Model-Based Economic Evaluations of Interventions for Dementia: An Updated Systematic Review and Quality Assessment

BACKGROUND

There has been an increase in model-based economic evaluations of interventions for dementia. The most recent systematic review of economic evaluations for dementia highlighted weaknesses in studies, including lack of justification for model assumptions and data inputs.

OBJECTIVE

This study aimed to update the last published systematic review of model-based economic evaluations of interventions for dementia, including Alzheimer's disease, with a focus on any methodological improvements and quality assessment of the studies.

METHODS

Systematic searches in eight databases, including PubMed, Cochrane, Embase, CINAHL, PsycINFO, EconLit, international HTA database, and the Tufts Cost-Effectiveness Analysis Registry were undertaken from February 2018 until August 2022. The quality of the included studies was assessed using the Philips checklist and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. The findings were summarized through narrative analysis.

RESULTS

This review included 23 studies, comprising cost-utility analyses (87%), cost-benefit analyses (9%) and cost-effectiveness analyses (4%). The studies covered various interventions, including pharmacological (n = 10, 43%), non-pharmacological (n = 4, 17%), prevention (n = 4, 17%), diagnostic (n = 4, 17%) and integrated (n = 1, 4%) [diagnostics-pharmacologic] strategies. Markov transition models were commonly employed (65%), followed by decision trees (13%) and discrete-event simulation (9%). Several interventions from all categories were reported as being cost effective. The quality of reporting was suboptimal for the Methods and Results sections in almost all studies, although the majority of studies adequately addressed the decision problem, scope, and model-type selection in their economic evaluations. Regarding the quality of methodology, only a minority of studies addressed competing theories or clearly explained the rationale for model structure. Furthermore, few studies systematically identified key parameters or assessed data quality, and uncertainty was mostly addressed partially.

CONCLUSIONS

This review informs future research and resource allocation by providing insights into model-based economic evaluations for dementia interventions and highlighting areas for improvement.

Is it Effective and Cost-saving to Send all Tonsillectomy Specimens for Histopathological Examinations?

INTRODUCTION

The present study aimed to investigate the necessity or unnecessity of sending all tonsillectomy specimens for pathological examinations in Shiraz, Iran; moreover, it examined malignancies, cost-saving, causes, and the ways to prevent sending all specimens.

MATERIALS AND METHODS

In the first retrospective phase of the study, a checklist was used to gather demographic, clinical, and cost information of 18,437 tonsillectomy specimens during 2004-2018 in Shiraz, Iran. In order to estimate the cost of each pathology specimen, the cost components, including human resources costs and consumables, were collected in the private and public sectors separately and divided by the number of cases performed. Finally, the financial burden resulting from these services (in the study centers) was calculated by multiplying each item's cost by the total number of these services.

RESULTS

Out of the total 18,437 histopathology specimens examined, only 118 (0.64%) samples were identified with unusual diagnoses, of which 66 (56%) cases had malignant tumors, and the remaining 52 (44%) samples included benign tumors (n=41), infections (n=2), and other problems (n=9). The second phase results also indicated that according to the ear, nose, and throat experts, the rules and regulations governing the country's health system and the suspicion of tumors were the main reasons for sending tonsil specimens for pathological examinations. Generally, the annual cost-saving rates in the studied public and private centers were $87,919 and $179,530 purchasing power parity, respectively.

CONCLUSIONS

According to the results, sending tonsillectomy specimens should only be limited to nonroutine ones for economic-clinical reasons.

Selective serotonin reuptake inhibitors in major depression disorder treatment: an umbrella review on systematic reviews

BACKGROUND

Major depressive disorder (MDD) is a common mental problem and one of the leading causes of disability worldwide. SSRIs are the most commonly prescribed types of antidepressants which are called Selective Serotonin Reuptake Inhibitors and used as a primary therapeutic intervention in MDD. This umbrella review aimed to assess the efficacy and tolerability of selected SSRIs.

METHODS

A systematic review on systematic reviews based on meta-analysis was conducted for head-to-head comparisons on 6 antidepressants (fluoxetine, citalopram, escitalopram, sertraline, paroxetine, and fluvoxamine) as monotherapy in the acute-phase treatment for adults with MDD. The primary outcomes included response rate and remission rate. The secondary outcome was the withdrawal rate due to any cause. All articles published on 6 electronic databases, including PubMed, Embase, Scopus, Cochrane, Web of Science, and ProQuest, until 28 August 2018, were searched and analysed.

RESULTS

Fifteen meta-analysis based systematic reviews finally met all the inclusion criteria and pre-defined outcomes were extracted. Regarding the remission rate and withdrawal rate, statistically, significant comparisons showed that escitalopram was the better choice.

CONCLUSION

The descriptive analysis of the included articles showed that generally, escitalopram was more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate. Keypoints This work compiles evidence from multiple meta-analyses based on systematic reviews and provides a clearer picture for assessing the efficacy of SSRIs, clarify current gaps and direction of future research in this category of antidepressants. A minority of included articles attained the high-quality rank according to AMSTAR-2. The descriptive analysis of the included articles showed that generally, escitalopram was more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate.

Cost-utility of new film-coated tablet formulation of deferasirox vs deferoxamine among major beta-thalassemia patients in Iran

OBJECTIVES

Thalassemia is a hereditary disease, which caused economic burden in developing countries. This study evaluated the cost utility of new formulation of deferasirox (Jadenu) vs deferoxamine (Desferal) among B-Thalassemia-major patients from payer perspective in Iran.

