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

Abstract

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.

Economic evaluation of medical versus surgical strategies for first trimester therapeutic abortion: A systematic review

“…Economic evaluations are defined as the comparative analysis of alternative courses of action in terms of both their costs and consequences and provide clinicians, patients, policymakers, and health-care planners with important information on the available alternatives in the context of limited resources. [ 11 12 ] The aim of this study was to review previous research to determine the economic efficacy of medical and surgical strategies for women seeking pregnancy termination. This research is the first attempt to examine previous research with economic evaluation methods, including cost-effectiveness, cost-utility, cost-benefit, and cost minimization of pregnancy termination interventions.…”

Comprehensive league table of cost-utility ratios: A systematic review of cost-effectiveness evidence for health policy decisions in India

“…For example, there are league tables in Africa for 60 different interventions ( 6 ). The league tables are available in other countries as well ( 14 , 15 ). They have been used as policy tools for high-income, as well as low- and middle-income countries ( 5 ).…”