Direct and Indirect Costs Associated with Coronary Artery (Heart) Disease in Tabriz, Iran

Polypill versus medication monotherapy in the prevention of cardiovascular diseases in Iran: An economic evaluation study

Background and Aims

Cardiovascular diseases (CVDs) are one of the major diseases in developing and developed countries and have high prevalence and mortality rates. Pharmacological interventions, especially the use of combination medications, can have preventive effects in patients with CVDs. Recently, in the PolyIran trial, a combination of atorvastatin, hydrochlorothiazide, aspirin, and valsartan or enalapril (Polypill) was shown to be effective in providing survival benefits as a primary prevention strategy. In the present study, we examine the cost-effectiveness of the use of polypill compared to its individual components (named as medication monotherapy) in the prevention of CVDs in Iran.

Methods

This was an economic evaluation study conducted to compare the cost-utility of polypill with that of medication monotherapy for 10,000 hypothetical cohorts of people over 35 years of age using the Markov model and with a lifetime horizon. The study perspective was patient perspective and direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio were estimated. To deal with uncertaintysensitivity analyses were used.

Results

The results showed that polypill, with the lowest costs (871 USD) and highest QALYs (14.55), had the most cost-utility than medication monotherapy. Also, the results showed that the highest sensitivities were related to the utilities of angina and stroke states. At the 21,768 USD threshold, polypill had a 92% probability of being cost-effective versus other medications.

Conclusion

Considering that polypill had the most cost-utility, it is suggested that health system policymakers pay special attention to polypill in designing clinical guidelines. Also, through covering this medication by health insurance organizations, it is possible to complete the country's medicine pharmacopeia in preventing CVDs.

Heart failure: a prevalence-based and model-based cost analysis

Introduction

Heart failure (HF) imposes a heavy economic burden on patients, their families, and society as a whole. Therefore, it is crucial to quantify the impact and dimensions of the disease in order to prioritize and allocate resources effectively.

Methods

This study utilized a prevalence-based, bottom-up, and incidence-based Markov model to assess the cost of illness. A total of 502 HF patients (classes I-IV) were recruited from Madani Hospital in Tabriz between May and October 2022. Patients were followed up every two months for a minimum of two and a maximum of six months using a person-month measurement approach. The perspective of the study was societal, and both direct and indirect costs were estimated. Indirect costs were calculated using the Human Capital (HC) method. A two-part regression model, consisting of the Generalized Linear Model (GLM) and Probit model, was used to analyze the relationship between HF costs and clinical and demographic variables.

Results

The total cost per patient in one year was 261,409,854.9 Tomans (21,967.21 PPP). Of this amount, 207,147,805.8 Tomans (17,407.38 PPP) (79%) were indirect costs, while 54,262,049.09 Tomans (4,559.84 PPP) (21%) were direct costs. The mean lifetime cost was 2,173,961,178 Tomans. Premature death accounted for the highest share of lifetime costs (48%), while class III HF had the lowest share (2%). Gender, having basic insurance, and disease class significantly influenced the costs of HF, while comorbidity and age did not have a significant impact. The predicted amount closely matched the observed amount, indicating good predictive power.

Conclusion

This study revealed that HF places a significant economic burden on patients in terms of both direct and indirect costs. The substantial contribution of indirect costs, which reflect the impact of the disease on other sectors of the economy, highlights the importance of unpaid work. Given the significant variation in HF costs among assessed variables, social and financial support systems should consider these variations to provide efficient and fair support to HF patients.

Cost-utility analysis of valsartan, enalapril, and candesartan in patients with heart failure in Iran

BACKGROUND

Today, heart failure is one of the leading causes of death and disability in most developed and developing countries. By 2030, more than 23.3 million people are projected to die of cardiovascular diseases each year, and the prevalence of heart failure is expected to increase by 25%. One of the preventive interventions is pharmacological interventions which can be used to reduce the complications of cardiovascular diseases such as heart failure. One of the most important pharmacological interventions in patients with heart failure is the use of antihypertensive drugs such as candesartan, enalapril, and valsartan. This study aimed to compare the cost-utility of candesartan, enalapril, and valsartan in patients with heart failure using the Markov model in Iran in 2020.

METHODS

In the present study, a four-state Markov model was designed to compare the cost-utility of candesartan, enalapril, and valsartan for a hypothetical cohort of 10,000 heart failure patients older than 24 years. The payers' perspective was used to calculate the costs. The Markov states included outpatients with heart failure, patients with heart failure admitted to general hospital wards, patients with heart failure admitted to the intensive care units (ICUs), and death. The effectiveness measure in this study was the quality-adjusted life years (QALYs). The one-way and probabilistic sensitivity analyses were used to determine the robustness of the results. The TreeAge Pro 2011 software was used for data analysis.

RESULTS

The results showed that the average expected costs and QALYs were 119645.45 USD and 16.15 for valsartan, 113,019.68 USD and 15.16 for enalapril, and 113,093.37 USD and 15.06 for candesartan, respectively. Candesartan was recognized as the dominated option. Because the calculated incremental cost-effectiveness ratio (ICER) value (6,692.69 USD) was less than the threshold value (7,256 USD), valsartan was cost-effective compared to enalapril. The results of the cost-effectiveness acceptability curve showed that at the threshold of 7,256 USD, valsartan had a 60% chance of being cost-effective compared to enalapril. The results of one-way and probabilistic sensitivity analyses confirmed the robustness of the results. Moreover, the results showed that ICU (1,112 USD) had the highest cost among cost items.

CONCLUSION

According to the results, it is recommended that health policymakers consider the use of valsartan by cardiologists when designing clinical guidelines for the treatment of patients with heart failure.

Economic burden of breast cancer: a case of Southern Iran

BACKGROUND

Breast cancer is one of the main causes of death from cancer around the world, imposing a significant economic burden on the families and healthcare system. The present study aimed at determining the economic burden of breast cancer in the patients referred to the medical centers in Fars province in southern Iran in 2021.

METHODS

This cross-sectional study is a partial economic evaluation and a cost-of-illness study with a bottom-up and prevalence-based approach, conducted in Fars province in southern Iran in 2021 from the societal perspective. A total of 230 patients were randomly included in the study, and a researcher-made data collection form was used to collect the required data. The data on direct medical costs were collected using the information on patients' medical and financial records. On the other hand, the data on direct non-medical and indirect costs were obtained using self-reports by the patients or their companions. The Excel 2016 software was used to analyze the collected data.

RESULTS

The results showed that the annual cost of each breast cancer patient in the studied sample was 11,979.09 USD in 2021. Direct medical costs accounted for the largest share of costs (70.69%, among which the cost of radiotherapy was the highest one. The economic burden of the disease in the country was estimated at 193,090,952 USD.

CONCLUSIONS

In general, due to the high prevalence of breast cancer and the chronicity of this disease, its medical costs can impose a heavy economic burden on society, the health system, the insurance system, and patients. Thus, in order to reduce the costs, the following suggestions can be offered: the use of advanced radiotherapy techniques, increasing the insurance coverage of required services, establishing low-cost accommodation centers near medical centers for the patients and their companions, providing specialized medical services for the patients in towns, using the Internet and virtual space to follow up the treatment of the patients, and carrying out free screening programs and tests for faster diagnosis of the infected patients and susceptible or exposed people.

Cardiovascular Stents: Types and Future Landscape

One of the prominent reasons for mortality and morbidity worldwide is coronary artery disease (CAD), an ailment that manifests itself by the narrowing of the artery with the deposition of plaque. The definitive mode of action for dealing with this condition is using a medical device known as a stent at the affected location. This extremely important tubular equipment helps tremendously with vessel support. It also helps by keeping the path of blood flow clear for the heart muscle masses, its crucial nutrients, and oxygen supply. Several generations of stents have been continuously developed to improve patient outcomes and reduce side effects post-stent implantation. As we move from bare metal stents (BMSs) to drug-eluting stents (DESs) and, more recently, to bioabsorbable stents, the research area continues to develop. The use of this biomedical device has increased the standard of living in many cases; therefore, it is much needed to work on the possible growth areas in the cardiovascular stents and improve them to such an extent that the patients suffering from cardiovascular ailments get to live a comfortable life. Most articles deal with stents that are available for current use and their various types. They also cover the topic of stent optimization, as it is one of the key factors in enhancing stent usability and plays a prominent role in optimizing stent placement in the vessels of the body. To keep in touch with advances in stent technology over the past few decades, this article reviews advances in the devices, working on how available stents can be optimized to create new stents.

Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City

Introduction

This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China.

Methods

Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses.

Results

The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001).

Conclusions

The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.

Economic Burden of Asthma in Northwest Iran

Background

The economic burden of asthma is a major public health concern. This study estimates the economic burden of asthma in Northwest of Iran.

Methods

A longitudinal study was conducted between 2017 and 2018 in Tabriz (Iran) using the Persian version of the Work Productivity and Activity Impairment (WPAI) questionnaire. Direct and indirect costs associated with asthma were estimated based on the societal perspective, prevalence-based approach, and bottom-up method. Annual indirect costs were estimated using the human capital (HC) method. The structural equation model was used to evaluate the relationship between costs, sex, and asthma severity.

Results

A total of 621 patients with asthma were enrolled in the study. Significant differences were found between female and male patients for the mean cost of radiology (P=0.006), laboratory (P=0.028), and diagnostic (P=0.017) tests at baseline, and for laboratory (P=0.012), and diagnostic (P=0.027) tests at one-year follow-up. The more severe asthma, the more significant the costs for annual physician office visits (P=0.040) and medications (P=0.013). As asthma severity increased, significantly higher expenditures were observed in women for days lost from work at baseline (P=0.009) and one-year follow-up (P=0.001), and in men for productivity loss at work due to impairment at baseline (P=0.045). A significant association between indirect costs and the cost of impairment-related lost productivity at work (β=3.29, P<0.001), and between severe asthma and indirect costs (β=32.36, P<0.001) was observed.

Conclusion

High costs are incurred by Iranian asthma patients, especially because of impairment-related productivity loss at work associated with asthma exacerbation.

Change in coronary heart disease hospitalization after chronic disease management: a programme policy in China

This study aims at examining changes in coronary heart disease (CHD) hospitalization associated with a novel county-scale chronic disease management (CDM) programme policy implemented in March 2019 in China during the 13th Five-Year period (2016-2020). The CDM programme was designed to improve the health of populations with chronic diseases by means of an integrated way involving both county-level public hospitals and primary care institutes. Data originated from the medical files of CHD inpatients discharged from a secondary hospital from January 2017 to December 2020. A total of 6111 CHD patient records were collected. Univariate and multivariate regression analyses were performed to assess changes in hospitalization direct medical costs and length of stay of CHD patients. The mean direct medical cost of CHD hospitalization was 8419.73 Yuan, and the mean length of stay was 7.57 days. Results suggested that the implementation of CDM reduced hospitalization direct medical cost and bed days by about 23% (1956.12 Yuan at means) and 11.5% (almost 1 day at means), respectively. In addition, a further decreasing trend in medical costs over time was associated with chronic disease management. It is implied that chronic disease management is an effective way of relieving the medical and financial burden of hospitalization.

Evaluation of coronary stents: A review of types, materials, processing techniques, design, and problems

In the world, one of the leading causes of death is coronary artery disease (CAD). There are several ways to treat this disease, and stenting is currently the most appropriate way in many cases. Nowadays, the use of stents has rapidly increased, and they have been introduced in various models, with different geometries and materials. To select the most appropriate stent required, it is necessary to have an analysis of the mechanical behavior of various types of stents. The purpose of this article is to provide a complete overview of advanced research in the field of stents and to discuss and conclude important studies on different topics in the field of stents. In this review, we introduce the types of coronary stents, materials, stent processing technique, stent design, classification of stents based on the mechanism of expansion, and problems and complications of stents. In this article, by reviewing the biomechanical studies conducted in this field and collecting and classifying their results, a useful set of information has been presented to continue research in the direction of designing and manufacturing more efficient stents, although the clinical-engineering field still needs to continue research to optimize the design and construction. The optimum design of stents in the future is possible by simulation and using numerical methods and adequate knowledge of stent and artery biomechanics.

Estimation and predictors of direct hospitalisation expenses and in-hospital mortality for patients who had a stroke in a low-middle income country: evidence from a nationwide cross-sectional study in Iranian hospitals

OBJECTIVE

Stroke is the second most prevalent cardiovascular disease in Iran. This study investigates the estimation and predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke in Iranian hospitals.

SETTING

Patients who had a stroke in Iran between 2019 and 2020 were identified through the data collected from the Iran Health Insurance Organization and the Ministry of Health and Medical Education. This study is the first to conduct a pervasive, nationwide investigation.

DESIGN

This is a cross-sectional, prevalence-based study. Generalised linear models and a multiple logistic regression model were used to determine the predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke.

PARTICIPANTS

A total of 19 150 patients suffering from stroke were studied.

RESULTS

Mean hospitalisation expenses per patient who had a stroke in Iran amounted to US$590.91±974.44 (mean±SD). Mean daily hospitalisation expenses per patient who had a stroke were US$55.18±37.89. The in-hospital mortality for patients who had a stroke was 18.80%. Younger people (aged ≤49 years) had significantly higher expenses than older patients. The OR of in-hospital mortality in haemorrhagic stroke was significantly higher by 1.539 times (95% CI, 1.401 to 1.691) compared with ischaemic and unspecified strokes. Compared with patients covered by the rural fund, patients covered by Iranian health insurance had significantly higher costs by 1.14 times (95% CI, 1.186 to 1.097) and 1.319 times (95% CI, 1.099 to 1.582) higher mortality. There were also significant geographical variations in patients who had a stroke's expenses and mortality rates.

CONCLUSION

Applying cost-effective stroke prevention strategies among the younger population (≤49 years old) is strongly recommended. Migration to universal health insurance can effectively reduce the inequality gap among all insured patients.

Availability and affordability of cardiovascular medicines in a major city of Afghanistan in 2020

PURPOSE

Affordable access to quality medicines is a critical target of global efforts to achieve universal health coverage. The aim of this study is to measure the affordability and accessibility of cardiovascular medicines in the city of Herat, Afghanistan.

METHODS

The price, affordability, and availability data for 18 most sold generic (MSG) and lowest priced generic (LPG) products were collected from public and private pharmacies located in Herat city in Afghanistan in 2020, which in each area, six pharmacies were randomly selected from a combination of public and private ones based on the standardized methodology developed by WHO/HAI. According to this methodology on Medicine Prices, Accessibility, and Affordability, the minimum daily wage of an unskilled governmental worker, and the price of each type of cardiovascular medicines for one-month use were calculated separately. If the cost of the treatment was more than the minimum daily wage, the medicine was considered unaffordable.

RESULTS

The mean availability score for lowest price generic (LPG) in public and private pharmacies and based on the countries of origin including Iran, Pakistan, and India was 60%, 46%, and 31%, respectively. Of the 18 medicines surveyed, just Atenolol (Iranian brand) was found in all 30 pharmacies on the day of data collection. All Indian- brand medicines were less than fifty percent available in any of the surveyed public and private pharmacies. Among the medicines exported to Afghanistan, the population of Herat used more medicines made by Pakistan compared to India and Iran (MSG). Indian medicines were the most expensive ones and the Iranian medicines were the cheapest. A wage of less than one day was enough to afford one-month supply of generic medicines at the lowest price.

CONCLUSION

Access of patients to cardiovascular medicines in Afghanistan was 46% in this study which is regarded as low access. Most of available cardiovascular medicines in the market of this country were made in Iran, Pakistan and India. Although the Iranian ones were the cheapest, but people used more Pakistani medicines. LPG products were affordable to the studied population.

Laboratory-based and office-based Globorisk scores to predict 10-year risk of cardiovascular diseases among Iranians: results from the Fasa PERSIAN cohort

Background

Globorisk is a novel risk prediction model for predicting cardiovascular disease (CVD). Globorisk is a country-specific risk prediction model that determines CVD risk for all countries. This model has two versions; laboratory-based and office-based. This study aimed to determine the agreement between laboratory-based and office-based models in a large sample of the general population.

Methods

Baseline data from the Fasa cohort study was used for the current study. In total, 6810 participants ≥ 40 years without any history of cardiovascular disease or stroke were included in the study. To determine the laboratory-based risk model, factors include age, sex, current smoking status, history of diabetes, systolic blood pressure (SBP), and total cholesterol. To estimate the office-based risk model, factors were age, sex, current smoking status, SBP, and body mass index (BMI). Kappa statistics was used to distinguish the agreement between grouped scores in these two models. Additionally, correlation coefficients and scatter plots were used to determine the linear correlation between the two models.

Results

In this study 46.53% of the participants were men. The mean age (SD) of participants was 51.08 (7.88) years. Agreements between the two models were moderate and substantial in all women and all men, respectively. The agreement between the two CVD risk groups was 90.15% (kappa = 0.717) in all men, 92.94% (kappa = 0.571) among men aged < 60 years and 77.60% (kappa = 0.645) in men aged ≥ 60 years. The agreement between the two CVD risk groups was 86.68% (kappa = 0.572) among all women, 93.96% (kappa = 0.274) among women aged < 60 years and 62.46% (kappa = 0.422) among women aged ≥ 60 years. A very strong positive correlation (r = 0.94) was found between the two risk scores in all men, and it was similar among men aged < 60 years (r = 0.84) and men aged > 60 years (r = 0.94). Among all women, there was a very strong positive correlation (r = 0.87), and the strong positive correlation remained among < 60 years old (r = 0.76) and women > 60 years old (r = 0.76).

Conclusion

The Globorisk office-based model which is easier to use as it does not require blood testing can determine the risk groups in this population. The Globorisk office-based model may be used for CVD risk screening in low-middle income countries where resources are limited.

Hospitalization Expenses and Influencing Factors for Inpatients with Ischemic Heart Disease in Iran: A Retrospective Study

Background: Ischemic heart disease (IHD) is the leading cause of death and disability worldwide and in Iran, which imposes a heavy financial burden both on patient’s family and society. Objectives: This study aimed to analyze the direct medical costs of inpatients with IHD and its influencing factors in Iran in 2020. Methods: The sample of this cross-sectional study included 41,357 patients with IHD selected from the hospital information system (HIS) of the Iran Health Insurance Organization from August 23, 2019, to June 20, 2020. The study used the claims data of these patients, which included their demographics, length of stay (LOS), intensive care unit (ICU) admission, hospital accreditation grade, hospital ownership type, and patient discharge status. The multiple linear regression model was employed to evaluate the relationship between hospitalization costs and the associated factors. All statistical tests were conducted at the significance level of P < 0.05 using the R 3.6.3 software. Results: The mean age of patients was 63.95 ± 12.63 years old, and most of them were male (54.4%). The mean hospitalization cost per patient and per day was 586.42 ± 472.51 USD and 103.64 ± 100.29 USD, respectively. Moreover, the mean LOS was 4.92 days. Drugs and consumable medical supplies, as well as nursing and hoteling services, had the highest shares of hospitalization costs (29.54% and 29.4%, respectively). The hospitalization costs of patients with IHD were higher among men (β = 1.24), age 61 - 70 years (β = 1.38), LOS ≥ 5 (β = 2.92), ICU admission (β = 1.62), Iranian health fund (β = 1.21), and private hospitals (β = 1.91). Top-grade and first-grade hospitals had higher costs compared to grade 2 (β = 0.67), grade 3 (β = 0.35), and grade 4 (β = 0.72) hospitals. Deceased patients had also higher costs than patients with complete recovery (β = 0.63), relative recovery (β = 0.59), follow-up (β = 0.51), transfer to other medical centers (β = 0.44), and discharge against medical advice (DAMA) (β = 0.62). Conclusions: According to the results, shortening the LOS and controlling the high costs of drugs and consumable medical supplies are among the main strategies to reduce high hospitalization costs.

Clusters of the Risk Markers and the Pattern of Premature Coronary Heart Disease: An Application of the Latent Class Analysis

Background: Coronary heart disease (CHD) is the major cause of mortality in the world with a significant impact on the younger population. The aim of this study was to identify prematurity among patients with coronary artery bypass graft surgery (CABG) based on the clustering of CHD risk factors.

Methods: Patients were recruited from an existing cohort of candidates for CABG surgery named Tehran Heart Center Coronary Outcome Measurement (THC-COM). A latent class analysis (LCA) model was formed using 11 potential risk factors as binary variables: cigarette smoking, obesity, diabetes, family history of CHD, alcohol use, opium addiction, hypertension, history of stroke, history of myocardial infarction (MI), peripheral vascular disease (PVD), and hyperlipidemia (HLP). We analyzed our data to figure out how the patients are going to be clustered based on their risk factors.

Results: For 566 patients who were studied, the mean age (SD) and BMI of patients were 59.1 (8.9) and 27.3 (4.1), respectively. The LCA model fit with two latent classes was statistically significant (G2 = 824.87, df = 21, p < 0.0001). The mean (SD) age of patients for Class I and Class II was 55.66 (8.55) and 60.87 (8.66), respectively. Class I (premature) was characterized by a high probability of smoking, alcohol consumption, opium addiction, and a history of MI (P < 0.05), and class II by a high probability of obesity, diabetes, and hypertension.

Conclusion: Latent class analysis calculated two groups of severe CHD with distinct risk markers. The younger group, which is characterized by smoking, addiction, and the history of MI, can be regarded as representative of premature CHD.

Knowledge, attitudes, and barriers related to medication adherence of older patients with coronary heart disease in China

OBJECTIVES

To investigate the knowledge, attitudes, and barriers related to medication adherence in older patients with coronary heart disease (CHD).

METHODS

A total of 272 older patients with CHD were investigated by the Chinese version of the Medication Adherence Scale. The score ranges for the knowledge, attitudes, and barrier subscales were 0-30, 0-30, and 0-110, respectively. Higher scores indicate more knowledge, positive attitudes, and more barriers related to medication adherence.

RESULTS

The median scores of knowledge, attitudes and barriers were 25.5, 28, and 8, respectively. Having stents, living alone, good financial status and fewer chronic diseases were related to more knowledge. Younger age, having no stent, and more chronic diseases were associated with more barriers. Patients with good financial status and higher age had more positive attitudes.

CONCLUSIONS

Understanding older patients' knowledge, attitudes, and barriers related to medication adherence and their associated factors can help develop tailored interventions in medication adherence studies.

The economic burden of road traffic injuries until one-year after hospitalization: A survey study

OBJECTIVE

Road Traffic Injuries (RTIs) are one of the most crucial and challenging public health problems in low and middle income countries. Despite continuous efforts to estimate both personal and societal costs of RTIs however, their long-term effects have remained marginal. The current study aimed to explore the economic burden of RTIs until one year after the victim's hospitalization.

METHODS

The study included a total of 1150 RTI victims, who were admitted to two trauma-referral hospitals during 2016. Data on direct medical costs, direct non-medical costs and indirect costs were gathered for each study sample via hospital records and phone surveys. Direct and indirect costs from a social perspective were estimated based on Micro Costing Approach followed by the Human Capital Approach. Also, the explanatory variables affecting the costs of RTIs were identified using the liner regression model.

RESULTS

The average amounts of direct (medical, non-medical), indirect, and total costs of RTI were estimated as 2,908 US$ (1,591 US$, 1,316 US$), 5,790 US$, and 8,701 US$ respectively. Also, several variables were significantly affecting the costs of RTIs including age, marital status, employment status, severity of injury, receiving physiotherapy care, victim's vehicle type in crash, crash time and location.

CONCLUSIONS

Findings suggest that RTIs are considered as an enormous burden on Iranian GDP per capita and health expenditure per capita occupying 167% and 347% respectively. This enormous economic burden caused by RTIs requires more policy regulations and prevention programs to decrease RTIs.

The effect of training on treatment adherence in coronary artery patients: A single-blind randomised controlled trial

AIMS AND OBJECTIVES

The aim of this study was to investigate the effect of training, given by the nurses to coronary artery patients, on treatment adherence of the patients.

BACKGROUND

Treatment adherence can be defined as adherence of drug use and healthy lifestyle habits to healthcare recommendations. Training programmes enable to reduce healthcare expenditures and risk of mortality by increasing treatment adherence.

DESIGN

This study is a single-blind randomised controlled trial. The requirements of CONSORT statement were followed. The study was registered with clinicaltrial.gov. NCT04556006.

METHODS

The study was conducted with 58 patients hospitalised in the cardiology clinic of a state hospital (intervention = 30 and control = 28). Personal information form, anthropometric measurements, Framingham risk score and compliance questionnaire were used to collect the data. After the first data of the patients were collected, the training on treatment adherence was provided to those in the intervention group. The content of the training was repeated in 2^nd , 4^th , 8^th and 12^th weeks. At the end of 12^th week, the data of the patients in both groups were collected again and evaluated.

RESULTS

Compliance questionnaire scores were 22.53 ± 5.48 in the intervention group and 22.25 ± 7.02 in the control group at the beginning of the study (p > .05); whereas, they were 32.33 ± 4.82 in the intervention group and 24.04 ± 5.98 in the control group at the end of 12^th week (p < .001). Improvement was observed in anthropometric measurements (weight, body mass index, waist circumference and hip circumference) of the patients in the intervention group.

CONCLUSION

Planned training given to coronary artery patients contributed positively to treatment adherence and anthropometric measurements.

RELEVANCE TO CLINICAL PRACTICE

While evaluating treatment adherence, not focussing on a single area, interrelated adherence areas should be evaluated together. The prepared adherence guide can be used in adherence training programmes to be applied on different societies.

CLINICAL TRIAL REGISTRATION NUMBER

The study was registered with clinicaltrial.gov (NCT04556006).

Cardiovascular Stents: A Review of Past, Current, and Emerging Devices

One of the leading causes of morbidity and mortality worldwide is coronary artery disease, a condition characterized by the narrowing of the artery due to plaque deposits. The standard of care for treating this disease is the introduction of a stent at the lesion site. This life-saving tubular device ensures vessel support, keeping the blood-flow path open so that the cardiac muscle receives its vital nutrients and oxygen supply. Several generations of stents have been iteratively developed towards improving patient outcomes and diminishing adverse side effects following the implanting procedure. Moving from bare-metal stents to drug-eluting stents, and recently reaching bioresorbable stents, this research field is under continuous development. To keep up with how stent technology has advanced in the past few decades, this paper reviews the evolution of these devices, focusing on how they can be further optimized towards creating an ideal vascular scaffold.