METHODS

An economic-evaluation through Markov model was performed. A systematic review was conducted in order to evaluate the clinical effectiveness of comparators. Because of chelating therapy is weight-dependent, patients were assumed to be 2 years-old at initiation in first and 18 years-old in second scenario, and model was estimated lifetime costs and utilities. Costs were calculated to the Iran healthcare system through payer perspective and measured effectiveness using quality-adjusted life years (QALYs). One-way sensitivity analysis and budget impact analysis was also employed.

RESULTS

The 381 studies were retrieved from systematic searching through databases. After eliminating duplicate and irrelevant studies, 2 studies selected for evaluating the effectiveness. Jadenu was associated with an incremental cost-effectiveness ratio (ICER) of 1470.6 and 2544.7 US$ vs Desferal in first and second scenario respectively. The estimated ICER for Jadenu compared to generic deferoxamine was 2837.0 and 6924.1 US$ for first and second scenario respectively. For all scenarios Jadenu is presumed as cost-effective option based on calculated ICER which was lower than 1 gross domestic product per capita in Iran. Sensitivity analysis showed that different parameters except discount rate and indirect cost did not have impact on results. Based on budget impact analysis the estimated cost for patients using Desferal (based on the market share of brand) was 44,021,478 US$ in 3 years vs 42,452,606 US$ in replacing 33% of brand market share with Jadenu. This replacement corresponded to the cost saving of almost 1,568,872 US$ for the payers in 3 years. The calculated cost of using generic deferoxamine in all patients was 68,948,392 US$. The increase in the cost of using Jadenu for 10% of all patients in this scenario would be 934,427 US$ (1.36%) US$ at the first year.

CONCLUSIONS

Based on this analysis, film-coated deferasirox appeared to be cost-effective treatment in comparison with Desferal for managing child and adult chronic iron overload in B-thalassemia major patients of Iran.

Inputs of Iranian health system reform plan from health sector managers and policy-makers' points of view

CONTEXT

Health system reform plan refers to conducting some fundamental, systematic, and sustainable changes.

AIMS

The aim of the present study was to evaluate different required inputs of Iran Health Transformation Plan from experts' viewpoints.

SETTINGS AND DESIGN

The data of this qualitative study were collected using semi-structured interviews.

SUBJECTS AND METHODS

The purposive sampling method led to 18 participant selection and then they were interviewed. Interviewees were assured about confidentiality of information.

STATISTICAL ANALYSIS USED

The thematic analysis method and MAXQDA software were employed for analyzing the data.

RESULTS

There were 4 main themes and 35 subthemes extracted including management requirements for health development plan, human resources, information resources, and financial resources. Each theme had subthemes such as "resource allocation," "development of required standards for human resources," "human resources' motivation," "failures in IT infrastructures," "hospital information management software," "guidelines and instructions," "costs controlling," and "financing the plan".

CONCLUSIONS

Results of the present study put significant emphasis on the path of improving the effectiveness and efficacy of applying the discussed inputs, which can be a light for revising past policies and taking better future steps, it also can be a resource guide for policy-makers and managers of the health-care system.

Measuring Equity in Access to Pharmaceutical Services Using Concentration Curve; Model Development

This paper has two objectives. First, it establishes a model for scoring the access to pharmaceutical services. Second, it develops a model for measuring socioeconomic indicators independent of the time and place of study. These two measures are used for measuring equity in access to pharmaceutical services using concentration curve. We prepared an open-ended questionnaire and distributed it to academic experts to get their ideas to form access indicators and assign score to each indicator based on the pharmaceutical system. An extensive literature review was undertaken for the selection of indicators in order to determine the socioeconomic status (SES) of individuals. Experts' opinions were also considered for scoring these indicators. These indicators were weighted by the Stepwise Adoption of Weights and were used to develop a model for measuring SES independent of the time and place of study. Nine factors were introduced for assessing the access to pharmaceutical services, based on pharmaceutical systems in middle-income countries. Five indicators were selected for determining the SES of individuals. A model for income classification based on poverty line was established. Likewise, a model for scoring home status based on national minimum wage was introduced. In summary, five important findings emerged from this study. These findings may assist researchers in measuring equity in access to pharmaceutical services and also could help them to apply a model for determining SES independent of the time and place of study. These also could provide a good opportunity for researchers to compare the results of various studies in a reasonable way; particularly in middle-income countries.

Electronic health indicators in the selected countries: Are these indicators the best?

BACKGROUND

Many changes have been made in different sciences by developing and advancing information and communication technology in last two decades. E-health is a very broad term that includes many different activities related to the use of electronic devices, software as well as hardware in health organizations.

AIMS

The aim of this study is comparing electronic health indicators in the selected countries and discussion on the best indicators.

SETTINGS AND DESIGN

This study has chosen 12 countries randomly based on the regional division of the WHO. The relevant numbers of health indicators and general indicators and information technology indicators are extracted of these countries. We use data from the Bitarf's comparative study, which is conducted by the Iranian Supreme Council of Information Technology in 2007.

MATERIALS AND METHODS

By using Pearson correlation test, the relations between health general indicators and IT indicators are studied.

STATISTICAL ANALYSIS USED

Data was analyzed based on the research objectives using SPSS software and in accordance with research questions Pearson correlation test were used.

RESULTS

The findings show that there is a positive relation between indicators related to IT and "Total per capita health, healthy life expectancy, percent literacy". Furthermore, there is a mutual relation between IT indicators and "mortality indicator".

CONCLUSION

This study showed differences between selective indicators among different countries. The modern world, with its technological advances, is not powerless in the face of these geographic and health disparity challenges. Researchers must not rely on the available indicators. They must consider indicators like e-business companies, electronic data internet, medical supplies, health electronic record, health information system, etc., In future, continuous studies in this field, to provide the exact and regular reports of amount of using of these indicators through different countries must be necessary.