpatient benefits (OR = 1.75), and the premium revealed statistically significant (P < .001) disutility (OR = 0.96). Conclusion: Our findings revealed that participants would be willing to choose health insurance plans with higher cost coverage of healthcare services and with lower premiums. However, the demographic characteristics, income, and health status of the insured individuals affected their health insurance preferences. The findings can contribute to the design of better health insurance policies, improve the participation of individuals in health insurance, and increase the insured individuals’ utility from the insurance benefits packages

Exploring measures to control road traffic injuries in Iran: key informants points of view

Background: Injuries and fatalities from road traffic Injuries are global public health concerns, and a major problem in the Iran. This study aimed to explore strategies to control road traffic Injuries (RTI) in Iran. Methods: We conducted a qualitative study to explore possible ways to reduce the occurrence of road traffic Injuries in Iran in 2016. Interviewees were purposively sampled from various sectors due to multidisciplinary nature of RTIs. Participants were mainly representatives from the police, Ministry of Road, Municipal, emergency services and Minis-try of Health. Besides, public health authorities, researchers, and university professors were interviewed. We con-ducted in-depth interviews using generic guides. Data was analyzed using MAXQDA 10 software. Through content analysis, we interpreted core themes relevant to the accomplishment of our study objectives. Results: Themes that emerged from our study include; road traffic management, governance, education, improving accident database, enforcement, driving license restrictions, and construction of pedestrian overpass. Conclusion: This study revealed key informants’ views regarding available and affordable solutions to reduce RTIs in Iran. Many applicable strategies are identified in the control of RTIs in Iran. Although some solutions such as highway construction and/or expanding rail transportation have been suggested as effective measures for reducing accident, but they are costly and may not be fully applied in developing countries like Iran

Cost effectiveness of different cervical screening strategies in Islamic Republic of Iran: a middle-income country with a low incidence rate of cervical cancer

Objective: Invasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC. Methods: We constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results. Results: We found that the prevented mortalities for the 11 strategies compared with no screening varied from 26% to 64%. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was $8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran. Conclusion: We recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer