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Esmaeilzadeh F, Ahmadi B, Vahedi S, Barzegari S, Rajabi A. Major Thalassemia, Screening or Treatment: An Economic Evaluation Study in Iran. Int J Health Policy Manag 2022; 11:1112-1119. [PMID: 33619933 PMCID: PMC9808182 DOI: 10.34172/ijhpm.2021.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Beta-thalassemia minor and thalassemia major are an autosomal recessive disease with hypochromic, microcytic anemia, and morbidities, Today, therapeutic advances have significantly improved the life expectancy of thalassemia major patients, but at the cost of financial toxicity. The present study aimed to investigate the possibility of increasing the funding for thalassemia screening programs and comparing the cost-effectiveness of screening for thalassemia in the treatment of the patients. METHODS In this study, screening for thalassemia minor was compared with the treatment of thalassemia major patients. A decision tree model was used for analysis. A hospital database, supplemented with a review of published literature, was used to derive input parameters for the model. A lifetime study horizon was used and future costs and consequences were discounted at 3%. The approach of purchases of services was used to evaluate the screening test costs for patients with thalassemia major. Also, a bottom-up method was applied to estimate other screening and treatment costs. All the costs were calculated over one year. The number of gained quality-adjusted life years (QALYs) was calculated using the EQ-5D questionnaire in the evaluated patients. RESULTS In this study, 26.97 births of patients with thalassemia major were prevented by screening techniques. On the other hand, total screening costs for patients with thalassemia major were estimated equal to US$ 879879, while the costs of preventing the birth of each thalassaemia major patient was US$ 32 624 by screening techniques. In comparison, the cost of managing a patient with thalassemia major is about US$ 136 532 per year. The life time QALYs for this is 11.8 QALYs. Results are presented using a societal perspective. Incremental cost per QALY gained with screening as compared with managing thalassaemia major was US$ 11 571. CONCLUSION Screening is a long-term value for money intervention that is highly cost effective and its long-term clinical and economic benefits outweigh those of managing thalassaemia major patients.
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Affiliation(s)
- Firooz Esmaeilzadeh
- Department of Public Health, School of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Batoul Ahmadi
- Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sajad Vahedi
- Department of Healthcare Administration, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Barzegari
- Department of Health Information Technology, Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdolhalim Rajabi
- Department of Health Management and Social Development Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
- Department of Environmental Health Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
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Terán MM, Mónaco ME, Lazarte SS, Haro C, Ledesma Achem E, Asensio NA, Issé BA. Genetic Regulation of Redox Balance in β-Thalassemia Trait. Hemoglobin 2020; 44:122-127. [PMID: 32448013 DOI: 10.1080/03630269.2020.1765794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
β-Thalassemia (β-thal) trait is a heterogeneous group of genetic defects leading to decreased β-globin production, ineffective erythropoiesis, and oxidative stress. The aim is to evaluate the cytoprotective response, at transcriptional and systemic levels, of the variations of global redox balance in β-thal trait patients. Sixty-six subjects (40 healthy and 26 with β-thal trait) were analyzed at the Universidad Nacional de Tucumán, Tucumán, Argentina, between 2016 and 2017. The following parameters were evaluated: complete blood count, iron status, hemoglobin (Hb) electrophoresis, Hb A2, thiobarbituric acid reactive species (TBARS), serum catalase (CAT), and superoxide dismutase (SOD) activity, FOXO3a, NRF2, SOD, PRDX2, CAT, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) gene expression. The β-thal trait group showed a decrease in Hb levels, MCV, and MCH with higher TBARS levels. The SOD activity was significantly increased by 32.0% in β-thal trait patients respect to the control group. Relative expression of NRF2 was 4.7-fold higher in β-thal trait than in the control group, while FOXO3a expression was similar in both groups. The SOD, PRDX2, and proinflammatory cytokines transcriptional expression was significantly upregulated in β-thal trait patients. This is the first study on the genetic regulation of redox balance in β-thal trait patients in which interesting modifications were observed in the transcript levels of some redox regulators that could be associated with changes in the erythrocyte proteome in this disorder. A better understanding of the pathophysiological mechanisms present in these heterozygous patients would allow adequate therapy in situations such as growth, pregnancy, or high performance sports, favoring a personalized treatment.
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Affiliation(s)
- Magdalena M Terán
- Instituto de Bioquímica Aplicada, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Tucumán, Argentina.,Instituto de Biotecnología Farmacéutica y Alimentaria (INBIOFAL), Consejo Nacional de Investigaciones Científicas y Tecnològicas (CONICET), Universidad Nacional de Tucumán, San Miguel de Tucumán, Tucumán, Argentina
| | - Maria E Mónaco
- Instituto de Bioquímica Aplicada, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Tucumán, Argentina.,Instituto de Biología, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Miguel de Tucumán, Tucumán, Argentina
| | - Sandra S Lazarte
- Instituto de Bioquímica Aplicada, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Cecilia Haro
- Instituto de Bioquímica Aplicada, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Tucumán, Argentina.,Instituto de Biotecnología Farmacéutica y Alimentaria (INBIOFAL), Consejo Nacional de Investigaciones Científicas y Tecnològicas (CONICET), Universidad Nacional de Tucumán, San Miguel de Tucumán, Tucumán, Argentina
| | - Emilse Ledesma Achem
- Instituto de Bioquímica Aplicada, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Natalia A Asensio
- Instituto de Bioquímica Aplicada, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Blanca A Issé
- Instituto de Bioquímica Aplicada, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán, Tucumán, Argentina
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Long J, Yang CS, He JL, Liu XQ, Ding YB, Chen XM, Tong C, Peng C, Wang YX, Gao RF. FOXO3a is essential for murine endometrial decidualization through cell apoptosis during early pregnancy. J Cell Physiol 2018; 234:4154-4166. [PMID: 30132880 DOI: 10.1002/jcp.27167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/17/2018] [Indexed: 12/19/2022]
Abstract
Embryo implantation is essential for normal pregnancy, and the process of decidualization is critical for embryo implantation. However, the mechanism of decidualization during early pregnancy is still unknown. Forkhead box O3a (FOXO3a) is the most important functional transcription factor of the forkhead box family and is a highly conserved transcription factor of apoptosis-related genes. In the mouse uterus, FOXO3a was found to be expressed regularly from Days 1-7 of early pregnancy. Upon further exploration, it was found that FOXO3a was expressed at significantly higher levels at the implantation site than at the interimplantation site on Days 5-7 of pregnancy. Under artificial decidualization, FOXO3a was highly expressed in the first and second decidual zones. After decidualization, the expression of FOXO3a was significantly increased both in vivo and vitro. In primary stromal cells, apoptosis was reduced by decreased expression of FOXO3a after inducing decidualization. Moreover, when FOXO3a-small interfering RNA was transfected into the uteri of mice, the expression of decidualization- and apoptosis-related factors was impaired. Thus, FOXO3a might play an important role in decidualization during early pregnancy, and cell apoptosis might be one of pathways for FOXO3a-regulated decidualization.
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Affiliation(s)
- Jing Long
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Cheng-Shun Yang
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Jun-Lin He
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Xue-Qing Liu
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Yu-Bin Ding
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Xue-Mei Chen
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Chao Tong
- Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China.,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Peng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Laboratory of Maternal and Fetal Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying-Xiong Wang
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Ru-Fei Gao
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
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