Cost-effectiveness evaluation of aspirin in primary prevention of myocardial infarction amongst males with average cardiovascular risk in Iran

Amirsadri, Mohammadreza; Sedighi, Mohammad Javad

doi:10.4103/1735-5362.202453

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…Aspirin is a cost-effective option in men with a 10-year CVD risk of 15% from payer perspective[ [ 26 ]] and simvastatin 10 mg is a cost-effective intervention in CVD-healthy men aged 45 with a 10-year CVD risk of 15% for the prevention of myocardial infarction from payer perspective [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

QALY league table of Iran: a practical method for better resource allocation

Hashempour

Raei

Lari

et al. 2021

Cost Eff Resour Alloc

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Background The limited health care resources cannot meet all the demands of the society. Thus, decision makers have to choose feasible interventions and reject the others. We aimed to collect and summarize the results of all cost utility analysis studies that were conducted in Iran and develop a Quality Adjusted Life Year (QALY) league table. Methods A systematic mapping review was conducted to identify all cost utility analysis studies done in Iran and then map them in a table. PubMed, Embase, Cochrane library, Web of Science, as well as Iranian databases like Iran Medex, SID, Magiran, and Barakat Knowledge Network System were all searched for articles published from the inception of the databases to January 2020. Additionally, Cost per QALY or Incremental Cost Utility Ratio (ICUR) were collected from all studies. The Joanna Briggs checklist was used to assess quality appraisal. Results In total, 51 cost-utility studies were included in the final analysis, out of which 14 studies were on cancer, six studies on coronary heart diseases. Two studies, each on hemophilia, multiple sclerosis and rheumatoid arthritis. The rest were on various other diseases. Markov model was the commonest one which has been applied to in 45% of the reviewed studies. Discount rates ranged from zero to 7.2%. The cost per QALY ranged from $ 0.144 in radiography costs for patients with some orthopedic problems to $ 4,551,521 for immune tolerance induction (ITI) therapy in hemophilia patients. High heterogeneity was revealed; therefore, it would be biased to rank interventions based on reported cost per QALY or ICUR. Conclusions However, it is instructive and informative to collect all economic evaluation studies and summarize them in a table. The information on the table would in turn be used to redirect resources for efficient allocation. in general, it was revealed that preventive programs are cost effective interventions from different perspectives in Iran.

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Section: Resultsmentioning

confidence: 99%

QALY league table of Iran: a practical method for better resource allocation

Hashempour

Raei

Lari

et al. 2021

Cost Eff Resour Alloc

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“…Overall, cost-utility analysis was most frequently used (n = 29, 58%), followed by cost-effectiveness analysis (n = 14, 28%). Six studies used both CUA and CEA [ 37 , 45 , 50 , 52 , 62 , 63 ]. There was only one cost–benefit analysis [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…There was only one cost–benefit analysis [ 27 ]. Overall, among the 20 studies which did CEA, life years gained/saved was the predominant benefit measure [ 23 – 25 , 41 , 44 , 45 , 49 , 50 , 52 , 57 , 58 , 62 , 63 ], while the rest of the studies either used drop in blood pressure [ 33 , 34 , 37 , 39 ], avoided CVD [ 24 , 44 , 61 ] or restenosis [ 60 ] event as benefit measure. Out of 38 studies that mentioned their approach to defining an intervention as cost-effective or not, 7 employed the willingness to pay threshold, while the majority (n = 31) used the WHO’s Commission on Macroeconomics and Health (CMH) threshold using the respective countries’ GDP per capita.…”

Section: Resultsmentioning

confidence: 99%

Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations

Aminde

Fongwen

Zapata-Diomedi

et al. 2018

Cost Eff Resour Alloc

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BackgroundCardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low- and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study.MethodsIn this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC. Several medical (PubMed, EMBASE, SCOPUS, Web of Science) and economic (EconLit, NHS EED) databases and grey literature were searched. Screening of studies and data extraction was done independently by two reviewers. Drummond’s checklist and the National Institute for Health and Care Excellence quality rating scale were used in the quality appraisal for all studies used to inform this evidence synthesis.ResultsFrom a pool of 4059 records, 94 full texts were read and 50 studies, which met our inclusion criteria, were retained for our narrative synthesis. Most of the studies were from middle-income countries and predominantly of high quality. The majority were modelled evaluations, and there was significant heterogeneity in methods. Primary prevention studies dominated secondary prevention. Most of the economic evaluations were performed for pharmacological interventions focusing on blood pressure, cholesterol lowering and antiplatelet aggregants. The greatest majority were cost-effective. Compared to individual-based interventions, population-based interventions were few and mostly targeted reduction in sodium intake and tobacco control strategies. These were very cost-effective with many being cost-saving.ConclusionsThis evidence synthesis provides a contemporary update on interventions that offer good value for money in LMICs. Population-based interventions especially those targeting reduction in salt intake and tobacco control are very cost-effective in LMICs with potential to generate economic gains that can be reinvested to improve health and/or other sectors. While this evidence is relevant for policy across these regions, decision makers should additionally take into account other multi-sectoral perspectives, including considerations in budget impact, fairness, affordability and implementation while setting priorities for resource allocation.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0108-9) contains supplementary material, which is available to authorized users.

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“…Markov modeling technique was performed to evaluate the cost-effectiveness of type-2 diabetes screening in community pharmacies of Iran within a 30-year time horizon. For chronic diseases with recurrent events such as type-2 diabetes, particularly when the risk of the disease progression persists indefinitely, Markov modeling is generally the preferred choice( 7 ). The major complications of diabetes evaluated in the current study included blindness, end-stage renal disease (ESRD), myocardial infarction (MI), stroke, lower extremity amputation (LEA), and death.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness and cost-utility analysis of type-2 diabetes screening in pharmacies in Iran

Amirsadri

Torkpour²

2023

Res Pharma Sci

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Background and purpose: Several studies have shown the effectiveness of screening programs in decreasing the costs and disutility of type-2 diabetes and related complications. As there is a growth in the incidence of type-2 diabetes amongst the Iranian population, the cost-effectiveness of performing type-2 diabetes screening tests in community pharmacies of Iran was evaluated in this study from the payer’s perspective. The target population consisted of two hypothetical cohorts of 1000 people 40 years of age without a prior diagnosis of diabetes, for the intervention (screening test) and no-screening groups. Experimental approach: A Markov model was developed to evaluate the cost-effectiveness and cost-utility of a type-2 diabetes screening test in community pharmacies in Iran. A 30-year time horizon was considered in the model. Three screening programs with 5-year intervals were considered for the intervention group. The evaluated outcomes were quality-adjusted life-years (QALYs) for cost-utility-analysis and life-years-gained (LYG) for cost-effectiveness-analysis. To examine the robustness of the results, one-way and probabilistic-sensitivity analyses were applied to the model. Findings/Results: The screening test represented both more effects and higher costs. The incremental effects in the base-case scenario (no-discounting) were estimated to be 0.017 and 0.0004 (approximately 0) for QALYs and LYG, respectively. The incremental cost was estimated to be 2.87 USD/patient. The estimated incremental-cost-effectiveness ratio was 164.77 USD/QALY. Conclusion and implications: This study indicated that screening for type-2 diabetes in community pharmacies of Iran could be considered highly cost-effective, as it meets the WHO criteria of the annual GDP per capita ($2757 in 2020).

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Cost-effectiveness evaluation of aspirin in primary prevention of myocardial infarction amongst males with average cardiovascular risk in Iran

Cited by 9 publications

References 29 publications

QALY league table of Iran: a practical method for better resource allocation

QALY league table of Iran: a practical method for better resource allocation

Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations

Cost-effectiveness and cost-utility analysis of type-2 diabetes screening in pharmacies in Iran

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